{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T20:08:25Z","timestamp":1776456505358,"version":"3.51.2"},"reference-count":15,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2021,8,9]],"date-time":"2021-08-09T00:00:00Z","timestamp":1628467200000},"content-version":"vor","delay-in-days":770,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Avicenna J Med"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objectives: Since the uprising in 2011, there have been limited health-care data from inside Syria regarding women\u2019s health. This study aimed to provide an updated account of women\u2019s health, including pregnancy, perinatal care, childbirth, and other conditions to identify obstacles and challenges to health-care delivery in Northwestern Syria. Methods: This is a prospective data registry study, using a medical electronic records system that builds on the International Classification of Diseases, Tenth Revision (ICD-10) codes. We collected data from one medical center in Northwestern Syria during 2017. We conducted a survey to understand patients\u2019 knowledge of and barriers limiting antenatal care (ANC). Results: We studied 7213 patients\u2019 health status and surveyed 134 regarding ANC. Prenatal care, delivery, and miscarriage treatment represented the most common (70%) reasons for women\u2019s health-care visits, followed by menstrual disorders (17%). From 2057 delivery records, 70% delivered vaginally and 30% required cesarean delivery. Our findings showed that 1169 (24%) of the pregnant women (4936) in 2017 were adolescents, of them 22 (0.44%) were 14 years old. Regarding ANC visits, 85% of respondents did not have a single ANC visit in the first trimester, 82% had no visits in the second trimester, and 44% had no visits in the third trimester. Thirty-one percent had no ANC visit throughout the entire pregnancy. Only 13% had postnatal care (PNC) visits. Women who live in the refugee camp are 2.7 times less likely to meet the World Health Organization (WHO) criteria for focused ANC (FANC = 4 visits) compared to those who reside in town (P &lt; 0.001), with only 14% having met the FANC. The major barrier to ANC is related to transportation (34%), followed by factors related to the study center (29%) and knowledge and education (19%). We estimated the number of obstetrics-gynecology doctors per 1000 populations to be 0.02. Conclusions: We found a huge deficiency in ANC and PNC visits, a high adolescent birth rate, and a higher cesarean-to-vaginal delivery ratio than what is recommended by the WHO. We also found a severe shortage in the number of obstetrician-gynecologists serving this population.<\/jats:p>","DOI":"10.4103\/ajm.ajm_190_18","type":"journal-article","created":{"date-parts":[[2019,3,19]],"date-time":"2019-03-19T07:51:05Z","timestamp":1552981865000},"page":"94-106","source":"Crossref","is-referenced-by-count":13,"title":["Women\u2019s health in Northwestern Syria: Findings from Healthy-Syria 2017 study"],"prefix":"10.1055","volume":"9","author":[{"given":"Abdullah Sulieman","family":"Terkawi","sequence":"additional","affiliation":[{"name":"Syrian Expatriate Medical Association (SEMA), SEMA-US, Charlottesville, VA, USA; Department of Anaesthesiology, University of Virginia, Charlottesville, VA, USA; Department of Anaesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia; Outcomes Research Consortium, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Basil","family":"Bakri","sequence":"additional","affiliation":[{"name":"Syrian Expatriate Medical Association (SEMA), SEMA-US, Cincinnati, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amena S.","family":"Alsadek","sequence":"additional","affiliation":[{"name":"Syrian Expatriate Medical Association, Idlib, Syria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rawaa H.","family":"Alsibaee","sequence":"additional","affiliation":[{"name":"Syrian Expatriate Medical Association (SEMA), SEMA-Turkey, Gaziantep"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esraa M.","family":"Alasfar","sequence":"additional","affiliation":[{"name":"Charlottesville, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amna H.","family":"Albakour","sequence":"additional","affiliation":[{"name":"Syrian Expatriate Medical Association, Idlib, Syria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulhannan Y.","family":"Aljouja","sequence":"additional","affiliation":[{"name":"Syrian Expatriate Medical Association (SEMA), SEMA-Turkey, Gaziantep"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nour A.","family":"Alshaikhwais","sequence":"additional","affiliation":[{"name":"Syrian Expatriate Medical Association, Idlib, Syria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feras A.","family":"Fares","sequence":"additional","affiliation":[{"name":"Syrian Expatriate Medical Association (SEMA), SEMA-Turkey, Gaziantep"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela D.","family":"Flood","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Stanford University, Menlo Park, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hussam","family":"Jnaid","sequence":"additional","affiliation":[{"name":"Syrian Expatriate Medical Association (SEMA), SEMA-Turkey, Gaziantep, Turkey; Section Head of Polyclinics, Department of Family Medicine and Polyclinics, King Saud University, Riyadh, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amina A.","family":"Najib","sequence":"additional","affiliation":[{"name":"Syrian Expatriate Medical Association, Idlib, Syria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diaa A.","family":"Saloom","sequence":"additional","affiliation":[{"name":"Syrian Expatriate Medical Association, Idlib, Syria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noran A.","family":"Zahra","sequence":"additional","affiliation":[{"name":"Syrian Expatriate Medical Association, Idlib, Syria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khalid A.","family":"Altirkawi","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, King Saud University, Riyadh, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,8,9]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"2205","DOI":"10.1056\/NEJMp1603673","article-title":"The hell of Syria\u2019s field hospitals","volume":"351","author":"S Attar","year":"2016","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"h4736","DOI":"10.1136\/bmj.h4736","article-title":"Civilian deaths from weapons used in the Syrian conflict","volume":"351","author":"D Guha-Sapir","year":"2015","journal-title":"BMJ"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"51","DOI":"10.4103\/2231-0770.133329","article-title":"Syrians\u2019 alternative to a health care system: \u201cfield hospitals\u201d","volume":"4","author":"f Alahdab","year":"2014","journal-title":"Avicenna J Med"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/S0140-6736(15)60515-3","article-title":"Syrian crisis: health experts say more can be done","volume":"385","author":"S Cousins","year":"2015","journal-title":"Lancet"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"e103","DOI":"10.1016\/S2214-109X(17)30469-2","article-title":"Patterns of civilian and child deaths due to war-related violence in Syria: A comparative analysis from the violation documentation center dataset, 2011\u201316","volume":"6","author":"D Guha-Sapir","year":"2018","journal-title":"Lancet Glob Health"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"2278","DOI":"10.1016\/S0140-6736(17)31328-4","article-title":"Attacks against health care in Syria, 2015-16: Results from a real-time reporting tool","volume":"390","author":"M Elamein","year":"2017","journal-title":"Lancet"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s12916-018-1041-7","article-title":"The Syrian conflict: A case study of the challenges and acute need for medical humanitarian operations for women and children internally displaced persons","volume":"16","author":"R Aburas","year":"2018","journal-title":"BMC Med"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1742-4755-3-2","article-title":"Use of antenatal services and delivery care among women in rural western Kenya: A community based survey","volume":"3","author":"A M van Eijk","year":"2006","journal-title":"Reprod Health"},{"key":"ref17","first-page":"197","article-title":"Barriers to utilization of antenatal care services in eastern Nepal","volume":"3","author":"K K Deo","year":"2015","journal-title":"Front Public 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