Effect of consanguinity on birth weight for gestational age in a developing country.

Consanguinity, the marriage between relatives, has been associated with adverse child health outcomes because it increases homozygosity of recessive alleles. The objective of this study was to assess the effect of consanguinity on the birth weight of newborns in Greater Beirut, Lebanon. Cross-sectional data were collected on 10,289 consecutive liveborn singleton newborns admitted to eight hospitals belonging to the National Collaborative Perinatal Neonatal Network during the years 2000 and 2001. Birth weight was modeled by use of the fetal growth ratio, defined as the ratio of the observed birth weight to the median birth weight for gestational age. A mixed-effect multiple linear regression model was used to predict the net effect of first- and second-cousin marriage on the birth weight for gestational age, accounting for within-hospital clustering of data. After controlling for medical and sociodemographic covariates, the authors found a statistically significant negative association between consanguinity and birth weight at each gestational age. No significant difference was observed in the decrease in birth weight between the first- and second-cousin marriages. Overall, consanguinity was associated with a decrease in birth weight for gestational age by 1.8% (beta = -0.018, 95% confidence interval: -0.027, -0.008). The largest effects on fetal growth were seen with lower parity and smoking during pregnancy

Predictors of breast-feeding in a developing country: results of a prospective cohort study.

OBJECTIVE: Data on the prevalence and predictors of breast-feeding remain scarce in Lebanon. Moreover, no study has previously addressed the effect of the paediatrician's sex on breast-feeding. The present study aimed to assess the prevalence and predictors of breast-feeding at 1 and 4 months of infant age while exploring the potential role of the sex of the paediatrician. DESIGN: Prospective cohort study. Predictors of breast-feeding significant at the bivariate level were tested at 1 and 4 months through two stepwise regression models. SETTING: Infants were enrolled through the clinics and dispensaries of 117 paediatricians located in Beirut, Lebanon, and its suburbs. SUBJECTS: A total of 1,320 healthy newborn infants born between August 2001 and February 2002 were prospectively followed during the first year. FINDINGS: Breast-feeding rates at 1 and 4 months were 56.3 % and 24.7 %, respectively. Early discharge, high parity and religion were significantly associated with higher breast-feeding rates at 1 and 4 months of age. Maternal age proved significant only at 1 month, while maternal working status and sex of the paediatrician were significant at 4 months. A novel finding of our study was the positive effect of female paediatricians on breast-feeding continuation until 4 months of age (OR = 1.49; 95 % CI 1.03, 2.15). CONCLUSIONS: Breast-feeding rates are low at 1 and 4 months of infant age in Beirut. Further research to investigate the interactions between female physicians and lactating mothers in maintaining breast-feeding in other populations is warranted. The results constitute the basis for designing interventions targeting policy makers, health professionals and mothers

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

The extraordinary decline of infant and childhood mortality among Palestinian refugees

This article documents the levels and patterns of infant and child mortality among Palestinian refugees in Jordan, Lebanon and the Palestinian areas based on comparable data from household sample surveys conducted since 1995. The findings show that Palestinian refugees have clear advantage in mortality levels as compared to their non-refugee counterparts in every setting, and refugees living in the camps have similar or lower levels of mortality than their non-camp counterparts, other things being equal. The recent decline of infant and child mortality among this vulnerable segment of the Palestinian population demonstrates the importance of political will in halting the truncation of infant lives. An examination of the mortality patterns by sex and education sheds light on the nature of the decline currently underway.Infant mortality Childhood mortality Public health Palestinian refugees UNRWA Political causation

Fertility responses to violent conflict: evidence from the Second Palestinian Intifada

The Occupied Palestinian Territory has one of the highest rates of natural increase in the world. The persistence of high fertility in a context of prolonged conflict and military occupation has generated considerable research interest. However, previous work has been fairly descriptive. In this paper, we examine the impact of conflict on the fertility behaviour of Palestinian women during the second Intifada (2000-2005). Compared to previous research, our study has a number of strengths. For the first time, conflict intensity is measured using detailed information on monthly fatalities. Also, fertility responses are investigated by referring to individual conceptions on a monthly basis. A Cox model is used to assess the relationship between conflict intensity and conception hazards. Implications of our findings will be discussed

Intensity of conflict and fertility in the occupied Palestinian territory: a longitudinal study

Background The occupied Palestinian territory has one of the highest fertility rates in the world. We examined the association between the intensity of conflict in the region and the fertility behaviour of Palestinian women. Methods Intensity of conflict was measured using information from the human rights organisation B’Tselem on the yearly number of Palestinians killed for the period 1993–2009. The outcome variable, fertility, was investigated using birth history data from the 2010 Palestinian Family Health Survey. Cox regression models were used to assess the association between number of fatalities and women's likelihood of starting childbearing, adjusting for secular trend and relevant covariates. Findings According to B’Tselem data, 5268 Palestinians were killed between 1993 and 2009. Birth history data from the 2010 Palestinian Family Health Survey included a total of 6292 first conceptions during the study period. We found a significant positive association between intensity of conflict and fertility after adjustment for time trend (1990s, 2000s), governorate (North Gaza, Gaza, Dier El-Balah, Khan Yunis, Rafah, Jenin, Tubas, Tulkarm, Nablus, Qalqiliya, Salfit, Ramallah and Al-Bireh, Jericho, East Jerusalem, Bethlehem, Hebron), locality type (urban, rural, and refugee camp), household wealth (poorest, poor, middle, rich, richest) and woman's education (less than secondary, secondary or higher). A 1% increase in the yearly number of fatalities was associated with a 12% increase in the likelihood of starting childbearing for women in the Gaza Strip (hazard ratio 1·12; 95% CI 1·07–1·16) and a 9% increase for women in the West Bank (1·09; 1·06–1·13). Interpretation The results are relevant to the design of reproductive health interventions in emergency situations. Although the precise mechanisms of association between conflict and conception are not addressed here, efforts to maintain and strengthen family planning programmes during times of more intense conflict might be considered

Husbands’ Involvement in Housework and Women’s Psychosocial Health: Findings From a Population-Based Study in Lebanon

Objectives. We examined the association between husbands’ involvement in housework and the psychosocial health of their wives using data on married couples living in poor neighborhoods in Beirut, Lebanon. Methods. Data were derived from a cross-sectional survey of 2797 households; 1652 married couples and their families were included in the analysis. An index of husbands’ relative involvement in housework was constructed from 25 items focusing on division of housework activities. Logistic regression was used to assess associations between husbands’ involvement in housework and wives’ self-rated mental health status, marital dissatisfaction, and unhappiness. Results. Husbands’ involvement in housework was negatively associated with wives’ psychological distress, marital dissatisfaction, and overall unhappiness after adjustment for relevant risk factors. In comparison with wives whose husbands were highly involved in housework, wives whose husbands were minimally involved were 1.60 times more likely to be distressed, 2.96 times more likely to be uncomfortable with their husbands, and 2.69 times more likely to be unhappy. Conclusions. Our results showed a significant association between husbands’ involvement in housework and their wives’ psychosocial health