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BACKGROUND: Genetic literacy among primary healthcare providers is crucial for appropriate patient care with the advances in genetic and genomic medicine. Studies from high-income countries highlight the lack of knowledge in genetics and the need to develop curricula for continuing professional development of non-geneticists. Scarce data is available from resource-constrained countries in Middle East and North Africa. Lebanon is a small country in this region characterized by high rates of consanguinity and genetic disorders like several surrounding countries, such as Jordan, Syria, and Turkey. METHODS: The primary aim of this study assessed the genetic literacy, self-perceived and actual knowledge as well as practices among primary care providers in Lebanon. The secondary aim identified their educational needs and proposed evidence-based continuing education programs. A cross-sectional survey-based study, using a self-administered questionnaire, was conducted targeting physicians from Family Medicine, Obstetrics and Gynecology, and Pediatrics. The questionnaire was divided into five sections: demographics, familiarity with genetic tests, self-reported and actual knowledge, genetic practices, and educational needs. Statistics were performed using SPSS v24. The Chi-square test was used for independent variables. Differences between mean scores were measured using paired sample t-tests for groups of two levels and one-way ANOVA for more than two. Multiple linear regression was used to study the variables associated with the knowledge score while controlling for other variables. RESULTS: The survey included 123 physicians. They were mostly familiar with karyotype as first-tier genetic test. Although 38% perceived their knowledge as good, only 6% scored as such in knowledge assessment. A better knowledge score was observed in academic institutions as well as in urban settings (p<0.05). One third never ordered any genetic testing, mostly due to poor knowledge. Almost all (98%) were ready to attend continuing professional development sessions in genetics. CONCLUSION: Our findings show the need to improve genetic literacy among healthcare frontliners, focusing on remote regions and nonacademic centers in Lebanon, a model for other resource-constrained country in the Middle East and North Africa region. This study advances recommendations for evidence-based genetic continuing education programs and highlighted the role of that the few genetic specialists can play in their successful implementation.
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Alfabetización , Médicos de Atención Primaria , Humanos , Niño , Estudios Transversales , Atención a la Salud , LíbanoRESUMEN
BACKGROUND: Women's childbirth experiences in health facilities is at the core of quality of care. Their perceptions of poor-quality care, including disrespectful care at health facilities during childbirth, is recognized as a significant barrier to seeking care for subsequent births. Research that explores women's perspectives of the dimensions of disrespect and mistreatment during childbirth in Arab countries is scarce, and there is none pertaining to refugee groups who carry the burden of multiple vulnerabilities and who suffer from discontinued care, especially in fragile health systems. This paper aims at presenting Palestinian, Iraqi and Syrian refugee women's experiences, understanding and interpretation of disrespect and mistreatment during childbirth in hospitals in Lebanon. METHODS: This study employed phenomenology, a qualitative research design to generate data through in-depth interviews. Women who were 3 to 6 months postpartum were recruited through the non-governmental organizations (NGOs) that are actively engaged in providing welfare and healthcare services to different populations of refugee women in Lebanon. In total, 24 women were interviewed. All interviews were audio recorded, transcribed verbatim and subjected to thematic analysis. RESULTS: Of the 24 women who participated in this study, 9 were Palestinian, 12 were Syrian and 3 were Iraqi. The participants spoke of restricted choices to hospitals, care providers and to types of birth, while revealing adverse experiences during childbirth in healthcare facilities, including verbal and physical abuse, disrespectful verbal and non-verbal communication by healthcare providers. They also reported sub-standard care, denial of birth companions and breaches to their privacy. Our findings exemplify how the coverage of the cost of facility-based births by UN agencies and NGOs increase refugee women's vulnerability to disrespect and mistreatment during childbirth. CONCLUSION: This study shows how disrespect and mistreatment are intertwined in a complex system which is devised to ensure access to facility-based birth for displaced populations. Implications for programs and policies point to the need for strengthening capacity and for providing resources for the adaptation of global guidelines into context-specific strategies for the provision of quality maternity care during humanitarian crises and beyond.
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Servicios de Salud Materna , Refugiados , Actitud del Personal de Salud , Parto Obstétrico/métodos , Femenino , Humanos , Parto , Embarazo , Relaciones Profesional-Paciente , Investigación Cualitativa , Calidad de la Atención de SaludRESUMEN
BACKGROUND: Digital health interventions (DHIs) are increasingly being adopted globally to address various public health issues. DHIs can be categorized according to four main types of technology: mobile based, web based, telehealth, and electronic health records. In 2006, Norman and Skinner introduced the eHealth literacy model, encompassing six domains of skills and abilities (basic, health, information, scientific, media, and computer) needed to effectively understand, process, and act on health-related information. Little is known about whether these domains are assessed or accounted for in DHIs. OBJECTIVE: This study aims to explore how DHIs assess and evaluate the eHealth literacy model, describe which health conditions are addressed, and which technologies are used. METHODS: We conducted a scoping review of the literature on DHIs, based on randomized controlled trial design and reporting the assessment of any domain of the eHealth literacy model. MEDLINE, CINAHL, Embase, and Cochrane Library were searched. A duplicate selection and data extraction process was performed; we charted the results according to the country of origin, health condition, technology used, and eHealth literacy domain. RESULTS: We identified 131 unique DHIs conducted in 26 different countries between 2001 and 2020. Most DHIs were conducted in English-speaking countries (n=81, 61.8%), delivered via the web (n=68, 51.9%), and addressed issues related to noncommunicable diseases (n=57, 43.5%) or mental health (n=26, 19.8%). None of the interventions assessed all six domains of the eHealth literacy model. Most studies focused on the domain of health literacy (n=96, 73.2%), followed by digital (n=19, 14.5%), basic and media (n=4, 3%), and information and scientific literacy (n=1, 0.7%). Of the 131 studies, 7 (5.3%) studies covered both health and digital literacy. CONCLUSIONS: Although many selected DHIs assessed health or digital literacy, no studies comprehensively evaluated all domains of the eHealth literacy model; this evidence might be overlooking important factors that can mediate or moderate the effects of these interventions. Future DHIs should comprehensively assess the eHealth literacy model while developing or evaluating interventions to understand how and why interventions can be effective.
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Alfabetización en Salud , Telemedicina , Pruebas Diagnósticas de Rutina , Registros Electrónicos de Salud , Humanos , Salud Mental , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Social, behavioural and community engagement (SBCE) interventions are essential for global maternal, newborn and child health (MNCH) strategies. Past efforts to synthesise research on SBCE interventions identified a need for clear priorities to guide future research. WHO led an exercise to identify global research priorities for SBCE interventions to improve MNCH. METHODS: We adapted the Child Health and Nutrition Research Initiative method and combined quantitative and qualitative methods to determine MNCH SBCE intervention research priorities applicable across different contexts. Using online surveys and meetings, researchers and programme experts proposed up to three research priorities and scored the compiled priorities against four criteria - health and social impact, equity, feasibility, and overall importance. Priorities were then ranked by score. A group of 29 experts finalised the top 10 research priorities for each of maternal, newborn or child health and a cross-cutting area. RESULTS: A total of 310 experts proposed 867 research priorities, which were consolidated into 444 priorities and scored by 280 experts. Top maternal and newborn health priorities focused on research to improve the delivery of SBCE interventions that strengthen self-care/family care practices and care-seeking behaviour. Child health priorities focused on the delivery of SBCE interventions, emphasising determinants of service utilisation and breastfeeding and nutrition practices. Cross-cutting MNCH priorities highlighted the need for better integration of SBCE into facility-based and community-based health services. CONCLUSIONS: Achieving global targets for MNCH requires increased investment in SBCE interventions that build capacities of individuals, families and communities as agents of their own health. Findings from this exercise provide guidance to prioritise investments and ensure that they are best directed to achieve global objectives. Stakeholders are encouraged to use these priorities to guide future research investments and to adapt them for country programmes by engaging with national level stakeholders.
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Salud Infantil , Servicios de Salud Materna , Niño , Femenino , Salud Global , Prioridades en Salud , Humanos , Salud del Lactante , Recién Nacido , Salud Materna , Embarazo , InvestigaciónRESUMEN
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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Cesárea/estadística & datos numéricos , Familia , Trabajo de Parto/psicología , Atención Perinatal/métodos , Adulto , Doulas , Estudios de Factibilidad , Femenino , Implementación de Plan de Salud , Humanos , Medio Oriente , Atención Perinatal/economía , Embarazo , Adulto JovenRESUMEN
Health literacy is an important predictor of health status, health behaviours, and other health outcomes. However, research on health literacy in the Arab world is scarce and no health literacy tool has been validated to test the health literacy level of the Lebanese population so far. The aim of this study was to validate Arabic translations of three commonly used health literacy assessment tools, the S-TOFHLA, the REALM-R, and the Brief Health Literacy Screening items. The tools were linguistically and culturally adapted to the Lebanese context, and 250 face-to-face interviews were conducted in an outpatient clinic in Beirut, Lebanon, between April and June 2015. The General Self-Efficacy Scale and socio-demographic questions such as gender, age, origin, education and chronic condition were included to assess predictive validity. Reliability of the instruments was found to be low to high (Cronbach's α =0 .94 for the S-TOFHLA, Cronbach's α = 0.46 for the REALM-R). Younger and highly educated participants scored higher on the S-TOFHLA. The Brief Health Literacy Screening items were significantly correlated with age, education, self-efficacy and the S-TOFHLA, reinforcing the convergent and predictive validity of the two tools. Results indicate that the S-TOFHLA and the three screening questions are a valuable tool to measure health literacy in Lebanon and, allowing for minimal adaptations according to each country's healthcare system, in the entire Arabic-speaking area.
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Mundo Árabe , Alfabetización en Salud , Psicometría , Encuestas y Cuestionarios , Adulto , Femenino , Humanos , Líbano , Masculino , Reproducibilidad de los Resultados , TraduccionesRESUMEN
Prior to the conflict, Syria had relatively high fertility rates. In 2010, it had the sixth highest total fertility rate in the Arab World, but it witnessed a fertility decline before the conflict in 2011. Displacement during conflict influences fertility behaviour, and meeting the contraceptive needs of displaced populations is complex. This study explored the perspectives of women and service providers about fertility behaviour of and service provision to Syrian refugee women in Bekaa, Lebanon. We used qualitative methodology to conduct 12 focus group discussions with Syrian refugee women grouped in different age categories and 13 in-depth interviews with care providers from the same region. Our findings indicate that the displacement of Syrians to Lebanon had implications on the fertility behaviour of the participants. Women brought their beliefs about preferred family size and norms about decision-making into an environment where they were exposed to both aid and hardship. The unaffordability of contraceptives in the Lebanese privatised health system compared to their free provision in Syria limited access to family planning services. Efforts are needed to maintain health resources and monitor health needs of the refugee population in order to improve access and use of services.
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Conducta Anticonceptiva/etnología , Composición Familiar/etnología , Servicios de Planificación Familiar/organización & administración , Refugiados/psicología , Adolescente , Adulto , Factores de Edad , Actitud del Personal de Salud/etnología , Toma de Decisiones , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Entrevistas como Asunto , Líbano/epidemiología , Masculino , Persona de Mediana Edad , Paridad , Aceptación de la Atención de Salud/etnología , Siria/etnología , Adulto JovenRESUMEN
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 levels had higher levels of childbirth satisfaction. Women who had fewer children from Egypt and Lebanon, and those who received care by a team including both male and female physicians in the Syrian hospital were more likely to be dissatisfied than their counterparts. Variations in the management and provision of care between the three countries may explain the differences in satisfaction levels observed. Further qualitative research is needed to deepen our understanding of the concepts of control and satisfaction in the Arab culture as well as to establish the factors associated with women's positive childbirth experiences to inform the provision of quality maternity care.
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Árabes/psicología , Parto Obstétrico/psicología , Hospitales de Enseñanza/estadística & datos numéricos , Satisfacción del Paciente , Adulto , Femenino , Humanos , Trabajo de Parto/psicología , Servicios de Salud Materna/organización & administración , Servicios de Salud Materna/estadística & datos numéricos , Grupo de Atención al Paciente/organización & administración , Embarazo , Factores Socioeconómicos , Adulto JovenRESUMEN
BACKGROUND: Two recent recommendations made by the World Health Organization confirm the benefits of companion of choice at birth on labour outcomes; however institutional practices and policies do not always support its implementation in different settings around the world. We conducted a review to determine factors that affect implementation of this intervention considering the perspectives and experiences of different stakeholders and other institutional, systemic barriers and facilitators. METHODS: Forty one published studies were included in this review. Thirty one publications were identified from a 2013 Cochrane review on the effectiveness of companion of choice at birth. We also reviewed 10 qualitative studies conducted alongside the trials or other interventions on labour and birth companionship identified through electronic searches. The SURE (Supporting the Use of Research Evidence) framework was used to guide the thematic analysis of implementation factors. RESULTS: Women and their families expressed appreciation for the continuous presence of a person to provide support during childbirth. Health care providers were concerned about the role of the companion and possible interference with activities in the labour ward. Allocation of resources, organization of care, facility-related constraints and cultural inclinations were identified as implementation barriers. CONCLUSION: Prior to introducing companion of choice at birth, understanding providers' attitudes and sensitizing them to the evidence is necessary. The commitment of the management of health care facilities is also required to change policies, including allocation of appropriate physical space that respects women's privacy. Implementation research to develop models for different contexts which could be scaled up would be useful, including documentation of factors that affected implementation and how they were addressed. Future research should also focus on documenting the costs related to implementation, and on measuring the impact of companion of choice at birth on care-seeking behavior for subsequent births.
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Amigos , Personal de Salud/psicología , Implementación de Plan de Salud , Trabajo de Parto/psicología , Parto/psicología , Actitud del Personal de Salud , Conducta de Elección , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Embarazo , Investigación CualitativaRESUMEN
An equity lens to maternal health has typically focused on assessing the differences in coverage and use of healthcare services and critical interventions. While this approach is important, we argue that healthcare experiences, dignity, rights, justice, and well-being are fundamental components of high quality and person-centred maternal healthcare that must also be considered. Looking at differences across one dimension alone does not reflect how fundamental drivers of maternal health inequities-including racism, ethnic or caste-based discrimination, and gendered power relations-operate. In this paper, we describe how using an intersectionality approach to maternal health can illuminate how power and privilege (and conversely oppression and exclusion) intersect and drive inequities. We present an intersectionality-informed analysis on antenatal care quality to illustrate the advantages of this approach, and what is lost in its absence. We reviewed and mapped equity-informed interventions in maternal health to existing literature to identify opportunities for improvement and areas for innovation. The gaps and opportunities identified were then synthesised to propose recommendations on how to apply an intersectionality lens to maternal health research, programmes, and policies.
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Providing quality maternity care within the emergency care packages for internally displaced populations in war-affected areas is somewhat challenging, although very essential. In this retrospective study, we describe the experiences and health care seeking behaviors of 1,015 pregnant and postpartum women during the 2006 war in Lebanon. Women reported interruptions in regular maternity care and experienced more complications during this period. Availability of health services and experiences of complications were the most important determinants of health care seeking behaviors. Maternal health services should be a part of any comprehensive emergency responsiveness plan, catering to women's needs in war-affected areas.
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Accesibilidad a los Servicios de Salud , Servicios de Salud Materna/organización & administración , Obstetricia/normas , Aceptación de la Atención de Salud , Guerra , Adulto , Servicios Médicos de Urgencia/organización & administración , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Entrevistas como Asunto , Líbano , Servicios de Salud Materna/estadística & datos numéricos , Oportunidad Relativa , Periodo Posparto , Embarazo , Calidad de la Atención de Salud , Refugiados , Análisis de Regresión , Estudios Retrospectivos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: The MENA region is disproportionately affected by genetic disease. The aim of this research is to scope the region for evidence of genetic services and public health interventions to identify geographic gaps, and to provide a descriptive overview of interventions to identify knowledge gaps. METHODS: This study is conducted as a scoping review and follows the Arksey & O'Malley scoping review framework. RESULTS: Seventy-six articles spanning 16 MENA nations met inclusion criteria. Studies included interventions in the form of genetic service provision (n=28), as well as comprehensive programs including pilot programs (n=7), community-based genetics programs (n=6) national-level prevention programs (n=18), and national-level mandatory programs (n=17). CONCLUSIONS: There is an imbalanced response to genetic disease burdens across the MENA region. More research is warranted where interventions are scarce, particularly to inform development of pilot community-based programs. There is also a need for better monitoring and evaluation of existing nation-wide programs.
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BACKGROUND: Rates of breastfeeding (BF) remain suboptimal despite overwhelming evidence for its benefits to the mother and child. Pediatricians play an important role in supporting breastfeeding (BF). In Lebanon, the rates of both exclusive and continued BF are critically low. The objective of this study is to examine the knowledge, attitudes and practices (KAP) of Lebanese pediatricians in relation to supporting BF. METHODS: A national survey of Lebanese pediatricians was conducted through Lime Survey (n = 100, response rate 9.5%). The list of pediatricians' emails was obtained from the Lebanese Order of Physicians (LOP). Participants completed a questionnaire covering, in addition to sociodemographic characteristics, the KAP, related to supporting BF. Descriptive statistics and logistic regressions were used in data analysis. RESULTS: The most prevalent gaps in knowledge were related to the positioning of the baby during BF (71.9%) and the association between the mother's fluid intake and her milk production (67.4%). With regards to attitudes, 34% of participants reported unfavorable attitudes towards BF in public and BF while working (25%). As for practices, more than 40% of pediatricians kept formula samples and 21% had formula-related advertising in their clinics. Half of the pediatricians reported rarely/never referring mothers to lactation consultants. After adjustment, both being a female pediatrician and having done the residency in Lebanon were significant predictors of better knowledge (OR = 4.51 (95%CI: 1.72-11.85) and OR = 3.93 (95%CI: 1.38,11.19) respectively. CONCLUSION: This study revealed important gaps in the KAP related to BF support among Lebanese pediatricians. Coordinated efforts ought to be exerted to educate and equip pediatricians with needed knowledge and skills to support BF.
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Lactancia Materna , Conocimientos, Actitudes y Práctica en Salud , Pediatras , Femenino , Humanos , Lactante , Líbano , MadresRESUMEN
Background: Obstetric violence (OV) threatens the provision of dignified, rights-based, high-quality, and respectful maternal care (RMC). The dearth of evidence on OV in the Eastern Mediterranean Region poses a knowledge gap requiring research to improve rights-based and respectful health practice and policy. While efforts to improve the quality of maternal health have long-existed, women's experiences of childbirth and perceptions of dignity and respect are not adequately or systematically recorded, especially in the said region. Aim: This study centered on the experiences of women's mistreatment in childbirth to provide an overview of OV and offer recommendations to improve RMC. Methods: A scoping review was conducted, and a total of 38 articles met the inclusion criteria and were analyzed using Bowser and Hill's framework of the seven typologies of Disrespect and Abuse (D&A) in childbirth. D&A in childbirth (or violations to RMC) is a manifestation of OV and served as a proxy to analyze its prevalence in the EMR. Findings and Discussion: This study indicated that across the EMR, women experienced every type of D&A in childbirth. This happens regardless of health systems' strength or country's income, with 6 out of 7 types of D&A found in almost two-thirds of included countries. In the EMR, the most common types of D&A in childbirth are physical abuse (especially overused routine interventions) and non-dignified care (embedded in patriarchal socio-cultural norms). The intersections of these abuses enable the objectification of women's bodies and overuse of unconsented routine interventions in a hierarchical and patriarchal system that regards the power and autonomy of doctors above birthing women. If unchecked, the implications include acceptance, continuation, and underreporting of D&A in childbirth, as well as passivity toward human-rights violations, which all further cause the continuing the cycle of OV. Conclusion: In order to eliminate OV, a paradigm shift is required involving infrastructure changes, education, empowerment, advocacy, a women-centered and gender-sensitive approach to health system strengthening, and policy development. Recommendations are given at individual, community, health systems, and policy levels to ensure that every woman achieves her right to health and birth in a dignified, respectful, and empowered manner.
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OBJECTIVE: To compare the burden and causes of maternal deaths between Syrian and Lebanese women for the period of 2010-2018. METHODS: A retrospective analysis was conducted of maternal deaths from the national notification system at the Ministry of Public Health in Lebanon during the period of 2010-2018. Maternal deaths among Syrian refugees and Lebanese citizens were compared based on cause of death, age of the woman, and nationality. Causes of maternal deaths were categorized as direct and indirect following WHO definitions. RESULTS: The maternal mortality ratio among the Syrian refugee women in Lebanon was higher than that of Lebanese women in the period 2010-2018, with its highest rate of 55.1 in 2017. Hemorrhage and indirect causes of maternal deaths are more common among Syrian refugee women whereas embolism and hypertension have higher proportions among Lebanese women. Maternal deaths within 48 h after birth are more common among Syrian than Lebanese women. CONCLUSION: Syrian refugee women carry an increased risk for maternal mortality in Lebanon. Improving timely access and equitable provision of appropriate care should be a priority for the health system in Lebanon.
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Muerte Materna , Refugiados , Femenino , Humanos , Líbano/epidemiología , Mortalidad Materna , Estudios Retrospectivos , SiriaRESUMEN
We present the design, implementation, and evaluation of an e-service learning course, "Social Marketing for Health Promotion", offered to full-time and part-time students enrolled in the Master of Public Health at our institution. In a quasi-experimental trial, we introduced e-service learning in 2018, comparing a traditional face-to-face section to a blended course (33% online). Based on the positive feedback received, we progressively increased the online component in the following academic years, reaching 100% online in Fall 2020. We compared the quantitative and qualitative indicators evaluating three e-service learning-course iterations with a face-to-face control. The impact indicators included participation and engagement in the course, the attainment of the learning outcomes, satisfaction with the course, instructors and mode of delivery, and the impact of the experience beyond the classroom. Over the years, we trained 73 students whose engagement with the course remained relatively stable. The attainment of the learning outcomes and general course satisfaction steadily increased over time, demonstrating a positive impact on student learning. Qualitative data illustrate the importance of instructors in setting expectations and guiding students and community partners through a remote-learning process.
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Sistemas de Socorro , Mercadeo Social , Humanos , Aprendizaje , Líbano , Estudiantes , EnseñanzaRESUMEN
As the demand for dissemination and implementation (D&I) research grows globally, there is a need for D&I capacity building in regions where D&I science is underrepresented. The Workshop on Dissemination and Implementation Research in Health (WONDIRH) was aimed for participants in the Eastern Mediterranean region to (1) appreciate the complex process of bridging research and practice in a variety of real-world settings, and (2) develop research that balances rigor with relevance and employs study designs and methods appropriate for the complex processes involved in D&I. The present exploratory study investigates participants' satisfaction with the workshop, the enhancement of their self-rated confidence in D&I skills, as well as their intention to apply the learned content into practice. The workshop included four weekly 90-min virtual interactive training sessions in conjunction with open access content from the National Cancer Institute Training Institute in Implementation and Dissemination Research in Cancer (TIDIRC). We applied a one-group pre-post design for the evaluation of workshop. Participants were invited to self-rate their confidence in D&I competencies (15 items, pre and post workshop). At the end of the workshop, participants additionally were asked to rate their satisfaction (5 items, 1-5 scales), and their intention to apply the learned content into practice (4 items, 1-5 scales). Of the 77 workshop participants, 34 completed the evaluation. Confidence improved between pre- and post-workshop assessments in all 15 self-rated D&I competencies. Respondents were generally satisfied with the workshop (mean satisfaction range 3.82-4.26 across the 5 items) and endorsed intentions to apply workshop topics (mean intention range 4.03-4.35 across the 4 items). This initial workshop demonstrated the ability to attract and engage participants to enhance their confidence in D&I research competencies and skills and to build capacity in D&I research. Future efforts should consider offering targeted training for researchers at different stages and to clearly articulate learning objectives. Supplementary Information: The online version contains supplementary material available at 10.1007/s43477-022-00067-y.
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With the far-reaching COVID-19 pandemic starting in December 2019, a surge of misinformation, now coined by the World Health Organization (WHO) as an 'infodemic', has also taken the world by storm. False information and variations in interpretations about the pandemic and mitigation interventions/strategies continue to spread at a faster pace than the relevant scientific evidence. The WHO has called for a fight against this infodemic, describing it as the most contagious aspect of the pandemic. In this era of rapid information exchange, public health measures, and state interventions to control the pandemic, a contextual understanding of how information is communicated and shared is important for uncovering possible reasons for action or inaction by the general public. With the Lebanese state scrambling to implement and enforce different measures to control and mitigate the spread of COVID-19, adherence by the general public is not uniform. In this paper, we refer to social science and risk communication theory to discuss how the political, economic and social contexts in the country, and not only the content of the messages that people receive from officials, affect how they interpret and act on information. We highlight how this has played out in Lebanon and identify societal aspects of importance in a low-middle income country fraught with social, economic and political inequalities which continue to undermine the efforts to contain the spread. Implications to inform state response in the context of low-middle income countries are also discussed.
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COVID-19 , Comunicación , Información de Salud al Consumidor , Medio Social , Factores Socioeconómicos , COVID-19/prevención & control , Humanos , LíbanoRESUMEN
OBJECTIVE: To examine trends and variations of caesarean section by economic status and type of healthcare facility in Arab countries in the Middle East and North Africa (MENA). METHODS: Secondary data analysis of nationally representative household surveys conducted between 2008-2020 across nine Arab countries in the MENA region. The study population was women aged 15-49 years with a live birth in the two years preceding the survey. Temporal changes in the proportion of deliveries by caesarean section in each country were calculated using generalised linear models and presented as risk differences (RD) with 95% confidence intervals (95%CI). Caesarean section was disaggregated by household wealth index and type of healthcare facility. RESULTS: Use of caesarean section ranged from 57.3% (95%CI:55.6-59.1%) in Egypt to 5.7% of births (95%CI:4.9-6.6%) in Yemen. Overall, the use of caesarean section has increased across the MENA region, except in Jordan, where there was no evidence of change (RD -2.3 (95%CI: -6.0 â1.4)). Across most countries, caesarean section use was highest in the richest quintile compared to the poorest quintile, for example, 42.8% (95%CI:38.0-47.6%) vs. 22.6% (95%CI:19.6-25.9%) in Iraq, respectively. Proportion of caesarean section was higher in private sector facilities compared to public sector: 21.8% (95%CI:18.2-25.9%) vs. 15.7% (95%CI:13.3-18.4%) in Yemen, respectively. CONCLUSION: Variations in caesarean section exist within and between Arab countries, and it was more commonly used amongst the richest quintiles and in private healthcare facilities. The private sector has a prominent role in observed trends. Urgent policies and interventions are required to address non-medically indicated intervention.
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Cesárea/estadística & datos numéricos , África del Norte , Intervalos de Confianza , Estudios Transversales , Femenino , Humanos , Embarazo , Sector Privado/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
Lebanon invested in the prevention of maternal mortality after the civil war, which left a deficient vital registration system leading to unreliable estimates of maternal mortality ratio (MMR). Starting in 2004, the Ministry of Public Health integrated reproductive health into primary health care and established a national notification system of maternal and neonatal deaths. From 1990 to 2013, Lebanon achieved an annual change in MMR of -7.5%, which was the highest rate of reduction in the region and met the requirements of Millennium Development Goal 5. For the period 2010-2018, data collected through the national notification system indicate an MMR of 14.9, which is below the officially reported MMR of 23. Since the influx of Syrian refugees, Lebanon has experienced a rise in the number of live births with a slightly increasing trend in MMR, especially in regions with the highest concentration of refugees. Causes of maternal mortality in Lebanon align with the three-delays model, pointing to deficiencies in the quality of maternity care. More efforts are needed toward strengthening the national notification system to include cases that occur outside hospitals, identifying near-miss cases, reinforcing the emergency response system, and engaging with all stakeholders to improve quality of care.