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1.
Artigo em Inglês | MEDLINE | ID: mdl-33179265

RESUMO

INTRODUCTION: We aimed to give a global overview of trends in access to sexual and reproductive health and rights (SRHR) during the coronavirus disease 2019 (COVID-19) pandemic and what is being done to mitigate its impact. MATERIAL AND METHODS: We performed a descriptive analysis and content analysis based on an online survey among clinicians, researchers, and organizations. Our data were extracted from multiple-choice questions on access to SRHR services and risk of SRHR violations, and written responses to open-ended questions on threats to access and required response. RESULTS: The survey was answered by 51 people representing 29 countries. Eighty-six percent reported that access to contraceptive services was less or much less because of COVID-19, corresponding figures for surgical and medical abortion were 62% and 46%. The increased risk of gender-based and sexual violence was assessed as moderate or severe by 79%. Among countries with mildly restrictive abortion policies, 69% had implemented changes to facilitate access to abortion during the pandemic, compared with none among countries with severe restrictions (P < .001), 87.5% compared with 46% had implemented changes to facilitate access to contraception (P = .023). The content analysis showed that (a) prioritizations in health service delivery at the expense of SRHR, (b) lack of political will, (c) the detrimental effect of lockdown, and (d) the suspension of sexual education, were threats to SRHR access (theme 1). Requirements to mitigate these threats (theme 2) were (a) political will and support of universal access to SRH services, (b) the sensitization of providers, (c) free public transport, and (d) physical protective equipment. A contrasting third theme was the state of exception of the COVID-19 pandemic as a window of opportunity to push forward women's health and rights. CONCLUSIONS: Many countries have seen decreased access to and increased violations of SRHR during the COVID-19 pandemic. Countries with severe restrictions on abortion seem less likely to have implemented changes to SRHR delivery to mitigate this impact. Political will to support the advancement of SRHR is often lacking, which is fundamental to ensuring both continued access and, in a minority of cases, the solidification of gains made to SRHR during the pandemic.

3.
Int J Gynaecol Obstet ; 149(1): 113-119, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32012258

RESUMO

Ensuring universal access to sexual and reproductive healthcare services is Target 3.7 of the United Nations Sustainable Development Goals (SDG). Refugee and migrant women and children are at particular risk of being forgotten in the global momentum to achieve this target. In this article we discuss the violations of sexual and reproductive health and rights (SRHR) of particular relevance to the refugee and migrant reality. We give context-specific examples of denial of health services to vulnerable groups; lack of dignity as a barrier to care; the vulnerability of adolescents; child marriage; weaponized rape; gender-based violence; and sexual trafficking. We discuss rights frameworks and models that are being used in response to these situations, as well as what remains to be done. Specifically, we call for obstetricians and gynecologists to act as individual providers and through their FIGO member societies to protect women's health and rights in these exposed settings.


Assuntos
Refugiados , Saúde Reprodutiva/normas , Direitos Sexuais e Reprodutivos/normas , Migrantes , Adolescente , Adulto , Criança , Feminino , Saúde Global , Ginecologia/normas , Humanos , Cooperação Internacional , Obstetrícia/normas , Saúde Sexual/normas , Desenvolvimento Sustentável , Saúde da Mulher
4.
Int J Gynaecol Obstet ; 148(1): 14-20, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31596955

RESUMO

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.


Assuntos
Mortalidade Materna , Feminino , Humanos , Líbano/epidemiologia , Nascimento Vivo/epidemiologia , Gravidez , Refugiados/estatística & dados numéricos
5.
Hum Vaccin Immunother ; 14(6): 1501-1508, 2018 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-29461912

RESUMO

We designed our study to evaluate the knowledge and immunization practices among Lebanese obstetricians and gynecologists (OBGYN) for women of different age groups. Anonymous questionnaires were used to assess the knowledge and immunization practices among OBGYN. The survey was conducted at the annual meeting of the Lebanese Society of Obstetrics and Gynecology on November 13-15, 2014. Data collected included demographics, type of practice, academic background and familiarity with vaccine guidelines. Descriptive statistical methods were used to evaluate the responses. The response rate was 54.8% (114/208). Only 62.3% (71/114) recommend vaccination(s) to pregnant women with only 25.9% of those who recommend the Tdap vaccine for pregnant women giving it during the recommended third trimester. In addition, 52.6% are unaware of the CDC/ACIP immunization schedule for women in general. However, 83.0% (93/112) of respondents are willing to integrate vaccination in their practice. Our study highlights several gaps in the knowledge of Lebanese OBGYN regarding vaccination in addition to practices that are not in full accordance with common guidelines. Measures should be taken to spread proper awareness of the proper guidelines among Lebanese practitioners.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde/psicologia , Imunização/psicologia , Competência Profissional , Adolescente , Adulto , Feminino , Ginecologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Líbano , Pessoa de Meia-Idade , Obstetrícia , Inquéritos e Questionários , Adulto Jovem
6.
Int J Gynaecol Obstet ; 139(2): 155-163, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28755518

RESUMO

OBJECTIVE: To investigate associations between hymen protection and women's alternative sexual practices, perceptions, and attitudes. METHODS: A cross-sectional online survey was administered among university students (aged 18-30 years) in Lebanon between April 30 and August 31, 2012. The present analysis focused on female students who had engaged in oral/anal sex. RESULTS: Among 416 included women, 163 (39.3%) reported anal/oral sex to protect their hymen. Women ever concerned with hymen protection were less likely to be non-Lebanese and not religious/spiritual, but more likely to report unwanted sexual activities, a relationship in which they felt things were moving too fast physically, and to feel guilty about sexual feelings (all P<0.01). They were two-to-three times more likely to agree that it is harder to refuse sex after the first time and that oral sex is not as big of a deal as sexual intercourse (both P<0.001). Concerned women who later engaged in vaginal sex (n=75) were less religious and more accepting of premarital sex than were those who continued to protect their hymen (n=88; all P<0.005). CONCLUSION: Women concerned about hymen-breaking engage in alternative sexual practices, yet experience pressure, guilt, worry, and indecisiveness regarding their sex-related decisions. The navigation of sexual decisions is a more vulnerable process for these women because of prevailing patriarchal values and discriminating gender norms in Lebanon.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Hímen , Comportamento Sexual , Estudantes/psicologia , Adolescente , Estudos Transversais , Feminino , Humanos , Líbano , Inquéritos e Questionários , Universidades , Saúde da Mulher , Adulto Jovem
7.
J Med Liban ; 64(4): 205-10, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29845845

RESUMO

Background: The taboo surrounding reproductive and sexual health in the Middle East and North African (MENA) region, specifically among unmarried youth, has resulted in an incomplete and inaccurate documentation of the status of youth sexual and reproductive health (SRH). Documenting regional research processes and successes can support SRH researchers in promoting evidence-based services and local policies. This paper describes the process, challenges and lessons learned during the first online research study in the MENA to assess university students' sexual practices, values and perceptions. Methods: An online survey was completed by 2,182 university students attending the 4th largest private university in Lebanon. Results: An online SRH survey among Arab youth must be carefully developed with the cultural context and its prevailing issues in mind. Careful attention must be paid to any translation process specifically regarding tone and choice of certain sexual terms. The online program/software must be thoroughly piloted for possible technical flaws, language support, and web browser compatibility. Inter-disciplinary collaboration between the research team, IT and IRB offices is crucial in order to conduct an ethicallyappropriate technically-functional online survey. Conclusion: Online survey methods hold great promise for surveying SRH and other sensitive topics in Lebanon and the MENA.


Assuntos
Comportamento Sexual/estatística & dados numéricos , Sexualidade/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Adolescente , Adulto , Árabes , Feminino , Humanos , Internet , Líbano , Masculino , Projetos de Pesquisa , Universidades , Adulto Jovem
8.
Sex Reprod Healthc ; 6(1): 44-7, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25637425

RESUMO

OBJECTIVE: This study examines the association of the reporting of pain during intercourse in the postpartum period with mode of delivery, and describes women's reports of pain during intercourse and their health care seeking behavior over a period of 40 days-6 months postpartum. METHODS: A cross-sectional study recruited women in their 2nd and 3rd trimester of pregnancy from private obstetric clinics affiliated with 18 hospitals in two regions of Lebanon. Face-to-face interviews using a structured questionnaire were conducted at the women's homes from 40 days to 6 months postpartum. Verbal, informed consent was obtained from all women participating in the study before the interview. RESULTS: In a sample of 238 women, 67% reported experiencing pain during intercourse postpartum and 72.3% did not seek care. Women having a cesarean delivery (1.96; CI (1.29-2.63)), who were primiparous (OR=2.44; CI (2.05-2.83)) and residing in the Mount Lebanon region (OR=1.25; CI (1.09-1.40)) were significantly more likely to report pain during intercourse postpartum. CONCLUSIONS: Cesarean births may increase the chances of reporting of pain during intercourse postpartum among primiparous women. Given that the increasing cesarean section rates worldwide are perceived to be protective of women's sexual health, prenatal and postpartum care need to address women's sexual health problems.


Assuntos
Cesárea/efeitos adversos , Coito/psicologia , Dispareunia/etiologia , Dispareunia/psicologia , Período Pós-Parto/psicologia , Comportamento Sexual/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Líbano , Percepção da Dor , Gravidez , Parceiros Sexuais/psicologia , Saúde da Mulher , Adulto Jovem
9.
Asia Pac J Public Health ; 27(2): NP734-45, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22186399

RESUMO

This article assesses the association of women's HIV/AIDS knowledge of transmission and prevention with socioeconomic status (SES). Data from the 2004 Lebanese PAPFAM (Pan-Arab Project for Family Health) survey were used. The survey was based on a representative household sample (n = 5532 households; n = 3315 women) of ever-married women aged 15 to 55 years. Adjusted analysis revolved around multivariate logistic regression models. 18% of women were knowledgeable of HIV/AIDS transmission methods and 21% of prevention methods. Income and education were significantly related to women's transmission and prevention knowledge. Significant differences were also found by region and media exposure. Women in the richest income quintile were 4 times (95% confidence interval [CI] = 2.43-6.42) more likely to be knowledgeable than those in the poorest. Women with the highest education were 2.57 times more likely (95% CI = 1.98-3.34) to be knowledgeable than those with elementary education or less. These results suggest the need for incorporating contextual regional and population differences for more effective HIV/AIDS awareness campaigns in Lebanon.


Assuntos
Síndrome de Imunodeficiência Adquirida/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Classe Social , Adolescente , Adulto , Doenças Transmissíveis , Saúde da Família , Feminino , Inquéritos Epidemiológicos , Humanos , Renda , Conhecimento , Líbano , Modelos Logísticos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem
10.
Cult Health Sex ; 17(5): 555-75, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25391022

RESUMO

This study aimed to investigate gender differences in reasoning influencing the postponing of sexual debut among university youth in Lebanon. Findings aimed to develop understandings that might help inform future research on, and programme implementation of, young people's reproductive and sexual health. A cross-sectional survey of sexuality and sexual practices, attitudes and perceptions was conducted among private university students in Lebanon using a secure online method. Of 1838 participating students, 48.7% indicated they had never engaged in oral, anal or vaginal sex (i.e., penetrative sexual activity) during their lifetime (n =  895). Common socio-cultural concerns regarding sexual initiation included: gaining a bad reputation (47%), social rejection (58%), religion (70%) and parental disapproval (61%). Women were four times more concerned than men regarding loss of reputation and self-respect, six times more so regarding parental disapproval and three times more likely to be concerned with societal disapproval. Intrapersonal concerns included fear of contradicting one's own beliefs (67%), feeling guilty afterwards (62%) and losing self-respect (55%). Women were four times more likely to feel loss of self-respect and six times more likely to think sex was disgusting. Underlying reasons for postponing sexual intercourse are linked to adopted fears and social pressures that are internalised, and reinforce existing gender inequalities and reaffirm discriminatory gender norms.


Assuntos
Atitude , Religião e Sexo , Abstinência Sexual , Comportamento Sexual , Estigma Social , Estudantes/psicologia , Universidades , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Líbano , Masculino , Pais , Percepção , Fatores Sexuais , Valores Sociais , Inquéritos e Questionários , Adulto Jovem
11.
BMC Public Health ; 14: 671, 2014 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-24981921

RESUMO

BACKGROUND: Sexual activity accompanied by substance use can impair youth decision-making and enhance risk-taking behaviors. Less is known, however, about the sexual values, perceptions and subsequent sexual practices of youth whose sexual debut occurs while using alcohol/drugs. METHODS: A cross-sectional anonymous online survey was conducted in April-August 2012 among undergraduate and graduate university students (aged 18 to 30) attending the 4th largest private university in Beirut. Pearson's Chi-square and regression models were run using Stata/IC 10.0. RESULTS: 940 university students had engaged in oral, anal and/or vaginal sex, of whom 10% admitted to having had consumed alcohol or taken drugs at sexual debut, a behavior that was more common in the males, less religious, non-Arabs, students living alone or who had lived abroad. Students who used alcohol/drugs at sexual debut were twice as likely to have: their first oral and vaginal sex with an unfamiliar partner [odds ratio (OR) = 2.6, 95% confidence interval (CI): (1.6, 4.2) and OR = 2.1 (1.2, 3.5), respectively], controlling for sex, nationality, current relationship status, living abroad after the age of 12, and spirituality. Students who had sex the first time while using alcohol/drugs were three times as likely to report having had 11 or more subsequent sexual partners versus one or two [OR = 3.0 (1.5-6.0)]; and almost twice as likely to ever engage in something sexual they did not want to do [OR = 1.7 (1.1, 2.8)]. Perceived peer pressure to have sex by a certain age [OR = 1.8 (1.1, 2.9)], and perceived peer norms to consume alcohol/drugs before sex [OR = 4.8 (2.3, 9.9)] were also strong correlates of having sex for the first time while using alcohol and/or drugs. CONCLUSIONS: Findings stress the importance of sexuality education for youth, and the need to begin understanding the true interplay--beyond association--between youth sexual practices and substance use behaviors from a broader public health perspective.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Adulto , Intervalos de Confiança , Estudos Transversais , Feminino , Humanos , Líbano/epidemiologia , Masculino , Razão de Chances , Fatores de Risco , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Estudantes , Inquéritos e Questionários , Universidades , Adulto Jovem
12.
Ethn Health ; 19(5): 529-47, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24219619

RESUMO

OBJECTIVE: Fertility and consanguineous marriages among the Bedouin tribes of the Middle East have long generated interest particularly around health outcomes and social relations. In particular, Bedouin in Lebanon have increasingly embraced the Lebanese national bio-medical health system in the past two decades, while Lebanese policy-makers' responses continue to be minimal and ill-informed. This paper investigates the mismatch between policy-makers' formulations of Bedouin consanguineous marriages and the Bedouins's actual reproductive practices and discusses the implications of these formulations on the Bedouins's access to health services. DESIGN: The findings are drawn from the data collected as part of the Bedouin Health Project, an EU-funded five-year study (2005-2010), aiming at assessing access to reproductive and child health care among the Bedouin in Lebanon. The data was collected from 6 clusters representing the main Bedouin informal and unrecognized settlements in the Bekaa Valley of Lebanon. The data consists of 111 socioeconomic questionnaires with Bedouin women users of local public, private, and nongovernmental reproductive and child health-focused clinics, in addition to 40 in-depth interviews with Bedouin women across the clusters and 17 semi-structured interviews with policy-makers. RESULTS: The findings suggest a gap between the perceptions of policy-makers and the incidence of consanguineous marriages and reproductive practices among the Bedouin. While there was no national data available for the Bedouin populations, policy-makers relied on a constructed 'Bedouin reproductive profile' that portrayed them as 'a problematic health group'. The national policy formulation of the Bedouin reproductive profile has an exclusionary impact on the Bedouin population as they are ignored from any targeted health policies or provided with politically motivated palliative care provision. CONCLUSION: These findings highlight the importance of addressing stereotyping and discrimination among health practitioners and policy-makers, as a crucial part of improving the overall marriage and reproductive health practices of the Bedouin.


Assuntos
Árabes , Consanguinidade , Família/etnologia , Política de Saúde , Casamento/etnologia , Saúde Reprodutiva/etnologia , Adolescente , Adulto , Atitude , Feminino , Humanos , Entrevistas como Assunto , Líbano , Masculino , Pessoa de Meia-Idade , Racismo , Inquéritos e Questionários , Adulto Jovem
13.
Vaccine ; 31 Suppl 6: G45-50, 2013 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-24331819

RESUMO

The extended Middle East and North Africa (EMENA) region is the world region with the second youngest population, where globalization, migration, information technology, and political changes are contributing to the shaping of sexuality and sexual behaviors. Understanding the various sociocultural, demographic and public health dimensions of sexual and reproductive health of young people is fundamental to understanding the pattern of sexual behavior and the burden of sexually transmitted infections (STIs), including human papillomavirus-related diseases. New norms and forms of marriage have emerged to accommodate the changing trends in sexual behavior of premarital and extra-marital sex, as well as reports of increased prevalence of premarital penetrative and non-penetrative sexual behavior. Despite these trends, the burden of sexual illnesses remains low and is estimated at 7% of the general population being infected with curable STIs. Other STIs, such as herpes simplex virus 2, are also prevalent. The existing policies and health systems remain short of promoting youth reproductive and sexual health. Efforts should address establishing national preventive programmes, such as screening for STIs, primary prevention, comprehensive sexuality education, as well as youth-friendly services. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Extended Middle East and North Africa Region" Vaccine Volume 31, Supplement 6, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.


Assuntos
Saúde Reprodutiva , Comportamento Sexual , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/prevenção & controle , África do Norte/epidemiologia , Controle de Doenças Transmissíveis/métodos , Feminino , Humanos , Masculino , Oriente Médio/epidemiologia
15.
J Empir Res Hum Res Ethics ; 8(3): 12-21, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23933772

RESUMO

Informed consent forms (ICFs) maintain the integrity of research ethics and preserve participants' rights. Using cross-sectional online survey data on sexuality and sexual practices of private university students from Lebanon, this paper questions whether participants thoroughly read ICFs, and whether time taken to read ICFs is associated with data completeness. A total of 2,534 surveys were completed; a median time of 18.66 seconds was taken to read the 815-word ICF; 65% of participants consented within the first 30 seconds and 90% in less than the minimum predicted time (2.7 minutes). Our data indicates potential participant neglect of ICFs, raising the question of whether participants who endorse an informed consent form are truly informed of the study objectives and their rights.


Assuntos
Coleta de Dados , Ética em Pesquisa , Consentimento Livre e Esclarecido , Leitura , Adolescente , Feminino , Humanos , Líbano , Masculino , Comportamento Sexual , Sexualidade , Estudantes , Universidades , Adulto Jovem
16.
Health Care Women Int ; 34(5): 352-62, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23550947

RESUMO

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.


Assuntos
Acesso aos Serviços de Saúde , Serviços de Saúde Materna/organização & administração , Obstetrícia/normas , Aceitação pelo Paciente de Cuidados de Saúde , Guerra , Adulto , Serviços Médicos de Emergência/organização & administração , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Entrevistas como Assunto , Líbano , Serviços de Saúde Materna/estatística & dados numéricos , Razão de Chances , Período Pós-Parto , Gravidez , Qualidade da Assistência à Saúde , Refugiados , Análise de Regressão , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
17.
J Infect Dev Ctries ; 6(9): 680-3, 2012 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-23000869

RESUMO

INTRODUCTION: This study aimed to identify reproductive tract infections (RTIs) in married, non-pregnant women, aged 18 to 49 years, living in a low-income suburb of Beirut, and to investigate the relationship between demographic and socioeconomic factors and these infections. METHODOLOGY: Among 1,015 women recruited for the study, 502 were found eligible and 441 were medically examined. Appropriate specimens were collected for Nisseria gonorrhea, Chlamydia trachomatis, Trichomonas vaginalis, candidiasis, and bacterial vaginosis. RESULTS: The results showed a relatively high prevalence of RTIs (28.2%). The prevalence rates of different agents were as follows: 22.9% of the women were positive for T. vaginalis, 8.8% for candidiasis, 4.5% for bacterial vaginosis, and 1% for N. gonorrhea; none of the women were positive for C. trachomatis. Regression analysis showed that women between the ages of 30 and 39 were twice more likely to have T. vaginalis as compared to younger women. Furthermore, women whose husbands were taxi drivers were at higher risk of acquiring T. vaginalis (OR = 2.2) as compared with women whose husbands occupation was listed as skilled/unskilled. This conclusion can be drawn for the odds of developing any RTI (OR = 2.15). Moreover, those participants with the lowest income were twice as likely to have any RTI compared to those with higher incomes. CONCLUSIONS: This study shows a relatively high prevalence of RTIs (T. vaginalis mainly). It urges further in-depth research on cultural practices and economic factors to understand the pattern of sexual behavior in this community.


Assuntos
Infecções do Sistema Genital/epidemiologia , Adolescente , Adulto , Candidíase Vulvovaginal/epidemiologia , Feminino , Gonorreia/epidemiologia , Humanos , Líbano/epidemiologia , Pessoa de Meia-Idade , Pobreza , Gravidez , Fatores de Risco , Cônjuges , Vaginite por Trichomonas/epidemiologia , Vaginose Bacteriana/epidemiologia , Adulto Jovem
18.
Midwifery ; 26(5): 549-57, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20691519

RESUMO

OBJECTIVE: to provide basic information on the distribution (public/private and geographically) and the nature of maternity health provision in Lebanon, including relevant health outcome data at the hospital level in order to compare key features of provision with maternal/neonatal health outcomes. DESIGN: a self-completion questionnaire was sent to private hospitals by the Syndicate of Private Hospitals in collaboration with the study team and to all public hospitals in Lebanon with a functioning maternity ward by the study team in cooperation with the Ministry of Public Health. SETTING: childbirth in an institutional setting by a trained attendant is almost universal in Lebanon and the predominant model of care is obstetrician-led rather than midwife-led. Yet due to a 15-year-old civil war and a highly privatised health sector, Lebanon lacks systematic or publically available data on the organisation, distribution and quality of maternal health services. An accreditation system for private hospitals was recently initiated to regulate the quality of hospital care in Lebanon. PARTICIPANTS: in total, 58 (out of 125 eligible) hospitals responded to the survey (46% total response rate). Only hospital-level aggregate data were collected. MEASUREMENTS: the survey addressed the volume of services, mode of payment for deliveries, number of health providers, number of labour and childbirth units, availability of neonatal intensive care units, fetal monitors and infusion rate regulation pumps for oxytocin, as well as health outcome data related to childbirth care and stillbirths for the year 2008. FINDINGS: the study provides the first data on maternal health provision from a survey of all eligible hospitals in Lebanon. More than three-quarters of deliveries occur in private hospitals, but the Ministry of Public Health is the single most important source of payment for childbirth. The reported hospital caesarean section rate is high at 40.8%. Essential equipment for safe maternal and newborn health care is widely available in Lebanon, but over half of the hospitals that responded lack a neonatal intensive care unit. The ratio of reported numbers of midwives to deliveries is three times that of obstetricians to deliveries. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: there is a need for greater interaction between maternal/neonatal health, health system specialists and policy makers on how the health system can support both the adoption of evidence-based interventions and, ultimately, better maternal and perinatal health outcomes.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Serviços de Saúde Materna/organização & administração , Bem-Estar Materno/estatística & dados numéricos , Qualidade da Assistência à Saúde/organização & administração , Gestão da Segurança/organização & administração , Adulto , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Recém-Nascido , Líbano/epidemiologia , Tocologia/organização & administração , Gravidez , Resultado da Gravidez/epidemiologia , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Adulto Jovem
19.
J Womens Health (Larchmt) ; 18(10): 1701-8, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19785571

RESUMO

OBJECTIVE: The aim of this study was to examine the association between symptoms of reproductive tract infections (RTIs) and mental distress among women residing in three low-income urban neighborhoods in Greater Beirut. METHODS: A cross-sectional survey of currently married women aged 15-49 years (n = 1506) from the 2003 Urban Health Study was undertaken. The dependent variables were complaining of vaginal discharge, pelvic pain, and pain during intercourse. The main independent variable was mental distress, measured using the General Health Questionnaire-12 (GHQ). Other variables included decision-making power, "comfort" with husband, age, education, income, household wealth, employment, community of residence, displacement by war, presence of chronic disease, reported reproductive health problem, membership in any group, receipt of favor last month, and smoking. Analysis was conducted using logistic regression models on the complaint of any symptom of RTIs and on individual complaints. RESULTS: Forty-two percent of the interviewed women reported at least one symptom of RTIs. Vaginal discharge was the most commonly reported symptom, with 33% of currently married women complaining from it. Mental distress was significantly associated with any reported RTI symptom (odds ratio [OR] = 1.41; 95% confidence interval [CI] = 1.09-1.83), pelvic pain (OR = 2.38; CI = 1.71-3.30), vaginal discharge (OR = 1.35; CI = 1.03-1.77), and pain during intercourse (OR = 2.37; CI = 1.66-3.40) after adjusting for demographic, socioeconomic, and health risk factors. CONCLUSIONS: A significant association between mental distress and reported RTI symptoms was established by this study. A new approach to gynecological morbidity is needed, one that integrates biomedical and psychosocial factors into a unified framework.


Assuntos
Doenças dos Genitais Femininos/epidemiologia , Casamento/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Estresse Psicológico/epidemiologia , População Urbana/estatística & dados numéricos , Saúde da Mulher , Adolescente , Adulto , Comorbidade , Estudos Transversais , Feminino , Doenças dos Genitais Femininos/prevenção & controle , Nível de Saúde , Humanos , Líbano/epidemiologia , Pessoa de Meia-Idade , Prevalência , Percepção Social , Fatores Socioeconômicos , Estresse Psicológico/prevenção & controle , Inquéritos e Questionários , Adulto Jovem
20.
Int J Gynaecol Obstet ; 104(1): 60-3, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18954868

RESUMO

OBJECTIVE: To examine the patterns of care-seeking behavior and provider choice of women with self-reported reproductive health problems from 3 urban communities in Beirut. METHODS: The study was based on a sample of 1869 completed questionnaires from 2051 eligible women (married or had been married, and between 15 and 59 years) obtained during the Urban Health Survey. Associations between community of residence, other background characteristics, and two outcome measures (health care usage and choice of provider) were assessed using logistic regression. RESULTS: Of the 1869 women assessed, 439 (23.5%) reported reproductive health problems; of these, 273 (62%) women sought care for their problems, with the majority (52.5%) using private providers. Younger age, health insurance, and severity and duration of problems were associated with use. Women with higher parity and those with financial problems were significantly more likely to use public and subsidized services. CONCLUSION: The private health sector needs to be more involved in planning, implementing, and offering reproductive health care in low-income communities.


Assuntos
Serviços de Saúde Materna/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Áreas de Pobreza , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Líbano , Pessoa de Meia-Idade , Adulto Jovem
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