Background: Although leprosy ceased to be a global public health problem in 2000, some countries are still reporting new cases. Aim: To evaluate progress towards the interruption of leprosy transmission, and its elimination, in the Eastern Mediterranean Region. Methods: We extracted and analysed leprosy data for 2012–2023 for the Eastern Mediterranean Region countries from the WHO Global Health Observatory. We calculated the new case detection rates, the Grade 2 disabilities case rates and the new child cases per million population. Results: New case detection rate increased from 3.7 per million population in 2012 to 6.0 in 2018 and then decreased to 3.6 in 2023. Among children aged < 15 years, new case detection rate increased from 0.6 cases per million in 2012 to 1.3 in 2017 and then decreased to 0.5 in 2023. The proportion of females among new cases increased from 34.4% in 2012 to 42.0% in 2023. Grade 2 disability rate decreased from 0.5 cases per million population in 2012 to 0.3 in 2023. By 2023, Egypt, Pakistan, Somalia, Sudan, and Yemen accounted for 94% of cases. Thirteen countries reported 0–10 new autochthonous cases annually. The proportion of non-autochthonous cases increased from 3.4% in 2016 to 4.2% in 2023. Conclusion: Some Eastern Mediterranean Region countries are progressing towards the elimination of leprosy. The decrease in leprosy cases among children in the region indicates a reduction in active transmission. Continuous investment by all the countries will enhance early diagnosis and detection, ensure effective disease management and promote social inclusion as outlined by the WHO global leprosy strategy.

Background: Delay in the diagnosis and treatment of pulmonary tuberculosis contributes to its transmission and undermines control efforts, however, these delays have not been systematically assessed in Algeria. Aim: To assess the duration and determinants of delay in the diagnosis of pulmonary tuberculosis in Algeria. Methods: Between June and December 2019, we reviewed paper-based medical records of, and interviewed, 323 adult patients aged ≥ 15 years at 4 tuberculosis facilities in Blida District of Algeria. The participants were newly diagnosed pulmonary TB patients registered under the revised National Tuberculosis Control Programme. The data were analysed using Epi Info version 7.2.1, and univariable and multivariable logistic regression analyses were performed to identify factors associated with delays at the patient and health system levels. Results: The median patient delay was 15 days (interquartile range 7–35), median health system delay was 28 days (interquartile range 14–55), and median total delay was 52 days (interquartile range 33–88). Longer patient delays were observed among patients who initially sought care at a pharmacy, while health system delays were longer among those with delayed chest X-ray examination, comorbidities and sputum culture-based diagnosis. Conclusion: Diagnosis delays among patients with pulmonary tuberculosis in Algeria remains substantial and largely attributable to health system delays. Targeted programmes to minimise or eliminate self-medication and reduce the time spent for pre-diagnosis examinations, including chest X-ray services, are needed to reduce diagnosis delays.

Background: Viral hepatitis and HIV infections are common public health concerns among injecting drug users, however, there is limited evidence on their seroprevalence in Afghanistan. Aim: To determine the seroprevalence of hepatitis B, hepatitis C and HIV among male injecting drug users at Ibn Sina Drug Addiction Treatment Hospital, Kabul, Afghanistan. Methods: Using a structured questionnaire, we interviewed 397 injecting drug users at Ibn Sina Drug Addiction Treatment Hospital, Kabul, Afghanistan, between November and December 2022. We collected and tested 3–5 ml blood samples from the participants. We analysed the data using Epi Info version 7.2.1 and used binary logistic regression and χ2 tests to identify potential predictors of blood-borne hepatitis B, hepatitis C and HIV infections. Results: Of the total participants, seroprevalence of hepatitis B was 3.79%, hepatitis C 2.77% and HIV 0.50%. Syringe reuse (10%), sharing of syringes (18.6%) and history of blood transfusion (20.2%) were common, but there was no statistically significant association between these predictors and infection (P < 0.05). However, using shared blades was positively associated with hepatitis B infection. Conclusion: Although hepatitis B, hepatitis C and HIV seroprevalence were lower in our study than in previous studies, and no significant association was found between the risk factors and these diseases, there is a need to expand harm reduction services beyond needle-syringe programmes to include non-syringe components. The association between shared blade use and hepatitis B infection indicates that harm reduction efforts should also incorporate safe shaving practices.

Background: The conflict in Gaza has had catastrophic effects on the wellbeing of Gaza’s inhabitants as well as civilians in Israel. Aim: To investigate the impact of the conflict in Gaza on the wellbeing of Israeli civilians, using real-time wireless sensing on smart phones and smart watches. Methods: We prospectively monitored acute and robust reaction to the conflict in Gaza among 954 Israelis aged ≥ 50 years over a 6-week period. Measurements were recorded using mental related, energy expenditure related and sleep related indicators. We calculated the weighted average for 4 different periods, examined the correlation between the distances of participants’ residential city from Gaza, and tested the long-term effect of the war on different wellbeing indicators using mixed ANOVA. Results: Sixty-eight (7.1%) of the participants lived in high-risk areas, 704 (73.8%) in medium-risk areas and 182 (19.1%) were not exposed to missile attacks. The Israelis showed acute and robust reaction to the conflict, as all indicators worsened during the war, including spikes in heart rates, excessive onscreen time and reduction in sleep duration and quality. The changes were more significant among people who lived closer to the battlefield, younger individuals and women. However, all the indicators returned to normal within 2 weeks after ceasefire or humanitarian pause. Conclusion: Real-time monitoring of victims during a humanitarian crisis can help in early detection of their subjective and objective wellbeing and in designing and providing prompt assistance.

Background: Due to war, paediatric cancer patients from Gaza face several healthcare challenges, including frequent treatment disruptions, limited medication supplies, poor infrastructure, psychosocial burden, and war-related trauma. Aim: To assess the psychosocial status of paediatric cancer patients from Gaza treated at King Hussein Cancer Center (KHCC), Jordan. Methods: Using the psychosocial assessment tool, psychologist observations and caregiver reports, we collected data from 23 paediatric cancer patients aged 1–18 years, from Gaza, who received treatment at KHCC between November 2023 and April 2024. We conducted a retrospective thematic analysis of the data using Braun and Clarke's six-step process. Results: About half (52%) of the children had leukaemia, while others presented with sarcomas, lymphoma and other tumours. The patients reported emotional stress and sadness due to the war, separation from family, loss, or displacement, reflecting significant mental health challenges. They exhibited symptoms such as fatigue and poor appetite and expressed heightened fear and anxiety regarding their hospital stay and medical treatment. Strong family support was key in helping the children cope, for those who had immediate family members with them. Conclusion: This study highlights the complex health challenges that paediatric cancer patients from Gaza face and the need for integrated care to improve their physical and psychosocial wellbeing.

Background: Poverty is both a cause and a consequence of poor health, and the scarcity of resources limits access to essential health care services. Aim: To highlight the implications on health of the often-neglected social determinants. Methods: We examined the experiences of Shahida Parveen, a middle-aged, unmarried woman, living in a resource-poor setting in Rawalpindi, Pakistan, and the interplay of the social determinants and inadequate safety nets on her health and wellbeing. Results: Shahida's narrative unveiled a poignant journey marked by health challenges early in her lifetime, her profound losses and the systemic barriers to accessing healthcare. Poverty, limited social support, and healthcare disparities emerged as central factors in shaping her health outcomes. Conclusion: This case report highlights the need for a more just and more inclusive healthcare system that guarantees comprehensive social safety nets and accessible health care services for vulnerable populations.