Students' perception of asynchronous versus synchronous distance learning during COVID-19 pandemic in a medical college, southwestern region of Saudi Arabia.

BACKGROUND: COVID-19 preventive measures required a drastic shift to online teaching-learning in most of countries. Institutions used different combinations of live online lectures (synchronous) requiring students to attend the class in real-time, as well as recorded lectures uploaded by the instructors to be accessed by students as per their own convenience (asynchronous). We undertook this study to assess and compare the perceptions of students regarding their learning experiences in the synchronous versus asynchronous mode of instruction using  their teaching-learning during the compulsory online mode of instruction at the peak of the COVID-19 pandemic. METHODOLOGY: This cross-sectional questionnaire-based study received responses from 122 final-year medical students studying at the College of Medicine, King Khalid University, Abha, Saudi Arabia. An online 5-point Likert scale-based questionnaire was used to collect data regarding experience and perception towards synchronous and asynchronous learning. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A P-value less than 0.05 was considered significant. RESULT: All the students found both synchronous and asynchronous learning to be equally satisfying, enjoyable and comfortable. No statistically significant difference was found when both the methods were analyzed for enhancement of knowledge. The students opined that asynchronous learning helped them manage their time better whereas synchronous learning encouraged more interaction during the live lectures. CONCLUSION: Overall, the students' perceptions regarding both synchronous and asynchronous online learning were positive. As both methods have their advantages/limitations, a mix of both synchronous and asynchronous methods may be adopted depending upon the content of the topic and the desired learning outcomes.

Prevalence and associated factors of fear for childbirth among pregnant women in eastern Sudan.

BACKGROUND: Prenatal fear of childbirth (FOC) is a major health problem. In spite of its importance, there are few studies on FOC in Africa and no published studies on FOC in Sudan. OBJECTIVES: This research aims to assess the prevalence of FOC amongst pregnant Sudanese women and to determine its associated factors. METHOD: A cross-sectional study was conducted in Gadarif , eastern Sudan. The sociodemographic and obstetric data were gathered through a questionnaire. Fear of childbirth was assessed with the Wijma Delivery Expectancy Questionnaire (W-DEQ. The three-item Oslo social support scale was used to measure the psychosocial condition of the participants. A logistic regression analysis was performed with severe FOC as dependent variable and sociodemographic, obstetric factors and social support as independent factors. RESULTS: A total of 475 women were enrolled in the research. Their median age (interquartile range) was 26.0 (8.0) years. Of these 475 women, 110 (23.2%) were primigravidae, 270 (56.8%) were parous and 95 (20%) were grandmultiparae. Fitty -three (11.1%) women experienced severe FOC (scored ≥66 on the W-DEQ). In a multivariable logistic regression analysis, primiparity (adjusted odds ratio = 23.26) was associated with severe FOC. There was no significant association between age, education or social support and severe FOC. CONCLUSIONS: This study demonstrates that 11.1% of pregnant Sudanese women exhibited FOC. Primigravidae were more likely to have severe FOC. The implementation of birth education programmes for this risk group is recommended in Sudan.

Length of Hospital Stay After Cesarean Delivery and Its Determinants Among Women in Eastern Sudan.

Background: There is an increasing caesarean delivery (CD) rate globally. Length of hospital stay (LoS) is longer in CD compared with vaginal delivery. There are few published data on LoS following CD in Africa, including Sudan. We aimed to investigate LoS after CD in eastern Sudan and its associated risk factors. Methods: A cross-sectional study was conducted at Gadarif hospital in eastern Sudan from May to December 2020. Sociodemographic, clinical and obstetrical data were gathered through questionnaires. Poisson regressions were used to model the LoS and provide relative risk (RR) and a 95.0% confidence interval (CI). Results: We enrolled 544 women with CD. The median (interquartile range, IQR) of their age and parity was 28.0 (24.0 ‒32.0) years and 3(2‒3), respectively. The LoS range was 1.0-9.0 days (mean = 2.7 days) and its median (IRQ) was 3.0 (2.0‒3.0) days. The median (IQR) of the LoS was significantly higher in women who had emergency CD vs elective CD, [3 (3.0‒3.0) vs 3 (2.0‒3.0) days, P < 0.001] and in women with maternal complications vs women who had no maternal complications [3 (2.0‒3.0) vs 3 (2.0‒3.0) days, P < 0.001]. Poisson regression showed that women with emergency CD stayed for 13.0% longer than women with elective CD (RR=1.13, 95% CI=1.01‒1.29). Women with maternal complications stayed 24.0% longer than women who had no maternal complications (RR=1.24, 95% CI=1.07‒1.43). Women who had neonatal complications stayed for 21.0% longer than women who had no neonatal complications (RR=1.21, 95% CI=1.05‒1.40). Age, parity, residence, education, occupation and postoperative haemoglobin were not associated with LoS. Conclusion: The mean LoS in this study was 2.7 days, and women with emergency CD and maternal and neonatal complications had longer LoS.

Knowledge, Practice, and Associated Factors of Essential Newborn Care among Sudanese Women in Eastern Sudan.

(1) Background: There is a high neonatal mortality rate in countries with low resources, especially sub-Saharan countries. There is no published data in Sudan on mothers' knowledge and practice of essential newborn care. This study aimed to assess the maternal knowledge and practice of essential newborn care in Gadarif city, eastern Sudan. (2) Methods: A cross-sectional study was conducted in Gadarif city, eastern Sudan. Postnatal mothers (384) were recruited from postnatal and vaccination clinics. A structured questionnaire was used to collect the data. Mothers who responded to essential newborn care knowledge and practice items at a rate equal to 75% or above were classified as having good knowledge and practice. Logistic regression analysis was performed to identify the factors associated with essential newborn care knowledge and practice. (3) Results: In this study, 268 (66.4%) and 245 (63.8%) of the 384 participants had good knowledge and practice of essential newborn care, respectively. None of the investigated factors (age, residence, education, occupation, parity, antenatal care, and mode of delivery) was associated with knowledge and practice of essential newborn care with sociodemographic and obstetric factors. Mothers with poor knowledge were less likely to have good practices (adjusted odds ratios = 0.41; 95% CI (0.26-0.64)). The reported malpractices were giving dietary supplements to the babies (48.2%), mainly water (40.0%) and cow's milk (43.2%), and putting substances on the umbilical cord (62.8%), with butter (92.1%) accounting for the majority. (4) Conclusion: In the present study, around two-thirds of the participants had good essential newborn care knowledge and practice. Poor knowledge was less likely to be associated with good newborn care practices. More research is needed to build baseline data for neonatal mortality reduction plans.

Prevalence and Associated Factors for Post-Caesarean Delivery Blood Transfusion in Eastern Sudan: A Cross-Sectional Study.

Background: Obstetric haemorrhage is a leading cause of maternal mortality and morbidity worldwide. Caesarean delivery (CD) is associated with significant blood loss, which may require blood transfusions. This study aimed to determine the prevalence and associated factors for post-CD transfusion. Methods: A cross-sectional study was conducted in Gadarif maternity hospital, eastern Sudan, from March to September 2020. Sociodemographic, obstetric and clinical data, including pre- and postoperative haemoglobin levels, were collected. A multivariate logistic regression analysis was performed. Results: A total of 539 women were enrolled in the study; the median (interquartile range) age of these women was 28.0 (8.0) years. The overall post-CD transfusion rate was 8.2%. Emergency CD (adjusted odds ratio [AOR]=2.57, 95% confidence interval [CI]=1.25‒5.28) and antepartum haemorrhage (AOR=44.70, 95% CI=11.18‒178.76) were associated with increased risk of post-CD blood transfusion. Preoperative haemoglobin (AOR=0.48, 95% CI=0.36‒0.64) and rural residence (AOR=0.45, 95% CI=0.22‒0.93) were associated with reduced risk for post-CD blood transfusion. Conclusion: The overall prevalence of post-CD transfusion in this part of Sudan is 8.2%. Women with emergency CD, low preoperative haemoglobin levels and antepartum haemorrhage were at higher risk for post-CD transfusion. Risk identification and correction of antenatal anaemia can reduce the hazard of blood transfusion among CD women.

The prevalence and phenotypic manifestations of polycystic ovary syndrome (PCOS) among infertile Sudanese women: a cross-sectional study.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a global health problem associated with significant morbidity during reproductive age. Only a few published studies that address the clinical manifestations and phenotypic presentation of the disease have been conducted in Africa, including Sudan. Thus, this study aimed to evaluate the clinical and biochemical presentation of the different PCOS phenotypes among infertile Sudanese women. METHODS: A cross-sectional, descriptive study was conducted from January to December 2019. A total of 368 infertile women with PCOS (based on the Rotterdam criteria) were recruited from a fertility center in Khartoum, Sudan. Clinical, hormonal, and ultrasonographic characteristics were described and compared between the four phenotypes of PCOS. RESULTS: Majority (321 [87.2%]) of the women had oligo/anovulation (OA). Polycystic ovary morphology on ultrasound appeared in 236 (64.1%) women, acne in 171 (46.5%) women, acanthosis nigricans in 81 (22.0%) women, and hirsutism in 101 (27.4%) women. Phenotype D was the most prevalent among infertile Sudanese women (51.6%), followed by phenotype B (22.6%), phenotype C (18.2%), and phenotype A (7.6%). No statistical differences in the body mass index and hormonal profile between the four phenotypes were noted. Women with phenotype A were older and had high mean blood pressure, and a higher waist/hip ratio was observed among women with phenotype D. CONCLUSION: Unlike the global distribution of PCOS phenotypes, Sudanese women uniquely expressed phenotype D as the most prevalent. More epidemiological studies are needed in the region due to geographical, ethnic, and genetic variations.

Polycystic ovary syndrome (PCOS) is a global health problem associated with significant drawbacks during reproductive life. Few published studies have been conducted in Africa (including Sudan) addressing the clinical manifestations and phenotypic presentation of the disease. Therefore, we aimed to evaluate the clinical and biochemical presentation of the different PCOS phenotypes among infertile Sudanese women. A total of 368 infertile women with PCOS from a fertility center in Khartoum, Sudan, participated in the study. Clinical, hormonal, and ultrasonographic characteristics were described and compared between the four phenotype groups of PCOS. In this regard, Sudanese women uniquely expressed phenotype D as the most prevalent, and this does not match with the global distribution of PCOS phenotypes. Moreover, women with phenotype A were older and had high mean blood pressure, and a higher waist/hip ratio was observed among women with phenotype D. More epidemiological studies on this subject are needed in the region due to geographical, ethnic, and genetic variations.

Prevalence of anaemia and its associated factors among lactating mothers in eastern Sudan: a cross-sectional study.

BACKGROUND: Lactating mothers are susceptible to anaemia. Little published data are available on lactational anaemia in Africa, including Sudan. This study was conducted to assess the prevalence of and associated factors for anaemia among lactating mothers in eastern Sudan. METHODS: A cross-sectional study was conducted and sociodemographic and clinical characteristics were gathered through a questionnaire. RESULTS: A total of 650 lactating mothers were included in the analysis. Their median age and parity were 28.0 y (interquartile range [IQR] 23.7‒32.0) and 3.0 (IQR 2.0‒4.0), respectively. Haemoglobin (Hb) levels ranged from 7.0 to 15.0 g/dL (median 11.2 [IQR 10.4‒12.0]). Of the 650 lactating mothers, 442 (68.0%) had anaemia (Hb <12.0 g/dL). In multivariate analysis, lactating mothers with education less than the secondary level (adjusted odds ratio [AOR] 1.58 [95% confidence interval {CI} 1.05 to 2.37]) and lactating mothers who underwent caesarean delivery (AOR 1.74 [95% CI 1.17 to 2.58]) had a higher probability of being anaemic. Employment was associated to a lower frequency of anaemia (AOR 0.39 [95% CI 0.20 to 0.79]). CONCLUSIONS: This study showed a high prevalence of anaemia among lactating mothers. Public health intervention activities designed towards education would be helpful to reduce anaemia.

Maternal age and miscarriage: A unique association curve in Sudan.

This study's aim was to estimate the prevalence and maternal age and other risk factors of miscarriage among Sudanese women. A cross-sectional study was conducted at the Saad Abuelela Tertiary Hospital in Khartoum, Sudan, from February to December 2019. Sociodemographic, obstetric and clinical data were collected. A multivariate logistic regression analysis was performed. Four hundred thirteen (20.5%) women reported experiencing a miscarriage. Risk factors included older age, high parity, histories of caesarean delivery, and obesity. Logistic regression showed that the lowest risk for women aged less than 20 years (adjusted odds ratio [AOR], 0.33) or 20 to 24 years (AOR, 0.57), primiparas (AOR, 0.42) and women educated below the secondary level (AOR, 0.78). Unlike the global age-associated risk of miscarriage, the risk of miscarriage among Sudanese women follows a unique curve in relation to maternal age. Interestingly, the curve showed a lower risk for women less than 20 years and at 40 years.

Prevalence and associated factors of undernutrition among pregnant Sudanese women.

BACKGROUND: Maternal undernutrition is a global health challenge, and it is associated with significant maternal and perinatal morbidity and mortality. This study aimed to assess the prevalence and the factors associated with undernutrition among pregnant women in Sudan. METHODS: A cross-sectional study was carried out in Saad Abuelela Hospital in Khartoum, Sudan, from June to December 2019. Sociodemographic and obstetric characteristics were collected through a questionnaire. Mid-upper arm circumference was measured. Undernutrition was defined as a mid-upper arm circumference of <23 cm. Multiple logistic regression was used to assess the factors associated with maternal undernutrition. RESULTS: Of 1801 pregnant women, 226 (12.5%) were undernourished. Multivariable analysis revealed that ≤2 antenatal care clinic visits (adjusted OR [AOR]=3.06, 95% CI 1.68 to 5.58) was associated with undernutrition. Age (AOR=0.90, 95% CI 0.87 to 0.94) and haemoglobin levels (AOR=0.81, 95% CI 0.67 to 0.97) were negatively associated with undernutrition. There was no association between parity, education, interpregnancy interval, occupation and maternal undernutrition. CONCLUSIONS: Our findings indicated that 12.5% of the pregnant women in Khartoum were undernourished. More effort and action are need to improve the counselling and future inclusion of a supplemental food supply for undernourished pregnant women.

Misconceptions and traditional practices toward infant teething symptoms among mothers in eastern Sudan: a cross-sectional study

There is no much published data on the mothers' false beliefs about signs and symptoms associated with teething in Sudan. Aim: This cross-sectional hospital-based study was conducted to assess mothers` knowledge about infant teething process and to evaluate mothers' practices used to alleviate teething disturbances in Gadarif city, eastern Sudan. Methods: Questionnaires were used to collect data. Multivariate logistics regression models were performed and adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated. Results/Conclusion: Of a total of 384 participating mothers, 126 (32.8%) had good knowledge about infant teething. The mothers' knowledge was associated with a higher number of children in the family (adjusted odds ratio [AOR] = 1.14) and with having a job (AOR = 2.22). Mothers residing in rural areas (AOR = 0.40) and mothers with lower than secondary education (AOR = 0.43) were less likely to have good knowledge about teething. Diarrhea (88.5%), fever (86.5%), an urge to bite (76.6%), and poor appetite (71.9%) were the signs and symptoms most attributed to teething by mothers. Only the mother's knowledge about teething was associated with reporting fever as a sign. A considerable number (317; 82.6%) of mothers reported performing "Dokhan" (acacia wood smoke), 313 (81.5%) preferred to administer paracetamol or other systemic analgesics, 262 (68.2%) agreed that a child with tooth eruption should be taken to a hospital or health center, and 216 (56.3%) believed that antibiotics relieved symptoms related to teething

Susceptibility of hospital-acquired uropathogens to first-line antimicrobial agents at a tertiary health-care hospital, Saudi Arabia.

CONTEXT: Management of urinary tract infections (UTIs) is caused by antibiotic resistance uropathogens. AIM: This study aimed to determine the important uropathogens and their resistance to first-line urinary tract antimicrobial agents. SETTINGS AND DESIGN: The region of Aseer, Southern Saudi Arabia, between 2013 and 2016. MATERIALS AND METHODS: A total of 1506 isolates were recovered from the urine samples of patients that were identified and tested against nine first-line UTI antimicrobial agents. Laboratory analysis was done as per the standard methods. Confirmation of bacterial identity and antimicrobial susceptibility assay was achieved by the VITEK 2 automated system. STATISTICAL ANALYSIS USED: Statistical Package for the Social Sciences software version 21.0 was used for the statistical analysis. RESULTS: The dominant uropathogens were Escherichia coli (E. coli) 507 (33.7%); Klebsiella pneumoniae (K. pneumoniae), 229 (15.21%); Pseudomonas aeruginosa, 153 (10.2%); Acinetobacter baumannii, 80 (5.3%); Enterococcus faecalis, 71 (4.7%); and Proteus mirabilis, 61 (4.1%). Of all culture-positive uropathogens, 51.5% were resistant to the 39 agents, whereas 48.5% were sensitive (P = 0.7969). Regarding the susceptibility to the first-line agent, the most effective against the dominant (in vitro) agents against E. coli were fosfomycin and nitrofurantoin (93.5%) and (85.4%), respectively. Whereas those worked well against K. pneumoniae were cefoxitin (57.1). CONCLUSIONS: The present study recommends the use of fosfomycin, cefoxitin, nitrofurantoin, and amoxicillin/clavulanate as the first choice UTIs treatment given their relatively high in vitro activity against major uropathogens. Knowledge of the bacterial species and their antimicrobial sensitivity patterns are always necessary to serve as a base for selecting the empirical treatment of UTIs as resistance rates vary geographically and with time.

Blood Groups and Hematological Parameters Do Not Associate with First Trimester Gestational Diabetes Mellitus (Institutional Experience).

OBJECTIVE: There are few published researches on blood groups, hematological parameters [hemoglobin, red cell distribution width (RDW), white blood cells (WBCs), mean platelets volume (MPV)] and gestational diabetes mellitus (GDM). The aim of this study was to investigate the association of haematological indices with GDM in early pregnancy. METHODS: The study was carried out at Saad Abuelela Hospital (Khartoum, Sudan) during March-November of 2018. Pregnant Sudanese women in early pregnancy (gestational age <14 weeks) were enrolled in the study. The details of the medical and obstetrics history were recorded. The women were then followed up until 24-28 weeks of gestation when a 75-gram oral glucose tolerance test was performed. RESULTS: Two hundred and fifty-three women at 10.2 week of gestational age completed the follow-up. The mean (SD) of the age and gravidity at the initial antenatal visit were 28.03 (5.6) years, 2.32 (2.41). The mean (SD) of body mass index (BMI) was 27.28 (24.41-30.80) kg/m2. Fifty women (19.8%) had GDM. Age, parity, BMI, place of residence, employment and education were not significantly different between the two groups. Moreover, there was no significant difference in the blood groups and hematological parameters between women with and without GDM. CONCLUSION: In this study, the blood groups and other hematological parameters were not different between women with and without GDM.

Interpretation of maternal blood glucose during pregnancy at high altitude area, Abha-Saudi Arabia.

BACKGROUND AND AIMS: In women who reside at high altitude, fasting plasma glucose is lower than at sea level, and further decrease of fasting blood glucose was noticed during pregnancy. This study aimed to set cutoff level of fasting plasma glucose during pregnancy at high altitude. The obtained data intended for interpretation of gestational blood sugar results and early detection of those who at risk of developing gestational diabetes. METHODS: A cross-sectional study was conducted to determine the cutoff level of fasting plasma glucose during pregnancy at high altitude. The subjects were pregnant women who attending the routine antenatal care at Abha Maternity Hospital and Mahayil Aseer Maternity hospital. Plasma glucose concentrations and Body Mass Index (BMI), socio-demographic and obstetric data were entered into the Statistical Package for Social Sciences (SPSS) version 20. Comparison amongst these variables were carried out through t test (numerical variables) and Chi Square test (proportions). A P value of <0.05 was considered as statistically significant. RESULTS: The overall results obtained indicated that the fasting plasma glucose concentrations and BMI were significantly lower (p = 0.0001) at high altitude area (Abha) than low altitude area (Mahayil Aseer). Age was the only socio-demographic factor that showed significant difference between the two groups (p-value was <0.05). CONCLUSION: Up to our knowledge, this is the first study addressing the interpretation of fasting blood glucose during pregnancy at high altitude area in Saudi Arabia. Our findings support the importance of careful interpretation of fasting blood glucose of pregnant women who reside at high altitude areas. The implementation of this policy at high altitude areas in the Kingdom of Saudi Arabia is recommended for early detection of gestational diabetes and timed intervention to avoid complications.

The impact of outpatient clinical teaching on students' academic performance in obstetrics and gynecology.

INTRODUCTION: Clinical teaching at outpatient settings is an essential part of undergraduate medical students' training. The increasing number of students in many medical schools and short hospital stays makes inpatient teaching alone insufficient to provide students with the required clinical skills. To make up this shortfall, outpatient clinical teaching has been implemented by our Department of Obstetrics and Gynecology, King Khalid University, KSA, throughout the academic year 2015-2016. The aim of this study was to evaluate the impact of clinical teaching at outpatient settings on the academic performance of our students. MATERIALS AND METHODS: In this comparative retrospective study, the effects of outpatient clinical teaching of obstetrics and gynecology on the academic performance of student was assessed through an objective structured clinical examination (OSCE). During their course on obstetrics and gynecology, 58 students had their clinical teaching both at inpatient and outpatient settings and constituted "study group". The remaining 52 students had clinical teaching only at inpatient settings and were considered "control group". Students in both groups sat for OSCE at the end of week 8 of the gynecology course. Students in both groups sat for OSCE at the end of week 8 of the gynecology course. Four stations were used for assessment: obstetric history, gynecological history, obstetric physical examination of pregnant women, and gynecological procedure station. Twenty marks were allocated for each station giving a total score of 80. The OSCE scores for study group were compared with those of the control group using Student's t-test; p < 0.05 was considered statistically significant. RESULTS: The total mean OSCE score was statistically significantly higher in the study group (62.36 vs. 47.94, p < 0.001). The study group participants showed significantly higher scores in the gynecological procedure station (16.74 vs. 11.62, p < 0.0001) and obstetric examination station (16.72 vs. 10.79, p < 0.0001). CONCLUSION: Clinical teaching at outpatient settings leads to an improvement in students' performance in OSCE. There is evidence of remarkable improvement in the mastery of clinical skills as manifested in the students' scores in physical examination and procedures stations. These results will encourage us to have clinical teaching in other disciplines at outpatient settings.