Changes in attitudes to childbirth in modern times illustrated over three generations in Iraq.

OBJECTIVE: To describe changes in attitudes and expectations of labor over the previous six decades, comparing the Iraqi generation who labored at home without medical assistance with their descendants. STUDY DESIGN: We used semi-structured telephone interviews with 22 women across three generations of one extended family living and giving birth in Iraq between the 1950s and the 2010s. Qualitative data were analyzed thematically using open, axial, and selective coding. RESULTS: Each generation experienced a paradigm shift in childbirth, from exclusive home births to hospital-directed maternity care, to a trend that favors planned cesarean birth, driven by generation-specific changes in outlook. Emerging themes included social influences, changing technology, and medical professionals' recommendations; all of these affected attitudes toward childbirth and pregnancy. There were generational disconnects in perceptions concerning the reasons childbirth has changed over the past 60 years, with the youngest generation citing wider pressures regarding body image and marital relationships as two of the factors affecting preferences in childbirth options. CONCLUSIONS: Societal changes and availability of healthcare services affect women's choices and experiences of childbirth. To be successful, efforts to improve women's experiences in labor, as well as maternal and neonatal outcomes, must consider these wider sociocultural issues.

Heat stable carbetocin vs. oxytocin for the prevention of post-partum hemorrhage in emergency caesarean delivery: a randomized controlled trial.

OBJECTIVES: To evaluate the uterotonic effect of carbetocin compared with oxytocin in emergency cesarean delivery in Iraq. METHODS: A double-blinded randomized noninferiority single center trial. Three-hundred patients were systematically randomized to intravenous bolus injection of 10 IU oxytocin or 100 mcg carbetocin after delivery in a ratio of 2:1. The primary outcome was additional uterotonic use when inadequate uterine tone occur in the first 24 h after delivery. Secondary outcomes include the need for blood transfusion, blood pressure and pulse rate changes within an hour of drugs administration. Noninferiority margins for the relative risks outcomes was 4%. RESULTS: Addition uterotonics use was significantly lower in carbetocin group with a risk ratio of 0.36. Carbetocin was superior to oxytocin in reducing the need for additional uterotonic drugs by 12% and non-inferior to oxytocin for blood transfusion 3.5%. Noninferiority was not shown for the outcome of sever blood loss. Miner changes in blood pressure and pulse rate were observed in carbetocin group compared to oxytocin but clinically were not significant. CONCLUSIONS: Heat stable carbetocin is effective in reducing additional uterotonics use compared to oxytocin without clinically significant change in blood pressure or pulse rate, therefore, can be a potential alternative in Iraq.

Determinants of social accountability for medical schools in Iraq: A qualitative case study.

Background: The mandate of medical schools is to enrich the health system through education, research, and service to satisfy the health needs of the societies they serve. The social accountability (SA) movement aims to intensify the medical school's mission. Although the context of every school is unique, one of the increasingly significant roles of medical education is to develop the indicators that promote SA. The aim of this study is to define the determinants of SA in Iraq using AlKindy College of Medicine/University of Baghdad, Baghdad, Iraq as a case study. Methods: This is a qualitative research using open-ended questions through an online mode; data were analyzed using the content analysis technique. Results: Different themes related to the roles of medical schools, stakeholders, medical schools' mission, curriculum content, research characteristics, service characteristics, enhancers of SA, and accreditation role were identified. The themes are meant to characterize a socially accountable medical school within the context of Iraq. Discussion: The study needs to be replicated in different medical schools to successfully build the national determinants of SA.

Feasibility and acceptability of text messaging to support antenatal healthcare in Iraqi pregnant women: a pilot study.

OBJECTIVE: To determine the feasibility and acceptability of mobile health technology and its potential to improve antenatal care (ANC) services in Iraq. METHODS: This was a controlled experimental study conducted at primary health care centers. One hundred pregnant women who attended those centres for ANC were exposed to weekly text messages varying in content, depending on the week of gestation, while 150 women were recruited for the unexposed group. The number of ANC visits in the intervention and control groups, was the main outcome measure. The Mann-Whitney test and the Poisson regression model were the two main statistical tests used. RESULTS: More than 85% of recipients were in agreement with the following statements: "the client recommends this program for other pregnant women", "personal rating for the message as a whole" and "obtained benefit from the messages". There was a statistically significant increase in the median number of antenatal clinic visits from two to four per pregnancy, in addition to being relatively of low cost, and could be provided for a larger population with not much difference in the efforts. CONCLUSIONS: Text messaging is feasible, low cost and reasonably acceptable to Iraqi pregnant women, and encourages their ANC visits.

Student evaluation of medical school curriculum transformation in Iraq.

This article was migrated. The article was marked as recommended. Introduction: Decades of political and social unrest negatively impacted medical education in Iraq. Recently, new opportunities arose for medical schools to engage international education organizations and the World Health Organization to implement medical school curriculum changes, replacing older discipline-based, teacher-focused systems with a systems-based, student-focused reformed curriculum. Methods: A descriptive, cross sectional quantitative study was designed to survey medical students near the beginning (years 2-3) and at near the end (years 5-6) of their six-year program at the Al Kindy College of Medicine, University of Baghdad, Iraq. Results: A validated questionnaire collected data on thirty-two issues, including student perception of learning, student perception of teachers, academic self-perception and student self-perception. Seven of the thirty-two questions included in this survey resulted in significantly different responses from group 1 (second and third year) vs group 2 (fifth and sixth year) students. Conclusions: This study concluded that the two student groups were significantly different in their awareness of the need for curriculum change, but that student self-perception in both groups was less than ideal at present. In the future, studies are planned to assess student confidence in their professional development, as teaching institutions advance toward broader accreditation and thus opportunities for their students.

Academic Medicine and Science Diplomacy: Medical Education in Iraq.

Physicians are infrequently selected to serve in the yearlong role of Jefferson Science Fellow (JSF) as senior science advisor for the U.S. Department of State or the United States Agency for International Development. The authors discuss the role of a JSF in promoting "science diplomacy" from the perspective of one alumnus, who sites examples of ongoing, long-term collaborative projects including one focusing on medical education reform in Iraq that would not have been possible without the JSF program. More than 3 decades of political and social unrest, terrorism, the internal displacement of millions of Iraqi citizens, the arrival of Syrian refugees, international sanctions, and the effect of fluctuating oil prices that fund education in Iraq have all led to a standstill in modernizing educational systems and the need for reform. In 2016, new opportunities for international collaboration and travel allowed faculty from the Al Kindy College of Medicine, University of Baghdad, Iraq, to visit the United States, explore U.S. medical school teaching methods, interact with U.S. faculty and students, and then implement their vision of a revised medical curriculum. These faculty members shared their observations with the Iraqi Council of Deans, which represents all 30 Iraqi medical schools. Structural changes in curriculum content and teaching methods have been implemented with the goal of restoring quantifiable excellence in education and health care in Iraq. The authors close with lessons learned to encourage other physicians to participate in the JSF program, which offers a unique opportunity to influence foreign policy through science diplomacy.