Erbil Journal of Nursing and Midwifery

Association of Liver Function Tests and Inflammatory Biomarkers with eGFR in Chronic Kidney Disease Patients on Hemodialysis in Erbil City

Jwan Qader Azeez, Dler Qader Gallaly, Ismail Mustafa Maulood (Author) — Sat, 30 May 2026 00:00:00 +0000

Background and Objective: Chronic Kidney Disease is a global public health concern, particularly in patients undergoing hemodialysis, who face elevated cardiovascular risks and progressive renal dysfunction. These patients often exhibit disrupted lipid metabolism, impaired glycemic control, and altered body composition. However, the sex-specific associations between these metabolic factors and kidney function remain unclear. This study aimed to evaluate the relationship between anthropometric measurements, glycemic markers, and lipid profile components. It estimated the Glomerular Filtration Rate (eGFR) in male and female Chronic Kidney Disease patients on maintenance hemodialysis in Erbil City.

Methods: A cross-sectional study was conducted at Erbil Teaching Hospital between November 2024 and April 2025. It included 70 adult patients with Chronic Kidney Disease undergoing regular hemodialysis and 70 healthy controls. Body mass index (BMI), glycemic markers (fasting blood sugar and HbA1c), lipid profiles (total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and very-low-density lipoprotein), and eGFR (calculated using the 2021 CKD-EPI formula) were analyzed. Correlation analyses were performed separately for genders using GraphPad Prism.

Results: BMI showed a statistically significant but clinically weak negative relationship with eGFR in both men and women. Glycemic markers (blood sugar and HbA1c) were inversely correlated with eGFR in males, whereas in females they showed a positive correlation, possibly reflecting early hyperfiltration. TC was weakly positively associated with eGFR in males but not in females. HDL showed a strong positive correlation with eGFR in males only. LDL was marginally positively associated with eGFR in females, while TG and VLDL showed no significant correlation in either sex.

Conclusion: In individuals undergoing hemodialysis, metabolic indicators exhibited sex-specific correlations with eGFR levels. Glycemic parameters and HDL had a stronger correlation with eGFR than BMI and other lipid indices. These findings emphasize the significance of sex-specific assessment in the metabolic management of chronic renal disease patients.

Risk Factors Associated with Birth Asphyxia among Neonates in Maternity Teaching Hospital/Erbil City: A Case-Control Study

Suham Omar Azeez, Shukir Saleem Hasan (Author) — Sat, 30 May 2026 00:00:00 +0000

Background and Objectives: Birth asphyxia is a critical condition characterized by the inability to begin and sustain breathing at birth. It is a leading cause of neonatal morbidity and mortality worldwide. This study aims to investigate the common risk factors for birth asphyxia in Erbil City.

Method: Matched case-control study was conducted from 1st October 2024 to 15th of Jan 2025 at Maternity Teaching Hospital in Erbil city, Iraqi Kurdistan Region, Data were collected through a questionnaire format and direct interview with the mothers of neonates diagnosed with birth asphyxia. The study recruited 276 neonates (92 neonates with birth asphyxia as a case group and 184 neonates without birth asphyxia as a control group). Newborns with congenital anomalies, congenital heart disease, premature babies (<35weeks), and epilepsy family history were excluded from both groups. The study utilized SPSS Version 27 for data analysis, employing chi-square to identify associations between case and control groups and univariate and multivariate logistic regression to identify risk factors independently associated with asphyxia, with a P-value of ≤ 0.05 considered significant.

Result: Risk factors were identified by the study and divided into antepartum and intrapartum maternal periods. Asphyxia was significantly linked to poor socioeconomic position, maternal illiteracy, number of gravidas with P- value of (0.022, 0.011, 0.006) and emergency caesarean section %35.9 with a very high significant P-value (<0.001). After adjusted factors like hypertension, infection, and polyhydramnios, they are associated with increased risks of asphyxia during pregnancy with odds ratios of 3.109, 2.168, and 3.024. And preterm premature rupture of membrane, difficult labour, prolonged second stage of labour, and fetal distress are associated with increased risks of asphyxia during labor with odds ratios of (4.906, 5.116, 6.739, and 8.685, respectively) at a significant level of <0.05.

Conclusion: The study concluded that factors such as socioeconomic status,.....

Patient Satisfaction with Outpatient Physiotherapy Services: A Cross-Sectional Study in Erbil, Iraq

Sat, 30 May 2026 00:00:00 +0000

Background and Objectives: Patient satisfaction is increasingly recognized as a key indicator of healthcare quality. Physiotherapy services, in particular, play a vital role in rehabilitation and patient-centered care. This study addresses a regional gap by systematically evaluating patient satisfaction with outpatient physiotherapy services in Erbil, Iraq.
This study aimed to assess patient satisfaction with outpatient physiotherapy services, identify key factors influencing satisfaction, and provide evidence-based recommendations for improving service delivery.
Methods: A cross-sectional study was conducted from June to October 2024 involving 303 patients from governmental and private physiotherapy centers in Erbil. Data were collected via structured interviews using a validated 13-item satisfaction questionnaire covering administrative processes, comfort, therapist communication, and overall experience. Demographic data were also recorded. Statistical analysis included descriptive statistics and chi-square tests, with significance set at P-value ≤ 0.05.
Results: The majority of participants were female (72%). Satisfaction was highest for administrative processes and staff courtesy (48.5% rated 'very good'), facility comfort and relaxation (38% rated 'very good'), and overall recommendation of services (42.2% 'very good'). Overall, 38.3% rated services as 'good' while only 1.7% rated them as 'poor'. All domains showed statistically significant associations with overall satisfaction (p < 0.001).
Conclusions: Patients reported generally high levels of satisfaction with outpatient physiotherapy services in Erbil. Improvements are needed in treatment explanations and patient education. These findings highlight the importance of patient-centered approaches to strengthening healthcare quality.

Evaluation of the Success of Using a Manual Stretching Approach to Promote Knee Extension Following Total Knee Replacement

Shayda Shekhmohammed Ismael, Mohd Ashraf Thoker (Author) — Sat, 30 May 2026 00:00:00 +0000

Background and Objectives: Total knee arthroplasty is an advanced surgical method for patients with severe knee disorders, including osteoarthritis and rheumatoid arthritis. Knee arthroplasty is effective in managing pain and restoring extension for better function. This study focuses on manual stretching techniques, following total knee arthroplasty, to improve knee extension and the aim is to decrease back pain and improve the physical quality of life of patients by restoring maximum possible mobility.

Methods: A quasi-experimental study (pretest-posttest) design was conducted to evaluate the quality of life of 110 patients with an age range spanning from 40 to 75 years, who were recruited for the research between October 2024 and April 2025. The method for data collection was meticulous and multifaceted. Prior to the rehabilitation program, a thorough baseline assessment was carried out for each participant. This initial evaluation included precise measurement of the knee's extension range of motion using a standard goniometer and a quantitative assessment of pain intensity via the Visual Analogue Scale.

Result: The analysis of the collected data revealed overwhelmingly positive and statistically significant results, affirming the intervention's efficacy. The primary outcome, knee extension range of motion, showed a remarkable improvement, with the cohort's average measurement increasing from 156.1 degrees pre-intervention to a near-full extension of 172.2 degrees postintervention. This marked increase in joint mobility was strongly correlated with a significant decrease in patient-reported pain levels.

Conclusions: Manual stretches can be a significant technique for improving the rehabilitation of knee extension following surgery. However, manual stretching on its own is not a panacea for every patient, especially those with advanced knee osteoarthritis, obesity, or knee flexion contractures, which potentially would result in severe knee stiffness.

Evaluation of Post-cesarean Section Nursing Care in Maternal and Pediatric Teaching Hospitals

Gulala Abubakr Hussein, Iman Fadhil Omar, Renas Mohammed Khdhir (Author) — Sat, 30 May 2026 00:00:00 +0000

Background and Objectives: The worldwide increase in cesarean section rates has become a major public health concern due to associated maternal and neonatal risks. Appropriate post-cesarean nursing care plays a vital role in preventing complications and promoting recovery. This study aimed to assess nurses’ performance in providing post-cesarean nursing care and to determine its association with selected socio-demographic characteristics.

Methods: A descriptive study was conducted at the Maternal and Pediatric Teaching Hospital in Raparin Administration from July 21 to September 1, 2025. The study included all 22 nurses working in the women’s ward (total population sampling) The sample size was small because it included all available nurses working in the women’s department. Data were collected using direct interviews and observational checklists. Statistical analysis was performed using SPSS version 27. Chi-square and Fisher’s exact tests were applied to examine associations between variables. A p-value ≤ 0.05 was considered statistically significant.

Results: The mean age of participants was 47.5 ± 8.7 years (range: 32–61 years). Most nurses were married (90.9%), and 51% were graduates of secondary nursing school. Overall, the performance of post-cesarean nursing care was inadequate, particularly during the first 24 hours and at discharge. A highly significant association was found between nurses’ performance in providing care during the first 24 hours and their age, level of education, years of employment, and years of experience (p ≤ 0.05).

Conclusions: Post-cesarean nursing care in the studied hospital was generally inadequate. Nurses’ age, education level, and professional experience were significantly associated with care performance. Continuous training programs and regular supervision are recommended to improve the quality of post-cesarean nursing care, as they can enhance nurses' skills and knowledge, ultimately leading to better patient outcomes.

Women’s Perspectives and Experiences of Water Birth in Erbil City: A Qualitative Study

Fatemeh Jahanshah Hassani, Tiran Jamil Piro (Author) — Sat, 30 May 2026 00:00:00 +0000

Background and Objectives: Water birth is a pain-reducing and comfort-enhancing way of childbirth for women. Despite its origins in ancient methods, it has lately achieved global prominence, notably in midwifery-led care. However, acceptability and impression vary by area. This study aimed to explore women’s perspectives and experiences regarding water birth in Erbil City.

Methods: A qualitative study was conducted at Private Hospital Shar in Erbil, Iraq, from January to February 2025. Semi-structured video call interviews were conducted with seven Kurdish-speaking mothers who had given birth using water. A purposive sampling strategy was employed, and data saturation was obtained. The interviews were transcribed, translated from Kurdish to English, and evaluated using content analysis. The study's rigor was maintained by ensuring its credibility, reliability, and confirmability.

Result: Psychological effects, cultural perspectives, and overall experience were the three major themes that emerged from the investigation. Pain relief, a sense of peace, and stress management were among the psychological effects. Cultural perspectives reflected the community's beliefs and norms. The overall experience included emotional relief, barriers and challenges, and willingness to recommend water birth to others. The participants' experiences may be fully understood by researching these themes.

Conclusion: Water birth was associated with reduced pain and improved psychological comfort. Despite cultural concerns and practical challenges, participants reported positive experiences and a willingness to repeat water birth. This study emphasizes informed choice, partner support, and adequate facility protocols to ensure safe implementation across diverse settings.

Assessment of Intensive Care Nurses’ Knowledge of Evidence-Based Practices for Preventing Ventilator-Associated Pneumonia in Duhok City

Amar Khalid Saber , Khalid Mohammed Saber , Salar Omar Abdulqadir (Author) — Sat, 30 May 2026 00:00:00 +0000

Backgrounds and Objectives: A common hospital-acquired illness that affects patients who are seriously ill from mechanical ventilation and intubation is ventilator-related pneumonia. A lack of understanding may limit nurses’ adherence to evidence-based guidelines for preventing ventilator-associated pneumonia. This study aimed to assess the knowledge of those nurses who are working in the intensive care unit about mechanical ventilator-related pneumonia prevention.

Methods: A descriptive cross-sectional study was carried out in the 144 intensive care nurses’ units of major hospitals in Duhok City from 1 June through 31 December in 2025. Data were obtained using a structured questionnaire consisting of 4 demographic items and 17 knowledge-based questions adapted from a validated tool and supplemented by researcher-developed items. Independent sample t-tests, one-way ANOVA, and multiple regression were used in conducting inferential analysis.

Results: A total of 114 intensive care unit nurses were involved in the study; the majority of the participants were female (64.0%), and most of them had bachelor’s degrees (81.6%). In terms of overall knowledge about the prevention of ventilator-related pneumonia, 61.40% of participants in the present study were found to have poor knowledge (their scores were below 60).

Conclusions: Participants with higher degrees and those who had finished ICU training programs showed greater knowledge. These results point out the need for ongoing education, ICU-specific training, and frequent refresher courses to enhance nurses' skills and expertise. Patient safety, the incidence of ventilator-associated pneumonia, and the standard of care in intensive care units can all be improved by strengthening nursing education, implementing standardized ventilator -associated pneumonia prevention guidelines, and encouraging advanced training.

Beyond Iron: Dietary, Lifestyle, and Sleep Associated Factors of Anemia in Adults: Evidence from Ranya City, Iraq

Hero Salah Babakr, Renas Mohamed Khdir (Author) — Sat, 30 May 2026 00:00:00 +0000

Background and Objectives: Anemia, a common blood disorder of low hemoglobin, is a significant global public health issue. While traditionally linked to iron deficiency, recent studies suggest that lifestyle, dietary, and behavioral factors may also play important roles. In Iraq—and specifically Ranya District—there is limited data on how these broader factors contribute to adult anemia. To assess the prevalence of anemia and explore its sociodemographic, dietary, lifestyle, and sleep-associated factors among adults in Ranya District, Iraq.

Methods: A cross-sectional, community-based study was conducted among 384 adults in Ranya City by structured questionnaire administration and laboratory testing of hemoglobin levels. Descriptive statistics and chi-square tests to identify the association between anemia status and explanatory factors.

Results: The overall prevalence of anemia was approximately 24%, with a significantly higher rate among females (31.5%) compared to males (2.9%). Significant associations were found between anemia and gender, occupation, marital status, smoking, dietary patterns, supplement use, meal skipping, and sleep disturbances. Red meat and vegetable intake were not significantly associated. Sleep quality showed a strong relationship with anemia.

Conclusion: Anemia in adults from Ranya City is influenced not only by iron intake but also by modifiable lifestyle and behavioral factors, particularly sleep quality and meal patterns. Public health strategies should expand beyond iron supplementation to address these broader associated factors.

Pain-Related Musculoskeletal Disorders among Health Care Workers at SHAR Teaching Hospital in Sulaymaniyah city

Hawzhin Sabr Sleman, Delan Jamal Qader (Author) — Sat, 30 May 2026 00:00:00 +0000

Background and Objectives: Musculoskeletal disorders represent a significant global occupational health problem, especially among healthcare professionals engaged in physically strenuous activities such as patient handling, prolonged standing, and repetitive motions. These factors significantly affect quality of life and work efficacy. This study assesses the prevalence, anatomical distribution, severity, and associated factors of musculoskeletal pain among healthcare professionals at Shar Teaching Hospital in Sulaymaniyah City.

Method: A cross-sectional study was carried out between 15 December 2024 and 25 March 2025, including 235 nurses and physicians. Data were collected using a semi-structured questionnaire and a modified Nordic Body Map and analyzed with SPSS version 24.

Result: The findings indicated that all individuals experienced musculoskeletal discomfort in the preceding 12 months, with the lower back, feet/ankles, and neck (46.8%, 11.9%, and 22.6% respectively) identified as the most impacted areas. A majority of participants indicated experiencing moderate to severe pain (61.3%).Significant associations were identified between pain severity and several variables, including age, gender, years of experience, financial status, department, and work hours (p < 0.01). Although training in lifting techniques did not yield statistically significant results, a protective trend was observed. The major symptom was a gradual onset of pain (94%), commonly aggravated by prolonged standing or bending.

Conclusion: This study highlights the occupational impact of musculoskeletal disorders on healthcare workers, particularly in high-demand departments and among individuals with extended employment or financial stress.

Effects of Intervention Program for Frozen Shoulder Patients in Erbil City: A Comparison Study

Parween Askandar Hamza (Author); Dara Abdulla Al-Banna — Sat, 30 May 2026 00:00:00 +0000

Background and Objectives: Frozen shoulder is a painful inflammatory disorder characterized by progressive loss of shoulder mobility, most common in women aged 40–60 years. It may occur primarily, often associated with diabetes or thyroid disease, or secondarily following trauma or immobilization and typically progresses through painful, frozen, and thawing stages over a period of up to two years. This study evaluated the effect of a multi-technique intervention on shoulder Range of Motion in female patients treated at public hospitals.

Methods: A quasi-experimental study was conducted with 134 female patients aged over 30 years in the frozen phase of the condition. Participants were assigned based on matching criteria and availability to four groups. The three experimental groups received a multi-technique physiotherapy intervention, defined as the combination of shortwave diathermy, a specific glenohumeral joint mobilization technique, and prescribed home-based therapeutic exercises. Group A (n=30) received posterior mobilization; Group B (n=30) received anterior mobilization; and Group C (n=30) received inferior mobilization. Group D, the control group (n=34), received shortwave diathermy with home exercises only. Treatments were administered three times per week for three weeks. ROM—including flexion, extension, abduction, internal rotation, and external rotation—was measured before and after the intervention using a universal goniometer.

Results: All experimental groups showed significant ROM improvement (P-value <0.001). Posterior glide achieved the largest gain in external rotation (20.53° to 73.97°), anterior glide maximized flexion improvement (78.03° to 122.83°), and inferior glide enhanced both flexion and abduction. The control group improved modestly in flexion and abduction only (P-value <0.05).

Conclusion: The multi-technique program significantly improved shoulder ROM, with each mobilization showing specific benefits; posterior glide achieved the greatest gains.