The Reproductive Health Working Group (RHWG) was established in 1988 in Cairo to advance research in the Arab countries and Turkey on the health of women, broadly defined. The paper considers the ways in which the group contributed to... more
The Reproductive Health Working Group (RHWG) was established in 1988 in Cairo to advance research in the Arab countries and Turkey on the health of women, broadly defined. The paper considers the ways in which the group contributed to global health conversations through three examples of interdisciplinary research that, in privileging local contexts, modified or even challenged prevailing approaches to health and often raised entirely new issues for consideration. The three examples cited in the paper are: (i) the network’s early research on reproductive morbidity; (ii) a broad set of ongoing studies on childbirth/maternal health; and (iii) emerging research on health and conflict. The paper discusses how the RHWG has strengthened research capability in the region, and explores the reasons for the longevity of this research network. DOI: 10.1080/09688080.2017.1379864
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Background Syria has made progress in reducing maternal mortality and morbidity before the conflict in 2011. Despite the improvement in antenatal care (ANC) coverage and patterns of use, analyses of national surveys demonstrated wide... more
Background Syria has made progress in reducing maternal mortality and morbidity before the conflict in 2011. Despite the improvement in antenatal care (ANC) coverage and patterns of use, analyses of national surveys demonstrated wide regional variations in uptake, timing and number of visits even after controlling for women’s socio-demographic characteristics. This study compares two governorates: Latakia, where uptake of ANC was high and Aleppo, where uptake of ANC was low to highlight the barriers to women’s adequate uptake of ANC that existed in Syria pre-conflict. Methods This qualitative study carried out 30 semi-structured interviews with (18–45-year-old) pregnant women from Aleppo and Latakia (recruited purposively from different types of health facilities in rural and urban areas), and 15 observation sessions at health facilities. Transcripts and fieldnotes were analyzed using the Framework Method with attention to the dimensions of availability, accessibility and acceptabil...
Background In Syria, there are no previous studies on postpartum depression. The aim of this study is was identify the prevalence of postpartum depression and investigate its risk factors among Syrian women seen at the Primary Health Care... more
Background In Syria, there are no previous studies on postpartum depression. The aim of this study is was identify the prevalence of postpartum depression and investigate its risk factors among Syrian women seen at the Primary Health Care Centres in Damascus. Methods This descriptive cross-sectional study was carried out between January and December 2017 in Damascus, Syria. Postpartum women seen at a convenience sample of the largest and well-utilized primary health care centres in Damascus were invited to participate in the study. The Arabic version of the validated Edinburgh Postnatal Depression Scale questionnaire was used to measure postpartum depression. A cut-off score of 13 was considered to indicate probable depression. Results Out of a total of 1105 women participated in this study, 28.2% had a score of 13 (probable Depression). The multivariate analysis showed that postpartum depression was significantly associated with a reported a health problem during last pregnancy (OR...
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Aim: To assess the feasibility, acceptability, effectiveness and cost of the integration of a tailored labour companionship model in three public hospitals in Egypt, Lebanon and Syria. Methods: Phased implementation research using mixed... more
Aim: To assess the feasibility, acceptability, effectiveness and cost of the integration of a tailored labour companionship model in three public hospitals in Egypt, Lebanon and Syria. Methods: Phased implementation research using mixed methods. Implementation strategies consisted of steering committees in hospitals, seminars for healthcare providers, information, education and communication materials, and adjustments in labour rooms. The labour companionship model consisted of (i) identification of a female relative as labour companion by women; (ii) provision of information, education and communication materials to women and companions; and (iii) allowing companions to accompany women throughout the first stage of labour. Semi-structured interviews with women, labour companions and healthcare providers were used to assess feasibility and acceptability of the model. Effectiveness was assessed through structured interviews with women, information abstracted from medical records and cost data. The comparison was made between the pre-implementation and the implementation phases. Results: This model was found to be feasible, acceptable, effective and cost-beneficial. Women's satisfaction and perception of control improved and caesarean section rates were reduced significantly. Conclusion: This model can be adopted for these countries and elsewhere with comparable health systems. It enhances the quality of care and the provision of equitable and respectful maternity services.
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There are compelling epidemiological, economic, and ethical arguments for setting a global measles eradication goal. The 6 chairpersons of Regional Verification Commissions for Measles and Rubella elimination advocate that the time for... more
There are compelling epidemiological, economic, and ethical arguments for setting a global measles eradication goal. The 6 chairpersons of Regional Verification Commissions for Measles and Rubella elimination advocate that the time for courageously accelerating efforts to ensure a world where no child dies of measles, is NOW!
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Women's satisfaction and perceived control in childbirth are important attributes of the childbirth experience and quality of care indicators. This article presents findings from the pre-intervention phase of a multi-centre... more
Women's satisfaction and perceived control in childbirth are important attributes of the childbirth experience and quality of care indicators. This article presents findings from the pre-intervention phase of a multi-centre implementation study in Egypt, Lebanon and Syria, to introduce a labour companionship model in these countries. A sample of 2620 women giving birth in three public teaching hospitals from November 2014 to July 2015 in Beirut and Mansoura, and from November 2014 to April 2015 in Damascus were interviewed by trained field workers. Additional information was abstracted from medical charts. An adapted version of the Mackey Childbirth Satisfaction Rating Scale was used to measure women's satisfaction and the shortened version of the Labor Agentry Scale was used to assess perception of control. The total satisfaction score was high in all sites with the lowest being in Egypt. Perceived control was directly related to satisfaction. Women with low education level...
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The Reproductive Health Working Group (RHWG) was established in 1988 in Cairo to advance research in the Arab countries and Turkey on the health of women, broadly defined. The paper considers the ways in which the group contributed to... more
The Reproductive Health Working Group (RHWG) was established in 1988 in Cairo to advance research in the Arab countries and Turkey on the health of women, broadly defined. The paper considers the ways in which the group contributed to global health conversations through three examples of interdisciplinary research that, in privileging local contexts, modified or even challenged prevailing approaches to health and often raised entirely new issues for consideration. The three examples cited in the paper are: (i) the network's early research on reproductive morbidity; (ii) a broad set of ongoing studies on childbirth/maternal health; and (iii) emerging research on health and conflict. The paper discusses how the RHWG has strengthened research capability in the region, and explores the reasons for the longevity of this research network.
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To determine the effect of training residents in interpersonal and communication skills on women's satisfaction with doctor-woman relationship in labour and delivery rooms. A stepped wedge cluster randomised trial. 4 tertiary care... more
To determine the effect of training residents in interpersonal and communication skills on women's satisfaction with doctor-woman relationship in labour and delivery rooms. A stepped wedge cluster randomised trial. 4 tertiary care teaching maternity hospitals in Damascus, Syria. 2000 women who gave birth to a living baby in the four study hospitals and consented to participate in the intervention took part in the study. Women with difficult labour and high-risk pregnancies were excluded. All were interviewed at home after discharge. A specially designed training package in communication skills was delivered to all resident doctors at the four hospitals. The main outcome measure was women's satisfaction with interpersonal relationships in labour and delivery rooms measured via a series of questions on a Likert scale modified from the Medical Interview Satisfaction Scale. At the individual level, the mean for the average satisfaction score was 3.23 (SD 0.72) of a possible scor...
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This descriptive study was designed to describe the patterns and determinants of maternity care among Syrian women living in Damascus. All 39 birth registers in 2 large provinces were used to recruit 500 mothers of healthy newborns.... more
This descriptive study was designed to describe the patterns and determinants of maternity care among Syrian women living in Damascus. All 39 birth registers in 2 large provinces were used to recruit 500 mothers of healthy newborns. Mothers were interviewed in their homes using a semistructured questionnaire. Multivariate analysis of the determinants of the frequency of use of antenatal care showed the following variables were significant: urban residence and visit to antenatal care in the 1st trimester. The significant variables for an early visit to antenatal care were the woman's level of education; being pregnant with the 1st baby; and number of visits to antenatal care. Being young (age < 20 years) also correlated with early timing of the 1st antenatal visit.
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To assess injuries among 1125 preschool children in Damascus, and to investigate the risk factors, a retrospective home survey of childhood injuries for a period of 12 months was carried out in 4 areas of residence: agricultural rural,... more
To assess injuries among 1125 preschool children in Damascus, and to investigate the risk factors, a retrospective home survey of childhood injuries for a period of 12 months was carried out in 4 areas of residence: agricultural rural, non-agricultural rural, periurban and urban. More than 75% of mothers believed that injuries were preventable. During the year preceding the study, 261 injuries were reported, an incidence of 23%. The most frequent injuries were from falls, 52.0%, and most injuries (73.9%) occurred inside the home. Area of residence was the only independent predictor for the occurrence of childhood injuries.
Research Interests: Developing Countries, Multivariate Analysis, Rural Health, Humans, Accidents, and 15 moreFemale, Male, Incidence, Risk factors, Questionnaires, Retrospective Studies, Health surveys, Risk Factors, Child mortality, Logistic Models, Child preschool, Family Characteristics, Cause of death, Residence Characteristics, and Population surveillance
This study aimed to describe dietary habits of Syrian adolescents attending secondary schools in Damascus and the surrounding areas. A descriptive, cross-sectional study was carried out on 3507 students in 2001. A stratified, 2-stage... more
This study aimed to describe dietary habits of Syrian adolescents attending secondary schools in Damascus and the surrounding areas. A descriptive, cross-sectional study was carried out on 3507 students in 2001. A stratified, 2-stage random cluster sample was used to sample the students. The consumption pattern of food items during the previous week was described. More than 50% of the students said that they had not consumed green vegetables and more than 35% had not consumed meat. More than 35% said that they consumed cheese and milk at least once a day. Only 11.8% consumed fruit 3 times or more daily. Potential determinants of the pattern of food consumption were arialysed. Weight control practices and other eating habits were also described.
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In a prospective study of gender and TB outcomes, 552 newly diagnosed smear-positive patients throughout the Syrian Arab Republic were interviewed at recruitment (from January 2002 to July 2002) and followed until the end of treatment.... more
In a prospective study of gender and TB outcomes, 552 newly diagnosed smear-positive patients throughout the Syrian Arab Republic were interviewed at recruitment (from January 2002 to July 2002) and followed until the end of treatment. Delay in diagnosis was significantly longer among males. Significant differences between males and females were noted in relation to the place they usually use to seek care. Gender did not seem to affect knowledge and attitudes of TB patients. Although the women reported more barriers to seeking care, compliance with treatment tended to be higher and the treatment success rate was significantly higher among females than males. Multivariate analysis showed that male sex was a significant predictor of a negative treatment outcome, after controlling for other significant sociodemographic and health care related variables.
Research Interests: Health Care, Multivariate Analysis, Prospective studies, Humans, Female, and 15 moreMale, Gender Difference, Patient Compliance, Men, Questionnaires, Adult, Success Rate, Sex Factors, Educational Status, Occupations, Prospective Study, Predictive value of tests, Marital Status, Socioeconomic Factors, and Health Services Accessibility
The results on pregnancy outcomes of mothers afflicted with sickle cell trait are still contradictory. This study aimed to examine the fetal and maternal outcomes among a cohort of pregnant women. This is a prospective cohort study that... more
The results on pregnancy outcomes of mothers afflicted with sickle cell trait are still contradictory. This study aimed to examine the fetal and maternal outcomes among a cohort of pregnant women. This is a prospective cohort study that examined the fetal and maternal outcomes among 98 women with sickle cell trait (HbAS) and 402 women with normal hemoglobin (HbAA). The study was carried out in 4 health centers serving Palestinian Refugees in Damascus, during the period November 2000 to May 2002. Hemoglobin electrophoresis was carried out for all newly registered pregnancy women. Women were then followed up until 40 days after delivery. Data was collected from antenatal records and interviews with women. Outcomes of pregnancy were compared between women with HbAS and HbAA hemoglobin. There was no statistical difference in the rate of abortion, distribution of birth weight and perinatal mortality. Women with AS hemoglobin reported higher incidence of complications after delivery, name...
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To explore the perspectives of women, female relatives, and healthcare providers on labor companionship. In a qualitative study, data were collected from women giving birth, female family members, and healthcare staff via semi-structured... more
To explore the perspectives of women, female relatives, and healthcare providers on labor companionship. In a qualitative study, data were collected from women giving birth, female family members, and healthcare staff via semi-structured interviews in three large public teaching hospitals in Beirut (Lebanon), Damascus (Syria), and Mansoura (Egypt) between May and December 2012. Focus groups were conducted with midwives, nurses, and medical residents. Data were assessed by thematic analysis. A total of 69 women, 57 female relatives, and 28 obstetricians were interviewed, and two focus groups discussions occurred. Women reported that being alone during labor raises feelings of fear and anxiety. They reported appreciating professional support, but found comfort in the psychological support offered by family members during labor. Midwives and nurses pointed to structural factors related to the organization of care and to the marginalization of their role as barriers to implementing best practices. Obstetricians referred to the absence of prenatal education classes, and social norms as factors impeding the organization of labor support initiatives. Implementing labor companionship can improve women&amp;amp;amp;amp;#39;s childbirth experiences and outcomes. Organizational structural barriers and non-supportive providers&amp;amp;amp;amp;#39; attitudes need to be addressed to influence hospital practices.
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Patients' involvement and their willingness to cooperate in clinical teaching is a vital element of medical education. Clinical teaching at the Faculty of Medicine of Damascus University relies heavily on inpatients at teaching... more
Patients' involvement and their willingness to cooperate in clinical teaching is a vital element of medical education. Clinical teaching at the Faculty of Medicine of Damascus University relies heavily on inpatients at teaching hospitals but also on patients brought to teaching rooms. The purpose of this study was to identify patients' experiences and their attitudes toward the involvement of medical students in clinical consultations within teaching rooms conducted mainly for students' benefit. In-depth interviews were carried out by a sociologist using an interview guide with 14 patients whose clinical cases were presented to a large group of students in the teaching room at Damascus University teaching hospitals. Data analysis involved content analysis. Main themes were identified with negative ethical aspects, such as the lack of patient's involvement in decision making and approving to be part of clinical teaching. Risk and benefits were experienced by patients ...
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To describe the biomedical and other causes of maternal death in Syria and to assess their preventability. A reproductive age mortality study (RAMOS) design was used to identify pregnancy related deaths. All deaths among women aged 15-49... more
To describe the biomedical and other causes of maternal death in Syria and to assess their preventability. A reproductive age mortality study (RAMOS) design was used to identify pregnancy related deaths. All deaths among women aged 15-49 reported to the national civil register for 2003 were investigated through home interviews. Verbal autopsies were used to ascertain the cause of death among pregnancy related maternal deaths, and causes and preventability of deaths were assessed by a panel of doctors. A total of 129 maternal deaths were identified and reviewed. Direct medical causes accounted for 88%, and haemorrhage was the main cause of death (65%). Sixty nine deaths (54%) occurred during labour or delivery. Poor clinical skills and lack of clinical competency were behind 54% of maternal deaths. Ninety one percent of maternal deaths were preventable. The causes of maternal death in Syria and their contributing factors reflect serious defects in the quality of maternal care that need to be urgently rectified.
Research Interests: Program Evaluation, Primary Health Care, Developing Countries, Population Dynamics, Health, and 15 moreAdolescent, Information, Information Services, Maternal Mortality, Pregnancy, Population, Humans, Female, Middle Aged, Adult, Clinical Competence, Records, Information Retrieval systems, Delivery of Health Care, and Cause of death
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Research Interests:
Measles eradication. By - David N Durrheim, Hyam Bashour.
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A longitudinal community-based study of the epidemiology of acute respiratory infections (ARI) in children less than 5 years old was carried out in a low income peri-urban area of Syria. A total of 1030 children were followed up by weekly... more
A longitudinal community-based study of the epidemiology of acute respiratory infections (ARI) in children less than 5 years old was carried out in a low income peri-urban area of Syria. A total of 1030 children were followed up by weekly morbidity surveillance for a period of 24 weeks, starting September 1989. The results revealed that, on average, a child suffered 3.4 episodes of ARI per 100 child-days at risk. The average prevalence of ARI was 23 per cent of time of observation. The peak age-specific incidence occurred in children 6-12 months old for cough/cold, and in children 0-5 months for pneumonia. Male children experienced higher incidence and prevalence of ARI. The most frequently reported symptoms were nasal discharge and cough.
Research Interests: Poverty, Syria, Diarrhea, Humans, Female, and 15 moreMale, Infant, Risk factors, Health Status, Newborn Infant, Longitudinal Studies, Respiratory Tract Infections, Age Factors, Tropical, Risk Factors, Cohort Studies, Acute Disease, Child preschool, Conjunctivitis, and Paediatrics and reproductive medicine
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Research Interests:
A hospital-based study of acute hepatitis was conducted in Damascus, Syria, from 1995 to 1998. One hundred ninety-three sera from defined acute hepatitis cases were screened by ELISA for IgM anti-HAV, HBsAg, IgM anti-HBc and anti-HCV.... more
A hospital-based study of acute hepatitis was conducted in Damascus, Syria, from 1995 to 1998. One hundred ninety-three sera from defined acute hepatitis cases were screened by ELISA for IgM anti-HAV, HBsAg, IgM anti-HBc and anti-HCV. Serum samples negative for all markers indicating recent infection by hepatitis A, B, or C were tested for HEV markers. Overall, 47 cases (24.4%) had no detectable hepatitis markers (non-A-E). HAV infection was detected in 71.2% of all viral hepatitis cases. Acute hepatitis B and C constituted 24 and 1.4% of the cases, respectively. Only five cases of acute hepatitis E were noted. Of 47 patients who had non-A-E hepatitis, fifteen (31.9%) tested positive for IgG anti HEV. This study provides indirect evidence that HEV is very likely to be endemic in Damascus, Syria. It reports for the first time the occurrence of hepatitis E in the country, a health problem that should be investigated further.