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This reseach paper investigates obstetric fistula (OF) which is a devastating problem of survivors of prolonged obstructed labour (POL) resulted in an abnormal opening between the bladder and the wall of the vagina and/or the rectum. Living with obstetric fistula is perceived to be a big burden on women: Socially, psychologically and economically. This paper aimed at exploring Sudanese women's experiences and challenges of living with OF both prior to and after surgery. Women with OF were identified from Abbo's Fistula Centre in Khartoum. Purposively selected sample of 15 women were interviewed. Data were analyzed using thematic data analysis framework. Themes related to the experiences of living with OF stigma were identified. This study suggested that in Sudan women with obstetric fistula were not stigmatized or shunned by their families and/or their communities. It was the women themselves, who stigmatized themselves out of shame and embarrassment. They no longer participated in social activities such as wedding and funerals because of their fear of wetting themselves and smelling badly. However, the study findings suggested less isolation from the society and community evident in less instances of community rejection and ostracism. Felt-stigma seems to be a common social challenge that women face. Women used different modalities to cope with the problems of living with OF and were successful. Keyword: Obstetric Fistula, lived experience, Stigma, Coping, Sudan, Introduction The most common causes of death and disability among women of reproductive age in developing countries are complications of pregnancy and childbirth. Maternal morbidity in low income countries is [...]

OBJECTIVE: To estimate the medical and compensation costs of work-related injuries in insured workplaces in Lebanon and to examine cost distributions by worker and injury characteristics. METHODS: A total of 3748 claims for work injuries processed in 1998 by five major insurance companies in Lebanon were reviewed. Medical costs (related to emergency room fees, physician consultations, tests, and medications) and wage and indemnity compensation costs were identified from the claims. FINDINGS: The median cost per injury was US$ 83 (mean, US$ 198; range, US$ 0-16 401). The overall cost for all 3748 injuries was US$ 742 100 (76% of this was medical costs). Extrapolated to all injuries within insured workplaces, the overall cost was US$4.5 million a year; this increased to US$ 10 million-13 million when human value cost (pain and suffering) was accounted for. Fatal injuries (three, 0.1%) and those that caused permanent disabilities (nine, 0.2%) accounted for 10.4% of the overall costs and hospitalized injuries (245, 6.5%) for 45%. Cost per injury was highest among older workers and for injuries that involved falls and vehicle incidents. Medical, but not compensation, costs were higher among female workers. CONCLUSION: The computed costs of work injuries - a fraction of the real burden of occupational injuries in Lebanon - represent a considerable economic loss. This calls for a national policy to prevent work injuries, with a focus on preventing the most serious injuries. Options for intervention and research are discussed.

Background: Studies have shown that consanguinity affects birth outcome, rendering a newborn with increased risks of inheriting autosomal recessive genes. In many developing countries consanguinity has been prevalent. Accordingly we examined all newborns delivered at the American University of Beirut -Medical Center (AUB-MC) a tertiary care center, during a one-year period (1/9/97 to 31/8/98) to look at the determinants of consanguinity. Methods: Data concerning all newborns and their mothers was collected and analyzed using SPSS PC+, the [chi square] statistic, t-tests, and logistic regressions measured significant differences. Results: Data on consanguinity were available for 1,754 mothers such that 298 (17%) were consanguineous and 1,454 were not consanguineous. Consanguineous mothers were significantly younger than non-consanguineous mothers (t = 3.877, 0 = 0.000, 95% CI = 0.69, 2.10), and were also significantly less educated ([chi square] = 39.393, p = 0.000) with 36.6% of non-consanguineous women having university level education as opposed to 4.7% of the consanguineous group. Also, 73.8% of the consanguineous mothers were housewives, only 11.5% were employed ([chi square] = 35.140, p = 0.000). More (30.9%) rural residents attending this center were consanguineous as opposed to 16.4% of urban residents ([chi square] = 13.495, p = 0.000), with 53.7% of consanguineous patients being private vs. 65.3% being indigent. Among Muslim patients 18.4% were consanguineous as opposed to Christians (4.6%) ([chi square] = 18.559, p = 0.000). There were no significant differences between the number of Intensive Care admissions and Normal Nursery admissions apropos to consanguinity. Gravida and parity were significantly higher for the consanguineous (t = -3.235, p = 0.000, 95% CI-0.61, -0.13), and (t = -2.806, p = 0.005, 95% CI = = 0.47, -0.083) respectively. Conclusion: Our data reveals that there are differences among consanguineous and non-consanguineous patients regarding maternal characteristics. Place of residence, religion, maternal age, and socioeconomic status were the strongest determinants of consanguinity (p [is less than] 0.05) (Table). Contrary to the literature, indicating more consanguinity among older maternal ages, our data revealed more consanguinity among younger ages, which may be a result of post-war "return-migration" in Lebanon. Given the large proportion of the population in consanguineous unions, future research to investigate the prevalence of and the morbidity resulting from consanguinity is warranted., Independent Exp(B) Lower Upper Sign. R Variable 95% CI 95% CI Maternal working 0.8847 0.7760 1.0086 0.0669 -0.0303 status Place of residence 2.4731 1.5376 3.9776 0.0002 0.0898 Religion 0.3247 0.1482 [...]

Background: Lebanon, a developing country, has a birth rate of 2.6% and an estimated neonatal mortality rate of 20/1000 live births. An estimated 8,000 newborns are born prematurely and most of them are "ward" (W) patients (covered by the ministry of health (MOH)). Health behavior that may adversely influence outcome are practiced vastly by the ward population attending this center. The aim of the following study is to identify these behaviors and to reduce the financial burden of the MOH. Methods: Data concerning all neonates and their mothers at the American University of Beirut-Medical Center (AUB-MC) were collected prospectively from 1/9/97 to 31/8/98. SPSS PC + was used to perform statistical analyses and the [chi square] statistic was used. Results: There were 1854 inborn live births during a one-year period at AUB-MC, 1594 (86.0%) of which were admitted to the Normal Nursery (NN) and 260 (14.0%) to the NICU. Ward patients constituted 60% if NICU admissions as opposed to 40% of private ([chi square] = 13.656, p = 0.000). Ward patients mothers were younger than Private patient mothers ([chi square] = 59.596, p = 0.000), 31.1% of the ward patients being 15-24 years of age, as opposed to 19.2% of the private. More private (64.5%) had university level education contrary to ward patients (15.5%) ([chi square] = 515.122, p = 0.000). Furthermore, 35.8% of private admissions were working, while only 8.8% of ward admissions were ([chi square] = 199.694, p = 0.000). Significantly more ward women were smokers (59.4% vs. 40.6%, [chi square] = 18.679, p = 0.000). With increasing survival rates of premature infants to ward parents, the cost of NICU care becomes a predicament for the government and its tax-paying population. During the one-year period of the study, the MOH paid a total of $718,000 for 177 NICU (AUB-MC) patients. However, this figure is an underestimation since it does not include all costs paid by the National Social Security Fund and other governmental organizations. While hospital length of stay increases cost of care, all neonates staying over 31 days survived and were discharged home. Of the 13 neonatal deaths in the AUB-MC NICU, 10 died before one week of life, 2 in less than 28 days of life and only one lived up to 31 days, resulting in a good outcome for neonates who stayed longer. Conclusion: Data on 260 NICU admissions showed significantly more ward mothers. The mothers of these patients had a profile that increased their neonatal risks compared to private patients. There is thus a need for application of public health programs to fully assess and modify these factors to reduce the costs and improve the outcome for those patients., Khalid A. Yunis, MD,(1) FAAP, Mustafa Khogali(2) MD, Choghik Boulghourjian MSc,(1) Leila Nasr, BSc,(1) Mohammad Mikati, MD(1) (1) Department of Pediatrics and (2) Department of Family Medicine, American University of [...]

Purpose statement:The article explores assistive technology sources, services and outcomes in South Africa, Namibia, Malawi and Sudan. Methods:A survey was done in purposively selected sites of the study countries. Cluster sampling followed by random sampling served to identify 400–500 households (HHs) with members with disabilities per country. A HH questionnaire and individual questionnaire was completed. Country level analysis was limited to descriptive statistics. Results:Walking mobility aids was most commonly bought/provided (46.3%), followed by visual aids (42.6%). The most common sources for assistive technology were government health services (37.8%), “other” (29.8%), and private health services (22.9%). Out of the participants, 59.3% received full information in how to use the device. Maintenance was mostly done by users and their families (37.3%). Devices helped a lot in 73.3% of cases and improved quality of life for 67.9% of participants, while 39.1% experienced functional difficulties despite the devices. Conclusion:Although there is variation between the study settings, the main impression is that of fragmented or absent systems of provision of assistive technology. Implications for rehabilitationProvision of assistive technology and services varied between countries, but the overall impression was of poor provision and fragmented services.The limited provision of assistive technology for personal care and handling products is of concern as many of these devices requires little training and ongoing support while they can make big functional differences.Rural respondents experienced more difficulties when using the device and received less information on use and maintenance of the device than their urban counterparts.A lack of government responsibility for assistive device services correlated with a lack of information and/or training of participants and maintenance of devices. [ABSTRACT FROM PUBLISHER]