A Community-Based School Nutrition Intervention Improves Diet Diversity and School Attendance in Palestinian Refugee Schoolchildren in Lebanon.

Background: School feeding programs have the potential to supply children with healthy school food, alleviate short-term hunger, and improve children's educational outcomes.

Objectives: We linked community kitchens to a subsidized school snack intervention and assessed the impact of this intervention on nutritional (diet diversity, hemoglobin, and anthropometry) and educational (attendance and academic performance) outcomes of Palestinian refugee schoolchildren.

Methods: We collected data from 1362 students (aged 5-15 y) and their parents at baseline, and at an 8-mo follow-up in 2 control and 2 intervention schools.

Integrating Health Technologies in Health Services for Syrian Refugees in Lebanon: Qualitative Study.

Background: Lebanon currently hosts around one million Syrian refugees. There has been an increasing interest in integrating eHealth and mHealth technologies into the provision of primary health care to refugees and Lebanese citizens.

Objective: We aimed to gain a deeper understanding of the potential for technology integration in primary health care provision in the context of the protracted Syrian refugee crisis in Lebanon.

Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic.

Introduction: The COVID-19 pandemic has substantially impacted maternity care provision worldwide. Studies based on modelling estimated large indirect effects of the pandemic on services and health outcomes. The objective of this study was to prospectively document experiences of frontline maternal and newborn healthcare providers.

Responding to health needs of women, children and adolescents within Syria during conflict: intervention coverage, challenges and adaptations.

Background: Women and children suffer disproportionately in armed-conflicts. Since 2011, the protracted Syrian crisis has fragmented the pre-existing healthcare system. Despite the massive health needs of women and children, the delivery of key reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH&N) interventions, and its underlying factors are not well-understood in Syria.

The cascade of care in managing hypertension in the Arab world: a systematic assessment of the evidence on awareness, treatment and control.

Background: Hypertension is a leading risk factor for mortality and morbidity globally and in the Arab world. We summarize the evidence on awareness, treatment, and control of hypertension, to assess the extent of gaps in the hypertension continuum of care. We also assess the influence of gender and other social determinants at each level of the cascade of care.

Anaphylaxis in pregnancy: a population-based multinational European study.

Anaphylaxis in pregnancy is a rare but severe complication for both mother and infant. Population-based data on anaphylaxis in pregnancy are lacking from mainland European countries. This multinational study presents the incidence, causative agents, management and maternal and infant outcomes of anaphylaxis in pregnancy.

A Multisectoral Nutrition Program in Nepal Improves Knowledge of Dietary Diversity, Sick Child Feeding, and Handwashing, but Not All Practices: a Program Impact Pathways Mediation Analysis.

Background: Few intervention studies have focused on how inputs link with outcomes.

Objectives: This study tested whether Suaahara I program inputs translated into intended outcomes and identified gaps along the theorized program impact pathway to improved nutrition, care, and water, sanitation, and hygiene behaviors.

Methods: We used household-level, cross-sectional survey data from a process evaluation of Suaahara I conducted in 2014.

Indirect impact of violent events on emergency department utilization and disease patterns.

Background: The health effects of war and armed conflict on casualties and mental health of those directly exposed has been well described, but few studies have explored the indirect health effects of violent events. This paper assesses the indirect health impact of several violent events that took place in Beirut in 2013-2014 on ED visit utilization and disease patterns.

Methods: As tracked by media reports, there were 9 violent events in Beirut during 2013-2014.

Cash water expenditures are associated with household water insecurity, food insecurity, and perceived stress in study sites across 20 low- and middle-income countries.

Billions of people globally, living with various degrees of water insecurity, obtain their household and drinking water from diverse sources that can absorb a disproportionate amount of a household's income. In theory, there are income and expenditure thresholds associated with effective mitigation of household water insecurity, but there is little empirical research about these mechanisms and thresholds in low- and middle-income settings. This study used data from 3655 households from 23 water-insecure sites in 20 countries to explore the relationship between cash water expenditures (measured as a Z-score, percent of income, and Z-score of percent of income) and a household water insecurity score, and whether income moderated that relationship.

Financial relationships between patient and consumer representatives and the health industry: A systematic review.

Background: Patients and consumers are increasingly engaged in health policymaking, research and drug regulation. Having financial relationships with the health industry creates situations of conflicts of interest (COI) and might compromise their meaningful and unbiased participation.

Objective: To synthesize available evidence on the financial relationships between the health industry and patient and consumer representatives and their organizations.

A mixed-methods evaluation of community-based healthy kitchens as social enterprises for refugee women.

Background: The aim of this study is to investigate the potential impact of a community-based intervention - the Healthy Kitchens, Healthy Children (HKHC) intervention - on participating women's household's economics and food security status, decision making, mental health and social support.

Methods: We established two healthy kitchens in existing community-based organizations in Palestinian camps in Lebanon. These were set up as small business enterprises, using participatory approaches to develop recipes and train women in food preparation, food safety and entrepreneurship.

Linking women-led community kitchens to school food programmes: lessons learned from the Healthy Kitchens, Healthy Children intervention in Palestinian refugees in Lebanon.

Objective: Decades of marginalization have led Palestinian refugees living in Lebanon to experience multigenerational poverty and food insecurity. The Healthy Kitchens, Healthy Children programme implemented and examined the impact of a two-pronged intervention that employed women through community kitchens to deliver a subsidized healthy daily school snack to elementary-school children in Palestinian refugee camps in Lebanon. We describe the rationale, study design, theorized impact pathways, and discuss lessons learned.

Barriers, Attitudes and Clinical Approach of Lebanese Physicians Towards HPV Vaccination; A Cross- Sectional Study.

Objectives: HPV infection is associated with the development of cervical and oropharyngeal cancer. HPV vaccination prevents cervical cancer, but is still not part of Lebanon's routine vaccination schedule. As such, understanding physicians' practice towards HPV vaccination is essential.

Prevalence of intimate partner violence against women in the Arab world: a systematic review.

Background: Violence against women has particular importance for women's health and wellbeing in the Arab world, where women face persistent barriers to social, political and economic equality. This review aims to summarize what is known about the prevalence of physical, sexual and emotional/psychological intimate partner violence (IPV) against women in the 22 countries of the Arab League, including geographic coverage, quality and comparability of the evidence.

Methods: A systematic review of IPV prevalence in Arab countries was carried out among peer-reviewed journal articles and national, population-based survey reports published by international research programmes and/or governments.

The Household Water InSecurity Experiences (HWISE) Scale: development and validation of a household water insecurity measure for low-income and middle-income countries.

Objective: Progress towards equitable and sufficient water has primarily been measured by population-level data on water availability. However, higher-resolution measures of water accessibility, adequacy, reliability and safety (ie, water insecurity) are needed to understand how problems with water impact health and well-being. Therefore, we developed the Household Water InSecurity Experiences (HWISE) Scale to measure household water insecurity in an equivalent way across disparate cultural and ecological settings.

Child-Reported Food Insecurity Is Negatively Associated with Household Food Security, Socioeconomic Status, Diet Diversity, and School Performance among Children Attending UN Relief and Works Agency for Palestine Refugees Schools in Lebanon.

Background: Recent studies have shown that children are able to accurately describe their own experiences of food insecurity; however, few studies have quantified this experience.

Objectives: We aimed to develop and validate a child food security scale to be used in Arabic-speaking countries.

Methods: As part of the Healthy Kitchens Healthy Children study on food security and nutrition in schools, 14 questions were administered to 5-15-y-old children (n = 1433) attending 4 UN Relief and Works Agency for Palestine refugees schools.

Bullying Victimization and Use of Substances in High School: Does Religiosity Moderate the Association?

Alcohol, tobacco and other drug use continue to pose serious public health concerns among youth. Bullying victimization has been identified as a risk factor and religiosity a protective factor for adolescent substance use. No previous research has examined the potential moderating role of religiosity.

Development and validation protocol for an instrument to measure household water insecurity across cultures and ecologies: the Household Water InSecurity Experiences (HWISE) Scale.

Introduction: A wide range of water-related problems contribute to the global burden of disease. Despite the many plausible consequences for health and well-being, there is no validated tool to measure individual- or household-level water insecurity equivalently across varying cultural and ecological settings. Accordingly, we are developing the Household Water Insecurity Experiences (HWISE) Scale to measure household-level water insecurity in multiple contexts.

Food Insecurity and Subjective Wellbeing Among Arab Youth Living in Varying Contexts of Political Instability.

Purpose: To investigate associations between food insecurity experience and subjective wellbeing in Arab youth, across different political stability settings.

Methods: Data from the Gallup World Poll (2014-2015) were extracted for youth aged 15-24 years living in 19 Arab countries (n = 8,162). Food insecurity was assessed using the Food Insecurity Experience Scale.

Prevalence of Key Forms of Violence Against Adolescents in the Arab Region: A Systematic Review.

Purpose: This article presents a systematic review of the prevalence of violence against adolescents in the 22 countries of the Arab League.

Methods: Data on physical and emotional child maltreatment, sexual abuse, bullying and fighting, violence in schools, and intimate partner violence against adolescent girls were retrieved using: (1) a systematic search for peer-reviewed journal articles using Medline and the Social Sciences Citation Index; and (2) a search for nationally-representative, population-based surveys.

Results: Published evidence suggests that physical, sexual, and emotional violence against adolescents is widespread in the Arab region.

Assessing the referral of clients with respiratory symptoms to general physicians: a survey of community pharmacists in Beirut.

Objectives: The main objective of this study was to assess the ability of community pharmacists practicing in Beirut to identify red flag respiratory symptoms, and therefore to adequately refer clients to a general physician when warranted. Secondary objectives included determining whether demographic factors affect the odds of referral, and to qualify degree of agreement of community pharmacists with a panel of expert physicians.

Methods: In this cross-sectional study, pharmacies were randomly selected and invited to complete a self-administered survey, each containing 10 clinical vignettes that combined different characteristics (age group, gender, presenting symptom, duration of symptoms).

Factors associated with Human Papilloma Virus (HPV) vaccine recommendation by physicians in Lebanon, a cross-sectional study.

Persistent Human Papilloma Virus (HPV) infection is associated with the development of cervical cancer, a leading cause of female death worldwide. In Lebanon, cervical cancer is the 6th most common cancer amongst girls and women aged 14-44 years. Cervical cancer is preventable through HPV vaccination; however, Lebanon does not include HPV vaccination in its national routine vaccination schedule.

Validity of the Food Insecurity Experience Scale for Use in Sub-Saharan Africa and Characteristics of Food-Insecure Individuals.

Background: The Food Insecurity Experience Scale (FIES) is a UN FAO-Voices of the Hungry project (FAO-VoH) metric of food insecurity (FI). The FAO-VoH tested the psychometric properties of FIES with the use of global 2014 Gallup World Poll (GWP) data. However, similarities in its psychometric structure in sub-Saharan Africa (SSA) to allow aggregation of SSA results were untested.

Physical inactivity, gender and culture in Arab countries: a systematic assessment of the literature.

Background: Physical inactivity is associated with excess weight and adverse health outcomes. We synthesize the evidence on physical inactivity and its social determinants in Arab countries, with special attention to gender and cultural context.

Methods: We searched MEDLINE, Popline, and SSCI for articles published between 2000 and 2016, assessing the prevalence of physical inactivity and its social determinants.

Reproductive, maternal, neonatal and child health in conflict: a case study on Syria using Countdown indicators.

Introduction: Women and children account for a disproportionate morbidity burden among conflict-affected populations, and yet they are not included in global accountability frameworks for women's and children's health. We use Countdown to 2015 (Millennium Development Goals) health indicators to provide an up-to-date review and analysis of the best available data on Syrian refugees in Jordan, Lebanon and Turkey and internally displaced within Syria and explore data challenges in this conflict setting.

Methods: We searched Medline, PubMed, Scopus, Popline and Index Medicus for WHO Eastern Mediterranean Region Office and relevant development/humanitarian databases in all languages from January 2011 until December 2015.