Resilience and challenges: A qualitative exploration of Jordanian Mothers' experiences with children who have cerebral palsy.

PURPOSE: This study aimed to explore the experiences of Jordanian mothers of children with cerebral palsy (CP) in order to better understand the challenges they face while caring for their children. DESIGN AND METHODS: A qualitative descriptive study was applied, using semi-structured face to face interviews with a purposive sample of 10 mothers of children with CP. FINDINGS: Mothers caring for children with CP embark on a challenging journey. Navigating the diagnosis begins with shock and disbelief, followed by emotional struggles as they deal with the new reality. This initial phase also involves caregiving challenges and hardships. Mothers may experience societal stigma and feelings of rejection, which can contribute to social isolation. Additionally, the physical demands of care can lead to financial hardships. These financial constraints can further limit access to specialized care, creating a frustrating cycle for mothers. Throughout this process, mothers demonstrate resilience by adapting to the illness. This encompasses making changes in their lives, actively seeking support, and developing expertise in managing their child's specific needs. CONCLUSIONS: The results shed light on the emotional, physical, and social challenges faced by mothers of children with CP. The findings show a narrative of adaptation, resilience, and strength, encompassing adjustments to the diagnosis, substantial life changes, seeking support, and addressing challenges such as social stigma, isolation, and various hardships. PRACTICE IMPLICATIONS: Our findings lay the foundation for tailored interventions and empathic support for mothers caring for a child with CP.

Gender-specific differences in plasma ferritin in adolescents smoking cigarettes versus waterpipe smoking: the Irbid-TRY Project.

Introduction: Ferritin has been implicated in body physiology and pathology. Smoking cigarettes (Cg) alters ferritin metabolism. Waterpipe (Wp) smoking has recently reemerged as a global epidemic and is linked to the most devastating diseases. However, the effect of smoking Wp on ferritin is not known. Therefore, the current study compared plasma ferritin in adolescents smoking Cg, Wp, both (CgWp) versus never smoked. Material and methods: Self-reported smoking status and plasma ferritin levels were obtained from 849 boys (n = 470) and girls (n = 379) in the 7th-10th grade (age range = 13-17 years). Results: The ANCOVA revealed a main effect for gender (p < 0.000) and smoking status (p < 0.02) without an interaction effect (p > 0.9). Post-hoc analysis showed greater plasma ferritin in the adolescents smoking Wp (p < 0.03) and CgWp (p < 0.004) versus never smoked. Gender-stratified ANCOVA showed a main effect for smoking status in the boys (p < 0.02) and girls (p < 0.03). Additional comparisons among the boys showed greater plasma ferritin in the Wp (p < 0.006) and CgWp (p < 0.008) smoking groups versus never smoking, without differences (p > 0.5) between Wp and CgWp smoking. Another subgroup comparison showed greater plasma ferritin in the girls smoking Cg (p < 0.02) and CgWp (p < 0.02) versus never smoking, without a difference (p > 0.3) between Cg and CgWp smoking. Conclusions: The results indicate that ferritin is elevated in adolescent smokers, particularly the boys smoking Wp and CgWp and in the girls smoking Cg and CgWp.

The Impact of Behavioral Economics-Based Counseling and Mobile Phone Text Educational and Reminder Messages on the Use of Modern Family Planning in Jordan: A Cluster Randomized Controlled Trial.

BACKGROUND: Favorable attitudes toward modern family planning methods (MFPMs) among Jordanian and Syrian women do not always translate into behavioral changes, and the availability and cost of MFPMs do not appear to be related to either prior stalls in fertility rates in Jordan or to the current and likely temporary decline in fertility rates. This study aimed to determine whether behavioral economics (BE)-based family planning interventions influence the use of any family planning method, MFPMs use, continuation of MFPMs use, and pregnancy rates among women in Jordan. The BE-based family planning interventions included personalized text messaging and augmented counseling based on framing and identity-priming BE principles, with their effects tested over a 9-month period in the postpartum period following the birth of a child. METHODS: A parallel-group cluster randomized controlled trial was conducted to compare two interventions, augmented counseling based on framing and identity-priming BE principles and personalized mobile phone text messages reminders, aiming to improve the utilization of MFPMs among postpartum women over status quo family planning services in comprehensive health centers in the north of Jordan. RESULTS: In total, 1032 participated in the study: 295 women in the control group; 326 women in Intervention Group 1, which received only augmented counseling; and 411 women in intervention Group 2, which received augmented counseling and monthly text messages. The rates of using MFPMs in the counseling group and the counseling and messages group 3 months (54.7% and 57.1%, respectively), 6 months (50.0% and 51.7%, respectively), and 9 months (49.5% and 52.0%, respectively) were significantly higher than the rates among women in the control group (40.6% at 3 months, 37.6% at 6 months, and 34.3% at 9 months). Overall, 26.8% of women in the control group, 42.1% of women in the counseling-only group, and 45.2% of women in the counseling and messages group used MFPMs continuously for all 9 months. At 9 months, the pregnancy rate was significantly much higher in the control group (13.7%) compared to women in the counseling-only group (7.0%) and to women in the counseling and messages group (7.4%). CONCLUSIONS: Simple BE-based interventions can be effective methods for enhancing the use of MFPMs and maintaining the anticipated decline in Jordan's total fertility rate.

Caregiver burden among parents of children with chronic diseases: A cross-sectional study.

AIMS AND OBJECTIVES: This study aimed to assess the perceived caregiver burden among parents of chronically ill children in Jordan. BACKGROUND: Although there are few studies on the accurate prevalence of chronic diseases among Jordanian children, there are a few on the burden of caregiving, which is important because most children with chronic illness rely on their caregivers to perform their daily tasks. In Jordan, little is known about the caregiver burden associated with caring for children with chronic diseases. DESIGN: A cross-sectional design was reported in line with the STROBE guidelines. METHODS: The Katz Index of Independence was used to determine the children's level of dependence, and the Burden Scale for Family Caregivers was used to measure the caregivers' level of burden. RESULTS: Nearly, 49.3% of caregivers had a very severe burden, 31.2% of children had a severe functional impairment, 19.6% had a moderate impairment, and 49.3% had full functionality. Based on their children's dependency, caregivers' subjective burden varied greatly (p < .001). Fully functional children had a far lower disease burden than severely and moderately disabled children (p < .001). The caregiver burden score differed significantly across chronic disease categories (p < .001). Unemployed caregivers had a far higher subjective burden than working caregivers (p = .009), and single (divorced/widowed) caregivers had higher burdens than married caregivers. CONCLUSIONS: Various factors can increase caregiver burden. Therefore, healthcare providers must plan holistic and family-centred interventions to reduce the caregiving burden. RELEVANCE TO CLINICAL PRACTICE: There is a need to establish support programs to help reduce the level of burden among caregivers of children with chronic diseases.

Modifiable Factors and Delays Associated with Neonatal Deaths and Stillbirths in Jordan: Findings from Facility-Based Neonatal Death and Stillbirth Audits.

OBJECTIVE: This study employed the "three-delay" model to investigate the types of critical delays and modifiable factors that contribute to the neonatal deaths and stillbirths in Jordan. STUDY DESIGN: A triangulation research method was followed in this study to present the findings of death review committees (DRCs), which were formally established in five major hospitals across Jordan. The DRCs used a specific death summary form to facilitate identifying the type of delay, if any, and to plan specific actions to prevent future similar deaths. A death case review form with key details was also filled immediately after each death. Moreover, data were collected from patient notes and medical records, and further information about a specific cause of death or the contributing factors, if needed, were collected. RESULTS: During the study period (August 1, 2019-February 1, 2020), 10,726 births, 156 neonatal deaths, and 108 stillbirths were registered. A delay in recognizing the need for care and in the decision to seek care (delay 1) was believed to be responsible for 118 (44.6%) deaths. Most common factors included were poor awareness of when to seek care, not recognizing the problem or the danger signs, no or late antenatal care, and financial constraints and concern about the cost of care. Delay 2 (delay in seeking care or reaching care) was responsible for nine (3.4%) cases. Delay 3 (delay in receiving care) was responsible for 81 (30.7%) deaths. The most common modifiable factors were the poor or lack of training that followed by heavy workload, insufficient staff members, and no antenatal documentation. Effective actions were initiated across all the five hospitals in response to the delays to reduce preventable deaths. CONCLUSION: The formation of the facility-based DRCs was vital in identifying critical delays and modifiable factors, as well as developing initiatives and actions to address modifiable factors. KEY POINTS: · Death review committees play key roles in identifying critical delays and modifiable factors.. · The "three-delay" model was successful in identifying preventable neonatal deaths and stillbirths.. · Death review committees are central in developing actions to reduce preventable deaths..

The experiences of mothers of children with hydrocephalus in Jordan: A phenomenological study.

BACKGROUND: Available literature showed that mothers of children with hydrocephalus experience many challenges. Studies that described mothers' experiences in caring for their children with hydrocephalus are limited. Understanding the mothers' experiences and challenges is essential and may enable the provision of increased knowledge and support for these mothers. AIM: The aim of this study was to explore the lived experiences of Jordanian mothers of children with hydrocephalus. METHODOLOGY: A phenomenological descriptive approach was applied in this study, using semi-structured interviews with a purposive sample of 10 mothers of children with hydrocephalus. Transcribed interviews were analyzed using thematic approach. RESULT: Three main themes that explored the mothers' experiences emerged from the data analysis process. The first theme was the impact of living with a child with hydrocephalus. Four subthemes comprise this theme; namely the mothers' initial response, overwhelming responsibilities, social withdrawal, and adapting: loving the baby and growing stronger. The second theme was related to the support system. Two subthemes compose this theme; the role of husband, and social support. The last theme was related to feelings of uncertainty. Two subthemes constitute this theme; concerns about the child's future and considering abortion as a solution. CONCLUSION: The mothers in this study were found to have experienced many intense feelings and to have faced many stressors and difficulties associated with the different stages of their child's illness. This study provides evidence that could be used to develop guidelines to support mothers of children with hydrocephalus.

Neonatal Nurses' Perceptions and Needs of End-of-Life Care Practice: A Jordanian Qualitative Study.

End-of-life (EOL) care for newborns is challenging and requires well-prepared nurses to provide the best care for the dying baby and to prepare and support parents during such a difficult experience. This study aimed to explore Jordanian neonatal intensive care unit nurses' perceptions and needs regarding the provision of EOL care. This study used an exploratory descriptive qualitative approach and was conducted among a sample of 12 Jordanian neonatal intensive care unit nurses. Semistructured interviews were conducted to allow the nurses to describe their personal experiences and express their needs related to the provision of EOL care. Two main themes and 6 subthemes emerged from the analysis process. Main themes were (1) the challenges related to the provision of EOL care, and (2) nurses' needs: what matters most. The findings of this study shed light on neonatal care unit nurses' experiences and needs related to the provision of EOL care. The results of this study may be used to develop EOL care guidelines, programs, and protocols to be applied in intensive care units.

Prevalence of Adverse Childhood Experiences and Their Relationship with Self-esteem Among School-Age Children in Jordan.

This study aimed to assess the prevalence of adverse childhood experiences and their relationship with self-esteem among secondary school students in Jordan. A cross-sectional, retrospective design was utilized using a convenience sample of 559 secondary school children (grades 7-11). Results showed that among the participating students, emotional abuse was the most commonly reported type of abuse (59.6%), followed by household violence (52.2%), bullying (44.7%), physical abuse (31.7%), emotional neglect (26.3), physical neglect (12.7%), and parents' separation (5.2%). Male students reported significantly more physical abuse than female students (37.5% vs 26.2%, p < 0.001), and significantly more physical neglect than female students (18.2% vs 7.6%, p < 0.001). However, female students reported significantly more household violence than male student (60.0% vs 43.9%, p < 0.001). Self-esteem scores were lower for students who reported physical abuse (d = 0.38, p < 0.001), household violence (d = 0.25, p < 0.003), emotional neglect (d = 0.45, p < 0.001), physical neglect (d = 0.58, p < 0.001), and bullying (d = 0.29, p = 0.001). Self-esteem was best predicted by physical abuse (ß = - 0.114, p = 0.009), emotional neglect (ß = - 0.169, p < 0.001), and physical neglect (ß = - 0.148, p < 0.001). Efforts should be exerted to prevent violence against children. National programs and community awareness campaigns should focus on the violence's detrimental effects on children.

Sociocultural, political, and health system-related determinants of perinatal deaths in Jordan from the perspectives of health care providers: a qualitative study.

BACKGROUND: Perinatal mortality is a fundamental indicator of the quality of the healthcare provided to women during pregnancy and childbirth, as well as the healthcare provided to neonates in the first week of life. At the national level, determining the direct and indirect causes of these deaths is vital, as it will assist in tracking the quality of antenatal, natal and postnatal care and help to detect the areas for avoidance. This study aimed to identify the main determinants of perinatal deaths in Jordan from the perspectives of health care providers (HCPs). METHODS: A descriptive qualitative approach using focus group discussion was used. Four focus groups were conducted in each of the four hospitals where the approached HCPs are employed. An average of 5 HCPs were interviewed in each focus group with a total of 80 HCPs participating in the 16 focus groups. Thematic analysis was carried out to analyze the data. RESULTS: The HCPs provided a detailed description of the determinants of perinatal and neonatal death from their points of view. Four main themes with multiple subthemes emerged, namely maternal factors (ignorance, concealment of medical condition, and husbands' negligence), sociocultural factors (socioeconomic status, tribal and consanguineous marriage, and harmful cultural practices), political factors (early marriage driven by displacement and war consequences on maternal health), and health system-related factors (services management including capabilities and logistics, overcrowding of emergency rooms, discharge against medical advice, and unskilled general practitioners in private maternity clinics). CONCLUSIONS: As perceived by HCPs, maternal factors, sociocultural factors, political factors, and health system-related factors are the main determinants of perinatal deaths in Jordan. Improvement in the quality of maternal and neonatal health care services, maternal health education, and maternity staff training are strongly recommended.

Perceived Barriers of Using Modern Family Planning Methods among Women in Jordan: A Qualitative Study.

BACKGROUND: Some cultural and social factors may discourage the use of modern family planning (MFP) methods. The purpose of this study was to better understand the barriers and social norms that might affect women's ability to take optimal advantage of the free family planning services offered by the Jordanian Ministry of Health (MOH). METHODS: Using a qualitative descriptive design, 7 focus group discussions were conducted from January to February 2018, with a purposive sample of 52 married women. Each group consisted of 6-12 participants. Ethical approvals were obtained. Data were analysed using inductive thematic analysis. RESULTS: Data analysis revealed three main themes and four subthemes. The first theme 'conforming to social and cultural norms' included the following subthemes: 'to conform to family and social pressure to bear children' and 'to prioritize having male children'. The second theme 'unmet needs in expected family planning counselling' included the following subthemes: 'need for consistency across providers in family planning counselling', and 'need for follow-up counselling'. The third theme was the 'undesirable side-effects' of the MFP methods, which included both the 'experienced' and the 'anticipated' side effects. CONCLUSION: This study identified a number of women's perceived barriers to using MFP methods. These included conforming to the social pressure, inconsistency of the counselling process, and undesirable side effects. Their perspectives should be carefully addressed in any family planning program.

The Jordan Stillbirth and Neonatal Mortality Surveillance (JSANDS) System: Evaluation Study.

BACKGROUND: The Jordan Stillbirth and Neonatal Mortality Surveillance (JSANDS) is an electronic surveillance system that automatically transfers the data on births, stillbirths, and neonatal deaths to the concerned authorities in the Ministry of Health. JSANDS was implemented and tested in 5 maternity hospitals during the period spanning May 2019 through December 2020. OBJECTIVE: This study aimed to evaluate the usefulness and performance of JSANDS to register births, stillbirths, and neonatal deaths, and determine their causes. Specifically, this study examined the JSANDS attributes of acceptability, simplicity, flexibility, stability, representativeness, sustainability, penetration, data quality, sensitivity, and adoption. METHODS: An evaluation study was conducted after 18 months of the JSANDS implementation using the Updated Guidelines for Evaluating Public Health Surveillance Systems. The evaluation focused on how well the system operated to meet its purpose and objectives. The indicators assessing the system attributes were scored on a Likert scale. Each indicator and overall attribute percentage score was represented as score rank and interpreted as excellent (score ≥80%), good (score ≥60 and <80%), average (score ≥40 and <60%), and poor (score <40%). RESULTS: A total of 270 health care professionals participated in this study and evaluated the system performance. The system users rated the usefulness of JSANDS as excellent (percentage score=85.6%). The overall acceptability (percentage score=82.3%), flexibility (percentage score=80.2%), stability (percentage score=80.0%), and representativeness (percentage score=86.6%) were also rated excellent. The overall simplicity was scored good (percentage score=75.4%). All participants were trained on JSANDS and used it in the past 12 months. Of the 270 respondents, 219 (86.2%) reported that they intend to continue using the JSANDS system to register neonatal deaths and stillbirths in the future. All variables in JSANDS had complete data with no missing values. CONCLUSIONS: The performance of JSANDS in registering all stillbirths and neonatal deaths as well as their causes was excellent. Almost all attributes and indicators of JSANDS functionality were rated excellent. JSANDS can be scaled up to cover all maternity hospitals in Jordan. The potential for scaling up the system is very high for many reasons, including its usefulness, simplified stillbirth and neonatal death review tools, and ease of the reporting process.

Walk the Talk: The Transforming Journey of Facility-Based Death Review Committee from Stillbirths to Neonates.

BACKGROUND: Facility-based death review committee (DRC) of neonatal deaths and stillbirths can encourage stakeholders to enhance the quality of care during the antenatal period and labour to improve birth outcomes. To understand the benefits and impact of the DRCs, this study was aimed at exploring the DRC members' perception about the role and benefits of the newly developed facility-based DRCs in five pilot hospitals in Jordan, to assess women empowerment, decision-making process, power dynamics, culture and genderism as contributing factors for deaths, and impact of COVID-19 lockdown on births. METHODS: A descriptive study of a qualitative design-using focus group discussions-was conducted after one year of establishing DRCs in 5 pilot large hospitals. The number of participants in each focus group ranged from 8 to10, and the total number of participants was 45 HCPs (nurses and doctors). Questions were consecutively asked in each focus group. The moderator asked the main questions from the guide and then used probing as needed. A second researcher observed the conversation and took field notes. RESULTS: Overall, there was an agreement among the majority of DRC members across all hospitals that the DRC was successful in identifying the exact cause of neonatal deaths and stillbirths as well as associated modifiable factors. There was also a consensus that the DRC contributed to an improvement in health services provided for pregnant women and newborns as well as protecting human rights and enabling women to be more interdependent in taking decisions related to family planning. Moreover, the DRC agreed that a proportion of the neonatal deaths and stillbirths occurring in the hospitals could have been prevented if adequate antenatal care was provided and some traditional harmful practices were avoided. CONCLUSIONS: Facility-based neonatal death review audit is practical and can be used to identify exact causes of maternal and neonatal deaths and is a valuable tool for hospital quality indicators. It can also change the perception and practice of health care providers, which may be reflected in improving the quality of provided healthcare services.

Barriers to implementing palliative care in intensive care units: perceptions of physicians and nurses in Jordan.

BACKGROUND: Palliative care (PC) aims to relieve a person's suffering and provide the best possible quality of life (QoL) to people with chronic illnesses. Despite the significant impact of PC services on the QoL of patients, barriers exist that prevent healthcare providers from facilitating PC in intensive care units (ICUs). AIM: The purpose of this study was to explore the perceived barriers to implementing PC in ICUs. METHODS: A qualitative approach was used to conduct 17 semi-structured interviews with clinicians across two ICUs (urban and suburban) in Jordan. Thematic analysis was used for the transcribed interviews. RESULTS: Five main themes emerged: the ICU is a demanding and complex care environment; lack of preparation to implement PC; PC is a nicety, not a necessity; healthcare system-related barriers; and lack of cultural acceptance of PC. Lack of knowledge and training was identified as a major barrier for the effective implementation of PC by both physicians and nurses. CONCLUSION: Equipping healthcare providers with the knowledge and expertise to provide PC is essential to dispel myths related to PC and facilitate PC provision. Developing an interdisciplinary care team will support the effective implementation of PC services in any setting. Establishing national PC policies will foster the ethical and legal practice of PC in Jordan.

Caring for a Child with Cancer: Experiences of Jordanian Mothers.

The diagnosis of childhood cancer is one of the most serious and unexpected experiences a mother can endure. A descriptive phenomenological approach was used to explore the experiences of mothers of children diagnosed with cancer in Jordan. Themes that emerged include (1) Emotional response on knowing the diagnosis (feelings of shock, lack of preparedness, denial, and feelings of "paralysis"), (2) Fear of the dreaded disease (fear of suffering and fear of death), and (3) The challenges of the treatment journey (inadequate financial resources, role transition, and feeling socially isolated). This study describes the experiences of Jordanian mothers who care for their children diagnosed with cancer so that health care providers can develop strategies to provide adequate psychological support to these mothers.

Experiences of Neonatal Intensive Care Unit Nurses as Mothers of Newborns in Neonatal Intensive Care Units: A Jordanian Qualitative Study.

PURPOSE: Little research has explored the experiences and perspectives of neonatal intensive care unit (NICU) nurses who have also experienced being NICU parents. The purpose of this study was to explore the experiences of these nurses who have or have ever had an infant hospitalized in a NICU. DESIGN AND METHODS: A qualitative descriptive design using semi-structured interviews with a purposive sample of 9 registered Jordanian NICU nurses who have or have had a child admitted to a NICU. RESULTS: Findings suggest an oscillation between the role of being a nurse and the role of being a mother. The nurses' background clinical experience has an impact on how they provided and received care and on the decisions they made regarding their infants' care plans. Nurses reported fears of the "recommended patient syndrome" and tried to avoid being labeled as "nagging" by other healthcare providers. CONCLUSIONS: Study findings shed light on the needs of NICU nurses with NICU admitted infants and the struggle faced by nurses-mothers as a result of their dual role, and highlights the importance of the family centered developmental care approach that recognizes the family as the cornerstone of the NICU health care team. PRACTICE IMPLICATIONS: Findings highlight issues related to the shared needs between mothers and nurse-mothers in relation to proximity and involvement in newborn care plan.

The usability of Jordan stillbirths and neonatal deaths surveillance (JSANDS) system: results of focus group discussions.

BACKGROUND: Jordan Stillbirths and Neonatal Deaths Surveillance system (JSANDS) is a newly developed system and is currently implemented in five large hospitals in Jordan. This study aimed at exploring the healthcare professionals' perception about the usability of JSANDS. METHODS: A descriptive qualitative approach, using focus group discussions, was adopted. A total of 5 focus groups including 23 focal points were conducted in five participating hospitals in Jordan. RESULTS: Data analysis identified nine main issues related to the JSANDS system: the system usefulness, the system performance, data quality, the system limitations, human rights, female empowerment, nurses' competencies strengthened, the sustainability of the JSANDS, and COVID-19 impact on the system. Users reported that JSANDS data were useful, the system was simple and easy to use, and the data were accurate and complete. However, some users reported that some technical issues need to be enhanced. CONCLUSIONS: JSANDS was perceived positively by the current users. According to them, it provides a formative and comprehensive data on stillbirths and neonatal deaths and their causes, and therefore, was recommended to be adopted by its users and scaled up.

Parenting a Child With Autism Spectrum Disorder: Perspective of Jordanian Mothers.

INTRODUCTION: Parenting a child diagnosed with autism spectrum disorder (ASD) is challenging for mothers because of concerns related to behavior, difficulties in accessing specialized care, and lack of community acceptance, yet their stories in Jordanian context are still unknown. Common challenges in Jordan include financial burdens, lack of public awareness, and lack of specialized knowledge even among health care providers, which may lead to delays in obtaining the diagnosis and interventions for ASD. METHOD: A phenomenological descriptive approach was used to explore and understand the mothers' everyday lived experiences of raising a child with ASD. Semistructured interviews were conducted with 14 mothers to identify their challenges so that nurses can identify gaps in services, empower families, and facilitate optimum care to these Jordanian families. FINDINGS: The main themes that emerged were (1) mothers' journeys with the diagnosis, in which mothers recognized the abnormalities of their children, reported delays in getting the diagnosis and initiation of treatment, and described a wide range of reactions to the diagnosis from grief and guilt to a blessing from God; (2) the burden of care, by which mothers reported physical and emotional exhaustion, financial burdens, and concerns about the quality of available services; and (3) the consequences and the hurdle of having a child with ASD, which affected the family relationships and social life. DISCUSSION: Jordanian mothers caring for children with ASD face several challenges, including physical, psychological, financial, and social challenges, in addition to limited specialized services. Identifying their unique challenges and needs are essential to support them, provide appropriate services and resources, and develop policies and guidelines for culturally competent quality services.

Rate, Risk Factors, and Causes of Neonatal Deaths in Jordan: Analysis of Data From Jordan Stillbirth and Neonatal Surveillance System (JSANDS).

Background: It has been estimated that 27.8 million neonates will die worldwide between 2018 and 2030 if no improvements in neonatal and maternal care take place. The aim of this study was to determine the rate, risk factors, and causes of neonatal mortality in Jordan. Methods: In August 2019, an electronic stillbirths and neonatal deaths surveillance system (JSANDS) was established in in three large cities through five hospitals. Data on all births, neonatal mortality and their causes, and other characteristics in the period between August 2019 and January 2020 were exported from the JSANDS and analyzed. Results: A total of 10,328 births [10,226 live births (LB) and 102 stillbirths] were registered in the study period, with a rate of 14.1 deaths per 1,000 LBs; 76% were early neonatal deaths and 24% were late deaths. The odds of deaths in the Ministry of Health hospitals were almost 21 times (OR = 20.8, 95% CI: 2.8, 153.1) higher than that in private hospitals. Low birthweight and pre-term babies were significantly more likely to die during the neonatal period compared to full-term babies. The odds of neonatal mortality were significantly higher among babies born to housewives compared to those who were born to employed women (OR = 2.7; 95% CI: 1.2, 6.0). Main causes of neonatal deaths that occurred pre-discharge were respiratory and cardiovascular disorders (43%) and low birthweight and pre-term (33%). The main maternal conditions that attributed to these deaths were complications of the placenta and cord, complications of pregnancy, and medical and surgical conditions. The main cause of neonatal deaths that occurred post-discharge were low birthweight and pre-term (42%). Conclusions: The rate of neonatal mortality have not decreased since 2012 and the majority of neonatal deaths occurred could have been prevented. Regular antenatal visits, in which any possible diseases or complications of pregnant women or fetal anomalies, need to be fully documented and monitored with appropriate and timely medical intervention to minimize such deaths.

Rate, determinants, and causes of stillbirth in Jordan: Findings from the Jordan Stillbirth and Neonatal Deaths Surveillance (JSANDS) system.

BACKGROUND: Annually, 2.6 million stillbirths occur around the world, with approximately 98% occurring in low- and middle-income countries. The stillbirth rates in these countries are 10 times higher than the rates in high-income countries. METHODS: An electronic stillbirths and neonatal deaths surveillance system (JSANDS) was established in five large hospitals located in three of the largest cities in Jordan in August 2019. JSANDS was developed as a secure on-line data entry system to collect, organize, analyze, and disseminate data on stillbirths, neonatal deaths, and their contributing conditions. Data on births, stillbirths and their contributing conditions, and other demographic and clinical characteristics in the period between August 2019 - January 2020 were extracted and analyzed. RESULTS: A total of 10,328 births were registered during the reporting period. Of the total births, 102 were born dead (88 antepartum stillbirths and 14 intrapartum stillbirths), with a rate of 9.9 per 1000 total births. The main contributing fetal conditions of antepartum stillbirths were antepartum death of unspecified cause (33.7%), acute antepartum event (hypoxia) (33.7%), congenital malformations and chromosomal abnormalities (13.3%), and disorders related to the length of gestation and fetal growth (10.8%). The main contributing maternal conditions of antepartum stillbirths included complications of the placental cord and membranes (48.7%), maternal complications of pregnancy (23.1%), and maternal medical and surgical conditions (23.1%). Contributing fetal conditions of intrapartum stillbirths included congenital malformations, deformations and chromosomal abnormalities, other specified intrapartum disorders, and intrapartum death of unspecified cause (33.3% each). Contributing maternal conditions of intrapartum stillbirths included complications of the placental cord and membranes. In the multivariate analysis, small for gestational age (SGA) pregnancies were associated with a significant 3-fold increased risk of stillbirth compared to appropriate for gestational age (AGA) pregnancies. CONCLUSIONS: Although the rate of stillbirth is lower than that in other countries in the region, there is an opportunity to prevent such deaths. While the majority of stillbirths occurred during the antepartum period, care should be taken for the early identification of high-risk pregnancies, including the early detection of SGA pregnancies, and ensuring adequate antenatal obstetric interventions.

Neonatal nurses' knowledge and beliefs about kangaroo mother care in neonatal intensive care units: A descriptive, cross-sectional study.

The aim of this study was to assess Jordanian neonatal nurses' knowledge and beliefs toward the application of kangaroo mother care in the neonatal intensive care unit. A cross-sectional, descriptive survey was performed using a convenience sample of 229 nurses. The findings revealed that the majority of the nurses agreed that kangaroo mother care was beneficial to both mothers and infants; however, 47.2% believed that it was not feasible for all preterm infants. The majority of nurses believed that kangaroo mother care should be restricted to infants on intravenous treatment, intubated, or with an umbilical catheter. The majority of the nurses correctly answered questions regarding kangaroo mother care. A significant relationship was found between the nurses' knowledge and their beliefs toward kangaroo mother care. The findings of this study provide insights into Jordanian nurses' knowledge and beliefs toward the kangaroo mother care approach. If addressed, these findings will help improve the practice and nursing care for preterm infants.