Midwives’ Clinical Reasons for Performing Episiotomies in the Kurdistan Region : Are they evidence-based?

Objectives: An episiotomy is one of the most common obstetric surgical procedures and is performed mainly by midwives. The decision to perform an episiotomy depends on related clinical factors. This study aimed to find out midwives’ reasons for performing episiotomies and to identify the relationship between these reasons and the demographic characteristics of the midwives. Methods: This cross-sectional study was conducted between 1st July and 30th September 2013 in three governmental maternity teaching hospitals in the three main cities of the Kurdistan Region of Iraq. All of the midwives who had worked in the delivery rooms of these hospitals for at least one year were invited to participate in the study (n = 53). Data were collected through interviews with midwives as well as via a questionnaire constructed for the purpose of the study. The questionnaire sought to determine: midwives’ demographic characteristics; type of episiotomy performed; authority of the decision to perform the procedure, and reasons for performing episiotomies. Results: The main clinical reasons reported by midwives for performing an episiotomy were: macrosomia/large fetus (38, 71.7%), breech delivery (31, 58.5%), shoulder dystocia (29, 54.7%), anticipated perineal tear (27, 50.9%) and fetal distress (27, 50.9%). There was a significant association between the frequency of these reasons and midwives’ total experience in delivery rooms as well as their levels of education. Conclusion: Most of the reasons given by the midwives for performing episiotomies were not evidencebased. Age, years of experience, specialties and level of education also had an effect on midwives’ reasons for performing episiotomies

Nutritional Characteristics of Pregnant Women and its Relation with Anemia during Pregnancy in a Sample of Kurdish Women/Iraq

Anemia in pregnancy is a major public health problem, especially in developing countries. This study aimed to assess the nutritional characteristics of pregnant women and find out its relationship with anemia during pregnancy. A descriptive, cross-sectional study was conducted on 600 pregnant women who attended four primary health-care centers which randomly selected according to the geographical area. A specially designed questionnaire was prepared by the researcher after extensive review of relevant literature. The severity of anemia is determined according to Alene and Dohe. Estimation and calculation of dietary characteristics was done according to food frequency questionnaire, frequencies and percentage, mean and standard deviations, and Chi-square test of association and regression analysis. There was a highly statistically significant association between anemia with eating vegetables and chicken, and a high significant relation of anemia with eating beef and eating nuts. Furthermore, there was a highly significant association between severity of anemia with eating nuts, and a significant association with eating vegetables, while there was no significant association with other variables. Logistic regression analysis revealed that eating less than normal of vegetables, beef, and nuts were indicated risks of anemia. Eating less than normal of vegetables, beef, and nuts were indicated risks of anemia during pregnancy

Effect of Lupin (Lupinus albifrons) Flour on Microbial and sensory properties of local Yoghurt

This study conducted and implicated in the General State Company for Dairy Products, Abu-Ghraib/ Baghdad/Iraq in February to April /2014. Two different sweet lupin seed (Jordanian, Egyptian) origin were used for this study which been imported from the local markets. Soaking and boiling process (de- bittering process) of lupin seeds was used to destroy thermo-labile anti-nutritional factors, such as trypsin inhibitors, phytic acid and to soften the seed. It was been found that, the concentration (2, 4, 6)% of lupin seed supplementation for each origin (Jordan and Egypt) are the best in dairy product supplementation after conducting many different tests to see the best degree of agreement by the specialized panelists in the dairy company. The physicochemical analysis of the supplemented yogurt with different concentration (2, 4, and 6) % of Jordanian and Egyptian lupin flour showed that, it does not affect the percent of fat content statistically. But, there were clear positive statistical significant differences in the total solid. Also, there were statistically positive correlation between lupin flour concentration addition and total solid of the yogurt product which does affect directly the texture of the yogurt. There were statistically positive correlation between lupin flour concentration supplement and the pH of the yogurt product which does affect directly the flavor and taste of the yogurt product by the consumers. Thus, increasing the concentration of the supplementation with lupin flour lead to decrease the acidity and increase the pH in yogurt products significantly. Sensory evaluation of the supplemented yogurt product were showed that the 2 and 4% of lupin flour for both origin were the highest positive effect on physicochemical and sensory scores (flavor, taste, acidity, texture and consistency, appearance, and the total properties). Also, it was found that, the period of storage (1-14 days) did not affect the physicochemical and sensory evaluation clearly of the supplemented lupin dairy product. Therefore, we recommended the possibility of supplementation of yogurt with sweet lupin flour for its healthier and structural effect on human health to these kind of products. Keywords: Dairy product, Supplementation, Lupin flour, Physicochemical properties, Sensory evaluation, microbial content. 

Prevalence of Urinary Incontinence and Probable Risk Factors in a Sample of Kurdish Women

Objectives: The most common manifestation of pelvic floor dysfunction is urinary incontinence (UI) which affects 15–50% of adult women depending on the age and risk factors of the population studied. The aim of this study was to determine the probable risk factors associated with UI; the characteristics of women with UI; describe the types of UI, and determine its prevalence. Methods: A cross-sectional study was conducted between February and August 2011, in the Maternity Teaching Hospital of the Erbil Governorate, Kurdistan Region, northern Iraq. It included 1,107 women who were accompanying patients admitted to the hospital. A questionnaire designed by the researchers was used for data collection. A chi-square test was used to test the significance of the association between UI and different risk factors. Binary logistic regression was used, considering UI as the dependent variable. Results: The overall prevalence of UI was 51.7%. The prevalence of stress, urgency, and mixed UI was 5.4%, 13.3% and 33%, respectively. There was a significant positive association between UI and menopause, multiparity, diabetes mellitus (DM), chronic cough, constipation, and a history of gynaecological surgery, while a significant negative association was detected between UI and a history of delivery by both vaginal delivery and Caesarean section. Conclusion: A high prevalence of UI was detected in the studied sample, and the most probable risk factors were multiparity, menopausal status, constipation, chronic cough, and DM

Influence of Metal Ion Doping of Zinc Oxide Photoanode on the Efficiency of Dye Sensitized Solar Cell

Doping zinc oxide nanoparticles (ZnO NPs) and doped with Niobium (Nb5+) and Aluminium (Al3+) ions were synthesized to use as a photoanode for the Dye Sensitized Solar Cells (DSSCs). The structural of the synthetized samples were examined via X-ray diffraction (XRD). The XRD patterns for all samples confirmed the hexagonal wurtzite structure. The DSSCs based on the undoped and doped ZnO NPs were fabricated and assembled. Scanning electron microscopic (SEM) images were measured for all fabricated devices. The doping Nb5+ and Al3+ ions influenced the performance of the DSSCs. ZnO NPs doped Nb5+ led to higher surface area and hence more dye loading and retard the recombination of charges, which enhanced the open circuit voltage

Knowledge, attitudes, and positions of religious leaders towards female genital cutting: A cross-sectional study from the Kurdistan Region of Iraq

Background Understanding the perspectives of the key players in the community regarding female genital cutting (FGC) is very important for directing preventive programs. Religious leaders help shape community behaviors, which is highly pertinent in the case of FGC as it is frequently perceived to be a religious requirement. This study assesses religious leaders’ knowledge, attitudes, and positions towards FGC in the Kurdistan Region of Iraq. Methods This cross-sectional study was conducted in the Kurdistan Region of Iraq. It included a purposive sample of 147 local religious leaders (khateebs) representing the three governorates of Erbil, Sulaimaniyah, and Duhok. A self-administered questionnaire was used to collect data about the religious leaders’ knowledge, attitude, and position towards FGC. Results The participants identified reduction of the sexual desire of women as the main benefit (37%) and risk (24%) of FGC. Cultural tradition and religious requirements were the main reported reasons for practicing FGC. About 59% of the religious leaders stated that people ask for their advice on FGC. Around 14% of the participants supported performing FGC, compared to 39.1% who opposed it. Religious (73.9%) and cultural (26.1%) rationales were the main reasons given for supporting FGC. Being a cultural practice with harmful effects (53.5%) and lack of clear religious evidence (46.6%) were the main reasons for being against FGC. Around 52% of the participants recommended banning FGC by law, while 43.5% did not support banning it. A statistically significant association (P = 0.015) was found between religious leaders’ residence and their position on performing FGC. More than 46% of those residing in Duhok were against performing FGC, compared to lower proportions in Erbil (38.8%) and Sulaimaniyah (30%). Conclusion Religious leaders believed that cultural tradition was the main reason behind practicing FGC and they believed that FGC is not common in KRI, and even that it is decreasing. The religious leaders in our study reported that they could have an influential role in the FGC issue due to their position in the community. There was no statistically significant association between religious leaders’ age, education level, or work experience and their position on performing FGC. However, a statistically significant association was found between religious leaders’ residence and their position on performing FGC. A conclusive decision concerning the prohibition of FGC needs to be made by religious authorities. Health awareness activities incorporating FGC risks should be carried out to inform religious leaders at different levels of religious positions. Further research exploring perspectives of religious authorities concerning religious leaders’ inconclusive judgment about FGC is deemed necessary

Midwives’ Clinical Reasons for Performing Episiotomies in the Kurdistan Region; Are they evidence-based?

Objectives: An episiotomy is one of the most common obstetric surgical procedures and is performed mainly by midwives. The decision to perform an episiotomy depends on related clinical factors. This study aimed to find out midwives’ reasons for performing episiotomies and to identify the relationship between these reasons and the demographic characteristics of the midwives. Methods: This cross-sectional study was conducted between 1st July and 30th September 2013 in three governmental maternity teaching hospitals in the three main cities of the Kurdistan Region of Iraq. All of the midwives who had worked in the delivery rooms of these hospitals for at least one year were invited to participate in the study (n = 53). Data were collected through interviews with midwives as well as via a questionnaire constructed for the purpose of the study. The questionnaire sought to determine: midwives’ demographic characteristics; type of episiotomy performed; authority of the decision to perform the procedure, and reasons for performing episiotomies. Results: The main clinical reasons reported by midwives for performing an episiotomy were: macrosomia/large fetus (38, 71.7%), breech delivery (31, 58.5%), shoulder dystocia (29, 54.7%), anticipated perineal tear (27, 50.9%) and fetal distress (27, 50.9%). There was a significant association between the frequency of these reasons and midwives’ total experience in delivery rooms as well as their levels of education. Conclusion: Most of the reasons given by the midwives for performing episiotomies were not evidencebased. Age, years of experience, specialties and level of education also had an effect on midwives’ reasons for performing episiotomies

Knowledge and perspectives of female genital cutting among the local religious leaders in Erbil governorate, Iraqi Kurdistan region

Abstract Background Religious leaders are one of the key actors in the issue of female genital cutting (FGC) due to the influential position they have in the community and the frequent association of FGC with the religion. This study aimed to assess the knowledge and perspectives of the local religious leaders in Erbil governorate, Iraqi Kurdistan Region about different aspects of FGC. Methods In-depth interviews were conducted with a sample of 29 local religious leaders. A semi-structured questionnaire was used that included questions about their knowledge, understanding, and perspectives on different aspects of FGC such as the reasons for practicing it, their contact and communication with the community regarding the practice and perspectives about banning the practice by law. Results Participants believed that FGC is useful for reducing or regulating the sexual desire of women to prevent adultery and engagement in pre and extramarital sexual relations and to enhance hygiene of women. They indicated that there is no any risk in doing FGC if there is no excessive cut. Most participants indicated that FGC is attributed to the religion and some considered it a tradition mixed with the religion. People rarely ask the advice of the religious leaders regarding FGC, but they frequently complain about the effects of the practice. Participants did not support having a law to ban FGC either because they thought it would be against the religion’s advice on FGC or it will not work. Conclusions The local religious leaders lack adequate knowledge about different aspects of FGC particularly the health consequences. There are different and disputing viewpoints about the reasons for practicing FGC, and there is poor support for having a law banning the practice. There is an essential need for enhancing the knowledge of the local religious leaders regarding FGC and its adverse effects on the women’s health

Association between body weight perception and actual body mass index among adult women in Erbil city, Iraq

Abstract Background The misperception of body weight can significantly affect individuals' health behaviors, such as physical activity, diet, and weight management. This study aimed to examine the association between body weight perception and actual body mass index (BMI) among adult women and explore the factors influencing this relationship. Methods Five hundred forty female individuals aged 18–65 participated in this cross-sectional study. The validated Global Physical Activity Questionnaire was used for data collection. The BMI of the participants was calculated from measured body weight and height. Body weight perception was assessed using a single questionnaire item. The association of BMI and body weight perception was assessed, and the result was categorized as underestimation, consistency, and overestimation. The Chi-square test was used to assess the association between the consistency of BMI and body weight perception by different sociodemographic factors. The kappa test was used to analyze the consistency of BMI and body weight perception. Results Of the 540 participants, 13.3% underestimated their body weight status, 79.1% accurately perceived their body weight status, and 7.6% overestimated their body weight status. Unmarried women (11.7%) were more likely than ever married (4.3%) to overestimate their body weight (p = 0.005). On multiple logistic regression, being unmarried (OR = 1.68 (95%CI 1.01–2.80)) was significantly associated with body weight misperception. Body weight perception and BMI categories showed a significantly good consistency (kappa = 0.612, p < 0.001). Correct perception of body weight was highest among the overweight, followed by normal weight and underweight individuals (82.1%, 75.8%, and 72.2%, respectively). Conclusion Body weight perception was well associated with actual body weight status. Unmarried women are more likely to misperceive body weight, particularly overestimating it. Underestimation of body weight was relatively high and much higher than the overestimation, which might keep obese individuals from weight loss activities. Preventing obesity should include awareness about body weight misperceptions