IRAQI JOURNAL OF COMMUNITY MEDICINE

Background: In November 2021, the Iraqi Ministry of Health announced the opening of more vaccination channels across the country and that those
over 12 years of age were to be vaccinated. Vaccination rates are increasing in Iraq but there is very high resistance from a large segment of
the population due to misinformation speared among peoples, a lack of knowledge on vaccines and access to the vaccination process from
registering to receiving.
Objectives: To assess the knowledge and attitude among a sample of people attending AL Yarmouk teaching hospital toward COVID-19 vaccination.
Subjects and Methods: A cross sectional study was conducted in Baghdad, from beginning of February 2022 to the end of March 2022. Data of
298 participants who attending the out clinic of internal medicine department at AL Yarmouk Teaching Hospital was collected by direct
interview using a self- structured questionnaire. The study was approved by the ethics Committee of the Iraqi board for medical
specialization. Data were submitted to SPSS version 26 and presented in numbers, tables, and graphs. Chi-square test to show the association
was used. P-value of less than 0.05 was considered as statistically significant.
Results: There were 170 (57%) participants within age group 18-30 years. Male participants were 112 (37.6%) while female 186 (62.4%).
There were 80(26.8%) un-vaccinated and 218 (73.2%) vaccinated participants. Receiving COVID-19 vaccine appeared to be significantly
higher among participants within age group 31-40 years, lives in urban area, have higher education, and who got infected with COVID 19
previously (P=0.01, P=0.02, P=0.001, and P=0.001) respectively. Knowledge of participants about COVID-19 vaccine was good among 90
(30.2%), while attitude was good among 45 (15.1%) participants. Good knowledge was significantly higher among participants
with higher education and vaccinated participants P=0.006 and P<0.001 respectively. Poor attitude was significantly higher among female
gender (P=0.008).
Most common reasons that drive participant to get COVID-19 vaccine were Fear of infection 127 (58.3%), and their duty to the community to
participate in the eradication of the pandemic 115 (52.8%). While most common reasons that prevent un-vaccinated participants from getting
COVID-19 vaccine were do notbelieve in the efficacy of the vaccine 36 (45.0%).
Conclusions: Low proportion of participants has good Knowledge 30.2% about COVID-19 vaccine, and very low proportion of participants have
good attitude 15.1% about COVID-19 vaccine. Good knowledge was appeared to be dominant among participants with higher education and
vaccinated participants.Female gender was a determinant of poor attitude.

Background: Job satisfaction is a scale of people’s content with their job and an estimation of their work experience with effort
and the use of the right methods in performing the task, and then a success can be produced. The resulting success will
create a sense of satisfaction in work. This job satisfaction, if it can be enjoyed, will make an individual feel selfconfident, feel appreciated and in turn become a motivator in doing the job better.
Objective: To assess the job satisfaction among physicians working in family health care centers and primary health care centers
during COVID 19 pandemic and the factors associated with it.
Methods: A descriptive cross-sectional study with a convenient sample of 100 physicians was carried at the main primary health
care centers and family health care centers (14 PHC and 15 FHC) in Al-Rusaffa directorate, Baghdad, Iraq. Period of
study was from the first of February 2022 till the 30th of December 2022. The data were collected by self-administered
questionnaire after having verbal consent of doctors working in the mentioned centers.
Results: 89% of the participants had low satisfaction, 10% of the participants had fair satisfaction and only 1% of the participants
had high satisfaction, most of the participants were not satisfied about the incentives and letter of thanks (87%, 65%
respectively). According to the additional work and stress added during the pandemic, only 2% of the participants were
satisfied about the salary.
There was a statistical significant association between type of the center and satisfaction score. There was also a statistical
significant association between the number of doctors working in these centers and satisfaction score.
Conclusion: the overall satisfaction of doctors both specialists and GPs was low, the satisfaction was more in family health
center than primary health centers.

Background: A large number of reproductive age women experience at least some form of menstrual symptoms. Premenstrual
syndrome is characterized by physical, affective, and behavioral symptoms that significantly impair the daily lives of
women, including work and personal activities during the luteal phase and spontaneously resolve within a few days of the
onset of menstruation.
Objectives: To assess premenstrual symptoms (physical, psychological, behavioral) among a sample of women attending
primary healthcare centers during 2022 in Baghdad. And to find out if there is any association between premenstrual
symptoms and certain variables: (socioeconomic status, education, occupation, marital status, number of children,
menstrual history, and family history of premenstrual symptoms).
Method: A cross-sectional study was conducted among 400 female at reproductive age (15-49 years) who were attending
primary health care centers in Baghdad (Al-Karkh and Al-Russafa health directorates) for six months duration. Structured
questionnaire that derived from previous studies was used. Chi square test was used for data analysis by using SPSS
version 24.
Results: More than half of study participants (52.8%) were between 15 - 25 years. Females with intermediate socioeconomic
status (6-10) were formed 243 (61%). According to the anxiety score; 183 (46%) of included females had abnormal
score. According to depression score; 201 (51%) of the participants had abnormal scores. Sleeping disturbance occurred
in 77% of the participants, insomnia in 57.8%, and hypersomnia in 57%. About 68.3% face difficulty in concentration,
forgetfulness. 92.5% feel joint or muscle pain, 83.5% feel breast tenderness or swelling. 67.8% feel sensation of weight
gain. Headache and dizziness occurred in 75.3%, 70% of participants respectively. Feeling lethargy, easy fatigability was
common in 95.8% of participants. 97.3% of participants have abdominal pain and cramps, 94.8 have backache, 76.8%
have acne flare up, nausea and vomiting occurred in 51.3%, hot flashes in 74.85, palpitation in 64.2%.
Conclusions: Younger females were significantly more anxious during the premenstrual periods, and females with intermediate
socioeconomic status were significantly associated with an abnormal anxiety score. Lower educational level was
significantly associated with abnormal depression scores. There was no significant association between depression score
and socioeconomic status

Background: Cognitive Impairment, refers to trouble in remembering, learning and concentration, which might
affect the quality of day to-day life. Cognitive impairment is becoming a major public health problem,
Patients with mild cognitive impairment can revert to normal cognition, but many times progresses to
Alzheimer’s disease.
Objectives: To explore the levels of cognitive impairment among the elderly, and to determine its association with
some socio-demographic characteristics.
Method: A cross sectional study was conducted by selecting 533 old people from the attendees of 13 geriatric
friendly primary health care centers in Baghdad. The measurement of cognitive impairment was based on
the Mini Mental State Examination scale
d among 29.5%, severe cognitive impairment in 4.3%. Mild and severe cognitive impairment were significantly
higher among the ages of 60-74 years, females, Housewives, married, those lived with families, illiterate,
and financially dependent.
Conclusion: Mild cognitive impairment is the prominent feature among our elderly. It is important to notice that
the current levels of cognitive impairment can't be overlooked, and establishing an early screening
program, with adoption of cognitive behavioral therapy and life style management, to avoid progression
to Alzheimer disease is a fundamental.

Background: Smart phone is rapidly spreading throughout the world in recent years; it has become indispensable tool in everyday life and
mobile tool that everyone can easily reach.
Objectives: To determine the proportion of children who use smartphones and relationship with demographic variables, the impact on the
social, psychological and behavioral aspects of children.
Material and methods: The study targeted parents with children younger than 10 years who were in the community in Baghdad city. Selfreported questionnaires were distributed among 200 parents that were conveniency selected throughout the period of 10th January to
25th May 2022.
Results: 90.3% of children in present study were using smart phone devices with boy predominance 66%; mean age 7±1.63 Years. 37.6% of
children have their own devices. Most parents 88.6% supervise on their children while they are on the devices. Most children were
normal, the remaining 12%, 7%, 6%, 3% open minded, nervous, audacious, and isolated, consequently. Fifty-eight of parents noticed
variation in children's behaviors before and after using smartphone. Psychological effects detected in 17% of children. Both of girls
and boys (46%) smart phone have effects on their study. Approximately 10% have problems in growth processes, and lost regular meals
(64%).
Conclusions: The study concludes that the majority of parents notice differences in their child's behaviors after using smart phones.

Background; wounds represent an essential part of surgical operations, wound infection after appendicectomy remains a
significant problem around the world. The incidence varied from 6.2 in high-income countries to 11.1 per 100
appendectomies in low-income countries.
Objectives; this study aims to compare the type of wound closure (subcuticular vs interrupted) in terms of wound infection post
appendectomy.
Patients and Methods; this is a prospective cross-sectional study following a cohort of patients with appendectomy conducted at
Al Yarmook Teaching Hospital for 1 year, from the first of April 2021 up to the end of March 2022. A sample size of
100 patients was reached. Patients were enrolled in the study after assessment of eligibility and the allocation to
subcuticular suture or vertical interrupted mattress groups was determined randomly. Follow-up was achieved on 1, 2,
5, 10 and 30 days. All data were analyzed by using Statistical Package for Social Sciences (SPSS). Independent t-test
and Chi-square test were calculated to explore the difference and association between variables. Binary logistic
regression analysis was performed to predict the odds of having a wound infection. In all statistical analyses, a P-value
equal to or less than 0.05 was indicative of a statistically significant difference
Results; the average age for the subcuticular and interrupted mattress group was 25.56±9.76 and 27.84±8.65 respectively.
Wound infection occurred among 13/100 of the sample. No significant difference between the two types of suturing
techniques (subcuticular vs interrupted) along with the follow-up period. The odds of developing wound infection were
significantly higher among the males, smokers, and those with a positive family history of appendectomy and
complicated by wound infection
Conclusion; tihs stohs siuts tiht the odds of developing wound infection were significantly higher among the males, smokers,
and those with a positive family history of appendectomy and complicated by wound infection.

Background: Acute abdominal conditions are common non-traumatic surgical presentations in emergency department, it
includes spectrum of medical and surgical conditions ranging from mild to life-threatening conditions that develops during hours
which require hospital admission, investigations and treatment.
Objective: To study types of non-traumatic surgical emergencies visiting Emergency Department at Al-Kindy Teaching
Hospital.
Patients and Methods: A hospital-based records study was conducted at Al-Kindy Teaching Hospital on files of one hundred
forty patients underwent emergency surgery because of non-traumatic acute emergency during the period extended from 1st
January – 31st December 2019. A check list included sociodemographic information of patients (age & gender), presenting
symptoms & signs, comorbidities, provisional diagnosis, investigations done in emergency department, final diagnosis and final
destination was adopted.
Results: This study enrolled 76(54.3%) males & 64(45.7%) females, with mean age (28.8 ± 12.9) years. Acute appendicitis was
the most common diagnosis (78.6%), followed by acute cholecystitis (7.9%), perianal abscess (6.4%), gluteal abscess (5.7%),
complicated inguinal hernia (0.7%) & fecal impaction (0.7%).
Conclusion: Non-traumatic abdominal surgical emergencies were common cause for general surgical admissions. Most of the
patients were young males. Acute appendicitis was the most common diagnosis. The provisional diagnosis was the same of that
of final diagnosis

Background: Vitamin D deficiency and insufficiency is a worldwide issue. In addition to its well-known impact on
bone health and musculoskeletal function, recent studies relate it to many other diseases like cancer, diabetes
mellitus, autoimmunity and infectious diseases. This problem may be aggravated by the inconsistent
implementation of current clinical practice guidelines for vitamin D supplementation by the primary health care
providers
Objectives: To assess the knowledge and practice of primary health care doctors regarding vitamin D supplements
in infancy.
Methods: A descriptive cross-sectional study conducted between the 1st of February to 30th of July 2020 at 24
primary health care centers selected randomly from six sectors in Al –Karkh health directorate in Baghdad city,
and a convenient sample of 240 primary health care doctors involved. Data were collected through direct
interview.
Results Regarding knowledge, more than half of the study sample (53%) found to have fair knowledge ,while good
knowledge detected in 20% and 27% shows poor knowledge level. less than half (47%)of doctors possess a fair
practice level, whereas 29%, 24% had poor and good practice levels respectively. Poor practice noticed
regarding recommending sun exposure. Most of the participants choose vitamin D drops supplement.
Conclusion: There was a significant association between knowledge and practice level and gender, age, specialty,
years of experience. About half of participants had fair level of knowledge and practice, The Majority of vitamin
D prescriber shows higher level of knowledge and practice.

Background: Retirement is an important turning point in an individual’s life and also a
significant social stressor that can have an impact on physical and mental health,
moving from a relatively busy and regular lifestyle to a relatively inactive one is a
challenge, and the change of roles might be a trigger for some retirees to develop mental
health problems, on the other hand, retirement provides people with more leisure time
and opportunities as well as freedom from the stress of work, which might improve their
mental health, however the relationship between retirement and mental health can vary
by the type of retirement and country.
Objectives: A cross sectional study to assess the association between retirement and the
prevalence of depression in Iraq Babylon 2022
Methods: Data were collected at different district of Babylon health department primary health
care centers for a period of four months, from September 2022 and ended at the end of
November 2022, and included 250 participants, The questionnaire contained a
depression scale that contained eight questions, according to the total score before and
after retirement the participant is either diagnosed to have depression or below the
diagnostic score of 4.
Results: 33 patients had depression before retirement (13.2 %), the number of patients raise to
51 (20.4 %) after retirement.
Conclusions: the prevalence of depression increase after retirement, the prevalence risk raised
by 7.2 % after retirement.

Background:Bilateral breast cancer has a rising incidence due to the widespread adoption of bilateral
mammography and improved management of breast carcinoma leading to increase in life expectancy
and development of a second primary metachronous or synchronous breast cancer.
Objective: To determine the clinical picture of Bilateral breast carcinoma in a sample of Iraqi patients
Patients and Methods: A cross-sectional study was performed in AL-Imamain AL-Khadumain Teaching hospital
to determine the clinical features of bilateral breast carcinoma in a sample of Iraqi patients. Data
ollection was done in a period of five years, from April 2018, to April 2023. At first, the process was
explained to the patients and informed consent taken from all enrolled individuals. The patients were
divided into two groups; Group A patients with unilateral breast
carcinoma that have nosynchronous tumor, nor they develop metachronus tumor in 5 years. While
group B patients they were either hadsynchronous tumor or they develop metachronus tumor in the
course of their routine follow up or in case of any breast complaint.
Results:Breast carcinoma was diagnosed in 386(2.29%) patients. Group A (unilateral breast carcinoma) was
found in 373(2.21%) while Group B (bilateral breast carcinoma) was found in 13 (0.07%) patients;
8(0.04%) of them were patients withmetachronous tumor, and the other 5(0.02%) patients were
synchronous tumor. Family history for breast carcinoma was positive in 66 (17.09 %%) in Group A
patients, while family history was positive in 11 (84.61%) in Group B patients which is significant (p
value ≤ 0.05). Patients on hormonal treatment and developed breast carcinoma was 35(9.38%) in
Group A patients, while there were 9 (69.23%) patients in Group B which was significant (p value
≤0.05).