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PubMed2005

Introducing Arabic language patient education materials in Jordan.

OBJECTIVES: To describe the development and introduction of patient education materials in a primary care setting in Jordan. METHODS: During the 2003-2004 academic year, the authors collaborated to produce more than 25 Arabic language written patient education materials designed to conform to cultural and social norms and expectations. RESULTS: Patient education materials were frequently shared with friends and family members. Readability of materials was judged to be excellent when materials were presented at approximately a sixth grade reading level. CONCLUSIONS: Patient education materials are greatly needed in Jordan. A thorough understanding of the culture facilitates alignment of the health message with social norms and establishment of credibility with the target audience. The materials developed were well received by patients and physicians. PRACTICE IMPLICATIONS: The routine integration of patient education into all medical consultations in Jordan is an important goal. Practice based research will be vital in identifying and eliminating barriers to the introduction of patient education in the clinical setting.

Arabs↗
PubMed2005

Sero-prevalence of avian influenza among broiler-breeder flocks in Jordan.

Thirty blood samples were collected randomly from each of the 38 breeder-broiler farms in Jordan. Serum samples were examined using indirect ELISA for specific antibodies to avian influenza virus. The overall true flock-level sero-prevalence of avian influenza was 71% (95% CI: 55,83). Positive flocks had 2-30 sero-positive chickens and half of flocks had >20 sero-positive birds. The number of sero-positive flocks varied in the studied localities with more sero-positives in farms located within the migratory route of migratory wild fowl. The examined broiler-breeder flocks had no clinical signs, or noticeable decrease in egg production; mortalities were within the normal range (0.1-1%). The number of positive sera/flock correlated with flock size. There were a no significant (Pearsons r=0.21, p=0.21) correlation between positive flocks and age. A non-pathogenic AI virus infects broiler-breeder farms in Jordan. Wild local and migrating birds might promote the further spread of this virus in Jordan and other countries.

Animals↗
PubMed2005

Management approaches to integrated solid waste in industrialized zones in Jordan: a case of Zarqa City.

There is a need to recognize the difficulties experienced in managing waste and to understand the reasons for those difficulties, especially in developing countries such as Jordan. Zarqa is a Governorate located in central Jordan, which has 2874 registered industries, making up more than 52% of the total industries in the country. Zarqa Governorate suffers from serious solid waste problems. These problems arise from an absence of adequate policies, facilitating legislation, and an environmentally enthused public, which therefore have a negative impact on the environment and health. Solid waste generation in Zarqa Governorate has increased exponentially and has polluted natural resources and the environment. A significant change in municipal solid waste generation was evident between the years 1994 and 2000. The Zarqa Governorate generated 482 tons/day in 2002 with a per capita rate of 0.44 kg/cap-day [Consulting Engineers, 2002, Feasibility study for the treatment of industrial wastewater in Zarqa Governorate. A project funded by METAP and Zarqa Chamber of Industry. Unpublished report]. This manuscript assesses the current operational and management practices of solid waste in the Zarqa Governorate; and evaluates the associated issues of solid waste collection, storage, transport, disposal and recycling in developing countries. The lack of techniques, financial funds and awareness among public and private sectors form an obstacle for achieving a successful environmental program. Several options are proposed to address management goals. Although Jordan became the first country in the Middle East to adopt a national environmental strategy; waste disposal is still largely uncontrolled and large quantities of waste go uncollected. Ensuring proper management of solid wastes, enforcing regulations, and implementing proper environmental awareness programs that will enhance the public understanding and achieve greater efficiency, are the findings of this study.

Agriculture↗
PubMed2006

Knowledge of management of epilepsy in young adults in Jordan.

PURPOSE: Nationwide studies on public knowledge of epilepsy have been undertaken in several countries, but not in Jordan. The purpose of this study was to evaluate knowledge of the management of epilepsy in Jordan. METHODS: A cross-sectional study was performed during the period February-June 2005 on 16,044 individuals selected randomly to represent all regions of Jordan. Respondents were interviewed and asked to complete a five-item questionnaire testing their knowledge of the management of epilepsy. RESULTS: Most of the individuals (77.9%) agreed that patients with epilepsy are best treated in a specialized hospital for neurological diseases. Although the largest percentage of the sample (86.7%) agreed that the best person to treat epilepsy is a neurologist, others believed that a hypnotherapist (25.4%) or a religious healer (22.6%) is. As an immediate measure during an attack of epilepsy, most respondents (82.6%) agreed that protecting the patient's head is most important. During the postseizure period, 45.8% of respondents believed that offering the patient water or a cold or hot drink is appropriate. Two-thirds of the respondents (66.2%) agreed that epilepsy can be treated with drugs. Responses of the participants to the five items significantly differed with respect to age, gender, level of education, and occupation. CONCLUSION: Jordanians are reasonably well informed about most aspects of the management of epilepsy, but there is still a need for public education about this disorder.

Adult↗
PubMed2003

Retrospective surgical incidence and case distribution of cystic echinococcosis in Jordan between 1994 and 2000.

A retrospective follow-up study on the surgical incidence of cystic echinococcosis (CE) was carried out in major governmental, military and private hospitals throughout Jordan between 1994 and 2000. A total of 472 cases were recorded over the 7-year period and an overall mean annual surgical incidence (MASI) of 2.3 per 100,000 inhabitants was estimated. The highest number of surgical cases was recorded in hospitals of the middle region of the country. The highest MASI (3.6 per 100,000) was found in the southern region while the lowest (1.4 per 100,000) was in the northern region of the country. Taking into consideration the population size and the origin of surgically confirmed cases of each region, a relative surgical index (RSI) was calculated at which the highest (RSI=3.4) was among cases originated from the southern region and the lowest (RSI=0.7) was among those originated from the middle region of Jordan. The northern region and desert areas (badia) showed comparable RSI at 1.0 and 1.1, respectively. Males younger than 15 years of age showed significantly higher surgical incidence than females of comparable age at a ratio of 1.6:1, whereas the number of female cases of different age groups over 15 years of age was consistently higher than that of males at a ratio of 1.25-2.5:1.0. The liver was the primary site of cyst development in 69.4% of the cases and the lung involvement accounted for 13.3% of the cases. Diagnosis of CE in Jordan relies mostly on imaging methods with serological techniques being rarely used for diagnosis. The frequency of CE recurrence was 27.5% of the cases, which may be attributed to the low use of chemotherapeutic antihelminthics among surgically treated cases.

Adolescent↗
PubMed1993

Some observations on hydatidosis in Jordan.

A total of 2.8% (5 of 176) sera from schoolchildren and university students were seropositive for hydatidosis (Echinococcus granulosus), by the ELISA IgE test. The prevalence of seropositivity was 4.5% among females of all age groups (5-24 years) and among males of the age group 18-24 years. Males of the age group (5-17 years) were seronegative. The ratio of seropositivity between schoolboys and schoolgirls was 1:4. Sera collected from 1085 university students, aged 18-24 years, and from 1656 outpatients from northern and central Jordan, and the Jordan River valley, when tested by the IHA test, revealed the presence of anti-hydatid agglutinating antibodies in 5.16% (56 of 1085) and in 3.6% (60 of 1656) respectively, with a male to female infection ratio of 1:3 in the university students and 1:1.1 in the outpatients. Intensity, prevalence and cyst fertility of E. granulosus increased in sheep with age. The results of this study indicate that hydatidosis is in an endemic steady state in Jordan with estimated economic losses of JD 3.0 (= US $4.4) per infected sheep.

Adolescent↗
PubMed2004

Goiter prevalence and urinary iodine excretion in schoolchildren of Jordan.

Iodine deficiency disorders (IDD) are considered a major health problem in the eastern Mediterranean region. In Jordan, an IDD assessment was performed in 1993 following which, a salt iodization and consumption program was implemented and a monitoring survey performed in 2000. In schoolchildren 8 to 10 years of age (2457 in 1993 and 2601 in 2000) goiter was graded according to WHO classification. Urinary iodine was measured in 10% of the children in 1993 and in all of them in 2000. Percent of iodine consumption in households was assessed by rapid kit test in 2000. Prevalence of goiter was 37.7 and 32.1 % and median urinary iodine was 40 and 154 microg/L, in 1993 and 2000, respectively. Before salt iodization, the prevalence of goiter and severity of iodine deficiency was more pronounced in rural regions and in the southern part of Jordan. In 2000, all but one governorate had a median urinary iodine (MUI) of above 100 microg/L. The percentage of urinary iodine levels < 50 microg in two governorates was > 20%. Iodine consumption rate of households was 88.3% throughout the country, but was < 70% in three governorates. It is concluded that moderate and severe IDD existed before 1993 in Jordan. Although the iodized salt program has been successful in optimizing MUI, the program for the control of IDD needs further improvement.

Child↗
PubMed2002

Mumps: immune status of adults and epidemiology as a necessary background for choice of vaccination strategy in Jordan.

The prevalence of antibodies against mumps in 333 students at Jordan University was assessed using the ELISA technique. Most of the students (93.7%) were seropositive for mumps. About 50% of unvaccinated students and students vaccinated using the optional single-dose MMR vaccine had mumps. The incidence rate of mumps in different age groups and sexes, the geographic distribution and the seasonality of mumps infection prior to the adoption of compulsory MMR vaccination were investigated during the period from 1988 to 2000. Mumps occurred in all age groups in both sexes and the incidence rate was higher in children aged 5-14 years than in adults. There was a higher frequency in winter and spring with epidemic peaks in 1988, 1993 and 2000. Southern Jordan had the highest incidence rate due to low vaccination coverage by the private clinics. The data support the introduction of compulsory MMR vaccination in Jordan for all susceptible individuals. Evaluation of the effectiveness of the compulsory single-dose vaccine and, based on the outcome, a second dose of this vaccine is also recommended in order to achieve and maintain a high level of immunization.

Adolescent↗
PubMed2000

Pediculosis capitis in northern Jordan.

BACKGROUND: Little is known about the prevalence of pediculosis among school students in northern Jordan. OBJECTIVE: To study the incidence of pediculosis among school students of different socio-economic levels in northern Jordan. METHOD: A total of 2519 school students of both sexes enrolled in eight elementary governmental schools were examined for the presence of Pediculus capitis. Schools were grouped into four socio-economic classes: very low (VL), low (L), medium (M), and high (H). The chi-squared test was performed to analyze the results. RESULTS: Overall, 338 students (13.4%) were infested with nits, immature or adult P. capitis. Girls showed a higher prevalence (14.5%) than boys (11.1%). Statistical analysis for socio-economic classes and infestation rates yielded a significant effect of the four classes on infestation. This conclusion was evident among schoolgirls, where infestation rates were 28.8%, 18.9%, 6.1%, and 0.2% in VL, L, M, and H socio-economic classes, respectively. Schoolchildren in the age group 8-9 years exhibited higher prevalence rates (16% in boys and 22.1% in girls), while prevalences declined to 10.2% and 6.6% among boys and girls aged 10-12 years, respectively. CONCLUSIONS: This study reveals that socio-economic status is a major factor influencing the occurrence of pediculosis among school students of both sexes in Jordan. A national campaign should be implemented to enhance public awareness.

Animals↗
PubMed1988

Cutaneous leishmaniasis in Jordan: biochemical identification of human and Psammomys obesus isolates as Leishmania major.

As part of a series of epidemiological and ecological studies of leishmaniasis in Jordan, we have made functional studies of four isolates from human lesions and from ear lesions of three field-collected Psammomys obesus. Primary isolates were subcultured, frozen stabilates prepared and BALB/c mouse infectivity experiments initiated. Each mouse was inoculated with 4-8 x 10(4) promastigotes into a hind footpad. Quantitative evaluation of the footpads showed enlargement three to four weeks postinoculation. Amastigotes were readily identified in smears from footpad lesions and promastigotes in culture. At 47 days, liver and spleen samples grew out promastigotes. Biochemical characterization of these seven isolates was made by isozyme analysis using cellulose acetate membrane electrophoresis of fructokinase, phosphoglucose isomerase, phosphoglucomutase, aspartate aminotransferase, malate dehydrogenase, glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase. Reference isolates used for comparison were Leishmania major, L. tropica minor, L. donovani, L. aethiopica and L. m. mexicana. All seven Jordan isolates showed enzyme electromorphs identical to L. major, confirming our ecological/epidemiological studies that P. obesus is a major reservoir for human cutaneous leishmaniasis in Jordan.

Animals↗
PubMed1995

Prevalence of hydatid cysts in livestock from five regions of Jordan.

When the prevalences of cystic echinococcosis in indigenous sheep, goats, cattle and camels from five regions of Jordan were investigated, from March to December 1992, they were found to be 12.9%, 12.7%, 0.9% and 11%, respectively. They were substantially higher in sheep from Karak (27.6%) and in cattle from central Jordan (18.0% in Amman and 14.3% in Sahab) than in the same animals in other regions. Age-intensity data indicated that the parasite population is endemic in sheep and cattle and hyperendemic in goats. Infection rate increased steadily with age in sheep, but became constant in goats and cattle when they were about 2 years of age. The most common locations of cysts were the liver in sheep and goats and the lungs in cattle. Co-infection of the liver and lungs was common in sheep and cattle. Although the majority of the sheep, cattle and goats had 1-10 cysts, 20.4% of the sheep and 22.2% of the cattle had 11-50 and 11-30 cysts, respectively. Although 38.1% of the cysts in sheep were fertile, only 8.7% of the cattle cysts and 4.5% of the goat cysts were in this condition. The overall mean number of protoscolices/sheep cyst was 2.7 x 10(3); although the liver cysts had more protoscolices than the lung cysts (3.2 x 10(3) v. 1.9 x 10(3)/cyst), more of the lung cysts were viable (71.1% v. 62.3%). Some 0.2% of 13,436 sheep and 6.1% of 786 cattle imported live into Jordan were infected with hydatid cysts; 16.3% of the sheep cysts (61.4% viable) and 9.6% of the cattle cysts (76.1% viable) were fertile.

Age Distribution↗
PubMed1982

Gastroenterological problems in childhood in Jordan.

Gastrointestinal problems and, in particular, diarrhoeal illnesses are the commonest cause of morbidity and mortality among young children in Jordan. Children with diarrhea constitute about 20% of admissions to Jordan University Hospital (JUH). The aetiology of diarrhoea is multifactorial and bacterial pathogens are seldom isolated. Stool viruses have not been investigated. There is a steady fall in the prevalence of breast-feeding with a consequent increase in gastroenteritis, especially among the poor. The use of electrolyte solutions for oral rehydration therapy is encouraged, and the use of antibiotics in diarrhoeal illness is discouraged. The addition of sucrose instead of glucose to electrolyte solutions has also been adopted. Cow's milk protein intolerance, coeliac disease and chronic inflammatory bowel disease are rarely encountered. Hepatitis is common and is a major cause of morbidity among school children. Cystic fibrosis has been recognized in Jordan but is rare. JUH has been selected as the referral centre for cystic fibrosis in the Middle East.

Adolescent↗
PubMed1984

Cystic fibrosis in Jordan: a pilot study.

Cystic fibrosis (CF) was diagnosed in 12 children from a total of 15,314 children admitted to the Paediatric Department at Jordan University Hospital (JUH) over the period 1976-1980. A diagnosis of meconium ileus was made in five children. The remaining seven affected children were diagnosed clinically on the basis of recurrent chest problems, failure to thrive, positive family history and a high level of sweat chloride, range 72-115 mEq/l (mean 97.6 mEq/l). Five children died (41.7%); three of the group with meconium ileus died during the post-operative period and two of the other group died soon after the diagnosis was made. The cause of such a high mortality rate is multifactorial. As CF was only recently recognized in Jordan, it is believed that the prevalence of CF among Jordanian children is underestimated. CF is still a very serious illness that demands early diagnosis and an intensive programme of continuing care. Therefore, further prospective study to evaluate its prevalence and impact on child health in Jordan is urgently needed.

Child, Preschool↗
PubMed1996

Sickle cell anaemia in Jordan and its clinical patterns.

Homozygous sickle cell anaemia (SCA) is an inherited red blood cell disorder in which haemoglobin A is replaced by haemoglobin S. The disease exhibits a wide spectrum of clinical behaviour which has been well described in neighbouring countries. In Jordan, however, the disease has never been characterized. We used reviews of patients' notes and clinic interviews at Princess Badi'a Teaching Hospital, Irbid, Jordan to describe the clinical presentation of the disease in our area. The total number of patients was 41 (28 boys and 13 girls) and the median age was 9 years (range 1.5-21). The median age at presentation was 2.5 years (range 0.5-11). The commonest presenting feature was pallor (62%). An unusual feature of the disease in this series is the presence of a palpable spleen in 44% of patients older than 8 years. Associated G6PD deficiency was present in 29% of boys. Different clinical patterns of SCA were observed. Haemoglobin F is unlikely to be an explanation for this variability since it has not been shown to correlate with a number of severity indices of the disease such as the frequency of blood transfusions, hospitalizations and painful crises. Although the disease haplotype is not known in Jordan, our geographical location between Asia and Africa may suggest the presence of more than one haplotype and consequently different clinical patterns.

Adolescent↗
PubMed2001

Landmine amputees referred to the Royal Medical Services-Jordan.

OBJECTIVE: To assess the epidemiology of landmine amputees at the Royal Medical Services (RMS) in Jordan. METHODS: This is a retrospective study of patients with amputation due to landmine explosions seen in the prosthetics-orthotics clinic at the RMS in Jordan between January 1988 and January 2000. The records of all patients injured through landmine explosions were available for study. RESULTS: During the 12-year study period, 226 patients with 241 amputations were seen in the clinic. Of these 212 (94%) were male, and 14 (6%) were female. Military personnel comprised 68.6% of the total. The majority of amputations involved the lower limbs, and the most frequent level was trans-tibial. Most of the patients were injured in the 1970s and 1990s. The majority of the patients were young, and 10% of the patients were children. CONCLUSION: The occurrence of amputations from landmine injuries in Jordan is considerable, and places a significant burden on the health care system.

Adolescent↗
PubMed1984

Malignant melanoma in Jordan.

Seventy-four patients with primary cutaneous malignant melanoma were diagnosed in Jordan from June 1969 until April 1983. The percentage of melanomas to the total number of biopsied tumors was 4.1, and the prevalence of melanoma in the population of Jordan was 2.1 in 100,000. This is the first study of its kind on melanoma in Jordan and is based mainly on cases seen at three major referral centers.

Female↗
PubMed2006

Skin cancer trends in northern Jordan.

BACKGROUND: The Jordan Cancer Registry was established in 1996, since which time all cases of cancer have been reported and registered. We have used this registry to perform the first analysis of skin cancer in northern Jordan and to compare our findings with those of published reports from other regions. METHODS: All histopathologically proven cases of skin cancer, reported during the years 1997 through 2001, were reviewed. Information regarding tumor type, age, gender, and anatomical location was collected. RESULTS: A total of 272 cases of malignant skin tumors were diagnosed between the years 1997 and 2001. Basal cell carcinoma (BCC) was the commonest type, representing 52.9% of all skin cancers. Females were more frequently affected than males, with age-adjusted incidence rates of 23.3 and 19.7 per 100,000 of population, respectively. Squamous cell carcinoma (SCC) comprised 26.4% of the total, its age-adjusted incidence rate per 100,000 of population being 14.2 for males and 6.18 for females. the incidence rate increased in males and decreased in females during the study period. The incidence of both BCC and SCC increased with age. The head and neck region was the commonest site affected by both types of cancer. Malignant melanoma (MM) comprised 11.39% of all skin cancer cases, with a female to male ratio of 1.2 : 1. The median age at onset for female patients was 49 years while that for males was 70 years, and the commonest site affected was the lower limbs, followed by the trunk. CONCLUSIONS: In Jordan, sun-related skin cancers have relatively low incidences and a rather stable pattern, compared with other areas with similar climate and skin phenotypes.

Adult↗
PubMed2003

Effect of work related variables on growth among working boys in Jordan.

OBJECTIVE: To study the effect of work related variables on the height, weight, and body mass index (BMI) of working boys aged 10-16 years. DESIGN: Cross sectional survey. SETTING: Irbid, Jarash, and North Jordan Valley in Jordan. PARTICIPANTS: 135 working boys aged 10-16 years and their mothers. OUTCOME MEASURES: Height for age z score; weight for age z score; BMI for age z score. RESULTS: In bivariate analysis, child's duration of work (r=-0.20), maternal height (r=0.26), and household per capita income (r=0.23) were significantly correlated with height for age z score and duration of work (r=-0.24), maternal height (r=0.24), and household per capita income (r=0.19) with weight for age z score. Duration of work (p<0.001), child's monthly income (p=0.044), maternal height (p=0.002), and household per capita income (p=0.005) were retained in the regression model fitted on height z score that explained 20.1% of the variance. The regression model fitted on weight z score explained 20.1% of the variance and duration of work (p<0.001), child's monthly income (p=0.022), household per capita income (p=0.017), and maternal height (p=0.004) were retained. Only duration of work (p=0.001) was retained in the model fitted on BMI for age z score. CONCLUSION: The results of this study suggest that the length of time children have been working and low monthly income have a detrimental effect on growth of working boys independent of the effects of low household per capita income and small maternal stature. Relevance of these findings for social policy and health care of working boys in Jordan and elsewhere is discussed.

Adolescent↗