IRAQI JOURNAL OF COMMUNITY MEDICINE

Background: The neonatal period is the transitional time from intrauterine to independent existence, defined as approximately the first four weeks after delivery. The neonatal period is possibly the most tenuous in a human’s lifetime. Neonatal mortality is one of the world’s most neglected health problems. It is estimated that globally four million newborns die before they reach one month of age. Objective: To study the outcome of neonates admitted to the neonatal care units of maternity wards in Baghdad hospitals and identifying causes of admissions and causes of deaths. Methods: Across sectional study covering all neonatal intensive care units in Baghdad maternity wards. The study was carried out by hospital record review of 15 Neonatal care units for causes of admission and causes of death in neonatal care units during 2013(1/1/2013-31/12/2013.The study lasted from November 2013 till the end of March 2014. Results: Total admission was 13195. Main causes of admission were respiratory distress syndrome (43%), prematurity and low birth weight (19.4%), transient tachypnea (17.4%), birth asphyxia (4%), hypoglycemia (3.8%), congenital anomalies (3.7%), neonatal jaundice(3%),while meconium aspiration and septicemia were the lowest (1%).From all these admission 74%were discharged well, 6%were referred, while those discharged against medical advice were 4% and the rest 16% died. Main causes of death in neonatal intensive care units were respiratory distress syndrome (34%),prematurity and low birth weight (31%), congenital anomalies (12%),birth asphyxia (8%),septicemia (4%), meconium aspiration (1%), and 10%due to other causes. Highest case fatality rate was among congenital anomalies (54%) followed by septicemia (51%), birth asphyxia (32%),prematurity and low birth weight (26.2%), meconium aspiration (20%)while the lowest case fatality rate was for respiratory distress syndrome (12.7%). Conclusion: It can be concluded that respiratory distress syndrome and prematurity were the main neonatal health problems encountered in neonatal intensive care units in Baghdad. Keywords: Neonatal care units’ evaluation, Respiratory distress syndrome, Low birth weight.

Abstract: Background: Neural tube defects constitute one of the most common congenital malformations in newborns. Objectives: To find outthe admission rate of neural tube defects among the live birth neonates admitted to the Neonatal intensive care unit in Al-Yermouk Teaching Hospital. . Patients and methods: All cases of neural tube defectsadmitted to Neonatal care unit in Al-Yermouk teaching hospital for the period extended from1st June 2009 to31st May 2010 were included in this study. Data were collected on neonates and mothers according to special questioner sheet, all affected neonates were examined thoroughly. Results: The total lived birth was 13634, the total number of lived neonates with congenital malformation were 71, of them 38(53.5%) had neural tube defects, admission rate of neural tube defects during study period was 2.7/1000 live births, myelomeningocele constituted the most common cause (60.5%). It was found that female:male ratio was 2.1:1, more than two thirds of mothers aged 20-30 years (65.7%). More than half(55.2%) of the neonates were offspring of consanguineousmarriage, 68.5% of mothers attended antenatal care, 31.5% of mothers received regular folate supplementation during affected period of pregnancy (the first trimester), but no one received preconception folate. Conclusion: Thefrequency of neural tube defects was still high in comparison with other studies. Keywords: Al-YermoukHospital,Neural tube defects

Background: Retinopathy among patients with type 2 diabetes appears to be a public health problem in Iraq; it is serious eye disease lead to sever visual impairment and blindness if not detected early. Objective: To estimate the prevalence of retinopathy among patientswith type 2 diabetes mellitus who attended National Center of Diabetes of Al-Mustansiriyah University in Baghdad and to determine the risk factors of diabetic retinopathy. Methods: This cross sectional study was conducted at national center of diabetes of Al-Mustansiriyah University in Baghdad from January 2011 till January 2012. Two hundred eighty nine type 2 Iraqi diabetic patients with age> 35years and both sexes were included in this study. Diabetic Retinopathywas diagnosed by an ophthalmologist depending on the International Clinical Diabetic Retinopathy Severity Scale adopted by American Academy of Ophthalmologyand the International Council of Ophthalmology.All the data were obtained from the records of the diabetic patients which include Sociodemographic, clinical and laboratory data, like duration of diabetes,the type of treatment of diabetic mellitus, hypertension body mass index, triglyceride leveland glycemic controlwhich was assessed by measuring HbA1c. Result: From 289 patients with type 2 diabetes mellitus, 90 patients (33.1%) had retinopathy (47 males, 43 females). The mean±SDof the age was57.8±9.9years.Almosthalf of patientswereabove65 years oldand 69% residing in urban area. About 40% of the patients had diabetes for more than 15 years. 69%were treated with insulin 67% were hypertensive, 44% had body mass index>30,59%smokers,about 71% had HbA1c>7, and 66% had triglyceride>200. Conclusion: This study showed high prevalence of diabetic retinopathy among type 2 diabetic patients, with poor control of blood glucose, high triglyceride, longer diabetes duration, hypertension,insulin treatment and body mass index >30 are more prone to develop retinopathy. Keywords: Type 2 diabetes mellitus, diabetic retinopathy,

Background: One of the neglected problems in Iraq is the speech disorder among children, which is not uncommon public health, lifelong problem that may affect their social, emotional well-being, cognition, and behavior and may be associated with lowered school performance. Objectives: To determine the prevalence of speech disorder (specifically speech sound disorders and stuttering) among a sample of first class elementary school children in Al-Hilla City,Iraq,2014, and to identify some of contributing factors of this disorder. Subjects and Methods: This is a cross-sectional study carried on first class pupils in a randomly selected sample from 16 elementary schools (8 male and 8 female schools, 50% of studied schools were from rural area). The study was conducted during the academic year 2013-2014.The number of male pupils was 532 while the number of female pupils was 529. The data were collected by using teacher reports, questionnaire, and simplified screening tests. Results: The overall prevalence of school children with speech sound disorders was 11.4%, while the prevalence of stuttering was1.2%. The prevalence of speech disorder was significantly higher among male children as compared to female, the male to female ratio was1.8:1. There was a significant relationship between the level of education of parents and speech disorder. There was a significant correlation between stuttering and school performances of students, stutterers were low school performers. Conclusion: Speech disorders are highly prevalent in first class primary schools in our community, compared to other developed countries. Keywords: Stuttering, speech disorders, primary school children, Iraq, Hilla City

Background: VisceralLeishmaniasis is a serious parasitic disease; it is highly endemic in developing counters including Iraq. Objective: To identify some possible risk factors for Visceral Leishmaniasis among a sample of infected Children in Wasit Province. Patients and Methods: This is a hospital based case-control study that included 120 children (40 cases and 80 controls) admitted to three main hospitals in Wasit Province (Al-Swairra, Al-Aazizya & Al-Zahraa) during the period from first of February 2014through the end of April 2014. The diagnosis was based on clinical presentation and serological test. All Cases and control were interviewed through structural questioner which included (socio-demographic, sleeping characteristics, house characteristics) and other environmental related factors. Results: The risk factors in this study are the following: Presence of rodents in houses of patients is an important risk factor associated with Kalazar OR= 7.071 (95%CI= 2.79-17.926). The study showed that sleeping near animals was an important predictor for Kala azar and significantly associated with this disease OR= 6.176 (95%CI= 2.681-14.231). Another risk factor that associated significantly with this disease was the presence of insects in the houses of patients OR= 5.697 (95%CI= 2.331-13.922) and the presence of dogs near housesOR= 3.116 (95%CI= 1.316-7.380], another risk factor was found such as sleeping on ground OR=2.935 (95%CI= 1.332-6.469) while sleeping on first floor and using bed nets were found to be protective factors OR= 0.324 (95%CI= 0.089-1.187) OR=0.234 (95%CI= 0.101-0.544)respectively.The signs and symptoms of cases were fever reported in all patients (100%) while anemia in (75.0%), splenomegaly in (57.5%) and hepatomegaly in (45.0%). Conclusions: The most important risk factors that were associated significantly with visceral leishmaniasis in this region of Iraq were presence of rodents in houses of patients, sleeping near animals,insects in houses of patients,dogs near houses and sleeping characteristics like sleeping on ground.

Background: Patients satisfaction is a key criterion by which the quality of health care services is evaluated. Studies on patients’ satisfaction have been recognized as a way to identify priorities and problems of health care services. Objectives: To evaluate patients’ satisfaction with health care services provided at outpatient clinics of Al-Jumhori Teaching Hospital in Mosul, and its association with different socio-demographic and other factors of respondents. Methods: A cross-sectional study was conducted on 300 patients attending outpatient’s clinics at Al-Jumhori Teaching Hospital in Mosul for the period between the 1st of February and 30 th of April 2013. Adult patients 18 years and older, sexes, all social classes and all levels of educations were interviewed about their satisfaction with services provided at outpatient clinics in the hospital. Results: A total of 300 patients were enrolled in this study. The response rate was 90%. The mean age of the participants was (36.59±17.18) years, 57.3% were males and the rest were females. Majority (88.7%) of the respondents was satisfied with all aspects of services provided by outpatient’s clinics and the highest satisfaction was with physician’s care (89.7%). Satisfaction level was significantly related to age (P= 0.027), marital status (P=0.0001), educational level (P=0.0001) social class (P=0.0001), and history of previous visits to outpatient clinics (P=0.005). Gender, residence and type of clinic had no significant association with patients’ level of satisfaction in outpatient clinics. Conclusion: This research concluded that age, marital status, education level, social class and history of previous visit to outpatient clinics had significant effect on patients’ level of satisfaction with health care services provided at outpatient clinics of Al-Jumhori Teaching Hospital in Mosul.

Background: Polycystic ovary syndrome (PCOS) is considered to be the most common endocrine disorder in reproductive age. It is also one of the most enigmatic diseases. The etiology of PCOS is complex and is uncertain; recently, it has been shown that it is associated with excessive oxidative stress. Objective: Is to find whether PCOS is associated with oxidative stress by measuring one of the oxidative stress markers “malondialdehyde” (MDA). Methods: Between October 20012 and October 2013, fifty PCOS patients and fifty healthy controls were recruited into the study where the following parameters were determined for PCOS patients and compared to healthy control: Serum Follicle stimulating hormone (FSH) and Luteinizing hormone (LH) level along with LH/FSH ratio and testosterone levels. The concentration of MDA as marker of oxidative stress was determined according to Buege & Aust enzymology. Results: The study showed that the body mass index and LH, FSH, LH/FSH ratio, and testosterone were significantly different between the two groups (34.20±2.12 vs. 29.23±2.3; P=0.041, 8.83±2.34 vs. 8.20±1.76; P=0.012, 4.69±1.62 vs. 5.03±1.36; P=0.008, 2.05±0.56 vs.1.73±0.39; P=0.001, 2.09±1.27 vs. 0.98±1.24; P=0.005 respectively). The serum MDA level is product of lipid peroxidation as the oxidative stress marker where significantly higher in PCOS patients than in healthy controls (0.83±0.56 vs.0.433±0.234; P=0.001). Conclusion: The oxidative stress is increased in PCOS patients indicated by measurement of serum MDA level which is one of the oxidative stress markers and this may contribute to the pathogenesis of PCOS. Keywords: Oxidative stress, polycystic ovary syndrome

Background: Similar to smoking during pregnancy, a pregnant woman's exposure to secondhand smoke (SHS) affects many aspects of fetal development, from conception to birth. It increases the risk of having a low birth weight baby and premature delivery. Objective: To evaluate the effect of exposure to secondhand smoke during pregnancy on newborns' anthropometric measurements (birth weight, length and head circumference). Methods: A Retrospective cohort study was conducted in Baghdad, Iraq between first of December2013 to the first of May 2014 on a purposive non-random sample of 620 non-smoker mothers, interviewed within 24 hours after delivery and included two groups, first group included 310 non-smoker mothers who were not exposed to secondhand smoke and the second group included 310 non-smoker mothers who had history of such exposure. Results: The mean birth weight of infants born to mothers who were exposed to secondhand smoke (2.912±0.421) was significantly lower than infants of non-exposed women (3.010±0.411) (P=0.004). The mean head circumference of the infants of exposed mothers was smaller and length was shorter than that of infants of non-exposed mothers. The incidence of low birth weight (LBW) was higher in exposed women (15.8%) compared to non-exposed women (8.1%) (P=0.025; RR= 1.95). Conclusion: The study found a significant association between secondhand smoke exposure during pregnancy and decreased birth weight. Keywords: Secondhand smoke, prenatal exposure, low birth weight, neonatal length, head circumference