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Sammouri J, Khachfe HH, Fares MY, Salhab HA, Nassar AH, Chamsy D. Deliveries in Lebanon, the Country with the Highest Refugee Density in the World: A Descriptive Review. Matern Child Health J 2024; 28:601-608. [PMID: 37980311 DOI: 10.1007/s10995-023-03826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE The aim of this study is to analyze obstetrical and reproductive health parameters in Lebanon from 2015 until 2018 in the setting of the Syrian refugee influx in order to evaluate potential risks and provide a management plan to improve outcomes. DESCRIPTION Data from the Lebanese Ministry of Public Health (LMPH) on all obstetrical deliveries that occurred in Lebanon between 2015 and 2018 was screened and analyzed. Number and mode of delivery as well as maternal and neonatal outcomes were included. Joinpoint regression analysis was used for trends of selected parameters. Independent two-sample t-tests were used for comparisons. ASSESSMENT Women of non-Lebanese nationality residing in Lebanon had a significantly greater number of total deliveries (p-value < 0.001), vaginal deliveries (p-value = 0.002), cesarean sections (p-value = 0.02). When looking at delivery trends from 2015 to 2018, Lebanese women had a significant decrease in total number of deliveries (p-value < 0.001) and vaginal deliveries (p-value < 0.001). CONCLUSION Total number of deliveries and cesarean sections is on the rise in Lebanon. Cesarean section practice should be audited by the LMPH and the Lebanese Order of Physicians (LOP). Local and international agencies should prioritize the implementation and management of family planning facilities in refugee hosting countries.
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Affiliation(s)
- Julie Sammouri
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein H Khachfe
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Y Fares
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hamza A Salhab
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Riad El Solh, PO Box: 11-0236, Beirut, 1107 2020, Lebanon
| | - Dina Chamsy
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Riad El Solh, PO Box: 11-0236, Beirut, 1107 2020, Lebanon.
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Siösteen-Holmblad I, Larsson EC, Kilander H. What factors influence a Quality Improvement Collaborative in improving contraceptive services for foreign-born women? A qualitative study in Sweden. BMC Health Serv Res 2023; 23:1089. [PMID: 37821891 PMCID: PMC10568973 DOI: 10.1186/s12913-023-10060-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Improved contraceptive services could reduce the unmet need for contraception and unintended pregnancies globally. This is especially true among foreign-born women in high-income countries, as the health outcomes related to unmet need of contraception disproportionally affect this group. A widely used quality improvement approach to improve health care services is Quality Improvement Collaborative (QIC). However, evidence on to what extent, how and why it is effective and what factors influence a QIC in different healthcare contexts is limited. The purpose of this study was to analyse what factors have influenced a successful QIC intervention that is aimed to improve contraceptive service in postpartum care, mainly targeting foreign-born women in Sweden. METHODS A qualitative, deductive design was used, guided by the Consolidated Framework for Implementation Research (CFIR). The study triangulated secondary data from four learning seminars as part of the QIC, with primary interview data with four QIC-facilitators. The QIC involved midwives at three maternal health clinics in Stockholm County, Sweden, 2018-2019. RESULTS Factors from all five CFIR domains were identified, however, the majority of factors that influenced the QIC were found inside the QIC-setting, in three domains: intervention characteristics, inner setting and process. Outside factors and those related to individuals were less influential. A favourable learning climate, emphasizing co-creation and mutual learning, facilitated reflections among the participating midwives. The application of the QIC was facilitated by adaptability, trialability, and a motivated and skilled project team. Our study further suggests that the QIC was complex because it required a high level of engagement from the midwives and facilitators. Additionally, it was challenging due to unclear roles and objectives in the initial phases. CONCLUSIONS The application of the CFIR framework identified crucial factors influencing the success of a QIC in contraceptive services in a high-income setting. These factors highlight the importance of establishing a learning climate characterised by co-creation and mutual learning among the participating midwives as well as the facilitators. Furthermore, to invest in planning and formation of the project group during the QIC initiation; and to ensure adaptability and trialability of the improvement activities.
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Affiliation(s)
| | - Elin C Larsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Helena Kilander
- Department of Women's and Children's Health, Karolinska Institutet, and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden.
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
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Kilander H, Sorcher R, Berglundh S, Petersson K, Wängborg A, Danielsson KG, Iwarsson KE, Brandén G, Thor J, Larsson EC. IMplementing best practice post-partum contraceptive services through a quality imPROVEment initiative for and with immigrant women in Sweden (IMPROVE it): a protocol for a cluster randomised control trial with a process evaluation. BMC Public Health 2023; 23:806. [PMID: 37138268 PMCID: PMC10154759 DOI: 10.1186/s12889-023-15776-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/27/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Immigrant women's challenges in realizing sexual and reproductive health and rights (SRHR) are exacerbated by the lack of knowledge regarding how to tailor post-partum contraceptive services to their needs. Therefore, the overall aim of the IMPROVE-it project is to promote equity in SRHR through improvement of contraceptive services with and for immigrant women, and, thus, to strengthen women's possibility to choose and initiate effective contraceptive methods post-partum. METHODS This Quality Improvement Collaborative (QIC) on contraceptive services and use will combine a cluster randomized controlled trial (cRCT) with a process evaluation. The cRCT will be conducted at 28 maternal health clinics (MHCs) in Sweden, that are the clusters and unit of randomization, and include women attending regular post-partum visits within 16 weeks post birth. Utilizing the Breakthrough Series Collaborative model, the study's intervention strategies include learning sessions, action periods, and workshops informed by joint learning, co-design, and evidence-based practices. The primary outcome, women's choice of an effective contraceptive method within 16 weeks after giving birth, will be measured using the Swedish Pregnancy Register (SPR). Secondary outcomes regarding women's experiences of contraceptive counselling, use and satisfaction of chosen contraceptive method will be evaluated using questionnaires completed by participating women at enrolment, 6 and 12 months post enrolment. The outcomes including readiness, motivation, competence and confidence will be measured through project documentation and questionnaires. The project's primary outcome involving women's choice of contraceptive method will be estimated by using a logistic regression analysis. A multivariate analysis will be performed to control for age, sociodemographic characteristics, and reproductive history. The process evaluation will be conducted using recordings from learning sessions, questionnaires aimed at participating midwives, intervention checklists and project documents. DISCUSSION The intervention's co-design activities will meaningfully include immigrants in implementation research and allow midwives to have a direct, immediate impact on improving patient care. This study will also provide evidence as to what extent, how and why the QIC was effective in post-partum contraceptive services. TRIAL REGISTRATION NCT05521646, August 30, 2022.
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Affiliation(s)
- Helena Kilander
- Department of Women's and Children's Health, Karolinska Institutet, and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden.
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Rachael Sorcher
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Sofia Berglundh
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Kerstin Petersson
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - Anna Wängborg
- Department of Women's and Children's Health, Karolinska Institutet, and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Gemzell- Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Emtell Iwarsson
- Department of Women's and Children's Health, Karolinska Institutet, and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Brandén
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Center for Epidemiology and Social Medicine, Region Stockholm, Sweden
| | - Johan Thor
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Elin C Larsson
- Department of Women's and Children's Health, Karolinska Institutet, and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
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Chahine B, Souheil FA. Oral contraceptives: knowledge and counselling practices of Lebanese community pharmacists. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 30:45-51. [PMID: 34718596 DOI: 10.1093/ijpp/riab069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/21/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine the extent of Lebanese pharmacists' knowledge about oral contraceptives (OCs), the characteristics influencing their knowledge and the factors that may predict their counselling practices. METHODS A cross-sectional descriptive study was conducted between January and June 2020 in which a random sample of community pharmacists in Lebanon was asked to complete a self-administered questionnaire. The survey was divided into three sections including demographic information, pharmacists' knowledge and counselling practices, and their perceptions about OCs. KEY FINDINGS Of the 300 pharmacists invited to participate, 240 (80%) responded. The majority of the pharmacists (255; 85%) had satisfactory general knowledge about the indications, side effects, contraindications and drug interactions of OCs. However, only 173 (57.5%) participants had satisfactory knowledge about the proper use of OCs. Older pharmacists and those who have been in practice for more than 10 years achieved lower knowledge scores; however, those with postgraduate degrees had significantly higher scores. Pharmacists with a postgraduate degree and male pharmacists were less likely to counsel patients compared with their counterparts. Conversely, pharmacists with postgraduate OC training and those who had a private area for consultation presented better counselling practices. CONCLUSIONS More than half of the participating pharmacists appeared to have satisfactory knowledge about OCs and their proper use; however, limited counselling and key misconceptions were observed in this study.
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Affiliation(s)
- Bahia Chahine
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Farah Al Souheil
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
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