The nature of inappropriate referrals to wellness services in primary care setting in Qatar: Outcome of multifaced interventions on rate and quality of referrals.

Objectives: The objectives of this study were to explore the rate and types of inappropriate referrals to the wellness services and to assess the impact of multi-level interventions on the rate of inappropriate referrals at Rawdat Al-Khail health center in Qatar. Methods: This study employed a retrospective analysis of all referrals data to Rawdat Al-Khail wellness services extracted from the Electronic Health Records (EHRs) between July 2022 and August 2023. The monthly rates and types of inappropriate referrals were calculated. In this study, pre-post analyses were performed to evaluate the impact of two sets of interventions on reducing inappropriate referral rates. The first set involved the development and distribution of e-referral pathways training manual in September 2022. The second set, implemented in April 2023, included close monitoring the rate and types of referrals, and the initiation of feedback communication between wellness services supervisors and referring physicians for advice and corrective actions. Results: A total of 966 referrals were received during the study period, with 1:5 male-to-female ratio. Of all referrals, 34.9 % were classified as inappropriate, exhibiting considerable variations among different referring health centers. The most common reason for inappropriate referrals was due to the lack of "exercise wellness gym assessment form" (23.8 %). While interventions aimed at enhancing the referral process, they did not result in a significant overall reduction in inappropriate referral rates. However, there was a noteworthy reduction in the inappropriate referrals caused by the lack of "exercise wellness gym assessment form" observed from March to August 2023 (41 %-18 %). Conclusion: This study sheds light on the complexities of wellness services referrals, revealing a high rate of inappropriate referrals that require closer scrutiny. Despite interventions not significantly reducing the rate of these referrals, it emphasizes the need for ongoing improvement strategies. Structured, periodic interventions at higher levels are recommended to enhance referral appropriateness.

Prevalence of Obesity and Lifestyle Risk Factors Following Two Years' COVID-19 Related Service Closure at Wellness Center, Primary Health Care.

Background: COVID-19 lockdown has affected health behaviors and daily life in unprecedented ways. This study aimed to assess (i) the prevalence of lifestyle behaviors including physical activity, sedentary behavior, sleep, and stress levels during the COVID confinement, and (ii) evaluate anthropometric measures, body composition, cardiopulmonary and muscular endurance among regular Wellness Center attendees, following two years' service closure. Methods: A cross-sectional study was undertaken between 1st June 2022 and 30th January 2023. A structured validated questionnaire was utilized to retrospectively collect data related to the closure period, and quantitative objective measurements were obtained at the time of data collection. Results: A total of 100 adults with a mean age of 49.6 ± 10.5 years, mostly female (80%) and Qatari (76%) participated in the study. The results revealed high rates of low physical activity (47%), sedentary behavior (62%), poor sleep (58%), and stress levels (61% moderate and 5% high). Results also confirmed high prevalence of obesity (57%) marked by BMI and body circumferences, fat mass (34 ± 10.5 kg)/fat percentage (42.7 ± 7.2%) and muscle mass (20.6 ± 5.4 kg)/muscle percentage (25.4 ± 3.9%) above and below normal levels, respectively. The average cardiopulmonary (mean VO2 MAX was 15.5 ± 11 mL O2kg-1min-1) and muscular endurance (pushups per min 19 ± 8.9, L-sit 46 ± 35 secs, plank 42.7 ± 27.8 secs) were distinctly below normal levels for age and sex. Conclusion: The findings indicate that physically active adults have experienced adverse lifestyle behaviors during the COVID-19 lockdown. Obesity, unfavorable body composition, low cardiopulmonary and muscular endurance were evident. More emphasis should be put on the development of targeted intervention strategies to promote positive lifestyle behaviors during any potential future crises.

Prevalence and predictors of smoking cessation among smokers receiving smoking cessation intervention in primary care in Qatar: a 6-month follow-up study.

Objective: To estimate the rate and predictors of smoking cessation in smokers attending smoking cessation clinics in primary care settings in Qatar. Methods: A cross-sectional study was conducted among 759 smokers who had attended any of the 10 smoking cessation clinics in primary health care centers from January 2019 to June 2020. The sociodemographic, clinical, and smoking-related variables were assessed. Tailored behavioral and pharmacotherapy were delivered, and patients were interviewed at 6 months to estimate the 30-day point prevalence abstinence. To identify independent factors associated with smoking cessation, a multivariable logistic regression analysis was performed. Results: The mean age of participants was 40.6 (±11.3), majority being married, Arab and employed, and having a tertiary education. Almost half of the smokers (48.7%) received varenicline alone, 42.6% received NRT, and 31.8% received a combination of both. The selection of drug therapy was based on preferences, experiences, and history of previously encountered adverse effects. The overall 30-day quit rate at 6 months follow-up was 32.4%. About three-quarters (72.5%) of participants had at least one quit attempt and 12.5% had 3 or more attempts. Later age at smoking initiation, lower cigarette consumption at baseline, lower CO concentration at baseline, use of smoking cessation pharmacotherapy, having made fewer quit attempts and non-exposure to secondhand smoke among friends were identified as significant predictors of successful quitting at 6 months. Conclusion: The 30-day quit rate at 6 months follow-up (32.4%) is comparable to the worldwide figure. However, further efforts should be made to plan cost-effective tobacco dependence treatment taking into account predictors and at-risk groups.

The Impact of Training on Electronic Health Records Related Knowledge, Practical Competencies, and Staff Satisfaction: A Pre-Post Intervention Study Among Wellness Center Providers in a Primary Health-Care Facility.

Background: The transition to electronic health records (EHR) has improved the quality of health-care delivery and patient safety. However, poor usability and incongruent workflow may impose a significant burden on documentation and time management, resulting in staff burnout. We aimed to (i) evaluate the effectiveness of personalized EHR training on wellness providers' knowledge and practical competencies, and (ii) assess staff satisfaction regarding the EHR usage post-training. Methodology: An interventional study was conducted between July 15, 2021, and March 1, 2022, among 14 wellness staff (age: 38 ± 3.9 years; 7 males, 7 females) in the Wellness Center-Rawdat Al-Khail Health Center. Six months of blended training was delivered. The impact of training was assessed using a pre-post survey on the knowledge and practical competencies related to EHR usage. Staff satisfaction was assessed post-training. Results: Majority of respondents had improvement in identifying the advantages of EHR: improve confidentiality of care (pre = 35.7% vs post = 100%, p = 0.001), reduce medical errors (pre = 35.7% vs post = 85.7%, p = 0.02), improve quality of health care (pre = 35.7% vs post = 100%, p = 0.001), and reduce wait time (pre = 42.9% vs post = 85.7%, p = 0.03). Time performing these tasks by massage therapists/receptionists was reduced: viewing/editing ambulatory organizer (pre = 20±0 s vs post = 10±0 s), access PM office (pre = 155±136 s vs post = 10±0 s), selection/access patient chart (pre = 75±30 s vs post = 30±20 s), check-in/out (pre = 120±0 s vs post = 60±0 s), and view/edit massage form (pre = 135±75.5 s vs post = 60±0 s). For gym instructors, time to access ambulatory organizer (pre = 30±0 s vs post = 10±0 s), view/edit the gym form (pre = 101±57 s vs post = 71±36 s), view patients' clinical data (pre = 60±70 s vs post = 10±3 s), and place referral orders (pre = 197±144 vs post = 82±23 s) was reduced. A mean percentage score of 65.4±38.7 indicated very good staff satisfaction. Conclusion: This tailored, hands-on training has been well received and effectively improved wellness staff knowledge, competencies, and satisfaction relative to EHR functionalities.

Global Implications of COVID-19 Pandemic on Adults' Lifestyle Behavior: The Invisible Pandemic of Noncommunicable Disease.

COVID-19 pandemic, with its subsequent lockdown and mobility restriction is a public health emergency that has obliged substantial modifications in daily routines and lifestyle of people worldwide. The drastic measures of social isolation and home confinement has impacted to a great extent the physical and psychological health. The resultant abrupt in lifestyle-related behavior such as physical inactivity, unhealthy dietary habit, sleep disturbance, stress, tobacco use, and alcohol intake, is directly linked to the rising global burden of non-communicable disease. This review aims at gaining a rich and extensive understanding of the potential negative impact triggered by COVID-19 on lifestyle-related behaviors that will influence long-term physical and mental wellbeing. Electronic database search was conducted on PubMed, ScienceDirect, Google Scholar, and Scopus from January 1, 2020 to March 15, 2021. Data related to COVID-19 impact on lifestyle habits were extracted from these studies. Articles were included if meeting the inclusion criteria (i.e., assessed the impact of COVID-19 on physical inactivity and sedentary behavior, dietary habits, sleep, mental health, vitamin D, and substance use among adults. Further search was conducted to address these behavioral changes among athletes. While physical isolation is a necessary public health measure to protect the population, outcomes of this review indicate that in light of adverse lifestyle changes brought by the pandemic, noncommunicable disease remains a critical concern. Hence, adopting healthy lifestyle behavior is essentially important especially during the current time to boost immunity and reduce the risk of COVID-19 infection. Recognizing the pandemic collateral effects offers a forward-looking perspective to guide the government and health authorities in planning prevention and control programs that focus on resilient and sustainable behavioral change.

FIFA World Cup 2022: What can we learn from the inspiring Tokyo 2020 Olympic Games held in COVID-19 times?

Preparation for the FIFA World Cup 2022 (WC2022) comes in the time of the COVID-19 pandemic. This study aims were to (i) provide a brief overview of the 2020 Tokyo Olympic and Paralympic games in the context of the COVID-19 pandemic, and (ii) highlight the potential challenges and opportunities central to the hosting of the FIFA WC2022. The organisation, public health policies and prevention protocols of the postponed 2020 Olympic/Paralympic Games (Tokyo July-August 2021), the infection rates during the event, as well as the upcoming WC2022 and its related preparations and challenges, were analysed. An unparalleled International Olympic Committee (IOC) effort, together with the Japanese government and people's perseverance and drive, enabled the safe delivery of the Tokyo Olympic/Paralympic Games, which left a legacy beyond sport. This has been aided by the collection of critical data and lessons learnt throughout the games. The stringent public health policies and especially the tight bubble system for players and their respective delegations have certainly been the key components that ensured the successful containment of COVID-19 within the targeted population. One of the most significant lessons learned from the Tokyo 2020 Olympics is the improvement made in controlling COVID-19 in the context of mass gathering events. Strict infection control strategies to prevent future COVID-19 transmission during the FIFA World Cup 2022 are an immediate priority in Qatar and are constantly being prepared. The planned measures and health care strategies appear to be well adjusted to the risk, especially for the large anticipated number of visitors, and can provide sufficient guarantees to conduct relatively "safe" mega sports events.

Effects of eight weeks of mat pilates training on selected hematological parameters and plasma volume variations in healthy active women.

AIM: To evaluate the effects of eight weeks of mat Pilates training on selected hematological parameters, i.e. white blood cell, neutrophils, monocyte, lymphocyte, hematocrit, hemoglobin as well as plasma volume variations in healthy, active women. METHODS: Twenty-eight women physical education students volunteered to participate in the present investigation. They were assigned to two groups: a Pilates training group (n = 14) that followed an 8-week Pilates training program, and a control group (n = 14). Blood samples were collected at rest at two separate occasions before and after Pilates training. RESULTS: The Pilates training group had higher values of plasma volume variations and lower values of white blood cell (19.4%), neutrophils (32%), hematocrit (4.3%) and hemoglobin (4.6%) compared to control group (p<0.05). CONCLUSION: The results of the present study suggested that Pilates training could be an effective strategy for increasing plasma volume variations and boosting immune system in healthy active women.

A Narrative Review on Prevention and Early Intervention of Challenging Behaviors in Children with a Special Emphasis on COVID-19 Times.

Background: COVID-19 and the measures stemming from efforts to control it have affected the psychosocial wellbeing of children and adolescents. The increasing trend of challenging behavior has exerted further pressure on parents and schools. Understanding socioemotional development and interrelating triggers is the key to management. Early interventions prevent the future threat of mental illness and risky acts. Effective strategies are ones that primarily focus on strengthening parent-child interactions. Aim: The purpose of this paper is to review the literature on the (i) psychosocial and behavioral impacts of COVID-19 on children/adolescents and (ii) approaches to identify determinants of challenging behaviors as a principal guide to effective interventional strategies for children and their families. Methodology: Electronic database searches of PubMed, ScienceDirect, Medline, and Scopus were conducted to identify studies meeting the inclusion criteria that address the impact of COVID-19 on behaviors, contributing factors, and management in the context of families/schools. The content of the selected articles was themed under five categories, namely the developmental milestones, the Pyramid Model, the Positive Behavioral Support, the management strategies, and the impact of COVID-19 on children/adolescents' behavior. Results: The present review demonstrates considerable influence of COVID-19 on children and adolescents' behavior and mental wellbeing. It stresses the importance of early family-based interventions focusing on the triggers of challenging behavior. Functional Behavioral Assessment and Behavioral Intervention Plan provide a systematic analysis with a strategic plan that support children's self-regulation and socioemotional intelligence. Regular behavioral screening is vital to promote prevention and early management. Conclusion: Managing behavioral difficulties remains an area of deficit for parents, teachers, and health care providers. With a quality support, parents and schools will be able to clearly characterize the challenging behavior, understand the causes, reinforce parent-child interactions, and consequently, gain the strategic skills required to apply it within natural settings. Timely interventions will limit the risk of future misconduct and mental disorders.

COVID-19 and screen-based sedentary behaviour: Systematic review of digital screen time and metabolic syndrome in adolescents.

AIM: The COVID-19 pandemic has prompted governments around the globe to implement various restriction policies, including lockdown, social distancing, and school closures. Subsequently, there has been a surge in sedentary behaviour particularly screen time (ST) together with a significant decline in physical activity that was more marked amongst children and adolescents. Excessive screen exposure in adolescents has been correlated with cardio-metabolic risk factors including obesity, hypertension, high cholesterol, and glucose intolerance that may have adverse morbidity and mortality implications in adulthood. Thus, the current study aimed to synthesize the literature on the relationship between ST of various types and the risk of metabolic syndrome (MetS) in adolescents in the context of the COVID-19 pandemic. METHODS: In August 2021, a systematic search of the literature was undertaken using electronic databases: PubMed, PsycINFO, and the Cochran library. Studies were considered if they met the following key eligibility criteria: (i) Measure of ST as an exposure (TV, computer, videogames, internet, smartphone, tablet), using quantified duration/frequency either self-reported or observed; (ii) Measure of MetS as an outcome with standard definition and/or criteria required to establish MetS diagnosis. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the risk of bias. RESULTS: A total of ten studies met the inclusion criteria, and the majority were cross sectional studies. Most studies met fair bias scoring. Overall, the review revealed considerable evidence that suggests a significant negative association between ST and components of MetS among adolescents with dose-response association. CONCLUSION: During the pandemic, screen usage may become more prevalent through periods of school closures, lockdowns, social isolation, and online learning classes. Public health policies and health promotion strategies targeting parents are needed to raise awareness of the adverse health effects associated with screen-based sedentary behaviour as a precursor of NCDs. Parent or home focused interventions might be effective in limiting adolescents' screen exposure, alternatively substituted with an appropriate level of physical activity. PROSPERO REGISTRATION NUMBER: PROSPERO 2021 CRD42021272436.

Age and clinical signs as predictors of COVID-19 symptoms and cycle threshold value.

Many COVID-19 infected people remain asymptomatic, and hence the diagnosis at first presentation remains a challenge. Assessment at a presentation in primary care settings is usually done by visual triaging and basic clinical examination. This retrospective study involved investigating the medical e-records of COVID-19 positive patients who presented to a COVID-19 centre in Qatar for July 2020. The presence (symptomatic group) or the absence (asymptomatic group) of symptoms along with objective vital examination (ie; heart-rate (HR), temperature, haemoglobin saturation (SpO2)) were analysed and linked to the viral load (ie; cycle threshold (Ct)) of COVID-19 positive patients. Four hundred eighty-one symptomatic (230 males) and 216 asymptomatic (101 males) patients were included. Compared to the asymptomatic male group, the symptomatic male group was older, had lower Ct value and SpO2, and higher temperature and HR. Compared to the females asymptomatic group, the symptomatic females group had lower Ct value, and higher temperature. Compared to the asymptomatic group, the symptomatic group had lower Ct value and SpO2, and higher temperature and HR. Compared to the asymptomatic group, the symptomatic group had lower Ct values (age groups [21-30], [31-40], [41-50] and [51-60]), higher temperature (age groups [21-30] and [31-40], Ct ranges [20.01-25.00] and [25.01-30.00]), higher HR (age groups [21-30] and [31-40], Ct range [15.01-20.00]); and lower SpO2 (age groups [41-50] and [51-60], Ct ranges [15.01-20.00] and [35.01-40.00]). Compared with asymptomatic patients, symptomatic patients with COVID-19 are most likely to be febrile, tachycardic, hypoxic and having higher viral load. Higher viral load was associated with higher HR, higher temperature, lower SpO2, but there was no relation between viral load and age.

BNT162b2 COVID-19 Vaccine Hesitancy among Parents of 4023 Young Adolescents (12-15 Years) in Qatar.

Parental vaccine hesitancy (VH) remains a barrier to full population inoculation, hence herd immunity against the SARS-CoV-2 virus. We aimed to determine parental VH rate, subgroups and influencing factors related to the BNT162b2 COVID-19 vaccine among their young adolescents (12-15 years old) in Qatar. A retrospective, cross-sectional study was conducted from 17 May to 3 June using vaccination booking records of 4023 young adolescents. Sociodemographic characteristics (i.e., age, sex, and nationality), health status and BNT162b2 COVID-19 vaccination booking status were analysed. Among respondents, the VH rate was 17.9%. Parents of 12-years adolescents were more hesitant (21.6%) as compared to the 13- (16.0%) and 15- (15.2%) years groups (p < 0.05). Parents of adolescents belonging to Gulf Countries (97% Qatari) were more hesitant (35.2%) as compared to the four remaining groups of nationalities (Asiatic; excluding Gulf Countries), North-African, African (excluding North-African), and European/American/Oceanian, 13.3-20.4%, (p < 0.001). Parental VH rates were higher when adolescents suffered from chronic disease as compared to those without the chronic disease (21.3% vs. 17.4%, p < 0.05) or who previously were COVID-19 infected as compared to non-previously COVID-19 infected (24.1 vs. 17.5%, p < 0.01). Results of logistic regression revealed that age groups, nationalities, and recovery from COVID-19 were the main predictors of VH level. Precisely, parents of 12 years old adolescents were 38% more likely to be hesitant as compared to the parents of the 15 years old adolescents (OR = 1.38; 95%CI: 1.12-1.70). Compared with the Gulf countries, parents of adolescents belonging to the other nationality categories; namely North-African, African, Asiatic and European/American/Oceanian were 48% (95%CI: 0.36-0.65), 41% (95% CI: 0.27-0.62), 38% (95%CI: 0.29-0.50) and 34% (95% CI 0.21-0.56) less likely to be hesitant, respectively. Furthermore, parents of young adolescents being previously COVID-19 infected were 37% more likely to be hesitant as compared to those with no previous COVID-19 infection (OR = 1.37; 95%CI: 1.02-1.84). Effective communication strategies specifically targeting Gulf Country populations, parents of younger children aged 12 years and of those with chronic disease or have been previously infected with COVID-19 are crucial to build community trust and vaccine confidence, thereby increasing COVID-19 vaccine uptake.

Dietary Implications of Detoxified Jatrophacurcas Kernel for Clariasgariepinus Fingerlings.

Antinutritional components must be substantially reduced to ensure better utilization of unconventional feeds in animal nutrition. Among the different methods of processing, soaking represents a simple and inexpensive alternative. This study attempted to determine the nutritional properties of socked Jatropha curcas kernel (JCK) and the effect of its dietary inclusions on Clarias gariepinus (n = 50; mean initial weight = 6.19 ± 0.52 g). Three treatments of JCK (i.e., soaking 24, 48, and 72 h) were tested alongside a control group. The result showed that soaking substantially improved proximate composition and reduced anti-nutrient compared to the control JCK. A similar trend of improved performance was observed when the treated JCK was included in diets composed of 35% crude protein; a total of 315 kcal g-1 energy and fed to C. gariepinus for 56 days. Alongside the improvement observed in growth, it was also noted that carcass protein and haematological variables were improved with the dietary administration of soaked JCK. Histological examination of the intestine and liver tissues also revealed fewer signs of histopathological degeneration in the fish, consequent upon dietary inclusion of soaked JCK (i.e., 72 h) compared to those raised on the raw JCK-included diets. It was, therefore, concluded that soaking could be a much easier method of nutritionally improving JCK for the administration to C. gariepinus.

Dietary implications of toasted Jatropha curcas kernel on the growth, haematology, and organ histology of Clarias gariepinus fingerlings.

The nutritional value of Jatropha curcas kernel (JCK) can be improved through different processing methods; however, when using a thermal treatment, optimization of the process is needed to prevent denaturation of nutrients. In this study, JCK was toasted for varying durations (0, 10, 20, and 30 min) and nutritionally evaluated. The implication of feeding Clarias gariepinus with dietary inclusions (35% CP; 315 kcal g-1) of the toasted JCK was also reported. The results obtained suggest that prolonged duration of toasting improved the nutritional characteristics of the JCK until the 20th min. Beyond this time, the protein content and essential amino acids are reduced. However, the antinutrients continuously decreased with prolonged processing. The growth, carcass analysis, and haematology of the fish groups fed toasted JCK at varying duration also did better than those fed raw JCK. Importantly, the performance tends to reduce for those fed JCK toasted beyond 20 min. The estimated cost of producing 1 kg of the fish also substantially reduced with feeding the processed JCK than feeding raw JCK. Histological examination of the intestine and liver tissues further revealed fewer signs of histopathological degeneration for fish-fed processed JCK compared to the control. It was concluded that the processing of JCK by toasting should not exceed 20 min to improve the nutritional composition of the feed ingredients and their dietary utilization by fish.

Identification of microalgae cultured in Bold's Basal medium from freshwater samples, from a high-rise city.

This study aimed at exploring microalgal heterogeneity from fresh water samples collected from inland water bodies in the heavily built city of Singapore. Culturable pure isolates (n = 94) were subject to an in-house microalgal DNA extraction method and LSU rDNA sequencing. Isolates were analysed for their predominance and distribution. A total of 17 different algal genera were identified (H = 2.8, EH = 0.6), of which Scenedesmus spp. and Chlorella spp. constituted 27.5% and 21.3% of isolates respectively, followed by Micractinium spp. (18.8%) and Chlamydomonas spp. (12.5%). We also report 16 new microalgal strains from this region. The data is important from an ecological and biotechnological perspective.

Risk profile of Qatari women treated for infertility in a tertiary hospital: a case-control study.

BACKGROUND: Female infertility is a multifactorial condition constituting a worldwide public health problem. The ability to reproduce is an important product of any marriage, hence infertility may exert a negative impact on physical, financial, social and emotional wellbeing of affected couples. The cornerstone to the management of any disease, including infertility, is prevention. Identifying the modifiable risk factors of female infertility will aid at prevention, early detection, and treatment of medical conditions that can threaten fertility as well as promoting healthy behaviours that can preserve it. AIM: To explore the risk profile of infertility among Qatari women and compare risk factors distribution among primary vs. secondary infertility. METHODOLOGY: A hospital-based case control study was conducted from September 17th, 2017- February 10th, 2018. Cases (n = 136) were enrolled from infertility clinic and controls (pregnant women, n = 272), were enrolled from antenatal clinic, Women Hospital, Hamad Medical Corporation (HMC). Interview questionnaire was utilized to collect data about sociodemographic, risk factors related to infertility and patient health Questionnaire (PHQ)-2. Body Mass Index (BMI) was calculated. Logistic regression was used to identify the associated factors to infertility. Statistical significance was set at 0.05. RESULTS: Forty three primary and ninety three secondary infertility cases were included. Risk factors were age >  35 years (OR = 3.7, 95% CI: 1.41-9.83), second-hand smoking (OR = 2.44, 95% CI:1.26-4.73), steady weight gain (OR = 4.65,, 95% CI: 2.43-8.91), recent weight gain (OR = 4.87, 95% CI: 2.54-9.32), menstrual cycle irregularities (OR = 4.20, 95% CI:1.14-15.49), fallopian tube blockage (OR = 5.45, 95% CI: 1.75-16.95), and symptoms suggestive of sexually transmitted infections (STIs) including chronic lower abdominal/pelvic pain (OR = 3.46, 95% CI: 1.57-7.63), abnormal vaginal discharge (OR = 3.32, 95% CI:1.22-9.03) and dyspareunia (OR = 7.04, 95% CI: 2.76-17.95). Predictive factors for secondary infertility were; longer time from previous conception (OR = 5.8, 95% CI: 3.28-10.21), history of stillbirth (OR = 2.63, 95% CI: 1.04-6.67) or miscarriage (OR = 2.11, 95% CI: 1.21-3.68) and postpartum infection (OR = 3.75, 95% CI: 1.27-11.06). Protective factors were higher education level (OR = 0.44, 95% CI: 0.25-0.78), higher income (OR = 0.17, 95% CI: 0.06-0.49), and awareness/loyalty to fertility window (OR = 0.33, 95% CI: 0.21-0.52 and OR = 0.29, 95% CI: 0.19-0.44, consequently). CONCLUSION: This study highlighted the opportunities to strengthen public health as well as hospital-based health promotion programs importantly toward behavioural-related risk factors (e.g. smoking, obesity, STIs etc.). Moreover, detecting, preventing, and managing modifiable risk factors through awareness, screening and early management of chronic diseases, may contribute at reduction of incidence and severity of infertility. Such interventions can be delivered at premarital, family planning, post-natal and antenatal clinics at primary health care with early referral to secondary care if required.