Perception of genital prolapse: a hospital-based study in Alexandria (Part II).

Genital prolapse is a common health problem, understanding women's perceptions and beliefs may illuminate our understanding of their health seeking behavior which form a first step in any effort to improve their health. The present study was designed to investigate the perception of genital prolapse among women attending the outpatient clinic in El-Shatby Maternity University Hospital in Alexandria. Data was collected from a sample of 291 women who had any form of genital prolapse. Women's knowledge about risk factors for genital prolapse, women's beliefs related to genital prolapse as well as their beliefs about assistance at delivery (beliefs were assessed through the Health Belief Model) were measured for women who knew that they were suffering of genital prolapse (n = 40). The results revealed that more than two thirds of cases (70.4%) had poor (36.4%) or fair knowledge (34%) and only 29.6% had satisfactory knowledge. The majority of women having positive perception to diagnosis and symptoms for genital prolapse had high perception of "susceptibility" to and "severity" of complications of genital prolapse (97.5% and 85% respectively). More than two thirds (67.5%) had high scores of "perceived benefits" of treatment and medical advice, while nearly one third (32.5%) scored moderate. The majority of women (82.5%) had either moderate scores (55%) or high scores (27.5%) of perceived barriers to compliance to medical instructions or recommended surgery. About two thirds of cases (65.6%) sought medical care later than one year of perception of symptoms. Women's knowledge and degree of genital prolapse were directly related to women's report of symptoms characteristic of prolapse, while the level of education was inversely related. Health education for women on different aspects of reproduction using appropriate materials is highly recommended.

Antepartum and postpartum depression and infant feeding pattern: a prospective study.

Mother's depression during pregnancy and postpartum is a risk factor that can adversely affect mother's relationship with her infant. As breast feeding is an important situation for early mother-child interaction the effect of mother's depression on her breast feeding attitude and practice was decided to be studied prospectively. In this study, 158 primigravidae attending antenatal clinics in two MCH centres were interviewed at third trimester. The interview data covered social background, attitudes to breast feeding as well as self rating of depression using the Edinburgh Postnatal Depression Scale (EPDS). At postnatal interview 72 mother-infant pairs could be reached between 6-16 weeks after birth. They were subjected again to EPDS along with inquiry about type of infant feeding and breast feeding practices. Findings revealed that the prevalence of antepartum depression was 25.32%. Antepartum depression was significantly linked to postpartum depression and negative attitudes to breast feeding. Persistent maternal depression (ante- and postpartum) was a risk factor for early resorting to mixed infant feeding, retarded infant growth as well as some adverse maternal and infant health outcomes. Logistic analysis indicated that negative mothers' attitudes to breast feeding and postpartum depressive scores taken together predicted mixed infant feeding. Hence, preventive programs should be directed specifically towards modifying the mother's psychological status and her attitude on behalf of her infant.

Construction of a local standard symphysis fundal height curves for monitoring intrauterine fetal growth.

The aim of the present study was to construct standard symphysis fundal height percentile curves to be used as a reference chart in monitoring fetal growth. The construction was based on 1185 observations (symphysis fundal height measured to the nearest 0.5 cm by a malleable elastic tape) obtained from follow up of 105 cases of healthy pregnant women who were: sure of date of their last menstrual period, confirmed by early dating scan "before 20th gestational week", experienced a very strict normal course of pregnancy, giving birth to normal term newborn with appropriate weight for gestational age and sex. The selection of the study sample went through several screening levels starting by 4088 cases and ending by 105 cases. The measurements were taken biweekly from the 18th week of gestation to delivery "37-42 weeks of gestation." Tenth, 25th, 50th, 75th, 90th and 95th percentiles were calculated and represented graphically. Mean, mean-1 SD, mean-2 SD, mean +1 SD, mean + 2 SD were also calculated and represented graphically. The curve of best fit was determined by polynominal regression. The resulted percentile curves and mean values were found to be comparable to those in both developed and developing countries. It was recommended to incorporate the reference charts of symphysis fundal height into the maternity services after using it in routine antenatal examination for large number of cases and establishing its sensitivity and specificity.

A prospective study of morbidity pattern and nutritional status of a group of healthy newborns during their first year of life in a rural area near Alexandria.

The present work was planned to study morbidity pattern and nutritional status of a group of healthy new borns in a rural area near Alexandria (Abbis II, VIII villages) through a prospective follow up approach. Eighty two infants were followed up for 12 months. Each infant was subjected to 15 visits within the first year of life. Morbidity was recorded either from mother's history, records from rural health centres or detected by the researcher and expressed as morbidity risk exposures based on a tested scoring system. Anthropometric standards issued by WHO were used to classify the children's length for age, weight for age and weight for length in terms of a cut off point of 2 SD below the median of that of the reference. Gomez classification was used to diagnose undernutrition and Waterlow system was used to diagnose growth stunting. Socioeconomic status of infants' families was also assessed. Results indicated a high prevalence of morbidity risk exposure, growth retardation and under nutrition with a tendency for gradual increase towards the end of the follow up. The results also proved that diarrheal diseases were still the most common illness among infants followed by respiratory tract infections. Investigation of the effects of socioeconomic status on morbidity risk exposure proved its significance at the end of the follow up. The results also illustrated a significant effect of morbidity risk exposure on the nutritional status at the end of the first year.

PIP: Health workers visited 82 healthy newborns in 2 villages near Alexandria, Egypt 15 times during their 1st year of life. The morbidity pattern, the nutritional status, and the morbidity pattern's effect on the nutritional status of the infants were studied. At the end of 1 year, 40.24% of the children had diarrhea. The mean annual number of diarrheal episodes was 4.3%. Poor environmental sanitation and the presence of animals and birds in and around the infants homes probably contributed to the high prevalence of diarrhea. 35.37% had either an upper or lower respiratory tract infection at the end of follow up. The mean annual number of respiratory infections stood at 2.2. Skin disease was the 3rd most common disease during the 1st year particularly during the 1st 3 quarters (14.13%, 12.36%, and 11.91%). Eye disease especially conjunctivitis were the 4th most common diseases among these children, especially during the 3rd quarter (13.10). The only infectious disease was measles which afflicted only 3.66% of the infants. None of the infants from high middle socioeconomic households were considered at high morbidity risk exposure. Almost all (93.33%) of these infants were at low morbidity and low average risk exposures. 24.39% of infants from low socioeconomic households were at high morbidity risk exposure, however. The percentage of infants growing normally decreased over time. For example, at the 1st quarter, 91.3% grew normally and by the 4th quarter this decreased to 57.32%. By 1 year almost 1.5 were either stunted or wasted and 3.66% were both stunted and wasted. an association existed between morbidity and nutritional status of the infants. Children with high morbidity scores were also the children suffering from the most severe malnutrition. Health workers should encourage mothers to use child health services at the rural health centers. They also should use growth charts to monitor infant and child growth.

Malnutrition among children 6-24 months attending MCH centres in Alexandria an epidemiologic study. Part I: Prevalence.

A cross-sectional nutritional survey of children aged 6-24 months (weaning period) attending MCH centres in Alexandria governorate through the year 1988-1989 was conducted with the aim of determining the prevalence of protein calorie malnutrition. The sample size was 1000 children chosen from 6 MCH centres in Alexandria (one centre for each zone). The sample was distributed along the six centres in proportion to the total number of infants recorded to have attended those centres through 1985. The centres were visited during the period starting November 1988 through June 1989. Each centre continued to be visited until the number decided to be included was completed. The study included the determination of age and the measurement of height and weight. Anthropometric standards issued by WHO were used to classify the children's length for age, weight for age, and weight for length in terms of a cut off point of 2 SD below the median of that of reference (Waterlow system). Gomez classification using weight/age as a parameter was used to diagnose undernutrition. The results of the study revealed a prevalence rate of undernutrition of 25.6% which was mostly of the first degree as expressed by Gomez categories. When expressed using waterlow system a prevalence of stunting of 29.7% was observed while wasting was observed in only 0.7% and concurrent wasting and stunting constituted 0.1%. These results were considered to be relatively lower in comparison to earlier similar studies. It was thus recommended that similar surveys for preschool age children in Alexandria and other regions of Egypt would be valuable.

Screening of high risk pregnancy among mothers attending MCH centers in Alexandria.

A cross-sectional study was carried out on a sample of 900 pregnant women attending MCH centers in Alexandria to determine the incidence of high risk pregnancy and to demonstrate the common risk factors among them. The simplified scoring system developed by Morrison and Olsen (1979) was used. Mothers with scores 0-2 were considered at low risk those with score 3 and more were categorised as high risk. Results revealed that high risk women constituted 27.78% of the sample. Twenty three risk factors were identified among all pregnant women screened. The most frequently encountered were anaemia (37.33%), age 35+ (15.66%), parity 5+ (16.66%), previous gynecological surgery (8.88%) and history of previous stillbirth or neonatal death (6.11%). The mean number of risk factors in the low risk group was 0.95 compared to 3.03 in the high risk group. Stepwise regression analysis indicated that the reproductive history score was the best one variable predictor of total risk score explaining about 74% of the variation in the total score while the present history score explained a further 16% of the variation and the associated conditions score explained 9% only of the variation. The use of scoring technique is recommended to be used in identification of high risk pregnant women in MCH centers.

PIP: Data on 900 pregnant women attending 4 maternal and child health (MCH) centers in Alexandria, Egypt between June-August 1989 were analyzed to screen for high risk pregnancies and identify common risk factors among these pregnancies. The Morrison and Olsen scoring system revealed high or extreme risk pregnancy in 27.78% of the women. Women in the low risk group had a mean of 0.95 risk factors. Women in the high risk group had a mode of 2 risk factors and a mean of 3.03. The most frequent combination of 3 risk factors were maternal age of at least 35, parity =or 5, and anemia. Total scores ranged form 0 to 14. Among women of the high risk group, 49.6% received scores of 3-4, 28% of 5-6, and 22.3% of =or 7. The mean total risk score for the low risk group was 1.03 compared with 5.25 for the high risk group. The most common risk factors in order of frequency were anemia (37.33%), parity =or 5 (16.66%), maternal age of at least 35 (15.66%), previous gynecologic surgery (8.88%), and history of stillbirth or neonatal mortality (6.11%). All of these risk factors except anemia occurred significantly more often in the high risk group than in the low risk group. Reproductive history accounted for 74% of the variation in the total risk score. Present pregnancy score and associated conditions accounted for 16% and 9% respectively. It is suggested that health workers use a scoring system to screen pregnant women attending antenatal clinics. They should also learn how to identify and manage high risk pregnancies. Trained personnel should design and distribute uniform records for assessment of high risk pregnancy to all primary health care units with antenatal services. Each MCH center should register perinatal deaths so health workers can use the data to make antenatal diagnoses and determine care.

Knowledge about menstruation and practices of nursing students affiliated to University of Alexandria.

All secondary school nursing students enrolled in the Main University Hospital during the scholastic year 1987-1988 were studied for knowledge and practices related to menstruation. Over 85% of the students were acquainted with age of menarche, length of the menstrual cycle, and duration of menstrual bleeding. Only 71.54% gave correct answers about age of menstrual cessation. Students' practices revealed that one quarter of the sample avoid bathing during their bleeding period. About two thirds of the students stated that they use 3-8 sanitary pads per day. First year students significantly used less pads than those at higher grades. Menstrual pains and fear of bleeding were the causes of absenteeism from school among 37.62% of the sample. The higher the grade the more likely that the student carries out her normal daily activities without any difficulties. The main source of knowledge on the topic was the mother. The nursing school education was not mentioned except by minority of students in relation to menstrual hygiene.

Biochemical studies on the effect of breast and artificial feeding in newborn Egyptian infants. I. Serum proteins and immunoglobulins in 1--4-day-old newborns.

Investigations on the effect of colostrum feeding in 1--4-day-old newborn infants on serum proteins and their immunoglobulins were carried out. The values for serum total proteins, albumin and gamma globulins are higher in colostrum-fed infants than the artificially fed group. Immunoglobulin G and immunoglobulin A levels were significantly higher, while immunoglobulin M level was only slightly elevated in the former group. On the other hand, serum total proteins as well as albumin and gamma globulins levels were decreased in lactating compared with non-lactating females, while the alpha and beta globulins levels were higher for lactating than controls. For individual immunoglobulins; IgG level was lower and IgA, IgM levels were higher for lactating than non-lactating females.