Women's knowledge and attitude towards mode of delivery and frequency of cesarean section on mother's request in six public and private hospitals in Tehran, Iran, 2012

AIM

The rate of cesarean section (CS) has been reported to be as high as 40% among Iranian women in the year 2009. The aim of this study was to determine the rate of cesarean delivery on mother's request (CDMR) and to determine maternal attitude and knowledge about various modes of delivery in private and public (university) hospitals in Tehran.

MATERIAL AND METHODS

All primiparous mothers delivering in six selected hospitals between April 2010 and March 2011 were included. Trained investigators handed a predesigned questionnaire to mothers 1 day after delivery to be filled out in the presence of the investigator.

RESULTS

From 600 deliveries, 501 (83.5%) were CS and 99 (16.5%) were normal vaginal delivery. The CS rates in university hospitals versus private hospitals were 78.5% and 91.9%, respectively. In total, mothers' knowledge scores were poor, intermediate, and good in 55.6%, 37.9%, and 6.5% of cases, respectively, and no significant difference in knowledge was observed between mothers attending private or public hospitals. The overall rate of CDMR was 20.8%; and the most frequent reason was fear of pain. Women with CDMR were at higher marital age, education, insurance coverage, and socioeconomic status compared with the women with vaginal delivery.

CONCLUSION

Prompt action is needed to reduce the unacceptably high rate of unwarranted cesarean deliveries. Improving women's knowledge about the risks and benefits of different modes of delivery can lead to a positive maternal attitude towards vaginal delivery.

Survey of needle-stick injuries in paediatric health personnel of 5 university hospitals in Tehran

OBJECTIVE

To study the prevalence and correlates of needle-stick injury in the health personnel of the Paediatric Department of five university-affiliated hospitals in Tehran, from April till June 2009.

METHODS

Cross-sectional questionnaire survey. Physicians undergoing paediatric training and nurses working in the paediatric departments filled up a pre-designed questionnaire. Relevant variables were compared between doctors and nurses.

RESULTS

Three-hundred fifty-five health personnel were enrolled. Of these 49.3% had incurred needle stick injury at least once, 36.7% doctors and 54.9% nurses (p=0.002). Nurses fared better than the doctors as regards knowledge about hazards of improper needle disposal. Correct answers from doctors and nurses respectively were: 45.6% vs. 59.3% about needle separation and 41.9% vs. 81.2% about recapping, (p=0.02 and <0.001). Doctors 11.1% and Nurses 37.7% believed injections to be better than oral medication for children, (p<0.001), however, 68.9% of doctors and 46.6% of nurses believed that parents preferred injections to oral medicines for their children, (p<0.001). Only 26.6% knew about auto-disable syringes. Vaccinated against Hepatitis B was present in 92.7%. Doctors 58.7% and 55.3% nurses knew HBV to be the most common needle transmitted infection, (p=0.56).

CONCLUSION

Needle-stick injuries are common among Paediatric health care personnel and their knowledge about prevention strategies is suboptimal. Most, health personnel are immunized against Hepatitis B.

The use of baby walkers in Iranian infants

INTRODUCTION

A study was conducted to define the pattern of baby walker usage and the rate of walker-related injuries in infants, as well as to determine the effects of baby walkers on the start of independent walking among infants.

METHODS

Families of infants aged six months to two years who presented at health facility clinics in 2007 and 2008 were enrolled in the study. The study team interviewed the primary caregiver and documented the relevant data on a pre-designed questionnaire. The data of users of baby walkers was compared with that of non-users.

RESULTS

Walkers were used by 54.5 percent of 414 infants. Their use was significantly higher in one-child families (p-value is 0.009) and in those with higher parental education levels (p-value is less than 0.001). 78.6 percent of users and 85 percent of non-users were walking by 12 months of age (p-value is 0.283); no significant difference was observed between the two groups in terms of the age at which the infants starting walking (p-value is 0.401). 76.8 percent of parents of users versus 8.2 percent of parents of non-users believed that walkers promote early walking (p-value is less than 0.001). 44.7 percent of parents of users knew that walkers can be hazardous, as compared to 22.3 percent of parents of non-users. No serious injury was reported, but 14.1 percent of infants sustained trivial walker-associated injuries.

CONCLUSION

Baby walkers do not hasten independent walking and may be associated with injuries. However, it was noted that knowledge of the associated hazards has not deterred parents from using baby walkers for their infants.

Exposure to Secondhand Smoke in Infants: Declining Trends From 2001 to 2008?

Objective. To define the trend in young children’s exposure to parental secondhand smoke. Methods. Secondary analysis of data was done on families of infants between the ages of 6 and 24 months that had been enrolled for 2 cross-sectional studies in 2001 and 2008. Results. Data from 648 families were analyzed. Overall, 29.8% of children had been exposed to parental secondhand smoke; 32% in 2001 and 27.4% in 2008, ( P value >.05). In all cases, the source of exposure was the father; in 2008, 4 families reported both parents as being habitual smokers. Ratio of indoor to outdoor smokers was 2.92 in 2001 and 0.93 in 2008. Conclusion. The decline in the percentage of infants exposed to parental smoking is nonsignificant; parental indoor smoking has decreased significantly but remains at unacceptably high levels. Authorities responsible for the health of young children need to revise interventional policies.

An assessment of the necessity of lumbar puncture in children with seizure and fever

OBJECTIVE

It is frequently thought that lumbar puncture (LP), is a mandatory procedure in all children who have fever and a seizure; because a convulsion may be the sole clinical manifestations of bacterial meningitis. To assess whether meningitis could be recognized using readily available clinical information.

METHODS

This study was done during a 4 yr period from 2002-2006. A total of 254 previously healthy children aged 6 months to 5 years, were brought consecutively to the paediatric department of a teaching university hospital after their first fever-associated-seizure; lumbar puncture (LP) was performed in all cases. Children with seizure and fever and meningitis served as cases and those with fever and seizure, but no meningitis, served as control. Factors compared in the two groups were: age, lethargy, irritability, vomiting, nuchal rigidity, bulging fontanel, headache, drowsiness, toxicity, coma, complex seizure, and prior antibiotic use.

RESULTS

Twelve, (4.7%), cases were diagnosed as meningitis. Risk factors significantly associated with meningitis were: age < 12 months, lethargy, irritability, vomiting, nuchal rigidity, bulging fontanel, headache, drowsiness, toxicity, coma, complex seizure, and prior antibiotic use, (p < 0.05). All children with meningitis had at least one of the risk factors mentioned above.

CONCLUSION

Our results indicate that based on available clinical data, meningitis can be ruled out in children presenting with seizure and fever; thus there is no need for routine lumbar puncture in all children who present with fever and seizure. However a lumbar puncture is mandatory in infants younger than 12 months or who have received prior antibiotics.

Infant feeding and hospitalization during the first six months of life

OBJECTIVE

To compare the frequency of hospitalization during the first six months of life between breast-fed and bottle-fed infants.

METHOD

A descriptive cross-sectional study was conducted over twelve months, in hospital-based outpatient clinics. Mother-infant pairs, seen at the clinics during the study period, were enrolled. Infants were between the ages of 6-24 months and had been brought for routine check-ups, vaccinations or common childhood ailments. Subjects were recruited from babies with no congenital anomalies or chronic illnesses. Study team recorded necessary information about feeding practices, previous illnesses and hospitalizations on a structured questionnaire. Hospitalization rates in 3 groups of infants with different feeding methods i.e. predominant breastfeeding, partial breast-feeding, and bottle-feeding were compared. Results were analyzed using SPSS software, ANOVA was used for comparison of means between groups, and a p-value <0.05 was regarded as significant.

RESULTS

A total of 606 mother-infant dyads were enrolled, of which 73% infants were on predominant breastfeeding at 6 months of age. The rate of all-cause hospitalization before six months of age was: 6.3%, 22.2% and 27.2% in infants with predominant breast-feeding, partial breast-feeding and bottle-feeding, respectively, (p < 0.001). Figures for admission due to infectious cause were 6%, 17.6% and 25.6%, respectively, (p < 0.001). Adjusted Odds ratio between bottle-fed and breast-fed babies was 5.3 for all-cause hospitalization, and 6.1 for hospitalization due to infectious illnesses.

CONCLUSION

Our findings show that protective effect of breast-feeding is not limited to developing countries; it extends to young infants living in urbanized environments equipped with adequate sanitation and clean water supply.