doi:10.1111/jog.12680
J. Obstet. Gynaecol. Res. Vol. 41, No. 7: 1067–1073, July 2015
How do Egyptian gynecologists manage infertility? Cross-sectional study Ahmed Gibreel1, Noha Eladawi2, Abdel-Hady El-Gilany2, Nasser Allakkany1 and Maher Shams1 1
Obstetrics and Gynecology Department and 2Public Health Department, Mansoura University, Mansoura, Egypt
Abstract Aim: The purpose of this study was to determine the knowledge and practices of a sample of Egyptian gynecologists with respect to the management and diagnosis of infertility and the variation between gynecologists according to qualifications. Methods: A questionnaire assessing knowledge, practice habits, and perception towards the management of infertility was distributed to gynecologists. Data were collected during the annual meeting of the Clinical Society of Obstetricians and Gynaecologists, which was held in Mansoura, Egypt. Two hundred and fifty-eight gynecologists attended the meeting. Two researchers distributed the questionnaires to the clinicians. Clinician responses to questions were assessed according to the National Institute of Clinical Excellence (NICE) fertility guidelines. The main outcome measures were knowledge and adherence of gynecologists to NICE infertility guidelines. Results: Significant differences were identified between clinicians with Master degree/Diploma and those with higher degrees (MD or PhD) with regard to knowledge as well as management options of different causes of infertility. Conclusion: There is a need to develop and implement national strategies, including mandatory update of reproductive medicine curricula as well as providing continuous professional development programs, in order to boost infertility management in developing countries such as Egypt. Key words: Egypt, guideline, infertility, questionnaire.
Introduction Infertility is a disorder of the reproductive system that may be defined as failure to achieve clinical pregnancy after ≥12 months of regular unprotected sexual intercourse.1 It was estimated that at least 45 million couples worldwide were infertile in 2010.2 In Egypt, the overall prevalence of infertility has been reported to be 10.4% of married couples.3 Infertility can have serious deleterious consequences, including marital conflict, violence, stigmatization, isolation, and divorce.4
Currently, many patients do not receive the recommended medical care based on best available evidence.5 Clinical practice guidelines (CPG) intend to optimize patient care by providing recommendations regarding the benefits and risks of best practice in health care.6 A number of these guidelines have been published to outline the diagnosis and management of infertility.7 These guidelines are intended to provide clinicians with the best available evidence regarding diagnosis and management of infertility. Adequate implementation of these guidelines has the potential to
Received: July 25 2014. Accepted: December 19 2014. Reprint request to: Dr Ahmed Gibreel, Obstetrics and Gynecology Department, Mansoura Faculty of Medicine, Mansoura 53111, Egypt. Email: [email protected]
© 2015 The Authors Journal of Obstetrics and Gynaecology Research © 2015 Japan Society of Obstetrics and Gynecology
1067
A. Gibreel et al.
raise the standards of health care with respect to quality and safety.8 Evidence-based medicine is a dynamic science, hence these guidelines are supposed to be periodically updated to maintain validity.9 The National Institute of Clinical Excellence (NICE) guidelines serve as one of the best compilations of evidence-based medicine in the field of infertility. These guidelines were intended for gynecologists practicing in the British Isles. It may be the wide influence of the Royal College of Obstetricians and Gynaecologists (RCOG) worldwide that led to the widespread acceptance of these British guidelines in many countries, including Egypt. The Egyptian health system lacks medical guidelines, not only for infertility, but many other clinical specialties. It is not known how Egyptian gynecologists obtain and update their knowledge about the diagnosis and management of infertility. Egypt has national guidelines for the treatment of sexually transmitted infections, tuberculosis, and HIV,10–12 but there are no studies evaluating the impact of these guidelines on the knowledge and practice habits of physicians. Because Egypt lacks guidelines for the diagnosis and management of infertility, the purpose of this study was to assess the knowledge and practice habits of a sample of Egyptian gynecologists with respect to infertility management and diagnosis, and to compare variation based on qualifications.
Methods This study was conducted in April 2012 among obstetricians and gynecologists (307 physicians) attending the 13th Annual Meeting of the Clinical Society of Obstetricians and Gynaecologists, held in Mansoura, Egypt. We obtained a waiver from the Mansoura University Ethics Committee for ethical approval. Two hundred and fifty-eight physicians agreed to fill in the questionnaire, while a total of 49 physicians apologized for not participating in the study (response rate, 84.04%). The participants represented members and non-members of the Egyptian Gynaecologic Society. Thus, the participants represent the general population of Egyptian gynecologists. Physicians were asked to complete a selfadministered questionnaire written in English. Researchers were on hand to respond to any queries raised by the participating clinicians. In the first part of the questionnaire, the physicians were asked to state their demographic characteristics. The second part of
1068
the questionnaire assessed the knowledge of the physician on infertility. The third part of the questionnaire included questions regarding the diagnostic measures used to evaluate infertile couples, as well as management guidelines. The answers to the questions were assessed as true or false using the NICE guidelines as a gold standard.13 An updated version of these guidelines was released in February 2013.14 The data were collected and analyzed using SPSS (version 16). Variables are given as a number and percentage. Chi-squared test was used to compare the two groups (Master/diploma vs MD/PhD). P ≤ 0.05 was considered statistically significant.
Results Two hundred and fifty-eight physicians participated in the study. Two-thirds (66.3%) of the participants had a Master’s degree or diploma and 33.7% had a medical degree (MD) or doctorate (PhD). Both groups were matched regarding age, gender, and work affiliation (Table 1). A total of 86% of participants correctly defined infertility as the failure to conceive after ≥1 year of continuous unprotected intercourse (Table 2). Although most respondents (91%) agreed that no treatment should be offered before 1 year of exposure, 60% admitted that they had provided treatment, even in the absence of a cause, for couples unable to conceive in
J. Obstet. Gynaecol. Res. Vol. 41, No. 7: 1067–1073, July 2015
How do Egyptian gynecologists manage infertility? Cross-sectional study Ahmed Gibreel1, Noha Eladawi2, Abdel-Hady El-Gilany2, Nasser Allakkany1 and Maher Shams1 1
Obstetrics and Gynecology Department and 2Public Health Department, Mansoura University, Mansoura, Egypt
Abstract Aim: The purpose of this study was to determine the knowledge and practices of a sample of Egyptian gynecologists with respect to the management and diagnosis of infertility and the variation between gynecologists according to qualifications. Methods: A questionnaire assessing knowledge, practice habits, and perception towards the management of infertility was distributed to gynecologists. Data were collected during the annual meeting of the Clinical Society of Obstetricians and Gynaecologists, which was held in Mansoura, Egypt. Two hundred and fifty-eight gynecologists attended the meeting. Two researchers distributed the questionnaires to the clinicians. Clinician responses to questions were assessed according to the National Institute of Clinical Excellence (NICE) fertility guidelines. The main outcome measures were knowledge and adherence of gynecologists to NICE infertility guidelines. Results: Significant differences were identified between clinicians with Master degree/Diploma and those with higher degrees (MD or PhD) with regard to knowledge as well as management options of different causes of infertility. Conclusion: There is a need to develop and implement national strategies, including mandatory update of reproductive medicine curricula as well as providing continuous professional development programs, in order to boost infertility management in developing countries such as Egypt. Key words: Egypt, guideline, infertility, questionnaire.
Introduction Infertility is a disorder of the reproductive system that may be defined as failure to achieve clinical pregnancy after ≥12 months of regular unprotected sexual intercourse.1 It was estimated that at least 45 million couples worldwide were infertile in 2010.2 In Egypt, the overall prevalence of infertility has been reported to be 10.4% of married couples.3 Infertility can have serious deleterious consequences, including marital conflict, violence, stigmatization, isolation, and divorce.4
Currently, many patients do not receive the recommended medical care based on best available evidence.5 Clinical practice guidelines (CPG) intend to optimize patient care by providing recommendations regarding the benefits and risks of best practice in health care.6 A number of these guidelines have been published to outline the diagnosis and management of infertility.7 These guidelines are intended to provide clinicians with the best available evidence regarding diagnosis and management of infertility. Adequate implementation of these guidelines has the potential to
Received: July 25 2014. Accepted: December 19 2014. Reprint request to: Dr Ahmed Gibreel, Obstetrics and Gynecology Department, Mansoura Faculty of Medicine, Mansoura 53111, Egypt. Email: [email protected]
© 2015 The Authors Journal of Obstetrics and Gynaecology Research © 2015 Japan Society of Obstetrics and Gynecology
1067
A. Gibreel et al.
raise the standards of health care with respect to quality and safety.8 Evidence-based medicine is a dynamic science, hence these guidelines are supposed to be periodically updated to maintain validity.9 The National Institute of Clinical Excellence (NICE) guidelines serve as one of the best compilations of evidence-based medicine in the field of infertility. These guidelines were intended for gynecologists practicing in the British Isles. It may be the wide influence of the Royal College of Obstetricians and Gynaecologists (RCOG) worldwide that led to the widespread acceptance of these British guidelines in many countries, including Egypt. The Egyptian health system lacks medical guidelines, not only for infertility, but many other clinical specialties. It is not known how Egyptian gynecologists obtain and update their knowledge about the diagnosis and management of infertility. Egypt has national guidelines for the treatment of sexually transmitted infections, tuberculosis, and HIV,10–12 but there are no studies evaluating the impact of these guidelines on the knowledge and practice habits of physicians. Because Egypt lacks guidelines for the diagnosis and management of infertility, the purpose of this study was to assess the knowledge and practice habits of a sample of Egyptian gynecologists with respect to infertility management and diagnosis, and to compare variation based on qualifications.
Methods This study was conducted in April 2012 among obstetricians and gynecologists (307 physicians) attending the 13th Annual Meeting of the Clinical Society of Obstetricians and Gynaecologists, held in Mansoura, Egypt. We obtained a waiver from the Mansoura University Ethics Committee for ethical approval. Two hundred and fifty-eight physicians agreed to fill in the questionnaire, while a total of 49 physicians apologized for not participating in the study (response rate, 84.04%). The participants represented members and non-members of the Egyptian Gynaecologic Society. Thus, the participants represent the general population of Egyptian gynecologists. Physicians were asked to complete a selfadministered questionnaire written in English. Researchers were on hand to respond to any queries raised by the participating clinicians. In the first part of the questionnaire, the physicians were asked to state their demographic characteristics. The second part of
1068
the questionnaire assessed the knowledge of the physician on infertility. The third part of the questionnaire included questions regarding the diagnostic measures used to evaluate infertile couples, as well as management guidelines. The answers to the questions were assessed as true or false using the NICE guidelines as a gold standard.13 An updated version of these guidelines was released in February 2013.14 The data were collected and analyzed using SPSS (version 16). Variables are given as a number and percentage. Chi-squared test was used to compare the two groups (Master/diploma vs MD/PhD). P ≤ 0.05 was considered statistically significant.
Results Two hundred and fifty-eight physicians participated in the study. Two-thirds (66.3%) of the participants had a Master’s degree or diploma and 33.7% had a medical degree (MD) or doctorate (PhD). Both groups were matched regarding age, gender, and work affiliation (Table 1). A total of 86% of participants correctly defined infertility as the failure to conceive after ≥1 year of continuous unprotected intercourse (Table 2). Although most respondents (91%) agreed that no treatment should be offered before 1 year of exposure, 60% admitted that they had provided treatment, even in the absence of a cause, for couples unable to conceive in
