Prevalence and Associated Demographic Characteristics of Gestational Diabetes Mellitus in Gaza

ABSTRACT: The aim of the study was to identify the prevalence and sociodemographic characteristics of gestational diabetes mellitus (GDM) in Gaza. A retrospective case-control study that included 189 GDM women were compared with 189 non GDM delivered in 2010 in Gaza. The available data were obtained from 2011 United Nations Relief and Works Agency (UNRWA) primary health care clinics in Gaza. WHO criteria were used for diagnosing GDM. The multivariate logistic regression test was used to identify the odds ratios (ORs) with 95% confidence intervals (CI), and controlling confounder variables. The overall prevalence of GDM women was 1.8%. The mean age and standard deviation for GDM cases was (34.1 yr ±6.56) while for the control group was (34.2 yr ±6.77). The GDM cases showed a similar mean and standard deviation (162.4±5.42) of height in comparison to the control group (162.3 cm ±5.39). The mean and standard deviation of weight (81.1 kg ±13.16) in GDM women was statistically different with a p-value < 0.001 compared to control. The most GDM significant associated demographic factors with a p value <0.005 were low income (OR 0.35, CI 0.14, 0.84) and being overweight before pregnancy (OR 1.07, CI 1.04, 1.09). The prevalence of GDM was found to be average (1.8%) and is increasing. Appropriate interventions are required for individuals matching these socioeconomic characteristics.ABSTRACT: The aim of the study was to identify the prevalence and sociodemographic characteristics of gestational diabetes mellitus (GDM) in Gaza. A retrospective case-control study that included 189 GDM women were compared with 189 non GDM delivered in 2010 in Gaza. The available data were obtained from 2011 United Nations Relief and Works Agency (UNRWA) primary health care clinics in Gaza. WHO criteria were used for diagnosing GDM. The multivariate logistic regression test was used to identify the odds ratios (ORs) with 95% confidence intervals (CI), and controlling confounder variables. The overall prevalence of GDM women was 1.8%. The mean age and standard deviation for GDM cases was (34.1 yr ±6.56) while for the control group was (34.2 yr ±6.77). The GDM cases showed a similar mean and standard deviation (162.4±5.42) of height in comparison to the control group (162.3 cm ±5.39). The mean and standard deviation of weight (81.1 kg ±13.16) in GDM women was statistically different with a p-value < 0.001 compared to control. The most GDM significant associated demographic factors with a p value <0.005 were low income (OR 0.35, CI 0.14, 0.84) and being overweight before pregnancy (OR 1.07, CI 1.04, 1.09). The prevalence of GDM was found to be average (1.8%) and is increasing. Appropriate interventions are required for individuals matching these socioeconomic characteristics

A CASE STUDY ON 3 WEEKS PREMATURE RUPTURE OF MEMBRANES CAUSED BY OROPHARYNGEAL MICROBIOTA

Premature rupture of membrane (PROM) is produced when amniotic membranes tear before labor onset and is recorded in around 8 % of full-term gestations. Preterm PROMs (PPROMs) take place before the 37th week of gestation, with an incidence of 2–4 % of pregnancies, and it is associated with higher maternal and perinatal morbidity and mortality, mainly related to infectious processes and prematurity. Among maternal complications, which include postpartum infection, premature placental detachment, and maternal sepsis, we highlight clinical chorioamnionitis for its incidence and severity. Of decreasing frequency, perinatal complications include respiratory distress, neonatal sepsis, intraventricular hemorrhage, necrotizing enterocolitis, and neurological lesions. Full-term PROM frequently has a physiological cause and is a consequence of uterine contractions; however, PPROM usually has a multifactorial etiology that is often unknown, although the most frequently reported cause is an infection, observed in up to 60 % of cases. Therefore, the etiology of PPROM, although probably infectious, remains unknown in most cases. The obstetric approach varies as a function of gestational age, actively inducing the pregnancy in full-term PROM but performing an overall evaluation of maternal-fetal status in PPROM. In the latter situation, an assessment is made of the relative risks and benefits of a wait-and-see attitude versus pregnancy induction, considering signs of infection and/or prematurity, and ordering antibiotic treatment when PPROM is diagnosed . Multiple combinations of antimicrobial drugs have been proposed and better perinatal and maternal outcomes have been reported for the prophylactic administration of some new combinations. This study describes a case of PPROM caused by urinary tract infection

ميزوبروستول عن طريق الفم كطريقة بديلة لتحريض المخاض: دراسة ضابطه

Background: Misoprostol is a new promising agent for cervical ripening and induction of labor. The ideal dose; route and frequency of administration of misoprostol are still under investigation. Aims: To examine 50 μg of oral misoprostol for induction of labor for its different efficiency and safety on maternal& fetal outcomes. Methods: This was a case control study for sample size of 300 women 152 as group and 148 as control. The participants were chosen from the labor room at Al Shifa Hospital the largest hospital in Gaza Strip & the first governmental hospital which started to use oral misoprostol for labor induction beside the routine use of prostaglandin E2. The study was conducted between September 2018, and December 2018. All the group were assigned to receive misoprostol 50 μg orally every 6 h for a maximum of 4 doses. Results: The current study revealed that total h for the oral misoprostol induction group 20.5 h compared to 5.7 h in the control group. The Maternal complication in oral misoprostol was 12.5% versus 2.7% in the control group. Moreover, oral misoprostol group has a higher rate in birth canal injury & caesarean section 9.2%, 19.1% versus 2.0%, 0.7% respectively with control. The result revealed that, overall fetal complication was a higher rate in misoprostol group 14.5% versus 7.3% in control. Conclusion: it was found that misoprostol induction method still has a higher maternal & fetal complication which required more investigation before being recommended as an alternative method in labor inductionلخلفية: الميزوبروستول هو عامل جديد واعد لنضوج عنق الرحم وتحريض المخاض. الجرعة المثالية لا يزال الطريق وتكرار إدارة الميزوبروستول قيد التحقيق. الأهداف: دراسة 50 ميكروغرام من الميزوبروستول الفموي لتحريض المخاض لكفاءته وسلامته المختلفة نتائج الأم والجنين. الطريقة: كانت هذه دراسة حالة مراقبة لحجم عينة من 300 امرأة 152 كمجموعة و 148 كعنصر تحكم. ال تم اختيار المشاركين من غرفة العمل في مستشفى الشفاء وهو أكبر مستشفى في قطاع غزة والأول المستشفى الحكومي الذي بدأ في استخدام الميزوبروستول الفموي لتحريض المخاض بجانب الاستخدام الروتيني لل البروستاجلاندين E2. أجريت الدراسة في الفترة ما بين سبتمبر 2018 وديسمبر 2018. وكانت المجموعة كلها المخصصة لتلقي الميزوبروستول 50 ميكروغرام عن طريق الفم كل 6 ساعات لمدة أقصاها 4 جرعات. النتائج: كشفت الدراسة الحالية أن إجمالي ح لمجموعة الميزوبروستول عن طريق الفم 20.5 ساعة مقارنة مع 5.7 ساعة في المجموعة الضابطة. كانت المضاعفات الأمومية في الميزوبروستول الفموي 12.5٪ مقابل 2.7٪ في المجموعة الضابطة. علاوة على ذلك ، لدى مجموعة الميزوبروستول الفموي معدل أعلى في إصابة قناة الولادة والولادة القيصرية 9.2٪ ، 19.1٪ مقابل 2.0 ٪ ، 0.7 ٪ على التوالي مع السيطرة. وكشفت النتيجة أن المضاعفات الجنينية كانت أعلى في معدل مجموعة الميزوبروستول 14.5 ٪ مقابل 7.3 ٪ في السيطرة. الخلاصة: لقد وجد أن طريقة تحفيز الميسوبروستول لا تزال لديها مضاعفات أعلى للأم والجنين مطلوب مزيد من التحقيق قبل أن يوصى به كوسيلة بديلة في تحريض المخا

A CASE STUDY ON LIFE-THREATENING PREGNANCY-INDUCED HYPERTENSION IN PRETERM PREGNANCY AND MANAGEMENT CHALLENGES: Pregnancy induced hypertension

Pregnancy-induced hypertension (PIH) is life threatening for the mother and her baby. Pre-eclampsia in pregnancy is a multisystem, disorder associated with significant maternal and neonatal morbidity and mortality. The current case study was done to clarify the consequences of PIH as a life-threatening condition at one of the governmental hospitals. A follow-up with observation recording was done since the first admission until the end of treatment duration. The patient presented with life-threatening PIH at 32 weeks of gestation. She was very tired and irritable and stayed in the hospital for several days; the case condition was progressed toward worse, lack of high-risk cases management team, the treatment plan, and decision-making were delayed until the 2nd day in the presence of the senior doctors. The final consequence for the present case was delivered by complicated cesarean section, the uterine repair was done due to placenta accrete and the baby was transferred to the neonatal intensive care unit with low Apgar scoring. The study concluded that early detection and proper intervention with the presence of collaborative team are required to reduce the maternal complications in low resources countries

جودة الحياة للنساءالفلسطينيات في قطاع غزةبعدما تم تشخيصهن بمرض سكر الحمل

This qualitative descriptive study was conducted to explore the lived experience of refugee women residing in Gaza Strip following a diagnosis of gestational diabetes mellitus (GDM). DESIGN AND PARTICIPANTS: The study design was informed by grounded theory analysis. Twenty women who were recently diagnosed with GDM were recruited from the United Nations Relief and Work Agency (UNRWA) primary health care clinics in the Gaza Strip. Data was collected using semi-structured interviews. RESULTS: Three themes were identified: lack of awareness, coping with the situation, and maintaining sustainability. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Our findings highlight the positive and negative magnitudes experience among GDM women to sustain a new lifestyle, which may inform the UNRWA health care professionals to focus on the barriers that prevent sustaining a healthy life style after the diagnosis of GDM to prevent diabetes type IIin the future.This qualitative descriptive study was conducted to explore the lived experience of refugee women residing in Gaza Strip following a diagnosis of gestational diabetes mellitus (GDM). DESIGN AND PARTICIPANTS: The study design was informed by grounded theory analysis. Twenty women who were recently diagnosed with GDM were recruited from the United Nations Relief and Work Agency (UNRWA) primary health care clinics in the Gaza Strip. Data was collected using semi-structured interviews. RESULTS: Three themes were identified: lack of awareness, coping with the situation, and maintaining sustainability. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Our findings highlight the positive and negative magnitudes experience among GDM women to sustain a new lifestyle, which may inform the UNRWA health care professionals to focus on the barriers that prevent sustaining a healthy life style after the diagnosis of GDM to prevent diabetes type IIin the future

Towards the Provision of Palliative Care Services in the Intensive Coronary Care Units: Nurses’ Knowledge, Training Needs, and Related-Barriers

Despite the notable benefits of palliative care (PC) for patients with chronic diseases, its delivery to people with cardiac problems, particularly in the Middle East region (EMR), remains a critical issue. There is a scarcity of research assessing nursing staff’s needs and knowledge in providing PC to cardiac patients in the EMR. This study aimed to assess the level of knowledge and needs of PC among nurses towards the provision of PC in intensive coronary care units (ICCUs) in the Gaza Strip, Palestine. It also identified the barriers to the provision of PC services in ICCUs in the Gaza Strip. A hospital-based descriptive quantitative cross-sectional design was adopted to collect data from 85 nurses working in ICCUs at four main hospitals in the Gaza Strip. Knowledge about PC was collected using a developed questionnaire based on the Palliative Care Quiz Nursing Scale (PCQN) and Palliative Care Knowledge Test (PCKT). PC training needs and barriers were assessed using the PC Needs Assessment instrument. Approximately two-thirds of nurses did not receive any PC educational or training programs, which contributed to their lack of PC knowledge. Most nurses would like to enroll in PC training programs, such as family support and communications skills courses. Nurses reported that there was a high demand for PC guidelines and discharge planning for patients with chronic illnesses. Insufficient healthcare professionals’ knowledge about PC and a staff shortage were the main barriers to integrating PC into the Gaza healthcare system. This study suggests incorporating PC into nursing curricula and in-service training, and it covers both basic and advanced PC principles. Intensive coronary care unit nurses need knowledge and training about PC, guidance, and support to provide appropriate care to patients with cardiovascular issues

تصور العملاء تجاه جودة رعاية ما بعد الولادة في قطاع غزة ، فلسطين: اتجاه لتغيير السياسة الصحية

Introduction: Most maternal and neonatal deaths occur during the postnatal period. Therefore, the quality of care provided by healthcare professionals at this critical time is crucial in reducing complications, morbidity, and mortality rates. Objective: The present study aimed to determine the perceptions of Palestinian women living in the Gaza Strip considering the quality of care they received in the early postpartum period. Materials and Methods: An analytical cross-sectional study was conducted using a self-administered questionnaire developed by the researchers. A total of 200 pregnant women were selected by convenience sampling method from 4 governmental hospitals in the Gaza Strip, Palestine providing postnatal care. Descriptive statistics, including frequency, mean, and standard deviations, were used to describe the variables. Analysis of Variance (ANOVA) and Independent Samples t-test was used to compare the collected mean scores. Results: The study participants rated the postnatal services they received as high-quality care. High mean scores were achieved for all study domains. The “quality of postnatal care provided by midwives” received the highest Mean±SD score of 4.16±0.60, followed by the domain “quality of postnatal baby care” with a Mean±SD score of 3.89±0.85. The other two domains of “quality of provided health education” and “quality of provided communication and psychological support” received the lowest mean scores of 3.81 with standard deviations of 0.90 and 0.80, respectively. Patient-perceived postnatal care quality was not affected by many variables, such as age, parity, and gravidity. It was only affected by the subjects’ level of education (P=0.001) and the place of delivery (P=0.017). Conclusion: The obtained results posed a challenge for healthcare policymakers and professionals working in maternity departments. A new policy and leadership directions are required in this critical and vulnerable clinical area. To improve the quality of postnatal care, health policymakers must collaborate with midwifery staff. It is important to identify and eliminate any barriers that impede the provision of better care. This will be reflected by reducing maternal and neonatal morbidity and mortality rates and reducing the number of hospitalization days.مقدمة: تحدث معظم وفيات الأمهات والأطفال حديثي الولادة خلال فترة ما بعد الولادة. لذلك ، فإن جودة الرعاية المقدمة من قبل المتخصصين في الرعاية الصحية في هذا الوقت الحرج هي حاسمة في الحد من المضاعفات ، والمراضة ، ومعدلات الوفيات. الهدف: هدفت الدراسة الحالية إلى تحديد تصورات النساء الفلسطينيات اللواتي يعيشن في قطاع غزة مع الأخذ في الاعتبار جودة الرعاية التي تلقوها في وقت مبكر بعد فترة الولادة. المواد والطرق: أجريت دراسة مقطعية تحليلية باستخدام استبيان تم وضعه بواسطة الباحثين. ما مجموعه 200 امرأة حامل من 4 مستشفيات حكومية في قطاع غزة ، و التي تقدم رعاية ما بعد الولادة. النتائج: صنف المشاركون في الدراسة خدمات رعاية ما بعد الولادة التي تلقوها على أنها عالية الجودة. تم تحقيق متوسط ​​درجات عالية لجميع مجالات الدراسة. مجال "جودة رعاية ما بعد الولادة المقدمة من القابلات "حصلت على أعلى درجة ، تلاها مجال "جودة رعاية الطفل بعد الولادة" مجالا الدراسة الآخران "جودة التثقيف الصحي المقدم" و "جودة الاتصالات المقدمة والدعم النفسي ”حصل على أدنى متوسط ​​درجات. . لم تتأثر جودة الرعاية المقدمة بعد للولادة بالعديد من المتغيرات ، مثل العمر وعدد مرات الحمل و عدد مرات الولادة. العاملان الذان أثرا على نتائج البحث هما مستوى التعليم للمشاركات في البحث و مكان الولادة. الخلاصة: شكلت النتائج التي تم الحصول عليها تحديا لواضعي سياسات الرعاية الصحية و المهنيين العاملين في أقسام الأمومة. سياسة جديدة وتوجهات القيادة مطلوبة في هذا المجال السريري الحرج والضعيف. لتحسين جودة الرعاية بعد الولادة ، يجب على صانعي السياسات الصحية التعاون مع طاقم القبالة. من المهم تحديد وإزالة أي حواجز تحول دون تقديم رعاية أفضل. هذا سوف ينعكس على خفض معدلات الاعتلال والوفيات لدى الأمهات والأطفال حديثي الولادة وتقليل عدد أيام الاستشفاء

نوعيةالخدمه الصحيه المقدمه ما بعد الولادة الرعاية كما يتصورها الأمهات في المستشفيات الحكومية في محافظات غزة

Introduction: Providing antenatal care (ANC) to pregnant women has positive impact on the health of mothers and their newborns. Provided ANC should be of high quality to have such an impact. The aim of this study was to assess the quality of ANC services provided by the governmental primary health care centers in the Gaza Strip as perceived by nurses and midwives providing ANC to this group of health service users. Design: A cross sectional descriptive design was used in this study. Participants of the study were all nurses and midwives (55 participants) who provide ANC at governmental primary health care centers in the Gaza Strip. Results: Results showed that about half (50.9%) of the participants were between 36 – 45 years, the majority of them (72.7%) have more than 10 years of work experience. 40% of participants hold a diploma in midwifery and about one third of them (34.4%) were from Gaza Governorate. Results showed high scores of all study variables and domains. Participants thought that emotional support was the most essential feature of quality of antenatal care and that they are following the national standards criteria related to providing ANC. Conclusion: The results of this study showed that nurses and midwives working at the governmental primary health care centers are providing their clients a high quality ANC service according to national guidelines of ANC. However, this was the perception of the nurses and midwives who provide the services . An assessment of the quality of delivered ANC as perceived by service users is needed to get a full picture of the actual quality of ANC services.فترة ما بعد الولادة هي فترة حرجة للأم ولها طفل. التي تؤثر على حياتهم المستقبلية. لتحسين جودة الرعاية بعد الولادة تقييم وتقييم الرعاية المقدمة تحتاج إلى فحصها من قبل المستخدم والنساء أنفسهن. الأهداف: لذلك ، تهدف هذه الدراسة إلى تقييم جودة الرعاية بعد الولادة كما تتصور الأمهات في المستشفيات الحكومية في محافظات غزة