Neonatal mortality in Jordan: secondary analysis of Jordan Population and Family Health Survey (JPFHS) data

Objective: This study aimed to analyze the 2009 Jordan Population and Family Health Survey (JPFHS) data to determine the level, trend, and distribution of neonatal mortality (NNM) in Jordan and determine its associated factors.

Methods: Nationally representative data on NNM were extracted from the JPFHS data. Using multivariate analyses, the strength of associations between 12 clinical/sociodemographic variables and neonatal mortality were quantified after controlling for potential confounders.

Results: The weighted NNM rate for 2005–2009 period was 16 deaths per 1000 live births, with the early NNM rate and late NNM rates were 10 deaths per 1000 live births and six deaths per 1000 live births, respectively. Fluctuations of NNM according to year of birth and geographic variations were noted. Risk of NNM increased among male newborns, as mother’s education level decreased, in mothers 40–49 years old, in multiple gestations-low birth weight neonates, and as birth interval was <3 years.

Conclusions: The NNR rate for 2005–2009 period of 16 deaths per 1000 live births indicates that there are opportunities to decrease it. Risk factors of neonatal mortality with respect to predictors of death during first days of life and variables related to geographic variations require particular focus to improve the quality of obstetric and neonatal health services and to decrease neonatal mortality.     

Ethnic Discrimination and Smoking-Related Outcomes among Former and Current Arab Male Smokers in Israel: The Buffering Effects of Social Support

We examined the relationship between two forms of ethnic discrimination—interpersonal and institutional—and smoking outcomes among Arab men in Israel, and whether social support buffered these associations. We used cross-sectional data of adult Arab men, current or former smokers (n?=?954). Mixed-effects regression models estimated the association between discrimination and smoking status, and nicotine dependence among current smokers. Interpersonal discrimination was associated with higher likelihood of being a current smoker compared to a former smoker, whereas institutional group discrimination was not. Social support moderated the ethnic discrimination-nicotine dependence link. Among men with low social support, greater interpersonal discrimination was associated with greater nicotine dependence. Similarly, among smokers with high institutional group discrimination, those with high social support reported lower nicotine dependence compared to those with low social support. Ethnic discrimination should be considered in efforts to improve smoking outcomes among Arab male smokers in Israel.     

Level,Causes and Risk Factors of Neonatal Mortality,in Jordan: Results of a National Prospective Study

Objective The present study aimed at assessment of the magnitude of neonatal mortality in Jordan, and its causes and associated factors. Methods Through a multistage sampling technique, a total of 21,928 deliveries with a gestational period ≥20 weeks from 18 hospitals were included in the study. The status of their babies 28 days after birth, whether dead or alive, was ascertained. Extensive data were collected about mothers and their newborns at admission and after 28 days of birth. Causes of death were classified according to the neonatal and intrauterine death classification according to etiology. Preventability of death was classified according to Herman’s classification into preventable, partially preventable, and not preventable. Results Neonatal mortality rate, overall and for subgroups of the study was obtained. Risk factors for neonatal mortality were first examined in bivariate analyses and finally by multivariate logistic regression models to account for potential confounders. A total of 327 babies ≥20 weeks of gestation died in the neonatal period (14.9/1000 LB). Excluding babies <1000 g and <28 weeks of gestation to be consistent with the WHO and UNICEF’s annual neonatal mortality reports, the NNMR decreased to 10.5/1000 LB. About 79 % of all neonatal deaths occurred in the first week after birth with over 42 % occurring in the first day after birth. According to NICE hierarchical classification, most neonatal deaths were due to congenital anomalies (27.2 %), multiple births (26.0 %), or unexplained immaturity (21.7 %). Other important causes included maternal disease (6.7 %), specific infant conditions (6.4 %), and unexplained asphyxia (4.9 %). According to Herman’s classification, 37 % of neonatal deaths were preventable and 59 % possibly preventable. An experts’ panel determined that 37.3 % of neonatal deaths received optimal medical care while the medical care provided to the rest was less than optimal. After adjusting for socio-demographic characteristics, type of the hospital, and clinical and medical history of women, the following variables were significantly associated with neonatal mortality: male gender, congenital defects, inadequate antenatal visits, multiple pregnancy, presentation at delivery, and gestational age. Conclusion The present study showed the level, causes, and risk factors of NNM in Jordan. It showed also that a large proportion of NNDs are preventable or possibly preventable. Providing optimal intrapartum, and immediate postpartum care is likely to result in avoidance of a large proportion of NNDs.     

A Non-Randomized Controlled Trial for Reducing Postpartum Depression in Low-Income Minority Women at Community-Based Women’s Health Clinics

Maternal and Child Health Journal - To analyze an intervention that delivered tailored clinic staff training on postpartum depression (PPD) followed by awareness raising and social support aimed at...     

Challenges Facing Minority Women in Achieving Good Health: Voices of Arab Women in Israel

ABSTRACT

Arab women citizens of Israel bear a heavier burden of health problems compared with Jewish women. These inequalities were examined by conducting 6 focus groups that explored obstacles to achieving good health and strategies for maintaining good health as articulated by 86 Arab-Moslem women from the Triangle area in central Israel. Perceived obstacles ranged from personal to socio-political: unhealthy lifestyles, obedience to patriarchal norms, rapid lifestyle transitions, the political situation, poverty and lower socioeconomic status, and limited access to specific health care services. These multi-layered obstacles appeared to operate synergistically to limit women's access to social support and health care systems, intensify feelings of powerlessness, and further promote unhealthy behaviors. Moreover, these perceptions differed by the socioeconomic status of the group. The relatively more advantaged groups did not address issues related to poverty or access to health care services. Most health maintenance strategies discussed were personal and conservative, and ‘considerate’ of traditional Arab cultural norms. The findings provide a basis for developing more culturally competent and adequate health care services for Arab women in Israel and for further research concerning Arab women's health in the region.     

Dual tobacco smoking is the new trend among adolescents: Update from the Irbid-TRY

The current study evaluated the prevalence and contributing factors to smoking styles, particularly cigarette (Cg) and waterpipe (Wp), and dual (combined Cg and Wp) smoking, in adolescents. Tobacco consumption pattern and style, and demographic and socioeconomic characteristics were obtained from all participants. A total of 2,407 adolescents participated, of which 57.6% consumed tobacco. The prevalence of dual was 30%, which was greater than Wp only (21.1%) and Cg only (6.7%). Additionally, male adolescents are more likely to smoke Cg only (OR = 2.15; 95%CI: 1.3/3.4; p = 0.001), Wp only (OR = 1.3; 95%CI: 1/1.8; p = 0.05), and dual (OR = 2.95; 95%CI: 2.2/3.9; p = 0.001). Adolescents in grade 10 were more likely to be dual smokers as compared to grades 7 (OR = 0.5; 95%CI: 0.3/0.7; p = 0.001) and 8 (OR = 0.5; 95%CI: 0.3/0.7; p = 0.001). The study indicates that gender and grade can predict smoking status with dual is most prevalent in older boys. The data also show that dual smoking exceeds combined Cg-only and Wp-only smoking. Compared with previous studies, we are witnessing an increase in dual consumption, while Wp only and Cg only are decreasing, suggesting a shift in adolescent smoking-style selections. Therefore, studies and cessation programs for adolescents, especially for dual smoking among older boys, are warranted. Additionally, studies are needed to examine the health effects of dual smoking among adolescents.