Kingdom Of Bahrain Ministry of Health
2014
Public Health Annual Report 2014
Public Health Annual Report 2014 2
His Royal Highness His Royal Majesty His Royal Highness Prince Salman bin Prince Khalifa bin King Hamad bin Isa Salman Al Khalifa Al Khalifa Hamad Al Khalifa Crown Prince, Deputy
King of The Kingdom Supreme Commander Prime Minister of Bahrain and First Deputy Prime Minister
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Foreword
“ The Public Health Annual Report” is the best way to document another eventful year, with all its unparalleled changes that are always challenging and exciting.
Ministry of Health in Bahrain has a foremost role in changing illness to wellbeing. Primary Care and Public Health services through their variable programs are of the uppermost preventable systems in the country.
The Ministry of Health is dedicated to move to services focusing on maintaining a good health by supporting the public and enabling them to take better control of their health, hence, strengthening Public Health programs is the main area of focus.
It is with great pleasure that we release this issue of the Public Health Annual Report to share all our achievements with you.
Dr. Mariam Al Jalahma Assistant Undersecretary for Primary Care & Public Health
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Foreword
Throughout the past year, The Public Health Directorate implemented, enhanced and continued a wide range of programs and projects to support people in the Bahraini community make healthier choices.
Our various programs empower us all to improve and safeguard our own health, that of our families, neighbours, friends and the whole community.
The programs varied from Immunization, Communicable and Non-Communicable diseases fighting and prevention activities, Anti-Smoking, Nutrition, Food Safety, Environmental Health and School Health related training and educational activities and campaigns in addition to various laboratory analysis.
This Annual Report comes to mark our success and to give you a taste of some of the approaches we are working on with local people and partners to enable better levels of health and wellbeing.
We look forward to build on what we accomplished so far and to continue achieving together as a public health team to enhance the health and wellbeing of our community.
Dr. Mariam Al Hajeri Director of Public health
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Sincere Thanks to the Public Health Team who's coopera- tive efforts enabled the production of this report: Overall Revision & Authorization:
Dr. Mariam Al Hajeri
Report Groundwork, Design & Amending:
Mrs. Manal Ali Al-Sairafi ments Data Preparation & Authorization:
Mrs. Elham Ateeq Mrs. Jameela Mohammed
Mrs. Manal Ali Al-Sairafi Mrs. Rehab Ahmad Gomaa
wledg Dr. Adel Al-Sayyad Dr. Kubra S. Nasser
Dr. AbdulHussain Alajmi Dr. Jaleela S. Jawad no
k Dr. Sameer Al-Haddad Dr. Mona Al-Musawi
Dr. Ejlal Al-Alawi Dr. Basma Al-Saffar
Ac Ali Almawali Mrs. Mariam Janahi
Mr. Hussain Al-Raees Mr. Abdulaziz Al-Khudri
Mr. Khalil Ebrahim Ali Ms. Raja Al-Saloom
Mr. Mohsin Jassim Ali Mrs. Afifa Jaffar Bader
Mr. Mohammed Salman Mr. Faisal Al-Sari
Mrs. Amjad Ghanim Mrs. Jameela Ghazwan
Mr. Qassim Al-Oraibi Dr. Abbas Salman
Dr. Nadia Ghareeb Mrs. Mariam Al-Amer
Dr. Eman Haji S. Mustafa Abbas Alawi
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ABBREVIATIONS AND GLOSSARY
PHD Public Health Directorate MOH Ministry Of Health WHO World Health Organization PAHO Pan-American Health Organization ECP Excellence Coordination Program BCE Bahrain Center for Excellence DCS Disease Control Section CDC Communicable Diseases Control EPI Expanded Program on Immunization AEFI Adverse Events Following Immunization NCD Non-Communicable Disease OHG Occupational Health Group ASC Anti-Smoking Committee IHR International Health Regulations
WESG Water & Enterprises Sanitation Group MVCG Malaria and Vector Control Group
EG Entomology Group CPSG Consumer Product Safety Group PHL Public Health laboratory
NIC National Influenza Center
PFGE Pulse Field Gel Electrophoresis
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Contents
The Public Health Directorate ...... 10 Definition ...... 11 Key Functions ...... 11 Vision ...... 12 Mission ...... 12 Aim...... 12 Strategic Goals ...... 12 Organizational charts ...... 13 Public Health Services ...... 15 Health Resource Management ...... 16 Legal Affairs Office ...... 24 Excellence & Quality ...... 28 4.1 Consumer Protection Project ...... 31 4.2 Green Sticker Project ...... 34 International Health Regulations ...... 36 Disease Control Section ...... 42 6.1. Communicable Diseases Control Group ...... 45 6.2. The Expanded Program on Immunization (EPI) Group ...... 50 6.3. Non-Communicable Diseases Group ...... 64 6.4. Occupational Health Group ...... 72 6.5. Anti-Smoking Committee ...... 84 Environmental Health Section ...... 88 7.1. Water & Enterprises Sanitation Group ...... 89 7.2. Malaria & Vector Control Group ...... 90 7.3. Entomology Group ...... 92 7.4. Consumers Products safety Group ...... 94
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Contents
Food Control Section ...... 96 8.1. Domestic Food Safety Group ...... 100 8.2. Imported food Safety Group ...... 102 Public Health Laboratory ...... 104 9.1. Chemical Analysis Group ...... 113 9.2. Microbiological Analysis of Food & Water ...... 111 9.3. Communicable Diseases Microbiology Group ...... 108 Nutrition Section ...... 122 10.1. Children, Adolescent & Adult Nutrition ...... 94 10.2. Clinical Nutrition Unit ...... 98 10.3. Mother & Child Nutrition Unit ...... 99
Public Health Licensing Unit ...... 130 School Health ...... 134 The Public Health Directorate in Media ...... 148
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Public Health Directorate
Section 1
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Definition:
Public health is defined as:
“The art and science of preventing disease, prolonging life and promoting health through the organized efforts of society”
(Acheson, 1988; WHO)
Key Functions:
Key functions are essential for the accomplishment of the aim and objectives of Public Health Directorate, the Pan-American Health Organization/World Health Organization (PAHO/WHO) defined these functions: 1. Monitoring, evaluation, and analysis of health status. 2. Surveillance, research, and control of the risks and threats to public health. 3. Health promotion. 4. Social participation in health. 5. Development of policies and institutional capacity for public health planning and management. 6. Strengthening of public health regulation and enforcement capacity. 7. Evaluation and promotion of equitable access to necessary health services. 8. Human resources development and training in public health. 9. Quality assurance in personal and population-based health services. 10. Research in public health. 11. Reduction of the impact of emergencies and disasters on health.
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Vision: Lifelong high quality and comprehensive preventive health services.
Mission: Our mission goes in line with the Bahrain Health Strategy (Framework for Action) in which it works in partnership with stakeholders to ensure provision of accessible preventive health Services to the community of Bahrain, using available resources as efficiently and effectively as possible to provide a high standard of Preventive care based on research, evidence and relevant international and best practice.
Aim: To promote physical, mental and social well-being and prevent disease, injury and disability in the community through comprehensive community-based services which will be responsive to people’s needs and will ensure efficient and effective use of state of art technology and human resources to provide high standard Preventive Health Services.
Strategic Goals: Public Health Directorate should act as the central body for the Ministry of Health for establishing and monitoring of health standards and policies through achieving the following strategic goals: 1. Prevents epidemics and control communicable & non communicable disease 2. Promotes and encourages healthy lifestyle behaviors 3. Prevents injuries 4. Protects against occupational and environmental hazards 5. Responds to disasters and emergency 6. Maintain accurate registries and efficient information
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Organizational Structure of Public Health
Organizational Structure of Public Health within the Ministry of Health in the Kingdom of Bahrain
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Organizational Structure of Public Health
Organizational Structure of the Public Health Directorate
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Public Health Services
In terms of services, all the Public Health Services are delivered through the above mentioned sections, and include the followings:-
Monitor health status to identify community health problems.
Diagnose and investigate health problems and health hazards in the community.
Promote and protect the population’s health and wellbeing.
Facilitate community involvement and regional and international partnership.
Develops policies and strategies.
Enforces laws and regulations that protect health and ensure safety.
Identify Public Health service needs of population.
Assure a competent public health workforce.
Evaluate and monitor the provided public health services.
Plans and implements on-going research.
Note: In the following pages, background information about each section or unit in the directorate will be presented, as well as the main statistics of the section. Most statistics will be listed by yearly quarter as follows: Quarter 1 (Q1): January – March Quarter 2 (Q2): April – June Quarter 3 (Q3): July – September Quarter 4 (Q4): October – December Unless indicated otherwise.
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Resource Management
Section 2
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Background Introduction & Overview Health Resource Management Unit is the focal point and the artery that connects the sections and units of the Public Health Directorate and other bodies within the Ministry of Health via competence of managing human and financial resources, processing and services. In other words; overall work maintenance since all of these services are passed through the Unit of Health Resource Management which holds the responsibility of the preparation of transactions by implementation and follow-up.
Main Tasks & Duties: In response to the instructions of the Director of Public Health, the unit is responsible of coordination and follow-up with:
Department of Human Resources with respect to the affairs of the employee
since the start of joining until the end of the job he left for retirement.
Department of Finance regarding the financial budget for jobs and office furniture, Materials and devices for the PHD.
The Directorate of Materials and Equipment in term of providing the PHD needs.
Other link sections of Management such as Service Management, Management of Engineering & Maintenance.
Public and International relations Directorate for various media articles submission and managing printable materials, in addition to activity media coverage and arrangements.
Supervision of leaning services & gardening in PHD.
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Vision
Leadership in providing a comprehensive and integrated administrative and financial services.
Provide comprehensive, distinct administrative and financial services; to meet the needs of staff working at Public Health, through the optimum use of human and material resources; to achieve the goals of the Ministry efficiently and effectively.
Mission Resource Management Unit of Public Health targeted to build an appropriate administrative and financial work environment and effective through the provision of administrative and financial services to meet the needs of the employees of the Directorate, and the introduction of the principle of team- work. It works to employ information and communication technology in all of its work. Also developing a strategic plan for the organization of administrative, financial management of the business, the clarity of tasks, simplify the procedures and the design of business models for all its sections. And working on human capacity development of best management practices followed in the overall quality standards.
Aim Administrative Affairs aims to develop a sound basis for the administrative and financial work at the Directorate and is working to achieve the expected goals.
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Key Functions Coordination and follow-up with the Human Resources Department of the Ministry in regard to recruitment and personnel since joining the service through the appointment and joining the crew of public health till their retirement procedures. Coordination and follow-up with the financial management mechanism of the ministry in regard to the budget planned for the management of public health, such as salaries, furniture, appliances and other. Coordination and follow-up with the hardware and materials management in the ministry to provide the Directorate of Public Health its various sections devices and equipment required. Coordination and follow-up with other related departments such as management services and management of engineering and maintenance. The overall supervision of the administration side services such as cleaning, agriculture and transportation.
Strategic Goals
Administrative Affairs Department is seeking to be distinct to the Ministry of Health in the performance of its strategic role of Directorate of Public Health. To become the best to attract, recruit, develop and expand the value-added human resources which are contributing to the realization of the vision and mission and goals of the Ministry of Health. The unity of administrative affairs strategy in public health management stems from the vision and strategy of the Ministry of Health associated with the national vision of the Kingdom of Bahrain (2030) and improve health strategy (2015-2018), where these strategies can be summarized as follows: 1st Strategic Goal - The sustainability of health services : Effective Planning for human resource needs in line with Business requirement and Strategic directions of Public Health Directorate KPI Indicators The number of studies carried out by the Section for the development of the PHD organizational structure.
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2nd Strategic Goal - The sustainability of health services : Diversifying the sources of access to qualified personnel and to follow modern methods of recruitment and selection of qualified manpower to supplement the Directorate of Public Health with cadres that contribute to the achievement of the goals and vision of Ministry of Health, and Retain the qualified manpower.
KPI Indicators The achievement of the objectives set in the annual work plans.
3rd Strategic Goal – Quality First Provide true and accurate database for all employees of the Directorate of Public Health and provide the best possible services for staff.
KPI Indicators
Provide reliable and fast statistics when you needed.
Resource Management Organizational Structure
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Unit employees
As Per the Organizational Structure
No. of male employees 2
No. of female employees 4
Total employees 6
Vacancies 0
Actual Situation
No. of male employees 0
No. of female employees 4
Total employees 4
Vacancies 2
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Main Statistics
Table 1: Resource Management Unit Transactions
Transaction Type No.
INCENTIVES & REWARDS 109
PROMOTIONS 35
TRANSFERES 16
NEW RECRUTMENTS 9
RETIREMENT 21
DEPUTIZING 187
LEAVES 2958
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Future Programs & Projects
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Legal Affairs
Section 3
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Achievements of the Legal Affairs of Public Health Directorate
First:
Follow-up and amendment of health laws and ministerial decisions.
Follow-up project of Public Health Law No. 3 of 1975 and work on amending it, in addition to attending with the Commission services at the House of Representatives and parliament, in line with the current requirements.
Follow-up proposal to amend some provisions of the anti-smoking Law No. 8 of 2009 with the addition of many materials to meet the deficiencies.
Follow-up project to amend some provisions of Decree Law No. 3 of 1985 on imported food control.
Modify some of the provisions of the Ministerial Decree No. 83 of 2006 on the requirements of cafes and restaurants that offer tobacco and its derivatives for the purposes of smoking.
Organization hosting a delegation from the World Health Organization to review laws and health legislation in the Kingdom.
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Second: Preparation and conducting workshops for the Public Health Directorate inspectors in all related sections who have the status of judicial officer to introduce them to the concept of judicial officers and how to prepare the minutes of the judicial arrest of offenders in preparation for referring them to public prosecution.
Third: Study all laws related and relevant to Public Health Law No. 3 of 1975 regarding Veterinary Quarantine Law which indicates the transfer of oversight responsibility of meat at the ports to the Ministry of Municipalities instead of the Ministry of Health, and that the Ministry of Health role starts at the local/internal markets. Therefore, meat inspection at the ports should be carried by the veterinarian in accordance with the mentioned law. Also, we follow up the implementation of this law with the senior management of ports.
Fourth: Communication with the citizens to respond to their legal inquiries about their transactions in the Ministry of Health through seminars and consultative meetings such as the open consultation that was con- ducted in the Chamber of Commerce with Cafes owners.
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Fifth: Follow up the implementation of the Office of the complaints of patients in the Ministry of Health as per the directives of His Excellency the Prime Minister and the following decision of HE Undersecretary of the Ministry of Health, which had a profound impact on the customer and patient satisfaction in the ministry, where through the legal opinion in all the complaints received and categorized and forwarded to the authority concerned.
Sixth: Follow-up to the recommendations issued by the Office of Financial and Administrative Control on patients' complaints.
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Excellence & Quality
Section 4
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Background Introduction & Overview
Excellence Coordination Program is continuing to follow up excellence projects in public health directorate; namely 1 - The Intelligent Inspection Project (launched April 2012), 2 - The Green Sticker Project (Launched August 2013), These two projects have been approved by the higher authority in the Ministry of Health and have been adopted in the Ministries' strategy for Health improvement. Moreover, the projects have been enrolled in the Kingdom of Bahrain Government Programs for the years 2015 - 2018.
Among other responsibilities, the excellence program continues to provide technical support to the abovementioned programs by means of regular monitoring and evaluation in order to maintain the achieved level of success and unleash new opportunities for enhancement and improvement based on solid scientific evidence and knowledge.
“Information is power, however, sharing and using this information is more important and powerful”.
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Main Goals: The main goals of Excellence Program are to: Practically support excellence projects to make a pace change: from good or very good to ‘Excellent’. Change the mindset focus from reflection to action, and from being reactive to proactive. Facilitate information flow, link and comparison of data within the public health directorate, within the Ministry of Health, as well as nationally (between the Ministry of Health and other segments applying excellence programs in Bahrain both governmental and non-governmental). Ensure the project's full compliance with the agreed plan and goals.
Main Tasks & Duties: The Excellence & Quality Coordinator is responsible of: Preparation of annual goals and determination of excellence and quality standards in the Public Health Directorate. Periodic evaluation to facilitate active participation and application of Bahrain Center of Excellence recommendations. Coordination and cooperation with all excellence teams and projects within the Ministry of Health. Identification of improvement areas and opportunities according to their importance, besides prioritization & implementation follow up. Review and follow-up the measurements and outcomes of key processes and indicators to ensure alignment with main goals. Facilitate the establishment of an excellence culture in the practical reality within the Directorate. Work on the development of methodologies for integration, and support mechanisms of learning and knowledge management. Preparation of reports based on the indications given by all sections of Public Health Directorate.
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Public Health Excellence Projects:
4.1. “Consumer Protection from Foodborne Diseases” Commonly called “The Intelligent Inspection Project”, which has sustained its progress since April 2012 and has grown into a more solid and mature project to the extent that it is now an essential part of the inspection planning and procedures in the Food Control Section.
Project Aim: Minimize Food-Bourne Diseases
Project main goals:
Increase community partnership
Change “Punishment Inspection” to “Smart Inspection”
Enforce consumer protection
Main Achievements:
The project has been accepted as a “Best Practice” at the Third International Best Practice Competition held in Abu Dhabi (November 2014)
The project has been qualified to enter the “United Nations Public Service Awards Competition - UNPSA - ” It has been chosen as a best practice in Bahrain Government and would be published in the new annual book listing “Best Practices in Bahrain” approved by His Royal Highness the Prime Minister, and His Royal High- ness the Crown Prince, Deputy Supreme Commander and First Deputy Prime Minister.
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Main Statistics & Impact Measurement: As shown in the graph below, favorable changes occurred such as : Increase in routine inspection visits. Reduction in Poisoning Cases Reduction in closure actions Increase in complaints due to stronger contact with the public, however, we are aiming to reduce this during the next year of years by at least 10% by strength- ening inspection within the areas that have more complaints.
Inspection Indicators (2010 - 2014) 100000
10000
1000
100 Number:LogScale
10 2010 2011 2012 2013 2014 Visits 28324 29997 42049 50856 54786 Poisoning Cases 176 415 337 91 104 Complaints 666 599 511 578 817 Closure 114 199 127 62 41
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Progress in Reported Poisoning Incidence:
Poisoning % of total complaints by year
25.0
20.0
15.0
10.0
5.0
0.0 Poisoning Reports % 2012 21.6 2013 15.7 2014 12.7
Coverage: The net coverage percentage was counted which is the total coverage adjusted according to national holidays and leaves.
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4.2. “Green Sticker” The Green Sticker project started in August 2013 where it was applied to 12 restaurants only in Juffair area, and reached 220 restaurants by December 2014. More areas, restaurant types were covered through out this period which facilitates the next coming project (Food Entities Ratings) which will cover all grades and types of stickers according to the hygiene and safety status of the food entity. The Green Sticker is now displayed on the front window of assessed restaurants that have shown 80% or more compliance to health standards, as this reflects the tendency to provide safer food & protect consumers from food poisoning. The sticker is valid for six months, after which, it is reassessed to ensure that its maintaining the compliance with our requirements.
Project Aim:
Raise the hygiene and safety level of food provided to consumers.
Project main goals:
Raise Transparency level
Strengthen Community Partnership
Encourage Positive Competitiveness
Main Achievements:
The project has encouraged participating restaurants to reach and maintain a very high safety level. Other restaurants have been encouraged to participle as many approached us asking about the requirements and requesting an assessment.
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Green Sticker Progress from August 2013 to December 2014:
Assessment up to Aug 2013 Assessment up to Feb 2014 12 Restaurants 49 Restaurants
1 1 3 8% 8% 3 25% 25%
8 8 67% 67%
Blue Green Red Blue Green Red
Assessment up to Jul 2014 Assessmant up to Dec 2014 72 Restaurants 220 Restaurants
18 6 11 47 8% 15% 8% 21%
55 155 77% 71%
Blue Green Red Blue Green Red
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International Health Regulations
Section 5
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Background Introduction & Overview The International Health Regulations 2005 (IHR) are an international agreement legally binding on 194 States Parties, including all WHO Member States. They entered into force on 15 June 2007. States Parties are obligated by the Regulations to develop, strengthen and maintain national minimum core public health capacities. The national core capacities are described in functional terms in Annex 1 of the Regulations and include surveillance and response capacities to public health events including capacities at designated points of entry.
The Regulations are intended to rapidly identify and stop the emergence and spread of public health risks including emergency events. These risks are not restricted to communicable diseases with epidemic and pandemic potential but apply across all relevant hazards of zoonotic, food safety, chemical, radiological.
The IHR set out a time frame within which States Parties are to develop, strengthen and maintain national core capacities. According to the provisions of Articles 5 and 13 and Annex 1 of the IHR, State Parties should have assessed their core capacities for surveillance and response, including at designated points of entry, by 15 June 2009. The vision of the Bahrain IHR is to “minimize the health, economic and social impact of any public health emergencies of international concern.” Bahrain IHR mission is to “improve health protection in Bahrain, to be prepared and to respond to a public health emergency of international concern”.
In 2014, Bahrain met the IHR core capacity obligations by fulfilling all the requirements for IHR implementation through building the capacities before the global deadline (June 2014) by strengthening of existing structures, systems and institutional capacities for implementation of the International Health Regulations. Initiation of IHR activities among the various administrative levels and other concerned ministries and institutions in Bahrain which lead to advanced achievement whereby knowledge, findings, lessons learnt and experience gained from the outputs and outcomes.
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Progress in building capacities for surveillance and response was achieved in Bahrain as per annex 1 of the regulations that facilitate implementation in a more efficient, effective or beneficial manner. Strengthening the IHR communication Program was done in Bahrain by establishing Bahrain IHR website which facilitates coordination among the different entities involved in implementation of the IHR. Comparison of Bahrain IHR Indicators Scores 2014 with CEMRO 2014
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Achievements of the IHR
IHR points of entry monitoring program IHR Electronic Monitoring Program for Environmental Health at the Points of Entry IHR WHO Review Mission to Bahrain and its Recommendations, April 2014 WHO IHR mission Recommendations plan of implementation IHR National chemical Plan of action for -Bahrain 1,3.4.2014 Budget proposal for IHR monitoring program 2014 IHR National Action Plan for Chemical Events in Bahrain May 2014 IHR annual report 2013 June 2014 Bahrain profile 2013,June 2014
Lecture regarding preparedness to face Ebola in Bahrain August 2014.
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Bahrain Capacity Scoring 2014
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Bahrain Indicator Scoring 2014
1
. 1 . 68 3 1
1
. 1 . 82 2 1
1 . 1 . 000 1 1
1
. 1 . 98 0 1
1 . .3 000 9
1 . .2 000 9
1 . .1 000 9
1 . .2 000 8
1 . .1 000 8
1 . 60 .1 7
1 . .1 000 6
1 . .2 000 5
1 . .1 000 5
1 . 57 .2 4
1 . .1 000 4
1 . .2 000 3
1 . .1 000 3
2 . .1 000 2
1 . .1 000 2
1 . .1 000 1
%
r:
n i as a ato r c re o ah c ndi S I B
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Disease Control Section
Section 6
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Background Introduction & Overview Overall objectives of Diseases Control Section (DCS) are disease prevention and health promotion of the population. Therefore, Diseases Control section has to keep pace with rapid development of health care services and changing health patterns. The section must maintain control programs of diseases of low incidence with potential for re-emergence, as well as develop and maintain new programs. Diseases Control and prevention are integrated into all programs of health care from Primary Care to Secondary and Tertiary Care.
Like any other country in the world, the Kingdom of Bahrain is at risk not only from chronic diseases, but from emerging new infectious diseases. Significant achievement has been made in the control of communicable diseases in the Kingdom. This was coupled with an increasing importance of chronic diseases as leading causes of mortality. In the recent past years, some of the Communicable Diseases have been newly known to affect humans (e.g. HIV, SARS and avian influenza) and some of the old ones reemerged (e.g. Tuberculosis) with enhanced virulence and resistance to treatment.
Bahrain has eradicated or eliminated most of the communicable diseases which were relatively highly prevalent in the first half of this century. Morbidity and mortality data indicate that non-communicable diseases such as cardiovascular diseases, cancers, diabetes and accidents now represent today's main health problems. However, there is a real danger of re-emergence of already eradicated and controlled communicable diseases and of importation of dangerous infectious diseases, particularly in view of the continued and changing imported labor force.
The future of chronic disease amelioration, injury prevention, communicable and emerging diseases control will require a complex Diseases Control Section infrastructure to provide adequate services to every community, i.e. adequately trained personnel, information and communication systems for collecting and disseminating accurate data at the national and regional levels.
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Directions & strategies:
Vision: The section works in collaboration with various parties to improve the health of population of Bahrain through prevention and control of diseases.
Mission: The section’s mission goes in line with the Bahrain health strategy in which it works in partnership with stakeholder to ensure the prevention & control of disease and provide accessible preventive health services to the community of Bahrain, using available resources as effectively as possible to provide a high standard of preventive care based on research, evidence and relevant international and best practice .
Aim: To plan, monitor and evaluate the national disease control plans in Bahrain by integrating prevention & control activities with in the context of primary & secondary health care systems. It also aims to provide epidemiological surveillance, epidemic diagnosis and investigation for existing and emerging epidemics, immunization and other prevention services to the whole nation of the kingdom of Bahrain
Strategic goals: Disease control should act as the central body for the ministry of health for establishing and monitoring of disease control plans and policies, through achieving the following strategic goals:
Promotes and encourage healthy life style behaviours. Prevents communicable diseases, NCD and injuries. Prevents epidemics and control the emerging diseases. Protects against vaccine preventable diseases through expanding immunization services. Protects against occupational and environmental hazards. Maintain accurate registries, surveillance and efficient data management system. Responds to disasters and emergency.
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6.1. Communicable Diseases Control Group (CDC):
Vision: Keep Kingdom of Bahrain free from communicable diseases with severe impact on public health
Mission To implement plans and strategies that aim at preventing communicable diseases, reduce its transmission if it occur and minimize complications from these diseases in the short, medium and long term.
Purpose To protect the citizens and residents of the Kingdom by immunization and reduce the spread of communicable diseases.
The main objectives To Eradicate or eliminate communicable diseases with severe impact on public health which are consistent with the goals of the World Health Organization. To prevent communicable diseases occurrence. To limit the spread of communicable diseases. To prevent and reduce complications resulting from communicable diseases.
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Core functions Follow-up of cases of communicable diseases and their contacts through: Foodborne Control Program Vaccine Preventable Diseases Control Program Tuberculosis Control Program HIV Control Program Hepatitis A Control Program Hepatitis B Control Program Hepatitis C Control Program Hepatitis E Control Program Leprosy Control Program Sexually Transmitted Diseases Control Program Emerging and re-emerging diseases control program
Activation of the early warning system to detect outbreaks . Participate in the development of policies & strategies to prevent communicable diseases or minimize their impact on public health. Inspection of arriving and departing ships from the Kingdom to ensure that they are free from the risk of infections. Prepare and analyze statistics on weekly, monthly and yearly basis to take appropriate action in timely manner. Increase awareness among the health care workers and the community about ways to reduce the incidence of communicable diseases and their prevention.
Unit Staff:
Number of male staff 3 Number of female staff 8 Current Vacancies Public health consultant Needs Upgrade the hierarchy of the group to suit the contentiously evolving needs to detect and manage communicable diseases.
Public Health Annual Report 2014 46
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Public Health Annual Report 2014 47
6.1.2 Achievements in 2014
Preparation and updating of the standard operating procedures the various programs. Strengthening Influenza surveillance system in the health centers, as well as the strengthening of surveillance for a Sever Acute Respiratory Infections (SARI) in the hospital. (Salmaniya Medical Complex) and the collection of samples of influenza and other emerging viruses. Strengthening surveillance of targeted communicable disease by active surveillance system through increasing number of visits to health facilities and passive reporting of diseases through the daily and weekly reporting forms. Enhance cooperation and coordination between the various ministries in order to ensure control of communicable diseases . Send periodic information about communicable diseases to World Health Organization and other stakeholders . Continuous update of the investigation forms for enteric disease in line with international health organization recommendations. Contentious staff training on the latest developments in the field of controlling of communicable disease.
Public Health Annual Report 2014 48
6.1.3 Activities in 2014
DONE BY DATE PLACE LECTURE TITLE
Public Health Dr. Kubra 21/4/2014 Measles (FPRP) Directorate (PHD)
Dr. Kubra 31/3/2014 PHD T.B (FPRP)
Drill to evaluate the emergency MERS-cov Dr. Wafa 28/05/2014 PHD plan in the public health. For Public Health Staff Middle East Respiratory Syndrome Dr. Wafa 29/05/2014 KHUH coronavirus (MERS-cov) (healthcare workers) Workshop On Middle East Respiratory Dr. Kubra + 11/06/2014 PHD Syndrome Coronavirus (MERS-cov) Dr. Wafa (Doctors, nurses & healthcare workers)
Communicable Disease in School Setting Dr. Kubra 19/06/14 Y.E.HC (School Health Nurses)
Fathiya + 19/08/2014 Noaim HC Your Health in Summer Mona Sayed
Dr. Wafa 3/09/2014 EWA Ebola Virus (Staff of EWA )
Dr. Wafa 04/09/2014 Movambic Hotel Communicable Disease in Hajj Mona Sayed + 23/09/2014 Noaim HC Your Health in Hajj Mona Yahya
Dr. Kubra 30/10/2014 Government Schools Workshop Of School Health
Dr. Kubra 05/11/2014 Private Schools Workshop Of School Health
Dr. Kubra 10/11/2014 AGU Ebola Virus (FPRP)
Public Health Annual Report 2014 49
6.2. The Expanded Program on Immunization (EPI / Immunization) Group:
Vision: Community protection Lifelong through Expansion of immunization services against vaccine preventable diseases to cover different ages groups and targets
Mission provision of comprehensive high standard of immunization services which will be responsive to people’s needs and continuous throughout their life span, and encouraging personal responsibility for their well-being through proper use of allocated resources as efficiently and effectively as possible in collaboration with various stakeholders to protect the population against vaccine preventable diseases of public health concern and improved health in the kingdom of Bahrain.
Aim To protect the population and control the spread of vaccine preventable diseases.
The main objectives Expand the use of all existing cost-effective vaccines. Improve access to sustainable immunization services. Accelerate the development and introduction of new vaccines. Make immunization coverage an integral part of the design and assessment of health systems and national development efforts. Integrate the Immunization activities into general health services including preventive, as well as curative activities. Advocate for preventive Immunization Health Services to all age groups throughout their life span. Develop and adopt a multi-sectorial and multi-disciplinary approach. Emphasize the role of the individual in being responsible for his/her health. Achieve and maintain health and vaccination of all people. Develop sustainable and environmentally sound policies and programs that lead to improved immunization and health for both present and future generations. Implement quality improvement measures within health plans
Public Health Annual Report 2014 50
Key Functions: A. Immunization safety programs: Cold chain monitoring program Adverse events following immunization program Safe injection practices program Immunization units monitoring program
B. Quality Control programs: Data management program Scientific research program Training and development program Active surveillance program
C. EPI Diseases programs: Polio eradication program Measles elimination program Rubella & C.R.S elimination program Childhood Hepatitis B elimination program Meningitis data management program Rota virus data management program Hepatitis A reduction program Haemophilus Influenza type b monitoring program
D. Screening programs: Childhood TB infection screening program Antenatal hepatitis B screening program (Infant of Hepatitis B surveillance) Antenatal rubella screening (Risk of CRS predication ) Pre-school screening program (Pre-school vaccination coverage estimate)
E. Vaccination programs: Childhood vaccination program Adolescent vaccination program School students vaccination program People with special needs in Rehabilitation centers vaccination program Elderly Vaccination program High risk group vaccination program Health care workers vaccination program Pregnancy vaccination program Travelers Vaccination program
Public Health Annual Report 2014 51
Strategic Goals: The provision of services related to vaccine. Planning and program management. Storage of vaccines at the right temperature. Distribution and monitoring. Healthy trained staff.
Unit Staff:
Number of male staff 1 Number of female staff 13 Current Vacancies None Needs Upgrade the group, for the staff additional staff
Public Health Annual Report 2014 52
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Public Health Annual Report 2014 54
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Public Health Annual Report 2014 55
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Public Health Annual Report 2014 56
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Public Health Annual Report 2014 57
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Public Health Annual Report 2014 58
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Public Health Annual Report 2014 59
6.2.2 Achievements in 2014 Details: Updating the Vaccine Supply Chain Monitoring program and data quality assessment visits to include all governmental and private vaccination units. Updating data entry for the Elderly vaccination program in all governmental and private rehabilitation centers in Bahrain, to ensure that all vaccination related data is entered in the computerized system to obtain accurate statistical data and easily analyze it to be used in future research work. Updating data entry for High Risk group vaccination program, to ensure that all data entered in the computer system to obtain accurate statistical data and easily analyze it to be used in future research work. Upgrading of Congenital Rubella Syndrome program to follow up the suspected cases and to include (ICD10) diagnosis to identify suspected cases. Also, developing the electronic data entry system for this program. Updating data entry for the Vaccination Campaign Program to ensure complete data entry in the electronic program to obtain accurate statistical data and easily analyze the data to be utilized in future research work. Updating data entry for the Adverse Event Following Immunization Program (AEFI), to ensure that all vaccination information is entered in the computer system to obtain accurate statistical data and easily analyze it to be utilized in future research work. Updating Health Care Workers program and encouraging the use of the electronic system to enter all health care workers immunization data in the system. Implement new program for tracing immunization defaulter’s students in certain private schools with high percentage of expatriates and those with high numbers of defaulters for routine vaccinations. Develop collaboration and coordination between the various ministries in order to ensure proper control of communicable diseases and ensuring the access of immunization services for all targeted populations. Send periodic information on infectious diseases and immunization coverages to the World Health Organization (WHO) and other concerned parties. Updating the forms used in data entry for childhood and high risk immunization programs.
Public Health Annual Report 2014 60
Events: Celebrated the global Immunization Week with the eastern Mediterranean region (EMRO). The immunization group participated actively in this week through vaccination campaigns, awareness campaigns and printing posters about this activity and sharing the final report of the activities with the EMRO. The Disease Control Section participated in the World Health Organization WHO meetings concerning vaccinations and vaccine preventable diseases, including the regional meeting of measles elimination. Many lectures were conducted about vaccine preventable diseases and the importance of completing the vaccination. Participation in local, regional and global workshops and in various committees such as the Measles elimination committee in the Ministry of Health and Hajj coordination Committee and other committees. Participation in radio and television programs regarding vaccines and vaccine preventable diseases. Workshop on vaccine management, vaccine supply chain monitoring and Adverse Event Following Immunization were conducted to the nurses in primary health care and private sector. Vaccine management workshops were conducted in collaboration with the World Health Organization Training Center of Oman to train nurses and pharmacists providing vaccination services in both governmental and private sectors. Training workshops about vaccination, adverse event following immunization and contraindications were conducted to the doctors and nurses. Training workshops about Acute Flaccid Paralysis, communicable diseases, vaccines and the updated vaccination data forms was conducted to the nurses in the treatment room and Mother and child care health and to the doctors in primary health care. Training workshop about communicable diseases and immunization was conducted in coordination with the school health section to the governmental and private schools. Lectures about infectious diseases and vaccine preventable disease were held in collaboration with various health sectors, such as the Royal Medical Services, the Ministry of the Interior and at certain departments of the Ministry of Health including pediatric department. Training of medical students in Arabian Gulf University and others and provide lectures to training doctors in the Family Practice Residency Program.
Public Health Annual Report 2014 61
Publications: Many press reports in local newspapers. Guideline booklet about vaccinations and vaccine preventable diseases was published by the EPI group and communicable disease group. Updating the vaccination certificate. Printing vaccination certificates for completion of vaccinations to all students in grade seven at the government and private schools. Printing vaccination certificates for all medical students for completing all the required vaccinations. Issuing guideline circulars on the surveillance of communicable diseases and vaccinations to all health facilities. Issuing a Guideline poster for vaccinations. An educational poster about vaccinations contraindications and about information that must be obtained before giving vaccination was published. Periodic health bulletins about communicable diseases and vaccinations were published. Issuing circulars about communicable diseases and vaccinations.
Campaigns: In terms of providing protection for all, several awareness campaigns has been done for different population of society and several vaccination campaigns were held to vaccinate the school students, health care workers, medical students and others. Vaccination campaigns to the elderly and handicap and health care workers. MMR vaccinations campaigns were conducted in residency block where suspected cases of measles, mumps or Rubella have diagnosed. A wide response vaccination campaign with MMR vaccine and a pandemic analysis of cases and contacts was done in some areas. Vaccination campaign with MMR vaccine in one of the churches to raise the immunity level in the community especially among defaulters. Vaccination campaign with MMR vaccine in governmental and private schools where measles, mumps or Rubella cases were diagnosed.
Public Health Annual Report 2014 62
Lecture Lecturer Attendance Date EPI & Communicable Pneumococcal Update 14/1/2014 Diseases Staff
Vaccine management Pharmacist in PHC & DMM Feb /2014
Pneumococcal diseases EPI & Communicable 20/03/2014 and Vaccines Dr. Jaleela Diseases Staff Importance of elderly S.Jawad HCW 10/4/2014 vaccination EPI Staffs & Communicable Influenza Vaccination 28/4/2014 Diseases Vaccination Schedule EPI Staffs & Nurses 7/05/2014 ( Polio Update )
AFP and High risk Dr. Jaleela MCH Doctor and Nurses 27/05/2014 group Vaccination S.Jawad & in private and Defaulters and traveler Dr. Basma governmental facilities 28/05/2014 Vaccination Al Saffar Dr. Jaleela & Dr Basma EPI staff, WHO/ Nurses in governmental 31/05/2014 WHO/UNICEF Vaccine UNICEF and private sections - management workshop Collaborate Pharmacists 2/06/2014 Center in Central store staff Oman
High risk group Dr. Basma 19 and 23 School Nurses Defaulter Vaccination Al Saffar 06/2014
Vaccine management, Dr. Jaleela & PHC Nurses July/2014 AEFI, and cold chain Dr. Basma
October + Vaccination for students School health nurses and November at school MOE instructors 2014 Dr. Jaleela S.Jawad DCS staff, Doctors & “Update in vaccination” Nurses in governmental 13/11/2014 workshop and private sections, Pharmacists
Public Health Annual Report 2014 63
6.3. Non-Communicable Diseases Group:
Non communicable diseases (NCDs) are a group of diseases of long duration and generally slow progression. The four main types of NCDs are cardiovascular diseases (CVD), cancer, chronic respiratory diseases and Diabetes Mellitus (DM). These diseases share these risk factors: tobacco use, physical inactivity, unhealthy diets and the harmful use of alcohol. NCDs kill more than 36 million people each year, representing 63% of all annual deaths. Around 80% of all NCD deaths occur in low- and middle-income countries. The National Non-communicable Diseases Risk Factors Survey conducted in the Kingdom of Bahrain in 2007, showed that the prevalence of DM was 14.3%, Hypertension 38.2% and high cholesterol level 40.6%. Also, the study revealed that the overall prevalence of obesity was 36.3%; while the overall prevalence of overweight was 32.9%. Furthermore, 62.0% reported daily intake of vegetables while only 49.6% reported daily intake of fruits. In addition, 57.1% of the participants in the survey, stated that they do not practice any physical activity at leisure time. The overall prevalence of smoking was found to be 19.9%. Similar to the situation in the industrialized countries, the data of 2013 in Bahrain showed that NCD mortality constituted about 63% of total death, with CVD accounting for about 34%, cancer 14%, diabetes accounted for 24% , chronic respiratory diseases 3% and for other NCD diseases has reached 24% of total deaths.
Data also showed that in the age group 30-70 years, NCD accounted for 65% of the total deaths, with CVD accounting for 34%, diabetes for 23%, and cancer 18%. This constitutes a challenge for the health authorities to urgently start the implementation of the national comprehensive plan in order to reduce the life loss during productive age. As these diseases share the same risk factors, therefore the strategies for prevention can be integrated into one common approach by adopting an Integrated National Action Plan (INAP).
Public Health Annual Report 2014 64
In addition, it is important to strengthen the public-private partnership that are built on shared responsibility so that the government is not solely responsible for getting these programs out to the communities, but can rely on groups and national organizations that have complementary mandates.
General roles of NCD unit:
Mission To prevent and control major Non-Communicable Diseases (NCDs) in the Kingdom of Bahrain by integrating a comprehensive non-communicable disease prevention and control program within the context of intra sectorial and inter sectorial approach (integrated national action plan).
General Goal To reduce the preventable and avoidable burden of morbidity, mortality and disability due to Non communicable diseases in the kingdom of Bahrain by means of multi sectorial collaboration and cooperation at national levels, by enabling the population to reach the highest attainable standards of health, quality of life, and productivity at every age so making these diseases no longer a barrier to well-being or socioeconomic development, through reducing risk factors associated with them such as obesity, high blood pressure, tobacco use, diabetes and physical inactivity and unhealthy diet. This will be accomplished through implementing the following steps: * Collecting relevant health data to evaluate the current status of NCDs in the community. * Adopting a comprehensive national awareness campaigns to promote healthy life style. * Implementing an integrated plan to enhance preventive and therapeutic health services in the primary and secondary health care. * Enhancing tertiary and rehabilitation services.
Public Health Annual Report 2014 65
Main Objectives
Long Term Objectives : 25% reduction in current NCD ( CVD, Cancers, Diabetes and chronic respiratory diseases ) mortality in adults (30-70)during 15 years.
Strategic Objectives:
Primordial prevention of NCDs
Primary prevention of NCDs
Secondary prevention of NCDs
Quality improvement of health services with its three levels as provided to NCD patients and its complications.
Conduction and support of NCD research and Studies
Empowerment of NCD patients and their families to take part in the services provided and its quality control.
Community participation for control of NCDs
Support of methods of controlling, monitoring and evaluation of NCDs.
General Recommendation:
Given the magnitude of the NCDs problem in the Kingdom of Bahrain and its profound adverse impact on health and the economy, there is an urgent need for initiation of the national preventive action plan.
Public Health Annual Report 2014 66
Specific recommendations:
1- Inclusion of prevention of NCDs within the national development plans and policies for each country. 2- Work towards allocation of a specific part in the MOH budget to implement NCD control plans and programs. 3- Improvement of healthcare quality and provision of human and financial resources necessary to tackle these diseases at the three levels of healthcare. 4- Development of the PHC centers infrastructure to make these centers more appropriate to combat NCDs through improvements of diagnostic services and provision of essential drugs. 5- Enacting regulations and setting national policies aiming at reduction of risk factors and prevention of unhealthy life styles to cope with international directions in this respect. 6- Implementation of community initiatives for early detection of NCDs as well as health awareness campaigns for promotion of healthy life styles. 7- Strengthening partnership between governmental and non- governmental institutions as well as private sector with emphasis on joint community responsibility and the importance of coordinating efforts to control NCDs. 8- Setting an effective system for surveillance and control of NCDs. 9- Conduction and support of research and studies on NCDs. 10- Calling upon all concerned sections in MOH to update their plans based on the national action plan for NCDs (2014 – 2025) endorsed in the expanded meeting.
Public Health Annual Report 2014 67
Main Activities in 2014:
1– Protect Your Heart Campaigns in Governmental sites:
Year 2010 2011 2012 2013 2014 Total Campaigns 15 5 14 4 15
2– Protect Your Heart Campaigns in Non-Governmental sites:
Year 2010 2011 2012 2013 2014 Total Campaigns 0 0 4 9 3
Public Health Annual Report 2014 68
3– NCD Clinics:
Public Health Annual Report 2014 69
4– Non Communicable Diseases Bulletin:
Public Health Annual Report 2014 70
Public Health Annual Report 2014 71
6.4. Occupational Health Group:
Introduction & Overview of Occupational Health Group The Occupational Health Unit at the Ministry of Health was established in 1976. During the past 34 years or so, sections of the Unit has been either transferred to other ministries or rotated within different directorates at the Ministry of Health. Currently the Occupational Health Unit functions under the auspices of the Disease Control Section. The current manpower of the occupational health is five staff. The head of the unit, two occupational physicians and two staff nurse.
Functions: The main functions of Occupational Health Unit are: Periodic Medical Examination of workers in private and government sector; medical consultation for referred cas- es; awareness and training in occupational health.
Vision: The health of workforce is the cornerstone of economic development.
Mission: Strive to create a better working environment and to provide integrated and quali- ty occupational health services that will help to achieve the highest degree of physi- cal fitness, psychological and social wellbeing of all workers in all occupations and to ensure that their health is not affected because of their professions.
Aim: To promote health of workers. To contribute positively to productivity, quality of work, work motivation and job satisfaction. To improve overall quality of life of workers and society.
Public Health Annual Report 2014 72
Values: Be committed to excellence and quality in every aspect of our work. Treat those we serve with concern, kindness and respect. Act openly and truthfully in everything we do. Ensure equity and fairness Make workers feel valued and demonstrate integrity. Promote team work by recognizing that our combined efforts exceed what we can accomplish individually.
Priority objectives: Strengthening national policies for health at work and developing necessary policy tools. Developing health work environment, and health work practices. Establishment of support services for occupational health. Development of occupational health standards based on scientific risk assessment. Establishment of registration and data system information services for effective transmission and data rising of public awareness through public information. Workplace Health promotion. Radiation protection. Research.
Goals - Execute the Ministerial order (3) of 2001 concerning Periodic Medical Examination for workers at risk in establishments. - Early detection/ management of occupational diseases. - Minimize the damage caused by occupational diseases. - Reduce the ill effect of exposure to physical, chemical, biological, as well as ergonomically factors. - Improve workers social, mental & social well being. - Increase workforce awareness about Occupational hazards. - Increase productivity and reduce the cost of absenteeism, and treatment. - Prevent or reduce occupational accidents. - Reducing financial burden on the whole community. - Identify the magnitude of occupational related diseases, injuries and cancers in Bahrain. - Identification and Quality Control for general Radiography equipment in SMC and local health centers.
Public Health Annual Report 2014 73
Duties Occupational Health Group: Periodic Medical examination Carry out Workplace inspection visits to factories and various work sites. Medical education and training courses for health workers to deepen and in- crease medical knowledge in the field of occupational health. Health education and promotion at workplace Implementing the Action Plan prepared by the Commission on Safety and Occu- pational Health. Preparation of periodic reports on activities and achievements of the occupa- tional health department and proposals on development work. Analysis of reports and questionnaires received from international organizations and Arab, regional and to take the necessary action in respect thereof. Receiving and recording of Occupational diseases and Injuries reports for Health Care Workers in the Ministry of Health. Supervision and in collaboration with a group of immunization on vaccination of health workers at the Ministry of Health. Conducting studies and research in the field of occupational health. Consultations on referrals from medical commissions or local health centers. Identification and Quality Control for general Radiography equipment in SMC and local health centers. Programs 6.4.1 Periodic Medical Examination. Compliance with Ministerial order (3) of 2001 concerning Periodic Medical Examination for workers at risk in establishments, where there is no Occupational Health Units (Occupational clinic). Occupational diseases are unique in the sense that hazards that cause them are known even before exposure of the workers takes place. This fact characterizes occupational diseases as being entirely preventable; exposure can be controlled or prevented. To minimize the damage caused by occupational diseases, the best alternative is ear- ly detection of pathological changes at a stage when they are reversible. Certain oc- cupational exposures cause early clinical, functional, biochemical or morphological changes which when detected early enough, are reversible. Unfortunately, there are other occupational diseases which cannot be detected at a reversible stage.
Objectives of the Program 1. To execute the Ministerial order (3) of 2001 concerning Periodic Medical Examination for workers at risk in establishments. 2. To minimize the damage caused by the occupational diseases.
Public Health Annual Report 2014 74
6.4.2 Occupational Health Education Dissemination of information about the patterns of occupational diseases, occupational related diseases & occupational accidents. This will involve description of the relationship of different work environments and worker’s health and how to prevent or reduce it’s detrimental effects.
Objectives of the Program 1. Improve workers social, mental & social well being. 2. Identify causes of work accidents and methods of prevention. 3. Describe how different styles of work practices might affect the health and safety of the worker, colleagues and others. 4. Reducing financial burden on the whole community.
6.4.3 Development of Occupational Health Services Objectives of the Program 1. To execute the Ministerial order (3) of 2001 concerning Periodic Medical Examination for workers at risk in establishments 2. Assess the Magnitude of Occupational related diseases, injuries and cancers. 3. Improve workers social, mental & social well being. 4. To minimize the damage caused by the occupational diseases. 5. Identify causes of work accidents and methods of prevention.
6.4.4 Occupational Health Monitoring Objectives of the Program 1. To execute the Ministerial order (3) of 2001 concerning Periodic Medical Examination for workers at risk in establishments 2. Know health system and legislation. 3. Have first aid knowledge. 4. Be aware of all health and safety- related hazards.
6.4.5 Radiation Protection Radiation protection services program at MOH is actively involved in, or available for consultation on, all matters concerning radiation safety and medical physics is- sues in diagnostic, interventional, nuclear medicine and radiation oncology areas, including research applications. Its involvement is especially warranted where radiation doses are known to be high, and for optimization of doses for high risk groups such as infants, for dose con- straints in health screening and risk assessment in research proposals. Also, it is actively engaged in quality control & quality assurance program of radia- tion equipment modalities in the three areas of radiology, nuclear medicine and ra- diation oncology.
Public Health Annual Report 2014 75
Roles In justification: Generic risk assessment, especially for new equipment of techniques Communication with practitioner Risk assessment for research proposals, and Dose constrains in research.
In Optimization, including dosimetry and equipment quality assurance (QA) System for dose calibration and quantification Diagnostic reference levels and review Patients dose monitoring program and review, including dose reduction strategy Image quality evolution and outcome performance indicators Selection of equipment to include specification of radiology equipment Commissioning of new equipment & communication with applications specialist Advice on suspension of existing equipment Maintenance of equipment inventory Imaging equipment replacement policy review Audit and development of audit for medical exposures Operator function as identified for the medical physicist in the employer’s procedures, Communication with other employees and with maintenance engineers on prac- tical aspects.
In Other radiation protection matters concerning medical exposures: Incident investigation including patient dose assessment Radiation protection of comforters and carers. Communication role during inspection by the relevant statutory authorities Communication with other employers Advice on implementation of employer’s procedures Training Role in multidisciplinary medical audit and review, and Clarifying overlaps with other radiation protection and exposure legislation.
Public Health Annual Report 2014 76
Highlights of OHG activities for 2014: Within Ministry of Health: Periodic Medical Examination (PME) that include completion of Occupational Health questionnaire, Blood tests, X-Rays, ECG, Visual acuity, color vision, Audiometry and Spirometry. Ministry of Health: Laundry CSSD Radiology Artificial Kidney Unit Oncology wards Food hygiene (Kitchen Staff) Psychiatric Hospital Maintenance Staff Environmental Health Workers
Other Ministries Ministry of Works. Sewerage Workers
Private Sector Midal Cable Ahmadi Security Bahrain Atomaizars Bahrain Maintenance and Marine Services (BMDS) Durrat Resort Metal of Bahrain Oil Field Services (MTQ) Nasser Abd Mohammed B.S.C New Island Contracting (NIC) Yateem Oxygen Consultations on referrals from medical commissions and Local Health Centers. Update DPPs on Health Care workers (HCW) Health and Safety. Participation in the meetings of Infection control teams in SMC. Participation in the Accreditation task groups meeting for Radiology, oncology and health centers. Participation in the International Health Regulations committee meetings. Participation in the meetings with Immunization group and I-Seha team to develop the Immunization Health Care Workers electronic system. Participation in the meetings of the Hearing protection Committee. Participation in the Primary care Incidence Committee Meetings. Implementing health promotion through periodic medical examination. Preparation of the statistics of Health Care Workers vaccinations. Vaccination of health care workers in SMC. Workplace visit to Radiology sections in SMC and local Health Centers.
Public Health Annual Report 2014 77
Outside Ministry of Health Participation: The 7th GCC Occupational Health & Safety meeting: Qatar (December 2014). The Occupational Safety & Health Supreme Committee meetings. The Supreme council for environment Radiation Safety Information Managements Systems (RASIMS) committee. The Mutual Emergency Marine Aid Centre (MEMAC) committee: development of the action plan for response to radiological or nuclear emergencies.
Education & Training The unit is actively participating in many continuous educational and training activities within & outside MOH through workshops, conferences, lectures, courses and campaigns to facilitate the exchange of knowledge and skills concerning OH&S.
Inside the Ministry of Health: Deliver a course and Training in OH&S for FPRP residents. Deliver a presentation on Occupational Injuries during the introductory course for FPRP Residents. Deliver a presentation on Reporting of Occupational Diseases & Injeries to Ah- med Ali Kanoo H.C staff.
Outside the Ministry of Health: Deliver a presentation on Occupational Health & Safety for BANAGAS workers during the Safety, Health & Environment Week. Participation in the National Health Insurance Forum. Participation in the Expert mission meeting on Technical cooperation Advisory mission from IAEA by Dr. Petra Salme 27-29 May, 2014 Participation in the IAEA expert mission by Dr. Belal Moftah, September ,2014
Conferences and Seminars Organizing the GCC Sub-regional workshop on “Developing Mechanisms and Plans of Action for Applying Occupational & Environmental Health Standards for Accrediting Hospitals and other Health Care Facilities” Bahrain, Sep 2014. Organizing the IAEA workshop on Diagnostic reference levels. Organizing the IAEA workshop on the Role of medical physicist in radiotherapy.
Projects involvements: Radiation oncology linear accelerators replacements. Proposed nuclear Medicine suites at old pharmacy at SMC. Rehabilitation center at Aali. Halat Bu Maher HC. Jaber Al Sabah HC. North Muharreq HC X-ray suite renovation.
Public Health Annual Report 2014 78
Statistics of OHG for 2014:
9 5
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Public Health Annual Report 2014 79
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Public Health Annual Report 2014 80
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Public Health Annual Report 2014 81
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Public Health Annual Report 2014 82
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Public Health Annual Report 2014 83
6.5. The Anti Smoking Group
Vision: Tobacco-free Bahrain: healthy people, communities, and environments
Mission: To protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke by implementing tobacco control measures in order to reduce continually and substantially the prevalence of tobacco use and exposure to tobacco smoke. To advocate, enable and mobilize multi-sectoral support for stronger tobacco policies and programs in line with WHO FCTC To strengthen national capacity, leadership, governance, multisectoral action and partnerships to accelerate country response for the prevention and control of tobacco.
Aim: Full implementation of antismoking law, framework convention of tobacco con- trol (FCTC), national decrees and regulations.
Main objectives: Follow up on complaints received about smoking violations. Follow up the implementation of Antismoking Law. Convert the records of the violations which have been written in accordance with the provisions of Law No. 8 of 2009 to the Public Prosecution. Prepare reports and statistics and making recommendations on shops that require a license for the import, distribution, or sale of different kinds of tobacco or the provision of services for sheesha. Collaborate with the competent authorities inside and outside the Ministry of Health to facilitate the implementation of Antismoking Law.
Key Functions: Health inspection. Policy development. Laws and legislations. Training and education. Research. Support of tobacco use surveillance and epidemiology.
Public Health Annual Report 2014 84
Strategic Goals: Prevents epidemics and the control of communicable & non communicable disease Promotes and encourages healthy lifestyle behaviors Protects against occupational and environmental hazards Maintain accurate registries and efficient information
Unit Staff:
No. of male employees 4
No. of female employees 6
Vacancies 0
Needs 1 (Data Management)
Public Health Annual Report 2014 85
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lemen lemen tion s t to espec pt ent ion eop : elp e for 1 p ors an ax o easures. t oo or or ing t h n p med e healt uct - ect vention o slat require ma m nit nit d mot bl ud i er icat ces ind plem f orma ll imp ll imp t d d nsum bacc f egi a inf pro Regulate incl Warn an smoke, co Prot mass legi Con Raise t regulation Im O pro to Fu Fu pla all L an Mo ind curren Mo
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1 s a mmun s es a teg e c . ain at le be ot h 5 co y ect . tra t stri ard oura int S n orma icient d mmun cup 6 est f isease az lif Prom enc no d an co Prevent regi Ma ef environ Prot h oc inf Public Health Annual Report 2014 86
6.5.2 Information of the year 2014: Kingdom of Bahrain won the World No Tobacco Day (WNTD) 2014 award for EMRO region. Total health inspection visits accomplished to implement antismoking law increased from 6372 in 2013 to 140039 in 2014. Health inspectors issued 9373 written warnings and converted 333 persons and/or entities to public prosecution for violating Antismoking Law. Main Achievements Five new health inspectors joined anti-smoking group to of complete the existing vacancies in the structure of the 2014 group. Joined the newly opened Smoking Cessation clinic in BBK health center in Hidd. Expand the scope of Antismoking Group objectives to include health education about harmful effects of tobacco and implementation of antismoking Law. Participated in the FCTC conference of parties (COP) meeting which was held in Moscow in October 2014.
Daily health inspection visits to monitor implementation of Antismoking Law. Participated in all health campaigns to raise public awareness about tobacco and antismoking law. Main Activities of Prepared kingdom of Bahrain 3rd FCTC report which was submitted in April 2014. 2014 Participated in amendments to Antismoking Law and GCC tobacco products specifications. The group conducted 14039 visits throughout 2014, The group took 11629 actions throughout 2014
Public Health Annual Report 2014 87
Environmental Health Section
Section 7
Public Health Annual Report 2014 88
Background Introduction & Overview Environmental Health Section consists of the following groups:
7.1. Water & Enterprises Sanitation Group: The main duty of the group is to ensure water safety and portability for human consumption, with respect to international standards, through collecting samples from different sources such as main production stations, water network distribution systems in all towns and villages and civil societies institution like school, hotels, hospitals, and swimming pools. The group also controls licensing of institutions to ensure they meet health regulations e.g. tourism, hairdressing and beauty salons to ensure compliance with health requirements by carrying out periodical inspection. Conduct educational campaigns such as: lectures, seminars, and exhibitions for both schools staff and students, workers at salons in order to improve their knowledge about hygiene and to enhance sanitation standards.
Water Supply Bacteriological and Chemical Test Results by Source 2010 - 2014
Source Year Result Total Public water Schools, Hospitals, Hotels
% Unsatisfactory 0.54 1.96 2.50 2014 No. Of samples 910.00 1017.00 1,927
% Unsatisfactory 1.65 4.90 6.55 2013 No. Of samples 1269.00 1285.00 2,554
% Unsatisfactory 1.18 7.78 8.96 2012 No. Of samples 1437.00 1310.00 2,747
% Unsatisfactory 1.91 5.21 7.12 2011 No. Of samples 1,622 1,035 2,657
% Unsatisfactory 1.08 2.43 3.51 2010 No. Of samples 1,472 2,383 3,855
Public Health Annual Report 2014 89
7.2. Malaria and Vector Control Group The Group monitors the environment and controls the vector in all governorates in the kingdom. This is carried out through three environmental health centers, which provide their integrated control programs to citizens and residents (Tubli, Jidhafs, & Muharraq EHC). Each center provides its preventive measures and covers part of the kingdom. In addition to controlling the vectors, the malaria cases are followed up and investigated let alone attending the citizens and residents’ complaints.
1. Mosquitoes control: The group applies three control methods:
Chemical: By introducing various types of insecticides and oiling.
Physical: By cleaning up the stagnant water and drains and different breeding spots to minimize the optimum environment for mosquitoes to breed in.
Biological: By introducing a particular type of fish (Aphanius dispar) which feed and nourish on larva. Flies are controlled by eliminating human & animals’ excreta and by monitoring the refuse collections, cattle sheds, stables by using residual spraying and fly bait. Insects such as cockroaches are heavily controlled by residual spray. Dusting powder is distributed to people to destruct crawling insects such as cockroaches and ants. 2. Rodents control: Is efficiently achieved by using different types of rodenticide in places of the rodents presence in the houses, farms, sewerage systems, central markets, premises and coasts. Furthermore, low poisonous powder is distributed to citizens and residents to control rodents in their residence provided rodents exist.
Public Health Annual Report 2014 90
Examined and Positive Breeding Spots of Mosquito by Governorate 2010 - 2014
Governorate 2014 2013 2012 2011 2010
Potential spots examined Muharraq 9,737 8,527 7,372 6,358 7,457 Capital 27,914 25,311 27,232 25,301 28,204 Central 28,357 30,461 28,301 25,390 25,309 Northern 46,931 47,032 31,248 29,582 37,073 Southern 10,901 8,938 9,186 5,913 7,352 Total 123,840 120,269 103,339 92,544 105,395 Positive Culex spots Muharraq 253 151 174 119 99 Capital 1,182 701 376 688 912 Central 704 942 831 706 551 Northern 2,372 3,526 2,560 2 2,319 Southern 283 221 284 77 132 Total 4,794 5,541 4,225 1,592 4,013 Positive Anopheles spots Muharraq 4 - - - - Capital 5 2 7 2 6 Central 15 27 47 13 26 Northern 74 125 95 97 119 Southern 1 - 7 - 1 Total 99 154 156 112 152
Public Health Annual Report 2014 91
7.3. Entomology Group: Conducting annual assessment of pesticides efficacy received from local suppliers according to the M.O.H requirements. Detecting and recording possible and positive mosquito larvae breeding spots in all governorates beside installation of mosquito light traps for collecting adult mosquitoes and other flying insects for classification and density measurement. Rodent traps are also installed in different governorates to rear captured rodents in the Entomology laboratory to use them in the annual pesticide experiments as well. In addition to participating in special school lectures to educate students about public health topics and the annual ongoing calibration with Arabian Gulf University as part of community health programs for 2nd year students for an two month period. Main Activities 2014:
Report of the RQ pesticide was completed. Identification of insects sample brought from different places. Preparation and participation for EXPO 2014 exhibition from 15, 16, 17 April. Preparation for the world malaria day. Collecting mosquito larvae from field for pesticides experiments. Preparation & participation in 2 workshops for ministry of education employees on 1, 2 April. Graphic analysis was done for the workshops which were done on 1, 2 April. Preparation and participation in a health fair in Al-Hayat mall. Participating in Municipal work week in SH. Khalifa Garden. Supervising, participating the 3rd workshop of malaria & vector control for Yem- en delegation. Two lab experiments on a biological pesticide used for mosquito larvae brought from K.S.A. A one week long Field experiment on biological pesticide used for mosquito lar- vae brought from K.S.A. Preparations for the awareness and education Magazine of Environmental Health Section. Numbering and registration of pesticides received from suppliers. Sorting and drawing tables for the pesticides received from the suppliers. Identification of spider sample was sent from Durat AlBahrain. Installing agricultural insects light trap in AL-Kawara and collecting insects daily. Finishing the report of pesticides samples for the year 2014. Participation in the international lead poisoning preventing week of action.
Public Health Annual Report 2014 92
2 86 67 22 28 16 122
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Public Health Annual Report 2014 93
7.4. Consumer Products Safety Group Established almost seven years ago, the Consumer Product Safety Group (CPSG) assumes the responsibility of monitoring and controlling the import, export, and sale of non-pharmaceutical consumer products: such as cosmetics and Attar’s herbs. CPSG, and in collaboration with the National Health Regulatory Authority, inspects products entering the kingdom through customs, and grants licenses to those that meet the set criteria. The group also conducts routine visits to vendor shops selling the aforementioned products, assessing the storage conditions and inspecting for any unauthorized commercial activity of such products within the scope of the group’s responsibility. The CPSG assesses consumers’ complaints and conducts relevant investigations and follow-ups in that regard. In addition, it works on increasing the public’s awareness by providing up-to-date information through various articles published in the local newspapers: including the latest international updates, warnings if any, and reassurances when relevant. The group also organizes several workshops to train and educate workers handling the products.
Public Health Annual Report 2014 94
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Food Control Section
Section 8
Public Health Annual Report 2014 96
Vision The vision is to work jointly hand in hand with all segments of the society and involve them actively as far as possible so that we develop a food safety program that is the best in the region and a model that others follow in order to secure the highest levels of food safety. This can be achieved by being flexible, and dynamic able to renew ourselves, scanning the environment and monitoring changes.
Mission The mission of Food Safety in the Ministry of Health in the Kingdom of Bahrain is to protect the health of the consumers from any health hazard through ensuring that food is safe and fit for human consumption whether imported from outside, prepared, or manufactured locally. In addition to maintaining a clean environment for the people in Bahrain as well as ensuring economic interests in food trade.
Aim To ensure that all food served and sold within the Kingdom of Bahrain is compositionally sound, free from contaminants at levels that could cause harm or illness and is labeled with the correct safety instructions for use and storage.
Public Health Annual Report 2014 97
Key Functions Responsibilities Prevention & control of food borne illnesses. Coordinating with local and international organizations (WHO, WTO … etc) on all matters pertaining food safety. Representing the country in national and international meetings (GCC Standardization & Metrology Organization, WHO, WTO, . . .etc). Conducting researches and risk analysis to establish standards for maximum levels of contaminants and additives accepted in food and bottled water. Supporting food trade & ensuring fair practices. Prepare technical and statistical food safety reports. Ensuring safe and healthy discarding of unfit food products. Prevention of commercial fraud & adulteration of food products. Ensuring fitness and wholesomeness of imported food and water. Provide importers and exporters with expert technical, scientific and regulatory advice. Follow up and application of international food hazard notifications. Implementing sampling plans and procedures as recommended by regional and international organizations. Ensuring validity & authenticity of all documents accompanied with imported & exported food consignments. Ensuring the safety and quality of locally produced food products. Licensing all food establishments. Improvement of food industry by applying international advanced recommendations and systems related to food safety & quality.
Public Health Annual Report 2014 98
Developing and revising hygiene requirements for food establishments. Formulating and implementing requirements/specifications for equipment & facilities, based on scientific international recommendations. Investigating & follow up consumer’s complaints concerning food quality and safety. Designing, revising and implementing educational programs for food workers, importers, consumers and health professionals. Continuous follow up of innovations in food industry.
Public Health Annual Report 2014 99
8.1. Domestic Food Safety Group The group is responsible for two main activities: 1. Licensing new food establishments to ensure that they meet the requirements and comply with the health regulations. To do so, scheduled inspection visits are performed to evaluate the opening of new commercial activities dealing with food by any means, e.g.: restaurants, fast food cafeterias, cold stores, canteens, and hotels. 2. Monitoring the safety of food available in local market; to achieve this, frequent routine visits are conducted for inspection and verification of establishments based on daily scheduled duties as well as complaints from the public related to food. Main activities are conducted to elevate the safety level of displayed and presented food, and ensure that it is free from all types of contaminates, these activities include: 1. Routine full checkup visits, 2. Withdrawing samples from food establishments and public society establishment including educational establishments, tourism, health centers, hospitals, and other establishments for laboratory examination (Microbial and Chemical) to safeguard suitability for human consumption. 3. Educating and training food handlers and/or consumers via conducting symposiums, workshops, or preparing printable educational materials. Based on the Public Health Law No. 3 of 1975, authority was given the title of inspector commissioner to carry out inspections and issue notifications and warnings, fines, with closure notices for offenders with litigation before forwarded to the courts.
Public Health Annual Report 2014 100
Public Health Annual Report 2014 101
8.2. Imported Food Safety Group Responsibility of imported foods safety, and inspection is performed by the Imported Food Safety Group (IFSG). This group is responsible of all imported foods enter through various ports in the Kingdom of Bahrain and they are Air Cargo, Khalifa Bin Salman and King Fahad Causeway Ports, to insure it is safety and authenticity. Law of Imported Foods is issued in 1985 under law number (3). GCC’s food standards are followed plus the regional and international standards. Beside National Standards and Regional Standards, IFSG is following the World Trade Organization’s Agreement on Sanitary and Phytosanitary Measures (SPS Agreement) and the Agreement on Technical Barriers to Trade (TBT Agreement) as guides to international trade regarding food safety topics. IFSG is responsible for the inspection of foods to determine whether they conform to relevant criteria and food standards with regard to standards for raw materials, food additives, foods labelling and hazardous substances such as pesticides, veterinary drugs etc. As mentioned IFSG is responsible for the controlling and monitoring all types of foods & drinks from being contaminated with pathogenic bacteria, viruses … etc and other chemical and physical contaminants that make foods unsuitable for human consumption. As a monitoring tool, sampling protocol is implemented, and this protocol is based on the frequency of taking samples and the laboratory results. The sampling process enables a compliance history to be created, and every food shipment may need to be sent to laboratory tests, until a defined number of consecutive consignments meets the requirements. Once the laboratory show satisfactory results, the consignment will be released in case there were no other health problem. If the results show unsatisfactory, then the consignment will be rejected. In the case of rejection, option of destruction or re-exporting will be the choice of importer where he will be responsible for any expenses, and in both cases a specialist will supervise any taken option according to IFSG’s strategy and protocol in the case of rejected shipments.
Public Health Annual Report 2014 102
Public Health Annual Report 2014 103
Public Health Laboratories
Section 9
Public Health Annual Report 2014 104
Background Introduction & Overview Public Health laboratory (PHL) is a critical component of the public health directorate which operates as a first line of defense to protect the public against diseases and other health hazards. It is the provincial reference laboratory for chemical and microbiological diagnostic testing that critically linked to all sectors of the public health infrastructure (e.g. disease control and prevention, food control, environmental health, epidemiology, emergency preparedness and response) and performs several public health surveillance testing within and outside the Ministry of Health. The Laboratory is divided into three main groups based on the provided services namely: Microbiology Analysis for Communicable Disease Group, Food & Water Chemistry Analysis Group and Food & Water Microbiology Analysis Group.
The lab currently has 45 employees, 32 females and 13 males. There are 4 current vacancies while the need is for 5 more employees.
Public Health Lab Employees 2014
29% Male
Female
71%
Public Health Annual Report 2014 105
Vision Promote laboratory services that reflect best practices contributing to optimal public health protection and wellbeing.
Mission To provide comprehensive, cost effective and reliable clinical, environ- mental and food laboratory services (policies, programs and technologies) that assure continuous improvement in the quality of laboratory practice and health outcomes. To maintain international standards by adopting the principles of quality as- surance.
Aim Provide accurate and timely analytical data and services to protect and en- hance the public Health.
Main Objectives Provide quality services with dependable results. Provide timely laboratory results to clinicians so that treatment of patients can be initiated as soon as possible. Provide reliable results to the health authorities so that necessary action can be taken. Continually upgrade existing laboratory facilities to provide faster, economi- cal and more reliable result. Control epidemics by identifying the causative agent and source of infection and prevent spread of infection by identifying carriers of communicable dis- eases.
Public Health Annual Report 2014 106
Key Functions Disease identification and outbreak investigation Support of disease surveillance and epidemiology investigations Integrated data management Reference and specialized testing Environmental health and protection Food safety Policy development Emergency response Research Training and education
Strategic Goals Enhance protection against communicable disease & newly emerging dis- ease. Sustaining population’s health through health promotion & prevention. Establish capabilities for responding to any newly emerging food additives and Contaminants in food and beverages. Enhance protection against foodborne diseases. Ensure food & Water safety and Quality.
Public Health Annual Report 2014 107
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Public Health Annual Report 2014 111
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Public Health Annual Report 2014 114
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Public Health Annual Report 2014 115
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Public Health Annual Report 2014 116
Main Achievements of 2014
Communicable Diseases Microbiology group This group is the most important component of the public health laboratory that provides an extensive range of blood analytical testing for all hospitals and health centers in Bahrain. Its provide early detection of health risks associated with infectious agents, identify causes of disease and performs public health surveillance testing with cooperation with communicable disease section. It consists of 5 sub-units: Bacteriology, Serology, Molecular Biology, Virology, and Tuberculosis (TB). The main 2014 achievements for this group are: Serology unit contribute majority of CDM unit with a total work load of 402576 tests from January to December 2014. Among this load, Blood donors' tests were 97210 and pre-employment tests were 77007. As a national lab for Tuberculosis diagnosis, 4293 samples received and undergone for 15002 tests for the same period of year. Molecular detection and confirmation of Patient samples was done for 2426 patients. Out of the total, 1400 Influenza samples were enrolled for both influenza A, B, H1N1 and corona. Molecular typing and detection of other than TB strain was done for 187 samples. The number of Influenza typing and subtyping conducted for in the National Influenza center were in total 7676 tests. Bacteriology unit received 1358 samples for food handlers in restaurants and Hajj communities. In addition to that, 111 samples shipped to Reference Lab in Oman for further detection methods. Ashoora Blood Bank campaigns which enrolled over 700 donors in two days. Recertifying National Influenza Center for the current year Expanding TB diagnostic capacity with new culture machine with more quality control measures. Achievement of excellent scores in external Quality Assurance program (QAP) including UK-NEGAS, REQAS, EQAP. Introducing of RSV as new respiratory parameter Influenza samples
Public Health Annual Report 2014 117
Chemical Analysis group
This group provides an extensive range of analytical testing in area of food, water, animal feed and Biological fluids. It plays a vital role in food safety by providing objective scientific evidence and data for the proper risk assessment and risk analysis of food and water. It consists of 5 sub-units: Nutritive Value, Proximate Composition, Contaminants, Additives and Purity & Identity. The main 2014 achievements for this group up to November are: The Food samples contribute the majority of this group with a total work load of 17574 tests (2437 food samples). The number of Water analysis conducted for in this group were in total 552 water samples (2706 tests). Molecular detection and confirmation of processed meat samples was done for 37 samples. Out of the total, 24 processed meat samples were positive for pork DNA (65%).
Public Health Annual Report 2014 118
Food and Water Microbiology Analysis group
Food and water microbiology group specialized in microbiological analysis of all imported and locally manufactured food and water products to check for con- formity with GCC and other international standards in terms of keeping quality, hygiene levels, absence of pathogens. It consists of 5 sub-unit: Sterilization unit, Media preparation unit, food microbiology, water microbiology and parasitol- ogy. The main 2014 achievements for this group up to November are: The Food microbiology unit contributes the majority of this group with a total work load of 11503 tests (4002 food samples). Water analysis conducted for 2343 water samples. Determining treated sewage water parasites done for 188 samples. Food Poisoning Samples analysis was done for 393 suspected samples. Achievement of excellent scores in external Quality Assurance program (QAP)
including FEPAS, GFN and EQAP.
Public Health Annual Report 2014 119
Main Activities of 2014
Participation in the examination and analysis of blood bank and food samples for the season of Ashura campaign Creating in-house training activity once a week for each laboratory group. Creating in-house training activity on the importance of Biorisk management. Participation in the Biorisk Management Advanced Trainer Programme (BRM-ATP II) - Jordon. Participation in Laboratory, training workshop on measles and rubella virus detection, sequencing and sequence analysis - Oman. Participation in FAO/IAEA Workshop on Application of Quality Assurance and Control in Analytical Laboratories to Address Food Safety and Quality - Austria. Participation in Infectious Substance Shippers Training (ISST) workshop - Switzerland, Geneva Participation in Pesticides residue analysis in food training program - QCAP - Egypt
Public Health Annual Report 2014 120
Lab statistics through the years 2012 to 2014
Number of Lab Tests by Group & Year
Public Health Lab Groups 2012 2013 2014 Change %
Food Microbiology 45705 34912 29504 -35.45
Communicable Diseases 374459 425827 429038 14.58 Microbiology
Chemical Analysis 23231 20092 23699 2.01
Grand Total 443395 480831 482241 8.76
Number of Communicable Diseases Tests by Year
Tests 2012 2013 2014 Change %
Bacteriology (e.g. Sal-serotyping, 3717 753 1358 -63.47 Stool R/M, Urine R/M)
Serology (e.g. HBV, HIV, Anti- 348225 398177 402576 15.61 Rubella, Rot, VDRL)
Molecular Biology (e.g. all PCR: 917 1998 2426 164.56 Rubella, Measles, HIV)
Virology (NIC) 6069 8754 7676 26.48
TB 15531 16145 15002 -3.41
Grand Total 374459 425827 429038 14.58
Public Health Annual Report 2014 121
Nutrition Section
Section 10
Public Health Annual Report 2014 122
Background Introduction & Overview Nutrition Section of Public Health Directorate is taking the role of promoting Bahraini population health through increasing community nutritional awareness and healthy food choices to get the optimum nutrition, further establishing studies that illustrate the prevalence of nutrition-related diseases such as obesity and micronutrients deficiencies among different population age groups. Nutrition Section is publicizing and providing multiple nutritional and health awareness to elevate nutrition and health status of the community through its work units.
Nutrition Section Units Nutrition Section is subdivided into three units designed to cover the major life cycle nutrition related health problems: 1. Adolescents and adults Nutrition Group 2. Clinical Nutrition Group 3. Child, Mother and Elderly Nutrition Group
Nutrition Section currently has 13 employees, 12 females and 1 male. There are 6 current vacancies while the need is for 4 more employees until 2020.
Public Health Annual Report 2014 123
Vision To enhance the well-being of people by promoting informed food choices and optimal nutrition.
Mission To discover, disseminate, and apply knowledge to promote improved food choices, nutritional status, and well-being of people.
Aim Cover major life cycle & nutrition related health problems.
Main Objectives To focus on nutritional and bio-nutritional, with an emphasis on basic and applied approaches to consumer behavior; and Public Health Nutrition and nutrition education.
Public Health Annual Report 2014 124
Key Functions Set rules and regulations that ensure healthier life for the community. Establish projects and national nutrition programs that address nutrition related health problems and improve nutritional status of population groups. Lectures and presentations. Health and nutrition events.
Workshops and seminars.
Strategic Goals To achieve and maintain health and nutritional well-being of all people. To ensure continued access by all people to sufficient supplies of safe foods for a nutritionally adequate diet. To provide promotive, preventive and curative nutrition health services to all age groups throughout their life span. To integrate the nutrition activities into general health services including preventive as well as curative activities. To develop a sustainable and environmentally sound policies and programs that lead to improved nutrition and health for both present and future generations. To emphasize the role of the individual in being responsible for his/her health.
Public Health Annual Report 2014 125
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Public Health Annual Report 2014 126
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Public Health Annual Report 2014 127
Main Achievements of 2014
Recently (2012 Updated) of the law No 4, 1995 “Concerning the control on the use, Marketing and Promotion of Breast Milk Substitutes”. was reviewed, and a number of amendments were introduced but decision under study Mobile Unit for management obesity and overweight among school children (hand over and received) . National Iodine Nutritional Survey (submitted, Declaration) Ministerial Regulation of Salt Reduction in local, Arab and European bakeries (submitted prepared to MOH). Ministerial Regulation of Trans Fat Reduction (submitted proposed). Success Story for Management of Overweight and Obesity (International). Success Story for Breastfeeding. Nutrition Survey of Sodium (spot urine) for children and adults Nutrition Survey of 24-hour urinary sodium execration for adults. Update School Meals Menu for canteens suppliers. Nutrition Surveillance for school children (13-15 years). Overweight and Obesity Management for school children age (13-16 years) Survey of Vitamin D (pregnant and children)
Public Health Annual Report 2014 128
Main Activities of 2014
Educational booklets, brochures and leaflets related to nutritional aspects: printing Ass. Off Body Composition among children and adolecents using Stable Isotope Technique include: 2 days Training workshop on Dexa machine in AlHidd Health Center Training workshop on Ftir machine in AlHidd Health Center. GCC Standardization Organization (GSO): propose and review Nutritional Awareness and Publications through lectures at workplaces, schools, health centers, mass media. Nutritional awareness Campaign of Ramadan healthy food choices Nutritional awareness Campaign of World Breastfeeding Week Nutritional awareness Campaign of World Diabetes Day Nutritional awareness Campaign of World Nutrition Day Nutrition Products received from NHRA and Food Hygiene Section (analysis and review)
Public Health Annual Report 2014 129
Public Health Licensing Unit
Section 11
Public Health Annual Report 2014 130
Background Introduction & Overview In accordance with Bahrain vision 2030, Public Health Licensing Unit and in coordination with other governmental sectors are going to launched the Electronic Program in integration with other concerned parties within the Ministry of Health and other ministries, specially Ministry of Industry & Commerce. This giant step, will keep the Unit as an essential member in the commercial Licensing matrix as a Public Health Directorate representative with other concerned sections, to ensure the implementation of Public Health Regulations to license the institutions & companies to facilitate the investment in the kingdom according to the high recommendations issued by the government. Being a part of the Electronic Government to regulate the steady increase in the numbers of licenses issued by each concerned sector. As the statistics shows this increasing. The Public Health Licensing Unit going forward to be a coordination part to facilitate the services offered by the Public Health Directorate to the investors in coordination with other parties.
Public Health Annual Report 2014 131
Main Statistics of Public Health Licensing Unit Quar T Q2 Q3 Q4 Q1 otal ter
I ssu Cer Nu e 2 d He 7 6 6 5 ti 5 mbe 0 8 0 1 fi 0 2 5 5 1 c 3
ate
al r o th f Lic ensed & 2 V 8 2 1 1 5 7 3 1 5 i s 4 5 1 6 1 i 3 ts 0 4 1 2
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Public Health Annual Report 2014 132
Percentage of Licensing & Registration Activities for 2014
Public Health Annual Report 2014 133
School Health
Section 12
Public Health Annual Report 2014 134
Vision
(( All children and youth living healthy active lives))
Mission Looking for introducing a best health service with a higher quality, equitable and sustainable for all the pioneers of schools with motivating staff and students to practice healthy patterns, as we seek to raise the level of health awareness for employees of schools and community next door and involvement of parents the involvement of parents in achieving our goal. By this way we can prod use an emergence a conscious generation able share and participants in the Renaissance development of future requirements
Aim Improve the lifestyle of schools and young people and students to encourage healthy practices
Main Objectives
The development of school health strategic objectives and improve school health programs and services and improve the quality of performance all these objectives can be provided through the establishment of school health services department as follows: Strengthen primary care services for school students and the development of ongoing programs to promote school health such as comprehensive health examination for all students before each stage of study and even before entering the university. Raise the level the educational awareness and the community against health problems by applying the methods of prevention through raising awareness, knowledge and behaviors of the school community from chronic diseases by knowing the risk factors, this can performed by cooperation with the relevant authorities. Upgrading knowledge , awareness and behavior of the school community for prevention and control and reduce the spread of infectious diseases . Upgrading the nutritional situation in schools through the continuous work and development Expand and strengthen the health-promoting schools and let the other schools to be under its umbrella.
Public Health Annual Report 2014 135
Main Objectives (continued)
Provide schools by school nursing services, that can be a n existence permanent service present in all schools over the five coming years.
Early detection of learning difficulties, mental and behavioral disorders and to develop treatment plans in collaboration with its stakeholders.
Facilitating access to psychological services and reduce the stigma associated with mental health.
Improving the concept of mental health and reduce the stigma associated with visiting the psychiatric hospitals, through awareness and education programs and referral’s to mental health clinic as part of school health department .
Attention to preventive mental health
Improve and treat the speech disorder
Completion, of manpower, and qualified and specialized operating school health services (increase specialized in the field of school health personnel), which include mental health services, student services, nurses and school health nurses over the next five years to cover all needs.
Develop and strengthen the capacity of human resources and school health services.
Follow-up to the establishment of the School Health Information System database and update the website of school health.
Encouraged to do surveys and special studies related to school health data analysis and decisions upon which to build national strategies.
Preparation of evidence related to awareness and updated health-related issues
Strengthen legislation and regulatory decisions and regulations on school health
Encouraged to do surveys and special studies related to school health data analysis and decisions upon which to build national strategies
Public Health Annual Report 2014 136
Core Functions
Participation in meetings related to the health of students and their parents and school staff. Develop plans and programs for the care of the students and those with special needs and their families and the community. Follow-up and provide medical care for students, especially those who suffer from chronic diseases Encourage parents and community and school staff on health promotion. Follow-up growth and development of the student through the follow-up measurement of weight and height, and physical and psychological changes, so this examination annually. Ensure completion of all vaccinations, and coordination and cooperation with the concerned authorities to give immunizations on time. limited to students who suffer from chronic diseases and follow up teacher training school in first aid. Follow-up growth and development of the student through the follow-up measurement of weight and height, and physical and psychological changes, so this examination annually. Ensure completion of all vaccinations, and coordination and cooperation with the concerned authorities to give immunizations on time. limited to students who suffer from chronic diseases and follow-up teacher training school in first aid. Blood pressure measurement and analysis of the work of sugar for people with hypertension and hyperglycemia of students and workers and help them to control and control of these diseases. health education for chronic diseases and genetic and how to deal with it. Conduct health education about infectious diseases and how to prevent them and treat them.
Public Health Annual Report 2014 137
Strategic objectives Sharing the ministry of education in continuation the program of health promoting schools: Key strategies at the level of the Ministry of Health: • raise awareness. • Partnership. • Provide resources and development. • teacher training. • Research and Evaluation. • management, planning and support. Key strategies at the level of the Ministry of Education • Health Services • Health Education • healthy school environment • Sports and recreation • Nutrition and Food Safety • Mental Health • promote the health of workers • community participation
Section Staff:
Male staff 13
Female staff 75
Increase specialized in the field of school health personnel. Create Information School Health and database system. Strengthen the legislation and regulatory decisions and regulations on school health. Needs strengthen the relationship and partnership with various media. Assessing the overall "national school health program" School Health Initiative
Public Health Annual Report 2014 138
Main Groups: 12.1. Primary health care group: Provide health promotion and covers a wide range of programs, activities and services provided in schools and surrounding communities in order to enhance students' health and the health of their environment. Specific objectives: 1. Promote and develop programs to raise the level of health of the community. 2. Emphasize the importance of health & preventive education in early childhood. 3. Improving medical services, availability, accessibility and acceptance. 4. Improve the information base of children and adolescent health.
12.2. School health nurse group: Promote health within the school community to elevate the level of educational achievement, and link students, school administration, parents and health centers. Tasks and responsibilities: 1. Provide health care for cases of simple first aid. 2. Health education for chronic, hereditary & infectious diseases. 3. Annual Periodic students examination for height, weight, vision & dental. 4. Follow the students vaccination state and take action to complete them. 5. Survey of chronic diseases among students and school staff and follow-up. 6. Cooperation with the Committee on Safety and Health in the school to develop and implement plans and health programs. 7. Preparation of statistics and submitted to the concerned authorities.
12.3. School mental health group: Early detection of learning difficulties and psychological and behavior disorders and planning the treatment programs in cooperation with concerned departments. Services offered: 1. Counseling services to teachers, social workers in schools as well as parents. 2. Assessing and treating psychological and behavior disorders in students referred from Ministry of Education and Public Health Centers. 3. Applying psychological criteria, IQ tests, and learning difficulties special tests. 4. Assessing and treating speech disorders. 5. Organizing educational lectures, workshops and training courses.
12.4. Youth & adolescent health program: Established in the School Health Services in May 2012. Main Goals: 1. Establish a strategic plan to improve health services both curative & preventative service based from MOH strategy and WHO recommendation. 2. Construct a database, and establish an adolescent health service guideline. 3. Coordinate between sections who are providing adolescent and youth services. 4. Follow the national and international policies and legislations related to adolescent youth health at the level of kingdom of Bahrain. 5. To develop a program that reduce risk-taking behaviors of adolescents.
Public Health Annual Report 2014 139
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Public Health Annual Report 2014 144
Main Achievements of 2014
Primary health care group achievement 2014 :
Renewal of the handbook visits to students and staff in public schools to health centers.
Coordinate the work of the meetings between the departments of health centers and departments near each health center schools, to develop a mechanism for dealing treatment and restricting health problems and community celebrations.
Follow-up primary health care programs such as Optometry program and examination of students and second grade students at the secondary screening program for oral and dental genetic blood diseases.
Follow chronic conditions in schools.
Follow-up of infectious cases and establish a mechanism to deal with (head lice, insect bed).
Do Health Survey to identify health behaviors in schools.
Continue to examine new students in school.
Participate in educational, social and cultural programs.
Participation in public health and preventive and precautionary and therapeutic vaccines projects (mumps campaign + Hepatitis).
Health-promoting schools program and evaluation.
Implementation of the annual program of awareness of public and private schools in: 1. Education and awareness of infectious diseases and methods of prevention and the importance of vaccinations and the establishment of annual workshops. 2. Education for non-communicable diseases and methods of prevention by fighting risk factors and establish an annual workshops. 3. Chronic diseases and how to deal with it. 4. Training of health providers in public schools in first aid. 5. The participation of the public health department of nutrition in the fight against obesity to start a project for school students using modern diagnostic techniques, and so on (BBK center).
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School health nurse group: 1. Total of school visits around 206. 2. Participate in different health, medical program and investigation in schools and Governmental institutions. 3. Participate in Bahrain national, arab and international celebrations ( formula 1, world diabetic day, gulf week for adolescents and youth, nursing day, week vaccinations, gulf week for the health of dental,……..). 4. Prepared and arrange a clinic for the Bahrain First Festival. 5. Participate in annual students camping camps. 6. Participate in summer clubs for school students. 7. Participate in adolescents and youth programs (exp: we grown). 8. Participate in vaccination campaigns against measles and mumps. 9. Prepared some brochures for the section. 10. Join 5 school health nurses. 11. Join infection control department with school health section. 12. Administer new clear roles and regulation regarding follow up of completion of vaccination for students in governmental and private schools. 13. Provide introductory lectures about school health section including nursing services for private schools on 5th June 2014.
Public Health Annual Report 2014 146
School mental health group :
Introductory meetings with the coordination of Ministry of Education.
Follow up filed visits.
Organizing annual program for lectures and workshops
Youth & adolescent health program 2014 :
Review of school children health and the adolescent health strategy.
Attend the GCC committee for the school health &youth and adolescent health in February 2014 meeting.
Attend the GCC committee for the school health &youth and adolescent to develop a formal strategy in May 2014 .
Continue to coordinate the program for new students general screening in the preparatory phase.
Coordination to celebrate the GCC Day of the school student & youth and adolescent health and in 2014.
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Public Health Directorate
in Media
Section 11
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