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The Syrian crisis caused a massive influx of displaced people into neighboring countries, with Lebanon hosting the highest per capita number of refugees (3:10). Water remains the most critical natural resource that influences the resilience of host and refugee communities. We provide a new GIS-based updated water balance and water scarcity analysis at the national and the watershed level in Lebanon by comparing current conditions to no-refugee levels. Results show a small (6%) increase in water stress in an average water year at the national level that masks hot spots of water scarcity at the local geography. While domestic water use increased by 20%, we find that refugees' water use is only 10% of agricultural water use in summer. We also show that interventions to rehabilitate the water networks can reduce water stress to better than pre-conflict levels (3% less stress).

Background: This is a facility-based study designed to assess perceived quality of care and satisfaction of reproductive health services under the output-based approach (OBA) services in Kenya from clients' perspective., Method: An exit interview was conducted on 254 clients in public health facilities, non-governmental organizations, faith-based organizations and private facilities in Kitui, Kilifi, Kiambu, and Kisumu counties as well as in the Korogocho and Viwandani slums in Nairobi, Kenya using a 23-item scale questionnaire on quality of reproductive health services. Descriptive analysis, exploratory factor analysis, reliability test, and subgroup analysis using linear regression were performed., Results: Clients generally had a positive view on staff conduct and healthcare delivery but were neutral on hospital physical facilities, resources, and access to healthcare services. There was a high overall level of satisfaction among the clients with quick service, good handling of complications, and clean hospital stated as some of the reasons that enhanced satisfaction. The County of residence was shown to impact the perception of quality greatly with other social demographic characteristics showing low impact., Conclusion: Majority of the women perceived the quality of OBA services to be high and were happy with the way healthcare providers were handling birth related complications. The conduct and practice of healthcare workers is an important determinant of client's perception of quality of reproductive and maternal health services. Findings can be used by health care managers as a guide to evaluate different areas of healthcare delivery and to improve resources and physical facilities that are crucial in elevating clients' level of satisfaction.

Background: This study intended to compare the clients' satisfaction with the quality of childbirth services in a private and public facility amongst mothers who have delivered within the last twenty four to seventy hours., Methods: This was a cross-sectional comparative research design with both quantitative and qualitative data collection and analysis methods. Data were collected through a focused group discussion guide and structured questionnaire collecting information on clients' satisfaction with quality of childbirth services. The study was conducted amongst women of reproductive age (WRA) between 15-49 years in Tigoni District hospital (public hospital) and Limuru Nursing home (private hospital). For quantitative data we conducted descriptive analysis and Mann-Whitney test using SPSS version 20.0 while qualitative data was manually analyzed manually using thematic analysis., Results: A higher proportion of clients from private facility 98.1% were attended within 0-30 minutes of arrival to the facility as compared to 87% from public facility. The overall mean score showed that the respondents in public facility gave to satisfaction with the services was 4.46 out of a maximum of 5.00 score while private facility gave 4.60. The level of satisfaction amongst respondents in the public facility on pain relief after delivery was statistically significantly higher than the respondents in private facilities (U = 8132.50, p<0.001) while the level of satisfaction amongst respondents in the public facility on functional equipment was statistically significantly higher than the respondents in private facilities (U = 9206.50, p = 0.001). Moreover, level of satisfaction with the way staff responded to questions and concerns during labour and delivery was statistically significantly higher than the respondents in private facilities (U = 9964.50, p = 0.022)., Conclusion: In overall, majority of clients from both public and private facilities expressed satisfaction with quality of services from admission till discharge in both public and private facilities and were willing to recommend other to come and deliver in the respective facilities.

Background: The study seeks to evaluate the difference in access of long-term family planning (LTFP) methods among the output based approach (OBA) and non-OBA clients within the OBA facility., Methods: The study utilises a quasi experimental design. A two tailed unpaired t-test with unequal variance is used to test for the significance variation in the mean access. The difference in difference (DiD) estimates of program effect on long term family planning methods is done to estimate the causal effect by exploiting the group level difference on two or more dimensions. The study also uses a linear regression model to evaluate the predictors of choice of long-term family planning methods. Data was analysed using SPSS version 17., Results: All the methods (Bilateral tubal ligation-BTL, Vasectomy, intrauterine contraceptive device -IUCD, Implants, and Total or combined long-term family planning methods -LTFP) showed a statistical significant difference in the mean utilization between OBA versus non-OBA clients. The difference in difference estimates reveal that the difference in access between OBA and non OBA clients can significantly be attributed to the implementation of the OBA program for intrauterine contraceptive device (p = 0.002), Implants (p = 0.004), and total or combined long-term family planning methods (p = 0.001). The county of residence is a significant determinant of access to all long-term family planning methods except vasectomy and the year of registration is a significant determinant of access especially for implants and total or combined long-term family planning methods. The management level and facility type does not play a role in determining the type of long-term family planning method preferred; however, non-governmental organisations (NGOs) as management level influences the choice of all methods (Bilateral tubal ligation, intrauterine contraceptive device, Implants, and combined methods) except vasectomy. The adjusted R 2 value, representing the percentage of the variance explained by various models, is larger than 18% for implants and total or combined long-term family planning., Conclusion: The study showed that the voucher services in Kenya has been effective in providing long-term family planning services and improving access of care provided to women of reproductive age. Therefore, voucher scheme can be used as a tool for bridging the gap of unmet needs of family planning in Kenya and could potentially be more effective if rolled out to other counties.

Past reproductive and sexual characteristics of patients with tubal sterility (cases) and currently fertile women (control group) were studied. The ages at first coitus and the number of sexual partners were significantly more (p less than 0.01) in the cases than in the controls. Most cases (56.0%) had only primary school education whereas most of the controls (68.7%) had secondary school education. Nearly 70% of the cases had had the first sexual intercourse by 16 years compared with about 40% in the controls. Pre-menarcheal sexual intercourse occurred in 1/4 of the cases compared with less than 1/10 in the controls (p less than 0.001). Of those with secondary infertility; 33.3% had had the first pregnancy by the age of 16 years compared with 12.0% in the controls (p less than 0.001); and in 83.3% of the cases, the first pregnancy was not by the current husband compared with 26.0% in the controls (p less than 0.001). In addition, the cases had more abortions before marriage (p less than 0.001), more induced abortions (p less than 0.001) and had medically diagnosed sexually transmitted diseases more often (p less than 0.01). It is concluded that the reproductive and sexual events that occur during the teen-age determine the future prospects of fertility. Intensification of educational programs by the government and all relevant organisations, with emphasis on the relationship between sexual behaviour during adolescence and future reproductive problems, is strongly recommended.