Male infertility in Lebanon: A case control study.

According to the World Health Organization, infertility affects more than 80 million people around the world, whereby one in ten couples experience primary or secondary infertility. Most of those who suffer from infertility, moreover, live in developing countries where infertility prevention or treatment services remain unavailable and/or inaccessible. According to the National Institute of Health, male infertility is the cause of approximately 40% of the 2.6 million infertile married couples in the United States. It has been estimated that one-half of these men actually experience irreversible infertility, when advanced reproductive technologies are disregarded as a treatment option. In the Middle East, 10-15% of all married couples are estimated to have infertility problems. The overall prevalence of male factor infertility is still unknown and not a relatively easy figure to determine. A case-control study was conducted to determine the impact of familial predispositions (i.e. genetic) to infertility, reproductive histories and infections, lifestyle factors (such as intake of drugs, alcohol, caffeine, cigarette smoking), war exposures and occupational exposures on male infertility. No studies have been conducted in the Middle East to understand the underlying causes, risk factors and etiologies of male infertility in that region. Furthermore, the breadth of available scientific literature pertaining to the context of this problem in the region has only been primarily focused on women. 220 male cases (n=120) and controls (n=100) of either Lebanese, Syrian or Lebanese-Palestinian descent were selected from two of the busiest in vitro fertilization (IVF) clinics located in Beirut, Lebanon (i.e., American University of Beirut-Medical Center and FIRST IVF). Cases all suffered from impaired sperm count and function, according to World Health Organization guidelines for semen analysis. Controls were the fertile husbands of infertile women attending these clinics. Data were collected using a semi-structured interview questionnaire, laboratory blood testing, and the results of most recent semen analysis. Univariate, bivariate and multivariate logistic regression analyses were used in data analysis, along with checks for effect modification and control of confounders. The study highlighted the importance of consanguinity and the clustering of male infertility cases within families, as well as reproductive illnesses and war exposures as independently significant risk factors for male infertility. The odds of having infertility problems in the immediate family was 2.6 times higher in cases than controls. The odds of reproductive illness was 2 times higher in cases than controls. The odds of war exposures (e.g., participating as a fighter, residence near areas of intense bombing) was 1.57 times higher in cases than controls. Occupational exposures, smoking and caffeine intake were not shown to be important risk factors in this case-control study, given similar rates of exposure among cases and controls. This case-control study suggests the importance of investigating the etiology of male infertility in Middle Eastern communities. It also suggests the need to expand research on male reproductive health in the Middle East, in order to improve the prevention and management of male infertility and other male reproductive health problems. This is especially true in the context of Lebanon, a country in clear epidemiologic transition, affected by 15 years of civil war and swamped by highly westernized-urbanized lifestyles.Dr.P.H.Health and Environmental SciencesPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studies, School of Public Healthhttp://deepblue.lib.umich.edu/bitstream/2027.42/125794/2/3209093.pd

Face Validity of the Functional Assessment of Cancer Therapy-Breast Symptom Index (FACT- B) into Formal Arabic

Background: Breast cancer affects over one million women annually and is the most common global malignancy among women. Extensive improvements have taken place in the management of breast cancer in recent years and a higher percentage of women are cured from this disease. A proper assessment of the quality of life of women with breast cancer is an essential component in disease management. The Functional Assessment of Cancer Therapy- Breast Symptom Index has been commonly used and well-validated among English speaking populations as well as other populations. To date, no formal translation and evaluation of the Functional Assessment of Cancer Therapy-Breast System Index exists in Arabic. Therefore, this study intends to translate, adapt and face-validate the Functional Assessment of Cancer Therapy-Breast System Index into Arabic, specifically in the context of the Lebanese culture. Methods: We conducted forward and backward translation in Arabic, combined with face validity by clinicians. This was followed by pre-testing to ensure the instrument’s adequacy and cultural sensitivity conducted by the administration of face-to-face interviews with individual breast cancer patients (n=33) and two focus groups (4 women/group) to evaluate the relevance and appropriateness of each item and words used in the questionnaire. Results: Study results reinforced the value of the Arabic translated version of the Functional Assessment of Cancer Therapy-Breast System Index in capturing the quality of life of women with breast cancer in Lebanon. Conclusion: The instrument was perceived to be adequate, appropriate for use, culturally sensitive, simple as well as exhaustive. Suggestions have been made to enrich the instruments’ ability to incorporate other quality of life dimensions not captured, as well to enhance the cultural specificity of the Functional Assessment of Cancer Therapy-Breast System Index, when administered among Lebanese women diagnosed with breast cancer who are specifically beyond therapy

The impact of psychosocial interventions on condom and contraceptive use in LMICs:Meta-analysis of randomised controlled trials

Inconsistent contraceptive use and risky sexual behaviour perpetuate the burden of sexually transmitted diseases, especially in low- and middle-income countries (LMIC). Psychosocial interventions (PSI) can contribute to change sexual behaviour, however, their overall effectiveness is unclear. We thus conducted a meta-analysis of the effectiveness of PSIs to increase condom and contraceptive use in LMICs. Seven databases were searched systematically for randomised trials comparing a PSI with a control condition. Risk ratios of 31 eligible studies were pooled in random-effects analyses for condom and contraceptive use and unprotected sex, using sensitivity analyses to further investigate the results. Risk of bias was assessed using the Cochrane tool, and heterogeneity and publication bias were assessed. PSIs increased condom use by about 6% at post-test and 8% at follow-up as compared to control conditions. Contraceptive use was increased by about 14% at post-test. There were no effects on unprotected sex. Results suggest that PSIs have the potential to increase contraceptive and, to a smaller degree, condom use in LMICs. The reliability of these results is partly limited by heterogeneity and the risk of publication bias. PSIs were further found to provide substantial benefits to the exposed populations beyond the targeted outcomes

Psychosocial interventions for intimate partner violence in low and middle income countries:A meta-analysis of randomised controlled trials

Background: Intimate partner violence (IPV) is prevalent worldwide and presents pernicious consequences for women in developing countries or humanitarian settings. We examined the efficacy of psychosocial interventions for IPV among women in low- and middle-income countries (LMICs). Methods: Seven databases were systematically searched for randomised controlled trials (RCTs) examining psychosocial interventions for IPV in LMICs. Thirteen RCTs were included in random-effects meta-analyses. Risk ratios (RR) and risk difference were calculated as pooled effect sizes. Risk of bias was assessed using an adapted version of the Cochrane tool accounting for cluster RCTs. Sensitivity analyses were conducted for risk of bias and design characteristics. Publication bias and heterogeneity were assessed. Results: Psychosocial interventions reduced any form of IPV by 27% at shortest (relative risk (RR) = 0.73) and 25% at longest (RR = 0.75) follow up. Physical IPV was reduced by 22% at shortest (RR = 0.78) and 27% at longest (RR = 0.73) follow up. Sexual IPV was reduced by 23% at longest follow up (RR = 0.77) but showed no significant effect at shortest follow-up. Sensitivity analyses for risk of bias led to an increase in magnitude of the effect for any form of IPV and physical IPV. The effect on sexual IPV was no longer significant. Heterogeneity was moderate to high in the majority of comparisons. Conclusions: Psychosocial interventions may reduce the impact of IPV in humanitarian or low and middle income settings. We acknowledge heterogeneity and limited availability of RCTs demonstrating minimal risk of bias as limitations

Situation analysis for delivering integrated comprehensive sexual and reproductive health services for displaced population of Kasaï, Democratic Republic of Congo: Protocol for a mixed method study.

IntroductionDelivering integrated sexual and reproductive health services (SRHS) in emergencies is important in order to save lives of the most vulnerable as well as to combat poverty, reduce inequities and social injustice. More than 60% of preventable maternal deaths occur in conflict areas and especially among the internally displaced persons (IDP). Between 2016 and 2018, unprecedented violence erupted in the Kasaï's region, in the Democratic Republic of Congo (DRC), called the Kamuina Nsapu Insurgency. During that period, an estimated three million of adolescent girls and women were forced to flee; and have faced growing threat to their health, safety, security, and well-being including significant sexual and reproductive health challenges. Between August 2016 and May 2017, the "Sous-Cluster sur les violences basées sur le genre (SC-VBG)" in DRC (2017) reported 1,429 Gender Based Violence (GBV) incidents in the 49 service delivery points in the provinces of Kasaï, Kasaï Central and Kasaï Oriental. Rape cases represented 79% of reported incidents whereas sexual assault and forced marriage accounted for respectively 11% and 4% of Gender Based Violence (GBV) among women and adolescent girls. This study aims to assess the availability of SRHS in the displaced camps in Kasaï; to evaluate the SRHS needs of young girls and women in the reproductive age (12-49). Studies of sexual and reproductive health (SRH) in the Democratic Republic of Congo (DRC) have often included adolescent girls under the age of 15 because of high prevalence of child marriage and early onset of childbearing, especially in the humanitarian context. According to the 2013 Demographic and Health Survey (DHS), about 16% of surveyed women got married by age 14 while the prevalence of early child marriage (marriage by 15) was estimated at 30%; to assess the use of SRHS services and identify barriers as well as challenges for SRH service delivery and use. Findings from this study will help provide evidence to inform towards more needs-based and responsive SRH service delivery. This is hoped for ultimately improve the quality and effectiveness of services, when considering service delivery and response in humanitarian settings.Data and methodsWe will conduct a mixed-methods study design, which will combine quantitative and qualitative approaches. Based on the estimation of the sample size, quantitative data will be drawn from the community-based survey (500 women of reproductive age per site) and health facility assessments will include assessments of 45 health facilities and 135 health providers' interviews. Qualitative data will comprise materials from 30 Key Informant Interviews (KII) and 24 Focus Group Discussions (FGDs), which are believed to achieve the needed saturation levels. Data analysis will include thematic and content analysis for the KIIs and FGDs using ATLAS.ti software for the qualitative arm. For the quantitative arm, data analysis will combine frequency and bivariate chi-square analysis, coupled with multi-level regression models, using Stata 15 software. Statistic differences will be established at the significance level of 0.05. We submitted this protocol to the national ethical committee of the ministry of health in September 2019 and it was approved in January 2020. It needs further approval from the Scientific Oversee Committee (SOC) and the Provincial Ministry of Health. Prior to data collection, informed consents will be obtained from all respondents

Exploring the feasibility of establishing a core set of sexual, reproductive, maternal, newborn, child, and adolescent health indicators in humanitarian settings: results from a multi-methods assessment in Jordan

Plain English summary In humanitarian settings, data collection is often unreliable and not standardized – especially with regards to sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH). In order to address this gap in data quality, the World Health Organization proposed a list of core indicators to four countries, including Jordan. The goal was to use the findings from the Jordanian context to contribute to the determination of a core set of indicators, and accumulate a list of necessary policy, funding, infrastructure, capacity and training that will be required. This study had two components: a feasibility assessment and a multi-methods assessment. The feasibility assessment in Jordan focused on the relevance of the proposed indicators, the feasibility of measurement, the resources in place, and ethical issues. The multi-methods assessment included a desk review, interviews with key informants and focus groups, and facility assessments (including observational sessions). The findings showed that partners in Jordan supported developing a standard set of SRMCAH indicators that can be used among all humanitarian partners in the country. There are a number of systems in place that could be used or strengthened to improve data collection. However, the findings also showed that there must be better collaboration and coordination between the different partners in Jordan, as well as increased resources, to alleviate burden on front-line staff, starting with standardizing and strengthening Jordan’s health information system (HIS). In conclusion, though there is a desire to harmonize indicators, more input and resources are needed from the international community to aid in the standardization of data collection in order to meet local reporting requirements and ease burden on local staff

The relaxation exercise and social support trial-resst: study protocol for a randomized community based trial

Abstract Background Studies suggests a possible link between vaginal discharge and common mental distress, as well as highlight the implications of the subjective burden of disease and its link with mental health. Methods/Design This is a community-based intervention trial that aims to evaluate the impact of a psycho-social intervention on medically unexplained vaginal discharge (MUVD) in a group of married, low-income Lebanese women, aged 18-49, and suffering from low to moderate levels of anxiety and/or depression. The intervention consisted of 12 sessions of structured social support, problem solving techniques, group discussions and trainer-supervised relaxation exercises (twice per week over six weeks). Women were recruited from Hey el Selloum, a southern disadvantaged suburb of Beirut, Lebanon, during an open recruitment campaign. The primary outcome was self-reported MUVD, upon ruling out reproductive tract infections (RTIs), through lab analysis. Anxiety and/or depression symptoms were the secondary outcomes for this trial. These were assessed using an Arabic validated version of the Hopkins Symptoms Checklist-25 (HSCL-25). Assessments were done at baseline and six months using face-to face interviews, pelvic examinations and laboratory tests. Women were randomized into either intervention or control group. Intent to treat analysis will be used. Discussion The results will indicate whether the proposed psychosocial intervention was effective in reducing MUVD (possibly mediated by common mental distress). Trial Registration The trial is registered at the Wellcome Trust Registry, ISRCTN assigned: ISRCTN: ISRCTN98441241</p