Journal of Emergency Medicine, Trauma and Acute Care - 2 - International Conference in Emergency Medicine and Public Health-Qatar Proceedings, October 2016

Developing cultural competency in mental health provision became an imperative skill in the age of globalization. This involves the enhanced knowledge and attitudes of care givers (NKI). We will review the geodemographic, religious, linguistic, and family structure in the Middle East so we can understand some of the special approaches needed to achieve our goal. We evaluate the common pitfalls and caveats of our own practices starting with our formal western curriculum, the types of therapeutic approaches that we have gathered and learned, our biases and prejudices and all our educational, cultural, and life experience baggage. Also, we will go over the difficulty of applying diagnostic criteria applicable in the west to Middle Eastern pathologies, where albeit they carry the same name, the presentations are very different. A literature review of many documented experiences and research into the same issue was conducted, and we are including the most relevant findings and solutions to approach these practices. Many earnest efforts have been invested in building educational edifices and branches of international colleges in the Middle East that produce highly-educated and skillful professionals, yet the problem is the same for the curriculum that was given, as it was still a western plan tailored to a different society and culture.

Conclusion: Although it is a slow process, we have been able to identify some of the differences and as we go, we are applying the appropriate changes (Ex. Validated diagnostic scales, modified interviewing questions and better understanding the cultural idioms of complaints).

Background: Hamad General Hospital (HGH) houses the main Emergency Department (ED) in Qatar. This busy ED has a 27 bedded resuscitation area. Within a 24 hour period there could be any number between 1 to 10 cases that needed emergency or urgent intubation. Over the years, there has been multiple addition of new life saving devices to the resuscitation areas. All these devices add to the clutter of the already crowded resuscitation area, and may indirectly add to the chaos and occupational risk typically seen in a busy environment.

Methods: We aim to develop an airway trolley (by re-cycling available parts in the hospital) which can accommodate all standard airway equipment and all of our current difficult airway devices – Glidoscope, Stortz CMAC video laryngoscope and Stortz Flexible Intubating Video Endoscope.

Results: We created a robust and easy to clean trolley, with ample of work platform and storage spaces within easy reach. At the same time it is also small and mobile enough to tolerate our narrow resuscitation room floor space. It has multiple power sockets to charge all of the video intubating devices, and its main power cord is long enough to reach any wall socket without significantly obstructing medical staff movements.

Conclusion: With the help of the Engineering Department, we managed to create an airway trolley that fulfills our exact requirement more than what we can find in the current medical equipment market. At the same time we also declutter our busy ED resuscitation room.

Background: A minority of children attend an Emergency may have a serious underlying, systemic infection as a cause of fever. Blood culture remains the gold standard approach to establish the diagnosis and presence of pathogens in a child with suspected, serious bacterial infection. This study describes the proportion of positive blood cultures and correlation with a basic investigation (C-reactive protein, absolute neutrophil count) and clinical presentation in children visiting an emergency.

Methods: A retrospective study at Qatar- Al Wakra Hospital- pediatric emergency over one year. Patients younger than or equal to 3 months of age, patients with any form of immune deficiency and patient with no fever were excluded.

Results: A total 828 patients (mean age 3.83 years), presenting with fever or a history of fever, 121 (14.6%) admitted to the pediatric ward, 10 (1.2%) admitted to the pediatric intensive care unit, 1 (0.12%) admitted to the pediatric surgery. In total, 20 (2.4%) had positive blood culture, of these 20, 4 (20%) were admitted to the pediatric ward, and 9 (45%) were observed in the hospital less than 24 hrs, 7 (35%) were sent to their home after the investigations. We find no differences in the mean value of ANC (p = 0.934) or CRP (p = 0.572) in patient with positive or negative blood culture.

Conclusion: The yield of positive Blood Culture in routine care in an emergency department setting is low, 2.4%. There were no significant differences in associated clinical and laboratory investigations (ANC and CRP) between the groups with positive and negative blood cultures.

Background: Neurocysticercosis (NCC) is the most common parasitic disease of the central nervous system. On the basis of an incorrect assumption that human NCC does not occur in countries in which law prohibit swine breeding and consumption of pork, the disease has been considered rare in Arab world.

Materials and methods: A retrospective study carried out in Emergency Department, Alkhor hospital, HMC from April 2014 to May 2015 (14170/14). All patients above age of 18 yrs diagnosed to have neurocysticercosis from August 2005 to December 2013 were included. Data were retrieved from medical record department and electronic data base. This included baseline demography, clinical presentation and radiological findings.

Results: Out of a total of 137 subjects enrolled 9 were excluded. All the 128 subjects were male Majority of the subjects was in the age group 21–30 yrs (n = 86). Majority were from Nepal 76 (58.1%). 30 (20.3%) patients gave history of previous episodes of seizure, however only 8 of them were on antiepileptic medication. 107 patients presented to A&E with seizures (83.5%). Among which GTCS was the most common form 85%. Use of tobacco was seen in 20 subjects (13.6%) and alcohol in 10 (6.8%). Radiological examination, CT scan revealed solitary lesion in 84 (65.5%) subjects and majority were calcified. 114 patients were admitted to the hospital out of which 5 required ICU care. Anti-epileptic medication was initiated in all patients except 10 patients. Reason could not be identified. Except 13 patients all other patients received short course of oral steroids.

Conclusion: 1) Majority of the patients are young males from Asian countries, 2) GTCS is the most common mode of presentation, 3) Solitary lesion is the most common radiological finding. The increased ease of international travel and increasing number of immigration from developing countries have led to widespread recognition of NCC developed countries.

Background: Chickenpox is a contagious viral disease that affects any age group. Chickenpox is the most common infectious disease in Qatar. Most affected age groups in Qatar in the last three years are children. Chickenpox vaccination has been included in Qatar National Immunization Program in 2000.

Aim: To describe the epidemiological characteristics of chickenpox in Qatar in the year 2012–2014.

Methods: Descriptive analysis based on data retrieved from routine surveillance system, Qatar Information Exchange, Ministry Of Development Planning And Statistics and National Immunization Program. Incidence rate was calculated for each year by gender and age groups.

Results: Total number of chickenpox cases registered in Qatar in 2014 was 574 with the incidence (259.1 per 100,000) which was higher than 2012 (244.5) and 2013 (237.4). Most affected age groups in 2012 and 2013 were 5–9 years old (105.6 per 10,000) and (82.7 per 10,000) respectively while in 2014 age group 0–4 was most affected one (87.9 per 10,000). There was a remarkable increase in the incidence rate of chickenpox in the age groups 15–19, 45–49 and 50+ in 2014 comparing to 2012 and 2013. Although the number of affected cases was higher among men comparing to women, the incidence rate in men was lower.

Conclusion: Increase of incidence rate in 2014 comparing to 2012 and 2013 influenced by the increase of the incidence rate in middle and older age groups. Our results indicate that more evidence is needed to recommend use of varicella vaccine in adults and not only in children.

Background: Marked variations in the incidence and survival of particular types of childhood cancer exist between countries. This study is to explore epidemiology, survival and trends of pediatric cancers in Jordan 2001–2011.

Methods: Descriptive study done. Cases were identified from Jordan cancer registry. All Jordanian pediatric cancers which diagnosed during 2001–2011 were included. Data about age, sex, site, morphology, vital status (alive, dead), date of last visit were collected. SPSS software20 used for analysis & Kaplan Meier method was used to calculate five- and ten-year survival rate.

Results: There were 2267 (5%) registered malignant tumor during the period 2001–2011. Crude incidence rate for cancers is 99/million in children (111 for males and 85 for females). It is more common in males (57.8%), than in females (42.2%), M:F ratio 1.4:1, Median age was 5 years. The highest percent for pediatric cancers was seen in the age group 0–4 years 41.8%. The most common types of cancers were leukemia (31%), brain and CNS (16.5%), Lymphoma (15.9%). Five and ten years Survival rate for pediatric cancers is 70% and 65% respectively. Five Survival rate was best seen in eye cancer patients 91%, and the poorest survival rate was seen in neuroblastoma cancers patients (46%) leukemia (73%), brain CNS (58%) and lymphoma (86%).

Conclusion: The pattern of childhood cancer in Jordan seems to be similar to other countries in our region, where leukemia, lymphoma and brain & CNS were the most common cancers in Jordan and countries in the region, although survival rate is slightly better in Jordan than in other countries in the region.

Background: Standard Emergency Department (ED) operations goals include minimization of the time interval (hereafter tMD) between patients' initial ED presentation and initial physician evaluation.

Methods: The study was conducted using one month (May 2015) of an ED administrative database (EDAD), in HGH-ED, during the study month the ED saw 39,593 cases. The first step was generation of a multivariate model identifying the parameters associated with delay in tMD. In the second step, predictive marginal probability analysis was used to calculate the relative contributions of key covariates as well as demonstrate the likely tMD impact on modifying those covariates with operational improvements. Analyses were conducted with STATA 14 MP, with significance defined at p <  .05 and confidence intervals (CIs) reported at the 95% level.

Results: In an acceptable linear regression model that accounted for just over half of the overall variance in tMD (adjusted r2 .51), important contributors to tMD included shift census (p = .008), shift time of day (p = .002), and physician coverage n (p = .004). Marginal predictive probability analysis was used to predict the overall tMD impact (improvement from 50 to 43 minutes, p <  .001) of consistent staffing with 22 physicians.

Conclusions: The analysis identified expected variables contributing to tMD with regression demonstrating significance and effect magnitude of alterations in covariates including patient census, shift time of day, and physician n. Marginal analysis provided operationally useful demonstration of the need to adjust physician coverage numbers, prompting changes at the study ED.

Background: Age and sex are major determinants of cancer incidence. The objective of the study is to explore epidemiology of cancer in Jordan by age and sex for 2001–2011.

Methods: Descriptive study done, cases were identified from Jordan cancer registry (JCR), all Jordanian cancers patients that diagnosed and registered in 2001–2011 were included variables collected SPSS 20 used for analysis.

Results: Total number of cases in JCR were (45063), 22009 (48.8%) were males (23054) (51.2%) were females, M:F ratio 0.95:1. There is difference of distribution of cancer cases by age group, sex, (41.5%) of the cases in < 60 years, Male (57.7%) than female (42.3%), while females (60.1%) more common in the age group 30–59 years than males (39.9%), in the age>15 years males (57.8%) were more than female (42.2%). Top ten cancers in by different age groups: leukemia, lymphoma, and brain were predominant cancers in 0–19 years in both sexes, while breast cancer is the commonest cancer in female in 20–49 years then thyroid cancer. In males, lymphoma and colorectal are the commonest. In the age group < 50 years breast cancer (33.7%), again is the first in females followed by colorectal cancer (12.1%) while in males lung cancer (14.8%), colorectal (14.5%) and prostate cancers (11.6%) are the commonest.

Conclusion: There is variation of percentages of top ten cancers by different age groups in Jordan compared with other countries, efforts and attention to each age group and sex with type of cancer should be consider in cancer prevention. Further detailed studies about risk factors of cancer to age group and sex. Considering these data about age and sex in cancer screening programs in the future.

Background: To test the effectiveness of a school-based, peer-led smoking and asthma education program, known as the Triple A (Adolescent Asthma Action) in Jordan (TAJ), with an additional class smoke-free pledge strategy (TAJ-Plus) as compared to the TAJ alone on smoking-related knowledge and perception, nicotine dependence, and asthma control in male high school students in Jordan four months post-intervention.

Methods: In this cluster-randomized controlled trial, four public male high schools in Irbid, Jordan were randomly assigned to receive the TAJ-Plus (n = 215) or the TAJ (n = 218). TAJ educators were 3rd year male undergraduate nursing students (n = 9) who received training in a one-day workshop. These educators then trained senior students from the four schools to be Peer Leaders (n = 53), who then taught peers in grades 7 and 8 (n = 433). The Peer Leaders in the TAJ-Plus schools implemented the smoke-free pledge within the 7th and 8th graders, who voluntarily signed the pledge for four months. Data were collected from students in grades 7 and 8 using self-administered questionnaires at baseline and four months post-intervention.

Results: Students from the TAJ-Plus group reported significant improvements in smoking-related knowledge and perception (p < 0.001) and lower nicotine dependence (p < 0.001) as compared to the TAJ group. Improvement in asthma control was greater (p = 0.03) in non-smokers versus smokers.

Conclusions: Voluntary group commitment smoke-free through a pledge is feasible, and an incentive to motivate adolescents to abstain from smoking. Using social influences approaches in schools is useful in countering current aggressive tobacco marketing campaigns in Arab youth. TRN: NCT01938976

Objective: The study aimed to measure the status of cold chain management among primary health care professionals at primary healthcare centers (PHCC) in Qatar.

Methods: A cross-sectional design with pre-post-intervention study was conducted, and 570 primary health professionals were selected from 21 PHCCs using random sampling. A structured self-administered questionnaire was used to collect data regarding the status of cold chain system of healthcare workers before and after educational intervention.

Results: Of the 570 subjects, 492 (86.3%) participated in the post-intervention evaluation. cold chain management, before the intervention six elements were present in all of the PHCCs (100%), eight were present in >80%, another eight were present in 60–80%, while 13 were present in < 60%. These figures improved to 8, 13, 4, and 10, respectively, after the intervention.

Conclusion: In Qatar, The current status of cold chain status among primary healthcare workers had significantly improved after intervention. The practices of health professionals were also found to be adequate. Therefore, it is recommended that all health professionals working in PHCCs should receive mandatory cold chain management training to ensure delivery of safe and effective vaccines in Qatar.

Keywords: KAP, cold chain, primary health care center, immunization, PHC, Qatar

Background: Gestational diabetes mellitus is characterized by high blood glucose levels during pregnancy. The reported prevalence of GDM is 7% worldwide while 8% in Pakistan. About 19.5% of the women with GDM develop post-partum metabolic syndrome.

Methods: A prospective cohort study carried out at tertiary-care hospital in Lahore from Jan 2013 - Dec 2014 to determine the incidence of Mets in women with GDM. After informed consent, women with and without GDM were enrolled during 28th week of pregnancy. Demographic and personal data were recorded. Presence of Mets was evaluated 6 months after delivery measuring their blood pressure, anthropometry, fasting blood sugar (FBS) and triglycerides. Cumulative incidence of Mets, means of blood pressure, anthropometric measures were calculated. Comparisons of general characteristic and component of metabolic syndrome were done by student t-test.

Results: 102 women with GDM and 104 without GDM were followed. The Cumulative Incidence of Mets was 33% in GDM while 15.4% in non-GDM (P-value = 0.002). GDM group were significantly older than non-GDM group (P-Value < 0.001). In GDM group 29 (28.4%) had impaired FBS while in non-GDM group 7 (7%) had impaired FBS. Diabetes developed in 27 (26.5%) of GDM group while none of non-GDM group. BMI blood pressure fasting glucose, and triglycerides were significantly higher in GDM group than non-GDM group.

Conclusion: The study highlights that GDM group has more risk of developing Mets. They should be monitored as high risk for other cardiovascular diseases along with diabetes after delivery.

Keywords: metabolic syndrome, gestational diabetes mellitus, postpartum period

Background: Early identification and isolation of suspected communicable diseases are a major health concern, especially when there is an outbreak of a communicable disease. The ED is an essential component of the health care system and subject to workflow challenges, which may hinder ED personnel adherence to guideline based infection prevention practices.

Methods: In total, 993 suspected MERS-COV patients and their assigned nurses were screened, prospective data was recorded to study the compliance with set infection control practices. That is, hand hygiene (HH), proper use of personnel protective equipments (PPE), isolation techniques, and use of isolation indicators. Data was collected for a period of six months from Nov 2013 to April 2014. Data was then transferred into an excel sheet to calculate the percentage of compliance and non-compliance with each indicator. Each indicator was analyzed separately to find out the poor compliance.

Results: Out of 993 observations made 76.74% of nurses adhered to hand hygiene practices and 57.30% used proper PPE as recommended by CDC guidelines, 69.59% of suspected MERS-COV patients were isolated using the right technique and 73.31% used correct isolation indicators. The lowest indicator identified is in the use of proper PPE, were 42.70% of nurses are not complying with the standard.

Conclusion: Compliance with the infection control indicators showed improvement over time except in the use of proper PPE. Focused training, vigorous awareness campaigning is required to achieve a target of 100% compliance with infection control practices.

Background: Emergency Department (ED) is amongst the most crucial departments in the hospital. It receives around 1000 patient/day. ED overcrowding (EDOC) and increased Length of Stay (LOS) are key global issues for more than 20 years, as they have serious repercussions. No measurements have been done to assess the situation nationally.

Methods: The paper used direct observation for seven days to collect patient flow data on ED patients at a secondary care hospital in Kuwait. It calculated wait times and services to identify the major causes of EDOC and increased LOS.

Results: A total number of 6383 patient visits were registered, 1750 of them were referred to the ED observation room. Among these, 210 patients stayed more than 6 hours as a total ED visit time. The aggregated time of the 210 patients was 1918.95 hours. Further analysis revealed that they spent 1078.98 hours as wasted waiting time. (Waiting for a vacant in-patient bed) constituted 52% of that time, (waiting for a consultation reply) constituted 13.3% and (waiting for a radiology request to be executed) constituted 13.29%.

Conclusions: Around one-third of the ED design capacity was utilized by 12% of the ED patients. The wasted waiting time represents 56.2% of the aggregated LOS, and access block to inpatient wards was the primary cause of increased LOS and EDOC. A national-wide measurement project should be considered to assess the exact problem volume, its impact and test solutions, which should eliminate the waits before trying to reduce the service time.

Introduction: A mass casualty incident (MCI) or disaster can happen at any time. People at the extremes of ages are affected more especially children. Working in the nation's biggest Emergency Department (ED), Hamad General Hospital (HGH)-ED, staff preparedness is crucial to handle such unfortunate event or events. This study aims to assess the preparedness level, knowledge and the willingness of the HGH-ED staff to deal with MCI/Disaster involving children.

Methods: A prospective descriptive study design-using questionnaire to gather data. The study included a 21-item Questionnaire examining preparedness level, knowledge and the willingness of HGH-ED staff dealing with MCI/Disaster involving children. The questionnaire was send to 720 HGH-ED staff, descriptive statistics were used to describe study variables.

Results: Out of the total responders, 73.5% were ED nurse and 26.4% ED physician the average work experience was 7.81 ± 4.94 years. 74% reported that they have never been involved in disaster/MCI involving children's and 82% of the total responders they don't have any formal training in regard of dealing with pediatric victims of disaster. 64% where either unaware or uncertain about the existence of HGH-ED pediatric specific disaster plan.

Conclusion: The result of our study showed that the preparedness level and the knowledge to deal with disaster/MCI involving children in our ED staff were found to be low due to lack of knowledge of children special needs and lack of experience to deal with children involved in MCI and low level of training that ED staff had.

Background: Pesticide poisoning is a global public health problem. With growing population and rapid industrialisation in Qatar, there has been a natural increase in pesticide usage and hence, exposure amongst the workers handling them. It is therefore vital to understand existing knowledge, attitudes and practices about handling pesticides.

Methods: 100 municipality employees in Qatar who work with pesticides, were interviewed in person by trained bilingual staff using a structured questionnaire model.

Results: The mean age of the workers was 37.4 (SD-9.9) Of the interviewed workers, 81% did not know the contents or the name of the pesticides they were handling at work. Unsafe behaviours such as preparation of pesticides at the site of its usage rather than in a specified preparation room (29.6%), non-compliance with wearing protective clothing (38.8%), handling of drinking water (22%) and food (10%) on site where pesticides are used and not washing clothes every day after work (45.9%) were observed. Workers who received training in pesticides usage were more likely to be aware of its effects on the environment (61.6%) (OR-3.9), less likely to eat or drink while handling pesticides (83.6%) (OR-4.3) and more likely to give household members appropriate instructions prior to application of pesticides (90.4%) (OR-5.0). Workers who did not wear special protective clothes at work were found to be, more than twice as likely to visit hospitals per year, than those who wore (RR-2.2).

Conclusion: Unsafe practices were found to be significantly common amongst the personnel using pesticides. Workers who received prior training handled pesticides in a safer way.

Introduction: Sleeve gastrectomy has been a rising trend in management of morbid obesity in the Qatari population. National health insurance has included sleeve gastrectomy in the coverage scheme for patients with BMI of 40 or above, which has contributed to the consistent increase.

Objective: We aim to highlight one complication that we saw in our clinical practice of a 32 years old female who developed acute foot drop after sleeve gastrectomy. Clinical Scenario: We have been consulted to see a wheel chair bound 26 years old female who suffers from acute foot drop. The presentation was dramatic to the extent that hindered the patient from walking properly. Few weeks before this presentation, the patient has undergone a successful sleeve gastrectomy that was followed by a smooth period of convalescence and no reported post-operative complications.

Results and Conclusion: Sudden loss of popliteal pad of fat can fairly explain vague foot drop after sudden and rapid weight loss following bariatric surgery. Conservative management has proved to be effective saving the patient another surgical intervention.

Recommendations: Loss of popliteal pad of fat can fairly explain vague and sudden acute foot drop following rapid weight loss. Watchful waiting accompanied by physiotherapy proved to be effective management for this case and saved the patient surgical intervention of popliteal nerve decompression.

Background: Conventional endotracheal intubation (ETI) is challenging and requires high level of individual skills and experience. At the same time we are also committed to provide ETI training for Emergency Medicine Residents (EMR). Video laryngoscope (VDL) like the C-MAC (by Karl Storz) is designed to have a similar blade to the normal Macintosh blades (size 3 and 4). It has a bright light source and blade thickness that allow Direct Laryngoscopy (DL) and hence ETI under direct vision. We organised several sessions of ETI training using an intubating manikin. We found that the view from the C-MAC screen captured by the C-MAC video camera is the same view described by the operator doing the DL. There were enough consistencies reported during several training sessions that we decided to use the C-MAC for DL in real cases of ETI in the resuscitation room. We have done several ‘live’ cases and all intubations successfully as DL, with the added benefit of ‘video supervision’ and ‘video confirmation’ of the tube positioning. We also used the video recording and playback functions to give feedback to the EMR at the end of the procedure.

Methods (Case Report): In this educational poster, we describe a step-by-step laryngoscopic and ETI view seen on the C-MAC screen during one of our airway training session with the manikin. We also include several views of possible poor technique in laryngoscopy that may result in a failed intubation attempt.

Results: We discuss the potential safety and training benefits in conventional ETI using C-MAC VDL.

Conclusion: We conclude that promoting the use of this technique in ED, especially for ETI undertaken by a trainee improves patient safety and supervision.

Background: Obesity is a public health concern in both developed and developing countries, and it is a main risk factor for chronic diseases. Thus, Palestinian adults aren't spared from obesity and non-communicable diseases epidemic. This study aimed to assess the pattern of obesity among mothers in the Gaza Strip.

Methods: A cross-sectional study was conducted on of 357 mothers aged 18–50 years between April-October 2012 in the Gaza Strip. A structured questionnaire was used to collect sociodemographic information and the short form of the International Physical Activity Questionnaire (IPAQ) was used to assess the physical activity pattern. Mother's nutrition knowledge was evaluated using 16-item questionnaire. Anthropometric measurements were conducted among the mothers, and body mass index (BMI) ≥  30.0 kg/m² was computed to determine the prevalence of obesity. Multiple logistic regression was conducted to predict the associated factors of obesity.

Results: The prevalence of obesity among mothers was high (29.6%). About 78% of mothers were classified as moderately active, 21.6% of them were inactive, whereas, vigorous activity was not observed. Results revealed that as the age increased, the risk of mothers to be obese increased (OR: 1.11; 95% CI: 1.06–1.15; p < 0.001). Mothers with the medium education level have higher risks of being obese (OR: 2.39; 95% CI: 1.20–4.78; p = 0.013). Increased scores of nutrition knowledge to a participant increased the risk of being obese (OR: 1.17; 95% CI: 1.03–1.32.0; p = 0.013).

Conclusions: This study highlights obesity as a public health concern in the Gaza Strip. Age, educational level, and nutritional knowledge were found to have more influence on the prevalence of obesity. Community-based intervention programs should be applied to increase awareness among women and to help them to translate their nutrition knowledge into healthy dietary practices. In addition, effective program is required to increase physical activity levels for women.

Background: Worldwide ambulances are regularly involved in accidents as staff may not anticipate other drivers' actions, suffer from fatigue, or overestimate their driving privileges. An ambulance driving safety campaign started in June 2015 targeting some 935 registered HMCAS drivers. We aim to determine if our approach is effective in changing behaviours and believes, and reducing the number of accidents involving HMCAS vehicles.

Methods: This study was ethically approved as a quality improvement project and is still ongoing. The campaign made use of ambulance dashboard stickers and posters at ambulance stations' exits with respectively 4 and 6 key messages covering frequent issues resulting in collisions. An official circular also informed staff of the campaign. A month later a survey started to be distributed to staff.

Results: In two month, 189 anonymous online or paper questionnaires were fully completed. 69.2% of respondents had an HMCAS driving qualification (13.7% of qualified HMCAS drivers). On average, they reported having been involved in 0.90 accident requiring vehicle repair. Using a 5-point Likert scale (1 = very unsafe, 5 = very safe) respondents rated themselves as being safe drivers (4.24/5) and underestimated the monthly number of accidents with HMCAS vehicles to be 15.3 (Actual 21.2/month registered in 2014). Other data about self-reported driving behaviour and comparison between their perception about accidents and real data was analysed along with visibility and memorisation of the key messages.

Conclusions: Staff underestimated the number of accidents. Campaign material has been noticed by most staff except for the stickers inside the ambulances driving compartment which is not accessed by 23.2% of the respondents. Staff who saw the posters and stickers remembered nearly half of the information it contained. Although a significant decline accidents occurrences was noticed in September, the impact of the campaign cannot yet be reliably assessed over this relatively short period of time.

Infant mortality is a sensitive indicator of development of a country and investing in the health of children. Since 1997 Morocco has been engaged in a the program of the integrated care of the child. We evaluated the information system of the integrated child-care program and the opportunity for collecting reliable data and good quality necessary to identify priorities. We conducted an evaluation of the information system of the integrated child-care program performed at the province of Salé and that of Rabat. We included 135 health professionals. The evaluation was carried out according to World Health Organisation criteria. We used a comprehensive sample of Provincial Epidemiology Units' involved health professionals, Service Infrastructure and all Health Centers in the region involved in the integrated child-care program. We administered a questionnaire The Rate of participation 65s%. The system was considered easy by 72.7%. The reports were timely sent for 27.2%. These Reports we reproduced in 60% of health professionals involved in the integrated child-care program. The System was useful for 63.6%. The Data were only processed locally and in 27.2%. The Feedback was provided to the relevant structures in 9%. 81% have received training in the integrated child-care. This system is considered useful to estimate the burden of disease and allows the allocation of resources necessary for its operations, it is simple, relatively acceptable hence the need to provide significant efforts to improve the quality of the information produced: Generalizing the integrated child-care program to the entire region; Promoting the decentralization of the system at the regional level; Further developing the communication network between different levels: information and feedback; Adapting the system to the needs of users by simplifying collections of records and promoting the analysis of data collected.