Fatigue among post–hematopoietic stem cell transplant patients in Jordan: prevalence and associated factors
Authors : Abdalrahman, O.A., Othman, E.H., Khalifeh, A.H. & Suleiman, K.
Abstract : Background: During hematopoietic stem cell transplant (HSCT), patients underwent various serious prolonged treatments, including conditioning and immunosuppressive drugs, resulting in several symptoms and alterations in the patient’s functioning. One of the most commonly reported symptoms is fatigue. Aim: To assess fatigue levels and associated factors during the first 100 days post-HSCT among Jordanian patients. Methods: A descriptive cross-sectional design assessed fatigue and associated factors during the first 100 days post-HSCT among Jordanian patients. A convenient sample was used to recruit post-HSCT patients. Data were collected using the demographic survey and the Brief Fatigue Inventory (BFI) scale. Results: The findings of this study demonstrated that 40.5% of the participants had severe total fatigue scores, while the mean BFI intensity average score was 5.01 and the mean interference of fatigue with patients’ daily life was 5.06. In terms of fatigue interference with daily activities, the highest interference was with the patient’s mood and normal work, while the lowest interference was with the walking ability. The analysis revealed a strong positive correlation between the fatigue intensity and its interference with the daily activities (r = .98, p ˂.001). Besides, a significantly strong negative correlation was found between the number of days post-HSCT and fatigue scores (r = − .92, p ˂.001). Conclusion: Post-transplant, patients experienced increased fatigue intensity, reduced physical activity, interference with the patient’s mood, and diminished functional capacity. Patients who have HSCT require a significant nursing care immediately post-transplant.
Keywords : Fatigue, Cancer, Hematopoietic stem cell transplant, Physical activity
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Attitude and Associated Factors toward End of life Care among Nurses Working in Kuwait Hospitals: A Cross-sectional Study
Authors : Alenezi, E., Zeilani R., Othman E.H.
Abstract : Objective: The current study assessed the attitude toward end of life (EOL) care among nurses working in Kuwait hospitals. Material and Methods: A descriptive, cross-sectional design was used to recruit 900 nurses from nine public, private and military hospitals in Kuwait. Data were collected using a self-administered questionnaire of the Frommelt Attitude Toward the Care of Dying questionnaire. Results: The results showed that nurses in Kuwait had a favourable and supportive attitude towards EOL care, mainly toward the families’ need for emotional support, care for the dying patients, involving the family in care, and accepting death. Further, attitude scores differed significantly based on nurses’ age, year of experience, education level, nationality, type of hospital, and place of work. Conclusion: Nurses working in Kuwait have a favourable attitude toward care for dying patients but an unfavourable perception toward making conversation with patients about death. Hence, providing appropriate awareness to nurses about death and dying in Kuwait might be a promising intervention to improve their attitude and sensitise the concept of death among them.
Keywords : Attitude to death, End of life, Kuwait, Nurses, Terminal care
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Determinants of Exclusive breastfeeding and Mixed Feeding Among Mothers of Infants in Dubai and Sharjah, United Arab Emirates
Authors : Haleama Al Sabbah, Enas A. Assaf , Zainab Taha, Radwan Qasrawi and Hadia Radwan
Abstract : Background: Breastfeeding (BF) is considered the ultimate method of infant feeding for at least the first 6 months of life. Exclusive breastfeeding (EBF) is one of the most effective interventions to improve child survival. The main objective of this study was to assess the prevalence and duration of exclusive breastfeeding and the associated factors among women in Dubai and Sharjah, UAE. Methods: A cross-sectional study was conducted in four hospitals and four healthcare centers in Dubai and Sharjah between September 2017 and December 2017. Hospitals and centers are governmental and provide maternal and child health services. A convenience sample of 858 Arab and Emirati mothers with children under the age of 2 years participated in the study. Face-to-face interviews were conducted by using structured questionnaires. The study was approved by the University Ethical Committee and the UAE Ministry of Health before data collection. Descriptive statistics were computed to describe all the questionnaire items. The chi-square test was used to compare the study’s categorical variables. A binary logistic regression analysis was used to predict the relationship between BF and its associated factors. Statistical tests with P-values < 0.05 were considered statistically significant Results: The mean age of the participating mothers was 30.6 (SD 5.5) years. Results showed that the prevalence of exclusive breastfeeding among the study participants was 24.4% (31.1% in Sharjah and 22% in Dubai; P = 0.003). The binary logistic regression reported that mother’s and father’s education, skin-to-skin period, number of children, mothers’ health, and place of living were significantly associated with exclusive breastfeeding (P < 0.05). The results reported a significant association between EB and duration of breastfeeding (OR = 6.9, P = 0.002), husband education (OR= 2.1, P = 0.015), mother education (OR = 1.3, P = 0.027), number of children (OR = 7.9, P = 0.045), having any health problem (OR = 1.2, P = 0.045), and living place (OR = 1.4, P = 0.033), and a non-significant positive effect of family size and family income. Furthermore, the result reported a significant association between mixed breastfeeding and duration of breastfeeding (OR = 0.1, P = 0.000), skin-to-skin period (OR = 0.3, P = 0.002), underweight (OR = 4.7, P = 0.034), last infant’s sex (OR = 1.6, P = 0.010), having maid at home (OR = 2.1, P = 0.000), number of children (OR = 0.2, P = 0.013), and living place (OR =1.1, P = 0.014), and a non-significant association with family size and family income. Conclusions: Therefore, a health promotion program for exclusive breastfeeding during antenatal health رابط البحثs, together with initiating health policies in maternal hospitals to encourage the initiation of breastfeeding during the first hour of birth and the introduction of skin-to-skin contact during the first 5min of birth are highly recommended.
Keywords : exclusive breastfeeding, mixed feeding, practices, Sharjah, Dubai, UAE, child under two years
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The Effect of Benson Relaxation Technique on Depression, Anxiety, and Stress of Jordanian Patients Diagnosed with Multiple Sclerosis: A Cross-Sectional Study
Authors : Ahmad Rajeh Saifan , Mohannad Eid Aburuz, Enas A. Dhaher, Abdallah Rayyan, Mira Al Jaberi, and Rami Masa'Deh
Abstract : Depression, anxiety, and stress (DAS) are common symptoms of multiple sclerosis (MS) patients and are highly correlated with poor quality of life. Managing DAS among such patients can improve their quality of life (QoL), empowering them with improved autonomy, self-care, independency, and ability to perform daily activities. This study is aimed at examining the effectiveness of the Benson Relaxation Technique (BRT) on reducing DAS among patients diagnosed with MS in Jordan. This quasi experimental study of 105 Jordanian patients diagnosed with multiple sclerosis tested an intervention group (60 patients) who received BRT and a control group (45 patients) who received normal treatment. Data were collected from January 2021 to April 2021, using the Arabic version of the Depression Anxiety Stress Scale (DASS21). The intervention group was instructed to perform the BRT two times a day for 10 minutes at home for eight weeks at two specific times, with 7-8-hour intervals between each episode. STROBE guidelines were followed in reporting the review. At the baseline comparison, there was no statistical difference between the interventional and control groups with regard to DAS. The levels of DAS between the two groups after three months of the last sessions of the intervention (post intervention) were compared. The results showed that the intervention group had significantly lower levels of DAS compared to the control group. The levels of the DAS were significantly lower for the intervention group post intervention. Adding relaxation techniques to the therapeutic routine is a cost-effective complementary treatment to decrease DAS among MS patients and improve their QoL. Relevance to Practice. This study provides a baseline of data that could facilitate further investigations in the future to improve the quality of services delivered to such patients and thus their QoL and satisfaction.
Keywords : Benson Relaxation Technique, Multiple sclerosis, Anxiety, Stress, Jordan
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Semi-Experimental Study for Decreasing Perineal Trauma through Communication between Midwife and Saudi Woman
Authors : Enas A. Assaf and Raana Essa Ageely
Abstract : Background and Objective: Perineal trauma is one of the serious outcomes of childbirth. Part of the midwives’ role is to reduce the trauma through several measures among which is the use of effective communication and providing valid and clear information. To measure the effect of effective midwife-woman communication during childbirth before administering training and compare the difference of midwives behaviour and attitude to post-training in reducing Perineal trauma. Materials and Methods: A semi-experimental study (pre-test/post-test) was used as 25 midwives were observed during the process of childbirth by using an observational checklist. Followed by intensive three-day simulation training/five hours a day regarding effective communication in reducing Perineal trauma. Followed by observational documentation of the midwife’s behaviour, attitude and communication during childbirth to validate the difference. Results: The results showed that there were significant changes in the midwives behaviour, attitudes and communication with women during childbirth. Perineal trauma cases decreased, along with a decrease in the number of Episiotomy cases. The presence of bleeding during birth decreased significantly (p = 0.012) and the average pain scale also decreased from 7.48-6.96 post-training. Conclusion: Communication and health education during birth can help in reducing Perineal trauma. However, further specific and similar studies at different populations and areas need to be conducted in this regard.
Keywords : midwife communication, health education, normal childbirth, perineal trauma, episiotomy, midwives training, oxytocin
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Women’s Attitudes Toward Accepting Wife Beating in the Southern Region of Saudi Arabia
Authors : Enas A. Dhaher
Abstract : Background and Objective: A domestic violence victim who believes of justifying reasons for wife beating, would be a target for continuous violence and abuse in addition to significantly reduced reporting and help seeking. This study was conducted to explore the factors involved in women’s attitudes toward accepting wife beating in the southern region of Saudi Arabia. Material and Methods: A cross sectional survey was conducted in 2014 among 151 women in the Obstetrics and Gynecology clinics at the Armed Forces Hospital in the southern region of Saudi Arabia. The research setting was chosen because it serves the inhabitants of the southern region. Results: This study revealed that 51.7% of women in our sample believed that wife beating was justified in at least one situation out of 6 situations. The highest number of respondents accepted wife beating in scenarios described as "if a wife insults her husband" and " if she disobeys him" (43.0% and 32.5, respectively). The researcher also conducted interviews with the participants regarding household decision-making, the results of which are outlined in the relevant section in this study. Conclusion: Education and empowerment for women can help changing women’s attitudes towards wife beating and further comparative studies is recommended in different regions.
Keywords : domestic violence, wife beating, household decision making, female education, Saudi Arabia, Gulf countries
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Descriptive Study for Pregnant Women’s Knowledge Attitude and Practices Regarding Iron Deficiency Anemia and Iron Supplements in the Southern Region of KSA
Authors : Enas A. Dhaher
Abstract : Background and Objective: Pregnancy with iron-deficiency anaemia can put the mother and the infant into a high-risk category, therefore, women need to be aware of the risks and preventive measures. The main objective of this study was to ascertain and measure women’s knowledge, attitudes and practices related to iron deficiency anaemia and iron supplements in comparison to their haemoglobin (Hb) blood level in the southern region of Saudi Arabia. Material and Methods: A descriptive cross sectional survey using a self-administered questionnaire and checking the last haemoglobin level reported in patient’s file during the month of March, 2019 at the Armed Forces Hospital Southern Region Obstetrics and Gynaecology Clinics. Sample size of 342 pregnant women participated in the study. Results: The main study outcomes show that the prevalence of anaemia was 42.5% (mild 23.9, moderate 15.2 and severe 3.8) and the mean haemoglobin level was 11.4 g dL–1. For this study, poor knowledge score was 95, 38% had a negative attitude score and 84% received poor practice scores. Half of the women reported that their main source of information were from family and friends. Only 16% of the women received their health information from a health provider. Conclusion: Health education during antenatal رابط البحثs from health care providers needs to be personalized to each woman, along with a mass media campaign for awareness purposes in the region.
Keywords : Iron deficiency anaemia, pregnant women, Saudi Arabia, haemoglobin, Knowledge attitudes and practices
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Knowledge, Attitudes and Practices of Women in the Southern Region of Saudi Arabia Regarding Cervical Cancer and the Pap Smear Test
Authors : Enas A Dhaher
Abstract : Background: The main barrier for women to receive Papanicolaou (Pap) smear tests and immunization is lack of knowledge about the disease’s signs and symptoms, women’s attitudes toward prevention programs and cultural myths and beliefs. Therefore, the main objective of this study is to measure women’s knowledge, attitudes and practices about cervical cancer and the Pap smear test in the southern region of Saudi Arabia and to assess the findings in relation with women’s demographics. Methods: A cross sectional survey was conducted at the Armed Forces Hospital Southern Region Obstetrics and Gynecology Clinic using a self-administered questionnaire with a sample size of 255 women between the ages of 15 and 65 years. Results: Forty-three percent of the women in this region are aware of cervical cancer, but do not recognize its risk factors, implications, timing or main cause, which is Human papillomavirus (HPV). In fact, the primary source of information was obtained through social media. Only two women conducted Pap smear test and that was based on doctor’s referral, where women’s main reason from not conducting the test was feeling good and no need. Conclusions: There is a need, therefore, to create awareness programs for cervical cancer, its causes and risk factors, as well as its preventive measures for women in the southern region of Saudi Arabia.
Keywords : Cervical cancer- Pap-smear test- knowledge- Saudi Arabia
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Access to Reproductive Health Care Services for Women in the Southern Region of Saudi Arabia
Authors : Enas A. Dhaher
Abstract : A study of 151 women in the southern region of Saudi Arabia revealed that most women (94.2%) encountered at least one obstacle in accessing health care. Concerns ranged from finding a female health care professional (72.2%) to obtaining permission from her husband (25.2%). Furthermore, data indicate that women in this region face problems related to transportation, as they are not permitted to drive (51.7%); there is also a reluctance to access health services on their own (53%). Freedom of movement will empower women in Saudi Arabia to minimize problems in accessing health care.
Keywords : ccess to health care; transportation; female health, care professionals; Saudi Arabia
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Family planning KAP survey in the Southern Region of Saudi Arabia
Authors : Enas A Dhaher
Abstract : Background: Family planning practices could be determined through adopting proper knowledge and positive couple attitudes towards the use of family planning which would most likely result in favourable family decisions which would benefitted both the individual and the overall country welfare. Methods: A cross sectional study has been conducted using a structured questionnaire administered through face-to-face interview to a convenient sample of 151 pregnant women attending the obstetrics and gynaecology outpatient clinic at the Armed Forces Hospital in the southern region of Saudi Arabia in December 2014. Results: The results revealed that modern methods were popular among women. In general we found positive attitudes towards family planning among the sampled women as two third of the women have ever used contraceptives. However, the present study showed that 34% of women had unmet need of family planning. Women’s age, marriage years and number of children were all found to be associated factors with unmet need. Conclusions: National organized family planning programs might help satisfying the family planning needs for the families. Further studies regarding southern men’s knowledge and attitudes towards family planning is recommended.
Keywords : Family planning, KAP, Unmet need, Saudi Arabia
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Senior Nursing Students’ Perception of the Theoretical knowledge and Clinical Practice Gap in an in-hospital Nursing Program –A Descriptive Study conducted in Southern Saudi Arabia
Authors : Enas Dhaher
Abstract : In- Hospital Nursing training programs in Saudi Arabia are gradually being phased out, yet these nursing programs can help to reduce the gap between theoretical knowledge and practical training in nursing. Thus, this study aimed to explore senior internship nursing students’ perception of the gap between theoretical knowledge and clinical practice, specifically pertaining to its existence, the reasons for it and its effect on their nursing performance. A descriptive-explorative study was conducted among the 35 senior internship nursing students in an in-hospital Nursing program, affiliated to one of the tertiary hospitals in the southern region of Saudi Arabia. A self-administered questionnaire was used, comprising four main sections, namely areas where the theory-practice gap exists; reasons for the gap in clinical practice; reasons for the gap in theoretical knowledge; and finally, the impact of the gap on the students’ performance. Overall it was found that around 83% of the students experienced a gap between theory and practice. The reasons for the gap was perceived as theoretical knowledge that is not applicable to practice; the teaching strategy that was not well integrated into the training practice; and the sequence of the subjects at the nursing school that was not matching the practical training. About two thirds of the students expressed that adaptation to the hospital environment was one of their major concerns. It was found that the gap between theoretical knowledge and practical training could be reduced in an In-Hospital Training program by promoting more coordination between the nursing school and the hospital administration, along with improving teaching strategies.
Keywords : In-hospital nursing program, the Theory-Practice gap, Internship nursing students, Southern region of
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Attitudes Toward Wife Beating Among Palestinian Women of Reproductive Age From Three Cities in West Bank
Authors : Enas A. Dhaher, Rafael T. Mikolajczyk, Annette E. Maxwell
Abstract : A total of 450 women were interviewed in Mother and Child Health Care Centers in three cities in West Bank, Palestine, to assess attitudes toward wife beating. Overall, women perceived wife beating to be justified if a wife insults her husband (59%), if she disobeys her husband (49%), if she neglects her children (37%), if she goes out without telling her husband (25%), if she argues with her husband (11%), and if she burns the food (5%). Sixty-five percent of women agreed with at least one reason for wife beating, but there were statistically significant regional differences: Wife beating was most accepted in Jenin (73% acceptance of at least one reason) and least accepted in Hebron (55%). Lower level of education, not being employed, having more than one child, being married for fewer than 10 years, and making few household decisions were all associated with women’s acceptance of wife beating. The implications of these results are discussed.
Keywords : violence against women, wife beating, attitudes, West Bank, Palestine
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Factors associated with lack of postnatal care among Palestinian women: A cross-sectional study of three clinics in the West Bank
Authors : Enas Dhaher, Rafael T Mikolajczy, Annette E Maxwell and Alexander Krämer
Abstract : Background: Only about one-third of women in Palestine (West Bank and Gaza) obtain postpartum care. Therefore, the goal of this study was to assess factors associated with lack of postnatal care, women's reasons for not obtaining postnatal care, and their attitudes towards its importance. Methods: In early 2006, a cross-sectional survey was conducted at three clinics run by the Ministry of Health providing Mother and Child Health Care in West Bank, Palestine. A total of 264 postpartum women attending the clinics were interviewed face-to-face, using a structured questionnaire. Results: Although the majority of women considered postnatal care necessary (66.1%), only 36.6% of women obtained postnatal care. The most frequent reason for not obtaining postnatal care was that women did not feel sick and therefore did not need postnatal care (85%), followed by not having been told by their doctor to come back for postnatal care (15.5%). Based on a multivariable analysis, use of postnatal care was higher among women who had experienced problems during their delivery, had a cesarean section, or had an instrumental vaginal delivery than among women who had a spontaneous vaginal delivery. Use of postnatal care was also higher among women who delivered in a private hospital as compared to those who delivered in a public hospital. In addition, we found regional differences. Conclusion: The higher use of postnatal care among high-risk women is appropriate, but some clinically dangerous conditions can also occur in low-risk women. Future efforts should therefore focus on providing postnatal care to a larger number of low-risk women.
Keywords : postpartum care, Palestinian women, West Bank
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Factors associated with wife beating in Egypt: Analysis of two surveys (1995 and 2005)
Authors : Manas K Akmatov, Rafael T Mikolajczyk, Shokria Labeeb, Enas Dhaher , Mobarak Khan
Abstract : Background Wife beating is an important public health problem in many developing countries. We assessed the rates of wife beating and examined factors associated with wife beating in 1995 and 2005 in Egypt. Methods We used data from two Demographic and Health Surveys (DHS) conducted in Egypt in 1995 and 2005 using multistage household sampling. Data related to wife beating included information from 7122 women in 1995 and 5612 women in 2005. Logistic regression was used to analyze factors independently associated with wife beating. Special weights were used to obtain nationally representative estimates. Results In 1995 17.5% of married women in Egypt experienced wife beating in the last 12 months, in 2005 – 18.9% or 16.0%, using different measures. The association between socio-demographic differentials and wife beating was weaker in the newer survey. The 12-month prevalence of wife beating was lower only when both partners were educated, but the differences across education levels were less pronounced in 2005. Based on the information available in the 2005 survey, more educated women experienced less severe forms of wife beating than less educated women. Conclusion Different measures used in both surveys make a direct comparison difficult. The observed patterns indicate that the changes in prevalence may be masked by two opposite processes occurring in the society: a decrease in (severe forms of) wife beating and an increase in reporting of wife beating. Improving the access to education for women and raising education levels in the whole society may help reducing wife beating.
Keywords : intimate partner violence, wife beating
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Maternal near miss in four governmental hospitals in the West Bank, occupied Palestinian territory, in 2010: a retrospective, facility-based survey
Authors : Asma Mohammad Imam, Salwa Najjab, Enas Dhaher, Waleed Barghouti, Souzan Ahmad Abdo, Ali Nashaat Shaar, Said Sarahneh, Stephanie M Hansel
Abstract : Background In the past few years maternal near miss (MNM) has gained attention as an important indicator of the quality of obstetric care. Data for MNM in the West Bank, occupied Palestinian territory (oPt), have not been reported. Our aim was therefore to identify the frequency of MNM in four Ministry of Health maternity hospitals in the West Bank and review compliance with national protocols in case management. Methods We undertook a retrospective, descriptive, facility-based survey to identify maternal complications and suspected MNM cases in a total of 18 849 women admitted during 2010 to four selected Ministry of Health referral hospitals covering the north, middle, and south districts (main areas) of the West Bank. A random, stratifi ed sample of cases was selected from the hospitals according to an allocation sequence generated with WinPepi (version 11.15). The ratio of case selection was proportionate to the number of cases at each hospital. 198 (77 pre-eclampsia, 39 post-partum haemorrhage, 64 anti-partum haemorrhage, and 18 anaemia) of a total 403 suspected cases of MNM (157 pre-eclampsia, 82 post-partum haemorrhage, 130 anti-partum haemorrhage, and 34 anaemia) were selected to identify those meeting WHO’s diagnostic criteria. We undertook in-depth interviews with seven MNM cases admitted to intensive-care units (ICUs) according to an interview guide (of open-ended questions developed by the researchers and technical committee, and direct questions adapted from a questionnaire used in Brazil about severe maternal morbidity), and with 46 health-care professionals working in the maternity wards for the knowledge, attitudes, and practices (KAP) survey. In structured interviews of heads of maternity departments and other managers, we assessed the quality of maternal facilities. Because this study was hospital-based, post-partum data after discharge were excluded. The study was reviewed for ethical issues and approved by the UN Population Fund’s offi ce for the West Bank and Gaza Strip, and the Palestinian Ministry of Health and Palestinian Society of Obstetrics and Gynaecology, West Bank. We obtained written informed consent from the seven MNM cases. We used descriptive statistics (frequencies, mean, SD) to present the data and χ2 analysis (SPSS, version 13.0) to test the relation between health providers answering the knowledge questions and other factors in the KAP survey. For the in-depth interviews, the data were transcribed verbatim to describe women’s responses to the open-ended questions. Findings In 2010, in the four hospitals, 403 (2%) of 18 849 births were suspected cases of MNM according to diseasespecific criteria. 179 selected cases were analysed; according to WHO’s defi nition, the types of MNM were 75 (42%) preeclampsia, 54 (30%) ante-partum haemorrhage, 33 (18%) post-partum haemorrhage, 11 (6%) anaemia, and six (3%) ante-partum and post-partum haemorrhage. Of 179 women included in this study, 37 (21%) were admitted to ICUs. The 39 cases of post-partum haemorrhage were managed with oxytocin or methylergometrine (33 [85%]) and misoprostol (27 [69%]). 31 (79%) women had uterine massage and cervical and vaginal checks. Blood transfusion was administered in 16 (41%) cases, and fi ve (13%) had hysterectomies and internal iliac artery ligation. Moreover, the management of complications showed suboptimum compliance with the Palestinian Ministry of Health’s National Obstetrical Emergencies Guidelines and Protocols (November, 2008). In the KAP survey, 31 (67%) of 46 health staff who responded correctly answered questions about case management of post-partum haemorrhage; 12 (26%) correctly answered questions about the management of pre-eclamptic toxaemia; and 19 (41%) were able to defi ne the MNM classifi cation according to WHO’s criteria. The results of our facility audit showed that the equipment and machines used in the four hospitals were adequate; however, the maintenance of machines was diffi cult because there are no programmes for all governmental hospitals and no provision of training and monitoring of all staff . Interpretation We believe that the frequency of MNM in the oPt is higher than that noted in this study because of poor reporting and documentation of cases in hospitals. Therefore, a system of continuous education consisting of a thorough assessment of training needs and a clearly defi ned training plan, and ethical or legal responsibilities pertaining to proper documentation and management of cases are needed.
Keywords : near miss, maternal, mortality, Palestine, West Bank
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