Assessment of Syrian Obstetric Care Providers Knowledge, Attitude, and Practice Towards Preconception Care and Associated Factors: An online Cross-Sectional Study

Background: Preconception care was instituted in 2013 by the World Health Organization (WHO) to promote more attention to pregnant women by medical staff. Preconception care attempts to optimize pregnancy outcomes and promote health by managing and treating variables that influence it. Obstetric care providers in LAMICs have been reported to have low levels of preconception care awareness. This study investigates the Knowledge, attitudes, and practice-related features of obstetric care providers in Syria's public health institutions about preconception care.   Methods: A cross-sectional study was undertaken in Syria between 6 September 2022 and 7 October 2022 to evaluate obstetric care providers' Knowledge, attitudes, and practice at public health institutions regarding preconception care and related concerns. The questionnaire was designed using a validated scale from a prior study conducted in Ethiopia. The inclusion criteria for study participants were obstetricians and gynaecologists, midwives and residents, and nurses of Obstetrics and Gynecology. There were six sections in the questionnaire (sociodemographic information, Knowledge, practice attitude, additional factors associated with Preconception practice, and related actual & potential access to resources). The data were subjected to descriptive and multivariate logistic regression analysis using the IBM SPSS V. 28.0 software.   Results: The mean age of 499 participants was 31.8 (SD = 9.7). Most participants were female (81.8%) and physicians (60%). 91.4% of respondents were deemed knowledgeable about preconception care. the most identified question (96.2%) was (Women intending pregnancy should be encouraged to defer pregnancy until they have reduced their drug, alcohol, and cigarette usage). (24.8%) participants regularly queried their patients about their reproductive life plan, with women aged 18 to 49 being the most often questioned group (92.3%). Only 18.6% of physicians routinely informed their patients about environmental dangers and contaminants. In addition, 53.5% of responders inquired about the patient's surgical and medical histories. 29.7% of participants strongly agreed that PCC provides an opportunity to improve the health of couples, particularly women, whereas 18.2% are certain that PCC does not belong to their scope of duties. Knowledge was more likely to be poor among participants who had never seen a doctor practicing PCC than among those who had (OR=2.81, P value = 0.026). Participants who did not get training on reproductive life plan examination throughout their practice time were less knowledgeable than those who did (OR = 2.91, P value= 0.04).    Conclusion: Our results have shown that obstetric care providers in Syria have good Knowledge of and low to moderate practice and attitude towards preconception care. Improving access to training, carrier development, Internet, and library services is vital to improving PCC training. It is recommended that extra platforms be made accessible to obstetric care providers during their training to assist them in becoming preconception carers and in raising awareness about the significance of preconception care

Assessment Awareness of Breast Cancer Signs, Risk Factors, and Barriers: An Online Cross‑Sectional Study in Syria

Background: According to the World Health Organization (WHO), breast cancer (BC) is women's most common type of cancer. In LAMICs, breast cancer incidence is low. However, a lack of information about the signs and symptoms of breast cancer potentially results in the disease's progression to life-threatening stages.This study aimed to determine the levels of breast cancer symptom awareness among Syrian women and to identify the variables associated with a high level of awareness.   Methods: From 3 September 2022 to 27 September 2022, Syrian women participated in an online cross-sectional survey to measure their knowledge about breast cancer, risk factors, and symptoms. This survey was derived from previous research that included a comprehensive, authorized scale. The admission requirement was 18-year-old or older Syrian women from all Syrian governorates. The questionnaire was divided into two portions; the first component included sociodemographic characteristics. Based on the original BCAM scale, the second portion assessed the participant's knowledge of breast cancer symptoms, risk factors, and obstacles. Using the IBM SPSS V. 28.0 software, descriptive and multivariate logistic regression analyses were performed on the data.   Results: Among 1305 study participants, the mean age and standard deviation of the individuals were 30.7 and 11.2, respectively. Students constituted almost three-quarters (75.2%) of the study respondents. The average level of knowledge about risk factors was higher among women with chronic diseases (Mean = 4.44, SD = 2.176), whereas jobless people had a higher average level of information regarding obstacles than other subgroups of practical circumstances. In addition, single women scored higher on the barrier comprehension scale than other marital status groups (mean=3.34, SD=2.32). Only two variables, including age and educational level, were statistically significant in predicting an acceptable degree of knowledge of the risk factors for breast cancer. Participants with a PhD were more aware than other educational subgroups (P-value 0.05; OR =6.186). Participants with a PhD. are projected to be 6.18 times more aware of breast cancer risk factors than those with lower levels of education. Women with chronic conditions were 1.84 times more likely than others to be aware of breast cancer barriers.    Conclusion: Our findings indicate that Syrian females have a poor to moderate knowledge of breast cancer symptoms, risk factors, and barriers. It is proposed that more breast cancer awareness campaigns be conducted and that yearly screening programs be improved to combat the late detection of this illness. Social media and television might be effective venues for raising awareness of breast self-examination and early identification of symptoms

Assessment Knowledge, Attitude, and Practice Toward Tuberculosis Among Syrian People: An online cross-sectional study

Background: TB was reported to have the highest mortality rate among other infectious diseases in 2018 worldwide. Syria and other low-income countries have a higher incidence rate of TB in comparison to high-income countries. Stigma toward TB is extremely high in low-income countries like Syria, and these stigma delays patients from seeking healthcare facilities. Our purpose in this study is to assess the Syrian's knowledge, attitudes, and practices toward TB and understand their Practice related to this disease.    Methods: An online cross-sectional questionnaire was distributed between15 September 7 October 2022, among Syrians to assess their knowledge, attitudes, and practices toward TB. This questionnaire was adapted from a published study, and the inclusion criteria were all male and female Syrian citizens aged 18 or above. The survey was divided into four questions: the first section assessed sociodemographics, and the other sections were about knowledge, attitude, and practices, respectively. Using IBM SPSS V. 28.0, the data were submitted to descriptive and multivariate logistic regression analyses.   Results: About (38.6%) of the 1407 participants in this research were male. The research participants' knowledge scores indicated that 78.1% have excellent knowledge. However, 54.1% of interviewees agreed that shaking someone's hand may transmit tuberculosis. Regarding attitude, more than two-thirds (85.7%) of the participants in the survey had an optimistic outlook. Accordingly, most participants (81.3%) had effective TB preventive and control practices. Participants aged 61 to 70 had more TB knowledge than other age groups (P value<0.05; mean=6.63, SD=1.13). Participants with chronic illness had a more positive attitude toward tuberculosis than those without (P value<0.05) (mean=2.17, SD=0.63). Participants with a university degree demonstrated more TB practice than those with lower levels of education (mean=6.17, SD=0.85). Participants with a university degree were expected to have 4.38 times more TB knowledge than those without formal education (P 0.05). Participants with a university degree were projected to practice tuberculosis 10.63 times more often than those without education (P 0.001).   Conclusion: Our results indicate that there is poor knowledge regarding the route of transmission of TB; therefore, more efforts should be made to raise awareness about TB transmission, as understanding these facts is a crucial aspect in mitigating the incidence of TB. Consequently, individuals reported poor practices toward TB; for that reason, educating individuals about good practices toward TB should take priority in Syria as war has destroyed the understructure of the healthcare system

A Cross-Sectional of Syrians' Knowledge of Diabetes Mellitus and Hypertension Management

Background: Diabetes and hypertension are the two most common types of non-communicable diseases (NCDs) impacting people globally. There is no prior research on the Syrian population's knowledge and treatment of hypertension and diabetes, so it is crucial to assess how the Syrian population acknowledges and perceives these illnesses. This research intends to assess the level of hypertension and diabetes-related awareness, knowledge, attitude, and practices among Syrian individuals.    Methods: A cross-sectional study was conducted between 1 August and 25 August 2022 to assess adult awareness, knowledge, attitude, and behavior about hypertension and diabetes. The questionnaire for the study was developed based on previous research, and the inclusion criteria for the sample were Syrian residents older than 18 who presently live in Syria. On the questionnaire, there were four sections: sociodemographics information, WHO STEPS survey instrument on knowledge of and lifestyle determinants for hypertension and diabetes, respondents' knowledge of and comprehension of hypertension and diabetes, and respondents' awareness of these disorders.   Results: Among 976 participants, (65.8%) were females. Participants reported hypertension caused by (90.1%) stress, (78.2%) old age, (69%) anxiety, and (38.6%) drug usage. High salt consumption (87%), genetics (82.1%), and obesity (78%) are all risk factors for hypertension. In addition, minimizing salt consumption (92.4%), regular exercise (87.2%), and avoiding anxiety (85%) are preventative measures for hypertension. Participant answers to hypertension consequences were (75.8%) foot ulcer and (74%) eyesight loss. Primary and middle school educational status participants had greater hypertension knowledge (92.3%) than other educational levels. Alcohol use was linked to hypertension knowledge (P < 0.05). Participants whose lifestyles did not include alcohol use had a higher hypertension knowledge level (90.3%). Participants with a family history of diabetes have a greater knowledge of hypertension (92%) than those without (66.9%). Almost age groups have shown good knowledge of diabetes, especially participants aged above 55 (93.8%). However, most individuals have examined blood pressure (82.3%), whereas fewer than half had screened for blood sugar (64.4%). 82.2% of individuals check their blood pressure frequently, whereas 6.2% monitor their blood sugar. Men have a higher hypertension knowledge than females (mean=8.39, SD=2.02), P-value< 0.05, and knowledge of hypertension among participants was shown to be higher among those in good income status than other economic levels (mean=8.34, SD=1.98), P-value< 0.05. Participants between the ages of 40 and 55 showed better knowledge of diabetes compared to other age groups (mean=11.32, SD=2.54), P-value< 0.05; as well, men demonstrated greater knowledge of diabetes than females (mean=10.76, SD=2.79), P-value< 0.05.   Conclusion: Our results demonstrated that the Syrian population has a good to moderate understanding of hypertension and diabetes. However, there is still a shortage of standardized, regular screening practices. Since individuals remain involved in unhealthy lifestyle habits, it is vital to provide accurate information about hypertension and diabetes

Assessment Syrian Population Knowledge, Attitudes and Perceptions Towards Stroke: A Cross-Sectional Study from Syria

Background: Based on the stroke mortality rate, Syria was ranked 98th worldwide in 2020. Approximately 80% of strokes are avoidable by managing well-known modifiable risk factors, such as diabetes, hypertension, and cardiovascular disease. Due to the high prevalence of several modifiable risk factors for stroke in Syria, it is necessary to increase Syrians' understanding of strokes and encourage people to engage in healthy practices to eradicate these risk factors. This research aimed to evaluate the knowledge, attitudes, and health-related perceptions of adult Syrians about stroke.   Methods: This cross-sectional research was conducted between 2 September and 10 October 2022 among Syrians using an online survey to measure their knowledge, attitudes, and practices regarding stroke. This questionnaire was derived from a previously published article, and the inclusion criteria for this research were all Syrian residents aged 18 or older. The questionnaire utilized for this study consisted of three major sections: socio-demographic data, knowledge of stroke, and attitudes and perceptions about stroke.   RESULTS: 53.3 % of the 1,143 research participants were female. Most respondents (94.3%) recognized the brain as the organ impacted by stroke. Hypertension was the stroke's most identifiable cause and risk factor (72.8% and 73.6%, respectively). 72.8 % of participants recognized hypertension and atherosclerosis as causes of stroke. 94.3 % of survey participants accurately identified the oranges impacted by the stroke; however, only 50.1% properly identified the warning symptoms. 61.4 % of participants utilize the Internet as a source of stroke-related information. 22.3% of individuals aged 21 to 30 had identified at least one stroke warning sign. 12.58% of individuals with a high socioeconomic position have shown a solid understanding of stroke risk factors. Females were projected to be 1.55 times more knowledgeable about stroke warning signs than men (P value<0.05). It was expected that participants who believed that stroke is avoidable would be 2.2 times more knowledgeable about stroke warning signals than those who disagreed (P value<0.05). Participants who identified more than four causes of stroke were expected to have 14.77 times more knowledge of stroke risk factors than those who did not (P value<0.05).   Conclusion: Our research shows that although knowledge of stroke risk factors and symptoms is moderate to good, there is still a lack of perceptions toward this disease. Hopefully, this will encourage hospitals and other medical groups to continue their awareness-raising campaigns about the dangers of this illness. Stroke prevention and community response may be greatly enhanced by raising public consciousness of the condition and fostering individual agency in coping with it

Self-Reported Study Habits for Enhancing Medical Students\u27 Performance in the National Medical Unified Examination

Background: The National Medical Unified Examination (NMUE) is currently required for graduation, joining postgraduate medical training, and practicing medicine in Syria. Objective: To investigate self-reported study habits that correlate with high performance on the NMUE. Methods: First through 3rd year residents at the three main hospitals in Damascus, Syria, were asked to complete a retrospective cross-sectional survey investigating their study habits and previous scores. Results: Significantly higher score was associated with \u3e 15 study h/day and allocating 1-40% of study time for practicing questions. Mean NMUE score was not significantly different in relation to preparation months for examination or for those who reported spending all their time studying alone compared with spending any amount of time in a group setting. Scores of 231-240 on the Syrian scientific high school exam correlated with significantly higher NMUE performance compared with fewer scores, except scores of 221-230. For every 10 point increase in medical school cumulative grades, the NMUE score increased 3.6 (95% confidence interval 2.5-4.8). Conclusion: The NMUE score was significantly affected by hours spent studying per day, number of practice questions completed, percentage of study time allocated for doing questions, Syrian scientific high school exam scores, and the cumulative medical school class grades. It was not significantly affected by preparation months or studying in a group setting. More studies are needed to further describe and investigate the factors that might affect performance in the NMUE

Syrian Health Providers' Knowledge of Palliative Care: An Online Cross‑Sectional Study in Syria

Background: Palliative care is a method to alleviate pain and enhance the quality of life for patients suffering from the consequences of a life-threatening illness. The knowledge of palliative care among healthcare professionals is poor; therefore, training programs are needed to offer patients appropriate treatment and improve their health. In Syria, as palliative care programs are rarely applied, we aim to evaluate the knowledge regarding palliative care among healthcare workers.   Methods: This is an online cross-sectional study conducted between July 24 and August 28, 2022 to measure palliative care knowledge and its applications among Syrian healthcare workers. The questionnaire for the study was designed in light of a previous study, and the inclusion criteria were Syrian healthcare workers, including physicians and nurses, as well as medical and nursing students. The four sections of the questionnaire included sociodemographic information in the first part, while the second, third, and fourth parts assessed experience, knowledge, and attitude toward palliative care among healthcare workers, respectively. Data were analyzed in IBM SPSS V. 28.0 using descriptive and multivariate logistic regression analysis.   Results: Among 602 participants, 66.2% of participants were females. Most respondents were medical students (72.9%), while residents and nurses or nursing students represented 18.8% and 8.3%, respectively. The majority of participants (84%) answered the question about pain treatment goals correctly, while a small percentage (5.3%) answered the question about whether or not long-term opioid use is addictive correctly. No significant difference in the overall knowledge score was shown among geographical areas, genders, and different specialties. Regarding the knowledge questions related to palliative care, only 14 participants were considered knowledgeable. The three most responses that received agreement regarding the attitudes towards palliative care were “Pain relievers should be given as needed to terminally ill patients” (89.7%), “Spiritual care must include counseling for the terminally ill patient” (84.3%), “Patients have the right to determine their own degree of psychosocial intervention” (81%).  A significant difference existed between urban and rural residents in terms of the attitude score. When comparing first-year students to those in their fifth year, students in their fifth year were 8.06 times more likely to have a positive attitude.       Conclusions: Our results demonstrated that healthcare professionals have inadequate knowledge about palliative care. There is an urgent need to introduce palliative care to the health system in Syria in order to improve the quality of life of these patients in their terminal stages of illness and to provide care for patients who need it

The Awareness of Clinical Doctors and Medical Students Toward Monkeypox in Jordan: A National Cross-Sectional Study

Background: Following the diagnosis of the first confirmed monkeypox case in Jordan in August 2022, the necessity for assessing the perceived knowledge among healthcare personnel has gained more significance. Given that the knowledge of healthcare professionals plays a great role in protection against newly emerging epidemics, we therefore in this study aim to assess the awareness of medical students and practicing physicians in Jordan toward the monkeypox virus. Method: This cross-sectional study was conducted in Jordan to assess medical students' attitudes, general practitioners, residents, and specialists regarding the monkeypox virus. Data from the WHO, CDC, and literature were used to design this questionnaire. The questionnaire comprises 53 questions divided into three sections: socio-demographic variables and work-related characteristics, general and specific knowledge about the monkeypox virus. Snowball sampling was employed since it was convenient. The data were analyzed using SPSS version 25.0. A p-value < 0.05 was considered statistical significance. Results: Four hundred twenty-three healthcare professionals participated in this study. Only 7.3% (n = 31) of respondents have ever received information about monkeypox during studies in medicine. Respectively, the mean and median knowledge scores were 12.77 and 13, ranging from 4 to 25. More than half (51.3%, n = 3012) have heard about monkeypox before. About 45.9% (n = 194) of respondents reported that they had heard about monkeypox a few days ago for the first time, while 48.7% (n = 206) heard it a month ago. Most participants had a low level of good knowledge of monkeypox. Only 2.1% of respondents had correctly identified the natural host and the incubation period of monkeypox. More than half (52.1%) correctly answered the sign and symptoms of monkeypox. Almost 49.2% of respondents believed that monkeypox and smallpox have similar signs and symptoms. Respondents aged more than 30 years had higher level of knowledge (COR = 19.45, 95% CI = 6.7683-55.8933, p< 0.001). Respondents who are specialist doctors had higher knowledge of monkeypox (COR = 7.3125, 95% CI = 1.6793-31.8429, p = 0.008) than others. Conclusion: Monkeypox awareness among Jordanian medical students and practitioners is low; hence immediate action should be taken to address this catastrophic problem. Consequently, learning about monkeypox and spreading information about its prevention is crucial. Furthermore, increasing Doctors' ability to react to human monkeypox cases and report them to a disease surveillance system will depend on their education about the sickness.   Keywords:  Jordan, Monkeypox, Clinicians, Medical Students, Knowledge

Health Care Provider Burnout in Syria During COVID-19 Pandemic's Omicron Wave

Background: Healthcare workers have dealt with a range of psychological problems during the COVID 19 epidemic, including sadness, mental discomfort, anxiety, and poor sleep. Burnout is a state of prolonged work stress-related psychological, emotional, and physical stress brought on by emotional weariness, depersonalization, and decreasing professional success. The goal of this study was to find out how many healthcare workers burned out during the Omicron wave of the COVID-19 pandemic and to find out what factors put them at risk for this psychological effect.   Methods: This cross-sectional research was performed in Syria during the current Omicron wave of COVID-19 pandemic to evaluate the Burnout experienced by Syrian physicians who treat COVID-19 patients. The inclusion criteria were all Syrian healthcare workers who treated COVID-19 patients the current Omicron wave of COVID-19. The data was collected between April 3 and March 20, 2022. We investigated whether the questionnaire used was valid and understandable to the participants.   Results: A total of (729) healthcare providers inquired in our study; however, 30 participants were disqualified because their answers were not fully completed. The overall age of the participants was 31±9, and the ratio of males to females was almost equal. The majority (47.5%) of the sample study's participants are residents, and 72.8% of the participants carried for COVID19 patients. The prevalence of high level of burnout among the sample study was 41.6%. Compared to men (22.3%), women were much more likely (27.9%) to report experiencing a high degree of emotional exhaustion, also the participants who carried for COVID19 patients were much more likely (30.1%%) to report experiencing a high degree of emotional exhaustion compared to others, which individuals who carried for COVID19 patients were 1.76 times more likely than participants who did not carry for COVID19 patients to experience severe burnout (OR:1.766, 95%CI:1.2-2.4, P-value<0.001).   Conclusion: Our research found severe burnout among Syrian health care providers during the omicron wave of COVID19, with clinicians carrying COVID19 patients being considerably more likely to express high burnout than others. For this reason, it is imperative that we collaborate with international humanitarian organizations to provide a suitable psychiatric environment for Syrian physicians and provide practical recommendations to address this important concern

Large Ascites in a Cirrhotic Patient Reveal an Isolated and Late Metastasis of Ductal Breast Cancer: A Case Study

Breast cancer is the most prevalent cancer in women worldwide, and its prevalence has increased since the introduction of screening programs. Most cases are discovered at an early stage; however, despite effective treatment, some cases progress to metastasis. The most common breast cancer metastatic locations are the bone, liver, and lungs. Ascites malignant due to peritoneal involvement is a rare manifestation of metastatic breast cancer. After 8 years of well-controlled breast cancer, we report a 54-year-old woman who presents with malignant ascites and is known to have cirrhosis of the liver