Mona Nabulsi - Academia.edu (original) (raw)
Papers by Mona Nabulsi
Background: Studies evaluating breastfeeding promotion and support interventions suggest some eco... more Background: Studies evaluating breastfeeding promotion and support interventions suggest some economic benefits. This study assessed the direct and indirect costs of a multicomponent breastfeeding promotion and support intervention during the first two years of the infant’s life. Methods: This is a cost-benefit analysis of data generated from a randomized controlled trial that aimed at investigating whether provision of a multicomponent breastfeeding promotion and support intervention to Lebanese mothers in the first six months postpartum would improve breastfeeding rates compared to standard obstetric and pediatric care. Data on 339 participants included information on maternal socio-demographics and health, infant nutrition and health, and direct and indirect costs of the intervention. The primary outcome was the benefit-cost ratio (BCR) of the intervention at one, six, 12, and 24 months. Secondary outcomes included the overall costs of infant nutrition and infant-mother dyad heal...
http://isrctn.com/, Dec 30, 2021
International Breastfeeding Journal, Jun 9, 2020
Background: The Breastfeeding Behavior Questionnaire (BBQ) assesses women's perceptions of their ... more Background: The Breastfeeding Behavior Questionnaire (BBQ) assesses women's perceptions of their breastfeeding behavior. It was adapted to several languages and used in different settings, but has not been validated in Arabicspeaking populations. None of the previous studies that used the BBQ in other cultures examined its ability to predict the actual breastfeeding behaviors of mothers postpartum. This study validated the BBQ in a cohort of Lebanese pregnant women between December 2013 and January 2016, and examined whether it can predict exclusive breastfeeding at one, three and six months. Methods: The internal consistency reliability and construct validity of the Arabic BBQ (BBQ-A) were tested on 354 pregnant women. Its predictive ability was assessed by correlating the women's BBQ-A scores with their breastfeeding outcomes at one, three and six months post-delivery. Results: The BBQ-A had a good internal consistency reliability (Cronbach's alpha = 0.78). Exploratory factor analysis revealed that it is unidimensional. Inter-item correlations ranged between − 0.016 and 0.934, with corrected-item total correlations ranging from 0.273 to 0.678. Perceived positive breastfeeding behavior correlated with positive breastfeeding attitudes, good breastfeeding knowledge and stronger breastfeeding intention supporting its external validity. However, in binomial multivariate logistic regression analysis, the BBQ-A did not predict exclusive breastfeeding at one, three or six months. Conclusions: The BBQ-A is a reliable and valid instrument to assess women's perceptions of their breastfeeding behavior in an Arab context. Availability of this instrument is important for investigators conducting breastfeeding research in the Arab world. However, the BBQ-A does not predict exclusive breastfeeding at one, three or six months. Further research on the Breastfeeding Behavior Questionnaire is needed to examine its predictive validity in other cultures.
Trials, Feb 8, 2015
Background: Acute gastroenteritis is a major cause of pediatric morbidity and mortality, accounti... more Background: Acute gastroenteritis is a major cause of pediatric morbidity and mortality, accounting for 15% of all childhood deaths worldwide. In developing countries, diarrheal diseases continue to be a major public health burden. Evidence from developed countries suggests that intake of lactose-free milk during diarrheal episodes may reduce the duration of the illness in pediatric inpatients. It is unknown whether lactose-free milk reduces the severity or duration of acute gastroenteritis in infants treated in outpatient settings in developing countries where diarrhea is more severe, and results in higher morbidities and mortalities. We hypothesize that lactose-free milk intake during acute gastroenteritis would significantly decrease the duration and severity of diarrhea in infants presenting to the Emergency Department (ED), as compared with lactose-containing milk. Methods/Design: An open-label randomized clinical trial. Study population: 40 infants with acute gastroenteritis, age between 2 and 12 months, presenting to the ED, will be randomized to control or intervention group. Intervention: Lactose-free milk, whereas the control group will continue on regular infant formula for a total of 7 days. Infants will be followed up for 7 days. Outcome measures: Diarrhea duration, weight loss, illness clinic visits, hospitalization rate, parental satisfaction, and time to symptom resolution. Statistical analysis: Descriptive and regression analysis will be conducted under the intention-to-treat basis by using SPSS version 21. Discussion: Acute gastroenteritis is a public health burden for developing countries, with a significant impact on infant morbidity and mortality. Provision of infant formula that may reduce the duration and severity of diarrhea can decrease this burden in countries with limited healthcare resources, like Lebanon. The findings from this study are anticipated to provide evidence-based dietary recommendations for ambulatory infants with acute diarrhea in developing countries.
PubMed, Aug 10, 2004
The current status of hepatitis B infection in Lebanon is unknown due to the scarcity of publishe... more The current status of hepatitis B infection in Lebanon is unknown due to the scarcity of published studies on the subject. This study was conducted to summarize the available information on hepatitis B in Lebanon since 1966, as well as to determine the current status of the problem, by analyzing the prevalence of positive hepatitis B surface antigen (HBsAg) reported from different laboratories of major hospitals covering the six districts of Lebanon in the year 2000. The overall HBsAg carrier rate among 61,271 tested individuals was 2.2%, being 13% among 30,809 blood donors, and 3.6% among 13,669 tested individuals in serology laboratories. There were marked geographical variations in the HBsAg carrier rate being 0.8% in Mount Lebanon, 1.9% in each of Bekaa and Greater Beirut, 2.2% in North Lebanon, 2.4% in Nabatiyeh, reaching up to 4.7% in South Lebanon. These findings are comparable to the previously reported studies on pregnant women and children, thus confirming that Lebanon is moderately endemic for hepatitis B. Such information stresses the urgent need for efficient national public health surveillance campaigns, and mass vaccination programs. In addition, the universal screening of pregnant women for HBsAg, and the implementation of universal newborn vaccination against hepatitis B virus (HBV) should be the standard of medical care for the control and eradication of HBV in Lebanon.
BMC Pediatrics, Aug 30, 2011
Background: Breastfeeding is a cost-effective public health intervention that reduces infant morb... more Background: Breastfeeding is a cost-effective public health intervention that reduces infant morbidity and mortality in developing countries. In Lebanon, breastfeeding exclusivity and continuation rates are disappointingly low. This qualitative study aims at identifying barriers and promoters of breastfeeding in the Lebanese context by exploring mothers' perceptions and experiences in breastfeeding over a one year period. Methods: We conducted focus group discussions in three hospitals in Beirut, Lebanon, and followed up 36 breastfeeding mothers with serial in-depth interviews for one year post-partum or until breastfeeding discontinuation. Results: Themes generated from baseline interviews revealed several positive and negative perceptions of breastfeeding. Longitudinal follow up identified insufficient milk, fear of weight gain or breast sagging, pain, sleep deprivation, exhaustion, or maternal employment, as reasons for early breastfeeding discontinuation. Women who continued breastfeeding for one year were more determined to succeed and overcome any barrier, relying mostly on family support and proper time management. Conclusions: Increasing awareness of future mothers about breast feeding difficulties, its benefits to children, mothers, and society at large may further promote breastfeeding, and improve exclusivity and continuation rates in Lebanon. A national strategy for early intervention during school years to increase young women's awareness may improve their self-confidence and determination to succeed in breastfeeding later. Moreover, prolonging maternity leave, having day-care facilities at work, creation of lactation peer support groups and hotlines, and training of doctors and nurses in proper lactation support may positively impact breastfeeding exclusivity and continuation rates. Further research is needed to assess the effectiveness of proposed interventions in the Lebanese context.
http://isrctn.org/>, Dec 5, 2012
Hemoglobin, 2000
The molecular basis of β-thalassemia in Lebanon reflects the heterogeneity of the Lebanese popula... more The molecular basis of β-thalassemia in Lebanon reflects the heterogeneity of the Lebanese population. Eighteen different mutations were identified among a total of 277 chromosomes. There is evidence of clustering of some mutations in particular geographic regions or ...
Osteoporosis International, Aug 29, 2007
PLOS ONE, Sep 4, 2020
Background The optimal frequency, duration, and form of professional lactation support needed to ... more Background The optimal frequency, duration, and form of professional lactation support needed to continue exclusive breastfeeding (EBF) for six months have not yet been specifically identified. This study investigates the association between six-month EBF and the frequency, duration, and form (face-to-face vs. telephone contact) of professional lactation support in a cohort of Lebanese mothers, and explores barriers to EBF during the first six months postpartum. Methods An observational study was nested in a breastfeeding support randomized controlled trial. Secondary analysis of data from 159 trial participants who received professional lactation support was conducted. (1) Six-month EBF with professional lactation support frequency, duration, and form was investigated using bivariate and multivariate regression analyses. (2) Barriers to breastfeeding were explored using content analysis of narrative data collected about breastfeeding mothers by the lactation experts.
PLOS ONE, Sep 11, 2020
Background The World Health Organization and United Nations Children's Fund launched the Baby Fri... more Background The World Health Organization and United Nations Children's Fund launched the Baby Friendly Hospital Initiative (BFHI) to encourage best infant breastfeeding practices immediately after birth. In Lebanon, few hospitals are currently accredited as Baby Friendly. Aim To assess the knowledge of Lebanese women of BFHI steps, and to explore their attitudes towards Baby Friendly Hospitals, Skin-to-Skin Contact and Kangaroo Care practices. Methods A cross-sectional survey of a random sample of healthy pregnant women from Lebanon's six governorates. Results The mean (SD) age of the participants (N = 517) was 28.6 (4.7) years. Most participants were unfamiliar with the terms Baby Friendly hospital (93.7%), skin-to-skin contact or kangaroo care (75%), or were inadequately instructed on how to initiate (54.2%) or continue (46.2%) breastfeeding. However, when provided with information about the benefits of BFHI practices, most mothers (> 90%) stated that they would deliver in Baby Friendly hospitals. About 68.4% of mothers refused to give donor human milk to their sick premature infants because of religious beliefs. Knowledge of Baby Friendly hospitals was significantly associated with university education (p = 0.029), higher monthly income (p = 0.042), and previous experiences of skin-to-skin contact (p<0.001), rooming in (p = 0.037), or breastfeeding support (p = 0.036). Conclusion There is a need for national awareness campaigns that address both the numerous advantages of the BFHI practices and Lebanese women's knowledge gaps about these practices. Such knowledge will help scale up the implementation of BFHI practices in hospitals in
PLOS ONE, Oct 23, 2019
Background Despite the beneficial effects of peer support on breastfeeding, research on the proce... more Background Despite the beneficial effects of peer support on breastfeeding, research on the process of peer support is scarce. In Lebanon, exclusive breastfeeding is only 15% in infants below six months. A multidisciplinary team launched a multi-component breastfeeding support intervention, with peer support, and professional lactation support provided by International Board Certified Lactation Consultants (IBCLs) to target this decline. Aim To describe the experiences of breastfeeding mothers and peer support providers with the process of breastfeeding support, and the influence of the intervention on their social support system. Methods Using a qualitative methodology, a purposive sample of breastfeeding and support mothers was accessed from among those who completed their six months interview in the trial taking place in two hospitals in Beirut, Lebanon. Data were collected from 43 participants using in-depth interviews and following the data saturation principle. All interviews were audio recorded and transcribed verbatim. Thematic analysis was conducted, guided by the principles of grounded theory. Results Breastfeeding mothers were satisfied with their breastfeeding experience, and extremely appreciative of the support provided by their peers and the IBCLCs. They experienced these forms of support differently. Peer support was perceived to be important in encouraging breastfeeding continuation, whereas IBCLC support was influential in problem solving.
Journal of Human Lactation, Sep 26, 2016
Background: Valid instruments that can reliably assess maternal breastfeeding knowledge in Arabic... more Background: Valid instruments that can reliably assess maternal breastfeeding knowledge in Arabic-speaking populations are nonexistent. The availability of such an instrument is essential for investigators working in this field. Objective: This study aimed to describe the adaptation and validation of the Arabic Breastfeeding Knowledge Questionnaire (BFK-A) from the original 20-item English version. Methods: A translated version of the 20-item BFK was validated among 417 Lebanese women after pilot testing for clarity, comprehension, length, and cultural appropriateness. Exploratory factor analysis was run to examine dimensionality of the instrument and Kuder-Richardson-20 (KR-20) was used to assess its internal consistency. Results: The BFK-A is a unidimensional scale with acceptable internal consistency reliability (KR-20 = 0.652) after the exclusion of 4 items. Higher breastfeeding knowledge levels were strongly and statistically significantly associated with higher mean scores for the validated Arabic Iowa Infant Feeding Attitude Scale ( P < .001), thus confirming its construct validity. Conclusion: The Arabic 16-item BFK-A has an acceptable reliability, similar to the original instrument. Further studies are encouraged to confirm the validity of the 16-item BFK-A among other Arab populations. There is also a need to develop more reliable instruments to use in lactation research in this context.
![Research paper thumbnail of Equal antipyretic effectiveness of oral and rectal acetaminophen: a randomized controlled trial [ISRCTN11886401]](https://attachments.academia-assets.com/114381489/thumbnails/1.jpg)
](BMC Pediatrics, Sep 6, 2005
Background: The antipyretic effectiveness of rectal versus oral acetaminophen is not well establi... more Background: The antipyretic effectiveness of rectal versus oral acetaminophen is not well established. This study is designed to compare the antipyretic effectiveness of two rectal acetaminophen doses (15 mg/kg) and (35 mg/kg), to the standard oral dose of 15 mg/kg. Methods: This is a randomized, double-dummy, double-blind study of 51 febrile children, receiving one of three regimens of a single acetaminophen dose: 15 mg/kg orally, 15 mg/kg rectally, or 35 mg/ kg rectally. Rectal temperature was monitored at baseline and hourly for a total of six hours. The primary outcome of the study, time to maximum antipyresis, and the secondary outcome of time to temperature reduction by at least 1°C were analyzed by one-way ANOVA. Two-way ANOVA with repeated measures over time was used to compare the secondary outcome: change in temperature from baseline at times1, 2, 3, 4, 5, and 6 hours among the three groups. Intent-to-treat analysis was planned. Results: No significant differences were found among the three groups in the time to maximum antipyresis (overall mean = 3.6 hours; 95% CI: 3.2-4.0), time to fever reduction by 1°C or the mean hourly temperature from baseline to 6 hours following dose administration. Hypothermia (temperature < 36.5°C) occurred in 11(21.6%) subjects, with the highest proportion being in the rectal high-dose group. Conclusion: Standard (15 mg/kg) oral, (15 mg/kg) rectal, and high-dose (35 mg/kg) rectal acetaminophen have similar antipyretic effectiveness.
![Research paper thumbnail of Alternating ibuprofen and acetaminophen in the treatment of febrile children: a pilot study [ISRCTN30487061]](https://attachments.academia-assets.com/114381447/thumbnails/1.jpg)
](BMC Medicine, Mar 4, 2006
Background: Alternating ibuprofen and acetaminophen for the treatment of febrile children is a pr... more Background: Alternating ibuprofen and acetaminophen for the treatment of febrile children is a prevalent practice among physicians and parents, despite the lack of evidence on effectiveness or safety. This randomized, double-blind and placebo-controlled clinical trial aims at comparing the antipyretic effectiveness and safety of a single administration of alternating ibuprofen and acetaminophen doses to that of ibuprofen mono-therapy in febrile children. Methods: Seventy febrile children were randomly allocated to receive either a single oral dose of 10 mg/kg ibuprofen and 15 mg/kg oral acetaminophen after 4 hours, or a similar dose of ibuprofen and placebo at 4 hours. Rectal temperature was measured at baseline, 4, 5, 6, 7 and 8 hours later. Endpoints included proportions of afebrile children at 6, 7 and 8 hours, maximum decline in temperature, time to recurrence of fever, and change in temperature from baseline at each time point. Intent-to-treat analysis was planned with statistical significance set at P < 0.05. Results: A higher proportion of subjects in the intervention group (83.3%) became afebrile at 6 hours than in the control group (57.6%); P = 0.018. This difference was accentuated at 7 and 8 hours (P < 0.001) with a significantly longer time to recurrence of fever in the intervention group (mean ± SD of 7.4 ± 1.3 versus 5.7 ± 2.2 hours), P < 0.001. Odds ratios (95%CI) for defervescence were 5.6 (1.3; 23.8), 19.5 (3.5; 108.9) and 15.3 (3.4; 68.3) at 6, 7 and 8 hours respectively. Two-way ANOVA with repeated measures over time revealed a significantly larger decline in temperature in the intervention group at times 7 (P = 0.026) and 8 (P = 0.002) hours. Conclusion: A single dose of alternating ibuprofen and acetaminophen appears to be a superior antipyretic regimen than ibuprofen mono-therapy. Further studies are needed to confirm these findings.
Prenatal Diagnosis, 2002
To assess the attitudes of health professionals in Lebanon towards prenatal diagnosis and termina... more To assess the attitudes of health professionals in Lebanon towards prenatal diagnosis and termination of pregnancy, for a series of genetic, non-genetic and non-medical conditions. A total of 158 questionnaires were sent to geneticists, family doctors, pediatricians and obstetricians/gynecologists, that included information on sociodemographic variables and sets of questions and case scenarios, to which participants were asked to reply anonymously. Responses from the 75 participants revealed that the type of specialty did not significantly influence their attitude. However, acceptance of termination of pregnancy was influenced by gender, age, marital status, religion and its importance in their daily life. In general, acceptance of termination of pregnancy in the case of mild or severe clinical conditions was comparable to that reported from European countries, but more favorable in the case of sex chromosome abnormalities. Acceptance of prenatal diagnosis for non-clinical conditions was, however, lower than that reported in Western nations. The study provides a good basis for further studies with a larger number of respondents representing various geographical regions of the country.
Journal of Medical Ethics, Aug 16, 2010
Paediatric clinical research faces unique challenges that compromise optimal recruitment of child... more Paediatric clinical research faces unique challenges that compromise optimal recruitment of children into clinical trials. A main barrier to enrolment of children is parental misconceptions about the research process. In developing countries, there is a knowledge gap regarding parental perceptions of and attitudes towards their children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s participation in clinical trials. To explore such perceptions and attitudes in Lebanese parents. 33 in-depth interviews were conducted with parents with and without previous research experience. Interviews were tape-recorded, transcribed in colloquial Arabic, and later subjected to thematic analysis. Benefit/risk ratio assessment was a major determinant of parental consent. Fear of adverse events or painful procedures in research was a recurring theme in most interviews. Whereas perception of direct benefit to the child, trust in the physician or institution, financial gains or having a positive previous experience in research facilitated consent, a complex informed consent form and misunderstanding of the term &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;randomisation&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; hindered parental approval of participation. Lebanese parents have perceptions of and attitudes towards children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s participation in clinical trials that are similar to those reported from the industrialised world. Improving communication with parents and building trust between researchers and parents is important for successful recruitment. Investigators planning to conduct paediatric trials in developing countries need to simplify consent forms and devise new ways to explain randomisation.
JAAD case reports, Mar 1, 2015
BMC Medical Education, Feb 4, 2022
Background: Evidence on the effectiveness of team-based learning in teaching critical appraisal t... more Background: Evidence on the effectiveness of team-based learning in teaching critical appraisal to large classes of preclinical medical students is scarce. This study investigated whether team-based learning is effective in teaching critical appraisal to large classes of preclinical medical students. Methods: Between April 2018 and May 2019, 107 first-year medical students were randomly allocated to receive instruction in critical appraisal using team-based learning or traditional group discussions as teaching methods. The primary outcome was students' performance on the Berlin Questionnaire administered at the end of second year. Results: Students' mean (SD) age was 22.0 (0.7) years. Baseline characteristics of the two groups were similar (all p values > 0.05). The mean (SD) Berlin scores of both groups were 80.4 (11.6) and 80.1 (12.1) for team-based learning and group discussions, respectively. Multivariate stepwise linear regression analysis revealed that the student's academic achievement in medical school was the sole predictor of performance on the Berlin Questionnaire (ß = 1.079, p < 0.001), adjusting for gender, Medical College Admission Test score, student's self-reported preferred teaching method, rank upon admission to medical school, score on the Epidemiology and Biostatistics course, and teaching method (team-based learning versus group discussions). Conclusions: Team-based learning and group discussions were equally effective instructional strategies to teach critical appraisal to large classes of undergraduate medical students. Replication of our findings is needed in other educational settings.
Background: Studies evaluating breastfeeding promotion and support interventions suggest some eco... more Background: Studies evaluating breastfeeding promotion and support interventions suggest some economic benefits. This study assessed the direct and indirect costs of a multicomponent breastfeeding promotion and support intervention during the first two years of the infant’s life. Methods: This is a cost-benefit analysis of data generated from a randomized controlled trial that aimed at investigating whether provision of a multicomponent breastfeeding promotion and support intervention to Lebanese mothers in the first six months postpartum would improve breastfeeding rates compared to standard obstetric and pediatric care. Data on 339 participants included information on maternal socio-demographics and health, infant nutrition and health, and direct and indirect costs of the intervention. The primary outcome was the benefit-cost ratio (BCR) of the intervention at one, six, 12, and 24 months. Secondary outcomes included the overall costs of infant nutrition and infant-mother dyad heal...
http://isrctn.com/, Dec 30, 2021
International Breastfeeding Journal, Jun 9, 2020
Background: The Breastfeeding Behavior Questionnaire (BBQ) assesses women's perceptions of their ... more Background: The Breastfeeding Behavior Questionnaire (BBQ) assesses women's perceptions of their breastfeeding behavior. It was adapted to several languages and used in different settings, but has not been validated in Arabicspeaking populations. None of the previous studies that used the BBQ in other cultures examined its ability to predict the actual breastfeeding behaviors of mothers postpartum. This study validated the BBQ in a cohort of Lebanese pregnant women between December 2013 and January 2016, and examined whether it can predict exclusive breastfeeding at one, three and six months. Methods: The internal consistency reliability and construct validity of the Arabic BBQ (BBQ-A) were tested on 354 pregnant women. Its predictive ability was assessed by correlating the women's BBQ-A scores with their breastfeeding outcomes at one, three and six months post-delivery. Results: The BBQ-A had a good internal consistency reliability (Cronbach's alpha = 0.78). Exploratory factor analysis revealed that it is unidimensional. Inter-item correlations ranged between − 0.016 and 0.934, with corrected-item total correlations ranging from 0.273 to 0.678. Perceived positive breastfeeding behavior correlated with positive breastfeeding attitudes, good breastfeeding knowledge and stronger breastfeeding intention supporting its external validity. However, in binomial multivariate logistic regression analysis, the BBQ-A did not predict exclusive breastfeeding at one, three or six months. Conclusions: The BBQ-A is a reliable and valid instrument to assess women's perceptions of their breastfeeding behavior in an Arab context. Availability of this instrument is important for investigators conducting breastfeeding research in the Arab world. However, the BBQ-A does not predict exclusive breastfeeding at one, three or six months. Further research on the Breastfeeding Behavior Questionnaire is needed to examine its predictive validity in other cultures.
Trials, Feb 8, 2015
Background: Acute gastroenteritis is a major cause of pediatric morbidity and mortality, accounti... more Background: Acute gastroenteritis is a major cause of pediatric morbidity and mortality, accounting for 15% of all childhood deaths worldwide. In developing countries, diarrheal diseases continue to be a major public health burden. Evidence from developed countries suggests that intake of lactose-free milk during diarrheal episodes may reduce the duration of the illness in pediatric inpatients. It is unknown whether lactose-free milk reduces the severity or duration of acute gastroenteritis in infants treated in outpatient settings in developing countries where diarrhea is more severe, and results in higher morbidities and mortalities. We hypothesize that lactose-free milk intake during acute gastroenteritis would significantly decrease the duration and severity of diarrhea in infants presenting to the Emergency Department (ED), as compared with lactose-containing milk. Methods/Design: An open-label randomized clinical trial. Study population: 40 infants with acute gastroenteritis, age between 2 and 12 months, presenting to the ED, will be randomized to control or intervention group. Intervention: Lactose-free milk, whereas the control group will continue on regular infant formula for a total of 7 days. Infants will be followed up for 7 days. Outcome measures: Diarrhea duration, weight loss, illness clinic visits, hospitalization rate, parental satisfaction, and time to symptom resolution. Statistical analysis: Descriptive and regression analysis will be conducted under the intention-to-treat basis by using SPSS version 21. Discussion: Acute gastroenteritis is a public health burden for developing countries, with a significant impact on infant morbidity and mortality. Provision of infant formula that may reduce the duration and severity of diarrhea can decrease this burden in countries with limited healthcare resources, like Lebanon. The findings from this study are anticipated to provide evidence-based dietary recommendations for ambulatory infants with acute diarrhea in developing countries.
PubMed, Aug 10, 2004
The current status of hepatitis B infection in Lebanon is unknown due to the scarcity of publishe... more The current status of hepatitis B infection in Lebanon is unknown due to the scarcity of published studies on the subject. This study was conducted to summarize the available information on hepatitis B in Lebanon since 1966, as well as to determine the current status of the problem, by analyzing the prevalence of positive hepatitis B surface antigen (HBsAg) reported from different laboratories of major hospitals covering the six districts of Lebanon in the year 2000. The overall HBsAg carrier rate among 61,271 tested individuals was 2.2%, being 13% among 30,809 blood donors, and 3.6% among 13,669 tested individuals in serology laboratories. There were marked geographical variations in the HBsAg carrier rate being 0.8% in Mount Lebanon, 1.9% in each of Bekaa and Greater Beirut, 2.2% in North Lebanon, 2.4% in Nabatiyeh, reaching up to 4.7% in South Lebanon. These findings are comparable to the previously reported studies on pregnant women and children, thus confirming that Lebanon is moderately endemic for hepatitis B. Such information stresses the urgent need for efficient national public health surveillance campaigns, and mass vaccination programs. In addition, the universal screening of pregnant women for HBsAg, and the implementation of universal newborn vaccination against hepatitis B virus (HBV) should be the standard of medical care for the control and eradication of HBV in Lebanon.
BMC Pediatrics, Aug 30, 2011
Background: Breastfeeding is a cost-effective public health intervention that reduces infant morb... more Background: Breastfeeding is a cost-effective public health intervention that reduces infant morbidity and mortality in developing countries. In Lebanon, breastfeeding exclusivity and continuation rates are disappointingly low. This qualitative study aims at identifying barriers and promoters of breastfeeding in the Lebanese context by exploring mothers' perceptions and experiences in breastfeeding over a one year period. Methods: We conducted focus group discussions in three hospitals in Beirut, Lebanon, and followed up 36 breastfeeding mothers with serial in-depth interviews for one year post-partum or until breastfeeding discontinuation. Results: Themes generated from baseline interviews revealed several positive and negative perceptions of breastfeeding. Longitudinal follow up identified insufficient milk, fear of weight gain or breast sagging, pain, sleep deprivation, exhaustion, or maternal employment, as reasons for early breastfeeding discontinuation. Women who continued breastfeeding for one year were more determined to succeed and overcome any barrier, relying mostly on family support and proper time management. Conclusions: Increasing awareness of future mothers about breast feeding difficulties, its benefits to children, mothers, and society at large may further promote breastfeeding, and improve exclusivity and continuation rates in Lebanon. A national strategy for early intervention during school years to increase young women's awareness may improve their self-confidence and determination to succeed in breastfeeding later. Moreover, prolonging maternity leave, having day-care facilities at work, creation of lactation peer support groups and hotlines, and training of doctors and nurses in proper lactation support may positively impact breastfeeding exclusivity and continuation rates. Further research is needed to assess the effectiveness of proposed interventions in the Lebanese context.
http://isrctn.org/>, Dec 5, 2012
Hemoglobin, 2000
The molecular basis of β-thalassemia in Lebanon reflects the heterogeneity of the Lebanese popula... more The molecular basis of β-thalassemia in Lebanon reflects the heterogeneity of the Lebanese population. Eighteen different mutations were identified among a total of 277 chromosomes. There is evidence of clustering of some mutations in particular geographic regions or ...
Osteoporosis International, Aug 29, 2007
PLOS ONE, Sep 4, 2020
Background The optimal frequency, duration, and form of professional lactation support needed to ... more Background The optimal frequency, duration, and form of professional lactation support needed to continue exclusive breastfeeding (EBF) for six months have not yet been specifically identified. This study investigates the association between six-month EBF and the frequency, duration, and form (face-to-face vs. telephone contact) of professional lactation support in a cohort of Lebanese mothers, and explores barriers to EBF during the first six months postpartum. Methods An observational study was nested in a breastfeeding support randomized controlled trial. Secondary analysis of data from 159 trial participants who received professional lactation support was conducted. (1) Six-month EBF with professional lactation support frequency, duration, and form was investigated using bivariate and multivariate regression analyses. (2) Barriers to breastfeeding were explored using content analysis of narrative data collected about breastfeeding mothers by the lactation experts.
PLOS ONE, Sep 11, 2020
Background The World Health Organization and United Nations Children's Fund launched the Baby Fri... more Background The World Health Organization and United Nations Children's Fund launched the Baby Friendly Hospital Initiative (BFHI) to encourage best infant breastfeeding practices immediately after birth. In Lebanon, few hospitals are currently accredited as Baby Friendly. Aim To assess the knowledge of Lebanese women of BFHI steps, and to explore their attitudes towards Baby Friendly Hospitals, Skin-to-Skin Contact and Kangaroo Care practices. Methods A cross-sectional survey of a random sample of healthy pregnant women from Lebanon's six governorates. Results The mean (SD) age of the participants (N = 517) was 28.6 (4.7) years. Most participants were unfamiliar with the terms Baby Friendly hospital (93.7%), skin-to-skin contact or kangaroo care (75%), or were inadequately instructed on how to initiate (54.2%) or continue (46.2%) breastfeeding. However, when provided with information about the benefits of BFHI practices, most mothers (> 90%) stated that they would deliver in Baby Friendly hospitals. About 68.4% of mothers refused to give donor human milk to their sick premature infants because of religious beliefs. Knowledge of Baby Friendly hospitals was significantly associated with university education (p = 0.029), higher monthly income (p = 0.042), and previous experiences of skin-to-skin contact (p<0.001), rooming in (p = 0.037), or breastfeeding support (p = 0.036). Conclusion There is a need for national awareness campaigns that address both the numerous advantages of the BFHI practices and Lebanese women's knowledge gaps about these practices. Such knowledge will help scale up the implementation of BFHI practices in hospitals in
PLOS ONE, Oct 23, 2019
Background Despite the beneficial effects of peer support on breastfeeding, research on the proce... more Background Despite the beneficial effects of peer support on breastfeeding, research on the process of peer support is scarce. In Lebanon, exclusive breastfeeding is only 15% in infants below six months. A multidisciplinary team launched a multi-component breastfeeding support intervention, with peer support, and professional lactation support provided by International Board Certified Lactation Consultants (IBCLs) to target this decline. Aim To describe the experiences of breastfeeding mothers and peer support providers with the process of breastfeeding support, and the influence of the intervention on their social support system. Methods Using a qualitative methodology, a purposive sample of breastfeeding and support mothers was accessed from among those who completed their six months interview in the trial taking place in two hospitals in Beirut, Lebanon. Data were collected from 43 participants using in-depth interviews and following the data saturation principle. All interviews were audio recorded and transcribed verbatim. Thematic analysis was conducted, guided by the principles of grounded theory. Results Breastfeeding mothers were satisfied with their breastfeeding experience, and extremely appreciative of the support provided by their peers and the IBCLCs. They experienced these forms of support differently. Peer support was perceived to be important in encouraging breastfeeding continuation, whereas IBCLC support was influential in problem solving.
Journal of Human Lactation, Sep 26, 2016
Background: Valid instruments that can reliably assess maternal breastfeeding knowledge in Arabic... more Background: Valid instruments that can reliably assess maternal breastfeeding knowledge in Arabic-speaking populations are nonexistent. The availability of such an instrument is essential for investigators working in this field. Objective: This study aimed to describe the adaptation and validation of the Arabic Breastfeeding Knowledge Questionnaire (BFK-A) from the original 20-item English version. Methods: A translated version of the 20-item BFK was validated among 417 Lebanese women after pilot testing for clarity, comprehension, length, and cultural appropriateness. Exploratory factor analysis was run to examine dimensionality of the instrument and Kuder-Richardson-20 (KR-20) was used to assess its internal consistency. Results: The BFK-A is a unidimensional scale with acceptable internal consistency reliability (KR-20 = 0.652) after the exclusion of 4 items. Higher breastfeeding knowledge levels were strongly and statistically significantly associated with higher mean scores for the validated Arabic Iowa Infant Feeding Attitude Scale ( P < .001), thus confirming its construct validity. Conclusion: The Arabic 16-item BFK-A has an acceptable reliability, similar to the original instrument. Further studies are encouraged to confirm the validity of the 16-item BFK-A among other Arab populations. There is also a need to develop more reliable instruments to use in lactation research in this context.
BMC Pediatrics, Sep 6, 2005
Background: The antipyretic effectiveness of rectal versus oral acetaminophen is not well establi... more Background: The antipyretic effectiveness of rectal versus oral acetaminophen is not well established. This study is designed to compare the antipyretic effectiveness of two rectal acetaminophen doses (15 mg/kg) and (35 mg/kg), to the standard oral dose of 15 mg/kg. Methods: This is a randomized, double-dummy, double-blind study of 51 febrile children, receiving one of three regimens of a single acetaminophen dose: 15 mg/kg orally, 15 mg/kg rectally, or 35 mg/ kg rectally. Rectal temperature was monitored at baseline and hourly for a total of six hours. The primary outcome of the study, time to maximum antipyresis, and the secondary outcome of time to temperature reduction by at least 1°C were analyzed by one-way ANOVA. Two-way ANOVA with repeated measures over time was used to compare the secondary outcome: change in temperature from baseline at times1, 2, 3, 4, 5, and 6 hours among the three groups. Intent-to-treat analysis was planned. Results: No significant differences were found among the three groups in the time to maximum antipyresis (overall mean = 3.6 hours; 95% CI: 3.2-4.0), time to fever reduction by 1°C or the mean hourly temperature from baseline to 6 hours following dose administration. Hypothermia (temperature < 36.5°C) occurred in 11(21.6%) subjects, with the highest proportion being in the rectal high-dose group. Conclusion: Standard (15 mg/kg) oral, (15 mg/kg) rectal, and high-dose (35 mg/kg) rectal acetaminophen have similar antipyretic effectiveness.
BMC Medicine, Mar 4, 2006
Background: Alternating ibuprofen and acetaminophen for the treatment of febrile children is a pr... more Background: Alternating ibuprofen and acetaminophen for the treatment of febrile children is a prevalent practice among physicians and parents, despite the lack of evidence on effectiveness or safety. This randomized, double-blind and placebo-controlled clinical trial aims at comparing the antipyretic effectiveness and safety of a single administration of alternating ibuprofen and acetaminophen doses to that of ibuprofen mono-therapy in febrile children. Methods: Seventy febrile children were randomly allocated to receive either a single oral dose of 10 mg/kg ibuprofen and 15 mg/kg oral acetaminophen after 4 hours, or a similar dose of ibuprofen and placebo at 4 hours. Rectal temperature was measured at baseline, 4, 5, 6, 7 and 8 hours later. Endpoints included proportions of afebrile children at 6, 7 and 8 hours, maximum decline in temperature, time to recurrence of fever, and change in temperature from baseline at each time point. Intent-to-treat analysis was planned with statistical significance set at P < 0.05. Results: A higher proportion of subjects in the intervention group (83.3%) became afebrile at 6 hours than in the control group (57.6%); P = 0.018. This difference was accentuated at 7 and 8 hours (P < 0.001) with a significantly longer time to recurrence of fever in the intervention group (mean ± SD of 7.4 ± 1.3 versus 5.7 ± 2.2 hours), P < 0.001. Odds ratios (95%CI) for defervescence were 5.6 (1.3; 23.8), 19.5 (3.5; 108.9) and 15.3 (3.4; 68.3) at 6, 7 and 8 hours respectively. Two-way ANOVA with repeated measures over time revealed a significantly larger decline in temperature in the intervention group at times 7 (P = 0.026) and 8 (P = 0.002) hours. Conclusion: A single dose of alternating ibuprofen and acetaminophen appears to be a superior antipyretic regimen than ibuprofen mono-therapy. Further studies are needed to confirm these findings.
Prenatal Diagnosis, 2002
To assess the attitudes of health professionals in Lebanon towards prenatal diagnosis and termina... more To assess the attitudes of health professionals in Lebanon towards prenatal diagnosis and termination of pregnancy, for a series of genetic, non-genetic and non-medical conditions. A total of 158 questionnaires were sent to geneticists, family doctors, pediatricians and obstetricians/gynecologists, that included information on sociodemographic variables and sets of questions and case scenarios, to which participants were asked to reply anonymously. Responses from the 75 participants revealed that the type of specialty did not significantly influence their attitude. However, acceptance of termination of pregnancy was influenced by gender, age, marital status, religion and its importance in their daily life. In general, acceptance of termination of pregnancy in the case of mild or severe clinical conditions was comparable to that reported from European countries, but more favorable in the case of sex chromosome abnormalities. Acceptance of prenatal diagnosis for non-clinical conditions was, however, lower than that reported in Western nations. The study provides a good basis for further studies with a larger number of respondents representing various geographical regions of the country.
Journal of Medical Ethics, Aug 16, 2010
Paediatric clinical research faces unique challenges that compromise optimal recruitment of child... more Paediatric clinical research faces unique challenges that compromise optimal recruitment of children into clinical trials. A main barrier to enrolment of children is parental misconceptions about the research process. In developing countries, there is a knowledge gap regarding parental perceptions of and attitudes towards their children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s participation in clinical trials. To explore such perceptions and attitudes in Lebanese parents. 33 in-depth interviews were conducted with parents with and without previous research experience. Interviews were tape-recorded, transcribed in colloquial Arabic, and later subjected to thematic analysis. Benefit/risk ratio assessment was a major determinant of parental consent. Fear of adverse events or painful procedures in research was a recurring theme in most interviews. Whereas perception of direct benefit to the child, trust in the physician or institution, financial gains or having a positive previous experience in research facilitated consent, a complex informed consent form and misunderstanding of the term &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;randomisation&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; hindered parental approval of participation. Lebanese parents have perceptions of and attitudes towards children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s participation in clinical trials that are similar to those reported from the industrialised world. Improving communication with parents and building trust between researchers and parents is important for successful recruitment. Investigators planning to conduct paediatric trials in developing countries need to simplify consent forms and devise new ways to explain randomisation.
JAAD case reports, Mar 1, 2015
BMC Medical Education, Feb 4, 2022
Background: Evidence on the effectiveness of team-based learning in teaching critical appraisal t... more Background: Evidence on the effectiveness of team-based learning in teaching critical appraisal to large classes of preclinical medical students is scarce. This study investigated whether team-based learning is effective in teaching critical appraisal to large classes of preclinical medical students. Methods: Between April 2018 and May 2019, 107 first-year medical students were randomly allocated to receive instruction in critical appraisal using team-based learning or traditional group discussions as teaching methods. The primary outcome was students' performance on the Berlin Questionnaire administered at the end of second year. Results: Students' mean (SD) age was 22.0 (0.7) years. Baseline characteristics of the two groups were similar (all p values > 0.05). The mean (SD) Berlin scores of both groups were 80.4 (11.6) and 80.1 (12.1) for team-based learning and group discussions, respectively. Multivariate stepwise linear regression analysis revealed that the student's academic achievement in medical school was the sole predictor of performance on the Berlin Questionnaire (ß = 1.079, p < 0.001), adjusting for gender, Medical College Admission Test score, student's self-reported preferred teaching method, rank upon admission to medical school, score on the Epidemiology and Biostatistics course, and teaching method (team-based learning versus group discussions). Conclusions: Team-based learning and group discussions were equally effective instructional strategies to teach critical appraisal to large classes of undergraduate medical students. Replication of our findings is needed in other educational settings.