Background Provider bias is a main barrier that extensively violates the right of free family pla... more Background Provider bias is a main barrier that extensively violates the right of free family planning method choice. Egypt is one of the countries that shows skewness in its method mix. Provider bias and insufficiency of alternative methods are identified as potential factors underlying this phenomenon which contributes to high unmet needs and discontinuation rates. Provider bias may be influenced by cultural beliefs and societal trends and is usually overlooked as a possible cause of this skewed method mix. This study aims to explore the presence of provider bias in rural Upper Egypt and its potential causes, a community with conservative cultural beliefs and least contraceptive prevalence rates. Methods This is a qualitative study using the “simulated client’s approach.” The study was conducted in 16 villages in Assiut and Sohag governorates in Egypt. The simulated clients visited 30 clinics, 15 in each governorate, including primary healthcare units and private clinics. Three sc...
European Journal of Orthopaedic Surgery and Traumatology, Mar 22, 2023
Purpose To predict the most important preoperative factor affecting the patient satisfaction afte... more Purpose To predict the most important preoperative factor affecting the patient satisfaction after total knee arthroplasty (TKA) in trial to improve patient counselling process. Methods We retrospectively reviewed all patients who underwent primary TKA from January 1, 2018, to January 31, 2019, with minimum one-year follow-up for the previously collected patient-reported outcome measures (PROMs) as Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Outcome Score for joint replacement (KOOS, JR) preoperative, 6 months and 12 months postoperative. Results By using Oxford knee score at 12 months as dependent variable, we found a negative moderate spearman correlation between age and Oxford knee score at 12 months postoperative. Moderate negative spearman correlation was also found between Oxford knee score at 12 months postoperative and KOOS pain, stiffness and function scores at preoperative and 6 months postoperative, denoting higher satisfaction at 12 months with less perceived stiffness, pain and limited function at baseline and 6 months postoperative. A multivariate regression analysis was done using the oxford knee score at 12 months as dependent variable to detect the predictors of oxford knee score at 12 months postoperatively and showed that younger age and less perception of stiffness at baseline were significant predictors of higher Oxford knee score: higher satisfaction at 12 months postoperative. Conclusion Preoperative stiffness can predict the postoperative satisfaction score more than any other factor. We also address the importance of combining more than one PROM in assessing patients as OKS and KOOS, JR.
Background The early childhood period is considered the most important developmental phase in an ... more Background The early childhood period is considered the most important developmental phase in an individual's lifespan. However, it is not addressed in the Egyptian health system. We aimed to explore mothers' and healthcare providers' perceptions about early childhood development (ECD) and identify their needs to support ECD in Egypt. Methods Focus group discussions with 79 mothers of children younger than 2 years old from different socioeconomic backgrounds and residing in urban and rural areas and 26 primary healthcare providers were used to collect data. Emerging themes and subthemes were identified from the data analysis. Results Urban and rural mothers in Egypt of all educational levels are not well prepared to support their children's early development, especially the cognitive and emotional aspects. Limited sources of information about ECD, the large families of rural women and an absence of developmental health services and family support were the most important factors that led to a neglect of motherchild communication and stimulation. Conclusion Raising community awareness and training primary healthcare providers to counsel mothers about ECD are important prerequisites for supporting ECD in Egypt. Rural and first-time mothers would be the most valuable starting point.
To explore the attitude of health care providers about screening for and dealing with domestic vi... more To explore the attitude of health care providers about screening for and dealing with domestic violence in the health care setting and to assess the physicians screening behavior. Methods: We surveyed physicians and nurses working in different departments of Assiut University Hospital using a self-administered questionnaire. Two focus group discussions with physicians and nurses were also conducted. Results: 44.3% and 46.5% of physicians and nurses mentioned time constraints as a barrier for DV screening. Physicians believed that it is not important to screen for DV because it is a socially accepted problem and because of the unavailability of the necessary referrals to help victims (30.2% and 20.0%, respectively). The unsuitability of the outpatient clinics to screen for DV was also mentioned by 65.6% and 75.5% of physicians and nurses respectively. Only 36.7% of physicians perceived having the communication skills to facilitate disclosure of DV exposure. Regarding practice, only 35.0% of physicians have screened for DV in the three months preceding data collection. Urban residence, perception of the negative health consequence of DV exposure and perception of the physicians to have the required communication skills predicted positive attitude towards DV screening, while feeling distressed to discuss exposure to DV was associated with negative physicians' attitude. Conclusion: In-service training of health care providers to identify and manage victims of DV and establishing supportive system would have great implications for reducing the physical and mental negative consequences of DV exposure.
Purpose to predict the most important preoperative factor affecting the patient satisfaction afte... more Purpose to predict the most important preoperative factor affecting the patient satisfaction after total Knee arthroplasty (TKA) in trial to improve patient counselling process. Methods we retrospectively reviewed all patients who underwent primary TKA from 1st of January 2018 to 31st of January 2019 with minimum one year follow up for the previously collected patient reported outcome measures (PROMs) as Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Outcome Score for joint replacement (KOOS, JR) preoperative, 6 months and 12 months postoperative. Results By using Oxford knee score at 12 months as dependent variable, we found a negative moderate spearman correlation between age and oxford score at 12 months postoperative. Moderate negative spearman correlation was also found between oxford score at 12 months postoperative and KOOS pain, stiffness and function scores at preoperative and 6 months postoperative, denoting higher satisfaction at 12 months with less perceived ...
The Focus Group Discussion and In-depth Interview Guides file includes the English language versi... more The Focus Group Discussion and In-depth Interview Guides file includes the English language version of the guides that were designed specifically for the purpose of this study and were tailored for mothers as well as nurses and doctors to understand their perceptions pertaining to the medicalization of FGM/C. (DOCX 18 kb)
The Population Council confronts critical health and development issues-from stopping the spread ... more The Population Council confronts critical health and development issues-from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world. Established in 1952, and headquartered in New York, the Council is a nongovernmental, nonprofit organization governed by an international board of trustees.
Background: Stigma and discrimination against people living with human immunodeficiency virus (HI... more Background: Stigma and discrimination against people living with human immunodeficiency virus (HIV) are obstacles in the way of effective responses to HIV. Understanding the extent of stigma / discrimination and the underlying causes is necessary for developing strategies to reduce them. This study was conducted to explore stigma and discrimination against PLHIV amongst healthcare providers in Jimma zone, Southwest Ethiopia. Methods: A cross-sectional study, employing quantitative and qualitative methods, was conducted in 18 healthcare institutions of Jimma zone, during March 14 to April 14, 2011. A total of 255 healthcare providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support and HIV-related stigma and discrimination. Factor analysis was employed to create measurement scales for stigma and factor scores were used in one way analysis of variance (ANOVA), T-tests, Pearson's correlation and multiple linear regression analyses. Qualitative data collected using key-informant interviews and Focus Group Discussions (FGDs) were employed to triangulate with the findings from the quantitative survey. Results: Mean stigma scores (as the percentages of maximum scale scores) were: 66.4 for the extra precaution scale, 52.3 for the fear of work-related HIV transmission, 49.4 for the lack of feelings of safety, 39.0 for the value-driven stigma, 37.4 for unethical treatment of PLHIV, 34.4 for discomfort around PLHIV and 31.1 for unofficial disclosure. Testing and disclosing test results without consent, designating HIV clients and unnecessary referral to other healthcare institutions and refusal to treat clients were identified. Having in-depth HIV knowledge, the perception of institutional support, attending training on stigma and discrimination, educational level of degree or higher, high HIV case loads, the presence of ART service in the healthcare facility and claiming to be non-religious were negative predictors of stigma and discrimination as measured by the seven latent factors. Conclusions: Higher levels of stigma and discrimination against PLHIV were associated with lack of in-depth knowledge on HIV and orientation about policies against stigma and discrimination. Hence, we recommend health managers to ensure institutional support through availing of clear policies and guidelines and the provision of appropriate training on the management of HIV/AIDS.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which affects all aspects of q... more Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which affects all aspects of quality of life (QoL) of the patients. Comprehensive patient assessment should include QoL measures in addition to the objective clinical measures of the disease. There is no specific Arabic instrument for assessment of QoL of SLE patients. The objective of this study was to translate and cross culturally adapt the SLEQOL questionnaire into Arabic and test its reliability and validity. The SLEQOL questionnaire was translated into Arabic based on the Guidelines for Translation and Cross-cultural Adaptation into other languages. Reliability was assessed by interviewing patients three times: two interviews on the same day by different interviewers and the third interview 14 days later by one of the first interviewers. Validity was assessed by correlating SLEQOL scores of 91 patients with 36-item Short Form Health Survey (SF-36) scores and clinical parameters of the patients. We found that the Arabic version of SLEQOL has a Cronbach's alpha of 0.936, interobserver and intraobserver correlation coefficients of 0.809 and 0.886 respectively. Strong correlations were also found between SLEQOL scores and SF-36 Physical and Mental Component summaries. In conclusion, the Arabic version of SLEQOL is a reliable and valid instrument for measuring QoL of Egyptian SLE patients. Lupus (2018) 0, 1-8.
The medicalization of FGM/C has been increasing significantly in Egypt making it the country with... more The medicalization of FGM/C has been increasing significantly in Egypt making it the country with the highest rate of medicalization. In this qualitative study, we explore the drivers and motives behind why health-care professionals perform FGM/C and why mothers rely on them to perform the practice on their daughters
Background Despite the observed decrease in female genital mutilation (FGM) prevalence, it is inc... more Background Despite the observed decrease in female genital mutilation (FGM) prevalence, it is increasingly being medicalized. We examined the attitudes of both parents towards the FGM practice in Egypt, and highlighted the effect of fathers’ decision making and attitudes towards FGM and violence on FGM practice and medicalization. Methods This study is a secondary analysis of Egypt Health Issues Survey (EHIS), 2015. The 2015 EHIS involved a systematic random selection of a subsample of 614 Shiakhas/villages out of the 884 shiakhas/villages that had been chosen as Primary Sampling Units in the 2014 EDHS. Descriptive statistics of the study sample and parents’ attitudes was performed. Three indices were created describing; mothers’ and fathers’ attitudes towards FGM, decision making and rejecting violence against women. Bivariate and multivariable analyses were conducted to identify predictors of FGM practice and medicalization. Results A considerable proportion of EHIS girls; 16.4% w...
ABSRRACT Background: parents face many barriers in feeding their children in a healthy way, and t... more ABSRRACT Background: parents face many barriers in feeding their children in a healthy way, and these perceived barriers may affect children's eating habits. Aim: this study aimed to investigate the existing barriers perceived by mothers in relation to the eating behaviors of their preparatory school children. Participants and Methods: four focus groups were conducted with mothers of students (N=30) at 3 preparatory girl schools in Assiut city. Focus group discussions (FGD) were conducted using a FGD guide. Analysis was conducted using Nvivo11 software. Results: the reported barriers to healthy eating among Egyptian population included personal barriers, family barriers, social barrier peer pressure, and community settings barrier. Family barriers included parents' dietary habits and taste preferences, mother's knowledge about healthy diet, mothers' working status and house chore commitment, and family socioeconomic conditions. Personal barriers included taste preferences, psychological changes of adolescence and sense of independence, adolescents' denial of the unhealthy nature of their preferred food, and culture and values. Conclusion: family and personal barriers were the main barriers to healthy eating behaviors perceived by mothers. Recommendation: the reported barriers to healthy eating from the mothers' perspective should be taken in consideration during construction of nutritional education program to improve its success.
Journal of the International Association of Providers of AIDS Care (JIAPAC)
HIV stigma among health care providers in the Arab world is understudied due to a lack of valid a... more HIV stigma among health care providers in the Arab world is understudied due to a lack of valid and reliable measures. Data from 352 Egyptian physicians was used to validate an Arabic version of the Health Care Provider HIV/AIDS Stigma Scale (HPASS). Exploratory factor analysis ( n = 1 9 4) suggested a 3 -factor structure. Confirmatory factor analysis ( n = 1 5 8) validated the three-factor solution with 18 items, which explained 5 3 .3 6% of the variance. All items loaded on their designated constructs, which ranged from 0 .58 to 0 .82 (prejudice) to 0 .58 to 0 .66 (stereotypes) and 0 .52 to 0 .91 (discrimination). The prejudice, stereotypes, and discrimination subscales consisted of seven, five, and six items, respectively. The internal consistency (α = 0 .9 0) and the test-retest reliability demonstrated ( r = 0 .9 5) were excellent. The cultural adaptation of the Arabic version of HPASS suggests that it is a suitable scale for assessing HIV stigma among Arab health care providers.
Background: HIV/AIDS is highly prevalent among youth. Inadequate knowledge and major misconceptio... more Background: HIV/AIDS is highly prevalent among youth. Inadequate knowledge and major misconceptions related to HIV/AIDS among adolescents/youth including university students would increase its transmission. Objective: to assess knowledge about HIV/AIDS and its determinants among Assiut University students. Method: A cross-sectional study was carried out on a representative sample of 776 students in Assiut University. A multistage stratified cluster sampling technique was used. A self-administered questionnaire was used to collect data. HIV/AIDs knowledge was assessed and a knowledge score was calculated. Results: Only 70.5% of Assiut University students have heard about AIDS. The main sources of the students’ knowledge were media (46.3%), internet (44.6%), school (28%), university educational courses and health education sessions (27.8%), friends (23.9%) and family (22.5%). The students in the study had a low knowledge score of 35 percent. Some misconceptions about transmission were...
The European Journal of Contraception & Reproductive Health Care, 2021
Objectives This study aims to assess pregnant women’s intention in rural Upper Egypt to use the c... more Objectives This study aims to assess pregnant women’s intention in rural Upper Egypt to use the copper-bearing intrauterine device (IUD) and to identify the factors influencing their intention to use the method. Methods The study was a household survey of 400 pregnant women in 16 villages in Assiut and Sohag Governorates in Upper Egypt. Results Only one third of the study participants (30.8%) had the intention to use IUD. Reasons of not intending to use IUD were; perceived pain during IUD insertion or removal (37.5%), perceived side effects (21.3%) and misconceptions (15.2%), husbands’ disapproval for using the method (15.8%) and the desire for future fertility (12.3%). Having a secondary or a higher level of education (OR (95% CI) = 1.726 (1.085–2.746), p = 0.01) and previous use of IUD (OR (95% CI) = 2.277 (1.108–4.678), p = 0.02) were the positive predictors of the intention to use IUD, while perception of husband opposition to IUD use (OR (95% CI) = 0.604 (0.379–0.964), p = 0.03...
The European Journal of Contraception & Reproductive Health Care, 2021
Objectives The aims of the study were to explore the contraceptive practices of married adolescen... more Objectives The aims of the study were to explore the contraceptive practices of married adolescent girls in rural Upper Egypt and identify the determinants of their ever use of modern contraception. Methods The study was a household survey of 729 married adolescent girls in 23 villages of two governorates in Upper Egypt. Listing and enumeration of all households in the selected villages were performed prior to data collection, to recruit married adolescent girls below 20 years of age. The girls were interviewed using a structured questionnaire. Results Only 6% of married adolescent girls were using a modern contraceptive method; 10.6% had ever used a modern contraceptive method, mostly a short-acting method. Considerable proportions of participants believed that using contraception would reduce a woman’s fertility and that women should not delay their first pregnancy (34% and 54.3%, respectively); only 50.2% believed that contraception could be used for birth spacing. Predictors of ...
Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, 2017
OBJECTIVES To assess the attitudes of physicians providing family planning services at the public... more OBJECTIVES To assess the attitudes of physicians providing family planning services at the public sector in Egypt about recommending intrauterine device (IUD) for family planning clients, and to identify the factors that could affect their attitudes. METHODS A descriptive cross sectional study, in which all the physicians providing family planning services in Assiut Governorate were invited to complete self-administered questionnaires. The study participants were recruited at the family planning sector monthly meetings of the 13 health directorates of Assiut Governorate, Upper Egypt. 250 physicians accepted to participate in the study. Bivariate and Multivariate regression analyses were performed to identify the most important predictors of recommending IUD to family planning clients when appropriate. RESULTS Less than 50% of physicians would recommend IUD for clients with proper eligibility criteria; women younger than 20 years old (49.2%), women with history of ectopic pregnancy (...
Background The etonogestrel implant Implanon is a favourable and cost-effective contraceptive met... more Background The etonogestrel implant Implanon is a favourable and cost-effective contraceptive method for women in developing countries, and expansion of its use represents a priority for the family planning (FP) programme in Egypt. We studied the factors affecting first-year Implanon discontinuation from clients' and providers' perspectives. Methods We used a mixed quantitative-qualitative methodology. We conducted a household survey of Implanon clients and three focus group discussions with FP physicians and directors. Results We found that 13.5% of Implanon users discontinued its use in the first year. Survival analysis found that clients who had previously used Implanon (HR 0.36, 95% CI 0.15 to 0.88) and whose husbands had secondary or a higher level of education (HR 0.36,95% CI 0.19 to 0.69) were less likely to discontinue Implanon use after the first year, while clients who experienced side effects of Implanon use were more likely to discontinue it (HR 3.6,95% CI 1.60 t...
The Population Council confronts critical health and development issues-from stopping the spread ... more The Population Council confronts critical health and development issues-from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world. Established in 1952, and headquartered in New York, the Council is a nongovernmental, nonprofit organization governed by an international board of trustees.
Background Provider bias is a main barrier that extensively violates the right of free family pla... more Background Provider bias is a main barrier that extensively violates the right of free family planning method choice. Egypt is one of the countries that shows skewness in its method mix. Provider bias and insufficiency of alternative methods are identified as potential factors underlying this phenomenon which contributes to high unmet needs and discontinuation rates. Provider bias may be influenced by cultural beliefs and societal trends and is usually overlooked as a possible cause of this skewed method mix. This study aims to explore the presence of provider bias in rural Upper Egypt and its potential causes, a community with conservative cultural beliefs and least contraceptive prevalence rates. Methods This is a qualitative study using the “simulated client’s approach.” The study was conducted in 16 villages in Assiut and Sohag governorates in Egypt. The simulated clients visited 30 clinics, 15 in each governorate, including primary healthcare units and private clinics. Three sc...
European Journal of Orthopaedic Surgery and Traumatology, Mar 22, 2023
Purpose To predict the most important preoperative factor affecting the patient satisfaction afte... more Purpose To predict the most important preoperative factor affecting the patient satisfaction after total knee arthroplasty (TKA) in trial to improve patient counselling process. Methods We retrospectively reviewed all patients who underwent primary TKA from January 1, 2018, to January 31, 2019, with minimum one-year follow-up for the previously collected patient-reported outcome measures (PROMs) as Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Outcome Score for joint replacement (KOOS, JR) preoperative, 6 months and 12 months postoperative. Results By using Oxford knee score at 12 months as dependent variable, we found a negative moderate spearman correlation between age and Oxford knee score at 12 months postoperative. Moderate negative spearman correlation was also found between Oxford knee score at 12 months postoperative and KOOS pain, stiffness and function scores at preoperative and 6 months postoperative, denoting higher satisfaction at 12 months with less perceived stiffness, pain and limited function at baseline and 6 months postoperative. A multivariate regression analysis was done using the oxford knee score at 12 months as dependent variable to detect the predictors of oxford knee score at 12 months postoperatively and showed that younger age and less perception of stiffness at baseline were significant predictors of higher Oxford knee score: higher satisfaction at 12 months postoperative. Conclusion Preoperative stiffness can predict the postoperative satisfaction score more than any other factor. We also address the importance of combining more than one PROM in assessing patients as OKS and KOOS, JR.
Background The early childhood period is considered the most important developmental phase in an ... more Background The early childhood period is considered the most important developmental phase in an individual's lifespan. However, it is not addressed in the Egyptian health system. We aimed to explore mothers' and healthcare providers' perceptions about early childhood development (ECD) and identify their needs to support ECD in Egypt. Methods Focus group discussions with 79 mothers of children younger than 2 years old from different socioeconomic backgrounds and residing in urban and rural areas and 26 primary healthcare providers were used to collect data. Emerging themes and subthemes were identified from the data analysis. Results Urban and rural mothers in Egypt of all educational levels are not well prepared to support their children's early development, especially the cognitive and emotional aspects. Limited sources of information about ECD, the large families of rural women and an absence of developmental health services and family support were the most important factors that led to a neglect of motherchild communication and stimulation. Conclusion Raising community awareness and training primary healthcare providers to counsel mothers about ECD are important prerequisites for supporting ECD in Egypt. Rural and first-time mothers would be the most valuable starting point.
To explore the attitude of health care providers about screening for and dealing with domestic vi... more To explore the attitude of health care providers about screening for and dealing with domestic violence in the health care setting and to assess the physicians screening behavior. Methods: We surveyed physicians and nurses working in different departments of Assiut University Hospital using a self-administered questionnaire. Two focus group discussions with physicians and nurses were also conducted. Results: 44.3% and 46.5% of physicians and nurses mentioned time constraints as a barrier for DV screening. Physicians believed that it is not important to screen for DV because it is a socially accepted problem and because of the unavailability of the necessary referrals to help victims (30.2% and 20.0%, respectively). The unsuitability of the outpatient clinics to screen for DV was also mentioned by 65.6% and 75.5% of physicians and nurses respectively. Only 36.7% of physicians perceived having the communication skills to facilitate disclosure of DV exposure. Regarding practice, only 35.0% of physicians have screened for DV in the three months preceding data collection. Urban residence, perception of the negative health consequence of DV exposure and perception of the physicians to have the required communication skills predicted positive attitude towards DV screening, while feeling distressed to discuss exposure to DV was associated with negative physicians' attitude. Conclusion: In-service training of health care providers to identify and manage victims of DV and establishing supportive system would have great implications for reducing the physical and mental negative consequences of DV exposure.
Purpose to predict the most important preoperative factor affecting the patient satisfaction afte... more Purpose to predict the most important preoperative factor affecting the patient satisfaction after total Knee arthroplasty (TKA) in trial to improve patient counselling process. Methods we retrospectively reviewed all patients who underwent primary TKA from 1st of January 2018 to 31st of January 2019 with minimum one year follow up for the previously collected patient reported outcome measures (PROMs) as Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Outcome Score for joint replacement (KOOS, JR) preoperative, 6 months and 12 months postoperative. Results By using Oxford knee score at 12 months as dependent variable, we found a negative moderate spearman correlation between age and oxford score at 12 months postoperative. Moderate negative spearman correlation was also found between oxford score at 12 months postoperative and KOOS pain, stiffness and function scores at preoperative and 6 months postoperative, denoting higher satisfaction at 12 months with less perceived ...
The Focus Group Discussion and In-depth Interview Guides file includes the English language versi... more The Focus Group Discussion and In-depth Interview Guides file includes the English language version of the guides that were designed specifically for the purpose of this study and were tailored for mothers as well as nurses and doctors to understand their perceptions pertaining to the medicalization of FGM/C. (DOCX 18 kb)
The Population Council confronts critical health and development issues-from stopping the spread ... more The Population Council confronts critical health and development issues-from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world. Established in 1952, and headquartered in New York, the Council is a nongovernmental, nonprofit organization governed by an international board of trustees.
Background: Stigma and discrimination against people living with human immunodeficiency virus (HI... more Background: Stigma and discrimination against people living with human immunodeficiency virus (HIV) are obstacles in the way of effective responses to HIV. Understanding the extent of stigma / discrimination and the underlying causes is necessary for developing strategies to reduce them. This study was conducted to explore stigma and discrimination against PLHIV amongst healthcare providers in Jimma zone, Southwest Ethiopia. Methods: A cross-sectional study, employing quantitative and qualitative methods, was conducted in 18 healthcare institutions of Jimma zone, during March 14 to April 14, 2011. A total of 255 healthcare providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support and HIV-related stigma and discrimination. Factor analysis was employed to create measurement scales for stigma and factor scores were used in one way analysis of variance (ANOVA), T-tests, Pearson's correlation and multiple linear regression analyses. Qualitative data collected using key-informant interviews and Focus Group Discussions (FGDs) were employed to triangulate with the findings from the quantitative survey. Results: Mean stigma scores (as the percentages of maximum scale scores) were: 66.4 for the extra precaution scale, 52.3 for the fear of work-related HIV transmission, 49.4 for the lack of feelings of safety, 39.0 for the value-driven stigma, 37.4 for unethical treatment of PLHIV, 34.4 for discomfort around PLHIV and 31.1 for unofficial disclosure. Testing and disclosing test results without consent, designating HIV clients and unnecessary referral to other healthcare institutions and refusal to treat clients were identified. Having in-depth HIV knowledge, the perception of institutional support, attending training on stigma and discrimination, educational level of degree or higher, high HIV case loads, the presence of ART service in the healthcare facility and claiming to be non-religious were negative predictors of stigma and discrimination as measured by the seven latent factors. Conclusions: Higher levels of stigma and discrimination against PLHIV were associated with lack of in-depth knowledge on HIV and orientation about policies against stigma and discrimination. Hence, we recommend health managers to ensure institutional support through availing of clear policies and guidelines and the provision of appropriate training on the management of HIV/AIDS.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which affects all aspects of q... more Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which affects all aspects of quality of life (QoL) of the patients. Comprehensive patient assessment should include QoL measures in addition to the objective clinical measures of the disease. There is no specific Arabic instrument for assessment of QoL of SLE patients. The objective of this study was to translate and cross culturally adapt the SLEQOL questionnaire into Arabic and test its reliability and validity. The SLEQOL questionnaire was translated into Arabic based on the Guidelines for Translation and Cross-cultural Adaptation into other languages. Reliability was assessed by interviewing patients three times: two interviews on the same day by different interviewers and the third interview 14 days later by one of the first interviewers. Validity was assessed by correlating SLEQOL scores of 91 patients with 36-item Short Form Health Survey (SF-36) scores and clinical parameters of the patients. We found that the Arabic version of SLEQOL has a Cronbach's alpha of 0.936, interobserver and intraobserver correlation coefficients of 0.809 and 0.886 respectively. Strong correlations were also found between SLEQOL scores and SF-36 Physical and Mental Component summaries. In conclusion, the Arabic version of SLEQOL is a reliable and valid instrument for measuring QoL of Egyptian SLE patients. Lupus (2018) 0, 1-8.
The medicalization of FGM/C has been increasing significantly in Egypt making it the country with... more The medicalization of FGM/C has been increasing significantly in Egypt making it the country with the highest rate of medicalization. In this qualitative study, we explore the drivers and motives behind why health-care professionals perform FGM/C and why mothers rely on them to perform the practice on their daughters
Background Despite the observed decrease in female genital mutilation (FGM) prevalence, it is inc... more Background Despite the observed decrease in female genital mutilation (FGM) prevalence, it is increasingly being medicalized. We examined the attitudes of both parents towards the FGM practice in Egypt, and highlighted the effect of fathers’ decision making and attitudes towards FGM and violence on FGM practice and medicalization. Methods This study is a secondary analysis of Egypt Health Issues Survey (EHIS), 2015. The 2015 EHIS involved a systematic random selection of a subsample of 614 Shiakhas/villages out of the 884 shiakhas/villages that had been chosen as Primary Sampling Units in the 2014 EDHS. Descriptive statistics of the study sample and parents’ attitudes was performed. Three indices were created describing; mothers’ and fathers’ attitudes towards FGM, decision making and rejecting violence against women. Bivariate and multivariable analyses were conducted to identify predictors of FGM practice and medicalization. Results A considerable proportion of EHIS girls; 16.4% w...
ABSRRACT Background: parents face many barriers in feeding their children in a healthy way, and t... more ABSRRACT Background: parents face many barriers in feeding their children in a healthy way, and these perceived barriers may affect children's eating habits. Aim: this study aimed to investigate the existing barriers perceived by mothers in relation to the eating behaviors of their preparatory school children. Participants and Methods: four focus groups were conducted with mothers of students (N=30) at 3 preparatory girl schools in Assiut city. Focus group discussions (FGD) were conducted using a FGD guide. Analysis was conducted using Nvivo11 software. Results: the reported barriers to healthy eating among Egyptian population included personal barriers, family barriers, social barrier peer pressure, and community settings barrier. Family barriers included parents' dietary habits and taste preferences, mother's knowledge about healthy diet, mothers' working status and house chore commitment, and family socioeconomic conditions. Personal barriers included taste preferences, psychological changes of adolescence and sense of independence, adolescents' denial of the unhealthy nature of their preferred food, and culture and values. Conclusion: family and personal barriers were the main barriers to healthy eating behaviors perceived by mothers. Recommendation: the reported barriers to healthy eating from the mothers' perspective should be taken in consideration during construction of nutritional education program to improve its success.
Journal of the International Association of Providers of AIDS Care (JIAPAC)
HIV stigma among health care providers in the Arab world is understudied due to a lack of valid a... more HIV stigma among health care providers in the Arab world is understudied due to a lack of valid and reliable measures. Data from 352 Egyptian physicians was used to validate an Arabic version of the Health Care Provider HIV/AIDS Stigma Scale (HPASS). Exploratory factor analysis ( n = 1 9 4) suggested a 3 -factor structure. Confirmatory factor analysis ( n = 1 5 8) validated the three-factor solution with 18 items, which explained 5 3 .3 6% of the variance. All items loaded on their designated constructs, which ranged from 0 .58 to 0 .82 (prejudice) to 0 .58 to 0 .66 (stereotypes) and 0 .52 to 0 .91 (discrimination). The prejudice, stereotypes, and discrimination subscales consisted of seven, five, and six items, respectively. The internal consistency (α = 0 .9 0) and the test-retest reliability demonstrated ( r = 0 .9 5) were excellent. The cultural adaptation of the Arabic version of HPASS suggests that it is a suitable scale for assessing HIV stigma among Arab health care providers.
Background: HIV/AIDS is highly prevalent among youth. Inadequate knowledge and major misconceptio... more Background: HIV/AIDS is highly prevalent among youth. Inadequate knowledge and major misconceptions related to HIV/AIDS among adolescents/youth including university students would increase its transmission. Objective: to assess knowledge about HIV/AIDS and its determinants among Assiut University students. Method: A cross-sectional study was carried out on a representative sample of 776 students in Assiut University. A multistage stratified cluster sampling technique was used. A self-administered questionnaire was used to collect data. HIV/AIDs knowledge was assessed and a knowledge score was calculated. Results: Only 70.5% of Assiut University students have heard about AIDS. The main sources of the students’ knowledge were media (46.3%), internet (44.6%), school (28%), university educational courses and health education sessions (27.8%), friends (23.9%) and family (22.5%). The students in the study had a low knowledge score of 35 percent. Some misconceptions about transmission were...
The European Journal of Contraception & Reproductive Health Care, 2021
Objectives This study aims to assess pregnant women’s intention in rural Upper Egypt to use the c... more Objectives This study aims to assess pregnant women’s intention in rural Upper Egypt to use the copper-bearing intrauterine device (IUD) and to identify the factors influencing their intention to use the method. Methods The study was a household survey of 400 pregnant women in 16 villages in Assiut and Sohag Governorates in Upper Egypt. Results Only one third of the study participants (30.8%) had the intention to use IUD. Reasons of not intending to use IUD were; perceived pain during IUD insertion or removal (37.5%), perceived side effects (21.3%) and misconceptions (15.2%), husbands’ disapproval for using the method (15.8%) and the desire for future fertility (12.3%). Having a secondary or a higher level of education (OR (95% CI) = 1.726 (1.085–2.746), p = 0.01) and previous use of IUD (OR (95% CI) = 2.277 (1.108–4.678), p = 0.02) were the positive predictors of the intention to use IUD, while perception of husband opposition to IUD use (OR (95% CI) = 0.604 (0.379–0.964), p = 0.03...
The European Journal of Contraception & Reproductive Health Care, 2021
Objectives The aims of the study were to explore the contraceptive practices of married adolescen... more Objectives The aims of the study were to explore the contraceptive practices of married adolescent girls in rural Upper Egypt and identify the determinants of their ever use of modern contraception. Methods The study was a household survey of 729 married adolescent girls in 23 villages of two governorates in Upper Egypt. Listing and enumeration of all households in the selected villages were performed prior to data collection, to recruit married adolescent girls below 20 years of age. The girls were interviewed using a structured questionnaire. Results Only 6% of married adolescent girls were using a modern contraceptive method; 10.6% had ever used a modern contraceptive method, mostly a short-acting method. Considerable proportions of participants believed that using contraception would reduce a woman’s fertility and that women should not delay their first pregnancy (34% and 54.3%, respectively); only 50.2% believed that contraception could be used for birth spacing. Predictors of ...
Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, 2017
OBJECTIVES To assess the attitudes of physicians providing family planning services at the public... more OBJECTIVES To assess the attitudes of physicians providing family planning services at the public sector in Egypt about recommending intrauterine device (IUD) for family planning clients, and to identify the factors that could affect their attitudes. METHODS A descriptive cross sectional study, in which all the physicians providing family planning services in Assiut Governorate were invited to complete self-administered questionnaires. The study participants were recruited at the family planning sector monthly meetings of the 13 health directorates of Assiut Governorate, Upper Egypt. 250 physicians accepted to participate in the study. Bivariate and Multivariate regression analyses were performed to identify the most important predictors of recommending IUD to family planning clients when appropriate. RESULTS Less than 50% of physicians would recommend IUD for clients with proper eligibility criteria; women younger than 20 years old (49.2%), women with history of ectopic pregnancy (...
Background The etonogestrel implant Implanon is a favourable and cost-effective contraceptive met... more Background The etonogestrel implant Implanon is a favourable and cost-effective contraceptive method for women in developing countries, and expansion of its use represents a priority for the family planning (FP) programme in Egypt. We studied the factors affecting first-year Implanon discontinuation from clients' and providers' perspectives. Methods We used a mixed quantitative-qualitative methodology. We conducted a household survey of Implanon clients and three focus group discussions with FP physicians and directors. Results We found that 13.5% of Implanon users discontinued its use in the first year. Survival analysis found that clients who had previously used Implanon (HR 0.36, 95% CI 0.15 to 0.88) and whose husbands had secondary or a higher level of education (HR 0.36,95% CI 0.19 to 0.69) were less likely to discontinue Implanon use after the first year, while clients who experienced side effects of Implanon use were more likely to discontinue it (HR 3.6,95% CI 1.60 t...
The Population Council confronts critical health and development issues-from stopping the spread ... more The Population Council confronts critical health and development issues-from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world. Established in 1952, and headquartered in New York, the Council is a nongovernmental, nonprofit organization governed by an international board of trustees.
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Papers by Mirette Aziz