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M Metwally A, A Helmy M, Aboulghate A, Abu-Mandil Hassan N, S Mahmoud W, S Ismail A, M El Shebini S, H Ahmed N, B Mabrok H, H Mahmoud M, A Elshaarawy G, Elsaied A, A Ashaat E, S ElRifay A, Abdelhady S, E Eldeeb S, M El-Saied M, A El-Masry S, E Hassan N, Y Badawy H, A Elghareeb N, Abdelrahman M, M Alian K. The odds of having obesity in Egyptian children with autism spectrum disorders is higher than stunting compared to healthy developing peers: a national survey. BMC Pediatr 2024; 24:465. [PMID: 39033272 PMCID: PMC11264811 DOI: 10.1186/s12887-024-04934-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 07/08/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND The nutritional status and growth of children with Autism spectrum disorders (ASD) is influenced significantly by two factors; food selectivity behaviors due to their consumption of a limited variety of food and the high incidence of gastrointestinal (GIT) disorders. AIM This study aimed to assess the nutritional adequacy and growth pattern of ASD children aged three to twelve years compared to their healthy developing peers. METHODS A national comparative, facility-based cross-sectional study was conducted in eight Egyptian governorates on 285 Egyptian children diagnosed with ASD and 224 children who are their relatives as healthy developing peers. Anthropometric measurements were obtained, including weight, height, head circumference, and mid-upper arm circumference. Body Mass Index (BMI) was calculated and all numbers were plotted on WHO growth charts. Assessment of food preferences, and nutrient intake adequacy of children was done using the Food preference questionnaire, and the Dietary Reference Intakes (DRIs) of Egyptian children. RESULTS Calorie-dense food and sugar intake were higher among ASD children than their healthy developing peers. ASD children omit some important protein sources such as dairy (COR = 5.2, 95% CI:2.7-9.9), meat, and poultry (COR = 2.7, 95% CI: 1.6-4.7), and a lower intake of fruits and vegetables than their healthy developing peers. For children with ASD in all age groups, a deficiency in the range of 50-60% was detected for vitamins (C, D, B6, thiamine, riboflavin, niacin) and minerals (iron). A deficiency in the range of 60-70% was detected for folate and calcium. A deficiency of vitamin C calcium and iron was also detected for both children with ASD and their healthy developing relatives aged 6 to 12 years. GIT disorders were common among ASD children compared to healthy developing peers (COR = 2.8 to 10.3). Children with ASD had four-fold higher odds of stunting (COR = 4.1, CI: 1.7-10.1), threefold higher odds of being overweight (COR = 3.3, CI: 1.48-7.32), and nearly eleven-fold higher odds of obesity (COR = 11.4, CI: 4.05-32.17) compared to their healthy developing peers. CONCLUSION ASD children are prone to overweight and protein malnutrition. Their intake of fruits and vegetables is inadequate and hence their intake of vitamins and minerals is insufficient, contributing to stunting.
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Affiliation(s)
- Ammal M Metwally
- Community Medicine Research Department/Medical Research and Clinical Studies Institute, National Research Centre, P.O. 12622, Dokki, Cairo, Egypt.
- Public Health and community medicine, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Giza, Egypt.
| | - Mona A Helmy
- Environmental and Occupational Medicine Department, Environmental and climate change Research Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Ahmed Aboulghate
- Community Medicine Research Department/Medical Research and Clinical Studies Institute, National Research Centre, P.O. 12622, Dokki, Cairo, Egypt
| | - Naglaa Abu-Mandil Hassan
- Biological Anthropology Department/Medical Research and Clinical Studies Institute/National Research Centre, Dokki, Cairo, Egypt
| | - Walaa S Mahmoud
- Biological Anthropology Department/Medical Research and Clinical Studies Institute/National Research Centre, Dokki, Cairo, Egypt
| | - Ahmed S Ismail
- Biological Anthropology Department/Medical Research and Clinical Studies Institute/National Research Centre, Dokki, Cairo, Egypt
| | - Salwa M El Shebini
- Nutrition and Food Science Department/Food Technology and Nutrition Division, National Research Centre, P.O: 12622, Dokki, Cairo, Egypt
| | - Nihad H Ahmed
- Nutrition and Food Science Department/Food Technology and Nutrition Division, National Research Centre, P.O: 12622, Dokki, Cairo, Egypt
| | - Hoda B Mabrok
- Nutrition and Food Science Department/Food Technology and Nutrition Division, National Research Centre, P.O: 12622, Dokki, Cairo, Egypt
| | - Maha H Mahmoud
- Nutrition and Food Science Department/Food Technology and Nutrition Division, National Research Centre, P.O: 12622, Dokki, Cairo, Egypt
| | - Ghada A Elshaarawy
- Community Medicine Research Department/Medical Research and Clinical Studies Institute, National Research Centre, P.O. 12622, Dokki, Cairo, Egypt
| | - Amal Elsaied
- Child with Special Needs Dept./ Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Engy A Ashaat
- Clinical Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Amira S ElRifay
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Safaa Abdelhady
- Department of Psychiatry, Mansoura General Hospital, Ministry of Health and Population, El Dakahlyia, Egypt
| | - Sherif E Eldeeb
- Community Medicine Research Department/Medical Research and Clinical Studies Institute, National Research Centre, P.O. 12622, Dokki, Cairo, Egypt
| | - Mostafa M El-Saied
- Child with Special Needs Dept./ Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Sahar A El-Masry
- Biological Anthropology Department/Medical Research and Clinical Studies Institute/National Research Centre, Dokki, Cairo, Egypt
| | - Nayera E Hassan
- Biological Anthropology Department/Medical Research and Clinical Studies Institute/National Research Centre, Dokki, Cairo, Egypt
| | - Hala Y Badawy
- Prevention of disability general directorate, Ministry of Health and Population, Cairo, Egypt
| | - Nahed A Elghareeb
- Prevention of disability general directorate, Ministry of Health and Population, Cairo, Egypt
| | - Mohamed Abdelrahman
- Community Medicine Research Department/Medical Research and Clinical Studies Institute, National Research Centre, P.O. 12622, Dokki, Cairo, Egypt
| | - Khadija M Alian
- Biological Anthropology Department/Medical Research and Clinical Studies Institute/National Research Centre, Dokki, Cairo, Egypt
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Metwally AM, Abdallah AM, El-Din EMS, Zeid DA, Khadr Z, Elshaarawy GA, Elkhatib AA, Elsaied A, Ashaat EA, Elghareeb NA, Abdou MH, Fathy AM, Eldeeb SE, AbdAllah M, Soliman MAT, El Banna RAS, Hassanein AK, Rabah TM, Abdelrahman M, Sallam SF. Screening and determinant of suspected developmental delays among Egyptian preschool-aged children: a cross-sectional national community-based study. BMC Pediatr 2023; 23:521. [DOI: ttps:/doi.org/10.1186/s12887-023-04335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023] Open
Abstract
Abstract
Background
Early childhood life is critical for optimal development and is the foundation of future well-being. Genetic, sociocultural, and environmental factors are important determinants of child development.
Aim
The objectives were to screen for suspected developmental delays (DDs) among Egyptian preschool children, and to explore the determinants of these delays based on sociodemographic, epidemiological, maternal, and child perinatal risk factors.
Methods
A national Egyptian cross-sectional developmental screening of a representative sample of preschool children (21,316 children) aged 12 to 71 months. The Revised Denver Prescreening Developmental Questionnaire (R-PDQ) followed by the Denver Developmental Screening Test, 2nd edition (DDST) was used.
Results
Each screened child manifested at least one of six developmental categories. Either typical development, gross motor delay (GM), fine motor adaptive delay (FMA), Language delay (L), Personal-social delay (PS), or multiple DDs. The prevalence of preschool children with at least one DD was 6.4%, while 4.5% had multiple DDs. Developmental language delay was the most prevalent, affecting 4.2% of children. The least affected domain was GM (1.9% of children). Boys were more likely to have DD than girls. Children in urban communities were more likely to have at least one DD than those in rural areas (OR = 1.28, 95%CI: 1.14–1.42), and children of middle social class than of low or high social class (OR = 1.49, 95%CI: 1.30–1.70 & OR = 1.40, 95%CI: 1.23–1.59 respectively). The strong perinatal predictors for at least one DD were children with a history of postnatal convulsions (OR = 2.68, 95%CI: 1.97–3.64), low birth weight (OR = 2.06, 95%CI: 1.69–2.52), or history of postnatal cyanosis (OR = 1.77, 95%CI: 1.26–2.49) and mothers had any health problem during pregnancy (OR = 1.73, 95%CI: 1.44–2.07). Higher paternal and maternal education decreased the odds of having any DD by 43% (OR = 0.57, 95% CI: 0.47–0.68) and 31% (OR = 0.69, 95%CI: 0.58–0.82) respectively.
Conclusion
This study demonstrates a considerable attempt to assess the types and the prevalence of DD among preschool children in Egypt. Perinatal factors are among the most common determinants of DD in preschool children and the majority could be preventable risk factors.
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Metwally AM, Abdallah AM, El-Din EMS, Zeid DA, Khadr Z, Elshaarawy GA, Elkhatib AA, Elsaied A, Ashaat EA, Elghareeb NA, Abdou MH, Fathy AM, Eldeeb SE, AbdAllah M, Soliman MAT, El Banna RAS, Hassanein AK, Rabah TM, Abdelrahman M, Sallam SF. Screening and determinant of suspected developmental delays among Egyptian preschool-aged children: a cross-sectional national community-based study. BMC Pediatr 2023; 23:521. [PMID: 37858055 PMCID: PMC10585886 DOI: 10.1186/s12887-023-04335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Early childhood life is critical for optimal development and is the foundation of future well-being. Genetic, sociocultural, and environmental factors are important determinants of child development. AIM The objectives were to screen for suspected developmental delays (DDs) among Egyptian preschool children, and to explore the determinants of these delays based on sociodemographic, epidemiological, maternal, and child perinatal risk factors. METHODS A national Egyptian cross-sectional developmental screening of a representative sample of preschool children (21,316 children) aged 12 to 71 months. The Revised Denver Prescreening Developmental Questionnaire (R-PDQ) followed by the Denver Developmental Screening Test, 2nd edition (DDST) was used. RESULTS Each screened child manifested at least one of six developmental categories. Either typical development, gross motor delay (GM), fine motor adaptive delay (FMA), Language delay (L), Personal-social delay (PS), or multiple DDs. The prevalence of preschool children with at least one DD was 6.4%, while 4.5% had multiple DDs. Developmental language delay was the most prevalent, affecting 4.2% of children. The least affected domain was GM (1.9% of children). Boys were more likely to have DD than girls. Children in urban communities were more likely to have at least one DD than those in rural areas (OR = 1.28, 95%CI: 1.14-1.42), and children of middle social class than of low or high social class (OR = 1.49, 95%CI: 1.30-1.70 & OR = 1.40, 95%CI: 1.23-1.59 respectively). The strong perinatal predictors for at least one DD were children with a history of postnatal convulsions (OR = 2.68, 95%CI: 1.97-3.64), low birth weight (OR = 2.06, 95%CI: 1.69-2.52), or history of postnatal cyanosis (OR = 1.77, 95%CI: 1.26-2.49) and mothers had any health problem during pregnancy (OR = 1.73, 95%CI: 1.44-2.07). Higher paternal and maternal education decreased the odds of having any DD by 43% (OR = 0.57, 95% CI: 0.47-0.68) and 31% (OR = 0.69, 95%CI: 0.58-0.82) respectively. CONCLUSION This study demonstrates a considerable attempt to assess the types and the prevalence of DD among preschool children in Egypt. Perinatal factors are among the most common determinants of DD in preschool children and the majority could be preventable risk factors.
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Affiliation(s)
- Ammal M Metwally
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Public Health and Community Medicine, Dokki, P.O. 12622, Giza, Egypt.
| | - Ali M Abdallah
- Quantitative Methods Department - Aswan University, Aswan, Egypt
| | - Ebtissam M Salah El-Din
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Giza, Egypt
| | - Dina Abu Zeid
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Giza, Egypt
| | - Zeinab Khadr
- Department of Statistics, Faculty of Economics and Political Science, Cairo University, Cairo, Egypt
- The Social Research Center of the American University in Cairo, Cairo, Egypt
| | - Ghada A Elshaarawy
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Public Health and Community Medicine, Dokki, P.O. 12622, Giza, Egypt
| | - Alshaimaa A Elkhatib
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Giza, Egypt
| | - Amal Elsaied
- Child With Special Needs Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Giza, Egypt
| | - Engy A Ashaat
- Clinical Genetics Department/ Human Genetics and Genome Research Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Giza, Egypt
| | - Nahed A Elghareeb
- Prevention of Disability General Directorate, Ministry of Health and Population, Cairo, Egypt
| | - Mohamed H Abdou
- Mansoura Health Directorate, Ministry of Health and Population, Mansoura, Dakahlia, Egypt
| | - Asmaa M Fathy
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Public Health and Community Medicine, Dokki, P.O. 12622, Giza, Egypt
| | - Sherif E Eldeeb
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Public Health and Community Medicine, Dokki, P.O. 12622, Giza, Egypt
| | - Mohamed AbdAllah
- Complementary Medicine Department/ Medical Research and Clinical Studies Institute/National Research Centre (Affiliation ID: 60014618), Dokki, Giza, Egypt
| | - Muhammed Al-Tohamy Soliman
- Biological Anthropology Department/ Medical Research and Clinical Studies Institute/National Research Centre (Affiliation ID: 60014618), Dokki, Giza, Egypt
| | - Rokia AbdElshafy S El Banna
- Biological Anthropology Department/ Medical Research and Clinical Studies Institute/National Research Centre (Affiliation ID: 60014618), Dokki, Giza, Egypt
| | - Abdelrahman K Hassanein
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Public Health and Community Medicine, Dokki, P.O. 12622, Giza, Egypt
| | - Thanaa M Rabah
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Public Health and Community Medicine, Dokki, P.O. 12622, Giza, Egypt
| | - Mohamed Abdelrahman
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Public Health and Community Medicine, Dokki, P.O. 12622, Giza, Egypt
| | - Sara F Sallam
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Giza, Egypt
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Metwally AM, Aboulghate A, Elshaarawy GA, Abdallah AM, Abdel Raouf ER, El-Din EMS, Khadr Z, El-Saied MM, Elabd MA, Nassar MS, Abouelnaga MW, Ashaat EA, El-Sonbaty MM, Badawy HY, Dewdar EM, Salama SI, Abdelrahman M, Abdelmohsen AM, Eldeeb SE, Naga MM, Elshamy NH, Shaaban FA, ElRifay AS. Prevalence and risk factors of disabilities among Egyptian preschool children: a community-based population study. BMC Psychiatry 2023; 23:689. [PMID: 37735643 PMCID: PMC10514965 DOI: 10.1186/s12888-023-05171-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Child disability has significant implications on their well-being and healthcare systems. AIM This survey aimed to assess the magnitude of seven types of disability among Egyptian children aged 1 < 6 years and their socio-demographic, epidemiological, and perinatal predictors. METHODS A national population-based cross-sectional household survey targeting 21,316 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for identifying seven disability categories. RESULTS The percentage of children with at least one disability was 8.1% as follows: speech/communication (4.4%), Mobility/physical (2.5%), Seizures (2.2%), Comprehension (1.7%), Intellectual impairment (1.4%), Visual (0.3%) and Hearing (0.2%). Age was not found to affect the odds of disability except for visual disability (significantly increased with age (AOR = 1.4, 95% CI:1.1-1.7). Male sex also increased the odds of all disabilities except visual, hearing, and seizures. Convulsions after birth significantly increased the odds of disability as follows: hearing (AOR = 8.1, 95% CI: 2.2-30.5), intellectual impairment (AOR = 4.2, 95% CI: 2.5-6.9), and mobility/physical (AOR = 3.4, 95% CI: 2.3-5.0). Preterm delivery and being kept in an incubator for more than two days after birth increased the odds for visual disability (AOR = 3.7, 95% CI: 1.1-12.1 & AOR = 3.7, 95% CI: 1.7-7.9 respectively). Cyanosis increased the odds of seizures (AOR = 4.7, 95% CI: 2.2-10.3). Low birth weight also increased the odds for all disability domains except for visual and hearing. Maternal health problems during pregnancy increased the odds for all types of disability except hearing and seizures. Higher paternal education decreased the odds for all disabilities by at least 30% except for vision and hearing. CONCLUSION The study found a high prevalence of disability among Egyptian children aged 1-6 years. It identified a number of modifiable risk factors for disability. The practice of early screening for disability is encouraged to provide early interventions when needed.
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Affiliation(s)
- Ammal M. Metwally
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Ahmed Aboulghate
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Ghada A. Elshaarawy
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Ali M. Abdallah
- Quantitative Methods Department, Aswan University, Aswan, Egypt
| | - Ehab R. Abdel Raouf
- Child With Special Needs Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Ebtissam M. Salah El-Din
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Zeinab Khadr
- Department of Statistics, Faculty of Economics and Political Science, Cairo University, Cairo, Egypt
- The Social Research Center, American University in Cairo, Cairo, Egypt
| | - Mostafa M. El-Saied
- Child With Special Needs Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Mona A. Elabd
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Maysa S. Nassar
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Marwa W. Abouelnaga
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Engy A. Ashaat
- Clinical Genetics Department, Human Genetics and Genome Research Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Mohamed M. El-Sonbaty
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Hala Y. Badawy
- Prevention of Disability General Directorate, Ministry of Health and Population, Cairo, Egypt
| | - Eman M. Dewdar
- Prevention of Disability General Directorate, Ministry of Health and Population, Cairo, Egypt
| | - Somia I. Salama
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Mohamed Abdelrahman
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Aida M. Abdelmohsen
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Sherif E. Eldeeb
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Maie M. Naga
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Nada H. Elshamy
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Giza, Dokki Egypt
| | - Fatma A. Shaaban
- Child With Special Needs Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
| | - Amira S. ElRifay
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Cairo, Dokki Egypt
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Metwally AM, Aboulghate A, Elshaarawy GA, Abdallah AM, Abdel Raouf ER, El-Din EMS, Khadr Z, El-Saied MM, Elabd MA, Nassar MS, Abouelnaga MW, Ashaat EA, El-Sonbaty MM, Badawy HY, Dewdar EM, Salama SI, Abdelrahman M, Abdelmohsen AM, Eldeeb SE, Naga MM, Elshamy NH, Shaaban FA, ElRifay AS. Prevalence and risk factors of disabilities among Egyptian preschool children: a community-based population study. BMC Psychiatry 2023; 23:689. [DOI: https:/doi.org/10.1186/s12888-023-05171-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/08/2023] [Indexed: 10/31/2023] Open
Abstract
Abstract
Background
Child disability has significant implications on their well-being and healthcare systems. Aim: This survey aimed to assess the magnitude of seven types of disability among Egyptian children aged 1 < 6 years and their socio-demographic, epidemiological, and perinatal predictors.
Methods
A national population-based cross-sectional household survey targeting 21,316 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for identifying seven disability categories.
Results
The percentage of children with at least one disability was 8.1% as follows: speech/communication (4.4%), Mobility/physical (2.5%), Seizures (2.2%), Comprehension (1.7%), Intellectual impairment (1.4%), Visual (0.3%) and Hearing (0.2%). Age was not found to affect the odds of disability except for visual disability (significantly increased with age (AOR = 1.4, 95% CI:1.1–1.7). Male sex also increased the odds of all disabilities except visual, hearing, and seizures. Convulsions after birth significantly increased the odds of disability as follows: hearing (AOR = 8.1, 95% CI: 2.2–30.5), intellectual impairment (AOR = 4.2, 95% CI: 2.5–6.9), and mobility/physical (AOR = 3.4, 95% CI: 2.3–5.0). Preterm delivery and being kept in an incubator for more than two days after birth increased the odds for visual disability (AOR = 3.7, 95% CI: 1.1–12.1 & AOR = 3.7, 95% CI: 1.7–7.9 respectively). Cyanosis increased the odds of seizures (AOR = 4.7, 95% CI: 2.2–10.3). Low birth weight also increased the odds for all disability domains except for visual and hearing. Maternal health problems during pregnancy increased the odds for all types of disability except hearing and seizures. Higher paternal education decreased the odds for all disabilities by at least 30% except for vision and hearing.
Conclusion
The study found a high prevalence of disability among Egyptian children aged 1–6 years. It identified a number of modifiable risk factors for disability. The practice of early screening for disability is encouraged to provide early interventions when needed.
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Metwally AM, Nassar MS, Salah El-Din EM, Abdallah AM, Khadr Z, Abouelnaga MW, Ashaat EA, El-Saied MM, Elwan AM, Bassiouni RI, Monir ZM, Badawy HY, Dewdar EM, El-Hariri HM, Aboulghate A, Hanna C, Rabah TM, Mohsen A, Elabd MA. National screening for developmental delays and their determinants among Egyptian school age children: A step towards implementing life skills programs. PLoS One 2023; 18:e0287315. [PMID: 37725608 PMCID: PMC10508607 DOI: 10.1371/journal.pone.0287315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/03/2023] [Indexed: 09/21/2023] Open
Abstract
AIM This study aimed to estimate the national prevalence of developmental delays (DDs) and their determinants among Egyptian children aged 6 to 12 years. Such estimation is a prerequisite step toward the application of Life Skill Education (LSE) programs that will potentiate children's future capabilities. METHODS Vineland Adaptive Behavior Scales" was used as a reliable and diagnostic test for DDs screening during this national cross sectional study. Gross motor (GM), fine motor (FM), daily living skills, communication, and socialization skills were assessed. The multivariate logistic regression analysis was used to identify factors associated with DDs. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval was estimated to indicate the strength of association. A p-value of <0.05 was used to declare statistical significance. RESULTS Out of the 20324 surveyed school-aged children, 7.4% were found to have at least one delay. Communication deficits were the most common (6.4%) followed by delay in daily living skills (2.0%). The final model of logistic regression had a good fit for seven variables out of the sociodemographic, epidemiological characteristics, maternal and perinatal problems that were associated with a higher likelihood of at least one DD: Children suffering from any convulsions (AOR = 4.32; 95% CI: 3.18-5.88), male gender (AOR = 1.86; 95% CI: 1.65-2.09), birth weight less than 2.5 kg (AOR = 1.77; 95% CI: 1.40-2.24), history of maternal health problem during pregnancy (AOR = 1.64; 95% CI:1.34-2.01), children staying in an incubator for more than two days (AOR = 1.57, 95% CI: 1.29-1.91), having less educated fathers (AOR = 1.55, 95% CI: 1.24-1.95) and belonging to the middle social class (AOR = 1.40, 95% CI: 1.24-1.58). CONCLUSION The identified types and determinants for each DD are allowing for the implementation of tailored programs for school children's life skills promotion for achieving the most sustainable effects on children's biological and psychological health and well-being.
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Affiliation(s)
- Ammal M. Metwally
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Maysa S. Nassar
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Ebtissam M. Salah El-Din
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Ali M. Abdallah
- Quantitative Methods Department, Aswan University, Tingar, Egypt
| | - Zeinab Khadr
- Department of Statistics, Faculty of Economics and Political Science, Cairo University, Giza, Egypt
- The Social Research Center of the American University in Cairo, New Cairo, Egypt
| | - Marwa W. Abouelnaga
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Engy A. Ashaat
- Clinical Genetics Dept., Human Genetics and Genome Research Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Mostafa M. El-Saied
- Child with Special Needs Dept., Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Ahmed M. Elwan
- Child with Special Needs Dept., Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Randa I. Bassiouni
- Clinical Genetics Dept., Human Genetics and Genome Research Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Zeinab M. Monir
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Hala Y. Badawy
- Disability Prevention General Directorate, Ministry of Health and Population, Cairo, Egypt
| | - Eman M. Dewdar
- Disability Prevention General Directorate, Ministry of Health and Population, Cairo, Egypt
| | - Hazem M. El-Hariri
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Ahmed Aboulghate
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Carine Hanna
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Thanaa M. Rabah
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Amira Mohsen
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Mona A. Elabd
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, Egypt
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7
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Metwally AM, Nassar MS, Salah El-Din EM, Abdallah AM, Khadr Z, Abouelnaga MW, Ashaat EA, El-Saied MM, Elwan AM, Bassiouni RI, Monir ZM, Badawy HY, Dewdar EM, El-Hariri HM, Aboulghate A, Hanna C, Rabah TM, Mohsen A, Elabd MA. National screening for developmental delays and their determinants among Egyptian school age children: A step towards implementing life skills programs. PLoS One 2023; 18:e0287315. [DOI: https:/doi.org/10.1371/journal.pone.0287315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Aim
This study aimed to estimate the national prevalence of developmental delays (DDs) and their determinants among Egyptian children aged 6 to 12 years. Such estimation is a prerequisite step toward the application of Life Skill Education (LSE) programs that will potentiate children’s future capabilities.
Methods
Vineland Adaptive Behavior Scales” was used as a reliable and diagnostic test for DDs screening during this national cross sectional study. Gross motor (GM), fine motor (FM), daily living skills, communication, and socialization skills were assessed. The multivariate logistic regression analysis was used to identify factors associated with DDs. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval was estimated to indicate the strength of association. A p-value of <0.05 was used to declare statistical significance.
Results
Out of the 20324 surveyed school-aged children, 7.4% were found to have at least one delay. Communication deficits were the most common (6.4%) followed by delay in daily living skills (2.0%). The final model of logistic regression had a good fit for seven variables out of the sociodemographic, epidemiological characteristics, maternal and perinatal problems that were associated with a higher likelihood of at least one DD: Children suffering from any convulsions (AOR = 4.32; 95% CI: 3.18–5.88), male gender (AOR = 1.86; 95% CI: 1.65–2.09), birth weight less than 2.5 kg (AOR = 1.77; 95% CI: 1.40–2.24), history of maternal health problem during pregnancy (AOR = 1.64; 95% CI:1.34–2.01), children staying in an incubator for more than two days (AOR = 1.57, 95% CI: 1.29–1.91), having less educated fathers (AOR = 1.55, 95% CI: 1.24–1.95) and belonging to the middle social class (AOR = 1.40, 95% CI: 1.24–1.58).
Conclusion
The identified types and determinants for each DD are allowing for the implementation of tailored programs for school children’s life skills promotion for achieving the most sustainable effects on children’s biological and psychological health and well-being.
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Onambele L, Guillen-Aguinaga S, Guillen-Aguinaga L, Ortega-Leon W, Montejo R, Alas-Brun R, Aguinaga-Ontoso E, Aguinaga-Ontoso I, Guillen-Grima F. Trends, Projections, and Regional Disparities of Maternal Mortality in Africa (1990-2030): An ARIMA Forecasting Approach. EPIDEMIOLOGIA 2023; 4:322-351. [PMID: 37754279 PMCID: PMC10528291 DOI: 10.3390/epidemiologia4030032] [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: 06/29/2023] [Revised: 08/03/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
With the United Nations Sustainable Development Goals (SDG) (2015-2030) focused on the reduction in maternal mortality, monitoring and forecasting maternal mortality rates (MMRs) in regions like Africa is crucial for health strategy planning by policymakers, international organizations, and NGOs. We collected maternal mortality rates per 100,000 births from the World Bank database between 1990 and 2015. Joinpoint regression was applied to assess trends, and the autoregressive integrated moving average (ARIMA) model was used on 1990-2015 data to forecast the MMRs for the next 15 years. We also used the Holt method and the machine-learning Prophet Forecasting Model. The study found a decline in MMRs in Africa with an average annual percentage change (APC) of -2.6% (95% CI -2.7; -2.5). North Africa reported the lowest MMR, while East Africa experienced the sharpest decline. The region-specific ARIMA models predict that the maternal mortality rate (MMR) in 2030 will vary across regions, ranging from 161 deaths per 100,000 births in North Africa to 302 deaths per 100,000 births in Central Africa, averaging 182 per 100,000 births for the continent. Despite the observed decreasing trend in maternal mortality rate (MMR), the MMR in Africa remains relatively high. The results indicate that MMR in Africa will continue to decrease by 2030. However, no region of Africa will likely reach the SDG target.
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Affiliation(s)
- Luc Onambele
- School of Health Sciences, Catholic University of Central Africa, Yaoundé 1110, Cameroon;
| | - Sara Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
| | - Laura Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Department of Nursing, Suldal Sykehjem, 4230 Sands, Norway
| | - Wilfrido Ortega-Leon
- Department of Surgery, Medical and Social Sciences, University of Alcala de Henares, 28871 Alcalá de Henares, Spain;
| | - Rocio Montejo
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, 413 46 Gothenburg, Sweden;
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, 413 46 Gothenburg, Sweden
| | - Rosa Alas-Brun
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
| | | | - Ines Aguinaga-Ontoso
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Area of Epidemiology and Public Health, Healthcare Research Institute of Navarre (IdiSNA), 31008 Pamplona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, 46980 Madrid, Spain
| | - Francisco Guillen-Grima
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Area of Epidemiology and Public Health, Healthcare Research Institute of Navarre (IdiSNA), 31008 Pamplona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, 46980 Madrid, Spain
- Department of Preventive Medicine, Clínica Universidad de Navarra, 31008 Pamplona, Spain
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9
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Metwally AM, Salah El-Din EM, Abdel-Latif GA, Nagi DA, El Etreby LA, Abdallah AM, Khadr Z, Bassiouni RI, Abdel Raouf ER, Elsaied A, Elkhatib AA, Sallam SF, El-Sonbaty MM, Shehata MA, Elghareeb NA, Badawy HY, Ahmed DE, Ibrahim NA, Emam H, Abd El Dayem SM, Fathy AM. A national screening for the prevalence and profile of disability types among Egyptian children aged 6-12 years: a community-based population study. BMC Public Health 2023; 23:1599. [PMID: 37608272 PMCID: PMC10463448 DOI: 10.1186/s12889-023-16489-8] [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: 01/17/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023] Open
Abstract
AIM This study aimed to determine the prevalence of disability domains among Egyptian children in the age group of 6-12 years as well as assess their socio-demographic, epidemiological, and perinatal predictors. METHODS A national population-based cross-sectional household survey targeting 20,324 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for the identification of disabilities. RESULTS The prevalence of children with at least one type of disability was 9.2%. Learning/ comprehension was the most prevalent type (4.2%), followed by speech/communication (3.7%), physical/ mobility and seizures (2.2% for each), intellectual impairment (1.5%), visual (0.7%), and hearing (0.4%). The commonest predictors for disabilities were children who suffered from convulsions or cyanosis after birth and maternal history of any health problem during pregnancy. However, preterm and low birth weight (LBW) babies or being admitted to incubators for more than two days were strong predictors for all disabilities except hearing disability. A history of jaundice after birth significantly carried nearly twice the odds for seizures (AOR = 2.2, 95% CI:1.5-3.4). History of difficult labor was a predictor of intellectual impairment (AOR = 1.5, 95% CI:1.1-2.0). A disabled mother was a strong predictor for all disabilities except seizures, while a disabled father was a predictor for visual and learning/ comprehension disabilities (AOR = 3.9, 95% CI:2.2-7.1 & AOR = 1.6, 95% CI:1.1-2.4 respectively). Meanwhile, both higher maternal and paternal education decreased significantly the odds to have, physical/ mobility and Learning/ comprehension by at least 30%. CONCLUSION The study found a high prevalence of disability among Egyptian children aged 6-12 years. It spotted many modifiable determinants of disability domains. The practice of early screening for disability is encouraged to provide early interventions.
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Affiliation(s)
- Ammal M. Metwally
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Ebtissam M. Salah El-Din
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Ghada A. Abdel-Latif
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Dina A. Nagi
- Clinical Genetics Department/ Human Genetics and Genome Research Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Lobna A. El Etreby
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Ali M. Abdallah
- Quantitative Methods Department, Aswan University, Aswan, Egypt
| | - Zeinab Khadr
- Department of Statistics, Faculty of Economics and Political Science, Cairo University, Cairo, Egypt
- The Social Research Center of the American University in Cairo, Cairo, Egypt
| | - Randa I. Bassiouni
- Clinical Genetics Department/ Human Genetics and Genome Research Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Ehab R. Abdel Raouf
- Child With Special Needs Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Amal Elsaied
- Child With Special Needs Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Alshaimaa A. Elkhatib
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Sara F. Sallam
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Marwa M. El-Sonbaty
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Manal A. Shehata
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Nahed A. Elghareeb
- Prevention of Disability General Directorate, Ministry of Health and Population, Giza, Egypt
| | - Hala Y. Badawy
- Prevention of Disability General Directorate, Ministry of Health and Population, Giza, Egypt
| | - Doaa E. Ahmed
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Nihad A. Ibrahim
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Hanaa Emam
- Skin and Venereal Diseases Research Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Soha M. Abd El Dayem
- Pediatrics Dept. Medical Research and Clinical Studies Institute, National Research Centre, P.O: 12622, Dokki, Cairo Egypt
| | - Asmaa M. Fathy
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
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10
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Metwally AM, Salah El-Din EM, Abdel-Latif GA, Nagi DA, El Etreby LA, Abdallah AM, Khadr Z, Bassiouni RI, Abdel Raouf ER, Elsaied A, Elkhatib AA, Sallam SF, El-Sonbaty MM, Shehata MA, Elghareeb NA, Badawy HY, Ahmed DE, Ibrahim NA, Emam H, Abd El Dayem SM, Fathy AM. A national screening for the prevalence and profile of disability types among Egyptian children aged 6–12 years: a community-based population study. BMC Public Health 2023; 23:1599. [DOI: https:/doi.org/10.1186/s12889-023-16489-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/09/2023] [Indexed: 10/31/2023] Open
Abstract
Abstract
Aim
This study aimed to determine the prevalence of disability domains among Egyptian children in the age group of 6–12 years as well as assess their socio-demographic, epidemiological, and perinatal predictors.
Methods
A national population-based cross-sectional household survey targeting 20,324 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for the identification of disabilities.
Results
The prevalence of children with at least one type of disability was 9.2%. Learning/ comprehension was the most prevalent type (4.2%), followed by speech/communication (3.7%), physical/ mobility and seizures (2.2% for each), intellectual impairment (1.5%), visual (0.7%), and hearing (0.4%). The commonest predictors for disabilities were children who suffered from convulsions or cyanosis after birth and maternal history of any health problem during pregnancy. However, preterm and low birth weight (LBW) babies or being admitted to incubators for more than two days were strong predictors for all disabilities except hearing disability. A history of jaundice after birth significantly carried nearly twice the odds for seizures (AOR = 2.2, 95% CI:1.5–3.4). History of difficult labor was a predictor of intellectual impairment (AOR = 1.5, 95% CI:1.1–2.0). A disabled mother was a strong predictor for all disabilities except seizures, while a disabled father was a predictor for visual and learning/ comprehension disabilities (AOR = 3.9, 95% CI:2.2–7.1 & AOR = 1.6, 95% CI:1.1–2.4 respectively). Meanwhile, both higher maternal and paternal education decreased significantly the odds to have, physical/ mobility and Learning/ comprehension by at least 30%.
Conclusion
The study found a high prevalence of disability among Egyptian children aged 6–12 years. It spotted many modifiable determinants of disability domains. The practice of early screening for disability is encouraged to provide early interventions.
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11
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Metwally AM, Helmy MA, Salah El-Din EM, Saleh RM, Abdel Raouf ER, Abdallah AM, Khadr Z, Elsaied A, El-Saied MM, Bassiouni RI, Nagi DA, Shehata MA, El-Alameey IR, El-Hariri HM, Salama SI, Rabah TM, Abdel-Latif GA, El Etreby LA, Elmosalami DM, Sami SM, Eltahlawy E, Ibrahim NA, Elghareeb NA, Badawy HY, Dewdar EM, Ashaat EA. National screening for Egyptian children aged 1 year up to 12 years at high risk of Autism and its determinants: a step for determining what ASD surveillance needs. BMC Psychiatry 2023; 23:471. [PMID: 37381024 DOI: 10.1186/s12888-023-04977-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/20/2023] [Indexed: 06/30/2023] Open
Abstract
This study aimed to provide a national estimate of the prevalence of the high risk of autism spectrum disorder (ASD) and their determinants. A national screening survey was conducted for 41,640 Egyptian children aged 1 to 12 years in two phases. Tools used were Vineland's Adaptive Behavior Scales, Modified Checklist for Autism in Toddlers, Gilliam Autism Rating scale, and Denver II Developmental screening test. The overall prevalence of children at high risk of ASD was 3.3% (95% CI:3.1%-3.5%). Children living without mothers in homes, suffered from convulsions (AOR = 3.67; 95%CI:2.8-4.8), a history of cyanosis after birth (AOR = 1.87; 95% CI:1.35-2.59) or history of LBW babies (AOR = 1.53; 95% CI:1.23-1.89) carried higher odds of being at high risk of ASD.
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Affiliation(s)
- Ammal M Metwally
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre, Cairo, 60014618, Dokki, Egypt.
| | - Mona A Helmy
- Environmental and Occupational Medicine Department, Environmental and Climate Change Research Institute, National Research Centre, Dokki, Cairo, 60014618, Egypt
| | - Ebtissam M Salah El-Din
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618, Egypt
| | - Rehan M Saleh
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre, Cairo, 60014618, Dokki, Egypt
| | - Ehab R Abdel Raouf
- Child With Special Needs Dept./ Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618, Egypt
| | - Ali M Abdallah
- Quantitative Methods Department - Aswan University, Tingar, Egypt
| | - Zeinab Khadr
- Department of Statistics, Faculty of Economics and Political Science, Cairo University, Giza, Egypt
- The Social Research Center of the American University in Cairo, Cairo, Egypt
| | - Amal Elsaied
- Child With Special Needs Dept./ Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618, Egypt
| | - Mostafa M El-Saied
- Child With Special Needs Dept./ Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618, Egypt
| | - Randa I Bassiouni
- Clinical Genetics Dept./ Human Genetics and Genome Research Institute, National Research Centre , Dokki, Cairo, 60014618, Egypt
| | - Dina A Nagi
- Clinical Genetics Dept./ Human Genetics and Genome Research Institute, National Research Centre , Dokki, Cairo, 60014618, Egypt
| | - Manal A Shehata
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618, Egypt
| | - Inas R El-Alameey
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618, Egypt
| | - Hazem M El-Hariri
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre, Cairo, 60014618, Dokki, Egypt
| | - Somia I Salama
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre, Cairo, 60014618, Dokki, Egypt
| | - Thanaa M Rabah
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre, Cairo, 60014618, Dokki, Egypt
| | - Ghada A Abdel-Latif
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre, Cairo, 60014618, Dokki, Egypt
| | - Lobna A El Etreby
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre, Cairo, 60014618, Dokki, Egypt
| | - Dalia M Elmosalami
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre, Cairo, 60014618, Dokki, Egypt
| | - Samia M Sami
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618, Egypt
| | - Eman Eltahlawy
- Environmental and Occupational Medicine Department, Environmental and Climate Change Research Institute, National Research Centre, Dokki, Cairo, 60014618, Egypt
| | - Nihad A Ibrahim
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre, Cairo, 60014618, Dokki, Egypt
| | - Nahed A Elghareeb
- Disability Prevention General Directorate, Ministry of Health and Population, Cairo, Egypt
| | - Hala Y Badawy
- Disability Prevention General Directorate, Ministry of Health and Population, Cairo, Egypt
| | - Eman M Dewdar
- Disability Prevention General Directorate, Ministry of Health and Population, Cairo, Egypt
| | - Engy A Ashaat
- Clinical Genetics Dept./ Human Genetics and Genome Research Institute, National Research Centre , Dokki, Cairo, 60014618, Egypt
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12
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Metwally AM, Helmy MA, Salah El-Din EM, Saleh RM, Abdel Raouf ER, Abdallah AM, Khadr Z, Elsaied A, El-Saied MM, Bassiouni RI, Nagi DA, Shehata MA, El-Alameey IR, El-Hariri HM, Salama SI, Rabah TM, Abdel-Latif GA, El Etreby LA, Elmosalami DM, Sami SM, Eltahlawy E, Ibrahim NA, Elghareeb NA, Badawy HY, Dewdar EM, Ashaat EA. National screening for Egyptian children aged 1 year up to 12 years at high risk of Autism and its determinants: a step for determining what ASD surveillance needs. BMC Psychiatry 2023; 23:471. [DOI: https:/doi.org/10.1186/s12888-023-04977-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/20/2023] [Indexed: 10/31/2023] Open
Abstract
AbstractThis study aimed to provide a national estimate of the prevalence of the high risk of autism spectrum disorder (ASD) and their determinants. A national screening survey was conducted for 41,640 Egyptian children aged 1 to 12 years in two phases. Tools used were Vineland's Adaptive Behavior Scales, Modified Checklist for Autism in Toddlers, Gilliam Autism Rating scale, and Denver II Developmental screening test. The overall prevalence of children at high risk of ASD was 3.3% (95% CI:3.1%–3.5%). Children living without mothers in homes, suffered from convulsions (AOR = 3.67; 95%CI:2.8–4.8), a history of cyanosis after birth (AOR = 1.87; 95% CI:1.35–2.59) or history of LBW babies (AOR = 1.53; 95% CI:1.23–1.89) carried higher odds of being at high risk of ASD.
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13
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Metwally AM, Sallam SF, Mawla MAA, Alian KM, Abdel-Latif GA, Hasanin HM, Kamal AN, Hanna C, Shebini SME, Ahmed NH, Mabrok HB, Mahmoud MH, Ismail AS, Boseila SAW, El-Alameey IR, Mahfouz NN, Shaaban FA, Ibrahim NA, Hassan NE, El-Masry SA, Naga MM, Khalil A. Promoting weaning practices and growth of Egyptian infants by using communication for behavioral development approach. BMC Pediatr 2022; 22:689. [DOI: https:/doi.org/10.1186/s12887-022-03741-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/10/2022] [Indexed: 10/31/2023] Open
Abstract
AbstractBackgroundAccess to various affordable and nutritious foods is considered a challenging factor for households with limited resources affecting the proper weaning practices. In order to motivate communities to adhere to the right and proper weaning practices, the social aspect should be considered through close communication with the targeted communities. This study aimed to evaluate how impactful the use of the principles of Communication for Development (C4D) that respect parents’ beliefs and their cultural norms is in improving the weaning practices and growth of infants in an Egyptian village.MethodsAn interventional three-phase study was conducted for three years. The intervention targeted 464 mothers of infants up to 2 years of age. C4D interventions encouraged each mother to provide her baby with nutritious and varied options through age-appropriate introduction and diversification of nutrient-rich complementary foods under the slogan “ enjoy meals like a baby”. The effectiveness of the approach was measured by five essential weaning practices: Introduction of solid, semi-solid, or soft foods, Minimum dietary diversity, minimum meal frequency, Minimum acceptable diet, and consumption of iron-rich foods.ResultsThere was marked and significant improvement in the awareness and of the majority of the weaning practices’ indicators as a result of the interventions. This was noticed for the timely introduction of complementary foods which increased from 36.7% to 82.0%, the minimum meal frequency indicator (3–5) which increased from 25.3% to 67.3%, iron-rich or fortified food (68.0% to 82%) as well as a regular checkup for baby health at the health unit (71.3%). Indicators that were improved but failed to achieve the target were the “Minimum Dietary Diversity” (reached 32%) and the minimum acceptable diet (reached 22.0%). A significant effect on linear growth especially for females is evidenced by the remarkable decrease in wasting (from 31.5% to 11.1%) and obesity (from 12.0% to 0%) associated with a considerable decrease in underweight (from 40% to 16.7%).ConclusionTargeting caregivers through the C4D approach have succeeded in providing them with the support required for the provision of adequate nutrition for their infants that had significantly marked improvement in growth indices of their infants.
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14
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Metwally AM, Sallam SF, Mawla MAA, Alian KM, Abdel-Latif GA, Hasanin HM, Kamal AN, Hanna C, Shebini SME, Ahmed NH, Mabrok HB, Mahmoud MH, Ismail AS, Boseila SAW, El-Alameey IR, Mahfouz NN, Shaaban FA, Ibrahim NA, Hassan NE, El-Masry SA, Naga MM, Khalil A. Promoting weaning practices and growth of Egyptian infants by using communication for behavioral development approach. BMC Pediatr 2022; 22:689. [PMID: 36456920 PMCID: PMC9713754 DOI: 10.1186/s12887-022-03741-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/10/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Access to various affordable and nutritious foods is considered a challenging factor for households with limited resources affecting the proper weaning practices. In order to motivate communities to adhere to the right and proper weaning practices, the social aspect should be considered through close communication with the targeted communities. This study aimed to evaluate how impactful the use of the principles of Communication for Development (C4D) that respect parents' beliefs and their cultural norms is in improving the weaning practices and growth of infants in an Egyptian village. METHODS An interventional three-phase study was conducted for three years. The intervention targeted 464 mothers of infants up to 2 years of age. C4D interventions encouraged each mother to provide her baby with nutritious and varied options through age-appropriate introduction and diversification of nutrient-rich complementary foods under the slogan " enjoy meals like a baby". The effectiveness of the approach was measured by five essential weaning practices: Introduction of solid, semi-solid, or soft foods, Minimum dietary diversity, minimum meal frequency, Minimum acceptable diet, and consumption of iron-rich foods. RESULTS There was marked and significant improvement in the awareness and of the majority of the weaning practices' indicators as a result of the interventions. This was noticed for the timely introduction of complementary foods which increased from 36.7% to 82.0%, the minimum meal frequency indicator (3-5) which increased from 25.3% to 67.3%, iron-rich or fortified food (68.0% to 82%) as well as a regular checkup for baby health at the health unit (71.3%). Indicators that were improved but failed to achieve the target were the "Minimum Dietary Diversity" (reached 32%) and the minimum acceptable diet (reached 22.0%). A significant effect on linear growth especially for females is evidenced by the remarkable decrease in wasting (from 31.5% to 11.1%) and obesity (from 12.0% to 0%) associated with a considerable decrease in underweight (from 40% to 16.7%). CONCLUSION Targeting caregivers through the C4D approach have succeeded in providing them with the support required for the provision of adequate nutrition for their infants that had significantly marked improvement in growth indices of their infants.
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Affiliation(s)
- Ammal M. Metwally
- grid.419725.c0000 0001 2151 8157Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Sara F. Sallam
- grid.419725.c0000 0001 2151 8157Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Mohamed A. Abdel Mawla
- grid.419725.c0000 0001 2151 8157Pediatrics Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Khadija M. Alian
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Ghada A. Abdel-Latif
- grid.419725.c0000 0001 2151 8157Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Hasanin M. Hasanin
- grid.419725.c0000 0001 2151 8157Pediatrics Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Ayat N. Kamal
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Carine Hanna
- grid.419725.c0000 0001 2151 8157Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Salwa M. El Shebini
- grid.419725.c0000 0001 2151 8157Nutrition and Food Science Department, Food Technology and Nutrition Research Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Nihad H. Ahmed
- grid.419725.c0000 0001 2151 8157Nutrition and Food Science Department, Food Technology and Nutrition Research Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Hoda B. Mabrok
- grid.419725.c0000 0001 2151 8157Nutrition and Food Science Department, Food Technology and Nutrition Research Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Maha H. Mahmoud
- grid.419725.c0000 0001 2151 8157Nutrition and Food Science Department, Food Technology and Nutrition Research Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Ahmed S. Ismail
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Samia A. W. Boseila
- grid.419725.c0000 0001 2151 8157Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Inas R. El-Alameey
- grid.419725.c0000 0001 2151 8157Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt ,Faculty of Applied Medical Sciences, Clinical Nutrition Department, Taibahu University, Almadina almunawara, Saudi Arabia
| | - Nermine N. Mahfouz
- grid.419725.c0000 0001 2151 8157Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Fatma A. Shaaban
- grid.419725.c0000 0001 2151 8157Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Nihad A. Ibrahim
- grid.419725.c0000 0001 2151 8157Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Nayera E. Hassan
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Sahar A. El-Masry
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Maie M. Naga
- grid.419725.c0000 0001 2151 8157Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Aya Khalil
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
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15
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Metwally AM, Abdallah AM, Salah El-Din EM, Khadr Z, Raouf ERA, Elghareeb NA, Saleh RM, Abuelela MH, Amer HA, Hasanin HM, Mawla MAA, Sallam SF, El-Alameey IR, Sami SM, Abdel-Latif GA, Abdelrahman M, Shehata MA. A national prevalence and profile of single and multiple developmental delays among children aged from 1 year up to 12 years: an Egyptian community-based study. Child Adolesc Psychiatry Ment Health 2022; 16:63. [DOI: https:/doi.org/10.1186/s13034-022-00498-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/18/2022] [Indexed: 10/31/2023] Open
Abstract
Abstract
Objective
This study aimed at providing a national prevalence of single and multiple developmental delays (DDs) among 41,640 Egyptian children aged 1 to 12 years and exploring DDs’ associated risk and protective factors.
Methods
A national household survey from eight governorates of Egypt representing the four major subdivisions of Egypt was conducted through systematic probability proportionate to size. All enrolled children were assessed according to Vineland Adaptive Behavior Scales, (VABS) as a reliable screening questionnaire for identifying categories of DDs that were verified by pediatrics’ specialists.
Results
The overall prevalence of children with DDs was 6.7%. The prevalence of a single DD was 3.9% versus 2.8% multiple DDs. Communication deficit was the most prevalent type (5.3%). Lower prevalence was identified for fine motor delay (1.0%), gross motor delay, and socialization deficit (1.5% each). Whereas deficits in daily life skills (self-help and adaptive behavior delay) amounted to 2.3%. Living without mothers and/or fathers in homes was associated with increased odds of having DDs by one and a half times (OR = 1.72 and OR = 1.34 respectively). Multiple logistic regression analysis revealed the most predictors for DDs including children who suffer from convulsions after birth (OR = 3.10), low birth weight babies (OR = 1.94), male sex (OR = 1.75), mothers having health problems during pregnancy (OR = 1.70) and belonging to middle socioeconomic status (OR = 1.41). Children who suffered from cyanosis after birth was found to be at risk for any or multiple DDs. Difficult labor was significantly associated with increased odds for multiple DDs (OR = 1.55). Higher paternal and maternal education was associated with decreased odds to have any DDs by 40% (OR = 0.60 and OR = 0.58 respectively).
Conclusions
The detected prevalence of DDs is within the estimated range of prevalence of DDs for the pediatric population. The majority of the detected risk factors are preventable. Developmental screening is recommended to be implemented in all primary care settings as a routine practice.
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16
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Metwally AM, Abdallah AM, Salah El-Din EM, Khadr Z, Raouf ERA, Elghareeb NA, Saleh RM, Abuelela MH, Amer HA, Hasanin HM, Mawla MAA, Sallam SF, El-Alameey IR, Sami SM, Abdel-Latif GA, Abdelrahman M, Shehata MA. A national prevalence and profile of single and multiple developmental delays among children aged from 1 year up to 12 years: an Egyptian community-based study. Child Adolesc Psychiatry Ment Health 2022; 16:63. [PMID: 35932037 PMCID: PMC9356393 DOI: 10.1186/s13034-022-00498-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study aimed at providing a national prevalence of single and multiple developmental delays (DDs) among 41,640 Egyptian children aged 1 to 12 years and exploring DDs' associated risk and protective factors. METHODS A national household survey from eight governorates of Egypt representing the four major subdivisions of Egypt was conducted through systematic probability proportionate to size. All enrolled children were assessed according to Vineland Adaptive Behavior Scales, (VABS) as a reliable screening questionnaire for identifying categories of DDs that were verified by pediatrics' specialists. RESULTS The overall prevalence of children with DDs was 6.7%. The prevalence of a single DD was 3.9% versus 2.8% multiple DDs. Communication deficit was the most prevalent type (5.3%). Lower prevalence was identified for fine motor delay (1.0%), gross motor delay, and socialization deficit (1.5% each). Whereas deficits in daily life skills (self-help and adaptive behavior delay) amounted to 2.3%. Living without mothers and/or fathers in homes was associated with increased odds of having DDs by one and a half times (OR = 1.72 and OR = 1.34 respectively). Multiple logistic regression analysis revealed the most predictors for DDs including children who suffer from convulsions after birth (OR = 3.10), low birth weight babies (OR = 1.94), male sex (OR = 1.75), mothers having health problems during pregnancy (OR = 1.70) and belonging to middle socioeconomic status (OR = 1.41). Children who suffered from cyanosis after birth was found to be at risk for any or multiple DDs. Difficult labor was significantly associated with increased odds for multiple DDs (OR = 1.55). Higher paternal and maternal education was associated with decreased odds to have any DDs by 40% (OR = 0.60 and OR = 0.58 respectively). CONCLUSIONS The detected prevalence of DDs is within the estimated range of prevalence of DDs for the pediatric population. The majority of the detected risk factors are preventable. Developmental screening is recommended to be implemented in all primary care settings as a routine practice.
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Affiliation(s)
- Ammal M Metwally
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt.
- Public Health and Community Medicine, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt.
| | - Ali M Abdallah
- Quantitative Methods Department, Aswan University, Giza, Egypt
| | - Ebtissam M Salah El-Din
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Zeinab Khadr
- Department of Statistics, Faculty of Economics and Political Science, Cairo University, Giza, Egypt
- The Social Research Center of the American University in Cairo, Cairo, Egypt
| | - Ehab R Abdel Raouf
- Department of Child with Special Needs/Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Nahed A Elghareeb
- Prevention of Disability General Directorate, Ministry of Health and Population, Giza, Egypt
| | - Rehan M Saleh
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Manal H Abuelela
- Public Health Department, Research Institute of Ophthalmology, Giza, Egypt
| | - Hala A Amer
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
- Department of Infection Control, King Saud Medical City, Riyadh, Saudi Arabia
| | - Hasanin M Hasanin
- Pediatrics Dept., Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Mohamed A Abdel Mawla
- Pediatrics Dept., Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Sara F Sallam
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Inas R El-Alameey
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
- Faculty of Applied Medical Sciences, Clinical Nutrition Department, Taibah University, Riyadh, Saudi Arabia
| | - Samia M Sami
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Ghada A Abdel-Latif
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Mohamed Abdelrahman
- Community Medicine Research Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Manal A Shehata
- Child Health Department/ Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
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17
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Bucholc M. Abortion Law and Human Rights in Poland: The Closing of the Jurisprudential Horizon. HAGUE JOURNAL ON THE RULE OF LAW 2022; 14:73-99. [PMCID: PMC9079218 DOI: 10.1007/s40803-022-00167-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 07/20/2023]
Abstract
On 22 October 2020, the Constitutional Tribunal of Poland ruled that an abortion due to foetal impairment was unconstitutional. This article discusses the context of this controversial ruling as well as its main tenets, focusing on the interpretation of the human rights proffered by the Tribunal and on the rule of law concerns raised by the Tribunal’s decision. Against the backdrop of a brief history of the legal regulation of abortion in Poland since 1945, the article offers a critical assessment of the human rights framework used in the Polish abortion debate. Based on a close reading of the Tribunal’s ruling and the dissenting opinions, the article points out the particularities in the Tribunal’s engagement with international law and human rights jurisprudence. The article argues that the Tribunal’s decision is yet another symptom of the crisis in which the rule of law in Poland has found itself since 2015. It bears evidence to the closing of the jurisprudential horizon caused by the political change which has been taking place in Poland since 2015, consisting of the reduction of the role of international human rights debates as a reference in Polish constitutional jurisprudence. The ruling is therefore a portent of Poland’s future compliance with its international commitments in human rights matters.
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Affiliation(s)
- Marta Bucholc
- Faculty of Sociology, University of Warsaw, Karowa 18, 00-927 Warsaw, Poland
- Centre de Recherche en Science Politique, Université Saint-Louis Bruxelles, 119 Rue du Marais, 1000 Brussels, Belgium
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18
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Metwally AM, El-Sonbaty M, Elmosalami D, Amer H, Abuelela M, Mohamed H, Ahmed M, Hasan H, Mohsen A, El Etreby L, Abdel-Latif GA, Ibrahim NA, Emam H, Abdelmohsen A, Fouad W, Salama SI, Salama I, Saleh R. Assessing the Effective Communication Channels to Reduce Child and Adolescent Marriage in Rural Communities of Egypt. Open Access Maced J Med Sci 2021; 9:1288-1299. [DOI: doi 10.3889/oamjms.2021.7620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND: Low levels of scholarly achievement, poverty, and geographical isolation are all known to be linked to early marriage.
AIM: This study aimed at identifying the most credible and the best-suited communication channels (CCs) to reach rural communities for motivating them to reduce child and adolescent marriage.
METHODS: This study was a community-based cross-sectional systematic formative research. The study targeted 1000 wives who were ever married women in childbearing period aged 15–49 years and their husbands in 21 rural village units of two governorates of Upper Egypt through questionnaires. Decisions concerning the choice of the best-suited CCs were based on their reach, frequency, managerial feasibility, and effectiveness. The investigated CCs included: modern social media (search browser engine/Facebook group and/or twitter/YouTube or messaging through WhatsApp or any mobile app), traditional mass media (T.V/Radio/Reading), and interpersonal communication (talk with religious leaders/partners/friends/doctors/health promoters). Comparisons between different CCs were done using odds ratios (OR) and 95% confidence intervals (CI).
RESULTS: A vast majority of the surveyed wives (96.6%) were married at an age ranging from 15 to 24 years. The spread of social media through smartphones was limited to only one-third of wives and their husbands through mainly searching on YouTube (31.7% of wives and 27.8% of husbands). Television was the most accessible means of mass media for both wives and husbands (72.5% and 63.3%, respectively). The most credible and the best-suited CCs methods for wives were talking with the health promotors and doctors with 2 times significantly higher (OR = 2.0, CI = 1.7–2.4 for each one) than that with the search on YouTube and 3 times significantly higher (OR = 3.1, CI = 2.5–3.7 and OR = 3.1, CI = 2.6–3.8, respectively) than that for social media using browser engine. For husbands, the odds of the most credible and the best-suited CCs methods were more than 1½ times higher for the talk with the health promotors than the search on You Tube (OR = 1.6, CI = 1.3–2.0) or the search using browser engine (OR = 1.6, CI = 1.3–1.9), Whereas the odds were one and a third higher for the talk with the doctor than the search on You Tube (OR = 1.3, CI = 1.1–1.6) or the search using browser engine (OR = 1.6, CI= 1.1–1.6). Significant difference was detected in favor of the traditional media as the most credible source of information only for wives’ intention to postpone their children early marriage.
CONCLUSIONS: Despite the availability of recent social media worldwide, rural communities with high illiteracy have limited access to the internet and limited availability of smartphones. Interpersonal communication is considered their most effective CCs for achieving equity in reducing child marriage. It seems vital during the implementation of any strategies toward reproductive health to use not only the media broadcasts, but also to rely on the channels that are most credible and suitable for the targeted communication to support meeting the unmet need.
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19
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Metwally AM, El-Sonbaty M, Elmosalami D, Amer H, Abuelela M, Mohamed H, Ahmed M, Hasan H, Mohsen A, El Etreby L, Abdel-Latif GA, Ibrahim NA, Emam H, Abdelmohsen A, Fouad W, Salama SI, Salama I, Saleh R. Assessing the Effective Communication Channels to Reduce Child and Adolescent Marriage in Rural Communities of Egypt. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Low levels of scholarly achievement, poverty, and geographical isolation are all known to be linked to early marriage.
AIM: This study aimed at identifying the most credible and the best-suited communication channels (CCs) to reach rural communities for motivating them to reduce child and adolescent marriage.
METHODS: This study was a community-based cross-sectional systematic formative research. The study targeted 1000 wives who were ever married women in childbearing period aged 15–49 years and their husbands in 21 rural village units of two governorates of Upper Egypt through questionnaires. Decisions concerning the choice of the best-suited CCs were based on their reach, frequency, managerial feasibility, and effectiveness. The investigated CCs included: modern social media (search browser engine/Facebook group and/or twitter/YouTube or messaging through WhatsApp or any mobile app), traditional mass media (T.V/Radio/Reading), and interpersonal communication (talk with religious leaders/partners/friends/doctors/health promoters). Comparisons between different CCs were done using odds ratios (OR) and 95% confidence intervals (CI).
RESULTS: A vast majority of the surveyed wives (96.6%) were married at an age ranging from 15 to 24 years. The spread of social media through smartphones was limited to only one-third of wives and their husbands through mainly searching on YouTube (31.7% of wives and 27.8% of husbands). Television was the most accessible means of mass media for both wives and husbands (72.5% and 63.3%, respectively). The most credible and the best-suited CCs methods for wives were talking with the health promotors and doctors with 2 times significantly higher (OR = 2.0, CI = 1.7–2.4 for each one) than that with the search on YouTube and 3 times significantly higher (OR = 3.1, CI = 2.5–3.7 and OR = 3.1, CI = 2.6–3.8, respectively) than that for social media using browser engine. For husbands, the odds of the most credible and the best-suited CCs methods were more than 1½ times higher for the talk with the health promotors than the search on You Tube (OR = 1.6, CI = 1.3–2.0) or the search using browser engine (OR = 1.6, CI = 1.3–1.9), Whereas the odds were one and a third higher for the talk with the doctor than the search on You Tube (OR = 1.3, CI = 1.1–1.6) or the search using browser engine (OR = 1.6, CI= 1.1–1.6). Significant difference was detected in favor of the traditional media as the most credible source of information only for wives’ intention to postpone their children early marriage.
CONCLUSIONS: Despite the availability of recent social media worldwide, rural communities with high illiteracy have limited access to the internet and limited availability of smartphones. Interpersonal communication is considered their most effective CCs for achieving equity in reducing child marriage. It seems vital during the implementation of any strategies toward reproductive health to use not only the media broadcasts, but also to rely on the channels that are most credible and suitable for the targeted communication to support meeting the unmet need.
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Metwally AM, Yousof H, Elkholy MM, Eletreby LA, Barakat AA, Abd El Dayem SM, Abdelrahman M, Eldeeb SM. Determinants Influencing Awareness and Healthy Practices among a Sample of Insulin-dependent Diabetic Egyptian Patients: A Rural Community-based Study. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND: The prevalence of diabetes mellitus (DM) is predicted to increase over the coming years.
AIM: The objectives of the study were to measure the level of awareness and healthy practices related to five healthy domains and assess the effect of different demographic characteristics, glycated hemoglobin (HbA1c) level, and body mass index (BMI) on these levels among diabetic patients in a rural Egyptian village.
METHODS: A cross-sectional study was done on 300 selected insulin-dependent diabetic patients resident in an Egyptian village. Data were collected using a questionnaire covering five domains: General disease awareness and management compliance practice, check-up, foot care, diet, and physical activity. HbA1c and BMI were also measured as an impact of the management adherence.
RESULTS: The study found that more than three quarters of the participants (82.0%) were uncontrolled or poorly uncontrolled (HbA1c >8) diabetics and 76.0% were either obese or morbidly obese. Total awareness and practices percentage scores were low (42.4 ± 16.8% and 40.5 ± 12.3%, respectively). The linear regression model showed that high educational level had significantly positive effects on both the total awareness and practice scores as well as their domains. The study found that female participants and those having relatives with DM had significantly higher diet awareness and practice scores (p < 0.05). Younger age had significantly higher scores on foot care and diet awareness scores, physical activity, general disease awareness, and management compliance practices domains.
CONCLUSION: The studied awareness and practice domains were inadequate. Their improvement is cornerstones to impact glycemic control of diabetics and control their health risks, especially in rural communities.
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Metwally AM, Yousof H, Elkholy MM, Eletreby LA, Barakat AA, Abd El Dayem SM, Abdelrahman M, Eldeeb SM. Determinants Influencing Awareness and Healthy Practices among a Sample of Insulin-dependent Diabetic Egyptian Patients: A Rural Community-based Study. Open Access Maced J Med Sci 2021; 9:500-508. [DOI: https:/doi.org/10.3889/oamjms.2021.6017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND: The prevalence of diabetes mellitus (DM) is predicted to increase over the coming years.
AIM: The objectives of the study were to measure the level of awareness and healthy practices related to five healthy domains and assess the effect of different demographic characteristics, glycated hemoglobin (HbA1c) level, and body mass index (BMI) on these levels among diabetic patients in a rural Egyptian village.
METHODS: A cross-sectional study was done on 300 selected insulin-dependent diabetic patients resident in an Egyptian village. Data were collected using a questionnaire covering five domains: General disease awareness and management compliance practice, check-up, foot care, diet, and physical activity. HbA1c and BMI were also measured as an impact of the management adherence.
RESULTS: The study found that more than three quarters of the participants (82.0%) were uncontrolled or poorly uncontrolled (HbA1c >8) diabetics and 76.0% were either obese or morbidly obese. Total awareness and practices percentage scores were low (42.4 ± 16.8% and 40.5 ± 12.3%, respectively). The linear regression model showed that high educational level had significantly positive effects on both the total awareness and practice scores as well as their domains. The study found that female participants and those having relatives with DM had significantly higher diet awareness and practice scores (p < 0.05). Younger age had significantly higher scores on foot care and diet awareness scores, physical activity, general disease awareness, and management compliance practices domains.
CONCLUSION: The studied awareness and practice domains were inadequate. Their improvement is cornerstones to impact glycemic control of diabetics and control their health risks, especially in rural communities.
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Metwally AM, Amer HA, Salama HI, Abd El Hady SI, Alam RR, Aboulghate A, Mohamed HA, Badran HM, Saadallah AA, El-Sonbaty MM, Eltahlawy E, Saad W, Mohsen A, Abdel-Latif GA, Fathy AM, Hassanain AI, Eldali A. Egyptian patients'/guardians' experiences and perception about clinical informed consent and its purpose: Cross sectional study. PLoS One 2021; 16:e0252996. [PMID: 34125842 PMCID: PMC8202917 DOI: 10.1371/journal.pone.0252996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 05/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Informed consent (IC) is a healthcare standard emphasizing the meaning of human dignity as clarified in the Universal Declaration of Human Rights. Data about IC practices in Egypt is insufficient. This study aimed to assess the Egyptian patients'/guardians' experiences about IC and their expectations about its practices' purposes in general and according to the type of the healthcare facility. METHODS Self-administered questionnaire was carried out for 1092 participants who had undergone or were scheduled to a procedure requiring an IC at three studied types for Egyptian health care facilities. Ten statements were ranked twice by the participants to reflect their perception of IC purpose as per what is currently practiced and what they believe should be practiced. RESULTS IC implementation varies significantly (p<0.05) across the health care facilities in Egypt. The percentage of its implementation at the non-governmental facilities, governmental facilities, and university hospital was 85.9%, 77.8%, and 63.8 respectively. The first three ranked purposes of the current IC practices were: "Helping patient/guardian decide (64.9%)", "Documenting patient's/guardian's decision (59.3%)", and "Having shared decision (57.3%)". The perceived purposes of IC to be practiced were: "Informing the patient/guardian (68.4%)", "Making sure patient/guardian understand (65.3%)" and "Documenting patients/guardians decisions (65.1%)". "Being a meaningless routine" was reported by the majority to be ranked as a low purpose for IC current and preferred practices. CONCLUSION The practice of IC is common within the Egyptian medical community. Participants believe that information disclosure "Making sure patients understand" has to help in IC decision making and its main purpose. However, unfortunately, this is not perceived as a current purpose of IC. There was consensus agreement that documenting the patient's/guardian's decision and informing the patient/guardian are perceived as both important current and preferred purposes for IC practices.
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Affiliation(s)
- Ammal M. Metwally
- Medical Research Division, Community Medicine Research Department, National Research Centre, Dokki, Cairo, Egypt
| | - Hala A. Amer
- Medical Research Division, Community Medicine Research Department, National Research Centre, Dokki, Cairo, Egypt
- Department of Infection Control, King Saud Medical City, Riyadh, KSA
| | - Hend I. Salama
- National Blood Transfusion Services Mansoura Region, Ministry of Health and Population, Egypt
| | | | - Raefa R. Alam
- Faculty of Nursing, Mansoura University, Mansoura, Egypt
- Egyptian Liver Research Institute And Hospital (ELRIAH), Mansoura, Egypt
| | - Ahmed Aboulghate
- Medical Research Division, Community Medicine Research Department, National Research Centre, Dokki, Cairo, Egypt
| | - Hanan A. Mohamed
- Faculty of Nursing, Mansoura University, Mansoura, Egypt
- Egyptian Liver Research Institute And Hospital (ELRIAH), Mansoura, Egypt
| | - Hanan M. Badran
- Faculty of Nursing, Mansoura University, Mansoura, Egypt
- Egyptian Liver Research Institute And Hospital (ELRIAH), Mansoura, Egypt
| | - Amal A. Saadallah
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Marwa M. El-Sonbaty
- Medical Research Division, Child Health Department, National Research Centre, Cairo, Egypt
- Department of Pediatrics, College of Medicine, Taibah University, Madinah, K.S.A
| | - Eman Eltahlawy
- Environmental Research Division, Environmental Health and Occupational Medicine, National Research Centre, Egypt
| | - Walaa Saad
- Department of biological anthropology, National Research Centre, Egypt, Cairo, Egypt
| | - Amira Mohsen
- Medical Research Division, Community Medicine Research Department, National Research Centre, Dokki, Cairo, Egypt
| | - Ghada A. Abdel-Latif
- Medical Research Division, Community Medicine Research Department, National Research Centre, Dokki, Cairo, Egypt
| | - Asmaa M. Fathy
- Medical Research Division, Community Medicine Research Department, National Research Centre, Dokki, Cairo, Egypt
| | - Amal I. Hassanain
- Medical Research Division, Child Health Department, National Research Centre, Cairo, Egypt
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Metwally AM, Amer HA, Salama HI, Abd El Hady SI, Alam RR, Aboulghate A, Mohamed HA, Badran HM, Saadallah AA, El-Sonbaty MM, Eltahlawy E, Saad W, Mohsen A, Abdel-Latif GA, Fathy AM, Hassanain AI, Eldali A. Egyptian patients’/guardians’ experiences and perception about clinical informed consent and its purpose: Cross sectional study. PLoS One 2021; 16:e0252996. [DOI: https:/doi.org/10.1371/journal.pone.0252996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Background
Informed consent (IC) is a healthcare standard emphasizing the meaning of human dignity as clarified in the Universal Declaration of Human Rights. Data about IC practices in Egypt is insufficient. This study aimed to assess the Egyptian patients’/guardians’ experiences about IC and their expectations about its practices’ purposes in general and according to the type of the healthcare facility.
Methods
Self-administered questionnaire was carried out for 1092 participants who had undergone or were scheduled to a procedure requiring an IC at three studied types for Egyptian health care facilities. Ten statements were ranked twice by the participants to reflect their perception of IC purpose as per what is currently practiced and what they believe should be practiced.
Results
IC implementation varies significantly (p<0.05) across the health care facilities in Egypt. The percentage of its implementation at the non-governmental facilities, governmental facilities, and university hospital was 85.9%, 77.8%, and 63.8 respectively. The first three ranked purposes of the current IC practices were: “Helping patient/guardian decide (64.9%)”, “Documenting patient’s/guardian’s decision (59.3%)”, and “Having shared decision (57.3%)”. The perceived purposes of IC to be practiced were: “Informing the patient/guardian (68.4%)”, “Making sure patient/guardian understand (65.3%)” and “Documenting patients/guardians decisions (65.1%)”. “Being a meaningless routine” was reported by the majority to be ranked as a low purpose for IC current and preferred practices.
Conclusion
The practice of IC is common within the Egyptian medical community. Participants believe that information disclosure “Making sure patients understand” has to help in IC decision making and its main purpose. However, unfortunately, this is not perceived as a current purpose of IC. There was consensus agreement that documenting the patient’s/guardian’s decision and informing the patient/guardian are perceived as both important current and preferred purposes for IC practices.
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Rights based approaches to sexual and reproductive health in low and middle-income countries: A systematic review. PLoS One 2021; 16:e0250976. [PMID: 33914834 PMCID: PMC8084237 DOI: 10.1371/journal.pone.0250976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 04/18/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION The Sustainable Development Goals, which are grounded in human rights, involve empowering women and girls and ensuring that everyone can access sexual and reproductive health and rights (Goal 5). This is the first systematic review reporting interventions involving rights-based approaches for sexual and reproductive health issues including gender-based violence, maternity, HIV and sexually transmitted infections in low and middle-income countries. AIMS To describe the evidence on rights-based approaches to sexual and reproductive health in low and middle-income countries. METHODS EMBASE, MEDLINE and Web of Science were searched until 9/1/2020. Inclusion criteria were: Study design: any interventional study.Population: females aged over 15 living in low and middle-income countries.Intervention: a "rights-based approach" (defined by the author) and/or interventions that the author explicitly stated related to "rights".Comparator: clusters in which no intervention or fewer components of an intervention were in place, or individuals not exposed to interventions, or exposed to fewer intervention components.Outcome: Sexual and reproductive health related outcomes. A narrative synthesis of included studies was undertaken, and outcomes mapped to identify evidence gaps. The systematic review protocol was registered on PROSPERO (CRD42019158950). RESULTS Database searching identified 17,212 records, and 13,404 studies remained after de-duplication. Twenty-four studies were included after title and abstract, full-text and reference-list screening by two authors independently. Rights-based interventions were effective for some included outcomes, but evidence was of poor quality. Testing uptake for HIV and/or other sexually transmitted infections, condom use, and awareness of rights improved with intervention, but all relevant studies were at high, critical or serious risk of bias. No study included gender-based violence outcomes. CONCLUSION Considerable risk of bias in all studies means results must be interpreted with caution. High-quality controlled studies are needed urgently in this area.
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Accelerating Hepatitis C virus elimination in Egypt by 2030: A national survey of communication for behavioral development as a modelling study. PLoS One 2021; 16:e0242257. [PMID: 33621232 PMCID: PMC7901784 DOI: 10.1371/journal.pone.0242257] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/20/2020] [Indexed: 12/24/2022] Open
Abstract
AIM OF THE WORK This study aimed at assessing the dominance of risk practices associated with HCV endemicity in Egypt and detecting the behavioral development level concerning different aspects of HCV risk behaviors with respect to age and gender. The survey highlights the most cost-effective strategies that could accelerate HCV elimination in Egypt. SUBJECTS AND METHODS A national household survey targeted 3780 individuals (age range: 10-85 years). The sample was a systematic probability proportionate to size from 6 governorates representing the six major subdivisions of Egypt. The indicators used for assessing the behavioral development level towards HCV included six domains: awareness (7 indicators), perceived risk (5 indicators), motivation with the intention to change (4 and 5 indicators for males and females respectively), trial, rejection or adoption (6 and 5 indicators for males and females respectively). RESULTS The study revealed that along the continuum of behavior development, the percentage of the participants who acquired half of the scores was as follows: 73.1% aware, 69.8% developed perceived risk, 80.6% motivated with only 28.9% adopting the recommended behaviors, 32% rejected them, 2.3% were in the trial stage versus 35.8% who did not try any. Adolescents had significantly lower levels of development for almost all domains when compared to adults. Statistical higher significance was detected in favor of adults, employees, married, Lower Egypt governorates, and university-educated participants (p<0.001) regarding awareness, perceived risk, and motivation scores. More than half of the participants incorrectly believed that contaminated food, sharing food utilities, contaminated water, mosquitoes, and schistosomiasis would lead to HCV transmission. CONCLUSION Egypt would be closer to HCV elimination when cost-effective strategies are directed not towards creating awareness, perceived risk or motivation to change- (at an acceptable level)- but towards motivating adopting risk-reduction behaviors for HCV, tackling misconceptions and reinforcement of social support.
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Metwally AM, Elmosalami DM, Elhariri H, El Etreby LA, Aboulghate A, El-Sonbaty MM, Mohsen A, Saleh RM, Abdel-Latif GA, Samy S, El Deeb SE, Fathy AM, Salah MM, Abdel Mawla MA, Imam HM, Ibrahim NA, Shaaban FA, Elamir RY, Abdelrahman M, El-Sayed MH. Accelerating Hepatitis C virus elimination in Egypt by 2030: A national survey of communication for behavioral development as a modelling study. PLoS One 2021; 16:e0242257. [DOI: https:/doi.org/10.1371/journal.pone.0242257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Aim of the work
This study aimed at assessing the dominance of risk practices associated with HCV endemicity in Egypt and detecting the behavioral development level concerning different aspects of HCV risk behaviors with respect to age and gender. The survey highlights the most cost-effective strategies that could accelerate HCV elimination in Egypt.
Subjects and methods
A national household survey targeted 3780 individuals (age range: 10–85 years). The sample was a systematic probability proportionate to size from 6 governorates representing the six major subdivisions of Egypt. The indicators used for assessing the behavioral development level towards HCV included six domains: awareness (7 indicators), perceived risk (5 indicators), motivation with the intention to change (4 and 5 indicators for males and females respectively), trial, rejection or adoption (6 and 5 indicators for males and females respectively).
Results
The study revealed that along the continuum of behavior development, the percentage of the participants who acquired half of the scores was as follows: 73.1% aware, 69.8% developed perceived risk, 80.6% motivated with only 28.9% adopting the recommended behaviors, 32% rejected them, 2.3% were in the trial stage versus 35.8% who did not try any. Adolescents had significantly lower levels of development for almost all domains when compared to adults. Statistical higher significance was detected in favor of adults, employees, married, Lower Egypt governorates, and university-educated participants (p<0.001) regarding awareness, perceived risk, and motivation scores. More than half of the participants incorrectly believed that contaminated food, sharing food utilities, contaminated water, mosquitoes, and schistosomiasis would lead to HCV transmission.
Conclusion
Egypt would be closer to HCV elimination when cost-effective strategies are directed not towards creating awareness, perceived risk or motivation to change- (at an acceptable level)- but towards motivating adopting risk-reduction behaviors for HCV, tackling misconceptions and reinforcement of social support.
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Metwally AM, Abdel-Latif GA, Mohsen A, El Etreby L, Elmosalami DM, Saleh RM, El-Sonbaty MM, Amer HA, El Deeb SE, Fathy AM, Hanna C, Azmy O, Taha TF, Abbassy A, Alalfy M, Hasan HM, Abdelrahman M. Strengths of community and health facilities based interventions in improving women and adolescents’ care seeking behaviors as approaches for reducing maternal mortality and improving birth outcome among low income communities of Egypt. BMC Health Serv Res 2020; 20:592. [DOI: https:/doi.org/10.1186/s12913-020-05412-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/09/2020] [Indexed: 10/31/2023] Open
Abstract
Abstract
Background
Provision of emergency obstetric care is considered the key for maternal mortality reduction worldwide. This study evaluated the impact of community- and facility-based educational programs on provision of emergency obstetric care in Egypt. The study focused on evaluating utilization of the available health services and care seeking behaviors of mothers in the childbearing period.
Methods
We implemented a package of community- and facility-focused educational interventions in two of Egypt’s lowest income governorates. At facility level, health professionals at rural health units from 21 villages over 5 years were trained. Mass media gathering, individual teaching at health facilities, printed materials and home-based care sessions were provided. Collectively, these interventions were designed to focusing on recognition of the early warning signs during pregnancy, delivery and postpartum period for timely referral to hospitals for 20,494 women and adolescents mothers.
Results
The impact of the interventions was highly reflected on the percent of mothers received care during their pregnancy period. Proper antenatal care at governmental or private health facilities was raised dramatically from 0.6 to 59.3% and those who utilized at least one family planning method from 61.4 to 74.4%. Accordingly, the rate of complications significantly reduced during pregnancy (38.1 to 15.1%), during delivery (24.1 to 13.1%) and during postpartum (81.7 to 7.0%). As an impact to the improvement, there was a marked reduction in adolescent pregnancy by 55% and better birth outcome with a reduction in the percent of stillbirth by 11.5%.
Conclusion
It is important to provide a comprehensive package that works at both improving qualities of care as well as empowering women by knowledge to first aid measures at the community level. The cost-effective way to empower mothers to provide first aid measures as emergency obstetric care is to adopt the outreach approach which could be more influential than mass media campaigns for the at-risk and vulnerable and low-income communities.
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28
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Metwally AM, Abdel-Latif GA, Eletreby L, Aboulghate A, Mohsen A, Amer HA, Saleh RM, Elmosalami DM, Salama HI, Abd El Hady SI, Alam RR, Mohamed HA, Badran HM, Eltokhy HE, Elhariri H, Rabah T, Abdelrahman M, Ibrahim NA, Chami N. Egyptians' social acceptance and consenting options for posthumous organ donation; a cross sectional study. BMC Med Ethics 2020; 21:49. [DOI: https:/doi.org/10.1186/s12910-020-00490-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 06/03/2020] [Indexed: 10/31/2023] Open
Abstract
Abstract
Background
Organ donation has become one of the most effective ways to save lives and improve the quality of life for patients with end-stage organ failure. No previous studies have investigated the preferences for the different consenting options for organ donation in Egypt. This study aims to assess Egyptians’ preferences regarding consenting options for posthumous organ donation, and measure their awareness and acceptance of the Egyptian law articles regulating organ donation.
Methods
A cross sectional study was conducted among 2743 participants over two years. Each participant was required to rank eleven consenting options from 1 (most preferred) to 11 (least preferred), and to report his awareness and acceptance of the seven articles of the Egyptian law of organ donation.
Results
47% of the participants expressed willingness to donate their organs after death. This percentage increased to 78% when consenting options were explained to participants. “Informed consent by donor only” was the most preferred type of consent for one third of respondents. Awareness of the law articles regulating organ donation was relatively low ranging from 56% to 23%.
Conclusion
Currently, around half of the Egyptian population agree to posthumous organ donation. This percentage could be increased significantly by raising the awareness about how the process of donation could be regulated and how the patient’s right of decision could be protected.
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Metwally AM, El-Sonbaty MM, El Etreby LA, Salah El-Din EM, Abdel Hamid N, Hussien HA, Hassanin AM, Monir ZM. Impact of National Egyptian school feeding program on growth, development, and school achievement of school children. World J Pediatr 2020; 16:393-400. [DOI: ttps:/link.springer.com/article/10.1007/s12519-020-00342-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/16/2020] [Indexed: 10/31/2023]
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30
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Metwally AM, El-Sonbaty MM, El Etreby LA, Salah El-Din EM, Abdel Hamid N, Hussien HA, Hassanin AM, Monir ZM. Impact of National Egyptian school feeding program on growth, development, and school achievement of school children. World J Pediatr 2020; 16:393-400. [DOI: doi 10.1007/s12519-020-00342-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/16/2020] [Indexed: 10/31/2023]
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31
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Metwally AM, El-Sonbaty MM, El Etreby LA, Salah El-Din EM, Abdel Hamid N, Hussien HA, Hassanin AM, Monir ZM. Impact of National Egyptian school feeding program on growth, development, and school achievement of school children. World J Pediatr 2020; 16:393-400. [PMID: 32056148 DOI: 10.1007/s12519-020-00342-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/16/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND School feeding program (SFP) increases access to education and to better health. This study aims to evaluate the effects of SFP on physical growth, cognitive development, psychosocial behavior, and learning achievement of school children. METHODS A quasi-experimental study was conducted. The intervention group included 903 pupils in the fifth grade receiving the school meal, while the control group included 886 pupils, matched for age and sex, without meal. The meal consisted of a pie made of flour fortified with vitamins A, B6, B12, C, thiamin, riboflavin, niacin, folate, calcium, iron, zinc, and phosphorus. Socioeconomic position, nutritional status, and dietary behavior were evaluated. Neuropsychological tests were done. Psychosocial behavior was rated and educational achievement was recorded. Post hoc and independent sample t tests were used to detect the association of the studied parameters with the intake of school snack. RESULTS Children who took the meal had better scores on visual memory, auditory vigilance tests (9.71 ± 2.80 vs. 7.45 ± 3.25; 25.02 ± 3.36 vs. 10.82 ± 8.92, respectively, P < 0.001), the afternoon attention and working memory test (8.20 ± 2.21vs. 7.75 ± 3.05) (P < 0.001), but less score of externalizing behavior (P < 0.001) than the control group. No significant changes of children's nutritional status were detected between the two groups. School meal was the main predictor of visual memory and auditory vigilance (P < 0.001), and was the strongest predictor of academic achievements when combined with family size and meals' frequency (P < 0.001). CONCLUSION School meal improves academic achievements of school children.
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Affiliation(s)
- A M Metwally
- Medical Research Division, Community Medicine Department, National Research Centre, (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Marwa M El-Sonbaty
- Department of Pediatrics, College of Medicine, Taibah University, Madinah, Kingdom of Saudi Arabia. .,Medical Research Division, Child Health Department, National Research Centre, (Affiliation ID: 60014618), Dokki, Cairo, Egypt.
| | - L A El Etreby
- Medical Research Division, Community Medicine Department, National Research Centre, (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - E M Salah El-Din
- Medical Research Division, Child Health Department, National Research Centre, (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | | | | | | | - Z M Monir
- Medical Research Division, Child Health Department, National Research Centre, (Affiliation ID: 60014618), Dokki, Cairo, Egypt
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32
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Metwally AM, Abdel-Latif GA, Mohsen A, El Etreby L, Elmosalami DM, Saleh RM, El-Sonbaty MM, Amer HA, El Deeb SE, Fathy AM, Hanna C, Azmy O, Taha TF, Abbassy A, Alalfy M, Hasan HM, Abdelrahman M. Strengths of community and health facilities based interventions in improving women and adolescents' care seeking behaviors as approaches for reducing maternal mortality and improving birth outcome among low income communities of Egypt. BMC Health Serv Res 2020; 20:592. [PMID: 32600377 PMCID: PMC7322855 DOI: 10.1186/s12913-020-05412-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/09/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Provision of emergency obstetric care is considered the key for maternal mortality reduction worldwide. This study evaluated the impact of community- and facility-based educational programs on provision of emergency obstetric care in Egypt. The study focused on evaluating utilization of the available health services and care seeking behaviors of mothers in the childbearing period. METHODS We implemented a package of community- and facility-focused educational interventions in two of Egypt's lowest income governorates. At facility level, health professionals at rural health units from 21 villages over 5 years were trained. Mass media gathering, individual teaching at health facilities, printed materials and home-based care sessions were provided. Collectively, these interventions were designed to focusing on recognition of the early warning signs during pregnancy, delivery and postpartum period for timely referral to hospitals for 20,494 women and adolescents mothers. RESULTS The impact of the interventions was highly reflected on the percent of mothers received care during their pregnancy period. Proper antenatal care at governmental or private health facilities was raised dramatically from 0.6 to 59.3% and those who utilized at least one family planning method from 61.4 to 74.4%. Accordingly, the rate of complications significantly reduced during pregnancy (38.1 to 15.1%), during delivery (24.1 to 13.1%) and during postpartum (81.7 to 7.0%). As an impact to the improvement, there was a marked reduction in adolescent pregnancy by 55% and better birth outcome with a reduction in the percent of stillbirth by 11.5%. CONCLUSION It is important to provide a comprehensive package that works at both improving qualities of care as well as empowering women by knowledge to first aid measures at the community level. The cost-effective way to empower mothers to provide first aid measures as emergency obstetric care is to adopt the outreach approach which could be more influential than mass media campaigns for the at-risk and vulnerable and low-income communities.
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Affiliation(s)
- Ammal M Metwally
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt.
| | - Ghada A Abdel-Latif
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt
| | - Amira Mohsen
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt
| | - Lobna El Etreby
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt
| | - Dalia M Elmosalami
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt
| | - Rehan M Saleh
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt
| | - Marwa M El-Sonbaty
- Child Health Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt
- Department of Pediatrics, College of Medicine, Taibah University, Madinah, Kingdom of Saudi Arabia
| | - Hala A Amer
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt
- Infection Control Department, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Sherif E El Deeb
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt
| | - Asmaa M Fathy
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt
| | - Carine Hanna
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt
| | - Osama Azmy
- Reproductive Health Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt
| | - Tamer F Taha
- Reproductive Health Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt
| | - Amr Abbassy
- Reproductive Health Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt
| | - Mahmoud Alalfy
- Reproductive Health Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt
| | - Hatem Mohamed Hasan
- Reproductive Health Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt
| | - Mohamed Abdelrahman
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID: 60014618), P.O. 12622, Dokki, Giza, Egypt
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Metwally AM, Abdel-Latif GA, Eletreby L, Aboulghate A, Mohsen A, Amer HA, Saleh RM, Elmosalami DM, Salama HI, Abd El Hady SI, Alam RR, Mohamed HA, Badran HM, Eltokhy HE, Elhariri H, Rabah T, Abdelrahman M, Ibrahim NA, Chami N. Egyptians' social acceptance and consenting options for posthumous organ donation; a cross sectional study. BMC Med Ethics 2020; 21:49. [PMID: 32539704 PMCID: PMC7296756 DOI: 10.1186/s12910-020-00490-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 06/03/2020] [Indexed: 12/03/2022] Open
Abstract
Background Organ donation has become one of the most effective ways to save lives and improve the quality of life for patients with end-stage organ failure. No previous studies have investigated the preferences for the different consenting options for organ donation in Egypt. This study aims to assess Egyptians’ preferences regarding consenting options for posthumous organ donation, and measure their awareness and acceptance of the Egyptian law articles regulating organ donation. Methods A cross sectional study was conducted among 2743 participants over two years. Each participant was required to rank eleven consenting options from 1 (most preferred) to 11 (least preferred), and to report his awareness and acceptance of the seven articles of the Egyptian law of organ donation. Results 47% of the participants expressed willingness to donate their organs after death. This percentage increased to 78% when consenting options were explained to participants. “Informed consent by donor only” was the most preferred type of consent for one third of respondents. Awareness of the law articles regulating organ donation was relatively low ranging from 56% to 23%. Conclusion Currently, around half of the Egyptian population agree to posthumous organ donation. This percentage could be increased significantly by raising the awareness about how the process of donation could be regulated and how the patient’s right of decision could be protected.
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Affiliation(s)
- Ammal M Metwally
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt.
| | - Ghada A Abdel-Latif
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Lobna Eletreby
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Ahmed Aboulghate
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Amira Mohsen
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Hala A Amer
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt.,Infection Control Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Rehan M Saleh
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Dalia M Elmosalami
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Hend I Salama
- Egyptian Liver Research Institute And Hospital, Mansoura, Egypt
| | | | - Raefa R Alam
- Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | | | - Hanan M Badran
- Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | | | - Hazem Elhariri
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Thanaa Rabah
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Mohamed Abdelrahman
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Nihad A Ibrahim
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Nada Chami
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
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Pugliese-Garcia M, Radovich E, Campbell OMR, Hassanein N, Khalil K, Benova L. Childbirth care in Egypt: a repeat cross-sectional analysis using Demographic and Health Surveys between 1995 and 2014 examining use of care, provider mix and immediate postpartum care content. BMC Pregnancy Childbirth 2020; 20:46. [PMID: 31959149 PMCID: PMC6971907 DOI: 10.1186/s12884-020-2730-8] [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: 11/19/2019] [Accepted: 01/09/2020] [Indexed: 11/23/2022] Open
Abstract
Background Egypt has achieved important reductions in maternal and neonatal mortality and experienced increases in the proportion of births attended by skilled professionals. However, substandard care has been highlighted as one of the avoidable causes behind persisting maternal deaths. This paper describes changes over time in the use of childbirth care in Egypt, focusing on location and sector of provision (public versus private) and the content of immediate postpartum care. Methods We used five Demographic and Health Surveys conducted in Egypt between 1995 and 2014 to explore national and regional trends in childbirth care. To assess content of care in 2014, we calculated the caesarean section rate and the percentage of women delivering in a facility who reported receiving four components of immediate postpartum care for themselves and their newborn. Results Between 1995 and 2014, the percentage of women delivering in health facilities increased from 35 to 87% and women delivering with a skilled birth attendant from 49 to 92%. The percentage of women delivering in a private facility nearly quadrupled from 16 to 63%. In 2010–2014, fewer than 2% of women delivering in public or private facilities received all four immediate postpartum care components measured. Conclusions Egypt achieved large increases in the percentage of women delivering in facilities and with skilled birth attendants. However, most women and newborns did not receive essential elements of high quality immediate postpartum care. The large shift to private facilities may highlight failures of public providers to meet women’s expectations. Additionally, the content (quality) of childbirth care needs to improve in both sectors. Immediate action is required to understand and address the drivers of poor quality, including insufficient resources, perverse incentives, poor compliance and enforcement of existing standards, and providers’ behaviours moving between private and public sectors. Otherwise, Egypt risks undermining the benefits of high coverage because of substandard quality childbirth care.
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Affiliation(s)
- Miguel Pugliese-Garcia
- Faculty of Public Health and Policy, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK.
| | - Emma Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Nevine Hassanein
- Gynuity Health Projects, Egypt team, 220 East 42nd, New York, NY, 10017, USA
| | | | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Institute of Tropical Medicine, Antwerp, Belgium
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