Perspective Chapter: Contemporary Challenges in Postnatal Care in Low- and Middle-Income Countries

The postnatal phase is the first six weeks after delivery and is a critical time for mothers, newborns, and other caregivers as a highly neglected phase of a transition period. Almost all maternal and neonatal deaths occur in low- and middle-income countries, where fewer services are provided for mothers after the delivery period, which constitutes a tremendous challenge facing mothers in these countries. Barriers were markedly observed in low-and middle-income countries as a result of financial constraints, distance from the health center, poor programming for postnatal care, negative childbirth experiences, and cultural constraints. Moreover, the unproper advocacy of contraceptive use during the postpartum period impacts prolonged interpregnancy intervals and indirectly increases postpartum complications mainly in low- and middle-income countries. The importance of the quality of postnatal care was frequently addressed to answer the required interventions that should be implemented at the level of healthcare facilities, household, and community levels as part of the process of reducing the impact of postnatal complications, disabilities, and maternal mortality

Health Beliefs Related to Diabetes Mellitus Prevention among Adolescents in Saudi Arabia

 Objectives: The incidence of type 2 diabetes mellitus (T2DM) is growing rapidly in the Saudi population. The purpose of this study was to assess the constructs of the health belief model (HBM) as they relate to T2DM lifestyle and prevention behaviours among adolescents. Methods: A cross-sectional study was conducted between May and October 2013 among 426 non-diabetic secondary school students from randomly selected schools in Riyadh, Saudi Arabia. An Arabic version of an adapted English language questionnaire was used to assess knowledge and attitudes related to the severity and prevention of T2DM. A preventative behaviour assessment was also conducted to assess physical activity and dietary habits. Results: The majority of the students (63.4%) had at least one diabetic family member. Obesity was more frequent in males compared to females (P = 0.013). Awareness about the importance of maintaining a healthy body weight to prevent T2DM was lower in males than females (P = 0.037), although males engaged in routine exercise more often (P = 0.001). Males were less likely than females to recognise the risks for T2DM, including obesity (P = 0.030), heredity (P = 0.013) and high fat intake (P = 0.001). Conclusion: An alarmingly high number of Saudi students were unaware of T2DM severity and associated risk factors. Female students were more aware of the benefits of T2DM preventative lifestyle behaviours than males, although males engaged in routine exercise more often. Raising adolescents’ awareness about the primary prevention strategies for T2DM should be a public health priority in Saudi Arabia. The HBM could inform further research on diabetes prevention among Saudi adolescents

Deaths, DALY and other related measures of breast cancer in Yemeni women: Findings of the Global Burden of Disease Study (1990–2010)

Background: Although the rate of breast cancer in Yemen is not high in comparable to other high developed indexed countries, it is among the highest rate of incidence among Yemeni women. Objective: The aim of the study is to estimate the main outcomes of breast cancer using some other parameters such as death rates, Disability Adjusted Life Years (DALY); Years Lived with Disability (YLD); and Years of Life Lost (YLL) among the Yemeni women. Methods: Data from Aden Cancer registry was used to describe the incidence of the breast cancer cases over 15 years period (1997–2011). Also data from the Global Burden of Diseases (GBD) from the Institute for Health Metrics and Evaluation (IHME) were used for the analysis of the death rate, DALY, YLD and LLY. Results: The age standardized rate of breast cancer among female showed the highest peak at the age group of 45–49 years old (35.1/100,000). Death rates, DALY, YLD and YLL were reported higher in 2010 than in 1990 with almost two folds and show steady increase with increase of age. By using the analysis of the DALY for cases with breast cancer for the year 2009 and YLL analysis for the same year has shown a peak of the mean at the age-group of 50–54 (915.9 and 505.2 per 100,000, respectively). Conclusion: Findings from this study support the use of other epidemiological parameters used to express the burden of breast cancer in Yemen by other method than the incidence rate. The burden of breast cancer among Yemeni women was clear health priority and needs a rigorous plan for implementing prevention, and early detection for better control

Assessment of Pregnant Women’s Satisfaction with Model of Care Initiative: Antenatal Care Service at Primary Health Care in Cluster One in Riyadh, Saudi Arabia

The current study assessed pregnant women’s satisfaction with antenatal care (ANC) services at primary health care centers (PHCs) in Riyadh Cluster One. The study was conducted at 11 PHCs where the ANC initiative has been implemented. A total of 646 pregnant women were enrolled. A questionnaire was completed by participants to measure the level of satisfaction with the provided services, care, and consultation. Subsequently, the data were analyzed to determine the significant differences and conduct regression analysis. The overall satisfaction with initial triage assessment, provided services, consultation, and examination was 93.7%, 87.8%, 71.8%, and 53.9%, respectively. Regarding ANC services, education was the only statistically significant variable that influenced patient satisfaction (p p p < 0.05) were the statistically significant role players. In the regression analysis, secondary education was statistically significantly related to the provided services, consultation, and examination. Despite the satisfactory level of ANC at the selected PHCs, higher patient satisfaction could be achieved in the future by improving the consultation and examination practices. Overall satisfaction with the health care workers at PHCs is high. Incorporating implied ameliorations would enhance the quality of services and patient satisfaction

Seroepidemiology and risk factors of hepatitis B virus in Aden, Yemen

Background There is little published data concerning hepatitis B virus (HBV) infection in Aden and no data concerning risk factors for infection. This study aimed to determine the prevalence of HBV infection and risk factors for infection in Aden, Yemen. Methods A prospective cross sectional survey of individuals attending primary health care facilities was stratified by age and population size. Five hundred and thirty five participants were interviewed and serum was screened for the presence of Immunoglobin G HBV core antibodies (antiHBc). AntiHBc positive participants were tested for antibodies to hepatitis B surface antigen (HBsAg). A case–control analysis of risk factors for HBV was undertaken comparing risk factors between antiHBc positive cases and seronegative controls. Results The age-standardized seroprevalence for antiHBc was 16.2% (95% confidence interval (CI) 13.1–19.3) and for HBsAg was 1.5% (95% CI 0.5–2.5). The seroprevalence of antiHBc and HBsAg was estimated to range from 5.5% and 0% in infants to 40% and 4.6% in adults, respectively (p 5–9 members, AOR = 2.9, 95% CI = 1.1–7.6) and ownership of a landline telephone (AOR = 2.8, 95% CI = 1.3–5.8) were independent risk factors for HBV infection. Conclusions HBV is still a public health problem in this community, with older individuals having much higher prevalence than younger generations. The results of this study would categorise Aden as a low HBV endemic zone. Perinatal transmission does not seem to be a major route of transmissio

Knowledge, attitudes and practices of the Saudi population toward people with epilepsy: narrow or wide?

Abstract Background Although epilepsy has been acknowledged as an illness since ancient time, the public attitude toward epilepsy has not changed drastically due to the lack of appropriate information. This study aims to determine the public perceptions of epilepsy in five main regions of Saudi Arabia. Methods In this cross-sectional questionnaire-based study, Saudi citizens living in the major cities of the five main regions of the Kingdom of Saudi Arabia (the central, eastern, western, northern, and southern regions) completed the survey that included 27 questions about epilepsy awareness. Results A total of 7118 individuals from five regions participated in the survey: 6749 (94.8%) of respondents were Saudi, and 369 (5.2%) were non-Saudi. Of the 7118 respondents, 6897 respondents (96.9%) did not have epilepsy, and 3378 respondents (47.5%) stated that they had never witnessed an epileptic episode. In addition, 3749 (52.7%) respondents incorrectly attributed epilepsy to non-neurologic conditions, and 4865 (68.3%) respondents had an overall negative attitude toward people with epilepsy (PWE). They expressed objections to their child associating with PWE (2002; 28.1%) or their close relatives marrying PWE (3192; 44.8%), some believed that PWE are inferior (402; 5.6%), refused to hire a PWE (1126; 15.8%), and would feel discomfort around PWE (724; 10.3%). In addition, 2025 individuals (28.4%) believed that the health of PWE deteriorates over time; 1485 individuals (20.9%) believed that PWE get sick more often than others; 181 individuals (2.5%) believed that epilepsy could be transmitted; and 568 individuals (8.0%) believed that epilepsy could progress to malignant disease. Conclusions In Saudi Arabia, there is a substantial need for increasing the awareness and improving education on epilepsy in order to reduce stigma and increase the understanding of epilepsy. Such efforts could help improve the lives of people afflicted with the disease and ultimately contribute to better health outcomes for the entire community