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Article: Interventions addressing genetic disease burdens within selected countries in the MENA region: a scoping review.

Grant, Madison / Kabakian-Khasholian, Tamar / Yazbek, Soha

2023 Volume 14, Issue 1, Page(s) 29–39

Abstract: Background: The MENA region is disproportionately affected by genetic disease. The aim of this research is to scope the region for evidence of genetic services and public health interventions to identify geographic gaps, and to provide a descriptive ... ...

Abstract	Background: The MENA region is disproportionately affected by genetic disease. The aim of this research is to scope the region for evidence of genetic services and public health interventions to identify geographic gaps, and to provide a descriptive overview of interventions to identify knowledge gaps. Methods: This study is conducted as a scoping review and follows the Arksey & O'Malley scoping review framework. Results: Seventy-six articles spanning 16 MENA nations met inclusion criteria. Studies included interventions in the form of genetic service provision (n=28), as well as comprehensive programs including pilot programs (n=7), community-based genetics programs (n=6) national-level prevention programs (n=18), and national-level mandatory programs (n=17). Conclusions: There is an imbalanced response to genetic disease burdens across the MENA region. More research is warranted where interventions are scarce, particularly to inform development of pilot community-based programs. There is also a need for better monitoring and evaluation of existing nation-wide programs.
Language	English
Publishing date	2023-01-24
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	2543127-4
ISSN	1868-6001 ; 1868-310X
ISSN (online)	1868-6001
ISSN	1868-310X
DOI	10.1007/s12687-023-00633-3
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Article ; Online: Exposing Obstetric Violence in the Eastern Mediterranean Region: A Review of Women's Narratives of Disrespect and Abuse in Childbirth.

Khalil, Merette / Carasso, Kashi Barbara / Kabakian-Khasholian, Tamar

Frontiers in global women's health

2022 Volume 3, Page(s) 850796

Abstract: Background: Obstetric violence (OV) threatens the provision of dignified, rights-based, high-quality, and respectful maternal care (RMC). The dearth of evidence on OV in the Eastern Mediterranean Region poses a knowledge gap requiring research to ... ...

Abstract	Background: Obstetric violence (OV) threatens the provision of dignified, rights-based, high-quality, and respectful maternal care (RMC). The dearth of evidence on OV in the Eastern Mediterranean Region poses a knowledge gap requiring research to improve rights-based and respectful health practice and policy. While efforts to improve the quality of maternal health have long-existed, women's experiences of childbirth and perceptions of dignity and respect are not adequately or systematically recorded, especially in the said region. Aim: This study centered on the experiences of women's mistreatment in childbirth to provide an overview of OV and offer recommendations to improve RMC. Methods: A scoping review was conducted, and a total of 38 articles met the inclusion criteria and were analyzed using Bowser and Hill's framework of the seven typologies of Disrespect and Abuse (D&A) in childbirth. D&A in childbirth (or violations to RMC) is a manifestation of OV and served as a proxy to analyze its prevalence in the EMR. Findings and discussion: This study indicated that across the EMR, women experienced every type of D&A in childbirth. This happens regardless of health systems' strength or country's income, with 6 out of 7 types of D&A found in almost two-thirds of included countries. In the EMR, the most common types of D&A in childbirth are physical abuse (especially overused routine interventions) and non-dignified care (embedded in patriarchal socio-cultural norms). The intersections of these abuses enable the objectification of women's bodies and overuse of unconsented routine interventions in a hierarchical and patriarchal system that regards the power and autonomy of doctors above birthing women. If unchecked, the implications include acceptance, continuation, and underreporting of D&A in childbirth, as well as passivity toward human-rights violations, which all further cause the continuing the cycle of OV. Conclusion: In order to eliminate OV, a paradigm shift is required involving infrastructure changes, education, empowerment, advocacy, a women-centered and gender-sensitive approach to health system strengthening, and policy development. Recommendations are given at individual, community, health systems, and policy levels to ensure that every woman achieves her right to health and birth in a dignified, respectful, and empowered manner.
Language	English
Publishing date	2022-04-25
Publishing country	Switzerland
Document type	Journal Article ; Review
ISSN	2673-5059
ISSN (online)	2673-5059
DOI	10.3389/fgwh.2022.850796
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Article ; Online: "A person who does not have money does not enter": a qualitative study on refugee women's experiences of respectful maternity care.

Kabakian-Khasholian, Tamar / Makhoul, Jihad / Ghusayni, Aleni

BMC pregnancy and childbirth

2022 Volume 22, Issue 1, Page(s) 748

Abstract: Background: Women's childbirth experiences in health facilities is at the core of quality of care. Their perceptions of poor-quality care, including disrespectful care at health facilities during childbirth, is recognized as a significant barrier to ... ...

Abstract	Background: Women's childbirth experiences in health facilities is at the core of quality of care. Their perceptions of poor-quality care, including disrespectful care at health facilities during childbirth, is recognized as a significant barrier to seeking care for subsequent births. Research that explores women's perspectives of the dimensions of disrespect and mistreatment during childbirth in Arab countries is scarce, and there is none pertaining to refugee groups who carry the burden of multiple vulnerabilities and who suffer from discontinued care, especially in fragile health systems. This paper aims at presenting Palestinian, Iraqi and Syrian refugee women's experiences, understanding and interpretation of disrespect and mistreatment during childbirth in hospitals in Lebanon. Methods: This study employed phenomenology, a qualitative research design to generate data through in-depth interviews. Women who were 3 to 6 months postpartum were recruited through the non-governmental organizations (NGOs) that are actively engaged in providing welfare and healthcare services to different populations of refugee women in Lebanon. In total, 24 women were interviewed. All interviews were audio recorded, transcribed verbatim and subjected to thematic analysis. Results: Of the 24 women who participated in this study, 9 were Palestinian, 12 were Syrian and 3 were Iraqi. The participants spoke of restricted choices to hospitals, care providers and to types of birth, while revealing adverse experiences during childbirth in healthcare facilities, including verbal and physical abuse, disrespectful verbal and non-verbal communication by healthcare providers. They also reported sub-standard care, denial of birth companions and breaches to their privacy. Our findings exemplify how the coverage of the cost of facility-based births by UN agencies and NGOs increase refugee women's vulnerability to disrespect and mistreatment during childbirth. Conclusion: This study shows how disrespect and mistreatment are intertwined in a complex system which is devised to ensure access to facility-based birth for displaced populations. Implications for programs and policies point to the need for strengthening capacity and for providing resources for the adaptation of global guidelines into context-specific strategies for the provision of quality maternity care during humanitarian crises and beyond.
MeSH term(s)	Attitude of Health Personnel ; Delivery, Obstetric/methods ; Female ; Humans ; Maternal Health Services ; Parturition ; Pregnancy ; Professional-Patient Relations ; Qualitative Research ; Quality of Health Care ; Refugees
Language	English
Publishing date	2022-10-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2059869-5
ISSN	1471-2393 ; 1471-2393
ISSN (online)	1471-2393
ISSN	1471-2393
DOI	10.1186/s12884-022-05083-2
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Article ; Online: Analyzing the social context of health information and misinformation during the COVID-19 pandemic: a case of emerging inequities in Lebanon.

Makhoul, Jihad / Kabakian-Khasholian, Tamar / Chaiban, Lea

Global health promotion

2021 Volume 28, Issue 1, Page(s) 33–41

Abstract: With the far-reaching COVID-19 pandemic starting in December 2019, a surge of misinformation, now coined by the World Health Organization (WHO) as an 'infodemic', has also taken the world by storm. False information and variations in interpretations ... ...

Abstract	With the far-reaching COVID-19 pandemic starting in December 2019, a surge of misinformation, now coined by the World Health Organization (WHO) as an 'infodemic', has also taken the world by storm. False information and variations in interpretations about the pandemic and mitigation interventions/strategies continue to spread at a faster pace than the relevant scientific evidence. The WHO has called for a fight against this infodemic, describing it as the most contagious aspect of the pandemic. In this era of rapid information exchange, public health measures, and state interventions to control the pandemic, a contextual understanding of how information is communicated and shared is important for uncovering possible reasons for action or inaction by the general public. With the Lebanese state scrambling to implement and enforce different measures to control and mitigate the spread of COVID-19, adherence by the general public is not uniform. In this paper, we refer to social science and risk communication theory to discuss how the political, economic and social contexts in the country, and not only the content of the messages that people receive from officials, affect how they interpret and act on information. We highlight how this has played out in Lebanon and identify societal aspects of importance in a low-middle income country fraught with social, economic and political inequalities which continue to undermine the efforts to contain the spread. Implications to inform state response in the context of low-middle income countries are also discussed.
MeSH term(s)	COVID-19/prevention & control ; Communication ; Consumer Health Information ; Humans ; Lebanon ; Social Environment ; Socioeconomic Factors
Language	English
Publishing date	2021-01-21
Publishing country	England
Document type	Journal Article
ZDB-ID	2502036-5
ISSN	1757-9767 ; 1757-9759
ISSN (online)	1757-9767
ISSN	1757-9759
DOI	10.1177/1757975920984178
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Article ; Online: To wear or not to wear a mask in the COVID-19 era? The broken bridge between recommendations and implementation in Lebanon.

Kabakian-Khasholian, Tamar / Makhoul, Jihad / Bardus, Marco

Journal of global health

2020 Volume 10, Issue 2, Page(s) 20311

MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/prevention & control ; Health Policy/legislation & jurisprudence ; Humans ; Lebanon ; Masks ; Pandemics/legislation & jurisprudence ; Pandemics/prevention & control ; Pneumonia, Viral/prevention & control ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-07-31
Publishing country	Scotland
Document type	Journal Article ; Review
ZDB-ID	2741629-X
ISSN	2047-2986 ; 2047-2978
ISSN (online)	2047-2986
ISSN	2047-2978
DOI	10.7189/jogh.10.020311
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Article ; Online: Teaching Social Marketing Using E-Service Learning Amidst Health and Humanitarian Crises: A Case Study from Lebanon.

Bardus, Marco / Nasser AlDeen, Khawla / Kabakian-Khasholian, Tamar / Kanj, Mayada / Germani, Aline

International journal of environmental research and public health

2022 Volume 19, Issue 19

Abstract: We present the design, implementation, and evaluation of an e-service learning course, "Social Marketing for Health Promotion", offered to full-time and part-time students enrolled in the Master of Public Health at our institution. In a quasi- ... ...

Abstract	We present the design, implementation, and evaluation of an e-service learning course, "Social Marketing for Health Promotion", offered to full-time and part-time students enrolled in the Master of Public Health at our institution. In a quasi-experimental trial, we introduced e-service learning in 2018, comparing a traditional face-to-face section to a blended course (33% online). Based on the positive feedback received, we progressively increased the online component in the following academic years, reaching 100% online in Fall 2020. We compared the quantitative and qualitative indicators evaluating three e-service learning-course iterations with a face-to-face control. The impact indicators included participation and engagement in the course, the attainment of the learning outcomes, satisfaction with the course, instructors and mode of delivery, and the impact of the experience beyond the classroom. Over the years, we trained 73 students whose engagement with the course remained relatively stable. The attainment of the learning outcomes and general course satisfaction steadily increased over time, demonstrating a positive impact on student learning. Qualitative data illustrate the importance of instructors in setting expectations and guiding students and community partners through a remote-learning process.
MeSH term(s)	Humans ; Learning ; Lebanon ; Relief Work ; Social Marketing ; Students ; Teaching
Language	English
Publishing date	2022-10-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph191912696
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Article ; Online: Knowledge, attitudes, and practices of pediatricians in relation to breastfeeding support: A national survey in Lebanon.

Al Rifai, Hiba / Shatila, Hiba / Nasreddine, Lara / Yazbeck, Nadine / Kabakian-Khasholian, Tamar / Itani, Leila / Naja, Farah

PloS one

2023 Volume 18, Issue 4, Page(s) e0281865

Abstract: Background: Rates of breastfeeding (BF) remain suboptimal despite overwhelming evidence for its benefits to the mother and child. Pediatricians play an important role in supporting breastfeeding (BF). In Lebanon, the rates of both exclusive and ... ...

Abstract	Background: Rates of breastfeeding (BF) remain suboptimal despite overwhelming evidence for its benefits to the mother and child. Pediatricians play an important role in supporting breastfeeding (BF). In Lebanon, the rates of both exclusive and continued BF are critically low. The objective of this study is to examine the knowledge, attitudes and practices (KAP) of Lebanese pediatricians in relation to supporting BF. Methods: A national survey of Lebanese pediatricians was conducted through Lime Survey (n = 100, response rate 9.5%). The list of pediatricians' emails was obtained from the Lebanese Order of Physicians (LOP). Participants completed a questionnaire covering, in addition to sociodemographic characteristics, the KAP, related to supporting BF. Descriptive statistics and logistic regressions were used in data analysis. Results: The most prevalent gaps in knowledge were related to the positioning of the baby during BF (71.9%) and the association between the mother's fluid intake and her milk production (67.4%). With regards to attitudes, 34% of participants reported unfavorable attitudes towards BF in public and BF while working (25%). As for practices, more than 40% of pediatricians kept formula samples and 21% had formula-related advertising in their clinics. Half of the pediatricians reported rarely/never referring mothers to lactation consultants. After adjustment, both being a female pediatrician and having done the residency in Lebanon were significant predictors of better knowledge (OR = 4.51 (95%CI: 1.72-11.85) and OR = 3.93 (95%CI: 1.38,11.19) respectively. Conclusion: This study revealed important gaps in the KAP related to BF support among Lebanese pediatricians. Coordinated efforts ought to be exerted to educate and equip pediatricians with needed knowledge and skills to support BF.
MeSH term(s)	Female ; Humans ; Infant ; Breast Feeding ; Health Knowledge, Attitudes, Practice ; Lebanon ; Mothers ; Pediatricians
Language	English
Publishing date	2023-04-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0281865
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Article ; Online: Companion of choice at birth: factors affecting implementation.

Kabakian-Khasholian, Tamar / Portela, Anayda

BMC pregnancy and childbirth

2017 Volume 17, Issue 1, Page(s) 265

Abstract: Background: Two recent recommendations made by the World Health Organization confirm the benefits of companion of choice at birth on labour outcomes; however institutional practices and policies do not always support its implementation in different ... ...

Abstract	Background: Two recent recommendations made by the World Health Organization confirm the benefits of companion of choice at birth on labour outcomes; however institutional practices and policies do not always support its implementation in different settings around the world. We conducted a review to determine factors that affect implementation of this intervention considering the perspectives and experiences of different stakeholders and other institutional, systemic barriers and facilitators. Methods: Forty one published studies were included in this review. Thirty one publications were identified from a 2013 Cochrane review on the effectiveness of companion of choice at birth. We also reviewed 10 qualitative studies conducted alongside the trials or other interventions on labour and birth companionship identified through electronic searches. The SURE (Supporting the Use of Research Evidence) framework was used to guide the thematic analysis of implementation factors. Results: Women and their families expressed appreciation for the continuous presence of a person to provide support during childbirth. Health care providers were concerned about the role of the companion and possible interference with activities in the labour ward. Allocation of resources, organization of care, facility-related constraints and cultural inclinations were identified as implementation barriers. Conclusion: Prior to introducing companion of choice at birth, understanding providers' attitudes and sensitizing them to the evidence is necessary. The commitment of the management of health care facilities is also required to change policies, including allocation of appropriate physical space that respects women's privacy. Implementation research to develop models for different contexts which could be scaled up would be useful, including documentation of factors that affected implementation and how they were addressed. Future research should also focus on documenting the costs related to implementation, and on measuring the impact of companion of choice at birth on care-seeking behavior for subsequent births.
MeSH term(s)	Attitude of Health Personnel ; Choice Behavior ; Female ; Friends ; Health Knowledge, Attitudes, Practice ; Health Personnel/psychology ; Health Plan Implementation ; Humans ; Labor, Obstetric/psychology ; Parturition/psychology ; Pregnancy ; Qualitative Research
Language	English
Publishing date	2017-08-31
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2059869-5
ISSN	1471-2393 ; 1471-2393
ISSN (online)	1471-2393
ISSN	1471-2393
DOI	10.1186/s12884-017-1447-9
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Article ; Online: Genetic literacy among primary care physicians in a resource-constrained setting.

Karam, Pascale E / Hamad, Lina / Elsherif, Mohamed / Kreidieh, Khalil / Nakouzi, Ghunwa / El Asmar, Khalil / Kabakian-Khasholian, Tamar / Curi, Dany Assaf / Yazbek, Soha N

BMC medical education

2024 Volume 24, Issue 1, Page(s) 140

Abstract: Background: Genetic literacy among primary healthcare providers is crucial for appropriate patient care with the advances in genetic and genomic medicine. Studies from high-income countries highlight the lack of knowledge in genetics and the need to ... ...

Abstract	Background: Genetic literacy among primary healthcare providers is crucial for appropriate patient care with the advances in genetic and genomic medicine. Studies from high-income countries highlight the lack of knowledge in genetics and the need to develop curricula for continuing professional development of non-geneticists. Scarce data is available from resource-constrained countries in Middle East and North Africa. Lebanon is a small country in this region characterized by high rates of consanguinity and genetic disorders like several surrounding countries, such as Jordan, Syria, and Turkey. Methods: The primary aim of this study assessed the genetic literacy, self-perceived and actual knowledge as well as practices among primary care providers in Lebanon. The secondary aim identified their educational needs and proposed evidence-based continuing education programs. A cross-sectional survey-based study, using a self-administered questionnaire, was conducted targeting physicians from Family Medicine, Obstetrics and Gynecology, and Pediatrics. The questionnaire was divided into five sections: demographics, familiarity with genetic tests, self-reported and actual knowledge, genetic practices, and educational needs. Statistics were performed using SPSS v24. The Chi-square test was used for independent variables. Differences between mean scores were measured using paired sample t-tests for groups of two levels and one-way ANOVA for more than two. Multiple linear regression was used to study the variables associated with the knowledge score while controlling for other variables. Results: The survey included 123 physicians. They were mostly familiar with karyotype as first-tier genetic test. Although 38% perceived their knowledge as good, only 6% scored as such in knowledge assessment. A better knowledge score was observed in academic institutions as well as in urban settings (p<0.05). One third never ordered any genetic testing, mostly due to poor knowledge. Almost all (98%) were ready to attend continuing professional development sessions in genetics. Conclusion: Our findings show the need to improve genetic literacy among healthcare frontliners, focusing on remote regions and nonacademic centers in Lebanon, a model for other resource-constrained country in the Middle East and North Africa region. This study advances recommendations for evidence-based genetic continuing education programs and highlighted the role of that the few genetic specialists can play in their successful implementation.
MeSH term(s)	Humans ; Child ; Literacy ; Cross-Sectional Studies ; Physicians, Primary Care ; Delivery of Health Care ; Lebanon
Language	English
Publishing date	2024-02-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2044473-4
ISSN	1472-6920 ; 1472-6920
ISSN (online)	1472-6920
ISSN	1472-6920
DOI	10.1186/s12909-024-05110-0
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Article ; Online: Maternal mortality in Lebanon: Increased vulnerability among Syrian refugees.

El Kak, Faysal / Harb, Hilda / Daouk, Sirine / Nassar, Anwar / Kabakian-Khasholian, Tamar

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

2021 Volume 159, Issue 1, Page(s) 166–172

Abstract: Objective: To compare the burden and causes of maternal deaths between Syrian and Lebanese women for the period of 2010-2018.: Methods: A retrospective analysis was conducted of maternal deaths from the national notification system at the Ministry of ...

Abstract	Objective: To compare the burden and causes of maternal deaths between Syrian and Lebanese women for the period of 2010-2018. Methods: A retrospective analysis was conducted of maternal deaths from the national notification system at the Ministry of Public Health in Lebanon during the period of 2010-2018. Maternal deaths among Syrian refugees and Lebanese citizens were compared based on cause of death, age of the woman, and nationality. Causes of maternal deaths were categorized as direct and indirect following WHO definitions. Results: The maternal mortality ratio among the Syrian refugee women in Lebanon was higher than that of Lebanese women in the period 2010-2018, with its highest rate of 55.1 in 2017. Hemorrhage and indirect causes of maternal deaths are more common among Syrian refugee women whereas embolism and hypertension have higher proportions among Lebanese women. Maternal deaths within 48 h after birth are more common among Syrian than Lebanese women. Conclusion: Syrian refugee women carry an increased risk for maternal mortality in Lebanon. Improving timely access and equitable provision of appropriate care should be a priority for the health system in Lebanon.
MeSH term(s)	Female ; Humans ; Lebanon/epidemiology ; Maternal Death ; Maternal Mortality ; Refugees ; Retrospective Studies ; Syria
Language	English
Publishing date	2021-12-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	80149-5
ISSN	1879-3479 ; 0020-7292
ISSN (online)	1879-3479
ISSN	0020-7292
DOI	10.1002/ijgo.14063
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