Journal of Epidemiology and Global Health

Volume 6, Issue 4, December 2016, Pages 329 - 330

Reply to the commentary of Dr. Josué Lily Vidal

Authors
Lahoud Nathaliea, b, *, nathalie.lahoud@hotmail.com, Salameh Pascalec, Saleh Nadined, Hosseini Hassana, e
aEA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris Est, Créteil, France
bLebanese University, Doctoral School of Sciences and Technology, Hadath, Lebanon
cLebanese American University, School of Pharmacy, Byblos, Lebanon
dFaculty of Public Health, Lebanese University, Fanar, Lebanon
eHenri Mondor Hospital, AP-HP, Paris, France
*Corresponding author at: Bauchrieh 1203, Maguy El Hajj Street, Gebran Taouk building 56, Lebanon. Fax: +961 1 44 40 27.
Corresponding Author
Available Online 22 August 2016.
DOI
10.1016/j.jegh.2016.08.001How to use a DOI?
Copyright
© 2016 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd.
Open Access
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

We would like to thank Dr. Lily Vidal for his valuable commentary on our paper. We appreciate the time he spent on reading and appraising our paper.

In fact, Dr. Lily Vidal shed light on the selection bias that we encountered in our study and discussed at the end of our paper. The selection bias emerged from our choice to select the study sample from those possessing a landline phone number in Lebanon.

Dr. Lily Vidal is totally right. In fact, and as he said, the population that possesses a landline phone number is probably more aged and of a higher socio-economic level. However, the selection bias has a clear effect on the estimation of the prevalence, as it is mentioned in the paper and by Dr. Lily Vidal as well: it would overestimate stroke prevalence. It is one of the reasons after our decision to submit the results for publication, as the bias effect had a clear direction.

Furthermore, the study was conducted as a pilot survey (as clearly mentioned in the title) and for comparative reasons as well. Its results, although pilot, were valuable on a national level as they showed a large discrimination between Lebanese governorates. They also called our attention on the low Lebanese stroke prevalence in comparison with developed countries (which is probably even lower), a finding that questions stroke management and mortality rates in the country.

Over and above that, our results were adjusted to age and sex of the Lebanese population, which substantially mitigate the noncoverage bias [1].

The ultimate point to discuss is why the authors and I opted to run a telephone survey instead of a face-to-face household survey or a cellphone survey. In Lebanon, as well as other parts of the region, access to certain geographical areas (especially in the North and South Lebanon, and the Bekaa) may be physically challenging considering sociopolitical conflicts and the presence of gated communities, and people may have become more hesitant to let in “strangers” into their homes given security concerns [1]. Moreover, a telephone survey is undoubtedly less expensive and time-consuming than face-to-face surveys, and nonresponse bias is extremely limited as the respondent answers the phone call with zero cost and in an anonymous way (interview/social desirability bias). As for the cellphone survey, we intended to select a sample distributed in a proportional way on all Lebanese governorates, and the list of cellphones does not provide this information and might also result in the selection of younger individuals among whom it may be difficult to find any stroke case.

Finally, the authors and I would like to declare and confirm our full awareness of the noncoverage bias when conceptualizing the study, the bias that we largely discussed at the end of our paper.

It is extremely important to conduct further studies to investigate and develop our knowledge on stroke prevalence, incidence and mortality rates in Lebanon and the region.

Footnotes

Peer review under responsibility of Ministry of Health, Saudi Arabia.

Journal
Journal of Epidemiology and Global Health
Volume-Issue
6 - 4
Pages
329 - 330
Publication Date
2016/08/22
ISSN (Online)
2210-6014
ISSN (Print)
2210-6006
DOI
10.1016/j.jegh.2016.08.001How to use a DOI?
Copyright
© 2016 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd.
Open Access
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Cite this article

TY  - JOUR
AU  - Lahoud Nathalie
AU  - Salameh Pascale
AU  - Saleh Nadine
AU  - Hosseini Hassan
PY  - 2016
DA  - 2016/08/22
TI  - Reply to the commentary of Dr. Josué Lily Vidal
JO  - Journal of Epidemiology and Global Health
SP  - 329
EP  - 330
VL  - 6
IS  - 4
SN  - 2210-6014
UR  - https://doi.org/10.1016/j.jegh.2016.08.001
DO  - 10.1016/j.jegh.2016.08.001
ID  - Nathalie2016
ER  -