Patient safety

Eastern Mediterranean and African Adverse Events Study

How was the project created?

WHO Patient Safety carried out a workshop in research methodologies to estimate patient harm in developing countries in Amsterdam on 18 and 19 October 2004.

The workshop focused on raise the awareness on the magnitude of the problem and issues, involved in setting up a patient safety agenda in countries. Participants at the workshop (policy-makers and clinical/technical experts) from the selected developing and transitional countries were exposed to the state-of-the art experiences in tackling the patient safety methodologies and tools for estimating patient harm.

At the end of this workshop a consensus was reached around the importance of measuring the nature and scale of harm to patients as means to improve patient safety and the specific research methodologies that can be applied. Follow up steps to implement studies in countries were delineated.

In December 2005, WHO Patient Safety organized a first five day training workshop in Cairo, Egypt. Participating countries for the Eastern Mediterranean Region (EMRO) were Egypt, Jordan, Kuwait, Morocco, Sudan, Tunisia and Yemen; the African Region (AFRO) was represented by Kenya and South Africa. Each country fielded a team including clinical nurses and medical records specialists, clinicians, epidemiologists, research specialists and ministry officials. Following this meeting, the prevalence studies were launched in the eight participating countries. Two follow-up workshops took place in May 2006 and February 2007 respectively.

The workshops helped to train the eight participating country teams in the techniques of retrospective records review, and on the organization and management of patient safety research studies.

Objectives of the study

  • Measure harmful incidents in hospitals of these regions
  • Identify the type of harmful incidents and their frequency
  • Identify the preventability of harmful incidents and the contributing factors


Two-step retrospective study:

  • Medical records of randomly selected past patients were screened for harmful incidents
  • Cases with a high likelihood of these were subsequently given a more in-depth examination to assess the possible harmful incidents that might have occurred.

Team of participating countries from the African and the Eastern Mediterranean regions during its first training workshop in Luxor, Egypt, 2007.

  • Principal Investigators: Ross Wilson, Philippe Michel, Sisse Olsen
  • WHO EMRO: Ahmed Abdelatif, Riham El-Assady, Sameen Siddiqi
  • WHO AFRO: Jean-Bosco Ndihokubwayo
  • Egypt: Ossama S Rasslan, Atef Badran, Mahi El-Tehewy, Aisha Aboul Fotouh, Suzan Mohammed
  • Jordan: Safa Qusous, Mai Rahaleh, Wael Kildani
  • Morocco: Amina Sahel, Nabil Kenjaa, Amine Ali Zeggwagh
  • South Africa: Stuart Whitaker, Fikile Sithole
  • Sudan: Malik Abdo Ali, Zahir Mohammed Khier Allah, Sara Hassan Mostafa, Hatim Zain Alabdeen Abdul Bari, Al-Khatami Elias
  • Tunisia: Mondher Letaief, Mohammed Salah Ben Ammar
  • Yemen: Nasr Ali Ahmed, Adel Al-Moayed

Thanks to David Bates for his expert advice, to Sir Liam Donaldson for his vision, to all reviewers, to collaborators and coordinators in the participating hospitals.