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PubMed1988

Species identification and serotyping (capsular antigen) of Pasteurella strains from sheep flocks in south Germany and in Syria.

135 Pasteurella strains were cultivated from nasal swabs of sheep as well as pneumonic lungs of dead and slaughtered sheep. The specimen originated from 41 flocks in South Germany and from 15 flocks and 60 slaughter sheep in Syria (Hama region). Serovariety A2 prevailed amongst P. haemolytica strains (6) isolated in South Germany (53 strains) and in Syria (41 strains). In addition 10 further serovarieties were identified in South Germany (next frequent were A8, A1 and A6) and 7 in Syria. Untypable strains appeared to be more frequent in Syria. Other Pasteurellae (17) represented 1/4 of isolates in Syria and 1/3 of isolates in South Germany. Species identification resulted in P. multocida ssp. multocida (25), P. multocida ssp. septica (4 strains, Syria only), P. canis (3 strains, South Germany only) and Pasteurella-like strains (9 strains). Twelve P. multocida ssp. multocida strains carried capsular antigen D and 7 capsular antigen A. In most cases where multiple samples were examined from one flock, strains with different capsular antigens and/or belonging to different Pasteurella species were isolated (max. 8).

Animals↗

PubMed2002

Cost-effectiveness of different treatment strategies for tuberculosis in Egypt and Syria.

SETTING: The National Tuberculosis Programmes in Egypt and Syria. OBJECTIVES: To calculate the costs and effectiveness of alternative ways of implementing TB control in Egypt and Syria, in order to illustrate the factors influencing the cost-effectiveness of TB treatment in middle-income countries. DESIGN: We compared the costs and cure rates in Egypt and Syria of the World Health Organization recommended directly observed treatment, short-course (DOTS) strategy and alternative strategies. The study included costs both to the health services and to the patient. RESULTS: In Egypt and Syria, the cost-effectiveness of DOTS implemented through the primary health care (PHC) system was respectively $258 and $243 per patient cured. This compares to a cost per patient cured of $297 (Egypt) and $693 (Syria) for alternative strategies implemented through specialist clinics. In Egypt, when DOTS is implemented through specialist chest clinics it costs $585 per patient cured. Hospitalisation costs either $1490, $1621 or $1699 per patient cured, depending on treatment delivery in the continuation phase. CONCLUSION: This study demonstrates that the move towards DOTS integrated at the PHC level has substantially improved the effectiveness of TB treatment in Egypt and Syria, without substantially increasing costs. An analysis of the different costs and effectiveness of the variety of TB treatment strategies has enabled both National Tuberculosis Programmes to expand DOTS and implement it in a way that takes into account limited resources and local health systems.

Antitubercular Agents↗

PubMed2002

Smoking in Syria: profile of a developing Arab country.

One of the main obstacles to tobacco control in the Middle East lies in the shortage of reliable, standardised data on the spread and patterns of tobacco use in society. In Syria, a project aiming at drawing an epidemiological map of the tobacco epidemic in this country was started 4 years ago. Overall, nine studies have resulted, with a total of 6780 participants. The crude prevalence of current smoking among adults in Syria, based on combined information from all studies, is 48% and 9% for males and females, respectively. The prevalence of current smoking among high school adolescents is 16% and 7% for boys and girls, respectively, and was strongly associated with parental and sibling smoking. High school students from families with parents and/or siblings who smoked were 4.4 times more likely to be current smokers than those from non-smoking families. The biggest influx of new smokers among males in Syria is occurring in the early twenties, but an earlier pattern can occur among youths with low academic performance or socioeconomic status. Smoking in women, evaluated by data from physicians, tends to start later than in men and continues to increase with age. Women's smoking in Syria is related to their level of social liberalisation. Data show that active smoking is associated with an increased risk of respiratory diseases among smokers, and that exposure to environmental tobacco smoke (ETS) is associated with an increased risk of respiratory symptoms in children. Knowledge about the harmful effects of smoking and the desire to quit are disproportionate to the rate of successful cessation. The evidence collected indicates possible avenues for tobacco control in Syria, including price increases, smoking cessation programmes, restriction of adolescents' access to cigarettes, and intensive prevention work among women.

Adolescent↗

PubMed2001

A review of the oral health status in Syria.

AIM: To estimate the prevalence and severity of dental caries and periodontal diseases in Syria and to determine possible secular changes in the last two decades. METHODS: Epidemiological studies performed between 1980-1999, using the WHO criteria for dental caries and the CPITN criteria for periodontal diseases in Syria were retrieved and reviewed. RESULTS: The caries experience of 5-year-old children was high (dmft of 4.7-5.2). The estimated DMFT score of 12-year-old Syrian children was 1.9-2.3. A secular change of the caries experience in the last two decades was not apparent. The amount of untreated caries lesions was high and had not changed substantially in the last two decades. The D component comprised 72-90% of the DMFT of 12-15-year-old children and 26-30% of the DMFT of 35-44-year-old Syrians. The majority of 15-24-year-olds, and more than 80% of the 35-44-year-olds had calculus. Despite the widespread and chronic existence of calculus, only 3-11% of the 35-44-year-old persons had one or more deep periodontal pockets. CONCLUSION: The caries experience in Syria is moderately low and does not seem to have changed in the last two decades. The increased output of graduate dentists in the last decade has not changed the large amount of untreated caries lesions. In Syria, where the prevalence of unmet (caries) treatment needs is high, regular removal of calculus (scaling) for the sake of preventing periodontal pockets should not have a high priority in the oral health services.

Adolescent↗

PubMed2002

Neoplastic diseases in Aleppo, Syria.

The objective of this study was to determine the pattern of occurrence and distribution of different types of neoplastic diseases in Aleppo, Syria, during one year. The study was set in Aleppo Governorate, Syria with a population of 2.7 million. Information about newly diagnosed cases of cancer was obtained from pathology labs ( =12) and general hospitals ( =5) in the city between August 1998 and August 1999. Pre-piloted charts were distributed to the labs and one of the labs staff was instructed on how to fill them. Information about benign tumours was also gathered. Between August 1998 and August 1999, 1802 new cases of cancer were diagnosed in Aleppo Governorate (970 in men and 832 in women), giving an overall crude incidence rate of 72.8 per 100 000 person-years for this population. The mean age of patients diagnosed with malignant tumours was 51.2 +/- 21.3 and 47.6 +/- 18.5 for males and females, respectively. In males, age-adjusted incidence rates were higher for bladder, leukaemia and lung cancers, in that order. In females age-adjusted incidence rates were higher for breast, uterus (+ cervix) and leukaemia. In conclusion, the presented data represent the first attempt to use standardized methodology to arrive at approximate estimates of the rate of occurrence of different cancers in Aleppo, Syria, and to characterize their patterns and distribution within the population. It calls for the importance of establishing a reliable cancer registry in Syria.

Adolescent↗

PubMed2006

Injuries in Aleppo, Syria; first population-based estimates and characterization of predominant types.

BACKGROUND: Despite the growing burden of injuries worldwide, Syria and many other Arab countries still lack population-based estimates of different types of injuries. This study aims to provide first population-based estimates of major injuries in Syria and characterize groups at increased risk. METHODS: An interviewer-administered population-based survey of adults 18-65 years residing in Aleppo, Syria was conducted in 2004. The study sample involved 2038 household representatives in Aleppo (45.2% men, mean age 35.3 +/- 12.1, response rate 86%). We inquired about participants self-reported injuries in the past year that required medical attention as well as injuries among their household members. When reported, injuries were further assessed according to type, place, and outcome. RESULTS: Overall, there was 153 self-reported injuries in the past year (77.3 per 1000 adult respondents, 93.1 per 1000 in men and 64.4 per 1000 in women, p = 0.02). Other than gender, injuries differed by age (the older age group being least affected), and place of occurrence, as men were more likely to sustain traffic injuries and be injured outside the home. Injuries were reported among 236 household members (21.0 per 1000), and were slightly more frequent in children than adults (22.0 per 1000 for children, and 19.7 per 1000 for adults, p = 0.2). Traffic injuries, falls, and poisoning (food) were by far the most common types of injury experienced by participants as well as their household members. Falls and traffic injuries seem to have caused most morbidity for the injured, while burns, although not frequently reported, were associated with an unfavorable outcome in the majority of cases. CONCLUSION: This information provides baseline information about the burden of different injuries in Syria, and the sociodemographic factors related to them.

Adolescent↗

PubMed2005

Smoking among adults in Syria: proxy reporting by 13-14 year olds.

Despite active epidemiological research related to smoking in Syria in the past few years, there is currently no population-based prevalence data for adult smoking in this country. This study presents the first such figures based on information about the smoking habits of 3066 couples in Aleppo, Syria collected during a survey on respiratory morbidity among 13-14-year-old youths. Reports from the young people indicated levels of parental smoking to be 54% for men and 18% for women. This figure for women is twice that reported previously. The mean number of smokers within the studied households was one smoker per household. Smoking among women was found to be strongly associated with their educational status and their spouse's smoking status. This information is of major importance for public health efforts to deal with the smoking epidemic in Syria, as it indicates a hidden epidemic of smoking among women, most likely due to under-reporting.

Adolescent↗

PubMed2002

Survey of dental radiographic services in private dental clinics in Damascus, Syria.

OBJECTIVES: To perform a radiographic survey of private dental clinics in Damascus, Syria using a postal questionnaire to produce recommendations for improving the quality of dental radiographic services and education in Syria. METHODS: Three hundred private dental clinics in Damascus were surveyed using a postal questionnaire (in English and Arabic) containing 27 questions on demographic information, equipment, techniques, selection criteria, frequency of examinations, and undergraduate/ postgraduate education. RESULTS: Two hundred and two (67%) dentists responded of which 95% graduated in Syria. The results showed a general lack of knowledge and understanding of dental radiography. Sixty four per cent did not know the kVp setting of their equipment, 73% used D-speed film, 57% did not use film holders and beam aiming devices, 25% did not use a viewing box. In addition, 45% of known equipment operated at 50 kVp or less and 16% was over 20 years old. No meaningful selection criteria existed with a wide variation in type and frequency of radiographs used for different clinical conditions. Syrian undergraduate training in dental radiology was minimal and there was no postgraduate education in the speciality. CONCLUSIONS: Several areas of the radiographic service in Damascus fall short of current recommendations on good practice. Recommendations are made to improve the service, the quality of undergraduate education and to establish postgraduate education.

Adult↗

PubMedDate not supplied

Hepatitis E in Damascus, Syria.

A hospital-based study of acute hepatitis was conducted in Damascus, Syria, from 1995 to 1998. One hundred ninety-three sera from defined acute hepatitis cases were screened by ELISA for IgM anti-HAV, HBsAg, IgM anti-HBc and anti-HCV. Serum samples negative for all markers indicating recent infection by hepatitis A, B, or C were tested for HEV markers. Overall, 47 cases (24.4%) had no detectable hepatitis markers (non-A-E). HAV infection was detected in 71.2% of all viral hepatitis cases. Acute hepatitis B and C constituted 24 and 1.4% of the cases, respectively. Only five cases of acute hepatitis E were noted. Of 47 patients who had non-A-E hepatitis, fifteen (31.9%) tested positive for IgG anti HEV. This study provides indirect evidence that HEV is very likely to be endemic in Damascus, Syria. It reports for the first time the occurrence of hepatitis E in the country, a health problem that should be investigated further.

Adolescent↗

PubMed2005

Mapping the health and environmental situation in informal zones in Aleppo, Syria: report from the Aleppo household survey.

OBJECTIVES: Despite large communities living in informal zones around major cities in Syria, there is currently no information on the health and environmental situations in these areas. From May to August 2004, the Syrian Center for Tobacco Studies (SCTS) conducted the first household survey aiming to provide a baseline map of main health problems and exposures affecting these communities in Aleppo, the second largest city in Syria (2,500,000 inhabitants). METHODS: Information on 1,021 participants randomly selected using stratified cluster sampling were available (46% males, mean age 34+/-11.7, age range 18-65 years, response rate 86%), including self-reported health/disability, exposures, and saliva cotinine measurement. RESULTS: Some positive findings include better than expected access to electricity, piped water, city sewage, and the use of propane for cooking. Particular areas of concern include high fertility rates, overcrowded housing conditions, and gender inequality in education and work. Household features likely to reflect negatively on residents' health include the use of diesel chimneys for heating and lack of smoking restrictions. Overall, residents of informal zones suffer from substantial physical and mental health problems and are exposed to high levels of indoor air pollution. All seem to affect women and the elderly disproportionately, while men are more affected by smoking, occupational respiratory exposures, and injuries. Both infectious and non-infectious respiratory outcomes were very common among study participants. Chronic and degenerative disease, including CVD and joint problems, were a source of substantial morbidity among the studied communities. CONCLUSIONS: This study highlights major health and environmental specificities of marginalized populations living in Aleppo, where women seem to bear a disproportionate burden of poor health and disability. Smoking and exposure to tobacco smoke seem among the major exposures facing these populations.

Adolescent↗

PubMed2004

Beliefs and attitudes related to narghile (waterpipe) smoking among university students in Syria.

PURPOSE: To assess the beliefs and attitudes related to narghile (waterpipe) smoking that are likely to contribute to its increased popularity among young people in Syria. METHODS: In 2003, a cross-sectional survey was administered to university students in Aleppo, using an interviewer-administered questionnaire. Overall, 587 students participated in the study (278 males, 309 females; mean age, 21.8 +/- 2.1; response rate 98.8%). RESULTS: The most common positive perceptions of narghile were related to its smell and taste. Negative perceptions of narghile included the smoke produced, the pollution, and perceived adverse health effects. Students believed the popularity of narghile to be part of a rising regional trend in its use, due to its being an appealing way to spend leisure time socializing with friends. More students (49.7%) believed narghile to be more harmful to health than cigarettes, compared with 30% who believed the opposite. Respiratory disease was the most commonly cited health effect of narghile smoking. Family attitudes regarding tobacco use by younger members were more permissive about narghile compared with cigarettes, and, surprisingly, were more permissive about females smoking narghile than males doing so. CONCLUSIONS: The rise in narghile smoking as a trendy social habit appears to be occurring despite considerable appreciation of its potential health risks. Permissiveness of adult family members towards narghile use by young female members, especially in the presence of a strong taboo against female cigarette smoking may contribute to the continuous spread of narghile smoking among women in Syria.

Adolescent↗

PubMed2004

Gender and smoking status-based analysis of views regarding waterpipe and cigarette smoking in Aleppo, Syria.

BACKGROUND: Narghile (waterpipe) smoking is increasing across the Eastern Mediterranean region (EMR), though little is known about the social attitudes and perceptions related to this method of tobacco use, and how those attitudes and perceptions are influenced by gender. METHODS: Data from two cross-sectional surveys conducted in 2003 in Aleppo, Syria, were used to examine these issues. Overall, 855 participants were included (439 men, 416 women; mean age, 24.4+/-7.1 years; response rate, 97%). The current analysis focuses on responses to four similar nine-item questions tapping perceptions related to narghile smoking by women or men, and cigarette smoking by women or men. Scores on the nine items were summed to yield a total score to gauge participants' perceptions about narghile and cigarette. RESULTS: Generally, participants were less positive about women smoking relative to men smoking, and cigarette smoking relative to narghile smoking. Cigarette smoking by women was the behavior least associated with positive perceptions. Individuals who resided in the city, were economically better-off, and were Christian, had higher perception scores (i.e., more positive attitudes) toward all forms of smoking, whereas older and married participants had higher perception scores for narghile only. Smoking status of participants, especially narghile smoking, was also associated with more positive perceptions toward smoking in general. CONCLUSIONS: We conclude that preliminary analysis shows that views on different forms of smoking in Syria differ by gender and smoking status.

Adolescent↗

PubMed2004

Characteristics of cigarette smoking and quitting among university students in Syria.

BACKGROUND: No study to date in Syria has documented the smoking and quitting characteristics in a representative sample of university students, and this study aims to fill this void. DESIGN: In 2003, a cross-sectional survey was carried out among students at Aleppo University using an interviewer-administered questionnaire. Overall, 587 students participated in the study (278 males, 309 females; mean age, 21.8 +/- 2.1 years; response rate, 98.8%). Experiences and attitudes related to smoking and quitting were assessed for two popular forms of tobacco use in Syria-cigarettes and narghile (waterpipe). RESULTS: Current cigarette smoking was reported by 30.9% of male and 7.4% of female students and daily smoking by 24.8% of male and 5.2% of female students. Narghile smoking was seen among 25.5% of men and 4.9% of women, mostly on an occasional basis. More than half of current smokers (56%) believed they could quit cigarettes, 75.2% were interested in quitting, and 78% of those had made a quit attempt in the past year. Important correlates of cigarette smoking among students were being older, male, and smoking narghile, while being older and from a poorer family were associated with increased interest in quitting. Interestingly, peers' smoking was associated with current smoking among students, but inversely with their willingness to quit. CONCLUSIONS: Cigarette smoking is mainly a problem of male students, whose narghile smoking is likely to be dramatically increasing as well, sometimes practiced as a substitute for cigarettes. The findings that most smokers in this sample are interested in quitting smoking and have tried unsuccessfully to do so indicate that cessation support for youths in this country is urgently needed.

Adult↗

PubMed2000

Genetic variation among populations of the Hessian fly Mayetiola destructor (Diptera: Cecidomyiidae) in Morocco and Syria.

The RAPD-PCR technique was used to study genetic variation within and among geographical populations of the Hessian fly, Mayetiola destructor (Say), from Morocco and Syria, associated with the fly's ability to overcome resistance in three wheat cultivars containing H5, H13 and H22 resistance genes. Variation was detected both for the level of susceptibility of the cultivars and RAPD profiles of M. destructor populations. By the use of RAPD-PCR, high genetic variability was detected among individuals and populations of M. destructor within and between areas separated geographically. The DNA fingerprints of populations of M. destructor were area-specific with Nei's measures of genetic distance ranging from 0.156 (between Abda and Beni Mellal, Morocco) to 1.977 (between Marchouch, Morocco and Lattakia, Syria). Cluster analysis of the genetic distances among the populations, identified the Syrian population as an outlier. A highly significant correlation (r = 0.81) observed between the genetic and geographic distances among the populations, provided genetic support for dispersal of the fly from its presumed origin in West Asia to Morocco.

Animals↗

PubMed2006

The tobacco epidemic in Syria.

BACKGROUND: The Syrian Center for Tobacco Studies (SCTS) was established in response to the smoking epidemic in Syria and lack of local knowledge and expertise to confront it. OBJECTIVES: To (1) study tobacco use and local smoking practices using both qualitative and quantitative research methods; (2) develop and test an effective smoking cessation intervention for the Syrian environment; and (3) train Syrian researchers. METHODS AND RESULTS: The Aleppo Household Survey involved a representative sample of adults in Aleppo (2038 subjects, 45.2% men, mean age 35.3 years, response rate 86%). The prevalence of cigarette smoking was 56.9% among men and 17.0% among women, while the prevalence of waterpipe smoking was 20.2% among men and 4.8% among women. Daily use predominated for cigarettes (29.0%), while the opposite was seen in waterpipe use with 10.6% smoking occasionally. Interest in quitting was greater for cigarette than waterpipe smokers (74.0% v 48.6%), while quit rates were higher for waterpipe compared to cigarettes (28.2% v 16.5%). In-depth ethnographic interviews with smokers show that smoking waterpipe is often viewed as an aesthetic enjoyable experience, while smoking cigarettes is viewed as a mundane anxiety-relieving addiction. Clinical laboratory studies reveal that both waterpipe and cigarette smokers in Syria are exposed to smoke toxicants and exhibit dependence symptoms. CONCLUSIONS: All these data have been used iteratively to adapt smoking cessation interventions from developed countries to suit the local Syrian environment. Research conducted in the SCTS to date has provided a fertile training ground for Syrian researchers, as well as for the building of regional collaborations.

Adult↗

PubMedDate not supplied

Incidence of childhood brain tumors in Syria (1993-2002).

OBJECTIVE: To determine whether the incidence and location of childhood CNS tumors in Syria follows the same pattern described in Western and Far Eastern countries. PATIENTS AND METHODS: We analyzed the data compiled from 367 children with brain tumors operated on in our Department of Neurosurgery between 1993 and mid-2002. We excluded all vascular and metastatic lesions and adopted the latest WHO classification in grouping all glial tumors. RESULTS: We found that 47% of brain tumors were located in the supratentorial, and 53% in the infratentorial region. The ratio of male to female occurrence was 1:1.2 (52% males, 48% females). For lesions in the supratentorial space, the distribution was 56% males and 44% females, while in the posterior fossa, the distribution was 61% males and 39% females. Low-grade tumors (WHO I/II) constituted 53.5% of all lesions, and the rest were high grade tumors (WHO III/IV) 46.5%. The most common tumor found in our childhood population was medulloblastoma (27.5%), followed by astrocytoma (25.8%), then craniopharyngioma (14.1%). The most common tumor in the posterior fossa was medulloblastoma (53.5%), followed by astrocytoma (22.5%), then ependymoma (17%). The most common tumors in the supratentorial space were astrocytoma and craniopharyngioma. CONCLUSIONS: In our patient population, the incidence and distribution of CNS tumors were somehow different than those reported by authors from the Western and Far Eastern countries. Whether these results are unique to Syria, or reflect a regional difference in the disease distribution between the Middle East region and the rest of the world, remains to be determined.

Adolescent↗

PubMed2004

Estimating the beginning of the waterpipe epidemic in Syria.

BACKGROUND: Waterpipe smoking is becoming a global public health problem, especially in the Eastern Mediterranean region (EMR). METHODS: We try in this study, which is a cross sectional survey among a representative sample of waterpipe smokers in cafes/restaurants in Aleppo-Syria, to assess the time period for the beginning of this new smoking hype. We recruited 268 waterpipe smokers (161 men, 107 women; mean age +/- standard deviation (SD) 30.1 +/- 10.2, response rate 95.3%). Participants were divided into 4 birth cohorts (</= 1960, 1961-1970, 1971-1980, >1980) and year of initiation of waterpipe smoking and daily cigarette smoking were plotted according to these birth cohorts. RESULTS: Data indicate that unlike initiation of cigarette smoking, which shows a clear age-related pattern, the nineties was the starting point for most of waterpipe smoking implicating this time period for the beginning of the waterpipe epidemic in Syria. CONCLUSION: The introduction of new flavored and aromatic waterpipe tobacco (Maassel), and the proliferation of satellite and electronic media during the nineties may have helped spread the new hype all over the Arab World.

Adolescent↗

PubMed2001

Field investigations of brucellosis in cattle and small ruminants in Syria, 1990-1996.

The authors present the epidemiological status of brucellosis in cattle and small ruminants in Syria from 1990 to 1996, based on laboratory findings at the Brucellosis Centre, Damascus. Initial investigations using the Rose Bengal plate test, the complement fixation test and a miniaturised variant of the slow agglutination test were conducted throughout the country in 1990 and 1991, revealing an overall herd seroprevalence rate of 3.14% in cattle herds and 2.94% in small ruminant flocks. Although partially biased by previous vaccination of young female cattle with S19 vaccine, these figures indicate that brucellosis in cattle is widespread, particularly in the urban governorates (provinces) of Damascus, Aleppo and Suwaydah. Brucellosis seroprevalence in sheep and goats was relatively high in the governorates of Damascus, Aleppo and Dara'a. The results of a second series of investigations, performed between 1992 and 1996, show that herd seroprevalence in cattle decreased steadily from 17.48% in 1992, to 2.59% in 1996, in the Government-owned farms, while seroprevalence increased in the private sector during the same period. The difference may be explained by the restriction of brucellosis vaccination to public farms (although this was far from systematic), combined with partial application of a 'test-and-slaughter' policy. In sheep and goats, brucellosis seroprevalence fluctuated in the two sectors, but was higher in the private sector where husbandry is principally extensive. Bacteriological investigations led to the isolation of Brucella melitensis biovars 2 and 3 in sheep and B. abortus biovar 9 in cattle. Although no specific methodology was employed, particularly with regard to sampling, this study is significant as the first international report of the distribution of brucellosis in Syria. Further, well-structured studies are required, the results of which could be used to plan an appropriate national control programme for brucellosis.

Abortion, Veterinary↗