Women In Low-income Countries Research Articles

Higher Gravidity and Parity Are Associated with Increased Prevalence of Metabolic Syndrome among Rural Bangladeshi Women

BackgroundParity increases the risk for coronary heart disease; however, its association with metabolic syndrome among women in low-income countries is still unknown.ObjectiveThis study investigates the association between parity or gravidity and metabolic syndrome in rural Bangladeshi women.MethodsA cross-sectional study was conducted in 1,219 women aged 15–75 years from rural Bangladesh. Metabolic syndrome was defined according to the standard NCEP-ATP III criteria. Logistic regression was used to estimate the association between parity and gravidity and metabolic syndrome, with adjustment of potential confounding variables.ResultsSubjects with the highest gravidity (> = 4) had 1.66 times higher odds of having metabolic syndrome compared to those in the lowest gravidity (0-1) (P trend = 0.02). A similar association was found between parity and metabolic syndrome (P trend = 0.04), i.e., subjects in the highest parity (> = 4) had 1.65 times higher odds of having metabolic syndrome compared to those in the lowest parity (0-1). This positive association of parity and gravidity with metabolic syndrome was confined to pre-menopausal women (P trend <0.01). Among the components of metabolic syndrome only high blood pressure showed positive association with parity and gravidity (P trend = 0.01 and <0.001). Neither Parity nor gravidity was appreciably associated with other components of metabolic syndrome.ConclusionsMulti parity or gravidity may be a risk factor for metabolic syndrome.

Economic and Social Upgrading in Global Apparel Production Networks

The apparel industry is one of the most globalized. Export production contributes substantially to national export earnings and employs tens of millions worldwide, particularly women in low-income countries. However, the globalization of production has also led to poor working conditions and regional wage depression. Over time, the national structure of manufacturer-driven value chains has given way to increasingly fragmented production systems, but in recent years the trend towards concentration, supply chain transparency and strategic partnerships between buyers and suppliers has improved conditions for some supplier firms and workers. Trade and preferential market access policies severely constrain economic and social upgrading opportunities.

A population based survey in Ethiopia using questionnaire as proxy to estimate obstetric fistula prevalence: results from demographic and health survey

BackgroundObstetric Fistula (OF) remains a major public health problem in areas where unattended obstructed labor is common and maternal mortality is high. Obstetric Fistula was able to be prevented, treated and eradicated in high-income countries; however, it still affects many women in low-income countries. To our knowledge, only few studies have described the prevalence and factors associated with Obstetric Fistula in Ethiopia in population-based surveys.ObjectiveThe aim of this study is to describe the prevalence and factors associated with Obstetric Fistula in Ethiopia.MethodsThe study used women’s dataset from the 2005 Ethiopian Demographic and Health Survey. The survey sample was designed to provide national, urban/rural, and regional representative estimates of key health and demographic indicators. The sample was selected using a two-stage stratified sampling process. OF was measured using questionnaire. The data is analyzed using descriptive and multivariate statistical methods to determine factors associated with Obstetric Fistula.ResultsA total of 14,070 women of reproductive age group were included in the survey. Of which 23.2% ever heard of obstetric fistula. Among women who ever given birth (9,713), some 103 (1.06%, 95% CI; 0.89%-1.31%) experienced obstetric fistula in their lifetime, which means 10.6 per 1000 women who ever gave birth. It is estimated that in Ethiopia nearly 142,387 (95% CI: 115,080-169,694) of obstetric fistula patients exist. Those women who are circumcised had higher odds of reporting the condition (Chi square = 4.41, p-value = 0.036). In the logistic regression model women from rural areas were less likely to report obstetric fistula than their urban counterparts (OR = 0.21, 95% CI: 0.06-0.69). Women who gave birth 10 or more had higher odds of developing obstetric fistula than women with 1-4 child (OR = 4.34; 95% CI; 1.29-14.55).ConclusionsObstetric fistula is a major public and reproductive health concern in Ethiopia. This calls for increased access to emergency obstetric care, expansion of fistula repair service and active finding of women with OF with campaigns of ending fistula is recommended.

Population-based intervention for cardiovascular diseases related knowledge and behaviours in Asian Indian women.

There is poor knowledge and behaviors regarding chronic diseases related nutritional and lifestyle factors among women in low income countries. To evaluate efficacy of a multilevel population-based intervention in improving knowledge and practices for related factors we performed a study in India. Population based study among women 35-70 years was performed in four urban and five rural locations. Stratified sampling was performed and we enrolled 4624 (rural 2616, urban 2008) of eligible 8000 women (58%). Demographic details, medical history, diet, physical activity and anthropometry were recorded and blood hemoglobin, glucose and total cholesterol determined. Knowledge and behaviors regarding diet in chronic diseases were inquired in a randomly selected 100 women at each site (n=900). A systematic multilevel population based intervention (using posters, handouts, street plays, public lectures, group lectures and focused group discussions) was administered over 6 months at each site. The questionnaire was re-administered at the end in random 100 women (n=900) and differences determined. Descriptive statistics are reported. Comparison of parameters before and after intervention was assessed using Mann Whitney test. Prevalence (%) of chronic disease related lifestyles and risk factors in rural/urban women, respectively, was illiteracy in 63.6/29.4, smoking/tobacco use 39.3/18.9, high fat intake 93.6/93.4, high salt intake 18.2/12.6, low physical activity 59.5/70.2, overweight/obesity 22.5/45.6, truncal obesity 13.0/44.3, hypertension 31.6/48.2, hypercholesterolemia 13.5/27.7, and diabetes in 4.3/15.1 percent. Composite chronic diseases knowledge at baseline vs after intervention increased significantly in overall (32.0 vs 62.0), rural (29.0 vs 63.5) and urban (39.5 vs 60.5) groups (p<0.001). Significant increase in knowledge regarding diet in hypertension, diabetes, heart disease and anemia as well as importance of dietary proteins, fats, fibres and fruits was observed (p<0.001). There was insignificant change in most of the practices regarding intake of low fat, high protein, high fibre diet except sieving the flour which declined significantly (80.1 vs 53.6, p<0.001). A short-term multilevel population-wide intervention among women in rural and urban locations in India increased chronic disease knowledge but failed to influence practices.

Level and intensity of objectively assessed physical activity among pregnant women from urban Ethiopia

BackgroundWomen in low-income countries are generally considered to have a high physical workload which is sustained during pregnancy. Although most previous studies have been based on questionnaires a recent meta-analysis of doubly labeled water data has raised questions about the actual amount of physical activity performed. In this study we report objectively assessed levels of physical activity, cardiorespiratory fitness and muscular fitness among pregnant urban Ethiopian women, and their association with demographic characteristics and anthropometric measures.MethodsPhysical activity was measured for seven consecutive days in 304 women using a combined uniaxial accelerometer and heart rate sensor. Activity energy expenditure was determined using a group calibration in a branched equation model framework. Type and duration of activities were reported using a 24-hour physical activity recall and grip strength was assessed using a dynamometer.ResultsMedian (interquartile-range, IQR) activity energy expenditure was 31.1 (23.7-42.0) kJ/kg/day corresponding to a median (IQR) physical activity level of 1.46 (1.39-1.58). Median (IQR) time in sedentary, light, and moderate-to-vigorous intensity was 1100 (999–1175), 303 (223–374) and 40 (22–69) min/day, respectively. Mean (standard deviation) sleeping heart rate was 73.6 (8.0) beats/min and grip strength was 21.6 (4.5) kg. Activity energy expenditure was 14% higher for every 10 cm2 difference in arm muscle area and 10% lower for every 10 cm2 difference in arm fat area and 10-week difference in gestational age.ConclusionThe level and intensity of physical activity among pregnant women from urban Ethiopia is low compared to non-pregnant women from other low income countries as well as pregnant European women from high-income countries.

Prevalence and risk factors for symptoms of common mental disorders in early and late pregnancy in Vietnamese women: A prospective population-based study

BackgroundLittle is known about the prevalence of and risk factors for common mental disorders (CMD) in pregnant women in low-income countries. The aim of this study was to establish the prevalence of and psychosocial risk factors for clinically significant symptoms of CMD in early and late pregnancy in women in rural Viet Nam. MethodsA population-based sample of women was surveyed in early and late pregnancy. CMD were assessed by the Edinburgh Postnatal Depression Scale-Viet Nam Validation and psychosocial risks by study-specific structured interviews. ResultsIn total 497/523 (97%) eligible women were recruited and 419 (84%) provided complete data. Prevalence of CMD only in early pregnancy was 22.4% (95% CI 18.4–26.4); only in late pregnancy was 10.7% (95% CI 7.8–13.7) and at both assessment waves was 17.4% (95% CI 13.8–21.1). Non-economic and economic coincidental life adversity, intimate partner violence, past pregnancy loss, and childhood abuse were positively associated with persistent antenatal CMD. Older age, having a preference for the baby’s sex, and nulli- or primiparity were risk factors for CMD in early pregnancy. ConclusionsPersistent antenatal CMD are prevalent in rural areas of Viet Nam. Psychosocial risk factors play a major role in this significant public health problem.

Mental health spillovers and the Millennium Development Goals: The case of perinatal depression in Khayelitsha, South Africa.

Mental illness currently ranks among the top ten causes of burden of disease in low-income countries [1]. In the African region specifically, neuropsychiatric disorders account for approximately 5% of disability-adjusted life years lost, with nearly one-quarter of this burden attributable to unipolar depressive disorders [1]. Furthermore, this burden is projected to increase by 2030 [2]. There is accumulating evidence on the potential public health impact of scalable mental health treatments involving non-psychiatrists [3-5], with more studies under way [6-8], but overall the prevention and treatment of mental disorders have been relatively neglected in the global agenda [9,10]. A substantive portion of the burden of mental disorders in low-income countries is thought to be attributable to many of the failures of human development as targeted through the Millennium Development Goals (MDGs), including poverty, HIV, and gender inequality. The evidence on depressive disorders and depressed mood is most well developed in this respect (see Figure 1). Depression has been associated with economic deprivation, especially in low-income countries and with regards to specific indicators of deprivation such as food insecurity [12,13]. Depression is also a known consequent of poor physical health [14]. And finally, gender inequality [15], often manifested starkly as violence against women in low-income countries [16], is commonly conceptualized as a risk factor for poor mental health among women [17]. Figure 1 Conceptual framework of multilevel influences on depression and corresponding types of interventions. Adapted from McKinlay & Marceau [11]. If these relationships were causal and unidirectional, then interventions targeting MDG indicators related to poverty, HIV, and gender inequality would be expected to reduce the burden of disease from mental disorders. However, some of these relationships are bidirectional, suggesting that scaling up interventions to improve mental health may support efforts to achieve the MDGs. Emphasizing these spillover effects on other health outcomes of greater political interest may be one effective strategy to build support for mental health programming [18]. For example, depressive disorders and depressed mood are associated with significant psychosocial disability resulting in reduced economic productivity [19]. Depressed mood among women in the postnatal period has been associated with elevated risks for diarrhea and poorer growth among their newborn infants [20-23]. And, among persons living with HIV/AIDS, psychological stress and poor mental health have been associated with reduced adherence to HIV antiretroviral therapy [24] and worsened HIV-related outcomes [25]. Photo: Courtesy of Dr Mark Tomlinson, personal collection

Menstrual hygiene in Ugandan schools: an investigation of low-cost sanitary pads

Menstrual hygiene management (MHM) is a largely overlooked issue in the water, sanitation and hygiene (WASH) sector. Every day, millions of menstruating girls and women in low-income countries struggle to find clean water for washing, private places for changing and adequate blood absorbing materials. This study aims to explore the difficulties experienced by schoolgirls in Uganda in managing menstrual hygiene and investigates the extent to which low-cost sanitary pads are part of the solution. Low-cost sanitary pads, either re-usable or disposable, are a timely, simple and innovative means of improving menstrual hygiene and of addressing a broader set of problems related to MHM in schools. Other factors highlighted are: pain relief, education, safe water provision, clean and private latrines, hygienic and secure bathing facilities, use of soap, sealed waste disposal points, private drying places, anal cleansing materials and effective facility operation and management strategies.

The GENACIS project: a review of findings and some implications for global needs in women-focused substance abuse prevention and intervention

Gender, Alcohol, and Culture: An International Study (GENACIS) is a collaborative study of gender-related and cultural influences on alcohol use and alcohol-related problems of women and men. Members conduct comparative analyses of data from comparable general population surveys in 38 countries on five continents. This paper presents GENACIS findings that (1) age-related declines in drinking are uncommon outside North America and Europe; (2) groups of women at increased risk for hazardous drinking include women who cohabit, women with fewer social roles, more highly educated women in lower-income countries, and sexual minority women in North America; (3) heavier alcohol use shows strong and cross-culturally consistent associations with increased likelihood and severity of intimate partner violence; and (4) one effect or accompaniment of rapid social, economic, and gender-role change in traditional societies may be increased drinking among formerly abstinent women. These findings have potentially important implications for women-focused intervention and policy. Substance abuse services should include attention to middle-aged and older women, who may have different risk factors, symptoms, and treatment issues than their younger counterparts. Creative, targeted prevention is needed for high-risk groups of women. Programs to reduce violence between intimate partners must include attention to the pervasive role of alcohol use in intimate partner aggression. Social and economic empowerment of women, together with social marketing of norms of abstention or low-risk drinking, may help prevent increased hazardous alcohol use among women in countries undergoing rapid social change. Greater attention to effects of gender, culture, and their interactions can inform the design of more effective prevention, intervention, and policy to reduce the substantial global costs of alcohol abuse in both women and men.

High prevalence of cervical squamous intraepithelial lesions in women on antiretroviral therapy in Cameroon: Is targeted screening feasible?

Background: Cervical cancer is the most common cancer in women in low-income countries. Although cervical cancer incidence and mortality is higher in HIV-positive women, resource limitations restrict the implementation of systematic screening programs in these women. We explored the potential for targeted screening by assessing the prevalence, severity and predictors of cervical squamous intra-epithelial lesions (SILs) in HIV-positive women in Cameroon. Methods and findings: We conducted a cross-sectional study of women on antiretroviral therapy in Cameroon. Socio-demographic, behavioral, and clinical information was obtained from eligible women. Cervical exfoliated cells were then collected, a conventional cytology performed and epithelial lesions classified according to the Bethesda 2001 system. A total of 282 women, aged 19–68 years, were enrolled in this study. The median CD4 count was 179 cells/microliter (interquartile range: 100–271). SILs were detected in 43.5% of the 276 women with satisfactory samples: including atypical squamous cells of unknown significance (ASCUS) 0.7%, low-grade SIL (LSIL) 25.0%, atypical squamous cells, cannot exclude high grade lesions (ASC-H) 14.5%, and high-grade SIL (HSIL) 3.3%. None of the demographic or clinical characteristics considered significantly predicted the presence of any SILs or the presence of severe lesions requiring colposcopy. Conclusion: The prevalence of SIL in women on antiretroviral therapy in Cameroon was high underscoring the need for screening and care in this population. In the absence of any accurate demographic or clinical predictor of SIL, targeted screening does not seem feasible. Alternative affordable screening options need to be explored.

The Role of Demand Factors in Utilization of Professional Care during Childbirth: Perspectives from Yemen

Background. Utilization of professional care during childbirth by women in low-income countries is important for the progress towards MDG 5. In Yemen, home births have decreased minimally during the past decades. Objective. The study investigates the influence of socio-demographic, birth outcome and demand factors on women's future preference of a home or institutional childbirth. Method. We interviewed 220 women with childbirth experience in urban/rural Yemen. We performed bivariate chi-square tests and multiple logistic regression analysis. A multistage sampling process was used. Results. The issues of own choice, birth support and birth complications were the most important for women's preference of future location of childbirth. Women who had previously been able to follow their own individual choice regarding birth attendance and/or location of childbirth were six times more likely to plan a future childbirth in the same location and women who received birth support four times more likely. Birth complications were associated with a 2.5-fold decrease in likelihood. Conclusions. To offer women with institutional childbirth access to birth support is crucial in attracting women to professional care during childbirth. Yemeni women's low utilization of modern delivery care should be seen in the context of women's low autonomy and status.

P2-S9.07 Economic risk factors for syphilis infection among pregnant women in rural Haiti

BackgroundOf the 12 million global adult syphilis infections occurring globally each year, syphilis disproportionately affects women in low-income countries. WHO estimates about 80% of syphilis positive pregnancies go untreated, often...

Epidemiology of iodine deficiency: Salt iodisation and iodine status

Universal salt iodisation (USI) and iodine supplementation are highly effective strategies for preventing and controlling iodine deficiency. USI is now implemented in nearly all countries worldwide, and two-thirds of the world's population is covered by iodised salt. The number of countries with iodine deficiency as a national public health problem has decreased from 110 in 1993 to 47 in 2007. Still one-third of households lack access to adequately iodised salt. Iodine deficiency remains a major threat to the health and development of populations around the world, particularly in children and pregnant women in low-income countries. Data on iodine status are available from 130 countries and approximately one-third of the global population is estimated to have a low iodine intake based on urinary iodine (UI) concentrations. Insufficient control of iodine fortification levels has led to excessive iodine intakes in 34 countries. The challenges ahead lie in ensuring higher coverage of adequately iodised salt, strengthening regular monitoring of salt iodisation and iodine status in the population, together with targeted interventions for vulnerable population groups.

Maternal mortality in Cambodia, Thailand, Malaysia and Sri Lanka: a systematic review of local and national policy and practice initiatives.

Review question / objective The primary objectives of this systematic review are to compare and evaluate the health policy positions across Cambodia, Thailand, Malaysia and Sri Lanka as they relate to maternal mortality and the provision of midwifery services. The specific questions this review will seek to address are: 1. What are the strategies to reduce maternal mortality in Cambodia, Thailand, Malaysia and Sri Lanka? 2. Which strategies have had the greatest impact in relation to a change in maternity care practice within the countries of interest? Inclusion Criteria Types of participants The review will consider studies that include: pregnant and birthing women who receive care from a skilled birth attendant. Types of intervention(s)/phenomena of interest The review will consider studies that describe: 1. The health system / service delivery structures and underlying policy. 2. The maternity care provided by a skilled birth attendant. Types of outcomes The primary outcomes of interest in this review are: Strategies that have reduced maternal mortality rates. Secondary outcomes of interest to this review include: Strategies that have had the greatest impact in relation to: a) Changes to health system structures related to pregnancy and childbirth (including resources / finances) b) Change in cultural practices related to pregnancy and birth c) Empowerment of women and their position in society (and what impact this has had with respect to their choice of pregnancy and birth care)

PW01-107 - Prevalence of maternal depression in a paediatric clinic: a study from a low income country

IntroductionDepression is a global public health problem with highest rates in women in low income countries including Pakistan. Paediatricians may be a resource to help with maternal depression. Little is known in low income countries about the prevalence of depression and its social correlates in mothers of children attending paediatric clinics.MethodsUsing cross-sectional design consecutive women attending the paediatric clinic were screened using the Edinburgh Postnatal Depression Scale (n=185). Women scoring 12 or more (n=70) and a random sample of low scorers (n=16) were interviewed using the Clinical Interview Schedule Revised (CIS-R) to confirm the diagnosis of depression, the Oslo scale was used to measure social stress and EQ-5D for health related quality of life.ResultsThe prevalence of maternal depression was 51%. The mean age of the sample was 26 years. Depressed mothers were more likely to be living in a joint family household, they were less educated and they and their husbands were less likely to be employed. The depressed mothers had more financial difficulties and they were more likely to sleep hungry during the last month due to financial problems. The depressed mothers had less social support and poorer quality of life compared to non depressed mothers.ConclusionMaternal depression in this health care setting is high and it is associated with social stress and poor social support. Paediatric appointments may be an opportunity for care and care delivery for maternal depression.

P02-377 - Antidepressants and group psychosocial treatment for depression: an rct from a low income country

BackgroundDepression is a global public health problem with highest rates in women in low income countries including Pakistan. There are no treatment trials from such countries comparing the efficacy of antidepressant treatment with a group psychological intervention.MethodsWe conducted a preliminary RCT in an urban primary care clinic in Karachi, Pakistan. Consecutive eligible women scoring &gt; 12 on the CIS-R and &gt; 18 on HDRS (n=66) were randomly assigned to antidepressant or group psychosocial treatment. The primary outcome measure was HDRS score; secondary outcome measures were disability and quality of life.Results96% patients were assessed at 3 &amp; 6 months after baseline. At 6 months response (50% reduction of HDRS score) occurred in 20 (60.6%) and 22(66.7%) of the psychosocial and antidepressant groups respectively. There was also significant reduction in disability and improvement in health related quality of life in both groups.ConclusionLow costs antidepressants and group psychosocial treatment on the principles of CBT merit further assessment as primary treatments for depression in low income countries.

Global issues in women's health

World population growth in the past century has taxed the ability of healthcare systems in low-income countries to provide reproductive health care. Maternal mortality and morbidity, sexually transmitted diseases, and cervical cancer are major problems. Expansion of reproductive health services, training of appropriate medical personnel, and elevating the status of women in society are all necessary and appropriate solutions to improve the health of women in low-income countries.

Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India.

Cervical cancer is a leading cause of cancer death among women in low-income countries, with ∼25% of cases worldwide occurring in India. We estimated the potential health and economic impact of different cervical cancer prevention strategies. After empirically calibrating a cervical cancer model to country-specific epidemiologic data, we projected cancer incidence, life expectancy, and lifetime costs (I$2005), and calculated incremental cost-effectiveness ratios (I$/YLS) for the following strategies: pre-adolescent vaccination of girls before age 12, screening of women over age 30, and combined vaccination and screening. Screening differed by test (cytology, visual inspection, HPV DNA testing), number of clinical visits (1, 2 or 3), frequency (1 × , 2 × , 3 × per lifetime), and age range (35–45). Vaccine efficacy, coverage, and costs were varied in sensitivity analyses. Assuming 70% coverage, mean reduction in lifetime cancer risk was 44% (range, 28–57%) with HPV 16,18 vaccination alone, and 21–33% with screening three times per lifetime. Combining vaccination and screening three times per lifetime provided a mean reduction of 56% (vaccination plus 3-visit conventional cytology) to 63% (vaccination plus 2-visit HPV DNA testing). At a cost per vaccinated girl of I$10 (per dose cost of $2), pre-adolescent vaccination followed by screening three times per lifetime using either VIA or HPV DNA testing, would be considered cost-effective using the country's per capita gross domestic product (I$3452) as a threshold. In India, if high coverage of pre-adolescent girls with a low-cost HPV vaccine that provides long-term protection is achievable, vaccination followed by screening three times per lifetime is expected to reduce cancer deaths by half, and be cost-effective.

Social capital and mental health: A comparative analysis of four low income countries

Women and the poor are disproportionately affected by common mental disorders (CMD), and women in low income countries are particularly at risk. Social capital may explain some of the geographical variation in CMD, but the association between social capital and CMD in low income countries has rarely been studied. This paper aims to explore the relationship between individual and ecological measures of social capital and maternal CMD in four low income countries. Cross-sectional data from the Young Lives (YL) study with information across 234 communities in Peru, Ethiopia, Vietnam and Andhra Pradesh (India) were used. The mental health of mothers of one-year-old children ( n = 6909 ), and the individual cognitive and structural social capital of all respondents was assessed. Ecological social capital was calculated by aggregating individual responses to the community level. Multi-level modelling was used to explore the association between individual and ecological (community level) social capital and maternal CMD in each of the four countries, adjusting for a wide range of individual and community level confounders. The analysis shows that individual cognitive social capital is associated with reduced odds of CMD across all four countries. The results for structural social capital are more mixed and culturally specific, with some aspects associated with increased odds of CMD. This suggests that structural social capital has context-specific effects and cognitive social capital more universal effects on maternal CMD.

Awareness of Family Medicine Providers and Consumers’ Perception Concerning Vitamin A Deficiency

Vitamin A deficiency [VAD] is a major public health problem, especially in Africa and South-East Asia. The most vulnerable groups are pre-school children and pregnant women in low-income countries. In Egypt, prevalence studies on VAD are limited. World Health Organization [WHO] considers VAD in Egypt to be a moderate subclinical deficiency, but one that needs assessment. WHO had recommended that prevention of blindness should be an integral part of Primary Health Care. It is essential for doctors, nurses, and paramedical personnel to be trained in the recognition and treatment of children with xerophthalmia and other children at high risk of VAD. The aim of the present study was to assess the knowledge, attitude and practices [KAP] of family medicine [FM] providers and consumers’ perception concerning VAD in 9 randomly selected FM units and centers in Alexandria, Egypt. The total number of FM providers was 137 [57 family physicians and 80 nurses] and the consumers were 300. Data were collected using 2 different questionnaires: a self-administered questionnaire to assess the level of KAP of the FM providers concerning VAD and an interview questionnaire to measure the consumers perception towards VAD. About 59% of FM providers were working in FM units and 58.4% of them were nurses. Females represented 82.5% of the study sample and the majority [81.8%] had no postgraduate degrees, also 47.4% had no training courses at all. The majority of FM providers had poor knowledge [88.3%], positive attitude [46.7%], and poor practice [86.9%] concerning VAD. There was no statistical significant association between any of the FM providers’ general characteristics and their total KAP scores except for training about VAD. It was found that there was a high statistical significant association between the total knowledge and practice score and training about VAD. The majority of FM providers [83.2%] who had poor knowledge had poor practice and 4.4% who had fair knowledge had partial practice. About 62.7% of the studied consumers were selected from FM units and females represented 80% of the study sample. It was found that 31.7% and 28.7% of the consumers received primary and preparatory education, respectively. Regarding their total knowledge score, 79.3% of the consumers had poor knowledge, 17.3% had fair knowledge, and only 3.3% of them had good knowledge regarding VAD.