RESUMO
BACKGROUND: The Syrian crisis has put tremendous strain on the Lebanese health system, particularly in the historically underserved border region. The ICRC Primary Health Care program has focused on refugee and host communities in these areas. This study objectives were: 1) to determine whether the ICRC program was reaching the most vulnerable populations; 2) to understand the key perceived health needs in the catchment areas of the ICRC supported facilities; and 3) to identify barriers to utilization of health care services. METHODS: Between July and September 2017 we conducted two cross-sectional studies - one randomized household survey and one clinic-based - in the catchment areas of three ICRC-supported facilities, targeting women of reproductive age and caretakers of children under five. Differences between groups were analysed with t-test or chi-squared test. RESULTS: In the household survey, similar socio-demographic profiles were observed between Syrian refugee women and vulnerable Lebanese hosts. With regard to the study objectives:The most vulnerable populations were those seen in the ICRC-supported facilities.For both populations, the most common reasons for seeking care were non-communicable diseases (40.6%) and sexual and reproductive health issues (28.6%). Yet the people reaching the ICRC supported facilities were more likely to seek care for communicable diseases affecting their children (37.8%), rather than for the most common reasons expressed in the household survey.In the catchment areas, reported gaps included low immunization coverage and low levels of antenatal care and family planning both for Syrian and Lebanese. Dental care also emerged as an issue. Out of pocket expenditures was reported as a critical barrier for utilization of primary health care services for both populations, while the most important barrier for utilization of ICRC-supported services was lack of awareness. CONCLUSIONS: Despite the ICRC reaching the most vulnerable Syrian and Lebanese communities, the population-based survey revealed that important gaps exist in terms of utilization of health care services among women of reproductive age and their children. A stronger outreach component is needed to address lack of awareness. Innovative solutions are also needed to address cost barriers at the levels of both facility and individual user.
RESUMO
Spontaneous unilateral postpartum carotid arterial dissection is a rarely reported event. This is the first reported case of bilateral carotid artery dissection. A 35-year-old gravida 4, para 3 woman presented to our emergency department with complaint of headache for 3 days. Medical history included delivery of a full-term infant by cesarean section 9 days before presentation because of arrest of descent after 3 hours of pushing. Symptoms were later attributed to a parietal lobe cerebral vascular accident and bilateral internal carotid artery dissection. Physicians should consider the possibility of arterial dissection in any postpartum patient with unremitting headache when evaluation of typical causes fails to lead to a diagnosis. Appropriate diagnostic evaluation and treatment should be actively pursued in this population.
