Distribution of doctors' workforce in Erbil governorate

Background and objective: Imbalance in the distribution of health workforce might result in inequities in health services delivery. The aim of this study was to assess the distribution of doctors' workforce in Erbil governorate and identify the possible reasons for rapid turnover of doctors

Methods: This descriptive cross-sectional study included all the 962 doctors working in the health facilities of Erbil governorate. A questionnaire was used to collect data that included 40 questions divided into four broad sections of identification information, socio-demographic characteristics, information on professional characteristics and factors influencing employment process in rural areas

Results: There were 5.1 doctors per 10,000 populations. Most of the doctors were deployed in urban areas [83.6%]. Most doctors were working in hospitals [74.2%] and 23.3% in primary health centers. Specialists constituted the largest categories of doctors [33.5%] and general practitioners the smallest [6.7%]. Doctors' willingness to stay at the current workplace was significantly associated with being married, having opportunities to select workplace, working in private clinics and having the workplace inside Erbil

Conclusion: The density of doctors per 10,000 populations in Erbil governorate is below the regional and international average, with a remarkable urban-rural imbalance in numerical, geographical and institutional terms

Risky driving behaviours among medical students in Erbil, Iraq

This study aimed to assess risky driving behaviours among medical students in Erbil, Iraq, and to explore the relationship between risky driving behaviours and perceptions of risky driving. This self-administered questionnaire-based survey was conducted from January to May 2014 among a random sample of 400 medical students at Hawler Medical University in Erbil. The questionnaire was designed to assess the frequency of engagement in 21 risky driving behaviours, the perceived risk of each behaviour and the preference for each behaviour as ranked on a 5-point scale. A total of 386 students responded to the survey [response rate: 96.5%]. Of these, 211 reported that they currently drove a vehicle [54.7%]. Drivers most frequently engaged in the following behaviours: playing loud music [35.9%], speeding [30.4%], allowing front seat passengers to not wear seat belts [27.9%] and using mobile phones [27.7%]. Least frequent driving behaviours included not stopping at a red light [3.9%], driving while sleepy [4.4%], driving after a mild to moderate intake of alcohol [4.5%] and drunk driving [6.4%]. Mean risky driving behaviour scores were significantly higher among males [P <0.001] and those who owned a car [P = 0.002]. The mean risk perception score was higher among >20-year-olds [P = 0.028]. There was a significant positive relationship between the preference for risky behaviours and risky driving behaviours [beta = 0.44; P <0.001]. Medical students in Erbil reported high frequencies of several serious risky driving behaviours. The preference for risky behaviours was found to be an important predictor of risky driving behaviours among medical students in Erbil

Distribution of chronotypes among a sample of Iraqi Kurdish medical students

The aim of this study was to assess the distribution of chronotypes in a sample of Iraqi Kurdish medical students. A descriptive cross-sectional study was conducted at the Hawler Medical University College of Medicine in Erbil City, Iraq, between 1[st] January and 31[st] March 2013. A total of 580 students were given the reduced version of the Horne and Ostberg Morningness-Eveningness Questionnaire [MEQr], a close-ended self-administered questionnaire. Of the 580 students, 130 [22.4%] were male and 450 [77.6%] were female. The mean age +/- standard deviation was 20.3 +/- 1.45 years, with a range of 17-24 years. Most of the students [52.6%] were in the intermediate class, followed by morning type [24.1%] and evening type [23.3%]. Significant gender differences were detected in the proportion of morning, intermediate and evening types [P <0.001]. The mean scores for the female students were 14.8 +/- 2.2 and the mean scores for the male students were 14.6 +/- 7.3, with no statistically significant differences [P = 0.45]. Students in the College of Medicine were mostly classified as intermediate types. The morning type was more common among this student population, particularly male students, than has been reported in similar age groups in some Western countries. There was a significant gender difference in the proportion of MEQr types

Association of certain sociodemographic and clinical characteristics of diabetic patients with quality of life

Diabetes mellitus is a common and demanding health problem that has a great effect on everyday life of patients. This study was done to determine sociodemographic and clinical characteristics that affect the quality of life [QOL] of diabetic patients. A total of 300 patients with diabetes mellitus in Erbil city were included in this study. The World Health Organization Quality of Life [WHOQOL-100] questionnaire was applied for assessment of 6 domains of QOL using multiple regression analysis. Type of work and body weight were the most significant factors shown to affect diabetic patients QOL domains. Type of work was significantly affecting physical [P=0.006], psychological [0.004], level of independence [P<0.001] environmental [P=0.007] and spiritual [P=0.009] QOL domains. Duration of diabetes was significantly affecting physical [P=0.002], psychological [P=0.037] and level of independence [P<0.001] domains. Body weight was significantly affecting physical [P=0.039], psychological [P=0.012], level of independence [P=0.036], social relationships [P=0.022] and spiritual [P=0.030] QOL domains. QOL had a variable significant association with certain sociodemographic and clinical characteristics of diabetics. There should be an emphasis on improving QOL of diabetics and consequently achieving better metabolic control

Mental health of Iraqi adolescents

To estimate the prevalence of flourishing and the association of mental health status with the socio-demographic characteristics and conduct problems of adolescents. A total of 8807 adolescents were included in this study. Data were obtained from knowledge, attitudes and practices household survey carried out in 2004. Each adolescent was interviewed by a trained team and a specially designed questionnaire was filled. Emotional, psychological and social well-beings were assessed through a series of measurements. Conduct problems were measured by self-reporting of school skipping, smoking, alcohol drinking, inhalant use and arrestment. The prevalence of flourishing, moderate mental health status and languishing were 5.6%, 20.3% and 74.1%, respectively. The prevalence rates of school skipping, smoking, and other conduct problems [alcohol drinking, inhalant use, and arrestment] were 60.1%, 62.8% and 59.2%, respectively. Mental health was significantly associated with age, educational level, and various conduct problems [p<0.001]. No significant sex variation was demonstrated. Flourishing was significantly decreasing with advancing age [p<0.0001] and it was significantly lower among smokers [p<0.0001], and those with other conduct problems [p<0.0001]. The low rate of flourishing among adolescents was associated with a high rate of conduct problems which could be a psychological response to the stressful condition prevailing in the country during the last 3 decades

Case fatality rate of first-ever stroke in erbil city

Stroke is the third most common cause of death. The objective of this study was to find out the case fatality rate of first-ever stroke in Erbil city. This cross-sectional study included 228 first-ever stroke patients hospitalized to teaching hospitals in Erbil city from January, 1[st] 2009 to August, 31st 2009. Stroke was diagnosed by the consultant internist or neurologist and confirmed by brain CT-scan. Patients were followed-up and one month case-fatality rate was calculated. The one month case-fatality rate was 23.7% with a higher proportion of deaths occurred in females [26.4%] than in males [21.2%] [P= 0.358]. The case-fatality increased with age [P= 0.019]; around 75% of deaths occurred in the 7[th] and 8th decades of life and more than 95% occurred among those 60 years and more. More deaths occurred from haemorrhagic [31.3%] than ischaemic [20.7%] strokes [P= 0.093]. The mean +/- SD ages of dead and alive were 68.56 +/- 11.52 and 61.32 +/- 12.91 years, respectively [P=0.001]. Multiple logistic regression revealed significant association of stroke outcome with age [P= 0.037] and atrial fibrillation [P=0.001]. The one month case-fatality rate was relatively comparable to that reported in other developing countries

Risk factors for stroke in erbil city: a case-control study

Stroke is a worldwide health problem. This study was carried out to find out the risk factors associated with stroke in Erbil city. A hospital based case-control study was carried out in Erbil city from January, 1[st] 2009 to June, 30[th] 2009. The sample included [173 cases and 173 controls] cases admitted to Erbil teaching hospitals with first-ever stroke diagnosed by the consultant internist or neurologists and confirmed by brain CT-scan. Sex and age-matched [ +/- 5 years] patients admitted to the same hospital, who do not have stroke, were taken as a control group. The mean +/- SD ages of cases and controls were 62.2 +/- 13.4 and 61.54 +/- 13.16 years, respectively with a male: female ratio of 1.1:1. Nearly 70% were ischaemic and 30% were haemorrhagic. A slightly more than half [51.45%] of strokes occurred in the 7[th] and 8[th] decades of life. Multiple logistic regression analysis revealed statistically significant association between smoking [P<0.001], exercise [P<0.001], hypertension [P=0.001], family history of stroke [P=0.004], BMI [P=0.012] and PCV% [P<0.001] with stroke. However multiple logistic regressions of risk factors for ischaemic and haemorrhagic strokes separately revealed that diabetes was significantly associated with ischaemic stroke [P=0.025] while body mass index was significantly associated with haemorrhagic stroke [P=0.001]. Majority of stroke patients were of older age. The most frequent risk factor among stroke cases were lack of exercise, overweight and obesity and hypertension

Prevalence of skin diseases among primary school children in Erbil city

Skin diseases constitute serious public health problems through the world, especially in children. The aim of the study was to determine the prevalence of skin diseases in primary school children in Erbil city, and its relation to various socio-demographic factors. A total of 6915 pupils aged 6-15 years were randomly selected from 32 primary schools using multistage random sampling technique. Data regarding general socio-demographic variables were collected from each student in a specially designed questionnaire. Children were clinically examined and the dermatological findings were recorded. The overall prevalence of skin diseases was 40.6%, Infectious dermatoses have the highest prevalence rate [15.27%], followed by eczematous skin diseases [13.13%]. The overall prevalence of skin diseases and infectious dermatoses were significantly higher among females, younger age groups and those of low socioeconomic status, while eczematous skin diseases were significantly higher among males. Skin conditions are common among school children, which may reflect prevailing low socio-economic conditions. Relevant health education programs and preventive measures should be implemented

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

Prevalence of hepatitis C virus antibodies among health care workers in Baghdad, Iraq

There are several reports on the occupational risk of hepatitis C virus infection of health care workers [HCWs] by accidental inoculation of infected blood. This study was carried out to determine the prevalence of anti-HCV among a sample of Iraqi HCWs. A total of 1656 HCWs selected from various hospitals and medical units in Baghdad, together with 238 "apparently" healthy subjects [controls] were tested for anti-HCV from June 1995 to April !998. Serum testing was carried out by a third generation of enzyme immunoassay [EIA] for screening for anti-HCV and a third generation recombinant immunoblot assay [RIA-111] for confirmation of the presence of HCV antibodies. A higher rate of anti-HCV [1.51%] was observed among HCWs than controls [0.84%]. The highest prevalence rate of anti-HCV was detected in the renal dialysis group [6.25%] followed by the dentistry group [4.26%]. These were the only groups having a statistically significant higher prevalence of anti-HCV than controls when each group was compared with controls. An increase in the prevalence of anti-HCV with duration of professional practice was demonstrated. The highest rate of anti-HCV was detected among HCWs in cardiovascular surgery hospitals [4.21%] followed by infectious disease hospitals [3.37%]. Efforts to reduce exposure to blood and other body fluids are needed to reduce the risk of the occupational transmission of HCV infection, as no vaccine against HCV infection is available yet

Brain abscess in Iraq during a 10 years period: part 1. epidemiology, aetiology and clinical picture

This study comprises two parts, [this part deals with epidemiology, aetiology and clinical features of brain abscess during a 10 years period, while the second will deal with diagnostic investigation, management and final outcome of brain abscess. The case records of patients with brain abscess admitted to the neurosurgical specialties hospital in Baghdad over a 10 years period extending from 1[st] Jan. 1993 to 31[s] Dec. 2002, inclusive were reviewed. Data obtained included demographic and clinical data. A total of 78 cases [1.2% of total admission] of brain abscess were admitted. Their age ranged from one month to 68 years. The most common aetiological factor was cyanotic heart disease, with the congenital anomaly being unrepaired in all cases. Remote infection foci other than the heart represented minority. Half of the cases had a rapid onset and fluminant progression. The presenting features of the patients older than one year were raised intracranial pressure, and focal neurological deficit and infection. Maintaining a high index of clinical suspicions in patients having one of the infection sources together with neurological signs should be emphasized

Brain abscesses in Iraq during a 10 years period: Part 11. Diagnostic investigations, management -and outcome

This study comprises two parts, the first one dealt with epidemiology etiology and clinical picture of brain abscess. This part describes diagnostic investigation management and final outcome of brain abscess during a 10 years period. The case records of patients with brain abscess admitted to the neurosur, specialties hospital in Baghdad over a 10 years period extending from 1 "Jan. 1993 to 31 " Dec. 2002, inclusive were reviewed. Data obtained included demographic and clinical data. Results of peripheral leukocytes count, ESR and CSF were supportive in 16.7%, 67.9% 78% of cases in which tests were applied, respectively. CT scan was suggestive in 100% of cases. Use of antibiotic therapy as a preliminary treatment line was adopted in 37.8% cases, while surgery as a preliminary line of treatment was adopted in 62.3% of cases. Out 68 cases, complete resolution was encountered in 70.6% ol'cases, sequlae in 11.8% and death in 17.9%. Bad neurological 'status on admission was the most encountered contributing factor for death. Metastasis from a remote infection process is a risky aetiology contributing to bad prognosis. The use Of C I Scan represents all important change in the diagnostic regimen brain abscess in the last 10-15 years

HBV markers and antibody protective level among Iraqi vaccinated and unvaccinated subjects

Iraq is among countries of intermediate hepatitis B endemicity. Although several studies have been carried out on the prevalence of HBV markers, no previous study was done to determine the protective antibody level after HBV vaccination. Therefore, this study was carried out to detect HBV markers and antibody protective level among vaccinated and unvaccinated Iraqi subjects. A total of 400 subjects [298 thalassaemic patients and 102 [healthy] subjects] were included in the study for the period 1[st] Oct. 2002 to 28[th] Feb. 2003. Thalassaemic patients represent the vaccinated group, and the [healthy] subjects represent the unvaccinated control group. The same rate of HBsAg was detected in vaccinated and unvaccinated groups [2%]. Protective anti-HBs level was demonstrated in 229 [76.8%] and 25 [24.5%] of vaccinated and unvaccinated groups, respectively. The protective rate of protective level of anti-HBs among those who receive three primary doses of vaccine [77.7%] was significantly higher than among those who did not complete the course of vaccination. The rate of protective anti-HBs level among those who received the full course of vaccination is lower than that reported in literature. Improper vaccination or handling of the vaccine could also contribute to this low level as result of deterioration of health services during the last 2 decades

Low birth weight an Baghdad, Iraq

Many reports demonstrated an increase in low birth weight in the past three decades. This work was carried out to study the prevalence of low birth weight and its determinants among neonates delivered in Baghdad, Iraq. A total of 400 singleton newborns delivered at two hospitals in Baghdad city during 15[th] June to I5[th] Nov. 2003 were included in the study. Half of the neonates were born with low birth weight. Out of the low birth weight neonates, there were 83% preterm neonates. Prevalence of low birth weight neonates was significantly associated with maternal age, age at marriage, parity, and anaemia. This study indicates that the most appropriate approach for prevention low birth weight and prematurity in newborns is through improvement of nutritional status and health services

CMV infection among HIV/AIDS patients in Iraq

The aim of the study was to determine the prevalence of CMV infection among HIV/AIDS patients in relation to disease progression, and to study the mortality during the period of the study. The study included 155 HIV/AIDS patients [148 HIV- infected and seven AIDS patients] and 122 apparently "healthy" controls. CMV [IgG and IgM] antibodies "were determined by ELISA. The patients were followed up for a period of nine months, and retested frequently for development of active CMV infection. The prevalence of CMV [IgG] antibodies in the HIV/AIDS patients was 100%. A significant higher prevalence of CMV [IgM] among AIDS patients [42.9%] than among HIV infected patients [0.0%] and "healthy" controls [0.8%]. No deaths were reported among asymptomatic HIV infected patients while the mortality among AIDS patients was [42.9%]. Only one patient [7.7%] out of 13 asymptomatic HIV infected developed active CMV infection 10 years later by testing for CMV [IgM] in 1991 and 2001. Demonstration of active CMV is of prognostic value in detection of development of AIDS and survival of patients

Prevalence of asymptomatic urinary tract infection among preschool female children in Babel governorate, Iraq

Urinary tract infections represent a major health problem in many parts of the world. The purpose of this report is to find out the prevalence of bacterial urinary tract infection in a sample of asymptomatic preschool female children and to identify the infecting organisms among them. Mid-stream specimens of urine were collected from 600 female children selected from various districts of Babel governorate. Bacterial cultures were performed on blood agar and MacConkey agar plates. Diagnosis of bacteriuria was made by bacterial count. A bacterial colony count of >/= 10[5]/ml of urine was considered as evidence of significant bacteriuria. The prevalence rate of significant bacteriuria among the 600 female children was 13.3%. Age variations of the prevalence of significant bacteriuria were of statistical significance. Prevalence of bacterium was significantly associated with the place of residence, educational level of mother, availability of a municipal piped water supply, birth weight, and prematurity of the child. The most frequently encountered bacterium was Escherichia coli which accounted for 75% of isolates. Asymptomatic urinary tract infection needs to be considered in young female children with underlying voiding anomalies. They should be referred appropriately for further evaluation and treatment

Hydatid disease in western region of Iraq: a review of the case records of Saddam general hospital in Ramadi

The surgical records of all patients admitted to Saddam General Hospital In Ramadi were reviewed for the five-year period 1987 through 1991 and 173 cases of surgically proved hydatid disease were identified, with a proportional rate of 10.2 cases per 1000 surgical admissions, Patients were admitted from allover Al-Anbar governorate. The annual case rate for the governorate for the study period was 4.9 per 100.000 population. Patients age ranged between 20 and 49 years in more than 60% of the cases, with a peak incidence at 20-29 year age group. There was a predominance of female to male patients with a male female ratio of 0.2:1; the females being mostly housewives, The liver was involved in 74% of cases of hydatid disease, the lung being the next. The public health importance of the disease and the need for further studies are discussed

preliminary study on bacteriuria in pregnant women in Baghdad

The prevalence rate of significant bacteriuria [colony count

Comparative evaluation of three methods of diagnosis of schistosoma haematobium infection

A total of 100 urine samples were examined for S. haematobium infection by filtration, centrifugation and sedimentation methods. A significantly higher proportion of S. haematobium-ova was detected by filtration method [34%] than by centrifugation [24%] and sedimentation [19%] methods, and a higher intensity of infection was detected by filtration method as well. All patients with heavy infection [>/= 50 eggs/10 ml urine] detected by filtration technique were also positive by the other methods, while only 50% and 25% of those with light infection[< 50 eggs/10 ml urine] were positive by centrifugation and sedimentation methods respectively