Community participation in health responses in humanitarian crises is increasingly promoted by humanitarian actors to support adoption of measures that are relevant and effective to local needs. Our aim was to understand the role of community participation in humanitarian health responses for conflict-affected populations (including forcibly displaced populations) in low- and middle-income countries and the barriers and facilitators to community participation in healthcare responses. Using a systematic review methodology, following the PRISMA protocol, we searched four bibliographic databases for publications reporting peer-reviewed primary research. Studies were selected if they reported how conflict-affected populations were involved in healthcare responses in low- and middle-income settings, and associated changes in healthcare responses or health outcomes. We applied descriptive thematic synthesis and assessed study quality using study design-specific appraisal tools. Of 18,247 records identified through the database searching, 18 studies met our inclusion criteria. Various types of community participation were observed, with participation mostly involved in implementing interventions rather than framing problems or designing solutions. Most studies on community participation focused on changes in health services (access, utilisation, quality), community acceptability and awareness, and ownership and sustainability. Key barriers and facilitators to community participation included political will at national and local level, ongoing armed conflict, financial and economic factors, socio-cultural dynamics of communities, design of humanitarian responses, health system factors, and health knowledge and beliefs. Included studies were of mixed quality and the overall strength of evidence was weak. More generally there was limited critical engagement with concepts of participation. This review highlights the need for more research on more meaningful community participation in healthcare responses in conflict-affected communities, particularly in framing problems and creating solutions. More robust research is also required linking community participation with longer-term individual and health system outcomes, and that critically engages in constructs of community participation.

Health-related emergencies, from minor incidents to life-threatening situations, can occur unexpectedly in dental clinics. Ensuring that dentists and their teams are well-prepared with adequate training and essential equipment is crucial. Proper preparedness can lead to effective management of emergencies and reduce potential complications. This cross-sectional national study aimed at assessing the preparedness of Lebanese dentists in managing medical emergencies. Data was collected between August and October 2024 using an online questionnaire which was distributed to all registered Lebanese dentists through the Lebanese Dental Associations located in Beirut and Tripoli. The study found that 38.2% of dentists had an emergency kit in their clinics, and 88.0% had some emergency equipment; yet only 5.9% had a defibrillator. While 71.3% had emergency training in university, 28.5% never received it. Only 18.8% reported staff training in medical emergencies. Most dentists (74.2%) encountered minor medical issues, and 22.4% faced major emergencies, with only 1.8% reporting cardiac arrest cases. Vasovagal reactions, hypoglycemia, and orthostatic hypotension were common emergencies. While 69.0% felt capable of managing minor issues, confidence dropped for major emergencies and specific procedures. An overwhelming 87.8% expressed a need for more emergency training. Post-graduation training, prior defibrillator use, and having an emergency kit were linked to better emergency management capabilities in the logistic regressions. The findings of this study indicate significant gaps in emergency preparedness among Lebanese dentists. Many lack adequate training and resources, highlighting the urgent need for further training and better-equipped clinics. Strengthening policy frameworks and resource allocation is crucial. Stakeholders should prioritize implementing mandatory training programs and developing clear guidelines to ensure that dental clinics in Lebanon are adequately prepared to manage health-related emergencies effectively.

Background: Self-medication with leftover antibiotics (LA) is a global health crisis, particularly in contexts of economic and political instability. This study examines the social determinants of health (SDOH) influencing LA use among Lebanese households, focusing on how individuals are born, grow, live, and work. Methods: A cross-sectional study was conducted among 368 Lebanese adults to collect data on socio-demographic characteristics, self-medication practices related to LA, and key SDOH such as socioeconomic status (SES), perceived discrimination in medical settings (DMS), political and economic instability, drug shortages, and trusted sources of health information. Data were analyzed using bivariate tests and multivariable logistic regression. Results: Bivariate analysis showed that LA use was significantly associated with male gender (45.0% vs. 33.3%, p = 0.024), lower educational levels (58.7% vs. 35.1%, p = 0.002), presence of chronic disease (54.7% vs. 32.2%, p < 0.001), older age (p = 0.028), and a higher household crowding index (p = 0.018). LA use was also more prevalent among participants impacted by political instability, economic crisis, and drug shortages (all p < 0.001). In multivariable logistic regression, chronic disease (OR = 2.711, p = 0.002), economic crisis (OR = 2.013, p < 0.001), and prior experience with the same illness (OR = 4.085, p < 0.001) were identified as significant predictors for LA use. Conclusion: These findings show the critical role of socio-economic instability, healthcare access challenges, and experiential factors as key SDOH driving LA practices. The study highlights the urgent need for multi-sectoral interventions addressing economic hardship, improving healthcare access, and enhancing public awareness to mitigate LA misuse and its contribution to antimicrobial resistance in Lebanon.

Background: Self-medication with leftover antibiotics (SMLA) drives antimicrobial resistance (AMR), particularly in developing countries. This study examined knowledge–practice gaps regarding antibiotic use and handling among individuals with prior SMLA across seven developing countries. Methods: A cross-sectional study (February 2023–February 2024) included 3191 adults from Bangladesh, Brazil, Egypt, India, Jordan, Lebanon, and Serbia who reported previous leftover antibiotic use. The questionnaires assessed knowledge of antibiotic use (15 items), resistance (12 items), and SMLA risks (15 items). Storage and disposal practices were evaluated using dichotomized correct/incorrect measures. Results: Participants demonstrated above-average knowledge scores as follows: antibiotic use (54.4 ± 8.4), resistance (43.3 ± 6.1), and SMLA risks (58.4 ± 10.3). However, substantial practice gaps emerged. Only 21.9% properly disposed of leftover antibiotics, while 47.0% used household garbage. For storage, 55.1% used appropriate methods, but 32.6% stored antibiotics inappropriately, and 12.8% lacked protocols. Serbian participants showed the highest SMLA risk knowledge (64.3 ± 10.6), Bangladeshi participants the lowest (52.0 ± 8.5, p < 0.001). Women had superior knowledge (59.6 ± 10.4 versus 56.5 ± 9.8, p < 0.001) and storage practices (56.6% versus 52.7%, p = 0.031). Paradoxically, higher AMR knowledge was associated with poorer disposal practices (OR = 0.97, p < 0.001). Conclusions: Despite extensive theoretical knowledge, unsafe medication practices persist, revealing a critical knowledge–practice gap. Our findings challenge education-focused AMR approaches, suggesting cognitive awareness alone cannot drive behavioral change. Effective interventions must address structural barriers, cultural factors, and individual health beliefs beyond traditional knowledge-deficit models.

PURPOSE: Lebanon's ongoing economic collapse has severely disrupted the health care system, particularly access to essential cancer therapies. Small cell lung cancer (SCLC) is an aggressive malignancy with limited treatment options and poor prognosis. Immune checkpoint inhibitors (ICIs) have provided modest survival benefits in extensive-stage SCLC (ES-SCLC), but access in resource-limited settings is highly vulnerable to financial instability. In October 2022, Lebanon officially withdrew public subsidies for ICIs, threatening equitable cancer care. This study evaluates the impact of the Ministry of Public Health subsidy withdrawal on access to ICIs and associated outcomes in patients with ES-SCLC. MATERIALS AND METHODS: A mixed-methods study was conducted at Hôtel-Dieu de France (HDF) University Hospital in Beirut. The qualitative component involved a semi-structured interview with the HDF pharmacy to characterize operational challenges. The quantitative component was a retrospective cohort study of patients diagnosed with ES-SCLC from 2019 to 2024. Data included demographics, treatment access, and survival. Analyses included bivariate statistics, Kaplan-Meier survival analysis, and Cox proportional hazards regression. RESULTS: The interview identified financial hardship and drug shortages as major barriers. Among 71 patients, 75% did not receive guideline-concordant optimal treatment. Access to ICIs was significantly associated with method of payment (χ ² = 13.8, P = .037) and public insurance coverage (χ ² = 8.6, P = .035). Survival was higher among patients receiving optimal treatment ( P = .021), male patients ( P = .004), and those treated before subsidy withdrawal ( P = .037). In multivariable Cox regression, male gender, optimal treatment, and public insurance were independently associated with improved survival. CONCLUSION: The withdrawal of public subsidies amid Lebanon's economic crisis critically disrupted access to ICIs and contributed to poorer outcomes. Robust financial protection mechanisms are urgently needed to sustain equitable cancer care.