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OBJECTIVES: Since the uprising in 2011, there have been limited health-care data from inside Syria regarding women's health. This study aimed to provide an updated account of women's health, including pregnancy, perinatal care, childbirth, and other conditions to identify obstacles and challenges to health-care delivery in Northwestern Syria. METHODS: This is a prospective data registry study, using a medical electronic records system that builds on the International Classification of Diseases, Tenth Revision (ICD-10) codes. We collected data from one medical center in Northwestern Syria during 2017. We conducted a survey to understand patients' knowledge of and barriers limiting antenatal care (ANC). RESULTS: We studied 7213 patients' health status and surveyed 134 regarding ANC. Prenatal care, delivery, and miscarriage treatment represented the most common (70%) reasons for women's health-care visits, followed by menstrual disorders (17%). From 2057 delivery records, 70% delivered vaginally and 30% required cesarean delivery. Our findings showed that 1169 (24%) of the pregnant women (4936) in 2017 were adolescents, of them 22 (0.44%) were 14 years old. Regarding ANC visits, 85% of respondents did not have a single ANC visit in the first trimester, 82% had no visits in the second trimester, and 44% had no visits in the third trimester. Thirty-one percent had no ANC visit throughout the entire pregnancy. Only 13% had postnatal care (PNC) visits. Women who live in the refugee camp are 2.7 times less likely to meet the World Health Organization (WHO) criteria for focused ANC (FANC = 4 visits) compared to those who reside in town (P < 0.001), with only 14% having met the FANC. The major barrier to ANC is related to transportation (34%), followed by factors related to the study center (29%) and knowledge and education (19%). We estimated the number of obstetrics-gynecology doctors per 1000 populations to be 0.02. CONCLUSIONS: We found a huge deficiency in ANC and PNC visits, a high adolescent birth rate, and a higher cesarean-to-vaginal delivery ratio than what is recommended by the WHO. We also found a severe shortage in the number of obstetrician-gynecologists serving this population.
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INTRODUCTION: The Hospital Anxiety and Depression Scale (HADS) is widely used to predict and diagnose hospital anxiety and depression. It has been translated and validated in many languages, but the existing Arabic version was not validated in hospitalized patients. The aim was to translate, culturally adapt, and validate the HADS Questionnaire into Arabic language for in-patient use, especially for surgical wards. METHODS: A systematic translation process was used to translate the original English HADS into Arabic. After the pilot study, we validated our version in surgical patients at two tertiary care centers. We tested the reliability of our version using internal consistency. We examined the validity by assessing construct validity, concurrent validity (by testing the associations between HADS, Generalized Anxiety Disorder 7-item scale [GAD-7], and Major Depression Inventory [MDI]), and face validity. The questionnaire was administered before and after surgery to examine responsiveness. RESULTS: A total of 110 patients (22 men, 88 women) were included in the study. Cronbach's αs for the HADS anxiety subscale were 0.83 (95% confidence interval: 0.79- 0.88) and for the HADS depression subscale were 0.77 (0.7-0.83). Nearly 36% of the patients reported symptoms indicative of borderline or case anxiety before surgery, which decreased to 25% 1 week after surgery. HADS anxiety score was strongly correlated with GAD-7, and HADS depression score was strongly associated with MDI. Patients with higher American Society of Anesthesiologists Physical Status and those who remained hospitalized for more than 5 days were more likely to report depression symptoms. Most patients found the HADS questions to be clear and easy to understand, and thought the questionnaire items covered all their problem areas regarding their hospital anxiety and depression. CONCLUSIONS: Our Arabic version of HADS is a reliable and valid tool to assess the mood states in hospitalized patients.
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INTRODUCTION: The pain catastrophizing scale (PCS) is the most widely used tool to assess pain catastrophizing. The aim of this study was to translate, culturally adapt, and validate the PCS questionnaire in Arabic. METHODS: A systematic translation process was used to translate the original English PCS into Arabic. After the pilot study, we validated our version among patients with chronic pain at two tertiary care centers. We tested the reliability of our version using internal consistency and test-retest reliability. We examined the validity by assessing construct validity, concurrent validity (by investigating the associations with Brief Pain Inventory [BPI]), and face validity. RESULTS: A total of 113 subjects (50 men, 63 women) were included in the study. Cronbach's α was 0.94 (95% confidence interval [CI]: 0.92-0.96), and interclass correlation coefficients was 0.83 (95% CI: 0.77-0.89) for the total scale. There was no statistically significant difference in the total PCS scores between patients who reported experiencing current pain and those who did not. Among patients who reported having current pain, pain severity was weakly associated with the total PCS scores (r = 0.22, P = 0.03). PCS and its subscales were not statistically significantly associated with any of the BPI items. Nonetheless, patients who were diagnosed with neuropathic pain had statistically significantly higher scores on the total PCS, rumination, and helplessness subscales. Most patients found the PCS questions to be clear and easy to understand, and thought the questionnaire items covered all their problem areas regarding their pain catastrophizing. CONCLUSION: Our translated version of PCS is reliable and valid for use among Arabic-speaking patients.
