IRAQI JOURNAL OF COMMUNITY MEDICINE

Background: Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder seen in both primary and secondary care.
It is a major socioeconomic burden because affected patients use more health‑care resources with reduced work productivity when compared
to the healthy population. Objectives: The objectives of this study were to assess the knowledge, attitude, and practice of IBS patients and
to assess some sociodemographic factors that may related to these variables. Patients and Methods: A cross‑sectional study was conducted
in the Gastroenterology Clinic and Internal Medicine clinic at Al‑Imamain Al‑Kadhimain Medical City in Baghdad/Iraq during the period
from April 1, 2023, to August 31, 2023. All patients 18 years and older diagnosed with IBS were included in the study. A total of 280 patients
participated in the study. Data were collected through a face‑to‑face interview with the patients using a standardized questionnaire with some
modifications. Results: The average participant age was 39.61 ± 14.77 years, with most (72.1%) falling between 18 and 45 years, and 65.7%
reported having a family history of IBS. The results show that 171 patients(61%) had an acceptable level of knowledge score. Two hundred and
sixty‑six patients (95%) acknowledged the role of stress and anxiety in IBS, and most participants (92.5%) knew the importance of immediate
medical attention for serious symptoms. Education plays a pivotal role (P = 0.0001). Higher education correlates with excellent knowledge,
Illiterates mostly have poor knowledge. One hundred and seventy‑eight patients (64%) had positive attitude. One hundred and sixty‑nine
patients (60%) had bad practice. One hundred and ninety‑five patients (69.6%) avoid certain foods that are known to trigger IBS symptoms,
and 157 patients (56.1%) reported adequate sleep. Conclusions: The majority of IBS patients had an acceptable level of knowledge, positive
attitude, and bad practice. Most of them know that managing anxiety and changing diet can improve IBS symptoms

Background: Tetanus–diphtheria‑containing vaccine is still recommended for pregnant women even in countries that declared the elimination of neonatal tetanus and consequently the maternal tetanus. Many factors may affect vaccination during pregnancy. Knowledge is a key factor that greatly affects pregnant women. Objective: The objective of this study was to assess the knowledge and attitude of tetanus–diphtheria vaccine among pregnant women and to find any association between vaccine knowledge and attitude and study variables (age, educational status, employment, family income, socioeconomic status [SES], and antenatal care [ANC]). Subjects and Methods: A cross‑sectional study was conducted in Baghdad city. Data collection was from March 1, 2023, to May 30, 2023. Thirteen primary health‑care centers and two teaching hospitals were chosen conveniently to be included in the study. Total number of participants were 329 primigravida pregnant women. An interview questionnaire was used to collect quantitative data related to the knowledge and attitude of women about tetanus–diphtheria immunization and tetanus infection. Results: the study found that 73.6% of women had an accepted level of knowledge, 11.8% had an optimal level of knowledge, while 14.5% had a poor level of knowledge. Higher knowledge and attitude levels were significantly higher among older age group women and those with higher level of education and SES. ANC attendance and work status showed statistical insignificance regarding the level of knowledge and attitude. Women identify ANC and family members and friends as their primary sources of information about tetanus infection and immunization. Conclusions: Women’s knowledge was acceptable regarding tetanus infection and tetanus–diphtheria immunization. It is possible for proper health education targeting young women to prevent the occurrence of maternal neonatal tetanus. This might be possible with proper use of mass media to increase awareness.

Background: Primary health‑care (PHC) physicians may encounter a wide variety of conditions including acute and emergent cases considering the limited access to diagnostic investigation in PHC practice. Chest X‑ray (CXR) remains the imaging modality of choice to diagnose pulmonary, cardiac and other chest diseases, and it is the unique imaging technique available in Iraqi PHC centers (PHCCs), relatively inexpensive and has a low dose of radiation exposure. Aim of the Study: Competency assessment of diagnostic accuracy and confidence degree for Iraqi PHC physicians (PHCPs), regarding the interpretation of CXR in acute and emergent conditions. Subjects and Methods: A cross‑sectional study that included a convenient sample of 330 participants through an online questionnaire, during the period from January 2023 to January 2024. The study included some background information such as gender, years in practice, training type, interest in pulmonary medicine and diagnostic radiology, and having adequate training on the interpretation of CXR. The questionnaire consists of 10 chest radiographs with brief clinical information for each case. Participants were asked to choose the most likely diagnosis and to rate their degree of confidence in the interpretation of the CXR for each case. Descriptive statistics were presented using tables and graphs, continuous variables summarized by mean and standard deviation. The categorical variables summarized by percentages and frequency distributions and compared using Fisher’s exact test. The level of statistical significance was set at a P < 0.05. Cutoff point of diagnostic accuracy is considered equal or more than 5 correct answers from 10 is competent, and that of confidence rate equal or more than 3 scores from 5 is confident. Results: Overall diagnostic accuracy is 296 (89.7%) and overall diagnostic confidence is 116 (77%). Diagnostic accuracy among family medicine specialist 164 (91.1%) and diagnostic confidence are 138 (76.7%) within their group, while among nonspecialist PHCPs, diagnostic accuracy only 132 (88%) and diagnostic confidence 116 (77.3%) within their group. Proportion of competent family medicine specialists among all competent participants was more than half 164 (55.4%) and for nonspecialists was 132 (44.6%). A moderately positive correlation (r = 0.417) between diagnostic accuracy and confidence level appeared. Cardiogenic pulmonary edema 300 (90.9%) and normal CXR 284 (86.1%) cases had the highest diagnostic accuracy scores, whereas the lowest scores were for lobar collapse 168 (50.9%) and pneumomediastinum 140 (42.4%). More than half of the participants 202 (61.2%) lived in the capital and more than three quarters of the participants 266 (80.6%) were females. Family medicine specialists was constitute the largest number 180 (54.5%) of the participants and more than half of the sample 170 (51.5%) having more than 10 years of experience. Approximately 230 (70%) of the participants had no elective rotation in diagnostic radiology and about half of the sample 162 (49.1%) were uncertain about their training adequacy. More than three quarters of the sample 258 (78.2%) interested in diagnostic radiology and 198 (60%) interested in pulmonary medicine. Conclusions: The competency of Iraqi PHCPs in CXR interpretation in acute and emergency conditions was optimal generally. Nonspecialist PHCPs had fewer competencies than specialists that belong to knowledge and training deficiency. An introduction of radiology training courses in emergent conditions and the use of tele‑radiology platform in PHCCs should be considered.

Background: Epilepsy, affecting 50 million people globally, disproportionately impacts children and those in low‑and middle‑income countries. It leads to recurring seizures and significant social, cognitive, and psychological challenges. Stigma and lack of awareness, especially in educational settings, hinder the quality of life and inclusion of individuals with epilepsy. Addressing these challenges through improved understanding and support in schools is crucial for enhancing the well‑being of those affected. Objectives: The objective of this study was to assess knowledge and attitudes toward epilepsy among school teachers and to examine the influence of sociodemographic factors and school types on the level of knowledge and attitude. Methodology: A cross‑sectional study was conducted in Baghdad’s Al‑Mansour District from February to December 2023. A cluster sampling technique was used to select 30 schools. All teachers in selected schools were included in the study. Data collection involved a self‑administered questionnaire covering sociodemographic information, knowledge, and attitudes toward epilepsy. Results: The entire study sample was 530 school teachers, only 45% had poor knowledge, and 18% demonstrated good knowledge. Fifty‑one percent of teachers displayed poor attitudes toward epilepsy. Logistic regression analysis identified a family history of epilepsy and witnessing an epileptic attack as significant factors positively influencing knowledge. However, demographic factors showed no significant impact on knowledge or attitudes toward epilepsy. Conclusion: A notable knowledge gap and attitudes about epilepsy. Social media and television were important sources of information about epilepsy, which may not always provide accurate or comprehensive knowledge. Teachers with a family history of epilepsy and teachers who have witnessed epileptic attacks tend to have better knowledge. However, age, gender, marital status, and educational level do not significantly influence knowledge and attitude levels.

Background: In a labor and delivery facility, clinical maternity conditions can change quickly, which can result in unanticipated morbidities for both the mother and the baby. One important way to assess the quality and accessibility of a labor and delivery unit is to look at the rates of normal vaginal deliveries (NVDs) and cesarean sections (CS). These metrics are presented in the maternity dash board (MDB), as it firstly implemented in the Obstetric and Gynaecologic Teaching Hospital in Karbala. Patients and Methods: Research data were collected from the medical records of a labor and delivery unit manually and put in the MDB program, which was newly implemented in that hospital in 2023. The data were collected from the January 1st to December 31, also used data from last year before implementing the program, and then compared the data before and after the installation of MDB. Results: As the result of our study, the total NVD rate was 66% and 68% before and after implementation, respectively, indicating a significant increase in NVD (P < 0.0024), and the CS rate was 33% and 31% before and after implementation, respectively, indicating a significant reduction in the CS rate (P < 0.0001) after the implementation of the MDB. Conclusion: There is a significant reduction in the CS rate after the implementation of the MDB.

Background: Hospital stays, mortality, and expenditures rise with health‑care‑associated infections, especially in developing countries. Public health promotes infection control. Aim: The aim of this study was to assess health‑care workers’ (HCWs) infection control knowledge, attitude, and practice and determine how sociodemographic and job descriptive variables affect them. Settings and Design: A cross‑sectional study at four Baghdad/Al‑Rusafa government hospitals (Shaikh Zayed Hospital, Al‑Shaheed Al‑Sader Hospital, Ibn Al‑Balady Children and Maternity Hospital, and Fatima Al‑Zahraa Children and Maternity Hospital). Subjects and Methods: All resident doctors, nurses, and laboratory personnel who were present during data collection and agreed to participate were included in this study. Statistical Analysis: Data were entered using Excel 2019 and then analyzed using SPSS 26. Frequency and percentage analyzed quantitative data, while Chi‑square test analyzed categorical data. P <0.05 indicated statistical significance. Results: Knowledge level was higher among HCWs aged 30–39 years (79.4%), doctors (81.0%), individuals with more than 5 years of experience (75.0%), and those who received training (83.7%). Positive attitudes were most prevalent among HCWs aged 49 years and older (68.6%), laboratory workers (59.4%), individuals with more than 5 years of experience (55.5%), and those who received training (60.6%). A higher level of practice was observed in individuals aged 30–39 years (83.2%), laboratory personnel (80.4%), those with 5–14 years of experience (80.4%), and trainees (83.0%). Conclusions: Three‑quarters of HCWs had good knowledge and practice regarding infection control precautions, and nearly half of them had a positive attitude. The knowledge, attitude, and practice of HCWs were increasing with progress in age, increasing work experience, and also with training.

Background: A diverse range of illnesses known as lymphomas are caused by immune system constituent cells or their progenitors.18FFluorodeoxyglucose positron emission tomography (PET)/computerized tomography has been routine practice to improve the characterization and prognosis of both Hodgkin and non-Hodgkin lymphomas (NHLs). Objectives: The objective of the study was to assess the role of positron emission tomography (PET) scan in clinical evaluation of lymphoma and its ability to identify the correct stage of lymphoma. Patients and Methods: cross-sectional follow-up study was conducted on 50 patients with pathologically proven lymphoma in 2021 who were admitted to the hospital. All patients included in the study performed computed tomography (CT) and PET scan for initial staging. Results: In NHL, PET scan staging differed significantly from clinical in two stages; there were 7 patients versus none with Stage II according to clinical and PET scan staging, respectively. Furthermore, only five patients had Stage IV according to clinical staging versus 17 patients in PET scan staging. Accordingly, there was no agreement between the two modalities (κ = 0.085, 95% = 0.045–0.123, P = 0.394). In Hodgkin lymphoma (HL), the two modalities differ significantly in the appraisal of Stage IV, in which there were 2 patients based on clinical staging and 11 patients according to PET scan staging. Thus, there was a poor agreement between the two modalities (κ = 0.314, 95% confidence interval = 0.283–0.376, P = 0.002). PET scan upstaged 50% and 61.54% of the patients with HL and NHL, respectively, with a highly significant difference, whereas there was no change in staging for 50% and 34.62%, respectively, with a highly significant difference. In NHL, PET scan demonstrated higher positive bone marrow (BM) involvement than biopsy (34.62% vs. 19.23%) with a highly significant difference. Similarly, in HL, PET scan revealed far more positive BM involvement than biopsy (45.83% vs. 8.33%) with a highly significant difference. Conclusions: There is poor or no agreement between PET scan and clinical staging of lymphoma, with high detection with PET scan for BM involvement compared with CT scan, which leads to the identification of additional involved sites of patients with lymphoma.

Background: Acute coronary syndrome (ACS) is still one of the main causes of morbidity and mortality worldwide, and an early diagnosis of acute myocardial infarction (MI) aims to decrease mortality in MI patients. The ACS is manifested as one of three subtypes. These subtypes include MI with the electrocardiogram (ECG) is showing ST‑segment elevation (STEMI), the other is MI with the ECG is showing no ST‑segment elevation (NSTEMI), and the third type is unstable angina (UA). Objectives: The objectives of this study were to evaluate the role of serum copeptin (CPP) level in early diagnosis of subtypes of ACS. Materials and Methods: One hundred and twenty patients (72 males and 48 females) aged ≥30 years were consecutively selected from those who were admitted and diagnosed as ACS. The ACS patients comprised three subgroups: STEMI, NSTEMI, and UA, while apparently, healthy subjects were recruited as controls for this study. For each study subject, serum CPP was measured. Results: The CPP mean level showed an overall significant difference among study groups. On paired comparison, the CPP mean level was significantly higher in STEMI and NSTEMI subgroups (P < 0.001) as well as in UA subgroup of ACS patients than in controls (P < 0.05). On receiver operator characteristic analysis, the CPP levels showed good sensitivity and specificity in differentiation of each ACS subtype patients from controls as well as in differentiation of patients among subtypes of ACS. Conclusion: Serum CPP level is significantly higher in all subtypes of ACS than in controls in the first hours after the onset of acute chest pain in ACS patients in addition to having better sensitivity and specificity in the differentiation of patients among the subtypes of ACS.

Background: The quality of life for patients treated with the FOLFOX protocol can vary depending on the stage of their cancer and how they respond to treatment. Objectives: The current study aimed to assess the quality of life (QoL) and adherence to treatment in a sample of Iraqi patients diagnosed with colon cancer and treated with FOLFOX protocol. Patients and Methods: A cross‑sectional study was conducted at the Oncology Teaching Hospital, Al‑Amal National Hospital for Oncology, and Al‑Imamain Al‑Kadhimiyan Medical City. Fifty adult patients with histologically proven colon cancer receiving treatment with the FOLFOX protocol were recruited for this research. The European Organization for Research and Treatment of Cancer (EORTC QLQ‑C30) and Morisky Medication‑taking Adherence Scale (MMAS) were employed in this research. Results: It was observed that phlebitis 32 (64.0%) was the most common adverse event experienced after treatment with FOLFOX protocol, followed by neuropathy 27 (54.0%), nausea and vomiting 19 (38.0%), neutropenia 15 (30.0%), and diarrhea 12 (24.0%). Concerning participants adherence to treatment, according to MMAS‑8 questionnaire, 27 (54%) had medium adherence and 19 (38%) had high adherence to treatment. Regarding the functional scales of EORTC QLQ‑C30, role and emotional functioning were the most affected, with a lower mean than other scales. Among the symptoms scale of EORTC QLQ‑C30; fatigue, nausea, vomiting, and appetite loss were the most distressing symptoms reported. Conclusion: Colon cancer’s rising incidence underscores its significant impact on patients, affecting daily activities and emotional well‑being. This extends to treatment modalities such as the FOLFOX protocol, potentially influencing patients’ overall QoL.

Background: Febrile convulsion (FC) is the most common seizure in children worldwide. Between 1% and 4% of children develop FCs. It is also a leading reason for pediatric hospital admissions. Aim of the Study: The study aimed to assess the level of mothers’ knowledge regarding FC in children and to identify the factors affecting mothers’ knowledge about FC. Methodology: A descriptive cross‑sectional study was conducted in Children Welfare Teaching Hospital, Medical City Complex (outpatient clinic and emergency unit), during the period between November 2023 and August 2024. The study involved 426 mothers with children aged <7 years who attended the outpatient clinic and emergency unit. A dedicated knowledge score was established based on 20 questions, dividing the mother’s knowledge into three categories (high, moderate/fair, and poor knowledge). Results: Mothers’ knowledge scores revealed that their scores ranged from 6 to 20 with a mean of 13.4 ± 2.4 standard deviation; 24 (5.6%) got poor knowledge, 317 (74.4%) got fair knowledge, and 85 (19.9%) got high knowledge. The associations were statistically significant between mothers’ knowledge level and their residency (P = 0.018) and between mothers’ knowledge level and their education (P = 0.001). Conclusion: The majority of mothers (74.4%) had a fair knowledge of FC. Their knowledge is significantly associated with higher maternal education and urban residence.

Background: Urinary tract infections (UTI) are considered one of the most prevalent infections that affect pregnant women. Their prevalence estimated to be around 4–47%. They may present as symptomatic infection in form of acute cystitis or pyelonephritis, or they may present as asymptomatic bacteriuria. Objectives: Determine the prevalence and the associated factors of urinary tract infection in pregnant women attending the obstetric clinic of Baghdad Teaching Hospital. Methods: A cross sectional study was carried out in the outpatient obstetric clinics of Baghdad Teaching Hospital, Baghdad, Iraq, from December 2023 to the end of February 2024. It included a convenient sample of pregnant women. A questionnaire was used for the collection of data, and urines cultures were sent to identify women with UTI. Results: A total of 243 women were included in the study, the prevalence of UTI was found to be 31%, asymptomatic bacteruria 7%. The presence of diabetes, a previous history of catheterization and history of UTI in the previous year were found in 18.4%, 10.5% and 42.1% of the participants with positive urine cultures respectively, which were significantly higher than that found in the participants with negative urine cultures (4.8%, 3% and 21.6% respectively) where P-values were < 0.05. Women having ≤ 1 sexual intercourse per week were observe to have higher rate of negative urine cultures (62.9%) than those having ≥ 2 sexual intercourse per week (P-value < 0.001).There were no significant statistical associations between UTI diagnosis and the age, occupation, educational level, residence and income, trimester of pregnancy, number of parities, number of abortions, presence of hypertension, anemia, nor antenatal care where all the p values were > 0.05. Conclusions: UTI is frequently encountered in pregnancy, implementation of screening program is recommended.

Background: The term “long‑COVID‑19” describes the condition of individuals who have either recovered from the acute phase of COVID‑19 but are still reporting persistent effects of the infection, have had recurrence of the initial clinical symptoms, or have new symptoms other than the initial symptoms. The prolonged course of the COVID‑19 illness is a problem that is becoming more widely noticed, affecting both health and economic systems. Aim of the Study: To establish base‑line data for health policy makers to prevent and control this important public health problem. Methodology: A cross‑sectional study design was adopted for this study. The study was conducted in 39 health‑care centers selected randomly in Baghdad from ten health districts. In the first stage, ten health districts were chosen by a simple random sampling method. Then, in the second stage, a simple random sampling method selected 50% of primary health‑care centers from each district. A convenient sample of 600 participants was involved in the study. The collection of the data was completed within 10 months (from January 2nd to the end of October 2023). A level of P < 0.05 considered significant in both univariate and multivariable analysis performed in this research. Results: The current study revealed that 231 out of 600 (38.5%) participants had persistent symptoms for more than 4 weeks after the onset of illness. The symptoms that had persisted for more than 4 weeks were: fatigue in 145 out of 600 (24.1%), cough in 98 out of 600 (16.3%), and loss of smell or taste in 93 out of 600 (15.5%). By Chi‑square test analysis, statistically significant association was found between the duration of illness and: age, sex, smoking history, presence of chronic diseases, COVID‑19 vaccination before infection, reinfection with severe acute respiratory syndrome coronavirus 2 and obesity. On logistic regression analysis only increasing age (odds ratio [OR] 1.678, 95% confidence interval [CI] 1.089–2.586), female sex (OR 2.676, 95% CI 1.829–3.916), smoking (OR 2.878, 95% CI 1.964–4.216), and COVID‑19 vaccination before infection (OR 0.560, 95% CI 0.387–0.811) were significant factors. Conclusions: More than one‑third of participants (38.5%) had long COVID. The most frequent symptoms that persisted for more than 4 weeks in this study were fatigue, followed by cough, and loss of smell or taste, respectively. The increasing age, female sex, smoking were significant risk factors, in contrast to COVID‑19 vaccination before infection was significant protective factor.

Background: More than 21% of births worldwide are by cesarean section (CS). CS can save lives, but it increases the risk of neonatal respiratory morbidity, especially before 39 weeks. Preterm elective CS has been linked to higher newborn respiratory distress rates. Understanding these risks is essential for optimizing CS timing to improve neonatal outcomes. Patients and Methods: This study employed a hospital-based descriptive cross-sectional design conducted at two hospitals in Kirkuk City, Iraq, between December 2023 and February 2024. The study included 230 mothers who delivered infants between 36 and 41 weeks of gestation via elective or emergency CS or vaginal delivery. Data were collected using a structured questionnaire covering maternal medical history, gestational age, mode of delivery, and neonatal respiratory outcomes. Results: The study found that 14.8% of neonates developed respiratory distress syndrome (RDS), and 2/3 of them experienced transient tachypnea of the newborn. Infants delivered before 37 weeks were three times more likely to develop RDS than those delivered at or after 37 weeks (odds ratio = 3.1 and P = 0.003). Elective CSs were associated with lower respiratory morbidity compared to emergency CSs. In addition, advanced maternal age was significantly linked to higher rates of neonatal respiratory distress (P = 0.046). Conclusion: Delaying elective CSs until 39 weeks significantly reduces the risk of neonatal respiratory distress. Infants born before 39 weeks face a higher likelihood of RDS.