Nazar P Shabila
@cue.edu.krd
College of Health Sciences
Catholic University in Erbil
Nazar P Shabila has MSc degree in Public Health in Developing Countries from London School of Hygiene and Tropical Medicine and PhD in Community Medicine from Hawler Medical University. He is professor of public health at Catholic University in Erbil, Erbil, Iraq. He teaches different courses including epidemiology of communicable disease, health economics, health information and demography. He has more than 75 publications. His current research work is mainly related to health services research, women’s and reproductive health and conflict and health. Before pursuing the academic career, he established seven years of experience in the humanitarian relief field through working with the ICRC and UNOPS-IDPs Project on addressing the needs of the internally displaced people.
EDUCATION
PhD Community Health
MSc Public Health in Developing Countries
MBChB
RESEARCH INTERESTS
Conflict and Health, Health services research, Communicable diseases, Women's Health
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Aryan R. Ganjo, Salah Tofik Jalal Balaky, Ahang Hasan Mawlood, Sakar B. Smail, and Nazar P. Shabila
Springer Science and Business Media LLC
Abstract Background Escherichia coli (E. coli) is a multidrug resistant opportunistic pathogen that can cause secondary bacterial infections in patients with COVID-19. This study aimed to determine the antimicrobial resistance profile of E. coli as a secondary bacterial infection in patients with COVID-19 and to assess the prevalence and characterization of genes related to efflux pumps and porin. Methods A total of 50 nonduplicate E. coli isolates were collected as secondary bacterial infections in COVID-19 patients. The isolates were cultured from sputum samples. Confirmation and antibiotic susceptibility testing were conducted by Vitek 2. PCR was used to assess the prevalence of the efflux pump and porin-related genes in the isolates. The phenotypic and genotypic evolution of antibiotic resistance genes related to the efflux pump was evaluated. Results The E. coli isolates demonstrated high resistance to ampicillin (100%), cefixime (62%), cefepime (62%), amoxicillin-clavulanic acid (60%), cefuroxime (60%), and ceftriaxone (58%). The susceptibility of E. coli to ertapenem was greatest (92%), followed by imipenem (88%), meropenem (86%), tigecycline (80%), and levofloxacin (76%). Regarding efflux pump gene combinations, there was a significant association between the acrA gene and increased resistance to levofloxacin, between the acrB gene and decreased resistance to meropenem and increased resistance to levofloxacin, and between the ompF and ompC genes and increased resistance to gentamicin. Conclusions The antibiotics ertapenem, imipenem, meropenem, tigecycline, and levofloxacin were effective against E. coli in patients with COVID-19. Genes encoding efflux pumps and porins, such as acrA, acrB, and outer membrane porins, were highly distributed among all the isolates. Efflux pump inhibitors could be alternative antibiotics for restoring tetracycline activity in E. coli isolates.
Sherzad A. Shabu, Mariwan H. Saka, Manhal N. Boya, Hamdia M. Ahmed, Sahar M. Zaki, Florentina Hettinga, and Nazar P. Shabila
Springer Science and Business Media LLC
Abstract Background The misperception of body weight can significantly affect individuals' health behaviors, such as physical activity, diet, and weight management. This study aimed to examine the association between body weight perception and actual body mass index (BMI) among adult women and explore the factors influencing this relationship. Methods Five hundred forty female individuals aged 18–65 participated in this cross-sectional study. The validated Global Physical Activity Questionnaire was used for data collection. The BMI of the participants was calculated from measured body weight and height. Body weight perception was assessed using a single questionnaire item. The association of BMI and body weight perception was assessed, and the result was categorized as underestimation, consistency, and overestimation. The Chi-square test was used to assess the association between the consistency of BMI and body weight perception by different sociodemographic factors. The kappa test was used to analyze the consistency of BMI and body weight perception. Results Of the 540 participants, 13.3% underestimated their body weight status, 79.1% accurately perceived their body weight status, and 7.6% overestimated their body weight status. Unmarried women (11.7%) were more likely than ever married (4.3%) to overestimate their body weight (p = 0.005). On multiple logistic regression, being unmarried (OR = 1.68 (95%CI 1.01–2.80)) was significantly associated with body weight misperception. Body weight perception and BMI categories showed a significantly good consistency (kappa = 0.612, p < 0.001). Correct perception of body weight was highest among the overweight, followed by normal weight and underweight individuals (82.1%, 75.8%, and 72.2%, respectively). Conclusion Body weight perception was well associated with actual body weight status. Unmarried women are more likely to misperceive body weight, particularly overestimating it. Underestimation of body weight was relatively high and much higher than the overestimation, which might keep obese individuals from weight loss activities. Preventing obesity should include awareness about body weight misperceptions.
Gashaw Khalid, Abubakir Majeed Saleh, Nazar Shabila, Malin Bogren, and Delér Shakely
Springer Science and Business Media LLC
Abstract Background Unsafe abortion is a major contributor to maternal morbidity and mortality in countries where induced abortion is restricted. In Kurdistan Region of Iraq, induced abortion is strictly forbidden except for life-threatening situations, increasing the risk of seeking unsafe abortions. Attitudes among healthcare professionals who directly encounter cases and consequences of induced abortion can be studied to improve women’s access to safe abortion. This study aimed to examine attitudes towards induced abortion among gynecologists in Kurdistan Region of Iraq. Methods This cross-sectional facility-based study was conducted in the first quarter of 2022 in Kurdistan Region of Iraq in the cities of Erbil, Sulaymaniyah, and Duhok. Convenient sampling was used to invite 330 gynecologists to participate, with 171 ultimately completing the questionnaire, giving a response rate of 53%. Questionaries using the Taylor and Whitehead abortion attitude scale were sent in person or digitally. The data was then analyzed using Chi-square and Fisher’s exact tests to determine the independence of attitudes and associations between attitudes and sociodemographic factors. Results Among 171 gynecologists, 25% of the gynecologists agreed that induced abortion is unacceptable under any circumstances. Most (71%) disagreed that a woman has the right to choose to have an induced abortion. Around 51% considered induced abortion murder, and 41% agreed that induced abortion goes against all morals. Around 57% disagreed with the legalization of induced abortion, while 43% agreed. Gynecologists who were unmarried (P = 0.025), under the age of 40 (P = 0.044), and with less than 10 years of clinical experience (P = 0.043) were more likely to support the legalization of induced abortion in Kurdistan Region. None of the variables was found to be independently associated with attitudes towards abortion legalization. Conclusions Despite some younger gynecologists having more favorable attitudes towards induced abortion, most gynecologists in Kurdistan Region had less favorable views. Most gynecologists were willing to provide post-abortion care regardless of their legal status. We recommend conducting more studies to investigate the consequences of current abortion legislation among women in need of induced abortion in Kurdistan Region of Iraq.
Sherzad A. Shabu, Mariwan H. Saka, Dara A. Al-Banna, Sahar M. Zaki, Hamdia M. Ahmed, and Nazar P. Shabila
Springer Science and Business Media LLC
Abstract Background Limited research has investigated the barriers to physical exercise among women in Iraqi Kurdistan Region and other similar Muslim and Middle Eastern societies. This study aimed to determine the prevalence of perceived barriers to physical exercise among women and examine the associations of these barriers with the participants’ sociodemographic characteristics. Methods A cross-sectional study was carried out in Erbil, Iraqi Kurdistan Region, from December 2022 to January 2023. A self-administered online survey was designed using Google Forms. A convenience sample of 500 women and girls aged 18–65 years was selected for the study. A questionnaire was designed for data collection, including a list of 21 potential barriers to physical exercise developed based on literature review and experts’ opinions. The barriers were divided into three categories: interpersonal (8 barriers), social environment (8 barriers), and built environment factors (5 barriers). The participants were asked to indicate for each potential barrier whether it was “not really a barrier, somewhat a barrier, or a very important barrier.“ The statistical package for social sciences was used to estimate the prevalence of different barriers and assess their association with sociodemographic characteristics using the Chi-square test. Results The prevalence of physical inactivity among the study participants was 68.2%. The most prevalent interpersonal barriers to physical exercise included lack of time (47.4%), followed by fatigue (24%), and cost (22.4%). Regarding social environment factors, work (30.6%), harassment outside (22.2%), not having a friend or family member accompanying (19%), and not being allowed by family (15.4%) were the most prevalent barriers to physical exercise. Lack of footpaths, cycle lanes, or parks (34.4%), limited accessibility of gyms or other exercise facilities (25.8%), and environmental pollution (21%) were the most prevalent built environment factors as barriers to physical exercise. Conclusion Women in Iraqi Kurdistan Region experience many barriers to physical exercise. Women require family and social support and awareness about exercise benefits to overcome interpersonal and social environment barriers to physical exercise. Built environment factors are very important barriers and can be reduced by taking appropriate action and adopting necessary policies to provide the required infrastructure and facilities for physical exercise.
Karwan M-Amen, Sherzad A Shabu, Kazhan I Mahmood, and Nazar P Shabila
Journal of Infection in Developing Countries
Introduction: Human perceptions and behavioural responses to the risk of epidemics have always been crucial factors in studying and containing disease spread. This study aims to assess and understand the risk perception and the behavioural response of a sample of the population in the Kurdistan Region toward COVID-19. Methodology: A self-administered online survey (designed on Google Forms) was designed to get a rapid appraisal of the risk perception and behavioural response of people living in the Iraqi Kurdistan Region about COVID-19 from 17–25 November 2020. Results: A total of 390 individuals responded to the survey. Many respondents (65.6%) recognized COVID-19 as a high or very high threat level. The most frequently applied protective behaviours included avoiding spitting on the ground (76.2%), avoiding contacting ill persons (75.9%) and wearing face masks (75.6%). The main source of information about COVID-19 was Internet news (46.2%), followed by social media (44.9%). Significantly higher perceptions of the threat of COVID-19 were found among females (p = 0.004) and those having family members with chronic diseases (p < 0.001). Conclusions: Understanding the general public’s risk perception toward the COVID-19 infection is essential for determining effective protective measures and can be used to guide proper preventive behaviour.
Banaz A. Saeed, Saween K. Ismael, Redar Muhmed Amin, Nasraw Mustafa Mahmud, Dara A. Al-Banna, and Nazar P. Shabila
Public Library of Science (PLoS)
Background The COVID-19 pandemic and its prevention and control measures, such as social distancing, self-isolation, and quarantine, have a negative impact on the population’s mental health. This study aimed to determine the prevalence of anxiety and stress among the general population during the outbreak of COVID-19 and assess their associated factors. Methods We carried out a cross-sectional study in Erbil governorate, Iraqi Kurdistan Region, from July 18 to September 12, 2020. We used an online survey questionnaire to collect data from a sample of Erbil population. The 10-items Perceived Stress Scale and the 7-item Generalized Anxiety Disorder scale were used to measure the levels of stress and anxiety. Results A total of 851 persons responded to the survey. The prevalence of moderate and high perceived stress was 59.6% and 16.6%, respectively. The prevalence of moderate and severe anxiety was 24.7% and 22.7%, respectively. Age, gender, economic level, having contact with COVID-19 patients, and following COVID-19 news were independent variables significantly associated with stress levels. Age, gender, economic level, employment status, having symptoms of COVID-19, having contact with COVID-19 patients, and following COVID-19 news were independent variables significantly associated with anxiety levels. Conclusion A high proportion of people experienced stress and anxiety during the COVID-19 outbreak in Erbil, Iraqi Kurdistan Region. Females, younger age, poor, and unemployed reported significantly higher stress and anxiety levels. There is a need to establish mechanisms at the population level to decrease the stress and anxiety risks and provide mental health coping measures in times of crisis, such as education about positive thinking, stress management programs, and the role of social support.
Abubakir Saleh and Nazar P. Shabila
Australasian College of Health Service Management
Background: Pfizer-BioNTech vaccine was one of the first vaccines developed for COVID-19 to be used in Iraq. While the benefits of the vaccine outweigh the risks, potential side effects remain major concerns for people and can increase vaccine hesitancy despite usually being short-lasting and mild. This study aimed to evaluate the side effects of Pfizer-BioNTech vaccination among vaccinated adults in Erbil city, Iraq. Methods: A cross-sectional study was carried out with a convenience sample of 401 subjects who received the Pfizer vaccine in nine public healthcare centres in Erbil, Iraq, on February 20th, 2022, and April 17th 2022. Data was collected through interviews with the patients using a questionnaire designed by the researchers; a p-value ≤ 0.05 was considered statistically significant. Results: The prevalence of side effects was 84.4%. Among participants who experienced side effects, the most common was pain at the injection site (93.1% for the first dose and 88% for the second dose). For the first dose, the onset of side effects on the vaccination day (day zero) was reported by 78.9% of those experiencing side effects, and the duration was one day for 45.4% of participants. Severity was rated as mild by 54.3%, and similar results were found for the second dose. Analgesics were used following the first dose by 47% of participants, which resulted in good relief for 96.6% of patients using them, and similar results were found for the second dose. Conclusions: Most participants who received the Pfizer-BioNTech vaccine experienced side effects, the most common of which was pain at the injection site, which was reported for both the first and second doses.
Intisar Malik, Sherzad Abdulahad, Abubakir Saleh, and Nazar Shabila
Australasian College of Health Service Management
Background: Employees require an appropriate working environment that helps them work without problems limiting their performance. Objective: This study aimed to assess the perspectives of the employees at the Ministry of Health in the Iraqi Kurdistan Region regarding their work environment and satisfaction with the various aspects of work. Methods: This self-administered questionnaire survey involved 109 employees from the Ministry of Health in Erbil, Iraqi Kurdistan Region. A questionnaire containing different questions about the work environment and work satisfaction was used to assess employees' perspectives about their working environment. Results: The participants thought that the sense of preserving public money and materials and feeling responsible among employees is low. The employees were not much satisfied with the relations between managers and employees. Most participants thought that improving the financial situation would affect the employees' capacity (96.3%) and that implementing modern systems, equipment, and programs would improve protection (84.4%). Most participants were satisfied with their workplace (71.6%) and thought their education was relevant to their work (73.4%). They emphasizedthe importance of making employees feel responsible, providing training courses, and improving the services and work facilities to improve the working conditions. Conclusion: Low work awareness and commitment exist among employees. The working environment was an important factor in the job satisfaction of employees.
M. Haje, A. S. Jamil, Nazar Polis Shabila and Danar Darsim Jawad
This study aimed to determine the outcomes of intracytoplasmic sperm injection (ICSI) if oocyte retrieval was done 32–34 hours or 34:05–36 hours after human chorionic gonadotropin (hCG) injection. A randomized sample involving 186 patients with tubal failure was divided into groups A (96 patients) and B (90 patients). Intracytoplasmic sperm injection was performed on all patients according to described protocols. The number of oocytes retrieved, oocyte cumulus complex quality, number of fertilized eggs, and pregnancy rates were compared between groups. The total of oocytes retrieved in group B was significantly higher than in group A but not significant (P=0.068). The oocyte maturation rate was also significantly higher in the long interval group B than in the short interval group A (P=0.039). There was a significant difference between the two groups in terms of fertilization rate (0.040), and the pregnancy rate in group B was higher than that in group A, but it was not significant (P=0.055). The prolonged interval could also increase the pregnancy rate, but it was not significant. It seems that if the interval between hCG priming and oocyte retrieval is prolonged, the percentage of the number of oocytes retrieved, mature oocytes (MII), and fertilized oocytes increases.
Abubakir M. Saleh, Samir M. Othman, Kameran H. Ismail, and Nazar P. Shabila
Springer Science and Business Media LLC
Abstract Background and objective Early marriage is prevalent in Iraq, but the factors related to this behavior, especially people's attitudes about it, have not been well studied. It has been proven that early marriage seriously threatens young girls' lives and health. This study aimed to explore the perception of people about early marriage in the Iraqi Kurdistan region. Methods A qualitative method was employed to carry out this study in 2020. Data were collected through 16 focus group discussions in different health centers in Erbil, Iraq. Each focus group included 8–12 participants who had the experience of early marriage. The transcripts of the focus groups were analyzed through the six methodological activities of Van Manen. The trustworthiness of the data was confirmed by using qualitative data evaluation criteria. Results Different themes and subthemes regarding the ideal age of marriage, attitudes toward marriage, reasons for early marriage, advantages and disadvantages of early marriage, and practice of early marriage in the community emerged from focus group discussions. Most participants identified early marriage as inappropriate social behavior that should not be practiced. Reasons for early marriage included poor economic status, protection of girls and boys, low educational level, and respect for old traditions of the community. Divorce and violence against women were the main disadvantages of early marriage. Conclusion There is a generally negative attitude towards early marriage, and the practice's disadvantages and health and psychological consequences are well recognized in Iraqi Kurdistan Region. However, different social, traditional, economic, educational, and religious factors encourage early marriage in the region. Further research is recommended in other governorates in the area to have a more precise and representative idea about the topic.
Benjamin Schmid, Éimhín Ansbro, Emmanuel Raju, Ruth Willis, Nazar Shabila, and Pablo Perel
Springer Science and Business Media LLC
AbstractNon-communicable diseases (NCDs) are the leading cause of death and disability globally. Their importance in humanitarian settings is increasingly recognised, but evidence about how best to address NCDs in these setting is limited. This scoping review aimed to explore models of NCD care for displaced populations in Iraq, in order to build evidence to design context adapted models of care. A search of key databases (Medline, Embase, Scopus, EconLit, Global Health, Web of Science, and the Iraqi Academic Scientific Journals) was conducted and complemented with grey literature and snowballing searches. Documents were included if they referred to models of NCD care for displaced populations. We synthesised the data using a conceptual model of care framework. The findings were reported according to the PRISMA guidelines for scoping reviews. We identified 4036 documents of which 22 were eligible for inclusion. Only six documents were peer-reviewed studies with most being internal reports, commentaries, or press releases. Of the 14 documents that reported on their methods, most applied quantitative approaches (n = 7), followed by mixed-methods (n = 5) and qualitative approaches (n = 2). Only one document reported on outcome data and none applied longitudinal study designs. Documents generally described individual framework dimensions, mostly centring around medicines, facility-based services, and selected access dimensions. Most dimensions had few or no references. The most common model for displaced populations in Iraq was primary-level centred care that complemented or supported existing—mostly tertiary—public health system structures. Additionally, private facilities played an important role and were frequently accessed by displaced populations in most settings. Quality of care, particularly patient-perceived quality, emerged as a critical factor for designing context-adapted models of NCD care. This review also identified a strong regionality of NCD care, particularly in terms of access rates and barriers. We concluded that there is a scarcity of evidence on the effectiveness of models of NCD care for displaced populations in Iraq, calling for capacity building initiatives focused on implementation research and evaluation.
Shahla K. Alalaf, Tarek Mohamed M. Mansour, Sileem Ahmad Sileem, and Nazar P. Shabila
Springer Science and Business Media LLC
Abstract Background There is a lack of reliable methods to estimate the risk of uterine rupture or dehiscence during a trial of labor in women with previous cesarean sections. This study aimed to assess the lower uterine segment and myometrial thickness by ultrasonography in women with previous cesarean sections during labor and assess their association with the uterine defect. Methods A cross-sectional study was conducted on 161 women in the active phase of labor having one previous cesarean section. The study was conducted et al.-Azhar University Hospital, Assiut City, Egypt, from March 2018 to March 2019. Ultrasound measurements of lower uterine segment thickness and myometrial thickness were conducted by vaginal and abdominal ultrasound by two observers. The correlation of both thicknesses with the uterine defect was analyzed. Results Uterine defects were reported in 42 women (25.9%), uterine rupture in four women (2.5%), and dehiscence in 38 women (23.5%). The uterine defects were not associated with maternal factors (maternal age, gestational age at labor, body mass index, birth weight, interpregnancy, and inter-delivery interval). Receiver operating curve analysis demonstrated that lower uterine segment thickness was linked with uterine defect, with an area under the curve of 60% (95% CI, 51–70%, P = 0.044). Myometrial thickness was also linked to the uterine defect, with an area under the curve of 61% (95% CI, 52–71%, P = 0.025). Full lower uterine segment thickness of 2.3 mm and myometrial thickness of 1.9 mm were the cutoff value with the best combination of sensitivity and specificity for the uterine defect. Lower uterine segment thickness (OR = 0.49, 95%CI 0.24–0.96) and myometrial thickness (OR = 0.44, 95%CI 0.20–0.94) were significantly associated with the uterine defect. Lower uterine segment thickness (OR = 0.41, 95%CI 0.22–0.76) and myometrial thickness (OR = 0.33, 95%CI 0.16–0.66) were also significantly associated with cesarean section delivery. Conclusion A lower uterine segment thickness of 2.3 mm and myometrial thickness of 1.9 mm during the first stage of labor are associated with a high risk of uterine defects during a labor trial. These measurements during labor can have a practical application in deciding the mode of delivery in women with previous cesarean sections and might reduce uterine rupture.
Kazhan I. Mahmood, Sherzad A. Shabu, Karwan M-Amen, Abubakir M. Saleh, Hamdia Ahmed, Barzhang Q. Mzori, and Nazar P. Shabila
Public Library of Science (PLoS)
Background Understanding the perspectives of the key players in the community regarding female genital cutting (FGC) is very important for directing preventive programs. Religious leaders help shape community behaviors, which is highly pertinent in the case of FGC as it is frequently perceived to be a religious requirement. This study assesses religious leaders’ knowledge, attitudes, and positions towards FGC in the Kurdistan Region of Iraq. Methods This cross-sectional study was conducted in the Kurdistan Region of Iraq. It included a purposive sample of 147 local religious leaders (khateebs) representing the three governorates of Erbil, Sulaimaniyah, and Duhok. A self-administered questionnaire was used to collect data about the religious leaders’ knowledge, attitude, and position towards FGC. Results The participants identified reduction of the sexual desire of women as the main benefit (37%) and risk (24%) of FGC. Cultural tradition and religious requirements were the main reported reasons for practicing FGC. About 59% of the religious leaders stated that people ask for their advice on FGC. Around 14% of the participants supported performing FGC, compared to 39.1% who opposed it. Religious (73.9%) and cultural (26.1%) rationales were the main reasons given for supporting FGC. Being a cultural practice with harmful effects (53.5%) and lack of clear religious evidence (46.6%) were the main reasons for being against FGC. Around 52% of the participants recommended banning FGC by law, while 43.5% did not support banning it. A statistically significant association (P = 0.015) was found between religious leaders’ residence and their position on performing FGC. More than 46% of those residing in Duhok were against performing FGC, compared to lower proportions in Erbil (38.8%) and Sulaimaniyah (30%). Conclusion Religious leaders believed that cultural tradition was the main reason behind practicing FGC and they believed that FGC is not common in KRI, and even that it is decreasing. The religious leaders in our study reported that they could have an influential role in the FGC issue due to their position in the community. There was no statistically significant association between religious leaders’ age, education level, or work experience and their position on performing FGC. However, a statistically significant association was found between religious leaders’ residence and their position on performing FGC. A conclusive decision concerning the prohibition of FGC needs to be made by religious authorities. Health awareness activities incorporating FGC risks should be carried out to inform religious leaders at different levels of religious positions. Further research exploring perspectives of religious authorities concerning religious leaders’ inconclusive judgment about FGC is deemed necessary.
Nazdar Alkhateeb, Abubakir Majeed Salih, Nazar Shabila, and Ali Al-Dabbagh
Public Library of Science (PLoS)
Background Objective structured clinical examination (OSCE) has been used in evaluating clinical competence in health professions education around the world. Despite its implementation in Iraq for around a decade, limited studies investigated the challenges and opportunities to improve the standard and quality of this examination from student’s perspective. Methods This qualitative study was based on an online open-ended questionnaire survey that was carried out in the College of Medicine, Hawler Medical University, Iraq at the beginning of the 2018–2019 academic year. A convenience sample of 180 students in the clinical phase (4th, 5th, and 6th) year of study were invited to participate. Results A total of 141 students responded to the online questionnaire. The participants were generally happy with the OSCE, and they recognized many positive aspects, including the role of the OSCE in increasing confidence, engagement and motivating learning, the role of the OSCE in achieving a higher level of learning, the content validity of the OSCE, and the quality of the OSCE. The main weak points of the OSCE identified by the students included unfairness, gender discrimination, duration of the OSCE, and the behavior of the examiners. Suggestions to improve the OSCE examination included improving the examiners’ behavior, with the focus on the training of the examiners, and avoiding discrimination among students. Conclusions Most of the students were generally satisfied with the current OSCE examination. The main concern of the students was related to the organization of the OSCE. Valuable suggestions were raised to improve the OSCE quality including examiners’ and simulated patients’ training.
Kawa M Hasan, Ahmed Y Elmeshhadany, and Nazar P Shabila
Sultan Qaboos University
Objectives: This study aimed to evaluate the effectiveness of ruxolitinib and compare it with the best available therapy in patients with primary myelofibrosis. Ruxolitinib is a Janus kinase inhibitor that is approved for the treatment of myelofibrosis. The therapeutic protocol has changed after the introduction of ruxolitinib. Methods: In this retrospective study, 72 patients with primary myelofibrosis were scrutinised from January 2012 to January 2018 at Nanakali Hemato-Oncology Teaching Centre in Erbil, Iraqi Kurdistan. The patients were divided into two cohorts: 26 of them were treated with ruxolitinib and 46 received the best available therapy. The patients’ characteristics, their response to the treatment and the outcomes were evaluated. The efficacy of the treatment in both groups was compared. Results: Most patients (n = 46; 63.9%) were in the high and intermediate-2 risk groups according to the international prognostic scoring system. At the time of diagnosis, no noticeable differences in the clinical characteristics and laboratory data were observed among the ruxolitinib and best available treatment groups. Ruxolitinib was found to be effective in reducing the size of the spleen and improving the overall survival rate when compared to the best available treatment group (P <0.001 and P = 0.008, respectively). The patients’ performance status had a significant effect on the overall survival in both treatment groups (P = 0.003). Conclusion: Ruxolitinib appears to have a significant role in reducing the spleen size and potentially affect the survival outcomes in patients with myelofibrosis. Keywords: Ruxolitinib; Myelofibrosis; Splenomegaly; Janus Kinase Inhibitor; Iraq.
Kazhan I. Mahmood, Sherzad A. Shabu, Karwan M. M-Amen, Salar S. Hussain, Diana A. Kako, Sharron Hinchliff, and Nazar P. Shabila
SAGE Publications
There is increasing concern about the impact of the COVID-19 pandemic and the lockdown’s social and economic consequences on gender-based violence. This study aimed to assess the impact of the COVID-19 pandemic on gender-based violence by comparing the prevalence of spousal violence against women before and during the COVID-19 related lockdown periods. This study was conducted in the Kurdistan Region of Iraq using a self-administered online questionnaire survey after the COVID-19 lockdown period in June 2020. Data were collected from a sample of 346 married women about the occurrence, frequency, and forms of spousal violence before and during the lockdown period. Significant increases in violence were observed from the pre-lockdown period to the lockdown period for any violence (32.1% to 38.7%, p = .001), emotional abuse (29.5% to 35.0%, p = .005), and physical violence (12.7% to 17.6%, p = .002). Regarding emotional abuse, humiliation (24.6% to 28.3%, p = .041) and scaring or intimidation (14.2% to 21.4%, p < .001) significantly increased during the lockdown. For physical violence, twisting the arm or pulling hair (9.0% to 13.0%, p = .004) and hitting (5.2% to 9.2%, p = .003) significantly increased during the lockdown. Forcing to have sexual intercourse also significantly increased during lockdown (6.6% to 9.5%., p = .021). The concerned authorities and women’s rights organizations should collaborate to enhance the prevention of violence against women. An effective prevention strategy should emphasize recognizing and acknowledging the extent of the problem, raising awareness about the problem and the available resources to address it, and ensuring social and economic stability. Lessons learned about the increased prevalence of spousal violence against women during the COVID-19 pandemic and the need to adopt appropriate strategies to prevent and address it will be valuable for similar future crises.
Salah Tofik Jalal Balaky, Arthur Saniotis, Ahang Hasan Mawlood, Ali M. Hussein, and Nazar P. Shabila
Springer Science and Business Media LLC
Rundk Ahmad Hwaiz, Sahar Mohammed Zaki Abdullah, Salah Tofik Jalal Balaky, Katan Sabir Ali, Mohammed Yousif Merza, Shakhawan Assad Khailani, and Nazar Pauls Shabila
SAGE Publications
Background COVID-19 primarily presents as a respiratory tract infection, but studies indicate that it could be considered a systemic disease that can spread to affect multiple organ systems, including respiratory, cardiovascular, gastrointestinal, hematopoietic, neurological, and immune systems. Objective To describe and analyze the clinical and hematological characteristics of 300 hospitalized COVID-19 patients in Erbil, Kurdistan. Methods This retrospective study included 300 patients of any age admitted to hospital due to confirmed COVID-19 between September 2020 and February 2021. Cases were diagnosed by reverse transcriptase polymerase chain reaction assays of nasopharyngeal swab specimens. Results The highest proportion of patients were aged 21–40 years. The most common symptoms among the patients were myalgia (66.7%), fatigue (62.3%), headache (50.7%), and chest pain (52.7%). Differences in hematological and biochemical parameters were observed between deceased and recovered patients. Only the mid-range absolute count percentage (MID%) was significantly higher in the recovered patients than in the deceased ones (6.41% vs. 4.48, p = 0.019). Death was significantly higher among older patients (>40 years) than younger ones (≤40 years) (6.8% vs. 1.3%, p = 0.015), diabetic than non-diabetic (10.8% vs. 3%, p = 0.047), and those having chronic diseases than those without chronic diseases (10.6% vs. 2.1%, p = 0.006). Conclusions Different hematological and biochemical parameter findings were observed among the COVID-19 patients. Low MID%, older age, and presence of diabetes mellitus and chronic disease were significantly associated with death among COVID-19 patients.
Karwan M-Amen, K. I. Mahmood, S. A. Shabu, and N. P. Shabila
Informa UK Limited
Abstract Public perceptions and behaviors in relation to COVID-19 have been at the forefront of public health policy to mitigate the transmission of the infection and reduce the burden on healthcare infrastructure. This study assesses people’s perspectives towards COVID-19, especially concerning disease risk, adherence to protective measures, and the effectiveness of the imposed prevention and control measures. An explorative study based on Q-method was conducted in Erbil, the Kurdistan Region. The study involved a purposively selected sample of 40 persons representing different educational, social, and economic levels. 41 statements were extracted that covered various aspects of the impact of COVID-19 on the lives of people and their perspectives about these experiences, using 41 statements answerable with a nine-point Likert scale, with responses ranging from ‘least agree’ to ‘most agree’. Data analysis involved a by-person factor analysis using PQMethod 2.35. Three distinct viewpoints and one consensus perspective were identified. Viewpoint 1, confidence and adherence to protective measures, centers on compliance with the main protective measures, the seriousness of COVID-19, and the effectiveness of the public health preventive measures. Viewpoint 2, apprehensiveness and noncompliance, focuses on extreme apprehension from the disease and concerns about the public health policies against COVID-19. Viewpoint 3, inattentive, emphasizes the lack of awareness and adherence to protective measures by the people and the ineffectiveness of the public health preventive measures. The primary aspects distinguishing the three viewpoints included risk perception, protective behavioral response, and public health preventive measures. Risk perception can potentially guide appropriate protective behavior. To strengthen preventive measures and comply with protective behaviors, different approaches that can address the needs of different groups of people are required. The focus should be on increasing risk awareness, reducing anxiety, and explaining the justification and effectiveness of public health policy preventive measures.
Nazar P. Shabila
Informa UK Limited
BACKGROUND
The increasing trend of cesarean section (CS) delivery can significantly increase the morbidity and mortality among infants and mothers, especially when it is medically unjustified. This study aimed to assess the trends and changes in the CS rates in Iraq between 2011 and 2018 and determine the factors associated with increased rates.
MATERIALS AND METHODS
This study included secondary data analysis of the Iraq Multiple Indicator Cluster Survey 2011 and 2018. The CS rates were calculated for both 2011 and 2018 surveys by governorate and by other exposure variables. The relative change in the CS rates between 2011 and 2018 surveys was computed for each variable.
RESULTS
The CS rates in the 2018 survey remarkably increased compared to the rates of the 2011 survey. The relative change (RC) for Iraq was 49.5%, 58.5% for the Kurdistan Region, and 45.1% for the rest of Iraq. The increase was highest in Kirkuk (RC = 119.5%), Ninewa (RC = 81.1%), and Erbil (RC = 75.4%). The increase was highest among women aged less than 20 years (RC = 80.7%), women with no education (RC = 85.1%), women in the poorest and the middle wealth quintiles (RC = 55.9 and 55.8%), and women from rural areas (RC = 86.3%).
CONCLUSION
The CS rate in Iraq is significantly higher than the recommended rate. The rates are higher in the Kurdistan Region, while the whole country has witnessed a remarkable increasing trend from 2011 to 2018. The CS rates are higher among women with higher socioeconomic status, while the increasing trend is higher among women with lower socioeconomic status.
Nazar P. Shabila
Springer Science and Business Media LLC
Abstract Background Female genital mutilation (FGM) is commonly practiced in Iraqi Kurdistan Region, where there are extensive efforts to combat the practice over the last decade. This study aimed to determine the trends and changes in the FGM prevalence in Iraq between 2011 and 2018 and assess their associated factors. Methods Secondary data analysis of the Iraq Multiple Indicator Cluster Survey 2011 and 2018 was carried out to calculate the prevalence and the relative changes in the prevalence of FGM for 2011 and 2018 by governorate. The change in the prevalence was compared with the changes in other exposure variables such as age, education level, wealth, and area of residence over the same period. Results The prevalence of FGM in 2018 was high in Erbil and Suleimaniya governorates (50.1% and 45.1%). The prevalence of FGM decreased remarkably from 2011 to 2018 in all governorates of the Iraqi Kurdistan Region. The decrease in the prevalence was statistically significant in Erbil and Suleimaniya. FGM prevalence declined remarkably in all age, education level, residence area groups, and most economic level groups. Such decline was associated with a significant increase in the education level, wealth, and urban residence. The decline was highest in the younger age groups, with a relative change of − 43.0% among 20–24 years and − 39.2% among 15–19 years. The decline was also highest in those with secondary and higher education (relative change = −32%). The decline was higher in rural areas than in urban areas (relative change = −35.3% and − 27.4%, respectively). The decline was higher among the poorest and second wealth quintile (relative change = −38.8% and − 27.2%, respectively). Conclusion The trend of FGM in Iraqi Kurdistan Region declined remarkably and significantly from 2011 to 2018. Further decline is predicted because of having lower rates and a higher decline in the younger age groups. However, the rates remained high in Erbil and Suleimaniya governorates that need further intensifying the preventive measures. The education level of women plays a primary role in decreasing the prevalence and should be considered in future efforts to ban the practice.
Banaz A. Saeed, Nazar P. Shabila, and Aram Jalal Aziz
Public Library of Science (PLoS)
Background During infectious disease outbreaks, healthcare workers are at high risk of infection, infecting others, and psychological distress. This study aimed to determine the prevalence of stress and anxiety in physicians during the COVID-19 outbreak in the Iraqi Kurdistan Region and assess their associated factors. Methods This cross-sectional study was carried out in Erbil, Iraqi Kurdistan Region, from March 28 to April 15, 2020. An online self-administered survey questionnaire was used to collect data from physicians working in specialized COVID-19 centers and other healthcare facilities. The level of stress was measured based on the 10-items Perceived Stress Scale. The level of anxiety was measured based on the 7-item Generalized Anxiety Disorder scale. Results A total of 370 participants responded to the perceived stress component of the survey, of whom 57 (15.4%) had low perceived stress, 249 (67.3%) had moderate stress, and 64 (17.3%) had high stress. Being female was significantly associated with having moderate/high stress (adjusted odds ratio (AOR) = 2.40 (95% CI 1.31–4.39)). A total of 201 participants responded to the generalized anxiety disorder component of the survey, of whom 19 (9.5%) had no anxiety, 57 (28.4%) had mild anxiety, 79 (39.3%) had moderate anxiety, and 46 (22.9%) had severe anxiety. Working in COVID-19 centers (AOR = 2.23 (95% CI 1.02–4.86)) and being general practitioners (AOR = 4.16 (95% CI 1.14–15.14)) were significantly associated with having moderate/severe anxiety. Conclusion A considerable proportion of physicians experience stress and anxiety during the COVID-19 outbreak in Iraqi Kurdistan region. Generalists and those in special COVID-19 units report the greatest anxiety. There a need to establish mechanisms to reduce the risks of stress and anxiety among physicians. Mental health coping interventions through counseling should be based on COVID-19 protocol guidelines. Interventions should also emphasize physicians’ ability to work safely and efficiently in providing care to the patients.
Beena Shawki, Tariq Al-Hadithi, and Nazar Shabila
World Health Organization Regional Office for the Eastern Mediterranean (WHO/EMRO)
Background: Substance use and bullying are prevalent among adolescents and have a wide range of adverse outcomes. The association of bullying with substance use has not been examined in Kurdistan and Iraq, which have suffered from the effects of long-term conflict and economic hardship. Aims: To examine the association between each form of bullying among adolescents and substance use. Methods: This cross-sectional study was conducted in a sample of public schools in Erbil City, Iraq in 2017. The study involved 1070 adolescents selected from 35 schools using a multistage cluster sampling method. A self-reported close-ended questionnaire was used for data collection. Male and female students attending grades 7–12 and aged 13–18 years were included. Results: The overall prevalence of bullying behaviour was 60.0%; 30.8% were victims, 26.2% were bully-victims, and 3.0% were bullies. There was a significant association between different forms and categories of bullying and substance use. The strongest association was with the students involved in sexual bullying, followed by racial and cyber bullying. The strongest association between bullying and substance use was found in the bully-victim category, followed by victims and bullies. Conclusions: Substance use and bullying behaviour seem to be widespread problems among adolescents in Erbil schools. Substance use is significantly associated with different categories of bullying behaviour. There is a need for effective school-based preventive interventions to tackle these problems. Future research needs to examine the likely direction of the association between bullying and substance use.
Milat Ismail Haje and Nazar P. Shabila
CMB Association
Freezing embryos is the best way to increase fertility for women with ovarian hyper-stimulation syndrome and women at risk for ovarian dysfunction. Due to the importance of freezing and pregnancy embryos, the present study was conducted to compare the fertility rate and the affecting factors following fresh embryos and frozen embryos in women treated with assisted reproductive techniques. In this study, 250 infertile women and IVF/ICSI candidates were studied. Embryos were used in fresh or frozen groups for transfer to the uterus. The expression of the caspase-3 gene was also examined for further evaluation. Data analysis was performed using SPSS 16 software, Chi-square, independent t-test, and Kruskal-Wallis tests. Out of 250 infertile women, 96 (38.4%) became pregnant, of which 54 were in the fresh embryo group and 42 were in the frozen embryo group, which was not statistically significant (P=0.32). Infertility causes, number of embryonic cells and grading of transferred embryos, delivery complications, embryo implantation methods, number of produced embryos after delivery, and endometrial thickness were not significantly different between the two groups (P=0.53). The difference between the mean number of transferred embryos in the two groups was significant (P<0.05), which was no longer significant after excluding non-pregnant women, and in comparing with only pregnant women (P=0.36). The result of caspase-3 gene expression showed that there was significant differences between fresh embryos, healthy thawed frozen embryos, and destroyed thawed frozen embryos. But these results were totally different from the results of the Pregnancy rate section. Therefore, it is inferred that although caspase-3 genes are expressed in frozen embryos after thawing and are ready to destroy the embryo, there are probably a number of involved factors that prevent the activity of caspase-3 and do not allow the apoptotic process to occur. What these factors are and how they prevent this process needs further study.
Nazar P. Shabila, Nazdar Ezzaddin Alkhateeb, Ali Shakir Dauod, and Ali Al-Dabbagh
IOS Press
BACKGROUND: The use of e-learning has become mandatory during the COVID-19 pandemic. However, there are many barriers to applying e-learning in medical education. OBJECTIVE: This study aimed to explore medical students’ perspectives on the application of e-learning in medical education during the COVID-19 pandemic. METHODS: This Q-methodology explorative study was conducted in Kurdistan Region of Iraq. A sample of 37 medical students was purposively selected to represent different characteristics. The students distributed 37 statements representing different aspects of e-learning in medical education into a nine-point scoring grid from “least agree” to “most agree.” RESULTS: Data analysis revealed three distinct viewpoints. The first viewpoint, complete dependence on e-learning, emphasized a preference for e-learning to continue medical education and complete the study year with a minimal return to study halls or practical/clinical sessions. The second viewpoint, opponents of applying e-learning in medical education, included a generally negative view about e-learning and its role in medical education during the COVID-19 pandemic. The third viewpoint, e-learning as a supplement to medical education, emphasized a generally positive view about e-learning and considered it a supplement to the theoretical parts of medical education during the pandemic. CONCLUSION: The three diverse viewpoints are primarily distinguished by the availability of e-learning experience and skills, availability of technology, risk perception of COVID-19, and the need for in-hospital clinical teaching. Provision of necessary facilities and training is required to strengthen the role of e-learning in medical education. A safe environment is needed for on-campus or hospital clinical teaching.