Ahmad Abdallah - Academia.edu (original) (raw)

Papers by Ahmad Abdallah

Providing health services at affordable prices while balancing quality with cost has been a major... more Providing health services at affordable prices while balancing quality with cost has been a major challenge for health managers as well as policy makers particularly in the developing world in an era of major constraints on financial and human resources. This balance has been difficult to sustain especially in the public sector, often criticized for low levels of efficiency. On the other hand, the private sector has made strides in management efficiency and cost control. Research efforts have been focusing on financial incentives and its impact on the decision making process of the provider in terms of quantity and quality of services. This study assessed the impact of ownership, on the practice patterns of providers under different physician payment mechanisms in primary care centers in Lebanon. The results support the notion that not only payment mechanisms, but also type of ownership affects physicians ’ behavior. Government health centers exhibited a lower mean duration of visit...

An unprecedented sanitary challenge is threatening human beings due to COVID-19 pandemic. There i... more An unprecedented sanitary challenge is threatening human beings due to COVID-19 pandemic. There is no light at the end of the tunnel concerning treatment and worries from a possible second wave start to arise even before the end of the first one. We conducted a multicenter study to reassess the different aspects of radiology departments’ preparedness in Lebanon stating the points of strength and more importantly depicting the points of weakness. Lessons were then extracted to be more prepared for possible future similar circumstances.

Journal of Public Budgeting, Accounting & Financial Management

Many developing countries have at some point in their quest for health reform considered decentra... more Many developing countries have at some point in their quest for health reform considered decentralization as a strategy. A search of Lebanese health policy texts revealed a call for some form of decentralization in the mid eighties through Decree 159. This paper highlights the experience of health centers in Lebanon and discusses the importance of implementing an incremental decentralization of the system by highlighting the importance of ensuring political commitment as well as building the capacity of administrative and clinical staff as prerequisites for the implementation of a fully decentralized system.

The Journal of Contemporary Dental Practice

Aim: The aim of the present study was to evaluate sterilization practices and effectiveness in th... more Aim: The aim of the present study was to evaluate sterilization practices and effectiveness in the Lebanese private dental sector and identify potential factors contributing to sterilization failure. Materials and methods: A 13-item questionnaire consisting of four demographic/professional questions and nine questions related to sterilization practices along with self-contained biologic indicators (SCBIs) were delivered to a representative sample of Lebanese private offices. Univariate statistics and bivariate analyses were performed to compare sterilization failure rates according to demographic, professional, and sterilization-related conditions. Results: Out of the 560 dentists contacted, 205 dentists returned the completed questionnaires and undamaged processed SCBIs. The tested autoclaves (n = 134) were mostly dynamic air removal (69.4%) and had a mean age of 10.5 ± 6.9 years. The dry heat ovens (n = 71) were all static air and had 12.9 ± 8.1 years. The dental assistants performed the routine sterilization procedures in nearly 62% of the practices and sterilization cycles were run 4 to 6 times per week in 75% of the offices. Correct temperature/time ratios were applied in 97% of the autoclaves and 80.3% of the ovens. Few dental practices reported having preventive maintenance (17.9% for the autoclaves and 14.1% for the ovens). Routine monitoring of sterilizer efficacy was infrequently performed and was mostly conducted using physical indicators. Sterilization failure rate was higher for the ovens (16.9%) than for the autoclaves (7.5%).

International journal of dentistry, 2017

Evaluate infection control knowledge, attitude, and practice in Lebanese private dental clinics. ... more Evaluate infection control knowledge, attitude, and practice in Lebanese private dental clinics. A survey including 46 questions related to routine safety procedures was sent to 1150 Lebanese dentists between July 1st and 2nd, 2015. The study sample was selected from the database of registered dentists based on a proportional random sampling ensuring equitable representation of the 5 geographic regions of Lebanon. A subset of 29 questions was used to generate an overall score of compliance (excellent, good, fair, and poor). Comparisons according to gender, type, region, and years of practice were performed. 417 dentists returned the completed questionnaires. 96% expressed concern about infection transmission, 90.6% were vaccinated against Hepatitis B, and 61.8% asked routinely about patients medical history. Only 43% used protective eyewear. Although most dentists (65%) used autoclaves, dry heat was still used. Significant correlations were found between gender and use of personal p...

Journal of Health Care Finance, Aug 22, 2014

Providing health services at affordable prices while balancing quality with cost has been a major... more Providing health services at affordable prices while balancing quality with cost has been a major challenge for health managers as well as policy makers particularly in the developing world in an era of major constraints on financial and human resources. This balance has been difficult to sustain especially in the public sector, often criticized for low levels of efficiency. On the other hand, the private sector has made strides in management efficiency and cost control. Research efforts have been focusing on financial incentives and its impact on the decision making process of the provider in terms of quantity and quality of services. This study assessed the impact of ownership, on the practice patterns of providers under different physician payment mechanisms in primary care centers in Lebanon. The results support the notion that not only payment mechanisms, but also type of ownership affects physicians' behavior. Government health centers exhibited a lower mean duration of visit and less referral patterns. In governmental centers, fee-for-service physicians reported the highest referral rate compared with salaried physicians. A mixed payment mechanism that would provide a prospective payment coupled with some risk adjustment, pay for performance, to reward value added services might be a viable alternative to current practices.

Public Health Nutrition, 2006

Objective: Breast-feeding (BF) provides the ideal food for the healthy growth and development of ... more Objective: Breast-feeding (BF) provides the ideal food for the healthy growth and development of infants. The prevalence of BF in Lebanon shows mixed results. The present study was the first large-scale, extensive survey on BF parameters in Lebanon that aimed to explore demographic, socioeconomic and other fundamental issues associated with the initiation and duration of BF by Lebanese mothers. Design: The survey was cross-sectional in design and administered over 10 months. Setting: Information on all variables was collected from mothers at health centres. Subjects: Two-stage sampling was conducted to select participants. A total of 1000 participants were randomly selected. A consent form was provided to each participant. Data were collected from 830 of these. Results: Almost all mothers were Lebanese, married and had given birth in a hospital. About a third stated that breast milk was the first food introduced after birth. Although 55.9% started breast-feeding their newborns within a few hours after birth, and 18.3% within half an hour, 21.2% replied that they initiated BF a few days after birth. Only 4.6% of the mothers replied that they never breast-fed their infant. Timing of initiation of BF was associated with the type of delivery (vaginal/Caesarean section) and hospital-related factors (rooming-in, night feedings and frequency of mother-infant interaction). Of the mothers who breast-fed exclusively beyond 6 months, 86.7% had initiated BF a few hours following delivery, while only 13.3% had initiated BF a few days later. Compared with the exceptionally high proportion of BF initiation, exclusivity of BF was low, dropping to 52.4% at 1 month. Exclusivity of BF was also associated with place of residence (urban/rural) and negatively associated with educational level of the mother. Duration of BF was inversely associated with the use of pain killers during delivery and maternal education. Rural mothers and those who practised exclusive BF maintained BF for a longer duration. Conclusion: Initiation rates of BF are very high in Lebanon but rates of exclusive BF are low and duration of BF is short. Future research targeting the factors associated with BF, with particular emphasis on exclusivity, is needed. For the 95.4% of mothers who initiated BF, an ecological perspective on intervention aimed at women and their social support system is required to improve duration and exclusivity.

Journal of Pediatric Oncology Nursing, 2006

This study describes the relationship between different indicators of pain, including self-report... more This study describes the relationship between different indicators of pain, including self-reports, behavioral observations, and physiological measures, in children with cancer undergoing invasive procedures. Forty-five children between the ages of 4 and 10 years were evaluated while undergoing Port-a-Cath access. The study was conducted in the outpatient clinics of the Children's Cancer Center in Beirut, Lebanon. Children used 2 self-report measures of pain (the Wong-Baker FACES Pain Rating Scale and an adaptation of the FACES, the DOLLS). Parents and nurses assessed the child's pain on the FACES and the child's distress on the Observational Scale of Behavioral Distress-Revised. Nurses recoded behavioral observations as well as physiological responses to pain. There was a high degree of consistency between the self-reports and moderate to high correlations between self-reports, behavioral parameters, and physiological parameters, suggesting that accurate pain assessments can be made by both nurses and parents. The results also demonstrate adequate validity and reliability of the DOLLS scale in a Lebanese population, in addition to being the preferred assessment tool for all the children in the study.

Human Resources for Health, 2007

Background: The early decades of the 21 st century are considered to be the era of human resource... more Background: The early decades of the 21 st century are considered to be the era of human resources for health (HRH). The World Health Report (WHR) 2006 launched the Health Workforce Decade (2006-2015), with high priority given for countries to develop effective workforce policies and strategies. In many countries in the Eastern Mediterranean Region (EMR), particularly those classified as Low and Low-Middle Income Countries (LMICs), the limited knowledge about the nature, scope, composition and needs of HRH is hindering health sector reform. This highlights an urgent need to understand the current reality of HRH in several EMR countries. The objectives of this paper are to: (1) lay out the facts on what we know about the HRH for EMR countries; (2) generate and interpret evidence on the relationship between HRH and health status indicators for LMICs and middle and high income countries (MHICs) in the context of EMR; (3) identify and analyze the information gaps (i.e. what we do not know) and (4) provide forward thinking by identifying priorities for research and policy. Methods: The variables used in the analysis were: nurse and physician density, gross national income, poverty, female literacy, health expenditure, Infant Mortality Rate (IMR), Under 5 Mortality Rate (U5MR), Maternal Mortality Rate (MMR) and Life Expectancy (LE). Univariate (charts), bivariate (Pearson correlation) and multivariate analysis (linear regression) was conducted using SPSS 14.0, besides a synthesis of HRH literature. Results: Results demonstrate the significant disparities in physician and nurse densities within the EMR, particularly between LMICs and MHICs. Besides this, significant differences exist in health status indicators within the EMR. Results of the Pearson correlation revealed that physician and nurse density, as well as female literacy in EMR countries were significantly correlated with lower mortality rates and higher life expectancy. Results of the regression analysis for both LMICs and MHICs reveal that physician density is significantly associated with all health indicators for both income groups. Nurse density was found to be significantly associated with lower MMR for the two income groups. Female literacy is notably related to lower IMR and U5MR for both income groups; and only with MMR and LE in LMICs. Health expenditure is significantly associated with lower IMR and U5MR only for LMICs. Based on results, gap analysis and the literature synthesis, information gaps and priorities were identified. Conclusion: The implication of the results discussed in this paper will help EMR countries, particularly LMICs, determine priorities to improve health outcomes and achieve health-related Millenium Development Goals.

American Journal of Kidney Diseases, 2010

American Journal of Kidney Diseases, 2011

Providing health services at affordable prices while balancing quality with cost has been a major... more Providing health services at affordable prices while balancing quality with cost has been a major challenge for health managers as well as policy makers particularly in the developing world in an era of major constraints on financial and human resources. This balance has been difficult to sustain especially in the public sector, often criticized for low levels of efficiency. On the other hand, the private sector has made strides in management efficiency and cost control. Research efforts have been focusing on financial incentives and its impact on the decision making process of the provider in terms of quantity and quality of services. This study assessed the impact of ownership, on the practice patterns of providers under different physician payment mechanisms in primary care centers in Lebanon. The results support the notion that not only payment mechanisms, but also type of ownership affects physicians ’ behavior. Government health centers exhibited a lower mean duration of visit...

An unprecedented sanitary challenge is threatening human beings due to COVID-19 pandemic. There i... more An unprecedented sanitary challenge is threatening human beings due to COVID-19 pandemic. There is no light at the end of the tunnel concerning treatment and worries from a possible second wave start to arise even before the end of the first one. We conducted a multicenter study to reassess the different aspects of radiology departments’ preparedness in Lebanon stating the points of strength and more importantly depicting the points of weakness. Lessons were then extracted to be more prepared for possible future similar circumstances.

Journal of Public Budgeting, Accounting & Financial Management

Many developing countries have at some point in their quest for health reform considered decentra... more Many developing countries have at some point in their quest for health reform considered decentralization as a strategy. A search of Lebanese health policy texts revealed a call for some form of decentralization in the mid eighties through Decree 159. This paper highlights the experience of health centers in Lebanon and discusses the importance of implementing an incremental decentralization of the system by highlighting the importance of ensuring political commitment as well as building the capacity of administrative and clinical staff as prerequisites for the implementation of a fully decentralized system.

The Journal of Contemporary Dental Practice

Aim: The aim of the present study was to evaluate sterilization practices and effectiveness in th... more Aim: The aim of the present study was to evaluate sterilization practices and effectiveness in the Lebanese private dental sector and identify potential factors contributing to sterilization failure. Materials and methods: A 13-item questionnaire consisting of four demographic/professional questions and nine questions related to sterilization practices along with self-contained biologic indicators (SCBIs) were delivered to a representative sample of Lebanese private offices. Univariate statistics and bivariate analyses were performed to compare sterilization failure rates according to demographic, professional, and sterilization-related conditions. Results: Out of the 560 dentists contacted, 205 dentists returned the completed questionnaires and undamaged processed SCBIs. The tested autoclaves (n = 134) were mostly dynamic air removal (69.4%) and had a mean age of 10.5 ± 6.9 years. The dry heat ovens (n = 71) were all static air and had 12.9 ± 8.1 years. The dental assistants performed the routine sterilization procedures in nearly 62% of the practices and sterilization cycles were run 4 to 6 times per week in 75% of the offices. Correct temperature/time ratios were applied in 97% of the autoclaves and 80.3% of the ovens. Few dental practices reported having preventive maintenance (17.9% for the autoclaves and 14.1% for the ovens). Routine monitoring of sterilizer efficacy was infrequently performed and was mostly conducted using physical indicators. Sterilization failure rate was higher for the ovens (16.9%) than for the autoclaves (7.5%).

International journal of dentistry, 2017

Evaluate infection control knowledge, attitude, and practice in Lebanese private dental clinics. ... more Evaluate infection control knowledge, attitude, and practice in Lebanese private dental clinics. A survey including 46 questions related to routine safety procedures was sent to 1150 Lebanese dentists between July 1st and 2nd, 2015. The study sample was selected from the database of registered dentists based on a proportional random sampling ensuring equitable representation of the 5 geographic regions of Lebanon. A subset of 29 questions was used to generate an overall score of compliance (excellent, good, fair, and poor). Comparisons according to gender, type, region, and years of practice were performed. 417 dentists returned the completed questionnaires. 96% expressed concern about infection transmission, 90.6% were vaccinated against Hepatitis B, and 61.8% asked routinely about patients medical history. Only 43% used protective eyewear. Although most dentists (65%) used autoclaves, dry heat was still used. Significant correlations were found between gender and use of personal p...

Journal of Health Care Finance, Aug 22, 2014

Providing health services at affordable prices while balancing quality with cost has been a major... more Providing health services at affordable prices while balancing quality with cost has been a major challenge for health managers as well as policy makers particularly in the developing world in an era of major constraints on financial and human resources. This balance has been difficult to sustain especially in the public sector, often criticized for low levels of efficiency. On the other hand, the private sector has made strides in management efficiency and cost control. Research efforts have been focusing on financial incentives and its impact on the decision making process of the provider in terms of quantity and quality of services. This study assessed the impact of ownership, on the practice patterns of providers under different physician payment mechanisms in primary care centers in Lebanon. The results support the notion that not only payment mechanisms, but also type of ownership affects physicians' behavior. Government health centers exhibited a lower mean duration of visit and less referral patterns. In governmental centers, fee-for-service physicians reported the highest referral rate compared with salaried physicians. A mixed payment mechanism that would provide a prospective payment coupled with some risk adjustment, pay for performance, to reward value added services might be a viable alternative to current practices.

Public Health Nutrition, 2006

Objective: Breast-feeding (BF) provides the ideal food for the healthy growth and development of ... more Objective: Breast-feeding (BF) provides the ideal food for the healthy growth and development of infants. The prevalence of BF in Lebanon shows mixed results. The present study was the first large-scale, extensive survey on BF parameters in Lebanon that aimed to explore demographic, socioeconomic and other fundamental issues associated with the initiation and duration of BF by Lebanese mothers. Design: The survey was cross-sectional in design and administered over 10 months. Setting: Information on all variables was collected from mothers at health centres. Subjects: Two-stage sampling was conducted to select participants. A total of 1000 participants were randomly selected. A consent form was provided to each participant. Data were collected from 830 of these. Results: Almost all mothers were Lebanese, married and had given birth in a hospital. About a third stated that breast milk was the first food introduced after birth. Although 55.9% started breast-feeding their newborns within a few hours after birth, and 18.3% within half an hour, 21.2% replied that they initiated BF a few days after birth. Only 4.6% of the mothers replied that they never breast-fed their infant. Timing of initiation of BF was associated with the type of delivery (vaginal/Caesarean section) and hospital-related factors (rooming-in, night feedings and frequency of mother-infant interaction). Of the mothers who breast-fed exclusively beyond 6 months, 86.7% had initiated BF a few hours following delivery, while only 13.3% had initiated BF a few days later. Compared with the exceptionally high proportion of BF initiation, exclusivity of BF was low, dropping to 52.4% at 1 month. Exclusivity of BF was also associated with place of residence (urban/rural) and negatively associated with educational level of the mother. Duration of BF was inversely associated with the use of pain killers during delivery and maternal education. Rural mothers and those who practised exclusive BF maintained BF for a longer duration. Conclusion: Initiation rates of BF are very high in Lebanon but rates of exclusive BF are low and duration of BF is short. Future research targeting the factors associated with BF, with particular emphasis on exclusivity, is needed. For the 95.4% of mothers who initiated BF, an ecological perspective on intervention aimed at women and their social support system is required to improve duration and exclusivity.

Journal of Pediatric Oncology Nursing, 2006

This study describes the relationship between different indicators of pain, including self-report... more This study describes the relationship between different indicators of pain, including self-reports, behavioral observations, and physiological measures, in children with cancer undergoing invasive procedures. Forty-five children between the ages of 4 and 10 years were evaluated while undergoing Port-a-Cath access. The study was conducted in the outpatient clinics of the Children's Cancer Center in Beirut, Lebanon. Children used 2 self-report measures of pain (the Wong-Baker FACES Pain Rating Scale and an adaptation of the FACES, the DOLLS). Parents and nurses assessed the child's pain on the FACES and the child's distress on the Observational Scale of Behavioral Distress-Revised. Nurses recoded behavioral observations as well as physiological responses to pain. There was a high degree of consistency between the self-reports and moderate to high correlations between self-reports, behavioral parameters, and physiological parameters, suggesting that accurate pain assessments can be made by both nurses and parents. The results also demonstrate adequate validity and reliability of the DOLLS scale in a Lebanese population, in addition to being the preferred assessment tool for all the children in the study.

Human Resources for Health, 2007

Background: The early decades of the 21 st century are considered to be the era of human resource... more Background: The early decades of the 21 st century are considered to be the era of human resources for health (HRH). The World Health Report (WHR) 2006 launched the Health Workforce Decade (2006-2015), with high priority given for countries to develop effective workforce policies and strategies. In many countries in the Eastern Mediterranean Region (EMR), particularly those classified as Low and Low-Middle Income Countries (LMICs), the limited knowledge about the nature, scope, composition and needs of HRH is hindering health sector reform. This highlights an urgent need to understand the current reality of HRH in several EMR countries. The objectives of this paper are to: (1) lay out the facts on what we know about the HRH for EMR countries; (2) generate and interpret evidence on the relationship between HRH and health status indicators for LMICs and middle and high income countries (MHICs) in the context of EMR; (3) identify and analyze the information gaps (i.e. what we do not know) and (4) provide forward thinking by identifying priorities for research and policy. Methods: The variables used in the analysis were: nurse and physician density, gross national income, poverty, female literacy, health expenditure, Infant Mortality Rate (IMR), Under 5 Mortality Rate (U5MR), Maternal Mortality Rate (MMR) and Life Expectancy (LE). Univariate (charts), bivariate (Pearson correlation) and multivariate analysis (linear regression) was conducted using SPSS 14.0, besides a synthesis of HRH literature. Results: Results demonstrate the significant disparities in physician and nurse densities within the EMR, particularly between LMICs and MHICs. Besides this, significant differences exist in health status indicators within the EMR. Results of the Pearson correlation revealed that physician and nurse density, as well as female literacy in EMR countries were significantly correlated with lower mortality rates and higher life expectancy. Results of the regression analysis for both LMICs and MHICs reveal that physician density is significantly associated with all health indicators for both income groups. Nurse density was found to be significantly associated with lower MMR for the two income groups. Female literacy is notably related to lower IMR and U5MR for both income groups; and only with MMR and LE in LMICs. Health expenditure is significantly associated with lower IMR and U5MR only for LMICs. Based on results, gap analysis and the literature synthesis, information gaps and priorities were identified. Conclusion: The implication of the results discussed in this paper will help EMR countries, particularly LMICs, determine priorities to improve health outcomes and achieve health-related Millenium Development Goals.

American Journal of Kidney Diseases, 2010

American Journal of Kidney Diseases, 2011