Evidence-based health policymaking in Iraqi Kurdistan: facilitators and barriers from the perspectives of policymakers and advisors

Background and objective: Evidence from research is underutilized in policy and practice in the majority of developing countries including Iraq. This aim of this study was to assess the role of research in health policy making in Iraqi Kurdistan context and identify the main barriers and facilitators for enhancing such role

Methods: This cross-sectional survey was carried out between November 2013 and March 2014 in the three governorates of the Iraqi Kurdistan Region, Erbil, Duhok and Sulaimaniyah. The study participants included 10 key health informants and three health advisors. Two types of combined questionnaires for health policy makers and health advisors were used for data collection

Results: Conferences and seminars were the main sources of scientific evidences identified by health policymakers [80%], followed by consultants [70%]. Different jargons/discourse was the main obstacle in consulting researchers [90%], followed by lack of tradition in collaborating [70%]. Collection of specialists/advisors, followed by professional associations, scientific committees and international organizations/UN agencies were the main groups identified by health advisors to build bridges between the scientific community and policymakers

Conclusion: Policymakers very rarely consult researchers directly in their decision making. There is poor networking among researchers, policy-makers, practitioners and representatives from civil society which has its negative impact on evidence-based policymaking. There is obviously a lack of any sort of program of funded research that can inform policymaking

Prevalence of urinary incontinence and probable risk factors in a sample of Kurdish women

The most common manifestation of pelvic floor dysfunction is urinary incontinence [UI] which affects 15-50% of adult women depending on the age and risk factors of the population studied. The aim of this study was to determine the probable risk factors associated with UI; the characteristics of women with UI; describe the types of UI, and determine its prevalence. A cross-sectional study was conducted between February and August 2011, in the Maternity Teaching Hospital of the Erbil Governorate, Kurdistan Region, northern Iraq. It included 1,107 women who were accompanying patients admitted to the hospital. A questionnaire designed by the researchers was used for data collection. A chi-square test was used to test the significance of the association between UI and different risk factors. Binary logistic regression was used, considering UI as the dependent variable. The overall prevalence of UI was 51.7%. The prevalence of stress, urgency, and mixed UI was 5.4%, 13.3% and 33%, respectively. There was a significant positive association between UI and menopause, multiparity, diabetes mellitus [DM], chronic cough, constipation, and a history of gynaecological surgery, while a significant negative association was detected between UI and a history of delivery by both vaginal delivery and Caesarean section. A high prevalence of UI was detected in the studied sample, and the most probable risk factors were multiparity, menopausal status, constipation, chronic cough, and DM

Assessment of referral characteristics of a sample of patients attending the secondary care units at Erbil Teaching Hospital

The referral system constitutes a key element of health system. With limited research on this important aspect of health system in Iraqi Kurdistan, this pilot study examined the referral characteristics of a sample of patients attending the secondary care units at Erbil Teaching Hospital in Erbil, Iraq. A cross sectional study on 193 patients visiting the secondary care units in Erbil Teaching Hospital was conducted. A specially designed questionnaire was administered to these patients by direct interview. Data were collected on the socio-demographic characteristics of the patient and referral characteristics including the type, source and reasons for referral. The study showed that the self-referral rate at this secondary care setting was 25.4% with 30.6% of the actual referrals being of self-requested type. The source of referral was mainly from emergency hospital [43.1%] followed by physicians' private clinics [30.6%] and primary health care centers [26.4%]. Self-referral was significantly more common among females [32.3%] and never married [31.55] than males [18.6%] and singles [14.3%], respectively. Self-requested referral was significantly higher among those who had history of previous visits to this particular hospital [40.0% vs. 21.6%]. A relatively high proportion of patients seen in this secondary care setting were not referred. Even among those referred a relatively high proportion had asked for this referral. This results in inefficient use of physician's time and other resources on problems that can be managed at the lower level. A more comprehensive epidemiological study is recommended to look at different aspects of the referral system and understand its main shortcomings and needs for improvement

Prevalence of silent stroke in Kurdistan, Iraq

To measure the prevalence of silent strokes in the Iraqi Kurdish population, and to identify silent stroke risk factors. This cross-sectional study was carried out in Rizgary Teaching Hospital, Erbil, Iraq from January to June 2009. A sample of 200 patients attending the outpatient clinic was taken. The results of CT and MRI were analyzed, and the proportion of silent infarcts was measured. Patients were interviewed for presence of hypertension, diabetes, ischemic heart disease, alcohol drinking, and smoking. Body mass index and serum lipid levels were calculated. Out of 200 subjects, 19% showed silent infarct[s]. Logistic regression analysis showed significant association between hypertension and old age with presence of silent infarcts. The age of affected individuals was significantly higher than the age of the non-affected individuals. The percentage of silent infarcts among apparently normal individuals in the Kurdish population is around 19%, and physicians must always keep this diagnosis in mind, especially among hypertensive and older aged patients

Epidemiology of burn injury in Erbil government: a hospital based study

The aim of this study was to find out the burden of burn injury and identify the high risk groups in Erbil city which could help in implementing effective preventive measures. The case records of patients with burn injury admitted to the Emergency Management Center in Erbil city from January 1st 2006 to December 31st 2007 were reviewed. Data on age and sex of patients, extent and aetiology of burn injury, and monthly and seasonal variations of injury were extracted from the case records. Out of 1920 burn patients admitted to the hospital; 452 died with an overall mortality rate of 23.54%; 70 [15.49%] were children and 382 [84.51%] were adults. The mortality rate was significantly higher among adults than children, 35.30% and 8.35%, respectively [p<0.001] and among females than males, 34.38% and 9.63% respectively [p<0.001], giving a male: female ratio of 0.22:1. The highest mortality rate was among adult females [47.88%] particularly the 15-29 years age group [53.07%]. The trend of injury and mortality showed fluctuation with increasing frequencies during the summer months. Flame injury was the main aetiology of burn [94.47%], which was significantly more common than scald injury among adults compared to children and among females compared to males. The study reports a high rate of mortality from burn injury with very high total body surface area [TBSA] burned especially among young adult females, and identifies the significance of burn injury as a public health problem and a social concern

Pattern of migraine headache in a group of Kurdish Iraqi patients

To study the pattern of migraine, and to show the effect of age and duration of illness on the evolution of migraine symptoms. A review of 200 migraine cases [attending the outpatient neurology clinic at Rezgary Teaching Hospital, and Kurdistan Private Neurology Clinic] was carried out during the period between October 2007 to May 2008. Case definition of migraine was according to the International Headache Society [IHS] criteria. The majority [77%] of the studied sample was female. The mean age [ +/- SD] at onset was 22.33 +/- 9.52 years. The most common type of migraine observed was migraine without aura [72%]. Different symptoms like phonophobia [92%], nausea [86.5%], photophobia [84%], vertigo [78%], scalp tenderness [75%], attacks of facial pallor [64%], sweating [57%], vomiting [50%], pain in the arms [39%], and pain in the chest [6%] was studied in relation to age at presentation and duration of illness in years. No significant association was found between the duration of illness and age at presentation and evolution of migraine symptoms. No significant association was found between the duration of illness and frequency of the attacks. Many migraine symptoms remain the same in each attack no matter the duration of illness and age at presentation, except for bouts of vomiting, which may be less common in younger patients

Anthropometric measurements of a group of newborns in a teaching hospital in Baghdad

To show the normal standards of trunk and limbs anthropometric measurements in a group of normal full term newborns in Al-Kadhimiya Hospital, Baghdad, and to use the above mentioned standards [as a reference] in the evaluation of newborns, mainly those with dysmorphic features. A cross-sectional study was carried out in the Obstetric Department, Al-Kadhimiya Teaching Hospital, Baghdad, Iraq, involving 300 full term newborns [within the first 24 hours of birth] delivered in the delivery room, from January 1, 2002 through December 31, 2004. Ten anthropometric measurements were studied. The mean weight [ +/- SD] was 3.5 +/- 0.46 Kg, with a median of 3.6 Kg, ranging from 2-4.75 Kg. The mean length [ +/- SD] was 48.45 +/- 2.17 cm, with median of 49 cm, ranging from 33-54 cm. Results showed that the mean head circumference [ +/- SD] was 35 +/- 1.47 cm, ranging from 31.5-38.5 cm. Very trivial [if any] differences were found between males and females. The mean weight for age Z score [ +/- SD] was 0.6063 +/- 1.0737, with a median of 0.67. The mean height for age Z score [ +/- SD] was -0.8144 +/- 0.983, with a median of -0.7. This preliminary survey showed that almost all measurements in our newborns were less than the previously published data in other populations. For the time being, these measurements can be used as a rough guide to detect some congenital anomalies

Determinants of intrauterine device discontinuation among women attending some family planning clinics in Baghdad

Discontinuation rates for the intrauterine devices [IUDs] vary in different parts of the world. To explore current usage of IUDs in relation to their effective life, and to identify determinants for IUD discontinuation. A cross-sectional study was carried out during the first half of the year 2001. A sample of 203 women attending three main family planning clinics in Baghdad [for the purpose of IUD removal] was considered. The mean duration of the current IUD usage was 2.7 +/- 1.8 years. More than one quarter [26.6%] of women retain their IUD for one year or less. The main causes for IUD removal as stated by women were desire for pregnancy [46.4%], husband's wish [19.6%], increased menstrual bleeding [11.8%], and fear from complications [7.8%]. More than one third [35.5%] of women had no acceptable cause for device removal according to doctors' opinion in the family planning clinics. A comparison was made between women with early discontinuation [

Patterns of management of acute respiratory infections among under-five children at primary health care centers in three provinces in Iraq

Acute respiratory infections [ARIs] are major causes for morbidity and mortality among under five children particularly in developing countries. Assessing patterns of management of ARIs among under five children at primary health care [PHC] centers as practiced by medical and paramedical health care providers. A total of 172 medical and 53 paramedical personnel working in PHC centers in three Iraqi governorates were observed using a pre-coded, pre-tested checklist. Recognition of both serious signs and symptoms and other signs and symptoms of ARI were significantly higher among medical than paramedical personnel [P<0.05]. Antibiotics were prescribed for 74.5% of patients by paramedical personnel compared with 54.1% of patients by medical personnel [P<0.05]. Trained health care providers [medical and paramedical] were significantly more capable in identifying danger signs and symptoms of ARIs compared with the untrained care providers. Medical and trained health care providers were managing ARIs conditions among under five children more efficiently than para-medical and non-trained care providers