1
|
Shindala GS, Dauod AS, Alkhateeb NE. Effectiveness of SNAPPS Implementation in the Family Medicine Residency Program in Erbil: A Randomized Controlled Trial. Cureus 2024; 16:e64897. [PMID: 39035591 PMCID: PMC11259456 DOI: 10.7759/cureus.64897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2024] [Indexed: 07/23/2024] Open
Abstract
Background and objectives There is a crucial need to embrace modern methodologies for enhancing medical education in disciplines such as Family Medicine. The study introduces the SNAPPS (Summarize, Narrow, Analyze, Probe, Plan, and Select) model, a six-step mnemonic representing a learner-centered case presentation approach that streamlines fact reporting while encouraging clinical reasoning, aiming to evaluate the effectiveness of the SNAPPS method as compared to the traditional model of case presentation in Family Medicine outpatient clinics and to gain insights into how students and preceptors perceive it. Methods A randomized controlled trial was conducted in Family Medicine outpatient clinics in Erbil, Iraq, from March 15, 2023, to August 30, 2023. Using convenience sampling, all Family Medicine board residents (n=30) in Erbil and six preceptors from the Community and Family Medicine department/College of Medicine/Hawler Medical University were randomly assigned into two groups by using the RAND function in Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States). The SNAPPS method was introduced to the SNAPPS group employing approved tools and methods, while no intervention was needed in the control group. Subsequently, 30 cases were presented in each group with a total of 60 case presentations; the case presentations served as the units for data analysis. Feedback and data were gathered after each presentation using validated data recording sheets. Results The study showed a significant advantage for the SNAPPS group over the control group in terms of time efficiency, number of basic clinical attributes covered, and justified diagnoses (P value < 0.001). In the SNAPPS group, 90% of the students sought clarification and information, surpassing 30% in the control group (P-value < 0.001). Almost all SNAPPS group students (96.7%) discussed case-related topics, compared to 43.3% in the controls (P-value<0.001). The SNAPPS group received superior overall ratings from both preceptors and students. Conclusion The SNAPPS method enhances clinical diagnostic reasoning in Family Medicine outpatient clinics. It is time-efficient and encourages students to articulate uncertainties, pose questions, and identify case-related topics for self-study.
Collapse
Affiliation(s)
| | - Ali S Dauod
- Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, IRQ
| | - Nazdar E Alkhateeb
- Department of Medical Education/Pediatrics, College of Medicine, Hawler Medical University, Erbil, IRQ
| |
Collapse
|
2
|
Evolution of Therapeutic Patient Education: A Systematic Scoping Review and Scientometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106128. [PMID: 35627665 PMCID: PMC9140728 DOI: 10.3390/ijerph19106128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/03/2022] [Accepted: 05/09/2022] [Indexed: 01/04/2023]
Abstract
Therapeutic patient education (TPE) aims to empower the patients and their caregivers to effectively care for and manage their conditions. Such educational programs have been shown to improve health behaviors, disease outcomes, and quality of life among different patient populations. The field of TPE has evolved extensively over decades, owing to interdisciplinary research. No study so far has been done to map this field, to identify the stakeholders and gaps requiring future research. By leveraging the theory of co-citation, CiteSpace was used to visualize the bibliographic data pertaining to TPE research. A total of 54,533 articles published in English language were analyzed to identify influential funders, regions, and institutes contributing to this field. Besides these, significant theoretical and empirical contributions that shaped this field were mapped. Our analysis revealed several important insights. Most of the important theories that helped shape TPE were inspired from the social sciences. Five important research themes were identified: disorders, study designs utilized in TPE research, the scope of the TPE literature and outcomes, and populations. The research focused on improving perceptions, behaviors, and attitudes toward health promotion, reducing stigma, self-management and medication adherence. Most of the research was developed in the context of high-income countries. Future research should involve patients and use digital technology. Meta-analytical studies need to be done to identify the effectiveness and moderators of TPE interventions across different disorders. Further research should involve low and middle-income countries (LMIC) to ensure knowledge and technology transfer.
Collapse
|
3
|
Ali SM, Clark MT, Khedher Ghalib A, Skirton H, Donaldson C. "We don't have up to date knowledge about the disease" Practical challenges encountered in delivery of cervical cancer screening in Iraq. Eur J Cancer Care (Engl) 2021; 30:e13457. [PMID: 33932055 DOI: 10.1111/ecc.13457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 01/27/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
This qualitative study aimed to explore the lived experience of medical doctors in delivering cervical cancer screening in a city in Iraq. METHODS An applied grounded theory approach explored the reported experiences of doctors in the field. A purposive sample of 12 gynaecologists and one general practitioner (GP) working in two main hospitals participated: Semi-structured interviews took place from June to September 2015. Thematic coding of data was peer reviewed and included participant reading of transcripts and translations from Arabic to English. Theory generation involved synthesis of a prior literature review and interview findings. RESULTS Gynaecologist and GP experiences showed overwhelming gaps in cervical cancer experience and screening. Iraqi women mainly presented for help with late-stage cancer. Practical barriers included cultural stigma, low priority for women's health needs, lack of knowledgeable leadership and perceived shortage of adequately trained staff. CONCLUSION There is an urgent need for culturally appropriate cervical cancer prevention policies and strategies in Iraq, focused on evidence-based population-based cervical screening to identify and prevent advanced cervical cancer among women. Regional educational initiatives should be encouraged and primary healthcare systems supported to undertake screening.
Collapse
Affiliation(s)
| | - Maria T Clark
- Department of Post Qualifying Practice, Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | | | - Heather Skirton
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - Craig Donaldson
- School of Biomedical Sciences, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| |
Collapse
|
4
|
Shabila NP. Changes in the prevalence and trends of female genital mutilation in Iraqi Kurdistan Region between 2011 and 2018. BMC WOMENS HEALTH 2021; 21:137. [PMID: 33794859 PMCID: PMC8017769 DOI: 10.1186/s12905-021-01282-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/25/2021] [Indexed: 11/29/2022]
Abstract
Background Female genital mutilation (FGM) is commonly practiced in Iraqi Kurdistan Region, where there are extensive efforts to combat the practice over the last decade. This study aimed to determine the trends and changes in the FGM prevalence in Iraq between 2011 and 2018 and assess their associated factors. Methods Secondary data analysis of the Iraq Multiple Indicator Cluster Survey 2011 and 2018 was carried out to calculate the prevalence and the relative changes in the prevalence of FGM for 2011 and 2018 by governorate. The change in the prevalence was compared with the changes in other exposure variables such as age, education level, wealth, and area of residence over the same period. Results The prevalence of FGM in 2018 was high in Erbil and Suleimaniya governorates (50.1% and 45.1%). The prevalence of FGM decreased remarkably from 2011 to 2018 in all governorates of the Iraqi Kurdistan Region. The decrease in the prevalence was statistically significant in Erbil and Suleimaniya. FGM prevalence declined remarkably in all age, education level, residence area groups, and most economic level groups. Such decline was associated with a significant increase in the education level, wealth, and urban residence. The decline was highest in the younger age groups, with a relative change of − 43.0% among 20–24 years and − 39.2% among 15–19 years. The decline was also highest in those with secondary and higher education (relative change = −32%). The decline was higher in rural areas than in urban areas (relative change = −35.3% and − 27.4%, respectively). The decline was higher among the poorest and second wealth quintile (relative change = −38.8% and − 27.2%, respectively). Conclusion The trend of FGM in Iraqi Kurdistan Region declined remarkably and significantly from 2011 to 2018. Further decline is predicted because of having lower rates and a higher decline in the younger age groups. However, the rates remained high in Erbil and Suleimaniya governorates that need further intensifying the preventive measures. The education level of women plays a primary role in decreasing the prevalence and should be considered in future efforts to ban the practice.
Collapse
Affiliation(s)
- Nazar P Shabila
- Department of Community Medicine, Hawler Medical University, Erbil, Iraq.
| |
Collapse
|
5
|
Balai E, Mummadi S, Jolly K, Darr A, Aldeerawi H. Rhinocerebral Mucormycosis: A Ten-Year Single Centre Case Series. Cureus 2020; 12:e11776. [PMID: 33409023 PMCID: PMC7779117 DOI: 10.7759/cureus.11776] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction Rhinocerebral mucormycosis (RCM) is a rare, frequently lethal, opportunistic infection of the paranasal sinuses and brain caused by fungi of the Mucoracea family. The overall global incidence is low, with the condition most commonly found in India and the Middle East. Early diagnosis and aggressive treatment are essential. Overall mortality is high; reported rates range from 25-60%. Its infrequent presentation can pose both diagnostic and therapeutic challenges for centers not familiar with the condition. Objective We aimed to evaluate patient demographics, clinical presentation, diagnosis, management, and the complications of this uncommon condition. Methods We carried out a retrospective case-series analysis of all patients with a confirmed diagnosis of RCM presenting to a single tertiary-level hospital between 2000-2010. Hospital patient records were used to attain the specific clinical details for each case. Results A total of nine patients (eight males and one female) were diagnosed with RCM during this period. All patients had diabetes mellitus; the mean age was 58.2 years. The most common presenting features were foul-smelling blood-stained rhinorrhoea (100%), nasal congestion (100%), reduced visual acuity (89%), and hard palate ulceration (67%). Two patients had a cerebral abscess at presentation; two patients had skull base erosions with associated cranial nerve palsies. All patients received systemic amphotericin B and surgical debridement. The overall mortality rate was 78%. Conclusions Rhinocerebral mucormycosis is a notoriously difficult infection to treat. Our case series demonstrates how patients often present late with a disease that has already spread beyond the paranasal sinuses. Despite treatment with antifungals and extensive surgical debridement, mortality remains high.
Collapse
Affiliation(s)
- Edward Balai
- Otolaryngology, The Royal Wolverhampton NHS Trust, Birmingham, GBR
| | - Sangha Mummadi
- Otolaryngology, University Hospitals North Midlands, Stoke, GBR
| | - Karan Jolly
- Otolaryngology, The Royal Wolverhampton NHS Trust, Birmingham, GBR
| | - Adnan Darr
- Otolaryngology, The Royal Wolverhampton NHS Trust, Birmingham, GBR
| | - Husham Aldeerawi
- Otolaryngology, University of Basra Hospital, College of Medicine, Basra, IRQ
| |
Collapse
|
6
|
Emberti Gialloreti L, Basa FB, Moramarco S, Salih AO, Alsilefanee HH, Qadir SA, Bezenchek A, Incardona F, Di Giovanni D, Khorany R, Alhanabadi LHH, Salih SO, Akhshirsh GS, Azeez BS, Tofiq BA, Palombi L. Supporting Iraqi Kurdistan Health Authorities in Post-conflict Recovery: The Development of a Health Monitoring System. Front Public Health 2020; 8:7. [PMID: 32083050 PMCID: PMC7003511 DOI: 10.3389/fpubh.2020.00007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Iraq has endured several conflicts and socio-political tensions that have disrupted its public health system. Nowadays, because health data are not collected on a routine basis, the country still lacks proper statistics and, consequently, response plans to meet present and future health needs of its population. An international partnership is developing in the Iraqi Kurdistan a Health Monitoring System with the aim of supporting evidence-based health policy decisions. Methods: The pilot phase for assessing the feasibility of the programme was launched in 2015. In 2018 the implementation phase began. The first step was to choose the software platform and the coding system, as well as to identify the public hospitals (PH) and Public Health Centers (PHC) to be included in the e-health system. The technical infrastructure of each PHC or PH was updated. The staff of each center was trained in the use of the e-health system and in disease coding. Several seminars introduced regional and district health managers to the basic concepts of data-driven decision making. A local team of experts was trained to create a highly specialized staff with the objective of "training the trainers" and ensuring the future self-sufficiency of the system. Results: By September 2019, 59 PHC and PH were entering data in the Health Monitoring System, while 258 health operators (medical doctors, administrative staff, nurses, statisticians, IT and public health specialists, pharmacists) have been already trained. Currently, more than 600,000 disease events have been collected. Additionally, further 734 medical doctors, statisticians, and health managers have been trained on the basics of public health practice. The goal during the next 3 years is to reach 120 operative centers within the region, envisaging a subsequent expansion of the system to all Iraq. Conclusions: The creation of a functioning health monitoring system is feasible also in regions characterized by socio-political tensions. However, multiple stakeholder partnerships are essential. The provision of an e-health information system, coupled with the establishment of a team of local experts, allows the routinely and timely collection of health information, facilitating prompt responses to present and emerging needs, while guiding the formulation and evaluation of health policies.
Collapse
Affiliation(s)
| | - Faiq B Basa
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Rizgary Teaching Hospital, Erbil, Iraq
| | - Stefania Moramarco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Haveen H Alsilefanee
- Family Medicine, Directorate of Health, Duhok, Iraq.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Sivar A Qadir
- Directorate of Health, Sulaimaniya, Iraq.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Daniele Di Giovanni
- Department of Industrial Engineering, University of Rome Tor Vergata, Rome, Italy
| | | | - Luma H H Alhanabadi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Primary Health Care Department, Preventive Health Affairs Directorate, Duhok, Iraq
| | - Shahla O Salih
- Department of Statistics and Informatics, University of Sulaimaniya, Sulaimaniya, Iraq.,Department of Civil Engineering and Computer Science Engineering, University of Rome Tor Vergata, Rome, Italy
| | - Gorgees S Akhshirsh
- Department of Civil Engineering and Computer Science Engineering, University of Rome Tor Vergata, Rome, Italy.,Computer Systems Engineering, Erbil, Iraq
| | - Bayar S Azeez
- Department of Civil Engineering and Computer Science Engineering, University of Rome Tor Vergata, Rome, Italy.,Computer Systems Engineering, Erbil, Iraq
| | | | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
7
|
Abdulah DM, Perot KA. Factors Influencing Prescribing Perceived Utility of Drugs: Experiences from Iraqi Kurdistan. Innov Pharm 2019; 10:10.24926/iip.v10i4.2316. [PMID: 34007584 PMCID: PMC8051892 DOI: 10.24926/iip.v10i4.2316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Pharmaceutical expenditures have increased dramatically in most developed and developing countries in recent decades. Healthcare system policymakers have expressed concerns about the inappropriate, irrational, or harmful prescribing of drugs. OBJECTIVES The attitudes of physicians towards prescribing generic drugs and predictors of perceived utility of drugs were investigated in the present study. METHODS In this cross-sectional research, 77 physicians at different levels of job hierarchies, working in various public sector shifts, were recruited to participate in a survey of their attitudes toward prescribing generic drugs in Iraqi Kurdistan in 2018. The doctors were located in a general, an emergency, and a pediatric hospital. A self-administered structured questionnaire was designed based on the extended technology acceptance model for product use (TETPU). RESULTS The doctors agreed that drugs should be prescribed according to their utility for patients (median [M] = 5.0; interquartile range [IQR] = 2.9). Most of the physicians mentioned that they prescribed drugs according to the patients' needs (75.0%), evaluation of the availability of alternatives (69.0%) and consumer perceptions of a price (69.0%). The analysis showed that (1) the importance of physicians' perceptions and their recognition of patients' need achievement (P=.012), (2) the physicians' recognition of the actual use of drugs by consumers (P=.030) and (3) being male (p=.009) were associated with perceptions of drug utility. CONCLUSIONS The study's results suggest that perceived drug utility in prescription writing is associated with physicians' perceptions of need achievement and attitudes toward how patients actually use medicines.
Collapse
Affiliation(s)
| | - Karwan Ali Perot
- School of Health and Environmental Sciences, Auckland University of Technology, New Zealand and Kurdistan Business School, University of Kurdistan- Hewler, Iraqi Kurdistan
| |
Collapse
|
8
|
Primary care in an unstable security, humanitarian, economic and political context: the Kurdistan Region of Iraq. BMC Health Serv Res 2017; 17:592. [PMID: 28835274 PMCID: PMC5569530 DOI: 10.1186/s12913-017-2501-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 08/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background This study presents a descriptive synthesis of Kurdistan Region of Iraq’s (KRI) primary care system, which is undergoing comprehensive primary care reforms within the context of a cross-cutting structural economic adjustment program and protracted security, humanitarian, economic and political crises. Methods The descriptive analysis used a framework operationalizing Starfield’s classic primary care model for health services research. A scoping review was performed using relevant sources, and expert consultations were conducted for completing and validating data. Results The descriptive analysis presents a complex narrative of a primary care system undergoing classical developmental processes of transitioning middle-income countries. The system is simultaneously under tremendous pressure to adapt to the continuously changing, complex and resource-intensive needs of sub-populations exhibiting varying morbidity patterns, within the context of protracted security, humanitarian, economic, and political crises. Despite exhibiting significant resilience in the face of the ongoing crises, the continued influx of IDPs and Syrian refugees, coupled with extremely limited resources and weak governance at policy, organizational and clinical levels threaten the sustainability of KRI’s public primary care system. Diverse trajectories to the strengthening and development of primary care are underway by local and international actors, notably the World Bank, RAND Corporation, UN organizations and USAID, focusing on varying imperatives related to the protracted humanitarian and economic crises. Conclusions The convergence, interaction and outcomes of the diverse initiatives and policy approaches in relation to the development of KRI’s primary care system are complex and highly uncertain. A common vision of primary care is required to align resources, initiatives and policies, and to enable synergy between all local and international actors involved in the developmental and humanitarian response. Further research that integrates the knowledge synthesized in this article, and enables actors in KRI to learn from their own experiences and efforts, along with those of other jurisdictions, would be invaluable towards the ongoing development of primary care.
Collapse
|
9
|
Hwang JH, Kim YR, Ahmed M, Choi S, Al-Hammadi NQ, Widad NM, Han D. Use of complementary and alternative medicine in pregnancy: a cross-sectional survey on Iraqi women. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:191. [PMID: 27389024 PMCID: PMC4936269 DOI: 10.1186/s12906-016-1167-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 06/29/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Due to the lack of strong evidence on safety and efficacy of complementary and alternative medicine (CAM) approaches, the use of CAM in women during pregnancy could be hazardous for mother and fetus. Meanwhile, little is known regarding the patterns, the reasons and the factors affecting use of CAM among pregnant women in Iraq. METHODS A cross sectional survey design was used to carry out face-to-face interviews with 335 consecutive pregnant women. The questionnaire comprised of three sections: socio-demographic characteristics, pregnancy-related aspects and the patterns and attitudes towards use of CAM. Determinants of CAM use were assessed through the logistic regression analysis. RESULTS Three hundred thirty-five pregnant women completed the questionnaire. 56.7 % reported using at least one form of CAM modalities. In total, 24 different types of CAM were used; with herbal medicine (53.7 %) and multivitamins (36.3 %) the most commonly used modalities. From the logistic regression analysis, the variables positively associated with CAM use were: rural residence (odds ratio (OR) 2.0, p < 0.01), no occupation (OR 2.7, p < 0.05), high income (OR 2.0, p < 0.05), perceived healthy status (OR 2.6, p < 0.05) and ever use of contraception (OR 2.0, p < 0.01). Only 0.5 % of CAM users disclosed their CAM use to physicians. CONCLUSIONS The proportion of CAM users among pregnant women is relatively high and it is important to learn what types of CAM they use. However, disclosure of CAM use was extraordinarily low. Given the low rate of disclosure, it should be ensured that physicians establish good level of communication with pregnant women and have adequate knowledge of CAM.
Collapse
Affiliation(s)
- Jung Hye Hwang
- />Department of Obstetrics and Gynecology, University of Hanyang College of Medicine, Seoul, South Korea
- />Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Yu-Rim Kim
- />Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Mansoor Ahmed
- />Institute of Health Services Management, Hanyang University, Seoul, South Korea
- />Department of Global Health and Development and Department of Preventive Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763 South Korea
| | - Soojeung Choi
- />Institute of Health Services Management, Hanyang University, Seoul, South Korea
- />Department of Global Health and Development and Department of Preventive Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763 South Korea
| | | | | | - Dongwoon Han
- />Institute of Health Services Management, Hanyang University, Seoul, South Korea
- />Department of Global Health and Development and Department of Preventive Medicine, Hanyang University, College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763 South Korea
| |
Collapse
|
10
|
Karadaghi G, Willott C. Doctors as the governing body of the Kurdish health system: exploring upward and downward accountability among physicians and its influence on the adoption of coping behaviours. HUMAN RESOURCES FOR HEALTH 2015; 13:43. [PMID: 26041465 PMCID: PMC4464857 DOI: 10.1186/s12960-015-0039-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 05/25/2015] [Indexed: 06/02/2023]
Abstract
BACKGROUND The health system of Iraqi Kurdistan is severely understudied, particularly with regard to patient-physician interactions and their effects. We examine patterns of behaviour among physicians in Kurdistan, the justifications given and possible enabling factors, with a view to understanding accountability both from above and below. METHODS An ethnographic study was conducted in the Sulaimaniyah Teaching Hospital in the Kurdistan Region of Iraq. Data was collected through negotiated interactive observation, and interviews were conducted with 10 participants, 5 physicians and 5 patients. Data collected was analysed using thematic analysis. RESULTS Common patterns of practice among physicians in Kurdistan include displays of discontent, reluctance to negotiate decisions with patients and unfavourable behaviours including dual practice and predatory behaviours towards patients. These behaviours are justified as a mechanism of dealing with negative aspects of their work, including overcrowding, low salaries and social pressure to live up to socially conceived ideas of a physician's identity. CONCLUSIONS Michael Lipsky's theory of street-level bureaucrats and their coping behaviours is a useful way to analyse the Kurdish health system. Physician behaviours are enabled by a number of factors that work to enhance physician discretion through lowering of upward and downward accountability. Physicians are under very little pressure to change their behaviour, and as a result, they effectively become the street-level governing body of the Kurdish health system.
Collapse
Affiliation(s)
- Goshan Karadaghi
- Department of Family and Community Medicine, University of Sulaimaniyah, Sulaimaniyah, Kurdistan Region, Iraq.
| | - Chris Willott
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| |
Collapse
|
11
|
Cetorelli V, Shabila NP. Expansion of health facilities in Iraq a decade after the US-led invasion, 2003-2012. Confl Health 2014; 8:16. [PMID: 25221620 PMCID: PMC4163049 DOI: 10.1186/1752-1505-8-16] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 09/02/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In the last few decades, Iraq's health care capacity has been severely undermined by the effects of different wars, international sanctions, sectarian violence and political instability. In the aftermath of the 2003 US-led invasion, the Ministry of Health has set plans to expand health service delivery, by reorienting the public sector towards primary health care and attributing a larger role to the private sector for hospital care. Quantitative assessments of the post-2003 health policy outcomes have remained scant. This paper addresses this gap focusing on a key outcome indicator that is the expansion of health facilities. METHODS The analysis is based on data on health facilities provided by the World Health Organisation and Iraq's Ministry of Health. For each governorate, we calculated the change in the absolute number of facilities by type from early 2003 to the end of 2012. To account for population growth, we computed the change in the number of facilities per 100,000 population. We compared trends in the autonomous northern Kurdistan region, which has been relatively stable from 2003 onwards, and in the rest of Iraq (centre/south), where fragile institutions and persistent sectarian strife have posed major challenges to health system recovery. RESULTS The countrywide number of primary health care centres per 100,000 population rose from 5.5 in 2003 to 7.4 in 2012. The extent of improvement varied significantly within the country, with an average increase of 4.3 primary health care centres per 100,000 population in the Kurdistan region versus an average increase of only 1.4 in central/southern Iraq. The average number of public hospitals per 100,000 population rose from 1.3 to 1.5 in Kurdistan, whereas it remained at 0.6 in centre/south. The average number of private hospitals per 100,000 population rose from 0.2 to 0.6 in Kurdistan, whereas it declined from 0.3 to 0.2 in centre/south. CONCLUSIONS The expansion of both public and private health facilities in the Kurdistan region appears encouraging, but still much should be done to reach the standards of neighbouring countries. The slow pace of improvement in the rest of Iraq is largely attributable to the dire security situation and should be a cause for major concern.
Collapse
Affiliation(s)
- Valeria Cetorelli
- Department of Social Policy, London School of Economics and Political Science, Houghton Street, WC2A 2AE London, UK
| | - Nazar P Shabila
- Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq
| |
Collapse
|
12
|
Shabila NP, Ahmed HM, Yasin MY. Women's views and experiences of antenatal care in Iraq: a Q methodology study. BMC Pregnancy Childbirth 2014; 14:43. [PMID: 24450437 PMCID: PMC3902000 DOI: 10.1186/1471-2393-14-43] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 01/22/2014] [Indexed: 12/02/2022] Open
Abstract
Background Understanding women’s experiences and perspectives of antenatal care services is particularly critical for enhancing effectiveness of services delivery and addressing women’s needs and expectations. As part of a comprehensive assessment of the maternity care services in Iraq, this study aimed to explore the views and experiences of antenatal care in a sample of women. Methods This explorative study was conducted in Erbil governorate, Iraq. Data were collected using Q methodology, a technique for eliciting subjective views and identifying shared patterns among individuals. A sample of 38 women of different educational and socioeconomic statuses were invited to sort a set of 39 statements reflecting different aspects of the available antenatal care services and issues related to their last pregnancies into a distribution on a scale of nine from “disagree most” to “agree most”. By-person factor analysis was used to derive latent views through centroid factor extraction and varimax rotation of factors. Results Analysis of the participants’ Q sorts resulted in identifying four distinct views and experiences of pregnancy and antenatal care services: (i) public maternity services second best: preference for, and ability to afford, private care, (ii) dissatisfaction with public maternity services: poor information sharing and lack of health promotion, (iii) satisfaction with public maternity service but information gaps perceived and (iv) public maternity services second best: preference for private care but unaffordable. The typical characterizations that were associated with each view were highlighted. Conclusions This study revealed different patterns of views and experiences of women of pregnancy and antenatal care services and recognized the particular issues related to each pattern. Different patterns and types of problems and concerns related mainly to inadequate provision of information and poor interpersonal communication, poor utilization of public services and a general preference to use private services were identified in the different groups of women.
Collapse
Affiliation(s)
- Nazar P Shabila
- Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.
| | | | | |
Collapse
|
13
|
Shabila NP, Al-Tawil NG, Al-Hadithi TS, Sondorp E. Post-conflict health reconstruction: where is the evidence? Med Confl Surviv 2013; 29:69-74. [PMID: 23729099 DOI: 10.1080/13623699.2013.765200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In the context of the CARA Iraq Research Fellowship Programme, staff from Hawler Medical University in Erbil, Iraq and the London School of Hygiene and Tropical Medicine in the UK collaboratively conducted a multimodal research project analysing challenges and opportunities for reform of the primary care system in Iraq. Through a mix of quantitative and qualitative methods a range of challenges were identified, both in terms of services offered and the utilisation of those services. The collaborative study proved positive in terms of direct research outcomes, in boosting academia with skill development and use of new methodologies, and in reengaging displaced Iraqi academics.
Collapse
Affiliation(s)
- Nazar P Shabila
- Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq
| | | | | | | |
Collapse
|
14
|
Shabila NP, Al-Tawil NG, Al-Hadithi TS, Sondorp E. The range and diversity of providers' viewpoints towards the Iraqi primary health care system: an exploration using Q-methodology. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2013; 13:18. [PMID: 23514334 PMCID: PMC3606603 DOI: 10.1186/1472-698x-13-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 03/15/2013] [Indexed: 11/17/2022]
Abstract
Background The increasingly recognized need for reorganizing the primary health care services in Iraq calls for a comprehensive assessment of the system to better understand its problems and needs for development. As part of such comprehensive assessment and due to the important role of primary health care providers in adopting any change, we ought to explore the range and diversity of viewpoints of primary health care providers towards the Iraqi primary health care system. Methods This explorative study was carried out in Erbil governorate, Iraq from May to July 2011. Data were collected from primary health care providers using Q-methodology to elicit subjective viewpoints and identify shared patterns among individuals. Forty primary health care providers representing eight primary health care centers sorted 41 statements reflecting different aspects of the Iraqi primary health care system into a distribution on a scale of nine from “disagree most” to “agree most”. By-person factor analysis was used to derive latent viewpoints through centroid factor extraction and varimax rotation of factors. Results Analysis of the participants’ Q-sorts resulted in four distinct viewpoints among primary health care providers toward the current primary health care system. One factor emphasized positive aspects of the current primary health care system that is content with the current primary health care system. The other three factors highlighted the negative aspects and they included (i) professionally-centered viewpoint, (ii) comprehensive perception and problem-based solutions and (iii) critical to leadership/governance aspects of the system. Conclusions This study revealed diverse viewpoints of primary health care providers toward the current Iraqi primary health care system and recognized the particular issues related to each viewpoint. The findings can contribute to a better understanding of health policy makers and primary health care managers concerning the problems facing the primary health care system that might contribute to change in the management of this system.
Collapse
Affiliation(s)
- Nazar P Shabila
- Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.
| | | | | | | |
Collapse
|