Main Subjects : Epidemiology

National Health Systems Response to COVID-19 Outbreak, Iraq an Example

Alaa Hussein Abed; Dhurgham A. Abdulwahid; Haider A. Jassim

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 1-6
DOI: 10.33762/mjbu.2021.130218.1071

This article describes chronologically the development of COVID-epidemic in Iraq, mainly Basra Province, and the response of the national and provincial health system response to control this crisis. It points some strengths and weaknesses of this response. In addition, it mentions some of the opportunities that need to get benefit from, including following an evidence-based approach in epidemic control management. Some of the international assessments' results showed that the performance of Iraqi health system come at the tail of the sorted list of international health systems. This necessitates conducting a scientific systematic evaluation to the national performance to precisely quantify structural and process strengths and weaknesses.

Intrauterine vertical transmission of COVID-19 during pregnancy: A systematic review

Jasim Al Asadi; Sadiq M Mousa

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 7-20
DOI: 10.33762/mjbu.2021.128851.1045

Background: COVID-19 infection in pregnancy raised concerns about the risk of intrauterine vertical transmission of the SARS-CoV-2 from mother to fetus.
Objectives: to review the current evidence on the possibility of intrauterine vertical transmission potential among COVID-19 infected pregnant mothers.
Methods: Eligible studies published from December 2019 until August 1, 2020, were searched for from PubMed, PubMed Central, Google scholar, medRxiv, and bioRxiv collection databases using MeSH-compliant keywords including COVID-19, pregnancy, intrauterine vertical transmission, Coronavirus 2019, SARS-CoV-2, 2019-nCoV, and maternal-fetal transmission.
Results: The initial search yielded 152 articles. After elimination of duplicates, review, commentaries, and articles from media, 78 articles were deemed relevant and comprised neonatal outcome data for 1231 neonates whose mothers were infected with COVID-19. Of these 78 articles, 24 articles that fulfilled the inclusion criteria were eventually selected for analysis yielding 517 neonates from 514 pregnancies (3 sets of twins). Most of the women (64.4%) were delivered by cesarean section. Vaginal delivery was reported in 31.7%, and in 20 women (3.9%), the mode of delivery was not reported. Of the total 517 neonates reported in the 24 analyzed articles, 51 neonates (9.9%; 95% CI, 7.4-12.8) were tested by positive by at least one of the investigation tools, and 38 neonates (7.3%; 95% CI, 5.3-9.9) were found positive for SARS-CoV-2 by RT-PCR nasopharyngeal swab.
Conclusions: The risk of intrauterine vertical transmission of SARS-CoV-2 in late pregnancy is possible but rare. However, the potential risk of vertical transmission in early pregnancy is not yet assessed.

The Pandemic of COVID-19 in Eastern Mediterranean Region: Selected Outcome Parameters

Omran Habib; Dhurgham A Abdul-Wahid; Nabil Salim Khudair; Nihad Qasim Mohammed; Riyadh A Al-Hilfi

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 15-24
DOI: 10.33762/mjbu.2020.128305.1036

Background: Despite the passage of eight months since the start of COVID-19 pandemic, it still represents a major public health problem at global, regional and national levels.
Objective: To present comparative outcome indicators and time trends for the pandemic among countries in the Eastern Mediterranean Region and to discuss possible determinants behind such trends.
Methods: We used data on all newly reported cases of COVID-19 infection from the start of the pandemic in each EMR country till the middle of August, 2020. Two sources of data were used: the World Health Organization Website (Corona World meters) and a private website reporting cases world countries. Numbers were directly abstracted from these sources and Excel programme functions were used to make graphic presentations.
Results: As on August 5,2020 countries of the Eastern Mediterranean Region varied substantially in scale of the incidence rate per million population (from highest of 38939.1 in Qatar to lowest of 54.2 in Syria), the case fatality (closed case fatality ratio) ranged from Lowest of 0.2% in Qatar to the highest of 37.0% in Yemen. Cause-specific mortality rate ranged from 1.1 to 212.5 per million population in Jordan and Iran respectively. Testing policy was the main determinants of reported cases. None of the countries has reached a stage of clear exit based on scientific evidence despite the decline in the scale of cases in most countries.
Conclusion: Most of The countries are experiencing a pattern of accelerated pandemic and are heading towards declining trend.

The Epidemiological Pattern of COVID-19 Epidemic, During the Initial Phase in Thi-Qar Governorate, Iraq: A Case Series Study

Muslim Dhahr Musa

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 25-36
DOI: 10.33762/mjbu.2020.128230.1033

Background/ Aims: Understanding the epidemiological features and transmission dynamic during the initial phase of the COVID-19 epidemic provide valuable information for control and mitigation of the outbreak. Thus, this study focused on a cohort who represent early cases in Thi-Qar governorate for describing the early epidemiological features during the initial phase of the COVID-19 outbreak.
Subject & Methods: This case series study was conducted in AL-Hussien Teaching Hospital, Thi-Qar governorate, from 27, February to 8, May 2020. Patient's data were obtained from official records of the Public Health Department of ThiQar Health Directory. A descriptive and analytical statistic were used by the aid of SPSS, also household secondary attack rate was estimated.
Results: The median age was 37 years (IQR:31,20-51), females were 57.2% and males were 42.8%. According to age groups, as a higher infection rate (30.61% %) was found in the age group (14-26), while only (4%) found old age groups(66-78,79-91). Only six patients(12.25%) had comorbidities. Clinically, majority(79.6%) of cases were mild and (18.4%) moderate while only (4%) were severe. The age and comorbidities had an effect on the severity of symptoms. Family transmission(80.43%) was the predominant dynamic of disease transmission. Three index cases in this cohort fulfill the criteria of super-spreader as collectively transmitted the disease to 79.6% individuals, the household secondary attack rates were 22%, 24%, and 17% respectively.
Conclusion: Family transmission was the predominant dynamic of transmission which was the result of the presence of a super-spreader event in the early infected patients in the governorate.

Epidemiological Features of COVID-19 Epidemic in Basrah-Southern Iraq-First Report

Omran S Habib; Abbas K AlKanan; ِAlaa H Abed; Nihad Q Mohammed

The Medical Journal of Basrah University, 2020, Volume 38, Issue 1, Pages 7-18
DOI: 10.33762/mjbu.2020.126943.1008

Epidemiological Features of COVID-19 Epidemic in Basrah-Southern Iraq-First Report
Background: COVID- 19 expanded from an outbreak in China to a devastating pandemic across the world. .
Objective: To describe the epidemiology of COVID-19 in Basrah Province-Southern Iraq
Methods: Data were obtained from the Department of Public Health in Basrah and the daily communique of the Ministry of Health. Data on population were obtained from the Ministry of Planning. For all provinces the total number of cases and their fate in terms of being under treatment, cured or died was obtained. For cases in Basrah, data on age, sex, residence, fate, travel history and presence of co-morbidity for 152 cases.
Results: In Basrah, The mean age was 46 years (Median 45 years) and the range was 13-98 years. No difference in the risk of COVID-19 was related to sex. Geographical variation was inconclusive The time trend of the epidemic is modest in both new daily cases and in cumulative numbers. At one point in time (April 10) the incidence rate was 56.28 per million , which was at intermediate level among other provinces.
The total cases used for Iraq was 1279. The highest numbers were reported in Baghdad, Najaf, Erbil, Basrah and Sulaymaniyah.The lowest incidence rate was in Salah Al-Din (0.61 per million) and the highest was in Najaf (170.16 per million). The case fatality ratio for closed cases and for all cases was variable among provinces.
Conclusion: COVID-19 in Basrah and Iraq is modest until today the 10th of April 2020.

The dynamics of COVID-19 epidemic in Basrah province-Second report

Omran Habib; Haider Jassim; Wael Jasimy Al-Shihaby; Mustafa AR Mohamed

The Medical Journal of Basrah University, 2020, Volume 38, Issue 1, Pages 19-28
DOI: 10.33762/mjbu.2020.127210.1019

Background: COVID-19 pandemic still expanding across the world and continuing at modest pattern In Basrah.
Objective: To further elaborate on COVID-19 epidemic in Basrah province and document the changing dynamic of the disease.
Methods: two sources were used for obtaining data in this study. The first is an excel sheet containing information on 736 cases covering age, gender, residence, travel history, comorbidity and fate, which is obtained from The Department of Public Health in Basrah. The second is the daily numbers of new cases (also 736) obtained from the daily communiqué of the Ministry of Health. Statistical Package for Social Sciences (SPSS-version 20) and Excel programmes were used for statistical analysis.
Results: The mean age was 35.5±18.9 (for males=35.6+19.0 and for females=35.5±18.8), the median was 34 years (males =34 and females =33). The incidence rate was higher in older age groups, females and three districts (Basrah city, Al-Hartha and Al-Mdaina). The case fatality was within the international figures and significantly predicted by older age, travel history and presence of co-morbidity. The epidemic curve is moderate, fluctuant and does not help yet in predicting an exit from the epidemic.
Conclusion: The epidemic of COVID-19 in Basrah is moderate, cluster in transmission and changing in time but is unpredictable.
Key words: COVID-19, Case fatality ratio, incidence rate

Knowledge and practice of adults attending primary health care centers regarding major coronary heart disease risk factors in Basrah city

Jhood Abdul Samad Molan; Narjis Ajeel

The Medical Journal of Basrah University, 2020, Volume 38, Issue 1, Pages 89-99
DOI: 10.33762/mjbu.2020.165441

Introduction: Cardiovascular diseases (CVDs) are common in the general population, affecting the majority of adults past the age of 60 years. The prevalence of coronary heart disease (CHD) is approximately one-third to one-half that of total CVD. Knowledge of CHD risk factors has been identified as a prerequisite for changes in behavior and is often targeted by prevention programs.
Objective: The study aimed to study the knowledge of risk factors and the practice of CHD related behaviors among individuals > 18 years of age attending PHC centers in Basrah city center and to find out the sociodemographic factors that affect such knowledge and practice.
Methods: The study involved 423 male and female aged 18 years and above, attending 6 primary health care centers in Basrah city. Data were collected through direct interview of the participants by the investigators, using a special questionnaire form prepared for the purpose of the study.
Results: The results of the study showed that 77.3% of the participants had good level of knowledge (know at least 7 risk factors).  The most common knowledgeable risk factors by the participants were stress, smoking, fatty diet and obesity in descending order. Older age groups, high educated persons, governmental employees and participants with history of coronary heart disease related illness were more likely to have higher knowledge score. Practicing diet modification and regular exercise were prevalent in 23.5% and 12.8% of the participants respectively.
Conclusions: The knowledge level of risk factors for CHD in selected PHC centers in Basrah seems to be good, however, the practice of CHD preventive behaviors was quite poor, this necessitates the need for public health education programs.

A study on job satisfaction of family physicians in Basrah

Rana Ali; Omran Habib

The Medical Journal of Basrah University, 2019, Volume 37, Issue 2, Pages 51-58
DOI: 10.33762/mjbu.2019.163348

Background: Job satisfaction is a reflection of interaction of the physicians and all the components of the surrounding environments. A high level of satisfaction is desirable and may contribute to better workers performance.Objectives: To explore the degree of satisfaction of family physicians in Basrah with their jobs. Methods: A cross-sectional study targeting all family physicians who were working in Basrah at the time of the study (2018) was carried out. A total of 67 out of 74 physicians were successfully interviewed according to a special questionnaire form that was prepared in the light of selected readings and guided by the researchers view on areas of interest. The data collection phase lasted for four months (April-August 2018). Results: A good proportion (43.3%) of family physicians in Basrah were posted in places other than family medicine practice. The majority were young, females, and reasonably lived close to their work sites. Family physicians were very satisfied with the supervisors (95.5%), colleagues (97.0%) and clients (86.6%). They were also satisfied with their competence in handling their daily tasks and fairly satisfied with their postgraduate training and in-services training. They were very unsatisfied with their income, their work conditions in terms of amenities and staffing, with respect to specialty under two thirds (61.2%) expressed their satisfaction with their status as family physicians but 38.8% were not satisfied and this was reflected on their desire to quit to other specialty (55.2%). A big problem is the perception that the specialty is not respected by the public (85.1%), not respected by other clinical specialties (95.5%), not supported by mass media (95.5%), and the specialty is not optimally utilized (79.1%). However, 67.2% reported that the specialty improved care delivery at primary health care centres. Conclusions: Mostly family physicians were happy with competence required to handle tasks. Except for the overall work environment, participants denied to have adequate amenities. Most positive points were related to humanities. Most of negative points were related to income, recognition and amenities. They expressed negative views on all aspects of salary valuation and most of them wanted to change specialty.

Socio-demographic characteristics of maternal deaths in Basrah or the period (2013-2017)

Riyadh ِA Al Hilfi; Rajaa A Mahmoud; Nihad Q Al Hamadi

The Medical Journal of Basrah University, 2019, Volume 37, Issue 1, Pages 1-7
DOI: 10.33762/mjbu.2019.163349

Introduction and Background: In Iraq, and due to the decades of wars and sunctions that affected people’s accessibility to the health care services, maternal death was among the main health problems over the years. Thus, studying the factors influencing this important problem is a mandatory step for a better evidence based intervention in controlling the problem. Objective: To analyze the socio-demographic factors that influence maternal deaths in Basrah during the period 2013-2017.Methodology design: The study is an observational retrospective one included information collected from the medical records, death certificate and forensic medicine reports in addition to interviewing the family as needed. A total of 201 deaths were included in the study. Results: The study shows that maternal death rate in Basrah increased sharply during 2016 compared to that of 2013 with a highest rate in Shat Al-Arab and Al-Mudiana districts. Then, a sharp decrease was noticed in 2017 compared to 2016. Maternal mortality rates were found to be increasing with increasing women’s age with the highest rate among women above 40 years old. But no big difference between maternal death rates in urban and rural areas. (88.1%) of the study women died in hospital while 11.9% of them died outside the hospital Conclusions and recommendations: Maternal death is still a problem in Basrah in spite of the decline that occurred between (2016-2017) compared to the rates in 2013. Strengthening of maternal mortality monitoring system across all districts of Basrah governorate in addition to improving the quality of registering all pregnancy related information are the main recommendations of the study.