the variations of auricular tubercle among ika people in delta state, nigeria anibor ese, enaohwo mamerhi taniyohwo & esinulo ogechi peace department of human anatomy and cell biology, delta state university, pmb 1, abraka, nigeria. correspondence: esinulo ogechi peace email: ogechiesinulo@gmail.com abstract introduction: darwinian tubercle is a congenital ear structure which often presents as a thickening in the helix at the junction of the upper and middle third of the outer ear. this crosssectional study considered the prevalence of auricular tubercle among ika people in delta state, nigeria. materials and methods: ethical clearance was gotten from the ethical board of human anatomy department, delta state university, abraka in nigeria. the data were sorted by means of the statistical package for the social sciences (spss), version 25.0. this study made use of 388 subjects and informed consent was obtained from the volunteer subjects before commencement of the study. results: the most common auricular tubercle congenital association was accessory tragus, followed by weathering nodules, and congenital absence of the helix. bilateral asymmetry exists as regards the shape of the ear. auricle shape varied with the left and right sides as well as sexes. the darwin tubercle displayed significant gender difference in auricular prevalence (p<0.05), and there was no significant age difference in auricular prevalence (p>0.05). conclusion: the prevalence of auricular tubercle in this study is forty-nine percent. the most common auricular tubercle congenital association is accessory tragus. key words: tubercle, auricle, ika, gender, darwin ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 09 | september 2022 | https://www.ijojournals.com/index.php/hsn/index 1 introduction a very large and prominent part of the head is the ear. an aesthetically fine ear allows one to get a 'natural' look [1]. the ear is an auditory organ involved in preserving the body's balance. it consists of three parts: the middle ear, the outer ear, and the inner ear. the outer ear is formed by the pinna or auricle and external auditory meatus [2]. the curved rim of the auricle is known as the helix [3]. at the posterosuperior part of the helix is a small tubercle known as the auricular tubercle (darwin’s tubercle). a congenital ear structure called darwinian tubercle frequently manifests as a thickening of the helix at the intersection of the upper and middle thirds [3]. around the sixth month of fetal development, when the entire auricle closely resembles that of adult monkeys, darwinian tubercle becomes highly noticeable [4]. charles darwin initially identified the darwinian tubercle as a vestige trait that suggests shared ancestry among monkeys. however, darwin himself gave it the term "woolnerian tip" in honor of thomas woolner, who initially termed it a primeval trait by depicting it in one statue [5]. the aim of this research considered the prevalence of auricular tubercle among ika people in delta state, nigeria. materials and methods a cross-sectional study design was employed. exactly 388 ika subjects in delta state were used for this study. the duration of this study was three months (january to march, 2022). data on the auricular tubercle was collected using a data collection sheet. subtypes of darwin’s tubercle were noted thus: 1 = undeveloped darwin’s tubercle: in this type no darwin’s tubercle was seen on the helix 2 = semi-developed darwin’s tubercle: there is a semi-developed small sized darwin’s tubercle in this subtype but still it was not easily seen. 3.= fully-developed darwin’s tubercle: in this subtype darwin’s tubercle is easily found on helix but was not so clear as to be seen from half a meter away. 4 = very significant darwin’s tubercle: darwin’s tubercle is very significant and even from a meter away it could easily be seen. 5 = multiple darwin’s tubercle: in this subtype more than one darwin’s tubercles are seen. approval for this enquiry was gotten from the research and ethics committee of anatomy department, faculty of basic medical sciences, delta state university, abraka. the ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 09 | september 2022 | https://www.ijojournals.com/index.php/hsn/index 2 data obtained was analyzed using statistical package for the social sciences (spss), version 25.0. chi-square test at the 95% confidence interval was also used to evaluate gender and age differences in the darwin’s tubercle. p value lesser than 0.05 was considered to be statistically significant. results table 1 depict that the common auricular subtypes in descending order are: projection, nodosity, enlargement and tubercle (29%, 27%, 25.4%, and 18% respectively). from table 2, the right ear had the highest prevalence of auricular tubercle (39.7%), followed by the left ear (35.4%), and both ears (24.9%). from table 3, the most common auricular tubercle congenital association is accessory tragus (47.9%), followed by weathering nodules (28.8%), and congenital absence of the helix (23.3%). table 4 divulged that the enlarged auricular shape and nodosity were common in both ears, the projection was predominant on the right ear and tubercle was least prevalent in the right ear. the prevalence of auricule was more among male subjects when compared to females, as seen in table 5. in descending order it was more prevalent among subjects aged 20-24 years (18.8%), 25-29 years (13.1%), 35-39 years (6.7%), 15-19 years (5.2%), and 30-34 years (4.9%), as seen in table 6. table 7 divulged a significant gender difference in auricular prevalence (p<0.05). there was however no significant age difference in auricular prevalence (p>0.05) as seen in table 8. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 09 | september 2022 | https://www.ijojournals.com/index.php/hsn/index 3 figure 1: distribution of gender in the studied populace. table 1: distribution of auricular tubercle subtypes auricular subtypes frequency (%) enlargement 48 (25.4) nodosity 51 (27.0) projection 56 (29.6) tubercle 34 (18.0) total 189 (100.0) table 2: distribution of ear side with auricular tubercle. ear side with auricular tubercle frequency (%) both 47 (24.9) left 67 (35.4) right 75 (39.7) total 189 (100.0) ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 09 | september 2022 | https://www.ijojournals.com/index.php/hsn/index 4 table 3: distribution of auricular tubercle congenital association. auricular tubercle congenital association frequency (%) accessory tragus 35 (47.9) congenital absence of the helix 17 (23.3) weathering nodules 21 (28.8) total 73 (100.0) table 4: distribution of auricular tubercle shapes based on sides of ear auricular prevalence shapes frequency (%) left right both enlargement 14 (7.4) 15 (7.9) 19 (10.1) nodosity 9 (4.8) 18 (9.5) 24 (12.7) projection 12 (6.3) 24 (12.7) 20 (10.6) tubercle 12 (6.3) 10 (5.3) 12 (6.3) total 47 (24.9) 67 (35.4) 75 (39.7) table 5: distribution of auricular prevalence based on gender auricular prevalence frequency (%) male female absent 119 (30.7) 80 (20.6) present 133 (34.3) 56 (14.4) total 252 (64.9) 136 (35.1) ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 09 | september 2022 | https://www.ijojournals.com/index.php/hsn/index 5 table 6: distribution of auricular prevalence based on age age group (years) frequency (%) absent present 15-19 17 (4.4) 20 (5.2) 20-24 85 (21.9) 73 (18.8) 25-29 49 (12.6) 51 (13.1) 30-34 29 (7.5) 19 (4.9) 35-39 19 (4.9) 26 (6.7) total 199 (51.3) 189 (48.7) table 7: chi-square test of association of auricular prevalence based on gender auricular prevalence frequency (%) chi-square df p-value male female absent 119 (30.7) 80 (20.6) present 133 (34.3) 56 (14.4) 4.759 1 0.029 total 252 (64.9) 136 (35.1) table 8: chi-square test of association of auricular prevalence based on age age group (years) frequency (%) chi-square df p-value absent present 15-19 17 (4.4) 20 (5.2) 20-24 85 (21.9) 73 (18.8) 25-29 49 (12.6) 51 (13.1) 4.112 4 0.391 30-34 29 (7.5) 19 (4.9) 35-39 19 (4.9) 26 (6.7) total 199 (51.3) 189 (48.7) discussion this study utilized 388 subjects (n = 252, 65% males and n = 136, 35% females). the age of the subjects ranged from 20-24 years, followed by 25-29years, 30-34years, 35-39ears and 15ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 09 | september 2022 | https://www.ijojournals.com/index.php/hsn/index 6 19years. this study finding was not in line with that of krishan et al. [6] who reported that their study comprised of 90 males and 87 females; rubio et al. [7] who utilized 303 individuals between 18 and 72 years old; purkait and singh [5] who utilized 700 male and female participants. the prevalence of auricular tubercle in this study was forty-nine percent (49%). this prevalence was higher than the 40% recorded by loh and cohen [8]. however, it was lower than the 98.9% recorded by shihab and shakir [9]. in this study, the common auricular subtypes in descending order are: projection, nodosity, enlargement and tubercle. the most common auricular tubercle congenital association was accessory tragus, followed by weathering nodules, and congenital absence of the helix. this study finding was not in line with that of krishan et al. [6] who found that the nodosity type darwin’s tubercle was the most prevalent followed by enlargement and projection. bilateral asymmetry occurred concerning the shape of the ear. the shape of the auricle also varied with regard to the right and left sides as well as gender. the right ear had the highest prevalence of auricular tubercle, followed by the left ear, and both ears. the wide variability of the ear could be credited to the distinctive structure and features of the ear. the enlarged auricular shape and nodosity were dominant in both ears, the projection was rampant in the right ear and tubercle was least prevalent in the right ear. loh and cohen [8] who found that the darwin’s tubercle was common bilaterally supported this study’s finding. in this study, the gender prevalence of auricular prevalence was such that it was more prevalent among male subjects when compared to females and this variation was significant (p<0.05). the finding of verma et al. [10] who reported no significant gender difference in auricular prevalence disagreed with this study finding. this disparity could be accredited to differences in the study population and area. however, shihab and shakir [9] who found that it was more prevalent among male subjects when compared to females supported this study finding. this study noted that in descending order, darwin tubercle was more prevalent among subjects aged 20-24 years, 25-29 years, 35-39 years, 15-19 years, and 30-34 years and that there was no significant age difference in auricular prevalence (p>0.05). this finding was supported by that of rubio et al. [7] who recorded that there was no significant age difference in tubercle prevalence (p>0.05). ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 09 | september 2022 | https://www.ijojournals.com/index.php/hsn/index 7 conclusion the prevalence of auricular tubercle in this study was forty-nine percent (49%). the most common auricular tubercle congenital association was accessory tragus. the shape of the auricle varied with the left and right sides as well as gender. references 1. wilferd m. and godfrey, i.m. prominent ears: anthropometric study of the external ear of primary school children of harare, zimbabwe. annals of medicine and surgery. 2015; 4:287-292. 2. moore kl, dalley af. and agur, am. clinically oriented anatomy, 7th edition lippincott williams & wilkins. 2013; 848-849. 3. iorgoveanu c, zaghloul a. and desai a. bilateral earlobe creaseas a marker of premature coronary artery disease. cureus journal. 2018; 10 (5):e2616. 4. tiffany yl. and philip rc. darwin’s tubercle: review of a unique congenital anomaly. dermatology therapeutics (heidelb). 2016; 6 (2):143-149. 5. purkait r. and singh p. anthropometry of the normal human auricle. aesthetic plastic surgery. 2007; 31(4):372-379. 6. krishan k, kanchan t. and thakur s. a study of morphological variations of the human ear for its applications in personal identification. egyptian journal of forensic science. 2019; 9 (6) :1-5. 7. rubio o, galera v. and alonso mc. anthropological study of ear tubercles in a spanish sample. homo. 2015; 66 (4):343-356. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 09 | september 2022 | https://www.ijojournals.com/index.php/hsn/index 8 8. loh ty. and cohen pr. darwin’s tubercle: review of a unique congenital anomaly. dermatology therapeutics. 2016; 6 (2):143-149. 9. shihab af. and shakir ma. a genetic study to darwin's tubercle trait of external ear in the population of salah al –dein and kirkuk. iraqi academics science journal. 2015; 20 (3):70-78. 10. verma p, sandhu hk, gupta kv, goyal s, sudan m. and ladgotra a. morphological variations and biometrics of ear: an aid to personal identification. journal of clinical diagnostic research. 2016; 10 (5):138-142. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 09 | september 2022 | https://www.ijojournals.com/index.php/hsn/index 9 the variations of auricular tubercle among ika people in delta state, nigeria first page 1st author name: dr nandadeep v chodankar assistant professor in department of kayachikitsa rjvs bhaisaheb sawant ayurved mahavidyala, sawantwadi, maharastra. email iddr.chodankar@gmail.com address for correspondence: dr nandadeep v chodankar f 129 salaiwada, panchayat samitti road sawantwadi, districtsindhudurga pin code416510 email iddr.chodankar@gmail.com 2nd author dr subodhan kashalikar general practitioner at sawantwadi email id:-drsubodhan@gmail.com 3rd author prajkta gajanan chaudhari intern doctor at r.j.v.s. hospital, sawantwadi. email id:prajktachaudhari799@gmail.com 4th author smita nathilal tiwari intern doctor at r.j.v.s. hospital, sawantwadi. email id:-smitatiwari1998@gmail.com 5th author dr akbar r walandkar professor and hod shalyatantra hon shri annasaheb dange ayurved medical collage, ashta. email idakbar.walandkar@gmail.com mailto:dr.chodankar@gmail.com mailto:dr.chodankar@gmail.com mailto:drsubodhan@gmail.com mailto:smitatiwari1998@gmail.com mailto:akbar.walandkar@gmail.com management of psoriasis (ekakushtha) according to ayurvedic pathophysiology:-a case study abstract immune response of a human body to the uncertain factors leads to the accelerated inflammatory proliferation of the ailing cells of the skin known as psoriasis. although the condition found described many decades ago, the etiology and treatment look under-researched. in ayurveda many herbs have proven efficacy in psoriasis, but multifaceted etiology of the disease needs a multimodal treatment approach. we report about ayurveda treatment in 62 yrs old male patient with plaque psoriasis presented with erythematous patches. on the anterior surface of legs, hands, back of foot sole. the treatment protocol was adopted as per ayurvedic samprapti (pathophysiology) and patient was cured completely without reporting any adverse event or recurrence after the 6 month of therapy. introduction psoriasis is a chronic immune-mediated inflammatory condition mainly affecting the skin and joints. its prevalence in india is about 0.44-2.8 percent. males are being affected by psoriasis two times more common than female1. various sites of the body such as scalp, face, trunk, limbs, palms and soles involve in psoriasis. the diagnosis of psoriasis depends on tissue biopsy and distribution of skin damage. plaque psoriasis (psoriasis vulgaris), inverse psoriasis, gutlate psoriasis, pustular psoriasis and erythrodermic psoriasis are a few of the clinical patterns, reported in psoriasis cases2. the chronic nature, recurring pattern, and visibility of psoriasis produce a great adverse impact on the psychological and social aspects of patient’s life. psychological disability affects their daily work, as well as social interactions. in recent studies, stress is found to be the important leading cause of psoriasis. in ayurveda, all skin diseaseare described under the umbrella of kushta. ekakushta is one of the kshudrakushta describe in ayurvedic text. in charak samhita chikitsasthan(chap.7)3,ekakushta is described as vat-kaphaj disease. ekakushta4 has signs and symptoms i.e.aswedanam(absence of sweating), mahavastu (big size lesions) and matsyashaklopaman(scaling) which can be compared with psoriasis. as in ayurveda, ekakushta is mention as krucchasadhya (difficult to treat). as in modern medicine, the treatment approach is symptomatic and not focus to the root cause. so it leads to reaggravation of symptoms in favorable environment. as in ayurveda our main aim is to focus on root cause of disease. and by destructive the root cause we can achieve the fruitful results. ayuveda has good results in psoriasis. in ayurveda many herbs have proven effective in psoriasis; but the multifeatured etiology of disease need a multimodal treatment approach, in which aampachak, agnidipana, dhatugatjwarchikitsa, kushtachikitsa, is adopted. in the present case, the multimodal ayurveda treatment approach resulted in early recovery from psoriatic lesion with no recurrence so far. aims and objectives to evaluate the role of ayurvedic medicine in management of psoriasis. materials and methods ayurvedicsamhita ayurvedic research articles ayurvedic journals official records photographs need of study psoriasis is recurring chronic disease for which it is difficult to treat. place of study the present case study done in department of kaychikitsa rjvs sawantwadi, maharashtra. case report information of patient patients opd case number:426383 age-62 yrs, sexmale religionhindu socioeconomic statuslower class occupationcobbler diet-mix diet pattern pradhanvedana (present complaints) erythematous patches on both hands, legs, back and foot soles -: 3 yrs itching and rashes with scaling on scratchingnodaha vartaman vyadhivritta (h/o present illness) the patient was symptomatic before 3 yrs after that he developed complain of scaly rashes on his back and which gradually progressed and involved his both upper and lower extremities at anterior aspect of leg along with itching and scaling after scratching. he took allopathic medicine for 2 yrs, which provided symptomatic relief till treatment continues. on discontinuation of the treatment, again the symptoms aggravated. purvavyadhivritta (history of past illness) patient has no significant past history of any chronic illness. kulajvritta (family history) no any history. vyaktika vritta (personal history) appetite was low. predominant rasa in aahara was madhur, milk products, fish, excess drinking of water. sleep was disturbed due to itching. on examination general condition was fair and afebrile vitals were normal s/e cvss1s2 normal rsaebe clear cnsnad investigations general investigations like cbc, bsl, urine routine and microscopic were completely under normal values. asthavidha pariksha nadi-kaphaditridoshaj mutra-frequency and colour within normal range with no “daha” mala-normal jivha-sama shabda-clear and fluent sparsha-ruksha drikh/o using spectacles since 20 yrs. aakritisthool local examination inspection -scaly lesions present on back, both hands and legs -they were symmetrical and well demarcated. colour initially it was reddish in appearance which by time changes to blackish. progressionslow duration it increases in winter and hot climate. -auspitz sign28present (appearance of small bleeding points after successive layers of scale have been removed from the surface of psoriatic papules or plaques) -candle grease sign28present (when scratched, psoriatic scales fall off, revealing a shiny candle like surface) diagnosis-ekakushta (psoriasis) as per ayurvedic text, the symptoms of ekakushta are aswedanam mahavastu matsyashakalopaman signs and symptoms 1. aswedanam(absence of sweat) present at scaly region 2. mahavastu (big size legion) present 3. matsyashakalopaman(scaling)-present 4. candle grease signpresent 5. auspitz’s signpresent nidanpanchak nidan viruddhaaaharsevaan27 (simultaneous use of milk and milk product and fish) raktadushtikaraahar and vihar excessive use of salty food, curd, butter milk, sleeping after lunch samprapti doshapitta, kapha, rakta dushyarasadhatu, raktadhatu, mansadhatu agnimand aamajatharagni and dhatwagnijanya strotasrasavaha, raktavaha, mansavaha adhisthantwaka rogmargbahya vyadhiswabhavachirkari (chronic) sadhyasadhyatvakrucchasadhya(difficult to treat) treatment and observation 1st visit table 1.1 (treatment given on first visit) formulation dose time anupana duration 1.kumariaasav+paripathadi kadha 15ml (1:1) m/e 6am/6pm koshnajala(luke warm water) 2 weeks 2.rasapachak (kalinga, patol, katukarohini)equal proportion 250 mg bl/bd koshnajala(luke warm water) 2 weeks 3.gokshuradi guggulu 250 mg 8am/8pm dhanyakphanta 2 weeks 4. shwetkutajsiddataila l/a morning after bath 2 weeks 5. udwartana (yashtimadhu+ sariva+vacha+haridra+manjishta) l/a before bath 2 weeks 2nd visit observation seen: reduction in dryness of skin, agniagnivriddhi(appetite increases); jivhaniram table 1.2 (treatment given on second visit) formulation dose time anupana duration 1.kumariaasav+paripathadi kadha 10 ml m/e 6am/6pm koshnajal 2 weeks 2. raktapachak 250 mg bl/bd koshnajal 2 weeks 3.gokshuradi guggulu 250 mg 8am/8pm dhanyakphanta 2 weeks 4. haridrakhandapak 2 tsp al/ad 2 weeks 5. udwartana (yashtimadhu+ sariva+vacha+haridra+manjishta) l/a morning before bath 2 weeks 6.shwetkutajsiddataila l/a morning after bath 2 weeks 3rdvisit: observation seen: kandureduced,dryness of skin reduced, scaly patches on elbow region decreased. table 1.3 (treatment given on third visit) formulation dose time anupana duration 1 paripathadikadha 10 ml 6am/6pm water 2 weeks 2 raktapachaka 250 mg bl/bd koshnajala(luke warm water) 2 weeks 3 udwartana (yashtimadhu+ sariva+vacha+haridr a+manjishta) l/a at the time of bath 2 weeks 4 shwetkutajsiddataila l/a after bath 2 weeks 5 haridrakhandapaka 2 tsp bl/bd 2 weeks 4 th visit observation seen: blakish discoloration on patches start changing to reddish, patch on right leg reduced in size table 1.4 (treatment given on fourth visit) formulation dose time anupana duration 1. raktapachak 250mg before koshnjal(luke 2 weeks 5th visit observation seen: patches present on both hand and back reduced significantly, scale formation on both soles reduces table 1.5 (treatment given on fifth visit) formulation dose time anupana duration 1. manshapachak 250 mg before lunch/ before dinner koshnjal(luke warm water) 2 weeks 2. dwipantarvacha 30 mg morning/evening 2 tsp milk 2 weeks 3. udwartana (yashtimadhu+ sariva+vacha+harid ra+manjishta) l/a at the time of bath 2 weeks 4. shwetktajsidda taila l/a after bath 2 weeks 6th visit observation seen: scale formation on both soles start reducing with formation of healthy skin table 1.6 (treatment given on sixth visit) formulation dose time anupana duration 1. 1.manshapachak 250 mg before lunch/ before dinner koshnjal(luke warm water) 2 weeks 2. 2.dwipantar vacha 30 mg morning/evening 2 tsp milk 2 weeks 3. 3.udvartana l/a at the time of bath 2 weeks lunch / before dinner warm water) 2. haridrakhand 2tsp after lunch / after dinner koshnjal(luke warm water) 2 weeks 3. shwetkutajsiddataila l/a after bath 2 weeks 4. udwartana (yashtimadhu+ sariva+vacha+haridra+manjishta) l/a at the time of bath 2 weeks 4. 4.shwetktaj sidda taila l/a after bath 2 weeks 7th visit observation seen: after healing of all patches, discolouration of skin were there and preventing the recurrence of disease following medication given. table 1.5 (treatment given on fifth visit) formulation dose time anupana duration 1.laghumanjishtadi kadha 10 ml morning/evening water 1 month 2.haridra siddha taila l/a at night 1month before treatment after treatment discussion in the present case, pitta, kapha and rakta were the doshas and rasadhatu, raktadhatu, mansadhatu were the dushya.doshadushyasamurchana was taken place due to the circulation of vitiated doshas and their sthanashanshraya at twaka with clinical presentation of vyadhilakshana. the treatment protocol was adopted for sampraptibhedana(to counter act the the pathophysiology). where, pitta-kaphara, kushtaghana, kledanashak, aushadiyogas were performed. alsoagnidipana,raktaprasadaka, rasaprasadaka were achieved with the help of all internal and external medicine. the treatment protocol was adopted for sampraptibhedana(to counter act the pathophysiology and dhatwagnivardhan). the intake of viruddhaaahara is one of the important causative factors in the etiopathogenesis of skin disease. the patient was told to avoid viruddhaaahara for better treatment response, speedy recovery and to avert the recurrence in chronic skin ailments. the ongoing pathological changes were attenuated and corrected following internal medications such as kumriaasav, paripathadikwath,rasapachaka, gokshuradiguggulu, upatana, shwetkuttaj siddha narikeltaila, haridrakhandapaka, dwipantervacha, raktapachaka, mansapachaka, laghumanjishtadikwath and hridra siddha taila. 1st visit (table 1.1) 1. kumariaasava +paripathadikwath as in kumariaasava9, the main content is kumari(aloe vera tourn) having tikta rasa, katuvipaka and sitavirya. it mainly workon liver which is an important organ for normal functioning of pitta dosha and raktadhatu. it improves appetite and aids in digestion due to aamapachakaand jatharagnivardhaka properties. also work as rechak. 2. paripathadikadha in paripathadikadha the main content is paripatha(fumaria officinalis)20 having tikta rasa, ushnavirya,katuvipaka. it mainly reduces the excess heat present in the body especially in rakta dhatu and also having the properties of vishaghna help in exfoliation of chronic dosha from body and maintain the anushanaguna of rakta dhatu. in combination with kumariaasavait work as dosha nashak and pittarechaka and by giving it empty stomach at kapha kala the effect of medicine occur faster. 3.gokshuradi guggulu as gokshur(tribulus terrestris)16 comes under mutravirechakgana and work as kledakanashaka, saraka, bastishodhak with help of this properties. it help in exfoliation of kledafrom mutra marg which is the faster and easiest passage to remove kleda from body. gokshuradiguggulu with anupana of dhanyakphant(coridandrum sativum) help in reducing the ushnagunadharma( heat) from body. 4. rasapachaka10 as according to pathophysiology patient having symptoms of agnimandya which leads vikrutito uttarakthordhatu utpatti and cause dhatwagnimandya. rasapachaka contain kalinga(holarrhena antidysentrica)(9) patola(tricossanthes diociaroxb) katurohini, nimbapatra(azardiracehta indica)(26) as, we know this kalpa is use in dhatugatjwar where, dosha mainly affecting rasadhatuand cause rasadhatwagnimandya(slow) leads to vikrut (inapropriate) dhatu utpatti. as said by aacharya. by correcting dhatuagni we can exfoliate the dosha out of the body. top layer of skin is upadhatu(superior by product) of rasadhatu. considering that rasapachakwas given. kalinga reduces dravata, patola as ushnatanashak(heat decreasing). kutkiremovesdosha through mala( defication). nimbaworks as krumighna and vishagna. 5.shwetkutajsidda taila aacharyacharak has mentioned kutaj(holarrhena antidysentrica)9 in kandughnagana. it is tikta in rasa, katuvipaka and sitavirya work as vranshodhak and vranropan, kushtagna and pittasarak in nature. it is prescribe for external use in which coconutoil has processed with shwetkutaj. as shwetkutajsiddataila retards hyperkeratinisation, silvery scales, inflamematory response, reduce exfoliation. it prevents itching and formation of scales and sores; coconut oil improves symptoms of skin disorders by its moisturizing, soothing and emollient effects. 6. udvartan in psoriasis, already the skin is dry with scale formation, on application of soap and chemical products ; it increase the dryness by replacing soap with udvartandravya which are sariva(hemidesmus indicus)13, manjishth(rubia cordifolia)12, yashtimadhu(glycyrriza glabra)22, lodhra(symlocos racemola roxb)21 , vacha(acours calmus)14 comes under kushtagnagana maintain kanti(texture) of varnya (apperence) of skin. 2nd visit (table1.2) as patient has complain of kandu (itching) on patches. haridrakhandwere added. haridrakhandapak the main content is haridra(curcuma longa)17. aacharyacharak has mentioned haridra in kushtaghna, kandughnagana and aacharyasushrut has mention it in shleshmashanshamana..haridra is tikta ,katu in rasa with ushnavirya. on internal use of haridrakhand. it work as kaphaghna and kandughnawithpittarechaka and krumighna. 3rdvisit (table1.3) as discoloration of patches which are blackish color reduces. raktapachak is added. raktapachak10 containspato(trichsanthes diocia), sariva(hemidesmus indicus)13, musta(cyperus rotundus), kutaki(picrorhiza kurrooa), patha(cissamplelos pareira)20 this drug mainly work on raktadhatu by exfoliating dosha and increasing dhatu agni, which helps in formation of prakrutraktadhatu. 4th visit (table1.4) as patient having good effects with no any other complain. the same medication is continues for 2 weeks. 5th visit (table 1.5) manshapachak10 as dosha were reach till mansadhatu.mansdhatudushti was there to correct the dhatuagnimanshpachak were given which arepatol(trichosanthes dioica),nimba(azadiracehta indica), manuka(vitis vinifera), musta(cyperus rotundus),kutaj(holarrhena antidysentrica) , triphala-haritaki(terminelia chebula),aamlki(embilica offcinalis),bibhitaki(terminalia bellirica). dwipantervacha11 dwipantervacha (smilex china) works on rasa-rakta-mansa dhatu. if any kstrav( secretion) is present on patches. it helps in reducing and helps in fast healing of patches. 6th visit – as patient having good recovery,continue the pervious treatment for next 2 weeks 7thvisit (table1.7) as psoriasis is relapsing disease to reduce the recurrence, laghumanjishthadikadha5is continue for next 1 month, which work as raktaprasadaka. as after healing of psoriasis patch, discolouration of skin were there to make even tone of skin haridra17siddataila was given for local application which act as varnya. conclusion in present case, the treatment protocolwere adopted as per ayurvedic sampraptiand the treatment response was observed much earlier as compared to previous allopathic treatment. no recurrence reported after the end of active treatment. the importance of a wholesome diet as a health promoter is also revalidated. the external and internal medications of ayurveda help to correct the complex pathophysiology of psoriasis like chronic disease. altogether, multimodal ayurveda treatment lead to speedy substantial recovery from a chronic case of psoriasis. references– 1.thappa dm muniscamy,research on psoriasis in india ; where do we stand ?indian j med res 2017; 146(2): 147-9 https:\\doi.org\10.4103 ijmr-1296-17|0.4|03% fijmr.|jmr|296-17. 2.rendon a, schakes k. psoriasis pathogenesis and treatment int.jmo|sci 2019:20;1475 https://doi.org|10.3389|fimmu 2019-00657. https://doi.org|10.3389|fimmu/ 3.dr. bramhanad tripathi, charak samhita, 2009 edition chaukhambhasurbhartiprakashan ,varansi (ch.chi7). 4..dr. bramhanad tripathi, charak samhita, 2009 edition chaukhambhasurbhartiprakashan , varansi (ch.chi7|21,27 pg no305-306) 5.bhavprakash uttrardh , shri bhramshankarmishr ,chaukhambha sanskrit prakashan, forth edition (shlok no. 99-100) 6.5.bhavprakash-part 1 , shri bhramshankarmishr ,chaukhambha sanskrit prakashan, sanskrit series 130. 7.bhaisajya ratnavali, shri ambikaduutasastri, chaukhamba sanskrit prakasan edition 2004 (pg no.641,shlok no 13-17). 8.sahastryogam dr.ramnivassharma |dr.surendrasharma ,chaukhamba sanskrit prakashan edition 2004(pg no 173) 9.dravyagun vijnana vol2 prof p.vsharma , chaukhamba bharti academy, reprint year 2019 (pg no 463) 10.dr. bramhanad tripathi, charak samhita, 2009 edition chaukhambhasurbhartiprakashan ,varansi (ch.chi 03/200-202) 11.dravyagunvijnana vol2 prof p.vsharma , chaukhamba bharti academy, reprint year 2019 (pg no 804) 12.dravyagunvijnana vol2 prof p.vsharma , chaukhamba bharti academy, reprint year 2019 (pg no 802) 13.dravyagunvijnana vol2 prof p.vsharma , chaukhamba bharti academy, reprint year 2019 (pg no 800) 14.dravyagunvijnana vol2 prof p.vsharma , chaukhamba bharti academy, reprint year 2019 (pg no 125) 15.dravyagunvijnana vol2 prof p.vsharma , chaukhamba bharti academy, reprint year 2019 (pg no 117) 16.dravyagunvijnana vol2 prof p.vsharma , chaukhamba bharti academy, reprint year 2019 (pg no 632) 17.dravyagunvijnana vol2 prof p.vsharma , chaukhamba bharti academy, reprint year 2019 (pg no 162) 18.dravyagunvijnana vol2 prof p.vsharma , chaukhamba bharti academy, reprint year 2019 (pg no 253) 19.dravyagunvijnana vol2 prof p.vsharma , chaukhamba bharti academy, reprint year 2019 (pg no 753,755) 20.dravyagunvijnana vol2 prof p.vsharma , chaukhamba bharti academy, reprint year 2019 (pg no 626) 21.9.dravyagunvijnana vol2 prof p.vsharma , chaukhamba bharti academy, reprint year 2019 (pg no 616) 22.9.dravyagunvijnana vol2 prof p.vsharma , chaukhamba bharti academy, reprint year 2019 (pg no 256) 23.dravyagun vijnana vol2 prof p.vsharma , chaukhamba bharti academy, reprint year 2019 (pg no 133) 24.dravyagunvijnana vol2 prof p.vsharma , chaukhamba bharti academy, reprint year 2019 (pg no 162) 25. dravyagunvijnana vol2 prof p.vsharma , chaukhamba bharti academy, reprint year 2019 (pg no 149) 26.kumar;et al.(2010). robbin’s text book of pathology. new delhi:elsevier.p.841.isbn 978-81-3121036-9. 27.dr. bramhanad tripathi, charak samhita, 2009 edition chaukhambhasurbhartiprakashan ,varansi (ch.vi 05/13) 28.auspitz sign: a view from the top journal of the american academy of dermatology (jaad.org) https://www.jaad.org/article/s0190-9622(19)31127-2/fulltext covid 19 and the impact on the beginning of life 1. ali mahmood, md, facs, fascrs a. corresponding author b. strikermd@hotmail.com c. attending surgeon houston methodist specialty group methodist sugar land colon & rectal surgery assistant professor of clinical surgery institute of academic medicine houston methodist hospitals system assistant professor of clinical surgery department of surgery weill cornell medical college 2. aiva mariam mahmood a. research assistant b. houston methodist specialty group i. houston, tx abstract covid 19 is a pandemic that has crippled the world. the disease process started in the hubei province of china, but has been successfully confirmed in 181 countries at the time of this article. much of the data and literature have centered around the adult population and there have been few reports pertaining to covid 19 and pregnancy. there have been even fewer studies addressing breastfeeding in postpartum mothers affected with covid 19. the purpose of our study was to review and compile the literature addressing whether breastfeeding was a safe and viable option following delivery in covid 19 mothers. methods: we searched pubmed, medline, google scholar, scopus, embase to find potential studies. data mining was focused around covid 19 positive pregnancies with subsequent breastfeeding results: we found 12 studies that were pertinent to our topic. delivery methods were varied, with most studies calling for vaginal delivery, unless established criteria were met for a caesarean section. breastfeeding was recommended in both studies and ultimately citing human milk was not a vector in viral transmission.13 discussion: there is sparse literature studying the effects of breastfeeding on infants born to mothers who have tested positive for covid 19. the benefits of breastfeeding are clearly significant, ijo international journal of health sciences and nursing volume 03 |issue 04 | april 2020 www.ijojournals.com 1 mailto:strikermd@hotmail.com however the disease is known to carry significant mortality for the immune compromised and the immune naïve patient population. key words: covid 19, pandemic, pregnancy, breastfeeding, immune compromised, newborns, infants, covid 19 is a pandemic that has crippled the world. fist described in the hubei province of china in late 2019, the virus has since been confirmed in 181 countries. covid 19 is caused by the sars-cov-2 virus (severe acute respiratory syndrome corona virus). multiple sources have cited significant mortality, with the johns hopkins university conoravirus resource center reporting 1.2 million cases, and 64,606 deaths.1 while there has been significant data and literature encompassing the spread, virology, diagnosis and treatment of the disease entity in adults, there has been little addressing pregnancy. furthermore, post partum, the question of breast feeding has remained almost unanswered with very little data in the literature. the question of vertical transmission has yet to be firmly answered. the disease is spread via droplets, and possibly aerosolized during certain procedures, however, the question remains if the virus is transmitted via breast milk, and are the transitive protective properties of breast milk transcended by the morbidity and mortality of the virus. the purpose of this paper was to investigate the literature and determine if breastfeeding was safe post partum in covid 19 mothers. we searched pubmed, medline, google scholar, scopus, embase to find potential studies. data mining was focused around covid 19 positive pregnancies with subsequent breastfeeding. we found 12 studies that were pertinent to our topic.2-13 only 2 of the 10 looked at breastfeeding in the postpartum covid 19 patient cohort.12,13diagnosis of the pregnant patients was established using real time reverse transcriptase polymerase chain reaction, rt-pcr and diagnostic imaging, ct chest. there was a single study that reported vertical transmission at 14.2%, however this was not substantiated by other data.5 two studies tested the products of conception for presence of sar-cov-2 and none was reported, 0%.10,11delivery methods were varied, with most studies calling for vaginal delivery, unless established criteria were met for a caesarean section, however there was an outlier study, citing caesarean section for 84.3% patients.5,6,8,12 breastfeeding was recommended in both studies and ultimately citing human milk was not a vector in viral transmission.13 covid 19 in a novel disease process. much of the literature is centered aroundthe patients affected and thus the pregnancy population comprises only a small subset. the breastfeeding contingent is further smaller in number. the gravid patient population did exhibit the same clinical symptoms as the remaining covid 19 population, consisting of fever, cough and fatigue.5 diagnosis was established using laboratory testing and diagnostic imaging. the ct chest depicted the classic findings described in covid 19. ground glass opacities in the peripheral lung parenchyma in the setting of clinical symptoms have a sensitivity and specificity ijo international journal of health sciences and nursing volume 03 |issue 04 | april 2020 www.ijojournals.com 2 upwards of 90%.5,14,15,16 rt-pcr was used to confirm the diagnosis from sputum and nasopharyngeal swabs.4,7 the benefit of breastfeeding has long been established. the transmission of important immunological factors along with the psychosocial aspects of bonding are not being questioned or challenged. the question of covid 19 spread to an immune naïve newborn, however, have yet to be answered. data from italy conferred that direct breastfeeding was allowable under “strict measures of infectious control” thus implying that the transmission was not spread via milk bodily fluids.12 the second study, much larger, from the united kingdom also concurred with these findings.13 however the total number of patients studied was insufficient to arrive at a definitive conclusion. although the disease process is not thought to spread via vertical transmission, save one publication, the continual close proximity of the affected mother and newborn do raise some concerns. even the single case of reported vertical transmission could have been attributed to post partum care, rather than antepartum spread. until more data and studies are available, we recommend a cautious approach to breast feeding. furthermore, we recommend a baseline rt-pcr on the newborn, and should the baby exhibit any signs of fever, decreased appetite or a change in clinical condition, we recommend cessation of beast feeding and repeat testing for covid 19. the benefit of breast feeding, although crucial and beneficial, is yet to be accurately weight against the paramount devastation of this novel virus. references 1. johns hopkins university of medicine coronavirus resource center. https://coronavirus.jhu.edu/map.html 2. risks of novel coronavirus disease (covid-19) in pregnancy; a narrative review.panahi l, amiri m, pouy s. arch academerg med. 2020 mar 23;8(1):e34. ecollection 2020. review. pmid: 322322 3. emergency cesarean section on severe acute respiratory syndrome coronavirus 2 (sars cov-2) confirmed patient. lee dh, lee j, kim e, woo k, park hy, an j. korean j anesthesiol. 2020 mar 31. doi: 10.4097/kja.20116. [epub ahead of print] pmid: 32229802 4. clinical analysis of pregnant women with 2019 novel coronavirus pneumonia. chen s, liao e, shao y.j med virol. 2020 mar 28. doi: 10.1002/jmv.25789. [epub ahead of print] pmid:32222119 5. clinical features and obstetric and neonatal outcomes of pregnant patients with covid19 in wuhan, china: a retrospective, single-centre, descriptive study. yu n, li w, kang ijo international journal of health sciences and nursing volume 03 |issue 04 | april 2020 www.ijojournals.com 3 https://coronavirus.jhu.edu/map.html https://www.ncbi.nlm.nih.gov/pubmed/32232217 https://www.ncbi.nlm.nih.gov/pubmed/32232217 https://www.ncbi.nlm.nih.gov/pubmed/32229802 https://www.ncbi.nlm.nih.gov/pubmed/32229802 https://www.ncbi.nlm.nih.gov/pubmed/32222119 https://www.ncbi.nlm.nih.gov/pubmed/32220284 https://www.ncbi.nlm.nih.gov/pubmed/32220284 q, xiong z, wang s, lin x, liu y, xiao j, liu h, deng d, chen s, zeng w, feng l, wu j. lancet infect dis. 2020 mar 24. pii: s1473-3099(20)30176-6. doi: 10.1016/s14733099(20)30176-6. [epub ahead of print] pmid: 32220284 6. maternal health care management during the outbreak of coronavirus disease 2019 (covid-19). chen y, li z, zhang yy, zhao wh, yu zy. j med virol. 2020 mar 26. doi: 10.1002/jmv.25787. [epub ahead of print] review. pmid: 32219871 7. coronavirus disease 2019 (covid-19) pandemic and pregnancy. dashraath p, jing lin jeslyn w, mei xian karen l, li min l, sarah l, biswas a, arjandaschoolani m, mattar c, lin sl. am j obstet gynecol. 2020 mar 23. pii: s0002-9378(20)30343-4. doi: 10.1016/j.ajog.2020.03.021. [epub ahead of print] pmid: 32217113 8. expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (covid-19) infection. chen d, yang h, cao y, cheng w, duan t, fan c, fan s, feng l, gao y, he f, he j, hu y, jiang y, li y, li j, li x, li x, lin k, liu c, liu j, liu x, pan x, pang q, pu m, qi h, shi c, sun y, sun j, wang x, wang y, wang z, wang z, wang c, wu s, xin h, yan j, zhao y, zheng j, zhou y, zou l, zeng y, zhang y, guan x. int j gynaecol obstet. 2020 mar 20. doi: 10.1002/ijgo.13146. [epub ahead of print] pmid: 32196655 9. pregnancy and perinatal outcomes of women with coronavirus disease (covid-19) pneumonia: a preliminary analysis. liu d, li l, wu x, zheng d, wang j, yang l, zheng c.ajr am j roentgenol. 2020 mar 18:1-6. doi: 10.2214/ajr.20.23072. [epub ahead of print] pmid:32186894 10. perinatal transmission of covid-19 associated sars-cov-2: should we worry? fan c, lei d, fang c, li c, wang m, liu y, bao y, sun y, huang j, guo y, yu y, wang s. clin infect dis. 2020 mar 17. pii: ciaa226. doi: 10.1093/cid/ciaa226. [epub ahead of print] pmid: 32182347 11. an analysis of 38 pregnant women with covid-19, their newborn infants, and maternal-fetal transmission of sars-cov-2: maternal coronavirus infections and pregnancy outcomes. schwartz da. arch pathol lab med. 2020 mar 17. doi: 10.5858/arpa.2020-0901-sa. [epub ahead of print] ijo international journal of health sciences and nursing volume 03 |issue 04 | april 2020 www.ijojournals.com 4 https://www.ncbi.nlm.nih.gov/pubmed/32219871 https://www.ncbi.nlm.nih.gov/pubmed/32219871 https://www.ncbi.nlm.nih.gov/pubmed/32217113 https://www.ncbi.nlm.nih.gov/pubmed/32196655 https://www.ncbi.nlm.nih.gov/pubmed/32196655 https://www.ncbi.nlm.nih.gov/pubmed/32186894 https://www.ncbi.nlm.nih.gov/pubmed/32186894 https://www.ncbi.nlm.nih.gov/pubmed/32182347 https://www.ncbi.nlm.nih.gov/pubmed/32180426 https://www.ncbi.nlm.nih.gov/pubmed/32180426 https://www.ncbi.nlm.nih.gov/pubmed/32180426 pmid: 32180426 12. coronavirus in pregnancy and delivery: rapid review. mullins e, evans d, viner rm, o'brien p, morris e. ultrasound obstet gynecol. 2020 mar 17. doi: 10.1002/uog.22014. [epub ahead of print] review. pmid: 32180292 13. breastfeeding and coronavirus disease-2019. ad interim indications of the italian society of neonatology endorsed by the union of european neonatal & perinatal societies.davanzo r, moro g, sandri f, agosti m, moretti c, mosca f. matern child nutr. 2020 apr 3:e13010. doi: 10.1111/mcn.13010. [epub ahead of print] review. pmid: 32243068 14. [construction and evaluation of a novel diagnosis process for 2019-corona virus disease].xiong z, fu l, zhou h, liu jk, wang am, huang y, huang x, yi b, wu j, li ch, quan j, li m, leng ys, luo wj, hu cp, liao wh. zhonghua yi xuezazhi. 2020 mar 11;100(0):e019. doi: 10.3760/cma.j.cn11213720200228-00499. [epub ahead of print] chinese. pmid: 32157849 15. correlation of chest ct and rt-pcr testing in coronavirus disease 2019 (covid-19) in china: a report of 1014 cases. ai t, yang z, hou h, zhan c, chen c, lv w, tao q, sun z, xia l. radiology. 2020 feb 26:200642. doi: 10.1148/radiol.2020200642. [epub ahead of print] pmid: 32101510 16. clinical and high-resolution ct features of the covid-19 infection: comparison of the initial and follow-up changes.xiong y, sun d, liu y, fan y, zhao l, li x, zhu w. invest radiol. 2020 mar 3. doi: 10.1097/rli.0000000000000674. [epub ahead of print] pmid:32134800 ijo international journal of health sciences and nursing volume 03 |issue 04 | april 2020 www.ijojournals.com 5 https://www.ncbi.nlm.nih.gov/pubmed/32180292 https://www.ncbi.nlm.nih.gov/pubmed/32243068 https://www.ncbi.nlm.nih.gov/pubmed/32243068 https://www.ncbi.nlm.nih.gov/pubmed/32243068 https://www.ncbi.nlm.nih.gov/pubmed/32157849 https://www.ncbi.nlm.nih.gov/pubmed/32157849 https://www.ncbi.nlm.nih.gov/pubmed/32101510 https://www.ncbi.nlm.nih.gov/pubmed/32101510 https://www.ncbi.nlm.nih.gov/pubmed/32134800 https://www.ncbi.nlm.nih.gov/pubmed/32134800 334-article text-1420-1-4-20200426 disclosure of diagnosis and prognosis information of cancer in jordan: comparative analysis 1. assistant professor, khaldoon alnawafleh, 1al-hussein bin talal university, princess aisha bint al-hussein faculty of nursing and health sciences. khaldoon.nawafleh@ahu.edu.jo 2. walid theib mohammad al-hussein bin talal university princess aisha bint al hussein college for nursing and health sciences princess aisha nursing college 9901002@ahu.edu.jo abstract there is no common disclosure practice among healthcare providers when it comes to cancer diagnosis, whether to tell or not to tell. the lack of a clear policy for healthcare practitioners, who face this dilemma every day in their professional practice, further complicates the situation. the aim of this review is to attempts to look into what governs the public attitude towards disclosure in jordan as an example of what may affect attitudes in developing countries. also brings some data from national research among physicians and patients as well as from public surveys to describe the changing attitude over the years with a comparative analysis of the western literature, a search was done via medline for all publications related to this review objective were included emanating from jordan and western countries (usa, australia and uk). the findings showed that western countries have high levels of reported disclosure compared to jordan, which has a slight growth in disclosure due to some obstacles in the sociocultural constructs lacks patient education resources and low health literacy. key words: cancer, decision making, information provision, jordanian, physicians ijo international journal of health sciences and nursing (issn: 2805-413x) volume 4 | issue 11 | november 2021 | http://ijojournals.com/index.php/hsn 1 mailto:khaldoon.nawafleh@ahu.edu.jo mailto:9901002@ahu.edu.jo introduction cancer is a complicated illness, represents a significant event that changes individuals’ life trajectory. cancer meant death, usually perceived by patients as highly stressful, resulting in fear, shock, depression, and unresolved denial (jaiswal& breitbart, 2014). there is no agreement among health care providers on a unified disclosure practice, either to say it or not. this is a complex issue due to the lack of evidence policy for healthcare practitioners, who each face this issue a day in their clinical practice (ni & alræk, 2017). disclosing a terminal diagnosis or prognosis to their patients, clinicians have been described as intermediaries or master of ceremonies" to the transition from health to life-threatening illness and for some, death (wolfreys, 2016). disclosure and truthtelling can be overwhelming emotionally for patients as well as for health care providers, who have a prior belief that there is no cure and death is linked to cancer (rozveh et al., 2017). in most of these clinical situations, the family’s request for nondisclosure of diagnosis or prognosis to the patient is the most contradicting and at the same time, the most difficult to manage. to appropriately respond to this request, physicians need to deeply understand the sociocultural background of such an attitude (paternotte et al., 2015). disclosing the diagnosis or prognosis to cancer patients in jordan can be a serious challenge to the physician in his daily clinic practice. the public attitude towards disclosure is still conservative, and in order to appropriately deal with such an attitude, physicians and nurses need to much understand its sociocultural background (al qadire, 2018). this paper attempts to look into what governs the public attitude towards disclosure in jordan as an example of what may affect attitudes in developing ijo international journal of health sciences and nursing (issn: 2805-413x) volume 4 | issue 11 | november 2021 | http://ijojournals.com/index.php/hsn 2 countries. also brings some data from national research among physicians and patients as well as from public surveys to describe the changing attitude over the years with a comparative analysis of the western literature. disclosure of cancer in jordan vs western countries many researchers have referred to a different perspective on the importance of disclosing cancer in their various studies. the following studies have been selected to compare disclosure in jordan and western countries (usa, australia and uk). studies by (obeidat and khrais, 2015), (obeidat and khrais, 2016), (al qadire, 2018) and (borgan et al., 2018). all of these studies were conducted for jordan. according to obeidat and khrais (2016) was conducted a study to determine the attitude of jordanian physicians toward disclosure of cancer information, comfort and use of different decision making approaches, and treatment decision making by used a descriptive comparative research design ,a convenience sample of 86 jordanian medical , radiation oncologists and surgeons practicing mainly in oncology setting. the result of this study show that almost 91% of all physicians indicated that the doctor should tell the patient and let him/her decide if the family should know of an early stage cancer diagnosis. similarly, al qadire (2018) conducted a study to explore jordanian public preference on cancer diagnosis disclosure and the type of information they need by used a descriptive cross-sectional survey design and the sample consisted of 485 participants. the result of this study show 421 (86.8%) participants wanted to be informed of the diagnosis if they developed cancer. however, obeidat and khrais (2015) was conducted study to determine jordanian women’s attitudes toward disclosure of breast cancer information and their information needs by used descriptive comparative research design among 156 jordanian women who had a confirmed first time diagnosis of breast cancer. the ijo international journal of health sciences and nursing (issn: 2805-413x) volume 4 | issue 11 | november 2021 | http://ijojournals.com/index.php/hsn 3 result of this study show the vast majority of patients wanted to know whether the diagnosis was breast cancer (92%) and the stage of the disease (78%) and information about spread of the disease and chances of cure was of highest importance for the majority of the patients (88 % and 85 %). borgan et al. (2018) was conducted study to explore the truth disclosure practices of physicians in jordan, a developing country. by used a descriptive cross sectional survey design and sample consisted of 240 physicians. the findings show that 77 % of physicians opted for a usual (tell) policy. surprisingly, specialists were more likely to have adopted a (do not tell) policy compared to non-specialists (34 % and 19 %), non-disclosure was primarily motivated by request from the patient’s family (71 participants, 54 %).most respondents opt to disclose the truth; however, the vast majority of these respondents make exceptions and instances of non-disclosure are primarily motivated by sociocultural constructs. obeidat and khrais (2016) indicated that almost 48% of the participating physicians reported using shared decision making as their usual approach for treatment decision making; the cultural norms, in which patients are not accustomed to being involved in medical decision making, are rooted deep in jordanian society and may be responsible for jordanian patients’ willingness to play a passive role in treatment decision making. al qadire (2018) was found that people with a high monthly income requested more information, while the inhabitants of the southern region needed relatively less information than others related to economic status of participants. on the other hand, other studies were conducted for western countries ; (enzinger et al., 2015), (chittem and butow, 2015) and, (munro et al., 2015) .both enzinger et al. (2015) and munro et al.(2015) have supported disclose information for patient. ijo international journal of health sciences and nursing (issn: 2805-413x) volume 4 | issue 11 | november 2021 | http://ijojournals.com/index.php/hsn 4 according to enzinger et al. (2015) conducted a study in new york to determine how prognostic conversations influence perceptions of life expectancy (le), distress, and the patient-physician relationship among patients with advanced cancer. that used multicenter observational study of 590 patients with metastatic solid malignancies with progressive disease after one line of palliative chemotherapy, undergoing follow-up to death. the results showed that 71% wanted to be told their le, but only 17.6% recalled a prognostic disclosure by their physician .similarly, munro et al. (2015) conducted a study to identify disclosure patterns among patients with cancer and to determine the factors associated with disclosure among 120 patients who had received a diagnosis of either lung, colorectal or skin cancer in uk. the findings showed that the majority of patients (95%) found it helpful to disclose information and did so to a variety of social targets, with the highest levels of disclosure being reported to medical personnel. additionally, chittem and butow (2015) using the snowball method, 14 australian (western: 9, non western: 5) oncologists to explore differences in the attitudes and practices of western born and non western born oncologists in australia when faced with a nondisclosure request. the results showed that six main themes emerged from the study: (1) barriers to truthful communication, (2) an ethical and moral dilemma, (3) high costs of nondisclosure, (4) cultural influences on interpretation and understanding of requests for nondisclosure, (5) emotional impact of bad news on patients, families and oncologists, and (6) truthful disclosure as a gentle balancing act. discussion of findings the aim of this paper was to discuss seven published studies and compare the disclosure in jordan versus in the western countries (table 1). jordanian researchers referred to several reference points related to the issue of patient disclosure. ijo international journal of health sciences and nursing (issn: 2805-413x) volume 4 | issue 11 | november 2021 | http://ijojournals.com/index.php/hsn 5 according to obeidat and khrais (2016) indicated for important facts that the jordan ministry of health website lacks patient education resources and low health literacy has been implicated as one of the major barriers for the successful implementation of shared decision making in clinical practice. this barrier is inconsistent with the results of the al qadire (2018) study it was found that the majority of jordanians opted strongly for disclosure of cancer diagnosis, with high information needs about all aspects of cancer and its treatment. in the same way, obeidat and khrais (2015) indicated to the majority of jordanian women wanted information about breast cancer diagnosis, chances of cure and treatment side effects. another obstacle to disclosure in jordan is the sociocultural constructs and fear of psychological consequences is the most common reason for nondisclosure is a direct request to the respondent from the patient’s family, without the patient’s consent. this finding provides first-hand evidence of the strong presence of family centered care in jordan (borgan et al., 2018). in comparison to western countries, the findings showed that high average levels of disclosure were reported to ‘family’ and ‘friends’ social subgroups expands the earlier work that has emphasized the importance of informal helpers and confidants. higher levels of disclosure were also associated with higher levels of social support, confirming suggestions that social support systems provide an important context for disclosure (munro et al., 2015).also, western oncologists felt there were high costs of nondisclosure to patients and their families, they agreed that there were cultural influences on interpretation and understanding of requests for nondisclosure, they observed an emotional impact of bad news on patients, families and oncologists, and they believed that truthful disclosure was a gentle balancing act (chittem& butow, 2015). additionally, the increased optimism treatment in western country for some ijo international journal of health sciences and nursing (issn: 2805-413x) volume 4 | issue 11 | november 2021 | http://ijojournals.com/index.php/hsn 6 cancers due to advances in surgical and radiation methods and the beginning of medical oncology gave more treatment options and increased survival in many cancers; this in turn provided the momentum toward disclosing diagnoses to patients (enzinger et al., 2015). conclusion attitudes are steadily passing, although their growth has been slow in many nonwestern countries, including jordan. public education and partial cultural openness due to the communication revolution, and worldwide globalization are having some effect in changing a few aspects of the sociocultural constructs in jordan. socially sanctioned roles in the patient provider relationship in non western countries, whose cultures are mostly family centered, are different from those in western countries (autonomous, self determinate patients and authoritative physicians). references al qadire, m. (2018). disclosure of cancer diagnosis: an individualized and non paternalistic approach is preferred. journal of cancer education, 33(5), 996 1001. borgan, s. m., amarin, j. z., othman, a. k., suradi, h. h., & qwaider, y. z. (2018). truth disclosure practices of physicians in jordan. journal of bioethical inquiry, 15(1), 81-87. chittem, m., & butow, p. (2015). responding to family requests for nondisclosure: the impact of oncologists' cultural background. journal of cancer research and therapeutics, 11(1), 174 enzinger, a. c., zhang, b., schrag, d., & prigerson, h. g. (2015). outcomes of prognostic disclosure: associations with prognostic understanding, distress, ijo international journal of health sciences and nursing (issn: 2805-413x) volume 4 | issue 11 | november 2021 | http://ijojournals.com/index.php/hsn 7 and relationship with physician among patients with advanced cancer. journal of clinical oncology, 33(32), 3809. jaiswal, r., alici, y., & breitbart, w. (2014). a comprehensive review of palliative care in patients with cancer. international review of psychiatry, 26(1), 87-101. munro, h., scott, s. e., king, a., & grunfeld, e. a. (2015). patterns and predictors of disclosure of a diagnosis of cancer. psycho‐oncology, 24(5), 508-514. ni, y. h., & alræk, t. (2017). what circumstances lead to non-disclosure of cancer related information in china? a qualitative study. supportive care in cancer, 25(3), 811-816. obeidat, r., & khrais, h. i. (2015). information needs and disclosure preferences among jordanian women diagnosed with breast cancer. journal of cancer education, 30(1), 94-99. obeidat, r., & khrais, h. i. (2016). jordanian physicians’ attitudes toward disclosure of cancer information and patient participation in treatment decision making. asia-pacific journal of oncology nursing, 3(3), 281. paternotte, e., van dulmen, s., van der lee, n., scherpbier, a. j., & scheele, f. (2015). factors influencing intercultural doctor–patient communication: a realist review. patient education and counseling, 98(4), 420-445. rozveh, a. k., amjad, r. n., rozveh, j. k., & rasouli, d. (2017). attitudes toward telling the truth to cancer patients in iran: a review article. international journal of hematology-oncology and stem cell research, 11(3), 178. wolfreys, j. (2016). beyondbreaking bad news': clinicians' experiences of disclosing a life-limiting illness to their patients. ijo international journal of health sciences and nursing (issn: 2805-413x) volume 4 | issue 11 | november 2021 | http://ijojournals.com/index.php/hsn 8 table 1. summary of studies that used in comparative analysis summary of findings setting approach/ design/ sample objectives authors/ y\ears -prognostic disclosure was not associated with worse patientphysician relationship ratings, sadness, or anxiety in adjusted analyses. prognostic disclosures are associated with more realistic patient expectations of le. new york (usa) -quantitative prospective study (cohort ) 590 patients with advanced cancer patients with metastatic solid malignancies and progressive disease after one line of palliative chemotherapy -to determine how prognostic conversations influence perceptions of life expectancy (le), distress, and the patient-physician relationship among patients with advanced cancer. enzinger et al., (2015) -the majority of jordanian women wanted information about breast cancer diagnosis, chances of cure, and treatment side effects jordan -quantitative method descriptive comparative research design a convenience sample of 156 jordanian women to determine jordanian women’s attitudes toward disclosure of breast cancer information and their information needs. obeidat, r., & khrais, h. i. (2015). all oncologists felt that the family request for nondisclosure was difficult, with many cultural and emotional nuances to take into consideration. some immigrant australian oncologists who had a similar cultural background as the patient/family, felt they could better understand the desire for nondisclosure. australia using the snowball method, 14 australian (western = 9, non western = 5) oncologists . to explore differences in the attitudes and practices of western‑born and nonwestern born oncologists in australia when faced with a nondisclosure request. chittem& butow, (2015) ijo international journal of health sciences and nursing (issn: 2805-413x) volume 4 | issue 11 | november 2021 | http://ijojournals.com/index.php/hsn 9 the majority of patients (95%) found it helpful to disclose information and did so to a variety of social targets, with the highest levels of disclosure being reported to medical personnel london, uk -quantitative method -descriptive research design a convenience sample of 120 cancer patients. -to identify disclosure patterns among patients with cancer and to determine the factors associated with disclosure munro et al.(2015) almost 91% of all physicians indicated that the doctor should tell the patient and let him/her decide if the family should know of an early‑stage cancer diagnosis. physicians provide abundant information about the extent of the disease, the side effects and benefits of the treatment, and details of the treatment procedures jordan -quantitative method -a descriptive, comparative research design was used. convenience sample of 86 jordanian medical and radiation oncologists and surgeons practicing mainly in oncology was recruited. -to determine the attitude of jordanian physicians toward disclosure of cancer information, comfort and use of different decision‑making approaches, and treatment decision making. obeidat, r., & khrais, h. i. (2016). this study marks a point of change in public thinking about health issues. jordanian public preferred to be fully informed of their cancer diagnosis. they wanted information about their prognosis, treatment and the available jordan quantitative method a descriptive cross-sectional survey design was used. -the sample consisted of 485 participants who were conveniently selected from the jordanian public. -to explore jordanian public preference on cancer diagnosis disclosure and the type of information they need. al qadire, m. (2018). ijo international journal of health sciences and nursing (issn: 2805-413x) volume 4 | issue 11 | november 2021 | http://ijojournals.com/index.php/hsn 10 supportive services. most respondents opt to disclose the truth; however, the vast majority of these respondents make exceptions. -instances of nondisclosure are primarily motivated by sociocultural constructs. jordan quantitative method a descriptive cross-sectional survey design was used the sample consisted of 240 physicians from four major hospitals in amman, jordan. -to explore the truth disclosure practices of physicians in jordan, a developing country. borgan et al. (2018) ijo international journal of health sciences and nursing (issn: 2805-413x) volume 4 | issue 11 | november 2021 | http://ijojournals.com/index.php/hsn 11 abstract ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges lalanirina gaël lauricia 1 , lahiniriko abel solaar 1 , andrianjafinoro tsiriniaina hasinjanahary 2 , ratsimandresy naomy namboarintsoa 1 , andrianasolo volahasina valentina 1 , razanadraisoa albertine 1 , rabarijaona sergio nicko haritiana 1 , ranaivo joachim marco 1 , ralaiarimanana liantsoa fanja emmanuel 1 . 1. department of dental prosthetics institute of tropical odonto-stomatology of madagascar – university of mahajanga – madagascar 2. department of conservative odontology endodontics institute of tropical odontology-stomatology of madagascar – university of mahajanga – madagascar corresponding author: lalanirina gaël lauricia dentistry department, pzaga university hospital center, mahajanga department of dental prosthesis, institute of tropical odontostomatology of madagascar (iostm) abstract a bonded bridge is a fixed prosthesis bonded to the palatal or lingual surface of the abutment teeth. it is one of the current trends in prosthetics. for this reason, we wanted to know where we stood with regard to this issue, which is why we conducted this study, the aim of which was to describe the knowledge and practice of odontostomatologists on this subject. this cross-sectional descriptive study was conducted from 12 june to 21 july 2023 among odontostomatologists in the city of antananarivo who were registered with the national order of odontostomatologists and who had given their consent to be surveyed. a total of 107 odontostomatologists were included. thirty-four point six percent were aware of bonded bridgework and 6.5% of them practiced it. this knowledge was related to their place of training (p=0.033) ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 24 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges and their practice was strongly related to their knowledge (p=0.000), as well as to their specialization (p=0.022). the main obstacle to their practice was lack of knowledge (83%). on average, 71.4% followed the steps in the procedure. the most common bonding material used was luting cement (71.4%) and the most common bonded bridge was the 2-winged bridge (85.7%). this study revealed that bonded bridges were less well known and very little practiced. additional awareness-raising and training could be considered to promote and encourage them to practice it. keywords: knowledge, practice, bonded bridge introduction a bonded bridge is a fixed prosthesis that is bonded to the dental structures, mainly to the previously prepared enamel. it can be used to correct a single or short gap. this bridge represents a better alternative, especially in developing countries where access to implant treatment is still limited for the majority of the population, or in the event of implant failure [1, 2, 3]. according to lam's 2013 study in china, bonded bridges had a higher success rate of 89.7% compared to implant solutions, which achieved a success rate of 69.2%. in addition, they showed fewer complications, with a percentage of 25.6%, while the implant solution recorded a complication rate of 7.7% after more than 8 years of observation [4]. originally, this type of prosthesis had two wings, but thanks to improved bonding techniques, the development of new materials, changes in preparation and wing concepts and the partial debonding of the two-wing prosthesis, the bonded bridge is gradually changing and the trend is beginning to move towards the single-wing bonded bridge, also known as the cantilever bonded bridge, which has a much higher success and survival rate than its predecessor [5]. this survival rate was 100% in germany according to huttig f and klink a [6], in switzerland according to sailer i and hämmerle ch [7], in china according to xu b et al [8], and in egypt according to saker s et al [9]. in 2016, the french national authority for health (has) recommended bonded single-arch bridges for single tooth edentulism [10], and practitioners in ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 25 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges developed countries have widely integrated these bridges into their daily practice. in view of this trend towards bonded bridges, we wanted to find out more about the situation in madagascar. the aim of this study was to describe the knowledge and practice of bonded bridges in dental practices in the city of antananarivo. methodology this study was carried out among odontostomatologists in the city of antananarivo, in private or public practice. it was a descriptive cross-sectional study that took place over a period of one and a half months, from june 12, 2023 to july 21, 2023. all odontostomatologists in the city of antananarivo registered with the ordre national des odontostomatologistes (national order of odontostomatologists) who gave their consent to be surveyed were included in the study. excluded were those who did not fill in their form completely (on the last day of our visit) or correctly. sampling was exhaustive, and 107 odontostomatologists were selected. data were collected using individual self-administered forms. each form was divided into three distinct parts. the first part contained socio-demographic information such as age, gender, place of training, length of practice, professional status, and specialization in prosthetics. the second part dealt with knowledge of bonded bridges, and the third with the practice of bonded bridges. data were then processed and analyzed on a computer using statistical package for social sciences (spss) software, version 20.0 for windows. univariate analyses were performed to examine frequency distribution, while bivariate analyses were used to assess relationships between dependent and independent variables. the relationship between variables was verified by the chi-square test, where the significance level was 0.050. as part of this study, we obtained authorization to conduct surveys from the president of the ordre national des odontostomatologistes. the request for ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 26 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges authorization to conduct a survey (attached) was issued by the head of the odontostomatology department at the institut d'odontostomatologie tropicale de madagascar. we have taken every precaution to guarantee the confidentiality of the data collected. we also ensured the anonymity of participants' responses. the study was limited by the sincerity, cooperation and availability of the odontostomatologists. results table i: distribution of odontostomatologists according to socio-demographic profile socio-demographic profile workforce percentage (%) gender male 55 51.4 feminine 52 48.6 total 107 100 age range less than or equal to 40 years 42 39.2 41 years or older 40 37.4 not mentioned 25 23.4 total 107 100 year of exercise less than 10 years old 32 29.9 between 11 to 20 years old 36 33.6 more than 20 years 39 36.4 total 107 100 activity area ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 27 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges audience 32 29.9 private 75 70.1 total 107 100 table ii: distribution of odontostomatologists according to place of training training site workforce percentage (%) madagascar 96 89.7 stranger 6 5.6 madagascar and abroad 5 4.7 total 107 100 table iii: distribution of odontostomatologists according to their knowledge and practice of bonded bridge workforce percentage (%) knowledge of bonded bridge yes 37 34.6 no 70 65.4 total 107 100.0 bonded bridge practice yes 7 6.5 no 100 93.5 total 107 100.0 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 28 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges table iv: distribution of odontostomatologists according to their reason for not practicing glued bridge patterns workforce percentage (%) lack of concept 83 83 rumor about its high failure rate 6 6 fear of premature separation 4 4 absence of patient to practice it 2 2 product supply problem 2 2 high cost 1 1 banned by the workplace 1 1 incapacity of prosthesis laboratories 1 1 total 100 100 table v : distribution of odontostomatologists according to their practice protocol protocols numbers (n=7) percentage (%) pre-prosthetic treatments 6 85.7 preparation of abutment teeth 6 85.7 temporary filling 6 85.7 creation of a temporary prosthesis 4 57.1 tooth surface conditioning 6 85.7 conditioning the prosthetic surface 3 42.9 checking the occlusion 7 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 29 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges table vi: distribution of odontostomatologists according to the materials of manufacture and assembly and the number of wings of the bonded bridges produced materials numbers (n=7) percentage (%) crafting materials metal-ceramic 03 42.9 fiber reinforced composite 02 28.6 ceramic 04 57.1 zircon 00 0 assembly materials sealing cement 05 71.4 composite 03 42.9 glue 02 28.6 hybrid materials 01 14.3 number of fins a fin 03 42.9 two fins 06 85.7 more than two fins 00 00 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 30 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges table vii : distribution of odontostomatologists according to their knowledge and socio-demographic profile socio-demographic profile knowledge of glued bridge p yes no total not % not % not % gender 0.225 male 22 40 33 60 55 100 feminine 15 28.8 37 71.2 52 100 total 37 34.6 70 65.4 107 100 age range 0.445 less than or equal to 40 years 16 38.1 26 61.9 42 100 41 years or older 15 37.5 25 62.5 40 100 not mentioned 6 24 19 76 25 100 total 37 34.6 70 65.4 107 100 year of exercise 0.472 less than 10 years old 11 34.4 21 65.6 32 100 between 11 to 20 years old 15 41.7 21 58.3 36 100 more than 20 years 11 28.2 28 71.8 39 100 total 37 34.6 70 65.4 107 100 activity area 0.977 audience 11 34.4 21 65.6 32 100 private 26 34.7 49 65.3 75 100 total 37 34.6 70 65.4 107 100 training site 0.033 madagascar 30 31.2 66 68.8 96 100 stranger _ 5 83.3 1 16.7 6 100 madagascar and abroad 2 40 3 60 5 100 total 37 34.6 70 65.4 107 100 specialization 0.195 prosthesis 4 66.7 2 33.3 6 100 none 32 33.3 64 66.7 96 100 others 1 20 4 80 5 100 total 37 34.6 70 65.4 107 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 31 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges table xiii: distribution of odontostomatologists according to the practice of glued bridge and their socio-demographic profile socio-demographic profile bonded bridge practice p yes no total not % not % not % gender 0.753 male 4 7.3 51 92.7 55 100 feminine 3 5.8 49 94.2 52 100 total 7 6.5 100 93.5 107 100 age range 0.451 less than or equal to 40 years 2 4.8 40 95.2 42 100 41 years or older 2 5 38 95 40 100 not mentioned 3 12 22 88 25 100 total 7 6.5 100 93.5 107 100 year of exercise 0.091 less than 10 years old 1 3.1 31 96.9 32 100 between 11 to 20 years old 5 13.9 31 86.1 36 100 more than 20 years 1 2.6 38 97.4 39 100 total 7 6.5 100 93.5 107 100 activity area 0.936 audience 2 6.2 30 93.8 32 100 private 5 6.7 70 93.3 75 100 total 7 6.5 100 93.5 107 100 training site 0.504 madagascar 6 6.2 90 93.8 96 100 stranger _ 1 16.7 5 83.3 6 100 madagascar and abroad 0 0 5 100 5 100 total 7 6.5 100 93.5 107 100 specialization 0.022 prosthesis 2 33.3 4 66.7 6 100 none 5 5.2 91 94.8 96 100 others 0 0 5 100 5 100 total 7 6.5 100 93.5 107 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 32 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges discussion we undertook a descriptive cross-sectional study to describe the knowledge and practice of odontostomatologists in the city of antananarivo regarding bonded bridges. 107 odontostomatologists were surveyed. 1. socio-demographic profile of surveyed odontostomatologists (table i) in the present study, 76.6% of the odontostomatologists surveyed agreed to state their age. this ranged from 25 to 68 years, with an average age of 42. of these, 39.2% were 40 or under, while 37.4% were 41 or over (table i). these results are similar to those of the study conducted by anguis m et al in france in 2021, which also observed a rejuvenation of dental professionals [11]. a slight male predominance ((51.4%) with a sex ratio of 1.06 was observed. the majority of odontostomatologists worked in the private sector (70.1%) and had more than 20 years' experience (36.4%). in contrast to this study, anguis m et al in france and randriamalala nc in the analamanga, boeny and atsimo andrefana regions of madagascar, in 2021 reported respectively that women were more numerous and the major part or 37.6% had experience of 1 to 10 years [11, 12]. in accordance with ranivoarilanto e's 2014 study on the status and outlook for oral health in madagascar, 52.80% of odontostomatologists practiced in the private sector [13]. 2. training site a minority of odontostomatologists have trained and graduated abroad (5.6%) (table ii). the lack of resources and the relatively high cost of training in developed countries may account for this. this result corroborates those of the study carried out by the observatoire national de la démographie des professions de santé on the current state of the demography of dental surgeons in france in december 2013, which showed that 4.3% of odontostomatologists in france obtained their diploma abroad [14]. 3. knowledge and practice of bonded bridges ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 33 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges the results in table iii show a low rate of knowledge and practice of bonded bridges among oodontostomatologists: 34.6% and 6.5% respectively. these figures differ from those of a study carried out in côte d'ivoire by koua in 2018, where a knowledge rate of 76.1% was observed, although the practice rate was similar [15]. and moreover, knowledge of bonded bridge was significantly related to place of training, with a p-value equal to 0.033 (table xii); which meant that there was a high probability that odontostomatologists who graduated abroad would have more knowledge of bonded bridge compared to those who underwent initial training in madagascar. similarly, there was a significant relationship between the practice of bonded bridgework and specialization in prosthetics, with a p-value equal to 0.022 (table xiii). this would mean that those who had specialized in prosthetics were more likely to practice bonded bridgework than those who had not. this correlation could be attributed to insufficient theoretical and virtually non-existent practical training during their initial and continuing education [16]. what's more, according to the has, the teaching of bonded bridges is faculty-dependent, and their performance by odontostomatology students during their course of study often appeared optional for annual validation [17]. the results of the survey confirmed this observation, as 83% of the odontostomatologists questioned admitted that lack of knowledge on the subject was their main obstacle to the practice of this type of fixed prosthesis (table v). 3.1. stages in the bonded bridge procedure as part of the pre-prosthetic treatment, scaling and caries treatment were considered by the majority of odontostomatologists (71.4%). 42.9% of them devitalized the abutment teeth prior to prosthetic treatment, thereby reducing their resistance [18]. according to boschatel dj, vanoverschelde s in 2022, gingival preparation was little practiced by odontostomatologists (14.3%), yet it is of major importance for optimal esthetic integration, particularly in cases of space filling caused by dental agenesis. according to them, this involved creating ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 34 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges a gingival contour by ovalizing the edentulous ridge and compressing the gingiva to create a base for the future prosthesis [19]. as for tooth preparation, 14.3% of odontostomatologists did not prepare the abutment teeth. in 2005, kern described how stabilization, support and retention of the bridge could be ensured by creating a shoulder with a rounded internal angle, two mesial and distal grooves, and a cingular stabilization well [20]. furthermore, some odontostomatologists (14.3%) had skipped the provisional stage, even though dentine hypersensitivity was common after tooth preparation. however, it is only this stage, which is sometimes neglected, that ensures protection of the dentino-pulpary complex and promotes healing [21]. before bonding a bridge, the tooth surface must be conditioned to ensure optimum adhesion. this step was carried out by 85.7% of odontostomatologists, while 14.3% did not. according to bouhai (2021), it is not possible to bond bridge wings to enamel that has not been treated with 30-40% concentrated orthophosphoric acid. this conditioning procedure must be protected from moisture, as the adhesives used are hydrophobic. this is also why adhesion to dentin is not recommended, as it has intrinsic moisture and is therefore less retentive [22]. to ensure the durability of the bonded connection, it was recommended that a specific surface treatment should also be carried out, particularly on the prosthesis winglet. this step was carried out by only 42.9% of odontostomatologists. according to cazier s and amar j, simple bonding without adequate surface treatment would not be sufficient to ensure the longevity of the bonded junction. it is therefore necessary to prepare the prosthetic surface appropriately before bonding. techniques such as sandblasting, silica deposition or the use of a specific bonding agent can be employed to improve adhesion between the prosthesis and surrounding tooth surfaces. this surface treatment optimizes bond retention[23]. finally, checking the occlusion is also a crucial step in the bridge bonding process, and all the odontostomatologists who practiced this bridge took this step ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 35 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges into account. according to dahan l, it is essential to ensure that there is no occlusal contact at the limit of the bridge's fins. this is necessary to avoid cleavage or shear stresses that could compromise the strength of the bonded connection [24]. careful checking of the occlusion and adjustment of the occlusal contacts, if necessary, ensures optimum distribution of masticatory forces and increased durability of the bonded bridge [4]. 3.2. type of bonded bridge and materials used for fabrication and assembly two-winged bonded bridges were more commonly used by odontostomatologists than single-winged bridges, with a percentage of 85.7% versus 42.9% (table iv). despite their higher frequency of use, bonded two-wing bridges may present an increased risk of complications compared to single-wing bridges, since, according to lucile d, as the number of abutment teeth increases, so does the risk of detachment [24]. in addition, damien a and daniel d in 2020 demonstrated that single-wing bonded bridges have a significantly higher success and survival rate than double-winged bridges [5]. the majority of odontostomatologists (71.4%) used luting cement as luting materials, and only 28.6% used adhesives. cazier s and amar j pointed out that this was due to the lack of adhesives available on the market [23] and the high cost of the product. this limitation was one of the reasons why some odontostomatologists chose not to perform bonded bridges (table iv). however, the choice of a suitable bonding material is essential to optimize the adhesion of the bonded bridge [21]. all-ceramic bonded bridges were the most common, accounting for 57.1%. in second place were metal-ceramic bridges with 42.9%, followed by glass-fiberreinforced bonded bridges with 28.6%. however, no zircon bridges were made. this may be explained by the fact that ceramic is more rigid than metal. as a result, it has less resistance to bending forces, according to lanoiselee e in 2022 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 36 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges [25]. numerous studies have also shown that metal-ceramic is frequently used in the manufacture of cemented bridges, in particular cantilever cemented bridges [26,27]. conclusion a bonded bridge is a fixed prosthesis that is attached by a bonding system to the palatal or lingual surfaces of healthy abutment teeth. one of the current trends is the two-winged to single-winged bonded bridge, which is a modern option for the management of a single edentulous tooth. in the city of antananarivo, bonded bridgework has been less common and still lags behind the evolution of this type of bridge. this was mainly due to a lack of knowledge on the subject. in addition, some odontostomatologists did not follow the correct steps in bridge fabrication, and the bonding material most commonly used was unsuitable for this type of prosthesis, due to the cost and unavailability of glue on the market in madagascar. this situation jeopardizes the survival of bonded bridges. at the end of this study, we hope to bring about a change of attitude among odontostomatologists in their general practice and with regard to the management of small edentulous restorations. references 1. benfaida s, andoh a. bonded bridge with handle. aos. 2017;286(5): 1-6. 2. kouam ka, pesson dm, didia e, tra bzr, baku od, binaté a, et al. obstacles to the practice of bonded bridge in côte d'ivoire. rev col odontostomatolafrchirmaxillo-fac. 2018;(special):95-9. 3. boudas r. cantilever ceramic bonded bridge on veneer. dentoscope;(219):52-6. 4. lam wy, botelho mg, mcgrath cp. longevity of implant crowns and 2-unit cantilevered resin-bonded bridges. clin oral implants res. 2013;24(12):1369-74. 5. alegre d, dot d. _ all-ceramic cantilever bonded bridge: precautions, protocol, survival rate and illustration by two clinical cases. clinic. 2020;3. ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 37 https://www.editionscdp.fr/recherche/article.html?query=%22daniel%20dot%3cb%3e%3csup/%3e%3c/b%3e**%22&revues%5b%5d=cli&sortby=relevance https://www.editionscdp.fr/recherche/article.html?query=%22daniel%20dot%3cb%3e%3csup/%3e%3c/b%3e**%22&revues%5b%5d=cli&sortby=relevance https://www.editionscdp.fr/recherche/article.html?query=%22daniel%20dot%3cb%3e%3csup/%3e%3c/b%3e**%22&revues%5b%5d=cli&sortby=relevance ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges 6. huttig f, klink a. zirconia-based anterior resin-bonded single-retainer cantilever fixed dental prostheses: a 15to 61-month follow-up. int j prosthodont. 2016;29(3):284-6. 7. sailer i, hämmerle ch. zirconia ceramic single-retainer resin-bonded fixed dental prostheses (rbfdps) after 4 years of clinical service: a retrospective clinical and volumetric study. int j periodontics restorative dent. 2014;34(3):333-43. 8. xu b et al. single-tooth replacement in the anterior arch by means of a cantilevered ips e.max press veneer-retained fixed partial denture: case series of 35 patients. int j prosthodont. 2013;26(2):181-7. 9. saker s et al [saker s et al. clinical survival of anterior metal-ceramic and allceramic cantilever resin-bonded fixed dental prostheses over a period of 60 months. int j prosthodontics. 2014;27(5):422-4. 10. assessment of cantilever (cantilever bridges) and cement-retained multi-unit prostheses. (bonded bridges). has. 2016:8-12. 11. anguis m, bergeat m, pisarik j, vergier n, chaput h. what recent and future demographics for the medical and pharmaceutical professions? demographic findings and projections. drees files. 2021;76:4-11. 12. randriamalala nc, andrianjafinoro th, rakotonirina fp, ramaroson j. therapeutic therapeutic success of iatrogenic perforation in endodontics in the analamanga, boeny, atsimo andrefana region (madagascar). ijpsat. 2022;34:07-14. 13. ranivoarilanto e. oral health in madagascar: current situation and perspectives. 2014. 14. demographic situation of dental surgeons. ondps. 2013. 15. koua yv. bonded bridges: knowledge, attitudes and practices of dental surgeons in the city of abidjan [chir dent thesis]. abidjan-ivory coast: ufros. 2018:152. 16. kouam ka, pesson dm, didia e, tra bzr, baku od, binaté a, et al. obstacles to the practice of bonded bridge in côte d'ivoire. rev col odontostomatolafrchirmaxillo-fac. 2018;(special):95-9. ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 38 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || knowledge and practices of odontostomatologists in the city of antananarivo on bonded bridges 17. evaluation of cantilever bridges and partially coronal-anchored fixed multi-unit prostheses has. 2015:14. 18. viennot s , malquarti g, allard y. tissue economy and aesthetics. prosthesis notebooks. 2003;(124). available at: https://www.editionscdp.fr/revues/lescahiers-de-prothese/article/n-124/economie-tissulaire-et-esthetique.html 19. boschatel dj , vanoverschelde s. cantilever bridge contribution of plastic surgery for an aesthetic result. the dental wire. 2022. available at: https://www.lefildentaire.com/articles/bridge-cantilever-apport-de-la-chirurgieplastique-pour-un-resultat-esthetique/ 20. kern m. clinical long-term survival of two-retainer all ceramic resin-bonded fixed partial dentures. quintessence int. 2005;36(2):141-7. 21. durand sh, farges jc, pirel c, jemai s, millet c. prosthetic restoration on living teeth, preserving the pulp. inf. tooth. 2009; 91(9):411-9. 22. bouhai. bonded bridges. facmeduniv constantine 3. 2021. 23. cazier s , amar j. metal bonding procedures: example of the assembly of a cast noble alloy splint. alternative;(27):13-22. 24. dahan l. update on bonded bridges: the 10 key points in bonding: 60-5. available on file:///e:/pr%c3%a9paration%20clinicat%202023/journ%c3%a9e%20de%20s omaprod/nouveau%20dossier/article_20dahan.pdf 25. lanoiselee e. arguments in the sense of nuance. dental floss. 2022. 26. botelho mg, chan aw, leung nc, lam wy. long term evaluation of cantilevered vs fixed-fixed resin bonded fixed partial dentures for missing maxillary incisors. j dent. 2016;45:59-66. 27. lalanirina gl, andrianjafinoro th, andrianinarivo rg, razanadraisoa a, rabarijaona hsn, ratsimandresy nn et al. therapeutic treatment of an anterior edentulous unit: a case of a cantilever bonded bridge. malagasy online odontostomatology journal issn 2220-069x2022;23:20-28. ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 39 https://www.editionscdp.fr/recherche/article.html?query=%22%3cb%3eyves%20allard%3c/b%3e%0a%09%09%09***%22&revues%5b%5d=cdp&sortby=relevance https://www.editionscdp.fr/recherche/article.html?query=%22%3cb%3eyves%20allard%3c/b%3e%0a%09%09%09***%22&revues%5b%5d=cdp&sortby=relevance https://www.editionscdp.fr/revues/les-cahiers-de-prothese/article/n-124/economie-tissulaire-et-esthetique.html https://www.editionscdp.fr/revues/les-cahiers-de-prothese/article/n-124/economie-tissulaire-et-esthetique.html https://www.lefildentaire.com/auteur/jeandavidboschatel/ https://www.lefildentaire.com/auteur/sebastienvanoverschelde1/ https://www.lefildentaire.com/auteur/edouardlanoiselee/ 3.1. stages in the bonded bridge procedure 3.2. type of bonded bridge and materials used for fabrication and assembly erinleolusolaoyetunde federaluniversityoftechnology, universityhealthcentre,akure, ondostate,nigeria. topic: influenceofoccupationalstress,role-conflict,sex,age andworkexperienceonmaritalsatisfactionamong nursesinunimedteachinghospital,akure. abstract thisstudywasdesignedtoinvestigatetheinfluenceofoccupationalstress,roleconflict,sex,ageandworkexperienceonmaritalsatisfactionamongnursesin universityofmedicalscience teaching hospitalakure.the studyutilises the descriptive surveydesign.200 respondents purposivelydrawn among married nursesworkinginunimedteachinghospital,akureparticipatedinthestudy.the instrumentsused forthe studywere standardized questionnaire which include enrichmaritalsatisfactionscale,jobrelatedtensioninventoryandworkfamily conflictscale.thedataobtainedfrom thestudywereanalysedusingindependentttest,ancovaandanovatotestallthehypothesesraisedforthestudyat0.05level ofsignificance.theresultofthestudyrevealedthatoccupationalstresshasno significantinfluenceonmaritalsatisfactiont(198)=.178,p>0.05.thestudy revealedfurtherthatthereisnosignificantinfluenceofoccupationalstresson maritalsatisfactionf(1,198)=.032p>.05withtheinterferenceofroleconflictwith occupationalstressthereisstillnosignificantinfluenceofoccupationalstresson maritalsatisfactionf(1,197)=.023p>.05.alsothereisnosignificantinfluenceof stress on maritalsatisfaction f(1,194)= .148 p>.05.subsequently,there is no significantinfluenceofageonmaritalsatisfactionf(2,194)=.992p>.05.thereisno significantjointinfluenceofsexandageonmaritalsatisfactionf(2,1194)=.219 p>.05.finallyworkexperiencehasnosignificantinfluenceonmaritalsatisfaction f(4,195)=1.96p>.05.basedonthefindingsofthisstudyitwasconcludedthat occupationalstress,workexperience,age,sexandroleconflictdoesnotinfluence maritalsatisfaction.theresearcherrecommendedthatsinceallthevariablesdidnot significantlyinfluencemaritalsatisfaction,thefutureresearchercouldlookintothe areaofchoiceofmarriage,personality,culturalbackground,sexualintimacyand religiousadherencetoworkon.also,nursesandhealthworkersshouldtryasmuch possibletostrikeabalancebetweentheirofficeandfamilyresponsibilities;none should be taken with levity as role managed wellwillnotinfluence marital satisfaction. ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 1 emailaddress:erinleolusola67@gmail.com keywords:occupationalstress,maritalsatisfaction,roleconflict,workexperience,age. backgroundtothestudy nursingisknownasajobwithhighriskofexhaustionanddisease.thehospital environmentcancausestressandphysicalproblemsamongitsemployees;infact jobstresscanleadtophysicalinjuryormentalillnessandinthelongterm cancause negativeresultsinperformanceofpeopleanditsworkplace.pressureinnursing can affectfamilylife and maritalproblems,disruptcommon socialproblems, increasefamilyconflictsandendangerpeople’sgeneralhealth.workisoneofthe mainsourcesofstressinpeople.(peimanpack,mansur,sadeghi,purebrahim (2013). maritalsatisfactionsimplymeansmaritalcontentment.satisfactioniswhenthe desire,intimacyandperceivedneedofapartnerinarelationshipareactualized.itis astateofcontentmentandpleasurewiththeabsenceofproblem andcomplaint. accordingtofincham (2006),therearemanyfactorsthatcontributetoahappy marriagebecausetheredoesnotseem tobeonemagicfactorthatguarantees maritalbliss.thesefactorsincludeeffectivecommunication,interaction,gender roles,conflictmanagement,problem solvingandintimateplay.maritalsatisfaction isthegeneralhappinessandpleasurebetweencouples.itisthegoodfeelingof marriage. workisofprimaryimportancetomankindandithasbeenamotivatorphysically, ethicallyandideologically.workhasgivenhumanbeingasenseofmasteryover natureandithasbeenatremendousfeelingofself-fulfilment.itisanyexpenditure ofenergythatproducesservicesandproductsofvaluetootherpeople.particular valuesandfunctionsofworkarespecifictotimeandplace(omolayo2005).thibaut andkelly(1989)definedworkasaweaponwithwhichcommonmancouldachieve notonlywealthbutalsohappiness. familyisthebasicunitoflife;itisthefundamentalunitofsocietyreferredtoasthe buildingblockofanysociety.oakley(1984)definesfamilyasasetofpeoplerelated byblood,marriageorsomeotheragreeduponrelationshiporadoptionwhoshares theprimaryresponsibilityorreproductionandcaringformembersofthesociety. roleconflictoccurswhenthereareincompatibledemandsplaceduponaperson relatingtotheirjoborposition.personexperiencesroleconflictwhentheyfind ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 2 themselvespulledinvariousdirectionsastheytrytorespondtothemanystatuses theyhold.burke&green-glass(1999).therearetwotypesofroleconflict;intrarole conflictreferringtoincompatiblerequirementswithinthesamerole,andinterrole conflictreferringto clashingexpectationsfrom separateroleswithinthesame person.roleconflictisastressorthatcanoccurintheworkplacewhenpersonal valuesconflictswithjobresponsibilities,rolesarepoorlydefined,incompatibleroles areperformed,orexpectedrolesforoneorganisationdon’tmatchthoseofanother, whenconflictingrolesbothhavethesamestatusrolestrainresults.thishappens whenapersonwhoneedstofulfilacertainroleisstrainedbecauseofobligationsor extensivedemandsonenergy,timeorresourcescausedbythemultipleroles. workexperiencehasalongwaytoupholdandtodisintegratemaritalsatisfactionin oursociety.experiencetheysayisthebestteacher,thehigheryougoinhierarchy themoreresponsibilityyouhaveinnursingprofession,therearesomeskillsgained from workexperiencesuchasproblem solvingskills,interpersonalskills,maturity, team work,practicalskills,self-confidenceandself-esteem havingalltheseskillswill helpmarriednursestocopeathomeleadingtomaritalsatisfaction. gendertendstodenotethesocialandculturalroleofeachsexwithinagivensociety. ratherthanbeingpurelyassignedbygenetics,assexdifferencesgenerallyare, peopleoftendeveloptheirgenderrolesinresponsetotheirenvironmentsincluding familyinteractions,themedia,peersandeducation. ageisthelengthoftimethatapersonhaslivedorhasexisted(chaffee1991).age gapaffectstheevolutionmaritalsatisfactionoverthedurationofmarriage.marital satisfactiondeclineswithmaritaldurationforbothmenandwomenindifferently. agedcouplesarerelativetothoseinsimilaraged-relationship.theinfluenceofage onmaritalsatisfactionamongmarriednursescouldnotbeascertainasthereisa divorceandseparationoccasionallyamongyoungmarriedcoupleslikewisethose whohadbeenmarriedforalongtime. statementoftheproblem nursingasaprofessionbringsalotofresponsibilities,whichcanbeexhausting, complicated,boring,andstressful.overtheyears,thenursesworkinginalltiersof governmenthealth facilities are faced with a series ofmaritalchallenges as applicabletomanydivorcesintheirhomewhichcanbeattributedtojobstressand strainswithresultantmaritaldissatisfaction. ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 3 theratioofmaletofemalenursesinakureondostateisabout1:4,accordingtothe studyconductedbyadejumo,akinbode,iyawe,emmanuelandogungbemi(2018) forassessmentofknowledgeofchronickidneydiseaseamongnon-nephrology nurses,themajorityofnursesarefemale.theresearcherkeepsonwonderinghow theywillmaintainmaritalsatisfactionattheendoftheclosinghourofeveryshift dutybecausenursesbattlewiththreedifferenttypesofshifttoensuretheycover24 hoursoftheday,thenursesatunimedareoftenandareusuallytoobusyattending tovariousformsofcasualtiesandemergencycases.theresearcherperceivedthat thismayberesponsibletomostofthebehaviourexhibitedatworkandathome therebyinfluencetheirtemperamentandemotionsandthismakesthesocietyto haveimpressionthatnursesaretootemperamental.thewearandtearonnursesat everyshiftdutyisbecomingalarmingandyetmostnursesensurethattheymaintain maritalsatisfactionlikeeveryotherprofessionalwhileattimesthereverseisthe case.the workload from the discharge ofnursesdutydirectlyand inversely influencetheirmaritalsatisfactionandoccasionallyresortedintosocial,physical, psychologicalandemotionalviolenceamongthemarriednursesandthisinfluences theirmaritalstabilityandsatisfaction. copingwithparentingalsoasanursebringsadditionalstress;parentingistime consuming,eventhoughparentsallovertheworldtakecareoftheirchildrenwith devotion,enjoymentandlove.parentingbringsalotofresponsibilitywhichcanbe exhausting,complicatedandunrewardingattimes(bögels,hellemans,deursen, römer,&meulen,2014).whilethebirthofachildmostoftenaffectstheparents positively,theresponsibilityandroleconflictbetweenworkandfamilymayhave negativeeffectsonmaritalsatisfaction(nomaguchi&milkie,2003).basedonthe backgroundofthisstudyithoweverbecomesanapparentinteresttoinvestigate moreintothisstressorandevaluateitseffectonmaritalsatisfactionamongnurses. objectivesofthestudy -themainobjectiveofthisstudyistoinvestigatetheinfluenceofoccupational stressonmaritalsatisfaction.otherobjectivesarespecificallyto; -accesswhetherroleconflictcouldinterferewithoccupationalstresstoinfluence maritalsatisfactionamongnurses. -investigatewhethersexandagecouldinfluencemaritalsatisfactionamongnurses. -examinewhetherworkexperiencecould influencemaritalsatisfactionamong ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 4 nurses. thehypothesesforthisstudyare:1-therewillbeasignificantinfluenceofoccupationalstressonmaritalsatisfaction amongunimednurses,akure. 2-therewouldbeinterferenceofroleconflictwithoccupationalstresstoinfluence maritalsatisfaction 3-therewillbeasignificantinfluenceofsexandageonmaritalsatisfaction 4-workexperiencewillinfluencemaritalsatisfaction. significanceofthestudy thisstudyaimstoimproveindividualunderstandingontheroleofoccupational stress,role-conflict,age,sexandworkexperienceanditsdetrimentaleffecton maritalsatisfactionandwillrecommendwhatpossiblechangesshouldbeadoptedif thesevariableswouldinfluencemaritalsatisfaction.thestudywillhelptoknow whatinfluencesmaritalsatisfactionamongnurses.thefindingsofthisstudywill addtotheexistingliteratureonmaritalissues,alsothisstudywillrecommend variouspsychologicaldimensionsinamelioratingmaritalproblemsandoccupational stressamongnursesandotherhealthprofessionals. literaturereview thetheoreticalframeworkforthisstudyshallbesocialexchangetheoryand transactionalmodelofstress:socialexchangetheoryproposedbythibault&kelly (1989)poststhatallhumanrelationshipsareformedbytheuseofsubjectivecostbenefitanalysis and comparism of alternatives.this theory strengthen the adaptation and adjustmentstrategy ofa married couple to enhance marital satisfaction,alsohelpstofacetherealityoflifesquarelyanddeviceanalternative meanstoachievemaritalsatisfaction. transactionalmodelofstressthetransactionalmodeldefinesstressasarising from theappraisalthatparticularenvironmentaldemandsareabouttotaxindividual resources,thusthreateningwell-being(holroyd&lazarus,1982).stressisaproduct ofthetransactionbetweentheindividualandtheenvironment.theauthorityand powerofthetransactionliesintheprocessofappraisalthatbindsthepersonand theenvironmentand,itisthis“relationalmeaning”(lazarus,2001)thattheperson constructsfrom thetransactionandthatliesattheheartofthestressprocess. ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 5 theabovemodelexplainedtheimplicationoftheenvironmentasastimulusthat predisposesstressinanindividual,andunconduciveenvironmentwillinitiatestress, likewiseunconduciveenvironmentintheworkplacewillcausestressandmayaffect maritalbliss.italsoevaluatestheavailabilityofcopingstrategiesandtechniques foradaptingto stressinorderto maintainmaritalsatisfactionanditprovides measuresforself-interpretationandevaluationoffactorsresponsibleforstressto ensuremaritalsatisfaction. empiricalliteraturereview storyandrepetti(2006)conductedahierarchicallinearmodelling(hlm)among43 couplestoinvestigatetheeffectofdailyfluctuationsinmaritalbehaviour(angerand withdrawal)asafunctionofsame-dayjobstressors.theresultsshowthatthereare greatsignificantrelationsbetweenjobstressorsandmaritalinteraction;theresults alsosuggestthatspousesinhigh-conflictfamiliesmaybeespeciallyvulnerableto theeffectsofjobstressorsonmaritalinteraction.inaresearchinvestigationby baltes and heydens-gahi (2003), the role of selection, optimisation, and compensation(soc)behavioursinrelationtobothjobandfamilystressorsand work-in-family(wif)conflictandfamily-in-work(fiw)conflictwasexamined.the resultssuggestthattheuseofgeneralsocbehavioursinbothworkandfamily domainsarerelatedtoloweramountsofjobandfamilystressorsandsubsequently loweramountsofwifconflictandfiw conflict. anotherstudyconductedbywierda-boer,gerrisandvermulst(2009)examinedhow personality,domain-specificstress,andwork-familyinterferenceareinterrelated.a questionnairedataof276 dutch dual-earnercoupleswith young children were analysedusingstructuralequationmodelling.thefindingsdemonstratedthatjob stressandparentingstresswerepositivelyrelatedtowork-to-familyconflictand family-to-workconflictrespectively.forwomen,athepresenceofstressatworkis almostinevitableinmanyjobswhenpressurebeginstobuildup,itcancause adversestrainonone’semotions,thoughtprocesses,andphysicalcondition.when stressbecomesexcessive,employeesdevelopvarioussymptomsofstressthatcan harm theirjobperformanceandhealth,andeventhreatentheirabilitytocopewith theenvironment.peoplewhoarestressedmaybecomenervousanddevelopchronic ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 6 worry.theyareeasilyprovokedtoangerandareunabletorelax.theymaybe uncooperativeorusealcoholordrugsexcessively.althoughtheseconditionsalso occurfrom othercauses,theyarecommonsymptomsofstress.inthewordsof leth(1995),“toearnagoodsalaryonehastoearnalivingandtoearnagoodsalary onecannotlivelife”. stressoveraprolongedtimealsoleadstogeneratediseases oftheheart,kidney,bloodvessels,andotherpartsofthebody.therefore,itis importantthatstressbothonandoffthejob,bekeptatalowlevelenoughformost peopletotoleratewithoutdisorders(asthana,1985). methodology theresearchdesignforthisstudyisasurveyresearchdesignwherecopiesof questionnairesweredistributedtoresearchparticipantsinordertomeasuretheir response.thesamplesforthisstudyweredrawnfrom apopulationofmarried nursesofunimedteachinghospitalinakurewherebyacarefullyselectedsample of200participants(marriednurses)wasconsidered.stratifiedrandom sampling techniqueswereusedinselectingresearchparticipantsinordertoensurethatall targetpopulationswereadequatelyrepresentedforthestudy.thedatacollectionin thisstudywasthroughtheaidofstandardquestionnairesmadeof4sectionswith totalnumberof40items. sectiona;demographicdatawith5itemstapingthepersonaldataofthe participantssuchasage,sex,maritalstatus,workexperienceandemployment status sectionb; enrichmaritalsatisfactionscale. emsisa15itemsscaleusedtomeasuremaritalsatisfaction,usinga5pointlikert scalerangingfrom (1)stronglydisagreestostronglyagree(5).respondentswere askedtoindicatetheirlevelofagreementwithstatements reliability theemsscalewasevaluatedforinternalconsistencyandtest-retestreliability. cronbach’salpharevealedaninternalreliabilityof.86.test-retestreliabilitywas assessedwith115individualsoveraperiodof4weeks.thereliabilitycoefficient overtimewas.86.item-totalcorrelationswereconductedtofurtherassessthe ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 7 degreetowhichtheitemsform acohesivescale. validity concurrentvalidity;emsscalehadcorrelationsof.71formenand.77forwomen andhadcorrelationsof.71forconstructvalidity.emsscaleisareliableandvalid scaleforthemeasurementofmaritalsatisfaction sectionc jobrelatedtensioninventory jobrelatedinventoryispsychologicalinstrumentmeasuringoccupationalstress.it wasdevelopedbyr.lkahn,(1964).tomeasurethenature,causesandconsequence ofjobstress.itconsistsof15itemsusinga6pointlikertscale.respondentsare askedtoindicatehow frequentlytheyarebotheredbyjobrelatedfactorsranging from 1(neverbothered)to5(botheredallthetime)and6(doesnotapply). reliabilitythecoefficientofalphaobtainedbysheridan(1979)andoseghare(1988) are0.87and0.89respectively. validity avaliditycoefficientof0.77wasobtainedbycorrelatingj.t.withrated performance(sheridan,1978)whileoseghare(1988)obtainedacoefficientof.86 whenthecorrelatedj.tequivalentwithchecklistsymptomsstressbykyriaconand cliff(1978). scoringthescaleisscoredusingdirectscoringfrom 1,2,3,4,and5.thehighest participantscangetoneachscaleis70.thelowestis14. sectiond workfamilyconflictscale workfamilyconflictscaleisapsychologicalinstrumentmeasuringroleconflicts.it wasdevelopedbynetemeyer,(1996)withacronbachalphaof0.94.theaverage alphalevelforworkfamilyconflictscalewas.88(netemeyer,1996)witha5point likertscale ranging from strongly disagree (1) to strongly agree (5).the respondentswereaskedtoindicatetheirlevelofagreementwithstatementssuch as:“the amountoftime my job takes up makes itdifficultto fulfilfamily responsibilities”and“thingsiwanttodoathomedonotgetdonebecauseofthe ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 8 demandsmyjobputonme”. procedurefordatacollection the sample technique thatwas used forthis research was stratified random samplingtechnique.theresearchwasconductedbetween11/04/2019and11/05 /2019.the researchercollected letterofintroduction from eksu psychology departmenttothechairmanethicsandresearchcommitteeoftheunimedteaching hospitalakure,seekingtheirpermissiontocollectthedata.thereaftermarried nursesinunimedwereapproached;thepurposeandbenefitsofthestudywere explainedtothem.theywereassuredoftheirconfidentiality.aresearchassistant whoisanurseandalsoworkinginunimedwasemployedtohelpinthecollectionof dataandallthe200copiesofquestionnairewereretrieved. results table1:independentt-testsummarytableshowingtheinfluenceof occupationalstressonmaritalsatisfaction variable n mean sd se df t p highoccupationalstress 101 27.37 1.67 .17 .86>.05 198 .178 lowoccupationalstress 99 27.32 1.76 .18 from thetable1aboveitisobservedthatoccupationalstresshasnosignificant influenceonmaritalsatisfaction.thisnegateshypothesis1whichstatesthatthere wouldbeasignificantinfluenceofoccupationalstressonmaritalsatisfaction(t(198) =.178,p>.05).hypothesisnotsupported table2:analysisofcovarianceshowingtheinterferenceofroleconflictwith occupationalstresstoinfluencemaritalsatisfaction. source ss df ms f p roleconflict .384 1 .384 .130 .72 occupationalstress .067 1 .067 .023 .88 ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 9 error 582.72 197 2.96 total 583.19 199 from thetable2above,itisobservedthatthereisnosignificantinfluenceof occupationalstressonmaritalsatisfactionf(1,198)=.032p>.05.withthe interferenceofroleconflictwithoccupationalstressthereisstillnosignificant influenceofoccupationalstressonmaritalsatisfactionf(1,197)=.023p>.05.this negateshypothesis2thatstatesthattherewouldbeinterferenceofroleconflict withoccupationalstresstoinfluencemaritalsatisfaction.hypothesisnot supported. table3:descriptivetableshowingthemeanofsexandagescoreonmarital satisfaction. variables n mean s.d sex male 56 27.25 1.79 female 144 27.38 1.68 age 20-35 39 27.28 1.77 36-45 126 27.25 1.74 >45 35 27.74 1.52 table3revealedthatthesexwhichcomprisesofmaleandfemalehadthetotal numberof200whilethecompositionis56menand144femalewiththefollowing meanscore;27.25and27.38respectively.thesd formaleis1.79andsd for femaleis1.68.thevariabilityintheirsdis0.11,thereforethemalenursesand femalenursesarenotlikelytobetoodifferfrom eachotherinmostoftheirdealings. themeanscorefortheiragerangesbetween20-35,36-45,>45are27.28,27.25and 27.74respectively.thesdforthethreecategoriesofageare1.77,1,74and1.52 respectively.thevariabilityintheagerangebetween20-35and36-45is0.03while thevariabilityintheagerangebetween36-45and>45is0.22.thisshowsthatthe varianceishigherbetweentheagerangeof36-45and>45whileitislowerinage rangebetween20-35and36-45 ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 10 table4:2x3anovatableshowingtheinfluenceofsexandageonmarital satisfaction. source ss df ms f p sex .439 1 .439 .148 .701 age 5.88 2 2.94 .992 .373 sex&age .438 2 .219 .074 .929 error 575.01 194 2.96 total 583.19 199 from thetable3&4aboveitshowsthatthereisnosignificantinfluenceofsexon maritalsatisfactionf(1,194)=.148p>.05). thereisnosignificantinfluenceofageonmaritalsatisfactionf(2,194)=.992p> .05). thereisnosignificantjointinfluenceofsexandageonmaritalsatisfactionf(2,194) =.219p>.05).hypothesisnotsupported. table5:onewayanovasummarytableshowingtheinfluenceofworkexperience onmaritalsatisfaction. workexperience n mean sd df f p 1-5yrs. 43 27.72 1.55 6-10yrs. 38 26.71 1.51 4 1.96 .103 11-15yrs. 38 27.47 1.78 195 16-20yrs. 45 27.44 1.92 >20yrs. 36 27.31 1.65 ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 11 from thetable5aboveitisobservedthatworkexperiencehasnosignificant influenceonmaritalsatisfaction.thisnegateshypothesis4whichstatesthatwork experiencewillinfluencemaritalsatisfactionf(4,195)=1.96p>.05).hypothesisnot supported. discussion hypothesisonestatesthatoccupationalstresswillsignificantlyinfluencemarital satisfactionanditwasobservedfrom thestudythatthereisnosignificantinfluence ofoccupationalstressonmaritalsatisfaction.thisresultisnotinagreementwith theworkofdierdorffandellington(2008)whoinvestigatedthe3behaviour-based antecedentsofwork–familyconflictlinkedspecificallytooccupationalworkrole requirements(interdependence,responsibilityforothers,andinterpersonalconflict). thevariancemayperhapsbeasaresultofdifferentenvironmentalconditioninthe researchsettingandculturalvariation.accordingtobradbury,fincham &beach (2000)affirmedthatmaritalrelationshipsareheavilyguidedbyculturallydetermined norms,customsandexpectation(berscheid,1995).maritalsatisfactionnot determinedbystressalonebecausemanyundergostressdailybutstillhaving maritalfulfilment. itisimportantto recognizethatexamining differencesin work–familyconflict acrossoccupationsnaturallyinvolvesvaryinglevelsofanalysis,asindividualsare “nested”withinoccupations.onewaytoconceptualizeoccupationsinthismanneris byconsideringthedistinctbehaviouralcontextsthatoccupationsgenerate.these behaviouralcontextsaredelineatedbythevarietyofsituationalopportunitiesand constraintscommensuratetoanoccupation(johns,2006,ascitedin,dierdorffand ellington,2008).theaboveliteraturereview revealstherelationshipbetweenlong hoursofwork,heavyworkload,person-jobfit;jobstressorssignificantlyaffectthe maritalhappinessamong employees.thereview also showsthatorganization policiesandsupportcanimprovesignificantlymaritalhappinessandinturnimprove ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 12 theworkefficiency,physicalandpsychologicalwell-beingoftheemployees.the earlierresearches also show thatemployees who are high on maritalrole commitmentwereassociatedwithincreasedenhancementinworkefficiency.thus, these researches provide a potentialassertto the presentinvestigation to understandtherelationshipbetweentheworkenvironmentandmaritalhappiness. a meta-analysisbytwenge(2003)ontheeffectsofhavingchildrenonmarital satisfaction,indicatedthatbecomingaparenthasanegativeeffectonmarital satisfactionandeveryadditionalchildaddstothateffect.parentsreportedless maritalsatisfactionthancoupleswhodidnothavechildren.womenreportedless maritalsatisfactionthanmen;especiallymothersofinfants.thosewithhigher educationallevels and better financialpositions also reported less marital satisfactionintheroleofparenthood. hypothesis two states that role conflict willsignificantly influence marital satisfactionanditwasobservedfrom thestudythatroleconflictdoesnothavea significantinfluenceon maritalsatisfaction.thisresultnegatestheopinion of carstensen(2010)whosuggestedthatroleconflicthasanegativeinfluenceon maritalsatisfactionandthusaffectsthepsychologicalwell-beingofanindividual. roleconflictsaidtobringpsychologicaldiscomforttothestressorandthishasthe capabilityofinfluencingthemaritalsatisfactionofanindividual.hsu,chen,yu,& lou(2010)alsoarguedthatindividualwithanundefinedrolemayfinditdifficultto realizetheirfullpotentialinanygiventaskandthisthuscouldfosteraggressionand intra-psychicconflictwithinsuchindividual,ifthisisnotaddressedintime,thein burntangeriscapableofleadingtodepressionwhichinturnwillleadtomarital dissatisfactionassuchindividualmayfinditdifficulttomaintainrelationshipwith anotherperson. theresultofthisstudyshowsthatabilitytomanagemanyrolespreventmarital crisis,manywithlimitedrolesmayhaveconflictsifnotproperlymanaged. hypothesis3statesthatsexandagewillsignificantlyinfluencemaritalsatisfaction anditwasobservedfrom thetablethatsexandagedoesnothavesignificant influenceonmaritalsatisfaction.thisresultnegatestheworkofbridge(2009)who opined thatolderpeople tends to be more satisfied maritallyas a resultof ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 13 experiencegottenfrom theirjobinanattempttorelateworkwiththeirmaritallife. also,wang-shenglee&terramckinnish(2018)alsoopinedthatoldernursestends toenjoytheirmarriagethantheyoungerones,inhisstudy,hearguedthatolder nurseshaslearntinthetimepastsignificantfactorsthat’scapableofinfluencing maritalsatisfactionandmanyareintheprimesoftheircareerandtheyarenotas busyastheyarewhentheyareyoung,sothisthusallow them tocaterfortheir homesinordertoenjoythepeaceintheirmaritallifeandthismaybeveryunlikelyto theyoungerones.thisstudyisinagreementwithpreviousstudiesconductedby schwartz(2006)thatagewasfoundtobenegativelyrelatedtomaritalsatisfaction. hypothesis fourstates thatworkexperience willsignificantlyinfluence marital satisfaction and itwas reported from the table thatwork experience has no significantinfluenceonmaritalsatisfaction.theresultisnotinagreementwiththe workofkahana&kahana(1971)thatarguedthatexperiencegottenfrom workacts a moderatorofmaritalsatisfaction.forinstance,a nursewho haslearntthe contributionofgooddiettoindividualphysicalwell-beingandpsychologicalwellbeingmaythereforeunderstandthestrongreasonofpreparinggoodmealsathome inanattempttoimprovethephysicalandpsychologicalwell-beingofthemembers ofhis/herfamily. inaccordancewithlee& shehan(1989)foundthatactoreffectofworkhours deferredformenandwomen.men’sworkhourswerenegativelyassociatedwith theirmaritalsatisfaction,consistentwithhypothesis4andthenotionthattime baseddemandscandepletepersonalresourcesandreducefamilysatisfaction. however,incontrasttothishypothesis,women’slongerworkhourswerepositively associatedwiththeirmaritalsatisfaction. experiencegoesalongwayininfluencingmaritalsatisfaction.bandura(1971) arguedthatbehaviourcanbelearntandunlearnandthislearningisapermanent changeinbehaviourasaresultofourexperience.theconsistencymayalsobe linkedtosimilarityinthehumanbehaviourregardlessofthetribe,raceandethnicity. therefore,learningisanadaptivemeasurethatallowsindividualtoknowwhattodo atamomentinordertoenjoytheblissoflife. ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 14 conclusion basedontheabovediscussion,itcanbeconcludedthatoccupationalstress,role conflict,sex,age,andworkexperiencedoesnothaveasignificantinfluenceon maritalsatisfaction.this implies thatnurses are resilientand thatmarital satisfactionandoccupationalstressaretwodifferententitieswhichmayormaynot influenceeachother.thesocietywillnowunderstandthatnurses’temperamentand maritalsatisfactionisnotasaresultofoccupationalstressandsameapplicableto otherprofessions. recommendations basedonthefindings,thefollowingaretherecommendationsofthestudy: followingcriticalreviewandanalysisofthisstudy,itseemsotherfactorslike numberofchildren,sexualsatisfaction,choice ofmarriage,personality, culturalbackground,religiousadherencecoupledwithothervariablescould significantlyinfluencemaritalsatisfactionthereforefutureresearchercould worktowardsthisdirection. nursesandhealthworkersshouldtryasmuchaspossibletostrikeabalance betweentheirofficeandfamilyresponsibilities;(noneshouldbetakenwith levity)asrolemanagedwellwillnotresultinmaritalinstability individualshouldattaincertainagebeforegoingto marriageandbefore engagingintoanypensionableworkasthevariabilityinmaritalsatisfactionis higheratagegreaterthan45. workers atalllevels should be wellinformed through various religious organisationtoimproveontheirlevelofresilienceandadaptationinorderto enhancehighmaritalsatisfaction ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 15 references adejumoa.o,akinbodewaa.a,iyawei.o,emmanuela,andogungbemio(2018). assessmentofknowledgeofchronicdiseaseamongnon-nephrologynursesin akure, south west nigeria. sandi journal of family http://www.sjkdt.org/text.asp?1417/2482 asthama,h.s(1985).theconceptofstress:aphenomenologicalapproachsocial scienceinternational,1,39-44. baltes,b.b.,&heydens-gahi,h.a.(2003).reductionofwork-familyconflictthrough theuseofselection,optimization,and compensation behaviors.journalof appliedpsychology,88(6),1005-1018. bandura,a,(1977)self-efficacytowardsaunifyingtheoryofbehaviouralchange. psychologicalreview,84,pp191-215.walterr.h (1963)sociallearningand personalitydevelopment.newyork.holt,rinehart&winston berscheid,e(1995)helpwanted:a grandtheoristofinterpersonalrelationships, sociologists or anthropologist preferred. j.soc. pers.relt. 12529533.doi:10.1177/0265407595124005 bogels s.& restifo,k (2014)mindfulparenting:a guide formentalhealth practitioners.newyork:springersciencebusinessmedia. bradbury,t.n.,fincham,f.d.,andbeach,s.r.(2000).researchonthenatureand determinantofmaritalsatisfaction:adecadeinreview.j.marr.fam.62,964ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 16 980doi:10.1111/j.1741-3737.2000.00964.x burke.r.j&green-glass,e.r(1999).work-lifecongruenceandwork-lifeconcerns amongnursingstaff.canadianjournalofnursingleadership,12(2),21-29. carstensenl.l,gottmanj.m,levensonr.w (2010)emotionalbehaviourinlong term marriage.psychologyandaging10:457-470. chaffee,s.hmccleod,j.m.,(1991)theconstructionofsocialreality,inj.tedeschi (ed),thesocialinfluenceprocess(pp50-59).chicago:aldineatherton. dierdorff,e.c.,&ellington,j.k.(2008),itisthenatureofthework:examining behavior-basedsourcesofwork–familyconflictacrossoccupations.journalof appliedpsychology,93(4),883–892. fincham f.d.,beach s.r.h(2006)relationship satisfaction.in d.perlman & a vangelisti(eds).thecambridgehandbookofpersonalrelationship(pp579-594) cambridge,england:cambridge,universitypress. fowersb.j.olsond.h(1989)enrichmaritalinventory,adiscriminantvalidityand crossvalidityassessment.journalofmaritalandfamilytherapy.15(1),65-79.doi: 10.1111/j.1752-0606.1989.tb00777.x. helroydk.a,lazarusr.s,1982.stresscopingandsomaticadaptation.ingoldberger leab,s.editor.handbookofstress;theoreticalandclinicalaspects,newyork, ny:freepress.pp.21-35. hsu,h.y.,chen,s.h.,yu,h.y.,&lou,j.h(2010).jobstressachievementmotivation andoccupationalburnoutamongmalenurses.journalofadvancednursing. 66(7),1592-1601.http://doi.org/10.1111/j.1365-2648.05323. johnsg.(2006).theessentialpartofthecontextonorganisationalbehaviour, academyofmanagementreview,31(2),386–408. kahana e, kahana b (1971). theoretical and research perspectives on grandparenthood.internationaljournalofagingandhumandevelopment.2:261268. ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 17 kahnr.lwolf,d.m.,quinn,r.p.,snoek,j.j.,rosenthal,r.a(1964).occupational stress:studiesinroleconflictandambiguity,newyork,wiley. kyriacou,c&ssutcliff(1978).teacherstress:prevalence,sourcesandsymptoms. britishjournalofeducationalpsychology,48,159-167. lazarus,r.sandfolksman.s,(2001)cognitivetheoriesofstressandtheissueof circularity.in mh appleyand r trubull(eds),(2001).dynamicsofstress. physiologicalandsocialperspectives(pp63–80).new york;plenium.(2001) stressandemotions:anewsynthesis.newyork.ny:springer. leeg&sheham,c.l.,(1989).retirementandmaritalsatisfaction.j.gerontol,44, 226-230,doi:10.1093/geronj/44.6.s226. netemeyer,r.g.,boles,j.s..,&mcmurrian,r.(1996),developmentandvalidationof work-family conflictand family work conflictscales.journalofapplied psychology,81,(4),400-410. nightingale,f.(1946).notesonnursing:whatitis,andwhatitisnot.new york: appleton-century. nomaguchik.m.,&milkie,m.a.(2003).costsandrewardsofchildren:theeffects ofbecomingaparentonadults’lives.journalofmarriageandfamily,65(2), 356–374.https://doi.org/10.1111/j.1741-3737.2003.00356.x oakley,a.(1984).thesociologyofhousework.oxford:blackwell. olson d.h,fourier,d.g & druckman j.m (1992) counsellor’s manualfor prepare/enrich(revisededition).minneapolis,m.n,prepare/enrich,lnc. omolayo,b.o.(2005).psychology ofhuman being atwork.akure:adeyemo publishinghouse. oseghare,c.k (1988).an evaluation study ofmc lean’s stressors checklist. departmentofpsychology,universityoflagos. peimanpakf,mansarl,sadeghim,purebrahim t.(2013)therelationshipofjob stresswithmaritalsatisfactionandmentalhealthinnursesoftehranhospitals. ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 18 quarterlyjournalofcareerandorganisationalcounselling.4(13).27-54. schwartz,s,h.(2006).a theoryofculturalvalueorientations:explicationsand applications.comp.social.5,137-182,doi:10.1163/156913306778667357. selye,h.(1976).thestressoflife(rev.edn).new yorkmcgraw-hill.(1983)the stressconcept:post,presentandfuture.inc.l.cooper(ed),stressresearch: issuesofeighties.chiester:wiley.nthestressoflife,new york:mchraw-hill bookcompany(1956). sheridan,j.e(1978).usefulnessofleadershipbehaviourandsocialpowervariables inpredictingjobtension,performanceandturnoverofnursingemployee.journal ofappliedpsychology,6(3):89-95:http://dx.doi.org/10.1037/0021-9010.63.1.89. story,l.b&repettir(2006).dailyoccupationalstressorsandmaritalbehaviour, journaloffamilypsychology,20(4),690–700 thibaut,j.&kelly,h.(1989)exchangetheoryandgroupdynamics:apsychologyof smallgroupbehavior.newjersey:mcgrawhill. twenge,j.m.,campbell,w.k.,& foster,c.a.(2003).parenthoodandmarital satisfaction:a meta-analyticreview.journalofmarriageand family,65(3), 574–583.https://doi.org/10.1111/j.1741-3737.2003.00574.x wang-shenglee&terramckinnishi(2018).themaritalsatisfactionofdifferently agedcouples.journalofpopulationeconomics,springer:europeansocietyfor populationeconomics.vol.31(2),pages337-362. wierda-boer,h.h.,gerris,j.r.m.,&vermulst,a.a.(2009).managingmultipleroles personality,stress,andwork-familyinterferenceindual-earnercouples.journal ofindividualdifferences,30(1),6-19. ijo international journal of health sciences and nursing ( issn: 2814-2098 volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 19 fear of relapse and its impact on of colorectal cancer survivors : a systematic review maryam changizi1*(phd candidate), hooshang mohammadian1(msc) 1 abadan faculty of medical sciences, abadan, iran correspondence address: abadan faculty of medical sciences, abadan, iran phone: +98 9396489240 email : mrs.changizi@yahoo.com abstract background: one of the most commonconcern is the fear of recurrence (fcr). our study aimed to investigate the fear of colorectal cancer and its impact on the survivors. method the present study is a systematic review, which was initiated by searching “mesh” in databases of scopus, web of sciences, pubmed and embasein all field (titles, keywords, abstracts).finally4 papers were selected .qualitative evaluation was done through combined strobe statement checklist. result fear of cancer recurrence among survivors were ranging from medium to high. fcr had a relationship with the quality of life (qol) and its dimensions (p<0.001) . lack of physical activity and gender (female more than male, or=1.58) were more likely to face fcr. conclusion according to the results, for the people with crc experience, interventions should be planned with a view toward calming care, by increasing self-efficacy and social support. key words: fear, recurrence, colorectal cancer ijo international journal of health sciences and nursing volume 4| issue 03| march | 2021 http://ijojournals.com/index.php/hsn 1 introduction colorectal cancer is one of the most common cancers in men and women in the world, with 65% of this disease occurring in developing countries. 1.80 million of the cases and 862,000 of the deaths in the world occur due to this type of cancer. in the last decade, early diagnosis and therapeutic advances in cancer have led to an increase in cancer survival rates and consequently, in the number of cancer survivors (2,1). survivors of colorectal cancer are not only complain about a series of physical problems, but they also experience a series of psychological problems such as fear of recurrence. [3]. one of the most common concerns in the survivors of this disease is the fear of relapse of the disease. the fear or the concern is the relapse of disease or its progression to the same organ or other organs of the body. [3]. the fear of common relapse is grievous, and almost 50% of the recoveries and 70% of the more vulnerable groups (such as young survivors) report high or moderate fears of relapse [4]. the fear of relapse is studied as a multidimensional structure and shows itself in a wide range of normal to high-level reactions [5]. at the normal level, the person is aware of the symptoms of the disease and takes enough care of himself. but if fear is more than normal, it can have undesirable effects on the quality of life, social activities and mental stress of the individuals and it can create intrusive thoughts [5-2]. the consequence is an increase in health care costs for patients. [4]. due to the importance of this issue, our study is conducted to investigate the fear of colorectal cancer and its impact on survivors. method the present study is a systematic review. in this study, the databases of scopus, web of science, pubmed and embase were used and the key words of mesh، (colorectal neoplasms)[title/abstract] or colonic neoplasms)[title/abstract] or sigmoid neoplasms)[title/abstract] and colon cancer)[title/abstract] or colorectal cancer)[title/abstract] or rectal neoplasms)[title/abstract] or rectal cancer)[title/abstract] or anus neoplasms)[title/abstract] or rectum cancer)[title/abstract] or rectum neoplasm)[title/abstract] or colorectal tumors)[title/abstract] or colon tumor)[title/abstract] or rectum tumor)[title/abstract] or rectal tumor)[title/abstract] or cancer of the rectum)[title/abstract] or cancer of the colon)[title/abstract] and fear)[title/abstract] and recurrence)[title/abstract] or relapse)[title/abstract] or ijo international journal of health sciences and nursing volume 4| issue 03| march | 2021 http://ijojournals.com/index.php/hsn 2 recrudescence[title/abstract]) were applied. the criteria for entering the study included crosssectional descriptive articles with frequent reports on fears of cancer relapse, published in english. after searching for databases in year 2019, at first, 1527 articles were found, that, after limiting human-based searches, the date of publication of the articles (the past 10 years) and the method of performing the study (descriptive cross-sectional), the number of articles reduced to 3085 .in this range in all fields (titles, keywords, abstracts) we were obtained so many articles. many of these have not related to our subject and were removed after review. finally, 45 papers were selected. after removing repetitive and irrelevant items inconsistent with the entry variable, lack of summary and lack of access to the full article, four articles were selected. qualitative evaluation of the articles was conducted through combined strobe statement checklist. figure 1. flowchart for selection of primary study 2limited to human samples 3limited to 2010-2019 4limited to english language 5limited to cancer subject 6limited to journal article 7excluded because irrelevance, whiteout abstract , unavailable full text, unrelated results, type of study. , results the findings from this review showed that there is a fear of a return to disease in survivors of colorectal cancer and this score is moderate and upward. the study of fisher (2016) showed that 50% of the survivors, are afraid of disease’s relapse. in this study, women, in comparison with the men, (or=1.58, ci95%=1.46-1.71) and younger people (in comparison with older ones) (or=1.58, ci95%=1.46-1.71) and suburbanites (or=1.14, ci95%= 1.05-1.23), in comparison with the other people, were more worried about disease relapse. also, fcr has a meaningful relationship with some of the health behaviors, including physical activity and smoking, and it has been found that smokers are more likely to experience a fear of disease relapse than non-smokers. more current smokers (or= 1.34, ci= stage 2: 1210 stage 3:546 stage 4: 498 stage 5: 349 stage 6: 308 stage 7: 45 stage 8: 4 stage 1: 1527 ijo international journal of health sciences and nursing volume 4| issue 03| march | 2021 http://ijojournals.com/index.php/hsn 3 1.101.58, p < 0.005), ex smoker (or= 1.11, ci= 1.041.21, p < 0.005). in this regard, it has been reported that patients who have recently been more under treatment, have showed more fear of disease relapse. (p < 0.001). in addition, this study showed that inactive patients are more afraid of disease relapse. [6]. jae custers (2015) reported that the rate of disease relapse in survivors who have filled out the cws (cancer worry scale) questionnaire was 38% (1.1% low fcr, 2.9 high fcr) and they experienced a high level of fear. the relationship between fcr and life quality showed that people with high levels of fear have lower quality of life. (f(1,66)= 14.1, p<0.001). also, people with high level of fear of relapse, experience general anxiety disorder and cancer-related distress. (p<0.001). feeling of anxiety and discomfort caused limitations in performing daily, f (1.66) = 8.7, p <0.004), emotional (f (1.66) = 24, p <0.001), cognitive (f (1.66)) = 11.2, p <0.001) and social functions (f (1.66) = 22.9, p <0.001). also, survivors with high fcr significantly had more problems with body image (f (1.70) = 13.7, p <0.001) and future prospects (f (1.70) = 39.6, p <0.001) compared to people with lower levels of fcr [7]. henfer (2017) aimed at determining the prevalence of fear of colorectal cancer reversal or its progression (fop / fcr) using the fear of progression questionnaire (fop-q-sf), which indicated that 36% of patients were worried about the disease's relapse or its progression. in addition, fop / fcr is correlated with fatigue side effects (r (53) = 0.0477, p <0.001, diarrhea (r (53) = 0.424, p <0.001), nausea (r (53) = 0.540, p <0.001) and vomiting (r (53) = 0.359, p <0.001). in this study, the level of fear of patients was moderate to high. the study found that people suffering from cancer are trying to convince themselves that everything is good or they think positively, find solutions and replace those thoughts with pleasurable ones. (39,36,32%). in this regard, the reported strategies to counteract this status consisted of prayer, meditation and attempts to distract thought or not to think about it (75.61.57%) [8]. backer, in 2005, made use of cpils(cancer problems in living scale) to show that 63.3% of patients with colorectal cancer are worried about the onset of illness and more than half of them are worried about the future and 37.5% felt vulnerability. see table no.1. ijo international journal of health sciences and nursing volume 4| issue 03| march | 2021 http://ijojournals.com/index.php/hsn 4 http://www.farsi123.com/?word=%d8%a2%d8%b3%db%8c%d8%a8%20%d9%be%d8%b0%db%8c%d8%b1%db%8c table 1. research methodology and features results publication date type of study sample size place questionnaireauthor 50% patient reported fear of their cancer returning. 2016 cross-sectional 10969 uk proms fisher a,et al. 63.3% of patients with colorectal cancer worried about the disease's return. 2005 cross-sectional total = 752 colorectal patient =65 usa cpils baker f, et al. (36%) patient suffered from fop/fcr . levels of fop/fcr seemed to be mostly moderate to high. 2017 prospective & descriptive 58 germany fop-q-sf hefner j ,et al. (38 %) patient with high levels of fcr, characterized by higher levels of distress, posttraumatic stress symptoms, lower quality of life. 2016 211 netherland cws josé a. e. custers , et al. discussion the aim of this study was to determine the frequency of fear of disease relapse and the effects of this fear on the life of patients and survivors of colorectal cancer. the results showed that differences in the scores of the individuals is an indication of fear of cancer relapse, which is in line with the other results [10]. also, fcr was higher in women comparing with the men. perhaps the reason lies in stereotypes. [11]. also, the results of the study considering the relationship of fcr with age, showed that younger individuals are more afraid of disease relapse than the older ones. it seems that younger people have more expectations from life which is due to the social roles and the duties they have and they follow their treatment procedure seriously. in contrast, the older individuals are less expected and the time and the resources they have at their hand are less than the younger people[3]. furthermore, the results of the study showed that ijo international journal of health sciences and nursing volume 4| issue 03| march | 2021 http://ijojournals.com/index.php/hsn 5 suburbanite were more afraid of cancer relapse. perhaps, it is resulted from financial problems and lack of accession to treatment services. [3, 12]. those individuals that have passed the early stages of the disease such as chemotherapy, developed more fear of the diseases which is consistent with the findings of the studies [13, 14]. in the present study, fear of cancer relapse is higher in smokers. this may be due to the extensive advertisements and advices in relation to the smoking and cancer by health care providers and specialists during the treatment procedure or before that, that are repeated for several times. active patients expressed fewer fears of cancer. one of the strategies of third-party prevention and decelerating the reversal of symptoms of illness can be health promoting behaviors, including physical activities. [16] active people have a better mental status and have greater power for dealing with the problems and may be less afraid of disease relapse. [17]. based on the theory of protection motivation theory, fear can affect the attitude and the behavior of the individual and it can motivate him to behave (18). the aim of the physical activities for cancer patients is to improve the quality of life, reduce its symptoms, including fatigue, depression and improvements in fitness indicators related to patient survival. [19]. in addition, patient’s involvement in health care and their active role in treatment is very helpful. [20] this decrease shows itself in almost all aspects of the quality of life (emotional, social, etc.). lack of familiarity with cancer and post-treatment measures, daily functions and activities in humans are reduced and fear of death and anxiety about the future create obsessive thoughts that can affect the health of these individuals [21-24]. it seems that it is the result of low self-efficacy. in addition, meditation and spirituality are effective in controlling anxiety. the enhancement of self-efficacy is important in confronting with cancer. this is due to the positive meaningful relationship between self-efficacy and life quality and the meaningful statistical relationship between self-efficacy and areas of quality of life including physical health, mental health, social relationships and environment satisfaction. [25] health education can be beneficial to cancer patients. [26]. conclusion : according to the findings, the patient's back illness can lead to physical and psychological damage and, in general, a decrease in the quality of life in them and disruption of the function. therefore, physical activities, patient activation in the treatment process, palliative care that includes role management, treatment and symptoms, and training on ways to seek social support, lifestyle changes to control bad health conditions, and facilitating access to services in marginalized individuals to continue the life of this group of people is recommended and it is ijo international journal of health sciences and nursing volume 4| issue 03| march | 2021 http://ijojournals.com/index.php/hsn 6 http://www.farsi123.com/?word=%d8%b4%db%8c%d9%85%db%8c%20%d8%af%d8%b1%d9%85%d8%a7%d9%86%db%8c http://www.farsi123.com/?word=%da%a9%d9%86%d8%af%20%da%a9%d8%b1%d8%af%d9%86 better that with the help of informal observant of patients health interventions are conducted in this direction. limitations a large number of articles are found with the intended key word and the evaluation became complicated for us. other limitations were the lack of application of the same questionnaire to report the fear of relapse in the study. refrences: 1. alteri r, et al., cancer facts & figures2016. 2016, american cancer society, inc.: 250 williams street, nw, atlanta,georgia. 2. heins mj , korevaar jc, rijken pm .for which health problems do cancer survivors visit their general practitioner?eur j cancer, 2013. 49(1):211-8. 3. simard s, thewes b , humphrisg , et al., fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies.j cancer survive, 2013. 7(3): p. 300-22. 4. van de wal m, thewes b, gielissen m, et al.efficacy of blended cognitive behavior therapy for high fear of recurrence in breast, prostate, and colorectal cancer survivors: the sword study, a randomized controlled trial.j clin oncol, 2017. 35(19): p. 2173-2183. 5. simard, s. and j. savard, screening and comorbidity of clinical levels of fear of cancer recurrence.j cancer survive, 2015. 9(3): p. 481-91. 6. a fisher 1, r j beeken 1, m heinrich., et al., health behaviours and fear of cancer recurrence in 10 969 colorectal cancer (crc) patients.psychooncology, 2016. 25(12): p. 1434-1440. 7. a e custers j , f m gielissen m, h v janssens, et al.fear of cancer recurrence in colorectal cancer survivors.support care cancer, 2016. 24(2): p. 555-562. 8. hefner j , berberich s, lanvers e, et al., new insights into frequency and contents of fear of cancer progression/recurrence (fop/fcr) in outpatients with colorectal carcinoma (crc) receiving oral capecitabine: a pilot study at a comprehensive cancer center. patient prefer adherence, 2017. 11: p. 1907-1914. 9. baker f, denniston m, smith t, et al.adult cancer survivors: how are they faring?cancer. 2005. 104: p. 2565-76. 10. m w jones s, ziebell r, walkerr ,et al .association of worry about cancer to benefit finding and functioning in long-term cancer survivors.support care cancer, 2017. 25(5): p. 1417-1422. 11. vrinten c, van jaarsveld ch, waller j, et al., the structure and demographic correlates of cancer fear. bmc cancer, 2014. 14: p 597. 12. miles a , l mcclements p, j c steeler , et al. perceived diagnostic delay and cancerrelated distress: a cross-sectional study of patients with colorectal cancer.psychooncology, 2017. 26(1): p. 29-36. ijo international journal of health sciences and nursing volume 4| issue 03| march | 2021 http://ijojournals.com/index.php/hsn 7 https://pubmed.ncbi.nlm.nih.gov/?term=heins+mj&cauthor_id=22897842 https://pubmed.ncbi.nlm.nih.gov/?term=korevaar+jc&cauthor_id=22897842 https://pubmed.ncbi.nlm.nih.gov/?term=rijken+pm&cauthor_id=22897842 https://pubmed.ncbi.nlm.nih.gov/?term=hefner+j&cauthor_id=29180853 https://pubmed.ncbi.nlm.nih.gov/?term=berberich+s&cauthor_id=29180853 https://pubmed.ncbi.nlm.nih.gov/?term=lanvers+e&cauthor_id=29180853 13. tam ashing k ,cho d, lai l, et al. exploring characteristics, predictors, and consequences of fear of cancer recurrence among asian-american breast cancer survivors.psychooncology, 2017. 26(12): p. 2253-2260. 14. allen s, lowe d, v harrisr ,et al. is social inequality related to different patient concerns in routine oral cancer follow-up clinics? eur arch otorhinolaryngol, 2017. 274(1): p. 451-459. 15. humphris, g.m. and s.n. rogers, the association of cigarette smoking and anxiety, depression and fears of recurrence in patients following treatment of oral and oropharyngeal malignancy.eur j cancercare, 2004. 13(4): p. 328-35. 16. piercy kl, troiano rp, ballard rm, et al.the physical activity guidelines for americans. jama, 2018. 320(19): p. 2020-2028. 17. ballard-barbash r, friedenreich cm, courneya ks, et al.physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review.j natl cancer inst, 2012. 104(11): p. 815-40. 18. rogers, r.w., a protection motivation theory of fear appeals and attitude change1. j psychol, 1975. 91(1): p. 93-114. 19. kathryn h schmitz, kerry s courneya, charles matthews, et al., american college of sports medicine roundtable on exercise guidelines for cancer survivors.med sci sports exerc, 2010. 43(1): p. 1409-26. 20. graffigna, g., barello s, bonanomi a . the role of patient health engagement model (phe-model) in affecting patient activation and medication adherence: astructural equation model.plos one, 2017. 12(6): p. e0179865. 21. denlinger cs, barsevick am, barsevick .the challenges of colorectal cancer survivorship.j natl compr canc netw, 2009. 7(8): p. 883-93; quiz 894. 22. deckx l, van abbema dl, van den akker m.a cohort study on theevolution of psychosocial problems in older patients with breast or colorectal cancer: comparison with younger cancer patients and older primary care patients without cancer.bmc geriatr, 2015. 15: p. 79. 23. lynch bm, steginga sk, hawkes al, et al. describing and predicting psychological distress after colorectal cancer.cancer, 2008. 112(6): p. 1363-70. 24. hawighorst-knapstein, s,claudia fusshoeller, cordula franz, et al., the impact of treatment for genital cancer on quality of life and body image--results of a prospective longitudinal 10-year study.gynecol oncol, 2004. 94(2): p. 398-403. 25. kiaei mz , ferdosi m, moradi r,et al., association between self-efficacy and quality of life in women with breast cancer undergoing chemotherapy. journal of qazvin university of medical sciences (jqums), 2015. 20(2): p. 58-65. 26. changizi m, kaveh mh, hosseini s ,et al., he role of health education in cancer prevention: a systematic review. international journal of pharmacy and technology, 2016. 8(4): p. 24082-24099. ijo international journal of health sciences and nursing volume 4| issue 03| march | 2021 http://ijojournals.com/index.php/hsn 8 ijo international journal of health sciences and nursing volume 4| issue 03| march | 2021 http://ijojournals.com/index.php/hsn 9 anatomy and physiology of pituitary gland dr. qaiswer shah lakanwal1 teaching assistant lecturer at anatomy and histology department in medical faculty shaikh zayed university, khost, afghanistan qiswer@gmail.com ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 46 abstract the pituitary gland, known as the “master gland,” is involved in the homeostatic regulation of numerous body functions as well as in governing reproduction and childbirth. found at the base of the skull, surrounded by cranial nerves and critical blood vessels, it is composed of the adenohypophysis and neurohypophysis. the adenohypophysis is controlled by the hypothalamus via releasing/inhibiting hormones released into the pituitary portal veins to secrete adrenocorticotropic hormone, thyroidstimulating hormone, growth hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin. these govern four major hormone systems: adrenal, thyroid, growth hormone, and reproduction/lactation. these systems are regulated by feedback loops from the effector hormones. the posterior pituitary gland is directly stimulated by the hypothalamus to produce vasopressin for fluid homeostasis and oxytocin for lactation and uterine contraction. dysfunction or over activity of any of these hormones can affect multiple organ systems. it is important to understand the normal anatomy and physiology of the pituitary gland to help diagnose and treat patients with pituitary disorders mailto:qiswer@gmail.com ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 47 keywords pituitary gland,hypothalamus,homeostasis,feedback loop,adrenal gland, thyroid gland, growth hormone,reproductive system,prolactin. introduction along with the nervous (central nervous system (cns)) and circulatory systems, the endocrine system coordinates and integrates a huge variety of vital body functions. the blood circulation is a main carrier for the hormones’ distribution to targettissues. the neurosecretory cells of the hypothalamus produceand release the neurohormones that through the anterior andposterior lobes of the pituitary gland (pituitary gland) stimulate the synthesis and secretion of different hormones into the bloodstream, which regulate and maintain the control of theadrenal and thyroid glands and gonads through the cascadeof complex neuroendocrine feedback and a number of neuronal peripheral mechanisms. the focus of this article is the organization of the pituitary gland, the major elements of the neuroendocrine pathways, and the role of the pituitary gland in the control and modulation of a variety of vital body functions. the brief history of the pituitary gland the first historical description of the pituitary gland (hypothesis) was provided by galen (ad 150) who proposed the potential role for the found anatomical structure as a draining passage for the phlegm from the brain to the nasopharynx. in 1742, joseph lieutaud discovered the pituitary–portal blood system (hypothalamic–hypophyseal axis), and saucerotte was the first to describe acromegaly in 1772. the gland was for thefirst time fully described in 1778 by soemmering and called‘hypophysis cerebri.’ the anatomical formation of the pituitary gland was described by rathke in 1838. the posterior part of the pituitary gland wasinvestigated by oliver and schafer in 1895 and by dale in 1906, who discovered the vasopressor and oxytocic activitiesof the posterior pituitary, showing antidiuretic and galactokinetic properties. the first solid description of the clinical symptoms and pathology of the pituitary gland was provided by minkowski in1887 and vassale and sacchi in 1892, who demonstrated thatsurgically removing the pituitary gland (hypophysectomy) causes irreversible change on the water and mineral metabolisms of the body,and it also has been stated that overdevelopment and hyperfunction of the pituitary gland cause acromegaly. the first experimentallinks between the reproductive organs and pituitary gland were demonstrated via hypophysectomy leading to dwarfism in growinganimals in 1909, by aschner, and by cushing in 1910. development and basic anatomy of the pituitary gland development complex development of the pituitary glandis occurring at the early stage of embryogenesis and linked to that of the forebrain. the pituitary gland contains three lobes that have dual embryonic origins: anterior lobe ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 48 (adenohypophysis), intermediate lobe derived from rathke’s pouch (the primitive pharynx), and posterior lobe, whichdevelops from the infundibulum (a stalk derived from theregion of the ventral diencephalon). the anterior pituitarylobe (adenohypophysis) and posterior pituitary lobe (neurohypophysis) both develop from rathke’s pouch. during thedevelopment anterior pituitary loses contact with the oral cavity and the posterior pituitary stays connected with the base ofthe hypothalamus. adenohypophys and neurohypophysisbasically are joined together in the sella turcica (turkish saddle)at the base of the middle cranial fossa. the forming of theanterior pituitary (adenohypophysis) primordium is controlledby a complex signal emanating from the ventral diencephalon/infundibulum and from rathke’s pouch, and after that,rathke’s pouch forms a sac that differentiates and forms theadenohypophysis, connecting to the hypothalamus via stalk. the molecular nature of extrinsic signals and especially transcriptionfactors/morphogenes that are involved in the patterning of many other organs, lineage specification, and cell type-specific geneexpression in pituitary organogenesis has been recently investigated. the ectodermal primordium of rathke’s pouch is foundto be induced by two major signals emanating from the diencephalon: bmp4 (bone morphogenetic proteins), inducing theformation of the pouch rudiment, and fgf8 (fibroblast growthfactor), activating the key regulatory gene and development ofthe rudiment into a rathke’s pouch. highly regulated geneexpression of the controlling processes of cell proliferation and appearance of specific transcription factors allow the formation of gland cell types. a human pituitary gland embryogenesis andforming of the neuronal posterior pituitary and nonneuronalanterior pituitary tissues are usually complete at 12 weeks ofgestation. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 49 basic anatomy of the pituitary gland the pituitary gland, which is a relatively small anatomical structure that is situated deep within the head, at the base of the skull, deep in the pit of the sphenoid bone, is surrounded by the optic chiasm, blood vessels, and other important brain structures. it consists of the larger part (80% of the pituitary gland size) called anterior pituitary lobe (adenohypophysis), intermediate lobe, and posterior pituitary lobe (or neurohypophysis), connected to the hypothalamus by the pituitary stalk. the adenohypophysis is composed of (a) pars distalis, containing epithelial cells surrounded by capillaries and fibers, with the cells being divided into acidophils (predominantly located in the lateral part of the lobe), basophils (concentrated in the central portion of the pars distalis), chromophils, and chromophobes, (b) pars intermedia, and (c) pars tuberalis. acidophils consist of somatotrophs which produce growth hormone (gh), mammotrophs which produce prolactin (prl), basophils consist of gonadotrophs which produce follicle-stimulating hormone (fsh), thyrotrophs which produce thyrotropin releasing hormone (tsh), and corticotrophs which produce adrenocorticotropic hormone (acth). cromophils consist of cytoplasm with a large number of secretory granules in difference from chromophobes which consist of cytoplasm with no secretory granules. pars inter media is located between the pars distalis and pars tuberalis and contains small basophilic cells. pars tuberalis is a part of the adenohypophysis around the infundibulum, composed of basophilic cells that secrete gonadotrophs (luteinizing hormone (lh) and fsh). the adenohypophysis is responsible ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 50 for the majority of the signaling hormones released into the bloodstream through the well-developed hypothalamic–hypophyseal portal capillary system that drains into hypothalamic–hypophyseal portal veins and the posterior pituitary lobe (or neurohypophysis, consisting of three distinct regions: pars nervosa (posterior lobe, which includes herring bodies and pituicytes), infundibulum (pituitary stalk, which connects the hypothalamic and hypophyseal systems), and median eminence (me) (which is included as part of the posterior pituitary). the pituitary stalk contains the fibers of the neurohypophysis connecting the posterior lobe tothe supraoptic nucleus (son) and paraventricular nucleus(pvn) of the hypothalamus and the portal venous system,transmitting hypothalamic peptides that control anterior lobe secretion. the pathology of the pituitary gland leads to the development of symptoms dependent on its change of secretion or symptomsdependent on the new anatomical intracranial relations thatarise (lesions, tumors, etc.). it has been found that lack ofbalanced pituitary gland hormonal secretion could lead to acromegalicgigantism (first time described by pierre marie in 1886), dwarfism, frohlich’s disease (dystrophia adiposa genitalis), acutepituitary insufficiency (causes fevers and toxemias), and polyglandular syndrome (autoimmune disease leading to inflammation, lymphocytic infiltration, and partial or completegland destruction). the typical anatomical pathology of the pituitary gland is a tumor (cushing’s disease) indicative of increased intracranial pressure causing headache, vomiting, vision impairment,nausea, and partial blindness, with main symptoms such asweak immune system, osteoporosis, extreme hair growth on face, fatigue, and cognitive dysfunctions ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 51 neurovascular link between hypothalamus and pituitary gland the pituitary stalk comprises mainly neural and vascular components, though an incomplete layer of epithelial cells, the pars tuberalis, whose function is uncertain, covers its ventral aspect .the bulk of the stalk is made up of neural tissue in which lie the various coiled capillary vessels on whichend the nerve fibres that are derived from cells in the hypophysiotrophic area. the neurohormones coming down these nerve fibres are transferred from the endings of the fibres into the blood passing through the coiled capillaries, and thus into the portal vessels. these portal vessels, as was first pointed out by xuereb et al. (1954b), can be classified as long and short. the origin of the vessels which supply them makes a distinction most important. the afferent arterioles to the coiled capillaries from which the long portal vessels are derived spring from the arterial ring supplied by the superior hypophysial arteries (arising from the internal carotid arteries above the level of the diaphragma sellae), while those which supply the coiled capillaries that form the short portal vessels are derived from the inferior hypophysial arteries, which leave the internal carotid arteries within the cavernous sinus. the long portal vessels run down the pituitary stalk to supply the larger part of the pars distalis, while the short portal vessels supply a restricted part of the lobe adjacent to that part of the lower infundibular stem which is buried in the pars distalis. xuereb et al. (1954a, b) describe this system of vessels, and daniel and prichard (1975) also describe the system in other species. a portal system of vessels is found in all vertebrates, and a valuable recent study is of that in the horse (vitums, 1975). when the pituitary stalk is cut surgically, to try to produce regression of various forms of carcinoma ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 52 hormones of the adenohypophysis the different cells of the adenohypophysis synthesize and release into the bloodstream vital endocrine hormones such as acth (secreted by corticotrophs), tsh (secreted by thyrotrophs), fsh (secreted by gonadotrophs), lh (secreted by gonadotrophs) in females also known in males as interstitial cell-stimulating hormone, growth hormone (gh, secreted by somatotrophs), ghrh (secreted by somatotrophs), prl (secreted by lactotrophs), and melanocyte-stimulating hormone (a-msh, secreted by melanotrophs). all those hormones can be classified into three major groups: glycoproteins (tsh, lh, and fsh composed of a common a-subunit and a hormone-specific b-subunit), growth hormones (gh and ghrh), and proopiomelanocortins (a-msh, regulating the production and distribution of melanin by melanocytes) hormones of the neurohypophysis the large (magnocellular) neurons located in the son and pvn of the hypothalamus synthesize and transport along the axons to terminals situated within the posterior lobe of the pituitary gland (neurohypophysis) two vital hormones: oxytocin and vp (or antidiuretic hormone (adh)), which are secreted by calcium-dependent exocytosis. the posterior pituitary hormones are transported in association with specific proteins, the neurophysins, via the ‘unmyelinated’ nerve fibers that extend through the infundibulum along with small cellscalled pituicytes to end in nerve terminals that lie withinthe posteriorlobe; prior to secretion, they are stored in secretory granules in the herring bodies. the oxytocin stimulates contraction of the uterus during labor, prevents posttraumatic hemorrhage, and is involved in lactation and milk ejection from the nipples, sexual arousal, suppressing appetite, etc. oxytocin is also called the ‘love and bonding hormone’ that plays an important role in social recognition (especially in trust, empathy, rejection, and suspicions in the group), increasing positive attitudes, the formation and realization of maternal instinct, orgasm, depression and anxiety, wound healing, and soothing inflammation. oxytocin receptors are expressed by neurons not only in the neurohypophysis but also in the septum, nucleus accumbens, brain stem, amygdala, and other parts of the ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 53 brainand body. the chemical structure of vp (adh) is very\ similar to oxytocin, and this is why oxytocin has milddiuretic properties, and high levels of adh can cause uterine contractions. the main functions of the adh are waterretention and maintaining normal body fluid volume viaspecific renal (v2) and vascular (v1) receptors, regulation ofbody temperature, initiation of aggressive behavior, and male pair-bonding behavior. adh produces vasodilationin the renal, pulmonary, cerebral, and mesenteric vascularbeds by stimulating endothelial nitric oxide (no) releaseand increases the systemic blood pressure. adh is alsoinvolved in the modulation of the corticosteroid releasefrom the adrenal gland in response to stress during pregnancy and lactation and also may cause an analgetic (nociceptive) effect during sex and stress. adh demonstrates anti-inflammatory properties via inhibition of the inflammatory cytokine interleukin-1 released in response totrauma or infection. adh deficiency, as a result of the hypothalamic–neurohy pophyseal lesions or in sensitivity ofthe kidney to adh in nephrogenic diabetes insipidus, leadsto dehydration, diarrhea, hyperosmolality, and eventualdeath. adh overproduction promotes excessive water retention and hyponatremia, which may cause convulsions andcoma. adh could be effective in reversing hypotensionproduced by septic shock and could be a useful therapy for hypovolemic cardiac arrest. conclusion recent advances using a wide range of methodologies provide more detailed knowledge and generate new valuable insights about the cellular, molecular, and genetic mechanisms involved in the anatomy, organization, development, and ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 54 function of the human pituitary gland. the recognition of the fascinating role of the pituitary gland and its sophisticated hormonal system, which is a retrograde regulator of hypothalamic and peripheral endocrine functions, raises important questions regarding the extraordinary complexity and vital role of the pituitary gland in neuroendocrine regulation of a huge variety of human physiological functions on molecular, organic, and systemic levels that remain virtually not fully explored. reference: 1. https://en.cnki.com.cn/article_en/cjfdtotal-zxdy200818029.htm 2. text book of genenral anatomy rawlani shivlal, rawlani shobha edition2 2018(https://www.google.com/imgres?imgurl=https%3a%2f%2fcdn.shop ify. 3. text book of anatomy and physiology for nursing and health care stuent 2020https://www.amazon.in/textbook-anatomy-physiologynursessciences/dp/8123916469/ref=sr_1_1?dchild=1&qid=1627587383&refinem ents=p_27%3akhurana+i.&s=books&sr=1-1 4. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6257623/ 5. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc1467652/ 6. https://academic.oup.com/neurosurgery/articleabstract/59/5/1001/2559088 7. https://books.google.com/books?hl=en&lr=&id=fxmsu4rbtymc&oi=fnd& pg=pr5&dq=pituitary++national+journal+of+clinical+anatomy&ots=wgjn sdiwfg&sig=h4morgz8iqcqxa1qevpfq4eaydc ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 55 https://en.cnki.com.cn/article_en/cjfdtotal-zxdy200818029.htm https://www.google.com/imgres?imgurl=https%3a%2f%2fcdn.shopify.com%2fs%2ffiles%2f1%2f1562%2f2795%2fproducts%2f51ftcmrikkl._sx327_bo1_204_203_200.jpg%3fv%3d1571691251&imgrefurl=https%3a%2f%2fwww.libreriauniversalbooks.com%2fproducts%2ftextbook-of-general-anatomy&tbnid=ysco-1xl6ozzmm&vet=12ahukewj65kc4ginyahuilbokhbjdbmwqmygaeguiardzaq..i&docid=sdxykoqyryevxm&w=499&h=499&q=anatomy%20book&ved=2ahukewj65kc4ginyahuilbokhbjdbmwqmygaeguiardzaq https://www.google.com/imgres?imgurl=https%3a%2f%2fcdn.shopify.com%2fs%2ffiles%2f1%2f1562%2f2795%2fproducts%2f51ftcmrikkl._sx327_bo1_204_203_200.jpg%3fv%3d1571691251&imgrefurl=https%3a%2f%2fwww.libreriauniversalbooks.com%2fproducts%2ftextbook-of-general-anatomy&tbnid=ysco-1xl6ozzmm&vet=12ahukewj65kc4ginyahuilbokhbjdbmwqmygaeguiardzaq..i&docid=sdxykoqyryevxm&w=499&h=499&q=anatomy%20book&ved=2ahukewj65kc4ginyahuilbokhbjdbmwqmygaeguiardzaq https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6257623/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc1467652/ https://academic.oup.com/neurosurgery/article-abstract/59/5/1001/2559088 https://academic.oup.com/neurosurgery/article-abstract/59/5/1001/2559088 https://books.google.com/books?hl=en&lr=&id=fxmsu4rbtymc&oi=fnd&pg=pr5&dq=pituitary++national+journal+of+clinical+anatomy&ots=wgjnsdiwfg&sig=h4morgz8iqcqxa1qevpfq4eaydc https://books.google.com/books?hl=en&lr=&id=fxmsu4rbtymc&oi=fnd&pg=pr5&dq=pituitary++national+journal+of+clinical+anatomy&ots=wgjnsdiwfg&sig=h4morgz8iqcqxa1qevpfq4eaydc https://books.google.com/books?hl=en&lr=&id=fxmsu4rbtymc&oi=fnd&pg=pr5&dq=pituitary++national+journal+of+clinical+anatomy&ots=wgjnsdiwfg&sig=h4morgz8iqcqxa1qevpfq4eaydc 8. https://academic.oup.com/jcem/article-abstract/45/5/903/2677242 9. https://en.cnki.com.cn/article_en/cjfdtotal-zglc200204006.htm 10. https://www.thieme-connect.com/products/ejournals/html/10.1055/s-00321331807 11. clinical anatomy volum 34 number 5, 2021 12. natinal journal of clinical anatomy volum9,4 2021 13. inderibir singh 2018 text book of neuroanatomy 5th ediation , jupyee books publication inc. vollium 14. mark s. greenberg 2019 hand book of neurosurgery 7th edition , neurosurgery university of south 15. florida tampta ,library of congress cataloging-in – publication,inc. page 672-677 16. azmat s.l. q spenky b lak. k 2016. sotta operative neurosurgery text book . 9th edition. themcgraw-hill companies ,inc chapter 19 page 1190-1197 17. https://www.google.com/imgres?imgurl=https%3a%2f%2fkbimages1a.akamaihd.net%2f15bae07b-9dbd-43f6-ac51 18. https://open.umn.edu/opentextbooks/textbooks/169 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 56 https://academic.oup.com/jcem/article-abstract/45/5/903/2677242 https://en.cnki.com.cn/article_en/cjfdtotal-zglc200204006.htm https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0032-1331807 https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0032-1331807 https://www.google.com/imgres?imgurl=https%3a%2f%2fkbimages1-a.akamaihd.net%2f15bae07b-9dbd-43f6-ac51 https://www.google.com/imgres?imgurl=https%3a%2f%2fkbimages1-a.akamaihd.net%2f15bae07b-9dbd-43f6-ac51 https://open.umn.edu/opentextbooks/textbooks/169 keywords meliouh khalida / université mohamed khaider gourmat narimane / mohamed khaider biskra (algeria)/ hadjlakehal radhia / mohamed khaider biskra (algeria)/ abstract: in this paper, we highlight the pathological culture of psychiatric and mental illnesses. we refer to schizophrenia in algerian society, where society's culture of schizophrenia is mainly caused by magic, envy and evil spirit, even the thoughts of the schizophrenic patient. society's culture attributes the causes of various psychological and mental disorders to many metaphysical factors. keywords: social culture, schizophrenia, algerian society. introduction: "i have never been so desperate, i felt as if i was in an abyss when my son forced me inside the closet and closed on me, i almost suffocated. there is nothing worse than this. i was crying and i could not believe what was happening to my son whom i love." schizophrenic mother. xavier amador (2007) says: “staying in the hospital is only a temporary band-aid if we do not encourage him to take care of his treatment permanently.” he also directs his words to the families of patients with schizophrenia. “if we want someone dear to us to have great chances of recovery, we must we face the two problems of a lack of understanding of the disease and a refusal to treat it .“ schizophrenia is a mental disease characterized by a disturbance in thinking, conscience, behavior, and sometimes perception. if not treated, ijo international journal of health sciences and nursing ( issn: 2814-2098 ) meliouh khalida * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || social culture of the schizophrenic patient in algerian society social culture of the schizophrenic patient in algerian society ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 69 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) meliouh khalida * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || social culture of the schizophrenic patient in algerian society it leads to a deterioration in the social behavioral level, as the individual loses his personality and thus becomes isolated from the real world and society. (favrod, 2012) through research on this disorder, we have come to define the meaning of schizophrenia, and we have also been able to say that there is no "miracle" cure, but tranquilizers that were discovered forty years ago only reduce symptoms, relieve the patient's suffering, and improve the fate of the disease. in the first months from the onset of the disease, it is difficult for the schizophrenic patient and for those around him, especially the relatives. we focus on the mother who suffers more than the pleasure of her liver and who counts the days and all the moments for her son or daughter to be straight. all families of schizophrenics are burdened by the illness of their relative. acceptance of a relative’s illness is always painful, no matter what type of illness it is, and accepting schizophrenia is more difficult, especially for parents. the 30-year-old has a future as an inmate in a mental hospital because the waiting room in the mental health service is considered the waiting room of shame and failure. (tobin, 1994). and through our clinical practice in the department of mental illness, where we saw many cases, and what caught our attention is that most cases suffer from schizophrenia, and the worst of this is: the schizophrenic patient improved in the hospital, but after being discharged, he became ill in a very short period of time. failure to follow up on cases for treatment and their absence for long periods ranging from six months to a year. and that their return to the interest is through the police or civil protection, as they are in a state of agitation, that is, in a state of acute crisis. all this prompted us to search for the causes of relapse after a short ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 70 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) meliouh khalida * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || social culture of the schizophrenic patient in algerian society period of receiving treatment and the reasons for their absence from the doctor's appointment. first, we wanted to search for these reasons within the family of a schizophrenic patient, and we focused on the mother, as she is responsible for taking care of her son. we conducted clinical interviews with the mothers of these patients, and we discovered that the mother completely denies her son's illness and is ignorant of its nature, which makes her explain it based on other factors that are referenced by irrational ideas, such as infection with witchcraft or the evil eye, for example. accordingly, she does not see a benefit in drug treatment, and on the other hand, she is not aware of the disease, its symptoms, and its treatment method. mothers of patients with schizophrenia believe that their children are affected by touch and witchcraft, and this belief has an anthropological dimension as well. historical stages of religion, which is generally associated with the control of human beings in supernatural powers. where abdel-latif (2009) explains: the symptoms of schizophrenia are strange, so charlatans linked them to confirm the prevailing popular beliefs for their own benefits. they claim treatment by the holy qur’an while they are far from each other, and the patient’s family is asked to slaughter a black animal and smear blood on it, or write his name on a stone, and we find people influenced by charlatans and charlatans. multiculturalism in the midst of maghreb society led to a change in concepts, especially in the field of health and disease. it is the one that determines the personality or dimensions of the algerian personality. this change, for example, as the complete or partial absence of the mother on the child, has an impact on the emergence of some psychological and mental disorders, and some popular beliefs on the pathological map of mental and mental illnesses and conflicts in society, and here we focus on schizophrenia. that jealousy, envy, and witchcraft are the causes of the ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 71 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) meliouh khalida * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || social culture of the schizophrenic patient in algerian society emergence of some psychotic disorders, this is what makes social diversity that can expose individuals to schizophrenia has become accepted among many researchers bloke the idea that there are more stressful cultures than others and that there are cultural models and pressures robert, faris, cooper, sullivan, kaplan, palmer all believe that schizophrenia is a rare condition or even missing in cohesive societies that have weak contact with western societies or are characterized by solid family ties and attitudes of tolerance and kindness. the so-called "ethnic psychosis", the presence of schizophrenia or the absence of schizophrenia in traditional societies described as primitive seems to be related to the development of culture in these societies, as the prevalence of schizophrenia cases is related to a large extent in many regions in africa, india and elsewhere. this researcher looked at the gradual transformation of the social and cultural structures and their development towards patterns similar to western patterns. the same thing almost happens and is repeated in the arab maghreb according to professor salim ammar. the general number of mental patients has significantly doubled, whether it is for men or women, to reach in that era approximately 27% for both sexes, a percentage that is confirmed by a study by bourisha in the same country. salim ammar attributes this increase to the transformation that occurred at the level of family structures. and aspirations of each group. because of the disintegration of the bonds that used to unite its members, as well as to the radical shifts in needs and beliefs chapter two psychosis 98 based on the number of schizophrenia cases recorded per year for males and females, the prevalence of the disorder is for men and from 9% to 17% for women and from 12% to 27% for both sexes. the mental illness ranged from 1960-6162 to 1969-70-71 from 14% to 36%, which is an intermediate percentage, according to salim ammar, between the standard french classification (20%) and the international classification (35%), which is included in cases of schizophrenia, delirium the same reason may stand behind the increase in schizophrenia cases in morocco according to christozov, who also records a significant increase in the forms of catatonia and ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 72 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) meliouh khalida * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || social culture of the schizophrenic patient in algerian society paranoïdes (because of the disturbances that the traditional society knows as a result of the shift towards modern life, and the category that is more vulnerable to this type of high singles are affected in particular (65% for acute schizophrenia and 78% for chronic schizophrenia) disorders, as it is noted that 56% of them suffer from acute schizophrenia and 48% from chronic schizophrenia, which is a percentage. most of them agree on the role of the cultural and social factor in its impact on the symptoms of this disorder and its clinical characteristics (ben abdullah mohamed 2010, pp. 165-168) 13-1 clinical characteristics of the phenomenon of schizophrenia in the maghreb society. among these clinical characteristics that the phenomenon of schizophrenia in the arab maghreb is characterized by many previous studies, to the dominance of delirium, persecution, poisoning, witchcraft and possession by the jinn, to religious, cosmic and political implications, to physical complaints and other symptoms that spread in the phenomenon of hysteria. the cyclical forms and the hébéphénique forms for women and the paranoïdes for men, but in contrast the schizophrenic cases of the stuporous and african catatonic type are rare and are imprinted with strange features that give them relative privacy. these delusional thoughts, which are dominated by the element of persecution, appear catatonique, characteristic of psychiatry chapter ii psychosis 99 in the view of christof with a variety of sensory-motor reactions that include cases of calm as well as cases of agitation and a few cases of illness with ideas of paranoia. (ben abdullah mohammed 2010). usurpation, impulsiveness, aggressiveness, and the dominance of paranoïdes delirious ideas that are sometimes associated with a class that discovers that the clinical characteristics of schizophrenia in moroccan society are related to the prevailing cultural meaning in society, and this delirium is nothing but a disconnection from cultural reality, and therefore even the delusions of the schizophrenic mental patient are linked to the prevailing socio-cultural perceptions. ......all of them are in our well-established culture, relatives, and we find it common among women, and this same cultural given is prevalent in society, even the ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 73 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) meliouh khalida * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || social culture of the schizophrenic patient in algerian society patient is affected and affected, as abdul latif 2009 confirms that the symptoms of schizophrenia are strange. we find him suffering from auditory hallucinations of voices speaking to him, and the charlatans find them the opportunity they interpret many mental illnesses as being attributed to natural powers such as witchcraft, the evil eye, and possessed by demons, and all these persecutory thoughts are attached to women because they only have this means to influence the family and society, and thus influence the behavior of men, as the concept of illness is especially mental. it varies according to culture, and this difference lies in the form of this disease and its connection to reality, and the condition of the mentally ill in algerian society is the result of a "fit" or magic that causes harm to others, and is seen as disruption and threatening insults and insults, and sometimes stoning at the hands of child gangs. for society, the life of the mentally ill in urban cities is a physiological life that is characterized by misery, especially those who suffer from what has been said about the clinical characteristics of the schizoid phenomenon. even the patient does not leave him to live a normal life. if he enters a mental hospital, he is stigmatized as insane, or what is colloquially called insane, and when he goes out into the street, children stone him with stones and run after him, and people and friends turn away from him. the case that aroused the researcher's attention is that a patient entered the mental institution with a group of very strange behaviors, from molding his thoughts and neglecting his hygiene. chapter 2 psychosis 103 he talks to himself a lot as a result of auditory hallucinations and a group of delusions, and he was diagnosed as schizophrenic. ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 74 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) meliouh khalida * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || social culture of the schizophrenic patient in algerian society 2 culture of psychological and mental pathology in algerian society: culture is one of the concepts, perceptions and terminology through which the subject is transferred to the mind so that it is judged by the latter and prepares a set of different behaviors and practices from one group to another and from one place to another, and one person may differ in the same group from the other. today's culture refers to a set of knowledge acquired that enables the individual to develop a critical spirit and judgement ability as well as all individual and collective behaviours as well as customs and traditions. with the addition of both tools of work and production, it is the centre that encompasses knowledge, beliefs, arts, morals, laws, abilities and qualities acquired by man as a member of society. therefore, the influence of cultural beliefs coincides with all stages of human life and development through social and family upbringing and other accumulated experiences that affect ideas and beliefs that lead to different kinds of behaviour in the individual associated with his emotions and emotions and his perceptions, which he acquires over the ages through oral transmission, greatly contribute to the crystallization of his character. culture and personality are among the most important subjects in anthropological research in general and anthropology in particular the latter is characterized by many wrong practices that may bring the individual to turmoil. this illustrates the role that culture plays and its apparent influence in instilling the wrong ideas, values, principles and beliefs of every societal pattern, this explains the apparent difference ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 75 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) meliouh khalida * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || social culture of the schizophrenic patient in algerian society between them and the impact on the composition of the components and specificity of the personality and its determinants. many people, especially algerian society, enjoy a broad culture and tend to have metaphysical interpretations, i.e., to rely on supernatural forces in the interpretation of psychiatric and mental illnesses. these behaviours were the result of misinterpretations dominating people's minds. ideas about psychiatric and mental illnesses have been linked in their causes and symptoms, especially in eastern societies, to the punishment of their sins or as a result of the influence of hidden forces of evil, such as witchcraft, envy and the eye. culture is therefore directly responsible for defining individual insights and perceptions of psychiatric and mental illnesses. so that in some explanations gin and its touching is an inescapable fact that it has the mind or part of it, which makes them worse. the trend in psychiatric and mental illnesses tended to be superstitious methods of treatment by priests with prayers,spells and cleansing rituals. from psychological and mental illnesses, we refer to the schizophrenia that has been interpreted. to both jealousy.envy, magic is the cause of the emergence of some psychotic disorders, this is what made social diversity that can expose individuals to schizophrenia become acceptable to many bloke researchers. faris, cooper, sullivan, kaplan, palmer all believe that schizophrenia is a rare condition and even missing in coherent societies that have poor contact with western societies or are characterized by solid family ties, tolerance and compassion trends, and devereux remains the first researcher with great interest "the social theory of schizophrenia" or so-called "ethnic psychosis". the existence of ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 76 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) meliouh khalida * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || social culture of the schizophrenic patient in algerian society schizophrenia or the absence of schizophrenia in traditional societies described as primitive appears to be linked to the evolution of culture in these societies, as the prevalence of schizophrenia is largely related in many regions of africa, india and elsewhere. 3-cultural perception of schizophrenia in algerian society: bospsey explains the clinical characteristics of schizophrenia by the dominance of oppressive subjects in rave episodes of the process of interpretation associated with traditional perceptions prevailing in maghreb society that attribute each disorder, every injury and every pain to others, as well as the group's method of taking care of the individual early and permanently from birth to death hence, mental disorder can only be perceived as a result of external assault or punishment due to an individual's excess of the prohibitions. (mahfoud . b 1978 ) conclusion : from what has been said in the clinical characteristics of the schizophrenia phenomenon, it is clear that in the arab society in general, it suffers from ostracism and deprivation. and not understanding the meaning of disease, especially in our algerian society, and linking it to popular beliefs such as witchcraft, juggling and touching of gin and devil, even the patient does not let him live a normal life, if he enters the psychiatric hospital with a stigmatization of the crazy, or so-called vaginal colloquialism, when he comes out on the street, the children translate him with stones and run him behind him. and people and friends keep their distance from him, by contacting the researcher with two mental ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 77 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) meliouh khalida * http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || social culture of the schizophrenic patient in algerian society patients in the interest of mental illness with diligence. s attention ", the case raised by the researcher was that a patient had entered mental health with a range of very strange behaviours of stereotyping and neglect of his hygiene. bibliography : abdul latif hussein faraj (2009): psychiatric disorders (fear, anxiety, stress, psychiatric illnesses of children), b 't, dar hamid, amman, jordan. amadorx (2007):how to make the patient accept his treatment schizophrenia and bipolar disorder french translation:dr p.klotzet dry.hodé.paris. bin abdallah mohamed (2010): psychopathology of moroccan personality, p. t., algiers university publications office, algeria. favord . jmaties . a(2012):recovering from schizophrenia;elsevier maison s.a.s lausanne.switzerland. mahfoud boucebci (1978) : psychiatric society and development2nd edition, national publishing and dissemination company, algiers . tobin . c (1994): schizophrenia in the daily life,,editionodile jacob,paris ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 78 first page 1st author name: dr nandadeep v chodankar assistant professor in department of kayachikitsa rjvs bhaisaheb sawant ayurved mahavidyala, sawantwadi, maharastra. email iddr.chodankar@gmail.com address for correspondence: dr nandadeep v chodankar f 129 salaiwada, panchayat samitti road sawantwadi, districtsindhudurga pin code416510 email iddr.chodankar@gmail.com 2nd author dr. rajesh kumar mishra associate professor in rjvs bsam, sawantwadi email id:-dr.rajeshmishra64@gmail.com 3rd author afrin mulani intern doctor at r.j.v.s. hospital, sawantwadi. 4th author tabsum mujawar intern doctor at r.j.v.s. hospital, sawantwadi. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 36 mailto:dr.chodankar@gmail.com mailto:dr.chodankar@gmail.com mailto:dr.rajeshmishra64@gmail.com review of lifestyle modification in special referances with vatayyadhi a) abstract = the incidences of illness raises with advancing age ; at the same time, life expectancy decreases. ayurveda has got the potential for prevention of diseases by health promotion & management of diseases occurring in old age. now-a-days, people used to move towards urbanization, utilised technology which instead of making like comfortable develops a busy life & people are away from maintaining the dinacharya, ritucharya, sadavritta, etc. which increases the prevelance of vatavyadhi. here, we discuss lifestyle recommendations such as smoking cessation, exercise, yoga, rasayana therapy good nutrition. keywords: lifestyle modification, vatavyadhi, ayurveda. b) introduction = the main motto of ayurveda is �व�थ�य�वा��यर�णम।्अनरु�यिवकार�शमनमच॥ [meaning = normal maintenance of health, prevention & curing of disease through systematic follow up of regimens ] according to this, we wants to manage our quality as well-as quantity of human life. human health is totally based on equilibrium of tridoshas ,trimala & saptdhatus. in ayurveda, our ancient aacharya give prime importance to vata dasha among tridosha. referances (a.hri.su.) pitta dosha, kaph dosha ,trimata & sapidhatus are unable to perform their work without having presence of vata-dosha. also there are 80 types of nanatmaja vatavyadhi mentioned in ancient ayurvedic samhitas. as-well-as, there are numerous vatavyadhi according to sthana.that's why deep study & research over vatavydhi is a need of present era. the signs & symptoms of vatavyadhi are still same in present era.but, etiology factors which are discribed in ancient ayurvedic samhitas are totally differant from todays factors. so, we have to study recent etiological factors which are responsible for vatavyadhi to get the proper idea about etiopathology [priviously called as samprapti] of disease. the focused branch rasayana (rejuvenation) or jara-chikitsa promotes healthy longevity. it is the demand of an hour to develop an effective holistic protocol for vatavyadhi care by combining rasayana, panchkarma, dietetics, ayurvedic medicines, lifestyle & yoga is timely. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 37 c) etiology = as said in ayurveda, that pradnyaparadha ,asatmya indriya artha samyogam & parinama are 3 main causative factor for the diseases. * dietary factors/aaharaj hetu = 1) asatmyaj / virudha aahar seven. 2) over-eating 3) over dependance on processed food. 4) energy drinks / carbonated drinks. 5) artificial sweeteners. 6) alcohol consumption. 7) tobacco chewing. * behavioural factor/ viharaj hetu = 1) ati-vyayam. 2) cheshta-dveshi / less sport activities. 3) diva-swapn. 4) constant work with improper sittingposture infront of computer. 5) prolonged travelling by riding bike. 6) drug addiction like smoking ,alcohol, etc. *material factors = 1) dushana of vayu bhumi jalakala. 2) radiation. 3)mis-use of technology. 4) worksite hazards. * psychological factor/ mansik hetu = ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 38 1) control of a-dharniya vega. 2)stress. 3) depression. 4)anxiety. d) symptoms of vatavyadhi = vatavriddhi & kshaya lakshanas (a.hri.su.11) symptoms similar to premonitory symptoms are manifested in vatavyadhi. the same symptoms are manifested in bigger form. the symptoms are variable & are in accordance with hetu(causative factors) & sthana(place of manifestetion of disease). ch.chi.28 e)incidances = a survey study was done on 500 patients of vatavyadhi, in national institute of ayurveda jaipur, india & in some yoga kendras in jaipur (in 2015). among 500 patients, in following ways diseases were found. disease out of 500 patients surveyed; 1) 20.2 % = were found sandhivata. 2)18.6 % = were found avabahuka. 3) 11.4 % = were found katigraha. 4)09.2% = were found gridhrasi. 5) 08.4 % = were found pakshaghata. 6)06.8 % = were found vatakantaka. 7) 5.6 % = were found grivastambha. 8) 4.4 % = were found ardita. 9)4.4 % = were found koushtukshirsha. 10) 3.8 % = were found ardhang vata 11) 3.2 % = were found vishwachi. 12) 02 % = kampavata. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 39 13) 02% = sarvang vata. incidences according to age = incidences according to gender = incedences (in %) gender 49 female 51 male incidences according to residence (desha) = incedences (in %) residence 89.2 urban habitat 10.8 rural habitat the disease is maximum in house wife. because spending time infront of television, lack of physical activity lends to obesity (sthoulya) & due to thoulyas ,other dhatus do not get nutrition & asthi is the next dhatu of meda (which is the main dhatu involved in sthoulya).so causes diseases like sandhivata (osteoarthritis).it also leads to promeha ( diabetes mellitus) which leads disease like avbhahuka( frozen shoulder). there is excessive sitting ,driving,cooking, stading, walkingin other occupations. it gives improper movement of body & leads to various types of vatavyadhi. in these cases,vayu doesn't get the proper movement & get loggded in different site according to posture & make samprapti of various vatavyadhis. in ancient era, there was injury from elephant, horse riding,etc. but,now-a-days, there is increase of accidents due to increasing number of vehicles, which leads to vatavyadhi like pakshaghata (paralysis), gridhrasi (sciatica), kampavata(parkinsonism), ardhang vata etc. incidences according to habit of diva-swapn = incidences according to vega-vidharana = incedences (in %) vega – vidharana 56.4 vega dharanregularly 27.8 vega dharannever number of cases age group (in yrs) 65.5 % 51 – 70 30 % 30 50 4.5 % 21 30 incedences (in %) type of sleeep 24 day sleep 76 not taken day sleep ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 40 15.8 vega dharansome times incidences according to behavioral factors = incedences (in %) behavioral factor – chinta / stress 42.4 had stress 57.6 had not f) list of life-style modification disorder w.r.t. vatavyadhi = a) physics problems 1. akshepata = convulsions 2. dhanurvata ( dhanustambha) = tetanus 3. aptanaka = tetani 4.apatantraka = hysteria. 5. abhyantara ayama = emposthotonous 6.baahya ayama = opisthotonos 7. pakshavadha = hemiplegia, paralysis 8. ardita = facial paralysis 9. hanu-graham = lack jaw 10. manya stambham = torticollis or wry neck 11. jivha-stambha = glossal palsy or tongue paralysis 12. gridhrasi = sciatica. 13. vishwachi , apabahuka = radial neuritis, ulnar neuritis, radio-ulnar paralysis. 14. kroshtu sheersha = sino-arthritis of knee joint, inflamed knee 15. khanja = limp,monoplegia 16. pangu = lame, paraplegia 17. vata-kantaka = ankle arthritis ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 41 18. pada-daha = peripheral neuritis 19. amsa shosha = emaciation of scapular region following paralysis 20. kampa vata = shaking palsy, paralysis agitans 21. khalli = muscle champs b) psychological problems 1. alzheimer’s disease 2. insomnia 3. dementia 4. depression g) life style modification steps = etiology modification steps behavioral factors * sadavritta – ch.su.8/17 which includes behavioral do’s and don’ts,ethics of eating,ethics of malamutra visarjana, ethics of social conducts, ethics of behaving with ledies, ethics of learning, ethics of teaching, ethics of work place, etc. * dharniya vegas of mana – ch.su.7/27. * dharniya vegas of vani – ch.su.7/28. * dharniya vegas of sharira – ch.su.7/29. * importance of dharniya vegas – ch.su.7/30. *adharniya vegas – ch.su.7/3-4. behavioral + psychological factors aachar rasayana – ch.chi.1(1)/30-35 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 42 aacharya charaka explains in rasayana adhyaya about aachar rasayana , the physical & behavioral conducts for the purpose of ethical way of leading the life which includes improving the health status, social behaviors & self behavior. dietary factors * dincharya – matrashitiyadhyaya (ch.su.5) waking in brahma – muhurta, voiding of metabolic waste, oral hygiene by-means-of dantadhavan, cleaning of tongue(jivha-nirlekhana),flushing of oral cavity by kaval – gandusha dharana, vyayama, snana, etc. material factors * ritucharya – ch.su.6/3. seasonal evacuation of doshas, various do’s & don’ts in the form of aahara, vihara. h) preventive & curative measures in vatavyadhi = aacharya charak say’s “ he, who treats the disease before its commencement, experiences long – lasting happiness.”hence, by adopting a healthier lifestyle, the risk of various diseases can be reduced. these factors are diet & nutrition, exercise, weight, smoking & alcohol quiting & social activities,etc. aaharaj vichar (diet & nutrition) = ashtau-aahar-vidhi-visheshayatana (ch.vi.1/21) 1. diet should be taken w.r.t. persons habitat, seasons, age & its digestive power (agni means fire.fire is a basic essential of life & has been a proof of our evolution & a source of lot of innovations through eges. even today much of our life activities depends on fire & its utility in one or other form. human body too needs fire for the mechanisam of life to keep going & the life element dependes on the quality and quantity of fire located in the system. there is an activity in each and every cell& according to ayurveda, this activity is more or les dependent on fir, its quality & quantity in each of these cells.) 2.food should be fresh. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 43 3.food must contain shadrasas. 4.food should neighter be very hot nor be very cold. 5.mind should be peaceful while eating. 6.eating only whenever hungry & avoidance of overeating. 7. heavy physical work should avoid after meal. 8.heavy food should not be given at night. 9.proper time for dinner is 2-3 hrs. before going to bed & after dinner, it is better to advise for ashort walk (shatpavali). shodhana = vatasyopakrama a.hri.su.13/1 to 3. it aims removing the vitilated doshas, so that the pathology would be reversed or disease would be prevented. rasayana = 1. rasayana has broad meaning indicating qualitative & quantitave improvement of dhatus. 2. vayasthapana are specialised rasayana – drugs that reverse degenerative changes, increases life – span with quality health. 3. rasayana is the only solution from the point-of-view of effective management in any system of medicine. 4. rasayana become more effective, if it is preceded with suitable panchkarma. 5. some evidence based research – i. buteamonosperma (root) = management of age related immature cataract. ii. tinospora cordifolia (guduchi) = immuno-modulatory agent. iii. boswelia serrata (shallaki) = in rheumatoid arthritis. iv. commiphora wightii (guggulu) = in hrperlipidemia. v. withania somnifera (ashwagandha) = as a anti-aging. vi. centell aasiatica (manduk parni) = as a anti-anxiety drugs. vii. glycyrrhiza glabra (yashtimadhu) = as a anti-anxiety drugs. viii. nordostachys jatamansi (jatamansi) = as a anti-anxiety drugs etc. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 44 yoga = 1. yoga is a combination of body & mind with spirit. 2. there is a harmony between body, mind & spirit. which results in improved fitness, flexibility, stress management, relaxation, mentalclearity & overall well-being which are the ways for prevention of life style diseases. 3. the following longivity promoting yogik pratices-aasan, surya-namaskara, pavan muktasana, bhujangasana, etc. 4. pranayam = nadi-shodhan, kapal – bhati, tratak, etc. 5. mudras = khechari mudra removes diseases. cutting down alcohol & smoking social activities = mixing with other people having similar stage of life or perhaps similar health concern can help people realise that they are not alone. i) conclusion = this study reveals that,vatavyadhi increases with increasing urbanisation. due to rising technology, people thought that, their life is getting more comfortable. but , reality shows that according to increasing population & technology, there are also increased variety of occupations. that’s why, compition in every levelalso gets increases which results into mental stress to people. people are running after money that’s why they forget to follow dincharya, ritucharya, etc. different types of continuous wrong posture’s develops,which ultimately leads to various vatavyadhis. so, to prevent such vatavyadhis in future, we have to follow life style modification changes, which will surely prevent vatavyadhis. our amcient aacharyas mentioned in samhitas, the real lifestyle of human being like dincharya, ritucharya, aachar rasayana, sadavritta, vatasyopkarama,etc. by following these golden rules, we live life delightfully…….. j) referances = 1. https://www.easyayurveda.com/2017/06/05/vata-disorders-vatavyadhi/ 2. http://www.easyayurveda.com/2016/04/19/agni-types-functions-concepts/ 3. http://dx.doi.org/10.7897/2321-6328.03214 4. charak samhita (purvardha) by – aacharya vidyadhar shukla & pro. ravidatta tripathi.[chaukhamba sanskrit prakashna] 5. charak samhita (uttarardha) by – aacharya vidyadhar shukla & pro. ravidatta tripathi.[chaukhamba sanskrit prakashna] 6. sarth vagbhat by – dr.ganesh krushna garde [chaukhamba surbharti prakashana varanasi] ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 01 | january 2023 | https://www.ijojournals.com/index.php/hsn/index 45 https://www.easyayurveda.com/2017/06/05/vata-disorders-vatavyadhi/ http://www.easyayurveda.com/2016/04/19/agni-types-functions-concepts/ http://dx.doi.org/10.7897/2321-6328.03214 relationship of quality of life, resilience, and associated factors among emergency nurses during covid-19 in saudi arabia noof khelif alanezi nursing service department sharaf hospital, hail city email: nkalanezi@moh.gov.sa abstract background: the covid-19 pandemic made a lot of effects in the people life during 2020, plus of this it corresponding to a lot of bad consequences results in increasing of death. while in the medical field nursing had effected by this pandemic in their quality of life and all of activities. propose:this study was conducted at king khalid hospital (kkh) in saudi arabia.to determine the relationship between quality of life, resilience, and associated factors among ed nurses during covid-19 pandemic. methods:the study sample consisted of (77) nurses working in kkh who are available during the period of the study. the data was collected by using a questionnaire design for the study of nursing demographic data and a cross-sectional, descriptive survey design for nurse regarding to tool included qol, resilience scales tool included qol, resilience scales.data were analyzed using statistical packages for social sciences (spss) (version 20) presented in tables and figures. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 1 mailto:nkalanezi@moh.gov.sa results: the study showed thatseventy-seven working nurses completed survey with a score of 98.7%. the majority (n = 77, 98.7%) were between 24 and 54 years old, and the mean years of work experience was 13 (sd= 0.817). there was only few of the male nurses 7.7 %( n = 6) respondents. the correlation of the environment (r=0.43, p<0.035) (m=27.1) and psychological factors was (0510, p<0.003) (m=20.3) was high. while when comparing the scores of qualities of life of ed nurses in the other factors like social (m= 10.6) were low among ed nurses. we found a poor score of qol by 38% and poor resilience by 11.3%. conclusion: on light of the study results it can be concluded that resilience was the strongest factor and its related to quality of life among daily activities recommendation: the study recommended that emphasis should be placed on comparing with pre-pandemic data or tracking developments during the pandemic. keywords: covid-19; ed nurses; quality of life; resilience; saudi arabia. 1. introduction the corona virus in december2019(covid-19) pandemic made a lot of effects in the people life during 2020, plus of this it corresponding to a lot of bad consequences results in increasing of death .while in the medical field nursing had effected by this pandemic in their quality of life ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 2 and all of activities (1). a lot of psychological situations appear among health care stuff such as worry of infection, tension and pressure disorders(2). resilience has a big role in improving the healthcare systems. resilience is defined as a person's ability to generate many new and unconventional ideas, and it expresses the fluidity of his thoughts and his ability to change them to suit and adapt to different and emergency situations he faces. it also means the extent to which individuals absorb and accept new ideas according to changing circumstances and multiple perspectives (3). the quality of life (qol) and the resilience are very important for the individual to continue to work, so that the individual has the best production, and is successful in their work, and for successful professional adaptation more than one direction, the individual must adapt first with himself and then adapt to the work environment and conditions and adapt with colleagues and employers(4). individuals as they provide strategies for coping and awareness of variables such as sequins and a diversion of positive feeling and support for psychological hardness to strengthen resilience (5). according to (5) “rigidity, also called 'temporary resilience' is a personality pattern associated with resilience, good health, and performance under stressful conditions", which can predict individuals' adaptation to stressful and traumatic events. during the eighties, the scientist kolbas developed the ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 3 concept of flexibility to create a method that faces pressures, stress and hardship at work and protects from various emerging symptoms. the main parts of this method consist of three methods: flexibility, challenges, and boldness that produce the ability to use resources, improve recovery ability and enhance positive performance (6). (7)show that boldness is the attitudes that constitute courage and motivation to deal with stressful events. nurses have faced a lot of pressures such as teaching, research, and also community management. therefore, toughness represents a personal trait that predicts health and performance (7). studies have confirmed that this will affect the quality of life and consequently the ability of nurses to be flexible and lead to leaving the environment. academic and work, where nursing is the main engine and the beating heart of any health institution, and accordingly (8). personal and professional changes alter the quality of life and consequently affect resilience and exposure to anxiety and turmoil, as in taiwan, where the study indicated that nurses have the ability to adapt and balance with the demands of work and life and identify strategies to maintain a healthy quality of life where nurses faced the emerging challenges of demand for education, support students their educational needs during the unprecedented covid-19 pandemic and the requirements for social distancing(1).quality of life is a measure of life ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 4 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 5 experiences that are determined by happiness and satisfaction. individuals can also be supported and encouraged, and standards developed for a sense of awareness, health promotion, well-being and the required flexibility (6). (9) found that the overall level of fine of life among nursing become slight (mean = one hundred sixty five; sd = 26.eight). bivariate analysis showed that non-saudi nationality, older age, more paintings experience, marital popularity, full-time employment, rotating shift and specialized devices had been massive elements contributing to higher qol ratings (p < .05). a total of 290 healthcare professionals responded to the survey. the mean overall quality of life score was 3.37 ± 0.97, general health = 3.66 ± 0.88, domains, i.e. physical = 11.67 ± 2.16, psychological = 13.08 ± 2.14, social = 13.22 ± 3.31, and environment = 12.38 ± 2.59. respondents over 40 years of age, male gender, married status, being a physician, having work experience >15 years and no overtime had higher imply ratings in numerous areas of pleasant of life (qol), and standard qol, and widespread health (p < zero.05) (10). (11) found extra than a third of nurses members (n = 127; 36.6%) revel in burnout. guys had better best-of-lifestyles scores than women within the areas of bodily health (p = 0.001; d < 0.five), mental (p = 0.001; d < zero.five) and social relationships (p = zero.048; d < zero.five). girls had been more fatigued than guys (p = 0.001; d < 0.five). flexibility, online revel in, and an amazing aptitude for online gaining knowledge of have been related to each area of qol. remarkably, 21% to 54% of nursing students' qol ratings indicated terrible high-quality of existence. also elasticity changed into the strongest predictor of each domain of qol. the nursing nurses who have suggested improved great of existence are those who've been capable of adapt to the changes and demanding situations imposed during the covid-19 pandemic. resilience had a fantastic and direct effect at the university of nursing and qol students. having a workspace at domestic and being nicely prepared for on-line studying had advantageous indirect outcomes on great of life, through flexibility (12). thus, this study amied todetermine the relationship between quality of life, resilience, and associated factors among ed nurses during covid-19 pandemic. 2. metods 2.1. methods and dezin a this examine used a cross-sectional, descriptive survey design had conducted on the king khalid health facility in hail metropolis, saudi arabia. the have a look at will cover a set of nurses who paintings inside the king khaled sanatorium in hail city. questions for the look at organization which might be consistent with questions regarding dating of best of existence, resilience, and related elements among ed nurses for the duration of covid-19 at kkh hospital might be obtained. fitness care vendors who do no longer cope with covid-19 patients could be excluded, in addition to fitness care providers who do not want to participate in the study, and who've less than three hundred and sixty five days of sensible revel in. the take a look at will be applied within a ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 6 duration of two months. as for the sample size, the range of fitness care companies nurses who deal without delay with covid-19 sufferers in the king khaled sanatorium in hail town can be approximately (n=77). the reliability of the whoqol-bref become assessed by means of standardized cronbach’s alpha coefficient, and the validity become measured by convergent validity, essential factor evaluation and confirmatory factor evaluation(13). the reliability of the scale by way of cronbach's alpha; the coefficient for the cd-risc-10 is zero.82 with a 95% confidence interval [0.82; 0.86], which may be very close to the authentic model (.eighty five)(14). the reaction alternatives have been rated on a five-factor likert scale; rankings had been transferred to a hundred-factor scale, with a higher rating indicating higher qol. the cdrisc-10 is a self-suggested shorter model of the authentic cd-risc-25 questionnaire measuring one's belief of resilience. the response options have been rated on a 5-factor likert scale, on a scale of 0 (no longer actual in any respect) to four (actual nearly all the time), with a higher score indicating higher resilience. 2.2 instrument of this study this examine used a cross-sectional, descriptive survey design. the take a look at was performed all through [25 march to 20 may 2022] at an ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 7 emergency department (ed) nursing at a kkh health facility/hail nurses self-administered the questionnaires, along with a a. who great of existence–bref (whoqol-bref) (casamali,et al,.2019). b. connor-davidson resilience scale 10 (cd-risc-10) ( wollny,et al,.2021). c. 12 work-associated and demographics questions and cronbach's scores for every qol area and resilience scale have been calculated for this look at. d. the institutional review board of the college permitted the look at. nameless records had been amassed via an electronic survey sent to all faculties of nurses. the survey took about 15 to half-hour to complete. statistics will recoded, taken care of, and organized for analysis using the spss model 26.0 software bundle (ibm corp, armonk, ny, united states of america).the obtained information will mentioned at the quit of this semester. the acquired consequences from this challenge might be stated in booklet and /or meetings participations. 2.3 ethical considerations this study had approval by the research and ethics committee, nursing faculty, deanship of development and quality hail university and ministry of health. institutional review board (irb). the study will be conducted ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 8 according to the guidelines laid down for medical research involving human subjects informed voluntary consent will be taken from each participant and information will be obtained from each participant in a private setting. the data will be accessible only by the principal investigator and co-investigators and confidentiality will ensured throughout the study, with explanation of study objectives with strict confidentiality and the name and identity will be optional. 2.4. data analysis data analysis was conducted using the ibm spss statistics software (version 25.20). descriptive analysis, including means, standard deviations, frequencies, and percentages, was used to describe the study variables. the independent samples t-test and one-way anova were used to assess the statistical significance of the mean differences in the nurses' perceptions of quality of life and perceived stress across the levels of measured binary and multi-level categorical demographic and professional characteristics. pearson's correlation coefficient (r) test was used to assess the associations between the metric variables. 3. results 3.1.sociodemographic and professional characteristics table 1 presents the characteristics of the study sample of seventy-seven working nurses ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 9 completed survey with a score of 98.7%. the majority (n = 77, 98.7%) were between 24 and 54 years old, and the mean years of work experience was 13 (sd= 0.817). there was only few of the male nurses 7.7 %( n = 6) respondents. the correlation of the environment( r=0.43, p<0.035 )(m=27.1) and psychological factors was (0510, p<0.003) (m=20.3) was high while, when comparing the scores of quality of life of ed nurses in the other. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 10 table 1. the demographic and professional characteristics of nurses (n =77) variable categories frequency (%) mean (sd) gender male 6 (7.7) fmale 71 (91.0) age (years) 24-34 years 39 (50.0) 34-44 years 23 (29.5) 44-54 years 15 (19.2) nationality saudi 32 (41.0) non-saudi 45 (57.7) years working as a nurse 1-3 years 16 (20.5) 4-6 years 13 (16.7) 7 years-above 48 (61.5) shift worked day shift 58 (74.4) mid shift night shift 11 (14.1) hours/shift 8 hours 60 (76.9) 10 hours 3 (3.8) 12 hours 14 (17.9) work status full-time 65 (83.3) part-time 6 (7.7) ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 11 per diem 6 (7.7) age nursing experience 13 (sd= 0.817). 3.2. the linear regression was conducted for each independent variable in table 2 below. the independent variables with p < .20 were entered in the multiple regression models to predict each qol domain. there was a high correlation between workspace environment and psychological factors with resilience score (r=0.43, p<0.035 and 0.510, p<0.003) respectively. table 1. multiple regression model summaries for qol domains qol domain r r2 adjusted r2 f p physical health .594 .353 .287 5.377 .000 psychological .510 .260 .185 3.459 .003 social relationship .593 .351 .285 5.336 .000 environment .436 .190 .108 2.310 .035 3.3. description of quality of life and resilience the basic descriptive statistics of quality of lifeand resilience are shown in table 2. the mean score for quality of life was 20.1 and the mean score for resilience was 30.2. the domain of satisfaction with social ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 12 relationship had the lowest mean score (10.6) in comparison to the other domains, while the domain of environment satisfaction had the highest mean score (27.1).psychological factors was (0510, p<0.003) (m=20.3)was high.while when comparing the scores of quality of life of ed nurses in the other factors like social (m= 10.6) were low among ed nurses. we found poor scores of qol by 38% and poor resilience by 11.3%. table 3. the relationship between sample characteristics, quality of life andresilience (n =77). scale/subscales (domains) m (sd) range reliability ( ) poor scorea,b n % quality of life scale (whoqol-bref) physical health (7 items) 22.5(4.1) 23-100 0.86 9 17.1 psychological (6 items) 20.3(3.4) 18-100 0.70 13 28.2 social relationship (3 items) 10.6(2.2) 12-100 0.61 17 38.1 environment (8 items) 27.1(5.1) 25-100 0.72 3 3.9 resilience scale (cd-risc-10) resilience (10 items) 30.2(3.7) 12-40 0.82 4 11.3 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 13 fig 1.shows the percentages of quality of life factors. while when comparing the scores of quality of life of ed nurses in the other social (m= 10.6) were low among ed nurses. 3.4. relationship between poor score of quality of life the basic descriptive statistics of resilience are shown in was 21.8% and resilience was 11.3% shows the percentages of quality of life factors. while when comparing the scores of quality of life of ed nurses in the other ) were low among ed nurses. 3.4. relationship between poor score of quality of life and resilience the basic descriptive statistics of poor score of both quality are shown in fig. 2. the mean poor score of quality of life was 21.8% and resilience was 11.3% shows the percentages of quality of life factors. while when comparing the scores of quality of life of ed nurses in the other factors like and resilience poor score of both quality of lifeand of quality of life ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 14 fig 2.shows the percentages of 4. discussion the results of this study discuss factors related to qol among e covid-19 pandemic. the advice resilience score for the nurse in our have a look at was 30.2 (sd, 3.7) comparing with some other have become a strong variable that used to measure the also in this study notably, 17% to 38% of nurses had indicating poor qol on measurement factors and 11.3% of nurses indicated poor resilience. study showed that 21% to 54% of nursing students' q life (16). previous studies reported that one of the factors that negatively affected the relationships between nurses and the environment surroundin nurses faced educational challenges that showed the link between flexibility and work. studies also proved that a good work environment is something that provides a personal .shows the percentages of poor score of both quality of life resilience the results of this study discuss factors related to qol among ed nurses during the the advice resilience score for the nurse in our have a look at was 30.2 (sd, 3.7) comparing with some other have a look at 38.2(sd 5.2) which resilience have become a strong variable that used to measure the factors (15). also in this study notably, 17% to 38% of nurses had indicating poor qol on measurement factors and 11.3% of nurses indicated poor resilience. similar to another study showed that 21% to 54% of nursing students' qol scores indicated poor qual previous studies reported that one of the factors that negatively affected the relationships between nurses and the environment surrounding their work is social distancing. also, nurses faced educational challenges that showed the link between flexibility and work. studies also proved that a good work environment is something that provides a personal quality of life and es during the the advice resilience score for the nurse in our have a look at was 5.2) which resilience also in this study notably, 17% to 38% of nurses had indicating poor qol on similar to another l scores indicated poor quality of previous studies reported that one of the factors that negatively affected the relationships g their work is social distancing. also, nurses faced educational challenges that showed the link between flexibility and work. studies also proved that a good work environment is something that provides a personal ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 15 space to manage challenges and develop capabilities to gain flexibility, thus enhancing workmanship(17). the correlation of the environment (r=0.43, p<0.035)(m=27.1) and psychological factors was (0510, p<0.003) (m=20.3)was high. while when comparing the scores of quality of life of ed nurses in the other factors like social (m= 10.6) were low among ed nurses. compared with another study more than a third of nursing members (n = 127; 36.6%) experienced fatigue. men had higher quality-of-life scores than women in the areas of physical health (p = 0.001; d < 0.5), psychological (p = 0.001; d < 0.5) and social relationships (p = 0.048; d < 0.5). women were more fatigued than men (p = 0.001; d < 0.5) (11). 5.1 conclusion the covid-19 epidemic has caused major disruption to nurses working in the ed. this study discussed the multiple factors associated with quality of life among nurses working in the ed at covid-19 pandemic. resilience was the strongest expectation variable across all four qol domains and the only importance a variable related to physical and mental health and domains of social relations qol. these findings illustrate the significance of resilience amongst nurses operating inside the emergency and help department develop proof-primarily based applications to build resilience that may enhance satisfactory of existence among nursing. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 16 5.2 recommendations there are several recommendations that will underpin future study. firstly, future interventional studies investigating the effects of flexibility on quality of working life should be considered. secondly, emphasis should be placed on comparing with pre-pandemic data or tracking developments during the pandemic. finally, longitudinal studies are needed to understand career quality trajectories and the resilience of emergency healthcare professionals in the pandemic and beyond. references 1carmassi, c., foghi, c., dell'oste, v., cordone, a., bertelloni, c. a., bui, e., &dell'osso, l. (2020). ptsd symptoms in healthcare workers facing the three coronavirus outbreaks: what can we expect after the covid-19 pandemic. psychiatry research, 292, 113312. 2asante, j. o., li, m. j., liao, j., huang, y. x., &hao, y. t. (2019). the relationship between psychosocial risk factors, burnout and quality of life among primary healthcare workers in rural guangdong province: a cross-sectional study. bmc health services research, 19(1), 1-10. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 17 3chesak, s. s., khalsa, t. k., bhagra, a., jenkins, s. m., bauer, b. a., &sood, a. (2019). stress management and resiliency training for public school teachers and staff: a novel intervention to enhance resilience and positively impact student interactions. complementary therapies in clinical practice, 37, 32-38. 4baskin, r. g., & bartlett, r. (2021). healthcare worker resilience during the covid 19 pandemic: an integrative review. journal of nursing management, 29(8), 2329-2342. 5caldeira, s., & timmins, f. (2016). resilience: synthesis of concept analyses and contribution to nursing classifications. international nursing review, 63(2), 191-199. 6solano, j. p. c., bracher, e. s. b., faisal-cury, a., ashmawi, h. a., carmona, m. j. c., lotufoneto, f., & vieira, j. e. (2016). factor structure and psychometric properties of the dispositional resilience scale among brazilian adult patients. arquivos de neuro-psiquiatria, 74, 1014-1020. 7rice, v., & liu, b. (2016). personal resilience and coping with implications for work. part i: a review. work, 54(2), 325-333. 8mendelson, m., nel, j., blumberg, l., madhi, s. a., dryden, m., stevens, w., & venter, f. w. d. (2021). long-covid: an evolving ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 18 problem with an extensive impact. samj: south african medical journal, 111(1), 10-12. 9alharbi, m. f., alahmadi, b. a., alali, m., &alsaedi, s. (2019). quality of nursing work life among hospital nurses in saudi arabia: a cross sectional study. journal of nursing management, 27(8), 17221730. 10maqsood, m. b., islam, m. a., naqvi, a. a., al qarni, a., alkarasneh, a. f., iffat, w.,&haseeb, a. (2021). assessment of quality of work life (qwl) among healthcare staff of intensive care unit (icu) and emergency unit during covid-19 outbreak using whoqol-bref. saudi pharmaceutical journal, 29(11), 1348-1354. 11alves, p. c., oliveira, a. d. f., &paro, h. b. m. d. s. (2019). quality of life and burnout among faculty members: how much does the field of knowledge matter?.plos one, 14(3), e0214217. 12keener, t. a., hall, k., wang, k., hulsey, t., &piamjariyakul, u. (2021). quality of life, resilience, and related factors of nursing students during the covid-19 pandemic. nurse educator, 46(3), 143148. 13casamali, f. f. c., schuch, f. b., scortegagna, s. a., legnani, e., & de marchi, a. c. b. (2019). accordance and reproducibility of ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 19 the electronic version of the whoqol-bref and whoqol-old questionnaires. experimental gerontology, 125, 110683. 14wollny, a. i., & jacobs, i. (2021). validity and reliability of the german versions of the cd-risc-10 and cd-risc-2. current psychology, 1-12. 15di monte, c., monaco, s., mariani, r., & di trani, m. (2020). from resilience to burnout: psychological features of italian general practitioners during covid-19 emergency. frontiers in psychology, 11, 2476. 16keener, t. a., hall, k., wang, k., hulsey, t., &piamjariyakul, u. (2020). relationship of quality of life, resilience, and associated factors among nursing faculty during covid-19. nurse educator, 46(1), 17-22. 17giusti, e. m., pedroli, e., d'aniello, g. e., strambabadiale, c., pietrabissa, g., manna, c., strambabadiale, m., riva, g., castelnuovo, g., & molinari, e. (2020). the psychological impact of the covid-19 outbreak on health professionals: a cross-sectional study. frontiers in psychology, 11. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 09 | september 2023 | http://ijojournals.com/index.php/hsn/index 20 a. who great of existence–bref (whoqol-bref) (casamali,et al,.2019). b. connor-davidson resilience scale 10 (cd-risc-10) ( wollny,et al,.2021). c. 12 work-associated and demographics questions and cronbach's α scores for every qol area and resilience scale have ben alculated for this look at. d. the institutional review board of the college permitted the look at. nameless records had been amassed via an electronic survey sent to all faculties of nurses. the survey took about 15 to alf-hour to complete. statistics will recoded, taken care of, and organized for analysis using the spss model 26.0 software bundle (ibm corp, armonk, ny, united states of america).the obtained information will mentioned at the quit of this semester. the acquired consequences from this challenge might be stated in booklet and /or meetings participations. 2.3 ethical considerations 5.1 conclusion 5.2 recommendations evaluation of the consumption of ready-to-use therapeutic food in therapeutic outpatient nutritional units in children aged 6 to 59 months. authors egnon k. v. kouakou (1 *), badiambile mpulumba (2), koffi p.v niaba (3), jean. sk dje (4), nankomo mudimbiyi (5), guy im akaji (6), ndasha sumbula (7), lasis d. kabey (8), abra e. atsakou (9), ézéchiel k. m'baya (10), valentin b. mbulu (11), fleur c. mbuyi (12), kanowa pj kabeya (13), séraphin kati-coulibaly (14), 1. nutrition and pharmacology laboratory, ufr biosciences, felix houphouet-boigny university (ufhb), abidjan, côte d´ivoire. 22 b.p. 582 abidjan 22, côte d'ivoire. 2. faculty of public health, official university of mbuji-mayi, kasaï oriental, democratic republic of congo. 3. agricultural valuation laboratory, jean lorougnon guédé daloa university, côte d´ivoire daloa, bp150 4. department of food and nutrition, faculty of pharmaceutical sciences, são paulo state university (unesp), rodovia araraquara-jaú, km 1, 14801 902, sao paulo, brazil 5. iberomercian international university puerto rico, usa, carr. 658 km 1.3 bo, arenalejos sector, palaches arecibo, puerto rico (ee, uu), 00613 6. national nutrition program of the province of kasai oriental, democratic republic of congo. 7. university of mwene ditu, province of lomami, democratic republic of congo. 8. higher institute of medical technology, mbuji mayi province of kasaï oriental, democratic republic of congo. 9. institute of technical and medical sciences of mbuji mayi mbuji mayi province of kasaï oriental, democratic republic of congo. 10. saint raphael mbuji mayi ophthalmological clinic kasaï oriental province, democratic republic of congo. ijo international journal of health sciences and nursing volume 03 |issue 05 | may 2020 www.ijojournals.com 6 corresponding author, e-mail: kouakouegnonvivien@yahoo.fr, tel (225) 08 49 93 34 / (+243) 893 311 965. abstract this study aims to assess the consumption of rutf in children aged 6 to 59 months. to do this, 436 children aged 6 to 59 months including girls 230 and 206 boys were selected for this study for a period of 6 months. this is a transversal descriptive study for analytical purposes which was carried out in the kabeya kamuanga health zone in the democratic republic of congo (drc), in 15 unta, between october 2019 and march 2020). indeed, the quantitative approach was used for this study, we analyzed the data using the software "epi-info" version 7.2.2.6 and "excel" the usual measurements will be calculated. at the end of this study, the analyzes showed which female sex predominated (57.51%) with a sex ratio of 1.1 girl for a boy. the 32 to 38 month age group was represented by men with (26.70%). concerning the consumption of rutf, the average varies between 120 and 150 sachets of 92 gr or 0.8 to 1.25 cartons of rutf and the large consumption of rutf varies between 120 and 212 sachets of 92 gr, or 0.8 to 1 , 76 boxes represented by the 46 to 52 month age group (46.68%) and the male sex was the most represented (19.40%). thus the age group from 19 to 24 months increased their entry weights (55.02%), while the entry and exit weight ratio (49.77%) increased their exit weights . the main predictors of consumption could be influenced by the age, sex, state of health of the child. however, further additional studies are needed to confirm or refute this claim. keywords: assessment, ready-to-use therapeutic food, drc, malnutition, child 6 to 59 months. introduction la malnutrition est un état pathologique qui résulte de la carence ou de l’excès d’un ou plusieurs nutriments ( remi,2010). la sous-malnutrition constitue actuellement un problème de santé publique dans les pays en développement (unicef,2017). a travers le monde, 51 millions d’enfants de moins de 5 ans sont touchées par la malnutrition aigüe, et 161 millions d’enfants par la malnutrition chronique (ahmed .m,2013). en afrique subaérienne 13 millions d’enfant souffre de la malnutrition aigüe (ben et al,2014). la république démocratique du congo (rdc) n’est pas épargnée. en république démocratique du congo, 43% d’enfants de 0-59 mois souffrent de la malnutrition chronique, 8% de malnutrition aigüe et 23% de malnutrition globale (ministère du plan et de la santé, rdc 2013-2014). cette malnutrition touche toutes les provinces de la rdc. cependant, elle présente des disparités selon les provinces. en effet, la situation nutritionnelle des enfants de moins de 5 ans demeure préoccupante dans la province du kasaï oriental du à l’épidémie de rougeole aggravées par le déplacement des populations. dans cette province la malnutrition ijo international journal of health sciences and nursing volume 03 |issue 05 | may 2020 www.ijojournals.com 7 atteint le pic de 16,1% pour la malnutrition aigüe globale, 3,8% pour la malnutrition aigüe sévère (pronanut rdc ,2014). dans le cadre du traitement de cette malnutrition infantile, un protocole national de prise en charge nutritionnelle a été mise en place. ce protocole s’appuie sur le protocole international de prise en charge intégrée de la malnutrition aiguë de l’unicef utilisant le plumpy nut pour le traitement. selon ce protocole, en moyenne 0,8 carton soit 120 sachets sont consommés avant la guérison totale d’un enfant malnutris. certains facteurs pourraient influencer la consommation de cet intrant d’un enfant malnutris à un autre. cependant, peu d’étude existe sur la consommation de cet intrant et les facteurs pouvant l’influencé lors de la prise en charge de la malnutrition aigüe. afin de combler cette carence, une étude s’avère nécessaire. cette étude vise à évaluer la consommation des aliments thérapeutique prêt à l’emploi (atpe) et certains facteurs l’influençant chez les enfants de 6 à 59 mois dans les unité nutritionnelle thérapeutique ambulatoire. ii. methodologie cette étude a été réalisée en république démocratique du congo dans la province du kasai oriental, zone de santé rurale de kabeya kamuanga. la zone santé de kabeya kamuanga compte une population totale de 229955 habitants avec une superficie de 4545 km2 et une densité de 41 habitants par km2. dans cette étude huit aires santé ont été sélectionnées. 1. recueil de données les données ont été recueillies à partir des registres d’admission et de sortie ainsi que les fiches de suivis individuels à l’unta 2. nature, durée de l’étude il s’agit d’une étude descriptive transversale à visée analytique qui a été réalisée dans la zone santé de kabeya kamuanga entre octobre 2019 et mars 2020. 3. critère de sélection les critères de sélection suivante ont été utilisés : 4. critère d’exclusion ont été inclus dans l’étude : tous les enfants répondant aux critères d’admissions du programme de prise en charge (p/t <-3, pb <115 mm, et/ou présence d’œdèmes) dans les unta de la zone santé de kabeya kamuanga, dont la tranche d’âge varie entre 6 et 59 mois, de la période allant du 03.10.2019 au 29.03.2020 soit une période de 6 mois. ijo international journal of health sciences and nursing volume 03 |issue 05 | may 2020 www.ijojournals.com 8 critere d’inclusion etaient exclus de l’étude : tous les enfants ne répondant pas aux critères d’admissions du programme de prise en charge dans les unité nutrition thérapeutique ambulatoire de la zone santé de kabeya kamuanga, tous les enfants qui n’ont pas la tranche d’âge qui concerne l’étude echantillonnage la population d’étude : la population de la présente étude a été constituée des enfants de plus de 6 à 59 mois. les unités statistiques : les unités statistiques étaient constituées de différentes unta de la zone santé de kabeya kamuanga et le traitement des données avec epi info version 7.2.2.6 la technique d’échantillonnage : nous avons procédé à un échantillonnage aléatoire à 2 degrés : au premier degré : nous avons sélectionné de façon aléatoire 8 aires de santé ; deuxième degré : nous avons procédé au choix aléatoire de 54 enfants par unta dans ladite zone. la taille de l’échantillon : l’estimation de la taille de l’échantillon a été calculée à l’aide de la formule suivante : n = �² �(���) �² n= la taille minimale de l’échantillon ; z= le coefficient de confiance au seuil de 95% (1,95) ; d= degré de précision (0,5%) ; p= la prévalence considérée ; 1-p = complément de la prévalence. en tenant compte de 10% dû au biais de l’étude, pour être représentatif, la taille minimale requise doit être supérieur à 5 cas. notre échantillon a été ainsi de 436 cas iv. resultats ces résultats ont porté sur deux aspects : l’analyse descriptive et analytique en comparant différentes variables au cours de l’admission. ijo international journal of health sciences and nursing volume 03 |issue 05 | may 2020 www.ijojournals.com 9 diagramme 1 : enfants malnutris en fonction de sexe les résultats montrent que le sexe ratio fille/garçon est de 1,1 de prédominance féminine, soit 52,75% filles contre 47,25% de garçons. tableau 1 : enfants malnutris en fonction de l’age et le sexe la tranche d’âge de 19 à 24 mois chez les filles a enregistré 67,57% de malnutris contre 70,73% chez les garçons de 53 à 59. 52.75% 47.25% 44.00% 45.00% 46.00% 47.00% 48.00% 49.00% 50.00% 51.00% 52.00% 53.00% 54.00% féminin masculin sexe age 6-11 12-18 19-24 25-31 32-38 39-45 46-52 53-59 féminin 66,67% 66,67% 67,57% 52,17% 45,00% 52,17% 40,48% 29,27% masculin 33,33% 33,33% 32,43% 47,83% 55,00% 47,83% 59,52% 70,73% ijo international journal of health sciences and nursing volume 03 |issue 05 | may 2020 www.ijojournals.com 10 tableau 2. consommation des atpe et le poids d’entree des enfants malnutris les résultats montrent que 100% des enfants ayant un poids de 2 à 4 kg ont consommés moins d’un carton de plumpy nut soit 38 à 68 sachets de 92 g contre 50% des enfants de 17 à 19 kg qui ont consommés 213 à 243 d’atpe. consommation atpe (sachets de 92 g) p o i d s e n t r e e 2 4 5 7 8 1 0 1 1 1 3 1 7 1 9 3 8 6 8 1 0 0 % 1 1 , 8 6 % 5 , 4 9 % 0 , 0 0 % 0 , 0 0 % 6 9 9 9 0 , 0 0 % 1 4 , 4 1 % 1 4 , 0 2 % 1 1 , 1 0 % 0 , 0 0 % 9 9 1 1 9 0 , 0 0 % 1 2 , 7 1 % 9 , 7 6 % 5 , 5 6 % 0 , 0 0 % 1 2 0 1 5 0 0 , 0 0 % 9 , 3 2 % 1 9 , 5 1 % 2 2 , 2 2 % 5 0 , 0 0 % 1 5 1 1 8 1 0 , 0 0 % 1 5 , 2 5 % 1 8 , 2 9 % 1 6 , 6 7 % 0 , 0 0 % 1 8 2 2 1 2 0 , 0 0 % 2 2 , 0 5 % 1 1 , 5 9 % 5 , 5 6 % 0 , 0 0 % 2 1 3 2 4 3 0 , 0 0 % 8 , 4 7 % 6 , 7 0 % 1 1 , 1 1 % 5 0 , 0 0 % 2 4 4 2 7 4 0 , 0 0 % 5 , 9 3 % 8 , 5 4 % 1 6 , 6 7 % 0 , 0 0 % 2 7 5 3 0 5 0 , 0 0 % 0 , 0 0 % 6 , 1 0 % 1 1 , 1 1 % 0 , 0 0 % ijo international journal of health sciences and nursing volume 03 |issue 05 | may 2020 www.ijojournals.com 11 tableau 3. consommation de l’atpe en fonction de l’age consom mation d’atpe age 6-11 12-18 19-24 25-31 32-38 39-45 46-52 53-59 38-68 35,69% 1 0 , 7 5 % 1 1 , 3 1 % 7 , 0 0 % 8 , 7 0 % 6 , 6 9 % 3 , 7 0 % 3 , 2 9 % 69-99 5 , 6 9 % 1 8 , 3 3 % 2 0 , 5 4 % 1 6 , 7 5 % 1 3 , 0 4 % 7 , 6 9 % 2 , 7 0 % 2 , 5 0 % 100-119 9 , 8 0 % 1 5 , 5 6 % 1 6 , 1 5 % 3 2 , 0 0 % 4 , 3 5 % 2 , 8 2 % 9 , 8 1 % 1 8 , 0 0 % 120-150 11,43% 1 1 , 5 7 % 1 2 , 6 7 % 6 , 3 1 % 2 4 , 0 0 % 1 6 , 0 9 % 2 1 , 0 8 % 1 3 , 7 3 % 151-181 11,43% 9 , 8 8 % 3 , 4 4 % 7 , 3 8 % 1 6 , 7 5 % 3 7 , 3 9 % 8 , 6 9 % 7 , 8 1 % 182-212 8 , 5 7 % 9 , 6 1 % 1 8 , 2 2 % 4 , 3 1 % 1 2 , 2 9 % 1 3 , 0 4 % 2 , 8 2 % 9 , 5 1 % 213-243 4 , 2 9 % 3 , 9 2 % 5 , 3 3 % 7 , 6 2 % 8 , 5 6 % 4 , 3 5 % 4 7 , 6 9 % 8 , 1 1 % 244-274 6 , 8 7 % 7 , 8 4 % 8 , 3 3 % 8 , 6 9 % 7 , 2 5 % 3 , 3 5 % 1 , 2 6 % 3 1 , 2 2 % 275-305 5 , 7 5 % 1 2 , 3 5 % 3 , 5 6 % 9 , 6 9 % 4 , 7 5 % 8 , 7 0 % 2 , 2 6 % 5 , 4 1 % total 100% 100% 100% 100% 100% 100% 100% 100% les résultants montrent que 35,69% des enfants ayant 6 à 11 ans ont consommés moins d’un carton de plumpy nut soit 38 à 68 sachets de 92 g contre 47,69% des enfants de 46 à 52 ans qui ont consommés une quantité d’atpe de 213 à 243 . ijo international journal of health sciences and nursing volume 03 |issue 05 | may 2020 www.ijojournals.com 12 diagramme 2. consommation de l’atpe en fonction de sexe le diagramme montre que 52,75% des enfants de sexe féminin ont consommés 182 à 212 sachets d’atpe contre 47,25% des enfants de sexe masculin avec une consommation qui varie entre 120 et 150 sachets d’atpe. tableau 4. classification des enfants malnutris en fonction du poids d’entree et de l’age poids entree en kg age en mois 06 -11 12 18 19 24 25 31 32 38 39 45 4652 53 59 04 – 06 88,00% 52,94% 3,45% 5,36% 4,77% 0,00% 11,11% 0,00% 07 – 09 12,00% 44,12% 93,10% 91,07% 86,90% 77,78% 72,22% 32,15% 10 – 12 0,00% 2,94% 3,45% 3,57% 8,33% 22,22% 13,89% 53,57% 13 -15 0,00% 0,00% 0,00% 0,00% 0,00% 0,00% 0,00% 10,71% 16 – 18 0,00% 0,00% 0,00% 0,00% 0,00% 0,00% 2,78% 3,57% les résultats révèlent que 93,10% des enfants malnutris de la tranche d’âge de 19 à 24 mois augmentaient leur poids d’entrée. 0 5 10 15 20 25 38-68 69-99 99-119 120-150 151-181 182-212 213-273 275-305 consommation des sachets de atpe en fonction du sexe fille % garçon % ijo international journal of health sciences and nursing volume 03 |issue 05 | may 2020 www.ijojournals.com 13 discussion cette étude sur la consommation des aliments thérapeutiques prêts à l’emploi a montré une prédominance féminine. cela se justifie par le sexe ratio fille/garçon de 1,1 observé au cours de l’étude. ainsi, il a été enregistré une proportion de 52,75% de filles contre 47,25% de garçons. ce ratio est en accord avec ceux trouvé avec le ministère de la santé publique à travers le programme national de nutrition de la république démocratique du congo qui ont relevé les mêmes constats dans l’etude démographique et de la santé (ministère de santé publique et pronanut, rdc 2016). ces résultats sont similaires à ceux trouvés par barry. b,2009 qui donnaient un effectif des enfants admis à 48,3% de garçons et 51,7% de filles, soit 1,07 de ration fille/garçon. les enfants de sexe féminin sont les plus touchés par la malnutrition . de même, les études d’ilboudo ,2004, au burkina faso sur les déterminants de la malnutrition des enfants ont soutenu que le sexe de l'enfant était un déterminant pour son état de santé. il appui d’ailleurs que la malnutrition aigüe est plus importante chez les filles que chez les garçons . de plus, notre étude est soutenue par hayfa g, 2007 qui indiquait aussi que la malnutrition est plus importante chez les filles que chez les garçons. cependant, d’autres études ont enregistré des résultats contraires aux nôtres. c’est le cas de sondé i,2009 , qui avait montré une prédominance du sexe masculin (57,7%). kabirou et al, 2002 rapportent quant à eux, une plus grande atteinte masculine . au niger, le rapport d'enquête nationale de nutrition montre que la malnutrition aiguë touche davantage plus les enfants de sexe masculin que leurs sœurs du même âge avec des taux respectifs de 15,0% et 11,6% (unicef niger et médecin sans frontière,2009 ). la prédominance féminine de cette étude comparée au sexe masculin de la malnutrition serait liée à la fragilité physiologique des filles. dans la plupart des pays en voie de développement, les nourrissons de sexe féminin ont tendance à faire un sevrage précoce que ceux de sexe masculin de même âge; et par conséquents plus exposées à la malnutrition (aptmic.org,2010). d’ailleurs cette étude a relevé que la majorité des enfants malnutris de la tranche de 6 à 24 mois était des filles. elle se vérifie par les proportions de 66,97% de filles contre 33,03% de garçon de cette même tranche d’âge de sexe opposé. les résultats de cette étude sont en accord avec ceux de gomez et al,2005 dans leur étude sur the malnutrition in infancy and childhood, with special reference to kwashiorkor. cependant, les garçons sont plus exposés vers trois ans (barry b,2009). les résultats enregistrés au cours de cette étude le confirment. ces résultats montrent que 58,27% de garçons malnutris contre 41,73 % de filles. sondé et al ,2009 ont fait les mêmes constations dans leur étude sur l’analyse de la prise en charge d'enfants en malnutrition au centre de récupération nutritionnelle (cren) de tanghin (burkina faso) . cette disparité pourrait se justifier par la diminution des fréquentations des centres de santé pendant cette tranche d’âge. de plus, la pratique de l’allaitement maternel sur une longue période chez les garçons pourrait aussi justifier ce fait. ils étaient sous la couverture et la protection des éléments nutritifs du lait maternel. après le sevrage, avec la croissance évolutive, les besoins physiologiques et nutritifs deviennent énormes (mpoy et al ,2014). ijo international journal of health sciences and nursing volume 03 |issue 05 | may 2020 www.ijojournals.com 14 pour barry et al, 2009, la tranche d’âge de 12 à 23 mois était la plus représentée, suivie de la tranche d’âge de 24 à 59 mois . ce phénomène s'expliquerait par la protection qu'offre l'allaitement maternel pour cette tranche d’âge (ilboudo ,2004). ces résultats ont montré que les enfants malnutris sont légèrement âgés que ceux présentés dans l’étude de mpoy et al ,2014 qui présente une médiane de 23 mois tandis que dans cette étude la médiane était de 30 mois. la consommation serait liée à l’état physiologique (elisabeth et al ,2008). le sexe, l’âge et le poids pourraient influencer la consommation des aliments thérapeutiques prêt à l’emploi (atpe). concernant le sexe, les résultats de cette étude révèlent que le sexe féminin (52 ,75%) consomme plus que le sexe masculin (47,25 %). en effet, dans cette étude la majorité des enfants malnutris étaient des filles de la tranche d’âge de 6 à 24 mois ; augmentant ainsi le nombre d’enfant malade lors des distributions. cette prédominance féminine serait liée à une plus grande sensibilité des filles à la malnutrition due à l'anthropométrie moyenne différente à celle des garçons au cours de cette période de croissance (waterlow j, 2002). cette valeur est au-delà de celle trouvée au mali/bamako (50%) dans l’étude de fadjiné d, 2018 sur l’évaluation des facteurs associés aux faibles scores de consommation et de diversité alimentaire dans les ménages. en plus du sexe, l’âge serait aussi lié à la consommation d’aliments (elisabeth et al ,2008). il a été enregistré dans cette étude une forte consommation d’aliments thérapeutique prêt à l’emploi chez les enfants de la tranche d’âge de 46 à 52 mois. cela se justifie par les données recueillies à la fin de leur sortie du programme de prise en charge nutritionnelle à l’unité nutritionnelle thérapeutique ambulatoire (unta). chez les enfants de cette tranche d’âge (46-52 mois), plus de 270 sachets de 92 g d’atpe, soit 1,8 cartons ont été consommés. cette valeur est largement supérieure à celle recommandé par l’unicef qui est de 120 sachets, soit 0,8 cartons (unicef new york,2017). hormis le sexe et l’âge, le poids serait aussi un facteur important pour l’indice de consommation alimentaire. les enfants avec un poids élevé consomment plus en comparaison des autres enfants de même âge dans le programme de prise en charge nutritionnelle dans les unités nutritionnelle thérapeutique ambulatoire. dans cette étude la majorité des enfants de plus de 17kg ont consommés au-delà de 240 sachets (1,60 cartons) d’aliment thérapeutique prêt à l’emploi de 92g par sachet. les études d’elisabeth et al, 2008 sur les déterminants des comportements alimentaires ont aussi montré ces faits. ils ont observé que, plus le poids est élève, plus la consommation est forte (fadjiné d,2018). cela se justifierait par les besoins physiologiques élevés en fonction du poids qui nécessite un apport énergétique suffisante pour satisfaire les besoins physiologiques. les résultats de cette étude pourraient accuse néanmoins quelques limites. il s’est agit d’une étude transversale. les études transversales n’ont pas la possibilité d’établir la séquence temporelle entre les variables identifiées et l’issue. bien que la collecte ait été réalisée conformément aux normes, cela n’exclus pas certains paramètres soient mal mesuré : les poids, taille et séjours à l’unta. ces faits peuvent avoir introduit un biais d’information. ijo international journal of health sciences and nursing volume 03 |issue 05 | may 2020 www.ijojournals.com 15 malgré quelques limites signalées ci-haut, cette étude a permis de contribuer à l’estimation de la consommation des atpe dans un programme de prise en charge nutritionnelle à l’unité nutritionnelle thérapeutique ambulatoire. conclusion la présente étude a été initiée pour évaluer la consommation des aliments thérapeutiques prêt à l’emploi chez les enfants de 6 à 59 mois souffrant de malnutrition sévère aigue (mas) dans les unités nutritionnelle thérapeutique ambulatoire. les résultats de cette étude ont montré un sexe ratio de 1,1 en faveur des filles malnutris de 6 à 59 mois. cette féminisation de la malnutrition est accentuée (66,33%) à la tranche d’âge de 6 à 24 mois. la majorité des grands consommateurs (plus 1,5 cartons) d’aliments thérapeutique prêt à l’emploi dans cette étude sont de la tranche de 53 à 59 mois lors de leur prise en charge avec une prédominance masculine. la consommation des aliments thérapeutique prêt à l’emploi des enfants de 6 à 59 mois pourrait être influencée par plusieurs facteurs dont le poids d’entrée au programme de prise en charge de l’enfant, le sexe et l’âge de l’enfant malnutris. cependant, le contexte de l’étude et d’autres facteurs non élucidés au cours de cette étude sur la consommation des aliments thérapeutique prêt à l’emploi pourrait aussi l’influencer. par conséquent, d’autres études complémentaires s’avèrent nécessaires pour mieux apprécier les facteurs liés à la consommation des aliments thérapeutique prêt à l’emploi chez les enfants de 6 à 59 mois malnutris dans les unités nutritionnelle thérapeutique ambulatoire. references bibliographiques 1. ahmed .mouchtak nabil, évaluation de l’état nutritionnel des enfants atteints de cancer suivis en oncologie pédiatrique .niger 2013 2. aptmic.org association pour la prévention et le traitement de la malnutrition infantile,2010 3. barry b, evaluation de la prise en charge de la malnutrition aigüe sévère dans le service de pédiatrie de l'hôpital de gao. thèse de la faculté de médecine, de pharmacie et d'odonto-stomatologie de l'université de bamako 2009. 55p 4. ben hobbs et anne. bush, génération nutrition, niger 2014 5. elisabeth g, france b, déterminant des comportements alimentaires, 2008 6. fadjiné d, evaluation des facteurs associés aux faibles scores de consommation et de diversité alimentaire dans les ménages au mali, 2018 mémoires de médecine. 7. gomez f,galvan rr, malnutrition in infancy and childhood with spécial reference to kwashiorkor 2005 adv pédiatr 2005 ijo international journal of health sciences and nursing volume 03 |issue 05 | may 2020 www.ijojournals.com 16 8. hayfa g. les déterminants sur la malnutrition des enfants: une analyse empirique; 2007. [google scholar 9. ilboudo les déterminants de la malnutrition des enfants au burkina faso . mémoire de master, institut de recherche empirique en économie politique; 2004. p. 79. [google scholar ] 10. kabirou f et iiboudo, étude de l’infection urinaire chez l’enfant malnutri dans le service de pédiatrie de l’hôpital national de niamey au niger. thèse de médecine : 2002 au niger 11. ministère de santé publique et pronanut de la république démocratique du congo 2016 12. ministère du plan et de la santé, enquête démographique et de santé, rdc 20132014 13. mpoyi i t,karibou, musau nkola a, ntambu a, mukengeshay, malonga kaj f. profil de la malnutrition sévère chez les enfants de 0 à 5 ans hospitalises a l’hgr jason sendwe. revue de pédiatrie du fleuve congo. 2014; 1(3-4):25. pubmed | google schola 14. pronanut rdc , enquêtes nutritionnelles territoriales, 2014 15. remi dit ere arama , malnutrition infanto-juvenile , tchad ,2010 16. sonde i, 2009. analyse de la prise en charge d'enfants en malnutrition au centre de récupération nutritionnelle (cren) de tanghin (burkina faso). mémoire de master complémentaire en sante publique. université de liège (ulg), 39 p. 17. unicef niger, médecin sans frontière ; document électronique consulté, 2009 18. unicef, who, wold bank group , joint malnutrition estimates ,new york,2017 edition 19. waterlow j, 2002. treatment of several ijo international journal of health sciences and nursing volume 03 |issue 05 | may 2020 www.ijojournals.com 17 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=search&doptcmdl=citation&defaultfield=title+word&term=mpoyi%20i%20t%5bauthor%5d+and++profil+de+la+malnutrition+s%c3%a9v%c3%a8re+chez+les+enfants+de+0+%c3%a0+5+ans+hospitalises+a+l%e2%80%99hgr+jason+sendwe http://scholar.google.com/scholar?hl=en&q=+profil+de+la+malnutrition+s%c3%a9v%c3%a8re+chez+les+enfants+de+0+%c3%a0+5+ans+hospitalises+a+l%e2%80%99hgr+jason+sendwe publication dr egnon 19052020 evaluation of the cost consumption of ready-to-use therapeutic foods in nutritional ambulatory therapeutic units in malnutric children from 6 to 59 months introduction social support profile is associated with increased psychological well-being and in response to important life events. social support aids in lowering problems related to one's mental health. elderly individuals who had relationships where their self-esteem was elevated were less likely to have a decline in their health. social support helps people reduce psychological distress such as anxiety or depression. social support functions as a problem-solving and emotion-focused coping strategy. several studies have been conducted based on social support. this paper addresses a description of social support, and a discussion of eleven studies that used social support. description of social support social support is the perception and reality of being cared for, having help available from other people, and most commonly, that person being part of a supportive social network. social support can be measured as the perception that an individual has help available, help already received, or the degree to which a person is integrated into a social network. support can come from many sources, such as family, friends, pets, neighbors, co-workers, and organizations. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 26 (raniaalabedhasan@gmail.com) (raniaalhasan2@gmail.com). utilization of social support: analyzing literature author: rania wa’el mohammad alabed hasan. rn, msn; al-bashir governmental hospital, jordan, amman, ashrafieh. (raniaalabedhasan@hotmail.com) (ranialabedhasan@hotmail.com) mailto:raniaalabedhasan@hotmail.com mailto:ranialabedhasan@hotmail.com mailto:raniaalabedhasan@gmail.com mailto:raniaalhasan2@gmail.com social support can be categorized and measured in several different ways. there are four common functions of social support (emotional support, tangible support, informational support, and companionship support). emotional support is the offering of empathy, concern, affection, love, trust, acceptance, encouragement, or caring. it is the warmth and nurturance provided by sources of social support. tangible support is the provision of financial assistance, material goods, or services, also called instrumental support. informational support is the provision of advice, guidance, suggestions, or useful information to someone. this type of information has the potential to help others problem-solving. companionship support is the type of support that gives someone a sense of social belonging. this can be seen as the presence of companions to engage in shared social activities. it is also referred to as "esteem support" or "appraisal support”. social support is studied across a wide range of disciplines including psychology, medicine, sociology, nursing, public health, education, rehabilitation, and social work. social support has been linked to many benefits for both physical and mental health. social support many researchers utilized social support to guide their studies ( wallace, driessnack, bohr, and tripp-reimer, 2015; gong and mao, 2016; jutagir, gudenkauf, stagl, carver, bouchard, lechner, glück, blomberg, and antoni, 2016; adisa, olajide and fakeye, 2017; li, wu, lin, zou, yang, cheng and guo, 2017; shao, liang, shi, wan and yu, 2017; zhao, mao, li, zhou and shen, 2017; kamp, luo, holmstrom, given, wyatt, 2019; langeveldt, dada, and boshoff, 2019; wallace, rodriguez, walker, dethlefs, dowd, filipi and barrington, 2019; sugiura, nouchi, honda, sato, imamura and abe, 2020). ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 27 wallace et al. (2015); gong et al. (2016); jutagir et al. (2016); adisa et al. (2017); li et al. (2017); shao et al. (2017); zhao et al. (2017). kamp et al. (2019). langeveldt et al. (2019); wallace et al. (2019) and sugiura et al. (2020). were completely dependent on the social support. wallace et al.'s study (2015) conducted a study to explore the feasibility of using the colored eco-genetic relationship map (cegrm) adapted for eliciting information about how individuals with diabetes use their social networks through support their selfmanagement efforts. however, gong et al.'s study (2016) conducted a study to assess healthrelated quality of life (hrqol) and to determine which factors, based on the wilson and cleary model, contribute to the prediction among chinese patients with rheumatoid arthritis (ra). while, jutagir et al.'s study (2016) conducted a study for the diagnosis and treatment of breast cancer (bca) that requires psychological adjustment and often involves an escalation of distress through several types of social support positively correlates with psychological adjustment to (bca), negative support is associated with poor adaptation. adisa et al.'s study (2017) conducted a study to assess available and desirable sources of social support between high blood pressure and type 2 diabetics (t2d). li et al.'s study (2017) conducted a study to assess the relationships between type d personality, disease perception, social support, and to investigate the effect of type d personality on quality of life (qol) in continuous ambulatory peritoneal dialysis (capd) patients. shao et al.'s study(2017) conducted a study to assess the effect of social support on glycemic control was sequentially mediated by self-efficacy and adherence. zhao et al.'s study (2017) conducted a study to compare demographic characteristics and source of perceived emotional or social support across the frequency of amphetamine-type stimulant (ats) use among female sex workers (fsws). kamp et al.'s study (2019) conducted a study to examine the relationship between two conceptualizations of social support (received and perceived availability of social support) and inflammatory ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 28 bowel disease (ibd)-related self-management behaviors among emerging adults. langeveldt et al.'s study (2019) conducted a study to measures of social support in raising a child with a disability through scoping review. wallace et al.'s study (2019) conducted a study to explore the types and sources of social media adult support in diabetes diagnosis and selfmanagement processes. on the other hand, sugiura et al.'s study (2020) conducted a study to identify various types of social support in an emergency disaster situation. wallace et al.'s study (2015) utilized social support through diabetes self-management, using the colored eco-genetic relationship map (d-cegrm) that appears to be possible and useful in assessing social networks for adults with diabetes and how they are used to support tasks related to self-management. the information obtained through structured questions about social support in a way that may better address the research questions. however, gong et al.'s study (2016) used the concept of social support to improve self-efficacy, relieve fatigue, delay the onset of disability, increase social support, and control disease activity through that improve the health-related quality of life (hrqol) among chinese patients with rheumatoid arthritis (ra )of this population. while jutagir et al.'s study (2016) using perceived social support items scored on likert through the sources of social support scale (ssss) divides social support by the type of support and distinguishes between the sources of support within the type. self-report emotional (listening), information (advice), instrumental (tangible assistance) and negative (arguing and criticism) support. the participants rate each item on a 5-point likert scale ranging from 1 (not at all) to 5 (lots) items measuring the same type of support were averaged on the subscales, with higher scores indicating more support. adisa et al.'s study (2017) does design and build tools for collecting data through a question that is largely open and the closed questions are divided into five sections. (section a) clarify the socio-demographic characteristics and average monthly ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 29 income. (section b) assessed the participant’s opinions on the need for a social support system and types of social support. (section c) consists of questions that explore information about sources and types of social support of the system. (section d) contained questions that explored the disease medication information. (section e) consists of 4 validated questions in the morisky adherence predictor scale administered in dichotomous response options (yes / no). li et al.'s study (2017) used the instrument as assessment of social support through applicant assessed social support status via social support rating scale (ssrs), this scale comprised of three dimensions: objective support (behavior that directly helps the person in need), personal support (providing sympathy, care, love, and trust), and the degree of usefulness of social support (support that is given and received from a social network). shao et al.'s study (2017) using social support rating scale (ssrs) designed by xiao to collect data on social support in china, measures three dimensions of social support as objective support (i.e. actual or visual support), subjective support (i.e., experience or emotional support, individual's feeling of respect satisfied in the community), and use of support (i.e. the acceptability of assistance) and 10 items of likert scale that actively looking for support. zhao et al.'s study (2017) using the perceived social support measurement is developed based on the existing literature on social support between female sex workers (fsws) and qualitative data participants were asked to respond to 12 items that reflected the social support. it was emotional support measured using 10 items, tangible support was measured using two items indicating financial support and other material support. the participants were also asked about the source of each social support item. scores were totaled under each type of social support, with a higher score indicating a higher level of support. kamp et al.'s study (2019) considered the relationship between two structures as affects the behavior of individuals in self-management, social support. among the elderly, social support has been shown improving self-management behaviors for individuals with chronic diseases, but this ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 30 relationship has not been examined with emerging adults (ages 18-29) who have inflammatory bowel disease (ibd). however, langeveldt et al.'s study (2019) utilize measures of social support and ensure its accurate measurement, the direction can be provided for intervention by allowing professionals to detect and address social support available. wallace et al.'s study (2019) categorizes four types of support: emotional, instrumental, informational, and appraisal. according to emotional support that offers empathy, love, trust, and attention, instrumental support that provides tangible aids and services that directly help the needy person, informational support that provides advice, suggestions, and information that anyone can use to address problems, appraisal support that provides useful information for self-assessment constructive feedback and confirmation. sugiura et al.'s study (2020) used five questions, these question naire items pertaining to social support through provision (helped, encouraged), and receipt through (helped, encouraged, perceived) each requiring a yes or no answer, were listed as related to mutual support, these elements were concerned with whether the respondents assisted or encouraged others during the evacuation. additionally, most of the researchers were completely depended on the social support as wallace, driessnack, bohr, and tripp-reimer, (2015); adisa, olajide and fakeye, (2017); wallace, rodriguez, walker, dethlefs, dowd, filipi and barrington, (2019). whereas wallace et al.'s study (2015), adisa et al.'s study (2017), wallace et al.'s study (2019) they do structured questions regarding social support for diabetes self-management. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 31 jutagir, gudenkauf, stagl, carver, bouchard, lechner, glück, blomberg, and antoni, (2016); li, wu, lin, zou, yang, cheng and guo, (2017). shao, liang, shi, wan and yu, (2017). they determine a scale of social support. jutagir et al.'s study (2016) perceived social support items scored on likert through the sources of social support scale (ssss), li et al.'s study (2017) assessed social support status via social support rating scale (ssrs), shao et al.'s study (2017) using social support rating scale (ssrs) designed by xiao to collect data on social support. gong and mao, (2016); jutagir, gudenkauf, stagl, carver, bouchard, lechner, glück, blomberg, and antoni,(2016); zhao, mao, li, zhou and shen, (2017); kamp, luo,holmstrom, given, and wyatt, (2019); wallace, rodriguez, walker, dethlefs, dowd, filipi and barrington,(2019); sugiura, nouchi, honda, sato and abe, (2020).they determine the type of social support. gong et al.'s study (2016) measured by using the medical outcomes study social support survey (mos-sss), the multi dimensional scale consists of four subscales that measure tangible support, affectionate support, positive social interaction, and emotional-informational support. for each component, asked the patients to assess the availability of each type of support on 5 points. jutagir et al.'s study (2016) divides social support the type of support as emotional (listening), information (advice), instrumental (tangible assistance), and negative (arguing and criticism) support. zhao et al.'s study (2017) used the perceived social support measurement on between female sex workers (fsws) and qualitative data participants were asked to respond to 12 items that reflected the social support. it was emotional support measured using 10 items, tangible support was measured using two items. kamp et al.'s study (2019) process measure by received social support for socially supportive behaviors through subscales a specific measurement types of support that received in the past four weeks: information support (guidance 14 items), emotional ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 32 support (14 items), tangible support (12 items), and the uses a 5-point likert scale. wallace et al.'s study (2019) determine the types of social support such as emotional support, automated support, informational support, evaluation support. sugiura et al.'s study (2020) provision (helped, encouraged), and receipt through (helped, encouraged, perceived) each requiring a yes or no answer. langeveldt, dada, and boshoff, (2019) measure the social support of primary caregivers by sixteen studies were included in the review. discussion of findings the eleven studies discussed previously explicitly indicate the importance of using social support. the researchers in the previous studies discussed the reason for choosing social support to guide their works. therefore, social support provides an effective assessment of the needs of individuals despite their health conditions. the strong assertion was placed on the importance of assessment of the effect of the individual‘s social supporton any changes in their lives. the strong assertion was placed on the importance of assessment of the various social supports that can affect the individuals' to any changes in their lives. the strong points of using social support were its ability to guide the directions of the studies, the ability to classify different types of social support through improving the ability to cope with stressful situations, alleviating the effects of emotional distress, promoting lifelong good mental health, enhancing self-esteem, lowering cardiovascular risks, such as lowering blood pressure, promoting healthy lifestyle behaviors. (see table 1). ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 33 summary social support has greatly influenced the profession of nursing. social support focuses on the concept of a healthy lifestyle and social relationships. nurses have a unique role to promote health in each type of social support.social support is one of the most frequently used that guides nursing research. eleven studies that utilized social support, three studies were conducted for structure question, three studies were conducted for the use of social support scale, six studies were conducted for the type of social support, one study for the review of the sixteen studies. references adisa, r., olajide, o., and fakeye, t. (2017,june). social support, treatment adherence and outcome among hypertensive and type 2 diabetes patients in ambulatory care settings in south western nigeria. original article, 51(2), 64-77. retrieved from www.ghanamedj.org. doi: http://dx.doi.org/10.4314/gmj.v51i2.4. gong ,g., and mao, j. (2016, january/february). health-related quality of life among chinese patients with rheumatoid arthritis.the predictive roles of fatigue, functional disability, self-efficacy, and social support. nursing research 65 (1), 55-67. retrieved from www.nursingresearchonline.com. jutagir, d., gudenkauf, l., stagl, j., carver, c., bouchard, l., lechner, s., glück, s., blomberg, b., and antoni, m. (2016). ethnic differences in types of social support from multiple sources after breast cancer surgery. ethnicity & health, 21 (5), 411–425. retrieved from http://dx.doi.org/10.1080/13557858.2015.1066494. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 34 http://www.ghanamedj.org/ http://dx.doi.org/10.4314/gmj.v51i2.4 http://www.nursingresearchonline.com/ http://dx.doi.org/10.1080/13557858.2015.1066494 shao, y., liang, l., shi, l., wan, c., and yu,s. (2017, may 25). the effect of social support on glycemic control in patients with type 2 diabetes mellitus: the mediating roles of self-efficacy and adherence. journal of diabetes research, 21(5), 1-8. retrieved from http://dx.doi.org/10.1080/13557858.2015.1066494. sugiura, m., nouchi, r., honda, a., sato, s., abe, t., and imamura, f. (2020, february 12). survival-oriented personality factors are associated with various types of social support in an emergency disaster situation. research article, 15 (2), 1-14.retrieved from https://doi.org/10.1371/journal.pone.0228875. kamp, k., luo, z, holmstrom, a., given, b., and wyatt, g. (2019, july/august). self management through social support. among emerging adults with inflammatory bowel disease. nursing research, 68 (4), 285-259.retrieved from www.nursingresearchonline.com. langeveldt, a., dada, s., and boshoff, k. (2019). measures for social support in raising a child with a disability: a scoping review. child care health dev, 45, 159-174.retrieved from wileyonlinelibrary.com/journal/cch. li, j., wu, x., lin, j., zou, d., yang, x., cheng, s and guo, q. (2017). type d personality, illness perception, social support and quality of life in continuous ambulatory peritoneal dialysis patients. psychology, health & medicine, 22 (2), 196-204. retrieved from http://dx.doi.org/10.1080/13548506.2016.1224371. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 35 http://www.nursingresearchonline.com/ http://dx.doi.org/10.1080/13548506.2016.1224371 http://dx.doi.org/10.1080/13557858.2015.1066494 wallace, a., driessnack, m., bohr, n., and reimer, t. (2015, march/april). diabetes self management using the colored eco-genetic relationship map to assess social support. nursing research, 64 (2), 111-116.retrieved from, from www.nursingresearchonline.com. wallace, d. rodriguez, h., walker, e., dethlefs, h., dowd, r., filipi, l., and barrington, c. (2019).types and sources of social support among adults living with type 2 diabetes in rural communities in the dominican republic. global public health, 14 (1), 135-146. retrieved from https://doi.org/10.1080/17441692.2018.1444782. zhao, q., mao, y., li, x., zhou, y., and shen, z. (2017). social support and amphetamine type stimulant use among female sex workers in china. aids care, 29 (10), 1324–1330. retrieved from https://doi.org/10.1080/09540121.2017.1328101. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 36 https://doi.org/10.1080/17441692.2018.1444782 https://doi.org/10.1080/09540121.2017.1328101 table (1): summary of studies that utilized social support findings concepts used approach/ design/ sample objectives countries authors/ years obtaining information about participants' use of social networks, expanding the diabetescegrm(dcegram)expanded on answers structured questions by identifying the positive and negative aspects of social support. structured questions regarding social support for diabetes self-management. a crosssectional survey design. explore the feasibility of using modified colored eco-genetic relationship map (cegrm) to elicit information about how diabetics use their social networks. portland. wallace, driessnack, bohr, and trippreimer, 2015. subscales were significantly lower in (ra) patients compared to the general chinese sample. lower selfefficacy, increased fatigue, increased functional disability, decreased social support, being unemployment, andhigher disease activity,more comorbidities, lowerincome level, being female, living in rural areas, and being older directly or indirectly it is significantly and negatively related to (hrqol). measure by using the medical outcomes study social support survey (mos-sss), multidimensional the scale consists of four subscalesthat measure tangible support, affectionate support, positive social interaction, and emotionalinformational support. for each component, asked the patients to assess the availability of each type of support on 5 points. a crosssectional design. to assess healthrelated quality of life (hrqol) and to determine which factors, based on the wilson and cleary model, contribute to the prediction of (hrqol) among persons with rheumatoid arthritis (ra). china. gong and mao, 2016. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 37 continued table (1): summary of studies that utilized social support findings concepts used approach/ design/ sample objectives countries authors/ years family is the biggest source of information and effective support for nhw hispanic women. hispanic originwomen reported higher negative support from male sources than the nhw women. the level of support from various sources may also depend on the time. perceived social support items scored on likert through the sources of social support scale (ssss) divides social support to the type of support as emotional (listening), information (advice), and instrumental (tangible assistance), and negative (arguing and criticism) support. experimental design. to diagnosis and treatment of breast cancer (bca) that requires psychological adjustment and often involves an escalation of distress through several types of social support positively correlates with psychological adjustment to (bca), negative support is associated with poor adaptation. taylor & francis. jutagir, gudenkauf, stagl, carver, bouchard, lechner, glück, blomberg, and antoni, 2016. the support was greatly required for a governmental and nongovernmental organization. access to family support did not positively affect medication adherence during access to financial support affected marginally outcomes among hypertensive and (t2d) patients. the tendency to be able to afford treatment significantly affected adherence and outcomes, and the need for expansion social support system to ensure consistently better results. do a design and build tools for collecting data through a question that is largely open and the closed questions are divided into five sections. cross-sectional questionnaire. to assess available and desirable sources and types of social support between high blood pressure and type 2 diabetics (t2d). ibadan, nigeria. adisa, olajide and fakeye, 2017. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 38 continued table (1): summary of studies that utilized social support findings concepts used approach/ design/ sample objectives countries authors/ years the strong association between type d personality, social support, illness perceptions, and (qol) in (capd) patients. perception of disease and level of social support are the possible mechanisms to explain the association between type d and poor quality of life in (capd) patients. assessed social support status via social support rating scale (ssrs), the scale is comprised of three dimensions: objective support, personal support, and the degree of usefulness of social support. cross-sectional, observational study. to assess the type d personality,illness perception, and social relationships support and investigation of the effect of a type d personality on quality of life(qol) in patients with continuous ambulatory peritoneal dialysis(capd). china. li, wu, lin, zou, yang, cheng and guo, 2017. social support, selfefficacy, and adherence had significant associations with glycemic control. better social support was linked better patient selfefficacy was associated with improved adherence to medication, which was associated with improved blood sugar control and the relationship between social support and glycemic control were serially and fully mediated by self-efficacy and commitment. using social support rating scale (ssrs) designed by xiao to collect data on social support in china. it measures three dimensions of social support such as: objective support (i.e. actual or visual support), subjectivesupport (i.e., experience or emotional support, individual's feeling of respectsatisfied in the community), and use of 10 items of likert scale. experimental design. to assess the effect of social support on glycemic control was sequentially mediated by selfefficacy and adherence. guangzhou china. shao, liang, shi, wan and yu, 2017. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 39 continued table (1): summary of studies that utilized social support findings concepts used approach/ design/ sample objectives countries authors/ years different types of social support from different sources can be either positively ornegatively associated with (ats) use among (fsws). use the perceived social support measurement on between (fsws) and qualitative data participants were asked to respond to 12 items that reflected the social support. it was emotional support measured using 10 items, tangible support was measured using two items. qualitative data. to explore the present case of amphetamine-type stimulant(ats) use among female sex workers(fsws) in guangxi, china and various associations examined types of social support from various sources using (ats). china. zhao, mao, li, zhou and shen, 2017. young adults who received high media support reported greater adherence to a medication when controlling biologics, time since diagnosis, and symptom frequency and feeling between adolescence and adulthood. no type of social support was associated with dietary modification. process measure by received social support for socially supportive behaviors throughsubscales a specific measurement types of support that received in the past four weeks: information support (guidance 14 items) emotional support (14 items), tangible support (12 items). andthe uses a 5-point likert scale. a convenience sample. to examine the relationship between two perceptions of social support (recipient and the perceived availability of social support) and selfmanagement behaviors associated with adult inflammatory bowel disease (ibd). university of washington, michigan state university. kamp, luo, holmstrom, given, and wyatt, 2019. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 40 continued table (1): summary of studies that utilized social support findings concepts used approach/ design/ sample objectives countries authors/ years sixteen studies were included in the review, of which nine were social support measures were identified. attributes of the measures were searched from the papers are referenced and described in terms of their reported psychometric properties. a review was conducted to determine the scope and description tools used to measure social support for primary caregivers (i.e. parents or grandparents)( raising a child (0-18 years old) with a congenital disability. sixteen studies were included in the review (a scoping review). to identify and describe studies that have measured social support for caregivers raising a child with a congenital disability with specific indication of purpose, setting, participants, definitionof social support provided and the measure of social support used. to describe the specific social support measures of the results in the first goal in terms of the rationale of the authors for development scale. there are sixteen studies were included in the review. where the first author from south africa, second author from south australia. langeveldt, dada, and boshoff, 2019. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 41 continued table (1): summary of studies that utilized social support findings concepts used approach/ design/ sample objectives countries authors/ years social support manifests itself differently, depending on the stage of diabetes experience. the types and sources of support available and needed can aid development community and clinical interventions for diabetes patients. individual social support assessment in the context of the stages of diabetes, it can assist health care providers and public health practitioners to direct social support more effectively as an important determinant of health pursuit and self-management behaviors. types of social support such as emotional support, instrumental support, informational support, appraisal support. qualitative interviews. to explore the types and sources of social media adult support in diabetes diagnosis and selfmanagement processes. latin america. wallace, rodriguez, walker, dethlefs, dowd, filipi and barrington, 2019. the respondents who were evacuated to avoid the tsunami, 21% reported that they helped and 54% encouraged another person during the evacuation, 12% of respondents received assistance, 42% encouraged by others, 54% considered themselves as such those receiving social support. females reported receiving help more often and they had higher levels from perceived support. the effect of age was not significant for any type of support. used five questions, these questionnaire items pertaining to social support through provision (helped, encouraged), and receipt through (helped, encouraged, perceived) each requiring a yes or no answer. randomly sampled from the electoral registers. to assess survival-oriented personality factors are associated with various types of socialsupport in an emergency disaster situation. australia. sugiura, nouchi, honda, sato and abe, 2020. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 42 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 1 ameliorative effect of natural spices mixture (ginger, garlic, and turmeric) on cadmium induced nephrotoxicity 1 mba eunice azuka, 2 ogugua victor nwadiogbu, 3 emmanuel ike ugwuja, 4 aniagolu miriam obiageli. 1department of medical biochemistry, college of medicine enugu state university of science and technology nigeria 2department of biochemistryuniversity of nigeria nsukka 3department of biochemistry, ebonyi state state university nigeria 4department of medical medical laboratory science, college of medicine enugu state university of science and technology nigeria abstract cadmium (cd), a known ubiquitous naturally occurring toxic element has been recognized to have deleterious effect in biological systems, affecting mostly the testis, liver, pancreas, kidneys, and bone. cd accumulates mainly in the kidney and liver which are critical targets for its acute toxicity. evaluation of toxic potentials of this metal is important for the risk assessment of those ordinarily exposed to it. this study investigated the effects of natural spices mixture on renal toxicity in rats exposed to cadmium. graded doses (200 mg, 300 mg, and 400 mg/kg body weight) of natural spices mixture were administered orally to the rats. after forty two days, significant increases in serum urea, and cratinine concentrations were observed in cadmium exposed rats compared to control group (p < 0.05). natural spices mixture treatment of cadmium exposed rats significantly loweredurea and creatinine concentrations, compared to cadmiumalone group (p < 0.05).natural spices mixture had significantly decreased all renal function parameters and protected kidney cells against cd induced toxicity. the histology evaluation of kidney tissues of the experimental rats showed that the induction of cd toxicity without treatment caused significant glomerular necrosis, while the administration of natural spices mixture protected the kidney tissues from necrosis and other pathological changes. the results of this study supported the potential ameliorative effects of natural spices mixture on rat kidney tissues against cadmium induced nephrotoxicity. key words: cadmium chloride; natural spices mixture (ginger, garlic, and turmeric); kidney; urea; creatinine; rat. introduction background of study in the present era, environmental contamination is one of the significant constraints of modern human society (ali and khan 2019; afzal et al., 2019). among environmental contaminants, heavy metals (hms) are the most toxic due to their persistent and bioaccumulative nature; thus, creating a deleterious risk to biological substances (ali et al., 2008). globally, the rate of hm mobilization and transport in the ecological system has been extraordinarily expanded since the 1940s due to rapid growth rate of industrialization (anyanwu et al., 2018). although, these metals naturally exist in the soil in a very minute concentration through characteristic lithogenic as well as pedogenic means (wuana and okieimen, 2011). however, various anthropogenic practices including mining, improper industrial as well as urban waste disposal, combustion of non-renewable energy sources, metallurgical industries, chemical fertilizers, and improper handling of industrial effluents are fundamental contributors to aggregate these metals in soil (tchounwou et al., 2012; yuan et al., 2019). non-essential hms including lead (pb), cadmium (cd), and silver (ag) have no or very little biological activity and their exposure above permissible limit poses a hazard to biological systems by interfering with their physiological and metabolic processes, contaminating food chain, causing ecological imbalances and resulting in lethal health issues due to their toxic nature (haider et al., 2021). cadmium is a highly noxious hm that is deleterious for biological systems through its uptake and accumulation in phototrophs and consequent trophic transportation. cadmium is released into the environment via both natural and anthropogenic systems. among natural systems, volcanic emissions, forest fires, weathering of cd-containing rocks, and waste water are the principal means of mobilizing it from the lithosphere (choppala et al., 2014). anthropogenic activities such as application of phosphate-based fertilizers (roberts 2014), manufacturing of ni–cd batteries, zn mining, agricultural practices such as waste water irrigation, electroplating, application of urban compost as well as metal-based pesticides, and industrial emission as a byproduct (zhao et al., 2015) are mainly responsible for cd aggregation in soil. human exposure to cadmium and cadmium compounds may occur in both occupational and environmental settings, the latter primarily via the diet and drinking water (atsdr, 1989). a variety of industrial activities can lead to cd exposure. examples includes mining and metallurgical processing, combustion of fossil fuel (genchi et al., 2020), textile printing, production of phosphate fertilizers, recycling of ferrous ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 2 scrap, electronic waste, motor oils, disposal and incineration of cd-containing products.the increasing industrial uses of cadmium causes soil, air and water contaminations. however, human exposure to cadmium occurs chiefly through inhalation and ingestion of contaminated food and water (ige et al., 2011). tobacco in all its forms contains appreciable amounts of cd and tobacco smoke is one of the largest single sources of cd exposure in humans (ibiam and uwakwe (2009). foods derived from plants, depending on the level of soil contamination, generally contain higher concentrations of cd than meat, egg, milk, and dairy products. among these, rice and wheat, green leafy vegetables,potatoes, carrot, and celery can contain higher concentrations of the metal than other food from plants. vegetarians and shellfish consumers may be exposed to a higher cadmium intake than omnivores (sirot et al., 2008). studies have proposed various mechanisms for cd toxicity which include, modification of biomolecules, modulation of dna repairs and genotoxic effects, antagonism and displacement of bivalent metal ions (zinc, selenium, calcium, and copper from their binding sites), induction of oxidative stress and impairment of p53 protein involved in suppression of cancer (anetor, 2012; el-boshy et al., 2015; gong and wang, 2019). cadmium toxicity in liver seems to be mediated by the production of reactive oxygen spices (ros) known to induce necrosis in various rat organs (razinger et al., 2008, hsu et al., 2007), lipids peroxidation (borges et al., 2008) and decrease in antioxidant enzymes (el-sharaky et al., 2007). condiments such as ginger, garlic, and turmeric which have been generally used as spices, flavouring agent, food preservative and medicine, have been revealed to play important role in the amelioration of heavy metal toxicity. this may be due to the presence of biologically active polyphenols and antioxidants present in them (el-sayed et al., 2015). for example, concurrent intake of garlic, ginger and nutmeg at culinary dose in diet has been found to have both therapeutic and prophylactic effect at mitigating cd toxicity (ugwuja et al., 2016). this reaffirmed the safety of spices combinations as being currently practiced. some agents like curcumin, caffeic acid, phenylethyl ester found in spices like turmeric have been shown to be effective in preventing cadmium toxicity (gong et al., 2012 gong et al., 2014). similarly, studies have shown that ginger (zingiber officinale) has ameliorative effect against cadmium-induced liver and kidney injury in rat model (egwurugu et al., 2007; mohammad et al., 2013). eteng et ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 3 al. (2014) have also demonstrated the reversal of cadmium induced toxicity after dietary supplementation with garlic, ginger and cabbage in male albino rats. statement of problem cadmium toxicity occurs even at a very low level in the blood and toxicity is usually without obvious signs and symptoms. with increase in industrialization/urbanization, heavy metals, including cadmium are released into the ecosystem, which will ultimately find its way into human systems. accumulation of cadmium in human systems, if left untreated may lead to adverse health effects, especially in pregnant women and children, who have been found to be most vulnerable (gehan and ayman, 2010). nanoparticle based antidote is very expensive and not readily accessible. many chelating agents and antagonists have been found to reduce cd toxicity, but part of them reveals undesirable side effects, intrinsic limitations and variability in the efficacy (gonick, 2008; jalilehvand et al., 2009). reports have been inconsistent on the roles of spices in protecting against cadmium toxicity. considering the rise in industrial activities with exponential emission of toxic metals, including cadmium, which has been classified as a category one carcinogen (iarc, 1994), coupled with reports of beneficial effects of nutrients and natural spices at ameliorating heavy metal toxicity, there is need to explore the potential beneficial effect of spices mixture at mitigating cd toxicity. aim and objectives this study was carried out to investigate the effects of natural spices mixture (ginger, garlic, and turmeric) on cd-induced nephrotoxicity in male albino rats, and therefore sought to: 1. determine the levels of serum urea and creatinine in order to assess the effects of administration of natural spices mixture on renal function of cadmium-induced nephrotoxicity in albino rats. 2. examine thekidney cell histology of the rats for morphological changes due to administration of natural spices mixture on cadmium-induced nephrotoxicity in albino rats. 3. compare the levels of these chemical parameters, and histological changes in the treated rats in relation to the control rats. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 4 significance of the study the data generated from this study may have policy relevance in designing mitigating strategy at reducing/preventing cd toxicity, especially in cadmium polluted settings for the improvement of health and wellbeing of residents. scope of the study this is a sub-acute study, and is limited to animal model – adult male albino rats of age 120 – 150 days. materials and methods subjects – rats twenty adult male albino rats, weighing between 150 and 205g were used for this study. the rats were obtained from the animal house of enugu state university of science and technology, college of medicine (esucom), enugu. they were arranged into five groups (a, b, c, d, and e) of four rats each and were kept for five days to acclimatize before initiating the study. they were allowed free access to clean drinking water, and were fed on standard growers mash rat pellets (grand cereals ltd, enugu) throughout the period of the study. the rats in group a were not induced with cadmium chloride, received no treatment with natural spices mixture, and served as normal control, while group b was administered 25 mg/kg body weight of cadmium chloride (cdcl2) without any treatment with natural spices mixture, and served as positive control. those rats in groups c, d, and e were induced with 25 mg cdcl2/kg body weight and treated with graded concentrations 200 mg/kg, 300 mg/kg, and 400 mg/kg body weights respectively for forty two days. all administrations were through oral route. two rats from each group were sacrificed at the end of the treatment period and their kidneys harvested. reagents and chemicals analytical grade of cadmium chloride (cdcl2) in the form of pure crystals were obtained from riedel-de haenagseelze-hannover germany through the analar grade laboratory reagents and chemical dealer at ogbete main market, enugu state. the reagents used for the biochemical assays were commercial test kits and products of randox (usa). ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 5 natural spices mixture ginger rhizomes, garlic bulbs and turmeric rhizomes were purchased from ogbete main market enugu, enugu state. the ginger, turmeric and garlic were peeled and all the three spices were washed with water. exactly 5.0g of each spice were homogenized and soaked overnight in distilled water. it was filtered and the filtrate was concentrated at 600c using electric oven. it was carefully evapourated to dryness in water bath at 400c (sofowora, 1977). collection of blood samples and preparation of serum at the end of the experiment (42 days), the animals were fasted overnight for sample collection and harvest of organs. the specimens (blood samples) were collected through the retro-bulbar plexus of the nasal canthus, into plain bottles, for the estimation of the chemical parameters. serum samples were prepared from the whole blood as follows: three milliliters (3ml) of whole blood was collected into clean plain test tube. this was allowed to clot and retract, and then centrifuged at 3,000 rpm for five minutes. the supernatant (serum) was separated from the sediment (red cells) and transferred into another clean plain test tube, for the chemical analyses. all serum samples were refrigerated (-4oc) until they were analysed. two rats from each group were sacrificed by euthanasia, with chloroform, their kidney dissected out and fixed in 10% formol saline solution, for histological studies. serum urea and creatinine estimation serum urea concentration was estimated by the modified diacetylmonoxime method of wybenga et al., 1971; while serum creatinine concentration was determined using alkaline picrate method of fabiny and ertingshaysen, 1971. principles in acid solution, diacetylmonoxime is hydrolysed to diacetyl, which reacts with urea to form a pink condensation product, which is measured at 480nm. the concentration of urea in each sample was determined by interpolation from urea standard curve. creatinine in the sample reacts with picrate in alkaline medium, forming a red-orange coloured complex. the intensity of ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 6 the colour read at 500nm is directly proportional to the concentration of creatinine present in the sample. the complex formation rate is measured in a short period to avoid interference from non-creatinine chromogens and creatinine present in the samples was interpolated from the creatinine standard curve. histopathological examination the histological evaluation was carried out using the method described by drury et al., (1967). tissue sections of the kidney from all the experimental groups were fixed in 10% formol saline for a minimum of 48 hours. the tissues were subsequently processed in an automatic tissue processor (trimmed, dehydrated in graded concentrations of alcohol (70%, 80%, 90%, and absolute alcohol), cleared in three grades of xylene and embedded in molten paraffin wax). on solidifying, thin sections (about 4-5 microns thick) were cut using rotary microtome, and stained by heamatoxylin and eosin (h & e) method, permanently mounted on degreased glass slides using dpx mountant. the prepared slides were examined using a light olympus microscope (magnification x100). the photomicrographs were taken using microscope camera at x400 magnification. staining principle haematoxylin was used as a nuclear stain preceding staining of cytoplasm and connective tissues with eosin. sections were stained with haematoxylin stain of sufficient power and for long enough to ensure some overstraining of nuclei, the superfluous and obscurative coloration of structures being removed by treatment with acid alcohol. eosin stains connective tissues and cytoplasm in varying intensity and shades of primary colour giving a most useful differential stain with haematoxylin. analysis of reslts statistical analysis of results was carried out using statistical product and service solutions (spss) version 20. results were expressed as mean ± standard error. statistical differences were evaluated using one way analysis of variance (anova), followed by duncan's multiple range test to detect the significant differences among the mean values of the different groups at p-values < 0.05. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 7 results after forty two days, significant increase in serum urea and creatinine were observed in cadmium-exposed rats without treatment, compared to the normal control group (p< 0.05), while treatment with natural spices mixture had significant effects on these renal function parameters. natural spices mixture treatment of cadmium exposed rats significantly lowered serum urea and creatinine concentrations compared to the cadmium alone group (p < 0.05). the concentrations of urea (2.48±0.10 mmol/l), and creatinine (50.25±1.18 µmol/l) in group d, which were treated with 300 mg/kg body weight of natural spices mixture were comparable with their levels in the normal control (2.74±0.05 mmol/l; 49.50±1.32 µmol/l), showing better ameliorative effect at mid dose. group e rats which were treated with high dose of natural spices mixture recorded a non significant decrease (p > 0.05) when compared to cadmium alone group (table 1). the histological evaluation of kidney tissues of the experimental rats showed that the normal control rats had normal histological architecture characterized by intact convoluted tubules (ct) and glomeruli (g) as shown in plate 1. however, the induction of cd toxicity without treatment caused a significant glomerular necrosis (plate 2), while the administration of natural spices mixture 300 mg/kg, protected the kidney tissues from necrosis and other pathological changes (plate 3). morphological changes in those groups treated with low dose of sm (200 mg/kg) and high dose of same (400 mg/kg) manifested as mild capsular hypertrophy, brush border loss, and tubular atrophy (plates 4, and 5). table 1: effect of spices mixture on the indices of renal function of cadmium induced toxicity in albino rats parameters group a group b group c group d group e urea (mmol/l) 2.74±0.05 5.88±0.14 3.80±0.08 2.48±0.10 5.63±0.15 creatinine (µmol/l) 49.50±1.32 106.75±1.18 65.50±1.32 50.25±1.18 81.75±3.93 results are expressed as mean + standard error of mean (n = 4). ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 8 plate 1. photomicrograph of normal control kidney. the kidney tissues showed intact convoluted tubules (ct) and glomeruli (g). h & e. magnification 100 x ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 9 plate 2. photomicrograph of cadmium exposed but untreated kidney. the kidney tissues showed glomerular necrosis (circled area), and hypertrophy of capsular space. h & e. magnification 100 x plate 3. photomicrograph of the group that received 300 mg sm/kg b.w. the kidney tissues appeared normal with intact convoluted tubules (ct) and glomeruli (g). h & e. magnification 100 x ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 10 plate 4. photomicrograph of the group that received 200 mg sm/kg b.w. the tissues showed mild tubular atrophy and loss of brush boarders h & e. magnification 100 x plate 5. photomicrograph of the group that received 400 mg sm/kg b.w. tissue showed mild tubular atrophy and loss of brush borders h & e. magnification 100 x ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 11 discussions the diverse deleterious health effect upon exposure to heavy metals in the environment, especially cadmium (cd), a heavy metal of considerable toxicity with destructive impact on most organ system, is of serious concern and a global issue. literature survey shows different treatment methods for cd toxicity such asnanoparticle based treatments and use of chelating agents. the main disadvantage of synthetic chelators is that the chelation process removes vital nutrients along with toxic metals. however, natural spices mixture (ginger, garlic, and turmeric) could provide a credible alternative to the presently used drugs for the amelioration of cadmium toxicity to avoid long term adverse health effects. this study evaluated the ameliorative effects of natural spices mixtures on cadmium nephrotoxicity. in the present study, serum urea, and creatinine were estimated to assess renal glomerular function. the data obtained showed significant increase in renal function biomarkers; urea, and creatinine following six weeks of cd exposure. this can be attributed to the impairment of the kidney, muscle wasting (weight loss), and dehydration (diarrhea) caused by the toxicant. the change in the levels of serum renal biomarkers represents renal damage caused by cd as reported by bekheet et al., (2011). these data were supported by others who reported that cadmium toxicity induced tubular necrosis or loss of the brush border and damage in the small tubules of kidney (wang et al., 2011). studies by jacquillet et al., (2006) suggested that in chronic cd2+ contamination, cd2+ has an effect in the proximal as well as in distal tubule, leading to a pronounced renal defect. this can affect the filtration as well as absorption of these substances in the renal tubules. in addition to that, the elevated blood urea and creatinine concentrations, caused by cadmium toxicity may be related to disorder in protein catabolism as a result of increase in the synthesis of arginase enzyme involved in urea production (tormanen, 2006), and glomerular functional disturbances such as lower filtration rate which results in poor creatinine clearance in cadmium intoxicated rats (l'azou et al., 2002). the levels of renal function parameters, urea and creatinine, of group treated with 300 mg natural spices mixture/kg body weight, was comparable to those of normal control and achieved ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 12 https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6717148/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6717148/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6717148/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6717148/ a statistically significant decrease (p < 0.05) when compared with cdcl2 induced but untreated group. groups treated with low dose (200 mg/kg), or medium dose (300 mg/kg) of natural spices mixture, were better protected from cd nephrotoxicity. treatment with high dose of natural spices mixture (400 mg/kg), caused a non significant (p > 0.05) decrease in the serum urea, and creatinine. the degree of increase in the levels of these renal parameters may be an indication of extent of renal tissue damage and impairment of kidney functions references afzal, h., ali, s., rizwan, m., rehman, m. z., qayyum, m. f., wang, h., and rinklebe, j. (2019). responses of wheat (triticum aestivum) plants grown in a cd contaminated soil to the application of iron oxide nanoparticles. ecotoxicol. environ. saf.173: 156–164. ali, h., khan, e., and ilahi, i. (2019). environmental chemistry and ecotoxicology of hazardous heavy metals: environmental persistence, toxicity, and bioaccumulation. j. chem.2019: 1–14. ali, b. h., blunden, g., tanira, m. o., and nemmar, a. (2008). some phytochemical pharmacological and toxicological properties of ginger (zinger officinale roscoe): a review of recent research. food chem. toxicol. 46(2): 409–420. anetor, j.i. (2012). rising environmental cadmium levels in developing countries: threat to genomestability and health. environmental anal toxicology,2:4-12. anyanwu, b. o., ezejiofor, a. n, igweze, z. n., and orisakwe, o.e. (2018). heavy metal mixture exposure and effects in developing nations: an update. toxics.6(4): 65. atsdr (agency for toxic substances and disease registry). (1989). toxicological profile for cadmium. atsdr/u.s. public health service, atsdr/tp-88/08. bekheet, s. h., awadalla, e. a., salman, m. m., and hassan, m. k. (2011). bradykinin, potentiating factor isolated from buthus occitanus venom has a protective effect against cadmium induced rat liver and kidney damage. tissue cell, 43:337–343. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 13 borges, l. p., brandao, r., gadio, b., nogueira, c. w., and zeni, g. (2008). oral administration of diphenyldiselenide protects against cadmium induced liver damage in rats. chemical biologyinteract,171: 15-25. choppala, g., bolan, n., bibi, s., iqbal, m., rengel, z., kunhikrishnan, a., ashwath, n., and ok, y. s. (2014). cellular mechanisms in higher plants governing tolerance to cadmium toxicity. crit rev. plant sci. 33: 374–391. drury, r. a., wallington, a., and cameroun, s. r. (1967). in: carletons histological techniques. oxford university press, new york. pp 1-420. el-boshy, m.e., risha, e.f., abdelhamid, f.m., mubarak, m.s., and hadda, t.b. (2015). protective effects ofselenium against cadmium induced haematological disturbances, immunosuppressive, oxidativestress and hepatorenal damage in rats. journal of trace elements medical biology, 29:104-10. el-sayed, y.s., el-gazzar, a. m., el-nahas, a. f. and ashry, k.m. (2016). vitamin c modulates cadmium induced hepatic antioxidants gene transcripts and toxicopathic changes in nile tilapia, oreochromis niloticus. environmental science of pollution research ,23:1664-1670. el-sharaky, a. s., newairy, a.a., badreldeen, m. m., and eweda, s. m. (2007). protective role of selenium against renal toxicity induced by cadmium in rats. toxicoogy,235: 185-193. eteng, m.u., onwuka, f.c., akpanyung, e.o., osuchukwu, n.c., bassey, s.c., and nwankpa, p. (2012). reversal ofcadmium induced toxicity following dietary supplementation with garlic, ginger and cabbage inmale wister rats. journal of natural products and plant resources,2(1):169-74. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 14 fabiny, d. l. and ertingshausen, g; (1971). automated reaction rate method for determination of serum creatinine with centrifuchem: clinical chemistry17: 696 – 700. gehan, a.e. and ayman, y.a. (2010). cadmium – ginger two way antagonistic relationships. arab journal of biotechnology,3 (1): 115-124. genchi, g., carocci, a., lauria, g., sinicropi, m.s., and catalano, a. (2020). nickel: human health and environmental toxicology. international environmental research in public health, 17: 679-685. gong, p., chen, f.x., liu, x.y., gong, x., wang, j., and ma, y.m. (2012). protective effect of caffeic acid phenylethylester against cadmium-induced renal damage in mice. journal of toxicological science, 37: 415–425. gong, p., chen, f., wan, l., wang, j., jin, s. and ma, y. (2014). protective effects of blueberries(vaccinium corymbosum) extract against cadmium-induced hepatotoxicity in mice. environmentaltoxicology and pharmacology,37:1015-1027. gonick, h.c. (2008). nephrotoxicity of cadmium & lead. indian j. med. res., 128:335–352. haider, f. u, liqun, c., coulter, j. a, cheema, s. a, wu, j., zhang, r., wenjun, m., and farooq, m. (2021). cadmium toxicity in plants: impacts and remediation strategies. ecotoxicolological and environmental safety211: 111887. hsu, p.c. and guo, y.l. (2002). antioxidant nutrients and lead toxicity. toxicology,180: 33– 44. iarc (1994). cd, hg, be, and the glass industry. monograph on the evaluation of risk to human. (58). lyons, france. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 15 ibiam, u.a. and uwakwe, a.a. (2009). levels of cadmium in different brands of cigarettes sold in abakaliki metropolis of nigeria. african journal of biochemical research, 3(8): 317320. ige, s.f., akhigbe, r.e., edeogho, o., ajao, f.o., owolabi, o.q., oyekunle, o.s. and ajayi, a.f. (2011). hepatoprotective activities of allium cepa in cadmium-treated rats. international journal ofpharmacological science,3 (5): 60-63. jacquillet, g.,barbier, o., cougnon, m.,tauc, m., namorado, m.c., martin, d., reyes, j.l., and poujeol, l. (2006). zinc protects renal function during cadmium intoxication in the rats. american journal of physiology,290(1): 127-137. jalilehvand, f., leung, b.o., and mah, v. (2009). cadmium (ii) complex formation with cysteine and penicillamine. inorg. chem., 48: 5758–5771. l'azou, b., dubus, i., ohayon-courtès, c., , j., perez l., pouvreau, c., juvet, l., and cambar, j. (2002). cadmium induces direct morphological changes in mesangial cell culture. toxicology. , 15: 233–245. mohammad, s.i., mustafa, i.a., and abdulqader, s.z. (2013). ameliorative effect of the aqueous extract ofzingiber officinaleon the cadmium-induced liver and kidney injury in female rats. jordan journal of biolologicalscience,6(3): 231-234. razinger, j., dermasti, m., koce, j. d., and zrimec, a. (2008). oxidative stress in duckweed caused by short-term cadmium exposure. environmental pollutant,159: 687-694. roberts, t. l. (2014). cadmium and phosphorous fertilizers: the issues and the science. procedia engg.83: 52–59. sirot, v., samieri, c., volatier, j. i., leblank, j. (2008). cadmium dietary intake and biomarker data in french high seafood consumers. journal of exposure science and environmental epidemiology,18(14); 400-409. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 16 sofowora, a. (1997). the state of medicinal plants 1st edn. enugu-nigeria: university of ibadan. tchounwou, p. b., yedjou, c. g., patlolla, a. k., and sutton, d. j. (2012). heavy metal toxicity and the environment. molecular clinical and environmental toxicology,101: 133-164. tormanen, c. d. (2006). inhibition of rat liver and kidney arginase by cadmium ion. j. enzyme inhib. med. chem.21: 119–123. ugwuja, e.i., erejuwa, o.o., and ugwu, n.c. (2016). spices mixture containing garlic, ginger and nutmeghas protective effects on the kidneys and liver of cadmium exposed rats. advancedpharmaceutical bulletin,6 (2): 271-274. wang, x., zheng, z., guo, x., yuan, j., and zheng, c. (2011). preparative separation of gingerols from zingiber officinale by high-speed counter-current chromatography using stepwise elution. food chem., 125: 1476–1480. wuana, r. a., and okieimen, f. e. (2011). heavy metals in contaminated soils: a review of sources, chemistry, risks and best available strategies for remediation. isrn ecol2011: 1– 20. zhao, f. j., ma, y., zhu, y. g., tang, z., and mcgrath, s. p. (2015). soil contamination in china: current status and mitigation strategies. environ sci technol,49: 750–759. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 06 | issue 08 | august 2023 | http://www.ijojournals.com/index.php/hsn/index 17 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || efficacy of mandibular advancement device in obstructive sleep apnea syndrome *correspondig author: rakotoson mariette department of dento-facial orthopedics, institute of tropical odonto-stomatology of madagascar, university of mahajanga, madagascar abstract mandibular propulsion device is a non-surgical, mechanical means of treating sleep apnea. left untreated, osa can have serious consequences. the aim of this study was to evaluate the efficacy of mandibular advancement orthoses in the treatment of obstructive sleep apnea syndrome (osas). this was a systematic review including ten recent articles reporting on mandibular advancement orthosis and osa. the articles concerned described the efficacy of the mandibular orthosis in reducing nocturnal apneas and hypopneas. despite its place as a second-line therapy in the face of continuous positive airway pressure (cpap), the mandibular orthosis can be complementary to cpap. key words: apnea, efficiency, mandible, syndrome. 1department of dento-facial orthopedics, institute of tropical odonto-stomatology of madagascar, university of mahajanga, madagascar 2department of prosthodontics, institute of tropical odonto-stomatology of madagascar, university of mahajanga, madagascar 3department of ear, nose and throat (ent), university hospital andohatapenaka antananarivo ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 33 rakotoson m1*, lalanirina gl2, rajaonarison lf3, ratsirarisoa t1, andriniaina fa1, andrinjakarivony nn1, rakotoharinivo hz1, rasoanirina mo1, randrianarimanarivo hm1 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || 1. introduction obstructive sleep apnea syndrome (osas) is defined as the occurrence during sleep of abnormally frequent episodes of complete or partial obstruction of the upper airways, responsible for interruptions (apneas) or significant reductions (hypopneas) in ventilation. of the upper airways, responsible for significant interruptions (apneas) or reductions (hypopneas) in ventilation. the frequency of obstructive airway events is considered abnormal when there are more than 10 apneas or hypopneas per hour of sleep (apnea-hypopnea index (ahi) greater than 10) [1]. prevalence is estimated at 2% in women and 4% in men in the general population [2]. its consequences can be serious for the patient and those around him or her: risk of daytime sleepiness with domestic or traffic accidents, cardiovascular complications: atherosclerosis, arterial hypertension, coronary ischemia and stroke [3]. mandibular propulsion orthoses (mpos) represent a non-surgical mechanical means of treating sleep apnea. they are devices designed to propel the mandible during sleep, in order to enlarge the pharyngeal airway [4]. the aim of this study was to evaluate the efficacy of the mandibular advancement orthosis in the treatment of obstructive sleep apnea syndrome (osas). 2. methodology type of study: study based on a systematic review. study duration: the study ran from january to february 2024. study population: the study focused on articles evaluating the effectiveness of mandibular advancement orthoses on obstructive sleep apnea syndrome (osas) using the prisma method. inclusion criteria: we included all articles evaluating the effectiveness of mandibular advancement orthoses on obstructive sleep apnea syndrome (osas) before 2024, in english and french. sampling: a total of 10 articles were selected. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 34 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || search strategy: the search engines used were pubmed and sciences direct using the keywords: " apnea, efficiency, mandible, syndrome" indicated in mesh bilingue and the search operators used were: "and, or, not". variables: the subject variable was based on the effectiveness of mandibular advancement orthoses on obstructive sleep apnea syndrome (osas). articles orthodontics et periodontics year of publication continent language types of articles effectiveness of mandibular advancement orthoses on obstructive sleep apnea syndrome (osas) data collection and analysis: data were then collected on a pre-tested and validated data extraction form and analyzed on spss 21.0. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 35 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || 3. results number of articles titles and authors results 1 orthodontic appliances for sleep apnea, a cephalometric and poysomnographic study. david m, saba sb, rodenstein d, rombaux p « orthodontic appliances are unquestionably effective in reducing the number of obstructive apneas and hypopneas.» [5] 2 long-term dental and skeletal effects of mandibular advancement devices in adults with obstructive sleep apnea: a systematic review patel s, rinchuse d, zullo t, wadhwa r “ mandibular advancement orthoses can cause a statistically significant, albeit slight, change in dentition when worn for long periods. » [6] 3 mandibular advancement device use in obstructive sleep apnea: orcades study 5-year follow-up data vecchierini mf, collet jm, mariepia, goutorbe f, kerbrat jb, leger d, et al « mandibular advancement device therapy remained effective in >50% of patients after 5 years” [7] 4 a mandibular advancement device for the treatment of obstructive sleep apnea: long-term use and tolerance brette c, ramanantsoa h, renouardierea j, renouardiere r, roismana g, escourrou p « opm j reduces symptoms of longterm sahos.» [8] 5 orthodontics treatments for managing obstructive sleep apnea syndrome in children: a systematic review and meta-analysis huynh nt, desplats e, almeida fr « these orthodontic treatments may be effective in managing pediatric snoring and obstructive sleep apnea” [9] 6 the first steps of the management of sleep apnea syndrome in yaounde massongo m, bouba ad, siafa ba, adamou bd, komo nme, yone pew « compliance and therapeutic efficacy were judged to be good» [10] ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 36 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || 7 preventive dentofacial orthopedic treatment of childhood apnea/hypopnea syndrome? guibert m, garcia r “early adapted treatment should reduce this risk” [11] 8 epidemiological, clinical and evolutionary profile of obstructive sleep apnea syndrome in department of respiratory diseases of the chu ibn rochd in casablanca zaghba n, chaanoun k, benjelloun h, yassine n “mandibular was prescribed in 86% of cases.” [12] 9 relationship between edentulism and sleep apnea: a systematic review of the literature ammar s, mabrouk y, labidi a, mansour l, trabelsi m “in 6 studies, an improvement in sleep apnea was noted with wearing the prosthesis at night” [13] 10 sleep apnea and prosthodontic implications chander ng “it is vital to be aware sleep disorders and the possible impact that can aid in providing effective care to the patients reporting to prosthodontic clinics” [14] 4. discussion sleep apnea syndrome (sas) is a sleep disorder characterized by a cessation or reduction in respiratory flow. it is defined by the number of apneas and hypopneas per hour. the diagnosis of sas is made as soon as the apnea index (ai) is greater than five (recording of more than 5 apneas per hour) or as soon as the apnea hypopnea index (ahi) is greater than ten (recording of more than 10 apneas and/or hypopneas per hour) [1]. removable braces are proposed for snoring patients with a measured index greater than 35, irrespective of the presence or absence of osa. the degree of mandibular advancement depends on the individual's maximum propulsion capacity, without inducing pain in the temporomandibular joints [15]. the quietknight is a device consisting of two thermoplastic parts linked together by a mechanical system. the two parts are softened in boiling water for a ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 37 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || few minutes and then molded onto the upper and lower teeth. a hook system is attached to the upper part of the appliance and engages with a clamp on the lower part. a screw in the upper hook system is inserted to adjust the mandibular advancement of the lower part of the appliance. the appliance allows the patient to breathe through the mouth. the mandibular positioner (mp) is a mandibular propulsion device made of thermoformable plastic, which joins the lower jaw to the upper jaw in a propulsive movement. from the outset, it does not allow oral respiration or any other mandibular movement. the herbst propulsion device has been in use for many years. a system of connecting rods holds the mandible in the propulsive position and allows this forward movement to be adjusted [16]. this device offers the advantage of enabling some mandibular movements, such as opening and closing the mouth, but also lateral movements. the mandibular positioner and herbst are made from the patient's own dental casts. patients were asked to wear their appliance every night for one month. at the end of this period [5]. according to the authors, when the prosthesis is placed in the mouth, the mandible rotates downwards. activity of the genioglossus is increased, which may widen the retro-lingual space by shifting the tongue forward [17]. the prosthesis can also promote an increase in the neuromuscular activity of the pharyngeal muscles, which is typically reduced during sleep, and can induce changes in the position of the mandible, soft palate and tongue, helping to improve pharyngeal permeability [17]. some authors have also considered that, in the supine position, the intercuspidation provided by the prosthesis could act as a brake against backward displacement of the mandible [18]. the prosthesis restores the vertical dimension of occlusion and consequently increases the retro-pharyngeal space [19]. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 38 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || in this respect, a cephalometric analysis of a subject with a prosthesis in the mouth showed an average increase of 1.88mm in the width of the retro-pharyngeal space and an average increase of 2.20mm in the depth of the pharynx compared with the analysis without a prosthesis [17]. mandibular advancement orthoses are currently considered to be the treatment of choice for osa [20]. 4. conclusion osa combines a reduction in the size of the upper airways with an alteration in their muscular activity. removable propulsive appliances can reverse these alterations by moving the mandible anteriorly and changing the position of the soft palate and tongue. orthodontic appliances are effective because they increase the size of the upper airway, provide a stable anterior position for the mandible, move the tongue and soft palate forward, and modify the activity of the genioglossal muscles. these devices improve nocturnal ventilation without impairing sleep quality. the treatment is simple, reversible, non-invasive and cost-effective. references 1. spicuzza l, caruso d, di maria g. obstructive sleep apnoea syndrome and its management. ther adv chronic dis 2015, vol. 6(5) 273–85. 2. meslier n. vol s, balkau b, gagnadoux f, cailleau m, petrella a, racineux j.l, et al. prevalence of symptoms of sleep apnea syndrome. study in a middle-aged french population. rev mal respir 2007; 24 : 305-13. 3. yaggi hk, et al. obstructive sleep apnea as a risk factor for stroke and death. new engl j med 2005;353:2034–41. 4. cohen-levy j, garcia r, petelle b, fleury b. treatment of the obstructive sleep apnea syndrome in adults by mandibular advancement device: the state of the art. int orthod 2009;7:287-304. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 39 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || 5. david m, saba sb, rodenstein d, rombaux p. orthodontic appliances for sleep apnea, a cephalometric and poysomnographic study. bull. group. int. rech. sci. stomatol. odontol. 2000 ; 42 : 73-81. 6. patel s, rinchuse d, zullo t, wadhwa r. long-term dental and skeletal effects of mandibular advancement devices in adults with obstructive sleep apnoea: a systematic review. international orthodontics 2019; 17: 3–11. 7. vecchierini mf, collet jm, marie-pia, goutorbe f, kerbrat jb, leger d, et al. mandibular advancement device use in obstructive sleep apnea: orcades study 5-year follow-up data. j clin sleep med. 2021 ; 17(8):1695–705. 8. brette c, ramanantsoa h, renouardierea j, renouardiere r, roismana g, escourrou p . a mandibular advancement device for the treatment of obstructive sleep apnea: long-term use and tolerance. international orthodontics 2012 ; x : 1-14. 9. huynh nt, desplats e, almeida fr. orthodontics treatments for managing obstructive sleep apnea syndrome in children: a systematic review and meta-analysis. sleep medicine reviews 25 (2016) 84-94. 10. massongo m, bouba ad, siafa ba, adamou bd, komo nme, yone pew. the first steps of the management of sleep apnea syndrome in yaounde. health sci. dis: vol 25 (1) january 2024 : 51-58. 11. guibert m, garcia r. preventive dentofacial orthopedic treatment of childhood apnea/hypopnea syndrome? j dentofacial anom orthod 2015;18:312. 12. zaghba n, chaanoun k, benjelloun h, yassine n. epidemiological, clinical and evolutionary profile of obstructive sleep apnea syndrome in department of respiratory diseases of the chu ibn rochd in casablanc. j func vent pulm 2021; 36(12): 1-75. 13. ammar s, mabrouk y, labidi a, mansour l, trabelsi m. relationship between edentulism and sleep apnea: a systematic review of the literature. iajd 2021;12(1): 48-57. 14. chander ng. sleep apnea and prosthodontic implications. the journal of indian prosthodontic society.2020;20(4):335-7. 15. marklund m, franklin ka, sahlin c, lundgren r. the effect of a mandibular advancement device on apneas and sleep in patients with obstructive sleep apnea. chest. 1998 ; 113 : 707-13. 16. eveloff se, rosenberg cl, carlisle cc, millman rp. efficacy of a herbst mandibular advancementt device in obstructive sleep apnea. am. j. respir. crit. care med. 1994 ; 149 : 905-9. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 40 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || 17. gassino g, cicolin a, erovigni f, carossa s, preti g. obstructive sleep apnea, depression, and oral status in elderly occupants of residential homes. int j prosthodont 2005;18:316-22. 18. bucca cb, carossa s, colagrande p, et al. effect of edentulism on spirometric tests. am j respir crit care med 2001; 162:1018 20. 19. arisaka h, sakuraba s, tamaki k, watanabe t, takeda j, yoshida k. effects of wearing complete dentures during sleep on the apnea-hypopnea index. int j prosthodont 2009;22:173-7. 20. chaccur dc, bittencourt lr, lucchesi l, et al. assessment of the impact of vertical dimension alterations on the quality of sleep in elderly patients wearing upper and lower full dentures. sleep sci 2012;5:1-6. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 41 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette¹* https://ijojournals.com/index.php/ volume 07 || issue 01 || january., 2024 || oral and dental health of users of psychoactive substances at the andranomena centre in toliara authors: randriamalala njarasoa charlette1, andriamanjato hasina menja2,andrianjafinoro tsiriniaina hasinjanahary1, rakotonirina faliniaina paul1,ramaroson juvence3 1 : formerintern in odontostomatology, institute of tropical odonto-stomatology of madagascar, university of mahajanga madagascar 2 : former intern in psychiatric, university hospital, tuléar, madagascar 3 : full professor in odontostomatology, institute of tropical odontostomatology of madagascar,university of mahajanga madagascar abstract the use of psychoactive substances can have a negative impact on general health, social life and oral health. the consequences from an oral health point of view are manifold and will depend on the products consumed, the mode of consumption, the duration of the addiction and the quantity ingested. the aim of this study was to evaluate the oral and dental condition of drug addicts at the foyer d'amitié andranomena toliara support centre for the mentally ill. our sample consisted of 40 male patients, with an average age of 26.8 years. cannabis use alone was reported by 37.5% of patients, and co-addiction with alcohol was recorded in 27.5% of cases and 22.5% for tobacco. the dcao index was 17.4 for 11.2 decayed teeth, 5.4 missing teeth and 0.8 filled teeth. for periodontal status, we used the community periodontal index in treatment needs (cpitn). according to the cpitn scale, 85% of patients were in code 2, requiring scaling and oral hygiene education. patients who use psychoactive substances are at high risk of dental caries and periodontal disease. oral and dental care is necessary to improve patients' quality of life. key words: users of psychoactive substances, oral condition, cao index, periodontal condition introduction according to saint-pierre, a doctor of dental surgery and psychotherapist, the mouth is a place of pleasure, but it can also become a place of danger, where drugs and psychotropic substances pass through [1]. the word "drug" is defined as "any substance that alters the functioning of the mind and/or body". a drug or psychoactive substance refers to a medicine that affects the central nervous system and alters consciousness and/or perceptions [2]. ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 8 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette¹* https://ijojournals.com/index.php/ volume 07 || issue 01 || january., 2024 || psychoactive substances are classified as licit, for example alcohol, tobacco or illicit products such as cannabis, amphetamine, cocaine and opiates [3]. the oral area partly reflects our state of health. however, the use of psychoactive substances can have a negative impact on general health, social life and oral health. the consequences from an oral and dental point of view are manifold and depend on the products consumed, the mode of consumption, the duration of the addiction and the quantity ingested. according to a study carried out in norway in 2019, 78% of illicit drug users suffer from dental caries and periodontal disease [4]. in australia in 2019, multiple substance users have more decayed and missing teeth than non-users [5]. in madagascar, few studies have been carried out on the prevalence of oral health and the use of psychoactive substances. the general objective of this study is to assess the oral and dental condition of drug addicts at the andranomena toliara support centre. methodology the study took place at the centre d'accompagnement des malades mentaux at the foyer d'amitié andranomena toliara. a cross-sectional prospective descriptive study was carried out. the study period ran from january 2020 to march 2020. all patients who had taken psychoactive substances and stayed at the centre during the study period were included in the study. patients who refused to take part in the survey or who had difficulty answering the questionnaire were excluded. we opted for an exhaustive sampling method given the numbers of patients accommodated at the centre. the sample consisted of 40 participants two assessment criteria were used to evaluate the oral condition of patients: firstly, the dmf (decayed, missing, filled) index, which is used to measure the incidence of caries disease in the population. this index is calculated by totalling the number of decayed, missing and filled teeth in permanent dentition over the number of subjects examined [6], then the community periodontal index in treatment needs (cpitn) was used to assess the periodontal care needs of our population. this index used clinical criteria recognised in the prevention and treatment of periodontal disease, such as the quantification of periodontal pockets, gingival inflammation and the presence of dental plaque. the principle is to assign a score according to the periodontal ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 9 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette¹* https://ijojournals.com/index.php/ volume 07 || issue 01 || january., 2024 || condition of the teeth examined. the results were presented using a scoring system to define the need for periodontal care [7]. table i: cpitn scale co de 0 no bleeding, no tartar, no pockets no need for care co de 1 no bleeding, no tartar, no pockets teaching oral hygiene (eho) co de 2 max. 3 mm pocket with tartar or overflowing filling (black area of probe completely visible) scaling, eho, removal of overflowing fillings co de 3 4 to 5 mm pocket (black area of probe partially masked) complex periodontal therapy including surfacing co de 4 minimum 6 mm pocket (black area of probe completely hidden) complex periodontal therapy, including surgical or non-surgical planing as required co de 5 edentulous area or 1 tooth complex periodontal therapy and prosthetic rehabilitation pre-prepared, tested survey forms were used to collect data, and an interview was carried out as well as a thorough oral examination to gather information. data were processed and analysed using spss for windows, version 20. the results were considered significant for a value of p<0.05. the confidentiality of information, professional secrecy, medical ethics and the privacy of participants ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 10 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette¹* https://ijojournals.com/index.php/ volume 07 || issue 01 || january., 2024 || are respected. the reliability of the results of this study depends on the sincerity of the participants' answers and their recall. results table ii: breakdown of users of psychoactive substances by social profile patient profile n % type male 40 100 female 0 0 age range [15 to 25 years[ 17 42,5 [25 to 35 years old[ 16 40 [35 to 45[ 4 10 ≥ 45 years 3 7,5 total 40 100,0 the entire sample was male. the most common age bracket was [25 to 35[, with 40% of the sample being male. ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 11 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette¹* https://ijojournals.com/index.php/ volume 07 || issue 01 || january., 2024 || table iii: breakdown of the sample by consumption of psychoactive substances psychoactive substances n % cannabis 15 37,5 alcohol + cannabis 11 27,5 tobacco + cannabis 9 22,5 alcohol + tobacco + cannabis 4 10 other drugs 1 2,5 total 40 100,0 cannabis is the substance most used by our sample (37.5%). however, co-addiction with other legal substances was observed, including alcohol in 27.5% of cases and tobacco in 22.5%. table iv: breakdown of sample by cao index tooth decay filled tooth missing tooth dfmt index standard deviation 11,2 0,8 5,4 17,4 9,1 the dfmt index was 17.4 for 11.2 decayed teeth, 5.4 missing teeth and 0.8 filled teeth. ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 12 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette¹* https://ijojournals.com/index.php/ volume 07 || issue 01 || january., 2024 || table v: breakdown of the sample by start of consumption and cao index age at start of consumption (in years) dfmt dfmt ˂ 3 3≤ dfmt˂ 8 dfmt ≥ 8 total n % n % n % n % [15 to 24 years[ 0 0 2 5 21 52,5 23 57,5 [25 to 34 years[ 0 0 3 7,5 7 17,5 10 25 [35 to 45 years[ 2 5 4 10 1 2,5 7 17,5 total 2 5 9 22,5 29 72,5 40 100 fifty-two point five percent (52.5%) of patients who started taking psychoactive substances between the ages of 15 and 25 have an dfmt ≥ 8 table vi: breakdown of the sample by cpitn indicator cpitn index n % code 0 0 0 code 1 0 0 code 2 34 85 code 3 3 7,5 ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 13 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette¹* https://ijojournals.com/index.php/ volume 07 || issue 01 || january., 2024 || code 4 2 5 code 5 1 2,5 total 40 100,0 according to the cpitn index, code 2 is the most common with 85%, although no people were registered in codes 0 and 1. table vii: breakdown of sample by consumption start and cpitn index cpitn age of onset [15 to 25 years[ [25to35 years[ [35 to45 years[ total n % n % n % n % code 0 0 0 0 0 0 0 0 0 code 1 0 0 0 0 0 0 0 0 code 2 16 40 12 30 6 15 34 85 code 3 2 5 1 2,5 0 0 3 7,5 code 4 2 5 0 0 0 0 2 5 code 5 1 2,5 0 0 0 0 1 2,5 total 20 52,5 13 32,5 6 15 40 100 an age of onset of consumption of [15 to 25 years] had codes 2, 3, 4 and 5 with 40%, 5%, 5% and 2.5% respectively. discussion social profile of patients what can we say? this study ismade up of 40 male patients, according to the study carried out by alson in 2018 on sociodemographic and clinical factors linked to cannabis use in the psychiatric department of the joseph raseta befelatanana university hospital, 94% of the study population was male [8]. moreover, the friendship centre is a residential site run by brothers, hence the totality of the male population in our study; the mean age of the study population was 26.8 years. the extremes of age ranged from 15 to 48 years; ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 14 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette¹* https://ijojournals.com/index.php/ volume 07 || issue 01 || january., 2024 || on the other hand, a case control study carried out by arora in 2019 showed that the average age of drug addicts was 30.8 years [9]. consumption of psychoactive substances thirty-seven point five per cent (37.5%) of patients used cannabis alone, and co-addiction with alcohol was recorded in 27.5% of cases and 22.5% for tobacco. according to joshi in 2016, substance use is systematically associated with smoking and alcohol consumption, both of which have harmful effects on the oral cavity [10]. caries and users of psychoactive substances our population suffers from polycaries with a dmft index of 17.4 for 11.2 decayed teeth, 5.4 missing teeth and 0.8 filled teeth (standard deviation 9.1, minimum 0, maximum 20). baghaie et al in 2017 showed that opiate users had more decayed teeth + 5.6 and fewer missing teeth than controls (-0.4) [11]. a case-control study was carried out in brazil in 2018 confirming that there were more decayed and missing teeth and fewer filled teeth than controls [12]. in fact, dental caries is the result of tooth demineralisation due to the acids produced by the fermentation of sugars by bacteria [13]. however, among consumers, hyposalivation and even xerostomia are common [14], and the buffering effect of saliva is reduced, leading to an increased risk of dental caries [15]. fifty-two point five (52.5%) of the patients who started taking psychoactive substances between the ages of 15 and 25 had a dmft > 8. this result is highly significant. according to a meta-analysis carried out in 2015, the longer the duration of drug use, the greater the risk to oral health. a significantly higher dmft was recorded in patients reporting use of 4 years or more [16]. in addition, poor oral hygiene, frequent sugar intake, no dental visits, an irregular lifestyle and longterm drug use increase the vulnerability of psychoactive substance users to caries [17]. periodontal status and psychoactive substance users according to the cpitn scale, 85% of patients are in code 2, requiring scaling and oral hygiene education. however, 12.5% of the sample require more complex periodontal therapy (codes 3 and 4). a 2017 meta-analysis of oral health and drug use found that drug users are more likely to have periodontal disease than non-users [11]. a highly significant association was recorded between the cpitn index and the onset of drinking age. ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 15 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette¹* https://ijojournals.com/index.php/ volume 07 || issue 01 || january., 2024 || this could be explained by the fact that poor oral hygiene leads to the proliferation of bacteria in plaque and gingival pockets, as well as initiating the development of inflammation leading to periodontitis, and by the effect of psychoactive substances on the periodontium itself [18]. in addition, smoking is a major risk factor for periodontal disease, which is widespread among illicit drug users [19]. conclusion in conclusion, this study provided an overview of the oral health of patients addicted to psychoactive substances. they are at high risk of dental caries and periodontal disease. oral health care is necessary to ensure that mastication and digestion function properly, and to improve patients' aesthetics and quality of life. a kap (knowledge, attitude, practice) study of users of psychoactive substances on oral and dental health is planned. conflicts of interest we declare that no conflicts of interest arose during this study. references [1] saint-pierre f. the mouth between pleasure and suffering. paris: eska.2000 [2] hanson gr, venturelli, pj, fleckenstein ae. drugs and society. 2005. jones & bartlett: 9th edn. sudbury. [3] united nations office on drugs and crime: world drug report 2008. [4] djou r, dewi ts. oral manifestation related to drug abuse: a systematic review: manifetasi oral terkait penggunaan obat-obatan terlarang: sebuah tinjauan sistematis. dentika dental journal. 2019;22(2):44-51 [5] teoh l, moses g, mccullough m. oral manifestations of illicit drug use. australian dental journal. 2019;64(3):213-22. [6] world health organization, editor. oral health surveys: basic methods. 5th edition. geneva: world health organization; 2013. 125 p. [7] marques tcn, sarracini klm, cortellazzi kl, mialhe fl, de castro meneghim m, pereira ac, et al. the impact of oral health conditions, socioeconomic status and use of specific substances on quality of life of addicted persons. bmc oral health. 2015;15(1):38. [8] alson re. sociodemographic and clinical factors related to cannabis use. thesis med . 2018. [9] arora pc, ragi kg, arora a, gupta a. oral health behavior and treatment needs among drug addicts and controls in amritsar district: a case-controlled study. j neurosci rural pract 2019;10:201-6. ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 16 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette¹* https://ijojournals.com/index.php/ volume 07 || issue 01 || january., 2024 || [10] joshi s, ashley m. cannabis: a joint problem for patients and the dental profession. br dent j 2016; 220: 597-601. [11] baghaie h, kisely s, forbes m, sawyer e, siskind dj. a systematic review and meta-analysis of the association between poor oral health and substance abuse. society for the study of addiction. 2017. doi:10.1111/add.13754 [12] antoniazzi r, zanatta f, ardenghi t, feldens c. the use of crack and other illicit drugs impacts oral healthrelated quality of life in brazilians. oral dis. 2018;24(3):482-8. [13] kumar s, tadakamadla j, johnson n. effect of toothbrushing frequency on incidence and increment of dental caries: a systematic review and meta-analysis. journal of dental research. 2016;95(11):1230-6 [14] yazdanian m, armoon b , noroozi a, mohammadi r, bayatah, ahounbare, higgs p, nasab hs, bayani a, hemmat am. dental caries and periodontal disease among people who use drugs: a systematic review and meta-analysis. bmc oralhealth. 2020 ; 20 (1) :44 [15] stookey gk. the effect of saliva on dental caries. the journal of the american dental association. 2008;139:11s-7s. [16] truong a, higgs p, cogger s, jamieson l, burns l, dietze p. oral healthrelated quality of life among an australian sample of people who inject drugs. j public health dent. 2015;75(3):218-24. [17] teng p-r, lin m-j, yeh l-l. utilization of dental care among patients with severe mental illness: a study of a national health insurance database. bmc oral health. 2016;16(1):87 [18] dania b, muath a, abeer a, jevae l n, fahad h, riddhi b, hesham a, tejasvita c, satomi o, constantine i v, israel t a. cocaine, polysubstance abuse, and oral health outcomes, nhanes 2009 to 2014. j periodontol . 2020 ;91(8):1039-48 [19] weinberger ah, funk ap, goodwin rd. a review of epidemiologic research on smoking behavior among persons with alcohol and illicit substance use disorders. preventive medicine. 2016;92:148-59. ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 17 https://pubmed.ncbi.nlm.nih.gov/?term=bahdila+d&cauthor_id=31919844 https://pubmed.ncbi.nlm.nih.gov/?term=aldosari+m&cauthor_id=31919844 https://pubmed.ncbi.nlm.nih.gov/?term=abdullah+a&cauthor_id=31919844 https://pubmed.ncbi.nlm.nih.gov/?term=nelson+jl&cauthor_id=31919844 https://pubmed.ncbi.nlm.nih.gov/?term=hegazi+f&cauthor_id=31919844 https://pubmed.ncbi.nlm.nih.gov/?term=badamia+r&cauthor_id=31919844 https://pubmed.ncbi.nlm.nih.gov/?term=alhazmi+h&cauthor_id=31919844 https://pubmed.ncbi.nlm.nih.gov/?term=chandel+t&cauthor_id=31919844 https://pubmed.ncbi.nlm.nih.gov/?term=odani+s&cauthor_id=31919844 https://pubmed.ncbi.nlm.nih.gov/?term=vardavas+ci&cauthor_id=31919844 https://pubmed.ncbi.nlm.nih.gov/?term=agaku+it&cauthor_id=31919844 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson m1* * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ orthodontic typology of obstructive sleep apnea syndrome in mahajanga, madagascar." orthodontic typology of obstructive sleep apnea syndrome in mahajanga, madagascar rakotoson m1,2*, randrianandraina mp3,4, ralaizafindraibe th3,6,raotoson h2,3, rakotoarison kka2, randrianarimanarivo hm1 1department of orthodontics, institute of tropical odonto-stomatology of madagascar (iostm) ; madagascar 2department of maxillofacial surgery, hospital professor zafisaona gabriel,madagascar 3faculty of medicinemahajanga; madagascar 4department of otorhinolaryngology (ent), hospital professor zafisaona gabriel,madagascar 5department of thoracicsurgery, hospital professor zafisaona gabriel, madagascar correspondingauthor : rakotoson mariette department of orthodontics, institute of tropical odonto-stomatology of madagascar (iostm) ; madagascar abstract purpose:the aim of ourstudywas to describe the orthodontictypology of studentswith osa in mahajanga madagascar. material and methods:this is a cross-sectional descriptive study on a student population of the university of mahajanga madagascar on world health day in 2024 at the university campus. sampling wasconducted in simple randomness. the data wasanalyzed on the sppss 25.0 software. results:the surveyidentified 120 studentswith a sex ratio of 0.84. the averageagewas 22 years. the prevalence of osa was 11.6%. the classification of the shift of the bony bases ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 9 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson m1* * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ orthodontic typology of obstructive sleep apnea syndrome in mahajanga, madagascar." wasdominated by class i at 50% of studentswhohad osa. the exooralexamination of the profile in the sagittal direction evaluated a convex profile at 85.7%. conclusion: osa is a seriousunderdiagnosedpathology in madagascar. the decliningintellectuallevel of studentscould have something to do withtheirhiddenhealth situation. dentofacial orthopedicsparticipates in the screening of thispathology in order to improve the health of the population in our country. key words:obstructive sleepapnea, madagascar, dentofacial orthopedics. 1. introduction obstructive sleepapnoea syndrome (osa) isdefined by the occurrence of abnormallyfrequentepisodes of complete or partial obstruction of the upperairwayduringsleep, resulting in total interruption (apnea) or significantreductions (hypopnea) in ventilation [1]. obstructive sleepapnea-hypopnea syndrome (osahs) isfeared, in addition to the cardiovascular complications it can induce or increase, for chronic fatigue, excessive daytimesleepiness, but also for the difficulties in concentration and attention to whichit exposes [2]. the literaturereview reports the prevalence of osa in the general population in the order of 4 to 5% of men and 2% of women [3].sleepdisorders are extremelycommon (4086%) in children and adolescents [4]. obstructive sleepapnea syndrome (osa) can have an impact on attention and learningskills. the student population maybeconfrontedwiththispathologywhich can alter itsability to assimilate. the objective of ourstudywas to describe the orthodontictypology of studentswith osa in mahajanga madagascar. 2. materials and methods this is a cross-sectional descriptive study. the studyiscarried out on a student population of the university of mahajanga madagascar during the universityhealth week dedicated to world health day in april 2024 at the university campus. sampling wasconducted in simple ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 10 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson m1* * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ orthodontic typology of obstructive sleep apnea syndrome in mahajanga, madagascar." randomness.the data collectedwereenteredinto an electronicsurveyformusing the access® software version 2007. the data wasanalyzed on the sppss 25.0 software. eachstudent's consent wasobtainedprior to their inclusion in the study and recalledprior to the start of the exam. the purpose of the study and all stages of the reviewwereexplainedorally. the confidentiality of information, humanrights, the rights to freedom of opinion, professionalsecrecy and privacy have been respected. 3. results the surveyidentified 120 studentswith a sex ratio of 0.84. the averageagewas 22 years. table 1 : gender distribution gender number percentage male 55 45,8% female 65 54,2% total 120 100% table 2 : age distribution age numbre percentage 18-23 yearsold 80 66,6% 24-30 yearsold 40 33,3% total 120 100% table 3 : distribution by gender and presence of sleepapnea(n=120) sleepapnea gender number percentage male 6 5% ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 11 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson m1* * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ orthodontic typology of obstructive sleep apnea syndrome in mahajanga, madagascar." female 8 6,6% total 14 11,6% table 4 : distribution by dental class (n=120) classe dentaire gender class i class ii class iii male 25 (20,8%) 18 (15%) 12 (10%) female 32 (26,6%) 23 (19,1%) 10 (8,3%) total 57 (47,5%) 41 (34,1%) 22 (18,3%) table 5 : distribution by profile (n=120) profile gender convex concave male 45 (37,5%) 10 (8,3%) female 56 (46,6%) 9 (7,5%) total 101 (84,1%) 19 (15,8%) 4. discussion our study reports a higher percentage of studentswithsleepapnea in the femalegender, while the literature states that the riskfactors for the development of sleepapneaare:obesity, male gender, age, black race, alcohol and tobacco and male genderisconsidered a predisposing factor. the frequency of osa ishigher in men than in women [5]. the literatureindicatesthatsnoringincreaseswithage and thatitisexacerbated, amongotherthings, by alcohol, smoking, sedatives, sleepdeprivation [6]. a studycarried out in kinshasa in 2008 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 12 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson m1* * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ orthodontic typology of obstructive sleep apnea syndrome in mahajanga, madagascar." reported a high percentage of subjectswith obstructive sleepapnea syndrome in groups of subjectsaged 25 to 35 years at 28.6% [7]. this differs in ourstudy, withstudentsaged 18 to 23 being more numerous at 66.6%. nevertheless, dayyat et al. proposedin 2007 a classification of osa intothree types [8].types 1 and 2 have in common the usualrespiratorysigns (snoring, restlesssleep, laboredbreathing, mouthbreathing, parent-describedbreathing stoppages, excessive sweating) and the possible existence of parasomnias (bedwetting, night terrors, and nightmares). in type 1, itismainlyyoung people who are not overweight, withmarkedadetonsillarhypertrophy and oftenwith attention deficithyperactivitydisorders, whereas in type 2 the children are overweightwithvisceral and truncalobesity, an increased neck diameter, and lessadenotonsillarhypertrophythan in type 1, but on the other hand, excessive daytimesleepiness and psychologicaldisorders (low self-esteem, depression, pathologicalshyness) are much more frequent, as well as cardiovascular and metabolic complications.type 3 osa occurs in subjectswithneurological, malformative or genetic pathologies, withcraniofacial malformations, neuromuscular or skeletalinvolvement (trisomy 21, prader-willi syndrome, pierre-robin syndrome, achondroplasia, craniostenosis) [9]. the prevalence of osa wasestimated at 3.23% [10], but ourstudyreveals a prevalence of 11.6%. the standard treatmentismostoftencontinuous positive airway pressure (cpap), but also a mandibular advanced orthosis, which have been reported by severalauthorsincludingrakotoson m et al in 2024 [11]. the mandibularadvancementorthosis can simultaneouslytreat a skeletal class ii, whichconstitutes 34.1% of ourstudy population.the convex profile makes up the majority of ourstudy population at 84.1%, whichcorroborates the study by rakotoson m et al in 2023 [12,13]. 5. conclusion osa is a serious and underdiagnosed condition in madagascar. the observation of excessive daytimesleepinessshouldbefearedbecause the decliningintellectuallevel of studentscould have ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 13 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson m1* * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ orthodontic typology of obstructive sleep apnea syndrome in mahajanga, madagascar." a relationshipwiththeirhiddenhealth situation. dentofacial orthopedics or orthodonticsparticipates in the screening of thispathology in order to improve the health of the population in our country. references 1.kelly a, evans. screening commercial vehicle drivers for obstrctivesleepapnea: tools, barriers, and recommendations. occupationalhealth and safety. 2017. 2.nowinski a, plywaczewski r, hawrylkiewicz, sliwinski p, gorecka d. probnplevel for screening of cardiovascular complications in obstructive sleepapnea. proc am thorac soc. 2006;3. 3.ba f, sène m, el hddjimba, fatou bintou s, arame m, ousmane c. obstructive sleepapneahypopnea syndrome in sub-saharanafrica:areview of the literature. sleepmedicine2020;17:169-76. 4.schröder cm. autismspectrumdisorders, sleep and biologicalrhythms. in:sleep, rhythms and psychiatry. eds cm schröder & i poirot, dunod2016. 5.escourrou p, meslier n, raffestin b. whatis the clinicalapproach and diagnostic procedure for osa?rev mal res2010;27:115-23. 6.arnulf i, derenne jp. « le sas ». medecine/sciences1999;15:807-14. 7.ntima-nsiemi ak, mbuila cn, kayembe jmb. risk of road accidents among bus drivers in kinshasa and signs suggestive of sleepapnea syndrome. healthsci. 2021;22:838. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 14 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson m1* * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ orthodontic typology of obstructive sleep apnea syndrome in mahajanga, madagascar." 8.dayyat e, kheirandish-gozal l, gozal d. childhood obstructive sleepapnea: one or two distinct diseaseentities? sleep med clin2007;2:433–44. 9.dayyat e, kheirandish-gozal l, gozal d. childhood obstructive sleepapnea: one or two distinct diseaseentities? sleep med clin2007;2:433–44. 10.ntima-nsiemi ka, kayembe jm, mbuilac;prevalence of signs suggestive of obstructive sleepapnoeahypopnea syndrome in kinshasa (drc). interest of management with the mandibularadvancementorthosis. ann. afr. med. 2017;11:1. 11.rakotoson m, lalanirina gl, rajaonarison lf, ratsirarisoa t, andriniaina fa, andrinjakarivony nn, rakotoharinivo hz, et al. efficacy of mandibularadvancementdevice in obstructive sleepapnea syndrome. ijp international journal of health sciences and nursing. 2024;7:33-41. 12.rakotosonm, rabarijaona sg, ralaizafindraibeth, andriniaina fa, ratsirarisoat, andrinjakarivonynn, rasoanirinamo, et al. obstructive sleepapnea syndrome (osas) management in dento-facial orthopedics. magna scientia advanced researchand reviews2023;07:035–41. 13.rakotoson m, andriniaina fa, ratsirarisoa t, andrinjakarivony n, rasoanirina mo, andriambololo-nivo rd, randrianarimanarivo hm. skeletalcephalometric profile of childrenaged 6 to 12 yearsaccording to steiner'sanalysis in mahajangamadagascar. rosmel2020;19:30-6. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 15 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar abstract the aim of this cross-sectional descriptive study was to describe the attitude and practice of odontostomatologists towards fixed prosthetics. a survey based on a questionnaire containing 6 items concerning sociodemographic and clinical characteristics, attitude, practice of standard guidelines on pre-prosthetic preparation and on impression taking was carried out among 114 odontostomatologists in practice in the urban commune of antananarivo madagascar in 2023, practicing fixed prosthetic restoration. univariate and bivariate analyses were performed using spss 25.0 software. the chi² test was used to compare proportions. the differenceis significant for p<0.05 with a confidence level of 95%. the sex ratio was 1.59; 77.2% worked in private practices; 59.6% worked less than 8 hours a day; 62.3% treated fewer than 10 patients a day. all (100%) of those surveyed offered their patients a prosthetic restoration. when preparing abutment teeth, 34.2% took a preoperative radiograph, 12.3% used a retraction cord, 75.4% used diamond burs. for the impression, 55.3% used alginate, 92.1% always disinfected it. the use of standard guidelines for fixed prosthetic restorations was influenced by gender (p=0.029), post-graduate training (p=0.001), place of practice (p=0.006), number of years in practice (p=0.01). a more in-depth and wider-ranging study of odontostomatologistspractising throughout madagascar would be desirable to fully identify the reality of their practice. ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 1 authors :volahasina valentina andrianasolo, jacques adrien ramagason, florian adélis andriniaina, boris roger tsaralahy, gael lauricia lalanirina, simone rakoto alson, liantsoa fanja emmanuel ralaiarimanana (1) department of prosthodontics, institute of tropical odonto-stomatology of madagascar, university of mahajanga, madagascar (2) department of oral surgery, institute of tropical odonto-stomatology of madagascar, university of mahajanga, madagascar (3) department of orthodontics, institute of tropical odonto-stomatology of madagascar, university of mahajanga, madagascar (4) department of periodontology, institute of tropical odonto-stomatology of madagascar, university of mahajanga, madagascar ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar key words: assesment practice, odontostomatologist, fixed prosthesis, antananarivo madagascar introduction dentures are synthetic replacements for missing natural teeth. some types of dentures are designed to replace a few missing teeth. other types of dentures replace all the teeth, gingiva and even surrounding tissues [1]. joint prostheses or fixed prostheses are a range of therapeutic methods designed to replace missing teeth and/or reconstruct decayed teeth to restore function and aesthetics in a context of optimal bio-integration. it can be dental or implant-supported [2]. it is the treatment of choice for the reconstruction of decayed, discolored or missingteeth, particularlywhencomfort and esthetics are paramount [3]. in fact, it provides the patient with a sense of well-being and good masticatory efficiency. its natural appearance and irremovable character help patients regain their self-esteem in the case of anterior edentulous teeth [4]. the different types of fixed dental prostheses are : dental crowns, to cover damaged teeth. dental bridge; used to replace one or more lost teeth, and can be adapted to a number of different situations. implant-supported dentures; this is a type of prosthesis that uses permanent dental implants to hold replacement teeth in place [5]. to ensure the longevity of the fixed prosthesis, which is the most delicate of all prostheses, perfect mastery of the clinical and laboratory sequences is essential, something not all odontostomatologists (os) and prosthetists can achieve. many errors can be accumulated during the production of a fixed ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 2 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar prosthesis, with inevitable repercussions on the durability of the dento-prosthetic element, including the loss of dental abutments [5,6]. treatments must meet patients' needs, which are essentially aesthetic or functional in nature, and are very often linked to socio-cultural factors. the main complaints mentioned by patients were occlusal (31.6%), followed by pulpal (27.8%) and finallyaesthetic and periodontal (15.6%) [7]. in madagascar, data on fixed prosthesis are scarce/limited, hence the interest of this work whose objectives were to: describe the attitude and practice of odontostomatologists (os) regarding fixed prostheses; analyze the relationship between sociodemographic and clinical profiles and the attitude and practice of oss towards fixed prosthetics. methods this is a descriptive cross-sectional study of odontostomatologists(os) working in the city of antananarivo (antananarivo urban district called cua), in the analamanga region, madagascar. the study ran from december 2022 to april 2023. as study population, we chose dental surgeons practicing in the city of antananarivo, in private, inter-company, public and military dental practices. dental surgeons practising for more than 05 years and registered with the national order of odontostomatologists were included in our study. os not practising fixed prosthetic restoration and those who were absent and uncooperative during the survey were excluded. sampling was carried out exhaustively. the independent variables were inspired by ghoneim's model [8]. these variables were : sociodemographic variables: gender, total years of practice, postgraduate training, place of work; clinical characteristics: number of hours worked per day, number of patients seen per day. ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 3 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar the dependent variables focused on the attitude and practice of os on the standard guideline to be followed in fixed prosthetic practice. the surveys were carried out at the dental surgery. initially, we contacted the sos and explained to them the purpose of our study, and the value of their cooperation in our study. after obtaining their informed consent, we proceeded to fill in their respective survey forms. after the survey, the questionnaires were counted manually. data were processed and analyzed using statistical package for the social sciences (spss) 25.0. univariate and bivariate analyses were performed to examine frequency distribution and association between independent and dependent variables, respectively. the chi² test was used to compare percentages. the difference is significant for p< 0.05 at the 95% confidence level. results of the two hundred and twenty-three (223) os practicing in the cua , 114 met our inclusion criteria.  socio-demographic characteristics (table i) among the study population, 61.4% were male, with a sex ratio of 1.59, and 57% had been working for more than 15 years. nine point six percent (9.6%) of the study population worked in public dental practices, 77.2% in private practices, 7.9% in inter-company centers and 5.3% in military dental practices. of these, 35% had specialised after obtaining their state doctorate diploma.  clinicalcharacteristics(table ii) in terms of total hours worked per day, 59.6% worked less than 08 hours. the number of os treating fewer than 10 patients per day was 62.3%. ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 4 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar  osattitude all the surgeons advisedtheir patients to have a fixed coronal restoration.  os practice in fixed prosthesis design  pre-prosthetic check-up forty point four percent (40.4%) of os always used a mouth model before making a fixed prosthesis; 42.1% rarely used it and 17.5% never used it (table iii). for dental technicians who had attended post-graduate training courses after their thesis, 57.5% always used a mouth model, 25% used it rarely and 17.5% never used it. in contrast, 31.1% of os who had not attended training courses after their thesis always used a mouth model, 51.4% rarely used it and 17.6% never used it. the difference is statistically significant (p=0.012). (table iv) thirty-four point two percent (34.2%) of os always took radiographs of the abutment teeth; 43% rarely did so and 22.8% of os never did so (table iii). sixty percent (60%) of dental technicians who had undergone post-graduate training did so always, 22.5% rarely and 17.5% never. and for os who had not undergone training after their thesis, 20.3% always took a preoperative x-ray, 54.1% rarely did so, and 25.7% never did. the difference is highly statistically significant (p=.0.001). (table iv) for the pulp vitality test on abutment teeth, 96.5% of os did so, while 3.5% did not (table iii).  preparingabutmentteeth the retracting cord was always used by 12.3% of os, 7% rarely and 80.7% never (table vi). no os working between 5 and 10 years used the retracting cord, 6.3% of os working between 10 and 15 years always used it, and 18.5% of os working more than 15 years. the differenceishighlystatisticallysignificant (p= 0.001). (table v) in terms of the type of burr used for dental preparation, 7.9% used tungsten carbide burs, 75.4% used diamond burs and 16.7% used both types of burs at the same time (table vi).in terms of the type of burr used for dental ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 5 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar preparation, 7.9% used tungsten carbide burs, 75.4% used diamond burs and 16.7% used both types of burs at the same time (table vi). for those os who took a diploma course after their thesis, 15% used tungsten carbide burs, 60% used diamond burs and 25% used both types of burs. os who did not follow diploma courses afterwards used tungsten carbide burs for 4.1% of them, 83.8% used diamond burs and 12.2% used both types of burs. the differenceisstatisticallysignificant (p= 0.015). (table vii) for those os who took a diploma course after their thesis, 15% used tungsten carbide burs, 60% used diamond burs and 25% used both types of burs. os who did not follow diploma courses afterwards used tungsten carbide burs for 4.1% of them, 83.8% used diamond burs and 12.2% used both types of burs. the differenceisstatisticallysignificant (p= 0.015). (table vii) as for the type of burr used, 63.6% of os working in the public sector used diamond burs and 27.3% tungsten carbide burs. os in the private sector used diamond burs for 80.7% and 2.3% used tungsten carbides. for os working in inter-company centers, 55.6% used diamond burs and 22.2% used tungsten carbides. among military os, 50% used diamond burs and 33.3% tungsten carbide burs. the differenceishighlystatisticallysignificant (p=.0.006). (table viii)  impression taking fifty-five point three percent (55.3%) of os surveyed used alginate as impression material, 43.9% used silicone and 0.9% used other materials. (table ix) fifty-two point nine percent (52.9%) of the male gender used silicone versus 47.1% for alginate. for the female gender, 29.5% used silicone versus 68.2% who used alginate. the difference is statistically significant (p= 0.029). (table x) fifty-seven point five percent (57.5%) of os with diploma training used silicone and 40% used alginate. os who had not completed a diploma course after their thesis used alginate as an impression material for 63.5% of them, and 36.5% used silicone. the differenceisstatisticallysignificant (p= 0.029). (table xi) ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 6 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar all the dental surgeons used inter-occlusal registration for the replacement of severalteeth; 41.2% didsowith silicone and 58.8% with wax (table ix). as for the type of material used for inter-occlusal registration, silicone was used by 55% of oss who had undergone diploma training after their thesis, while 45% used wax. but for oss who had not undergone post-graduate training after their thesis, 33.8% used silicone for inter-occlusal registration and 66.2% used wax. the differenceisstatisticallysignificant (p= 0.028). (table xi) disinfection of the final impression was always carried out by 92.1% of dental technicians, 6.1% rarely did so, and 1.8% of dental technicians never disinfected the final impression before processing it or sending it to the laboratory. (table xii) all os in the public sector always did so, 95.5% in the private sector, 55.6% in inter-company centers and 83.3% in the military. the difference is highly statistically significant (p= 0.009). (table xiii)  temporary crown fifty-six point one percent (56.1%) of dental technicians always used a provisional crown after the impression, 31.6% rarely and 12.3% never (table xii). in the public sector, 72.7% of os always used a provisional crown after the impression, 54.4% of os in the private sector, 55.6% in inter-company centers and 50% in the military. the differenceisstatisticallysignificant (p= 0.04). (table xiii) discussion we conducted a descriptive cross-sectional study to assess the knowledge, attitude and practice of fixed dental prosthesis in a sample of 114 os working in the capital of madagascar (antananarivo). our sample was representative of os in antananarivo in terms of age range and practice status. we used a face-to-face interview with the os, which resulted in a fairly high participation rate of 51.12% of os. in fact, this rate is lower than that of chisini's study in brazil, where the rate was 68% [9]. ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 7 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar of the os surveyed, 61.4% were male. this differs from the study by andrianasolo [10], who found 55% of the os in mahajanga to be female. fifty-nine point six percent (59.6%) of the operatives said they worked less than 8 hours a day, which corresponds to article 8, which states that the legal work schedule is 113.33 hours per month, equivalent to eight working hours per working day (continuous day system), with the exception of specific jobs (such as night watchman or concierge), with a break between 12 and 1pm [11]. the use of mouth models is essential for proper diagnosis and treatment planning.our study showed that 40.6% of os always performed a mouth model before starting a fixed prosthesis. this is slightly higher than the study by alhoumaid et al on the knowledge, attitude and practice in fixed prosthetics of os in quassim in 2019, which showed that 37.2% of practitioners used mouth models routinely [12]. radiographic root studies of abutment teeth in fixed coronal restorations are necessary to obtain detailed knowledge of the extent of bone support and root morphology of each abutment tooth to establish a comprehensive treatment plan [13]. in our study, only 34.2% of os always radiographed the abutment teeth prior to preparation.this is similar to the study by mohamed et al (2010) in karthoum, which was 35.57% [14]. assessingpulphealth and evaluatingpulpprognosis are essential prerequisites for restorations on pulpedteeth. ofrestorations on pulplessteeth. the question oftenaskedbeforerestoringpulpteethiswhether the tooth can berestored at all. oftenboils down to whether the tooth can bekept alive, or whetheritshouldbebedepulped [15]. our studyshowedthat 96.5% of os alwaystested the pulpvitality of abutmentteeth. this resultisconsiderablyhigherthanmohamed's figure of 46% [14]. with regard to the use of the retraction cord, our survey revealed that only 12.3% of oss in our study always used it. this is considerably lower than moldi's study, which showed that 72.8% used the gingival retraction cord before taking the final impression; marginal fit being one of the vital factors dictating the ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 8 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar prognosis of fixed prosthetics, it is essential to record the prepared and unprepared surfaces of the abutment with absolute precision [16]. the success of a fixed prosthesis depends on compliance with mechanical, aesthetic and periodontal requirements. a study by médina et al on the practice of fixed prosthodontics in ouagadougou in 2018 showed that the preparation of abutment teeth, the first link in the prosthetic chain, is the second greatest difficulty encountered by practitioners in their daily work (39.4%) but above all the leading cause of failure in fixed prosthetic restorations (54.5%) [7]. this study showed that 7.9% of os used tungsten burs, 75.4% diamond burs and 16.7% both types of burs. alhoumaidan's study showed that diamond burs were mainly used during preparation (53.8%), while 46.2% used both tungsten and diamond burs during preparation [12]. as impression materials, 55.3% of the dental surgeons in this study used alginate, and 43.9% silicone. this differs from moldi's study in india (2013), the aim of which was to assess dental practice regarding impression taking for prosthetic treatment, where in the urban area, 41.43% of os used alginate impression materials and 58.57% of participants preferred silicone impression materials [16]. concerning the use of occlusal registration, 100% of our study population always did so. wax was the most used material at 58.8%, followed by silicone at 41.2%. alhoumaidan's study showed that 83.4% of os in quassim always took bite registration for multiple tooth replacement, and wax was the most used material for bite registration at 61.7% [12]. a study by maru et al on the trend in the selection, use and techniques of inter-occlusal registration among private os in india showed that 79% of os use inter-occlusal registration materials for the fabrication of crowns and bridges. the mostcommonlyused inter-occlusal registration materialwas wax (54.6%) [17]. the temporary crown restores the anatomical shape of the prepared teeth. it prefigures the final result and, above all, ensures that the patient's socioprofessional life is not hampered during the final prosthetic phase [18]. the study ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 9 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar by alhoumaidan (2018) had shown that 45.5% of os in quassim were still using provisional restorations [12]. in ourpresentstudy, the provisional crown wasstillused by 56.1% of os surveyed. the risk of contamination of nursing staff and laboratory personnel via impressions exists, and must be properly managed. a study carried out in dakar on the typology of microorganisms present on fixed prosthetic impressions in dental surgeries showed that almost all impressions (94.3%) were rinsed after insertion under a trickle of tap water. 25.7% were decontaminated. chlorinated compounds were the decontamination solutions used exclusively, i.e. 100% [19]. in our study, 92.1% of os disinfected their impressions, but the decontamination solution was not specified. however, a study carried out in khartoum showed that 73.6% did not disinfect the impression before sending it to the dental laboratory [14]. conclusion the standard guideline to be followed in the practice of fixed prosthetic restoration has yet to be fully adopted by oss in the malagasy capital. a more indepth and wide-ranging study of dental surgeons practicing throughout madagascar would be desirable to fully identify the reality of their practice. references 1. norreddine b. contribution à l’automatisation de la conception et de la fabrication des prothèsesdentaires. 2013. thèse de doctorat. ecole nationalepolytechniqued'oran-maurice audin 2. batarec e. lexique des termes de prothèsedentaire. 2ème edition, cdp, 1998, 90 pages. 3. ogolnik r, vignon m, taïeb f. prothèsefixée :principes et pratiques. elseveir masson, paris, 1993, 246 pages ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 10 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar 4. unger f, lemaitre p, hoornaert a. prothèsefixée et parodonte. éditeur cdp, collection guide clinique, 1997. 5. bronnec f, hombrouck j. approche multi-disciplinaire des cas complexes. real clin. 2003 ; 14 (1) : 103-17. 6. morchad b, el yamani a. erreursenprothèsefixéelors des préparations et des essaiscliniques. cahprothèse2012 ; 157 :39-45. 7. fall m, thioune n, diarra a, el hadj bm . pratique de la prothèsefixée :enquêteauprès des praticiens de la ville de ouagadougou. ajdi. 2021 ; 20 : 62-70. 8. ghoneim a, yu b, lawrence hp, glogauer m, shankardass k, quiñonez c. does competition affect the clinicaldecision-making of dentists? a geospatial analysis. community dent oral epidemiol. 2019 ; 00 :1–11. doi : 10.1111/cdoe.12514. 9. chisini la, conde mc, correa mb, dantas rv, silva af, pappen fg, demarco ff. vital pulp therapies in clinical practice : findings from a survey with dentist in southern brazil. braz dent j. 2015 ; 26(6) :566–71. doi : 10.1590/01036440201300409 10. andrianasolo vv. connaissance, attitude et pratique des odontostomatologistes de mahajanga-i devant les dents délabrées. 2021. mémoireen sciences de la santé, option santépublique. iostm, université de mahajanga 11. chen m, andersen rm, barmes de, leclercq mh, lyttle cs. comparing oral health care systems. a second international collaborative study. world health organisation. geneva.1997 12. alhoumaidan a, mohan mp, doumani m. the knowledge, attitude and practice of fixed prosthodontics: a survey among qassim dental practitioners. j family med prim care 2019 ; 8 : 2882-7. 13. bartala m, blanchard jp, soenen a. prothèsefixée. guide cliniqued’odontologie. elsevier health sciences. 2011 14. mohamed ab, abu-bakr nh. assessment of crown and bridge work quality among sudanese dental practitioners. the journal of indian prosthodontic society. 2010 ; 10 : 53-6. 15. moldi a, gala v, puranik s, karan s, deshpandes, neela n. survey of impression materials and techniques in fixed partial dentures among the practitioners in india. international scholarly research notices. 2013. article id 430214, 5 pages ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 11 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar 16. talabani rm. influence of abutment evaluation on designing of fixed partial denture : a clinical study. int j oral health med res. 2016 ; 3:2395-7387. 17. guddu g. a study on application of prosthodontic techniques in private practice-a survey. university journal of dental sciences. 2022: 8, (1). 18. rosenstiel sf, land mf, fujimoto j. contemporary fixed prothodontics. 3rd ed. st louis : mosby ; 2001. p. 2. 19. thioune n, cissé b, fall m, bandiaky o, gueye m, mbodj ehb. typologie des microorganismesprésents sur les empreintesenprothèsefixée : etude descriptive dans les cabinets dentaires de la région de dakar. rev col odonto-stomatolafrchir maxillofac. 2021; 28 (3) : 68-72. table i: os distribution by socio-demographiccharacteristics (n= 114) social characteristics number (n) proportion (%) gender male 70 61,4 female 44 38,6 year of exercise 05 to 10 years 17 14,9 11 to 15 years 32 28,1 16 years and over 65 57 place of work public 11 9,6 private 88 77,2 inter-company 9 7,9 military camp 6 5,3 continuing training yes 40 35 no 74 65 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 12 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar table ii: os distribution by clinicalcharacteristics (n=114) clinicalcharacteristics number (n) proportion (%) total workinghours per day (h) ≤ 8 68 59,6 > 8 46 40,4 total 114 100 number of patients treated per day ≤ 10 71 62,3 > 10 43 37,7 total 114 100 table iii: os response rates for pre-prostheticpreparations (n=114) number (n) proportion (%) using a mouth model always 46 40,4 rare 48 42,1 never 20 17,5 total 114 100 preoperativeradiography of abutmentteeth always 39 34,2 rare 49 43 never 26 22,8 total 114 100 pulp vitality test on abutmentteeth yes 110 96,5 no 4 3,5 total 114 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 13 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar table iv: distribution of os according to pre-prostheticpreparation and post-thesis continuing training pre-prostheticpreparation post-thesis training p yes no total n (%) n (%) n (%) mouth model use always 23 (57,5) 23 (31,1) 46 (40,4) 0,012* rare 10 (25) 38 (51,4) 48 (42,1) never 7 (17,5) 13 (17,6) 20 (17,5) total 40 (100) 74 (100) 114 (100) radiography of abutmentteeth always 24 (60) 15 (20,3) 39 (34,2) 0,001** rare 9 (22,5) 40 (54,1) 49 (43) never 7 (17,5) 19 (25,7) 26 (22,8) total 40 (100) 74 (100) 114 (100) pulp vitality test yes 38 (95) 72 (97,3) 110 (96,5) 0,525 no 2 (5) 2 (2,7) 4 (3,5) total 40 (100) 74 (100) 114 (100) *p= 0,012 (< 0,05) significant **p= 0,001 (< 0,01) very significatif ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 14 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar table v: distribution of os according to pre-prostheticpreparation and year of practice preprostheticpreparation year of practice 05 to 10 years 11 to 15 years 16 years and over total p n (%) n (%) n (%) n (%) mouth model use always 8 (47,1) 11 (34,4) 27 (41,5) 46 (40,4) 0,873 rare 6 (35,3) 14 (43,8) 28 (43,1) 48 (42,1) never 3 (17,6) 7 (21,9) 10 (15,4) 20 (17,5) total 17 (100) 32 (100) 65 (100) 114 (100) radiography of abutmentteeth always 7 (41,2) 7 (21,8) 25 (38,5) 39 (34,2) 0,059 rare 10 (58,8) 14 (43,8) 25 (38,5) 49 (43) never 11 (34,4) 15 (23) 26 (22,8) total 17 (100) 32 (100) 65 (100) 114 (100) pulp vitality test yes 16 (94,1) 29 (90,6) 65 (100) 110 (96,5) 0,052 non 1 (5,9) 3 (9,4) 4 (3,5) total 17 (100) 32 (100) 65 (100) 114 (100) using the retractablecord always 2 (6,3) 12 (18,5) 14 (12,3) 0,001** rare 6 (35,3) 2 (3,1) 8 (7) never 11 (64,7) 30 (93,8) 51 (78,5) 92 (80,7) total 17 (100) 32 (100) 65 (100) 114 (100) **p= 0,001 (< 0,01) verysignificant ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 15 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar table vi: os response rate for preparation of abutmenttooth(s)(n=114) number (n) proportion (%) using the retractablecord always 14 12,3 rare 8 7 never 92 80,7 total 114 100 types of burrused tungstencarbide 9 7,9 diamond 86 75,4 both 19 16,7 total 114 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 16 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar table vii: distribution of os according to preparation of abutmentteeth and post-thesis training abutmentteethpreparation post-thesis training p yes no total n (%) n (%) n (%) types of burrused tungstencarbide 6 (15) 3 (4,1) 9 (7,9) 0,015 diamond 24 (60) 62 (83,8) 86 (75,4) both 10 (25) 9 (12,2) 19 (16,7) total 40 (100) 74 (100) 114 (100) impression material type alginate 16 (40) 47 (63,5) 63 (55,2) 0,029 silicone 23 (57,5) 27 (36,5) 50 (43,9) others 1 (2,5) 1 (0,9) total 40 (100) 74 (100) 114 (100) inter-occlusal registration yes 40 (100) 74 (100) 114 (100) no total 40 (100) 74 (100) 114 (100) type of materialused for inter-occlusal registration silicone 22 (55) 25 (33,8) 47 (41,2) 0,028 wax 18 (45) 49 (66,2) 67 (58,8) total 40 (100) 74 (100) 114 (100) *p= 0,015 (< 0,05) significant *p= 0,029 (< 0,05) significant *p= 0,028 (< 0,05) significant ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 17 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar table viii: distribution of os according to abutmentpreparation and place of practice preparation of abutmentteeth place of practice p public private intercompany military camp total n (%) n (%) n (%) n (%) n (%) types of burrused tungstencarbide 3 (27,3) 2 (2,3) 2 (22,2) 2 (33,3) 9 (7,9) 0,006 diamond 7 (63,6) 71 (80,7) 5 (55,6) 3 (50,0) 86 (75,4) both 1 (9,1) 15 (17) 2 (22,2) 1 (16,7) 19 (16,7) total 11 (100) 88 (100) 9 (100) 6 (100) 114 (100) impression material type alginate 6 (54,5) 49 (55,7) 7 (77,8) 1 (16,1) 63 (55,3) 0,440 silicone 5 (45,5) 38 (43,2) 2 (22,2) 5 (83,3) 50 (43,9) others 1 (1,1) 1 (0,9) total 11 (100) 88 (100) 9 (100) 6 (100) 114 (100) interocclusal registration yes 11 (100) 88 (100) 9 (100) 6 (100) 114 (100) no total 11 (100) 88 (100) 9 (100) 6 (100) 114 (100) type of materialused for interocclusal registration silicone 6 (54,5) 36 (40,9) 1 (11,1) 4 (66,7) 47 (41,2) 0,123 wax 5 (45,5) 52 (59,1) 8 (88,9) 2 (33,3) 67 (58,8) total 11 (100) 88 (100) 9 (100) 6 (100) 114 (100) *p= 0,006 (< 0,01) verysignificant p= 0,440 (> 0,05) not significant p= ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 18 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar p= 0,123 (> 0,005) not significant table ix: os response rates for impression taking (n=114) number(n) proportion (%) impression material type alginate 63 55,3 silicone 50 43,9 others 1 0,9 total 114 100 inter-occlusal registration yes 114 100 no total 114 100 type of materialused for inter-occlusal registration silicone 47 41,2 wax 67 58,8 total 114 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 19 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar table x: distribution of os by impression and gender impression gender p male female total n (%) n (%) n (%) impression material type silicone 37 (52,9) 13 (29,5) 50 (43,9) 0,029 alginate 33 (47,1) 30 (68,2) 63 (55,3) others 1 (2,3) 1 (0,9) total 70 (100) 44 (100) 114 (100) inter-occlusal registration yes 70 (100) 44 (100) 114 (100) no total 70 (100) 44 (100) 114 (100) type of materialused for inter-occlusal registration silicone 31 (44,3) 16 (36,4) 47 (41,2) 0,403 wax 39 (55,7) 28 (63,6) 67 (58,8) total 70 (100) 44 (100) 114 (100) *p= 0,029 (< 0,05) significant p= p= 0,177 (> 0,05) not significant ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 20 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar table xi: distribution of ossaccording to impression and post-thesis training impression post-thesis training p yes no total n (%) n (%) n (%) impression material type alginate 16 (40) 47 (63,5) 63 (55,2) 0,029 silicone 23 (57,5) 27 (36,5) 50 (43,9) others 1 (2,5) 1 (0,9) total 40 (100) 74 (100) 114 (100) inter-occlusal registration yes 40 (100) 74 (100) 114 (100) no total 40 (100) 74 (100) 114 (100) type of materialused for inter-occlusal registration silicone 22 (55) 25 (33,8) 47 (41,2) 0,028 wax 18 (45) 49 (66,2) 67 (58,8) total 40 (100) 74 (100) 114 (100) *p= 0,029 (< 0,05) significant *p= 0,028 (< 0,05) significant ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 21 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar table xii: os response rate for impression and abutment management afterpreparation (n=114) number (n) proportion (%) impression disinfection always 105 92,1 rare 7 6,1 never 2 1,8 total 114 100 temporary crowns use always 64 56, 1 rare 36 31,6 never 14 12,3 total 114 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 22 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr valentina andrianasolo* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || assesment and practice of fixed prosthetic restoration in the city of antananarivo, madagascar table xiii: distribution of oss on impression and abutment management afterpreparation and place of practice place of practice p public private intercompan y military camp total n (%) n (%) n (%) n (%) n (%) impression disinfection always 11 (100) 84 (95,5) 5 (55,6) 5 (83,3) 105 (92,1) 0,003* * rare 3 (3,4) 3 (33,3) 1 (16,7) 7 (6,1) never 1 (1,1) 1 (11,1) 2 (1,8) total 11 (100) 88 (100) 9 (100) 6 (100) 114 (100) temporary crowns use always 8 (72,7) 48 (54,5) 5 (55,6) 3 (50) 64 (56,1) 0,040* rare 2 (18,2) 32 (36,4) 2 (33,3) 36 (31,6) never 1 (9,1) 8 (9,1) 4 (44,4) 1 (16,7) 14 (12,3) total 11 (100) 88 (100) 9 (100) 6 (100) 114 (100) *p= 0,04 (< 0,05) significant **p= 0,009 (< 0,01) verysignificant ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 23 table i: os distribution by socio-demographiccharacteristics (n= 114) table ii: os distribution by clinicalcharacteristics (n=114) table iii: os response rates for pre-prostheticpreparations (n=114) table v: distribution of os according to pre-prostheticpreparation and year of practice table vi: os response rate for preparation of abutmenttooth(s)(n=114) table vii: distribution of os according to preparation of abutmentteeth and post-thesis training table viii: distribution of os according to abutmentpreparation and place of practice table ix: os response rates for impression taking (n=114) table x: distribution of os by impression and gender table xi: distribution of ossaccording to impression and post-thesis training table xii: os response rate for impression and abutment management afterpreparation (n=114) table xiii: distribution of oss on impression and abutment management afterpreparation and place of practice ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || case of dental concrescence associated with dens evaginatus on a mandibular permanent molar case of dental concrescence associated with dens evaginatus on a mandibular permanent molar rafalimino hn1,2, rakotonirina fp1,3,andrianjafinoro th1,2,randriamalala nc1,4,ramaroson j1. 1sub-section of conservative odontology endodontic at the tropical odonto-stomatological institute of madagascar (iostm), university of mahajanga ² university hospital profesora zafisaona gabriel androva mahajanga madagascar, 3oral health center, ministry of industrialization, trade and consumption antananarivo, madagascar, 4 university hospital joseph dieudonné rakotovao, befelatanana antananarivo, corresponding author: rafalimino holy nasandratra1, 2 1sub-section of conservative odontology endodontic at the tropical odonto-stomatological institute of madagascar (iostm), university of mahajanga summary our objective was to present an unusual clinical case of a dental concrescence that comes with a dens evaginatus on a mandibular left sector molar. this is about a description of this dental morphologic anomaly. the content of this article includes the clinical, radiological and anatomy morphological features of this anomaly of dental development of a 19-year-old female patient. the particularity of our case was its rarity, its installation on a posterior mandibular tooth, its localization on the mesial dental side, and finally the association of both cases of dental development anomalies. the treatment decision is based on the tooth conservation priority. the lack of its antagonist to preserve dental occlusion and strengthen the masticatory system, a preventive treatment is made to block all decay progression, combined with a prosthetic and orthodontic treatment recommendation. key words: dental anomaly, concrescence, dens evaginatus, permanent molar 1. introduction dental anomalies are generally classified into developmental, eruption and structural anomalies. dental concrescence is a developmental anomaly defined by the fusion of two adjacent teeth at the cementum level, whereas dens evaginatus is a morphological anomaly that generates an additional cusp projected from the amelo-cemental junction surface towards the occlusal border1,2,3. the concrescence is of mechanical origin, due to compression of the germ, lack of space or neighboring infection. if cemental fusion occurs during root development, it is called true concrescence; if it occurs after root formation, it is called acquired post-inflammatory concrescence. it can only be discovered by taking an xray. the etiology can be genetic, hormonal or systemic, and the impact can affect both temporary and permanent teeth. this anomaly may be generalized or localized, affecting only the crown, only the root, or both the crown and the root. its usual location is often ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 1 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || case of dental concrescence associated with dens evaginatus on a mandibular permanent molar between the upper permanent molars, and sometimes between a molar and a supernumerary tooth3,4. dens evaginatus comes from a developmental defect during the morphological differentiation stage, generating an additional cusp projected from the amelo-cemental junction surface. it generally affects permanent teeth and is rarely observed in temporary dentition, in mongolian descendants and exceptionally in blacks. the malformation affects the buccal and occlusal surfaces of the teeth, and is frequently located on the anterior teeth and premolars4, 5,6,7. these morphological malformations make the tooth susceptible to a high risk of decay. their therapeutic treatment consists of either conservative or radical treatment of the anomaly, calling essentially on the practitioner's clinical sense. apart from the dentistry conservative practice, this sometimes requirescollaboration between the orthodontist and the prosthetic technician, in order to restore aesthetics and maintain function. the main objective of our article is to report an unusual case of dental concrescence associated with dens evaginatus and located on a permanent molar in the mandibular left sector. it is about to describe the clinical, radiological and pathological features of the anomaly, and justify our treatment choice. 2.observation our observation concerned a 19-year-old malagasy female patient who came to a specialized odontostomatology center of the mahavoky atsimo university hospital in mahajanga madagascar. her consultation reason was odontalgia stimulated by a brief thermal variation in the posterior left sector of the mandible. during the anamnesis, the patient does not have any general health problems, except for asthma. during the intraoral clinical examination, the reason for consultation was the left lower second molar. by a random discovery, we observed a coronal malformation on the mesial side of this same tooth, in association with occlusal dentin decay. clinically, on the mesial side, a double protuberance projects from the amélo cemental junction towards the occlusal surface of the tooth (figure 1 and figure 2). figure 1: preoperative photograph of 37 showing dens evaginatus in (a) and (b) on the mesial aspect. occlusal view [rafalimino,2019]. figure 2:preoperative photograph of 37 with coronal dental anomaly. in (a) and (b) on the mesial surface. vestibular view [rafalimino,2019]. ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 2 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || case of dental concrescence associated with dens evaginatus on a mandibular permanent molar during our clinical examination, the survey allowed us to reveal a groove around the entire coronal margin and a groove around both protuberances, interrupted by the huge protuberance at the amelo-cemental junction. these areas are ideal niches for dental plaque.we noticed the presence of dentin decay in these grooves. the mandibular first molar had already been extracted six years previously. the mandibular second molar has three normal vestibular cusps.retro alveolar radiography confirmed that the mesial root of 37 was cemental fused to the occlusal surface at the root half, with the root of a supernumerary tooth on its distal surface, and that the two roots bifurcated at the root apical third (figure 3).we also note the absence of pulpal extension at the coronal level of the fused supernumerary tooth. due to the presence of a mesial coronal malformation with bacterial plaque accumulation in the sulcus, in order to halt the carious process and prevent the reinstallation of caries on this tooth, our treatment plan was a dentin capping at the occlusal dentinite level combined with a preventive treatment of fluid composite placement around the evagination to ensure the durability of the tooth and prevent the evolution of dental caries (figure 4).the patient was advised for a monthly visit to check for the presence of new decay, and the patient was referred to an odontostomatology specializing in prosthetics and orthodontics to study the management of the edentulous mandibular first molar. figure 3: preoperative retro alveolar radiograph of 37 showing dental concrescence at the cementum level of the mesial root of 37 in (a) with the root of a supernumerary tooth on the distal surface in (b) [rafalimino,2019]. figure 4: postoperative photograph of 37 receiving preventive treatment on the coronal tooth evagination and conservative composite treatment on the occlusal surface[rafalimino,2019]. 3.comments concrescence anomaly is positively detected after radiography. this anomaly is defined by one of the common anomalies of tooth shape occurring in the posterior maxillary sector characterized by the union between adjacent teeth, only through cementum and not dentin7,8,9.our clinical case was diagnosed as an association between dental concrescence ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 3 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || case of dental concrescence associated with dens evaginatus on a mandibular permanent molar and dens evaginatus. according to the location of the anomaly, which involves the vestibular cusps, this case of dens evaginatus was group 2 according to lau's classification9. according to ohelers' classification, based on the histological appearance of the pulp, our case was identified as anomalies without pulpal horn10. according to the literature, the complications associated with this anomaly are of three steps: carious pathologies, traumatic pathologies and complications linked to the presence of malocclusions and disharmonious tooth movement. in our case, the most anfractuous tooth morphology, combined with the presence accessory cusp contributes to plaque retention.dens evaginatus (de) is a dental anomaly with a supernumerary tubercle projection that typically contains dentin and pulp tissue. however, the tubercle projection can fracture, exposing the dentin and potentially the dental pulp, which induces pulpal diseases. this situation increases the risk of caries infiltration, which can lead to pulpal damage11. for this reason, the presence of this morphological anomaly calls for easier oral hygiene procedures. root fusion can complicate endodontic treatment. in terms of pick-up of charge, a number of therapeutic variants have been suggested, depending on their usefulness. surveillance therapy has been described as useful for early detection of complications. a preventive treatment would be the development of fluoridation or placement of sealant or composite flow in pits and cracks, or a "grinding" treatment alone or with fluoridation. conservative dentistry will be chosen in cases of carious pathology, or when polishing techniques are disrupted by the morphological anomaly. endodontic treatment is chosen when pulpal complications or coronal fractures with pulpal exposure are present. prosthetic and orthodontic treatment may be chosen depending on the therapeutic objective. finally, surgical treatment may be chosen if the anomaly causes other, more iatrogenic anomalies8,9. according to the study by dankner and all, this anomaly is predominant in the maxillar12. depending on anatomical location, mallinenne and his colleagueshave suggested that mandibular installation is rare13. coronal morphological anomalies can lead to caries complications9. the clinical cases presented by yoon and his colleaguescorroborate our own. increased plaque retention in the pits and cracks created by the accessory cusp, leading to increased caries risk 14. conclusion dens evaginatus can be detected clinically, but the discovery of dental concrescence requires radiography. depending on the morphology and volume of the anomaly to be treated, multiple therapeutic variants have been implemented. in terms of quality of care performance, many practitioners do not hesitate to combine all these options. the treatment of an evagination due to many possible complications is above all multidisciplinary. updating the classification of concrescence associated with other developmental anomalies must be considered. ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 4 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || case of dental concrescence associated with dens evaginatus on a mandibular permanent molar conflicts of interests we, the authors of this manuscript, declare no conflicts of interest regarding the publication of this article. patient consent the patient has given full permission for the publication other use of his clinical case and photographs. references 1. sicher s, bhasker sn. orban’s oral histology and embryology. cv mosby co. 1972; 17–37. 2. piette e, goldberg m. anomalies et malformations des dents. la dent normale et pathologique. 2001 ; 11. 212-34. 3. priddy, carterwl, auzins aj.dens evaginatus: an anomaly of clinical significance.j endod 1976; 2: 51-2. 4. echeverri ea, wang mm, chavaria c, taylor dl. multiple dens evaginatus: diagnosis, management, and complications: case report. pediatr dent. 1994 jul-aug;16(4):314–17. 5. shrestha a, marla v, shrestha s, maharjan ik. developmental anomalies affecting the morphology of teeth – a review. rsbo. 2015; 12 (1) : 68-78. 6. foran d, komabayashi t, lin lm. concrescence of permanent maxillary second and third molars: case report of non-surgical root canal treatment. journal of oral science. 2012; 54 (1); 133-6. 7. baumgart m, hänni s, suter b, schaffner m, lussi a. dent invaginée (dens invaginatus) : revue de la littératurerecommandations diagnostiques et thérapeutiques. rev mens suisse odontostomatol. 2009 ; 119 : 706-14. 8. gernhofer kj. concrescence of a maxillary second and third molar. journal of the california dental association. 2009; 479–81. 9. levitan me, himel vt.dens evaginatus: literature review, pathophysiology, and comprehensive treatment regimen.journal of endodontics. 2005 ; 32(1):1-9 10. kittipun l, danuchit b, kamolthip s, patcharin p, siriruk n. current management of dens evaginatus teeth based on pulpal diagnosis. joe. 2023;49 (1) : 1230-36. 11. hllttllh fn, yassin om, al nimri ks. talon cusp. clinical significance and management: case reports. quintessence international 1995; 26:115-20. 12. danker e, harari d, rotstein 1. dens evaginatus of anterior teeth: literature review and radiographic survey of 15000 teeth. oral surg oral med oral pathol oral radiol endod. 1996;81(4):472-5. ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 5 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || case of dental concrescence associated with dens evaginatus on a mandibular permanent molar 13. mallinenne sm. supernumerary teeth: review of the literature with recent updates. conference p a p e s i n s c i e n c e . 2014; 6. 14. yoon rk, chussid s. dental management of a talon cusp on a primary incisor. pediatric dentistry. 2007; 29 (1) 51-5. ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 6 ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain psychological impact of post-operative endodontic pain authors: andrianjafinoro tsiriniaina hasinjanahary1, randriamalala njarasoa charlette1, lalanirina gaël lauricia1, rakotonirina faliniaina paul1, rafalimino holy nasandratra1 ,randriamboavonjy aldy victoria pasca2, rakoto alson simone3 ,ramaroson juvence3 1 : formerinterne in odontostomatology, institute of tropical odonto-stomatology of madagascar, universityof mahajanga madagascar 2 : doctor of dental surgery iostm mahajanga bp 98 3 : full professor in odontostomatology, institute of tropical odontostomatology of madagascar, university of mahajanga madagascar abstract post-operative pain is defined as the onset or worsening of a painful symptomatology related to the therapeutic procedure and/or the pathological condition that justified the procedure. various types of post-endodontic pain have been observed, ranging from inflammatory to chronic. the aim of the present study was to determine the extent of the psychological impact of post-endodontic pain. the study was carried out in the city of majunga, at the centre de soins et de traitements dentaires of the institut odonto-stomatologie tropicale madagascar. it was a prospective, descriptive, cross-sectional study conducted from march to june 2023.fifty patients aged 18 and over with post-endodontic pain were recruited to the study.a questionnaire in the form of an interview was carried out to collect the data, which were entered, processed and analyzed on computer using spss 20.0 software. the results highlighted that the characteristics of postoperative pain in endodontics vary according to type, intensity, onset and even evolution. pain has a psychological impact on the patient's life, causing apprehension about pain (92%), fear of dentists (6%) and dental anxiety (12%). ijo international journal of health sciences and nursing ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 40 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain the management of post-operative pain and its impact on patient psychology should not be underestimated. thus, an analytical study with representative samples would be desirable to fully understand this pathology, which presents a real public health problem. key words: inflammatory flare-up, endodontic treatment, postoperative pain, psychology introduction postoperative pain is defined as the onset or worsening of a painful symptomatology related to the therapeutic procedure and/or the pathological condition that justified the procedure. it may be of immediate or delayed onset, and may be transient, prolonged or permanent. on the basis of its temporal definition, we can speak of postoperative inflammatory pain when it lasts less than 7 days, and of chronic pain when it lasts more than 3 months. [1] varying in intensity from patient to another, its clinical features are very often similar to those of acute apical periodontitis: they translate into continuous pain, exacerbated by occlusal percussion or periapical palpation and is often well localized by the patient. [2] in 2011, the results of a systematic review and meta-analysis by pak andal showed that the prevalence of post-operative pain averaged 40% 24 hours after treatment and 11% at 7 days [1]. in 2013, a prospective clinical study based on 374 root canal treatments reported a high incidence of pain of 47,3%, of which 69,5% occurred during the first two post-operative days [3]. the experience of pain is likely to leave a negative memory that can engender fear. this fear, experienced during treatment, encourages a hyperfocusing of attention on the treated area, and can amplify the painful experience. thus, pain can generate anxiety, but anxiety can also amplify, or even generate, pain, hence the psychological impact on a patient [4] [6]. following a survey, larrea l et al asserted that fear of pain is one of the main barriers to access to care, and thus contributes to the poor oral and dental health of part of the population: 4 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 41 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain to 20% of french people suffer from dental anxiety, including 6% for whom the phobia represents a total obstacle to care. [6] as a result, postoperative pain in endodontics may have a negative impact on treatment, by reducing patient compliance and confidence in the odontostomatologist; it also affects daily life, sleep quality and quality of life, and may reduce the patient's ability to work. it can also have psychological repercussions, including a permanent focus on pain. [7] in madagascar, few studies of post-operative pain in endodontics have been conducted. to contribute to this, this study was carried out on malagasy patients to answer the following research question: does post-endodontic treatment pain have psychological effects on the patient? the aims of the study were to identify the characteristics of post-operative pain in endodontics, and to determine the extent of the psychological impact of post-operative pain in endodontics. materials and methods this was a prospective, descriptive, cross-sectional study conducted over a three-month period from march 2023 to june 2023 at the dental care and treatment center (cstd) of the institut odonto-stomatologie tropicale madagascar (iostm) in majunga. the study population consisted of 50 patients presenting to the cstd for pain after endodontic treatment or retreatment during this period. patients aged 18 and over presenting with post-endodontic pain were included in the study. mentally handicapped and uncooperative patients were excluded from the study. the following items and information were recorded:  social characteristics (gender, age)  tooth types (monoradiculated, pluriradiculated)  initial dental pathology (pulpitis, pulpal necrosis, apical periodontitis)  types of treatment (initial endodontic treatment, endodontic retreatment) ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 42 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain  pain characteristics (location, intensity, description of pain, period of onset, frequency of onset in 24 hours, onset of pain, factors affecting pain, signs associated with pain, course of pain)  use of pain-relieving medication  psychological impact of pain (apprehension of pain, fear, anxiety) evaluation criteria: -for pain :  visual analogue scale (vas) this is the scale used to define the intensity of the subject's pain. -for anxiety:  the "cdas" scale (corah dental anxietyscale) is used to assess the patient's anxiety about dental treatment [8] a pre-established, tested and validated anonymous questionnaire has been designed to collect information. a request for authorization from cstd's clinical teaching staff was made before the start of the study, and information was collected in the form of individual interviews. free and informed consent was obtained from the patients interviewed, after the objectives of the study had been clearly explained to them, and confidentiality was respected. data were analyzed using sppss 20.0 software.then, the association between the existence of post-endodontic pain and social characteristics, pain characteristics and the psychological impact of pain was carried out using the chi-square test. the results were considered significant at p<0.05 if the test conditions were respected. ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 43 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain results table i: social characteristics of the sample social characteristics effective (n) proportion (%) gender male 21 42 feminine 29 58 total 50 100 age (in years) 18 to 24 19 38 25 to 34 11 22 35 to 44 11 22 45 to 54 5 10 ≥ 55 4 8 total 50 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 44 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain table i: distribution of the sample according to the history of the treated tooth treated tooth effective (n) proportion (%) type of treatment initial endodontic treatment 32 64.0 endodontic retreatment 18 36.0 total 50 100 type of tooth monorooted 20 40.0 multirooted 30 60.0 total 50 100 initial dental pathology pulpitis 24 48.0 necrosis 11 22.0 apical periodont itis 15 30.0 total 50 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 45 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain table ii: distribution of the sample according to the characteristics of post-endodontic pain pain characteristics effective (n) proportion (%) location localized 33 66.0 diffuse 17 34.0 total 50 100 intensity 2 to 4 (light) 10 20.0 5 to 7 (moderate) 26 52.0 8 to 10 (severe) 14 28.0 total 50 100 frequency of pain occurrence between 1 and 5 times 35 70.0 between 6 and 10 times 14 28.0 11 times and more 1 2.0 total 50 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 46 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain pain characteristics effective (n) proportion (%) types of pain shock 06 3.92 compression 14 9.15 stab 05 3.26 pain caused 14 9.15 painful cold feeling 06 3.92 sharp pain 10 6.53 shooting pain 06 3.92 radiating pain 25 16.33 throbbing pain 27 17.64 persistent pain 36 23.52 sensitivity at the gum 04 2.61 total 153 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 47 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain pain characteristic effective (n) proportion (%) period of onset of pain immediately after treatment 10 20.0 later in the day 2 4.0 the day after 19 38.0 48 hours after treatment 10 20.0 more than 2 days 9 18.0 total 50 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 48 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain pain characteristic effective (n) proportion (%) evolution of pain gradually diminished 23 46.0 very weak now 6 12.0 accentuated daily 7 14.0 completely disappeared 7 14.0 variable and episodic 4 8.0 don't remember anymore 3 6.0 total 50 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 49 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain table iii: distribution of the sample according to the possibility of taking medication medicines effective (n) proportion (%) taking medication yes 33 66.0 no 17 34.0 total 50 100 type of medications analgesic 17 34.0 analgesic + antibiotic 9 18.0 analgesic + nsaids 1 2.0 analgesic + atb + nsaids 1 2.0 antibiotic 5 10.0 none 17 34.0 total 50 100 atb: antibiotic nsaid: non-steroidal anti-inflammatory ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 50 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain table v: distribution of the sample according to the psychological impact of post-endodontic pain psychological impact effective (n) proportion (%) pain apprehension yes 46 92 no 4 8 fear of dentists yes 3 6 no 47 94 anxiety yes 6 12 no 44 88 total 50 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 51 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain table vi: distribution of the sample according to social characteristics and apprehension of pain social characteristics apprehension of pain yes (n) (%) no (n) (%) total (n) (%) gender male 14 66,7 7 33,3 21 100 féminine 25 86,2 4 13,8 29 100 total 39 78,0 11 22,0 50 100 age (in years) 18 to 24 16 84,2 3 15,8 19 100 25 to 34 8 72,7 3 27,3 11 100 35 to 44 8 72,7 3 27,3 11 100 45 to 54 4 80,0 1 20,0 5 100 ≥ 55 3 75,0 1 25,0 4 100 total 39 78,0 11 22,0 50 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 52 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain table vii: distribution of the sample according to pain intensity and pain apprehension pain intensity pain apprehension yes (n) (%) no (n) (%) total (n) (%) intensity 2 – 4 (light) 9 90.0 1 10.0 10 100 5 – 7 (moderate) 19 73.07 7 26.93 26 100 8 -10 (severe) 11 78.6 3 21.4 14 100 total 39 78.0 11 22.0 50 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 53 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain table viii: distribution of the sample according to social characteristics and fear of dentists social characteristics fear of dentists yes (n) (%) no (n) (%) total (n) (%) gender male 5 23,8 16 76,2 21 100 feminine 3 10,3 26 89,7 29 100 total 8 16,0 42 84,0 50 100 age (in years) 18 to 24 1 5,3 18 94,7 19 100 25 to 34 5 45,5 6 54,5 11 100 35 to 44 1 9,1 10 90,9 11 100 45 to 54 0 00,0 5 100,0 5 100 ≥ 55 1 25,0 3 75,0 4 100 total 8 16,0 42 84,0 50 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 54 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain table ix: distribution of the sample according to pain intensity and fear of dentists pain intensity fear of dentists yes (n) (%) no (n) (%) total (n) (%) intensity 2 4 (light) 2 20.0 8 80.0 10 100 5 7 (moderate) 5 19.24 21 80.76 26 100 8 – 10 (severe) 1 7.15 13 92.85 14 100 total 8 16.0 42 84.0 50 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 55 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain table x: distribution of the sample according to social characteristics and dental anxiety social characteristics dental anxiety yes (n) (%) no (n) (%) total (n) (%) gender male 4 19,0 17 81,0 21 100 feminine 5 17,2 24 82,8 29 100 total 9 18,0 41 82,0 50 100 age (in years) 18 to 24 3 15,8 16 84,2 19 100 25 to 34 2 18,2 9 81,8 11 100 35 to 44 1 9,1 10 90,9 11 100 45 to 54 3 60,0 2 40,0 5 100 ≥ 55 0 00,0 4 100,0 4 100 total 8 16,0 42 82,0 50 100 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 56 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain table xi: distribution of the sample according to pain intensity and dental anxiety pain intensity dental anxiety yes (n) (%) no (n) (%) total (n) (%) intensity 2 – 4 (light) 0 00.0 10 100.0 10 100 5 – 7 (moderate) 6 23.08 20 76.92 26 100 8 -10 (severe) 3 21.4 11 78.6 14 100 total 9 18.0 41 82.0 50 100 discussion social characteristics among the sample studied, the female gender predominates at 58% with a sex ratio of 0.72 (table i). according to akram andal in 2016, there is a similarity of results demonstrating the predominance of females in patients with post-endodontic pain. [36] similarly, some studies have shown a higher prevalence of postoperative pain in women than in men (walton, 2002). [9] several explanations have been put forward: ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 57 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain the pain tolerance threshold is higher in men (gotler andal, 2012) [10]. women suffer more psychosomatic illnesses and their pain is governed by emotional factors (ng andal, 2004)[11]. this could be explained by differences in the physiological response to pain, and by the fact that women present biological particularities that influence pain (hormonal fluctuation, contraceptive treatment) (gufran and al, 2012)[12]. according to age, the 18-24 age group was the most affected, at 38% (table i).2014 study by sipaviciute and manelien corroborates these results, explaining that older patients present less post-operative pain due to the reduced diameter of the root canal, allowing less debris to pass beyond the apex [13]. however, other authors conclude that there would be more pain in the elderly due to a decrease in the volume of the endodontic system, thinning of the dental canal making treatment more difficult and therefore increasing the risk of pain (arias andal, 2013)[14], less blood flow and delayed healing[11]. history of the treated tooth regarding the type of treatment (table ii), 64% of teeth treated with initial endodontic therapy showed more post-operative pain, compared with 36% of teeth treated with endodontic retreatment. this result corroborates the study by gotler et al, who reported significantly higher post-operative pain after initial treatment than after endodontic retreatment [10]. in contrast, other studies found that patients undergoing endodontic retreatment were clearly at greater risk of suffering an inflammatory outbreak[15]. whether initial treatment or retreatment, the main cause of postoperative pain may be due to incomplete mechanochemical preparation of the apical part of the root canal. in terms of initial dental pathologies (table ii), the proportion of teeth with pulpitis is high at 48%, followed by apical periodontitis (30%), and pulpal necrosis (22%).the correlation between postoperative pain and pulpal status (vital or necrotic tooth), is complex and still remains controversial where some reports have identified a significant relationship between these two ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 58 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain factors(segura-egea andal,2009[16],gotler andal., 2012)[10], others not (pasqualini andal, 2012)[17]; (sevekar and gowda, 2017)[18]. however, one study has shown that teeth with a periapical lesionare considered a risk factor for postoperative pain, and the risk of pain onset is 9.64 times greaterwhen a lesion is present prior to the practitioner's intervention [13]. depending on the type of tooth (table ii), there is a higher incidence of postoperative pain in pluriradiculate teeth (60%). a similar result was found by arias et al, who confirmed a higher incidence of postoperative pain in treated molars [3]. this may be explained by the fact that molars have a more complex anatomy and root canal morphology, particularly in the apical third, making complete debridement naturally more difficult, which predisposes to postoperative complications. pain characteristics various points have been observed to characterize pain (table iii): as for intensity, since pain is subjective, the pain perception threshold varies from one patient to another, despite the use of objective criteria to materialize it (vas scale). in this study, the 5 to 7 scale was qualified as moderate pain, accounting for 52% of the sample. this result is similar to beach's 2013 study, they found post-endodontic pain of moderate intensity. [19] the majority of patients indicated that the pain was localized (66%), and as for the type of pain, it was persistent in 23.52% of respondents, pulsatile pain (17.64%), radiating pain (16.33%), the same proportion for provoked pain and compression-type pain (9.15%). according to the study by pak jg and white sn, the clinical features of postoperative pain in endodontics are common to descriptions of acute apical periodontitis. it is a continuous, throbbing, well-localized pain, aggravated by occlusal pressure or periapical palpation. [1] ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 59 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain in this study, many patients began to feel pain the day after the procedure (38%), its frequency was 1 to 5 times in 24 hours (70%), for 46% of them it diminished progressively over the course of the day.there is a similarity of results to other studies, according to pak jg et al. pain sets in during the hours or days following treatment and diminishes substantially after treatment and especially during the first two days.[1]. the characteristics of pain vary from one subject to another, and depend on a number of physiological and physical circumstances. the possibility of taking medication concerning the use of medication (table iv), the study showed that the majority of patients took medication (66%). analgesics were the most commonly taken type of medication, at 34%. conversely, in france, according to bronnec andal in 2011, the systematic prescription of nsaids is indicated after the procedure has been performed, and then for 24 to 48 hours [2]. according to sipaviciute and manelien (2014), taking nonsteroidal anti-inflammatory drugs (nsaids), either immediately before surgery, before local anesthesia is administered, or immediately after the procedure has been performed, significantly reduces both intraoperative and postoperative pain [13]. based on these results, it will then be essential to provide patients with a prescription for analgesics for optimal prevention of postoperative pain, and for patients to take their analgesic treatment at a fixed time (every 6 hours) for at least 48 hours. psychological impact of post-endodontic pain endodontic pain is a source of great fear for patients, and endodontic therapy can be responsible for significant pain, which can have a psychological impact on patients. thus, the impact of pain is not only physiological or physical, but also psychological. in the present study, due to the low representativeness of the sample, no factor was statistically correlated with postoperative pain. ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 60 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain three points were observed with regard to the psychological impact of postoperative pain (table v): apprehension of pain (92%), fear of dentists (6%) and dental anxiety (12%).  apprehension of pain apprehension is defined as a fear in the face of danger that causes one to flee or avoid the situation. [20] according to gender, pain apprehension was predominantly experienced by women (86%), indicating that women presented a higher level of anticipated pain than men, and according to age, 84.2% of patients with pain apprehension were aged between 18 and 24 (table vi). this result is consistent with the study by catherine a andal. which found that women expected more sensory pain than men, and younger patients were more likely to expect higher levels of pain [21]. in view of these results, it may be that women are more concerned about pain and express it more, while men tend to minimize symptoms. studies of specific noxious stimuli and brain activity indicate that women are better able to discriminate between stimulus levels than men [22]. these distinctions may be linked to differences in cortical brain activity. it has been shown that although both genders show similar bilateral activation of the premotor cortex and several contralateral structures, women have greater activation of the insula and contralateral thalamus than men[23]. as such, it is certainly possible that this greater activation could be linked to greater pain expression in women. among the patients with pain apprehension, many presented pain of severe intensity (78.6%) and pain of moderate intensity (73.4%) (table vii). a similar result was observed by watkins ca andal. they carried out a study on 333 patients to compare expected and experienced pain intensities following endodontic treatment. the results highlighted that pain actually experienced was less than pain apprehended, and that patients ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 61 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain not apprehending post-operative pain developed pain of lower intensity than those expecting to experience pain [24]. it could be that the pain being assessed is memorized pain from previous experience.  fear of dentists fear of the dentist can be described as a subjective state of feeling or reacting to a known source of danger, latent in the unconscious [25].it is well known and dates back hundreds of years. the origin of fear of the dentist is associated with pain [26]. fear of the dentist" is the specific stress of the dental world, a phenomenon that is widespread throughout the world [27]. the prevalence of fear of dentists among adults varies from country to country. nevertheless, many studies estimate the prevalence of this fear in the world population at between 15 and 20%. [28,29] in the present study, more men (23.8%) than women (10.3%) were afraid of dentists (table viii). it could be that young men are confronted with various trials, some of which are physiological or even psychological, such as pain, which weakens their mental state due to a feeling they cannot master or control. the sensation of pain makes a man stressed and accentuates his stress by stimulating his uncontrollable imagination, often resulting in a state of fear. however, several studies have shown a higher prevalence in women. [40] as for age, it was found that the 25-34 age group experienced more fear(45, 5%). (table viii), a similar finding was observed according to the american psychiatric association, estimating that young adults are more inclined to trigger fear [30]. in terms of intensity, 19.4% of patients afraid of dentists reported moderate pain intensity (table ix). a study by o'keefe reported a significantly increased incidence of moderate to severe postoperative pain in patients with a history of painful dental treatment, and whose most severe pain in their lifetime was dental in origin [27]. this association could be explained by fear of the ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 62 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain dentist, leading patients to consult only during the severe stages of pain. this was confirmed in this study for patients who had already undergone endodontic treatment. the latter perceived less severe post-operative pain.  dental anxiety anxiety is an emotional disorder manifested by an indefinable feeling of insecurity. it is characterized by a sense of apprehension, tension, uneasiness and terror in the face of a peril of indeterminate nature. [31] anxiety is a psychic state with a negative emotional manifestation that may be transient or part of a personality trait. it is often linked to a painful stimulus and an increased perception of pain. as a result, these patients feel pain more easily and for longer. the average prevalence of dental anxiety ranges from 13.1% to 19.8% of the population. the etiology of dental anxiety is multifactorial. the two factors most frequently cited in the literature are a bad experience at the dental surgery and/or a family member [32]. the present study found that 17.2% of patients who experienced dental anxiety were female (table x). this result corroborates the study by perkovic et al, who found that the preponderance of females was 57.6%. [33] according to armfield jm, women are prone to signs of dental anxiety with higher scores than men[34].similarly, several research studies assert that women are generally more anxious than men about dental care[35]. it could be that women, with their psychological and behavioural differences, as well as their fast-paced lives, are more confronted with the daily stresses that can lead to anxiety. according to age, patients aged 45 to 54 (60%) and 18 to 24 (15.8%) were the most anxious (table x). in perkovic's 2014 study, the highest age range was between 23 and 45 years, or 34% among anxious endodontic patients [36]. ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 63 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain analysis of other authors' results clearly shows a clear proportion of anxious people among seniors. similarly, several studies show that older people generally have a higher degree of dental anxiety than younger people [35]. the correlation between the present study and their research can be explained by the physical or physiological state of these patients, who no longer have the same alertness as before, and a present painful feeling can give rise to a state of stress that increases into anxiety. as for intensity, it was observed that 23,08% of anxious patients had pain of moderate intensity and 21,4% had pain of severe intensity (table xi). previous research has found that the intensity of post-endodontic pain in an anxious patient can vary according to the type and duration of endodontic treatment, the type and amount of local anesthesia, the type and dose of analgesics prescribed, as well as individual patient characteristics such as age, gender, general and oral health status, and previous dental experience. and the average intensity of post-endodontic pain in an anxious patient ranges from 2 to 4 on a 0-10 visual analog scale (vas) [33]. post-endodontic pain usually peaks in the first 24 hours after endodontic treatment, then gradually decreases over the following days. [33] this may be because anxious patients tend to have negative expectations and overestimate the intensity of post-endodontic pain. conclusion post-operative pain is a subjective phenomenon, based above all on the patient's feelings, which makes it difficult to quantify, especially if the pain is not related to a lesion. this study has shown that the characteristics of postoperative pain in endodontics vary from one subject to another, depending on the type, intensity, onset and even evolution of the pain. in addition, post-endodontic pain has psychological impacts such as pain apprehension, fear of the dentist and dental anxiety. ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 64 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain post-operative pain management must be an integral part of endodontic care, and its impact on patient psychology must not be underestimated. to this end, it is essential that patients are informed of the possible post-operative consequences. last but not least, an analytical study with representative samples would be desirable to gain a clearer picture of this pathology, which represents a real public health problem. references 1pak jg, white sn. pain prevalence and severity before , during , and after root canal treatment : a systematic review . j endod . 2011; 37:429-38. 2bronnec f, descroixv, and y. boucher. “prevention and treatment of postoperative pain in endodontics. » clinical realities 2011;(4) (2011): 345 57 3arias a, de la macorra jc, hidalgo jjj et al. predictive models of pain following root canal treatment : a prospective clinical study.intendod j.2013; 46(8):784-93 4laroche f. et al. ; living with neuropathic pain; l&c scientific editions, 2007, 66. 5laroche f., soyeux e.; unexplained pain; l&c scientific editions, 2008, 66. 6larrea l et al. ; pain, attention and emotions; pain and analgesia; 2001; 14:78-87 7akram a, olivieri j, duransindreu f and al. influence of preoperative pain intensity on postoperative pain after root canal treatment : a prospective clinical study.j . dent.2016; 45:39–42 8bollore o, ourrad a, andrianisaina p, terbeche m, laidi c, yekhlef w, moulier v, and januel d. assessment of pain and anxiety during dental care in hospitalized psychiatric patients. the canadian journal of psychiatry 2019, 1-5 9walton r. interpoint flareups : incidence, related factors , prevention , and management endod . topics ; 2002, 3: 67-76 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 65 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain 10gotler m, bar-gil b, ashkenazi m post operative pain after root canal treatment : a prospective cohort study.int . j. dent. ; 2012: article id 310467, 5 p 11ng yl, glennon jp, setchell dj, gulabivalak.prevalence of and factors affecting postobturation pain in patients undergoing root canal treatment . int. endod . j; 2004; vol 37 (6): 381-391 12gufran as, mulay s, palekar et al. prevalence of and factors affecting post-obturation pain following single visit root canal treatment in indian population: a prospective, randomized clinical trial contempt clin dent. 2012; 3 (4): 459-463 13sipaviciute e, manelien r. pain and flare-up after endodontics treatment procedures stomatology, baltic dental and maxillofacial journal, 2014, vol 16 (1): 25-30. 14arias a, de la macorra jc, hidalgo jj, azabalm.predictive models of pain following root canal treatment : a prospective clinical study int. endod . j. 2013: 46: 784-793 15torabinejad m, dorn so, eleazer pd et al, effectiveness of various medications on post operative pain following root canal obturation.j endodontic.1994; 20(9):427-431 16seguraegeajj, cisneroscabello r, llamas -carreras jm, velasco -ortega e, 2009. pain associated with root canal treatment . int. endod . j. 42, 614–620 17pasqualini d, mollo l, scotti , n, cantatore g, castelluccia, migliaretti, g, berutti , 2012. postoperative pain after manual and mechanical glide path : a randomized clinical trials. j. endod.38, 32–36 18sevekar, sa, gowda s. postoperative pain and flare ups : comparison of incidence between single and multiple visit pulpectomy in primary molars . j. clin. diagn res.2017; 11 19beach david a. assessing postoperative pain after endodontic therapy dent today . 2013; 32(10):90-92-3. 20“apprehension”, french dictionary. larousse, 2019 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 66 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain 21catherine a. w, henrietta l, lester k. anticipated and experienced pain associated with endodontic therapy.jada , vol. 133, january 2002 22feine js, bushnell mc, miron d, duncan gh. sex differences in the perception of harmful heat stimuli. bread 1991;44(3):255-62 23paulson pe, minoshima s, morrow tj, casey kl. gender differences in pain perception and patterns of cerebral activation during noxious heat stimulation in humans . bread 1998;76:223-9 24watkins ca, logan hl, kirchner hl. anticipated and experienced pain with endodontic therapy . j am dent assoc . 2002 jan; 133(1):45-54. 25sillamy n. dictionary of psychology. larousse. paris; 1991. 26schult m. lucerne dental team dentophobia: the fear of the dentist, 2010-2013 27o’keefe. pain in endodontics therapy : a preliminary clinical study . j endodon 1976; 2:315-319. 28hill kb, chadwick b, freeman r, o'sullivan i, murray jj. adult dental health survey: relationships between dental attendance patterns, oral health behavior and the current barriers to dental care. br dent j. 2013;214(1):25-32. 29humphris g, crawford jr, hill k, gilbert a, freeman r. uk population norms for the modified dental anxiety scale with percentile calculator : adult dental health survey results . bmc oral health.2013;13:29. 30american psychiatric association: diagnostic and statistical manual of mental disorders. issy-les-moulineaux: elsevier masson, 2004 31weisenberg m, aviram o, wolf y, raphaeli n. relevant and irrelevant anxiety in the reaction to pain. bread. dec 1984;20(4):371 83. 32absi m, rokke pd. can anxiety help us tolerate pain? jul 1991;46(1):43 51 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 67 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) andrianjafinoro tsiriniaina hasinjanahary1* http://ijojournals.com/ volume 06 issue 12 || dec., 2023 || psychological impact of post-operative endodontic pain 33perković et al. anxiety level and pain perception of endodontic patients, croatian actastomatol . 2014 ; 48(4): 258-67. 34armfield jm, spencer aj, stewart jf. dental fear in australia : who's afraid of the dentist ? aust dent j 2006; (51): 78-85 35brahm co, lundgren j, carlson sg, nilsson p, corbeil j, hägglin c. dentists' views on the treatment of fearful patients: problems and promises. swed dent j. 2012; 36(2):79-90 36perković et al. anxiety level and pain perception of endodontic patients, croatian actastomatol . 2014 ; 48(4): 258-67 ijo journals volume 06 | issue 12 | december 2023 | http://ijojournals.com/index.php/hsn/index 68 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || factors influencing the choice of oral health care center by the population of mahajanga i, madagascar factors influencing the choice of oral health care center by the population of mahajanga i, madagascar rafalimino hn1,2, ratsimandresy nn3, 2randriamalala nc1,5, rakotonirina fp1,4,andrianjafinoro th1,, ranjarisoa ln6, ramaroson j1. 1sub-section of conservative odontology endodontic at the tropical odonto-stomatological institute of madagascar (iostm), university of mahajanga ² university hospital profesora zafisaona gabriel androva mahajanga madagascar, 3 sub-section of prosthodontics at the tropical odonto-stomatological institute of madagascar (iostm), university of mahajanga, madagascar 4 oral health center, ministry of industrialization, trade and consumption antananarivo, madagascar, 5 university hospital joseph dieudonné rakotovao, befelatanana antananarivo, 6 public health mention at tropical odonto-stomatological institute of madagascar (iostm), university of mahajanga corresponding author: rafalimino holy nasandratra1, 2 abstract the aim of this research study was to determine the factors influencing the choice of the type of oral health care center attended by the population of the city of mahajanga i in madagascar. methods based in a cross-sectional observational-analytical study, conducted in the city of mahajanga i in 2019. surveys were carried out among the class of population aged over 18 years, residing more than six months in the city of mahajanga i, visiting an oral health center more than once. the questionnaires were based on a description of the factors motivating patients to choose an oral health center. uni-variate and bivariate analyses were carried out. the bivariate analysis was conducted to identify the association between the variables studied and the type of oral health center attended. the pearson chi² test was used to test the significance of the results and a value of p< 0, 05 was considered significant. results managing, socio-economic factors and factors for assessing the quality of services influence the choice of the type of oral health care center by the population of mahajanga i. gender, age, profession and the type of approach and motivation offered at oral health care centers were factors associated with the choice of type of oral health care center by the population of mahajanga. key words: factors influencing, choice, dental service, cross-sectional analytical study. 1.introduction in the world, the global burden of disease study showed that 50% of the world's population suffers from oral diseases [1].in madagascar, in 2016, the prevalence of oral and periodontal ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 15 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || factors influencing the choice of oral health care center by the population of mahajanga i, madagascar diseases ranged from 80% to 98%. so, the attendance rate at public oral health care centers in madagascar is only 10.5 [2].the aim of this research study was to determine the factors influencing the choice of the type of oral health care center attended by the population of the city of mahajanga. 2.methods a cross-sectional observational-analytical study was conducted in the city of mahajanga, madagascar i, in 2019. our target was to investigate the class of population aged over 18 years, residing more than six months in the city of mahajanga i. included in our study was the entire population of the city of mahajanga, aged over 18, regardless of gender, residing for more than six months in the city of mahajanga i, attending an oral health center more than once in mahajanga. excluded from our study was the entire population of the city of mahajanga, aged over 18th, regardless of gender, residing for more than six months in the city of mahajanga i, presenting either a deafness or mental handicap, or those who refused to take part in the survey. using andersen's formula, and based on the prevalence of use of oral care in madagascar (10, 5), the sample size was 145. to ensure that our sample was heterogeneous with regard to the type of oral health center, we adopted a stratified random sampling method based on all twenty-four non-school oral health centers in the city of mahajanga. sample selection in each stratum was random. the interviewers were randomly selected.respecting ethical considerations, previously tested questionnaires were used during the survey. the survey was conducted between january 1 and december 4, 2019. using spss 20.0 software, uni-variate and bivariate statistical analyses were carried out. the uni-variate analysis was developed to describe the socio-demographic profile of the study population. the bi-variate analysis was conducted to identify the association between the variables studied and the type of oral health center attended. the pearson chi² test was used to test the significance of the results. a value of p< 0.05 was considered significant. there is strong significance when the p-value <0.001, moderate significance when the pvalue = 0.001, and barely significant when p<0.05 0.001. 3.results 3.1 uni-variate analyses 3.1.1 sociodemographic profile the study population was predominantly female (73.1%), with a sex ratio of 0.36. in terms of age, the 50+ age group constituted forty-five point five percent (45.5%) of the sample. individuals with an occupation in the tertiary sector were predominantly represented (45.5%). most of the individuals surveyed were married (73.1%). in terms of distance ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 16 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || factors influencing the choice of oral health care center by the population of mahajanga i, madagascar between home and the oral health care center attended, forty-three point four percent (43.4%) lived between 6km and 10km from the health care center (table i). 3.1.2 socioeconomic profile surveyed individuals with a monthly income ≥ 200,000 equivalent to $43.83 or €40.77 made up fifty-six point six percent (56.6%) of the sample. and seventy-five point two percent (75.2%) of the individuals surveyed declared that they had no savings allocated to oral health care (table ii). table i: distribution of individuals by sociodemographic profile socio-demographic profile n n=145) % gender male 39 26,9 sex-ratio = 0,36 female 106 73,1 total 145 100,0 age range 18 to 29 age 35 24,8 30 to 49 age 52 29,7 50 to age 58 45,5 total 145 100 profession primary sector 36 24,8 secondary sector 43 29,7 tertiary sector 66 45,5 total 145 100 marital status married 106 73,1 unmarried 39 26,9 total 145 100 distance between home and dental services 0 to 5km 55 38,0 6 to 10km 63 43,4 over 10km 27 18,6 total 145 100 ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 17 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || factors influencing the choice of oral health care center by the population of mahajanga i, madagascar table ii: distribution of individuals by socioeconomic profiles socio-economic profiles n (n=145) % monthly income <200 000 ariary 63 43,4 ≥ 200 000 ariary 82 56,6 total 145 100,0 possession savings allocated for dental care yes 36 24,8 no 109 75,2 total 145 100 3.1.3 type of dental care center visited the majority of individuals surveyed frequented the type of liberal oral health center (62.8%). twenty point seven percent (20.7%) of the individuals used to attend denominational to attend faith-based oral health centers. only a proportion sixteen point six percent (16.6%) of the individuals surveyed frequented public oral health centers (table iii). table iii: distribution of individuals by type of oral care center chosen type of oral health center chosen n (n=145) % public 24 16,6 denominational 30 20,7 liberal 91 62,7 total 145 100 3.2 bivariate analysis 3.2.1 type of oral health care attended and gender between the type of oral health center attended and gender, a significant difference was found. male patients (79.5%) were more likely to attend a private liberal dental structure (**p=0.01<0.05) in relation to women patients attended less (17%) public oral health care centers (**p=0.01<0.05) (table iv). ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 18 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || factors influencing the choice of oral health care center by the population of mahajanga i, madagascar table iv: distribution of individuals by type of oral health care centerattended and gender type of oral health center chosen gender khi² test male female n (n=39) % n (n=106) % public 6 15,4 18 17,0 *p = 0,01<0,05 denominational 2 5,1 28 26,4 liberal dental 31 79,5* 60 56,6 39 100 106 100 3.2.2 type of oral health care attended and age the result showed a highly significant difference in relation to age group and type of dental type of dental facility attended. subjects aged between 30 and 49 years (78.9%) usually attended public dental facilities (**p=0.006<0.05) (table v). table v: distribution of individuals by type of oral health care center attended and age group type of dental center chosen age range khi² test 18 to 29 age 30 to 49 age 50 age + n (n=35) % n (n=52) % n (n=58) % public 9 25,7 1 1,9 14 24,1 **p = 0,006<0,05 denominational 6 17,1 10 19,2 14 24,1 liberal 20 57,2 41 78,9** 30 51,8 35 100 52 100 58 100 3.2.3 type of oral health care attended and profession according to the type of oral health care center attended and profession, this study has found a significant difference. the majority of the population with an occupation in the tertiary sector (74.2%) opted for private oral health care centers (*p=0.02<0.05) (table vi). ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 19 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || factors influencing the choice of oral health care center by the population of mahajanga i, madagascar table vi: distribution of individuals by type of oral health care center and profession type of dental center chosen profession sector khi² test primary sector secondary sector tertiary sector n (n=36) % n (n=43) % n (n=66) % public 8 22,2 7 16,3 9 13,7 *p = 0,02<0,05 denominational 13 36,1 9 20,9 8 12,1 liberal 15 41,7 27 62,8 49 74,2* 36 100 43 100 66 100 3.2.4 type of oral health care attended and satisfaction with approach offered by the dentist according to the type of oral health care center attended and satisfaction with the approach offered by the dentist during oral health care, a highly significant difference was found. the majority of patients surveyed (65.5%) attending the type of liberal oral health center mentioned their satisfaction with the therapeutic approach opted for by the practitioner (***p=0.000<0.05) (table vii). table vii: distribution of individuals according to type of oral health care center chosen and satisfaction with practitioner's therapeutic approach type of dental center chosen satisfaction with practitioner's therapeutic approach khi² test yes no n (n=139) % n (n=6) % public 23 16,5 1 16,7 ***p = 0,000<0,05 denominational 25 18,0 5 83,3 liberal 91 65,5*** 0 0,0 138 100 6 100 4. discussion 4.1 discussion of the methodology the urban commune of mahajanga i was served by six types of school-based oral health care centers and twenty-eight non-school-based oral health care centers [3].the six types of ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 20 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || factors influencing the choice of oral health care center by the population of mahajanga i, madagascar school-based oral health care centers were excluded from our survey site due to the age of the individuals attending these facilities being under 18. in relation to the type of oral health care center, the sampling method adopted enabled us to obtain a heterogeneous sample. the sample size in each stratum respected the proportion of each stratum (table viii). 4.2 type of oral health center and gender: gender-related factors male individuals (79.5%) were more likely to visit private oral health centers (table 4). this result differs from the study by diouf m et al. in 2010. they reported a rate of 62.6% for women attending liberal oral health centers. as an interpretation, they pointed out that women greatly appreciate the high standard of service, where as there is no luxury in public health centers, so they frequent them less frequently [4]. 4.3 type of oral health center and age: age-related factors males (79.5%) were more likely to frequent private oral health centers. compared to age, there was a significant difference between age and the choice of the type of oral health center attended (***p=0.006<0.05) (table 5). age is a determining factor in the choice of oral health center. this result corroborates with fernandez r and collaborator’s study on 2020. they evocated a high school level showed high significance (p=.002) towards choosing private clinics for dental treatment. most patients other the age of 60 have chosen private clinics for dental treatment [5]. 4.4 type of oral health center and profession: factors related to profession individuals with occupations in the tertiary sector were the most frequent (74.2%) private oral health care centers (table 6). individuals with occupations in the tertiary sector were generally considered to be "higher-paid" professions, and able to afford the more expensive care offerings. this finding corroborates with ndame dieng s and collaborators’study on 2016. they reported that the majority of civil servants used private dental facilities (54%) [6]. 4.5 type of oral health center and satisfaction with the practitioner's approach: factors related to the quality of the practitioner's approach the majority of patients surveyed (65.5%) who attended the type of liberal oral health center reported satisfaction with the therapeutic approach chosen by the practitioner (***p=0.006<0.05). according to fernandez r and collaborators on 2019, a dentist’s reputation and personality played a positive role in influencing a patient’s decision in choosing them for treatment (34,8%) (p < 0.005) [7]. according to the study of alhabib s and coll, dental professionals play a crucial role in shaping their patients' experience. in the dental field of their study, patients were mainly satisfied with the dentist's attention (77.2%) [8]. ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 21 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || factors influencing the choice of oral health care center by the population of mahajanga i, madagascar conclusion in this study, the hypothesis was verified. socio-economic factors and factors for assessing the quality of services influence the choice of the type of oral health care center by the population of mahajanga i. despite the study's limitations, four significant results were found.gender, age, profession and the type of approach and motivation offered at oral health care centers were factors associated with the choice of type of oral health care center by the population of mahajanga. private oral health care centers were attended mainly by men. public oral health care centers are mainly frequented by the over-50s. the type of approach and therapeutic motivation offered by the dentist within the oral health care center is a factor strongly associated with conditioning the choice of which type of oral health care center to attend. as a perspective, would the design of oral health care rooms influence patients' motivation to seek treatment? acknowledgement none conflict of interest no conflict of interest references [1]. world health organization. management of noncommunicable diseases, noncommunicable diseases, rehabilitation and disability. global oral health status report: towards universal health coverage for oral health by 2030. america, 2023 : 1-40. [2]. ranivoharilanto e. santé bucco-dentaire à madagascar : état des lieux et perspectives. aide odontologique international. madagascar, 2016 : 1-38. [3]. ordre national des odonto-stomatologistes de madagascar. annuaire national dentaire. madagascar, 2019 : 1-55. [4]. diouf m , cisse d , lo cmm , faye d , traoré r. évaluation de la satisfaction des patients admis en service d’odontologie à dakar. s pratiques et organisation des soins. 2010 (vol 41) : 225-30 [5]. ragna lamprecht, julia struppek, guido heydecke, daniel r. reissmann. patients’ criteria for choosing a dentist: comparison between a university-based setting and private dental practices. international journal of dental and health sciences.original article. volume 03, issue 06. 2020: 1-7. ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 22 https://www.who.int/teams/noncommunicable-diseases https://www.who.int/teams/noncommunicable-diseases https://www.who.int/teams/noncommunicable-diseases https://onlinelibrary.wiley.com/authored-by/lamprecht/ragna https://onlinelibrary.wiley.com/authored-by/struppek/julia https://onlinelibrary.wiley.com/authored-by/heydecke/guido https://onlinelibrary.wiley.com/authored-by/reissmann/daniel+r. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || factors influencing the choice of oral health care center by the population of mahajanga i, madagascar [6]. ndame dieng s, cissé d, lomrail p, azougui-levy s. état de santé, offre et recours aux soins bucco-dentaires chez les enfants sénégalais : synthèse des données disponibles. santé publique .2016 : 257-65 [7]. fernandez r , eisa e, alqattan a , aldayel a , alkhalefah o , alanazi f , karshe b , alsulayyim a. factors influencing patients' decisions while choosing a dental care provider. international journal of dental and health sciences.original article. 2019(volume 03) : 1-8. [8]. alhabib s, albarikan o. impact of dental services on patients' perception at private dental clinics in riyadh, saudi arabia. iugjeps islamic university of gaza 2021 (vol 29): 262 -75. ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 23 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 1 job satisfaction of nursing staff and its contributing factors: an integrative literature review authors 1 lubna mohammad almuhtadi. rn, msn; majesty queen rania al abdullah governmental hospital, jordan (almuhtadilubna@yahoo.com) 2 rania wa’el mohammad alabed hasan. rn, msn; al-bashir governmental hospital, jordan ( raniaalabedhasan@hotmail.com), (ranialabedhasan@hotmail.com), ( raniaalabedhasan@gmail.com), (raniaalhasan2@gmail.com) 3 firas mohammed al_khawaldeh. rn, msn; royal medical services jordan, (firasrtrn@gmail.com) 4 nidal fareed eshah. prof of critical nursing, faculty of nursing, zarqa university, jordan (nidal2000jo@yahoo.com) abstract job satisfaction is a feeling of well-being that arises from the combination of numerous occupational factors, and it can have an impact on a nurse's connection with his or her employer, clients, and family. as a result, it becomes important for the quality of nursing care to reflect on this topic in depth. this study aimed to explore contributing factors that influence job satisfaction andeffects of job satisfaction on nursing work .an integrative review was conducted. electronic databases including: cinahl, medline, scopus and web of science, and reference lists of journal publications were searched for peer reviewed literature published between 2015 and 2020 related to registered nurse job satisfaction and career intentions. study quality was appraised, before thematic analysis was undertaken to synthesis the findings. introduction job satisfaction is in essential component for any organization to achieve its strategic goals (inegbedionet al. 2020).simply job satisfaction defied as the perception of the individuals towards their jobs (morsheda et al. 2016). the concept of job satisfaction is a complex and subjective phenomenon, whose definition varies depend to the adopted theoretical framework (morsheda et al. 2016). rahman et al. (2017) defined job satisfaction as the availability of physiological aspect, circumstances and environmental changes that make a person honestly say that i am satisfied with my job.although job satisfaction is influenced by many factors, it is still something internal that has to do with the way an employee feels (lu et al. 2016). job satisfaction is not only an individual feeling about his /her job; but also resulting from multiple aspects related to the work (liuet al. 2019). hee et al. (2018), reported that organizations with higher employee's satisfaction achieved 87 % higher customer ratings, 77 % more success in lowering turnover, revealed 45 % higher profitability and 76 % safety records. a recent interactive survey uncovered the following statistics on american job satisfaction, 45% of workers say they are either satisfied or extremely satisfied with their jobs. only 20% feel very passionate about their jobs, 33% believe they have reached a dead end in their career, and 21% are eager to change their career. previous studies reported several contributing factors that could influences job satisfaction such as: personal factors (age, gender, payments and benefits, perceived fairness of the promotion system within a company and employee jobrelationship), job factors (job adaptation, stressors, burnout, job absenteeism, turnover, organizational ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 2 citizenship and anger) (akirmak et al., 2019). other factors also highlighted, such as: health and wellbeing, resignation, autonomy, freedom, satisfaction with life and client satisfaction (kapur, 2018). therefore, workers’ job satisfaction has become a source of organizational concerns, as it contributes to the individual's well-being and strongly related to the quality ofworker’s performance (morshedaet al. 2016).job satisfaction has major implications because it is relevant to all professions, jobs and contexts (al maqbali, 2015). job satisfaction influences productivity in the workplace and it can be a factor in the subjective evaluation of the characteristics of work conditions (dianatet al. 2016). in nursing, job satisfaction is related to high performance and retention (lee et al., 2017), on other side,dissatisfaction leads to physical and mental fatigue, change in self-esteem and loss of interest in clients’ comfort, irritability and related to high staff turnover (morsheda , et al,. 2016;warmelinket al. 2015). understanding nurses job satisfaction can contribute to realizing problems in health care sector, plan for solutions and consequently improve the work environment and enhance the quality of care (meloet al. 2016). assessing job satisfaction in general can help highlight factors that increase it, which in turn can improve productivity and organizational work environment, and consequently motivate the employees to work harder (raziq&maulabakhsh, 2015). as it has often been said that “a happy employee is a productive employee.” a happy employee is, generally, that employee who is satisfied with his/her job (ariani, 2015). this integrated literature review aimed to analyze available scientific research on job satisfaction during the last 5 years. the underlying research questions are: a). whatare ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 3 the main contributing factors that influence employee's job satisfaction? b). what are the effects of job satisfaction on nursing work related outcomes? methodology this review included articles published between 2015 and 2020, and the following electronic databases, were searched: the national institute of health library, medline, cinahl, blackwell synergy and ebsco. the search for related literature was conducted through keywords, that available in the articles’ title, or abstract. these keywords include: nurses, job satisfaction, contributing factor, dissatisfaction at work. articles were included in the review if they satisfy the following inclusion criteria: available as full text, written in english, published in peer reviewed journals, available on-line and published between 2015 and 2020. initially, 45 articles were identified and after screening titles and abstracts of articles, checking the eligibility criteria, and eliminating duplicate articles; 24 articles were retained. after deep screening 18 articles met the inclusion criteria, and included in the current integrative review. result eighteen studies were reviewed to determine the main factors that influence employees’ satisfaction, how the job satisfaction helping managers to attract, motivate and retain their employees at long term, and what is the effect of job satisfaction on nurses and profession. the sample sizes of included studies varied from 34 to 7049 participants. participants were community nurses, nursing faculty members, nursing alumni, nurses in private organization, women nurses and midwives (six studies).in some studies, the data from various employees setting such as bank employee (one study), teacher (two studies), it ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 4 worker (one study), portuguese worker and general practice (eight studies). six studies (33%) focused on nursing job satisfaction, three studies (16%) reported data on job satisfaction in general employee, two studies (11%) investigate the relationship between psychosocial characteristics of work environment and job satisfaction and seven studies (38%) it is related to the effect the contributing factors on job satisfaction in specific setting (please see table 1). the variation in measurement of job satisfaction across studies and the differences in respondent characteristics makes comparison difficult. concerning the research design; 8 studies (44.4%) descriptive, 4 studies (22.2%) correlational, 4 studies qualitative (22.2%), 2 studies (5.55%) study post-test group. as for the instruments used to measure job satisfaction, 9 studies used instruments that developed by authors themselves, including open and closed questions, 5 studies used the index of job satisfaction (ijs) questionnaire, 3studies used the team satisfaction assessment scale in mental health services (satisbr) and 1 study used the job satisfaction measurement questionnaire (jsmq). factors influencing job satisfaction the contributing factors on job satisfaction are varied in these paper, seven studies (39%) of job factor (thriving at work by identity and autonomy, workload balance, primary care midwives,recruitment and retention, accreditation,job characteristic and acoustic environment, spillover of workplace it satisfaction), four studies (22%) of personal factors (worker and occupational personality, marital quality, gender inequality and person competencies). seven studies (39%) psychosocial characteristics' of work environment (motivating factor, trait anger, time perspective related to burnout, ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 5 emotional factors, role stressors by moderating role of social media, structural empowerment, and psychometric properties). job factor – certain factors are required to be taken into consideration and affect employees of job satisfaction. according to jiang et al. (2020)whose building on two studies to explore a thriving at work by the task of identity and autonomy,it will make the job satisfaction its outcome and focus on the moderating role of mentoring,to determine one found positively predicted between identity and autonomy on job satisfaction, the effect of task identity on thriving its indirect effect on job satisfaction in two study.these results also give practical regarding how to use motivating job characteristics and found resources to give positive individuals with enhanced wellbeing at work. inegbedionet al.(2020) used other concepts of workload balance to determine a potential relationship between employee perception of workload balance and job satisfaction via 764 employees from eight organizations and two private universities in nigeria. the results showed that the perception of workload balance significantly influenced the job satisfaction. while there are several studies on job satisfaction in nursing; little is known about the working conditions of nursing and midwives. warmelinket al. (2015) study was designed to obtain an understanding of how primary care midwives in the netherlands feel about their work and to identify factors associated with primary care job satisfaction through (99) participating practices midwives. the findings showed the participating primary care midwives in the netherlands were satisfied with their job and factors as direct contact with clients, the teamwork with immediate colleagues and supportive cooperation, the organization of and innovation within their practice group and the independence, autonomy, freedom, variety, and ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 6 opportunities positively associated with their job satisfaction. in the study college nursing faculty job satisfaction and retention, lee et al.(2017) meet the program requirements and certification standards which proved to be difficult and expensive for maintaining quality, decreasing costs, and providing health care to the public on job satisfaction. the concepts of job satisfaction and intent to stay become vital to the recruitment and retention of the nursing staff. recruitment and retention of the nursing staff was subject to indicators of job dissatisfaction, job dissatisfaction has been cited as a heavy workload, multiple role expectations, insufficient time, shortage of counseling and lack of group supportthrough 1350 nurse educators were included in the survey in the united states to analyze the variables of relationships with nurses' faculty job satisfaction and intended data collected. cooperative in academic careers in higher education (coache)was employed for the purpose of this study. the results did not indicate a significant relationship between age and job satisfaction. age shows a statistically negative relationship with intent to stay, the strongest relationship is institutional leadership. the effects can inform the academic directors who are seeking to retain the college of nursing. pedersenand waldorff(2020)examined if the accreditation affects the job satisfaction among general practitioners. the finding shows there were negative associations between job satisfaction and perceiving accreditation as a tool for external control. similarly, parket al. (2020)studied the association of acoustic physical factors and characteristics of the work and job satisfaction. the results showed that the active noise level has negative correlation with job satisfaction and, furthermore job satisfaction showed a negative correlation with speech privacy, and relationship between job satisfaction and noise ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 7 disturbance was not significant so observed relationship between task identity and job satisfaction was moderated by the active noise level and speech privacy. in the study spillover of workplace it satisfaction onto job satisfaction, wang et al. (2020) employee satisfaction with information technology in the workplace that becomes an integral part of the work and greatly influences work-related results. building on the theory of satisfaction prevalence, an empirical model was developed and tested to examine the relationship between individual satisfaction with it in the workplace and job satisfaction. two elements that are appropriate for user-important technology functional fit and occupational fitness to study the shift in employee satisfaction from the technological field to general job satisfaction. the effect of job satisfaction in the workplace on job satisfaction has been reduced through the presence of job and job fit. the effect of job fitness on job satisfaction was significant, while the impact of job fit on job satisfaction was not significant. the results indicate that functional relevance was a partial mediator, and the mediation effect of professional proportionality was not supported. the results indicate that practitioners should emphasize it in the workplace as a critical component in the business context and improve employee experiences with it. personal factors(marital quality, gender inequality and person competencies),according to ghetta et al.(2020)examine the relationship between persons-environment fit (p-e fit), and job satisfaction. by analyzing the congruence between the big five personality traits of a worker and of all job incumbents in the same occupation, this congruence relates to job satisfaction over time, by taking 7049 participants from the german socio-economic to assess changes in congruence and job ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 8 satisfaction over eight years, and created 3d response surface plots based on polynomial regression to investigate nonlinear relations between each big five trait and job satisfaction. the result showed the change between p–e fit and change in job satisfaction are not related and did not predict change that follows job satisfaction. the worker's and an occupation's personality are primary independently relevant for the level of job satisfaction and those effects differ accordingly to personality trait. marital quality is another personal factor that used in reference to marital adjustment and job satisfaction. marital quality is another personal factor that used in reference to marital adjustment and job satisfaction. a study conducted by ouyang et al. (2019)investigated the relationship between job satisfaction and marital quality to identify the association of demographics with job satisfaction and marital quality among 2296 married nurses. the result showed that marital quality and job satisfaction were positively correlated. age, marital status and average daily hours had positive impact on job satisfaction. another study, perugini and vladisavl (2019)conducted a study to obtain analyze job satisfaction gaps between 32 european cities and how to link differences in gender inequality, the result show provides clear and strong evidence on determining exposure to equal gender environments in the early stages of life and exposes gender differences in terms of job satisfaction, thus, women who grew up in equal working conditions have higher expectations than their male counterparts, working in typical male jobs achieves this compatibility, and proportion, but higher education levels do not play a similar effect. personal competenciesincluded (communication and expression abilities, lifelong learning ability, innovative abilities and creativity, cooperative ability, problem solving, positive attitudes, interpersonal skills and critical thinking ability) are associated with ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 9 successful job performance, are directly related to decrease nursing turnover, and is a critical indicator of their performance and quality of patient care. liu et al.(2019) conducted a study to explore the relationship between personal competencies, social adaptation, and job adaptation on job satisfaction amongnurse’s alumni. result revealed that alumni with extracurricular activities involvement had higher level of personal competencies and god job satisfaction. however, these results showed the positively and significantly correlated between personal competencies, social adaptation, job adaptation and job satisfaction. psychosocial characteristics of work environment (burnout through time perspective, emotional factors, anger, structural empowerment through role stressor and psychometric properties).a study of viotti et al. (2020) examined the crosslaggedof italian associations in a sample of kindergarten teachers between job satisfaction and two types of psychosocial characteristics of the work environment for motivating factors such as (job demands, work meaning, and role clarity) and psychosocial factors, such as (work family conflict, rewards, peer support, and superior support). the result indicated a positive relationship between job satisfaction and work meaning. motivating factors are more stringent than the psychosocial factors associated with job satisfaction. another study was conducted by la and yun (2019). examine the effects of each nurse's anger on job satisfaction and burnout in preceptornewly graduated nurse (ngn) relationship. as for the trait anger among 121 preceptors newly graduate nurse dyads in the two hospitals in south korea. anger was the level of the link between the preceptors’ anger, job satisfaction and burnout. the preceptors’ anger has a powerful effect on their burnout, but there is no effective effect on their job satisfaction. the anger of the ngns’ ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 10 trait has had a partner’s effect on the preceptors’ burnout, but there is no partner influence on preceptors’ job satisfaction. another studied wasconducted by akirmakandayla (2019),examined a time perspective is the basis of cognitive processing that related to burnout and job satisfaction, which in turn affects behavior decisions and attitudes, zimbardo time perspective inventory (ztpi)has five dimension past positive (pp), past negative (pn), present hedonistic (ph), present fatalistic (pf) and future (f). in a positive balance of time leads to the particular well-being. lead to a state of positive mood this leads to less stress and increased need for self-satisfaction. the unique contributions of cse and balanced tp to job satisfaction through job burnout in a path model. according to the cor theory, there may be multiple resources and pathways to achieve goals, this model evaluated the relative importance of balanced tp and cse in predicting job satisfaction. in a same context, atmaca et al. (2020) find out the interrelationships between teachers during emotional service, burnout, and job satisfaction in turkey. the teacher emotion inventory (tei), job satisfaction survey, and maslach burnout inventory were administered among 564 teachers in service in a wide range of disciplines. the tei model consisting of five factors (joy, anger, sadness, love, and fear) is confirmed. the dimensions of joy and love showed positive associations with job satisfaction. the love and fear dimensions highly predict job satisfaction with a modest effect. the dimensions of love, sadness, and fear greatly predicted teacher fatigue with a moderate effect. wang et al. (2020) studied in impact of the role of stressors on employee creativity through mediation and contextual factors that have an impact on relationships through the theory of transactional theory of stress. result of this study that included 56 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 11 organizational teams suggest that two social media usage patterns differentially moderate the relationships between role stressors and job satisfaction and the indirect relationships between role stressors and employee creativity through job satisfaction. orgambídez and almeida (2020) analyzed the relationships between structural empowerment, role stress (ambiguity and conflict), and job satisfaction, through the mediating role such as role stress on the relationship between structural empowerment and job satisfaction. the result showed the structural empowerment, role ambiguity, and role conflicts were significant predictors of job satisfaction. both ambiguity and role conflict partially mediated the effect of structural empowerment on job satisfaction. additionally the effect mediated by ambiguity was more than the effect mediated by role conflict in both registered nurses and certified nursing assistants. on the other hand, rodríguezet al.(2020).examined the psychometric properties of the satisfaction with job life scale (swjls) in portuguese workers by combining the procedures of the classical test theory (ctt) and the item response theory (irt) such as internal structure of the scale was studied through 404 workers. the result indicated swjls measures the same construct (satisfaction with work life) in both female and male work. discussion job satisfaction refers to workers’ subjective assessment of the extent to which job aspects can be negative or positive to their wellbeing. this assessment is dynamic, that is, the state of satisfaction can change according to the general work conditions offered. our review demonstrated agreement between studies in terms of the positive impact of a (professional role, identity, autonomy, workload balance, workplace relationships, ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 12 autonomy, information technology, burnout, role of stressors and psychometric properties) upon job satisfaction. many studies result support that the job satisfaction have advantages to both employee and organization (la et al. 2019; lee et al. 2017). even though not all study had the same job satisfaction contributing factor. in the studies under analysis, different factors have a negative correlation with job satisfaction, such as negative associations between job satisfaction and perceiving accreditation as a tool for external control, (pederson & waldorff, 2020) and the relationship between job satisfaction and noise disturbance was not significant. soob served relationship between task identity and job satisfaction moderated by the active noise level and speech privacy (park et al., 2020). only six studies were conducting for nurses, two studies focused on work stressor and anger related to, specially the effect of workload as a major and common problem in nursing career and how affect job satisfaction negatively (la, et al. 2019;orgambidez et al. 2020), and the correlation between job satisfaction and marital quality for women nurses and how the marital quality was positively correlated with job satisfaction (ouyang et at. 2019). woman had more job satisfaction than men and stronger relation between personal factor and gender equal settings (perugini et al. 2019)because women have lower positions in the labor market that were this view in the past, the changes in standards and expectations accompany changes in gender rights and roles associated with a decrease in women's well-being, woman gender associated with the highest values of work such as flexibility, social communication despite low wages and poor work conditions. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 13 another result of study conducted on female nurses support that marital status relationship with job satisfaction is a positive even if they is relatively low in sum study. this data support the notion that personal related factor is important and affect the job satisfaction level significantly like job related factor, and both factor have a significant effect on burnout and turnover which affect productivity (warmelink et al. 2015 ;atmaca et al. 2020). the resultof previous study support the relationship between psychological factor like emotion, anger and job satisfaction as important factor (atmaca et al. 2020) for example treated anger have positive relationship with job satisfaction but untreated anger have negative relationship with job satisfaction (la et al. 2019). job satisfaction affected by the organization leadership style because using social media within teams as a moderator influencing employee stress appraisal through the distinction between task-oriented and relationship-oriented social media use, two patterns of social media use modulate the relationships between role stress and job satisfaction, and the indirect relationships between role stress and employee creativity through job satisfaction, role ambiguity and role conflict affect job satisfaction and creativity negatively (wang et al. 2020). not only personal competences which have positive relationship with job satisfaction are investigated also leadership style and employee role are investigated (liu et al. 2019). the result support the positive effect of empowerment on job satisfaction and support that the structural empowerment is partially mediated by role stressor and role conflict, and support that the mediation effect of role ambiguity was much stronger than the mediating effect of role conflict, because the role conflict can be a result of role ambiguity (orgambidez et al. 2020& wang et al. 2020).surprisingly even the physical ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 14 work environment is investigated, a result support the relationship between acoustic environment and job satisfaction, but unfortunately many cofounding factor can affect the generalizability like light heat and personal deference's of the sample (park et al. 2020). limitations the variation in measurement instruments that used to determine level of job satisfaction and sample sizes made comparison difficult, convenience samples were used in many studies reviewed and small sample sizes at some studies also reduce the generalizability of their result. also, as many journal articles are not available as full text articles. the participants who chose themselves might have it higher commitment to job satisfaction, it may improve their physical and psychological abilities a situation that affects their satisfaction. even the six studies that were conducted by nurses did not focusing of the effect of low job satisfaction on career bath and quality of nursing care in detail, and don’t investigate the effect of motivation (intrinsic and extrinsic) relationship and effect on job satisfaction cultural deference's between the employee are generalizability of the result. implications and recommendations job satisfaction needs to be developed to meet their changing needs. participants are taking an increasing role in self–satisfaction, traditionally been recognized as the contributing factor enrolment and participation while providing follow-up support to selfsatisfaction. participants can focus on contributing factor modification, which provides excellent results with job satisfaction. self-satisfactions are useful as a technique to ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 15 improve nurses’ physiological and psychological status and decrease consequences of contributing factor crises to achieve the maximum benefits of self-satisfaction. participants in developing countries need to develop and participate in multidisciplinary self-satisfaction. use swjls that’s offers a quick and optimal way to measure a person's overall satisfaction regarding his/her work-life, the swjls would identify those workers with lower levels of job satisfaction in order to develop practical interventions that seek to improve their attitudes at work. the contexts which facilitate access to opportunities, information, support, and resources increase perceptions of job satisfaction, a key element for the performance of nursing professionals. on the other hand, high levels of structural empowerment reduce the levels of role stress by eliminating uncertainty about contradictory tasks and demands, preventing job dissatisfaction, and improving the quality of working life of nursing staff. using longitudinally study rather than crosssection designed that have a better idea of the nature of the relationships between these variables. future studies can extend current results by investigating theoretical mechanisms, mediators and supervisors of these associations. nurses need to perform studies that stress on job satisfaction to determine whether international recommendations are effective for their self. conclusion this literature review has helped identify factors that can affect the job satisfaction among employees and nurses in different countries. findings indicated a relationship between personal factors, job factors and psychological factor on job satisfaction. job satisfaction found to be increased in factors as time perspective, emotion, congruence ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 16 between worker and occupational personality, workload balance, thriving at work by a mentoring-moderated process linking task identity and autonomy, recruitment and retention, personal competences, social adaptation, structural empowerment, marital quality, gender, information technology it and primary care midwives. employees who have a higher levels of job satisfaction are less likely to be absent and leave from work, are more productive, resourceful and diligent, more likely to display organizational commitment and they are more likely to be satisfied with their lives. references akirmak, u. and p. ayla (2019). "how is time perspective related to burnout and job satisfaction? a conservation of resources perspective." personality and individual differences: 109667. al maqbali, m. a. (2015). "factors that influence nurses’ job satisfaction: a literature review." nursing management22(2). ariani, d. w. (2015). "employee satisfaction and service quality: is there relations." international journal of business research and management6(3): 33-44. atmaca, ç., et al. (2020). "an emotion focused approach in predicting teacher burnout and job satisfaction." teaching and teacher education90: 103025. caycho-rodríguez, t., et al. (2020). "psychometric properties of the satisfaction with job life scale in portuguese workers: a systematic study based on the irt and cfa modeling." heliyon6(6): e03881. dianat, i., et al. (2016). "association between objective and subjective assessments of environmental ergonomic factors in manufacturing plants." international journal of industrial ergonomics54: 26-31. ghetta, a., et al. (2020). "birds of a feather flock together: how congruence between worker and occupational personality relates to job satisfaction over time." journal of vocational behavior: 103412. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 17 gori, a. and e. topino (2020). "predisposition to change is linked to job satisfaction: assessing the mediation roles of workplace relation civility and insight." international journal of environmental research and public health17(6): 2141. hee, o. c., et al. (2018). "factors influencing employee job satisfaction: a conceptual analysis." international journal of academic research in business and social sciences8(6). inegbedion, h., et al. (2020). "perception of workload balance and employee job satisfaction in work organisations." heliyon6(1): e03160. jiang, z., et al. (2020). "thriving at work: a mentoring-moderated process linking task identity and autonomy to job satisfaction." journal of vocational behavior118: 103373. kapur, r. (2018). "factors influencing the students academic performance in secondary schools in india." university of delhi. la, i. s. and e. k. yun (2019). "effects of trait anger and anger expression on job satisfaction and burnout in preceptor nurses and newly graduated nurses: a dyadic analysis." asian nursing research13(4): 242-248. lee, p., et al. (2017). "college nursing faculty job satisfaction and retention: a national perspective." journal of professional nursing33(4): 261-266. liu, h.-y., et al. (2019). "the relationship of personal competencies, social adaptation, and job adaptation on job satisfaction." nurse education today83: 104199. melo, m. b. d., et al. (2016). "job satisfaction of nursing staff: integrative review." revista latino-americana de enfermagem19(4): 1047-1055. morsheda, h. u., et al. (2016). "assessment of job satisfaction among the senior staff nurses working at sadar hospital, naogaon, bangladesh." asian journal of medical and biological research2(4): 611-615. orgambídez, a. and h. almeida (2020). "exploring the link between structural empowerment and job satisfaction through the mediating effect of role stress: a crosssectional questionnaire study." international journal of nursing studies: 103672. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 18 ouyang, y.-q., et al. (2019). "a web-based survey of marital quality and job satisfaction among chinese nurses." asian nursing research13(3): 216-220. park, s. h., et al. (2020). "associations between job satisfaction, job characteristics, and acoustic environment in open-plan offices." applied acoustics168: 107425. pedersen, l. b., et al. (2020). "does accreditation affect the job satisfaction of general practitioners? a combined panel data survey and cluster randomised field experiment." health policy. perugini, c. and m. vladisavljević (2019). "gender inequality and the gender-job satisfaction paradox in europe." labour economics60: 129-147. rahman, k.-u., et al. (2017). "factors affecting employee job satisfaction: a comparative study of conventional and islamic insurance." cogent business & management4(1): 1273082. raziq, a. and r. maulabakhsh (2015). "impact of working environment on job satisfaction." procedia economics and finance23: 717-725. viotti, s., et al. (2020). "the relationship between psychosocial characteristics of the work environment and job satisfaction in an italian public ece service: a cross-lagged study." early childhood research quarterly53: 464-475. wang, w., et al. (2020). "spillover of workplace it satisfaction onto job satisfaction: the roles of job fit and professional fit." international journal of information management50: 341-352. wang, y., et al. (2020). "role stressors, job satisfaction, and employee creativity: the cross-level moderating role of social media use within teams." information & management: 103317. warmelink, j. c., et al. (2015). "an explorative study of factors contributing to the job satisfaction of primary care midwives." midwifery31(4): 482-488. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 19 table (1) author (s) n gender target population design objective result factor on job satisfaction (year) male female akirmak et al (2019) 135 23% 77% bank employees. a conservation of resources perspective measures of time perspective, core self-evaluations, burnout and job satisfaction the importance of time perspective in job attitudes and provide insights into enhancing humanstrengths from a positive psychology perspective, connection between the cor and time perspectivethrough theories based on motivation and goal attainment processes. time perspective burnout atmaca c et al.(2020) 455 49.3% 50.7% teachers descriptive correlation study find out the correlation between in-service teacher emotional, burnout and job satisfaction positive emotion correlation with job satisfaction and negative emotion correlation with burnout emotion, burnout ghetta et al (2020) 7049 53.3% 46.7% german socioeconomic panel longitudinal panel survey with repeated interviews of the same participants every year analyzing the congruence between the big fivepersonality traits of a worker and of all job incumbents in the same occupationhowever, thiscongruence relates to job change in p–e fit was not related to a simultaneous change in job satisfaction and did not predict change that follows job satisfaction the worker's and an occupation's worker, person environment fit and occupational personality ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 20 satisfaction over time personality are primary independently relevant for the level of job satisfaction and those effects differ accordingly to personality trait inegbedion et al. (2020) 764 57% 43% employees structure equation modeling investigated perception of workload balance and employee job satisfaction in work organizations show that comparison of workload with those of colleagues and employees' role alliance with their competencies significantly influence their perception of workload balance and job satisfaction perception of workload balance jiang et al. (2020) 140 44.3% 55.7% undergraduate student explored study explored thriving at work by considering task identity and autonomy as its antecedents and job satisfaction effect of task identity on thriving as well as its indirect effect on job satisfaction via thriving became weaker when the quality of mentoring increased identity and autonomy la et al. (2019) 121 1.7% 98.3% nurses crosssectional design to investigate trait anger and anger expression on job satisfaction and burnout the trait anger and anger were associated with job satisfaction and burnout trait anger, anger expression, burnout lee et al (2017) 1350 44.5% 55.5% nursing faculty retrospective study. for increased numbers of nurses, recruitment and retention of qualified nurse educators has become a priority findings support a variety of modifiable variables that are viewed as important by nursing faculty. the strongest relationship was found to be institutional leadership recruitment and retention liu et al (2019) 280 1.8% 98.2% nursing alumni secondary data analysis to explore the relationship between personal competencies, social adaptation, and job job adaptation, personal competencies, and having had a leadership personal competencies, social adaptation ,job adaptation ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 21 adaptation on job satisfaction for nurses. role in extracurricular activities are important concepts to improving nurses' job satisfaction job satisfaction orgambídez et al (2020) two groups of participants the first group (sample 1) was composed of 124% registered nurses, the second group (sample 2) consisted of 130% certified nursing assistants first group 33.9% males the second group 29.2% males first group 66.1% male the second group 70.8% females a registered nurse and assistant nurse in private health care organizations in southern portugal descriptive, a crosssectional questionnaire analyze the relationships between structural empowerment, role stress (ambiguity and conflict), and job satisfaction, through the mediating role such as role stress on the relationship between structural empowerment and job satisfaction showed in both samples, structural empowerment, role ambiguity, and role conflict were significant predictors of job satisfaction. both ambiguity and role conflict partially mediated the effect of structural empowerment on job satisfaction. and the effect mediated by ambiguity was more than the effect mediated by role conflict in both registered nurses and certified nursing assistants role stress and structural empowerment ouyang et al.(2019) 2269 100% women nurses descriptive correlation study. investigate the correlation between job satisfaction and marital quality both marital quality and job satisfaction were relatively low. additionally, marital quality was positively correlated with job satisfaction. marital quality ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 22 park et al.(2020) 324 five respondents not answer. 67.3% 31.2% employee descriptive correlation study investigation the relationship between job satisfaction and job characteristics' and acoustics environment several acoustics parameter showed significant correlation with job satisfaction job characteristics' and acoustics environment pedersen et al.(2020) 846 50.4% 49.7% general practice in denmark a combined panel data survey and cluster randomised field experiment examine if the accreditation affect the job satisfaction of general practitioners many gp have negative attitudes toward accreditation, because it is not there are negative associations between job satisfaction and perceiving accreditation as a tool for external controla relationship between the effect of accreditation on job satisfaction. even so, there are negative associations between job satisfaction and perceiving accreditation as a tool of external control. accreditation perugini et al (2019) 32 european countries (28 eu members plus norway, switzerland, iceland and serbia). 34.0% 35.4% european countries descriptive examine the relationship between gender inequality and the gender-job satisfaction paradox in europe show provides clear and strong evidence on determining exposure to equal gender environments in the early stages of life and exposes gender differences in terms of job satisfaction, thus, women who grew up in equal working conditions have higher expectations gender inequality ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 23 than their male counterparts, working in typical male jobs achieves this compatibility, and proportion, but higher education levels do not play a similar effect. rodríguez et al.(2020) 404 39% 61% portuguese workers a systematic study examine the psychometric properties of the satisfaction with job life scale (swjls) in portuguese workers by combining the procedures of the classical test theory (ctt) and the item response theory (irt) indicated the structure of the swjls measures the same construct (satisfaction with work-life) in both female and male workers. in addition to irt analysis indicates that higher levels of work-life satisfaction are needed to choose the higher response options, while a very low level of work-life satisfaction is required to increase the possibility of choosing the fewer response options. so the swjls is good, useful, and reliable for identifying people with low levels of job satisfaction and for measuring job satisfaction psychometric properties ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 24 viotti et al.(2020) 349 100% teachers cross lagged study investigate the relationship between psychosocial characteristics' of work environment and job satisfaction significant associated between job satisfaction and psychosocial characteristics' of work environment psychosocial characteristics' of work environment wang w et al.(2020) 207 40.58% 59.42% \ it worker descriptive cross sectional investigate spillover theory the role of job fit and professional fit on job satisfaction positive correlation between job satisfaction spillover and it satisfaction workplaces spillover, job fit, professional fit wang y et al.(2020) 334 44.6% 55.4% employee descriptive correlation study to light how role stressors influence employee creativity by jointly exploring the mediating mechanism job satisfaction as mediator job satisfaction partially mediates the negative relationship between ra (role ambiguity) and rc ( role conflict ) and employee creativity role ambiguity, role conflict warmelink et al. (2015) 99 1% 99% midwives explorative study an understanding of how primary care midwives in the netherlands feel about their work and to identify factors associated with primary care midwives' job satisfaction the factors positively associated with their job satisfaction supportive cooperation teamwork organization independence autonomy, freedom ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 05 | issue 02 | february 2022 | http://www.ijojournals.com/index.php/hsn 25 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ popularization perspective of biomimetics approaches in restorative dentistry." popularization perspective of biomimetics approaches in restorative dentistry rafalimino hn1,2, rakotonirina fp1,3, andrianjafinoro th1,2, randriamalala nc1,4, randrianarivelo th1, ramaroson j1. 1sub-section of conservative odontology endodontic at the tropical odonto-stomatological institute of madagascar (iostm), university of mahajanga ² university hospital profesora zafisaona gabriel androva mahajanga madagascar, 3oral health center, ministry of industrialization, trade and consumption antananarivo 4university hospital joseph dieudonné rakotovao, befelatanana antananarivo corresponding author: rafalimino holy nasandratra tropical odonto-stomatological institute of madagascar (iostm) ______________________________________________________________________ _ abstract biomimetics approaches in restorative dentistry are a concept that uses nature as a mentor in coronal dental restoration by using appropriate crown restoration materials. the overall aim of this study is to describe the importance of biomimetic practice in restorative dentistry. this is a literature review study carried out on article published on pubmed, google schoolar and science direct, during the years 2014 to 2024, in french or english language with an impact factor. among the 82 articles collected, 52 discussed biomimetic techniques in restorative dentistry. this research highlighted different techniques and effective protocols for achieving biomimetic restoration, as well as the concept of tissue economy and the choice of materials to be used. the pretherapeutic, therapeutic, and final finishing steps chosen by practitioners were identified. the longevity of aesthetic results using material composites was demonstrated. this study shows the importance of biomimetic approaches so that the techniques can be popularized by practitioners. keywords : adhesive dentistry, biomimetic materials, technic, biomimicry, bioemulation. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 22 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ popularization perspective of biomimetics approaches in restorative dentistry." i-introduction the word “biomimicry” is a neologism coined by otto hs, an american academic and inventor. it describes the notion of transferring biology to technology. derived from two greek roots, bios (life) and mimesis (imitation), this neologism refers to the age-old approach of the human species. it consists of observing nature and drawing inspiration from it to innovate, improve its condition, and its productions [1]. in the field of odontostomatology, restoring dental hard substance loss, whether of bacterial, nonbacterial or traumatic origin, requires ethical consideration [2]. adhesive dentistry allows for coronal dental restorations to be performed with respect for the therapeutic gradient, meaning they are becoming less and less invasive. this concept is part of an obvious tissue-sparing technique, or “biomimetic” approach, which enables the conservation of as much healthy hard tissue as possible. the evolution of these concepts, combined with advances in biomaterial engineering, is now giving a new impetus to adhesive and aesthetic dentistry, with considerable restoration durability [3]. this new concept seeks to prioritize composite restorations in order to restore the natural biological, mechanical, functional and esthetic appearance of the newly restored tooth [4]. how can biomimetic dentistry be applied to coronal restorations, according to the literature ? the overall aim of this research was to identify the techniques and materials needed to achieve biomimetic restorations. iimethodology this is a literature review study conducted using articles published on pubmed, google scholar, and science direct from 2014 to 2024. the research was carried out within the computer space of the tropical institute of odonto-stomatology in mahajanga, madagascar. keywords : “adhesive dentistry,” “biomimetic materials,” “technic,” “biomimicry,” and “bioemulation” are used with the boolean operators “and” searches. research were carried out via more database : pubmed, a database of openaccess scientific articles managed by the nih (national institute of health) in the usa, google scholar, an academic search engine that indexes academic articles, books, and technical reports from various academic sources, scaspace, em consult, science direct, an online platform offering a wide range of scientific articles, including specialist journals in dentistry, medline, and cochranec. all scientific articles dealing with biomimicry and bioemulation in adhesive dentistry were included in the search if they met scientific standards, had an impact factor, and were published and written in french or english language during the study period. the exhaustive sampling method was chosen. of the 1,701 articles consulted, a total of 82 scientific articles were selected, 52 of which addressed the specificity of biomimetic coronal restoration technic. articles published during the study period that did not meet the variable evaluation criteria were excluded from this search. the variables studied focused on general information of the articles consulted (continent of publication, year of ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 23 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ popularization perspective of biomimetics approaches in restorative dentistry." publication, language of writing, type of article, number of authors, topics evoked), the concept of evolution of biomimetic adhesive restorative materials, and the therapeutic steps evoked by the authors. the data obtained were analyzed using spss version 20.0 software. figure 1 : flowchart of scientific article selection iii-results this research was conducted to identify the importance of the practice of biomimicry technic in adhesive dentistry. the overall aim of this research was to identify the technic and materials needed to achieve biomimetic restorations.  general information on the articles reviewed according to the country of publication, 43.90% of the articles were published in america, 28.10% in europe, 21.91% in asia, and 6.09% in africa [table i]. as stated by the year of publication, 40.24% of the articles were published between 2021 and 2024, 32.92% were published from 2014 to 2017, and 26.84% were published between 2018 and 2020 [table ii]. according to the topics discussed, among the 82 scientific articles reviewed, 63.41% focused on biomimetic restoration techniques in adhesive ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 24 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ popularization perspective of biomimetics approaches in restorative dentistry." dentistry, while 28.05% discussed general topics, and 8.54% covered historical aspects of biomimicry in dentistry [table iii]. table i : distribution of scientific articles reviewed by continents continents n n=82 % america 36 43,90 europe 23 28,10 asia 18 21,91 africa 5 06,09 total 82 100 table ii : distribution of scientific articles reviewed by year of publication year of publication n n=82 % 2014 to 2017 27 32,92 201 to 2020 22 26,84 2021 to 2024 33 40,24 total 82 100 table iii : distribution of scientific articles reviewed by topics topics n n=82 % biomimetism in general 23 28,05 history 7 08 ,54 biomimetics approaches 52 63,41 total 82 100 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 25 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ popularization perspective of biomimetics approaches in restorative dentistry."  concept of restoration materials evolution regarding the evolution of restoration materials, 48.07% of the authors highlighted the evolution of dental composite materials, and 17.30% mentioned the evolution of dental adhesives. the concept of tissue economy was discussed by 21.15% of the authors [table iv]. table iv : distribution of scientific articles reviewed by concept of evolution in dental restoration concept of evolution n n=52 % tissue economy concept 11 21.15 aesthetic concept 5 09.63 evolution of dental adhesives 9 17.30 evolution of dental composites 25 48.07 evolution of the biological concept 2 03.85 total 52 100  therapeutisc steps emphasized before biomimetic restoration, the importance of dental isolation was emphasized by 78.85% of the authors [table v]. to mimic the natural appearance of the tooth being restored, 92.31% of the authors stressed the importance of chromatic analysis, which is useful for choosing the appropriate composite shades [table v]. a proportion of 96.15% of the authors preferred the composite modeling step during the finishing of the restoration and considered it crucial for achieving a biomimetic effect in the restoration [table v]. table v : distribution of scientific articles reviewed by therapeutic steps emphasized therapeutic steps emphasized n n=52 % dental isolation yes 41 78.85 no 11 21.15 total 52 100 chromatic analys yes 48 92.31 no 4 7.69 total 52 100 modeling and sculpture yes 50 96.15 no 2 3.85 total 52 100 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 26 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ popularization perspective of biomimetics approaches in restorative dentistry."  aesthetic longevity of the restoration the initial quality of composite restoration influences immediate and long-term success. the practitioner's expertise in implementing the procedures is therefore very important, and the use of microhybrid or nanohybrid composites is the standard. 51.92% of the authors reported an aesthetic longevity of results ranging from 5 to 10 years [table vi]. table vi : distribution of scientific articles reviewed by aesthetic longevity of the restoration aesthetic longevity of the restoration n n=52 % under 5 years 14 26.92 5 years to 10 years 27 51.92 over 10 years 11 21.16 total 52 100 ivdiscussion  popularization of the biomimetic restorative technique the scarcity of research on biomimetics in dentistry in africa (6.06%) was noted according to the research results [table i]. the majority of articles consulted were published between 2021 and 2024, with a proportion of 40.24% [table ii]. these demonstrate that the concept of biomimicry represents a new concept of interest to contemporary odontostomatological researchers.  restorative concept highlighted according to the characteristics of the materials used for the restoration, a proportion of 48.07% of authors mentioned the incessant evolution of dental composites [table iv]. according to kano p in 2023, biocompatibility and aesthetic concepts exploring in dental aesthetics will be achieved by examining the role of biomaterials [5].  biomimetic restoration steps highlighted before restoration, the importance of tooth isolating has been highlighted by authors. sarwar r, in 2024, confirmed the usefulness of the dental dam in both restorative dentistry and endodontics [6]. kharouf n et al. in 2024, propose combining the basic isolation principle with the use of a light-curing liquid dam to improve field sealing performance [7]. in order to imitate the natural appearance of the tooth, the majority of authors (92.31%) emphasized the usefulness of chromatic analysis. this step will be done when selecting the type of composite. the principle of composite shade selection outlined by vanini l and mangani f in 2001 was modernized by francisco c.-p, in ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 27 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ popularization perspective of biomimetics approaches in restorative dentistry." 2021. in his review, he proposes the use of artificial intelligence (ai) and machin learning (ml), which have wide applications in treatment planning and cosmetic dentistry procedures [8], [9]. when finishing the restoration, according to paolone g., scolavino s., gherlone in 2017, composite modeling enables modeling as well as easy and best for natural finishing of the restoration; it is manipulated with a brush before light-curing. composite sculpting enables the overall shape, macro-anatomy and microanatomy of the restoration to be realized [10]. a proportion of 96.15% of authors followed this step and considered it crucial for achieving a biomimetic effect of the restoration [table v].  aesthetic success of the restoration according to heintz s. et al, 2015, the average lifespan of a dental composite has been estimated to 7 and 10 years [12]. a proportion of 51.92% of authors reported a durability of aesthetic results of 5 to 10 years [table vi]. conclusion the general objective of this research was to identify the technic and materials necessary for a biomimetic restoration. the concept of biomimicry is based on fundamental principles that have become the ambassadors of modern and contemporary dentistry. it related to tissue economy, adhesion, the biomechanical behavior of substitutes, and aesthetics. the natural tooth obviously remains the reference model. it procure substituents tend to mimic as closely as possible the unique characteristics conferred by enamel, and dentin. this study found that the popularization of the biomimetic restorative technique on the african continent needs to be boosted. the most popular therapeutic concept is based on the continuous evolution of composite materials. this alarms practitioners to exploit effective restorative techniques specific to each variety of composite. the therapeutic restorative steps highlighted by the authors were the isolation of the tooth to be restored, the usefulness of chromatic analysis prior to the actual restoration, and, finally, the importance of the finishing stage of the restoration. the durability of the aesthetic result mentioned by the authors is 5 to 10 years. acknowledgement none conflict of interest no conflict of interest ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 28 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ popularization perspective of biomimetics approaches in restorative dentistry." références [1]. ricard p. le biomimétisme : s’inspirer de la nature pour innover durablement. journal officiel de la république française. france, 2015 : 48. [2]. fdi world dental federation. l’éthique en odontologie 2024. turquie, 2024 : 1-4. [3]. tirlet g, attal jp. le gradient thérapeutique : un concept médical pour les traitements esthétiques. information dentaire. france. 2009 : 2561. [4]. nc randriamalala, th andrianjafinoro, bi ismane, hn rafalimino, fp rakotonirina, ,ramaroson j. importance du facteur c en dentisterie adhesive. revue d’odontostomatologie malgache en ligne issn 2220-069x2020 ; volume 18 : pages 11-24. [5]. vanini l, mangani f. the five color dimension of the teeth : a new way of determination and communication of the color in composite resin restorations. practical periodontology an aesthetic dentistry. 2001 : 19-6. [6]. kano p. emerging trends in aesthetic dentistry: from biomaterials to digital solutions. article originale. dental update. 2023 ; 38(6) : 376-81. [7]. kharouf n, jmal h, hadra r, ball v, salameh z, claire eh, et all. effectiveness of liquid rubber dam in improving dental isolation : an in vitro study. international journal of adhesion and adhesives. 2024 : 1-4. [8]. vanini l, mangani f. the five color dimension of the teeth: a new way of determination and communication of the color in composite resin restorations. practical periodontology an aesthetic dentistry. 2001 : 19-6. [9]. francisco c.-p., oscar e, morales j. c., paravina r.d. : applications of artificial intelligence in dentistry. review ; epub 2021 ; 34(1) :259-280. [10]. paolone g., scolavino s., gherlone e, spagnuolo g. direct esthetic composite restorations in anterior teeth : managing symmetry strategies.mdpi.2021 :797. [11]. heintze s., rousson v., hickel r. clinical effectiveness of direct anterior restorations. méta-analyse. paris : pédiadol ; 2015 : 1-80. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 29 ijo international journal of health sciences and nursing calcifying epithelial odontogenic tumor or pindborg tumor : about a case in chu-jdr antananarivo. fahasoavana rohamah njatosoa¹*, henri rantonirina andriamanantena ², fenosoa vonimbola d’assiserakotoarimanana ², emmanuel andrianony rakotoarivony ¹, aurélien richard rakotoarison ³, alberto john bam razafindrabe ². ¹ department of maxillo-facial surgery in hospital centrer professor zafisaona gabriel androva, mahajanga, madagascar ² department of maxillo-facial surgery in hospital centrer university of joseph dieudonné rakotovao (chu-jdr) – befelatanana antananarivo ³ department of oto-rhino-laryngology and cervico-facial in (chenosoa) hospital centrer of soavinandriana antananarivo abstract pindborg tumor or calcifying epithelial odontogenic tumor (ceot) derived from the enamel epithelium. it is benign, rare (less than 1% of odontogenic tumors), painless, slowly evolving, hardand is embedded in the bone. it is frequent in subjects between 20 and 60 years old, with a balanced sex ratio. the area of predilection is the mandibular bone. the objective of this study was to diagnose pindborg tumor and to determine its management. we report the case of a 58-year-old woman, evolving for 10 years in the left ramus. the tumor was removed by enucleation under general anesthesia, then a recurrence occurred after three years. it was painless, bone-like, firm, benign looking, filling the vestibule. ct scan showed a mixed density osteolytic and osteocondensing image in the left ramus, blowing out the cortical bone, partitioned and seat of multiple calcifications. the second procedure consisted of an interrupting mandibular resection and immediate placement of a titanium screw plate for reconstruction.this tumor may be confused with ameloblastoma, ossifying fibroma, and other ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 1 correspondant author : fahasoavana rohamah njatosoa department of maxillo-facial surgery in hospital centrer professor zafisaona gabriel androva, mahajanga, madagascar ( issn: 2814-2098 ) https://ijojournals.com/ fahasoavana rohamah njatosoa¹* volume 07 || issue 01 || january., 2024 || mailto:njatosoas@outlook.com/ ijo international journal of health sciences and nursing ( issn: 2814-2098 ) fahasoavana rohamah njatosoa¹* http://ijojournals.com/ volume 07 issue 01 || january., 2024 || odontogenic tumors with mineralized components. the anatomopathological examination of the surgical specimen confirmed the diagnosis of ceot. because of its compartmentalized form, interrupted bone resection is the best technique to avoid recurrence. keywords: benign tumor, ceot, interrupting resection, recurrence. introduction pindborg's tumor or calcifying epithelial odontogenic tumor (ceot) was first discovered by jens jorgen pindborg in 1955 (1). it is a benign tumor, rare (less than 1% of odontogenic tumors), painless and slow-growing. it is common in people aged between 20 and 60, with a balanced sex ratio (2). hard, poorly limited, often associated with a molar and integral with the bone, the preferred site is mandibular (3). the aim of this study is to report a case of toec in a 58-year-old woman from antananarivo. case report a 58-year-old woman was referred to us in september 2019 with a recurrent mandibular, symphyseal and left paraspinal swelling (figure 1.a). the first tumoral manifestation had been evolving for around ten years, involving only the left paraspympetal region, anterior to 35. enucleation was performed under general anaesthetic. three years after the operation, a swelling reappeared at the same site, extending into the symphyseal region. the swelling was painless, close to the mandibular bone, firm, filling the vestibule, covered with ulcero-necrotic mucosa and a whitish coating, and did not bleed on contact. the floor of the mouth was free but pushed back, with a healthy mucosa; the tongue was mobile (figure 1.b). the patient had no associated sensory-motor disorders, and the cervical lymph nodes were free. the panoramic radiograph or orthopantomogram showed a polygeodic image of the left ramus, with a large symphyseal-parasymphyseal osteolytic zone and osteocondensing zones posteriorly (figure 2). computed tomography confirmed this radiographic diagnosis and added the notion of cortical effraction and the presence of multiple calcifications (figure 3). this reappearance of a new ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 2 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) fahasoavana rohamah njatosoa¹* http://ijojournals.com/ volume 07 issue 01 || january., 2024 || lesion at the same site is a probable sign of recurrence.a second operation was performed, consisting of an interrupted mandibular resection removing the tumour, followed by immediate placement of a titanium screw-plate for reconstruction (figure 4).the postoperative course was complicated by a submental salivary fistula which disappeared after removal of the sutures (figure 5).pathological examination of the surgical specimen suggested a calcified epithelial odontogenic tumor (pindborg tumor). the excision margins were healthy. comments ceotis a tumor usually seen in adults, but it can also develop in children (4). because of their almost identical nature, it is difficult to distinguish ceot from other benign odontogenic tumors such as ameloblastoma, calcifying odontogenic cyst and ossifying fibroma (5). indeed, ceot and ameloblastoma are two intraosseous tumors that share the same clinical and radiological appearance.their location in the mandibular premolar region is similar, as is their slow progression. on ct scan, the images are almost identical: ceot shows a mixed osteolytic and osteocondensing density in the mandibular body, compartmentalized and the site of multiple calcifications (6), as found in our patient. in ameloblastoma, multilocular soap-bubble osteolysis and multiple root resorption are typical (7). the histological appearance of ceot is specific: cells with enlarged, squamous-like, multi-nucleated nuclei and a low mitotic index, as well as amyloid deposits and calcifications (8); this is confirmed in our case. ameloblastoma, on the other hand, derives from malassez epithelial remnants and shows no calcifications (9). the indication for treatment depends on the size of the tumour, its relationship with the bony cortices, and whether or not it leads to disruption of the basilar border of the mandible, the posterior border or the upper end of the ramus (10). conservative enucleation-type treatment is indicated for less aggressive early lesions. this is the case for the management of a calcifying odontogenic cyst or a small ossifying fibroma. for invasive, polygeodic, recurrent and voluminous tumours such as our case, surgical treatment is radical (9): interrupting bone ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 3 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) fahasoavana rohamah njatosoa¹* http://ijojournals.com/ volume 07 issue 01 || january., 2024 || resection to avoid recurrence.it is important to respect an exeresis margin of 1 to 2cm, in healthy tissue, while preserving the functions of neighbouring tissues. thus, the indications for radical or conservative treatment of ceot depend on the size and location of the lesion, and whether it is polygeodic or not. indeed, the risk of recurrence after enucleation is 15 to 30% at a follow-up of 2 to 4 years (8).interruptive bone resection is indicated for large, recurrent and invasive ceot(9).however, this technique is highly invasive, leading to functional and aesthetic sequelae. immediately after tumor removal, a titanium screw-plate is inserted to provide a temporary solution. adaptation of the manducatory apparatus required re-education, so that the patient was gradually able to mobilize her jaw.the salivary fistula disappeared spontaneously after removal of the sutures.prognosis was good. conclusion ceot is a rare benign tumor specific to dento-maxillary structures.it could be confused with ameloblastoma or other odontogenic tumors, and it is the histological examination of the lesion that confirms the diagnosis.ceot shares the same surgical treatment technique as ameloblastoma. bone resection with a good margin off the tumor is the best treatment. references 1. ide f, matsumoto n, kikuchi k, kusama k. who originally described pindborg tumor? head and neck pathol. sept 2019;13(3):485-6. 2. caliaperoumal s, gowri s, dinakar j. pindborg tumor. contemp clin dent. 2016;7(1):95. 3. priya s, madanagopaal lr, sarada v. pigmented pindborg tumor of the maxilla: a case report. j oral maxillofac pathol. 2016;20(3):548. 4. fazeli sr, giglou kr, soliman ml, ezzat wh, salama a, zhao q. calcifying epithelial odontogenic (pindborg) tumor in a child: a case report and literature review. head and neck pathol. déc 2019;13(4):580-6. 5. more cb, vijayvargiyar. intraosseous calcifying epithelial odontogenic (pindborg) tumor: a rare entity. j oral maxillofac pathol. 2015;19(2):269. ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 4 https://pubmed.ncbi.nlm.nih.gov/?term=vijayvargiya+r&cauthor_id=26604515 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) fahasoavana rohamah njatosoa¹* http://ijojournals.com/ volume 07 issue 01 || january., 2024 || 6. hafian h, mauprivez c, furon v, pluot m, lefevre b. tumeur de pindborg : à propos d’une forme peu différenciée et sans calcification. revue de stomatologie et de chirurgie maxillo-faciale. sept 2004;105(4):227-30. 7. oikarinen vj, boris calonius pe, meretoja j. calcifying epithelial odontogenic tumor (pindborg tumor) case report. international journal of oral surgery. août 1976;5(4):187-91. 8. alraei k, sharqawi j, harcher s, ghita i. efficacy of the combination of rhbmp-2 with bone marrow aspirate concentrate in mandibular defect reconstruction after a pindborg tumor resection. case reports in dentistry. 18 mars 2020;2020:1-6. 9. chrcanovic br, gomez rs. calcifying epithelial odontogenic tumor: an updated analysis of 339 cases reported in the literature. journal of cranio-maxillofacial surgery. août 2017;45(8):1117-23. 10. hamdi h, ben alaya t, ben romdhane i, khatteche b, favre de thierrens c. la tumeur épithéliale odontogénique calcifiée : à propos d’un cas. med buccale chir buccale. 2002;8(2):87-90. figure 1: a. facial asymmetry caused by left mandibular tumor. b. endobuccal aspect of the tumor. (andriamanantena rh, 2017) ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 5 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) fahasoavana rohamah njatosoa¹* http://ijojournals.com/ volume 07 issue 01 || january., 2024 || figure 2: orthopantomogram showing an image of a large radiolucent zone in the left symphysis-parasymphysis, and polygeodic osteocondensing zones posteriorly with basilar rim involvement. (andriamanantena rh, 2017) figure 3: computed tomography (ct) scan showing mixed osteolytic and osteocondensing density, compartmentalized and the site of multiple calcifications. a: ct scan with contrast medium injection. b: ct scan without contrast medium injection. ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 6 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) fahasoavana rohamah njatosoa¹* http://ijojournals.com/ volume 07 issue 01 || january., 2024 || (andriamanantena rh, 2017) figure 4: interrupting mandibular resection removing the tumor, followed by placement of a screwed titanium reconstruction plate. (andriamanantena rh, 2017) figure 5: postoperative follow-up (one month post-op) (andriamanantena rh, 2017) ijo journals volume 07 | issue 01 | january 2024 | https://ijojournals.com/index.php/hsn/index 7 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || surgical-orthodontic symbiosis in the treatment of maxillary impacted canines autors : rakotoson m1*, njatosoa rf2, rasoanirina mo1, andriniaina fa1, ratsirarisoa t1, andrinjakarivony nn1, rakotoharinivo hzm1, randrianarimanarivo hm1 1department of dento-facial orthopedics, institute of tropical odonto-stomatology of madagascar, university of mahajanga, madagascar 2department of oral surgery, institute of tropical odonto-stomatology of madagascar, university of mahajanga, madagascar *correspondig author: rakotoson mariette department of dento-facial orthopedics, institute of tropical odonto-stomatology of madagascar, university of mahajanga, madagascar abstract the maxillary permanent canine is the dental organ whose intra-osseous retention is frequent. the objective of our study was to describe the surgical-orthodontic symbiosis in the treatment of impacted maxillary canines. this is a cross-sectional retrospective descriptive study relating to a literature review including articles published from 2012 to 2021. the study was carried out from november 2019 to january 2021. we collected 15 recent articles. the pre-surgical and surgical orthodontic stages with the use of open and closed techniques have been described. orthodontics with fixed appliances linked the treatment. success was judged by dental alignment. techniques and therapeutic means allow a better implementation of surgical and orthodontic protocols. this involves a complete and multidisciplinary clinical examination. key words : surgery, orthodontics, canine. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 42 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || introduction an impacted canine is defined as "a tooth retained in the maxillary or mandibular arch beyond its eruption date, surrounded by its pericoronal sac and without communication with the oral cavity" [1]. the canine plays a role in occlusion (release during lateral movements, support of arch width...) and its positioning on the arch is essential to ensure occlusal function. in order to limit the consequences of inclusion, particularly root resorption in adjacent teeth, diagnosis must be early and precise, so that appropriate treatment can be initiated [2]. worldwide, maxillary canines rank third among dental inclusions, with a frequency of 0.924%, far behind mandibular (22%) and maxillary (18%) wisdom teeth. this compares with a frequency of 0.10% to 0.35% for mandibular canines [3]. the overall aim of this study was to describe the surgical-orthodontic symbiosis in the treatment of maxillary impacted canines. methodology this is a descriptive, retrospective, cross-sectional study using a literature review during the period from january 2012 to december 2021. our study included articles on the surgical-orthodontic management of maxillary impacted canines, published from 2012 to 2021 and written in french or english. we excluded all articles on the surgical management of maxillary impacted canines published before 2012 and not in english or french. we opted for exhaustive sampling, reaching a sample size of 15 articles. the variables studied were: year of publication, type of article, radiological examinations, pre-surgical orthodontics, surgical techniques, orthodontic means and treatment success. searches were carried out using pubmed, google scholar, science direct and the medline and cochrane databases, using the following keywords and the boolean operators "and", "and", "or", "or", "except", "not". data were collected in a pre-tested and validated data extraction form corresponding to each article. the data obtained was then analyzed. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 43 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || results table 1 : distribution of year of articles years of articles number (n) pourcentage (%) 2012 1 6,7 2013 1 6,7 2015 5 33,3 2016 2 13,3 2017 2 13,3 2018 4 26,7 total 15 100 table 2 : distribution of type of articles types of articles number (n) pourcentage (%) original articles 13 86,7 clinical case 1 6,7 general revue 1 6,7 total 15 100 ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 44 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || table 3 : distribution of articles by radiographic examination radiography number (n) pourcentage (%) retroalveolar 1 6,7 occlusal 1 6,7 teleradiography 1 6,7 panoramic 6 40 scanner 5 33,3 others 1 6,7 total 15 100 table 4 : distribution of items by pre-surgical orthodontics pré-chirurgical orthodontics number (n) pourcentage (%) levelling, space opening space maintenance 8 53,3 not specified 7 46,7 total 15 100 table 5 : distribution of items by surgical technique surgical technique number (n) pourcentage (%) open closed 8 53,3 others 2 13,3 not specified 5 33,3 total 15 100 ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 45 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || table 6 : distribution of items by orthodontic appliances orthodontics appliances number (n) pourcentage (%) amovible 1 6,7 fixed 10 66,6 mini-implant 2 13,3 others 1 6,7 not specified 1 6,7 total 15 100 table 7 : distribution of articles according to therapeutic success therapeutic success number (n) pourcentage (%) parodontal health 1 6,7 teeth vitality 1 6,7 teeth alignement 2 13,3 not specified 11 73,3 total 15 100 discussion the most advanced radiological examinations were panoramic (40%), followed by ct (33.3%). retroalveolar, occlusal, teleradiography and others were equally important (6.7%). in the case of impacted teeth, the clinical examination can be used to hypothesize the presence of an impacted tooth, but it is really only the various radiological examinations that can confirm the diagnosis of an impacted canine. according to fleury (1985) and messaoudi: "the diagnosis of impacted canine is almost always made radiologically, since 79% of inclusions are asymptomatic. x-rays allow us to observe the general dental condition (caries, coronal and root fillings, pulpal or apical lesions, displacements) and the relationship between the impacted tooth and the other teeth, as well as the various anatomical elements (sinuses, nasal cavities, inferior dental nerve)". [4,5]. the recommendation put forward by the société française de stomatologie, de chirurgie maxillo-faciale et de chirurgie orale (sfscmfco) ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 46 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || and the société médicale d'orthopédie dento-maxillo-faciale in july 2015 states that: "classically, in order to assess the position of the canine, it is proposed to take 2 conventional radiographs using the horizontal and vertical parallax technique. for the horizontal parallax technique, 1 anterior occlusal x-ray and one or 2 retroalveolar x-rays are recommended. for the vertical parallax technique, one anterior occlusal and one panoramic or one retro-alveolar and one panoramic are recommended, and the cone beam can be proposed to improve patient management." [6,7]. figure 1: panoramic radiograpy (source : randrianarimanarivo henri martial) pre-surgical orthodontics is dominated by levelling, space opening and space maintenance (53.3%). according to boileau in 2012: "before any intervention, treatment most often begins with an orthodontic phase that has two main objectives: to create the necessary, or even slightly greater, space for the pulled tooth to take its place on the arch (mesio-distal diameter of the tooth to be pulled + approx. 2mm), this space can be measured using a caliper directly in the mouth, or on a plaster model from a study impression; and to prepare the arch to withstand the reaction induced by orthodontic traction on the impacted tooth. " [8]. figure 2 : pre-surgical orthodontic preparation (source : rakotoson mariette) ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 47 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || open and closed surgical techniques were the most explained (53.3%); however, other techniques were also put forward (13.3%). according to the société française de stomatologie, de chirurgie maxillo-faciale et chirurgie orale in 2015: two main techniques, "open" and "closed" are proposed for canines included in the palatal position. the so-called "open" technique involves surgically exposing the tooth, prior to orthodontic treatment, by removing a window of tissue around the tooth and then placing a dressing to cover the area for around ten days. a surgical dressing is then removed and the canine can erupt spontaneously. once sufficient eruption has taken place, an attachment is placed on the tooth to enable it to be properly positioned on the arch. the "closed" technique also involves surgically exposing the tooth and pulling it after repositioning the palatal flap. the closed technique requires the necessary emergence space for the canine to be prepared prior to traction [9,10]. figures 3-4-5-6-7 : closed surgical technique (source : delsol, 2008) the orthodontic appliance most frequently mentioned was the fixed appliance (66.6%), followed by the mini-implant (13.3%). removable appliances and other means were also cited, with equal percentages (6.7%). lecomte (2018) points out that orthodontic appliances are designed to retain the space created, prevent loss of anchorage and limit or even cancel parasitic movements that may occur in the anchorage teeth. orthodontic appliances may include continuous archwires attached to other teeth with brackets, nance palatal archwires, transpalatal archwires, quadhelix, extra-oral force or lingual archwires [11]. figure 8 : fixed appliance fixe (source : rakotoson mariette) ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 48 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || treatment success was judged mainly by dental alignment (13.3%), followed by periodontal health and dental vitality at 6.7% respectively. the eruption success rate is more favourable in younger patients; clinical results conclude in better periodontal health, shorter operating time, reduced perception of post-operative pain and improved canine aesthetics [9,12]. conclusion a total of 15 papers were reviewed, dominated by original papers of european origin, with a predominance of young women. diagnosis remained complete before surgical decision, panoramic radiography was most recommended, pre-surgical orthodontics enabled surgical preparation, surgical techniques were most represented by open and closed techniques, fixed orthodontics was the most used means and treatment success depended mainly on dental alignment. treatment of maxillary impacted canines using surgical-orthodontic symbiosis is a complex procedure requiring multidisciplinary expertise. we intend to broaden our scope of investigation through a clinical case study using mini-screws as an anchoring device in madagascar references 1. delsol l, orti v, chouvin m, canal p. . canines et incisives maxillaires incluses. diagnostic et traitement. encyc med chir (paris). 2008 ; 28-635-g-10. 2. auclair ac, baralle mm, bery a, blanchard py, bourdillat mc, fusari jp, et al. management of an impacted canine tooth. recommendations for good practice. société française de stomatologie, chirurgie maxillo-faciale et chirurgie orale.2015 ; 1 – 43. 3. dersot jm. periodontal surgery of the maxillary impacted canine for orthodontic purposes : proposal for a surgical decision tree. elsevier masson sas, paris, france. intern orthod. 2017 ; 15 : 221-37. 4. fleury j, deboets d, assad-auclaire c, maffre n, sultan p. the impacted canine: update on 212 observations. general principles of treatment. rev stomatol chir maxillofac.1985 ; 86 : 122-31. 5.messaoudi y, coudert jl, aknin jj. contribution of three-dimensional reconstruction using 3dneo software in the surgical-orthodontic treatment of impacted teeth.edp sciences. 2013 ; 84 : 147-55. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 49 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || 6. blanchard py, kerbrat jb, paulus c, saint-pierre f. management of impacted cuspid july 2015. elsevier masson sas. 2018 ; 2-5. 7. cloitre a, lemoine s, lesclous p. orthosurgical management of impacted maxillary canines. clinical realities.2018 ; 29 : 2-5. 8. boileau m-j, canal p. orthodontics for children and young adults. volume 2.issy-lesmoulineaux: elsevier masson; 2012. 312. 9. french society of stomatology, maxillofacial surgery and oral surgery. management of an impacted canine. recommandations de bonne pratique.2015 ; 1-43. 10. bagard g. orthosurgical traction failures: transplantation or implantology.open sciences. 2017 ; 3-141. 11. lecomte n. maxillary and mandibular impacted canines: anatomical setting and surgical techniques.open sciences ; sciences du vivant. 2018 ; 1-151. 12. zerouaoui mf, bahije l, zaoui f, rerhrhaye w. orthodontic-surgical placement of impacted canines: ways of predicting failure.edp sciences. 2012 ; 1-13. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 50 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022 rabab omer mohammed salih1. widad ibrahim adbulghader2. 1. ministry of health saudi arabia. neonatal intensive care unit 2. college of nursing, university of bahri rabab omer mohammed salih. hail general hospital. abstract background: newborn immediate care is the care given to the neonate after birth by qualified personnel in the delivery room. the midwives are the first contact of the newborns so we need them to be knowledgeable and aware about initial care and assessment of the neonate to decrease incidence of mortality and morbidity rate by using standard process for the immediate care of newborn. aim: to assess the effect of education program for immediate care of newborn on midwives knowledge. methods: a quasi-experimental design was conducted at sinnar state in governmental hospitals and covered midwives who were working in obstetrical and gynecological departments. the sample size consisted of (96) midwives comment [na1]: comment [na2]: ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 52 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." during the period of (february to july 2020). data were collected by using questionnaire designed was applied to the midwives pre and post intervention to determine their knowledge regarding immediate care of newborn. data analysis was performed by statistical package for social sciences (spss) (version 26) presented in tables and figure, t-test was used to test the differences between the means. results: the result revealed that midwives pre knowledge were (42.5%, 17.5% and 19.8%)for the good knowledge, satisfied knowledge and poor knowledge respectively. however for midwiferies post-knowledge were (82.3%, 9.4% and 8.3%) for the good knowledge, satisfied knowledge and poor knowledge respectively. total mean score of midwives knowledge were (24.1%, 68.4%) for the pre and post midwives knowledge respectively. all the parameter items for midwives knowledge were statistically significant (p 0.05) between pre and post midwives knowledge except for vital signs taken immediately after birth. conclusion the study findings showed that program had been an effective method of increasing the midwives’ knowledge about immediate care newborn. key words: effectiveness, education, immediate newborn care, knowledge, midwife, program ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 53 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." introduction newborn immediate care is the care given to the neonate after birth by qualified personnel in the delivery room (afjeih, et al.,2013.) the neonatal and postnatal period, which is the first 28 days and weeks after childbirth is very critical to the survival of both neonate and mother. during this period, major changes occur which determine the well-being of both mothers and their babies (who, 2014). lack of adequate care could result in significant ill health and even death during this period. during this period most maternal and infant deaths occur, most especially in developing countries (who, 2018).for a child to develop properly and to reach its maximum potential in the future, the care given at birth (i.e. immediate newborn care) is of immense importance (shahjahan, m. et al., 2012) which is influenced by newborn care and maternal care services received at health facilities at the time of birth and home care practices of mothers. causes of neonatal deaths in nigeria and globally are mostly as a result of infections, prematurity and birth asphyxia (wang, h. et al., 2013) the presence of a skilled professional/birth attendants in labor and delivery can reduce neonatal deaths drastically. worldwide about eight newborn babies die every minute. every year more than four million babies die during first week of life due to inadequate care. however, reduction of newborn mortality can be accomplished by improving the ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 54 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." quality of care provided to newborn babies. in developing countries 99% of the four million neonatal deaths per year. the highest numbers of deaths occur in south-central asia and the highest rates are in sub-saharan africa. (marcica, l .2010).in sudan in wad medani obstetrics and gynecology teaching hospital, there is high level of neonatal mortality and morbidity (11.7%), most babies take much time to decide about seeking care and admission the equipment’s in the nursery are not adequate . they are either not available or not operating (may m, et al., 2015). immediate newborn care (inc) is the care given to newborns in the transitional period(immediately after birth) is crucial to their survival. nursesmidwives require adequate knowledge to provide immediate newborn care interventions (you, d. et al., 2015). the care given to newborns immediately within the first few hours of birth was critical for their survival. however, their survival depends on the nursemidwife’s knowledge to deliver appropriate newborn care interventions. therefore, the knowledge of health care workers on immediate newborn care was vital to reduce neonatal morbidity and mortality. nurses midwives require knowledge provide immediate newborn care interventions (abdu, h. et al., 2019). professional care at birth is crucial for both the newborn baby and mother. nursesmidwives are regularly placed in the care of newborns admitted to formal health care facilities. improving their knowledge ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 55 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." are very important aspects of these health facilities (rutebemberwa, et al., 2009). the most important for newborn and maternal survival are labor, birth and the immediate postnatal period. unfortunately, in low and middle income countries most mothers and newborns do not receive adequate care. studies were showed that many newborn lives can be saved by using procedures involving simple equipment provided by a single professional birth attendant who cares for the mother and the neonate. caring of all newborns involves immediate and thorough drying, skin to skin contact, cord clamping and cutting after the first minutes after birth, early initiation of breastfeeding, and exclusive breastfeeding. after the first hour of life, newborns should receive eye treatment, vitamin k, and recommended immunizations (who, 2020). the essential newborn protocol is a series of time bound and chronologically ordered care that a baby receives at birth, and it has standardized elective procedural steps: dry and stimulate, evaluate breathing, cord care, keep the newborn warm, initiate breastfeeding within the rst one hour. heat warmer that provide a constant source of warmth. most important advances in intensive care have created a need for highly skilled personnel trained in the art of neonatal intensive care (gerald and sandra, 2010). nurses in the neonatal care units ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 56 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." should be highly trained in the management of variety of sophisticated mechanical devices, and educated in the infant's behavior, interpreting observations of others and timing interventions appropriately. the objective of this study was determining the effectiveness of education program on midwives’ knowledge before and after the educational program regarding immediate care of newborn. materials and method study design, sample and setting: the research is a quasi-experimental design. the research universe consists of the midwives who work at sinnar state, capital singa. it is located on the western east of the blue nile and about 37.844 km2 south of khartoum in october 2019 to august 2022. according to data in 2019. the study population consists and midwives who were working at governmental hospital, in obstetrical& gynecological in hospital, midwives who had midwifery certificate were directly involved in the provision for neonatal services, in singa and sennar in hospital during the period of the study. the total number covered in this study was 96 participants who distributed in sinnar maternity hospital and singa hospital. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 57 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." instruments and procedure: data in the research were collected with questionnaire forms that were created via google forms and these forms were sent via social media such as facebook, whatsapp, gmail, etc. due to the pandemia. the questionnaire form was constituted by the researcher by reviewing the literature (baghlani,et al., 2019). the questionnaire form consists of two parts. the first part has questions about socio-demographic characteristics such as age, qualifications, years of experience and attendance of previous training courses (fig. 1, 2), the second part has 35questions about the midwives’ knowledge was reviewed regarding immediate care of the newborn. this tool was used to measure the nurses' knowledge before and after the education program to evaluate the effect of the education program on their knowledge (table, 1 and 2).the first pilot study done to test accuracy of the questioner, the pre questionnaire will provide to participants to measure their knowledge and then education program has been conducted, midwives divided into groups according to their working hours and working place. statistical analysis in order to statistically analyze the data collected from the studysample to arrive at the results, the researcher used the spss-26andmicrosoft excel (2010) package. to analyze the data, statistical procedures were used as descriptive statistic and inferential statistic with a p-value equal or less than 0.05 were considered significant and t-test. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 58 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." ethical approval: approval from university of bahri faculty of postgraduates studies, permission of ministry of health and approval from all hospitals. verbal informed consent was obtained from the participants, confidentiality of response to both questionnaire and personal data sheet was assured. the participant were provide essential information for consent form and their signatures taken on consent form. the participant have right to with draw from the study at any time and that there would be no potential physical economical or legal harm to the participants. the result available and given the hospital ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 59 ijo international journa ( issn: 2814-2098 ) https://ijojournals.com/ “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar sta 1. socio demographic fig. (1).distribution of study group according to their figure (1) showed (44.8%) of the study sample at age ranged from international journal of health sciences and nursing rabab omer mohammed salih volume 08 || issue 03 || march effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar sta results fig. (1).distribution of study group according to their age n= %) of the study sample at age ranged from 41 – 50 years and nursing rabab omer mohammed salih 1 * march, 2025 || effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." age n=96 years ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 60 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." fig. (2) distribution of study group according to their years of experience n=96 figure (2) showed (53.1%) of the study sample the years of experience were more than 15 years. 2. knowledge assessment findings table (1): pre and post midwives good knowledge answers about immediate care of newborn frequency and percentages n=96 knowledge pre test post test sig. (2tailed) f % f % newborn health characteristic of the newborn skin 15 15.6% 81 84.4 % characteristic of the newborn head 25 26.7% 83 86.3 % factor affecting of the newborn health 06 06.3% 83 84.3 % normal body weight 13 13.5% 84 87.3 % normal head circumference 02 2.1% 87 90.6 % normal chest circumference 13 13.5% 92 95.8 % mean knowledge percent 15.1 87.6 0.00 vital signs taken immediately after birth normal heart rate 05 05.2% 23 24.6 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 61 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." % the best site to take body temperature 13 13.5% 20 20.8 % mean knowledge percent 09.3% 21.5 % 0.61 newborn health definition 11 11.5% 41 42.7 % importance 43 44.8% 88 91.7 % equipment 38 39.6% 87 90.6 % steps of the immediate care 38 39.6% 87 90.6 % prevention heat loss 55 57.3% 89 90.8 % signs of body temperature loss 45 46.9% 83 84.3 % method of clean airway 28 29.2% 59 61.5 % equipment used in suction 33 34.4% 50 52.1 % adequate breathing and circulation 22 22.9% 39 40.6 % mean knowledge percent 36.2% 71.7 % 0.01 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 62 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." whereas, f = frequency, % = percent.sig. =significant at p-value = 0.05 the table showed after the intervention, the knowledge about the characteristic of the newborn skin, head and factor affecting of the newborn, was improved from (84.4%, 86.3% and 84.7%). the table showed after education program the mean knowledge percent about vital signs taken immediately after birth, was (from 9.3% to 21.5%) but there was no significant relation. education program significant (p 0.05) increased items of newborn health between pre and post midwives knowledge (table 1). table (2): continue pre and post midwives good knowledge answers about immediate care of newborn frequency and percentages n=120 knowledge pre test post test sig. (2tailed) f % f % apgar score used 11 11.2% 91 94.8% characteristic 05 05.2% 87 90.6% evaluate 05 05.2% 79 82.2% mean knowledge percent 07.2% 89.2% 0.00 newborn resuscitation decided newborn need resuscitation 25 26.0% 79 82.2% steps 39 40.6% 78 81.3% equipment and supply need 51 53.1% 78 81.3% ratio of ventilation to compression 08 08.3% 68 70.8% mean knowledge percent 32.0% 78.9% 0.013 comment [na3]: 96 comment [na4]: ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 63 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." newborn health umbilical cord contains 05 05.2% 24 25.0% the distance between the navel and the umbilical cord 05 05.2% 15 15.8% care of umbilical cord 29 30.2% 28 29.2% contact baby site in skin to skin contact 18 18.8% 74 77.4% characteristics of skin care 38 39.6% 82 85.4% time starting breast feeding 07 07.3% 30 31.2% benefits of breast feeding for baby 60 62.5% 74 76.7% baby position during breast feeding 29 30.2% 72 75% mean knowledge percent 24.8% 60.0% 0.049 drug used immediately after birth medication used in eye 08 08.3% 14 14.5% time 05 05.2% 19 19.8% drug used to prevent bleeding 34 35.4% 86 89.6% mean knowledge percent 16.3 41.3% 0.39 whereas, f = frequency, % = percent. sig. =significant at p-value = 0.05 data in the table (2), showed after education program the knowledge about the decision that the newborn need resuscitation, steps, equipment and supply need and the ratio of ventilation to compression in newborn resuscitation was improved from (82.2%, 81.3%, 81.3%, and 70.8%). education program significantly (p 0.05) increased items of apgar score, newborn resuscitation, ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 64 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." newborn health and drug used immediately after birth between pre and post midwives knowledge table (3): pre and post midwives knowledge answers about the best site to take pulse and concept care of newborn frequency and percentages n=120 knowledge pre test post test f % f % the best site to take pulse radial 03 03.1% 02 02.1% apical 83 86.5% 91 94.4% femoral 02 02.1% 02 02.1% dorsal 01 01.0% 01 01.0% non 07 07.3% 0.0 0.0% mean 96 100% 96 100% concept yes 42 43.8% 96 100% no 54 56.3% 00 0.0% mean 96 100% 97 100% whereas, f = frequency, % = percent. the table showed after education program there was no significant change reported concerning the best site to take pulse. the knowledge about concept, used, characteristics and evaluate of apgar score, was improved from 43.8% to 100%for yes answers. however, from 56.3% to 0.0% for no answers (table 3). . comment [na5]: 96 comment [na6]: ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 65 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." table (4): comparing between pre and post education program regarding midwives immediate care of newborn n=120 item x±sd f sig. (2-tailed) pre total mean knowledge 24.1 ± 17.2 9.87 0.001 post total mean knowledge 68.4 ± 27.1 whereas, x = mean percent. sd = standard deviation. sig. =significant at p-value = 0.05 data in table (4) indicated that the education program statistically significant (p 0.05) increased total score knowledge regarding immediate care of newborn between pre and post midwives knowledge. comment [na7]: 96 comment [na8]: ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 66 ijo international journa ( issn: 2814-2098 ) https://ijojournals.com/ “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar sta fig. (3): distribution of study group according to their knowledge pre and post-test in developing countries 99% of the four million neonatal deaths per year. the highest numbers of deaths occur in south in sub-saharan africa (marcia, i. neonates requiring urgent help. neonatal care training is deficient in midwifery schools. also there is lack of education program neonatal midwives newborn care services in sudan have not progressed well over the years. inwad medani pediatric teaching international journal of health sciences and nursing rabab omer mohammed salih volume 08 || issue 03 || march effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar sta : distribution of study group according to their knowledge pre and discussion n developing countries 99% of the four million neonatal deaths per year. the highest numbers of deaths occur in south-central asia and the highest rates are africa (marcia, i.2010) midwives are the first line staff to deal with iring urgent help. neonatal care training is deficient in midwifery s lack of education program neonatal care for hospital midwives newborn care services in sudan have not progressed well over the . inwad medani pediatric teaching hospital was found to be significantly high and nursing rabab omer mohammed salih 1 * march, 2025 || effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." : distribution of study group according to their knowledge pre and n developing countries 99% of the four million neonatal deaths per year. the central asia and the highest rates are are the first line staff to deal with iring urgent help. neonatal care training is deficient in midwifery care for hospital midwives newborn care services in sudan have not progressed well over the hospital was found to be significantly high ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 67 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." and necessary equipment’s are not available in nicu (may. et al., 2015).this study was conducted during period from february to july 2020 in sinnar state on in governmental hospitals and covered midwives who were working in obstetrical and gynecological departments to provide important information about the level of midwives knowledge regarding immediate care of newborn. the study revealed that, all of study population were females this result similar to the findings of another study in sudan, which showed that all neonatal care nurses (100%) in the nicu were female. this can be attributed to hospital polices (babeker, z. 2015). the majority of midwives were age ranges between 41-50 years, this result was disagreed with jennifer et al., (2018) who studied that more than half of the nursesmidwives’ were aged between (22– 24) years. (44.8%), followed by whose age ranges from 31-40 years (28.1%), and above 50 years (22.8%). regarding the level of education the study showed that all of midwives at level of diploma degree. this result was disagreed with gebru,et al., (2019) who studied that majority (83%) of nurses-midwives were diploma graduated. the highest percentage (53.1%) of study sample was midwives their experience more than 15 years at governmental hospitals. this result was agreed with traore (2018) who revealed that the study sample have more than five years of professional experience in midwifery. this study showed that after the ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 68 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." education program, the knowledge of the participants was significantly improved (p < 0.05) in different relevant areas such as, the factor affecting newborn health, importance of immediate care of the newborn, equipment needed in immediate care of the newborn, steps of immediate care of the newborn and in using apgar score. likewise, similar findings were reported by perez (2022) who agreed that; the education evidence based interventions, are useful in push the newborn care related knowledge. this study showed that after the education program, the knowledge of the participants was significantly improved (p< 0.05) in different relevant areas such as the best site to take body temperature immediately after birth, and how to care of babys temperature. in similar context, purnamasari,et al., (2017) agreed with our findings and indicated that there was significant difference in nurses’ knowledge preand post-education intervention (p < .001; = .05). moreover, manuama, et al., (2022) agreed that education on prevention of heat loss is an effective strategy to promote nurses’ knowledge. the current study revealed that (19.8%) of the midwives showed a poor knowledge and after applying for the educational program and conducting the post-test, the midwives expressed good knowledge (82.35). similar result was by shireen, (2022) who indicated that (83.3%) of the midwives showed a lack ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 69 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." of knowledge and after applying for the educational program conducting the post-test, the midwives expressed good knowledge (86.7%). the result showed that all the parameter items for midwives knowledge were statistically significant (p 0.05) between pre and post midwives knowledge except for vital signs taken immediately after birth. this result agree with shreen, (2022), indicated that there was a statistically significant difference between the study group and the control group in the post-test measurement after implementing the educational program (p= 0.000).there were high significant differences in participants’ knowledge at pretest and posttest before and after the implementation of education program for study sample (wafaa and igbal, 2021). conclusion the study findings showed that the education program regarding immediate newborn care contributes in improving nursemidwife’s knowledge. the educational program had been effective method of increasing the nurses– midwives’ knowledge regarding immediate newborn care. comment [na9]: midwifs comment [na10]: comment [na11]: midwifs comment [na12]: ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 70 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." recommendations based on the conclusion the study recommended the following:  the health care providers should be encouraged to upgrade their educational level to build their skill retention and expose themselves to newborn care.  the hospital should be make policy for pediatrician has to attend in labor room for 24 hour  the ministry of health should be work to improve infrastructure, equipment, and supplies at basic level and ensure availability off all necessary supplies and equipment. refernces abdu, h, gebrselassie, m, abdu, m. (2019).knowledge and practice of immediate newborn care among midwives and nurses in public health facilities of afar regional state, northeast ethiopia. bmc pregnancy and childbirth. 2019; 19(1): 1-10, 422 afjeh sa,sabazehel mk,esmail f. (20130).neonatal resuscitation in delivery room from atertiary level hospital :risk factors and outcome. iran j pediatric.23(26):675-80.[pmc free acrticle][pubmed][googlescholar]. babeker, z. a. (2015). assessment of nurse’s knowledge and practice regarding care of premature baby in neonatal intensive care unit at omdurman maternity hospital and alribat university hospital in pediatric ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 71 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." nursing. faculty of graduate studies and scientific research, the national ribat university. baghlani, r., hosseini, m. b., safaiyan, a., alizadeh, m. and bostanabad, m. a. (2019). neonatal intensive care unit nurses' perceptions and knowledge of newborn individualized developmental care and assessment program: a multicenter study. iranian journal of nursing and midwifery research, 24(2), 113. doi:10.4103/ijnmr.ijnmr_54_18 gebru, t, murugan, r, abrha, a, goyteom, m. (2019). knowledge and practice of immediate new-born care among midwives in central zone public health facilities, tigray, ethiopia: cross sectional study. bmc research notes. 12(1): 487. jennifer, g, satchi, n, venkatesan, l. (2018). knowledge of nurses on essential newborn care. international journal of advance research, ideas and innovations in technology. 4(3):1741-1742. marcia l (2010).london maternal and child nursing care,publisher by personal education date of publisher. may m.elrofay, imad eldin eljack,elhadii.miskeen. (2015). study on neonatal mortality and neonatal health services in wad medani pediatric teaching hospital,gezirajurnal of health sciences. manuama, edit & pali, martina & morgan, alison. (2022). barriers and enablers to the .provision of postnatal newborn care at community health. centres in sikka district, east nusa tenggara province, indonesia. midwifery. 110. 103318. 10. 1016 / j .midw .2022 . 103318. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 72 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." perez bp, mendez md. (2022). routine newborn care. [updated 2021 jul 26]. in: stat pearls [internet]. treasure island (fl): stat pearls publishing; 2022 jan-. available from: https://www.ncbi.nlm.nih.gov/books/nbk539900. purnamasari, meivita& rustina, yeni&waluyanti, fajar. (2017). heat loss prevention education aids nurses’ knowledge in prevention of hypothermia in newborns. comprehensive child and adolescent nursing. 40. 37-44. 10. 1080 / 24694193 .2017 . 1386969. rutebemberwa, e, pariyo, g.(2009). utilization of public or private health care providers by febrile children after user fee removal in uganda. malaria journal, 8(1): 45 shahjahan m,ahmedmr,rahmanmm.afactors. (2012). affecting newborn care practices in bangladesh.paediatrperinat epidemiol,2012;26(1):13-18 [pubmed][googlescholar]. shireen owiiez hassan. (2022). effect of educational program on midwives'knowledge concerning lamaze method during the labor. master's degree in the nursing sciences. university of kerbala college of nursing. traoré, f, sylla, m, diall, h. (2018).knowledge of health professionals on essential newborn care in bamako, mali. open journal of pediatrics. 8(04):311. wafaa adnan hussein and iqbal majeed abbas. (2021). effectiveness of education program on nurse-midwife’s knowledge regarding immediate newborn care in delivery rooms at maternity hospitals in baghdad ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 73 https://www.ncbi.nlm.nih.gov/books/nbk539900 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of education program on midwives knowledge regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." city/iraq. indian journal of forensic medicine & toxicology, julyseptember 2021, vol. 15, no. 3 wang h ,liddell ca, coates mm,mooneymd,levitzce,schumacherae,etal. (2013). global, regional and national levels of neonatal, infant and under -5mortality during 1990-2013:asystematic analysis for the global burden of disease study 201lancet.2014;384(9947):957-979[pmc free articale] ][pubmed][googlescholar]. who. (2020). improve skills of birth attendants in newborn care at birth include pregnancy, childbirth, postpartum and newborn care: a guide for essential practice and essential newborn care course. who. (2018). world health organization, newborns: reducing mortality, world health organization. who. (2014). world health organization, who recommendations on postnatal care of the mother and newborn. you, d, hug, l, ejdemyr, s, idele, p. (2015). global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenariobased projections to 2030: a systematic analysis by the un inter-agency group for child mortality estimation. the lancet. 386(10010): 22752286. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 74 parents' attitudes towards early childhood distance learning in light of e-learning standards during the corona pandemic in the al-ahsa region dr. aida theeb mohammed associate professor department of kindergarten king faisal university ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 1 reem merdas alzmammi early childhood teacher – child learning center – national guard health affairs, ma student at kfu abstract the study aimed to identify the parent' s attitudes towards distance learning for early childhood in the light of e-learning standards during the corona pandemic in the al-ahsa region through the following variables (type of education, stage the child is studying, kinship, type of school) , the two researchers used a questionnaire consisting of seven areas: (leadership, technology, rehabilitation and support, design, interaction, justice and accessibility, measurement and evaluation) distributed over (38) paragraphs , the study showed that there were no significant differences due to the study variables on the seven domains, with the exception of the field of measurement and evaluation and in favor of government schools, the study recommended the importance of providing appropriate courses to develop the technological efficiency for students, parents and teachers on an ongoing basis to keep abreast of the latest developments in the crisis. keywords: e-learning, e-learning standards, early childhood stage. introduction the corona pandemic imposed many challenges on the education systems in most countries of the world, which led to the closure of schools and universities and the suspension of studies in attendance, therefore, these countries resorted to the second option, which is distance education, to ensure the continuity and management of the teaching and learning process distance education in the kingdom of saudi arabia plays an essential role in the life and culture of saudi society through its application of the national standards for e-learning in the kingdom these standards are a document and guide for controlling the quality of elearning in schools and public education institutions in the kingdom of saudi arabia, as it is a means of measuring the practices applied by educational institutions in the kingdom and determining the degree of achieving these standards. the adteck team on education affairs of the world bank confirmed that distance education is the best method of education during the corona pandemic for all educational materials and at all stages, which provides advantages that drive the continuity of education and improve the learner’s attitudes towards the educational situation (world bank edteck teem, 2020: 510). in this regard, (unesco, 2020) indicated that the goal of using technology and communication must achieve the goals of education, and for this to be achieved, standards and indicators must be provided to measure the quantity and quality of outputs that will be achieved by distance education. daradkeh (2013) indicates that the success of the educational process and its fulfillment of its mission depends on its organic association with the ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 2 institutions of society, especially the family, because one of its duties is to carry out effective activities to build a close relationship with parents. the success of distance education is not limited to teachers, students and those in charge of the educational process, so the views of students’ parents must be integrated as they are the most important elements of the educational process (leontyeva, 2018). david et al. 2020 confirms that despite the opportunities and benefits offered by distance education during the corona pandemic, the (covid19) crisis created obstacles as a result of the use of distance education platforms, and the most prominent of these obstacles :difficulty in measuring the results of distance learning due to the poor management of it remotely in addition to the slow progress of students in educational curricula, especially primary school students and students with low achievement and internet outagethe disparity in financial capabilities among students’ parents to secure portable computer devices for their children or the internet for each individual in light of the low financial income and weak technological skills for some parents, teachers and studentsdavid added that among the obstacles are also the distractions in the home that surround the learner during the distance learning process, and the lack of some learners' sense of responsibility and seriousness towards this type of education because it adds new tasks and the difficulty of matching them to all curricula in this type of education. the distance education pattern came with a decision by the saudi authorities, at the beginning of the corona pandemic the saudi ministry of education announced that, in accordance with the preventive and precautionary measures recommended by the competent health authorities in the kingdom of saudi arabia, as part of its tireless ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 3 efforts to control the new corona virus (covid19) and prevent its entry and spread. and based on the concern to protect the health of male and female students and the educational and administrative staff in public and university education and to ensure their safety. it was decided to temporarily suspend the study in all regions and governorates of the kingdom, starting from monday, rajab 14, 1441 ah, until further notice, the decision included schools and institutions of public, private and university education, and the general organization for technical and vocational training, both governmental and private. the minister of education in the kingdom of saudi arabia directed the activation of virtual schools and distance education during the suspension period, in order to ensure the continuation of the educational process in an effective and quality manner, as the competent committee in the ministry decided to follow up on the developments of the corona virus, according to the following: supervising offices begin their work during the suspension period to follow up the educational process, coordinate distance education procedures, and respond to parents’ inquiries. ensuring the functioning of the virtual school during the suspension period through the means of distance learning provided by the ministry of education, through the virtual school platform (vschool.sa), and the use of digital enrichment materials through the website and application located in the app store for apple and android under the name (unified education system). providing lessons for all academic levels asynchronously, through the ain tv. channel. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 4 universities, the general organization for substantive and technical training and the national center for e-learning complete the requirements for distance education for all male and female students. currently, the saudi authorities have announced arrangements for the reeducation in schools and universities for the academic year 2021-2022. after the ministry of education agreed with the ministry of health, it approved a plan for the return of education, which includes four basic points, to ensure the continuation of the educational process in line with the requirements of public safety in light of the corona pandemic. the arrangements stipulate that faculty members will return “to workplaces in schools, colleges, universities, institutes and vocational training institutions,” and they will have to take full doses of corona vaccines, which will be a requirement to enter these buildings, and this will be confirmed using the “tawakulna” and “tabaudna” applications, as the health safety of students will be required before they return to the study seats. study problem and questions: after the kingdom of saudi arabia took several precautionary measures to combat the spread of the corona virus and confront the education system to the great challenge that led to the launch of distance education programs despite the refusal and opposition of some parents to use distance education despite the advantages achieved by this system in addition, the conditions of the spread of the epidemic did not allow the education department to hold training courses to help parents deal with this system and to clarify the idea that this system is suitable for all educational materials and stages, including early childhood . from here emerged the problem of the current study, which came to identify the ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 5 reality of distance education for early childhood in the light of e-learning standards during the corona pandemic from the point of view of parents, and to assess the quality of this education through the capabilities and technologies that the kingdom provides to its schools, through : answer the following study questions: 1what are the attitudes of parents towards distance learning for early childhood in light of e-learning standards during the corona pandemic in the al-ahsa region? 2are there any statistically significant differences at the significance level (α ≥ 0.05) between the averages of the parents' responses. attributed to the variables of the study (type of education: diploma and less, bachelor's, postgraduate studies, stage taught by the child: kindergarten, primary grades. kinship: mother, father, other. school type: government education, private education)? study objectives: the current study sought to achieve the following objectives : 1identifying parents’ attitudes towards distance learning for early childhood in light of e-learning standards during the corona pandemic in the al-ahsa region. 2to identify the differences between the average responses of parents of children in early childhood that are attributed to the study variables (type of education: diploma or less, bachelor’s, postgraduate studies, stage taught by the child: kindergarten, primary grades. kinship: mother, father, other school type: public education, private education. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 6 the importance of studying the importance of the current study is as follows: the importance of this study comes from the importance of the subject. knowing the reality of the quality of distance education for early childhood in the light of e-learning standards in the kingdom of saudi arabia constitutes the actual knowledge of this type of education and for this important stage of education, which is a basic stage in the educational ladder , in addition to the desire of the two researchers to communicate the views of the study sample to officials and decision-makers based on the development of the educational process, and it is hoped that the results of this study will benefit teachers and researchers about the efficiency of this distance education system. the two researchers hope that this study will constitute a cognitive and theoretical addition in the field of distance education in early childhood stage. procedural terms and definitions quality of education: it is the process that aims to improve the educational process and achieve a qualitative leap through by applying a package of educational procedures and systems and documentation of the various educational programs, so that this improvement in the educational process is done by raising the different levels of students, and the quality of education is not limited to students only, it also includes different aspects such as the teacher, the curriculum, the school community and the surrounding environment. amer (2014). the two researchers define the quality of education procedurally: it is a set of standards, procedures and decisions whose implementation aims to improve the educational environment, and it is a reference for controlling the quality of aspects of education and e-training. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 7 these standards include educational institutions and the conditions of individuals who have a direct or indirect relationship with the educational system,it is measured by the degree that the respondent obtains on the study tool consisting of the following areas: (leadership, technology, rehabilitation and support, design, interaction, justice and accessibility, measurement and evaluation). distance education: it is a modern educational system and style that focuses on providing educational opportunities to learners through educational means, technologies and platforms available on the internet and modern technologies supported by audio, video and printed data (bozkurt, 2019). e-learning standards: it is a document issued by the national center for e-learning and represents a guide for controlling the quality of elearning. it includes two sections: standards for entities, which include standards for leadership, technology, qualification and support, and consists of 28 sub-standards.the second section is program standards, and it consists of four standards: design, interaction, justice, accessibility, measurement and evaluation. (national center for e-learning, 2020). previous studies the two researchers dealt with studies related to the subject, which are: al-enezi study (2020), which aimed to identify the attitudes of parents towards the role of the distance learning system in teaching arabic to students of foreign private schools during the corona crisis in the state of kuwait,the researcher used the questionnaire as a tool for the study, and the study sample consisted of (273) parentsthe results indicated that there were differences between parents' attitudes due to the kinship variable and in favor of the mothers, and there were no significant differences due ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 8 to the educational level variable and the stage in which the child was studying. abu ababa study (2020), which sought to evaluate the experience of the kingdom of saudi arabia in distance education in light of the corona pandemic from the parent's point of view in the city of riyadh,the researcher used the descriptive analytical method and the questionnaire as a tool to collect data from a sample of (310) parents, and the results indicated that the distance learning experience was successful and came to a high degree. malkawi study (2020), which aimed to identify the reality of distance education and its challenges in jordan during the corona pandemic from the parent's point of view, and the study sample reached (135) parents, the study used the descriptive analytical method and the questionnaire as a tool for the study, the results indicated that the reality of distance education during the corona pandemic from the parents' point of view came to a medium degree, and there were no significant differences due to a variable related to kinship. the study of al-maliki, haifa, daghestani, balqis (2020), which aimed to identify the role of electronic educational platforms in the professional growth of kindergarten teachers. the descriptive survey method was used to answer the questions of the study.. the sample size was (205) kindergarten teachers. the study found that kindergarten teachers' practice of electronic platforms amounted to (87.2%) when providing a flexible learning environment and using more than one way to display information , the study also showed that there are obstacles in the teachers' use of electronic platforms, including the lack of financial resources, the weakness of the internet within the school, the large ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 9 number of tasks and roles of the supervisory teacher, and the weakness of special training programs. foti study (foti, 2020) aimed at exploring perceptions, possibilities and limitations related to the implementation of distance education in kindergartens during the corona pandemic period, and the study used the questionnaire as a tool for data collection , the results indicated that the teachers responded to apply of distance education in order to maintain communication with their students, and to respond to helping the greek family in educating its children. the study of basilaia and kvadza (2020), which aimed to identify the attitudes and opinions of parents towards the rapid transition to distance education in the state of georgia , the study used the analytical inductive method, and the study sample consisted of (950) students and parents, and the results indicated that the attitudes of students and their parents towards the use of distance education during the corona crisis were successful and constitute a precedent for overcoming educational obstacles during this pandemic, and the results also showed that the most prominent obstacles to this method of education is the children's feeling of boredom while receiving their lessons. swed&jihan study (2020) the study aimed to know the reality of distance education in light of the spread of the corona virus and its impact on parents of school students , the researcher used the documentary descriptive approach by analyzing the events of the pandemic and its most important data. the researcher concluded that the psychological impact of the pandemic on parents was very large, as many parents do not prefer to continue distance education regardless of the side effects.the study also concluded that continuous ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 10 educational support must be provided to parents to ensure the success of the educational process. the researcher recommended the importance of holding encouraging training courses for parents before starting elearning, in addition to the need to pay attention to the sector of parents and work to reduce the burden on them. finally, the researcher recommended the importance of continuing distance education even after the return of in-person education to ensure the continuation of the educational process at any time. the study of al-qahtani, amal, al-shehhi, hayat, bin nasser, alia, embassy, azza (2020) the study aimed to know the motivation and its role in activating the distance learning process among basic education students in light of the corona pandemic from the point of view of parents and teachers.the researchers used the descriptive analytical approach on a sample of (330), and the study reached the satisfaction of parents with regard to the quality of education during the corona pandemic and that teachers' keenness to communicate and interact with students during distance education and provide them with feedback increases their educational levels.finally, the study recommended the generalization of the trend using distance education after the end of the pandemic, in addition to the presence education, and the need for continuous communication between the teacher and parents to increase their involvement in the education process, in addition to providing intensive training for both the teacher and the guardian in communicating via electronic platforms. the qur’an study (2021), which aimed to identify the reality of elearning in light of the corona pandemic among riyadh children from the teachers' point of view in the directorate of education in irbid ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 11 governorate – jordan and to achieve the objectives of the study, the researcher used the questionnaire as a tool for collecting data from a sample of (211) teachers who were selected by the simple random method , and the results showed that the estimates of the reality of elearning in light of the corona pandemic in kindergartens from the teachers' point of view in the directorate of education in irbid governorate jordan came to a medium degree, the results also indicated that there are differences due to the type of kindergarten and in favor of private kindergartens, and there are differences due to the educational qualification variable and in favor of higher studies. timmons, cooper, bozek&braund, 2021which aimed to identify the impact of the covid-19 epidemic in early childhood on e-learning, and the qualitative approach was used to answer the questions of the study , the study concluded that parents see themselves as having clearly improved in dealing with technology and smart devices. the results also showed that there are great concerns from parents about the lack of fairness and justice in e-learning among children,in addition to the lack of resources and sometimes the lack of internet, the study recommended that both parents and teachers should receive training in the use of technology before reopening schools, in addition to activating the community partnership between companies and other institutions.the study also recommended that children who are slow to learn should be given additional lessons to avoid any problem in learning and to achieve justice among children. method and procedure study approach ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 12 the two researchers adopted the descriptive approach using a questionnaire. study population and sample the study population consisted of all parents of children in early childhood in al-ahsa region. the study sample the study was applied to a random sample of (130) individuals from the parents of children in the kindergarten and primary grades who are enrolled in early childhood schools and kindergartens for the study year 1442-1443 ah, and table (1) shows the study sample number level variable 21 diploma and less the level 89 bachelor 20 postgraduate 52 kindergarten stage 78 primary classes 94 mother kinship 14 father 22 other 87 government education school 43 private education study tool in order to achieve the objectives of the current study, the two researchers designed the questionnaire with reference to the theoretical literature and e-learning standards in the kingdom of saudi arabia. the questionnaire consisted of two parts:the first relates to the primary data of the study ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 13 sample members: (educational level, educational stage, kinship relationship, and type of education) distributed over seven areas: (leadership, technology, rehabilitation and support, design, interaction, justice and accessibility, measurement and evaluation).the questionnaire items were designed according to the five-point likert scale (strongly agree, 4 agree, 3 neutral, 2 disagree, 1 strongly disagree) and the study adopted the following weights (3,68-5) high, (3.67-2,34) medium, (2,331) is weak. the validity of the study tool first: the sincerity of the arbitrators to achieve the validity of the tool, the two researchers designed the questionnaire electronically and sent it to a number of arbitrators specialized in the field of early childhood, curricula, teaching and educational techniques , based on what the arbitrators agreed upon, the two researchers reformulated some paragraphs and modified them so that the study tool consisted of (38) paragraphs distributed over 7 areas. second: structural validity “consistency validity:” consistency validity: the study tool was applied to an exploratory sample from outside the study sample consisting of (25) from outside the study sample, and the pearson correlation coefficient was calculated between the paragraph and the total score of the domain to which it belongs, and between the paragraph, the field, the total degree, and the table (2) shows that: table (2) ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 14 pearson correlation coefficient between the paragraph and the total score for the domain to which it belongs, and between the item, the domain and the total score statistical significance pearson's correlation coefficient, item and domain, with the total score statistical significance pearson's paragraph-todomain correlation coefficient domain paragraphs .000 .733** leadership .003 .576** .000 .688** my child's school follows the e-learning strategy approved by the competent authorities 1 .001 .601** .000 .834** my child's teacher strives to update content and activities without violating national laws and policies 2 .006 .536** .000 .845** my child's teacher uses e-learning applications efficiently to help the learner achieve international learning standards. 3 .001 .621** .000 .863** my child's teacher provides studentcentered learning opportunities in line with modern educational philosophies. 4 .010 .503* .000 .749** my child's teacher uses multiple measurement tools to measure learners' progress. 5 .012 .493* .001 .612** my child's teacher sets the exact time plan for all the steps that the learner is expected to carry it out. 6 .012 .496* .001 .634** my child's teacher adheres to the comprehensive assessment criteria for distance learning. 7 .000 .885** technology .000 .796** .000 .865** my child's school provides in its electronic system the electronic alert feature to constantly alert learners 8 .000 .731** .000 .913** the teacher encourages my child to use the e-learning system through his smart phone. 9 .000 .685** .000 .757** my child's teacher is keen to follow the interaction of learners to obtain data through the distance education system. 10 .000 .731** .000 .899** my child's teacher uses the right app for slow learners. 11 .007 .525** .000 .739** my child's teacher carries out the appropriate and required tests through the distance learning system. 12 .001 .629** .013 .489* my child's teacher is keen on how to securely enter the distance learning system 13 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 15 .000 .762** .000 rehabilitation and support .000 .662** .000 .885** my child's teacher encourages me to take advantage of parenting programs in the use of technology and distance learning skills. 14 .000 .722** .000 .946** educational institutions provide training for me in the use of technology and elearning platforms. 15 .000 .723** .000 .935** my child's teacher encourages my child to provide appropriate technical and educational assistance throughout the learning process. 16 .000 .901** the design .000 .725** .000 .794** my child's teacher is keen to keep the goals of electronic content clear. 17 .000 .679** .000 .787** my child's teacher adheres to the universal design standards for electronic content. 18 .000 .756** .000 .784** my child's teacher breaks the content into small, reusable pieces. 19 .000 .679** .000 .736** my child's teacher provides electronic content in various forms (texts, presentations, audio materials, etc.(. 20 .000 .715** .000 .801** my child's teacher prepares the content in different designs in terms of colour, shape and size, which reduces effort. 21 .000 .745** .000 .810** my child's teacher presents the electronic educational content in an organized manner and easy to navigate between its parts. 22 .000 .726** .000 .849** my child's teacher is keen on evaluating the learners and adding comments on the educational content of the electronic course. 23 .000 .692** interaction .012 .496* .001 .641** my child's teacher encourages him to help him read instructions on how to start using the e-learning system and enter the lessons. 24 .000 .796** .000 .797** my child's teacher sets the timelines for all the steps that learners are expected to perform for each electronic unit. 25 .011 .498* .000 .917** my child's teacher is always keen to answer learners' inquiries. 26 .000 .679** .007 .529** my child's teacher provides feedback to learners on tasks completed on an ongoing basis. 27 .002 .593** .000 .814** my child's teacher employs selfassessment techniques for learners to check their progress. 28 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 16 * statistical significant at the significance level (0.05). ** statistical significant at the level of significance (0.01). it is clear from table (2) that the values of the pearson correlation coefficients between the paragraphs of the questionnaire and the total degree of the domain to which it belongs are statistically significant at the significance level (0.01) or (0.05), and this indicates that all the questionnaire statements have a degree of sincerity, which indicates that the validity of the tool for measuring what it was prepared for. .011 .498* .000 .917** my child's teacher employs methods to measure learners' interaction and engagement during the educational presentation. 29 .000 .797** justice and accessibility .029 .437* .000 .948** my child's teacher helps me possess the minimum knowledge, technical skills and competencies required to pursue my child in e-learning 30 .000 .715** .000 .757** the distance learning system provides my child with access to all programs that serve the learning and education process 31 .013 .489* .000 .745** the distance learning system provides my child with easy techniques and ways to obtain them 32 .027 .441* .000 .871** the distance learning system allows the presentation of electronic content in multiple audio-visual ways 33 .000 .697** measurement and evaluation .001 .605** .000 .807** my child's teacher employs learning measurement tools that are appropriate to the activities and resources of electronic content. 34 .001 .623** .000 .868** learning system shows distance degrees policy evaluation of electronic courses. 35 .006 .536** .000 .909** my child's teacher sets descriptive criteria associated with the grading policy for evaluate learner performance. 36 .001 .621** .000 .849** the distance learning system provides a mechanism to measure the degree of beneficiaries' satisfaction with the elearning style of providing the material. 37 .006 .536** .000 .760** i have the opportunity to evaluate the electronic courses that my child is constantly studying. 38 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 17 stability: to calculate the values of the scale stability coefficient, the researcher applied the questionnaire to the survey sample consisting of (25), and the values of the reliability coefficient were calculated using cronbach's alpha coefficient. cronbach's alpha and table no. (3) show the stability coefficients of the tool fields and the total degree of the tool: table (3) cronbach's alpha stability coefficients for the domains of the early childhood distance education quality questionnaire in the kingdom of saudi arabia from the parents' point of view and the total cronbach's alpha stability coefficients the domain 0.87 domain one: leadership 0.86 domain two: technology 091 domain three: rehabilitation and support 0.90 fourth domain: design 0.84 fifth domain: interaction 0.82 domain six: justice and accessibility 0.89 seventh domain: measurement and evaluation 0.96 total marks it is clear from table (3) that the stability coefficient of the quality of distance education questionnaire for early childhood in the kingdom of saudi arabia from the parents' point of view was (0.96), and the stability ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 18 coefficients on the domains ranged (0.82 -0.91), which indicates that the tool has high stability. statistical methods: to answer the study questions, the researcher used a number of statistical methods to apply them in the spss statistical analysis program version (23) where it was extracted: arithmetic mean, and standard deviations to answer the first question, and analysis of variance was used to answer the second question. the results of the arithmetic mean value were interpreted in a scale according to the five-point scale that was used in the current study: the range is calculated, 5-1=4 the category length is calculated by dividing the range by the number of categories according to the category length 4/5 = 80, 0 1 to less 1.80---very weak, 1.80 to less than 2.60 a few, 2.60 to less than 3.40 medium, 3.40 to less than 4.20 large, 4.20 to 5.00 very large. study results the results of the first question: what are the attitudes of parents towards distance learning for early childhood in light of e-learning standards during the corona pandemic in the al-ahsa region? to answer this question, the arithmetic mean and standard deviations of parents' attitudes towards distance learning for early childhood were extracted in the light of e-learning standards during the corona pandemic in the al-ahsa region, and table (4) shows this: ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 19 table (4):arithmetic mean and standard deviations of parents' attitudes towards distance learning for early childhood in the light of e-learning standards during the corona pandemic in the al-ahsa region degree standard deviations arithmetic mean domain – paragraphs # large .788 4.06 leadership very large 1.034 4.22 my child's school follows the e-learning strategy approved by the competent authorities 1 very large .775 4.42 my child's teacher strives to update content and activities without violating national laws and policies 2 large 1.004 4.02 my child's teacher uses e-learning applications efficiently to help the learner achieve international learning standards. 3 large 1.062 3.94 my child's teacher provides learnercentered learning opportunities in line with modern educational philosophies. 4 large 1.057 3.88 my child's teacher uses multiple measurement tools to measure learners' progress. 5 large 1.000 4.01 my child's teacher sets the exact time plan for all the steps that the learner is expected to carry out. 6 large 1.041 3.97 my child's teacher adheres to the comprehensive assessment criteria for distance learning. 7 large .837 3.89 technology large 1.194 3.64 my child's school provides in its electronic system the electronic alert feature to constantly alert learners 8 large 1.147 3.82 the teacher encourages my child to use the e-learning system through his smart phone. 9 large .980 4.00 my child's teacher is keen to follow the interaction of learners to obtain data through the distance education system. 10 large 1.106 3.58 my child's teacher uses the right app to deal with slow learners 11 large .996 4.08 my child's teacher carries out the appropriate and required tests through the distance learning system. 12 very large .894 4.23 my child's teacher is keen on how to securely enter the distance learning system 13 very large .951 3.72 rehabilitation and support large 1.110 3.71 my child's teacher encourages me to take advantage of parenting programs in the use of technology and distance learning skills. 14 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 20 large 1.194 3.43 educational institutions provide training for me in the use of technology and e-learning platforms. 15 large .980 4.02 my child's teacher encourages my child to provide appropriate technical and educational assistance throughout the learning process. 16 large .795 4.08 the design large .972 4.03 my child's teacher is keen to keep the goals of electronic content clear. 17 large .946 3.94 my child's teacher adheres to the universal design standards for electronic content. 18 large .910 4.04 my child's teacher breaks the content into small, reusable pieces. 19 very large .940 4.22 my child's teacher provides electronic content in various forms (texts, presentations, audio materials, etc.(. 20 large .885 4.18 my child's teacher prepares the content in different designs in terms of color, shape and size, which reduces effort. 21 very large .798 4.25 my child's teacher presents the electronic educational content in an organized manner and easy to navigate between its parts. 22 large 1.076 3.92 my child's teacher is keen on evaluating the learners and adding comments on the educational content of the electronic course. 23 large .796 4.11 interaction large .984 4.09 my child's teacher encourages him to help him read instructions on how to start using the e-learning system and enter the lessons. 24 large .898 4.08 my child's teacher sets the timelines for all the steps that learners are expected to perform for each electronic unit. 25 large .973 4.15 my child's teacher is always keen to answer learners' inquiries. 26 large .913 4.18 my child's teacher provides feedback to learners on tasks completed on an ongoing basis. 27 large .995 4.05 my child's teacher employs self-assessment techniques for learners to check their progress. 28 large .915 4.12 my child's teacher employs methods to measure learners' interaction and engagement during the educational presentation. 29 large .908 3.93 justice and accessibility large 1.028 3.85 my child's teacher helps me possess the minimum knowledge, technical skills and competencies required to pursue my child in e-learning 30 large 1.036 3.89 the distance learning system provides my 31 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 21 it is clear from table (4) that the attitudes of parents towards distance learning for early childhood in the light of e-learning standards during the corona pandemic in the al-ahsa region came to a large extent with an arithmetic mean(3.97) and a standard deviation (0.746) the two researchers attribute this to the fact that distance education was the best solution taken by the state after the concerted efforts of several official bodies and the setting up of a huge budget in order to reach the desired goals, continue the learning process, and address the effects that resulted from the corona pandemic that prevented students from continuing their presence learning , as well as the keenness of parents to invest time and capabilities and continue their children to the process of learning and education. child with access to all programs that serve the learning and education process large .992 3.99 the distance learning system provides my child with easy techniques and ways to get them 32 large 1.045 3.98 the distance learning system allows the presentation of electronic content in multiple audio-visual ways 33 large .938 3.78 measurement and evaluation large .922 4.05 my child's teacher employs learning measurement tools that are appropriate to the activities and resources of electronic content. 34 large 1.089 3.85 the distance learning system clarifies the electronic course evaluation score policy. 35 large .965 3.92 my child's teacher sets descriptive criteria associated with the grading policy for evaluating learner performance. 36 large 1.288 3.57 the distance learning system provides a mechanism to measure the degree of beneficiaries' satisfaction with the elearning style of providing the material. 37 large 1.307 3.51 i have the opportunity to evaluate the electronic courses that my son is constantly studying. 38 large .746 3.97 total degree ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 22 this study agreed with the study of basilaia and kvavadza (2020), and the study of al-enezi (2020), which emphasized the keenness of parents to follow up their learning through distance learning systems, and the interaction field ranked first with an arithmetic mean(4.11) and a standard deviation (0.796). ) and to a large extent ,the two researchers attribute this to the fact that teachers have an effective role in accustoming the child and the family to electronic education and providing all possible means of communication between the family and the school. this study agreed with the study of al-qahtani, amal, al-shehhi, hayat, bin nasser, alia, embassy, azza (2020). which confirmed the teachers' keenness to communicate and interact with students during distance education and provide them with feedback. . the design domain ranked second with an arithmetic mean(4.08) and a standard deviation (0.795) with a significant degree, and the leadership domain ranked third with an arithmetic mean(4.06) and a standard deviation (0.788) with a significant degree, the domain of justice and accessibility ranked fourth with an arithmetic mean(3.93) and a standard deviation (0.908) and with a significant degree, and the field of technology ranked fifth with an arithmetic mean(3.89) and a standard deviation (0.837) with a significantit also ranked sixth in the field of measurement and evaluation with an arithmetic mean(3.78) and a standard deviation (0.938) with a significant large degree, and in the seventh and last rank, the field of rehabilitation and support got an arithmetic mean(3.72) and a standard deviation (0.951) with a significant degree.although the field of rehabilitation and support ranked last, it came to a large degree,the two researchers attribute this to the fact that all standards were of a high degree of importance from the point of view of parents, as well as from the point of view of those responsible for the ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 23 learning process who set these standards that contribute to achieving quality and competitiveness. the results of the second question: are there statistically significant differences at the significance level =( = 0.05) in the responses of the study sample members about the attitudes of parents towards distance learning for early childhood in the light of e-learning standards during the corona pandemic in the al-ahsa region according to the variables of type of education, educational stage, kinship, type of school? in order to answer this question, the arithmetic mean and standard deviations of the responses of the study sample members about parents’ attitudes towards distance learning for early childhood were extracted in the light of e-learning standards during the corona pandemic in the alahsa region according to the variables of type of education, educational stage, kinship, school type and schedule. (5) shows that: table (5): averages and standard deviations of parents' attitudes towards distance learning for early childhood in the light of e-learning standards during the corona pandemic in al-ahsa region according to the variables of type of education, educational stage, kinship, and type of school total degree leadership technology rehabilitation and support design interaction justice measurement and evaluation category variable x σ x σ x σ x σ x σ x σ x σ x σ 3.92 .763 3.99 1.02 3.83 .837 3.59 .999 3.99 .752 4.04 .732 3.93 .690 3.86 .904 diploma and less education level 3.96 .772 4.06 .756 3.88 .857 3.71 .968 4.07 .833 4.11 .798 3.88 .995 3.76 1.006 bachelor 4.08 .622 4.16 .670 4.02 .774 3.88 .840 4.21 .669 4.18 .885 4.16 .660 3.75 .645 postgraduat e ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 24 3.96 .675 4.03 .827 3.82 .805 3.65 .832 4.15 .655 4.15 .776 3.96 .884 3.72 .881 kindergarte n educational stage 3.97 .793 4.08 .764 3.94 .859 3.76 1.026 4.04 .877 4.09 .814 3.91 .928 3.82 .978 primary classes 3.98 .769 4.09 .780 3.92 .857 3.80 .934 4.06 .814 4.09 .830 3.95 .897 3.78 .970 mother kinship 4.08 .610 4.04 .734 4.07 .724 3.74 .583 4.30 1.04 7 4.27 .524 4.02 .600 3.90 .709 father 3.84 .732 3.95 .876 3.64 .799 3.35 .917 4.02 .859 4.13 .782 3.80 1.11 3.69 .950 other 4.04 .755 4.11 .768 3.93 .828 3.80 .921 4.12 .812 4.18 .821 4.00 .924 3.95 .929 governmental school type 3.82 .714 3.96 .824 3.81 .858 3.55 1.0 4.00 .762 3.97 .734 3.79 .868 3.43 .864 private it is evident from table (5) a difference in the arithmetic mean of the responses of the study sample members to the attitudes of parents towards distance learning for early childhood in the light of e-learning standards during the corona pandemic in the al-ahsa region according to the variables of type of education, educational stage, kinship, type of school and to indicate the significance differences between arithmetic mean, analysis of variance was used, and table (6) shows that: table (6): analysis of variance of parents' attitudes towards distance learning for early childhood in the light of e-learning standards during the corona pandemic in al-ahsa region according to the variables of type of education, educational stage, kinship, and type of school statistically significant f value mean squares (ms) df sum of squares (ss) the domain source of variance .719 .330 .210 2 .420 leadership level .662 .414 .293 2 .585 technology .494 .709 .630 2 1.260 rehabilitation and support .551 .599 .384 2 .768 design .737 .306 .197 2 .394 interaction .363 1.023 .851 2 1.702 justice and accessibility ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 25 .863 .148 .126 2 .251 measurement and evaluation .634 .458 .257 2 .515 total marks .952 .004 .002 1 .002 leadership stage .488 .483 .342 1 .342 technology .793 .069 .061 1 .061 rehabilitation and support .294 1.109 .711 1 .711 design .356 .859 .554 1 .554 interaction .547 .365 .304 1 .304 justice and accessibility .730 .119 .102 1 .102 measurement and evaluation .737 .113 .064 1 .064 total degree .662 .414 .264 2 .527 leadership kinship .229 1.493 1.056 2 2.112 technology .090 2.451 2.178 2 4.357 rehabilitation and support .581 .545 .349 2 .699 design .789 .238 .153 2 .307 interaction .705 .350 .291 2 .582 justice and accessibility .753 .284 .242 2 .484 measurement and evaluation .581 .545 .306 2 .613 total degree .243 1.377 .877 1 .877 leadership school .461 .547 .387 1 .387 technology .109 2.602 2.313 1 2.313 rehabilitation and support .251 1.333 .855 1 .855 design .112 2.567 1.655 1 1.655 interaction .112 2.563 2.132 1 2.132 justice and accessibility .003 9.282 7.898 1 7.898 measurement and evaluation .088 2.949 1.658 1 1.658 total degree .637 123 78.323 leadership the error .707 123 86.992 technology .889 123 109.318 rehabilitation and support .641 123 78.873 design .645 123 79.295 interaction .832 123 102.314 justice and accessibility .851 123 104.661 measurement and evaluation .562 123 69.163 total degree ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 26 130 2225.653 leadership total 130 2058.583 technology 130 1913.778 rehabilitation and support 130 2246.898 design 130 2280.778 interaction 130 2112.938 justice and accessibility 130 1967.880 measurement and evaluation 130 2118.571 total degree education level variable: table (6) shows that there are no statistically significant differences for parents' attitudes towards distance learning for early childhood in the light of e-learning standards during the corona pandemic in the al-ahsa region on the domains and the total degree according to the educational level variable the two researchers attribute this to the awareness of all parents of different educational levels of the importance of completing the education process for their children, equal opportunities for full-time and working parents in their presence with their children at home, and their conviction that distance learning is the best way to continue the learning process , and this result agreed with the result of al-anazi study (2020) with the current study in the absence of statistically significant differences for the educational level variable for parents, and it differed with the qur’an study (2021), which indicated that there are differences in favor of graduate studies. educational stage variable: table (6) shows that there are no statistically significant differences in parents' attitudes towards distance learning for early childhood in the light of e-learning standards during the corona pandemic in al-ahsa region on the domains and the total degree according to the educational ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 27 stage variable the two researchers attribute this to the parents’ awareness of the importance of both stages as it is a stage of establishing all skills and for the convergence of the characteristics of children in both stages, and because e-learning standards are essential and an important reference based on educational institutions in the teaching and learning process.kinship variable: table (6) shows the absence of statistically significant differences for parents' attitudes towards distance learning for early childhood in the light of e-learning standards during the corona pandemic in al-ahsa region on the domains and the total degree according to the kinship variable , the two researchers attribute that the family has a key role in the distance education process, as it is the main element in the initiation and continuity of the learning process, and it is the fertile environment for education. parents are the ones who are keen to provide all appropriate means to follow up the learning process of their children and help them use the techniques used in the distance education system skillfully. regardless of the relationship with the child , this result is consistent with the result of the study of malkawi (2020), which indicated that there are no significant differences due to the kinship variable. school variable: table (6) shows that there are no statistically significant differences for parents' attitudes towards distance learning for early childhood in the light of e-learning standards during the corona pandemic in the al-ahsa region on the domains and the total degree according to the school variable except for the seventh domain: measurement and evaluation and in favor of government educationthe two researchers attribute this to the opportunity imposed by the corona pandemic, which led to changing the ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 28 culture of saudi society and its orientation towards distance education, in order to achieve change towards a better future, in addition to the role played by the ministry of education in the kingdom of saudi arabia. and joint efforts with other parties play a major role in providing appropriate educational platforms for all stages in a short time for public and private education at the same time, in an effort to reach the quality of education.as for the difference that came in the field of measurement and evaluation and in favor of public schools, the researchers attribute this to the care and emphasis taken by the education department in the field of measurement and evaluation to include the areas of school leadership, learning methods, educational outcomes and the school environment, and measuring their quality and adequacy through questionnaires, observation, document analysis and interviews, in addition to providing a mechanism to measure the level of spending efficiency resulting from the delivery of curricula in an e-learning style. this study differs with the study of al-quran (2021) in jordan, which came in favor of private schools. recommendations in light of the results of the study, the researchers recommend the following: providing appropriate courses to develop the technological competence of students, parents and teachers on an ongoing basis to keep abreast of the latest developments in the crisis. implementation of awareness courses that contribute to spreading a positive atmosphere towards distance education. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 29 working on continuous updating of the educational content to make it attractive, especially to children of the early childhood stage. sources and references abu ababa, atheer. (2021). evaluating the experience of the kingdom of saudi arabia in distance education in light of the corona pandemic from the parents' point of view. journal of the islamic university of educational and psychological studies (3) .7-29. daradkeh, ahmed. (2013). the role of the school administration in activating the concept of the community school in the schools of the northern mazar district education directorate from the point of view of school principals, teachers and parents of students, and suggestions for improvement. [unpublished phd thesis]. college of education, yarmouk university. amer, tariq abdel-raouf. (2014) total quality and accreditation in education: contemporary trends. the arab group for training and publishing, cairo. al-anazi, maryam hamdan (2020). parents’ attitudes towards the role of the distance learning system in teaching arabic to students of foreign private schools during the corona crisis in the state of kuwait, journal of the college of education, mansoura university, p. 110, part 5, 14041433. the national center for e-learning. (2020). e-learning standards for general education in the kingdom of saudi arabia 2020. https://cutt.us/olssi. malkawi, souad. (2020). distance learning is a reality and challenges from the parents' point of view during the corona virus "covid-19" ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 30 https://cutt.us/olssi pandemic in irbid governorate in jordan. the comprehensive multidisciplinary electronic magazine. (23),1-19. al-quran, worod nasser. (2021). the reality of e-learning in light of the corona pandemic in kindergartens in the first irbid education directorate] unpublished master's thesis]. jerash university, amman, jordan. al-qahtani, amal and al-shehhi, hayat embassi, hayat. (2020) motivation and its role in activating the distance learning process among basic education students in light of the corona pandemic from the parents' point of view and teachers. reading and knowledge magazine, p. 229, 275-298. al-maliki, haifa, and daghestani, bilqis. (2020) the role of electronic educational platforms in the professional growth of early childhood teachers. the educational journal, p. 73, c. 30, 1127-1156. swed, jehan. (2021) a study of the reality of distance education in light of the spread of the corona virus and its impact on parents among school students in different educational stages (the primary stage). journal of environmental and energy research, vol. 15, vol. 9, 1-33. ministry of education (2021), kingdom of saudi arabia. basilaia,g.,&kvavadze,d.(2020).transition to online education in schools during asars-c0v-2 coronavirus (covid-19) pandemic in georgia . pedagogical research, 5(4)-10. bozkurt, a. (2019). from distance education to open and distance learning: a holistic evaluation of history, definitions, and theories. in s. sisman-ugur, & g. kurubacak (eds.), handbook of research on ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 31 learning in the age of transhumanism (pp. 252-273). hershey, pa: igi global. david, r. et.al.(2020). education during the covid-19 crisis: opportunities and constraints of using edtech in low-income countries, a joint publication between the edtech hub and digital pathways at oxford, blavatnik school of government. leontyeva, i.(2018).modern distance learning technologies in higher education: introduction problems, eurasiajournal of mathematics, science and technology education, 14(10), 1-8. foti, p (2020) research in distance learning in greek kindergarten school during the pandemic of covid-19 possibilities dilemmas limitation . european journal of open education and elearning , 5 (1) doi ; http://dx.doi.org. unesco. (2020). crisis-sensitive educational planning. paris: unesco world bank edteck teem, (2020, jul 15), remote learning distance education and online learning during the covid -19 pandemic, world bank . https:// www. world bank .org/en/topic/edutech/brief/edtechcovid-19. 5-10 timmons, k., cooper, a., bozek, e. et al. the impacts of covid-19 on early childhood education: capturing the unique challenges associated with remote teaching and learning in k-2. (2021). early childhood educ j. 10.1007/s10643-021-01207-z ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 5 | issue 12 | december 2022 | https://www.ijojournals.com/index.php/hsn/index 32 http://dx.doi.org/ ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson m1* * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ epidemiological profile of cleft lip and palate in children under 15 from 2015 to 2020 in madagascar." epidemiological profile of cleft lip and palate in children under 15 from 2015 to 2020 in madagascar rakotoson m1*, dally s2, soanasolo cm2, ralaiavy hh2, ratovoarisoa d3, ranjarisoa ln4 1department of dentofacial othopedics/ institute of tropical odonto-stomatology of madagascar (iostm) ; madagascar 2department of periodontics/ institute of tropical odonto-stomatology of madagascar (iostm) ; madagascar 3department of oral surgery / institute of tropical odonto-stomatology of madagascar (iostm) ; madagascar 4department of public health/ institute of tropical odonto-stomatology of madagascar (iostm) ; madagascar ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 1 abstract introduction: cleftlip and palate are the most common facial malformations, with prevalence varying between races and ethnic groups. they represent one of the major public health problems, often associated with severe malformations at high risk of infant mortality. hospital prevalence in madagascar was 4.66‰ in 2016. the overall objective of this study was to describe the epidemiological profile of cleftlip and palate in children under 15 years of age in madagascar from 2015 to 2020. methodology:this was a retrospective descriptive study reporting epidemiological data of children under 15 years of age from 2015 to 2020 at 09 different sites in madagascar. the sample size was exhaustive. data were collected by counting, independent and dependent variables were analyzed on sppss 21.0 software by the chi2 test who se significance threshold was set at a p<0.05. ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson m1* * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ epidemiological profile of cleft lip and palate in children under 15 from 2015 to 2020 in madagascar." results: the epidemiological profile of childrenwithcleftlip and palate in madagascar wasmarked by: apredominance of males, a lowsocio-economiclevel, a riskypregestationalmaternalstatus, and a multiparousfamily. discussion:male predominance has been observed in similarstudies in côte d'ivoire and france. scottish and american studies have demonstratedthat the existence of viral or parasitic infections duringpregnancyrepresents a risk of congenital malformation. in madagascar, the birth of an infant with a highlydisfiguringcongenital malformation leads to deliberateneglect. conclusion:cleftlip and palateremains a major public healthproblem in madagascar. keywords : child, cleftpalate, madagascar. 1. introduction cleftlip and cleftpalate are the mostcommon facial malformations, withprevalencevaryingbetween races and ethnic groups [1]. they are a major public healthproblem, oftenassociatedwithsevere malformations [2]. worldwide, an estimated 303,000 newborns die eachyearwithin four weeks of birth, due to congenital anomalies [2]. these malformations disruptseveralfunctions essential to the child's normal development: speech, hearing, dentition, as well as aestheticappearance and psychological balance. future sequelae of thiscongenital condition may have an impact on aesthetics and function. the psychologicalconsequences of the malformation are veryserious, particularly for the parents, and can lead to familytragedy in the face of thismuch-desiredchild, and even for the childaftersurgery [3]. it isestimatedthatbetween 1/700 and 1/1000 live birthsworldwide are affected byof orofacialclefts for different populations around the world, withconsiderable variations linked to geographicalorigins, ethnicity and socio-economic conditions [4].the sex ratio is 0.5 (predominantlyfemale) [5]. in europe, one childin 650 is a cleft carrier [4]. the lowestprevalenceisreportedamongafrican-americans, at around 0.5 per 1,000 births, and amongcaucasians, at around 1 per 1,000 births [5]. in south africa, earlierstudies on ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 2 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson m1* * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ epidemiological profile of cleft lip and palate in children under 15 from 2015 to 2020 in madagascar." thisprevalencewerecarried out in cape town, johannesburg and pretoria in the late 1980s. reportedprevalencerangedfrom 0.1 to 0.4 per 1,000 live births [3]. in madagascar, according to the study made by rakotoarisonin 2012, the prevalence of cleftlip and palatewas 0.48‰ from 1998 to 2007 and washigher in the highlands [6]. a studydone in mahajanga from 2007 to 2011 found a hospitalprevalence of 4.66%. the overallaim of thisstudywas to describe the epidemiological profile of cleftlip and palate in childrenunder 15 years of age in madagascar from 2015 to 2020. the specific objectives were to describe the socio-epidemiological profile of childrenunder 15 and theirparents;describe the prevalence of clefts in madagascar; identify the relationshipbetween the epidemiological profile and the type of cleft; propose suggestions. 2. materials and methods this is a retrospective descriptive studyreportingepidemiological data of childrenunder 15 years of agefrom 2015 to 2020 at 09 different sites in madagascar. this article deals with a site of 200 children. the studyranfromjanuary 01, 2015 to december 31, 2020. childrenunder 15 years of agewereincluded in the study. childrenunder 15 years of agewhose records could not beusedwereexcludedfrom the study. the sample size was exhaustive. the variables were : patient information age, gender, place of residence, sibling rank, ethnicity, presence of other anomalies, presence of allergy. information on parents (mother, father or guardian) ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 3 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson m1* * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ epidemiological profile of cleft lip and palate in children under 15 from 2015 to 2020 in madagascar." parents' age, socio-economiclevel, level of education, consanguinity, duration of pregnancy, complications duringpregnancy, complications at birth, toxic habits (tobacco, alcohol), medicationtakenduringpregnancy, folicacidtaken at birth, presence of cleft in the family, types of cleftlip and palate. data werecollectedethically, and independent and dependent variables wereanalyzedusing sppss 21.0 software, using the chi2 test with a significancethreshold of p<0.05. 3. results table 1:distribution of children by gender(n = 200) gender number (n = 173) percent (%) male 95 54,9 female 78 45,1 total 173 100 table 2 : distribution of children by parental consanguinity(n = 200) consanguinity number (n =173) percent (%) yes 31 17,9 no 142 82,1 total 173 100 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 4 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson m1* * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ epidemiological profile of cleft lip and palate in children under 15 from 2015 to 2020 in madagascar." table 3 : distribution of childrenaccording to theirmother's cigarette consumptionduringpregnancy(n = 200) consumptionduringpregnancy nombre (n = 173) pourcentage (%) yes 5 2,9 no 158 91,3 unknown 10 5,8 total 173 100 table 4 : distribution of childrenaccording to theirmother'salcoholconsumptionduringpregnancy(n = 200) consumptionduringpregnancy number (n = 173) percent (%) no 160 92,5 unknown 13 7,5 total 173 100 table 5 : distribution of childrenaccording to the existence of cleftfamilymembers(n = 200) cleft family members number (n = 173) percent (%) yes 20 11,6 no 146 84,4 unknown 7 4,0 total 173 100 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 5 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson m1* * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ epidemiological profile of cleft lip and palate in children under 15 from 2015 to 2020 in madagascar." table 6 : distribution of childrenaccording to the existence of associatedcraniofacial malformations (n = 200) existence of associatedcraniofacial malformations number (n =173) percent (%) yes 4 2,3 no 115 66,5 unknown 54 31,2 total 173 100 table 7 : distribution of children by cleft type (n = 200) type of cleft number (n = 173) percent (%) labial cleft 42 24,3 alveolar cleft 15 8,7 palate cleft 38 22,0 labio-alveolar cleft 16 9,2 labio-palate cleft 34 19,7 alveolo-palate cleft 3 1,7 labio-alveolo-palate cleft 25 14,5 total 173 100 4. discussion males accounted for 54.9% of the population. our studycorrelateswiththat of colemann jr in 2001, whostatedthat “cleftlip and palate are twice as frequent in boys” [7]. the majority of childrenhadunilateralclefts. studies by anderson p in 1942 and jensen bl in 1976-1981 confirmourstudythat “cleftlip tends to beunilateral (about 90%) and about two-thirdsoccur on the leftsideregardless of gender, ethnicity and severity of defect” [8]. consanguinityisalsopresent. a study by al-johar a in 2008 in saudi arabia reportedthat: “the reportedprevalence of consanguinity in familieswithcleftlip and palate in saudi arabia ranges ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 6 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson m1* * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ epidemiological profile of cleft lip and palate in children under 15 from 2015 to 2020 in madagascar." from 6.7% to 83%, with a high prevalence of marriagesbetween first cousins” [9]. some of the motherswerealcoholics. in 2007, honein ma assertedthat “alcoholconsumption (particularly for cleftpalates) and/or smoking during the first threemonths of pregnancy are environmentalfactors in the development of cleftlip and palate” [10]. rakotoarison ra in 2011 states that: “a particularityisobserved in the vakinankaratra region, wherethisprevalenceis double that of otherregions. this wouldbe due to the existence of very high doses of radioactivity in certain areas of thisregion” [6]. the dysmorphologicalseverity of cleftlip and palateisassociatedwith the severity of the phenotype in terms of other malformations, with a striking trend. bilateralcleftlip and palate cases are three times more likely to have anothersevere malformation thanunilateral cases” [11]. 5. conclusion cleftlip and palateremains one of the major public healthproblems in madagascar. the epidemiological profile of childrenwithcleftlip and palate in madagascar wasmarked by male predominance, lowsocio-economicstatus, riskypre-gestationalmaternalstatus, and multiparousfamilies. according to ourresults, relationshipsbetweenepidemiological profile and types of cleftexisted. however, the etiology of cleftlip and palateremainspoorlyknown in madagascar, henceour plan to broadenourresearch by conducting an analyticalstudy of cleftlip and palate in madagascar. references 1.bonaiti c. briard m.l., freingold j. an epidemiological and genetic study of facial cleft in france: epidemiology and frequency in relative. j med genet, 1982; 19:8-18. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 7 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson m1* * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ epidemiological profile of cleft lip and palate in children under 15 from 2015 to 2020 in madagascar." 2.plo s one. epidemiology and clinical profile of people withcleftlip and palateusingspecializeduniversitytreatment centers in south africa. 2019;14(5). 3.francannet c. facial cleft and nutritionalfactors. symposium of the europeangenomutation institute groupama foundation. lyon. 2002. 4.mange m, campbell r, gilyoma j, magori cc, kilalo m, mazyala e et al. an assessment of orofacial clefts in tanzania, published online 2011, doi: 10.1186/1472-6831-11-5. 5.omo-aghoja vw, omo-aghoja lo, ugboko vi, obuekwe on, saheeb bdo, feyiwaboso p et al. antenatal determinants of oro-facial clefts in southern nigeria. afr health sci. 2010; 10(1):31-9. 6.rakotoarison ra. cleft lip and palate in madagascar 1998-2007. british journal of oral of oral and maxillo-facial surgery.2012; 50(5):430-4. 7.coleman jr, sykes jm. the embryology, classification, epidemiology and genetics of facial clefting. fac plast surg clin. 2001;9:1–13. 8. foghanderson p. cleft lip and palate : inheritance of harelip and cleft palate. munksgaard, copenhagen, calnan js. oparaexdomebiologiaehareditariae universities. 1942. 9. aljohar a, ravichandran k, subhani s. pattern of cleft lip and palate in hospitalbased population in saudi arabia: retrospective study. cleftpalatecraniofac j. 2008; 45 : 592–6. 10. honein ma, rasmussen sa, reefhuis j, romitti pa, lammer ej, sun l, et al. maternal smoking and environmental tobacco smoke exposure and the risk of orofacial clefts. epidemiology. 2007; 18 : 226–33. 11. hagberg c, larson o, milerad j. incidence of cleft lip and palate and risks ofadditional malformations. cleft palate craniofac j. 1997; 35 : 40–5. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 8 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || chin-cervical distance and orthodontic forecast for children aged 6 to 12 in mahajanga madagascar autors: rakotoson m1*, randrianandraina pm2, rajaonarison lf3, rasoanirina mo1, andriniaina fa1, ratsirarisoa t1, andrinjakarivony nn1, rakotoharinivo hzm1, randrianarimanarivo hm1 1department of dento-facial orthopedics, institute of tropical odonto-stomatology of madagascar, university of mahajanga, madagascar 2department of ear, nose and throat (ent), university hospital professor zafisaona gabriel, androva, mahajanga 3department of ear, nose and throat (ent), university hospital andohatapenaka antananarivo *correspondig author: rakotoson mariette department of dento-facial orthopedics, institute of tropical odonto-stomatology of madagascar, university of mahajanga, madagascar abstract cervico-chin distance is used to assess the length and position of the mandible. skeletal disorders are aesthetically and functionally detrimental to patients. the objectives were to describe and predict patients' cervicomandibular distance. a cross-sectional descriptive study of 45 children aged 6 to 12 years was carried out without distinction of gender, in the city of mahajanga, from march to december 2018. cervico-chin distance measurement was obtained by the equivalent width of three finger crossings. among the 45 patients, we observed that cervico-facial distance was normal in 24.4%; decreased for the 40% and increased in the 35.5% of patients. dento-skeletal and functional disorders were significant. key words: cervical, chin, orthodontics. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 27 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || introduction the profile examination of a subject studies the sagittal development and vertical balance of the face. the cervico-chin distance is used to assess the length and position of the mandible. it must be in harmony with the face. it also plays an important role in the aesthetic balance of the profile [1]. maxillo-mandibular disorders are aesthetically prejudicial in the form of skeletal and functional deformity, such as upper airway obstruction, for a patient with a life-threatening prognosis, hence the interest of our present study [2]. in africa in 2004, 15.5% of the population were in class ii and 8% in class iii [1]. the objectives were to describe and predict orthodontically the cervico-chin distance of patients. methodology this is a descriptive cross-sectional study, carried out at the centre de soins et de traitements dentaires (cstd) at the institut d'odonto-stomatologie tropicale de madagascar (iostm). the study period spanned 10 months (march december) in 2018. we included: children aged 6 to 12 years , who came for consultation for aesthetic or functional concerns , with no orthodontic history. subjects with incomplete data were excluded. the sample size was 45 children. cervical-chin distance was measured as the width equivalent to three crossbars of the patient's fingers (index, middle and ring fingers) horizontally under the mandible. a forward chin defines an increased chin-cervical distance, and a backward chin defines a decreased chincervical distance. the data collected was entered and analyzed on computer using excel 2013 software. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 28 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || results table 1: distribution of children by age age number (n) frequency (%) under 9 years 28 62,2 10 years and over 17 37,8 total 45 100,0 table 2: distribution of children by gender gender number (n) frequency (%) masculine 24 53,3 feminine 21 46,7 total 45 100,0 table 3: distribution of children by chin-cervical distance chin-cervical distance number (n) frequency (%) normal 11 24,4 decreased 18 40,0 increased 16 35,5 total 45 100,0 ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 29 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || discussion in orthodontics, infantile and juvenile ages are potential periods for dento-maxillofacial growth. the high number of males in this age group indicates a maternal approach to the care of these children [2]. normal chin-cervical distance implies overall harmony, and overall aesthetics are appreciated, confirming the typological norm for normo-frontal subjects [3]. figure 1: 11-year-old patient with normal cervical-chin distance (source: rakotoson m, 2018). in the sagittal direction, photographs in cis-frontal profile at chin level, as well as an increased convexity angle and a decreased cervico-chin distance, are consistent with the high frequency of skeletal class ii diagnosis [4]. we can therefore conclude that there is a significant sagittal imbalance of the maxillary and mandibular bases of class ii origin, either mandibular or maxillary, depending on the case [3]. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 30 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || figure 2 : 11-year-old patient with diminished cervical-chin distance (source : rakotoson m, 2018) figures 3-4-5 : endo-buccal photographs of an 11-year-old patient with diminished chin-cervical distance (source : rakotoson m, 2018) the normal convexity of the profile in young children diminishes with growth. its increase indicates a class ii shift, while its disappearance or the concavity of the profile indicates a class iii [1]. figure 6 : 9-year-old patient with increased chin-cervical distance (source : rakotoson m, 2018) ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 31 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rakotoson mariette ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || figures 7-8 : endo-buccal photographs of a 9-year-old patient with increased chin-cervical distance (source : rakotoson m, 2018) the shape of the subchin-chin profile and the shape of the lips depend on the balance between protrusions and depressions. the prominence of the lips is analyzed in relation to the nose and chin, which they must balance: the more prominent they are, the more protruding the lips should be [1]. conclusion our study population showed significant sagittal imbalance of the maxillary and mandibular bases. in terms of sagittal dysmorphoses, the majority of patients in this study had a decreased chin-cervical distance. orthodontic prediction is oriented towards a class ii syndrome from an aesthetic, skeletal, dental and functional point of view. this calls for early treatment of infants for prevention and dento-maxillo-facial interception. references 1. boileau mj, bazert c, delbos y, rouas p. therapeutic principles and methods. diagnostic approach. elsevier masson. tome 1. 2011 ; 4-7. 2. mascarelli l, favot p, boileau mj, duhart am. the resident's manual, dentofacial orthopedics. emc odontology/dentofacial orthopedics. 2017 ; 8(4) :1-10. 3. deffrennes d, hadjean e, negrie rb. nasal disharmony. encycl med chir (elsevier, paris) otorhino-laryngologie. 1996 ; 37-92. 4. moulinier s. study of facial and oral characteristics of patients with rubinstein-taybi syndrome. surgery. 2014. ffdumas-01071594ff. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 32 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) fahasoavana rohamah njatosoa¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || ameloblastoma: from benign to malignant about a case report at the hospital center soavinandrina antananarivo (cenhosoa) fahasoavana rohamah njatosoa¹*, jacques adrien ramangason¹, lauricia gaël lalanirina¹, ramarosahanina harivola andrianantenaina¹, john alberto bam rakotondrabe², emmanuel andrianony rakotoarivony¹, aurélien richard rakotoarison³. ¹ department of maxillo-facial surgery in university hospital centrer professor zafisaona gabriel androva (chu-pzaga), mahajanga, madagascar ² department of maxillo-facial surgery in university hospital centrer joseph dieudonné rakotovao (chu-jdr) – befelatanana antananarivo ³ department of maxillo-facial surgery in hospital centrer soavinandrina (cenhosoa), antananarivo abstract ameloblastoma is a common odontogenic tumor of the maxillae in developing countries such as africa. it is a benign tumor, but highly invasive, recurrent and potentially malignant. the aim of this study was to share clinical experience of a rare case of ameloblastoma that had become malignant, and to determine the probable causes of this transformation. this is a retrospective study covering a 20-year period from 2002 to 2021. six cases were identified, but only one met our inclusion criteria. all parameters were reported for comparison with the literature. our patient was a 48-year-old adult who came to us in 2002 with a recurrence of right mandibular ameloblastoma. a total of six operations were performed on this patient, and on each occasion, the technique adopted was enucleation, which is a conservative surgery. the clinic is characterized by the absence of pain at its onset, becoming painful at the cancerous stage. the initial ct scan suggested well-limited, monogeneodic tissue osteolysis, then mixed polygeodic, then poorly limited with invasion into neighbouring tissues, and finally with lymph node and lung metastases. chemotherapy was administered, but the patient did not survive. when faced with a ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 1 correspondant author : names :fahasoavana rohamah njatosoa adress : centre hospitalier universitaire pzaga, androva majunga madagascar. mailto:njatosoas@outlook.com ijo international journal of health sciences and nursing ( issn: 2814-2098 ) fahasoavana rohamah njatosoa¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 2 recurrent ameloblastoma, radical surgery of the interrupting osteotomy or non-interrupting type would be the best indication to avoid multi-recurrence and malignant transformation. key words: ameloblastoma, surgery, recurrence, malignant transformation. introduction he overall aim of this study is to share a clinical experience on a case of historical ameloblastoma that became malignant. ameloblastoma is a benign, locally invasive odontogenic epithelial tumour.in 80% of cases, it is located in the posterior mandible.its annual incidence in the general population is 0.5 cases per 1,000,000 inhabitants, and more frequently in developing countries [1].this type of tumor is not an emergency pathology, but its seriousness stems from its insidious invasive evolution.their histopathological types can vary according to the who classification.the most common is the follicular plexiform type [2].clinically, an ameloblastoma remains asymptomatic and evolves slowly before the discovery of a swelling deforming the face, tooth mobility and/or falls [3].on radiography, it presents as a unior multilocular osteolytic lesion with a cystic and/or tissue-like appearance.sometimes, intra-lesional bone septa are visible, giving a honeycomb-like appearance [3].diagnosis is confirmed anatomically and pathologically [1, 2]. prognosis depends mainly on how early the disease is diagnosed and managed [3]. treatment is purely surgical, with a wide excision margin to avoid recurrence, which is very common. malignant transformation is possible after several recurrences [3, 4]. patient and method our study was carried out at the stomatology and maxillofacial surgery department of the soavinandriana hospital (cenhosoa) in antananarivo. this is a rare case report. all the variables mentioned in this case are compared with the data in the literature. over a study period extending from may 2002 to october 2021, i.e. 20 years, six cases were identified, but only one case met our inclusion criteria. this was the case of a patient with a multi-recurrent ameloblastoma who had undergone iterative surgery at cenhosoa, and who developed a malignant transformation. results this is a 48-year-old man who presented with a benign mixed variant ameloblastoma with tissue predominance at onset. this patient had several recurrences. indeed, five recurrences were ijo international journal of health sciences and nursing ( issn: 2814-2098 ) fahasoavana rohamah njatosoa¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || observed over 20 years. right genital swelling was the reason for our patient's consultation. it was painless to palpate and caused facial asymmetry and even significant deformity of the right face. dental mobility and displacement were also observed at the third recurrence in 2006. in the malignant stage, signs of odynophagia were mentioned. the pathological findings after the fifth operation suggested malignant ameloblastoma with cervical and pulmonary lymph node metastasis. the following table shows the evolution of our case. . ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 3 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) fahasoavana rohamah njatosoa¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || evolution 2002 2006 2009 2013 2014 mainspring for consultation painless tumefaction of the right genicus painless tumefaction of the right goniac angle painless tumefaction of the right ramus tumefaction of the right maxillary hemi-arcade painful tumefaction of the right hemiface clinical features functional discomfort facial asymmetry painless dental mobility and displacement odynophagia suspicious sign of malignancy chest pain odynophagia chest pain cervico-facial ultrasound mixed voluminous mandibular mass with tissue predominance palpable and visible homolateral adenopathies submental adénomégaly computed tomography right lateromandibular bone lysis mixed-content polygeodic osteolysis floor and pharyngeal compression multiple thoracic nodules invasions: submental nodes right maxillary sinus right nasal fossa lungs histology améloblastoma follicular améloblastoma follicular améloblastoma follicular améloblastoma malignant ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 4 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) fahasoavana rohamah njatosoa¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || the management of our case of ameloblastoma was always conservative surgery by enucleation. after diagnosis of malignancy, chemotherapy was received. by the sixth operation, the prognosis had become bleak. this was caused by respiratory distress probably secondary to pulmonary metastasis. also, chemotherapy was abandoned due to intolerance linked to poor general condition. discussion embryologically, during genesis, the epithelial cells of the dental follicle differentiate into several cells. the ameloblastic cells in turn disappear physiologically through apoptosis. the persistence of these cells is the origin of ameloblastoma, which develops within a fibrous stroma. it is characterized by being clinically benign locally, but invasive with a high risk of recurrence [5, 6]. malignant ameloblastoma is defined by the who as a tumor that presents architectural features of benign ameloblastoma and cytological signs of malignancy in the primary tumor and/or metastases [7, 8]. two percent of ameloblastic tumours are at risk of developing into malignancy [9]. it has a characteristic known as "clinical silence", which leads to neglect of patients who only come for consultation at an advanced stage of the tumor, causing aesthetic problems and functional problems such as dysphagia and dysarthria. it should be noted that the presence of pain can be attributed to a possible superinfection or, at worst, to a malignant form of the tumor. our case fits the profile of the type described in the literature. indeed, our patient belongs to the fourth decade of life and is male. the tumor started in the mandible and progressed to the maxilla. it is a follicular ameloblastoma recurring after repeated enucleations. however, although rare, this tumor has become malignant after several recurrences. the odontostomatologist has an important role to play in the early diagnosis of this tumoral pathology. he or she should consider it if mobile or displaced teeth are present, or if an osteolytic image is observed incidentally on an orthopantomogram or ct scan (see figures b, c, d). our study has been confirmed in the literature, which suggests an age of onset of between 30 and 50 years [1]. rammeh reported ameloblastic tumor involvement at the age of 64 [6]. burcu senguven reported a case in a 9-year-old child. the age of onset is therefore relative [10]. as for extension to the maxilla, our study corroborates the study done by faras in 2017 [11]. however, filizzola and siriwardena invalidated this result [12, 13]. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 5 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) fahasoavana rohamah njatosoa¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || our patient is male. in general, there is no significant difference between the genders, whereas the predominance of the male gender is mentioned in a study by raharison in antananarivo in 2004 [14], and by ahlem in tunisia in 2015 [15]. however, faras and li have demonstrated cases to the contrary [11]. our histo-pathological finding of follicular type is similar to that of soyele in nigeria [16]. in contrast, intapa in thailand reported a high frequency of the plexiform type in 2017 [17]. the suggestive clinical signs (facial asymmetry, tooth mobility and displacement) were confirmed by raharison's study [14] (see figure a). and that of bel hadj hassine in 2017 [9]. painful lymph node metastases appearing in 2009 were also a sign suggestive of malignancy according to the literature; as was the presence of chest pain evoked in our study, like the case mentioned by salami in 2018 [18]. indeed, malignant transformation is rarely evoked by authors, and not all multi-recurrences lead to malignancy as in our study and that of faras in 2017 [11]. treatment of this tumor is purely surgical, with a wide margin of resection. for the malignant form, additional cervical lymph node dissection is essential, particularly if lymph node metastases are observed on imaging. the enucleation technique caused recurrent tumor recurrence in our patient. ruslin in 2018 [19] and bal in 2016 [20] also adopted this enucleation technique; as did collins in 2021 [21]. indeed, the risk of recurrence is high due to the impossibility of exeresis margins in enucleation. interruptive or non-interruptive radical surgery is indicated in cases of recurrence and for polygeodic forms. according to amzerin in 2011 [22] and li in 2019 [23], complementary radiotherapy can give excellent results, and chemotherapy is very well indicated in the case of distant (pulmonary) metastasis. as in our case. thus, a healthcare system that promotes in-depth research to find ways of preventing this pathology, and a choice of appropriate surgery to limit recurrence, are essential and fundamental. the completion of this study would improve the attitude of the two main stakeholders, patient and practitioner, towards this pathology. conclusion this study reports a rare clinical case of a muti-recurrent ameloblastoma at cenhosoa antananarivo, from its benign to malignant stages. the tumor started in the mandible and invaded the maxilla after several recurrences. although very rarely observed in the literature, ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 6 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) fahasoavana rohamah njatosoa¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || malignant transformation is possible, as in our case. adjuvant chemotherapy and radiotherapy are then adopted, but the prognosis is guarded at this malignant stage. diagnosis is confirmed anatomically and pathologically. the earlier the diagnosis, the earlier the treatment, and therefore the better the prognosis. treatment should be radical surgery with an interrupting or non-interrupting osteotomy to avoid recurrence. references 1. reyes gm, cuello ufc. malignant ameloblastoma: multiple local reccurence and metastasis in the scalp. case reports. 2019;5(1):36-45. 2. konate m, elbouhairi m, benyahya i. améloblastome folliculaire de la mandibule : rapport d’un cas cliniquehttps://www.lecourrierdudentiste.com/casclinique/ameloblastome-folliculaire-de-la-mandibule-rapport-d-un-cas-clinique. [consulté le 02 mai 2020]. 3. turki im, douggaz a. a histologic variant of ameloblastoma: the acanthomatous type. med buccale chir buccale 2016;22:55-7. 4. rathore as, juneja s, khurana n, shetty dc. papilliferous keratoameloblastoma: a rare case report. int j appl basic med res. 2017 apr-jun;7(2):139–42. 5. milman t, ying gs, pan w, livolsi v. ameloblastoma: 25 year experience at a single institution. head neck pathol. 2016 dec;10(4):513–20. 6. rammeh s, zermanir, zeddinif, kourdan, farahf, bettaieb e et al. améloblastome malin : étude d’un cas et revue de la littérature. annales de pathologie. science direct. 2004 nov;24(1):149. 7. ali m, bukhari mh, hassan f, illyas m. clinicopathological study of ameloblastoma and detection of human papilloma virus by immunohistochemistry. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 7 https://www.lecourrierdudentiste.com/cas-clinique/ameloblastome-folliculaire-de-la-mandibule-rapport-d-un-cas-clinique.html https://www.lecourrierdudentiste.com/cas-clinique/ameloblastome-folliculaire-de-la-mandibule-rapport-d-un-cas-clinique.html https://www.lecourrierdudentiste.com/cas-clinique/ameloblastome-folliculaire-de-la-mandibule-rapport-d-un-cas-clinique https://www.lecourrierdudentiste.com/cas-clinique/ameloblastome-folliculaire-de-la-mandibule-rapport-d-un-cas-clinique https://www.ncbi.nlm.nih.gov/pubmed/?term=juneja%20s%5bauthor%5d&cauthor=true&cauthor_uid=28584748 https://www.ncbi.nlm.nih.gov/pubmed/?term=khurana%20n%5bauthor%5d&cauthor=true&cauthor_uid=28584748 https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5441264/ ijo international journal of health sciences and nursing ( issn: 2814-2098 ) fahasoavana rohamah njatosoa¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || pak j med sci. 2019 nov-dec; 35(6):1691–6. 8. nakano k,takabatake k, kawai h, yoshida s. notch signaling affects oral neoplasm cell differentiation and acquisition of tumor-specific characteristics. int j mol sci. 2019 apr;20(8):1973. 9. bel hhm, oualha l, ayachi s. ameloblastoma: a retrospective study. actual. odonto-stomatol. 2017;284: 4. 10. sengüven b, baris e, oygür t, öztemel a. recurrentunicystic mural type ameloblastoma in a 9-year-old boy, 8 years follow-up. contemp clin dent. 2013 oct-dec;4(4):569–72. 11. faras f, abo-alhassan f, israël y, hersant b, meningaud jp. multi-recurrent invasive ameloblastoma: a surgical challenge. int j surg case rep. 2017;30:43–5. 12. filizzola ai, ribeiro tc, santos bs, pires fb. ameloblastomas: clinicopathological features from 70 cases diagnosed in a single oral pathology service in an 8-year period. med oral patol oral cir bucal. 2014 nov;19(6):e556– 1. 13. siriwardena bsms, tennakoon tmpb, hunter kd, tilakaratne wm. unicystic ameloblastoma: analysis of 370 cases in a single center in sri lanka. j oral pathol med. 2018 aug;47(7):706-9. 14. raharison sa. problèmes diagnostiques des améloblastomes. biblio.univantananarivo.mg 2004, oct [consulté le 10 janvier 2022].http://biblio.univantananarivo.mg/pdfs/raharisonsolonomenjanaharya_med_doc_04.pdf. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 8 https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6861475/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6514842/ https://pubmed.ncbi.nlm.nih.gov/?term=seng%c3%bcven%20b%5bauthor%5d https://pubmed.ncbi.nlm.nih.gov/?term=bari%c5%9e%20e%5bauthor%5d https://pubmed.ncbi.nlm.nih.gov/?term=oyg%c3%bcr%20t%5bauthor%5d https://pubmed.ncbi.nlm.nih.gov/?term=%c3%96ztemel%20a%5bauthor%5d https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3883349/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5133465/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5133465/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4259370/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4259370/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4259370/ https://pubmed.ncbi.nlm.nih.gov/?term=siriwardena+bsms&cauthor_id=29858565 https://pubmed.ncbi.nlm.nih.gov/?term=tennakoon+tmpb&cauthor_id=29858565 https://pubmed.ncbi.nlm.nih.gov/?term=hunter+kd&cauthor_id=29858565 https://pubmed.ncbi.nlm.nih.gov/?term=tilakaratne+wm&cauthor_id=29858565 https://www.ncbi.nlm.nih.gov/pubmed/?term=nemes%20j%5bauthor%5d&cauthor=true&cauthor_uid=17183787 https://www.ncbi.nlm.nih.gov/pubmed/?term=nemes%20j%5bauthor%5d&cauthor=true&cauthor_uid=17183787 https://www.ncbi.nlm.nih.gov/pubmed/?term=nemes%20j%5bauthor%5d&cauthor=true&cauthor_uid=17183787 http://biblio.univ-antananarivo.mg/pdfs/raharisonsolonomenjanaharya_med_doc_04.pdf http://biblio.univ-antananarivo.mg/pdfs/raharisonsolonomenjanaharya_med_doc_04.pdf ijo international journal of health sciences and nursing ( issn: 2814-2098 ) fahasoavana rohamah njatosoa¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || 15. ahlem b, wided a, amani l, nadia z, amira a, faten f. study of ki67 and cd10 expression as predictive factors of recurrence of ameloblastoma. eur ann otorhinolaryngol head neck dis. 2015 nov;132(5):275-9. 16. soyele oo, adebiyi ke, adesina om, ladeji am, aborisade a. ameloblastic carcinoma: a clinicopathologic analysis of cases seen in a nigerian teaching hospital and review of literature. pan afr med j. 2018 nov 27;31:208. 17. intapa c. analysis of prevalence and clinical features of ameloblastoma and its histopathological subtypes in southeast myanmar and lower northern thailand populations: a 13-year retrospective study. j clin diagn res. 2017 jan;11(1):zc102-6. 18. salami a, ezenkwa u, salami m, ajani m, okolo c. malignant ameloblastoma: a challenging diagnosis. autops case rep. 2018 sep 26;8(4):e2018043. 19. ruslin m, hendra fn, vojdani a, hardjosantoso d, gazali m, tajrin a et al. the epidemiology, treatment, and complication of ameloblastoma in east-indonesia: 6 years retrospective study. med oral patol oral cir bucal. 2018 jan 1;23(1):e548. 20. ba1 b, singaré dk, diallo m, coulibaly ad. l’améloblastome mandibulaire: à propos de 51 cas. med buccale chir buccale 2016;22:7-11. 21. collins ap, mubarak n, hemaidan hs, hemaidan sm, hemaidan a. malignant ameloblastoma with hepatic metastasis in a 38-year-old haitianwoman. am j case rep. 2021;22:e929422-1–6. 22. amzerin m, fadoukhair z, belbaraka r, iraqui m, boutayeb s. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 9 https://pubmed.ncbi.nlm.nih.gov/?term=ahlem+b&cauthor_id=26386615 https://pubmed.ncbi.nlm.nih.gov/?term=wided+a&cauthor_id=26386615 https://pubmed.ncbi.nlm.nih.gov/?term=amani+l&cauthor_id=26386615 https://pubmed.ncbi.nlm.nih.gov/?term=nadia+z&cauthor_id=26386615 https://pubmed.ncbi.nlm.nih.gov/?term=amira+a&cauthor_id=26386615 https://pubmed.ncbi.nlm.nih.gov/?term=faten+f&cauthor_id=26386615 https://www.ncbi.nlm.nih.gov/pubmed/?term=soyele%20oo%5bauthor%5d&cauthor=true&cauthor_uid=31497184 https://www.ncbi.nlm.nih.gov/pubmed/?term=adebiyi%20ke%5bauthor%5d&cauthor=true&cauthor_uid=31497184 https://www.ncbi.nlm.nih.gov/pubmed/?term=adesina%20om%5bauthor%5d&cauthor=true&cauthor_uid=31497184 https://www.ncbi.nlm.nih.gov/pubmed/?term=ladeji%20am%5bauthor%5d&cauthor=true&cauthor_uid=31497184 https://www.ncbi.nlm.nih.gov/pubmed/?term=aborisade%20a%5bauthor%5d&cauthor=true&cauthor_uid=31497184 https://www.ncbi.nlm.nih.gov/pubmed/31497184 https://www.ncbi.nlm.nih.gov/pubmed/?term=intapa%20c%5bauthor%5d&cauthor=true&cauthor_uid=28274056 https://www.ncbi.nlm.nih.gov/pubmed/28274056 https://pubmed.ncbi.nlm.nih.gov/30775320/ https://pubmed.ncbi.nlm.nih.gov/30775320/ https://pubmed.ncbi.nlm.nih.gov/?term=ruslin+m&cauthor_id=29274152 https://pubmed.ncbi.nlm.nih.gov/?term=hendra+fn&cauthor_id=29274152 https://pubmed.ncbi.nlm.nih.gov/?term=vojdani+a&cauthor_id=29274152 https://pubmed.ncbi.nlm.nih.gov/?term=hardjosantoso+d&cauthor_id=29274152 https://pubmed.ncbi.nlm.nih.gov/?term=gazali+m&cauthor_id=29274152 https://pubmed.ncbi.nlm.nih.gov/?term=tajrin+a&cauthor_id=29274152 https://pubmed.ncbi.nlm.nih.gov/?term=collins%20ap%5bauthor%5d https://pubmed.ncbi.nlm.nih.gov/?term=mubarak%20n%5bauthor%5d https://pubmed.ncbi.nlm.nih.gov/?term=hemaidan%20hs%5bauthor%5d https://pubmed.ncbi.nlm.nih.gov/?term=hemaidan%20sm%5bauthor%5d https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8255087/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8255087/ ijo international journal of health sciences and nursing ( issn: 2814-2098 ) fahasoavana rohamah njatosoa¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || metastatic ameloblastoma responding to combination chemotherapy: case report and review of the literature. j med case reports. 2011;5:491. 23. li d, xu s, sun m, qiao l. maid chemotherapy regimen as a treatment strategy for metastatic malignant ameloblastoma: a case report. medicine (baltimore) 2019 jun; 98(25):e15873. figure a :asymmetrical patient face on after the other five invasive surgical procedures figure b :polygeodic image with mixed fluid content (tissue and fluid) (cenhosoa, 2002 à 2006) b a ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 10 https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3198715/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3198715/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6636961/ https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6636961/ ijo international journa ( issn: 2814-2098 ) https://ijojournals.com/ figure c : reflux or the buccal floor and pharynx figure d :invasion of maxillary sinus and right nasal cavity (cenhosoa, 2009 et 2014) c international journal of health sciences and nursing fahasoavana rohamah volume 07 || issue 02 || february lux or the buccal floor and pharynx with suspicious appearance of malignancy invasion of maxillary sinus and right nasal cavity d and nursing fahasoavana rohamah njatosoa¹* february, 2024 || suspicious appearance of malignancy ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 11 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ quality of life related to the oral health of edentulous patients in mahajanga madagascar." quality of life related to the oral health of edentulous patients in mahajanga madagascar authors: ratsimandresy naomy namboarintsoa1, rasoarivony marie angela2, razanadraisoa albertine1, edwin constand claudel3, ralaiarimanana liantsoa fanja emmanuel1 1 :dental prosthetics department at the institutd'odonto-stomatologie tropicale de madagascar (iostm) 2 :private dental practice in mahajanga 3 :public health section at the institutd'odonto-stomatologie tropicale de madagascar (iostm) correspondingauthor: ratsimandresy naomy namboarintsoa, dental prosthetics department at the institutd'odonto-stomatologie tropicale de madagascar (iostm), university of mahajanga madagascar abstract the aim of this study was to determine the relationship between quality of liferelated t oral health of edentulous patients and wearing dentures. this was a cross-sectional, analytical study of 384 edentulous people, with or without dentures, in the city of mahajanga madagascar. the ohip-14 score, the number of missing teeth, the edentulous area, the type of edentulous, the edentulous arch, whether or not a dental prosthesis was worn, the type of dental prosthesis and the quality of life were evaluated. we observed that the majority (82.8%) of the study population did not wear dentures. quality of life was related to the number of missing teeth, edentulous area type of edentulous according to the ohip-14 score. people who wore dental prostheses had a better quality of life than those who did not. it is vital to raise awareness of the need to wear dental prostheses and to provide information about the impact of edentulous on quality of life. in the future, a longitudinal study will be necessary. key words: edentulousness, prosthesis, quality of life, ohip-14 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 1 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ quality of life related to the oral health of edentulous patients in mahajanga madagascar." introduction edentulousness is the condition of being missing teeth and is a public health problem because of its prevalence and handicap [1]. according to the world health organization’s (who) 2022 report on oral health in the world, the global average prevalence of edentulousness is almost 7% in people aged 20 or over. for people aged 60 or over, the estimated global prevalence is much higher, at 23% [2]. in high-income countries, the prevalence of edentulousness is 10.5% on average, including 39% in north america, compared with 3% in less-developed countries [3]. in madagascar, data on the prevalence of edentulousness is still lacking, but the prevalence of common dental diseases (dental caries and periodontal disease), which are the main causes of edentulousness, is very high, ranging from 80 to 98%, affecting both children and adults [4]. however, according to the available data, the rate of denture wearers is still low. in 2010, in antsirabe, 63.3% of edentulous people had not their teeth restored [5]. in fianarantsoa, a study conducted in 2016 found that 59.3% of edentulous people were not wearing dentures [6]. there are many causes of edentulousness, such as untreated caries, periodontitis or periodontal disease and dental trauma. and edentulousness can be disturbing in functional, aesthetic, social and above all psychological terms, all of which can have an impact on edentulous patients' quality of life. the consequences of edentulousness can be prevented or avoided by prosthetic restorations, which play important functional, aesthetic and psychological roles. so, faced with all these situations, two questions arise: how is the quality of life of edentulous people in the town of mahajanga? and does wearing a dental prosthesis improve their quality of life? ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 2 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ quality of life related to the oral health of edentulous patients in mahajanga madagascar." the aim of this study was to determine the relationship between the oral health-related quality of life of edentulous people and the wearing of dental prostheses. the specific objectives were to: describe the socio-demographic characteristics of the study population; identify the characteristics of edentulous patients in the study population; assess the oral health-related quality of life of edentulous patients; compare the oral health-related quality of life of the study population wearing dentures with that of the study population not wearing dentures; materials and methods the study was carried out in the city of mahajanga, madagascar. mahajanga is the largest city on the west coast and the capital of the boeny region, located at the mouth of the betsiboka river on the mozambic channel. it is the most visited tourist town by foreigners and nationals thanks to its abundant landscape and its natural, maritime and mining resources. type of study this was a cross-sectional analytical study. study period data was collected from march 2024 to june 2024. study population the study population consisted of edentulous patients with or without dentures. individuals who agreed to take part in the survey were included in the study. those with incorrectly completed survey forms were excluded. sampling was accidental. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 3 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ quality of life related to the oral health of edentulous patients in mahajanga madagascar." the sample size was calculated using the classic andersen formula n = ��p(1 − p) �� n= sample size z = confidence interval of 1.96 p = prevalence i= margin of error = 0.05 as we had not found a well-defined prevalence of edentulousness for madagascar, we used an arbitrary prevalence of 50%, i.e. p = 0.5. n = 1.96� x 0.5 (1 − 0.5) 0.05� = 384.16 according to this formula, the sample size was 384. data was collected using a survey form containing a questionnaire to assess the quality of life linked to the oral health of edentulous people: the ohrqol questionnaire, with the ohip-14 score. the survey was carried out using a telephone equipped with the open data kit (odk) collect version 1.17.2 application. study variables these included: 1. independent variables such as variables related to the sociodemographic profile of the patients such as: age, gender, profession. variables related to the characteristics of the edentulous tooth such as: number of missing teeth, arch involved, edentulous sector (anterior, posterior, anterior and posterior), classification of the edentulous tooth, wearing of dental prostheses, type of dental prosthesis. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 4 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ quality of life related to the oral health of edentulous patients in mahajanga madagascar." 2. the dependent variable was quality of life: this was assessed using the ohip-14 score . high ohip-14 scores indicate a deterioration in quality of life, whereas low scores indicate a better quality of life [7]. data analysis once the data had been extracted from the odk database, they were processed and analyzed on a computer using statistical package for the social sciences (spss) version 25.0 for windows. descriptive statistics such as mean, standard deviation and frequency were used to analyze the data. independent "t" and anova tests were performed to compare means between continuous variables, and the chisquare test for categorical variables, with a level of statistical significance of p<0.05. results table i: distribution of the study population by socio-demographic characteristics socio-demographic characteristics n % age minimum age = 18 years under 50years 297 77.3 maximum age = 89 years 50 yearsand over 87 22.7 averageage = 37.6±15.16 years gender male 141 36.7 sex-ratio = 0.58 female 243 63.3 occupation primarysector 83 21.6 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 5 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ quality of life related to the oral health of edentulous patients in mahajanga madagascar." secondarysector 44 11.5 tertiarysector 154 66.9 total 384 100.0 n: numbers %: percentages table i provides information on the socio-demographic characteristics of the study population. in terms of age, the study population ranged from 18 to 89 years, with an average age of 37.6 ± 15.16 years. the under-50 age group was in the majority (77.3%). in terms of gender, 63.3% were women, with a sex ratio of 0.58. in terms of occupation, 66.9% of respondents worked in the tertiary sector. table ii: distribution of the study population according to edentulous characteristics edentulous characteristics n % number of missingteeth 1 to 5 teeth 295 76.8 6 to 10 teeth 44 11.5 mean number of missing teeth = 4.89±5.32 teeth more than 10 teeth 45 11.7 edentulousarch maxilla 73 19.0 mandible 109 28.4 both arches 202 52.6 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 6 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ quality of life related to the oral health of edentulous patients in mahajanga madagascar." edentuloussector anterior 28 7.3 posterior 260 67.7 antero-posterior 96 25.0 type partial 351 91.4 total 9 2.3 subtotal 24 6.3 classification class i 52 13.5 class ii 47 12.2 class iii 262 68.2 class iv 23 6.0 total 384 100.0 table ii provides information on the characteristics of edentulousness: 76.8% of the study population had between one and five missing teeth, and the average number of missing teeth per person was 4.89±5.32 teeth. the edentulousness mainly affected the two arches, with a percentage of 52.6%. the posterior sector was the most common, with a percentage of 67.7%. as for the type of edentulousness, partial edentulousness was in the majority at 91.4%. and according to the classification, class iii edentulousness predominated at 68.2%. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 7 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ quality of life related to the oral health of edentulous patients in mahajanga madagascar." table iii: distribution of the study population according to the mean ohip-14 score and the number of missing teeth number of missing teeth mean ohip-14 score f p 1 to 5 teeth 7.6 ± 6.4 6 to 10 teeth 10.2 ± 5.9 26.8 0.000*** more than 10 teeth 15.6 ± 10.6 total 8.8 ± 7.4 depending on the number of teeth missing, those with one to five teeth missing had a mean ohip-14 score of 7.6 ± 6.4. those with six to ten teeth missing had an average ohip-14 score of 10.2 ± 5.9. and those with more than ten missing teeth had a mean ohip-14 score equal to 15.6 ± 10.6. this result is highly statistically significant (f = 26.8; p = 0.000) (table iii). table iv: distribution of the study population according to the mean ohip-14 score by edentulous area edentulous area mean ohip-14 score f p anterior 10.2 ± 8.1 posterior 7.5 ± 6.4 14.8 0.000*** anterior and posterior 12.1 ± 8.6 total 8.8 ± 7.4 compared to the edentulousarea, thoseedentulous in the anteriorsectoralonehad a mean ohip-14 score equal to 10.2 ± 8.1; thoseedentulous in the posteriorsectorhad a mean score equal to 7.5 ± 6.4 and thoseedentulous in both the anterior and ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 8 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ quality of life related to the oral health of edentulous patients in mahajanga madagascar." posteriorsectorshad a mean ohip-14 score equal to 12.1 ± 8.6. this resultwashighlysignificant (f = 14.8; p = 0.000) (table iv). table v: distribution of study population according to mean ohip-14 score and denture wear denture wear mean ohip-14 score t p yes 7.4 ± 6.8 no 9.1 ± 7.4 3.1 0.03* total 8.8 ± 7.4 concerning denture wearing (table v), thosewhowore dentures had a mean ohip-14 score equal to 7.4 ± 6.8, and thosewhodidn'thad a mean score equal to 9.1 ± 7.4. this result is statistically significant (p = 0.03). discussion socio-demographiccharacteristics the study population was predominantly female (63.3%). the averageage was 37.6 ± 15.16 years, with thoseaged 50 and over accounting for 22.7% of cases. and in terms of occupation, those who worked in the tertiary sector predominated (63.3%). in a similar study carried out in poland in 2022, a sample of 1,112 participants aged between 20 and 79 was drawn. of these, 54.85% were women. nineteen-point eighty-seven percent (19.87%) of participants were over 65. the average age was 48.72. a large majority (65.20%) worked in the tertiary sector [8]. characteristics of edentulousness our study population had an average of 4.89±5.32 missing teeth per person. this is significantly lower than the mean number of missing teeth found by ratsimandresy and al. in fianarantsoa in 2016, which was 8.57 [6], and that found by rodakowska and ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 9 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ quality of life related to the oral health of edentulous patients in mahajanga madagascar." al. in poland in 2022, which was equal to 7.88 [8]. on the other hand, this average was roughly equal to that found by mbodj and al. in senegal in 2011, which was 4.4 [9]. according to the kennedy classification, class iii was the mostfrequent, with a percentage of 68.2%. this value is higher than that found by bouassaloandal. in 2023, kennedy class iii was 75.2% of edentulous arches [10]. edentulousness and denture wear in ourstudy, only 17.2% of the study population wore dentures. this is consider ably lower than the 62.0% found by malicka et al. [11]. in 2016, ratsimandresy and al. suggested that the number of missing teeth was a factor in denture wear. indeed, the greater the number of missing teeth, the greater the motivation to have dentures [6]. moreover, in a 2014 study in senegal, gueye and al. reported the same finding, that edentulous patients with dentures were made up of those with more than nine missing teeth, and that only 9.8% of patients with one to four missing teeth had under gone prosthetic restoration [12]. in fact, the ohip-14 score riseswith the number of missing teeth; in other words, the higher the number of missing teeth, the worse the quality of life related to oral health. the same finding was made by anbarserri and al. who found that patients with tooth loss in categories 1-5, 6-10 and>10 hadmean ohip-14 scores of 10.51 ± 10.36, 13.46 ± 10.06 and 21.46 ± 14.41 respectively. a statistically significant difference in ohip-14 score was observed between the different categories of tooth loss (p = 0.005). participants with more than 10 teeth lost had significantly higher ohip-14 scores than those in categories 1-5 and 6-10 (p<0.05). they concluded that the greater the tooth loss, the higher the ohip-14 score and the greater the damage to oral health [13]. edentulous area depending on the edentulous area, those with anterior and posterior edentulousness had higher mean ohip-14 scores than those with anterior or posterior edentulousnessa lone. and it was anterior edentulousness that was associated with ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 10 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ quality of life related to the oral health of edentulous patients in mahajanga madagascar." poor quality of life. this result concurs with that of imam and al. who found that one or more missing anterior teeth were significantly associated with higher ohip-14 total scores (worse for oral health-related quality of life) (17.2 vs. 25.1; p = 0.04) [14]. denture wear according to denture wear, a significant difference in mean ohip-14 score was found between those who wore dentures and those who did not (p = 0.03). those who did had a better quality of life than those who did not. this result corroborates the findings of kendeand al. in fact, they found that oral health-related quality of life improved rapidly in the month following prosthetic treatment (76% of patients)and showed further but moderate improvement in the 6 to 12 months following treatment in subjects wearing dentures, as indicated by the reduction in ohip-14 scores [15]. the study by fouda and al. also confirmed the same finding, stating that prosthetic treatment had a positive impact on oral health-related quality of life, which improved after treatment, particularly in the social domain. there is an association between prosthetic restoration in edentulous patients and the ohip-14 score [16]. conclusion in this study, those with more than ten missing teeth had a mean ohip-14 score equal to 15.6 ± 10.6. and those with dentures had a mean ohip-14 score equal to 7.4 ± 6.8. this study showed that wearing dentures improved oral health-related quality of life in edentulous patients. given that our study was a cross-sectional study, in the future, a longitudinal study will be considered with the aim of determining the evolution of the improvement in oral health-related quality of life in edentulous patients after prosthetic restoration. références 1. coulibaly b, kéita db, touré k, kamissoko k, diallo b, traoré l et al. assessment of dental prosthesisneeds in patients at the hepato-gastroenterology department of chugabriel. available on https://www.revues.ml/index.php/msp/article/view/1795/1252. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 11 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ quality of life related to the oral health of edentulous patients in mahajanga madagascar." 2. world health organization, global oral health status report. non-communicable diseasesdepartment, 20 avenue appia [online]. availableon: https:/www.who.int /heath-topics /oral-heath. (consulté le 10/07/23) 3. world healthorganization. world healthstatistics 2014. [online]. availableon : https://iris.who.int/bitstream/handle/10665/131954/9789240692688_fre.pdf;jsessioni d=cde9dac80ddb40b9a8891ba39b83aa33?sequence=1 4. ranivoharilanto e. oral health in madagascar: current situation and outlook available on :www.aoi-fr.org. 5. rasoamanarivo n, ralaiairamananalfe, ramaroson j, rakotoalson s, ralison g. treatmentwithremovable partial dentures in antsirabe:proposals for improvement. rosmel. 2010 ; 1 :34-41 6. ratsimandresy nn, andriamamimalala mh, rakotondratsara ma, ralaiarimanana lfe. knowledge, attitudes and practices of the population of the city of fianarantsoa regarding the replacement of missingteeth. rosmel. 2020 ; 18 : 01-10 7. slade gd, spencer aj. development and evaluation of the oral health impact profile. community dent health. 1994 ;11 :03–11 8. rodakowska e, jamiolkowski j, baginska j, kaminska i, gabiec k, stachurska z, kondraciuk m, dubatowka m, kaminski ka. oral health-related quality of life and missing teeth in an adult population: a cross-sectional study from poland. int j environ res public health. 2022 jan 31;19(3):1626. doi: 10.3390/ijerph19031626. pmid: 35162649; pmcid: pmc8834766. 9. mbodj eb, diouf m, faye d, ndiaye a, seck mt, ndiaye c, diallo pd. prostheticrehabilitation: needsassessment in senegalese dental practices. bulletin de pathologie exotique. 2011 ;104(5) : 355-6. 10. bouassalo km, adam s, dabo ps, hémou p, kébina b, béténora b, fagbegnon osa, baglo fe, n’bouké bj, bissa h, agoda pp, gueye m. profile of partial ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 12 https://iris.who.int/bitstream/handle/10665/131954/9789240692688_fre.pdf;jsessionid=cde9dac80ddb40b9a8891ba39b83aa33?sequence=1 https://iris.who.int/bitstream/handle/10665/131954/9789240692688_fre.pdf;jsessionid=cde9dac80ddb40b9a8891ba39b83aa33?sequence=1 http://www.aoi-fr.org/ ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ quality of life related to the oral health of edentulous patients in mahajanga madagascar." edentulousnessaccording to the kennedy-applegate classification in a lomé dental care facility (togo). rev sen odontolstomatolchir maxillo-fac 2023 ;20(2) :56-60. 11. malicka b, skośkiewicz-malinowska k, kaczmarek u. the impact of socioeconomic status, general health and oral health on health-related quality of life, oral healthrelated quality of life and mental health among polish older adults. bmc geriatr. 2022 jan 3 ;22(1) :2. doi: 10.1186/s12877-021-02716-7. pmid :34979959 ;pmcid : pmc8722217 12. gueye m, mbodj eb, dieng l, thioune n, toure a, seck mt. socio economic characteristics of patients rehabilitated with removable prostheses: a pilot study in an odontology department in senegal. rev iv odonto-stomatol.2014 ; 2(16) : 21-6. 13. anbarserri nm, ismail km, anbarserri h, alanazi d, alsaffan ad, baseer ma, shaheen r. impact of severity of tooth loss on oral-health-related quality of life among dental patients. j family med prim care. 2020 jan 28;9(1):187-191. doi: 10.4103/jfmpc.jfmpc_909_19. pmid: 32110588; pmcid: pmc7014884. 14. imam ay. impact of tooth loss position on oral health-related quality of life in adults treated in the community. j pharm bioallied sci. 2021 nov;13(suppl 2): s969s974. doi: 10.4103/jpbs.jpbs_87_21. epub 2021 nov 10. pmid :35017909 ;pmcid : pmc8686957. 15. kende d, szabó g, marada g, szentpétery a. protetikaiterápiáslehetoségekeletminoségregyakorolthatása [impact of prosthetic care on oral health related quality of life]. fogorvsz. 2008 apr ;101(2) :49-57. hungarian. pmid : 18664095. 16. fouda sm, gad mm, ellakany p, zayat me, alghamdi m, abdelrahman h, el-din ms. impact of prosthetic rehabilitation on oral health-related quality of life of saudi adults: a prospective observational study with pre–post design. the saudi dental journal 2024 (36) :1000–5. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 13 edentulousness is the condition of being missing teeth and is a public health problem because of its prevalence and handcap [1]. according to the world health organization’s (who) 2022 report on oral health in the world, the global average prevalenc of edentulousness is almost 7% in people aged 20 or over. for people aged 60 or over, the estimated global prevalence is much higher, at 23% [2]. in high-income countries, the prevalence of edentulousness is 10.5% on average, including 39% in north america, comparedwith 3% in less-developed countries [3]. in madagascar, data on the prevalence of edentulousness is still lacking, but the prevalence of common dental diseases (ental caries and periodontal disease), which are the main causes of edentulousness, is very high, ranging from 80 to 98%, affecting both children and adults [4]. however, according to the available data, the rate of denture wearers is still low. in 2010, in antsirabe, 63.3% of edenulous people had not their teeth restored [5]. in fianarantsoa, a study conducted in 2016 found that 59.3% of edentulous people were not wearing dentures [6]. there are many causes of edentulousness, such as untreated caries, periodontitis or periodontal disease and dental traum. and edentulousness can be disturbing in functional, aesthetic, social and above all psychological terms, all of which can have an impact on edentulous patients' quality of life. the consequences of edentulousness can be prevented or avoided by prosthetic restorations, which play important functionl, aesthetic and psychological roles. so, faced with all these situations, two questions arise: how is the quality of life of edentulous people in the town ofmahajanga? and does wearing a dental prosthesis improve their quality of life? the aim of this study was to determine the relationship between the oral health-related quality of life of edentulous peple and the wearing of dental prostheses. the specific objectives were to: describe the socio-demographic characteristics of the study population; identify the characteristics of edentulous patients in the study population; assess the oral health-related quality of life of edentulous patients; compare the oral health-related quality of life of the study population wearing dentures with that of the study populaion not wearing dentures; materials and methods the study was carried out in the city of mahajanga, madagascar. mahajanga is the largest city on the west coast and the apital of the boeny region, located at the mouth of the betsiboka river on the mozambic channel. it is the most visited tourist town by foreigners and nationals thanks to its abundant landscape and its natural, maritime and mining resources. according to this formula, the sample size was 384. data was collected using a survey form containing a questionnaire to assess the quality of life linked to the oral healt of edentulous people: the ohrqol questionnaire, with the ohip-14 score. the survey was carried out using a telephone equipped with the open data kit (odk) collect version 1.17.2 application. study variables these included: 1. independent variables such as variables related to the sociodemographic profile of the patients such as: age, gender, profession. variables related to the characteristics of the edentulous tooth such as: number of missing teeth, arch involved, edenulous sector (anterior, posterior, anterior and posterior), classification of the edentulous tooth, wearing of dental prostheses, type of dental prosthesis. 2. the dependent variable was quality of life: this was assessed using the ohip-14 score . high ohip-14 scores indicate a deterioration in quality of life, whereas low scores indicate a better quality of life 7]. data analysis once the data had been extracted from the odk database, they were processed and analyzed on a computer using statisticalpackage for the social sciences (spss) version 25.0 for windows. descriptive statistics such as mean, standard deviation and frequency were used to analyze the data. independent "t" and anova tests were performed to compare means between continuous variables, and the chi-square test for categorical variables, with a level of statistical significance of p<0.05. results conclusion ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." the organizational context and the utilization of research evidence by nurses; a review. rogers kiprotich chemoiwa1 1deparment of nursing, egerton university corresponding author: rogers kiprotich chemoiwa deparment of nursing, egerton university, p.o. box 536-20115, egerton, kenya abstract objective: the aim of this review is to broaden the understanding of the factors which prohibit or promote the interplay between the context and the utilization of research evidence by nurses. thematic analysis was used to review secondary data from published literature on utilization of research in clinical settings. findings of this review indicate that many research studies attribute the poor uptake of research by nursesin their daily clinical practice to their individual characteristics. however the challenges in transferring research into clinical practice are often more due to organizational contextual factors than to individual attributes. key words; organizational context, research utilization introduction at the heart of each and every health system, is the health workforce which is central to advancing health. they are the personification of a system’s core values – they heal and care for people, ease pain and suffering, prevent disease and mitigate risk. they are the human link that connects knowledge to health action. each year, billions of dollars are invested in different ways to strengthen the health workforce pillar. one common way is through knowledge generation from biomedical, clinical, and health services research. but despite this, health service providers have failed to utilize the research evidence generated, and as a result patient outcomes have failed to improve, and, health systems continue to underperform. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 130 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." organizational context the context of a health care organization can be seen from a variety of settings, communities and cultures that are all influenced by (for example) economic, social, political, fiscal, historical and psychosocial factors(a. kitson, harvey, & mccormack, 1998). in this review, the term context is used to refer to the physical environment or setting in which people receive health care services, or in terms of getting research evidence into practice, ‘the environment or setting in which the proposed change is to be implemented’ (kitson et al. 1998). such an environment has boundaries and structures that together shape the environment for practice(g. g. cummings et al., 2010; carole a. estabrooks, squires, cummings, birdsell, & norton, 2009; a. kitson et al., 1998; mccormack et al., 2002) the context of an organization, has been subdivided into three core elements or dimensions: an understanding of the prevailing culture, the nature of human relationships as summarised through leadership roles, and the organization’s approach to routine monitoring of systems and services—that is, measurement(carole a. estabrooks et al., 2009; a. kitson et al., 1998) . culture is defined as "the forces at work, which give the physical environment a character and feel" including the prevailing beliefs and values, as well as consistency in these values and a receptivity to change, among members of an organizational setting. the leadership dimension refers to the "nature of human relationships", with effective leadership giving rise to clear roles, effective teamwork and organizational structures, and involvement by organizational members in decision making and learning. evaluation or measurement dimension is the feedback ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 131 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." mechanisms (both at individual level and system level), sources, and methods for evaluation (g. g. cummings et al., 2010; carole a. estabrooks et al., 2008, 2009). research utilization research utilization, a specific form of knowledge translation, is a complex process in which research findings are transformed from one or more studies into instrumental, conceptual or persuasive utilization. instrumental research utilization is the direct or concrete application of research findings, often identified as the application of clinical practice guidelines, procedures and clinical protocols. conceptual research utilization occurs when research serves an 'enlightenment' function: that is, practitioners' become aware of research findings, and the findings inform, broaden or alter their thinking and practice in indirect ways. persuasive or symbolic research utilization is when research findings are used as a tool to advocate for a certain procedure or practice. generally speaking, overall research utilization can be defined as the use of research findings in any and all aspects of one's work .(g. g. cummings et al., 2010; c a estabrooks, 1999) organizational culture and utilization of research. organizational culture is defined as "the forces at work, which give the physical environment a character and feel", or “the invisible force behind the tangibles and observables in any organization, a social energy that moves people to act. it has been described as the unifying theme that provides meaning including the prevailing beliefs and values, as well as consistency in these values and a receptivity to change and, as such, it constitutes a potential contextual determinant of research utilization (cahill, narasimhan, dhaliwal, & heyland, 2010). ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 132 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." scott-findlay & golden-biddle, 2005, argue that organizational members draw on the organizational culture to understand how things operate. they also claim that organizational culture guides and shapes the behavior and attitudes of practitioners by providing a context where particular ideas, people, or events are more highly valued or deemed of worth than others. a culture that actively supports utilization of research evidence is significantly and positively related to research evidence beliefs and implementation among health service providers(ellis, howard, larson, & robertson, 2005; ward et al., 2015) in 2001, a canadianwide survey was undertaken and it was found that health service organizations that had a positive research culture were likely to increase research utilization by 4.81 percent (belkhodja, amara, landry, & ouimet, 2007). in another cross-sectional survey among 779 nurses in 32 patient care units in 8 canadian pediatric hospitals, unit culture significantly predicted nurses’ instrumental research use (i.e., direct use of research; when evidence is translated to a format such as a guideline or protocol and used for making decisions about patient care (squires et al., 2013; wallin, estabrooks, midodzi, & cummings, 2006; yamada, squires, estabrooks, victor, & stevens, 2017). similar work by belkhodja et al. found specific aspects of unit culture, such as the unit's research culture (i.e., research as the preferred source of information) and the intensity of use of research sources by the unit's members to also be positively correlated (p < 0.05) with research utilization by healthcare professionals in hospital units (belkhodja et al., 2007). ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 133 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." in a comparative ethnographic case study in two canadian provinces, it was found that nursing units with the highest mean research utilization scores clustered together on unit culture (as measured by work creativity, work efficiency, questioning behavior, co-worker support, and the importance nurses place on access to continuing education) (carole a. estabrooks et al., 2008). similar work by (scott & pollock, 2008) in a pediatric unit found that a low level of research utilization was associated with the following elements of the unit culture: hierarchical structure of authority, routinized and technology-driven work at the bedside, discouragement of innovation, being told what to do, and no expectation of using research in practice (scott & pollock, 2008). additionally, (ne, suurdt, ouelette-kuntz, & dk, 2007) conducted semi structured interviews with key informants that included physicians, nurses, managers and dietitians and organizational culture was identified as an important factor for successful adherence to nutritional guideline recommendations by health service providers. in malaysia where 37 primary care physicians participated in six focus group discussions (n=31) and six individual in-depth interviews, workplace culture was found to influence research utilization of the physicians (hisham, ng, liew, hamzah, & ho, 2016). in a ugandan study among midwives, respondents considered a culture that promoted on-thejob learning from peers, good communication and cooperation among the health workers in the unit as one of the most important ways to acquire knowledge on best practices(bergström, peterson, namusoko, waiswa, & wallin, 2012). similarly in a kenyan study to explore barriers to guideline implementation in an early phase intervention study in four district hospitals, it ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 134 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." was found that organization culture was a major barrier to encouraging correct practice, not just for implementing the new guidelines but also served as a motivation for acquiring new knowledge (nzinga, mbindyo, mbaabu, warira, & english, 2009). organizational leadership and the utilization of research leadership is; "the process of influencing others to understand and agree about what needs to be done and how to do it, and the process of facilitating individual and collective efforts to accomplish shared objectives"(gifford et al., 2008). leadership is an important ingredient in making changes happen in practice, particularly in terms of obtaining the same affective commitment to change and is necessary in institutionalizing utilization of research evidence in practice (kristensen et al., 2016). positive leadership is associated with more positive provider attitudes towards utilization of research evidence into practice. reviews and observational studies in nursing have supported the role of leadership in research evidence utilization and in influencing the use of practice guidelines. (aarons, ehrhart, farahnak, & hurlburt, 2015) the key leadership behaviors that have been demonstrated when research utilization is institutionalized was: creating a vision and sustaining it over time, role modeling by key leaders, and having strong mentors (stetler et al., 2009). in describing the role of leadership in integrating utilization of research evidence, delmonte and oman, asserted that demonstration ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 135 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." of ongoing commitment by a core group of leaders was found to be essential (delmonte & oman, 2010) . a recent mixed methods study of 37 organizations in canada, found leadership to be the only predictor of sustained use of clinical guideline recommendations two and three years postimplementation, accounting for 47 percent of the variance (p < .001) (davies, n.d.). in addition, using grounded theory to analyze 9 of the 37 organizations, gifford et al. identified leadership behaviors as having an important impact on nurses' use of research evidence to inform practice and in sustaining practice change based on guideline recommendations (gifford et al., 2008) leadership behaviors associated with sustained guideline use includes providing support, role modelling commitment, and reinforcing organizational policies and goals for evidence-based care. other effective leadership contributions are; supporting staff through adjusting workloads, allowing time to consider the evidence, and providing resources to free up staff time to support engaging in research evidence utilization in practice (squires et al., 2013). cummings and colleagues used structural equation modeling to test a theoretical model of relationships among features of organizational context and nurses' research utilization, they found that better leadership lead to reports of greater research use by nurses, which then led to fewer adverse patient events (g. g. cummings et al., 2010). a cross sectional study that involved 32 patient care units in 8 canadian pediatric hospitals showed that work environments that had strong leadership significantly moderated the effect of iru among nurses (yamada et al., 2017). in ugandan qualitative study among midwives ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 136 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." showed the perception on the importance of having a capable leader for knowledge translation was clear, whereby the leader was seen as a person that should be part of the working team and while also acting as a role model. respondents in the study believed that a good leader should inspire and support professional development and lead in the provision of new knowledge (bergström et al., 2012). another study conducted in four district hospitals in kenya, that included health service providers across cadres found out that poor leadership in the clinical area was the reason for lack of implementation of new clinical guidelines in hospitals (nzinga et al., 2009). organizational measurement/evaluation mechanisms and utilization of research evaluation relates to how the organization measures its performance, and how (or whether) feedback is provided to people within the organization, as well as the quality of measurement and feedback(yamada et al., 2017). measurement is a complex but necessary component of the environment that seeks to implement evidence into practice. measurement is both part of the research process that generates evidence on which to base practice and part of the evaluation or feedback process that demonstrates whether or not changes to practices are appropriate/effective/efficient (mccormack et al., 2002). audit coupled with a feedback mechanism, where data is fed back to a unit's providers in the form of some kind of report, is one of the most commonly applied evaluation mechanisms used in healthcare to implement the adoption of research-based practices (carole a. estabrooks et al., 2008). in low resource settings local communities are involved in measuring the performance of health service organizations at the primary care level, and this helps in shaping priorities, guide the ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 137 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." strengthening approach i.e (new guideline implementation), and creating local ownership and as a result health service providers are held accountable for their role in service provision (peters, el-saharty, siadat, janovsky, & vujicic, 2009) . evaluation has been positively correlated (at statistically significant levels) with all four types of research utilization: instrumental research utilization, conceptual research utilization, persuasive research utilization, and overall research utilization(hutchinson et al., 2008). in a canadian study that assessed organizational context (work environment) factors that influence use of best practices by care aides (nursing assistants) in nursing homes a significant predictor was evaluation (feedback mechanisms) (carole a. estabrooks et al., 2015).in another trial investigators reported that audit and feedback together with educational outreach and printed materials results in moderate improvements in nursing care, lending support to the importance of evaluation as a contextual predictor (cheater et al., 2006). additionally evaluation has been found to be a significant predictor of conceptual research use at the 5% level was evaluation (estimate: 0.353),(squires et al., 2013) supervision and audit with feedback has been found to be generally effective at changing practice than single component interventions. this was highlighted by evidence from a randomized trial which suggested that supportive supervision lead to the provision of improved professional practice and development (du mortier & arpagaus, 2005; haines et al., 2007). if it is correctly done, supervision could be a mechanism for providing professional development, ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 138 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." improving health workers’ job satisfaction, and increasing motivation.(rowe, de savigny, lanata, & victora, 2005) while exploring the experiences of health workers working in primary health care facilities in tanzania, participants who included nurses and doctors in focused group discussions (fgds) identified positive supervision and improved feedback from referral hospitals as two achievable measures to improve both moral and quality of health care delivery (manongi, marchant, & bygbjerg, 2006). other contextual factors and utilization of research research on organizational innovation suggests that slack resources, such as funds, staff time, facilities and equipment, are important determinants of successful implementation of new guidelines and a receptive context(helfrich, li, sharp, & sales, 2009). common perceived barriers by providers in their engagement in evidence based programs are resources, cost, and space (spassiani, harris, & hammel, 2016). additionally organizations that have been found to be most conducive to research use are those with the resources to incorporate multiple methods and sources of feedback into their evaluative framework(carole a. estabrooks et al., 2009; kontos & poland, 2009). evidence from research studies suggests that resources be added as the fourth important contextual component in the implementation of research evidence. (carole a. estabrooks et al., 2009). organizational slack refers to uncommitted or potential resources which allows an organization (unit) to adapt successfully to internal pressures for adjustments or to external pressures for ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 139 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." changes (carole a. estabrooks et al., 2009). more innovation is believed to occur in organizations with high levels of slack. organizational slack has been found to be significantly correlated with instrumental and conceptual research utilization. access to research and resources has also been consistently identified in nursing as important to the utilization of research (c. estabrooks, 2003) in order to improve knowledge in clinical practice nurses rely on formal and informal interactions. formal interactions are organizational or unit-sponsored events meant generally to enhance nurses’ professional skills while informal interactions informal exchanges that occur between individuals working within an organization (unit) that can promote the transfer of knowledge. estabrooks et al., 2005, reported that nurses rely heavily on social interactions as a knowledge source, using them more frequently than traditionally promoted sources, such as academic journals. this is because peers are not only viewed to be helpful but also receive “affirmational” support, that is, validation of their feelings and ctions.(carole a. estabrooks et al., 2005) . in a research study in canada, formal interactions, informal interactions, organizational slack [availability of resources (i.e., space, staff, time) which allow the unit to adapt successfully to internal or external pressures for change] (space), and unit specialty predicted conceptual research use (cru)(yamada et al., 2017) in uganda, health workers’ commitment was a major aspect of how context influences the implementation of new practices. this commitment commonly referred to as ‘loss of morale’ was due to scarce resources, low salaries, little appreciation, a heavy workload, and the ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 140 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." presence of informal payment. respondents in the study, brought up ‘resources’ which included; human resources, equipment, drugs and supplies, space, means of transport, and time as an issue that influenced both the implementation of new knowledge and healthcare services overall (bergström et al., 2012) a study undertaken at kenyatta national hospital, in kenya, reported that organizational support and availability of resources were significant motivators to research undertaking and results utilization by nurses (kyalo, 2015). in another study in kenya, health workers described barriers at the organizational level to include staff shortages, high staff turnover, heavy workload, frequent staff rotations, and poor workflow structure (nzinga et al., 2009) conclusion many research studies have attributed the poor uptake of research by nurses in their daily clinical practice to individual characteristics however this review shows that the challenges in transferring research into clinical practice are often more due to organizational contextual factors than to individual attributes. more research into this area needs to be carried out especially in low resource settings. references aarons, g. a., ehrhart, m. g., farahnak, l. r., & hurlburt, m. s. (2015). leadership and organizational change for implementation (loci): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation. implementation science, 10(1), 1–12. https://doi.org/10.1186/s13012014-0192-y belkhodja, o., amara, n., landry, r., & ouimet, m. (2007). the extent and organizational determinants of research utilization in canadian health services organizations. science ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 141 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." communication, 28(3), 377–417. https://doi.org/10.1177/1075547006298486 bergström, a., peterson, s., namusoko, s., waiswa, p., & wallin, l. (2012). knowledge translation in uganda: a qualitative study of ugandan midwives’ and managers’ perceived relevance of the sub-elements of the context cornerstone in the parihs framework. implementation science, 7(1), 1–13. https://doi.org/10.1186/1748-5908-7-117 cahill, n. e., narasimhan, s., dhaliwal, r., & heyland, d. k. (2010). knowledge in translation, 685–696. cheater, f. m., baker, r., reddish, s., spiers, n., wailoo, a., gillies, c., … cawood, c. (2006). cluster randomized controlled trial of the effectiveness of audit and feedback and educational outreach on improving nursing practice and patient outcomes. med care, 44(6), 542–551. https://doi.org/10.1097/01.mlr.0000215919.89893.8a cummings, g. g., hutchinson, a. m., scott, s. d., norton, p. g., & estabrooks, c. a. (2010). the relationship between characteristics of contextand research utilization in a pediatric setting. bmc health services research, 10, 168–177. retrieved from http://ezproxy.net.ucf.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true& db=aph&an=52804551&site=eds-live&scope=site davies, b. (n.d.). principal investigator. chsrf.ca. retrieved from http://www.chsrf.ca/migrated/pdf/researchreports/ogc/davies_final_e.pdf delmonte, j., & oman, k. (2010). preparing and sustaining staff knowledge about ebp. evidence-based practice. retrieved from https://www.google.com/books?hl=sv&lr=&id=dhodgfv9w4yc&oi=fnd&pg=pa55&ots=1 hbejnstfi&sig=mxib7nfkifotnctvyelcqmnacec du mortier, s., & arpagaus, m. (2005). quality improvement programme on the frontline: an international committee of the red cross experience in the democratic republic of congo. international journal for quality in health care : journal of the international society for quality in health care / isqua, 17(4), 293–300. https://doi.org/10.1093/intqhc/mzi042 ellis, i., howard, p., larson, a., & robertson, j. (2005). from workshop to work practice: an exploration of context and facilitation in the development of evidence-based practice. worldviews on evidence-based nursing, 2(2), 84–93. https://doi.org/10.1111/j.17416787.2005.04088.x english, m., ntoburi, s., wagai, j., mbindyo, p., opiyo, n., ayieko, p., … irimu, g. (2009). an intervention to improve paediatric and newborn care in kenyan district hospitals: understanding the context. implementation science, 4(1). https://doi.org/10.1186/17485908-4-42 estabrooks, c. (2003). translating research into practice: implications for organizations and ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 142 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." administrators. the canadian journal of nursing research = revue canadienne de recherche en sciences infirmières, 35(3), 53–68. retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14603570 estabrooks, c. a. (1999). the conceptual structure of research utilization, 203–216. https://doi.org/10.1002/(sici)1098-240x(199906)22:3<203::aid-nur3>3.0.co;2-9 estabrooks, c. a., rutakumwa, w., o’leary, k. a., profetto-mcgrath, j., milner, m., levers, m. j., & scott-findlay, s. (2005). sources of practice knowledge among nurses. qualitative health research, 15(4), 460–476. https://doi.org/10.1177/1049732304273702 estabrooks, c. a., scott, s., squires, j. e., stevens, b., o’brien-pallas, l., watt-watson, j., … williams, j. (2008). patterns of research utilization on patient care units. implementation science, 3(1), 1–16. https://doi.org/10.1186/1748-5908-3-31 estabrooks, c. a., squires, j. e., cummings, g. g., birdsell, j. m., & norton, p. g. (2009). development and assessment of the alberta context tool. bmc health services research, 9, 1–12. https://doi.org/10.1186/1472-6963-9-234 estabrooks, c. a., squires, j. e., hayduk, l., morgan, d., cummings, g. g., ginsburg, l., … norton, p. g. (2015). the influence of organizational context on best practice use by care aides in residential long-term care settings. journal of the american medical directors association, 16(6), 537.e1-537.e10. https://doi.org/10.1016/j.jamda.2015.03.009 gifford, w. a., davies, b., graham, i. d., lefebre, n., tourangeau, a., & woodend, k. (2008). a mixed methods pilot study with a cluster randomized control trial to evaluate the impact of a leadership intervention on guideline implementation in home care nursing. implementation science, 3(1). https://doi.org/10.1186/1748-5908-3-51 haines, a., sanders, d., lehmann, u., rowe, a. k., lawn, j. e., jan, s., … bhutta, z. (2007). achieving child survival goals: potential contribution of community health workers. lancet, 369(9579), 2121–2131. https://doi.org/10.1016/s0140-6736(07)60325-0 helfrich, c. d., damschroder, l. j., hagedorn, h. j., daggett, g. s., sahay, a., ritchie, m., … stetler, c. b. (2010). a critical synthesis of literature on the promoting action on research implementation in health services ( parihs ) framework. helfrich, c. d., li, y., sharp, n. d., & sales, a. e. (2009). organizational readiness to change assessment ( orca ): development of an instrument based on the promoting action on research in health services ( parihs ) framework, 13, 1–13. https://doi.org/10.1186/17485908-4-38 hisham, r., ng, c. j., liew, s. m., hamzah, n., & ho, g. j. (2016). why is there variation in the practice of evidence-based medicine in primary care? a qualitative study. bmj open, 6(3), 1–9. https://doi.org/10.1136/bmjopen-2015-010565 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 143 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." hutchinson, a. m., adachi, a., estabrooks, c. a., building, c. s., barwick, m., stinson, j., … mcgrath, p. (2008). project 2 cihr team in children ’ s pain prepared by kusp : knowledge utilization studies program. kitson, a., harvey, g., & mccormack, b. (1998). enabling the implementation of evidence based practice : a conceptual framework, 149–158. kitson, a., harvey, g., & mccormack, b. (1998). enabling the implementation of evidence based practice: a conceptual framework. quality and safety in health care, 7(3), 149–158. https://doi.org/10.1136/qshc.7.3.149 kontos, p. c., & poland, b. d. (2009). mapping new theoretical and methodological terrain for knowledge translation: contributions from critical realism and the arts. implementation science, 4(1), 1–10. https://doi.org/10.1186/1748-5908-4-1 kristensen, n., nymann, c., & konradsen, h. (2016). implementing research results in clinical practicethe experiences of healthcare professionals. bmc health services research, 16(1), 1–10. https://doi.org/10.1186/s12913-016-1292-y kyalo, m. a. (2015). nursing research and evidence based practice : assessment , educational intervention and its outcome at kenyatta national hospital , kenya a thesis submitted in fulfillment of the requirements for the degree of doctor of philosophy in nursing , university. kyalo mutisya, a., kagurekarani, a., & kigondu, c. (2015). research utilization among nurses at a teaching hospital in kenya. journal of caring sciences, 4(2), 95–104. https://doi.org/10.15171/jcs.2015.010 manongi, r. n., marchant, t. c., & bygbjerg, i. c. (2006). improving motivation among primary health care workers in tanzania: a health worker perspective. human resources for health, 4, 1–7. https://doi.org/10.1186/1478-4491-4-6 mccormack, b., kitson, a., harvey, g., rycroft-malone, j., titchen, a., & seers, k. (2002). getting evidence into pratice: the meaning of “context.” journal of advanced nursing, 38(1), 94– 104. ne, j., suurdt, j., ouelette-kuntz, h., & dk, h. (2007). implementation of the canadian clinical practice guidelines for nutrition support: a multiple case study of barriers and enablers. nutrition in clinical practice, 22(4), 449–457 9p. https://doi.org/10.1177/0115426507022004449 nzinga, j., mbindyo, p., mbaabu, l., warira, a., & english, m. (2009). documenting the experiences of health workers expected to implement guidelines during an intervention study in kenyan hospitals. implementation science, 4(1), 1–9. https://doi.org/10.1186/1748-5908-4-44 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 144 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." peters, d. h., el-saharty, s., siadat, b., janovsky, k., & vujicic, m. (2009). improving health service delivery in developing countries: from evidence to action. directions in development human development. https://doi.org/10.1596/978-0-8213-7888-5 rowe, a. k., de savigny, d., lanata, c. f., & victora, c. g. (2005). how can we achieve and maintain high-quality performance of health workers in low-resource settings? lancet, 366(9490), 1026–1035. https://doi.org/10.1016/s0140-6736(05)67028-6 rycroft-malone, j. (2004). the parihs framework—a framework for guiding the implementation of evidence-based practice. journal of nursing care quality, 19(4), 297– 304. https://doi.org/10.1097/00001786-200410000-00002 scott-findlay, s., & golden-biddle, k. (2005). understanding how organizational culture shapes research use. journal of nursing administration, 35(7–8), 359–65. https://doi.org/10.1097/00005110-200507000-00008 scott, s. d., & pollock, c. (2008). the role of nursing unit culture in shaping research utilization behaviors. research in nursing and health, 31(4), 298–309. https://doi.org/10.1002/nur.20264 spassiani, n. a., harris, s. p., & hammel, j. (2016). exploring how knowledge translation can improve sustainability of community-based health initiatives for people with intellectual / developmental disabilities, 433–444. squires, j. e., estabrooks, c. a., scott, s. d., cummings, g. g., hayduk, l., kang, s. h., & stevens, b. (2013). the influence of organizational context on the use of research by nurses in canadian pediatric hospitals. bmc health services research, 13(1). https://doi.org/10.1186/1472-6963-13-351 stetler, c. b., ritchie, j. a., rycroft-malone, j., schultz, a. a., & charns, m. p. (2009). institutionalizing evidence-based practice: an organizational case study using a model of strategic change. implementation science, 4(1), 1–19. https://doi.org/10.1186/1748-59084-78 wallin, l., estabrooks, c. a., midodzi, w. k., & cummings, g. g. (2006). development and validation of a derived measure of research utilization by nurses. nursing research, 55(3), 149—160. https://doi.org/10.1097/00006199-200605000-00001 ward, s. e., goldberg, n., miller-mccauley, v., mueller, c., nolan, a., pawlik-plank, d., … murphy, b. (2015). improving pain management at the nursing education level: evaluating knowledge and attitudes. bmc health services research, 18(1), 1865–1871. https://doi.org/10.1188/15.onf.165-173.evidence-based yamada, j., squires, j. e., estabrooks, c. a., victor, c., & stevens, b. (2017). the role of organizational context in moderating the effect of research use on pain outcomes in ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 145 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rogers kiprotich chemoiwa * * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “the organizational context and the utilization of research evidence by nurses; a review." hospitalized children: a cross sectional study. bmc health services research, 17(1), 1–11. https://doi.org/10.1186/s12913-017-2029-2 yost, j., ganann, r., thompson, d., aloweni, f., newman, k., hazzan, a., … ciliska, d. (2015). the effectiveness of knowledge translation interventions for promoting evidenceinformed decision-making among nurses in tertiary care: a systematic review and metaanalysis. implementation science, 10(1), 1–15. https://doi.org/10.1186/s13012-015-0286-1 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 146 abstract organizational context research utilization organizational culture and utilization of research. organizational leadership and the utilization of research organizational measurement/evaluation mechanisms and utilization of research other contextual factors and utilization of research references ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ management of black triangle by composit restoration : a clinical case report." management of black triangle by composit restoration : a clinical case report rafalimino hn1,2, rakotonirina fp1,3, radafisolo mef4, soanasolo cm5, andrianjafinoro th1,2, ,ramaroson j1. 1sub-section of conservative odontology endodontic at the tropical odonto-stomatological institute of madagascar (iostm), university of mahajanga ² university hospital profesora zafisaona gabriel androva mahajanga madagascar, 3oral health center, ministry of industrialization, trade and consumption antananarivo, 4sub-section of pediatric dentistry, at the tropical odonto-stomatological institute of madagascar (iostm), university of mahajanga 5sub-section of parodontology at the tropical odonto-stomatological institute of madagascar (iostm), university of mahajanga corresponding author: rafalimino holy nasandratra sub-section of conservative odontology endodontic at the tropical odontostomatological institute of madagascar (iostm), university of mahajanga -------------------------------------------------------------------------- abstract an adequate smile is dictated by the harmony and symmetry of the gingival biotype, lips outline, and dental crown shape. however, the loss of the interdental papilla leads to the appearance of a black triangle at the gingival base. this observation concerns a 55-year-old patient presenting multiple "black triangles" in the anteriorsuperior area, causing aesthetic concerns. the use of a specific matrix, the application of the fifth-generation adhesive mr2 system, alongside enamel and dentin nano-hybrid composites, allowed us to limit the requested interproximal shapes, ensure effective composite bonding, mimic the state of natural teeth, and mask the black triangles for the patient. considering ethics, the adhesive restorative technique will be the most costeffective therapeutic choice. in line with the therapeutic gradient, this minimally invasive technique should be the primary approach for cases involving "black triangles." keywords : aesthetic, black triangle, dental composite, interproximal area, operative dentistry ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 16 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ management of black triangle by composit restoration : a clinical case report." i.introduction according to the tarnow rule, disappearance of interdental papilla associated with a vertical distance bony crest contact point exceeding 6 mm diagnoses the presence of a black triangle [1]. the base of black triangles located at gingival base. also called open gingival embrasure, this gingival biotype defect promotes premature aging of the smile, causes functional discomfort, and undermines the periodontal health of the patient. frequently found in multiple locations, this pathology represents a complex aesthetic and functional issue. its etiology is multifactorial. periodontal origine due to bone loss, orthodontic treatment complication, or related to the root morphology (divergence greater than 3.65°), related to crown morphology (triangular dental morphology) [2]. according to a study by ko-kimura et al. in 2018, cases of black triangles were observed in 66.7% of individuals over 20 years old [3]. swasson kk in 2018, conducted a study about black triangle in washington. they reported that 40% of orthodontically treatment induced black triangles [4]. this condition is also frequently diagnosed in individuals with triangular dental morphology. where a more incisal contact point position is unfavorable for maintaining the interdental papilla [5]. depending on the degree of involvement, nordland and tarnow classified them into four classes from i to iii. in normal case, interdental papilla fills the gingival embrasure. in class i, the type of the interdental papilla is located between the contact point and the most coronal extent of the interproximal cemento-enamel junction (cej). in class ii, the crest of the papilla is at or apical to the interproximal (cej) but coronal to the facial cej. in class iii, the crest of the papilla is at or apical to the facial cej [1]. management options is interdisciplinary. it includes non-surgical approaches, such as additive composite restoration, proximal enamel reduction, or prosthetic treatmen. while surgical options involve interproximal bone grafting or gingival grafting. the overall objective of this work was to present a case of a black triangle managed by a non-surgical technique of additive composite restoration. ii.observation this is a 55-year-old man who presented to the odonto-stomatology department of the university hospital profesora zafisaona gabriela androva mahajanga due to aesthetic concerns. the patient's request is based on improving the aesthetics of the anteriorijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 17 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ management of black triangle by composit restoration : a clinical case report." superior area. during the anamnesis, the patient did not show any general health problems. endodontic treatment of a posterior tooth is on going. upon extraoral examination, he displayed a gingival-type smile. in the intraoral examination, the patient's oral hygiene was average, and a triangular crown morphology was noted, with the presence of black triangles in the anterior-superior and inferior sectors. according to the nordland and tarnow’s classification, class ii of black triangle was diagnosed in the anterior-superior area involving teeth 11, 12, 13, 14, 21, 22, and 23. the etiology is due to the triangular morphology of the dental crown. the tip of the papilla is located at the enamel-cement junction, and the most apical point is situated at the labial surface. the vertical distance from the alveolar crest to the contact point of the black triangles was greater than 7.1 mm (figure 1). the contact points are located close to the incisal base. gingival recessions have been observed. the therapeutic challenge focused on closing the gingival embrasures while considering the maintenance of periodontal health. the distal and mesial contours, the anatomical widths of the teeth, and the accuracy of the verticality of the contact points were all highlighted. as a means of management, the patient consented to a minimally invasive approach through additive composite restoration. the technique involves the re-anatomization of the dental crowns. pre-treatment, a photograph was taken, which will serve for the chromatic study of the color of the tooth to be restored and the shade of composites to be used, as well as delineating the additive restoration (figure 1). in addition to the basic clinical examination setup in odonto-stomatology, the technical setup for the additive restoration was prepared in advance. a bonding system, specifically a fifth-generation mr2 adhesive system, was utilized (figure 2). for the matrix system, a matrix with integrated curvature was employed (figure 3). for finalizing the restoration, the finishing of the transition lines was achieved using a yellow-ring turbine bur (figure 5). polishing was performed using polishing discs with a diameter of 14 mm, in medium, fine, and superfine grits. the chosen operative protocol includes an etching step with 37% phosphoric acid, followed by rinsing and drying, application of the fifth-generation adhesive system, then photopolymerization, adjustment of the matrix system (gingival groove) (figure4), combined composites placement according to the c-factor, and finishing and polishing of the restoration. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 18 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ management of black triangle by composit restoration : a clinical case report." figure 1: patient's pre-restorative dental condition (buccal view) in a: black triangle [rafalimino] figure 2: technical platform used in a: etching in b: adhesive system in c: composites [rafalimino] figure 3: finishing accessories a: stamping system b: polishing system [rafalimino] figure 4: adjustment of the matrix system [rafalimino] figure 5: finishing the restoration [rafalimino] figure 6: polishing step [rafalimino] figure 7: initial case status of black triangle [rafalimino] figure 8: post-therapeutic state [rafalimino] ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 19 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ management of black triangle by composit restoration : a clinical case report." iii.discussion as a result, the additive composite management technique for the black triangles was non-aggressive to the hard dental tissues compared to indirect techniques, and our results corroborate those of authors such as : swason kk and coll, who stated that it is the most conservative technique for this case [4]. al-khayatt as and coll, said that resin composite restoration is a minimally invasive and less costly treatment option relative to a fixed option [6]. composite restoration has a long-term survival rate and aesthetic benefit with the advantage of a straightforward maintenance visit such as minor repair or polishing of a chipped composite. according to clark d, the same matrix used and its manipulation technique procured predictable and positively anatomical results [7]. clarck dj noted that the composites used, specifically the combination of flowable composites with condensable composites, created the perfect viscosity to fill the interproximal spaces [8]. conclusion according to the results, the aesthetic efficiency of the additive restorative technique using composite has been observed, and the stability and compatibility of the composite material associated with the matrix system ensure effective filling. hence, the importance of prioritizing this therapeutic choice. conflicts of interests we, the authors of this manuscript, declare no conflicts of interest regarding the publication of this article. patient consent the patient has given full permission for the publication other use of his clinical case and photographs. references 1. tarnow, d. p., magner, a., & fletcher, p. (1992). the significance of the distance from the crest of bone to the contact point in the relationship of interproximal papilla to the teeth. journal of periodontology, 63(12), 996-99. 2. clarck dj. treatment of the dreaded black triangle: a case report and an introduction to injection moulded composite dentistry. international dentistry. african edition. whashintong. 2022; 18-4. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 20 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ management of black triangle by composit restoration : a clinical case report." 3. ko-kimura n, kimura-hayashi m, yamaguchi m, ikeda d, meguro d, kanekawa m et all. some factors associated with open gingival embrasures following orthodontic treatment. australian orthodontic journal.2003 : 19-4. 4. swason kk. predictable, conservative closure of black triangles. a simple technique to treat this increasingly prevalent issue with confidence.inside dentistry. whashintong. 2018; 32-6 5. sorel o, brezulier d. traiter ou prévenir la perte des papilles inter-dentaires. orthod fr 2018; 89:235–45 6. al-khayatt as, ray-chaudhuri a, poyser nj, et al. direct composite restorations for the worn mandibular anterior dentition : a 7-year follow-up of a prospective randomised controlled split-mouth clinical trial. j oral rehabil 2013 ;40(05) :389– 401 7. clarck d. treating the “black triangle” with direct composite – a microscopic perspective.microscope dentistry. 2010 :76-80. 8. clark dj. restoratively driven papilla regeneration; a microscopic perspective. canadian journal of rest dent and prosthodontics 2008 ; aug :40-46. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 21 https://pubmed.ncbi.nlm.nih.gov/?term=kanekawa+m&cauthor_id=12790352 https://orthodfr.edpsciences.org/articles/orthodfr/abs/2018/03/orthodfr180022/orthodfr180022.html ijo international journal of health sciences and nursing ( issn: 2814-2098 ) anieche john e.* https://ijojournals.com/ volume 07 || issue 10|| october, 2024 || academic stress and coping strategies among student nurses in colleges of nursing sciences in anambra state, nigeria academic stress and coping strategies among student nurses in colleges of nursing sciences in anambra state, nigeria 1. ottiwu perpetua c 2. *anieche john e. 1 & 2 : department of nursing science, nnamdi azikiwe university, nnewi campus absrtact this is a cross sectional study that explored the academic stress and coping strategies among the student nurses in colleges of nursing in anambra state, nigeria. a total of 366 respondents were proportionately drawn from a total of 1,894 students through taro yamene formula for sample size calculation. a validated questionnaire that was tested for internal consistency was used for data collection. ethical approval (nauth/cs/66/vol.16/ver.3/58/2024/04)was obtained from the rec, nauth, nnewi. data collected were analyzed through descriptive and inferential statistics using spss ibm version 25. pearson’s product moment correlation was used to test the relationship between colleges of nursing student coping strategies. independent sample t-test was also used to examine differences between the students’ training institutions and their sources of academic stress, and also between institutional training of the student and stress coping strategies of nursing students. multiple regression was employed to analyze the association between the demographic variables of the students and their stress coping strategies with value of p < 0.05 considered to be statistically significant. study revealed that a good number of the student nurses(52.7%) in colleges of nursing sciences in anambra state experience academic stress of which 78.0% saw the amount of class work materials to be learned as a source of stress and a greater number (67.5%) were of the opinion that financial problem causes stress to them. coping strategies applied by student nurses include: seeking professional support from senior nurses, listening to music or watching movies, family moral support, and others. positive correlation was found between the students’ training institution and their source of stress. study showed that there is an association between the demographic variables of the students and their stress coping strategies and there is no association between type of training institution and stress coping strategies among the students. key words: academic stress. coping strategies, student nurses, colleges of nursing introduction there are diverse types of stressors and consequences experienced by student nurses and their ability to cope with stress is essential for them to succeed. in the opinion of gibson et al, (2007) cited in ajibade et al, (2016), students undergoing training in nursing schools seem to possess a substantially higher level of potential for encountering pressure and challenges compared to other college students. stress maybe be seen as a common element in life regardless of race or cultural background but the emotional and physical means people respond to it may lead to mental and physical symptoms. the effects of stress sometimes vary depending on how it is appraised, and the coping strategies used. in the opinion of al-ayadhi, (2005)cited in mahfouz and alsahli,(2016), coping strategies to stress differ between individuals and are influenced by ethnic, cultural and socioeconomic ijo journals volume 07 | issue 10 | october 2024 | https://ijojournals.com/index.php/hsn/index 1 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) anieche john e.* https://ijojournals.com/ volume 07 || issue 10|| october, 2024 || academic stress and coping strategies among student nurses in colleges of nursing sciences in anambra state, nigeria characteristics of the persons involved. it has been found that one in five nurses want to quit their job and 40% nurses experience considerable burnout due to academic and workplace stress (yasmin et al., 2018). in nursing training, students experience increased tension prior to their clinical experiences and written examination especially their finals. studies confirmed that one third of student nurses experience stress severe enough to induce mental health problem such as depression and anxiety (screevany, 2015). students may have difficulty in adjusting to more rigorous academic expectations, separation from home for the first time and the varied structure of academic experience at the college level (pascoe, et al., 2019). going further, pascoe et al., (2019), stated that the common stressors among students include; academic workload, time pressure, decisionmaking, continuous changes, and economic mistakes which tend to negatively impact on them physically, psychologically, academically, and socially. worry about successes, academic workload, availability of time,family problems, and engagement in patients’ care were viewed by mohammed and ahmed (2021), to be among the factors that cause stress among higher school students. other factors may include assignment submission, excess homework, assessment deadlines, unclear assignments, uncomfortable classrooms and relations with faculty members. stress can be self-imposed as seen in setting too high standard or having unrealistic expectations regarding one’s ability, situational such as seen in time constraints, lack of resources, threats to emotional or physical well-being(iyi, 2015). stress could be connected with life changes, personal or work related and the inability to adapt successfully may result in illness. generally, what may be distressful to one person may be excitingly challenging (positive stressful) to another and the same event can be distressful at one time and stimulating or non-stressful at another (anand &nemera, 2015). for an event to cause distress may sometimes depend on individual’s perception of the situation. these notwithstanding, when stress gets out of control, it becomes challenging and may affect the individual’s health, one’s relationship with others and and distort life process (iyi, 2015). the stressful challenges encountered may include insecurity about clinical competence, fear of failure and interpersonal relations with patients, the pressure resulting from the fear of expulsion from the training, time pressure, and lack of motivation, poor social life, interacting with dying patients and interpersonal conflicts with other nurses. some of these may positively or negatively affect the student. chapman, et al. (2020), stated that stress could result into exhaustion, depersonalisation and decreased personal achievements. stressful events could make student nurses experience deterioration in academic performance which may result to elimination from the nursing program and shortage of nurses in clinical career (moustaka&constantinidis,2019). furthermore, studies have shown that one third of student nurses experience severe stress that might induce mental health problems such as depression and anxiety (chernomas& shapiro, 2013; zeng, et al. 2019).a study by parveen and inayat, (2017), showed that about 70% of students participants have positive view that academic, clinical and environmental factors cause among nursing students. in the same vein, oluwaseun, et al, (2023), in their cross-sectional descriptive study concluded that students' predominant stress sources were academic workload (73.1%) and financial difficulties (55.7%) for which self-distraction and instrumental support were used as coping strategies. khajehei and kashefi (2016),found out ijo journals volume 07 | issue 10 | october 2024 | https://ijojournals.com/index.php/hsn/index 2 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) anieche john e.* https://ijojournals.com/ volume 07 || issue 10|| october, 2024 || academic stress and coping strategies among student nurses in colleges of nursing sciences in anambra state, nigeria that palpitation, fatigue, decreased energy, unusual behaviour and inability to concentrate were common resultants of stress among students. the above notwithstanding, students cannot avoid stress but their ability to cope with these stressors is important in achieving success in the academic performance. so managing stress effectively and seeking coping strategy in an appropriate way is very important for preventing the negative effects of stress. since student nurses experience diverse types of stresses with possiblenegative consequences, the ability to cope with stress is essential for them to succeed and the need to adopt appropriate coping strategy is golden. the stress experienced by students can be altered and influenced by the coping strategies they choose to employ. effective coping strategies help students to perform markedly better in regards to their studies (khater, akhuzaheya &shaban, 2014). various coping strategies used by students include ventilation, diversion, relaxation, selfreliance, social peer group support, avoidance, praying, day dreaming listening to music and smoking, drinking, joking and others (regehr, glancy& pitts, 2013). stress management studies have shown that students can do little on their own to significantly reduce stress which they experience or to which they are exposed therefore, they should be guided on how to adapt and prioritize their own care among the other demands required of the profession (jarrad,et al. 2018). macarthur,(2014) cited by ajibade et al, (2016), further categorized coping strategies into active and avoidant. in his opinion, “active coping strategies” are either behavioral or psychological responses designed to change the nature of the stressors itself or how one thinks about it, whereas “avoidant coping strategies” lead people into activities such as alcohol use, or mental states such as withdrawal that keep them from directly addressing stressful events.semel institute for neuroscience and human behaviour (2023) stated that coping mechanisms can be either active or avoidant. sheu, etal(2013), identified other strategies such as: staying optimistic, application of transference, identifying triggers and warning signs, establishing routines, spending time with people who care and look after one’s health through eating healthy food, getting regular exercise and 1istening to music, walking or dancing as means of managing stress. in the opinion of regehr, glancy& pitts, (2013), stress management could also be behavioral or psycho-social with the outcome aimed at tolerating, reducing or minimize stressful events. in some instances, it could be problem solving or emotional focused coping strategies (al-gamal, alhosain&alusunaye, 2018). generally, active coping strategies, whether behavioral or emotional, are thought to be better ways to deal with stressful events, while avoidant coping strategies appear to be a psychological risk factor or marker for adverse responses to stressful life event. when coping with stress is successful, adaptation takes place and promotes health, psychological well-being and social functioning (soares & oliveira, 2013 in ajibade, et al, (2016). adopting appropriate management strategies is very important for counteracting the negative effects of stress among students. in the course of academic activities and interaction with students the researchers observed some unhealthy behaviours among students such as irritable actions, withdrawal from friends and academic activities. further probe into the situation revealed to some extent that some of them are not finding it easy with the stress they are passing through in their schools. these prompted the researchers to ask some questions relating to the origin of stress among the students, any coping strategies applied by the students and how effective these coping ijo journals volume 07 | issue 10 | october 2024 | https://ijojournals.com/index.php/hsn/index 3 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) anieche john e.* https://ijojournals.com/ volume 07 || issue 10|| october, 2024 || academic stress and coping strategies among student nurses in colleges of nursing sciences in anambra state, nigeria strategies have been in managing their stress. this study is therefore set to determine stress and stress coping strategies among student nurses in colleges of nursing in anambra state, nigeria. objective of the study were to: 1. identify sources of academic stress among student nurses incolleges of nursing in anambra state 2. determine the coping strategies applied by student nurses in colleges of nursing sciences in anambra state in the management of academic stress. the researchers hypothesized that: 1. there will be no significant association between student nurses’ training institution in anambra state nigeria and their source of stress. 2. training institution of the student nurses in anambra state nigeriawill not play any significant role in their stress coping strategies. 3. there will be no association between the demographic variables of the students and their stress coping strategies methodology research design the study adopted a cross sectional design to explore the academic stress, and coping strategies among the student nurses in anambra state. brotobor, et al., (2021) adopted the same design in their assessment of stress and stress management strategies adopted by students of the department of nursing sciences, ambrose alli university, ekpoma, nigeria. area of study the study was conducted in colleges of nursing in anambra state,south-eastern nigeria. anambra state is an industrial and commercial state in nigeria with nine colleges of nursing located in different senatorial zones of the state. these training institutions were accredited by the nursing and midwifery council of nigeria (nmcn) for the training of student nurses. ownership of the colleges differ. some are owned by the government while some are owned by the missions/churches. irrespective of the ownership, each college has required structures and human capacity to train nurses as required by the regulatory body for the training of nurses in nigeria. population of study population for the study comprised of 1,894 students enrolled in the colleges of nursing sciences in anambra state at the time of this study. these students were in their different academic levels. sampleand sampling technique cluster sampling technique was used to select the institutions. this was done based on the ownership of the colleges (federal, state and private/mission). one federal college of nursing, one state college of nursing and two privates/mission colleges were randomly selected to participate in the study. a total of 366 sample was proportionately drawnfor the study through taro yamene formula for sample size selection. respondents for the study were proportionately selected to ensure proper representation of the population for each training institution. ijo journals volume 07 | issue 10 | october 2024 | https://ijojournals.com/index.php/hsn/index 4 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) anieche john e.* https://ijojournals.com/ volume 07 || issue 10|| october, 2024 || academic stress and coping strategies among student nurses in colleges of nursing sciences in anambra state, nigeria instrument for data collection the instrument for data collection was modified questionnaire adopted from standardized perceived stress scale and coping behavior inventory gotten from previous studies. the instrument was validated by experts and tested for internal consistency through spearman brown correlation coefficient which yielded a reliability index of 0.90. ethical consideration the following ethical consideration were ensured by the researcher during the course of the study. ethical approval with reference number nauth/cs/66/vol.16/ver.3/58/2024/04 was obtained from nnamdi azikwe university teaching hospital human research committee, before data collection commenced. formal permission was also obtained from the provost of the selected colleges of nursing in anambra state before commencement of the study. anonymity of the respondents as well as confidentiality of information from them. voluntary participation was ensured as respondents were not not pressurized to participate in the study and respect for human dignity was equally ensured in the course of data collection. procedure for data collection the rec and individual institutional approvals were used to gain access to the respondents who also accepted to participate in the study. after interaction with the respondents during which the purpose and objectives of the study were explained to the respondents. clarifications were made were necessary before they responded to the instrument. the face to administration of the instrument lasted for three months method of data analysis the data were analyzed using descriptive and inferential statistics using spss ibm version 25. pearson’s product moment correlation was used to test the relationship between colleges of nursing student coping strategies. independent sample t-test was also used to examine difference between the student training institution and their source of academic stress and also between institutional training of the student and stress coping strategies of nursing students.multiple regression was employed to analyze the association between the demographic variables of the students and their stress coping strategies with value of p < 0.05 considered to be statistically significant. ijo journals volume 07 | issue 10 | october 2024 | https://ijojournals.com/index.php/hsn/index 5 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) anieche john e.* https://ijojournals.com/ volume 07 || issue 10|| october, 2024 || academic stress and coping strategies among student nurses in colleges of nursing sciences in anambra state, nigeria results table 1: socio-demographic variables of the respondents (n = 366) item frequency percentage (%) age 16 – 20 years 21 – 26 years 27 – 31 years 32 – 36 years 37 – 40 years 40 years and above 32 286 27 11 6 4 8.7 78.1 7.4 mean age:21.4years 3.0 sd=0.77 1.6 1.1 religion christianity muslim traditional others 338 16 12 0 92.4 4.4 3.3 0.0 level of study year 1 year 2 year 3 152 118 96 41.5 32.2 26.2 sex female male 319 47 87.2 12.8 marital status single married other 345 19 3 94.3 5.2 0.8 type of training institution federal state private/mission 87 84 195 23.7 22.9 53.3 table 1 shows that the mean age of the respondents is 21.4 years with sd of 0.77. majority of the respondents 152(41.5%) are in year one. majority of the respondents345 (94.3%) were females and 195(53.3%) belong to private/mission colleges of nursing. ijo journals volume 07 | issue 10 | october 2024 | https://ijojournals.com/index.php/hsn/index 6 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) anieche john e.* https://ijojournals.com/ volume 07 || issue 10|| october, 2024 || academic stress and coping strategies among student nurses in colleges of nursing sciences in anambra state, nigeria table 2: sources of academic stress among the students (n = 366) item s/agree (%) agree (%) disagree (%) s/disagree(%) maintain balance between 132(37.4) 193(52.7) 30(8.3) 5(1.4) study and leisure time the amount of class work 281(78.0) 63(17.5) 13(3.6) 9(2.5) materials to be learned less vacations/break 243(67.5) 93(25.8) 23(6.4) 7(1.9) thought of examination 173(48.1) 89(24.7) 52(14.4) 46(12.8) fear of failing a course 183(50.8) 119(33.1) 40(11.1) 24(6.7) fear of making mistake 21(5.8) 198(55.0) 113(31.3) 18(5.0) during clinical experience financial problems 243(67.5) 60(16.7) 47(13.1) 16(4.4) poor inter-personal 113(31.4) 198(55.0) 23(6.3) 16(4.4) relation with the teachers family problem 243(67.5) 93(25.4) 23(6.2) 7(1.9) table 2 shows the sources of stress commonly experienced by the student nurses. from the table, 193(52.7%) of the respondents agreed that maintaining balance between study and leisure time is stressful to them while 132 (37.4 %) of the respondents strongly agreed to this. the table further reveals that 281 (78.0%) of the respondents strongly agreed the amount of class work materials to be learned areamong the stressors commonly experienced by student. less vacation or break in colleges of nursing was identified by majority 243(67.5%) as stressors. the table further reveals that 173 (47.2%) of the respondents believed that the thought of examination constitute stress commonly experienced by student nurses. fear failing a course is a common stress experienced by student nurses asrevealed in the table where 183(50.8%) of the respondents strongly agreed to this. the fear of making mistake during clinical experience was agreed by 198 (55.0%) of the respondents to be a commonly experienced stress among student nurses. financial problem was seen by the majority of the respondents 243(67.5%) with strong agreement as a stress commonly experienced by student nurses. the table further shows that 243 (67.5%) of the respondents strongly agreed that family problem is stress commonly experience by student nurses. ijo journals volume 07 | issue 10 | october 2024 | https://ijojournals.com/index.php/hsn/index 7 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) anieche john e.* https://ijojournals.com/ volume 07 || issue 10|| october, 2024 || academic stress and coping strategies among student nurses in colleges of nursing sciences in anambra state, nigeria table 3: stress coping strategies applied by student nurses against academic stress (n = 366) item always (%) sometimes (%) rarely (%) never(%) look forward to the benefit 98(26.8) 189(52.5) 56(15.3) 23(6.3) of practicing as a nurse engage in diversion therapies 152(41.5) 104(28.4) 91(24.9) 19(5.2) outline a plan on how to 74(20.2) 225(61.4) 48(13.3) 19(5.2) address the situation seeking a professional 186(50.8) 98(26.8) 53(14.5) 29(7.9) support from senior colleagues listening to music and watch 154(42.1) 99(27.5) 67(18.3) 46(12.8) movie received moral support from family 205(56.0) 84(22.9) 62(16.9) 15(4.1) coping strategies used by student nurses in coping with academic stress and the frequency of usages of the strategies, the table 3 shows that 189(52.5%) of the respondents said they sometime looking forward to the benefit of practicing as a professional nurse helps them to cope with stress. a good number of the respondents 152(41.5%) always engage in diversion therapies as a coping strategy. table also shows that 225(61.4%) of the respondents outline a plan on how to address the situation as means of coping with academic stress.seeking support from senior colleaguesis preferred as coping strategy by 186 (50.8%) of the respondents. listening to music and watching movies are used as coping strategies applied by 154 (42.1%) of the respondents even as 205(56.0%) of the respondents said they always receive moral support from family as a coping strategy. ijo journals volume 07 | issue 10 | october 2024 | https://ijojournals.com/index.php/hsn/index 8 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) anieche john e.* https://ijojournals.com/ volume 07 || issue 10|| october, 2024 || academic stress and coping strategies among student nurses in colleges of nursing sciences in anambra state, nigeria table 4: karl pearson product moment correlation analysis result of the relationship between the student training institution and their source of stress. source of stress training institution source of stress pearson correlation 1 .906** sig. (2-tailed) .000 sum of squares and crossproducts 528.776 285.565 covariance 1.560 .842 n 366 366 training institution pearson correlation .906** 1 sig. (2-tailed) .000 sum of squares and crossproducts 285.565 187.797 covariance .842 .554 n 366 366 **. correlation is significant at the 0.01 level (2-tailed). the analysis showed a correlation coefficient of 0.906 indicating the existence of strong positive relationship between the student training institution and their source of stress. the test was significant at 0.01 significant level, and led to the rejection of the null hypothesis which states that there will be no significant association between the student training institution and their source of stress. ijo journals volume 07 | issue 10 | october 2024 | https://ijojournals.com/index.php/hsn/index 9 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) anieche john e.* https://ijojournals.com/ volume 07 || issue 10|| october, 2024 || academic stress and coping strategies among student nurses in colleges of nursing sciences in anambra state, nigeria table 5: karl pearson product moment correlation result of relationship between type of training institutional of the student and stress coping strategies of nursing students institutional training coping strategies institutional training pearson correlation 1 .948** sig. (2-tailed) .000 sum of squares and cross-products 250.578 244.844 covariance 1.400 1.368 n 366 366 coping strategies pearson correlation .948** 1 sig. (2-tailed) .000 sum of squares and cross-products 244.844 266.061 covariance 1.368 1.486 n 366 366 **. correlation is significant at the 0.01 level (2-tailed). table 5 shows a correlation coefficient of 0.948 indicating the existence of strong positive relationship between the training institutional of the student and their stress coping strategies. the test was significant at 0.01 significant level, and led to the rejection of the null hypothesis which states that institutional training of the student nurse will not play a significant role in the stress coping strategies of nursing students in anambra state. table 6: multiple regression analysis of the association between the demographic variables of the students and their stress coping strategies dependent variable = stress coping strategies the multiple regression analysis of the association between the demographic variables of the students and their stress coping strategies revealed a coefficient of determination (rvariable b standard error b t sig constant 2.307 0.396 5.231 .000 sex 0.312 0.035 0.418 4.081 .000 age -0.152 0.89 -0.169 -2.567 0.17 type of training institution 0.111 0.047 0.121 1.562 .071 level of study 0.412 0.077 0.334 3.984 .000 r = 0.396 r2 = 0.664 adjusted r2 = 0.139 std. error = 0.4826 calculated f* = 119.637 critical f* = 3.84 df1 = 3 df2 = 364 d/w = .416 significant @ p<0.05 ijo journals volume 07 | issue 10 | october 2024 | https://ijojournals.com/index.php/hsn/index 10 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) anieche john e.* https://ijojournals.com/ volume 07 || issue 10|| october, 2024 || academic stress and coping strategies among student nurses in colleges of nursing sciences in anambra state, nigeria square) of 0.644. this means that 64.4 percent of the response rate for stress coping strategies was accounted by the demographic variables of students represented in the model as sex, age, nature of school and level of study. this implies that the response rate acknowledged that stress coping strategies as a function of the variables; sex, age, nature of school and level of study. the value of r of 0.396 indicated the existence of a significant positive relationship between the demographic variables of the students and their stress coping strategies. breaking down the demographic variables of the student, the regression weight of sex had a standardized value of 0.418, a t value of 5.231 and a sig. level of 0.000 which is less than 0.05 level of significant. therefore, indicating a significant relationship between sex and stress coping strategies. this shows that the stress coping strategies is significantly associated with the sex of the students indicated that the male sex cope with stress better than their female counterpart. as regards age of the respondents, the regression weight of age had a standardized value of -0.169, a t value of -2.567 and a sig. level of 0.017 which is less than 0.05 level of significant, therefore, indicating a significant relationship between age and stress coping strategies. the negative weight value shows that the higher the age of the students, the lower their stress coping strategies, indicating that the older students have less stress coping strategy than their young counterpart. with respect to nature of school, the table disclosed that the regression slope of nature of school had a standardized value of 0.121, a t value of 1.562 and a sig. level of 0.071 which is greater than 0.05 level of significant indicating that there is no significant relationship between type of school and stress coping strategies. the result shows that stress is not associated with the nature of school indicating that all the students faces stress not minding the type of the school involved. thus, there is no relationship between type of school and stress coping strategies among students. lastly, the level of study indicated that the regression weight of level of study had a standardized value of 0.344, a t value of 3.984 and a sig. level of 0.000 which is less the 0.05 level of significant which indicate a significant relationship between level of study and stress coping strategies. this shows that the stress coping strategies is significantly associated with the level of study of the study. also, the positive weight value shows that the higher the level of study of the students, the higher their stress coping strategies, indicating that the older students have better stress coping strategy than the lower level study who are just experience stress. discussion sources of academic stress among student nurses in anambra state findings from the study revealed that a good number of the student nurses(52.7%) in colleges of nursing sciences in anambra state experience academic stress of which 78.0% saw the amount of class work materials to be learned as a source of stress. a good number of the students (67.5%) strongly believed that less vacation/break is the source of stress to them. the thought of examination was seen by lesser number of the students (48.1%) as sources of stress while a greater number (67.5%) were of the opinion that financial problem cause stress to them as students. poor inter-personal relation with the teachers constitutes sources of stress to about (55.0%) of the student even as 67.5% of them has family problem constituting sources of stress to ijo journals volume 07 | issue 10 | october 2024 | https://ijojournals.com/index.php/hsn/index 11 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) anieche john e.* https://ijojournals.com/ volume 07 || issue 10|| october, 2024 || academic stress and coping strategies among student nurses in colleges of nursing sciences in anambra state, nigeria them which aligns with parveen and inayat, (2017), oluwaseun, et al, (2023) and seyedfatemi,et al. (2018). coping strategies applied by student nurses in colleges of nursing sciences anambra state in the management of academic stress study revealed that the student nurses in colleges of nursing in anambra state employ some coping strategies in dealing with their academic stress.a good number of the students (52.5%) believe that looking forward to the benefit of practicing as a professional nurses help them to manage their academic stress.majority of the students (61.4%) outline their plan on how to address stressful as a strategy to manage stress. further, a good number of the students (50.8%) always seek professional support from senior nurses as means of managing stress while some others (42.1%) listen to music or watch movies.finding revealed that 56.0% of the student nurses said that family moral support assists them in managing their academic stressors. these findings are in line with lucas et al. (1993)in al-ahmadi, h. (2014). varied array of strategies employed by the students to manage stress could be based on the assertion that some stress can spur some students to do better in academics. association between type of training institution and sources of stress positive correlation was found between the students’ training institution and their source of stress.it shows that the type of institution and its characteristics like less break and poor interpersonal relationship with the teachers significantly influence students stress level. existence of positive correlation between the type of training institution and sources of stress may suggest that some training institutions’ poor interpersonal between the teachers and the students as well as difficult management policies, may be contributing factors to students’ academic stress. association between the demographic variables of the students and their stress coping strategies of nursing students in anambra state finding from study showed that there is an association between the demographic variables of the students and their stress coping strategies. negative weight value shows that the higher the age of the students, the lower their stress coping strategies, indicating that the older students have less stress coping strategy than their young counterpart as this could be due to their energy and stamina with fewer responsibility outside study than older students. there was no relationship between type of training institution and stress coping strategies among students thus, the findings shows that stress is not associated with the nature of school indicating that all students in the colleges of nursing in anambra state face related academic stress irrespective of the type of institution. this could be likened to the use of the same curriculum for the training of the students and possibly relatedness in the policies of the different institutions. the positive weight value shows that the higher the level of study of the students, the higher their stress coping strategies, indicating that the older students have better stress coping strategy than the lower-level students. this may be related to improved experience as students become more familiar with academic expectations and workload management and matured with age as they develop more coping mechanism conclusion stress may be a hindering factor towards effective learning but it remains inseparable in health care academic programmes. effective coping strategies can facilitate adaptation among student nurses with smooth academic progression. ijo journals volume 07 | issue 10 | october 2024 | https://ijojournals.com/index.php/hsn/index 12 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) anieche john e.* https://ijojournals.com/ volume 07 || issue 10|| october, 2024 || academic stress and coping strategies among student nurses in colleges of nursing sciences in anambra state, nigeria considering the findings of this study appropriate strategies there is need for well established staff student relationship for better coping among the students. recommendations based on the findings of the study, the following recommendations were made by the researchers:  studying hours should be regulated to enable student nurses have adequate time to rest and cope better in the course of their study.  teachers who are open to communication and can recognize signs of stress in students will make academic stress coping strategies easier for the students. conflict of interest authors declare that there was no conflict of interest in the course of this study references ajibade b.l, otabisi o.o, fabiyi b. ajao o.o, and ajeni a.r. (2016). stress, types of stressors and coping strategies amongst selected naming schools student european journal of biology and science research. 4(3): 1-15. http://www.eajournals.org/ al-ahmadi, h. (2014). anticipated nurses' turnover in public hospitals in saudi arabia. the international journal of human resource management.25(3):412 433.https://www.scirp.org doi:10.1080/09585192.2013.792856. al-gamal e., alhosain a., alsunaye k. (2018). stress and coping strategies among saudi nursing students during clinical education. perspectives in psychiatric care, 54(2), 198– 20510.1111/ppc.12223 pmid anand,s and nemera, n. (2015).stress and coping strategies among generic b.sc. nursing students of jimma university, south west ethiopia. international journal of recent advances in multidisciplinary research. 2(07); 0511-0517, brotobor, d., edeawe, o.i., owoeye, i.d., bankole, s.o., brotobor, o. and famuyide,o.k. (2021).stressors and stress management strategies adopted by student nurses in ambrose alli university nigeria. journal of medical research. 2(2):109-117).www.openjournalsnigeria.org.ng chapman,j.k,. scott,h. & rydon-grange,m.(2024). individual factors as predictors of secondary traumatic stress and burnout in forensic inpatient staff. journal of psychiatric and mental health nursing doi: 10.1111/jpm.13079 chernomas, w.m. & shapiro, c. (2013). stress, depression and anxiety among undergraduate nursing students. international journal of nursing education scholarship.10(1):255-266. https://www.scirp.org iyi, o. e. (2015). stress management and coping strategies among nurses, lovisa city, finland: a literature review. arcada. https://www.theseus.fi jarrad, r., hammad, s., shawashi, t. and mahmoud, n. (2018) compassion fatigue and substance use among nurses. annals of general psychiatry, 17(13). https://annals-general-psychiatry.biomedcentral.com https://doi.org/10.1186/s12991-0180183-5 pun, k. m., samson, p., & timalsina, r. (2018). stress, stress responses and coping strategies among bachelor nursing students. journal of patan academy of health sciences, 5(2), 74– 80.https://www.researchgate.netdoi.org/10.3126/jpahs.v5i2.24016 ijo journals volume 07 | issue 10 | october 2024 | https://ijojournals.com/index.php/hsn/index 13 https://www.tandfonline.com/toc/rijh20/25/3 https://www.scirp.org/ https://doi.org/10.1080/09585192.2013.792856 http://www.openjournalsnigeria.org.ng/ https://onlinelibrary.wiley.com/authored-by/chapman/katrina+jade https://onlinelibrary.wiley.com/authored-by/scott/helen https://onlinelibrary.wiley.com/authored-by/rydon%e2%80%90grange/michelle http://dx.doi.org/10.1111/jpm.13079 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) anieche john e.* https://ijojournals.com/ volume 07 || issue 10|| october, 2024 || academic stress and coping strategies among student nurses in colleges of nursing sciences in anambra state, nigeria khajehei, m ., & ziyadlou, s., hadzic, m &kashefi, f. (2011). the genesis and consequences of stress among midwifery students. british journal of midwifery.british journal of midwifery.19(6).379-385 https://www.magonlinelibrary.comdoi/abs/10.12968/bjom. khater, wejdan & akhu-zaheya, laila & shaban, insaf. (2014). sources of stress and coping behaviours in clinical practice among baccalaureate nursing students. international journal of humanities and social science. 4. 194-202. https://www.researchgate.net mahfouz,r.&alsahli,h. (2016). perceived stress and coping strategies among newly nurse students in clinical practiceshams university, cairo, egypt. journal of education and practice. 7(23).118.https://files.eric.ed.gov mohamed, b.m., &ahmed, e.s. perception of nursing students towards clinical stressors in the faculty of applied medical sciences-al jouf university – saudia arabia. journal of american science. 8(12):608-17. moustaka, a. &constantinidis, t. (2019). sources and effects of work-related stress in nursing. health science journal. 4(4), 210-216 oluwaseun, s. b &adeyinka, g. i. (2023) stress and coping strategies among baccalaureate nursing students in two selected universities in nigeria. international journal of innovation scientific research and review.05(03): 4120-4124 . http://www.journalijisr. pascoe, m. c., hetrick, s. e., & parker, a. g. (2019). the impact of stress on students in secondary school and higher education. international journal of adolescence and youth, 25(1), 104–112. https://doi.org/10.1080/02673843.2019.1596823 parveen a., inayat s. (2017). evaluation of factors of stress among nursing students. advanced practice nurse, 2(2), 13610.4172/2573-0347.1000136 regehr, c., glancy, d. & pitts, a. (2013). interventions to reduce stress in university students: a review and metaanalysis.journal of affective disorder.148(1), 1-11. roy, c. (2011) research based on the roy adaptation model: nursing science quarterly24(4):312320.doi:10.1177/0894318411419218.https://pubmed.ncbi.nlm.nih.gov/21 975478/ semel institute for neuroscience and human behaviour (2023). how do you cope 760 westwood plaza. los angeles, california. yes sir shoutal, c. (2009). chronic stress in the lives of college students: scale development and prospective prediction of distress. journal of youth and adolescence: 25:199-217. . 2010 feb;46(1):10-9. doi: 10.1007/s10597-009-9183-x. epub 2009 feb 20.https://pubmed.ncbi.nlm.nih.gov/19229610/ soares m.h, and oliveira f.s. (2013). the relation between alcohol, tobacco and stress in nursing students. smad. rev electronic saude mental alcohol drug: 9(2), 88-94. yasmin, s., hussain, m., parveen, s. & gilani, s.a. (2018). coping strategies of nursing student against academic and clinical stress at public sector labore. international journal of social sciences and management,5(3): 209-218. zeng, y., wang, g., xie, c., hu, x. & reinhardt, j.d. (2019). prevalence and correlates of depression, anxiety and symptoms of stress in vocational college nursing students from sichuan, china: a cross-sectional study. psychology, health & medicine, 24(7): 798-811. ijo journals volume 07 | issue 10 | october 2024 | https://ijojournals.com/index.php/hsn/index 14 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || management of dental erosive using composite layering technic and biomimetic efficiency management of dental erosive using composite layering technic and biomimetic efficiency rafalimino hn1,2, rakotonirina fp1,3, radadisolo mef4,5,randriamalala nc1,6, andrianjafinoro th1,2,ramaroson j1. 1sub-section of conservative odontology endodontic at the tropical odonto-stomatological institute of madagascar (iostm), university of mahajanga ² university hospital profesora zafisaona gabriel androva mahajanga madagascar, 3oral health center, ministry of industrialization, trade and consumption antananarivo, madagascar, 4sub-section odontology pediatric at the tropical odonto-stomatological institute of madagascar (iostm), university of mahajanga 5military hospital ampahibe,antananarivo, madagascar 6 university hospital joseph dieudonné rakotovao, befelatanana antananarivo, corresponding author: rafalimino holy nasandratra sub-section of conservative odontology endodontic at the tropical odonto-stomatological institute of madagascar (iostm), university of mahajanga abstract in the world, in 2006, the prevalence of dental wear was 46.9% among individuals aged 14 to 88 years. according to schlueter n and colleagues, by calculating an approximate average from available data, they estimated the average prevalence of dental erosion to be between 30 and 50% for deciduous teeth and between 20 and 45% for permanent teeth worldwide. they found that patients with gastro esophageal reflux (gerd) and eating disorders associated with vomiting had a clear impact on the prevalence of erosion. regardless of the type of dental substance loss in the anterior sector, composite crown restoration remains the most chosen restorative therapy by dentists. located in the anterior region, these types of dental substance losses affect aesthetics and make the smile unattractive. the individual's personality is disturbed as well as their communicative life. the objective of this article was to present the case of a patient with dental erosions in the anterior sector, managed by the composite layering technique, and to demonstrate the biomimetic efficiency of the restoration. keywords: biomimetic, dental erosion, layering, direct technique 1. introduction faced with dental substance loss due to decay or tooth wear, composite crown restoration remains the primary restorative therapeutic option chosen by the dentist. dental erosion is a chemical process characterized by acid dissolution of dental hard tissue not involving acids ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 7 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || management of dental erosive using composite layering technic and biomimetic efficiency of bacterial origin. erosive demineralization can result in progressive, irreversible loss of tooth mineral substance, and may be caused by intrinsic factors like acid reflux and excessive vomiting[1].located in the anterior region, these types of dental substance loses diminish aesthetics and make the smile unattractive. the individual's personality is disturbed as well as their communicative life. the objective of this article was to present the case of a patient with dental erosions in the anterior sector, managed by the composite layering technique, and to identify the factors determining the biomimetic success of the restoration. 2. observation this concerns a 44-year-old female patient, working as a client manager, who came to consult us at the specialized odontostomatology center in mahajanga. her reason for consultation was an aesthetic concern. upon examination of her general condition, the patient appears to be in good health, except that she frequently experiences almost daily gastro esophageal reflux. in order to limit this gastric problem, the patient frequently drinks lemon juice outside of meals. on physical examination, the extra-oral examination showed the absence of palpable or painful adenopathy in the submandibular, jugular-carotid, and supraclavicular areas. the intra-oral examination of the patient's hard tissues showed the presence of blatant erosive dental substance loss on the upper right and left central incisors. the dental wear was of moderate erosive type, with a bewe score of 2, an ace class iv, with a yellowish background indicating dentin exposure. the extent of the involvement includes the vestibular surface, the central incisal angle, one-third of the proximal surfaces, and onethird of the palatal surface of each tooth. the percentage of hard dental tissue involvement was less than 5%. aggravated by the patient's dietary habits, this dental erosion was observed to be actively progressing and requires immediate management to prevent further wear to other sextants. after a refined analysis of the remaining dental tissues, we opted for management by composite layering. our therapeutic choice was motivated by the importance of adhering to the therapeutic gradient developed by tirlet and colleagues and the biomimetic dental restoration principle presented by pascal m and colleagues. referring to the literature data, we adapted our therapeutic protocol according to the available technical resources. the technical setup used included a visual aid, a conservative dentistry examination tray, a mouth opener, a full-arch impression tray, type a alginate, high-viscosity silicone, a wax-up plate, a pkt-type instrument, a heidemann® spatula, a dental wedge, some micro-applicators, a turbine, a green-band contra-angle, diamond ball burs, composite finishing burs, an etching system, an mr3-type adhesive system, a micerium® enamel plus hfo enamel composite, a micerium® enamel plus hri enamel composite, a charm fill plus® dentin composite in shade a3.5, a charm fill plus® composite in shade a3, a celluloid matrix, composite restoration spatulas, 40µm thick articulating paper, a silicone composite finishing kit, a 12-megapixel camera. the therapeutic protocol presented was consented to by the ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 8 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || management of dental erosive using composite layering technic and biomimetic efficiency patient. in addition to patient clinical observation, eight steps were developed, including pre-stratification analysis of the causative tooth, making a silicone guide key, preparing the tooth for restoration, etching, applying the adhesive system, composite placement, composite finishing, and composite polishing. pre-stratification analysis of the teeth to be restored was performed based on the anatomical shape and color of adjacent teeth. a visual chromatic analysis was performed in the absence of a spectrophotometer. a personalized shade taking was made using the chosen composites for restoration, which helped us assess the difference in dental tissue saturation. in addition to photography, a chromatography card of the two teeth to be restored was useful in guiding us on the choice of composites to use for each tissue to be restored. brightness, enamel and dentin color, and intensity presence were noted on our chromatographic card. for shades, the dentin body was restored with charm fill® composite shade a3.5 at the cervical 2/3, the incisal 1/3 part was restored by charm fill composite shade a3, the dentin nipple was restored by charm fill® composite shade a2, the enamel on the vestibular and palatal surfaces was restored by hfo type obn® enamel composite, and characterization was restored by enamel plus hri composite by micerium®. after the patient's consent to the therapeutic proposal, an impression was taken with type a alginate followed by pouring the positive model in plaster. modeling of the desired morphology of the teeth to be restored was performed with cera reus dental® modeling wax, followed by an impression of the positive model with highviscosity putty silicone. to obtain the silicone guide key, the hardened silicone was cut in such a way that only the palatal part was preserved. its adaptation was checked in the mouth. prior to composite placement, a tooth preparation step was developed by forming a vestibular chamfer limit and a palatal "butt margin". we then opted for a two-step etching and bonding system by applying 37% phosphoric acid for 15 seconds at the enamel level followed by rinsing, and bonding with charmbond® photopolymerizable mono-component. the curing time was 30 seconds. the actual stratification began with the palatal aspect, then the proximal surfaces, the dentin body, and was finalized by the vestibular enamel. our goal was to build walls from the restorations to transform the lack of dental substance into a simple cavity. to do this, the previously prepared silicone key was placed on the palatal side after applying the non-photo-polymerized palatal enamel composite layer with the heidemann spatula. photo polymerization was activated after checking the key's positioning. then the proximal walls were restored using a matrix system such as celluloid strip. dentin masses in different shades were applied while respecting their respective positions recorded in the chromatography card. we ensured that the composite thickness did not exceed 2mm before each photopolymerization. part of the characterization was reproduced at the dentin nipple edge using enamel plus hri® composite. before polymerization, while respecting the surrounding tissues, the vestibular enamel layer was finally placed by tapping without ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 9 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || management of dental erosive using composite layering technic and biomimetic efficiency compressing the composite. as we did not have modeling resin®, smoothing was done with a micro-brush soaked in adhesive. the superficial enamel composite layer was checked to ensure it covers the vestibular chamfer to mask the tooth-restoration junction, and the thickness and optical effect were verified. primary and secondary anatomies were recreated based on adjacent teeth using diamond flame burs and round-ended cylindrical burs. after checking for occlusal discrepancies, the polishing step was performed, with decreasing grit size pop-on discs mounted on blue-band contra-angle used. the operative procedure lasted 60 minutes for the restoration of each tooth. biomimetic effectiveness was assessed after 24 hours of composite restoration rehydration and then after twenty-nine months of restoration. simultaneously, the patient was advised to discontinue acidic dietary habits. dietary hygiene education was provided to the patient. for the management of gastro esophageal reflux, she was referred to a gastroenterologist. 3. results after twenty-four hours of restoration, the tooth was checked, and rehydration was achieved, comparing it with the adjacent natural tooth considered as reference (figure 11). after 29 months of tooth restoration, we found that the biomimetic efficiency obtained was maintained, and we concluded that the ultra-conservative approach and the composite layering principle were effective and sustainable for our clinical case (figure 12). ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 10 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || management of dental erosive using composite layering technic and biomimetic efficiency 4. discussion according to the literature, the aesthetic success of a composite layering restoration has depended on the following factors: the choice of composite shades, the type of composite used, and the composite layering system. 4.1 aesthetic effectiveness of layering depending on the choice of composite shade during the pre-stratification stage, the choice of shade and the recording of the five dimensions of tooth color for a composite restoration have been discussed depending on the type of shade guide used. according to vanini, the use of the vita® shade guide combined with the concept of chromatography has served as a means of communication for practitioners, refining and noting all parameters contributing to tooth color restoration[35].for our clinical case, our shading concept was based on two principles: the use of a custom shade guide combined with the chromatography concept. this custom shade guide, made with the same types of composites used, helped us achieve precise shades for each composite layer to be restored and yielded an optimal and aesthetic result. this finding is consistent with the study by magne b and colleagues in 2010 and the study by manauti and ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 11 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || management of dental erosive using composite layering technic and biomimetic efficiency colleagues in 2014, which evaluated the effectiveness of the custom shade guide for choosing composite shades compared to ceramic shade guides. the use of the chromatography guide was a very effective reference tool to avoid errors in placing each type of composite [6-8]. using these two principles simultaneously yielded an aesthetically pleasing and biomimetic result. 4.2 aesthetic effectiveness depending on the use of the silicone key in terms of composite layering, we opted for using a single silicone guide key, which has been affirmed by kleeberger b and colleagues in 2008 and callin d and colleagues in 2014 as a key factor for aesthetic success and longevity of the restoration[9-10]. 4.3 aesthetic effectiveness depending on tooth form restoration regarding the form of tooth-restoration boundary, the use of a chamfer margin on the vestibular aspect and a butt margin on the proximal and palatal aspects has been suggested by vanini and colleagues to combine aesthetic appearance with mechanical performance of the restoration[4]. for our clinical case, using chamfer margin on the vestibular aspect and butt margin on the palatal aspect, combined with adequate polishing, resulted in optimal aesthetic effectiveness.the ability to delimit the thickness of composite layers has been cited as a determining factor for the success of a restoration. in their layering practice, dionysopoulos and colleagues in 2020 and alleman and colleagues in 2017 emphasized the importance of limiting the thickness of the composite layers to less than 2mm to avoid the grayish effect of the restoration. for our clinical case, to reduce stress during polymerization, the thickness of the increment was limited to less than 2mm during the application of the dentin body and superficial dentin layers. the longevity of our therapeutic success marked this observation[11-12]. 4.5 aesthetic effectiveness depending on composite mounting technique the layering technique chosen for our case was the modern three-layer histological layering technique. our therapeutic choice was motivated by the principle of layering respecting the natural arrangement of dental tissues. according to clinical practice of this principle by several authors, its aesthetic effectiveness has been affirmed[13-14]. conclusion according to the philosophy of the author magné p, biomimetic restorative dentistry involves respecting the natural structure and using it as a guide for restoration. the objective of this article was to present the case of a patient with dental erosions in the anterior sector, managed by the composite layering technique, and to discuss the expected results. the main ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 12 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || management of dental erosive using composite layering technic and biomimetic efficiency factors that optimized the aesthetic success of our restoration were: the use of a custom shade guide combined with the concept of chromatography, chamfer margin on the vestibular aspect and butt margin on the palatal aspect, the use of a single silicone guide key for mounting the palatal and proximal walls, adherence to the thickness of each composite layer not exceeding 2mm, and the composite layering system in three layers respecting the natural structure of dental tissues. these principles helped us achieve biomimetic efficiency of the crown restoration and the longevity of the restoration. in order to consolidate the benefits obtained through biomimetic practice, an effective matrix system should be analyzed. conflicts of interests we, the authors of this manuscript, declare no conflicts of interest regarding the publication of this article. patient consent the patient has given full permission for the publication other use of his clinical case and photographs. references 1. herman k. wpływ diety wegetariańskiej na występowanie erozji zębów. dent med probl. 2005;42(3):457-63 2. gandara bk, truelove el. diagnosis and management of dental erosion. j cont dent pract. 1999;1(1):1-17 3. vanini l, mangani f. the five color dimension of the teeth: a new way of determination and communication of the color in composite resin restorations. practical periodontology an aesthetic dentistry. 2001 : 19-6. 4. vanini l. restauration au composite des secteurs antérieurs. technique de stratification anatomique. information dentaire.2006 ; 88 (37) : 22-91. 5. dietschi d, fahl n. shading concepts and layering techniques to master direct anterior composite restorations: an udapte. br dent j. 2016 ; 765 – 71. 6. bazos p, magne p. bio-emulation: biomimetically emulating nature utilizing a histoanatomic approach; visual synthesis. the int j of esthetic dent. 2014 : 330 – 52. 7. magne p. adhesion, biomatériaux, cfao. biomimétique restauratrice sans tenons ni couronnes. biomatériaux clin. 2017 ; 1 (1) : 16 – 25. 8. manauti j, salat a, putignan w, devoto w, paolones g, hardan ls. stratification in anterior teeth using one dentine shade and predefinied thickness of enamel : a new concept in composite layering – part ii. tropical dental journal. 2014 : 5-12. ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 13 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rafalimino holy nasandratra1* https://ijojournals.com/ volume 07 || issue 04 || april, 2024 || management of dental erosive using composite layering technic and biomimetic efficiency 9. kleeberger b. restauration esthétique et fonctionnelle à l’aide de résine composite direct. jadc. 2008 : 345 -50. 10. callin d, mitrea m. anatomical and histological stratification of composite resin in esthetic anterior restoration. clinical anatomy. 2014 ; 404 – 06. 11. dionysopoulus d, gerasimidou o. biomimetic dentistry : basic principles and protocols. journal arc dental research. 2020; 1-3. 12. alleman ds, nejad ma. the protocols of biomimetic restorative dentistry : 2002 to 2017. inside dentistry. 2017 : 64-70. 13. dietschi d. layering concepts in anterior composite restorations. j adhesiv dent. 2001 ; 1-3. 14. roux t, cazier s, romain c. la stratification des composites esthétiques. quelles méthodes pour quel résultat ? information dentaire. 2012 ; 2-6. ijo journals volume 07 | issue 04 | april 2024 | https://ijojournals.com/index.php/hsn/index 14 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “epidemiological and clinical profile of non-restored edentulousness in the town of fianarantsoa madagascar." epidemiological and clinical profile of non-restored edentulousness in the town of fianarantsoa madagascar authors: ratsimandresy naomy namboarintsoa1, razanadraisoa albertine1, rakotoniaina iagarinosy fanomezantsoa shaffi2,rabarijaona hsn1, ralaiarimanana liantsoa fanja emmanuel1 1 dental prosthesis section, institutd'odonto-stomatologie tropicale de madagascar (iostm, university of mahajanga) 2 private dental practice in antananarivo corresponding author: ratsimandresy naomy namboarintsoa, dental prosthesis section, institutd'odonto-stomatologie tropicale de madagascar (iostm, university of mahajanga), bp : 98 mahajanga madagascar abstract background: despite policies to prevent oral diseases, there are still many partially or completely edentulous patients. the aim of this study was to describe the epidemiological and clinical profile of unrestored edentulousness in the city of fianarantsoa. methods:this work was carried out in the stomatology department of chu tambobe and csb ii anjoma on 207 people who came to these two departments for treatment, presenting with at least one missing permanent tooth. the number of missing teeth, the causes of edentulousness, the obstacles to wearing a prosthesis and the complications of edentulousness were assessed. results: it was found that the average number of missing teeth was 5.37 ± 2.4 per person. ninety-seven point one percent (97.1%) of the causes of edentulousness were caries-related, and 36.7% of edentulous patients cited financial problems as an obstacle to wearing dentures. uncompensated edentulousness had repercussions not only in functional, anatomical and aesthetic terms, but also on the general health of the individual. conclusion: it is necessary to raise awareness of the importance of wearing dentures and to inform the general public about them. key words: edentulousness, prosthetic restoration, clinic ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 106 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “epidemiological and clinical profile of non-restored edentulousness in the town of fianarantsoa madagascar." introduction edentulousness is a major public health problem worldwide, due to its high prevalence. according to world health organization (who) estimates for 2022, the global average prevalence of edentulousness is almost 7% in people aged 20 or over. for people aged 60 or over, the estimated global prevalence of edentulousness is much higher, at 23% [1]. in senegal in 2015, a study on the prevalence of edentulousness recorded a rate of 40.9% [2]. tooth loss is usually the result of a lifelong history of disease, mainly advanced caries and severe periodontal disease, but it can also be due to trauma and other causes, all of which can lead to tooth extraction. it can also be a consequence of poor oral health services in resourcepoor settings where restorative and prosthetic care is generally unavailable or unaffordable [3]. in fact, prosthetic restoration is a solution for remedying the consequences of edentulousness. the treatment that uses prosthetic restoration will depend on the clinical characteristics of the edentulousness [4]. lost teeth should normally be restored with the various types of dental prosthesis such as fixed prosthesis, removable prosthesis and implant-supported prosthesis; however, edentulous people do not necessarily have this attitude, whereas the repercussions of tooth loss affect not only the oro-facial sphere but also the well-being of the individual [5]. for the city of fianarantsoa, a study in 2016 found that 59.8% of edentulous people had not had their teeth restored [5]. knowing the characteristics of these edentulous people will make it possible to take action to remedy problems relating to edentulousness. hence the interest of this study, the aim of which is to describe the epidemiological and clinical profile of unrestored edentulousness in the city of fianarantsoa. methods this study was carried out in two public dental practices in the city of fianarantsoa: the stomatology department of the chu tambobe and the dental practice of the csb ii anjoma. this was a descriptive cross-sectional study conducted between march and may 2022. all people who came for treatment, had at least one permanent tooth missing for more than a month, had not been compensated and agreed to take part in the survey were included. all those who met the inclusion criteria during the study period were retained, and a total of 207 patients were enrolled. the following variables were studied: universal variables, independent variables such as the number of missing teeth, the class of edentulousness, the causes of edentulousness, the ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 107 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “epidemiological and clinical profile of non-restored edentulousness in the town of fianarantsoa madagascar." obstacles to wearing prosthesis, and the dependent variable linked to the complications of edentulousness. a survey technique in the form of an interview was adopted to obtain epidemiological data and a clinical examination was carried out to record clinical information. results table 1: distribution of patients by socio-demographic characteristics socio-demographic characteristics n % gender male 115 55,6 sex-ratio = 1,25 female 92 44,4 age 15 to 30 years old 73 35,3 moyenne d’âge = 47,2 ± 3,6 ans 31 à 50 91 44 51 and over 43 20,8 occupation unemployed 38 18,4 student 50 24,2 employed 56 27,1 liberal 48 23,2 retired 15 7,2 total 207 100,0 table 1 summarises the distribution of patients according to socio-demographic characteristics. in terms of gender, the study population was predominantly male, with a sex ratio of 1.25. as for age, the mean age was 47.2±3.6 years, and the largest age group was between 31 and 50 years.occupation varied from unemployed to retired. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 108 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “epidemiological and clinical profile of non-restored edentulousness in the town of fianarantsoa madagascar." table 2: distribution of patients by the number of missing teeth number of missing teeth n % 1 to 5 126 60,9 average number of missing teeth = 5.37 ± 1.84 per person 6 to 10 60 29 11 to 20 16 7,7 21 to 25 5 2,4 total 207 100,0 according to table 2, the average number of missing teeth per person was 5.37± 1.84 per person. and the majority (60.9%) of the population had between one to five missing teeth in their mouths. table 3: distribution of patients by causes of edentulousness causes of edentulousness n % tooth decay 201 97,1 periodontal disease 0 0 trauma 6 2,9 total 207 100,0 according to the causes of edentulousness (reported in table 3), dental caries is the leading cause at 97.1%. table 4: distribution of patients according to obstacles to wearing a prosthesis obstacles to wearing a prosthesis n % family history 1 0,5 financial 76 36,7 neglect 43 20,8 lack of information 22 10,6 lack of time 13 6,3 discomfort when wearing a prosthesis 31 15 aesthetic carelessness 21 10,1 total 207 100,0 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 109 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “epidemiological and clinical profile of non-restored edentulousness in the town of fianarantsoa madagascar." according to table 4, various reasons were given for the obstacles to wearing prosthesis, but the majority (36.7%) of respondents noted financial problems. table 5: distribution of patients according to type of mastication and number of missing teeth type of mastication number of missing teeth 1-5 teeth 6-10 teeth 11-20 teeth 20 teeth and more p n(%) n(%) n(%) n(%) normal mastication 120(95.2) 36(60.0) 5(31.3) 1(20.0) 0.000*** pathological mastication 6(4.8) 24(40.0) 11(68.7) 4(80.0) total 126(100.0) 60(100.0) 16(100.0) 5(100.0à there is a highly significant difference (p=0,000) between the type of mastication and the number of missing teeth (table 5). moreover, it has been found that pathological mastication increases with the number of missing teeth; the higher the number of missing teeth, the greater the increase in pathological mastication. discussion causes ofedentulousness in terms of the causes of edentulousness, dental caries is the leading cause at 97.1%. several authors confirm that tooth loss is generally the result of a lifelong history of disease, mainly advanced caries [3, 6]. number of missing teeth our study population had an average of 5.37 ± 1.84 lost teeth per person. this is much lower than the average number of missing teeth found by ratsimandresy and al. in fianarantsoa in 2016 which was 8.57 [5] and by batista and al. in brazil in 2015 which was 8.52 [7]. obstacles to wearing prosthesis with regard to obstacles to wearing dentures, it was found that the main obstacle to wearing dentures was financial problems, cited by 36.7% of respondents. a similar result was ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 110 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “epidemiological and clinical profile of non-restored edentulousness in the town of fianarantsoa madagascar." reported by the study carried out in 2016 in fianarantsoa by ratsimandresy's team, who found that the financial reason was the main obstacle preventing edentulous people from wearing prostheses 36.4% [5]. number of missing teeth and type of mastication there is a highly significant difference between the type of chewing and the number of missing teeth. pathological mastication increases with the number of missing teeth, and the higher the number of missing teeth, the more pathological the mastication. according to some authors, the loss of natural teeth alters the masticatory function. this impairment is correlated with the number of missing teeth [8, 9]. postaire also adds that the number of missing teeth does influence masticatory efficiency, particularly below 10 pairs of teeth in occlusion [10]. conclusion in conclusion, this study described the epidemio-clinical profile of unrestored edentulousness in the city of fianarantsoa. it was found that 97.1% of edentulous teeth were caused by dental caries, followed by financial problems (36.7%), which were the main obstacle to edentulous people not wearing dentures. finally, the repercussions of edentulousness extend to the patient's aesthetic and functional appearance. in functional terms, mastication is the first function to be affected. acknowledgments none conflict of interest authors declare no conflict of interest. references 1. world health organisation (2022). global oral health status report: towards universal health coverage for oral health by 2030:44 2. gueye me, dieng l, seck ak, toure a, thioune n (2015). evaluation of the prevalence of edentulism in an urban population in senegal. rev iv odonto-stomatol;17 (2):15-20 3. peres ma, macpherson lmd, weyant rj, daly b, venturelli r, marthur mr and al (2019). oral diseases: a global public health challenge. lancet ;394(10194) :249-60. doi:10.1016/so1406736(19)31146-8 4. ratsimandresy nn, delina n, ralaiarimanana lfe (2023). epidemio-clinical profile of edentulousness of patients who came for prosthetic restoration to the dental care and ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 111 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “epidemiological and clinical profile of non-restored edentulousness in the town of fianarantsoa madagascar." treatment centre in mahajanga from 2015 to 2019. online journal of dentistry & oral health.6:1-5 5. ratsimandresy nn, rakotondratsara ma, ralaiarimanana lfe (2020). knowledge, attitude and practice of the population of the city of fianarantsoa towards the replacement of missing teeth. revue d'odontostomatologie malgache en ligne issn 2220-069x2020;18:01-10 6. al-rafee ma (2020). the epidemiology of edentulism and the associated factors: a literature review. journal of family medicine and primary care;9(4):1841-3 7. batista mj, lawrence hp (2015). tooth loss classification: factors associated with a new classification in an adult population group. cien saude colet ; 20(9) : 2825-35 8. natapov l, kushnir d, goldsmith r, dichtiar r, zusman sp (2018). dental status, visits, and functional ability and dietary intake of elderly in israel. israel journal of health policy research ;7(1):58. 9. okamoto n, amano n, nakamura t, yanagi m (2019). relationship between tooth loss, low masticatory ability, and nutritional indices in the elderly: a cross-sectional study. bmc oral health ;19(1):110. 10. postaire m, boittin a (2016). edentulism and mastication. les cahiers de prothèse ;176:23-7 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 112 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || cad/cam (computer-aided design and manufacturing) fixed prosthesis : current situation in madagascar research article lalanirina gaël lauricia 1, alijaona diarivalisoa faneva1, razanadraisoa albertine 1, andrianasolo volahasina valentina 1, ranaivo joachim marco 1, randrianarivony jeannot 3 and ralaiarimanana liantsoa fanja emmanuel 1 1department of dental prosthetics institute of tropical odonto-stomatology of madagascar – university of mahajanga – madagascar 2 director of the institute of tropical odonto-stomatology of madagascar, department of dental prosthetics corresponding author : lalanirina gaël lauricia dentistry department, pzaga university hospital center, mahajanga department of dental prosthesis, institute of tropical odonto-stomatology of madagascar (iostm) abstract cad/cam or computer aided design and fabrication is a technique used in dentistry to design and fabricate crowns, bridges and veneers in fixed prosthetics. this approach enables good prosthetic results to be achieved, and is highly practical and comfortable for both odontostomatologists and patients. the aim of this study was to describe the knowledge and practice of cad/cam fixed prosthodontics in the cities of fianarantsoa and antananarivo. it was a descriptive cross-sectional study involving 81 registered odontostomatologists who agreed to take part in the survey, and those who passed through the study sites, did not fill in their forms correctly and had never heard of cad/cam were excluded. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 12 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || the results showed that 35.8% of odontostomatologists were familiar with cad/cam and 11.1% of them used it for the fabrication of fixed prostheses such as single crowns (100%), inlays, onlays and veneers (88.8%) and multi-unit restorations (55%). indirect cad/cam was most widely used (100%), and its use was highly correlated with participation in specific cad/cam training courses (p=0.000) and knowledge of cad/cam (p=0.001). practitioners stated that this system offered time savings and improved ergonomics. we therefore suggest that odontostomatologists attend regular training courses to keep abreast of technological advances. the installation of this system at the chu and the dental school in madagascar could improve this situation. key words: cad/cam, fixed prosthesis introduction cad/cam, which stands for computer-aided design and manufacture, encompasses all the equipment used in the field of dentistry by the digital chain, from modelling to the manufacture of dental prostheses [1]. in fixed prosthetics, cad/cam is used to produce inlays, onlays, veneers, crowns, inlay-cores and bridge frameworks, and to improve the precision of fit. according to a 2014 study, prostheses fabricated by machining have a more accurate and better marginal fit (48 ± 25μm) compared to conventionally fabricated prostheses (74 ± 47μm)[2].the improvement in the quality of conjoined prostheses comes from the reproducibility, reduction and simplification of shaping steps. today, many dental practices and laboratories are equipped with this cad/cam system to produce dental prostheses. in france, only 3% of dentists have adopted a fully digital dental practice, according to jf choura [3]. the rate of cad/cam use was 40%, of which more than half of these practitioners owned a machining centre in 2017[4]. in switzerland, a survey of members of the swiss dental association revealed that 23% of practices surveyed were equipped with a chairside ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 13 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || cad/cam system [5]. in addition, a survey of us navy dental clinics and laboratories confirmed that, as of june 2017, more than a third of indirect restorations supplied (38.1%) were fabricated by a cad/cam system [6]. clearly, many advances and innovations will flow from this technique. however, few studies have been conducted on cad/cam in madagascar. we hypothesized that the transition to digital prosthodontics represents a delicate transition for odontostomatologists in madagascar. the overall aim of this study was to describe awareness and practice of the cad/cam system for fixed prosthetics in the cities of fianarantsoa and antananarivo. methodology study location : this study was carried out in dental practices in the cities of fianarantsoa and antananarivo. type of study : this is a cross-sectional prospective descriptive study. study period : the survey was conducted over a 6-week period, from june 12 to july 21 -2023. study population : the study population consisted of all odontostomatologists in the cities of fianarantsoa and antananarivo. inclusion criteria : registered odontostomatologists who cooperated with the survey. exclusion criteria : odontostomatologists passing through the study sites, who had not correctly filled in their forms and had never heard of cad/cam were excluded. sample size : our sampling was exhaustive, with a sample size of 81 odontostomatologists. studied variables the following independent variables were taken into account in this study: gender, age group, length of practice, ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 14 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || practice area, type of fixed prosthesis used type of cad/cam. the dependent variables were as follows: odontostomatologists' knowledge of the cad/cam system odontostomatologists' use of the cad/cam system. data collection in fianarantsoa, data were collected using a questionnaire-interview survey of odontostomatologists. in antananarivo, however, the distribution of the forms was entrusted to a trustworthy person, supported by a telephone call to introduce him/herself to the odontostomatologists; the survey was carried out by selfadministration, i.e. we collected the survey forms when the odontostomatologists had already filled them in. data processing and analysis the data collected were entered on the computer using microsoft word and excel. statistical analysis was performed using spss 20.0 (statistical package for the social science) on windows. descriptive statistics presented the characteristics of participating odontostomatologists, and frequency tables were generated to illustrate responses to questions. the chi-square test was used for bi-variate analysis, and a p-value of less than 0.05 was considered significant. ethical and deontological considerations authorization to carry out the survey was granted by the institut d'odontostomatologie tropicale de madagascar and the ordre national. odontostomatologists who gave their consent were surveyed. the confidentiality of data and the anonymity of respondents were respected throughout the study. conflict of interest : none ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 15 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || results table i : distribution of odontostomatologists by socio-professional profile socio-professional profile effective (n) proportion (%) gender male 42 51.9 feminine 39 48.1 age range under 34 29 35.8 35 and over 52 64.2 sector of practice public 23 28.4 private 56 69.1 military 2 2.5 length of service less than 10 years 32 39.5 11 to 20 years 27 33.3 21 years and over 22 27.2 place of service fianarantsoa 15 18.5 antananarivo 66 81.5 table ii : distribution of odontostomatologists according to place of training and completion of specific cad/cam training courses training effective (n) proportion (%) training location madagascar 69 85.2 abroad 3 3.7 ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 16 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || madagascar and abroad 9 11.1 total 81 100 follow-up to specific cad/cam training courses yes 29 35.8 no 52 64.2 total 81 100 table iii : distribution of odontostomatologists according to knowledge and practice of the cad/cam system yes n(%) no n(%) total n(%) knowledge of the cad/cam system (exact answer on types and steps to follow) 29(35.8) 52(64.2) 81(100) practice of the cad/cam system 9(11.1) 72(88.9) 81(100) if yes, types of cad/cam practiced direct cad/cam 2 (22.2) 7 (77.8) 9 (100) semi-direct cad/cam 4 (44.4) 5(55.6) 9 (100) indirect cad/cam 9 (100) 0(0) 9 (100) types of fixed prosthesis performed full-coverage crown 9 (100) 0(0) 9 (100) partial veneer crown 8 (88.8) 1 (11.2) 9 (100) substitute crown 6 (66.6) 3 (33.4) 9 (100) bridge 5 (55.5) 4 (44.5) 9 (100) ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 17 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || table i: distribution of odontostomatologists (n=72) who do not use the cad/cam system, by reason for practice reasons for not using cad/cam effective n=72 proportion (%) lack of training yes 53 73.6 no 19 26.4 financial reason yes 59 81.9 no 13 18.1 profitability problem yes 40 55.6 no 32 44.4 dependency yes 2 2.8 no 70 97.2 table v : distribution of odontostomatologists according to the change felt since the introduction of cad/cam fixed prosthetics (n=9) yes n (%) no n(%) total n (%) time saving 9 (100) 0 (0) 9 (100) better ergonomics 9 (100) 0 (0) 9 (100) greater patient comfort 7 (77.8) 2 (22.2) 9 (100) longer prosthesis life 7 (77.8) 2 (22.2) 9 (100) greater precision 9 (100) 00 9 (100) ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 18 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) lalanirina gaël lauricia ¹* https://ijojournals.com/ volume 07 || issue 02 || february, 2024 || better aesthetics 9 (100) 00 9 (100) table ii: distribution of os according to the relationship between fixed prosthetic practice and knowledge of the cad/cam system cad/cam knowledge practice of fixed prosthetics with cad/cam systems yes n(%) no n(%) total n(%) p yes 8 (27.6) 21 (72.4) 29 (100) 0.001 no 1 (1.9) 51 (98.1) 52 (100) ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 19 table vii : distribution of odontostomatologists according to knowledge and practice of the cad/cam system and training knowledge of the cad/cam system cad/cam system practice yes n(%) no n(%) total n(%) p yes n(%) no n(%) total p training location madagascar 18 (26.1) 51 (73.9) 69 (100) 0.000 7 (10.1) 62 (89.9) 69 (100) 0.457 abroad 3 (100) 0 (0.0) 3(100) 1 (33.3) 2 (66.7) 3(100) madagascar and abroad 8 (88.9) 1 (11.1) 9 (100) 1 (11.1) 8 (88.9) 9 (100) specific training in cad/cam yes 6 (100) 0 (0.0) 6(100) 0.001 9 (64.3) 5 (35.7) 14(100) 0.000 no 23 (30.7) 52 (64.2) 75 (100) 0 (0) 67 (100) 67 (100) ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 20 discussion in this scientific study, we surveyed 91 odontostomatologists, including 15 (18.5%) in fianarantsoa and 66 (81.5%) in antananarivo, to describe their knowledge and practice of cad/cam in fixed prosthetics.  socio-professional profile of odontostomatologists the study reported a higher proportion of males (51.9%), with a sex ratio of 1.07. this is in line with the study by guinan jc et al, who found a value of 56.7% in 2022 in côte d'ivoire[7]. we can say that even if all odontostomatologists had access to the same cad/cam tools and software, men were more likely to use new technologies to design and manufacture fixed dental prostheses. sixty-four point two percent (64.2%) of respondents were over 35, with an average age of 44.5. this result is similar to that of hélène n in 2022, where the over 33 age group was predominant, with a rate of 62.5%[8]. sixty-nine point one percent (69.1%) of respondents worked in private dental practices and 28.4% in public dental practices. this is justified by the fact that experienced graduates tend to promote the opening of their own private dental practices. these results are similar to those of amrani alaoui et al in morocco in 2022, who reported that 56% of respondents worked in private dental practices and 30% in public dental practices[9]. most odontostomatologists (39.5%) had been practicing for less than 10 years. similar assertion, a study conducted by mbede net al, in 2022, in yaoundé showed that 63% of oss had been practicing for less than five years [10]. nearly all participants (85.2%) received their initial training in madagascar, and only 14.8% obtained their diploma abroad. not only for financial reasons (tuition fees, cost of living), but also because of geographical distance, odontostomatologists may be discouraged from pursuing their studies abroad. whereas in romania, according to a study published in september 2017, a third of oss graduated abroad [11]. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 21  knowledge of the cad/cam system for fixed prosthetics of those surveyed, only 35.8% knew exactly what the cad/cam system was (type of cad/cam and the steps involved in producing fixed prostheses using this system) (table iii). this could be explained by the fact that knowledge of new technologies depends on the availability of such training and awareness in the country. in addition, some odontostomatologists wanted to use more traditional methods in their practice. this rate of knowledge remains very low compared to that of janani in 2018,who revealed that in france, all practitioners, declared 100% knowledge of cad/cam regardless of their geographical location[12]. knowledge of the cad/cam system is very significantly linked to participation in specific cad/cam system training ( p=0.001) and highly significant with training location with a p=0.000 (table 8). training enables staff to acquire new knowledge in order to improve their practice. this result corroborates with the study carried out in 2017 in france, where one practitioner in two had undergone specific cad/cam training [13].  use of the cad/cam system in fixed prosthetics in this study, 11% of dental surgeons used the cad/cam system in fixed prosthetics, while 89% of dental surgeons surveyed said they did not. this rate of non-use of the cad/cam system in this study is very high compared with a study carried out in the uk, where only 55.6% did not use cad/cam [14]. according to practitioners who were not cad/cam users, the main obstacles to cad/cam were high costs (81.9%), lack of training for 73.6% of os; profitability problems (55.6%) and dependency (2.8%) (table iv). the adoption of new technologies could take time and depend on various factors such as access to training, resources and individual preferences. this result corroborates with that of petridis in 2016, who argued that in the uk, various reasons explain why some practitioners did not use cad/cam, but the majority reason was the cost of cad/cam machines and lack or absence of training for 55.6% of participants [14]. for dental surgeons using the cad/cam system, the indirect technique was the most widely used for the design and manufacture of their fixed prosthesis ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 22 (100%) (tableiii). this means that ownership of cad/cam equipment in the dental practice is low. these results are at odds with that of jananien 2018, where 25% of practitioners produced their prosthesis by cad/cam indirectly[12]. however, the indirect technique only concerns the laboratory part, and does not change the daily practice of odontostomatologists. indeed, many odontostomatologists who are not cad/cam users may have practised indirect cad/cam without being aware of it. this bias may have distorted the survey results. the total (100%) and partial (88.8%) veneering crown, the substitution crown (66.6%) and the bridge (55.5%) were fabricated using the cad/cam system (table iii). these results are in line with those of elkriefm in 2017, where 88% of practitioners used it for fixed unit prosthetics, 59% for fixed plural prosthetics and 56% for restorative dentistry such as inlays, onlays and veneers[4]. another study conducted by fabry j in 2018 reported that, in terms of clinical application, 98% of the odontostomatologists surveyed used chairside cad/cam for the fabrication of single-unit prosthetic crowns and for inlay and onlay restorations[15]. all practitioners confirmed that using the cad/cam system in fixed prosthetics offers time savings, improved ergonomics, prosthetic precision and also better aesthetics. seventy-seven point eight percent (77.8%) of odontostomatologists added that cad/cam improved patient comfort and prosthetic longevity. these advantages were also reported by janani et al. in their study, albeit to a lesser extent[12]. the use of cad/cam in fixed prosthetics was strongly correlated with participation in a specific training course (p=0.000) and knowledge (p=0.001) of this system (table 6).this could be explained by the fact that it is continuing education that enables odontostomatologists to keep up to date with technological advances and to understand the best practices and protocols recommended for achieving optimal aesthetic and functional results with dental cad/cam. the lack of willingness to train in new dental technologies may partly explain the reduced presence of cad/cam in dental practices [16]. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 23 conclusion cad/cam is a technology that combines the use of intra-oral scanners, computer-aided design software and a machine to produce dental prostheses. it is an undeniable advance in the daily practice of odontostomatologists, and this study has examined the case of madagascar in relation to this technology. the majority of odontostomatologists in fianarantsoa and antananarivo are still less familiar with and practise cad/cam. however, working with this system is simpler, faster and more efficient. the odontostomatologists who used them produced all kinds of fixed prostheses, in the same way as elsewhere. in madagascar, the major obstacle to the use of cad/cam is the investment required to set it up, not to mention the training time needed to master the technique. this obstacle is not irreversible, however, as the price of the machines will evolve in the same direction as any it system, and prices will become attractive. the future of cad/cam in dentistry is promising, as this technique offers many advantages to odontostomatologists. the integration of cad/cam equipment into public health establishments and dental schools in madagascar will facilitate access to digital technology for practitioners and students, ensuring better patient care in fixed prosthetics. references 1. berruet j, ciaffoloni r., pelissier b. cad/cam in dental practice with laboratory, adf congress quintessence, 2012;11:272-5. 2. ng j, ruse d, wyatt c. a comparison of the marginal fit of crowns fabricatedwith digital and conventional methods. j prosthet dent. 2014;112(3):555-60. 3. celo d. dental cad/cam: a global vision [internet]. 2018 [accessed 12/08/2023]. available from: https://www.3dcelo.com/la-cfao-dentaire-unevision-globale 4. elkrief m. cad/cam in dental practice: survey on the practices and opinions of dental surgeons in île-de-francein 2017. sciences du vivant[q-bio]. 2018. dumas-03212214. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 24 5. mühlemann s, sandrini g, ioannidis a, jung re, hämmerle chf. the use of digital technologies in dental practices in switzerland: a cross-sectionalsurvey. swiss dent j. 2019;129(9):700-7. 6. dickens n, haider h, lien w, simecek j, stahl j. longitudinal analysis of cad/cam restoration incorporation rates intonavydentistry. mil med. 2019;184(5-6):e365-e72. 7. guinan jc, da-danho v, meless gd, sangare ad, datte as, nouaman mn, et al. "factors associated with discriminatory attitudes of dental surgeons towards people living with hiv in côte d'ivoire," santé publique, 2022;2(34):255-62. 8. noumo h. démographie et suivi des chirurgiens-dentistesdiplômés de la faculté de médecine et d'odontostomatologie de bamako de 2013 à 2018 [internet]. 2018. [accessed 12/08/2023]. available online at https://www.bibliosante.ml/handle/123456789/5639 9. amrani a, figuigui l, yamani a. leséchecs en prothèseconjointe : enquêteauprès des médecinsdentistes du maroc [internet].[consulted on 15/08/2023]. available online at https://www.lecourrierdudentiste.com/dossiers-du-mois/les-echecs-en-protheseconjointe-enquete-aupres-des-medecins-dentistes-du-maroc.html 10. mbede n, zing s, dibagui l, koupouapouognigni n, et al. knowledge and practices of oral doctors of the of yaoundé city on partial prosthesisand its stabilization methods. healthsci, 2022;23(2):133-7. 11. martin r. un chirurgiendentistes surroisobtient son diplômeal'étranger [internet]. [consulted on 17/09/2023] available online at https://www.letudiant.fr/etudes/1-chirurgien-dentiste-sur-3-obtient-sondiplome-a-l-etranger.html 12. tamodarin j. la pratique quotidienne de la cfao en cabinet dentaire. volume2, enquête épidémiologique et perspectives. sciences du vivant [q-bio]. 2018. dumas-01961245. 13. dental floss. dental cad/cam: where do we stand? 2017 [internet]. [accessed 09/17/2023] available online at https://www.lefildentaire.com/la/cfao en cabinet dentaire où en sommes nous. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 25 14. tran d, nesbit m, petridis h. survey of uk dentists regarding the use of cad/cam technology. br dent j. 2016;221(10):639-44. 15. fabry j. integration of direct cad/cam in the practice. chirurgie. 2018. dumas-02025431 16. delain d. technical and environmental limitations of optical impression and cad/cam machined fixed prosthesis in implantology. sciences du vivant[q-bio]. 2017. dumas-02337694. ijo journals volume 07 | issue 02 | february 2024 | https://ijojournals.com/index.php/hsn/index 26 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) cholisah suralaga * https://ijojournals.com/ volume 08 || issue 01 || january, 2025 || the effect of using the diva score screening on the success of iv insertion in the pediatric ward unit of m hospital, jakarta the effect of using the diva score screening on the success of iv insertion in the pediatric ward unit of m hospital, jakarta the effect of using the diva score screening on the success of iv insertion in the pediatric ward unit of m hospital, jakarta abstract iv insertion is an invasive procedure that can cause complications such as pain, anxiety, and trauma. in the pediatric ward unit of m hospital, jakarta, iv insertion failures still occur in children, often due to factors like small vein diameters, non-linear vein shapes, and thinner, more fragile vein walls. the diva score was developed and is used as a guideline to determine the success rate of intravenous insertion. this study aims to analyze the effect of using the diva score screening on the success rate of iv insertions in the pediatric ward unit of m hospital, jakarta. a quasi-experimental design with a control group was employed. the study population consisted of 36 pediatric patients aged 0-13 years in the pediatric ward of m hospital, jakarta. data collection was carried out through observation by filling in the diva score observation sheet. the study results that iv insertion without using the diva score screening, 8 respondents (44.4%) succeeded with one attempt, 7 respondents (38.9%) succeeded after two attempts, and 3 respondents (16.7%) succeeded after more than two attempts. in contrast, for iv insertion using the diva score screening, all 18 respondents (100%) succeeded with just one attempt. there is a significant difference in the success rate of iv insertion when using the diva score screening, with a p-value of 0.000 ≤ 0.05. it is recommended that the diva score be implemented comprehensively, especially in units that frequently deal with patients at risk of difficult venous access. keywords: iv insertion, diva score, difficult veins, insertion cholisah suralaga1, masniati br sidabalok 2, andi mayasari usman3 1,3 nursing department, faculty of health science, nasional university,jakarta, indonesia 2 bachelor of nursing, faculty of health science, nasional university, jakarta, indonesia corresponding author: cholisah suralaga nursing department, faculty of health science nasional university, jakarta, indonesia jl. sawo manila, no.61 rt.14/rw.7, pejaten barat, pasar minggu, kota jakarta selatan, daerah khusus ibukota jakarta 12520 indonesia, doi 10.5281/zenodo.14744680 ijo journals volume 08 | issue 01 | january 2025 | https://ijojournals.com/index.php/hsn/index 1 https://zenodo.org/records/14744680 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) cholisah suralaga * https://ijojournals.com/ volume 08 || issue 01 || january, 2025 || the effect of using the diva score screening on the success of iv insertion in the pediatric ward unit of m hospital, jakarta introduction iv insertion is a collaborative nursing procedure performed by nurses to administer fluids or medication directly into the venous blood vessels in large quantities and for extended periods using an infusion set. iv insertion in children when admitted to the hospital can cause prolonged trauma (zannah, et al., 2015). iv insertion can also lead to infections and pain due to repeated needle punctures. this results in anxiety and trauma, causing children to resist the iv insertion procedure (hartini, 2015). iv insertion is essential in children for nutritional or medication needs through parenteral routes and to maintain fluid and electrolyte balance. parenteral nutrition is a form of nutrition provided directly through the bloodstream without passing through the digestive tract (kemenkes, 2019). the difficulty of iv insertion in neonates is caused by their small vein size, and the limited expertise of professional nurses in inserting ivs in babies often leads to repeated punctures (hastuti et al., 2021). complications from iv insertion procedures and the administration of fluids through an iv include a stinging or painful sensation (pramesti, 2018). iv access can be established through peripheral or central veins, depending on the patient's needs. however, failure often occurs when attempting iv access, due to anatomical issues, clinical conditions, and the skill of the medical personnel performing the procedure. this procedure is performed on over 70% of hospitalized patients and is necessary during pediatric hospital care (perdana, et al., 2020b). ensuring patient safety during clinical practice requires quick and effective venous access, especially in emergencies and for all anesthesia procedures. inhalational anesthesia is often administered to pediatric patients undergoing anesthesia procedures worldwide to facilitate access to iv insertion. however, in certain situations, this is not feasible, particularly in procedures conducted outside the operating room. one of the purposes of iv insertion is to administer medications, fluid therapy, transfusions, and contrast agents for imaging procedures. in a study conducted in a pediatric hospital by larsen et al. (2023), of 592 patients who underwent iv insertion, more than 50% succeeded after two or more attempts, with an average of 2.1 attempts. a similar study by reigart et al. found that only 48% of patients succeeded in obtaining iv access on the first attempt. this highlights the difficulty of obtaining peripheral access during the early stages of iv insertion. patients may experience challenges and trauma due to repeated injections, which can also result in more severe pain and potentially lead to complications such as hematoma and an increased risk of infection (reigart, et al., 2022). doi 10.5281/zenodo.14744680 ijo journals volume 08 | issue 01 | january 2025 | https://ijojournals.com/index.php/hsn/index 2 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) cholisah suralaga * https://ijojournals.com/ volume 08 || issue 01 || january, 2025 || the effect of using the diva score screening on the success of iv insertion in the pediatric ward unit of m hospital, jakarta the diva score is based on four proportional variables, including age, vein visibility after tourniquet application, vein palpability after tourniquet application, and a history of prematurity (gestational age at birth <38 weeks) (yen, et al., 2018). each predictor variable is assigned a point value, with a total score ranging from 0 to 10. the difficult intravenous access (diva) scale has been developed and used as a guideline in several studies to determine the success rate of iv insertion. preliminary studies conducted in the pediatric ward unit of m hospital, jakarta, revealed that the number of patients each month is quite high. according to quality indicator data for iv insertion incidents of more than 2 attempts in 2024, over the past three months, 41 patients required iv insertion between april and june 2024, with 17 patients in april 2024, 17 patients in may 2024, and 7 patients in june 2024. almost all of these patients underwent iv insertion. the difficulty of insertion in children is often due to their smaller vein diameter compared to adults, as well as non-linear vein shapes and thinner vein walls, which complicate the procedure. therefore, the researcher is interested in conducting a study titled "the effect of diva score screening on the success rate of iv insertion in the pediatric ward unit of m hospital, jakarta." materials and methods the research design used in this study is a quasi-experimental design with a control group. the study population consisted of pediatric patients aged 1-13 years in the ward unit, with an average of 41 children per month. the sampling technique applied in this study was purposive sampling, with the inclusion criteria as follows: 1) pediatric patients requiring iv insertion. 2) aged 1-13 years. 3) obtained informed consent from parents or guardians. the exclusion criteria were: 1) children with certain medical conditions (e.g., severe edema or vascular abnormalities). 2) children with a history of extensive iv insertion (more than four insertion attempts). 3) children undergoing medical treatments, such as vasoconstrictor medication use. the sample consisted of 36 children, divided into two groups: 18 children for the control group and 18 children for the intervention group. the dependent variable in this study was the success rate of iv insertion, while the independent variable was the diva score screening. the instruments used in this study were: 1) a respondent characteristic sheet covering age and gender. 2) a diva score observation sheet, which included the observation of iv insertion based on five doi 10.5281/zenodo.14744680 ijo journals volume 08 | issue 01 | january 2025 | https://ijojournals.com/index.php/hsn/index 3 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) cholisah suralaga * https://ijojournals.com/ volume 08 || issue 01 || january, 2025 || the effect of using the diva score screening on the success of iv insertion in the pediatric ward unit of m hospital, jakarta indicators: history of prematurity, age, vein visibility, vein palpability, and skin color. 3) the iv insertion sop sheet used at m hospital, jakarta. data analysis was conducted using the mannwhitney test. result table 1. frequency distribution of iv insertion success without diva score screening in the pediatric ward unit of m hospital, jakarta (n = 18) insertion attempt number of respondents percentage (%) 1 attempt 8 44.4% 2 attempts 7 38.9% > 2 attempts 3 16.7% total 18 100% based on table 1, regarding the success of iv insertion without using diva score screening, out of 18 respondents, 8 (44.4%) succeeded with 1 attempt, 7 (38.9%) succeeded after 2 attempts, and 3 (16.7%) succeeded after more than 2 attempts. table 2. frequency distribution of iv insertion success using diva score screening in the pediatric ward unit of m hospital, jakarta (n = 18) insertion attempt number of respondents percentage (%) 1 attempt 18 100% total 18 100% based on table 2, regarding the success of iv insertion using diva score screening, all 18 respondents (100%) succeeded with 1 attempt. table 3. effect of using diva score screening on the success rate of iv insertion in the pediatric ward unit of m hospital, jakarta (n = 18) variabel 1 insertion 2 insertion > insertion p-value control 8 7 3 0.000 intervention 18 0 0 doi 10.5281/zenodo.14744680 ijo journals volume 08 | issue 01 | january 2025 | https://ijojournals.com/index.php/hsn/index 4 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) cholisah suralaga * https://ijojournals.com/ volume 08 || issue 01 || january, 2025 || the effect of using the diva score screening on the success of iv insertion in the pediatric ward unit of m hospital, jakarta the statistical mann-whitney test results showed a p-value of 0.000 (p-value ≤ 0.05), indicating that ha is accepted, meaning there is a significant difference in the success rate of iv insertion when using diva score screening in the pediatric ward unit of m hospital, jakarta. discussion frequency distribution of iv insertion success without diva screening in this study, 8 respondents (44.4%) succeeded with one attempt, which suggests that most nurses or healthcare providers involved have sufficient skills to perform the insertion without the assistance of the diva screening tool. however, the results also show that some respondents required more than one attempt (38.9% with two attempts and 16.7% with more than two attempts), possibly reflecting the challenges in locating a suitable vein. previous research supports these findings, where the success of iv insertion is often influenced by the clinical experience and techniques used by medical personnel. a study by fields et al. (2014) revealed that using aids such as ultrasound or diva screening can increase the success rate on the first attempt, especially in patients with difficult venous access (fields, 2014)). however, in situations where such tools are unavailable, clinical experience and the skill of the healthcare provider become the primary determining factors. another study by gorski et al. (2016) also emphasized the importance of clinical experience in improving iv insertion success rates. they found that more experienced nurses tend to have higher first-attempt success rates compared to less experienced nurses, even without tools like diva screening. iv insertion requires good knowledge and skills to identify the right vein, particularly in patients with conditions like obesity, dehydration, or small and unclear veins. ideally, the first attempt should succeed to reduce pain, tissue trauma, and infection risk. however, factors such as subcutaneous tissue thickness, skin color, and the condition of the patient's veins can affect the success of the procedure. the results of this study show that despite not using diva screening, the success rate for the first insertion was relatively high at 44.4%. however, significant challenges remain, with 38.9% requiring two attempts and 16.7% more than two. this indicates a need for improved technical doi 10.5281/zenodo.14744680 ijo journals volume 08 | issue 01 | january 2025 | https://ijojournals.com/index.php/hsn/index 5 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) cholisah suralaga * https://ijojournals.com/ volume 08 || issue 01 || january, 2025 || the effect of using the diva score screening on the success of iv insertion in the pediatric ward unit of m hospital, jakarta skills and possibly the consideration of using aids in certain situations to reduce the frequency of repeated insertions. frequency distribution of iv insertion success using diva screening the study results, showing 100% success on the first attempt with the use of diva screening, demonstrate the effectiveness of this method in clinical practice. these results reflect not only advances in medical technology but also highlight the importance of evidence-based approaches in patient care requiring venous access. research by schoenfeld et al. (2018) supports these findings, showing that the use of diva screening can improve iv insertion success rates in patients with difficult venous access. in this study, patients identified through diva and then given appropriate interventions (such as ultrasound use) showed significant improvement in first-attempt success rates compared to the control group. additionally, fields et al. (2014) reaffirmed that technologies like diva enable early identification of patients with potential venous access difficulties, allowing for the use of more advanced techniques like ultrasound guidance or selecting alternative, more accessible veins. this study found that iv insertion success rates on the first attempt increased significantly when screening technology was used compared to procedures without screening. diva screening is a method used to identify patients at high risk of experiencing difficult venous access before iv procedures are performed. this tool helps healthcare providers determine more effective strategies, such as using ultrasound or choosing veins that are easier to access. by conducting early identification, the likelihood of multiple insertion attempts can be minimized, not only improving patient comfort but also reducing the risk of complications such as phlebitis or infection. the results showing 100% success on the first attempt with the use of diva screening confirm the importance of this technology in clinical practice, particularly in patients at high risk for difficult venous access. diva screening not only helps in choosing the right technique but also minimizes risks associated with multiple insertions, such as tissue trauma, infection, and increased patient pain. doi 10.5281/zenodo.14744680 ijo journals volume 08 | issue 01 | january 2025 | https://ijojournals.com/index.php/hsn/index 6 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) cholisah suralaga * https://ijojournals.com/ volume 08 || issue 01 || january, 2025 || the effect of using the diva score screening on the success of iv insertion in the pediatric ward unit of m hospital, jakarta effect of using diva score screening on iv insertion success rates the mann-whitney statistical test results showing a p-value of 0.000 confirm that using the diva score has a significant positive effect on clinical outcomes. in the context of this study, these results demonstrate that the use of diva screening can positively impact iv insertion success rates, reduce the number of required insertion attempts, and decrease complications that may arise from repeated insertions. research by fields et al. (2014) supports these findings, showing that the use of diva screening significantly increases iv insertion success on the first attempt compared to a control group without screening. in that study, patients identified through the diva score as high-risk were given special interventions, such as ultrasound use, which significantly increased insertion success. additionally, a study by sebbane et al. (2013) also demonstrated that the diva score is an effective predictor for identifying patients with difficult venous access. this study confirmed that using the diva score allows medical personnel to prepare better, ultimately increasing first-attempt iv insertion success and reducing complications such as hematoma or phlebitis. diva (difficult intravenous access) screening is a tool used to assess and identify patients likely to experience difficulty during iv insertion (schmidt, et al., 2022). this tool combines various risk factors, including the patient's physical condition, such as obesity, dehydration, and vein characteristics, to provide a risk score that healthcare providers can use to predict challenges in venous access (eren, 2022). by using this screening, healthcare providers can take preventive steps, such as using specific techniques or tools (e.g., ultrasound), which can significantly improve firstattempt success rates (perdana, et al., 2022a). according to the researchers, using the diva score screening has a significant impact on iv insertion success rates. this study confirms that the diva score is an effective tool in predicting potential challenges during iv insertion and can help nurses choose the most appropriate strategy for each patient. furthermore, this success is not only important for improving healthcare efficiency and effectiveness but also for reducing patient trauma, avoiding repeated insertions, and minimizing the risk of complications. doi 10.5281/zenodo.14744680 ijo journals volume 08 | issue 01 | january 2025 | https://ijojournals.com/index.php/hsn/index 7 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) cholisah suralaga * https://ijojournals.com/ volume 08 || issue 01 || january, 2025 || the effect of using the diva score screening on the success of iv insertion in the pediatric ward unit of m hospital, jakarta conclusion a total of 8 respondents (44.4%) succeeded with one iv insertion, 7 respondents (38.9%) succeeded with two insertions, and 3 respondents (16.7%) succeeded with more than two insertions.all 18 respondents (100%) succeeded with one iv insertion. this was because the healthcare staff understood and were able to coordinate effectively; if a diva score greater than 4 was detected, the iv insertion was performed by the scheduled insertion team.there is a significant difference in the success rate of iv insertion between those using the diva score screening and those not using it in the pediatric ward of m hospital, jakarta, with a p-value of 0.000 (≤ 0.05). acknowledgement the authors would like to thank the institutions and respondents for their cooperation during data collection and express their deepest gratitude to all parties who have supported them during this research and to those who have taken the time to fill out the survey and provide valuable input. author’s contribution cholisah suralaga as a principal investigator, conceptualised and designed the study, prepared the draft of the manuscript, conducted the study; masniati br sidabalok as reviewed the manuscript, conceptualized and designed the research, provided advice on data analysis and data interpretation; andi mayasari usman did the data analysis and interpretation; drafted the manuscript conducted research studies and assisted in drafting the manuscript. declaration of conflicting interests the authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. funding the authors received no financial support for the research, authorship and/or publication of this article. doi 10.5281/zenodo.14744680 ijo journals volume 08 | issue 01 | january 2025 | https://ijojournals.com/index.php/hsn/index 8 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) cholisah suralaga * https://ijojournals.com/ volume 08 || issue 01 || january, 2025 || the effect of using the diva score screening on the success of iv insertion in the pediatric ward unit of m hospital, jakarta references eren, h. (2022). difficult intravenous access and its management. in ultimate guide to outpatient care. intechopen. https://doi.org/10.5772/intechopen.96613 fields, j. m. , p. n. e. , a. a. k. , & k. b. s. (2014). a the difficult intravenous access (diva) score: a clinical prediction rule for identifying children with difficult intravenous access. pediatric emergency care, 30(1), 40–42. https://doi.org/10.1097/pec.0000000000000052 gorski, l. a., hadaway, l., hagle, m., broadhurst, d., clare, s., kleidon, t., & vesel, l. (2016). infusion therapy standards of practice. journal of infusion nursing, 39(1). hartini, s. (2015). penurunan skala nyeri pemasangan infus dengan emla pada anak prasekolah di ruang instalasi gawat darurat. jurnal keperawatan dan kesehatan masyarakat cendekia utama, 4(2) hastuti, w., pujiwati, s., & apriliyanti, r. (2021). pemberian air susu ibu (asi) dan dextrose 5% untuk mengurangi nyeri pemasangan infus pada neonatus (breast milk and dextrose 5% to reduce the pain of infusion in neonates). jurnal ilmu keperawatan maternitas, 4(1) kemenkes. (2019). peraturan menteri kesehatan republik indonesia nomor hk.01.07 tahun 2019 tentang pedoman nasional pelayanan kedokteran tata laksana malnutrisi pada dewasa. in kementerian kesehatan republik indonesia. larsen, e., gavin, n. c., runnegar, n., mihala, g., keogh, s., mcmillan, d., & rickard, c. m. (2023). association between parenteral nutrition–containing intravenous lipid emulsion and bloodstream infections in patients with single-lumen central venous access: a secondary analysis of a randomized trial. journal of parenteral and enteral nutrition, 47(6). perdana, a., manggala, s. k., & karina, a. (2020a). perbandingan keberhasilan insersi kanul intravena antara penggunaan dan tanpa penggunaan pemindai vena pada pasien pediatrik. majalah anestesia & critical care, 38(3), 176– 184. https://doi.org/10.55497/majanestcricar.v38i3.200 doi 10.5281/zenodo.14744680 ijo journals volume 08 | issue 01 | january 2025 | https://ijojournals.com/index.php/hsn/index 9 https://doi.org/10.5772/intechopen.96613 https://doi.org/10.1097/pec.0000000000000052 https://doi.org/10.55497/majanestcricar.v38i3.200 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) cholisah suralaga * https://ijojournals.com/ volume 08 || issue 01 || january, 2025 || the effect of using the diva score screening on the success of iv insertion in the pediatric ward unit of m hospital, jakarta perdana, a., manggala, s. k., & karina, a. (2020b). perbandingan keberhasilan insersi kanul intravena antara penggunaan dan tanpa penggunaan pemindai vena pada pasien pediatrik. majalah anestesia & critical care. pramesti, t. a. (2018). pemberian non-nutritive sucking (pacifier) terhadap respon nyeri neonatus yang dilakukan pemasangan infus. journal of borneo holistic health, 1(1). https://doi.org/10.35334/borticalth.v1i1.381 reigart, j. r., chamberlain, k., eldridge, d., o’brien, e., freeland, k. d., larsen, p., & hartzog, t. h. (2022). peripheral intravenous access in pediatric inpatients. clinical pediatrics, 51(5). schindler, t. (2022). advances in medical imaging techniques. journal of diagnostic medicine, 27(2). schmidt, g. a., blaivas, m., conrad, s. a., corradi, f., koenig, s., lamperti, m., & slama, m. (2019). ultrasound-guided vascular access in critical illness. intensive care medicine. schoenfeld, e. m., shapiro, n. i., mader, t. j., & weiner, s. g. (2018). development and validation of a difficult intravenous access score: a clinical prediction rule for identifying patients at risk of difficult intravenous access. journal of emergency medicine, 54(5). sebbane, m., claret, p. g., lefebvre, s., mercier, g., rubenovitch, j., eledjam, & coussaye, j. e. (2013). predicting peripheral intravenous catheterization difficulty in the emergency department: the diva score. annals of emergency medicine, 61(5) yen, k. , . , riegert, a., & gorelick, m. h. (2018). a pediatric difficult intravenous access (diva) score to improve the success of intravenous access in children. pediatric emergency care, 34(7). zannah, m., agustina, r., & marlinda, e. (2015). peran orang tua terhadap tingkat kecemasan anak pada saat pemasangan infus diinstalasi gawat darurat (igd) rsud banjarbaru. dunia keperawatan: jurnal keperawatan dan kesehatan, 3(2). doi 10.5281/zenodo.14744680 ijo journals volume 08 | issue 01 | january 2025 | https://ijojournals.com/index.php/hsn/index 10 https://doi.org/10.35334/borticalth.v1i1.381 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || authors : ratsimandresy naomy namboarintsoa1, razanadraisoa albertine1, rabarijaona haritiana sergio nicko1, lalanirina gaël lauricia1, nambininarivo fitiavantsoa antsatiana2, andrianasolo vv1, ralaiarimanana liantsoa fanja emmanuel1. 1 dental prosthetics section at institut d’odonto-stomatologie tropicale de madagascar (iostm) – university of mahajanga madagascar 2 private dental surgery in mahajanga madagascar corresponding author: ratsimandresy naomy namboarintsoa, dental prosthetics section at institut d’odonto-stomatologie tropicale de madagascar (iostm) – university of mahajanga madagascar iostm, pb : 98 abstract the metal partial denture (mpd) is defined as a metal device that restores a partially edentulous arch. it provides dual support for hard (dental) and soft (mucosal) tissues. the aim of this study was to identify the sources of imbalance in the mpd. an analytical study of 92 practitioners in antananarivo and mahajanga, making dental prostheses was carried out in 2023. it was shown that 38% of the practitioners surveyed had already experienced prosthetic instability at least once. several factors were found to be responsible for this imbalance in the mpd, such as: professional status (p=0.02), number of years in practice (p=0.001), practitioners not casting the model (p=0.002), not having a paralleling machine in the dental practice (p=0.001), not tracing the framework (p=0.01), and so on. “factors leading to imbalance in removable partial metal prostheses in antananarivo and mahajanga madagascar." factors leading to imbalance in removable partial metal prostheses in antananarivo and mahajanga madagascar ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 113 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “factors leading to imbalance in removable partial metal prostheses in antananarivo and mahajanga adagascar." in the future, in order to improve the analysis, the sample should be extended to make it more representative. key words: retention, stabilisation, sustentation, metal partial denture introduction despite constant developments in fixed and implant prosthetics, the removable metal partial dentures (rmpd) remains a useful and necessary treatment option for many of our patients, particularly those with limited financial resources [1, 2, 3]. however, several clinical studies have highlighted the high failure rate of mpd, notably due to a lack of retention and the presence of deleterious effects on the teeth supporting the clasps [4,5]. this is why the prognosis of mpd depends on the prosthetic design carried out by the practitioner. practitioners must rationally manage the complexity of the clinical situation in order to obtain an optimal prosthetic design that meets the requirements of the housset triad: retention, support and stabilisation [6-8]. retention is the action that opposes the vertical forces that tend to move the prosthesis away from its bearing surfaces. sustentation is the action that opposes the vertical forces that tend to push the prosthesis away from the bearing surfaces. finally, stabilisation is the action that counteracts the horizontal rotational forces to which the prosthesis is subjected. these three criteria apply to all types of prosthetic restoration but take on particular importance in partial removable prostheses, which are more exposed to the various factors of imbalance. ensuring the stabilitý and oral integration of a mpd involves finding a satisfactory balance between these three principles. if one of them is not ensured, this compromises the ac�on of the other two: it is the balance and therefore the durabilitý of the prosthesis that risks being compromised. hence the interest of the present study with the objective of determining the factors of mpd imbalance. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 114 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || socio-professional characteristics n % gender male 62 67.4 female 30 32.6 professional general practitionner 80 87,0 specialist 12 13,0 number of years of service less than or equal to 15 years 48 52,2 16 and over 44 47,8 total 92 100,0 sex ratio = 2.07 “factors leading to imbalance in removable partial metal prostheses in antananarivo and mahajanga madagascar." material and methods this study was carried out in dental surgeries in the city of antananarivo, madagascar, among 92 practitioners making dental prostheses. this was a cross-sectional analytical study. apart from the socio-professional profile of the practitioners, the variables linked to the different stages in the production of the mpd were studied. practitioners were asked whether they had ever had a case of prosthetic imbalance. in order to identify any manufacturing errors, the mpd manufacturing steps described in the mpd manufacturing guide described by j schittly, exbrayat and borel were used as a reference [9]. results table i:distribution of practitioners by socio-professional characteristics ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 115 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || variables proportion of practitionners with prosthetic imbalance p value odds ratio (or) [ci 95 % ] professional status general praticionner 42,5 0,02 0,06 [0,01 – 0,54] spcialist 8,3 year of practise < 15 years 22,9 0,001 4,04 [1,65 -9,90] 15 years and more 54,5 possession of a paralleling device in the dental practice yes 22,2 0,01 0,15 [0,050,52] no 64,86 drawing of the framework by practitionner yes 25 0,002 0,15 [0,040,54] no 75 “factors leading to imbalance in removable partial metal prostheses in antananarivo and mahajanga madagascar." table i provides information on the socio-professional characteristics of the practitioners. in terms of gender, males predominated, with a sex ratio equal to 2.07. in terms of professional status, general practitioners predominated at 87%. in terms of year of practice, those who had worked for less than 15 years predominated at 52.2%. table ii: distribution of practitioners according to the existence of a prosthetic imbalance and professional status, year of practice, possession of a paralleling device in the dental practice and drawing of the framework ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 116 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “factors leading to imbalance in removable partial metal prostheses in antananarivo and mahajanga madagascar." discussion according to professional status, there was a significant difference between general practitioners (gp) and specialists in terms of the existence of prosthetic imbalance. gps in particular had more prosthetic imbalance (p = 0.02 and or = 0.06 with ci 95 % = [0.01 0.54]. this result may be explained by the fact that specialist practitioners receive more training in the preparation of the mpd. in fact, they have mastered the various techniques involved in all the stages of making the mpd. practitioners with 15 years’experience or more had more prosthetic imbalance compared with those with less than 15 years’ experience. this result is very significant. this finding could be due to the effect of the possible routine that can happen to practitioners with more years of practice. the possession of a paralleling device in the dental practice and the drawing of the framework by the practitioner are factors that prevent the occurrence of prosthetic imbalance with respective p and or values of p = 0.01 and or = 0.15 with an ic95% = [0.050.52] and p = 0.002 and or = 0.15 with an ic95% = [0.040.54]. parallelogram analysis and frame tracing are an essential part of the practitioner's duties. after taking a complete medical and dental history, carrying out a full oral examination and performing a diagnostic set-up, the practitioner can make a fully reasoned choice based on the aids available [10]. the practitioner needs a simple parallelogram that allows accurate analysis of the study models, because the parallelogram is an essential tool for choosing the insertion axis [11]. the choice of insertion axis is one of the most important phases of the preprosthetic clinical examination, because it is much more than an axis of insertion and disinsertion. it is also an area for studying the elements involved in supporting the prosthesis, and for preparing the remaining teeth and osteomucosal elements. finally, it is the axis of prosthetic construction [12]. it is very rare that, at the end of an uncompensated partial edentulous treatment, the existing conditions can be ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 117 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “factors leading to imbalance in removable partial metal prostheses in antananarivo and mahajanga madagascar." used without modification. the absence of intervention risks perpetuating or aggravating a preexisting situation of imbalance. the practitioner must not allow himself to be imposed a prosthetic insertion axis by a given clinical situation without seeking, if necessary, to modify and adapt it to make possible the creation of a prosthesis with a therapeutic vocation. hence the importance of using a paralleling device [11]. unfortunately, these design and analysis stages are often delegated to the dental technician, despite his limited access to clinical data. indeed, if the dental technician carries out the paralleling analysis, no coronoplasty can be performed [13-15]. conclusion practitioners must follow each clinical step in the preparation of the papm. the use of appropriate equipment such as the parallelogram is essential in order to be able to analyse the clinical case in depth. references 1. buser d, sennerby l, de bruyn h. modern implant dentistry based on osseointegration : 50 years of progress, current trends and open questions. periodontol 2000. 2017;73(1):7 21 2. silva lh da, lima e de, miranda rb de p, favero ss, lohbauer u, cesar pf. dental ceramics: a review of new materials and processing methods. braz oral res 2017;31(1):133-46 3. mericske-stern r. removable partial dentures. int j prosthodont 2009;22(5):508 11 4. alageel o, ashraf n, bessadet m, nicolas e, tamimi f. evaluation of the design-driven prediction of removable partial denture retention. j prosthet dent2020;124(3):357 64 5. bilhan h, erdogan o, ergin s, celik m, ates g, geckili o. complication rates and patient satisfaction with removable dentures. j adv prosthodont 2012;4(2):109 15 6. rudd rw, rudd kd. a review of 243 errors possible during the fabrication of a removable partial denture: part i. j prosthet dent 2001;86(3):251 61 7. campbell sd, cooper l, craddock h, hyde tp, nattress b, pavitt sh, et al. removable partial dentures: the clinical need for innovation. j prosthet dent 2017;118(3):273 80 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 118 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) ratsimandresy naomy namboarintsoa 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “factors leading to imbalance in removable partial metal prostheses in antananarivo and mahajanga madagascar." 8. escure s, bertrand c, braud a, monod-broca j, cheherazade s. rational design of the metal frame from concept to completion. inf dent 2008;(37):2098-2106 9. schittly j, schittly e. partial removable prosthesis: clinic and laboratory. published by cdp groupe liaisons: 2006 paris:236 10. schittly j, schittly e. partial removable prosthesis: clinical and laboratory. 3rd ed. rueil malmaison: éditions cdp; 2020 :131-75 11. el miloud rahmani fb, ahmed abdedine, salwa berrada, bouabid el mohtarim. metal chassis. les cahiers de prothèse. 2006;133:14-25. 12. schittly j. coronoplasty of supporting teeth in removable partial dentures. inform dent 1987;30:2557-2566.]. 13. nassani mz, alotaibi ms. quality of communicating design features for cobalt chromium removable partial dentures in riyadh, saudi arabia. eur oral res. 1 sept 2020;54(3):123 9 14. lynch cd, allen pf. a survey of chrome-cobalt rpd design in ireland. int j prosthodont. août 2003;16(4):362 4. 15. lynch cd, lynch d, allen pf. quality of written prescriptions and master impressions for fixed and removable prosthodontics: a comparative study. br dent j. 8 janv 2005;198(1):17 20 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 119 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) chinedu-madu jane u 1 * https://ijojournals.com/ volume 08 || issue 04 || april, 2025 || “studies on activated partial thromboplastin time, red and white blood cell counts in coronary artery disease in owerri, nigeria.." studies on activated partial thromboplastin time, red and white blood cell counts in coronary artery disease in owerri, nigeria. chinedu-madu jane u1, onyejiawa favour c.2, and aloy-amadi oluchi c3. 1department of haematology, federal university otueke, bayelsa state, nigeria. 2, 3 department of medical laboratory science, imo state university, owerri, nigeria. corresponding author: chinedu-madu jane u. abstract background: coronary artery disease (cad) is a multifactorial condition influenced by cardiovascular, hematological and haemostatic factors. the knowledge of these parameters in cad patients, including gender-based differences, is essential for personalized diagnosis and treatment. objective: to investigate red cell indices and aspartate aminotransferase in cad patients federal teaching hospital, owerri, nigeria, and assess gender-based variations. methods: a cross-sectional study was conducted involving 30 cad patients (19 males and 11 females) and 30 age-matched healthy controls. a total of 5 ml of venous blood was collected from each participant, with 3 ml placed in edta tubes for hematological analysis and 2 mls into sodium citrate containers for aptt determination..haematological parameters were assessed using an automated hematology analyzer, while aptt was determined using a standard coagulometer and commercial reagents according to the manufacturer’s instructions. . statistical analysis was conducted using independent t-tests to compare group differences and pearson correlation for association studies, with p < 0.05 considered statistically significant. results: cad patients showed significantly higher mean activated partial thromboplastin time (aptt: 41.23 ± 4.09 )secsand white blood cell (wbc) count (15.23 ± 2.1) × 10 /l compared to controls (aptt: 28.30 ± 2.17)secs; wbc: (7.00 ± 1.68) × 10 /l with p-values of 0.002 and <0.001, respectively. red blood cell (rbc) count was significantly lower in cad patients (2.07 ± 0.35 )× 10¹²/l) compared to controls (4.01 ± 0.27 )× 10¹²/l. among cad patients, males had significantly higher aptt values (65.30 ± 14.48) secs than females (48.60 ± 8.95) secs(p = 0.035). no significant gender differences were observed in rbc and wbc counts. correlation ijo journals volume 08 | issue 04 | april 2025 | https://ijojournals.com/index.php/hsn/index 1 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) chinedu-madu jane u 1 * https://ijojournals.com/ volume 08 || issue 04 || april, 2025 || “studies on activated partial thromboplastin time, red and white blood cell counts in coronary artery disease in owerri, nigeria.." analysis revealed insignificant negative correlations of aptt with rbc (r = -0.025, p = 0.897), and wbc(r = -0.038, p = 0.843). conclusion: cad patients in owerri exhibit significant hematological abnormalities, including elevated aptt and wbc levels and reduced rbc counts. although gender-related variations were observed in aptt, no significant correlations among aptt, rbc, and wbc suggest independent pathological mechanisms. comprehensive hematological assessments should be incorporated into cad management protocols. further studies arewarranted to explore the underlying mechanisms of these hematological changes. key words: activted partial thromboplastin time, red blood cell, white blood cell, coronary artery disease. 1. introduction coronary artery disease (cad) is one of the foremost causes of morbidity and mortality globally, particularly in lowand middle-income countries where risk factor control is often suboptimal [1]. although the classical risk factors such as hypertension, diabetes mellitus, dyslipidemia, smoking, and sedentary lifestyle are well established, growing evidence suggests that hematological and haemostatic parameters significantly influence the pathogenesis and prognosis of cad [2]. activated partial thromboplastin time (aptt) assesses the intrinsic and common coagulation pathways and can reflect hypercoagulable or hypocoagulable states depending on the context [3]. in cad, alterations in coagulation markers may signal endothelial dysfunction or thrombosis risk. additionally, elevated white blood cell (wbc) count is a known marker of systemic inflammation and has been associated with plaque instability and adverse cardiac events [4]. conversely, reduced red blood cell (rbc) count may impair oxygen delivery to ischemic myocardial tissue, exacerbating tissue damage [5] gender-based differences in hematological and coagulation profiles in cad patients have also been reported. females may exhibit elevated coagulation markers and inflammatory indices compared to males, potentially influencing disease progression and therapeutic outcomes [6]. these gender-based disparities warrant investigation in specific populations, including nigerians, where there is a paucity of localized data. this study ijo journals volume 08 | issue 04 | april 2025 | https://ijojournals.com/index.php/hsn/index 2 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) chinedu-madu jane u 1 * https://ijojournals.com/ volume 08 || issue 04 || april, 2025 || “studies on activated partial thromboplastin time, red and white blood cell counts in coronary artery disease in owerri, nigeria.." aims to evaluate the levels of aptt, rbc, and wbc in cad patients in owerri, nigeria, and to assess gender-based differences in these parameters .2. materials and methods 2.1 study area the study was conducted at federal university teaching hospital, owerri, nigeria. 2.2 study design this study employed a cross-sectional analytical design to investigate selected hematological and haemostatic parameters—namely activated partial thromboplastin time (aptt), red blood cell (rbc) count, and white blood cell (wbc) count—in patients diagnosed with coronary artery disease (cad) compared to healthy age-matched controls. 2.3method of recruitment a total of 60 participants were recruited for the study. thirty (30) patients diagnosed with coronary artery disease (19 males and 11 females) were selected from the cardiology unit of a tertiary hospital in owerri, nigeria. thirty (30) ageand sex-matched apparently healthy individuals without a history of cardiovascular disease served as the control group. participants were recruited using purposive sampling based on inclusion and exclusion criteria. inclusion criteria for cad patients included clinical diagnosis of cad confirmed by a cardiologist. individuals with other comorbid conditions such as diabetes, malignancies, or hematological disorders were excluded. 2.4 ethical approval ethical approval for the study was obtained from the ethics and research committee of the [name of hospital or institution] (approval number: [insert number]). informed consent was obtained from all participants prior to sample collection. confidentiality and anonymity were maintained throughout the study. ijo journals volume 08 | issue 04 | april 2025 | https://ijojournals.com/index.php/hsn/index 3 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) chinedu-madu jane u 1 * https://ijojournals.com/ volume 08 || issue 04 || april, 2025 || “studies on activated partial thromboplastin time, red and white blood cell counts in coronary artery disease in owerri, nigeria.." 2.5 laboratory analysis venous blood samples (5 ml) were collected aseptically from each participant. three milliliters (3 ml) of the blood were dispensed into ethylenediaminetetraacetic acid (edta) tubes for hematological analysis. the remaining 2 ml was used for haemostatic analysis. hematological parameters, including rbc and wbc counts, were measured using a fully automated hematology analyzer. aptt was determined using a standard coagulometer and commercial reagents according to the manufacturer’s instructions. 2.6 statistical analysis data were analyzed using the statistical package for the social sciences (spss) version [insert version, e.g., 25.0]. results were expressed as mean ± standard deviation (sd). independent sample t-tests were used to compare the mean values between cad patients and controls, as well as between male and female subgroups. pearson correlation was used to determine the relationship between aptt, rbc, and wbc. a p-value < 0.05 was considered statistically significant. 3.results table 1 mean values of aptt, red blood cell and white blood cell counts in patients with coronary artery disease and healthy subjects (mean ± s.d) table 1 shows the mean levels of aptt. red blood cell and white blood cell counts in patients with coronary artery disease and healthy subjects the mean values of aptt (41.23± 4.09)secs and wbc (15.23± 2.1) x 109 /l in patients with coronary heart disease were significantly raised when compared to that of the controls (28.30± 2.17)secs and (7.00± 1.68) x 109 /l respectively (t= 20.01, p= 0.002 and t=59.58, p= < 0.001) on the other hand, the mean values of rbc (2.07± 0.35) x 1012 /l in patients with coronary heart disease were significantly reduced when compared to that of the controls (4.01± 0.27) x 1012 /l(t = 5.66, p =<0.001) ijo journals volume 08 | issue 04 | april 2025 | https://ijojournals.com/index.php/hsn/index 4 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) chinedu-madu jane u 1 * https://ijojournals.com/ volume 08 || issue 04 || april, 2025 || “studies on activated partial thromboplastin time, red and white blood cell counts in coronary artery disease in owerri, nigeria.." parameters no test (n=30) control (n=30) t-value p value aptt (secs) 30 41.23± 4.09 28.3 ± 2.17 20.01 0.002*. rbc (1012 /l) 30 2.07±0.35 4.09 ±0.27 -5.66. < 0.001*, wbc (109/l) 30 15.33± 2.15 7.0 ± 1.68 59.58 0.001* key: s.dstandard deviation *significant p value apttactivated partial thromboplastin time rbcred blood cell wbcwhite blood cell table 2: comparison of levels of aptt, red blood cell and white blood cell counts in male and female patients with coronary artery disease table .2 shows the mean values of aptt, red blood cell and white blood cell counts in male and female patients with coronary artery disease. the mean values of aptt (65.30± 14.48)secs in male patients with coronary heart disease was significantly increased when compared to female patients with coronary heart disease (48.60± 8.95)secs (t= 3.880, p= 0.035) the mean values of rbc (2.36± 0.32) x 1012 /l in male patients with coronary heart disease was insignificantly increased when compared to female patients with coronary heart disease (1.92± 0.22) x 1012 /l (t= 1.827, p= 0.076) the mean values of wbc (13.95± 2.20) x 109 /l in male patients with coronary heart disease was insignificantly reduced when compared to female patients with coronary heart disease (16.60± 5.68) x 1012 /l (t= -1.421, p= 0.167) ijo journals volume 08 | issue 04 | april 2025 | https://ijojournals.com/index.php/hsn/index 5 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) chinedu-madu jane u 1 * https://ijojournals.com/ volume 08 || issue 04 || april, 2025 || “studies on activated partial thromboplastin time, red and white blood cell counts in coronary artery disease in owerri, nigeria.." parameters no male (n=19) female (n=11) t-value p value aptt (secs) 30 65.3± 14.48 48.6± 8.95 3.88 0.035*. rbc (1012 /l) 30 2.36±0.32 1.92±0.22 1.83 0.076 wbc (109/l) 30 13.95± 2.2 16.6± 5.68 −1.421 0.167 key: s.dstandard deviation *significant p value apttactivated partial thromboplastin time rbcred blood cell wbcwhite blood cell table 3: correlation of aptt with red blood cell and white blood cell counts in patients with coronary artery disease table 3 showed the correlation ofaptt with red blood cell and white blood cell counts in patients with coronary artery disease there was a nonsignificant negative correlation of aptt with red blood cell (r= -0.025, p=0.897) among patients with coronary artery disease, and a nonsignificant negative correlation with white blood cell (r= -0.038, p=0.843) among patients with coronary artery disease ijo journals volume 08 | issue 04 | april 2025 | https://ijojournals.com/index.php/hsn/index 6 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) chinedu-madu jane u 1 * https://ijojournals.com/ volume 08 || issue 04 || april, 2025 || “studies on activated partial thromboplastin time, red and white blood cell counts in coronary artery disease in owerri, nigeria.." parameters n r p-value red blood cell 30 -0.025 0.897 white blood cells 30 -0.038 0.843 4. discussion this study observed that aptt and wbc counts were significantly elevated in cad patients when compared to controls, while rbc counts were significantly reduced. these findings suggest a concurrent state of inflammation and potential coagulopathy in cad, consistent with prior literature [3,4]. elevated aptt in cad patients may reflect an adaptive response to chronic endothelial damage or a prothrombotic state that is being compensated for by anticoagulant factors [7]. similar findings were reported by anvari et al., who observed a prolonged aptt in cad patients and linked it to altered coagulation dynamics and increased cardiovascular risk [3]. furthermore, the significantly higher aptt observed in male patients compared to females aligns with studies that suggest gender-based physiological differences in coagulation response and factor levels [6,8]. the elevated wbc count seen in cad patients corroborates with earlier reports that leukocytosis serves as a biomarker for inflammation and is associated with the development and progression of atherosclerosis [4,9]. a study by madjid et al. also established that higher leukocyte counts were linked to increased coronary heart disease risk and adverse outcomes [10].on the other hand, reduced rbc levels in cad patients, although sometimes overlooked, can aggravate myocardial ischemia by impairing oxygen delivery [5]. anemia has previously been associated with poor prognosis in cad, particularly in elderly and female patients [11] interestingly, while aptt was significantly higher in males, wbc was insignificantly lower, and rbc insignificantly higher compared to females. these gender variations are similar to those noted in a study by pradhan et al., who reported sex differences in inflammatory and coagulation profiles among cardiovascular patients [6]. ijo journals volume 08 | issue 04 | april 2025 | https://ijojournals.com/index.php/hsn/index 7 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) chinedu-madu jane u 1 * https://ijojournals.com/ volume 08 || issue 04 || april, 2025 || “studies on activated partial thromboplastin time, red and white blood cell counts in coronary artery disease in owerri, nigeria.." correlation analysis in this study did not show a significant relationship between aptt, rbc, and wbc, indicating that these parameters may contribute independently to cad pathophysiology. this independence reflects the multifactorial nature of cad, where inflammation, anemia, and coagulopathy may all simultaneously affect patient outcomes [12]. in summary, the findings support previous evidence of hematological disturbances in cad and suggest the need for routine hematologic assessments in cad management. further large-scale studies are necessary to explore these associations and validate their prognostic significance. 5. conclusion in conclusion, the study's findings highlight significant hematological and haemostatic alterations in cad patients, with notable gender-based differences. these insights underscore the importance of incorporating hematological assessments into the clinical management of cad and suggest avenues for personalized therapeutic strategies. further research is warranted to elucidate the mechanisms underlying these alterations and their implications for cad prognosis and treatment. references 1. roth ga, mensah ga, johnson co, et al. global burden of cardiovascular diseases and risk factors, 1990–2019: update from the gbd 2019 study. j am collcardiol. 2020;76(25):2982– 3021. 2. singh rb, mengi sa, xu yj, arneja as, dhalla ns. pathogenesis of atherosclerosis: a multifactorial process. expclincardiol. 2002;7(1):40–53. 3. sotoudehanvari m, tavakoli m, lotfi-tokaldany m, et al. coronary artery disease presentation and its association with shortened activated partial thromboplastin time. j tehran heart cent. 2018;13(1):1–5. 4. cannon cp, mccabe ch, wilcox rg, et al. association of white blood cell count with increased mortality in acute myocardial infarction and unstable angina pectoris. am j cardiol. 2001;87(5):636–639. 5. sabatine ms, morrow da, giugliano rp, et al. association of hemoglobin levels with clinical outcomes in acute coronary syndromes. circulation. 2005;111(16):2042–2049. ijo journals volume 08 | issue 04 | april 2025 | https://ijojournals.com/index.php/hsn/index 8 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) chinedu-madu jane u 1 * https://ijojournals.com/ volume 08 || issue 04 || april, 2025 || “studies on activated partial thromboplastin time, red and white blood cell counts in coronary artery disease in owerri, nigeria.." 6. pradhan ad, manson je, rifai n, buring je, ridker pm. c-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. jama. 2001;286(3):327–334. 7. sharma r, goyal a, sinha m, et al. coagulation profile in patients of ischemic heart disease with reference to activated partial thromboplastin time. int j adv med. 2018;5(3):612–615. 8. cushman m, glynn rj, goldhaber sz, et al. hormone replacement therapy and risk of venous thromboembolism in postmenopausal women. jama. 2004;292(13):1573–158, 9. libby p. inflammation in atherosclerosis.nature. 2002;420(6917):868–874. 10. madjid m, awan i, willerson jt, casscells sw. leukocyte count and coronary heart disease: implications for risk assessment. j am collcardiol. 2004;44(10):1945–1956. 11. sharma r, francis dp, pitt b, poole-wilson pa, coats aj, anker sd. haemoglobin predicts survival in patients with chronic heart failure: a substudy of the elite ii trial. eurheart j. 2004;25(12):1021–1028. 12. packard rr, libby p. inflammation in atherosclerosis: from vascular biology to biomarker discovery and risk prediction. clin chem. 2008;54(1):24–38. ijo journals volume 08 | issue 04 | april 2025 | https://ijojournals.com/index.php/hsn/index 9 2.5 laboratory analysis venous blood samples (5 ml) were collected aseptically from each participant. three milliliters (3 ml) of the blood weredispensed into ethylenediaminetetraacetic acid (edta) tubes for hematological analysis. the remaining 2 ml was used for haemostatic analysis. hematological parameters, including rbc and wbc counts, were measured using a fully automated hematology analyzer. aptt was determined using a standard coagulometer and commercial reagents according to the manufacturer’s instructions. 2.6 statistical analysis data were analyzed using the statistical package for the social sciences (spss) version [insert version, e.g., 25.0]. reults were expressed as mean ± standard deviation (sd). independent sample t-tests were used to compare the mean values between cad patients and controls, as well as between male and female subgroups. pearson correlation was used to determine the relationship between aptt, rbc, and wbc. a p-value < 0.05 was considered statistically significant. 3.results ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." evaluation of direct pulp capping with biodentine™ in diabetic patients randriamalala nc1*, andrianjafinoro th1, rakotoson m2, rakotonirina fp1, rafalimino hn1, rabialahy tdx3, ramaroson j1 1department of conservative dentistry endodontics, institute of odonto-stomatology of madagascar, university of mahajanga, madagascar 2department of dentofaciale orthopedics, institute of odonto-stomatology of madagascar, university of mahajanga, madagascar 3ondontostomatologist *corresponding :randriamalala njarasoa charlette department of conservative dentistry endodontics, institute of odonto-stomatology of madagascar, university of mahajanga, madagascar abstract diabetes is a systemic, endocrine pathology that affects a large number of people worldwide. its oral manifestations are numerous and can contribute to tooth mortification and loss. direct pulp capping represents a viable therapeutic alternative for preserving dental vitality, particularly with the advent of new calcium silicate-based materials such as biodentine™.the aim of this work is to evaluate the therapeutic efficacy of direct pulp capping with biodentine™ in diabetic patients.this study, carried out between march and september 2024 in a private dental practice in faravohitra, antananarivo, involved two cases. the results showed clinical and radiographic success: the patients were no longer in pain, the fillings were airtight, and no periapical or peridental lesions were observed, thus preserving the vitality of the treated teeth.nevertheless, further research is needed to confirm these long-term results and better understand the influence of different factors on treatment success, as well as to assess the performance of the biomaterials used. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 75 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." keywords :diabetes, hair styling, calcium tricalcium, biodentine introduction diabetes, a chronic non-communicable disease, occurs when the pancreas doesn't produce enough insulin or the body doesn't use it efficiently [1]. its growing prevalence is accompanied by increasingly severe complications, predicting that it will become the seventh leading cause of death worldwide by 2030 according to the who [1]. in madagascar, the disease is already more than 6% prevalent [2].diabetics are particularly prone to bacterial and opportunistic infections or opportunistic infections due to microangiopathy, which alters the leukotactic response. as the dental pulp has a terminal circulation, it is more prone to infection. clinical and radiographic studies have shown that there is a greater prevalence of periapical lesions in diabetics than in non-diabetics [3].conservative dentistry, which aims to preserve the vitality of pulp tissue, offers a therapeutic alternative in such cases. to this end, it has incorporated new approaches to treating caries, including the use of innovative materials such as biodentine™, a tricalcium silicate, known to promote tissue healing during direct pulp capping [4, 5]. faced with pulpal exposure in diabetic patients, the question arises as to the advantages and specificities of using biodentine™. the problem lies in altered inflammatory responses, the high risk of infection, delayed healing and glycemic variations [6], all of which can impact pulpal healing and the durability of restorations with this material. thus, the overall aim of the study is to evaluate the clinical and radiographic responses of direct pulp capping with biodentine™ in diabetic patients. the specific objectives are to identify the clinical and radiographic profile of patients, to describe the operative protocol during treatment treatment, as well as to evaluate treatment responses after clinical hindsight. methodology this is a prospective clinical case study carried out at the private dental practice of amadia, a national center specializing in the care of diabetic patients, located in faravohitra, antananarivo. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 76 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." the study lasted 11 months, from november 2023 to october 2024, and involved diabetic patients treated at amadia. the study included patients with dental caries diagnosed as pre-pulpitis, as well as caries with pulpal exposure due to bacterial aggression, requiring direct pulp capping. patients with caries types not requiring pulp capping, such as pulpitis, pulp necrosis or apical periodontitis, as well as those who refused to give consent, were excluded from the study. in the present study, various materials and equipment were used to ensure both clinical examination of patients and specific dental interventions. evaluation criteria were set to assess the success of the treatment, on the one hand clinical success criteria such as the absence of persistent or recurrent pain, the absence of other signs of inflammation as well as the integrity and watertightness of the coronal restoration and on the other hand radiographic success criteria namely the absence of periapical lesion, ligament thickening, signs of resorption or any other pathological process, and dentinal bridge formationof resorption or any other pathological process, and dentine bridge formation [7,8]. description of cases first case a 25-year-old woman with type 1 diabetes presented to the dental practice because of dental pain on contact with sugary foodsand cold water. the precise location of the pain was in the left anterosuperior region, affecting the left maxillary canine. on general examination, it was noted that the patient had a history of arterial hypertension. her blood glucose was measured at 1.12 g/l. inspection revealed deep caries on tooth 23, characterized by a brownish cavity and coronal decaysista 2.3. however, there was no dental dyschromia or signs of periapical periapical swelling (fig. 1). on palpation, the apex of the tooth was painless, with no significant tooth mobility. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 77 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." the tooth was sensitive to cold and probing, but remained alive according to pulp vitality tests. axial percussion was negative, while transverse percussion was positive. radiography showed a carious cavity close to the pulp chamber, but with no evidence of periapical lesion or root fracture (fig. 2). based on these observations, the diagnosis of prepulpitis of tooth 23 was made. surgical protocol the patient's care began with a blood glucose check, in line with the precautions in accordance with the precautions required for a diabetic patient. scaling followed by root planing was then performed to clean the oral cavity and limit the risk of infection. after these preliminary steps, the carious tissues of the causal tooth were carefully removed. however, despite our caution, pulpal exposure occurred, causing the patient occurred, causing bleeding and pain to the patient. following a detailed explanation of the tooth's condition, a treatment aimed at preserving pulp vitality by direct pulp capping using biodentine™, was opted for. figure 1:image showing the maxillary canine preoperatively[rabialahy2024] figure 2 : retro alveolarradiography of the maxillary canine [rabialahy2024] ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 78 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." adrenaline-free anaesthesia was administered, and carious tissue was removed using an excavator under copious irrigation, as well as with a ball bur mounted on a low-speed turbine. hemostasis was ensured with hydrogen peroxide, followed by disinfection of the dentin and exposed area with a 2.5% sodium hypochlorite rinse. the cavity was then rinsed with saline. the cavity was dried by compression using sterile cotton. once bleeding was controlled, biodentine™ was gently applied to the cavity the cavity, close to the pulpal effraction, using a fuller (figure 3). the tooth was protected by a provisional watertight eugenol zinc oxide filling. the patient was advised to maintain excellent oral hygiene and to avoid foods and drinks that could cause pain. she was also told of the importance of attending follow-up visits to monitor the condition of the tooth and post-treatment healing. figure 3 : cavityfillingwithbiodentine™ on the maxillary canine [rabialahy 2024] ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 79 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." second case observation summary a 26-year-old type 1 diabetic patient presented to the dental practice pain in the left anteriorinferior region. on general examination, the patient's blood glucose was measured at 1.19 g/l. the symptoms reported indicated that the pain was triggered by thermal stimuli, such as cold water, and was localized, ceasing after a few seconds. clinical examination revealed several significant features. on inspection the presence of deep caries with brownish discoloration in the cavity,as well as coronal decay classified as sista 2.3. there was no dental dyschromia or periapical swelling (figure 4). on palpation, the tooth apex was painless, with no tooth mobility. however, sensitivity to cold and probing was observed, and the tooth reacted positively to pulp vitality tests. axial percussion tests were negative, while transverse percussion transverse percussion tests were positive. figure 4:preoperative image of the mandibularpremolar[rabialahy 2024] ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 80 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." figure 5:preoperativeretroalveolarradiograph of the mandibularpremolar[rabialahy 2024] finally, radiographic examination showed a carious cavity close to the pulp chamber, with no periapical lesions or root fractures (figure 5). operative protocol the operative protocol began with a check of the patient's blood sugar levels to ensure proper management of the patient's health. this was followed by scaling and root planing to clean up the oral cavity and limit the risk of infectionthe oral cavity and limit the risk of infection. after explaining the condition of the patient's tooth and discussing the treatment options available, the decision was made to preserve pulp vitality by opting for a pulp capping treatmenta direct pulp capping treatment with biodentine™ was made. after scaling, a local anesthetic without adrenaline was administered. the carious tissue was carefully removed under copious irrigation using a turbine-mounted ball bur. hydrogen peroxide was used to ensure hemostasis. next, the dentin and exposed area were disinfected by rinsing with sodium hypochlorite 2.5% sodium hypochlorite rinse, followed by a saline rinse. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 81 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." the cavity was dried by compressing with sterile absorbent cotton. after checking that bleeding had stopped, the capping material was placed, namely biodentine™ was proceeded with the biodentine™ was gently treaded into the cavity, close to the pulpal of the pulp break, using a fuller. the tooth was then sealed with a provisional watertight filling using cvi, as illustrated in figure 6. the patient was advised to maintain excellent oral hygiene and to avoid foods or drinks that could cause pain. the importance of attending follow-up visits to monitor tooth condition and healing after treatment was also recommended. discussion patient's clinical profile age the patients examined and treated in this study were young adults. younger patients have a higher repair potential of the pulp-dentin complex. this assertion is corroborated by the study by auscill et al [9]. moreover, therapeutic success often appears to be higher in younger patients, due to better vascularization and more active immune defenses. despite these trends, figure6:cavityfillingwithbiodentine™ and cvi obturation [rabialahy2024] ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 82 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." studies such as that by andrei [10] suggest that treatment success depends on age and the type of biomaterial used. general condition in both of the clinical cases examined, blood glucose levels measured were balanced, ensuring greater metabolic stability during treatment. this study corroborates predine-hug's finding that good blood glucose control should be maintained at an hba1c level of less than 7% [11] to minimize the risk of complications during dental treatment, such as direct pulp capping [12]. surgical protocol the surgical protocol applied for direct pulp capping in diabetic patients is based on a series of measures designed to ensure patient safety and treatment success. once glycemic status was under control, scaling was performed to remove tartar build-up and improve oral hygiene. this is essential, as the links between periodontal disease and diabetes are well established, reducing the risk of complications [13]. as regards isolation of the surgical field, due to the unavailability of a dental dam as a preferred method of isolation, cotton rolls were used. the institut français pour la recherche odontologique in 2014 emphasized that cotton rolls can be used as a back-up ,moreover they are easy to use well tolerated by patients and present an advantageous cost, although their absorption capacity is limited [14]. for anesthesia, an adrenaline-free anesthetic was preferred to minimize the risk of complications, particularly in diabetic patients where the use of anesthetics with vasoconstrictors can be potentially dangerous[15]. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 83 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." curettage of carious tissue was performed with care to limit pulpal exposure. iwamoto et al. observed that the size of the pulpal exposure is a determining factor in pulp healing [16]. during pulpal exposure, a sterile cotton pellet soaked in sodium hypochlorite was applied to the site for 2-3 minutes for haemostasis. this method is recommended by demir et al in 2007 [17]. sodium hypochlorite not only ensures effective haemostasis, but also disinfects the cavity [18]. after hemostasis, the cavity was thoroughly rinsed with saline to remove any residual debris. excess moisture was then removed by compression using sterile cotton pads. capping and filling materials the choice of capping and obturation materials is a crucial step in the management of diabetic patients. the management of diabetic patients, given the significant impact pulpal health can have on their overall well-being. in our study, we selected biodentine™ as the capping material, eugenate for the provisional obturation, and cvi for definitive obturation. capping material: biodentine™ according to modena et al. biocompatibility of materials is paramount in minimizing pulp tissue irritation and degeneration [19]. biodentine™ stands out for its ability to promote healing of the vital pulp and repair dentin, at both coronal and root level. koubi g. et al. highlight its effectiveness in the treatment of carious lesions, asserting that biodentine™ preserves pulpal vitality after direct pulp capping [20]. this is particularly relevant in the treatment of diabetic patients, for whom maintaining pulp vitality is crucial to avoid further complications. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 84 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." one of the major advantages of biodentine™ is its release of calcium ions at higher concentrations than other styling materials. these calcium ions play a key role in remineralization and promote the formation of mineralized dentin tissue, which is essential for pulp healing [21]. studies also show that direct capping with biodentine™ resulted in good pulp preservation after 28 days, corroborating with our clinical observations. these results underline the importance of this material in the management of carious lesions, particularly in diabetic patients, where pulpal health is often compromised [22]. nevertheless, it should be remembered that successful pulp capping does not rely solely on the quality of the capping material. the tightness of the restoration is just as essential. swift et al. observed that failure to seal the pulp cavity would allow bacteria to infiltrate the marginal spaces, leading to treatment failure [23]. thus, to guarantee pulp vitality after capping, the placement of a tight restoration is paramount, as mentioned by filling material: cvi the choice of cvi for definitive obturation is based on its adhesion properties, its ability to release fluoride ions and its excellent sealing properties. as a dentin substitute, it provides thermal insulation, a barrier against bacterial diffusion, and compensates for mechanical stress [24]. because of its ability to seal the cavity effectively, cvi is a material of choice for coronal restorations after pulp capping, especially in the context of dental care for diabetic patients, where the risk of infection is increased. post-operative follow-up post-operative follow-up is essential for assessing treatment efficacy and pulpal health. according to bergenholtz, clinical and radiographic checks are recommended at one week, three months and six months after treatment, in order to establish a reliable prognosis and determine the appropriate time for fitting of a permanent restoration [24]. this approach not ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 85 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." only allows monitoring of pulp healing, but also early identification of possible complications, thus contributing to a better long-term outcome. studies show that regular follow-ups help prevent serious complications, such as pulpal and periapical infections. for example, mott et al. point out that follow-up visits enable treatment to be adjusted according to patient's clinical response and radiographic evolution [25]. in addition, post-operative follow-up is an opportunity to assess pulpal vitality through thermal sensitivity and percussion tests, providing clinical indicators of the success of the treatment. clinical assessment in the present study, the clinical assessment revealed distinct results between the two cases examined. in the first case, the patient presented an elevated blood glucose level at the threemonth post-operative check-up, whereas the results were balanced at the one-week and sixmonth check-ups. conversely, the second case showed a stable blood glucose level throughout the different control sessions. this glycemic imbalance could be a key factor influencing treatment success in the first case. the literature supports the view that glycemic control is essential to prevent complications and promote optimal healing. it confirms that an hba1c level below 7% is associated with a significant reduction in diabetes-related complications, including those affecting oral health [1]. on the other hand, poorly controlled diabetes can impair the healing process by decreasing collagen synthesis by fibroblasts and reducing blood flow due to microangiopathy[26]. in our study, capped pulps were considered “clinically healthy” at periodic checks, reacting positively to vitality tests, without pain or tenderness. vitality tests, without pain or increased sensitivity. on the other hand, signs of pain, discomfort or a negative response to sensitivity tests could be interpreted as treatment failures, as emphasized by dammaschke et al. [27]. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 86 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." radiographic assessment radiographic assessment plays an essential role in evaluating the success of pulp treatments. according to the european society of endodontology (2006), radiographic success criteria include dentine bridge formation, dentine repair formation, no radiological signs of apical periodontitis, no pulpal calcification or internal root resorption, and no decrease in pulpal volume [28]. studies support these criteria for successful treatment by the absence of complications such as the need for subsequent endodontics or the formation of a periapical lesion or ligament thickening, signs of resorption or any other pathological process at 6 months and 1 year postoperatively and secondly, the development of a dentinal bridge is an important marker of the success of this therapy [29]. the dentin bridge must meet a number of criteria. it may be present in large or small quantities. its homogeneity may vary [30]. in our study, radiographs showed the absence of periapical lesions at three and six months post-operatively. however, dentine bridge formation was not yet observed during the followup period, which limits our confirmation of treatment success from a radiographic point of view. the absence of radiographic complications is a good indicator of pulpal health. however, the identification of a dentinal bridge, although still absent, remains a long-term objective. this underlines the importance of ongoing radiographic follow-up to assess the progress of healing and the success of treatment. conclusion in conclusion, this study demonstrated that direct pulp capping with biodentine™ in diabetic patients can offer promising clinical and radiographic responses although adjustments may be necessary depending on patients' glycemic balance ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 87 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." the results obtained indicate preservation of pulpal vitality, accompanied by an absence of significant post-operative complications, and potential formation of reparative dentin over time. in the future, it is essential to raise awareness and train healthcare professionals in the specificities of managing diabetic patients in dental practice, in order to improve the quality of care. in the long term, further studies into the biocompatibility and efficacy of new materials, as well as the evaluation of integrated treatment protocols, could contribute to significant advances in the care of this vulnerable population. by fostering a collaborative approach between dentists and general practitioners, better oral and general health for diabetic patients could be guaranteed. references 1. the diabetic patient in dentistry: clinical manifestations and management [accessed 17 may 2023]. available on :https://www.lecourrierdudentiste.com/dossiers-du-mois/le-patientdiabetique-en-odontologie-manifestations-cliniques-et-prise-en-charge.html. 2. the pan-african agency for the development and promotion of medicines (apidpm), tropical health. "diabetes in madagascar: higher prevalence among overweight women". [accessed july 15, 2023]. available on: http://www.santetropicale.com/sites_pays/actus.asp?id=25542&action=lire&rep=madagascar. 3. bender ib, bender ab. diabetes mellitus and the dental pulp. journal of endodontics. 1 juin 2003 ;29(6) :383-9. 4. martens l, rajasekharan s, cauwels r. pulp management after traumatic injuries with a tricalcium silicate-based cement (biodentine): a report of two cases, up to 48 months followup. eur arch paediatr dent. 2015;16(6):491-6. 5. borkar sa, ataide i. biodentine pulpotomy several days after pulp exposure: four case reports. j conserv dent. 2015;18(1):73-8. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 88 https://www.lecourrierdudentiste.com/dossiers-du-mois/le-patient-diabetique-en-odontologie-manifestations-cliniques-et-prise-en-charge.html https://www.lecourrierdudentiste.com/dossiers-du-mois/le-patient-diabetique-en-odontologie-manifestations-cliniques-et-prise-en-charge.html http://www.santetropicale.com/sites_pays/actus.asp?id=25542&action=lire&rep=madagascar ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." 6. kaur m, singh h, dhillon js, batra m, saini m. mta versus biodentine: review of literature with a comparative analysis. journal of clinical and diagnostic research : jcdr. 2017 ;11(8) :01. 7. dammaschke t, leidinger j, schäfer e. long-term evaluation of direct pulp capping— treatment outcomes over an average period of 6.1 years. clin oral investig. 2010 ;14(5) :55967. 8. mente j, geletneky b, ohle m, koch mj, friedrich ding pg, wolff d, dreyhaupt j, martin n, staehle hjt. mineral trioxide aggregate or calcium hydroxide direct pulp capping : an analysis of the clinical treatment outcome. j endod. 2010 , 36 (5) : 806-13. 9. auscill, t.m. ; arweiler, n.b. ; hellwig, e. ; zamani-alaeli, a. ; sculean, a. success rate of direct pulp capping with calcium hydroxide [in german]. schweiz monatsschr zahnmed, 2003, 113 (9) : 946-52. 10. andrei m, vacaru r, coricovac a, ilinca r, didilescu a, demetrescu i. the effect of calcium-silicate cements on reparative dentinogenesis following direct pulp capping on animal models. molecules. 2021 ; 26(9) : 2725. 11. martin r g, dds, maed. a place for oral health in diabetes management. j can dent assoc 2010 ;76 : a24_f. 12. national academy of dental surgery.diabète de type ii et parodontopathie. 2007. 13. tan wc, tay fbk, and lim lp. diabetes as a risk factor for periodontal disease : current status and future considerations. ann acad med singapore 2006 ; 35 :571-81. 14. french institute for odontological research. ifro oral diseases and general diseases conference. dental tribune french edition.2014. 15. proche y. dental surgery and at-risk patients.medecine-science flammarion : 1996 ; n°10223. 16. iwamoto ce, adachi e, pameijer ch, barnes d, romberg ee, jefferies s. clinical and histological evaluation of white proroot mta in direct pulp capping. am j dent, 2006, 19 (2) : 85-90. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 89 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." 17. demir tcz. clinical and radiographic evaluation of adhesive pulp capping in primary molars following hemostasis with1.25% sodium hypochlorite :2yearresults. amj dent. 2007 ; 20(3) :182–8. 18. bogeng c. vital pulp therapy. in : ingle’sendodontics 6. people’sm.shelton, united states ; 2008 : 1310–29. 19. modena kc, casas-apayco lc, atta mt, costa ca, hebling j, sipert cr, navarro mf, santsos cf. cytotoxicity and biocompatibility of direct and indirect pulp capping materials. j appl oral sci. 2009 ; 17 (6) : 544-54. 20. koubi g, colon p, franquin jc, hartmann a, richard g, faure mo, lambert g. clinical evaluation of the performance and safety of a new dentine substitute, biodentine, in the restoration of posterior teeth a prospective study. clin oral invest 2013 ; 17(1) : 243-9 21. kurun aksoy m, tulga oz f, orhan k. evaluation of calcium (ca2+) and hydroxide (oh-) ion diffusion rates of indirect pulp capping materials. int j artif organs. 2017 ; 8 : 24-9. 22. arias-moliz mt, farrugia c, lung cyk, wismayer ps, camilleri j. antimicrobial and biological activity of leachate from light curable pulp capping materials. j dent. 2017 ; 20 (17) : 30151-3. 23. swift ej, trope m, ritter av. vital pulp therapy for the mature tooth can it work ? endodontic topics. 2003 ; 5 : 49-56. 24. bergenholtz g. advances since the paper by zander and glass on the pursuit of healing methods for pulpal exposures: historical perspectives. oral surg oral med oral pathol oral radiol endodontology. 2005 ; 100(2) : 102-8. 25. mott a, jha s, tiwari a, et al. the importance of post-operative follow-up in endodontics: a retrospective analysis of treatment outcomes. j endod. 2015;41(6):93540. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 90 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala njarasoa charlette 1* https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ evaluation of direct pulp capping with biodentine™ in diabetic patients." 26. american diabetes association. standards of medical care in diabetes 2020.diabetes care 2020 ;43(1). 27. dammaschke t, leidinger j, schäfer e. long-term evaluation of direct pulp capping— treatment outcomes over an average period of 6.1 years. clin oral investig. 2010 ;14(5) :55967. 28. european society of endodontology. quality guidelines for endodontic treatment : concensus report of the european society of endodontology. int endod j. 2006 : 92130. 29. bidar m, moushekhian s, gharechahi m, talati a, ahrari f, bojarpour m. the effect of low level laser therapy on direct pulp capping in dogs. j lasers med sci. 2016 ; 7(3) : 177-83. 30. matsuot, nakanishi t, shimizu h, ebisu s. a clinical study of direct pulp capping applied to carious-exposed pulps. j endod, 1996 ; 22 (10) : 551-6. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 91 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022 rabab omer mohammed salih1. widad ibrahim adbulghader2. 1. ministry of health saudi arabia. neonatal intensive care unit 2. college of nursing, university of bahri rabab omer mohammed salih. hail general hospital. abstract immediate newborn care is the care given to newborns in the transitional period (immediately after birth) which crucial to their survival. midwives require adequate training practice and skills to provide immediate newborn care. the study was aimed to assist the midwives working in labor room unit in obstetrics and gynecology teaching hospital to gain skills needed in the immediate care of the newborn. quasi-experimental designstudy was conducted from february to july 2020 at sinnar state in governmental hospitals. the sample size consisted of (96) midwives. data were collected by using observation checklist to monitor midwives performance pre and post intervention to determine their practice regarding immediate care of newborn. data analysis was performed by statistical package for social sciences (spss) (version 26) presented in tables and figure. the results of study indicated that midwives’ ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 30 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." practice assessment before the implementation of training program for study sample was moderate related to immediate newborn care. all the study group were labor room and female, they had got diploma certificate. majority(44.8%) of the study samples were ranged between (41-50) years. the highest percentage (52.5%) of study sample were attended training program in neonatal care. the total mean score of post midwives practice were (79.2%, 13.5% and 7.3%) for the done correctly, done not correctly and not done respectively. the results of the study indicated that (14.5%) of the midwives showed a good performance and after implementation practice program and conducting the post-test, the midwives expressed good performance (80.8%). there were high significant differences (p 0.01) in midwives’ practice at pretest and posttest before and after the implementation of practice program for study sample. the study findings showed that program had been an effective method of increasing the midwives’ practice about immediate newborn care. key words: midwives, implementation practice, immediate newborn care, sudan. introduction essential newborn care is the care providing to the newborn babies after labor within the labor room by practiced workers which includes drying and motivating, evaluating breathing air , cord care, skin to skin contact, initiating ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 31 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." exclusive breastfeeding, eye care, vitamin k providing, place of identification band and weighing (lazzerini, et al.,2019).a comparative study was done on essential newborn care practice in hospital and home deliveries in 2005 in medan, pakistan. this study highlighted the deficiencies in the newborn care.both hospital practices and traditional ones neglected the basic principles of newborn cleanliness, early breast feeding, eye care and cord care(who.2017).essential newborn care has standardized and active practical steps: drying and motivating, evaluating breathing, care of umbilical cord, protection the newborn warm (preventing hypothermia), starting breastfeeding within the first hour, managing eye drops / eye ointment, administering vitamin k intramuscularly, newborn identification straps, weighing the newborn, when stable and warm, write all notes and treatments, delay bathing the baby for 24 hours after birth (roué,et al., 2017). the majority of healthcare practitioners do not practice in a proper manner. many neonatal deaths can be avoided if necessary newborn care is provided (arba, 2022).the world health organization recommends that improving enc be emphasized as a priority activity around the time of birth in order to substantially reduce newborn mortality. despite the implementation of many efforts to improve vital infant care, only 16.4% and 13% of newborns received skilled health workers during delivery and the postnatal period, respectively (abdu, et al., 2019). ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 32 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." the majority of neonatal deaths occur in the first week of life, with asphyxiation at delivery (47.5 %), neonatal infections (34.3 %), and prematurity accounting for 93 % of nmr instances (11.1 %) (who,2017).according to certain research, 25 % of health care providers do not have sufficient knowledge of essential newborn care, 28 percent do not have effective essential newborn care practices, and only 9.8 % of participants in the study are informed about infant resuscitation(berhe, et al., 2017).one technique for improving infant health outcomes is to promote enc. this necessitates health care systems that can provide continuum of care from the onset of pregnancy (and even before), through professional competent childbirth care, and into the postnatal period. however, the standardized technique for obtaining enc is not widely used. one of the most important parts of health systems in terms of adhering to enc standards is knowledge (koru, 2013). new born mortality in sudan is estimated at (61 per 1 000). the high figure is attributed to poor neonatal care resources, and shortage of staff trained in new born care. midwives are the first line staff to deal with neonates requiring urgent help. neonatal care training is deficient in midwifery schools. also there is lack of in-service training m neonatal care for hospital midwives newborn care services in sudan have not progressed well over the years. medical and nursing staff involved in newborn care in the delivery rooms or special care ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 33 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." baby units have not gained much experience in proper newborn care. the midwives are the first contact of the newborns so we need them to be knowledgeable and aware about initial care and assessment of the neonate to decrease incidence of mortality and morbidity rate by using standard process for the immediate care of newborn. for this reasons this study is conduced to provide a training program on midwives practice regarding immediate care of the newborn. methodology a quasi-experimental design analytic study conducted to assess midwives' practice and to evaluate midwives' practices regarding immediate new born care for the study population using, the study was started at (october 2019 to august 2022). the study was performed in the labor room of sinnar city, obstetrics and gynecology teaching hospital. the study's sample included (96) midwives who work in the labor room at the obstetrics and gynecology teaching hospital and were participating in the assessment. the samples were chosen based on the midwives who worked in the labor rooms at sinnar city, obstetrics and gynecology teaching hospital. inclusion criteria was all midwives working in labor room in obstetrics and gynecological hospital at governmental hospital during the period of the study.an observational checklist ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 34 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." was developed by the researcher to observe the actual midwives performance before and after the training program. it included all midwives care and practices needed for the immediate care of the newborn. data collected by selfadminister questionnaire and checklist by researcher a questionnaire sheet was designed by the researcher in arabic language. the questionnaire consists of two main parts includes the following: part i: consists of midwives’ demographic characteristics such as (midwives age, level of education, number of years' service in a hospital, number of years' experience in midwifery, whether they have completed a training course for immediate newborn care, the number of training courses they have completed, and the location of their participation.). part ii: including the checklist concerning midwives’ practices about immediate care for newborns. consist of (17) items were divided to (5) mean group relating to midwives' practice of providing immediate care to newborns such as maintain airway clearance: (oral suctioning, nasal suctioning, and apgar score). umbilical cord such, skin and eye: (umbilical cord, skin to skin contact, skin care, and eye care). initiation of early breast feeding, given vitamin k: (initiation of early breast feeding and given vitamin k). measuring vital signs: (assess body temperature by rectal, assess heart rate and assess respiratory rate). measuring head and chest: (head circumference, chest circumference, weight and length). training program including theory and practice session (stimulation). the post questioner provided immediately conducting the education program, pre ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 35 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." and post questioner are same, and checklist used for measuring the practice. in the evaluation. the practice scenario conducted for the participant and registered in with video and checked the errors together, and deleted for those they do not want. during training program hand learning material distributed .at the end of the best participants done to handle the continues training program .fallow up done after four months and post questioner applied to the participants. approval from university of bahri faculty of postgraduates studies, permission of ministry of health and approval from all hospitals. verbal informed consent was obtained from the participants, confidentiality of response to both questionnaire and personal data sheet was assured. the participant were provide essential information for consent form and their signatures taken on consent form. the participant have right to with draw from the study at any time and that there would be no potential physical economical or legal harm to the participants. the result available and given the hospital. spss (statistical package for social sciences) version 26.0 and excel is used to examine the data. it includes: data of this study analyzed descriptive by identifying the change and the percentage, frequency, standard deviation and mean of score. also means determining the outcome. and inferential statistical tests (t-test and repeated measure anova). ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 36 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." results table (1): demographic characteristics of study group n=96 items frequency percent age 20-30 years 05 4.2% 31-40 years 27 28.1% 41-50 years 42 44.8% more than 50years 22 22.9% total 96 100% gender female 96 100% level of qualification diploma 96 100% field of study midwifery 96 100% years of experience 6 – 11 years 34 35.4% 11 – 15 years 12 12.5% more than 15 years 50 52.1% total 96 100% unite of work labor room 96 100% last attended training and participation in training courses in neonatal care yes 50 52.5% ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 37 ijo international journa ( issn: 2814-2098 ) https://ijojournals.com/ “effect of training program on midwives practice regard the table showed that all the study group room and female. majority(44.8%) were ranged between (41 highest percentage (52.1%) of study sample has training courses in immediate newborn care. fig. (1). performance of study group during maintain dry and warm newborn after birth n= 96 no total international journal of health sciences and nursing rabab omer mohammed salih volume 08 || issue 03 || march effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022 the table showed that all the study group were got diploma certificate, majority(44.8%) were ranged between (41-50) years. highest percentage (52.1%) of study sample has training courses in immediate fig. (1). performance of study group during maintain dry and warm 46 47.5% 96 100% and nursing rabab omer mohammed salih 1 * march, 2025 || ing immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." got diploma certificate, labor 50) years. the highest percentage (52.1%) of study sample has training courses in immediate fig. (1). performance of study group during maintain dry and warm for the 47.5% 100% ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 38 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." data in fig (1). midwives practice during maintain dry and warm for the newborn after birth were (80.3%, 10.4% and 6.3%) for the done correctly, done not correctly and not done respectively. table (2). performance of study group during midwives practice items in immediate care of newborn pre and post n=96 done correctly answers pre test post test f % f % maintain airway clearance oral suctioning 13 13.5% 73 76% nasal suctioning 10 10.4% 71 70.4% apgar score 10 10.4% 71 70.4% mean score 11 11.3% 72 74.3% nursing care (umbilical cord, skin and eye) umbilical cord 09 9.4% 79 82.2% skin to skin contact 12 12.5% 83 86.5% skin care 15 15.6% 80 83.3% eye care 18 18.8% 82 85.4% mean score 14 12.9% 81 79.5% nursing care (initiation of early breast feeding, given vitamin k) ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 39 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." initiation of early breast feeding 19 19.8% 78 81.4% given vitamin k 43 44.8% 85 88.5% mean score 31 23.3% 82 84.9% whereas, f= frequency, %= percent. this table presents that the mean scores midwives practice for pre and posttest about immediate newborn care; the mean score indicate that midwives practice were increased from (11.3%, 12.9% and 23.3%) to (74.3%, 79.5% and 84.9%) for maintain airway clearance, umbilical cord, skin and eye and initiation of early breast feeding, given vitamin k respectively. table (3). performance of study group during midwives practice items in immediate care of newborn pre and post n=96 correctly answers pre test post test f % f % measuring vital signs in immediate care of newborn assess body temperature by rectal 10 10.4% 78 81.3% assess heart rate 15 15.6% 78 81.3% assess respiratory rate 07 07.5% 81 84.4% mean score 11 11.7% 80 82.3 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 40 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." measuring head and chest circumference weight and length newborn after birth head circumference 07 07.3% 78 81.3% chest circumference 08 08.3% 82 85.4% weight 18 18.6% 77 80.2% length 17 17.7% 81 84.4% means score 13 12.8% 80 82.8% whereas, f= frequency, %= percent. this table presents that the mean scores midwives practice for pre and posttest about immediate newborn care; the mean score indicate that midwives practice were increased from (11.7% and 12.8%) to (82.3% and 82.8) for measuring vital signs in immediate care of newborn and measuring head and chest circumference weight and length newborn after birth respectively. table (4) mean of performance of study group during nursing care pre and post n=96 nursing practices pre test post test t sig. (2tailed) x±sd x±sd performance of study group during maintain dry and 11.4±1.8 74.3±3.4 -28.5 0.00** ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 41 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." warm, airway clearance and apgar score performance of study group during nursing care (umbilical cord, skin and eye) 12.9±6.0 79.5±2.4 -20.6 0.00** performance of study group during nursing care (initiation of early breast feeding, given vitamin k) 23±17.6 84.9±5.1 -19.8 0.008* performance of study group during measuring vital signs 11.7±4.1 82.3±1.7 -27.5 0.00** performance of study group during measuring head and chest circumference weight and length newborn after birth 12.8±6.1 82.8±2.5 -21.5 0.00** whereas, x = mean, t = t-test, sd = standard deviation. sig. =significant at p-value = 0.05 data in table (4), reveals that there was significant relationship between midwives’ pre and post practices with regard to their participation in training ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 42 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." program about assessment of immediate newborn care at (sig. (2-tailed) 0.01)). table (5): comparing between pre and post training program regarding midwives immediate care of newborn n= 96 item x±sd t sig. (2-tailed) pre total mean practice 14.5 ± 5.0 -22.3 0.00** post total mean practice 80.8 ± 4.1 whereas, x = mean, t = t-test, sd = standard deviation. sig. =significant at p-value = 0.05 data in table (5), reveals that there was significant relationship between midwives’ pre and post practices with regard to their participation in training program about assessment of immediate newborn care at (sig. (2-tailed) 0.01)). table (6): distribution of study group according to their performance pre and post-testn= 96 nursing performance level of performance pre test post test t sig. (2tailed) level of performance x±sd x±sd good performance 16.8±8.2 75.7±8.3 11.3 0.00** ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 43 ijo international journa ( issn: 2814-2098 ) https://ijojournals.com/ “effect of training program on midwives practice regard satisfied performance poor performance whereas x = mean, t = t-test, value = 0.05, data in table (6), reveals that there midwives’ performance from pre and post midwives their participation in training care at (sig. (2-tailed) 0.00 fig (2). total mean score of midwives practice for done correctly, done no correctly and not doe answers n international journal of health sciences and nursing rabab omer mohammed salih volume 08 || issue 03 || march effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022 satisfied performance 39.2±14.6 13.6±7.6 3.4 poor performance 40.1±18.4 6.8±1.2 4.04 test, sd = standard deviation, sig. =significant at p reveals that there was significant relationship between performance from pre and post midwives practices with regard to their participation in training program about assessment of immediate newborn 0.001)). ean score of midwives practice for done correctly, done no correctly and not doe answers n= 96 and nursing rabab omer mohammed salih 1 * march, 2025 || ing immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." 0.008** 4.04 0.004** , sig. =significant at psignificant relationship between practices with regard to of immediate newborn ean score of midwives practice for done correctly, done not ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 44 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." data in fig (2). showed the total mean score of midwives practice for done correctly, done not correctly and not doe answers for pre and post midwives practice. the total mean score of post midwives practice were (79.2%, 40.6% and 7.3%) for the done correctly, done not correctly and not done respectively. discussion according to their demographic characteristics the current study showed that more than half of the participants (44.8%) were above forty years in age. contradicted with findings were reported in other intervention study in sudan, in khartoum state (rabab and buthina. 2022) and found that the majority of their participants (74.5%) were aged 20–30 years. also mohammad, (2020) who found the specified age distribution of the respondents while revealing that the highest age group is between (20 – 29) years which made up(44.7%)of the study sample. all participants in this study were female which is similar to the findings of another study in sudan, which showed that all neonatal care nurses (100%) in the nicu were female. this can be attributed to hospital polices (babeker, z. a., 2015). the results show that all midwives had got diploma certificate. contradicted with mohammad, (2020) the results show that half of the study participants were graduates of a secondary midwifery school. the current study showed that the highest percentage (52.5%) of study sample were attended training program in neonatal care. similar results was found by ali, (2022), 86% of ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 45 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." nurse-midwives that they had taken training courses, 40 % was that they had taken 1-5 courses, and 24 % said they had taken 6-10 courses.while agreeing with khudhair s.h.; (2014) who done studied of evaluation nurses' practices, neonatal resuscitation in the delivery room,(100%) of the nurses in the study took neonatal resuscitation in the delivery room training courses in their own country. the majority (73.3 %) had attended training courses in labor and delivery care (nuri and ahmed, 2018). the study indicated the highest percentage is seen with more than 15 years among 52.5% of midwives while 35% have 6-11 years of experience. nuriy and ahmed,(2018) findings in erbil's city maternity teaching hospital. more than half of the nurse/midwives (53.3 %) had 1–9 years of experience in the labor room. assessment of midwives’ practices about immediate care for newborn the results of the study about the assessment of midwives’ practices showed that the total mean score of post midwives practice were (79.2%, 13.5% and 7.3%) for the done correctly, done not correctly and not done respectively. moreover, after the training intervention, the newborn care practice was improved in different relevant areas such as; maintain dry and warm for the newborn after birth, oral suctioning, nasal suctioning and apgar score. these results were in agreed to similar study from ethiopia (sintayehu,et al., 2020) who reported that a considerable proportion of the nurses and midwives had ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 46 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." improved newborn practices and skills. however, the improvement in our study was greater than some other studies, for example, in india (6.3%) (devi s. 2015). this might be due to the impact of the current focus of neonatal care service in the intervention material. the results of the study indicated that (14.5%) of the midwives showed a good performance and after implementation practice program and conducting the post-test, the midwives expressed good performance (80.8%). the current study indicated that there were high significant differences (p 0.01) in midwives’ practice at pretest and posttest before and after the implementation of practice program for study sample. whereas, the total means were (80.8%) for posttest, as for pretest (14.5%). this result was agree with (taghreed, 2019) found that the mean percentage of posttest graduates’ practices=88% and the pretest was at the moderate levels by (23.3%).and there was a high significant correlation between pretest and posttest (before and after the implementation of an educational and practice programs for study sample (arba. a. zana, 2020). conclusion the study concluded that the midwives' practice showing poor to fair level skills before training practice program. however, after training program they showing good level practice skills regarding immediate care of newborn. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 47 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." recommendations based on the conclusion the study recommended the following:  the researcher can conducted similar training program is required for midwives in-service education.  the health care providers should be encouraged to upgrade their training program level to build their skill retention and expose themselves to newborn care.  further, understanding factors affecting how midwives and nurses gain and retain skills using high-level methodology are essential refernces abdu h, gebrselassie m, abdu m, mare ku, tadesse w, liben ml.; (2019). knowledge and practice of immediate newborn care among midwives and nurses in public health facilities of afar regional state, northeast ethiopia. bmc pregnancy childbirth. 2019;19(1):422. ali, s. h., &ghafel, h. h. (2022). nurse-midwives’ knowledge and practices about immediate newborn care. international journal of health sciences, 6(s1), 8915–8940. retrieved from https://sciencescholar.us/journal/index.php/ijhs/article/view/7033 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 48 https://sciencescholar.us/journal/index.php/ijhs/article/view/7033 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." arba, a, zana, z. knowledge of essential newborncare and associated factors among nurses and midwives: a cross-sectional study at public healthfacilities in wolaita zone, southern ethiopia, 2019. international journal of pediatrics. 2020 : 1-8 babeker, z. a. (2015). assessment of nurses knowledge and practice regarding care of premature baby in neonatal intensive care unit at omdurman maternity hospital and alribat university hospital in pediatric nursing. faculty of graduate studies and scientific research, the national ribat university. berhe a. k. ,tinsae f. , ziabherg. g. ; (2017). knowledge and practice of immediate newborn care among health care providers in eastern zone public health facilities, tigray, ethiopia, 2016, bmc pediatr. 17 (1) (2017) 157. devi s. (2015). a study to assess the effectiveness of neonatal resuscitation programme, first golden minute certified training course on knowledge and skill set of nurses working in selected hospital of pune city. int j sci res [internet].;4(2277):432–5. khudhair s.h.;( 2014). evaluation nurses' practices toward neonatal resuscitation in the delivery room. assistant instructor, pediatric nursing department, college of nursing, university of baghdad ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 49 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." koru c (2013) newborn care practices at home and in health facilities in 4 regions of ethiopia. bmc pediatr 13:198 lazzerini m, valente ep, covi b, et al.; (2019). use of who standards to improve quality of maternal and newborn hospital care: a study collecting both mothers’ and staff perspective in a tertiary care hospital in italy. bmj open quality. 2019;8(1):e000525–e000525. doi:10.1136/bmjoq-2018000525 mohammad, h. n. ;(2020). nurse midwives knowledge regarding nursing management of post-partum hemorrhage at in iraq. medico legal update, 20(4), 1706-1712. nuriy l.a.m. & ahmed; h.m.; (2018). college of nursing, sulaimaniya university, sulaimaniya, iraq. department of midwifery, college of nursing, hawler medical university, erbil, iraq nurse/midwives' practices during labor and delivery in maternity teaching hospital in erbil city https://doi.org/10.15218/ejnm.2018.04 ejnm, vol. 1, no. (1), may, 2018original article taghreed mohammed abu hadaf1, hamza mohammed abdeljawad, and ayman mustafa abu mustafa. (2019). the effect of a midwifery educational program on graduates’ knowledge, attitudes, and practices in gaza strip: ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 50 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) rabab omer mohammed salih 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “effect of training program on midwives practice regarding immediate care of newborn on in governmental hospitals sinnar state. sudan, 2022." perception of graduates. pediatrics and neonatal nursing: open access. issn 2470-0983 | open access. volume 4 issue 1. rabab. mohamed adam* and buthinabassyonieelssayed (2022) “the effect of neonatal training programs on nicu nurses’ knowledge and practice in the military and police hospitals of khartoum state, sudan,” sudan journal of medical sciences, vol. 17, issue no. 1, pages 28–38. roué j-m, kuhn p, maestro ml, et al.; (2017). eight principles for patientcentred and family centred care for newborns in the neonatal intensive care unit. archives of disease in childhood fetal and neonatal page 20/22 edition 2017;102(4):f364-f68 sintayehu y, desalew a, geda b, tiruye g, mezmur h, shiferaw k, et al. (2020) basic neonatal resuscitation skills of midwives and nurses in eastern ethiopia are not well retained: an observational study. plos one 15(7): e0236194. who, (2019). newborn: reducing mortality, september 2019: https://www.who.int/ news-room/fact-sheets/detail/newborns-reducingmortality. accessed 28 jan 2019. 3. world health ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 51 table (1): demographic characteristics of study group n=96 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala ncr 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ determinants of psychoactive substance use among students in the urban commune of toliara." determinants of psychoactive substance use among students in the urban commune of toliara andriamanjato hmh1, randriamalala ncr1, randrianarivo rf2, tsialoa dee1, raobelle en3, raharivelo a4 1 antanambao university hospital, toliara, madagascar 2pzaga university hospital, mahajanga, madagascar 3faculty of medicine, mahajanga, madagascar 4faculty of medicine, antananarivo, madagascar summary introduction: the use of psychoactive substances is steadily increasing worldwide. among adolescents, this behavior exposes them to risks, dependence and health hazards. the aim of this study is to determine the prevalence of psychoactive substances and the profiles of high school students who use them. method: this was a prospective descriptive and analytical study carried out in public high schools in the urban commune of toliara. students who had used psychoactive substances in the previous 12 months were considered users. the hospital anxiety depression scale (hads) was used to assess students' psychological distress. results: 150 high school students were surveyed, 85.33% of whom had already used psychoactive substances, 70% of whom had consumed alcohol, 4% tobacco and 7.33% cannabis ; 88% of the students were in the 16-18 age group, and 50% were male. males are associated with the use of psychoactive substances. consumption by parents or friends, as well as peer influence, played a significant role in substance use. the presence of anxiety and depressive disorders was correlated with the use of psychoactive substances. conclusion: the use of psychoactive substances is increasingly attractive to teenagers. reducing adolescent consumption requires psychological support and parental education. key words: adolescent, epidemiology, associated factors, madagascar, psychoactive substances. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 120 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala ncr 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ determinants of psychoactive substance use among students in the urban commune of toliara." introduction the use of psychoactive substances represents a major public health challenge on a global scale, with prevalence rising steadily. developing countries are currently considered to be the hub of drug networks, and are not spared from the major current problem of combating drug addiction [1]. in madagascar, as in other low-income countries, this problem is exacerbated by complex socio-economic factors and limited access to prevention programs. adolescents and young adults are most exposed to the use of psychoactive substances. and it is often during adolescence that people are first introduced to the use of psychoactive substances, whether licit or illicit.the initiation of psychoactive substance use at an early age often leads to harmful use or even dependence [2]. the use of aps exposes adolescents to specific risks, such as difficulties in academic success or social and professional integration at a key period in the construction of their adult lives [3,4]. several factors can influence this consumption, such as intergenerational transmission and peer influence [5]. academic stress can also lead students to adopt risky behaviours, particularly the use of psychoactive substances, as can the psychological status of adolescents. negative emotional states such as anxiety and depression are common among substance users. adolescents use psychoactive substances to alleviate their emotional distress [6]. in toliara, an urban commune in south-west madagascar, no recent data have documented the extent of this phenomenon among high-school students, a key population for targeted interventions. this study aims to measure the prevalence of spa consumption (alcohol, tobacco, cannabis); identify associated profiles and factors (gender, family environment, mental health). ii material and method this was a descriptive and analytical cross-sectional study conducted between january and march 2024 in the public high schools of the urban commune of toliara, madagascar. the study population consisted of students aged 12 to 18 enrolled in classes from seconde to terminale. the schools were selected by stratified random sampling to represent the different districts of toliara. pupils were randomly selected by class, with a balanced boy/girl ratio. male and female students aged 12 to 18, present in the school during the survey period, were included in the study after informed consent had been obtained (oral for minors, with written ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 121 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala ncr 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ determinants of psychoactive substance use among students in the urban commune of toliara." parental consent). incomplete questionnaires (greter than 20% of missing data), students absent during the survey and who refused to participate in the study were excluded. sample size was calculated using cochran's formula for a finite population (margin of error 5%, confidence interval 95%), resulting in 150 participants. data were collected using an anonymous questionnaire. the questionnaire consists of three parts. the first part concerns the independent variables, grouping together variables relating to individual, family and socio-environmental factors. the second part evaluates the dependent variable, concerning the use of psychoactive substances (alcohol, tobacco, cannabis) in the last 12 months (binary answers: yes/no). the third part uses the hospital, anxiety and depression scale (hads) to assess anxiety (7 items) and depression (7 items). data collected, coded, entered on word/excel 2010 software, analysis via spss v.20.0. statistical tests were considered significant at p<0.05. the study was carried out after obtaining permission from the head of each school and the consent of parents and respondents. before the questionnaires were handed out, the purpose of the survey was explained, insisting on total respect for confidentiality in order to encourage adolescents to answer the questionnaire frankly. all information gathered on each individual was kept confidential. respect for anonymity was enforced by using codes for each file. iii results during the study period, 150 students were surveyed; of these, 88% were in the 16-18 age group; 11% in the 14-16 age group; 50% were male; 76.5% were involved in an extracurricular activity (sport). hostility was found in 19% of the students surveyed. concerning the results of the hads scale, 35% presented an anxiety disorder, 9% a depressive symptom and 7% an anxiety-depressive disorder. for variables relating to family factors: 68.67% of parents were married, 12.67% divorced; 77.33% of parents worked in the tertiary sector, 9.33% in the secondary sector and 8.67% unemployed. the students had a relationship of trust with their parents in 73% of cases, 21% ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 122 ijo international journa ( issn: 2814-2098 ) https://ijojournals.com/ “ determinants of psychoacti said there was no exchange with their parents and 6% had a conflictual relationship; 78.67% of parents were authoritarian and 21.33% had a democratic educational hand, 46.7% said they had a family problem. with regard to variables relating to the use of psychoactive substances : 85.33% of students had already used psychoactive substances. of these, 70% had used alcohol, 2.67% tobacco and 7.33% cannabis (fig 1). parents were spa users in 69% of cases ; and 55. 57% were influenced by bad company. figure 1 : distribution of students according to substance use the factors associated with the use of psychoactive substances are summarized in settings psychoactive substances nonuser alcohol n(%) n(%) gender masculine 5(22.7) 56(53.3) feminine 17(77.3) 49(46.7) consumer parents 0 non-user alcohol cannabis tobacco alcohol-tobacco alcohol-cannabis international journal of health sciences and nursing randriamalala ncr volume 08 || issue determinants of psychoactive substance use among students in the urban commune of toliara said there was no exchange with their parents and 6% had a conflictual relationship; 78.67% of parents were authoritarian and 21.33% had a democratic educational practice. on the other hand, 46.7% said they had a family problem. with regard to variables relating to the use of psychoactive substances : 85.33% of students had already used psychoactive substances. of these, 70% had used alcohol, 2.67% tobacco 3% cannabis (fig 1). parents were spa users in 69% of cases ; and 55. 57% were influenced by bad company. figure 1 : distribution of students according to substance use the factors associated with the use of psychoactive substances are summarized in psychoactive substances alcohol cannabis tobacco alcoholtobacco alcohol cannabis n(%) n(%) n(%) n(%) 56(53.3) 0(0.0) 3(27.3) 5(83.3) 2(100.0) 49(46.7) 4(100.0) 8(72.7) 1(16.7) 0(0.0) 22(14.66%) 105(70%) 11(7.33%) 4(2.67%) 7(4.67%) 1(0.67%) 20 40 60 80 100 and nursing randriamalala ncr 1* || issue 03 || march, 2025 || ve substance use among students in the urban commune of toliara." said there was no exchange with their parents and 6% had a conflictual relationship; 78.67% practice. on the other with regard to variables relating to the use of psychoactive substances : 85.33% of students had already used psychoactive substances. of these, 70% had used alcohol, 2.67% tobacco 3% cannabis (fig 1). parents were spa users in 69% of cases ; and 55. the factors associated with the use of psychoactive substances are summarized in table i p-value alcoholcannabis n(%) 2(100.0) 0.002 0(0.0) 120 ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 123 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala ncr 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ determinants of psychoactive substance use among students in the urban commune of toliara." no 19(86.4) 51(48.5) 1(25.0) 6(54.5) 3(50.0) 1(50.0) 0.008 yes 3(13.6) 54(51.4) 3(75.0) 5(45.5) 3(50.0) 1(50.0) parent-child relationship trust 17(77.3) 76(72.4) 2(50.0) 11(100.0) 4(66.7) 0(0.0) 0.003 lack of exchange 1(4.5) 26(24.8) 1(25.0) 0(0.0) 1(16.7) 2(100.0) conflictual 4(18.2) 3(2.9) 1(25.0) 0(0.0) 1(16.7) 0(0.0) consumer friends no 17(77.3) 44(41.9) 1(25.0) 1(9.1) 2(33.3) 0(0.0) 0.001 yes 5(22.7) 61(58.1) 3(75.0) 10(90.9) 4(66.7) 2(100.0) peer influence yes 1(4.5) 11(10.5) 3(75.0) 1(9.1) 4(66.7) 2(100.0) 0.001 no 21(95.5) 94(89.5) 1(25.0) 10(90.9) 2(33.3) 0(0.0) hostility no 21(95.5) 85(81.0) 2(50.0) 9(81.8) 4(66.7) 0(0.0) 0.018 yes 1(4.5) 20(19.0) 2(50.0) 2(18.2) 2(33.3) 2(100.0) hads scores no disorder 7(31.8) 59(56.2) 2(50.0) 2(18.2)) 3(50.0) 1(50.0) anxiety 11(50.0) 32(30.5) 0(0.0) 6(54.5) 3(50.0) 1(50.0) 0.048 depression 1(4.5) 8(7.6) 1(25.0) 3(27.3) 0(0.0) 0(0.0) anxietydepression 3(13.6) 6(5.7) 1(25.0) 0(0.0) 0(0.0) 0(0.0) iv discussion. adolescence is a vulnerable period when the probability of experimenting with aps is high. in this study, 85.33% of students had already used psychoactive substances. this result highlights a significant level of consumption, comparable to that reported in the literature. a study by andriamanjato hmh et al. among the general population in the urban commune of toliara, in 2022, found a rate close to 89% [7]. in toamasina, in 2023, ratobimanankasina hh et al, in a study of secondary school pupils, reported a similar rate of 81.5% [8]. on the ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 124 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala ncr 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ determinants of psychoactive substance use among students in the urban commune of toliara." other hand, in france in 2022, perrino j et al. found a high rate of spa consumption among students, but lower than in this study (65.5%) [9]. in terms of the type of substances used, alcohol, tobacco and cannabis were the main psychoactive substances consumed by students. alcohol topped the list of substances mentioned, with a rate of 70%. this result corroborates a study carried out in benin by kpozehouen a, who reported alcohol consumption among 74.66% of adolescents [10]. in madagascar, razanamihaja n et al. also reported high alcohol consumption among adolescents attending school in 2013, with a rate of 62% [11]. authors have reported that the age of first alcohol consumption in schools is between 10-14 years for boys and 15-19 years for girls [12]. young people seem to be attracted to alcohol for the sensations it provides. according to beck f and richard jb, drinking among young people is motivated by relaxation, the pleasure of partying, imitation of peers, and the search for intoxication [13], or even relief from an emotional disorder. two point sixty-seven percent (2.67%) of students have used tobacco. the prevalence of tobacco use among adolescents varies from one study to another. in mahajanga, randriamihangy na et al. found a prevalence of 6.6% among high school students [14]. in antananarivo, rakotomahefa nml et al. found a rate of 5.5% [15]. in algeria, elotmanie et al. reported a rate of 8.5% [16]. this variability could be linked to the accessibility of the products. cannabis is in second place after alcohol, with a rate of 7.33%. in mahajanga, randrianarivo rf, reports a cannabis prevalence of 8% and 54.5% initiated their consumption between the ages of 11 and 15[17]. in morocco, toxicological analysis of adolescents' urine revealed the presence of cannabis in 9.1% of cases [18]. although cannabis is an illegal substance, teenagers are often attracted by its euphoric, relaxing and de-stressing effects. however, cannabis can disrupt cognitive development and is a major cause of school drop-out. early use exposes adolescents to neurotoxins, increasing the risk of cognitive impairment in adulthood [19]. it is vital to implement preventive measures in the school environment to avoid the development of addiction or psychiatric complications. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 125 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala ncr 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ determinants of psychoactive substance use among students in the urban commune of toliara." several factors influence the use of psychoactive substances by adolescents. boys consumed more psychoactive substances than girls, with a significant difference observed (p=0.002). this finding has also been reported in the literature (p<0.001) [20,21]. the family environment and the influence of peers play a decisive role in the initiation of drug use. the use of psychoactive substances within the family, and in particular by parents, is a risk factor for use and use disorders, due to the social, psychological and behavioural consequences their children may face [22]. a significant difference was observed between the use of psychoactive substances and consumption by parents (p=0.008). rakotomahefa nl et al. also report that the presence of a parent (mother or father) who uses tobacco is a risk factor for use in children (p=0.005) [15]. jamison et al, have also reported that having one or two parents who smoke is associated with cigarette use in young people [23]. parents are the child's first social role model, so it's easy for children to be introduced to the use of psychoactive substances at an early age if one of their parents is a consumer. paradoxically, a trusting parent-child relationship does not appear to be a protective factor against use (p=0.003). on the other hand, in the literature, an association has been reported between psychoactive substance use among adolescents and poor parental supervision, parental permissiveness towards heavy alcohol consumption and low parent-child attachment [24] finally, poor company strongly influences drug abuse behavior. adolescents are often motivated by the need for social integration, with a significant correlation between substance use and peer influence (p=0.001). some authors have reported an association between aps use and having friends who use aps [10, 18, 25]. authors have reported an association between smoking and the means of socialization and integration at school [14,26]. anxiety, depression and hostility are also important risk factors. a quebec study highlighted the association between hostility, the presence of anxiety and poly-drug use in girls [27]. this finding was replicated in this study. according to wellman, rj et al, the presence of depressive symptoms and impulsivity are associated with cannabis use [17]. in this study, 30.5% of students consuming alcohol showed an anxiety disorder and 54.5% cannabis. for depression, 27.3% used cannabis and 25% of tobacco smokers were concerned. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 126 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala ncr 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ determinants of psychoactive substance use among students in the urban commune of toliara." v. conclusion the use of psychoactive substances among high-school students is reaching alarming levels, particularly where alcohol and cannabis are concerned. several factors are influencing this use, namely adolescents' psychological suffering, such as anxiety-depressive disorders, the use of psychoactive substances in their environment, and the influence of peers. a thorough understanding of these factors is essential, as it enables the implementation of appropriate preventive actions, targeting individuals in vulnerable situations or specific contexts favoring such use, as well as the enforcement of existing laws. laws prohibiting entry to places selling alcohol and the sale of products to minors. reference 1. de longueville x, geus c, schepens p. psychotic disorders and cannabis use: a retrospective study. l’encéphale. 2003 ; 29 : 41 – 3. 2. beck f, dervaux a, du roscoat e, gallopel-morvan k, grall-bronnex m, kern l, et al. addictive behaviors in adolescents: uses, prevention and support. main findings and recommendations. paris : inserm ; 2014 : 60. 3. wadsworth ejk, moss sc, simpson sa, smith ap. factors associated with recreational drug use. journal of psychopharmacology. 2004 ;18(2) :238-48. 4. henessy ea, tanner smith ee, finch aj, sathe n, kugley s. recovery schools for improving behaioral and academicoutcomes among students in recovery for substance use disorders. a systematic review. campbell syst rev.2018 ;14(1) :1-86. 5. imaine sahed.smoking and cannabis use in adolescence: the quest for identity and vulnerability in the consumption process.drugs, health and society, 2016, 14 (2), pp. 1-23. 6. bonnet, a., bejaoui, m., bréjard, v., et al.physiological dependence and emotional functioning in young adults: affectivity, emotional intensity and alexithymia in psychoactive substance use. in : annales médico-psychologiques, revue psychiatrique. elsevier masson, 2011 ; 169(2) : 92-97. 7. andriamanjato hmh, randriamalala ncr, raharison fo, rakotoniaina ai, raobelle en, riel am, rajaonarison bh, raharivelo a. state of consumption of ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 127 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala ncr 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ determinants of psychoactive substance use among students in the urban commune of toliara." psychoactive substances in the urban commune of toliara. ijpsat. 2022 ; 33(2) :240-248. 8. ratobimanankasina hh, razakandrainy ha, rajaonarison bh, raharivelo a. drug addiction among high school students in toamasina i madagascar in 2020. world journal of advenced research and reviews. 2023 ;17(01) :450-454. 9. perino j, tournier m, mathieu c, letinier l, peyré g, pereira e, fourrier-réglat a, pollet c, fatseas m, tzourio c, daveluy a. psychoactive substance use among students : a cross-sectional analysis. fundam clin pharmacol. 2022 ;36(5) :908-914. 10. kpozehouen a, ahanhanzo yg, paraizo mn et al. factors associated with the use of psychoactive substances among adolescents in benin. public health. 2015 ; 6 :871880. 11. razanamihajan, befinoana, marie-laure b. alcohol consumption by school-going adolescents in madagascar : prevalence and associated risk factors. j alcoholismdrug depend.2013 ;2 :145. 12. zengbé-acray p, ahoussou émk, ekou fk, kouassi dp, sablé ps, oussou kr, et al. alcohol consumption in urban areas among secondary school students in côte d'ivoire. public health. 2014;26(1):107–114. 13. beck f, & richard jb. adolescent alcohol consumption. archives of pediatrics2014 ;21(5) :168-169. 14. randriamihangy na, allaoui ab, raveloson f, raharimanana rn. prevalence of smoking and profile of student smokers in mahajanga i high schools in 2014 (madagascar). european scientific journal. 2016 ; 12(23) : issn : 1857-7881. 15. rakotomahefa nml, rafalimanana zhl, andriantahiana tn, raolijaona sr. smoking among young people in schools in antananarivo. rev malg ped. 2020 ;3(2) :38-44 ; 16. elotmanie fz., elbiaze m., amara b., serraj m., benjelloun mc. behaviors, attitudes, and knowledge of schoolchildren regarding smoking in the city of fés.respiratory diseases journal. 2015 ; 32 :137. 17. randrianarivo rf, ratobimanankasina hh, rakotoarinelina b, razafindrasara d, rajaonarison bh, raharivelo aprevalence and social determinants of cannabis use ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 128 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) randriamalala ncr 1 * https://ijojournals.com/ volume 08 || issue 03 || march, 2025 || “ determinants of psychoactive substance use among students in the urban commune of toliara." in the city of mahajanga i.. international journal of progressive sciences and technologies (ijpsat). 2023; 37(1):164-169. 18. zarrouq btissame. epidemiological and toxicological profile of the use of psychoactive substances and suicidal behaviors in moroccan adolescents,[thesis] maroc, 2015. 19. gray km, et squeglia lm. research review : what have welearned about adolescent substance use ? jounal of child psychologiy and psychiatry. 2018 ; 59(6) :618-627. 20. zarrouq b, bendaou b, el asri a, achour s, rammouz i, aalouane r, lyoussi b, khelafa s, bout a, berhili n, hlal h, najdi a, nejjari c, and el rhazi k. psychoactive substances use and associated factors among middle and high school students in the north center of morocco: a cross-sectional questionnaire survey. bmc public health, 2016 ; 16 : 1-9. 21. camara, pa, yao, km., adou, kfjb., et al.epidemiological approach to the consumption of alcoholic beverages in ivory coast. rev. ivoir. sci. technol, 2008 ;12 : 157-171. 22. m lejoyeux. psychopathological factors involved in addictionsin addiction. 2nd ed. elsevier masson. 23. jamison b, muula as, siziya s, graham s, rudatsikira e. cigarette smoking among school-going adolescents in lithuania: results from the 2005 global youth tobacco survey. bmc res notes. 2010;3:130. 24. gagnon v. parental practices, deviant friendships, and problematic substance use in adolescence: moderating effects of depressive symptoms and gender. [thesis] canada, 2013. 25. simplice nc, petronille z, eric m, frank k, damus p, parfait s et al. alcohol consumption in urban areas among secondary school students in côte d'ivoire. public health. 2014 ;26 :107-114. 26. camara a, balde d, sidibé s et al. smoking and associated factors among middle school students in dixinn, guinea. public health. 2015 ; 27(4) :585-591. 27. van tassel, mike. impact of anxiety, depression and hostility as components of psychological distress on the typology of alcohol and cannabis use in adolescents according to age and sex. [thesis]university of quebec in chicoutimi? 2017. ijo journals volume 08 | issue 03 | march 2025 | https://ijojournals.com/index.php/hsn/index 129 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria. nnadozie agatha c1, okoroiwu l. i2, aloy-amadi oluchi c3., chinedueleonu p.o4, nsonwu magnus c5.and iheanacho malachy c6. 1,2,3department of medical laboratory science, imo state university, owerri, nigeria. 4department of public health management, imo state university, owerri, nigeria. 5department of optometry, imo state university, owerri, nigeria. 6 department of haematology and blood transfusion, federal teaching hospital, owerri, nigeria. coressponding author: nnadozie agatha c. abstract background: medical workers in the radiology unit are frequently exposed to ionizing radiation, raising concerns about its potential impact on renal and electrolyte balance. objective: this research was a cross-sectional study aimed at determining the levels of some biochemical parameters among workers in the radiology unit, in imo state, nigeria. method: this study was carried out at three major hospitals in imo state (federal teaching hospital, imo specialist hospital, owerri and imo state teaching hospital orlu). a total of 40 individuals which comprised of 40 workers exposed to radiation and 40 non-radiation workers were recruited for the study. informed consent was obtained from each patient, and questionnaires were administered, after which blood sample was collected. the procedure was carried out at the hospital laboratory using standard laboratory procedures. the data were analyzed using spss version 27. results: there was a significant increase in the mean values of creatinine (1.23±0.51)mg/dl and urea (42.86±9.56)mg/dl in workers exposed to radiation when compared to controls ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 1 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." (0.84±0.45)mg/dl and (28.82±5.23)mg/dl (p=0.001 and p=0.000), anda significant decrease in the mean value of potassium in those exposed (3.83±0.56)mmol/l when compared to controls (4.37±0.49)mmol/l(p=0.000).during 3-10 years of exposure, creatinnie (0.97±0.46)mg/dl, urea (36.72±11.37)mg/dl and chloride (99.58±1.55) mmd/l showed no significant difference when compared to 11-18years (1.15±0.43)mg/dl, (43.58±8.47)mg/dl, and (99.94±1.46) mmd/l and >18years exposure (1.59±0.61)mg/dl, (46.64±5.67) mg/dl and (100.39±4.36)mmd/l (f=3.68; p=0.055; f= 3.11, p=00.57; and f=0.28, p=0.756). sodium (139.43±8.61) mmd/l during 11 year of exposure showed no significant increase when compared to 3-10 years(135.75± 4.12) and > 18 years of exposure (138.61±7.04) mm/dl (f=0.91, p=0.414). bicarbonate (27.79±4.33) mmol/l during >18years exposure showed no significant increase when compared to 3-10years (26.29±5.50)mmd/l and 11-18years (25.10±5.04)mmol/l respectively (f=0.77, p=0.471).there was a non-significant difference in the mean values of creatinnine (1.25±0.52) mg/dl, potassium (3.84±0.59) mmol/l and bicarbonate (26.44±5.26) mmol/l in male workers exposed to radiation when compared to females (1.14±0.59) mg/dl, (3.66±0.40)mmol/l, (22.9±2.43) mmol/l respectively ( t=1.05, p=0.492; t=0.42, p=0.080 and t=0.51, p=0.521).the mean values of urea (42.46±9.94)mg/dl, sodium (137.89±6.70) mmo/l and chloride (99.76±2.10)mmol/l in males were insignificantly lower when compared to females (45.66±6.38)mg/dl, (140.66±10.96)mmol/l and (101.66±2.97) mmo/l(t=0.44, p=0.126; t=1.45, p=0.542; t=1.43,p=0.810; t=2.22, p=0.432; t1.07,p=0.518, and t=0.48, p=0.151).the mean values of potassium (3.84±0.61)mmol/l, chloride (99.87±1.73)mmol/l and bicarbonate (23.66±3.44)mmol/l in workers exposed to radiation of ages (35-50)yrs were non-significantly raised when compared to those of ages >50 yrs (3.76±0.51) mmol/l, (99.48±3.37) mmol/l and (22.07±1.58) mmol/l ( t=0.65, p=0.674; t = 1.79, p = 0.632, and t=4.89 p=0.612), while that of creatinine (1.17±0.48) mg/dl, urea (40.60±10.46) mg/dl and sodium (137.45±6.68) mmol/l, in workers exposed to radiation of ages (35-50) yrs were not significantly lowered when compared to those of ages, >50yrs (1.35±0.59)mg/dl,(47.40±4.94)mg/dl and (140.05±8.13)mmol/l (t=0.43, p=0.301; t=0.69 , p=0.321 and t=0.79, p=0.290). conclusion:this study has shown that radiation alters the levels of creatinine, urea and potassium, but no significant effect on sodium, potassium, chloride and bicarbonate.these findings underscore the importance of routine renal function assessments for those exposed to radiation in the radiology unit. keywords: urea, creatinine, electrolytes, radiation. 1. introduction ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 2 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." medical workers in the radiology unit are routinely exposed to ionizing radiation, which may have deleterious effects on various biochemical and physiological parameters. chronic exposure to low-dose radiation has been associated with oxidative stress, dna damage, and alterations in cellular metabolism (1,2). among the biochemical parameters that may be affected are urea, creatinine, and electrolytes, which are critical for kidney function and overall homeostasis (3,4). in nigeria, where radiation safety regulations may not always be strictly enforced, radiographers working in diagnostic imaging centers may face significant occupational exposure risks (5). ionizing radiation generates reactive oxygen species (ros) that can damage cellular components, including lipids, proteins, and nucleic acids (6). the kidneys, being highly vascularized organs, are particularly susceptible to oxidative stress, which may lead to alterations in renal function markers such as urea and creatinine (7). elevated serum urea and creatinine levels often indicate impaired renal filtration capacity, which may be exacerbated by chronic radiation exposure (8). furthermore, radiation-induced nephrotoxicity has been reported in individuals ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 3 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." exposed to both low and high doses of radiation, suggesting that even occupational exposure may have long-term health implications (9). electrolytes, including sodium (na⁺ ⁺ ⁻), potassium (k ), and chloride (cl ), play essential roles in maintaining osmotic balance, nerve transmission, and muscle function (10). disruptions in electrolyte homeostasis can lead to severe physiological consequences such as hypertension, arrhythmias, and neuromuscular dysfunction (11). studies have shown that exposure to radiation may alter electrolyte balance by affecting the function of ion transporters and renal reabsorption processes (12). for instance, research on radiation-exposed workers in nuclear facilities has demonstrated significant variations in serum sodium and potassium levels, potentially due to radiation-induced damage to renal tubules and endocrine regulation mechanisms (13). despite the growing body of evidence on radiation-induced biochemical changes, there is limited data on how occupational radiation exposure affects medical workers exposed to radiation in nigeria. imo state, located in southeastern nigeria, has a high concentration of diagnostic imaging centers, increasing the likelihood of ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 4 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." cumulative radiation exposure among workers exposed to radiation (14). however, the extent to which this exposure influences renal function and electrolyte balance remains unclear. this study aims to evaluate the biochemical status of urea, creatinine, sodium, potassium, and chloride in medical workers exposed to radiation in imo state. the findings will contribute to understanding the occupational health risks associated with diagnostic radiation exposure and may inform policies to enhance radiation safety practices in nigeria. 2. materials and methods 2.1 study area the study wasconducted at the federal teaching hospital,imo specialist hospital. owerri, and imo state university teaching, hospital (imsuth) orlu, imo state. 2.2 study design this research was a cross-sectional study carried out at three major hospitals in imo state (federal university teaching hospital, owerri, imo specialist hospital, umuguma, owerri and imo state teaching hospital, orlu). a total of 40 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 5 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." individuals which comprised of 40 workers exposed to radiation and 40 non radiation workers were recruited for the study. informed consent and questionnaires were administered before sample collection, and five milliliters of venous blood was collected from each subject, and dispensed into plain container, for the estimation of the electrolytes. the procedure was carried out using standard laboratory procedures, and results of the tests were analyzed using spss version 27 2.3 method of recruitment medical workers exposed to radiation between the ages of 30 60yrs who were working with the three hospitals and gave their informed consents were recruited for the study. age-matched non-exposed subjects served as controls. strict confidentiality was maintained. 2.4 study population a total of forty (40) workers exposed to radiation and an equivalent number of age matched non-exposed subjects consisted the study population. ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 6 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." 2.5 ethical approval ethical approval was obtained from the ethics committee of federal teaching hospital, owerri, imo state teaching hospital, orlu and imo state specialist hospital umuguma. all study participants who gave their informed consent were enrolled in the study before sample collection. 2.6laboratory analysis the determination of urea was determined using abbott architect c16000, which uses the chemiluminescent microparticle immunoassay (cmis). the resulting chemiluminescent reaction is measured as a relative light unit (rlu). creatinine was also determined using abbott architect c1 6000, while the electrolytes were determined using the audicom (ac9803) electrolyte analyzer. 2.7 statistical analysis the statistical analysis was carried out using spss version 27 (statistical packages for social sciences). all values were expressed as mean± standard deviation. the student-t-test and pearson correlation were used to determine the differences in the ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 7 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." experimental variables. the tests with a probability p≤0.05 were considered statistically significant. 3.results table 1: mean values of creatinine, urea, sodium, potassium, chloride and bicarbonate in workers exposed to radiation (test) and non-exposed subjects (control). (mean ±sd). there was a significant increase in the mean values of creatinine (1.23±0.51)mg/dl and urea (42.86±9.56)mg/dl in workers exposed to radiation when compared to controls (0.84±0.45)mg/dl and (28.82±5.23)mg/dl( t=3.54,p=0.001 andt=7.12, p=0.000) potassium levels in those exposed(3.83±0.56)mmol/l were significantly lowered when compared to controls (4.37±0.49)mmol/l(t= 4.50 ,p=0.000). there was no si.89±2.17)mmol/l and bicarbonate (26.07±5.15)mmol/l in workers exposed to radiation when compared to controls (136.62±7.77)mmol/l, (99.75±1.95)mmol/l and a significant difference in the mean values of sodium (138.49±7.15)mmol/l, chloride (996.02±5.22)mmol/l( t= 1.12 ,p=0.265,t=0.31 , p=0.758 andt=0.48, p=0.633). ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 8 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." parameter test control t-value p-value creatinine (mg/dl) 1.23±0.51 0.84±0.45 3.54 0.001* urea (mg/dl) 42.86±9.56 28.82±5.23 7.12 0.000* sodium (mmol/l) 138.49±7.15 136.62±7.77 1.12 0.265 potassium (mmol/l) 3.83±0.56 4.37±0.49 4.50 0.000* chloride (mmol/l) 99.89±2.17 99.75±1.95 0.31 0.758 bicarbonate (mmol/l) 26.07±5.15 26.02±5.22 0.48 0.633 key: *: significant p value table 2: comparison of the mean levels of creatinine, urea, sodium, potassium, chloride and bicarbonate in workers exposed to radiation based on duration of exposure (mean±sd). ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 9 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." during 3-10 years of exposure, creatinine(0.97±0.46)mg/dl, urea(36.72±11.37)mg/dl and chloride (99.58±1.55) mmd/l showed no significant difference when compared to 11-18years(1.15±0.43)mg/dl, (43.58±8.47)mg/dl, and (99.94±1.46) mmd/l and>18years exposure (1.59±0.61)mg/dl, (46.64±5.67)mg/dl and (100.39±4.36)mmd/l (f=3.68; p=0.055; f= 3.11, p=00.57; and f=0.28, p=0.756).sodium(139.43±8.61) mmd/l during 11 year of exposure showed no significant increase when compared to 3-10 years(135.75± 4.12) and > 18 years of exposure (138.61±7.04)mm/dl(f=0.91, p=0.414) bicarbonate(27.79±4.33) mmol/l during >18years exposure showed no significant increase when compared to 3-10years(26.29±5.50)mmd/l and 1118years(25.10±5.04)mmol/l respectively (f=0.77, p=0.471). ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 10 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." parameter (3-10)yrs (11-18)yrs (>18)yrs f-value p-value creatinine (mg/dl) 0.97±0.46 1.15±0.43 1.59±0.61 3.68 0.055 urea (mg/dl) 36.72±11.37 43.58±8.47 46.64±5.67 3.11 0.057 sodium (mmol/l) 135.75±4.12 139.43±8.61 138.61±7.04 0.91 0.414 potassium (mmol/l) 4.12±0.66 3.78±0.41 3.69±0.54 1.97 0.154 chloride (mmol/l) 99.58±1.55 99.94±1.46 100.39±4.36 0.28 0.756 bicarbonate (mmol/l) 26.29±5.50 25.10±5.04 27.79±4.33 0.77 0.471 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 11 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." table 3: comparison of the mean levels of creatinine, urea, sodium, potassium, chloride and bicarbonate in workers exposed to radiation based on sex. there was a non-significant difference in the mean values of creatinine (1.25±0.52)mg/dl, potassium (3.84±0.59)mmol/l and bicarbonate (26.44±5.26)mmol/l in male workers exposed to radiation when compared to females(1.14±0.59)mg/dl, (3.66±0.40)mmol/l, (22.9±2.43) mmol/l respectively ( t=1.05, p=0.492; t=0.42, p=0.080 andt=0.51, p=0.521). the mean values of urea(42.46±9.94)mg/dl, sodium(137.89±6.70)mmo/l and chloride(99.76±2.10)mmol/lin males were insignificantly lower when compared to females (45.66±6.38)mg/dl, (140.66±10.96)mmol/l and (101.66±2.97) mmo/l(t=0.44, p=0.126; t=1.45, p=0.542; t=1.43,p=0.810; t=2.22, p=0.432; t1.07,p=0.518, and t=0.48, p=0.151). parameter male female t-value p-value ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 12 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." creatinine (mg/dl) 1.25±0.52 1.14±0.59 1.05 0.492 urea (mg/dl) 42.46±9.94 45.66±6.36 2.22 0.432 sodium (mmol/l) 137.89±6.70 140.66±10.96 1.07 0.518 potassium (mmol/l) 3.84±0.59 3.66±0.40 0.42 0.080 chloride (mmol/l) 99.76±2.10 101.66±2.97 0.48 0.151 bicarbonate (mmol/l) 26.44±5.26 22.91±2.43 0.51 0.521 table 4: mean values of creatinine, urea, sodium, potassium, chloride and bicarbonate based on age. the mean values of potassium (3.84±0.61)mmol/l, chloride (99.87±1.73)mmol/l and bicarbonate (23.66±3.44)mmol/l inworkers exposed to radiation of ages (3550)yrs were non-significantly raised when compared to those of ages>50 yrs (3.76±0.51)mmol/l, (99.48±3.37)mmol/l and (22.07±1.58)mmol/l ( t=0.65, p=0.674; t = 1.79, p = 0.632, and t=4.89 p=0.612), while that of creatinine (1.17±0.48)mg/dl, urea (40.60±10.46)mg/dl and sodium (137.45±6.68)mmol/l, in the exposed of ages (35-50)yrs were not significantly lowered when compared tothose exposed ofages,>50yrs(1.35±0.59)mg/dl,(47.40±4.94)mg/dl and (140.05±8.13)mmol/l (t=0.43, p=0.301; t=0.69 , p=0.321 and t=0.79, p=0.290). ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 13 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." parameter (35-50)yrs >50 yrs t-value p-value creatinine (mg/dl) 1.17±0.48 1.35±0.59 0.43 0.301 urea (mg/dl) 40.60±10.46 47.40±4.94 0.69 0.321 sodium (mmol/l) 137.45±6.68 140.05±8.13 0.79 0.290 potassium (mmol/l) 3.84±0.61 3.76±0.51 0.65 0.674 chloride (mmol/l) 99.87±1.73 99.48±3.37 1.79 0.632 bicarbonate (mmol/l) 23.66±3.44 22.07±1.58 4.89 0.612 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 14 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." 4. discussion the findings of this study indicate that medical workers exposed to ionizing radiation in imo state, nigeria, had significantly higher urea levels compared to thenon-exposed. this suggests potential radiation-induced alterations in renal function, as urea is a key marker of kidney filtration efficiency. previous studies have reported similar findings, where prolonged occupational exposure to ionizing radiation was associated with elevated urea levels, possibly due to subclinical nephrotoxicity and oxidative stress affecting renal tissues (15,16). radiation exposure generates reactive oxygen species (ros), which can damage renal cells and impair glomerular function, leading to reduced urea clearance and subsequent accumulation in the bloodstream (17). conversely, potassium levels were significantly lower in those exposed to radiation than in the control group. this finding is in agreement with research by prasad et al. (18), who observed hypokalemia in radiation-exposed workers, likely due to radiation-induced damage to renal tubular cells that regulate potassium reabsorption. ionizing radiation has been reported to influence the activity of ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 15 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." na⁺ ⁺/k -atpase pumps, which plays a crucial role in maintaining intracellular and extracellular potassium balance (19). moreover, studies on radiation-exposed populations have shown alterations in potassium levels due to potential effects on the endocrine system, particularly the adrenal glands, which regulate potassium homeostasis through aldosterone secretion (20). in contrast, sodium, chloride, and bicarbonate levels did not differ significantly between those exposed and the non-exposed. these findings are consistent with those of kadhim et al. (21), who reported no significant variations in these electrolytes among occupationally exposed individuals. this may indicate that radiation exposure at the observed levels does not significantly impair sodium and chloride homeostasis, possibly due to compensatory mechanisms in the kidneys that maintain electrolyte balance despite radiation-induced stress. however, some studies have found contradictory results, with reports of sodium retention and chloride imbalances in radiation workers, suggesting that individual susceptibility and exposure dose may influence these biochemical outcomes (22). ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 16 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." when the biochemical parameters were analyzed based on the duration of radiation exposure, no significant differences were observed between those exposed with 3– 10 years, 11–18 years, and more than 18 years of experience. this contrasts with previous studies that have demonstrated cumulative radiation effects over time, leading to progressive biochemical alterations (23). the lack of significant differences in this study may be attributed to variations in individual radiation protection practices, differences in exposure levels across workplaces, and the potential for adaptive physiological responses that mitigate long-term effects (24). similarly, no significant differences were found when comparing biochemical parameters based on age groups (35–50 years and >50 years). this aligns with findings from kumar et al. (25), who reported that renal and electrolyte function remained relatively stable across different age groups of radiation workers, provided that exposure levels were within occupational safety limits. however, some studies suggest that older individuals may be more susceptible to radiationinduced nephrotoxicity due to age-related decline in renal function and reduced antioxidant capacity (26). the absence of such findings in this study suggests that ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 17 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." occupational exposure levels may not be sufficient to cause age-dependent biochemical alterations or that radiographers adopt adequate protective measures that minimize age-related susceptibility. furthermore, there were no significant sex-based differences in biochemical parameters among workers exposed to radiation. this is in agreement with studies by chang et al. (27) and nuraeni et al. (28), who found that sex did not significantly influence renal and electrolyte parameters in radiation-exposed workers. while some research has indicated that hormonal differences between males and females might influence susceptibility to radiation-induced oxidative stress (29), the lack of significant sex-related variations in this study suggests that both male and female workers exposed to radiation may experience similar exposure effects and physiological responses. overall, the findings of this study suggest that while radiation exposure may impact renal function by elevating urea levels and reducing potassium levels, the effects on other biochemical parameters remain minimal. the absence of significant differences based on exposure duration, age, or sex suggests that either ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 18 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." the exposure levels are within tolerable limits or that individual adaptive mechanisms mitigate potential damage. however, further longitudinal studies with larger sample sizes and detailed radiation dose assessments are necessary to confirm these findings and establish long-term occupational health risks among medical workers exposed to radiation in nigeria 5. conclusion this study found significantly elevated creatinine and urea levels and decreased potassium levels in medical workers exposed to radiation compared to controls, suggesting a possible impact of chronic low-dose radiation exposure on renal function and electrolyte balance. however, sodium, chloride, and bicarbonate levels remained unchanged. these findings underscore the importance of routine renal function assessments for workers exposed and further research into the longterm effects of occupational radiation exposure. implementing preventive measures and early detection strategies could help mitigate potential health risks associated with prolonged radiation exposure in medical imaging professionals. ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 19 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." references 1. hall ej, giaccia aj. radiobiology for the radiologist. 7th ed. philadelphia: lippincott williams & wilkins; 2012. 2. mettler fa, upton ac. medical effects of ionizing radiation. 3rd ed. saunders elsevier; 2008. 3. raza sk, naqvi sa, rehman au. effects of ionizing radiation on kidney function parameters in radiology workers. int j radiat res. 2020;18(4):789-95. 4. al-hussaini m, al-nimer m, al-khazraji b. assessment of renal function and electrolytes in radiation workers. j occup med toxicol. 2016;11(1):23 5. akpochafor mo, uduma-olugu ni, adeneye so. radiation protection practices among radiographers in nigeria: a survey. radiography. 2019;25(3):e86-91. 6. yamada t, makita y, nagai y. oxidative stress and renal dysfunction in radiation-exposed workers. free radic biol med. 2018;115:83-9. ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 20 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." 7. kumar s, venkatesh p, kulkarni s. renal biomarkers in radiation workers: a study on oxidative damage. j nephrol. 2017;30(4):563-70. 8. prasad v, mohammad a, kumar r. radiation nephropathy and biochemical alterations: a clinical evaluation. int j nephrol. 2015;2015:567920. 9. kadhim m, salih t, al-tameemi r. chronic exposure to ionizing radiation and renal function impairment: a meta-analysis. j environ radioact. 2020;221:106336. 10. guyton ac, hall je. textbook of medical physiology. 13th ed. philadelphia: elsevier; 2016. 11. abdulhakeem m, oduwole o, adeniyi s. radiation exposure and electrolyte imbalances among healthcare workers. med phys. 2019;46(5):1256-62. 12. chang h, lee m, kim s. ionizing radiation and its effect on serum electrolytes in occupationally exposed workers. radiat res. 2017;188(3):356-64. 13. nuraeni w, setiawan d, rahman f. electrolyte disturbances in radiation workers: a cross-sectional study. j occup health. 2021;63(1):e12238. ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 21 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." 14. eze cu, okoye gc, agwu kk. radiation protection awareness among radiographers in southeastern nigeria. niger j clin pract. 2018;21(2):208-14. 15. yamada t, makita y, nagai y. oxidative stress and renal dysfunction in radiation-exposed workers. free radic biol med. 2018;115:83-9. 16. raza sk, naqvi sa, rehman au. effects of ionizing radiation on kidney function parameters in radiology workers. int j radiat res. 2020;18(4):789-95. 17. hall ej, giaccia aj. radiobiology for the radiologist. 7th ed. philadelphia: lippincott williams & wilkins; 2012. 18. prasad v, mohammad a, kumar r. radiation nephropathy and biochemical alterations: a clinical evaluation. int j nephrol. 2015;2015:567920. 19. al-hussaini m, al-nimer m, al-khazraji b. assessment of renal function and electrolytes in radiation workers. j occup med toxicol. 2016;11(1):23. 20. abdulhakeem m, oduwole o, adeniyi s. radiation exposure and electrolyte imbalances among healthcare workers. med phys. 2019;46(5):1256-62. ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 22 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." 21. kadhim m, salih t, al-tameemi r. chronic exposure to ionizing radiation and renal function impairment: a meta-analysis. j environ radioact. 2020;221:106336. 22. nuraeni w, setiawan d, rahman f. electrolyte disturbances in radiation workers: a cross-sectional study. j occup health. 2021;63(1):e12238. 23. eze cu, okoye gc, agwu kk. radiation protection awareness among radiographers in southeastern nigeria. niger j clin pract. 2018;21(2):208-14. 24. mettler fa, upton ac. medical effects of ionizing radiation. 3rd ed. saunders elsevier; 2008. 25. kumar s, venkatesh p, kulkarni s. renal biomarkers in radiation workers: a study on oxidative damage. j nephrol. 2017;30(4):563-70. 26. chang h, lee m, kim s. ionizing radiation and its effect on serum electrolytes in occupationally exposed workers. radiat res. 2017;188(3):356-64. ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 23 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) nnadozie agatha c 1 * https://ijojournals.com/ volume 08 || issue 05 || may, 2025 || “status of some biochemical parameters amongworkers in the radiology unit in imo state, nigeria." 27. guyton ac, hall je. textbook of medical physiology. 13th ed. philadelphia: elsevier; 2016. 28. nuraeni w, setiawan d, rahman f. gender differences in radiation-induced biochemical alterations: a comparative study. j radiat biol. 2022;98(1):45-53. 29. umegbolu ei, onwukwe os, agbaedeng ta. gender-based susceptibility to radiation effects: a review of hormonal influences. j biomed sci. 2020;27(1):14. ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 24 ijo international journal of health sciences and nursing ( issn: 2814-2098 )) iteke fefe rivain6* https://ijojournals.com/ volume 08 || issue 09 || september, 2025 || “securite en anesthesie au sud et a l’est de la rd congo : etat de lieu et perception communautaire" article original securite en anesthesie au sud et a l’est de la rd congo : etat de lieu et perception communautaire bahane mugalihya jean claude1, malashi mwisi joseph2, mukalay banza yves3, iragi muderhwa donation4, kayembe tony5, iteke fefe rivain6 1. technicien supérieur anesthésiste-réanimateur, assistant à l’institut supérieur des techniques médicales du lualaba en rd congo, master en gestions des épidémies et des urgences. 2. médecin spécialisant en anesthésie-réanimation, chef des travaux à l’institut des techniques médicales de likasi en rd congo. 3. médecin anesthésiste-réanimateur, assistant à la faculté de médecine de l’université de lubumbashi en rd congo. 4. technicien supérieur anesthésiste-réanimateur, chef des travaux à l’institut supérieur des techniques médicales du bukavu en rd congo, master en anesthésie-réanimation. 5. professeur associé et toxicologue à l’institut supérieur des techniques médicales de lubumbashi en rd congo. 6. professeur associé et chef de département d’anesthésie-réanimation de l’université de lubumbashi en rd congo. auteur correspondant : iteke fefe rivain6 résumé objectif : évaluer la situation actuelle de la sécurité en anesthésie au sud et à l’est de la république démocratique du congo en vue de réduire la morbi-mortalité liée à la pratique de l’anesthésie, ainsi qu’évaluer la perception de cette sécurité au sein de la communauté locale. méthodologie: cette étude est du type descriptive transversale avec un volet analytique, utilisant une approche prospective mixte quantitative dans 10 structures sanitaires de la région sud et est de la rd congo (cliniques universitaires de lubumashi, centre médical diamant, hôpital sendwe, polyclinique saintluc, hôpital daco, hgr de mwangeji, hôpital méthodiste, hôpital général de kadutu, hôpital skyborne et hpgr de kalemie) répartis respectivement dans les villes de lubumbashi (4 structures), de likasi (1 structure), de kolwezi (2 structures), de kalemie (1 structure) et de bukavu (2 structures) durant la période de septembre 2024 à février 2025 (6 mois environs) sur la sécurité en anesthésie au sud et à l’est de la rd congo : état de lieu et la perception communautaire. la sécurité en anesthésie est capturée à travers une évaluation des complications post-anesthésiques, la satisfaction des patients vis-à-vis de la prise en charge, le niveau de confiance exprimé par le patient envers les soins anesthésiques, la disposition des patients à recommander les autres dans les établissements de santé où ils sont bénéficiaires de prise en charge. par ailleurs, les variables de la sécurité selon les recommandations de l’oms sont prises en compte et comprennent entre autre la qualification du personnel soignant, l’utilisation de la liste de contrôle, la disponibilité et l’accès à des équipements de surveillance et aux médicaments, et la qualité des infrastructures sanitaires répondant aux normes. le niveau de perception communautaire est capturé à travers une analyse des attentes, les attitudes et la perception elle-même par rapport aux soins en anesthésie. l’échantillonnage est probabiliste et est déterminé par la formule de schwartz. une enquête a donc été menée auprès de 313 patients, 313 accompagnateurs et 37 prestataires dans cette région dans un contexte à ressources limitées. les données ont été collectées à l’aide d’un questionnaire numérique via kobocollect, https://doi.org/10.5281/zenodo.17165455 ijo journals volume 08 | issue 09 | september 2025 | https://ijojournals.com/index.php/hsn/index 1 ijo international journal of health sciences and nursing ( issn: 2814-2098 )) iteke fefe rivain6* https://ijojournals.com/ volume 08 || issue 09 || september, 2025 || “securite en anesthesie au sud et a l’est de la rd congo : etat de lieu et perception communautaire" puis nettoyées avec excel avant une analyse avec le logiciel epi info. l’analyse fréquentielle et les calculs de pourcentage sont utilisés pour la description tandis que le test de chi-deux et les calculs de odss ratio (ic 95%) sont appliqués pour établir l’association entre la survenue des complications et les autres variables. résultats : les résultats montrent que moins de 60% des structures cibles appliquent les protocoles de sécurité telles que recommandées par l’oms, à l’occurrence la check-list chirurgicale. les complications post-anesthésiques sont significativement associées à l’absence de suivi post-opératoire. conclusion : notre étude montre que la perception communautaire de l’anesthésie demeure globalement négative influencée par un niveau de sécurité. cela est justifié par le fait que les patients ayant une expérience défavorable de l’anesthésie perçoivent celle-ci comme une menace à leur santé et deviennent des clients négatifs qui sont un danger public. inversement, une expérience positive de l’anesthésie favorise non seulement la vulgarisation communautaire basée sur les bienfaits de l’anesthésie mais aussi rassure les patients chirurgicaux potentiels, par conséquent, la peur qui menaçant leur sécurité est bannie par la confiance envers les professionnels d’anesthésie. cette étude appelle à une approche clinique et communautaire intégrée pour faire de l’anesthésie une affaire de tous, allant des décideurs aux bénéficiaires des soins en passant par les professionnels d’anesthésie, en institutionnalisant l’usage de la check-list dans toutes les structures, en l’adaptant aux réalités et contexte des zones à ressources limitées, en renforçant la formation continue des praticiens d’anesthésie tout en mettant un système de suivi et évaluation standardisé dans ce secteur, gage de la perception communautaire comme indicateur de performance (kpi). mots clés : sécurité en anesthésie, morbimortalité péri-opératoire, perception communautaire, qualité des soins, r d du congo. summary objective: to assess the current anaesthesia safety situation in the south and east of the democratic republic of congo, with a view to reducing anaesthesia-related morbidity and mortality, and to evaluate the perception of safety within the local community. methodology: this is a descriptive cross-sectional study with an analytical component, using a mixed prospective approach (qualitative and quantitative) in 10 health facilities in the south and east of the dr congo (cliniquesuniversitaires de lubumashi, centre médicaldiamant, hôpital sendwe, polyclinique saint-luc, hôpital daco, hgr de mwangeji, hôpitalméthodiste, hôpitalgénéral de kadutu, hôpitalskyborne and hpgr de kalemie) located respectively in the towns of lubumbashi (4 facilities), likasi (1 facility), kolwezi (2 facilities), kalemie (1 facility) and bukavu (2 facilities) during the period from september 2024 to february 2025 (approximately 6 months) on anaesthesia safety in the south and east of dr congo: state of play and community perception. safety in anaesthesia is captured through an evaluation of post-anaesthetic complications, patient satisfaction with care, the level of confidence expressed by the patient in anaesthetic care, and the willingness of patients to recommend others in the health establishments where they receive care. in addition, the variables of safety according to who recommendations are taken into account and include, among others, the qualification of the health care staff, the use of the checklist, the availability of and access to monitoring equipment and medicines, and the quality of the health care infrastructure meeting the standards. the level of community perception is captured through an analysis of expectations, attitudes and perception itself in relation to anaesthesia care. sampling is probability based and determined by the schwartz formula. a survey was conducted among 313 patients, 313 carers and 37 providers in this region in a resource-limited setting. data were collected using a digital https://doi.org/10.5281/zenodo.17165455 ijo journals volume 08 | issue 09 | september 2025 | https://ijojournals.com/index.php/hsn/index 2 ijo international journal of health sciences and nursing ( issn: 2814-2098 )) iteke fefe rivain6* https://ijojournals.com/ volume 08 || issue 09 || september, 2025 || “securite en anesthesie au sud et a l’est de la rd congo : etat de lieu et perception communautaire" questionnaire via kobo collect, then cleaned with excel before analysis with epi info software. frequency analysis and percentage calculations were used for description, while the chi-square test and odss ratio (95% ci) calculations were applied to establish the association between the occurrence of complications and the other variables. results: fewer than 60% of the target facilities applied the who-recommended safety protocols, such as the surgical checklist. post-anaesthetic complications were significantly associated with the absence of postoperative follow-up. conclusion: our study shows that the community's perception of anaesthesia remains negative overall and is influenced by safety levels. this is because patients who have had a negative experience with anaesthesia perceive it as a threat to their health, which makes them negative customers who pose a public danger. conversely, a positive experience of anaesthesia promotes community outreach based on its benefits and reassures potential surgical patients that their safety is guaranteed by trusting anaesthesia professionals. this study calls for an integrated clinical and community approach to make anaesthesia everyone's business, involving decision-makers, anaesthesia professionals and care recipients. this can be achieved by institutionalising the use of the checklist in all facilities and adapting it to the realities and context of resource-limited areas. continuing education for anaesthesia practitioners should be reinforced, and a standardised monitoring and evaluation system should be implemented in this sector to guarantee success. key words: safety in anaesthesia, perioperative morbidity and mortality, community perception, quality of care, democratic republic of congo https://doi.org/10.5281/zenodo.17165455 ijo journals volume 08 | issue 09 | september 2025 | https://ijojournals.com/index.php/hsn/index 3 ijo international journal of health sciences and nursing ( issn: 2814-2098 )) iteke fefe rivain6* https://ijojournals.com/ volume 08 || issue 09 || september, 2025 || “securite en anesthesie au sud et a l’est de la rd congo : etat de lieu et perception communautaire" introduction la sécurité en anesthésie désigne un ensemble des moyens (mesures et protocoles) mis en œuvre pour minimiser les risques liés à l’administration d’anesthésiques et garantir des soins de qualité aux patients (bonet & ponchon, 2018). il s’agit d’un domaine multidimensionnel intégrant des aspects techniques, humains et matériels, visant à prévenir les complications, à assurer une surveillance continue et à gérer les patients en post-opératoire (gaba, 2000). le domaine de l’anesthésie étant sensible car il met en jeu la vie du patient, il est soumis à un cadre réglementaire visant à améliorer les résultats cliniques et à standardiser les soins y relatifs (asa, 2021). ces normes couvrent plusieurs éléments essentiels, notamment la présence continue d’un personnel qualifié et vigilant, la surveillance de l’oxygénation et de la perfusion tissulaire à l’aide d’un oxymètre de pouls, ainsi que le contrôle intermittent de la tension artérielle. elles insistent également sur la confirmation de l’intubation trachéale par auscultation et la détection du co2 expiré, et recommandent l’utilisation de la check-list de la sécurité chirurgicale de l’oms pour améliorer la prise en charge des patients (who, 2015). ces normes sont basées sur la présence et l’utilisation d’un équipement adapté à la prise en charge anesthésique pouvant assurer la sécurité du patient. à cela s’ajoute la présence et la disponibilité du personnel qualifié, la formation continue de ce dernier, la présence des infrastructures qui répondent aux normes standards et la disponibilité des drogues (who & fisa, 2018). plusieurs recherches africaines montrent que la sécurité anesthésique demeure un défi majeur en raison du manque d’anesthésistes qualifiés, de la faible couverture en équipements médicaux essentiels et de l’insuffisance de protocoles standardisés. plusieurs études révèlent que les taux de complications et de mortalité liés à l’anesthésie y sont largement supérieurs à ceux des pays à revenu élevé, atteignant parfois 2 à 3 % dans certaines zones à faibles ressources (walker, obua, mouton, & wilson, 2015). les hôpitaux africains, surtout en milieu rural, souffrent d’un accès limité à des dispositifs de surveillance comme les oxymètres ou les moniteurs cardiaques, ce qui compromet la prise en charge sécurisée des patients(dubowitz, detlefs, & mcqueen, 2010). en outre, les programmes de formation en anesthésie sont souvent insuffisants, sporadiques, et mal financés, ce qui entraîne une forte dépendance à des personnels sous-formés(obua, nabirye, & mwesigwa, 2016). nonobstant toutes les réformes institutionnelles et politiques apportées dans le cadre de l’amélioration continue de la prise en charge anesthésique, les rares études réalisées en rd congo prouvent que la réalité n’est pas loin de celle de l’afrique sub-saharienne. l'insuffisance des infrastructures, le manque de formation adéquate du personnel et l’accès limité aux équipements et aux médicaments essentiels sont cités comme défis majeurs freinant la réalisation d’une anesthésie sécurisée [(nganga, tshilenge, & lumeya, 2020)&(kayembe, 2019)]. en complément à ces recherches, l’étude de mubenga (2018) établit un lien entre complications anesthésiques et l’insuffisance de la formation des professionnels d’anesthésie ainsi que leur accès limité à des nouvelles technologies tel qu’exigé par l’oms, situation exacerbée par le ratio prestataire/patients inférieur aux standards de l’oms qui recommande 5 prestataires pour 100.000 habitants (mubenga, 2018)& (who, surgical care systems strengthening: developing national surgical, obstetric and anaesthesia plans. geneva: world health organization. , 2016). plusieurs autres études ont mis en évidence l’impact des réactions adverses aux anesthésiques, notamment les allergies médicamenteuses, révélant un déficit de suivi postopératoire et un manque de protocoles de détection et de prise en charge de ces incidents (ilunga, 2020). outre les défis techniques et structurels, la perception communautaire de l’anesthésie influence directement l’acceptation des soins. dans plusieurs régions de la rdc, l’anesthésie est perçue avec peur, notamment en raison du manque d’information et de l’association fréquente avec la mort ou la paralysie (kalombo & mbuyu, 2021). ces études soulignent une nécessité de garantir une prise en https://doi.org/10.5281/zenodo.17165455 ijo journals volume 08 | issue 09 | september 2025 | https://ijojournals.com/index.php/hsn/index 4 ijo international journal of health sciences and nursing ( issn: 2814-2098 )) iteke fefe rivain6* https://ijojournals.com/ volume 08 || issue 09 || september, 2025 || “securite en anesthesie au sud et a l’est de la rd congo : etat de lieu et perception communautaire" charge anesthésique sécurisée à travers la prise en compte des recommandations de l’oms et de la fisa. ainsi, nous nous sommes posé la question de savoir quel est l’état de lieu de la sécurité en anesthésie, c’està-dire le niveau d’applicabilité de ces recommandations au sud et à l’est de la rd congo et quelle en est la perception communautaire. au sud et à l’est de la rdc, la sécurité de l’anesthésie est reflétée par une augmentation du taux de morbi-mortalité péri-anesthésique, tapissée par les défis structurels, les dynamiques socioculturelles et les lacunes en communication se conjuguant pour façonner une expérience souvent anxiogène pour les patients et leurs proches menaçant cette sécurité et aggravant la peur dans la communauté. c’est dans le but de déterminer le niveau de sécurité en anesthésie dans cette partie du pays ainsi que d’explorer la perception communautaire qui en découle, que notre recherche s’inscrit. il convient alors d’exposer la démarche méthodologique adoptée pour répondre à notre question de recherche. patients et methode type, cadre et période d’étude : nous avons mené une étude descriptive transversale à visée analytique dans 10 structures de santé publiques et privées se retrouvant au sud et à l’est de la rdc dont la ville de lubumbashi, likasi, kolwezi au sud ainsi que la ville de kalemie et de bukavu à l’est, pour une période allant de septembre 2024 à février 2025 soit 6 mois. critères de sélection : étaient inclus dans notre étude tous les patients ayant subi une intervention chirurgicale nécessitant une anesthésie dans un hôpital ou une clinique au sud et à l'est de la rd congo dans les six derniers mois, les accompagnateurs et les prestataires présents pendant la période de notre recherche et ayant consenti librement pour ce faire. en plus, les patients et leurs accompagnateurs devraient être adultes et sans affection psychiatrique. il en était de même pour les prestataires travaillant dans les structures de santé sélectionnées au sud et à l’est de la rd congo. échantillonnage : il était aléatoire stratifié. nous avons déterminé la taille des échantillons (patients, accompagnateurs et prestataires) par la formule de schwartz avec correction pour le cas des populations connues et finies. variables d’études : la sécurité de l’anesthésie était principalement captée par la survenue des complications. cela était expliqué par des variables sociodémographiques, les caractéristiques cliniques et anesthésiques des cibles. le niveau de sécurité de l’anesthésie était fonction des variables telles que : l’existence et l’accessibilité aux équipements fonctionnels et médicaments, l’existence et l’utilisation de la check-list de l’oms, la présence des infrastructures répondant aux normes, la qualification du personnel, la réalisation régulière d’audits ainsi que l’existence d’une politique d’accompagnement du système de santé. la perception communautaire de la sécurité de l’anesthésie quant à elle explorait les dimensions psychologiques ayant train aux expériences des accompagnateurs, leurs inquiétudes, leurs opinions ainsi que leur niveau de satisfaction par rapport aux soins anesthésiques dans la région pouvant conduire à accepter de recommander leurs institutions de prise en charge antérieure aux autres personnes ou à une attitude négative quant à ce. matériels et outils : pour la réalisation de cette étude, plusieurs matériels et outils ont été utilisés. la collecte des données a été réalisée via des questionnaires numérisés intégrés dans les smartphones. le guide d’observations nous a aidé à collecter des informations saisies sur des papiers à l’aide de stylo. des entretiens semi-directifs ont été effectués grâce au questionnaire structuré et les informations ont été https://doi.org/10.5281/zenodo.17165455 ijo journals volume 08 | issue 09 | september 2025 | https://ijojournals.com/index.php/hsn/index 5 ijo international journal of health sciences and nursing ( issn: 2814-2098 )) iteke fefe rivain6* https://ijojournals.com/ volume 08 || issue 09 || september, 2025 || “securite en anesthesie au sud et a l’est de la rd congo : etat de lieu et perception communautaire" collectées manuellement sur papier. réalisation : une sélection préalable des structures a été effectuée avant de consulter leurs répondants pour collecter les informations sur la fréquentation moyenne des patients en vue d’une intervention chirurgicale ainsi que les taux de mortalité. ensuite, après détermination et stratification de l’échantillon, une enquête a été réalisée auprès de ces trois groupes des personnes constituant notre étude. les enquêteurs ont été préalablement formés sur la conduite des enquêtes dans les villes respectives. les enquêtés étaient retrouvés respectivement dans les structures cibles et une fiche de consentement leur avait été proposée pour signature afin de s’assurer que la participation était volontaire. des entretiens semi-directifs ont été réalisés auprès des répondants pour comprendre les défis auxquels les professionnels font face pour garantir une anesthésie sécurisée. à cela se sont ajoutées des observations pour permettre une triangulation des résultats. traitement et analyse des données : les données collectées sur kobotoolbox ont été exportées vers le logiciel excel pour nettoyage avant une analyse statistique. cette analyse a été faite grâce au logiciel epi info. l’étude a adopté une analyse univariée et bivariée. l’analyse univariée concernait la détermination des fréquences, des pourcentages ainsi que de la moyenne pour les variables continues ou numériques. le test de chi-deux, avec les mesures comparatives de rapport des côtes (or, ic à 95%) a été utilisé pour mesurer l’association entre la survenue des complications et les indicateurs de la sécurité en anesthésie, variables cliniques et anesthésiques. le test t de student (d’égalité des moyennes) a été utilisé pour vérifier l’existence d’une différence significative entre les taux de mortalité selon le type de structure (public ou privé). les résultats étaient présentés dans les tableaux et les graphiques selon les types des variables étudiées. résultats taux de réponse estimé : 313 patients et accompagnateurs ont été enquêtés dans le cadre de cette étude dont 47 à bukavu (15,02%), 29 à kalemie (9,27%), 93 à kolwezi (29,71%), 25 à likasi (7,99%) et 119 à lubumbashi (38,02%). profile des patients type des structures : 66 patients étaient issus des structures de type privé (21,09%) et 247 du type public (78,91%). age des patients : 26 avaient moins de 18 ans (8,31%), 164 avaient l’âge compris entre 18 et 30 ans (52,40%), 109 patients ayant l’âge compris entre 31 et 50 ans (34,82%) et 14 patients avaient plus de 50 ans (4,47%). sexe des patients : cette étude a concerné 141 femmes (45,05%) contre 172 hommes (54,95%). la sex-ratio était estimée à 1.22 montrant une prédominance masculine avec un écart de sexe de 9.9%. niveau d’étude des patients : 42 patients n’avaient aucun niveau (13,42%), 38 du niveau primaire (12,14%), 180 du secondaire (57,51%) et 53 du niveau supérieur/universitaire (16,93%). profile des accompagnateurs l’âge moyen des accompagnateurs interrogés était de 31 ans. leur majorité était des femmes (57.8%), dont le lien de parenté avec le patient accompagné était familial au premier degré (57.5%) et issus des milieux urbains (50.16%). profile des prestataires l’âge moyen des prestataires était de 30 ans. leur majorité avait l’âge compris entre 21 et 39 ans (83.8%). la majorité avait une expérience professionnelle comprise entre 1 à 5 ans (78.4%). le type d’anesthésie couramment pratiqué par les prestataires était l’anesthésie générale (70.3%). https://doi.org/10.5281/zenodo.17165455 ijo journals volume 08 | issue 09 | september 2025 | https://ijojournals.com/index.php/hsn/index 6 ijo international journal of health sciences and nursing ( issn: 2814-2098 )) iteke fefe rivain6* https://ijojournals.com/ volume 08 || issue 09 || september, 2025 || “securite en anesthesie au sud et a l’est de la rd congo : etat de lieu et perception communautaire" niveau d’application des normes de l’oms tableau i. distribution des prestataires selon les normes de l’oms n somme moyenne modalité ecarttype min max value pourc value pourc formation spécifique 37 14 38% 0.378 38% 2 0.492 0 1 disponibilité de la politique 37 10 27% 1.892 47% 4 0.994 1 4 mise à jour de la politique 37 7 19% 2.595 65% 5 1.117 1 4 accessibilité aux informations 37 25 68% 2.432 49% 5 1.191 1 5 information aux patients avant intervention 37 25 68% 3.811 76% 5 1.33 2 5 liste de contrôle de sécurité 37 9 24% 0.243 24% 2 0.435 0 1 conformité aux normes 37 3 8% 2.405 60% 4 1.013 1 4 ces normes font partie de celles exigées par l’oms pour assurer une prise en charge anesthésique sécurisée. seulement 38% des prestataires affirment avoir reçu une formation spécifique sur la sécurité en anesthésie. pour une moyenne de 0,378, un écart-type de 0,492 et un maximum de 1, les résultats relatifs à la formation spécifique prouvent que la majorité des données des prestataires n’atteignent pas le chiffre 1 (correspondant à la réponse «oui»). ces données sont situées entre -0,114 et 0,87 (moyenne ± écart-type), ce qui montre un fort regroupement autour de la non-formation. concernant la disponibilité et la clarté de la politique de sécurité anesthésique, seuls 27% des prestataires déclarent qu’elle est présente dans leur structure. la moyenne, à 1,892 sur 4 avec un écart-type de 0,994, indique une grande variabilité ; la majorité des valeurs se situent entre 0,9 et 2,9, n’atteignant pas la valeur de 3 (en accord avec la disponibilité de la politique de sécurité) et montrant des différences marquées selon les établissements. pour la mise à jour de la politique, seulement 19% confirment qu’elle est régulièrement actualisée. avec une moyenne de 2,595 sur 5 et un écart-type de 1,117, la dispersion des données entre 1,48 et 3,71 révèle une rareté dans la pratique de mise à jour de la politique de sécurité. l’accessibilité aux informations sur la politique de sécurité est plus satisfaisante puisque 68% des prestataires y ont accès. la moyenne est de 2,432 sur 5 avec un écart-type de 1,191, couvrant une plage de 1,24 à 3,62 (entre jamais et rarement en passant par parfois). de même, 68% des prestataires déclarent informer les patients avant intervention. avec une moyenne de 3,811 et un écarttype de 1,33, les valeurs se situent entre 2,48 et 5,14, ce qui traduit un bon respect relatif de ce volet. en revanche, l’utilisation de la liste de contrôle de sécurité est faible, avec seulement 24% de prestataires concernés. la moyenne étant à 0,243 et l’écart-type à 0,435, les données restent majoritairement en dessous de 1, attestant d’une faible application de cette mesure essentielle. enfin, la conformité globale aux normes oms est très limitée, confirmée seulement par 8% des prestataires. avec une moyenne de 2,405 sur 4 et un écart-type de 1,013, les valeurs fluctuantes entre 1,39 et 3,42 montrent une forte hétérogénéité et une proportion faible de structures pleinement conformes aux normes de l’oms. https://doi.org/10.5281/zenodo.17165455 ijo journals volume 08 | issue 09 | september 2025 | https://ijojournals.com/index.php/hsn/index 7 ijo international journal of health sciences and nursing ( issn: 2814-2098 )) iteke fefe rivain6* https://ijojournals.com/ volume 08 || issue 09 || september, 2025 || “securite en anesthesie au sud et a l’est de la rd congo : etat de lieu et perception communautaire" tableau ii. procédures de sécurité mises en œuvre n moyenne pourc ecart-type liste de contrôle de sécurité 37 0.243 24% 0.435 surveillance du patient 37 0.946 95% 0.229 communication entre l'équipe 37 0.784 78% 0.417 formation continue 37 0.162 16% 0.374 la liste de contrôle de sécuritéestutilisée par seulement 24% des prestataires, avec unemoyennefaible de 0,243 et un écart-type de 0,435. les résultatssontdoncmajoritairementendessous de 1.celaconfirmeune faiblesse dans lamiseenœuvre de cetoutilessentiel à la sécuritéanesthésique. ence qui concerne la surveillance du patient, un pourcentagetrèsélevé de 95% des prestatairesconfirmentsaréalisation. la moyennecorrespondanteest de 0,946, avec un faibleécart-type de 0,229, indiquant que la majorité des prestatairesrespectentcetteprocédure de façonhomogène et rigoureuse. pour la communication entre les membres de l’équipe, 78% des prestatairesrapportentqu’elleest effective. la moyenneestélevée, à 0,784, maisl’écart-type de 0,417 suggère que cetteprocédure, même si globalementprésente, ne s’applique pas dans toutes les structures. enfin, la formation continue est la procédure la moinsrespectée, avec seulement 16% des prestatairesconcernés. la moyenne de 0,162 et l’écart-type de 0,374 montrent que cettepratiquerestelargement absente pour la majorité des prestataires. tableau iii. distribution des prestataires selon les incidents critiques rencontrés n moyenne erreur standard somme ecart-type accident respiratoire 37 0.595 0.0818 22 0.498 difficultésd'intubation 37 0.595 0.0818 22 0.498 allergies médicamenteuses 37 0.243 0.0715 9 0.435 arrêtcardiaque 37 0.784 0.0686 29 0.417 sur un total de 37 prestataires, les incidents critiques les plus fréquemmentrapportéssontl’arrêtcardiaque (78,4%)et les accidents respiratoires ainsi que les difficultésd’intubation (59.5% chacun). les allergies médicamenteuses ont été rapportées chez 24.3% des prestataires. la somme des casconfirmésa atteint 22 pour les accidents respiratoires et difficultésd’intubation, et 29 pour l’arrêtcardiaque. sauf pour les allergies médicamenteuses (-0.192 et 0.678), les données sont largement dispersées autours de la moyenne, indiquant que la variabilité de ces incidents par structure. aussi, les erreurs standards pour chaque incident rapporté sont faibles, indiquant une association de cet échantillon jugée bénéfique sur la population. la combinaison la plus fréquente est «arrêt cardiaque + accident respiratoire + difficultés d’intubation avec 8 cas, représentant 21,6%, soit la plus grande proportion» https://doi.org/10.5281/zenodo.17165455 ijo journals volume 08 | issue 09 | september 2025 | https://ijojournals.com/index.php/hsn/index 8 ijo international journal of health sciences and nursing ( issn: 2814-2098 )) iteke fefe rivain6* https://ijojournals.com/ volume 08 || issue 09 || september, 2025 || “securite en anesthesie au sud et a l’est de la rd congo : etat de lieu et perception communautaire" tableau iv. les facteurs associés à la survenue des complications ou effets indésirables chez les patients variables indépendantes χ² p or intervalles de confiance à 95% borne inf supé rieur répondreclairement aux questions 12.7 < .001 0.335 0.18 0.623 sentiment de sécurité pendant l'intervention 12 < .001 0.372 0.21 0.658 appréciation de la compétence du personnel 0.46 0.498 0.846 0.521 1.37 état des équipements 4.61 0.032 0.574 0.345 0.955 disponibilité des médicaments 14.8 < .001 0.373 0.224 0.621 vérification des équipementsavant intervention 19.6 < .001 0.207 0.0985 0.437 plusieurs facteurs indépendants sont significativement associés à la réduction du risque de complications en anesthésie, comme le montrent les valeurs de χ² élevées et des p-values inférieures à 0,05. en particulier, le fait de répondre clairement aux questions des patients avant l’intervention diminue fortement le risque d’effets indésirables (or = 0,335 ; ic 95% : 0,18–0,623), cela indique que les prestataires qui communiquent efficacement réduisent d’à peu près 66% la probabilité de complications chez les patients. de même, le sentiment de sécurité éprouvé par les patients pendant l’intervention est significativement protecteur (or = 0,372 ; ic 0,21–0,658). la vérification des équipements avant l’intervention apparaît comme le facteur le plus protecteur, avec un odds ratio très bas (or = 0,207 ; ic 0,099–0,437), ce qui signifie que cette pratique réduit de plus de 79% la survenue des complications chez les patients. la disponibilité des médicaments (or = 0,373 ; ic 0,224–0,621) et un bon état des équipements (or = 0,574 ; ic 0,345–0,955) sont aussi significativement liés à une moindre survenue d’effets indésirables. en revanche, l’appréciation de la compétence du personnel par les patients n’est pas statistiquement associée aux complications (p = 0,498 ; or = 0,846 avec un intervalle de confiance qui inclut 1). état des lieux de la morbi-mortalité anesthésique au sud et à l’est de la rdc tableau v. taux de mortalité par catégorie levene's test for equality of variances t-test for equality of means f sig. t df sig. (2tailed) mean differenc e std. error difference 95% confidence interval of the difference lower upper mom equal variances assumed 4.454 0.068 2.075 8 0.072 52.5833 25.343 -5.8578 111.0245 https://doi.org/10.5281/zenodo.17165455 ijo journals volume 08 | issue 09 | september 2025 | https://ijojournals.com/index.php/hsn/index 9 ijo international journal of health sciences and nursing ( issn: 2814-2098 )) iteke fefe rivain6* https://ijojournals.com/ volume 08 || issue 09 || september, 2025 || “securite en anesthesie au sud et a l’est de la rd congo : etat de lieu et perception communautaire" le test de levene pour l’égalité des variances donne une valeur de f = 4,454 avec p = 0,068, ce qui est légèrement au-dessus du seuil classique de 0,05. cela suggère que l’hypothèse d’égalité des variances n’est pas rejetée de manière significative. le taux de mortalité diffère de manière très significative entre les deux groupes (structures publiques versus structures privées), avec un taux moyen de 5%, ce qui laisse entendre que la mortalité varie remarquablement selon le type de structure. le test t révèle une différence hautement significative entre les groupes (t(8) = 6,761, p < 0,001 en supposant égalité des variances, et t(7,152) = 7,906, p < 0,001 sans cette égalité). la moyenne du taux de mortalité observée est de 5% avec un écart-type partiellement faible (erreur standard ~0,63–0,74%). l’intervalle de confiance à 95% pour cette différence se situe entre environ 3,3% et 6,7%.pour la moyenne des opérations chirurgicales mensuelles (mom), le test t montre que, sans supposer l’égalité des variances, la différence entre les groupes est significative avec t(6,223) = 2,501 et p = 0,045. cette différence moyenne est de 52,58 opérations mensuelles en faveur du groupe 1 (structures publiques) ou 2 (structures privées), avec un intervalle de confiance 95% allant de 1,59 à 103,58, indiquant une différence significative du volume chirurgical mensuel entre les deux types de structures. perception communautaire de la sécurité en anesthésie tableau vi. la perception communautaire de la sécurité en anesthésie variables modalitédominante n % perceptions négative 181 57.7 % attentes non satisfaisante 140 44.9 % inquiétudes peur de la mort 177 56.4 % le tableau révèle que 57,69 % des accompagnateurs avaient une perception négative concernant l’anesthésie dans la région.44,87 % des accompagnateurs ont fait état de leurs attentes vis-à-vis de l'anesthésie qui n'ont pas été satisfaites.56,41 % des accompagnateurs ont évoqué la crainte de la mort comme principale inquiétude. equal variances not assumed 2.501 6.223 0.045 52.5833 21.0212 1.5901 103.5766 tauxmor talité (%) equal variances assumed 1.371 0.275 6.761 8 0 5.00% 0.74% 3.29% 6.71% equal variances not assumed 7.906 7.152 0 5.00% 0.63% 3.51% 6.49% https://doi.org/10.5281/zenodo.17165455 ijo journals volume 08 | issue 09 | september 2025 | https://ijojournals.com/index.php/hsn/index 10 ijo international journal of health sciences and nursing ( issn: 2814-2098 )) iteke fefe rivain6* https://ijojournals.com/ volume 08 || issue 09 || september, 2025 || “securite en anesthesie au sud et a l’est de la rd congo : etat de lieu et perception communautaire" discussion cette étude descriptive et analytique menée dans dix structures sanitaires du sud et de l’est de la rdc met en lumière un état préoccupant de la sécurité en anesthésie, avec des lacunes significatives tant sur le plan organisationnel que sur les perceptions communautaires. nos résultats confirment la faible application des normes internationales de sécurité anesthésique, notamment celles recommandées par l’oms. conformité aux normes de sécurité et pratiques la formation spécifique sur la sécurité anesthésique n’a concerné que 38% des prestataires, et la mise en œuvre de la liste de contrôle de sécurité reste très faible (24%). ces chiffres sont cohérents avec ceux rapportés dans des contextes similaires à ressources limitées, notamment en afrique subsaharienne où plusieurs études documentent une application partielle des checklists chirurgicales oms (haynes et al., 2009; biccard et al., 2018). haynes et al. ont montré que l’usage systématique de la checklist réduit significativement la morbidité et la mortalité opératoires, ce qui souligne le besoin urgent d’instaurer cette pratique en rdc. biccard et al. (2018), dans un large audit afrique, ont également noté des taux faibles d’implémentation de telles mesures, assimilables à des déficits en formation et en organisation. notre étude révèle également que 68% des prestataires ont accès aux informations nécessaires avant intervention et informent les patients, un point positif similaire à ce que rapportent certains établissements en afrique du sud (berg et al., 2020). cependant, cette communication ne suffit pas à compenser l’insuffisance des procédures formelles, notamment la faible formation continue (16%) et la faible conformité globale aux normes (8%). incidents critiques et facteurs associés nous observons une fréquence élevée d’incidents graves tels que l’arrêt cardiaque (78%), l’accident respiratoire (59%), et les difficultés d’intubation (59%). ces taux sont alarmants et supérieurs à ceux rapportés dans certaines études africaines récentes où l’incidence des complications respiratoires et cardiovasculaires post-anesthésiques varie entre 10 et 30% (biccard et al., 2018; maithel et al., 2016). cette surreprésentation d’incidents graves peut s’expliquer par les carences organisationnelles identifiées. les facteurs protecteurs identifiés (communication claire, sentiment de sécurité ressenti par le patient, vérification des équipements ainsi que la disponibilité des médicaments) corroborent les conclusions d’études précédentes qui établissent que ces éléments réduisent significativement les complications anesthésiques (vohra et al., 2019; weiser et al., 2014). l’odds ratio très bas lié à la vérification préalable des équipements (0,207) confirme l’importance capitale de cette pratique fréquemment négligée dans nos contextes (smith et al., 2017). mortalité opératoire et disparités entre secteurs public et privé le taux de mortalité moyen observé (5%) est élevé comparé aux standards internationaux qui tournent autour de 0,5 à 2% dans les pays à ressources limitées (baker et al., 2014). la différence significative du taux de mortalité entre les structures publiques et privées souligne des inégalités en termes de ressources, compétences et organisation (biccard et al., 2018). cela rejoint les constatations de weiser et al. (2016) sur les inégalités d’accès à des soins de qualité en afrique. perception communautaire la perception globale négative de l’anesthésie exprimée par 57,7% des accompagnateurs, principalement liée à la peur de la mort (56%), reflète un déficit de confiance largement rapporté dans des études africaines similaires (epiu et al., 2017). la non-satisfaction des attentes (44,9%) prouve l’impact direct des expériences https://doi.org/10.5281/zenodo.17165455 ijo journals volume 08 | issue 09 | september 2025 | https://ijojournals.com/index.php/hsn/index 11 ijo international journal of health sciences and nursing ( issn: 2814-2098 )) iteke fefe rivain6* https://ijojournals.com/ volume 08 || issue 09 || september, 2025 || “securite en anesthesie au sud et a l’est de la rd congo : etat de lieu et perception communautaire" négatives sur la confiance en soins chirurgicaux, facteur clé pour l’acceptation des interventions (kayambankadzanja et al., 2021). la perception communautaire pourrait ainsi devenir un indicateur indirect de la qualité et de la sécurité anesthésiques, confirmant l’importance d’une approche intégrée avec la communauté pour renforcer la sécurité (meara et al., 2015). conclusion au terme de cette étude, il ressort que la sécurité en anesthésie au sud et à l’est de la rd congo est encore insuffisamment assurée, avec une faible application des normes de l’oms dans la majorité des structures sanitaires évaluées. la formation spécifique, l’utilisation de la checklist de sécurité ainsi que la conformité aux protocoles restent très limitées, exposant les patients à un risque accru de complications graves telles que l’arrêt cardiaque, les accidents respiratoires et les difficultés d’intubation. ces résultats confirment les observations faites dans d’autres contextes à ressources limitées, où la mise en œuvre des standards internationaux reste un défi majeur. il apparaît que des facteurs clés comme la vérification rigoureuse des équipements, la disponibilité des médicaments et la communication claire avec les patients réduisent significativement la probabilité de survenue des complications, appuyant leur rôle essentiel dans l’amélioration de la sécurité anesthésique. par ailleurs, la différence significative des taux de mortalité entre structures publiques et privées souligne une inégalité notable dans la qualité des soins offerts. la perception communautaire, largement négative et marquée par la peur, illustre l’impact direct de ces insuffisances sur la confiance des patients, facteur crucial pour l’adhésion aux soins chirurgicaux. en conséquence, cette étude réaffirme qu’il est indispensable de promouvoir de façon sévère et adaptée les bonnes pratiques de sécurité anesthésique, à travers l’équipement adéquat, la formation continue des praticiens et l’institutionnalisation de la checklist oms dans toutes les structures. une approche intégrée, clinique et communautaire, s’avère nécessaire pour améliorer non seulement la sécurité des patients mais aussi leur perception rassurante du soin anesthésique en zones à ressources limitées, telles que la rdc. références 1. baker, t., lugazia, e., eriksen, j., mwafongo, v., irestedt, l., & konrad, d. (2014). perioperative mortality rates in low-income and middle-income countries: a systematic review and metaanalysis. lancet, 384(9950), 1285–1294. 2. berg, k., smith, c., &ngema, p. (2020). patient communication in perioperative anesthesia care in southern africa. anaesthesia, 75(6), 782–788. 3. biccard, b. m., madiba, t., kluyts, h.-l., et al. (2018). perioperative patient safety in low-income and middle-income countries: challenges and opportunities. anaesthesia, 73(3), 361–372 4. epiu, i., tindimwebwa, j. v., mijumbi, c., okello, m., wabule, a., & walker, i. a. (2017). perceptions and challenges of anesthesia provision in sub-saharan africa. world journal of surgery, 41(6), 1400–1407. 5. haynes, a. b., weiser, t. g., berry, w. r., et al. (2009). a surgical safety checklist to reduce morbidity and mortality in a global population. the new england journal of medicine, 360(5), 491– 499. 6. kayambankadzanja, j., mkwanda, c., &dube, b. (2021). community perceptions and surgical outcomes: insights from a rural health district in africa. plos one, 16(5), e0250366. https://doi.org/10.5281/zenodo.17165455 ijo journals volume 08 | issue 09 | september 2025 | https://ijojournals.com/index.php/hsn/index 12 ijo international journal of health sciences and nursing ( issn: 2814-2098 )) iteke fefe rivain6* https://ijojournals.com/ volume 08 || issue 09 || september, 2025 || “securite en anesthesie au sud et a l’est de la rd congo : etat de lieu et perception communautaire" 7. maithel, s. k., agrawal, v., &manchikanti, l. (2016). anesthesia complications in resource-limited settings. anesthesia & analgesia, 122(4), 1225–1234. 8. meara, j. g., leather, a. j., hagander, l., et al. (2015). global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. lancet, 386(9993), 569–624. 9. smith, j., patel, p., & williams, r. (2017). equipment checks and anesthesia safety: a review of standards and practices. anesthesia clinics, 35(2), 321–334. 10. vohra, r. s., shah, s., &arbon, p. (2019). patient safety interventions in low-resource environments: a scoping review. british journal of anaesthesia, 122(5), e120–e132. 11. weiser, t. g., regenbogen, s. e., thompson, k. d., et al. (2014). an estimation of the global volume of surgery: a modelling strategy based on available data. lancet, 372(9633), 139–144. 12. weiser, t. g., haynes, a. b., molina, g., et al. (2016). size and distribution of the global volume of surgery in 2012. bulletin of the world health organization, 94(3), 201–209. contribution des auteurs l’auteur 1, est le concepteur et investigateur principal de ce travail en lui offrant le modèle conceptuel ainsi que le cadre méthodologique et l’appui financier sur fond propre les auteurs 2, 3, 4 et 5 : ont contribué au carde méthodologique, aux analyses statistiques et à la discussion l’auteur 6, est le mentor de ce travail depuis sa conception jusqu’à sa défense comme mémoire de master complémentaire, et aujourd’hui à sa soumission comme article original. lien d’interet les auteurs ne déclarent aucun lien d’intérêt dans la réalisation de ce travail, qui par ailleurs n’a jamais été soumis dans une autre revue. https://doi.org/10.5281/zenodo.17165455 ijo journals volume 08 | issue 09 | september 2025 | https://ijojournals.com/index.php/hsn/index 13 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? title: uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? name of author: dr. angelina bazugba; assoc. professor, school of social and economic studies; and director of the national transformational leadership institute (ntli), university of juba; contacts: p.o box 82, juba, south sudan; abstract the policy measures introduced following the emergence of covid-19 pandemic have dramatically disrupted the daily livelihood of low-income female-headed households. most of them are less-educated, self-employed or employed in informal sectors without social protection or any kind of insurance. as care givers and head of households, the majority are involved in hand-to-mouth businesses, own fewer assets and live in densely populated areas which puts them at high-risk of exposure to the covid-19 infection. literature indicates that social distancing and stay at home policies can contribute to flattening of the curve of infections and reduce pressure on health systems. yet, such measures are less productive in the absence of alternative sources of income and livelihood. women and girls are disproportionately affected due to increased burden of unpaid work, gender-based violence, food insecurity, poverty and economic hardship. while there is inadequate health services and densely populated households, covid-19 has increased water usages by 50 percent. i argue that understanding the gender-differentiated impacts of disease outbreak is fundamental to creating effective and equitable policies and interventions that will leave no one behind. the research calls for clear policies on economic recovery and food distribution, behavioral change, information sharing and continuous inclusion of women in planning and decision-making structures to ensure that their concerns are effectively integrated in the implementation and monitoring of the covid-19 prevention and response measures. key words: gender, covid-19; protection; participation; socioeconomic impact; genderbased violence, recovery, resilience. introduction the emergence of the corona virus disease 2019 (covid-19) has not only caused panic across the globe but has resulted to massive utilization of global expert networks and partnerships for laboratory, infection prevention and control, clinical management and mathematical modelling projecting the infection frontier.[1]who has also continued to work with networks of researchers and other experts to coordinate global work on surveillance, epidemiology, modelling, diagnostics, clinical care and treatment, and other ways to identify, manage and limit onward transmission of the disease. correspondingly, the social and economic predicaments of the covid-19 pandemic, have called for unprecedented measures to be taken by local and national governments including social distancing, restriction of the movement and curfew at night hours, border closures, the confinement of entire cities, regions and countries, as well as the temporary https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 1 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? closure of formal and informal economic activities etc. such significant measures can dramatically flatten the curve of infections and reduce pressure on health facilities if there is adequate number of hospital beds, ventilators and other health care facilities.[2] south sudan like other african countries, the pandemic has served as a wake-up call and an opportunity to improve weak infrastructures, health facilities, transition of the education system to e-learning and improvement of data and statistical capacity in relation to health and civil registration.[3]while such measures are vital, the pandemic’s global outreach has already widened inequalities within and between countries, worsened already existing fragilities, and restricted employment and investment prospects.[4] for south sudan which has been in a cycles of conflict and economic hardship, the emergence of covid-19 is likely to have increased inequalities between men and women and boys and girls. by december 20th 2021, the republic of south sudan had confirmed 13,831 cases out of which 12,614 cases recovered.[5]with the frail health system and very informal and vulnerable economy, the covid-19 conclusively, has imposed heavy human, financial, economic, and social costs. although prevention measures previously adopted by the government had been relaxed with increased flattening of the curve, the emergency of covid19 has significantly impacted citizens’ lives, disrupted socio-economic development activities and the implementation of the peace agreement. consequently, there is increased poverty, street begging, armed robberies, social devastation and non-compliance and negligence of covid19 policies and guidelines. the initial studies conducted by the university of juba and undp (2020) revealed that households were under significant strain due to loss of income. specifically, women and youth who are mainly involved in informal sectors or self-employed were devastated as a result of lockdown. the closure of businesses had also triggered price hikes for food, medicines, essential household commodities and public transport fare. this paper seeks to explore two major questions: what is the differential impact of covid-19 upon women and men? what resilience and recovery measures can be put in place to support the marginalised groups to bounce back? thus, the objectives of the research were to identify the gender and socio-economic impact of the covid-19 pandemic with a particular focus on the unique needs, capacities, vulnerabilities and opportunities for women, girls, men and boys; identify the gender responsive interventions in place and provide recommendations to that will contribute to policy and programmatic service delivery and recovery across sectors. the first part of this paper has introduced the study, key questions and research objectives. it goes on providing the socio economic and health context of south sudan, followed by gender dimensions of covid-19 pandemic, and the justification for conducting a study. part two provides the methodology, while part three presents the results and discussion on the vulnerability factors in the south sudanese context. the last section concludes with policy implications and recommendations. south sudan socio-economic development and health context south sudan continues to encounter a serious humanitarian crisis due to the cumulative effects of years of conflict which has destroyed people’s livelihoods. extreme levels of acute food insecurity persist across the country and nearly more than 6 million (about half of the population) https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 2 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? are facing crisis-level food insecurity, with 1.4 million children under 5 years expected to be acutely malnourished in 2021.[6]almost 4 million people remain displaced by the humanitarian crisis, with nearly 1.6 million people displaced internally and some 2.2 million refugees in six neighboring countries. women and children continue to be the most affected. in 2020, communities were hit hard by the triple shock of intensified conflict and sub-national violence, a second consecutive year of major flooding, and the impacts of covid-19, exacerbating an already dire humanitarian situation. the emergence of the covid-19 pandemic, intensified a burden to a country with continuing pockets of conflict and fragility, recurrent naturally and human-induced systemic shocks and stress, weak institutions and economic instability.[7] following the independence in july 2011, the country fell back into conflict in 2013 and 2016 respectively which culminated with the signing of peace agreement (r-arcss) in september 2018. poverty is endemic and widespread with at least 80 percent of the 13.3 million population live below the poverty line (national bureau of statistics2010). women, in particular female headed households make up to 51.6% of the poor.[8] with an economic annual growth rate of 3.2% by 2018/2019 and total fertility rate of 7, the population is predominantly young with the age group under 30 years accounting for about 75%.[i] with a high level of illiteracy 73% for men and 84% for women, the unemployment rate in south sudan remained unchanged at 11.50% since 2016 (unocha 2016/2017).[ii] those in non-wage employment in the agriculture sector account for 61 percent of the employed. only a minority of workers enjoy formal salaried employment (13%) or employment in the tertiary sector (19%).[iii]poverty levels are expected to remain extremely high, with about 82 percent of the population in south sudan below the usd1.90 poverty line (2011 purchasing power parity).[iv]the insecurity situation and the decline in global oil prices since 2016 negatively affected the economy, leading to high (50 percent) youth and women unemployment. the next section explains the gender dimensions of covid-19 pandemic more broadly, but with specific experiences from south sudan. the gendered dimensions of covid-19 pandemic globally women make up 70% of the workers in health and other social sectors susceptible to covid19 outbreak including hospitals, tourism, air transport, entertainment, cleaning and domestic services. this means that the global pandemic risks an increase in socio-economic inequalities and exposure to the virus from infected patients and the related socioeconomic consequences. the evidence from past epidemics shows that gender-based inequalities affects both women and men´s health, economic status, security and safety in different ways.[v] although statistics, for example, show that more men than women are affected by covid-19, if the family is infected, it is the women who will play the double role of caring for men, children, elderly and themselves. not only does this increase their vulnerability, but it also increases the burden of unpaid care and household chores in which women do 2.5 times more than men do.[9]with the outbreak of covid-19 in south sudan, the lockdown measures have resulted in the disruption of community activities and social gatherings (meetings, burials, funerals and weddings), general and tertiary education. since the country was amidst of restoring peace and https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 3 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? tranquility, absence of such activities has not only slowed down the social cohesion and reconciliation programmes, stirred up insecurity, bitterness, rampant attacks and rebellion as a consequence of economic hardship among communities. there is an increased need for home-based care of patients and children following the school closures, making women run the risk of losing their jobs and get less paid than before. it aggravates gender gap in employment as women are predominantly employed in informal sectors which are largely on part-time basis or few working hours. the covid-19 crisis has aggravated the sufferings of people in south sudan who were already negatively impacted by the civil conflicts.[10]while it is difficult to assess the toll of the pandemic or determine the costs of health services and the scope of the coverage, given limited testing capacity and the size of population that is still outside in refugee camps or in idp centres, statistics from the ministry of health stated earlier has indicated the current status.[11]the pandemic has disrupted movement within and outside the country and thus negatively impacted on economic activities most of which were depending on in-country and cross-border supply of food produces, and goods and services. the limited availability has resulted into hiking of prices, constrained access to basic services including the health and education system, access to justice, humanitarian operations due to temporary suspension of activities and delays in the supply chains.[12] south sudan like other lowand middle-income countries increasingly recognizes the pivotal importance of addressing gender equality and has been mainstreamed at various levels including the peace agreement (r-arcss) in an effort to contribute to the attainment of sustainable development goals (sdgs) by 2030. even though, women remain underrepresented across all sectors, and are disadvantaged in terms of access to healthcare and economic resources. currently, one primary health center serves an average of 50,000 people. only 40 percent of nutrition treatment centers have access to safe water, a gap that puts more vulnerable people, particularly women, boys and girls, at risk of malnutrition and disease. the life expectancy at birth for both sexes is 56.3 years. despite improvements in some health outcomes, the majority of women (87%) deliver their babies at home. only about one in five childbirths involves a skilled health care worker.[13]family planning uptake is low (contraceptive prevalence rate is 4.5% for all methods and 1.7% for modern methods).[vi] there are also considerable gender differentials in terms of gender rights, access to human rights and access to justice. women and girls are particularly vulnerable to conflict-related sexual and gender-based violence. women, girls, and children make up the majority of idps and are in desperate need of humanitarian assistance.[vii]although the mean hiv prevalence rate was 3% in 2012, statistics show that 56.9% new hiv/aids infections is amongst adolescent and youth aged 10-34 years with women and girls constituting 64% of the most affected group.[14]this rate is expected to increase due to the low levels of awareness on hiv/aids and prevailing high-risk behaviors such as multiple concurrent sexual partners, polygamy, non-use of condom, and other factors such as low school enrolment and poverty.[viii] https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 4 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? correspondingly, gender inequality and sexual gender-based violence (sgbv) are widespread and mostly intensified by cultural norms and insecurity caused by interstate and intra communal conflicts. the 2019 gbv information management system data analysis indicates that 54% of the reported incidents were perpetrated by intimate partners.[ix] if cases of intimate partner violence (ipv) were pervasive before the emergence of covid-19, it is anticipated that there will be an increased trend of similar cases with self-isolation and other stay-at-home measures. unfpa south sudan report (2020) shows an increase in the reported incidents of physical assault in the first three months of 2020 following the emergence of covid-19 pandemic.[x] in comparison to the reports of the same period in 2019, there is an increase of eight per cent of sexual and gender based violence cases in 2020. specifically, those in abusive relationships are disproportionately affected due to the time spent in close contact with the abusers. it is also anticipated that at this time, women would also have less contact with the family members and friends who, under normal circumstances, would be able to provide support and protection in the face of any violence. sexual exploitation and abuse, especially among girls forced to be out of school due to dowry and covid-19 is also anticipated to increase during the lockdown in view of the past practices. there remains high rate of teenage pregnancies (300/1,000 for girls aged 15-19), attributable to high rate of child marriage in which 40% of girls are married off under 18 years. with the closure of schools, cases of forced marriages and rape have been reported to be on the increase.[xi] still, most remain underreported due to inadequate information on referral pathway, fear of revenge from perpetrators, stigma surrounding sexual violence and possible hiv/aids transmissions. the existing vulnerabilities of women and girls are anticipated to further multiply and pre-dispose them to serious implications that go beyond the covid-19 time. in terms of water, sanitation and health (wash) facilities, long distance to schools and extra burden from domestic chores especially for adolescent girls, result into high school dropout rate. a large part of the south sudan population is semi-nomadic and this prevents them from attending formal schooling. with the emergency of covid-19, the water usages per household and in business places is likely to have increased. due to economic hardship, basic hygiene and menstruation items could be unlikely prioritized thus, putting most women and girls in a disadvantaged position. why gender and socio-economic impact assessment of covid-19 in south sudan? while it can be argued that the covid-19 pandemic has presented an opportunity for the countries in the region to self-examine their fiscal, economic-policy priorities and build health sectors, the covid-19 irrefutably, has imposed heavy human, financial, economic, and social costs. the pandemic has impacted south sudanese citizens’ lives, disrupted socio-economic development activities and implementation of the peace agreement.[15]consequently, there is increased poverty, street begging, armed robberies, social devastation and non-compliance and negligence of covid19 policies and guidelines. overall, households are under significant strain due to loss of income especially as the majority of those employed in informal sectors https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 5 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? were sent home or lost their jobs. for female heads of households, the lack of alternative livelihood opportunities aggravated their families’ sufferings and poverty. moreover, the closure of businesses also triggered price hikes for food, medicines, essential household commodities and public transport fares and increased crime rate and insecurity at night. even though the uoj and undp (2020) study revealed that 68% of the population were aware of the disease, absence of alternative sources of livelihood suggest that it would be difficult for women to observe the regulations and therefore becoming vulnerable to the disease. women, being the majority and the primary caregivers at home for sick and wounded, to the elderly and children especially after school closures, as well as front liners in hospital, hospitality industry and in markets/informal sectors, are the most predisposed to covid-19 and other infectious diseases than their male counterparts. at the same time, family care roles/child-rearing responsibilities undercut opportunities and time available for women to engage in livelihoods and employment options. it is within that context that research was carried out to get an in-depth understanding of the gendered impact of covid 19 pandemic upon women and girls. materials and methods the research employed both qualitative and quantitative methods involving household survey technique developed and used by the south sudan national bureau of statistics (nbs). all state capitals, border towns and one administrative area were involved. each town was stratified into blocks or administrative units in accordance with the nbs sampling frame. then three (3) enumeration areas (ea) were randomly selected in which 50 households were drawn to make a sample of 150 households and 50 businesses. face to face interviews using semi-structured questionnaires were held with five key informants from government departments and nongovernmental institutions (including the ministries of health; water and irrigation; interior; humanitarian and disaster management; gender, child and social welfare; agriculture, industry and the chamber of commerce, key organizations responsible for relief services including who and world food program me (wfp). the selection was based on their significant roles and services the agencies provide in the communities.[16]the study included a rapid market survey to assess the supply chains and existing prices of food items, cooking energy and the transport fares which had significantly increased during the lockdown. a total of 1050 respondents and business owners were involved in the study. a data collection tool, kobo collect, was used to support the capi/tablets online questionnaire administration. the data was then subjected to descriptive statistical analysis using the statistical package for social sciences (spss) software. results of gender analysis and policy implications to understand the gendered impact of covid-19, the following section analyses the demographic features, education, social status, occupation of respondents, coping strategies and consequences. https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 6 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? demographic features of the interviewed population, 57 percent of the household heads were between 25-44 years old while 81 percent of the households aged less than 25 years were female. few respondents (5 percent) are more than 64 years old. while who (2020) reports indicate that elderly persons are more susceptible to covid-19 infection, the risk of succumbing to disease increases among young people in the presence of underlying conditions such as cardiovascular disease, diabetes, tuberculosis and hiv/aids whose prevalence rate is 3 percent.[17]statistics show that 56.9% new hiv/aids infection is amongst adolescent and youth aged 10-34 years in which women and girls constitute 64% of the most affected group. almost 100 percent of the female heads of household under 25 years were either single, divorced, separated or widow. more women 74 percent compared to men 26 percent had no basic school education or dropped out of school. higher rates of illiteracy were observed in the northern states like northern bahr el ghazal state, lakes state and upper nile compared to the equatoria region which is bordering kenya and uganda. (fig 2). whereas, the school enrollment rate is almost the same for girls and boys, findings indicate that the drop-out rate is higher among girls due to negative customs and practices that include child marriages, early pregnancies and economic hardship.[18] as a consequence, the number of girls enrolled in secondary schools, technical/vocational institutes and university continues to be low. for instance, akec (2021) found that there are 38,746 students enrolled in 14 institutions of higher education, of whom females constitute 26%.[19]in the field of stem, there were only 3,000 (24%) female out of 13,000 students enrolled. high illiteracy level among women increases their exposure and risk to covid-19 infections due to limited knowledge and ability to access and synthesize information. although information has been disseminated through mobile networks, radio, tv and posters, translation of radio programmes and tv messages to local languages is vital to fig 1: distribution of households by gender and age 74 26 60 40 44 56 16 84 21 79 0 20 40 60 80 100 f m f m f m f m f m n u m b er o f p er so n s fig 2: percentage distributions of household heads by education level and gender https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 7 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? reach out more women and girls. this is because 32 percent of household heads do not own mobile phones and out of these 61 percent are females. the study shows that 53 percent of the households were headed by female and there was increased care burden and economic downturn in response to policy measures established. women make up the majority of care providers in health and social sectors. the increased brunt of unpaid care work is in line with findings from ilo (2018) that shows globally, women perform 76.2 percent of total hours of unpaid care work, more than three times as much as men.[20]with the outbreak of covid-19, the need to care for patients at home and care for children following the closure of schools and learning institutions have increased the burden on women and girls. for example, while not all diseases are associated with covid-19, the study found that 2 out of every 5 households visited had at least one sick person over the past 2 weeks. as part of preventive measures, most hospitals do not admit patients unless otherwise the person is in critical condition. even though women and men have different exposure to covid-19, they are at high risk of contracting covid-19 due to their roles as primary care givers, nurses, housekeepers, waitress, cleaners and food vendors. specifically, those involved in domestic care, government and private hospitals and clinics face higher likelihood of exposure to coronavirus and fatigue due to long working hours with minimal pay or delayed salaries. the gendered impact of covid-19 on education following the closure of learning institutions in march 2020, many pupils and students found themselves at homes, contrary to their parents’ expectations. the country was caught by surprise and unprepared to embark on online teaching. neither could parents keep their children engaged with learning activities. in the absence of improved technology and affordable internet services, most students particularly boys were idle at home with more time spent on playing, watching tv or visiting their friends. girls in particular, (100 percent) were supporting their families with household chores, cooking and caring for the young ones, while others supported family businesses and income generating activities. only 17 percent of the children were found studying, out of which 15 percent were girls and85 percent boys. proportionately more boys were found to be idle at home. the ministry of education could have developed programmes to be taught through media, social media or online to keep pupils engaged. 0 20 40 60 80 100 120 girls boys girls boys girls boys girls boys girls boys girls boys girls boys girls boys fig 3: the distribution of boys and girls by activities after closure of schools https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 8 ijo international journa ( issn: 2814-2098 ) https://ijojournals.com/ uncovering the gendered impact of covid poverty and inadequate access to prolonged conflict and climatic shocks in south sudan, have increased dependency and poverty from 51% in 2009 to 82% populated with an average number of respectively. in the protection of civilians sites (p of internally displaced persons sharing setting. on average, women heads of households have limited ownership and inadequate housing space compared to men heads of facilities that might expose them to infections. populated/crowded households, t remains a daunting task as sharing of bathrooms and bedrooms is a common practice and treatment of patients endure, have inadequate skills on prevention and generally, 98.77 percent of respondents are aware of the covid encouraged to seek medical assistance in case of any symptoms. households involved in the study had could not visit a clinic or go to the hospital percent), fear of contracting covid percent), no functioning health facilities (1.3 percent) and and wanjok, the towns with active cross border businesses had the persons (40 percent) who did not visit any health facilities could potentially undercut the ability to detect and identify cases of covid to increased community transmission. on the other hand, absence of resou pay for medical bills. financial constraints, delays in vaccine transportation reported to interrupt service delivery to w the distribution of household heads by gender and the hours spent at home per day during official working hours neither has attention been paid to the ministry of health’s guidelines that include staying at home (fig 4), social distancing and wearing of masks. seemingly, the stay at home preventative measureis less observed by most families whose work is from ‘hand to mouth’ international journal of health sciences and nursing dr. angelina bazugba volume 07 || issue 09|| september uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? access to basic health services shocks in south sudan, have increased rate of unemployment 51% in 2009 to 82% in 2016.[xii]most households are average number of 10 and 5 persons per households in urban and rural areas rotection of civilians sites (pocs) in juba, bentiu and malakal, the number sharing tents were more than what was observed in setting. on average, women heads of households have limited ownership and inadequate housing space compared to men heads of households. some of them live in poor structures with shared facilities that might expose them to infections. maintaining social distance in dense temporary shelters or home with poor housing in task as sharing of public spaces and facilities like living room, and bedrooms is a common practice. in the absence of quarantine centers, home care , which increase care burden to women and girls n prevention and handling patients with covid-19 disease generally, 98.77 percent of respondents are aware of the covid-19 pandemic and had been medical assistance in case of any symptoms. yet, over 16.8 percent of the involved in the study had at least one sick person two weeks before the study, but could not visit a clinic or go to the hospital due to lack of money (70.4 percent), negligence(17 covid-19 while in the hospital (5.7 percent), lack of transport percent), no functioning health facilities (1.3 percent) and other reasons (3.1 percent active cross border businesses had the highest number of sick who did not visit any health facilities. inability to seek medical attention ability to detect and identify cases of covid-19 in time resulting community transmission. on the other hand, absence of resources may hamper their ability to seek medical atte . financial constraints, delays in vaccine transportation and reported to interrupt service delivery to women/mothers and children. heads by gender and the hours spent at home per day during 020406080 female male female male female male female less than 2 hoursbetween 3 to 5 hours between 6 to 8 hours between 9 to 11 hours 46.8853.1238.6561.3559.7140.2962.5337.47 fig 4. number of hours stay at home segregated by gender and nursing dr. angelina bazugba * 9|| september, 2024 || t resilience and recovery measures are needed? unemployment, most households are densely and rural areas in juba, bentiu and malakal, the number tents were more than what was observed in the urban setting. on average, women heads of households have limited ownership and inadequate housing live in poor structures with shared maintaining social distance in densely poor housing infra structures living room, kitchen, absence of quarantine centers, home care women and girls most of whom 19 disease. 19 pandemic and had been 16.8 percent of the two weeks before the study, but lack of money (70.4 percent), negligence(17 lack of transport (2.5 3.1 percent). in nzara highest number of sick inability to seek medical attention in time resulting k medical attention or and delivery were heads by gender and the hours spent at home per day during male between 9 to 11 hours 37.47 fig 4. number of hours stay at home segregated by https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 9 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? particularly in the absence of an alternative source of livelihood. the majority (35 percent) can stay home for 6 to 8 hours of which women make 60 percent. while it can be argued that going out is critical for sustenance of families whose main sources of livelihood were affected by covid-19 measures, support and information on prevention and response ought to be provided to reduce risk of disease and community transmission. perception, norms and practices against spread of covid-19 difficult living conditions, prevalence of certain myths and beliefs were found to limit the containment measures and application of moh guidelines and regulations. over 67 percent of the households approved preventive measures taken by the government, but the rest had different opinions about the disease. the majority of respondents interviewed said that the covid -19 is a global pandemic, some said it is foreign disease, while others stated that such disease cannot exist in south sudan because of higher temperature. see fig 5 meanwhile there are numerous social norms and practices that might contribute to the spread of covid-19. these include the group gathering by the road side while playing cards (largely among men), handshake habit, overcrowded homes due to high dependence, gathering in tea places, churches, communal eating habits, gathering for marriage, funeral or watching sports and games, spitting, hugging, churches or religious groups gatherings, kissing and skepticism about existence of covid-19 disease. figure 6 shows the distribution of households by social norms and practices that could encourage the spread of covid-19. [category name] [percentage] foreign disease 20% it is a real global disease 52% no idea about it 6% fig 5: percentage distribution of household perception about covid-19 disease https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 10 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? access to and control of resources and alternative sources of income: although women have been doing petty businesses, the lockdown measures have allowed them to venture into more micro enterprises to sustain their families. about 69 percent of women are operating in the market and along the roadsides by vending fruits, vegetables, porridge, tea, and take away food. the tea selling business is on a daily basis despite the announcement of covid-19 measures. in the absence of salary payment for government workers, the burden of caring for households has almost shifted to women. about 92 percent of them are the main source of livelihood, thus making it almost impossible to stop their petty businesses. such situation has been reported in other african countries for instance, angola, ethiopia and zambia, where there is already an increase in inflation by at least 5 percent, mainly due to disruptions in the supply of food and energy, the bulk of which are imported.[21-22] in border towns, and across borders women were found selling vegetables, while the majority of men (99 percent) illegally cross borders to sell consumable goods such as sugar, sorghum, onions, oil, garlic and salt. the cross-border restrictions have increased prices of basic food commodities, limited movement and separated families whose children were studying in the neighboring countries. moreover, the illegal border crossing without testing for covid-19 puts the women at risk of contracting the virus. in terms of ownership of resources, findings indicate that about 83 percent off male headed households do not own assets like buildings, shops or other businesses in which they can use as a collateral. control and ownership of assets is a condition employed by financial institutions to lend women the money. only, 60 percent of the respondents live in their own houses, 26.31 percent live in rented houses and the rest live in either protection of civilians, idp or in refugee camps. 5 6 7 8 8 8 8 9 9 10 11 11 0 2 4 6 8 10 12 kissing religious none believe in covid-19 hugging spitting group eating habit sport gathering such as wrestling and balls. marriages churches tea places overcrowding of houses due to high dependence handshake habit culture of gathering on the road side percentage of household heads fig 6: percentage distribution of households by the types of social norms and practices that could encourage the spread of covid-19 https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 11 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? increased income insecurity and dependency: the economic instability, retrenchment, closure of big businesses and some formal employment including schools and non-governmental organisations, have affected more than 52 percent of households. this is similar to most parts of the african continent, where the pandemic has triggered expansionary fiscal spending, doubling the already wide fiscal deficits, and its economic consequences has triggered expansionary fiscal policy responses across all categories of economies.[23] most men who are the main breadwinners and female headed households whose living conditions were already worse due to prolonged conflict, have continued to experience suffering due to reduced household income per day to less than usd 1.70.[24]findings further indicate that about 36 percent of the households have a monthly income of less than 5,000 ssp; and the majority (61 percent) of those families are headed by female. this amount is significantly low compared to the current cost of living and consumer prices.xiiithe average daily expenditure per household in south sudan is 979.00 ssp, an equivalent of 1.60 usd. since the average number of persons in the household in south sudan is eight, it suggests that each individual lives on 38 cents per day. this figure is significantly low compared to the international poverty line of usd $1.90 per day purchasing power parity poverty line and is in line with what the national bureau of statistics and world bank (2019) estimates indicating that 82% of the population lives below $1.90 per day. to cope with life, most households have embarked on small income generating activities which too, were impacted negatively by the stay at home and partial lockdown policies announced in april 2020; or sought more than one informal job and a few (42 percent) sought relief assistance or support from relatives and friends. deteriorating food security for vulnerable and single-headed families: the covid-19 and the difficult economic situation have increased the number of people who are unable to afford regular meals, a single meal or a balanced diet. to understand the magnitude of the problem, the survey explored the household needs, food items, water, cooking energy and access to market. findings indicate that there is food insecurity among women which increases with age. unlike older women, young women can venture into multiple income generating activities.[25-26]in male headed households, men had a role of searching and bring food home, while women and girls prepared and cooked the food. in case of food aid, women are responsible in collecting but distribution and decision-making on the usage is done by men who sometime sell the food in the market at higher prices. while it can be argued that the intention is to get money to meet other family obligations, the practice undercut the number of meals and nutrients uptake among women and children. of the household reached, 53 percent afforded one meal per day between february and april 2020 while only 26 percent afforded two to three meals. shortage of food and poor nutrition can easily predispose them to the covid-19 infection. this finding is in line with unocha (2020) showing that about half of the population were food insecure prior to the emergence of covid-19. states in dire need of food aid include northern and western bahr el ghazal, upper nile state and western equatoria. only 33 percent of households had food reserves that can last from two to four weeks. the extended lockdown might be detrimental and harmful particularly for children and women who are lactating. https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 12 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? inadequate water, sanitation and safety: the emergence of covid-19 has increased the water usage by 50 percent making a household of 8 persons use at least 240 litters of water per day. water is used for frequently washing of hands, clothes, drinking and cooking. still the problem of availability and access to clean and safe water perseveres. more than 72 percent of households in the urban areas use water from water tanks, donkey carriers and boreholes. specifically, in juba municipality, households depend on mobile water tanks (water tankers) as their main source of water supply. with increased usage and fuel, prices of water have also increased from 300 to 700 ssp per drum of 250 litters. with exceptional to wau town where men and boys deliver water by using donkey carters, the burden of searching and fetching water is upon women and girls who also fetch water from boreholes or line up in long queues. women and girls use about 80 percent of the household water (an average of 48 liters per person) for bathing, washing clothes, cleaning of utensils, cooking and drinking while men and boys use 20 percent of the household water (an average of 12 liters) per person each day, for bathing, washing clothes, and drinking. at the household level, women control the usage of water for domestic purposes, while men and local authorities control the water points and bore holes. there is increased cost of living as a result of increased prices of fuel, water and government taxes. subsequently, care of patients, general hygiene including women’s menstrual hygiene is affected. in rural areas and in the poc, over 85 percent of the respondents claimed that some water points, toilets and bathing facilities design and locations are less accessible, secured and unsafe for girls, women, people living with disability. walking long distances and line up in long queues are likely to encounter sexual and gender-based violence as they become an easy target for sexual harassment particularly during late or night hours. information dissemination and knowledge gap: generally, information about the covid-19 prevention and response has been disseminated widely. findings show that over 70% of the population have received information about covid-19 which was shared through mobile networks, radio, tv and posters. these medium of communication were effective but more timely, accurate and simplified messages on the disease is needed. absence of information implies that women will remain ill prepared and inexperienced to join the campaign. understanding the gender-differentiated impacts of disease outbreak is fundamental to creating effective, equitable policies and intervention mechanisms that will leave no one behind. since social norms are already underplaying women’s presence in decision-making roles as well as from information channels, it is unlikely that the majority of women have adequate access to internet and advanced technology globally. this has a direct impact on women´s ability to get informed, adapt to the covid-19 crisis and take part in economic recovery programmes as noted elsewhere by un women.[2,28] increased unemployment and gender based violence: with increased responsibility of health care workers, only few women have been able to maintain their jobs. the unpaid care work constitutes the main barrier to women’s participation in labor markets and is a key determinant of the lower quality of their employment compared to men. as noted elsewhere by ilo (2020) lack of employment and economic hardship can increase dependency, transactional sex and poverty which tend to disempower and subject women to sexual violence. for example, cases of https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 13 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? sexual violence and vulnerability of women in south sudan have been reported by unfpa (2020) to be on the rise.[ix]the prolonged closure of schools has created idleness and child pregnancies among girls. cases of gender-based violence and the weak support available to survivors before and during the lockdown period have been documented.[18, 24]this is in line with other countries in which statistics indicate that 90% of the recently reported cases of violence are related to the epidemic[26, 29,xiv] findings from the study underline existence of fear and anxiety from the extended quarantine, as well as the economic strain put on many families, which may have significantly contributed to the increased violence and abuse. there remains an enabling environment in which women and girls are generally viewed as commodities. such violence stem from the objectification of women and girls, which is deeply entrenched in the customs and culture of south sudan society: the local political economy of “bride price.”forced and underage marriages continue to be a hallmark of society, with more than 50 percent of girls married before the age of 18.[xv]this view of women and girls has also contributed to the development of a society in which violence against women is permeating and accountability is missing. decades of conflict has intensified the already glaring gender inequalities and risks for women and girls. yet, a culture of silence and limited reporting endure despite the existence of special protection units, one stop centers and mobile courts for survivors seeking formal justice instead of traditional courts.[xvi] lack of gender disaggregated data: while the ministry of health has been providing data of men and women who have tested positive as well as those who have recovered, there is still a gap of gender-disaggregated information about the crisis and its health impacts, hampering appropriate interventions as they are designed based on assumptions rather than reality. equally, it is yet to be established how many people are experiencing psychological effect or are traumatized as a result risk associated with home-based care and treatment of patients; and theeconomic impact of discontinuing working in the informal sector as a result of increased care work during the pandemic. risk and challenges the covid-19 pandemic emerged at a critical point in time when south sudan was implementing the revitalized peace agreement (r-arcss). while progress has been achieved in terms of formation of national and state governments, the lockdown and deviation of resources to humanitarian and relief work has dramatically slow down the dissemination of r-arcss and implementation of other chapters, constrain women’s movements, trade, and functioning of markets, leading to significant spillover effects. a relapse to conflict would reverse the gains made in economy recovery, exacerbate the macroeconomic policies and the humanitarian situation and increase domestic violence.[27, 28]south sudan heavily relies on the oil sector which accounts for about 97 percent of total exports of goods and services, and 45 percent of nominal gross domestic product. there is a need to urgently invest in agriculture and collect non-oil revenues which is more reliable. https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 14 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? there is also fear of revenge/reprisals, the inevitable stigma associated with being known as a survivor of sgbv or covid-19. sensitization and more studies in this area are needed in order to assess the magnitude and support systems needed for survivors of domestic violence especially during the lockdown period. conclusion and recommendations the analysis has underlined the differential impact of covid-19 upon women and men in terms lifestyle or health behavior, exposure and effects of covid-19; and socio-economic and development activities. overall, there has been significant inflation which includes food and basic energy prices, increased. equally, exchange rates have fluctuated widely during the pandemic as the country is dependent on exports for internal use and revenue, and the exchange rate regimes in place. the increase in covid-19 related health expenses, absence of unemployment benefits and tax cuts have affected the young economy which was already impacted by the internal conflict. such economic changes have a differential impact on women and men, and since most women are employed in informal sectors, their socio-economic and productive fabrics sustaining societies are declining with time. not only has the situation caused frustration, but has affected business and caused psychological problem. from the study, findings suggest that men are more likely to die of the virus than women, owing ostensibly to the biological and lifestyle factors such as smoking, drinking alcohol and other outdoor engagements that limit their time to stay at home. on the contrary, women spend more time at home because of their various roles and positions in the society as care givers, nurses, heads of households and domestic workers. women fall predominantly in the self-employed/informal sectors. they have fewer assets, limited access to information and control and ownership of resources; and few alternative livelihood opportunities. where houses are densely populated, women and girls are at risk of contracting the disease. in the absence of reliable sources of livelihoods, the general public is reluctant to observe the covid-19 preparedness and response measures. in the light of the above analysis, the study recommends the following priorities:  strict measures and testing should be undertaken at the border points. although transborder infections have been largely contained, the country remains at risk given the porous borders between all surrounding countries.  provide subsidies and control of sky rocketing prices: the increase in prices of goods and services have left households vulnerable and exposed without any safety net. urgent support in terms of food distribution and relief to needed.  the government and partners should strengthen referral pathways and one stop centers for prevention and response of gender-based violence (gbv) to improve reporting and access of services to the survivors of domestic violence;  facilitate the development of immediate community-based action plans prevention and response to covid-19. women should be included in decision-making processes;  relax lockdown measures and enforce the use of protective gears and provision of financial support to small entrepreneurs to facilitate economic stabilization and recovery; https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 15 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed?  undertake mass testing and community awareness campaigns to transform behavioral changes. acknowledgement the author wishes to acknowledge the ntli at the university of juba, the respondents from various institutions and undp -pacc for financial support. references 1. akec, j. (2021). status of higher education and tvet sector in south sudan-genderbased analysis of the st&i ecosystems. published by ruforum. available from https://www.ruforum.org/sites/default/files/reports/prof.akec%27s%20report%20final. pdf accessed 05/04/2021. 2. akpe, s. (2020). wmo conflict insight, the civil war in south sudan from 2013 2019, issn: 2628-6998, https://worldmediation.org/conflict-insight 3. cone, d. (2019). still in danger: women and girls face sexual violence in south sudan despite peace deal. field report: refugees international. available from https://www.refugeesinternational.org/reports/2019/10/15/still-danger-women-girls-facesexual-violence-south-sudan-peacedeal?gclid=cj0kcqjwmcwdbhcoarisalgj2qdg0u61usisr_vaukkfz4020kghy1bwaxmlt9idolr_s3vrgtlm4yaahzwealw_wcb accessed on 13/08/2021. 4. glassman, a.; chalkidou, k. and sullivan, r. (2020). does one size fit all? realistic alternatives for covid-19 response in low-income countries, available from https://www.cgdev.org/blog/does-one-size-fit-all-realistic-alternatives-covid19response-low-income-countriesaccessed 20/01/2021. 5. government of south sudanministry of health (2021). updates on covid-19 response december 20th 2021. available from http://moh.gov.ss//covid-19.php 6. ilo (2018). care work and care jobs for the future of decent work / international labour office – geneva: ilo. available from https://www.ilo.org/wcmsp5/groups/public/--dgreports/---dcomm/---publ/documents/publication/wcms_633135.pdf accessed on 05/04/2021. 7. ilo (2020). monitor 1st edition covid-19 and the world of work: impact and policy responses 18 march 2020 available from https://www.ilo.org/wcmsp5/groups/public/--dgreports/---dcomm/documents/briefingnote/wcms_738753.pdf accessed on 25th march 2020. 8. interaction (2020). the wider impacts of humanitarian shelter and settlements assistance. interaction, usaid. 9. iroulo, l. & boateng, o. (2020). african states must localize coronavirus response. giga focus africa no. 3. available from https://www.ssoar.info/ssoar/bitstream/handle/document/67242/ssoar-2020-iroulo_et_alafrican_states_must_localise_coronavirus.pdf?sequence=1&isallowed=y&lnkname=s soar-2020-iroulo_et_al-african_states_must_localise_coronavirus.pdf accessed 15/02/2021. https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 16 https://www.ruforum.org/sites/default/files/reports/prof.akec%27s report final.pdf https://www.ruforum.org/sites/default/files/reports/prof.akec%27s report final.pdf https://www.refugeesinternational.org/reports/2019/10/15/still-danger-women-girls-face-sexual-violence-south-sudan-peace-deal?gclid=cj0kcqjwmcwdbhcoarisalgj2qdg0u61usisr_vaukkfz4020k-ghy1bwaxmlt9idolr_s3vrgtlm4yaahzwealw_wcb https://www.refugeesinternational.org/reports/2019/10/15/still-danger-women-girls-face-sexual-violence-south-sudan-peace-deal?gclid=cj0kcqjwmcwdbhcoarisalgj2qdg0u61usisr_vaukkfz4020k-ghy1bwaxmlt9idolr_s3vrgtlm4yaahzwealw_wcb https://www.refugeesinternational.org/reports/2019/10/15/still-danger-women-girls-face-sexual-violence-south-sudan-peace-deal?gclid=cj0kcqjwmcwdbhcoarisalgj2qdg0u61usisr_vaukkfz4020k-ghy1bwaxmlt9idolr_s3vrgtlm4yaahzwealw_wcb https://www.refugeesinternational.org/reports/2019/10/15/still-danger-women-girls-face-sexual-violence-south-sudan-peace-deal?gclid=cj0kcqjwmcwdbhcoarisalgj2qdg0u61usisr_vaukkfz4020k-ghy1bwaxmlt9idolr_s3vrgtlm4yaahzwealw_wcb http://moh.gov.ss//covid-19.php https://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/---publ/documents/publication/wcms_633135.pdf https://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/---publ/documents/publication/wcms_633135.pdf https://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/documents/briefingnote/wcms_738753.pdf https://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/documents/briefingnote/wcms_738753.pdf https://www.ssoar.info/ssoar/bitstream/handle/document/67242/ssoar-2020-iroulo_et_al-african_states_must_localise_coronavirus.pdf?sequence=1&isallowed=y&lnkname=ssoar-2020-iroulo_et_al-african_states_must_localise_coronavirus.pdf https://www.ssoar.info/ssoar/bitstream/handle/document/67242/ssoar-2020-iroulo_et_al-african_states_must_localise_coronavirus.pdf?sequence=1&isallowed=y&lnkname=ssoar-2020-iroulo_et_al-african_states_must_localise_coronavirus.pdf https://www.ssoar.info/ssoar/bitstream/handle/document/67242/ssoar-2020-iroulo_et_al-african_states_must_localise_coronavirus.pdf?sequence=1&isallowed=y&lnkname=ssoar-2020-iroulo_et_al-african_states_must_localise_coronavirus.pdf ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? 10. kimatu, j. (2020). good newsantibodies studies show that africa has achieved acceptable covid-19 resistance, in kimatu (2020). the effects of the who guidelines on covid-19 and the immune system. biomedical and pharmacology journal. (paper under review). 11. kothari, s.; leon, a; and wesley, c. (2005). performance matched discretionary accrual measures. journal of accounting and economics. 29:163193. 12. mawejje, j; finn,arden jeremy (2020). south sudan economic update : poverty and vulnerability in a fragile environment (english). washington, d.c. : world bank group. available from http://documents.worldbank.org/curated/en/893571583937198098/south-sudaneconomic-update-poverty-and-vulnerability-in-a-fragile-environment accessed 09/04/2021 2020 13. mayai, a. (2020). the nature and magnitude of covid-19 outbreak in south sudan (rep.). sudd institute. retrieved april 14, 2021, from http://www.jstor.org/stable/resrep25123(p. 2-3) 14. mayai, a., awolich, a., & tiitmamer, n. (2020). (rep.). the economic effect of covid-19 pandemic in south sudan. sudd institute. retrieved april 14, 2021, from http://www.jstor.org/stable/resrep25124 15. monga, c. (2020). economic policies to combine covid-19 in africa. available from https://www.project.syndicate.org accessed 11/12/2020. 16. republic of south sudanministry of health (rossmoh) (2021). update on covid 19 response. available from http://moh.gov.ss./covid-19.php accessed on 15/03/2021. 17. republic of south sudan, ministry of gender, child and social welfare (mgcsw) (2013). national gender policy. juba: south sudan. 18. tiitmamer, n. and awolich, a. (2020). the covid-19 pandemic vulnerability factors in south sudan. policy brief. sudd institute. available from https://www.suddinstitute.org/assets/publications/5ec35cdc23465_thecovidpandemic vulnerabilityfactorsinsouthsudan_full.pdf accessed 12/03/2021. 19. tiitmamer, n. and awolich, a. (2020). the covid-19 pandemic vulnerability factors in south sudan. policy brief. sudd institute. available from https://www.suddinstitute.org/assets/publications/5ec35cdc23465_thecovidpandemic vulnerabilityfactorsinsouthsudan_full.pdf accessed 12/03/2021. 20. un women (2020). the covid –19, outbreak and gender: key advocacy points from asia and pacific. available from https://asiapacific.unwomen.org/en/digitallibrary/publications/2020/03/the-covid-19-outbreak-and-gender accessed on 11/12/2021. 21. undp (2020). briefing note: the economic impacts of covid-19 and gender inequality. recommendations for policymakers. 22. unfpa (2021). humanitarian action 2021 overview. available from https://www.unfpa.org/sites/default/files/pub-pdf/pagesunfpa_hao2021_report_updated_6_dec.pdf accessed on 12/03/2021 23. united nations (2020) shared responsibility, global solidarity: responding to the socioeconomic impacts of covid-19. available from https://unsdg.un.org/sites/default/files/2020-03/sg-report-socio-economic-impact-ofcovid19.pdf accessed on 12/12/2020 https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 17 http://documents.worldbank.org/curated/en/893571583937198098/south-sudan-economic-update-poverty-and-vulnerability-in-a-fragile-environment http://documents.worldbank.org/curated/en/893571583937198098/south-sudan-economic-update-poverty-and-vulnerability-in-a-fragile-environment http://www.jstor.org/stable/resrep25123 http://www.jstor.org/stable/resrep25124 https://www.project.syndicate.org/ http://moh.gov.ss./covid-19.php https://www.suddinstitute.org/assets/publications/5ec35cdc23465_thecovidpandemicvulnerabilityfactorsinsouthsudan_full.pdf https://www.suddinstitute.org/assets/publications/5ec35cdc23465_thecovidpandemicvulnerabilityfactorsinsouthsudan_full.pdf https://www.suddinstitute.org/assets/publications/5ec35cdc23465_thecovidpandemicvulnerabilityfactorsinsouthsudan_full.pdf https://www.suddinstitute.org/assets/publications/5ec35cdc23465_thecovidpandemicvulnerabilityfactorsinsouthsudan_full.pdf https://asiapacific.unwomen.org/en/digital-library/publications/2020/03/the-covid-19-outbreak-and-gender https://asiapacific.unwomen.org/en/digital-library/publications/2020/03/the-covid-19-outbreak-and-gender https://www.unfpa.org/sites/default/files/pub-pdf/pages-unfpa_hao2021_report_updated_6_dec.pdf https://www.unfpa.org/sites/default/files/pub-pdf/pages-unfpa_hao2021_report_updated_6_dec.pdf https://unsdg.un.org/sites/default/files/2020-03/sg-report-socio-economic-impact-of-covid19.pdf https://unsdg.un.org/sites/default/files/2020-03/sg-report-socio-economic-impact-of-covid19.pdf ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? 24. united nations office of the coordination of humanitarian affairs (unocha) (2019). south sudan situation report, september 16, 2019. available from https://reliefweb.int/report/south-sudan/south-sudan-situation-report-16-september-2019. accessed 14/03/2021 25. who (2019). annual report who in south sudan. available from https://www.afro.who.int/sites/default/files/202009/who%20south%20sudan%20annual%20report%202019.pdf accessed on 20/12/2020 26. who (2020). novel coronavirus (2019-ncov) situation report-1, 21 january 2020. available from https://www.who.int/docs/default-source/coronaviruse/situationreports/20200121-sitrep-1-2019-ncov.pdf?sfvrsn=20a99c10_4 accessed on 31st march 2020. 27. wipc and mgcsw (2020). compiled report on women, peace and security training for the gender focal persons in line ministries and commissions, august 10th-15th 2020 and september 21st-25th 2020. held at royal palace hotel, juba, south sudan under technical assistance from african women’s development fund (awdf). 28. women enabled international (2020). covid-19 at the intersection of gender and disability: findings of a global human rights survey. available from https://womenenabled.org/pdfs/women%20enabled%20international%20covid19%20at%20the%20intersection%20of%20gender%20and%20disability%20may%202 020%20final.pdf. accessed on 18/12/2021. 29. world bank (2020). south sudan economic update: peace agreement spurs economic recovery, but poverty remains. april 2020 issue: juba, south sudan. available from https://www.worldbank.org/en/country/southsudan/publication/south-sudan-economicupdate-peace-agreement-spurs-economic-recovery-but-poverty-remains accessed 06/04/2021. i national bureau of statistics, world bank projections (2019 – 2021); poverty: world bank projections, 2019. ii https://www.cia.gov/library/publications/the-world-factbook/geos/od.html; http://www.worldbank.org/en/country/southsudan/overview ; http://www.worldometers.info/world-population/south-sudanpopulation/ ; http://countrymeters.info/en/south_sudan; https://www.humanitarianresponse.info/en/operations/southsudan iii see for example guarcello s., lyon f. and rosati (2011) labour market in south sudan country report december 2011, understanding children’s work (ucw) programme, http://www.ucwproject.org/attachment/30052016798labour_market_in_south_sudan.pdf iv the world bank. south sudan country overview. oct. 16"', 2019. https://www.worldbank.org/en/country/southsudan/overview13 ilo 2019 in hor 2019 undp. http://hdr.undp.org/en/indicators/43006 v undp (2020) undp covid-19 response, gender offer for gender equitable response and recovery. vi south sudan health data http://web.worldbank.org vii south sudan gender analysis: a snapshot situation analysis of the differential impact of the humanitarian crisis on women, girls, men and boys in south sudan south sudan | reliefweb viii information available from: http://www.unaids.org/en/resources/presscentre/featurestories/2018/june/south-sudan-raisingthe-profile-of-hiv-in-humanitarian-contexts ix unfpa (2021). humanitarian action 2021 overview available from https://www.unfpa.org/sites/default/files/pubpdf/pages-unfpa_hao2021_report_updated_6_dec.pdf accessed 12/09/2021 https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 18 https://reliefweb.int/report/south-sudan/south-sudan-situation-report-16-september-2019. accessed 14/03/2021 https://reliefweb.int/report/south-sudan/south-sudan-situation-report-16-september-2019. accessed 14/03/2021 https://www.afro.who.int/sites/default/files/2020-09/who south sudan annual report 2019.pdf https://www.afro.who.int/sites/default/files/2020-09/who south sudan annual report 2019.pdf https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf?sfvrsn=20a99c10_4 https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf?sfvrsn=20a99c10_4 https://womenenabled.org/pdfs/women enabled international covid-19 at the intersection of gender and disability may 2020 final.pdf https://womenenabled.org/pdfs/women enabled international covid-19 at the intersection of gender and disability may 2020 final.pdf https://womenenabled.org/pdfs/women enabled international covid-19 at the intersection of gender and disability may 2020 final.pdf https://www.worldbank.org/en/country/southsudan/publication/south-sudan-economic-update-peace-agreement-spurs-economic-recovery-but-poverty-remains https://www.worldbank.org/en/country/southsudan/publication/south-sudan-economic-update-peace-agreement-spurs-economic-recovery-but-poverty-remains ijo international journal of health sciences and nursing ( issn: 2814-2098 ) dr. angelina bazugba * https://ijojournals.com/ volume 07 || issue 09|| september, 2024 || uncovering the gendered impact of covid-19 pandemic in south sudan: what resilience and recovery measures are needed? x see also unfpa (2020) safety elusive for women in south sudan’s protection sites amid pandemic. available from https://www.friendsofunfpa.org/safety-elusive-for-women-in-south-sudans-protection-sites-amidpandemic/?gclid=cj0kcqjwi7ycbhdjarisamwfscp6fncym_c2gvkzp5amly9kozatunelconyvbopsdpkgbidybnavqsaaiutealw _wcb xi unknown gunmen rape 125 women in south sudan: aid agency,” reuters, november 30, 2018, https://www.reuters.com/article/us-southsudan-violence/unknown-gunmen-rape-125-women-in-south-sudan-aid-agencyiduskcn1nz24d; “statement on the situation in bentiu, south sudan,” ocha, unicef, and unfpa, december 3, 2018, https://www.unfpa.org/press/statement-situation-bentiu-south-sudan; nick cumming-bruce, “sexual violence on the rise in south sudan, u.n. says,” the new york times, february 15, 2019, https://www.nytimes.com/2019/02/15/world/africa/southsudan-rape-sexual-violence.html. xii https://blogs.worldbank.org/africacan/how-conflict-and-economic-crises-exacerbate-poverty-in-south sudan xiii the amount of ssp 5,000 as of 5 th april 2021 is equivalent to usd $ 8.2 by using the black market exchange rate of $1= 610ssp xiv unmiss, survivors of sexual violence in south sudan struggle to access health care, 19 may 2020, https://unmiss.unmissions.org/survivors-sexual-violence-south-sudan-struggle-access-health-care. xv see also : luedke, “the commodification of women and girls in south sudan ; south sudan,” girls not brides, https://www.girlsnotbrides.org/child-marriage/south-sudan/; unfpa and mgcsw -joint statement call for action to end gender-based violence and impunity for gbv perpetrators in south sudan (july 2020). xvi mgcsw (2017) progress report on the implementation of the unscr 1325 on women peace and security in east and southern africa: south sudan country report, july 2017; wipc (2020) validation workshop report on what south sudan has achieved after the 20 years of the implementation of the unscr 1325 (2000) globally. prepared by wipc and q&a consultancy firm, presented on 26 th of november 2020 at quality hotel, juba. https://zenodo.org/doi/10.5281/zenodo.13731820 ijo journals volume 07 | issue 09 | september 2024 | https://ijojournals.com/index.php/hsn/index 19 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." a post-mortem analysis of the impact of covid-19 pandemic on socioeconomic development and public order in nigeria peter archibong essoh department of sociology and anthropology university of uyo, nigeria okoro sunday asangausung department of sociology and anthropology akwa ibom state university, nigeria rosemary cletus effiong directorate of public order and information management university of uyo, nigeria abstract nigeria was seriously affected by the covid-19 pandemic, which had far-reaching consequences across its economic, social and institutional spheres. the crisis exposed and deepened longstanding structural weaknesses, including an underfunded healthcare system, an oil-dependent and fragile economy, widespread poverty and inadequate social protection mechanisms. these vulnerabilities were further compounded by the government's limited capacity to respond effectively. public order deteriorated amid rising public frustration, enforcement challenges and mistrust in state institutions. this paper presented a post-mortem analysis of the impact of covid-19 pandemic on socioeconomic development and public order in nigeria. it was guided by the assumption of martha albertson fineman’s vulnerability theory developed in 2019. the paper relied on qualitative methods using documentary evidence (analysis of secondary data from textbooks, journals, periodicals, government publications and internet sources) and content analysis was used to analyse the secondary data. the results showed that covid-19 disrupted the economy, educational system, healthcare system and public order in nigeria. it was recommended, among others, that the government should focus on reviving the economy through stimulus packages, support for small businesses and job creation initiatives. policies that could put strains on nigerians and surviving businesses should be avoided to avoid economic hardship. investments should also be made into strengthening healthcare infrastructure while ensuring that essential healthcare services continue unhindered during crises. medical personnel should be encouraged to work in nigeria. this research contributed to a better understanding of how pandemics can exacerbate existing social challenges within a developing country context. moreover, analysis into the impact of covid-19 on public order in nigeria provides valuable insights into how disruptions such as lockdowns and restrictions can strain law enforcement capabilities, exacerbate tensions within communities, affect crime rates and compromise social stability. keywords: post-mortem analysis, covid-19pandemic, socio-economic development, public order https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 25 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." introduction the coronavirus disease, otherwise called covid-19, originated in wuhan city, hubei province of china, in december 2019. following its rapid global spread, the world health organisation (who) declared it a pandemic on march 11, 2020 (usman et al., 2024; okorie et al., 2022; inegbedion, 2021). asangausung et al. (2022) noted that the pandemic caught the world unprepared, resulting in widespread mortality, economic paralysis and the closure of numerous businesses, with severe ripple effects, including a rise in crime. the crisis laid bare the fragility of healthcare systems across africa, nigeria included, highlighting critical gaps in healthcare infrastructure, medical research, access to essential services and public health preparedness. ironically, contrary to western projections that africa would be most devastated by the pandemic, the continent, including nigeria, proved relatively resilient in terms of infection and mortality rates, though the socioeconomic consequences were extensive. economically, the pandemic inflicted unprecedented disruption. usman et al. (2024), inegbedion (2021), agbeyo (2020) and joan et al. (2022) submitted that a significant proportion of businesses in nigeria experienced closures, reduced operating hours, rising operational costs and workforce downsizing. inegbedion (2021) emphasised that approximately 40 million small and medium-scale enterprises (smes), which are critical to youth employment in nigeria, were severely affected by restrictions and economic slowdown. the consequences were evident in the labour market. adebimpe et al. (2021) noted that unemployment among youths aged 15–34 surged to 30.1% in the fourth quarter of 2020, up from 26.7% in the previous quarter, primarily due to the shutdown of economic activities. this aligns with the findings of alex and obinachiwori (2020), who observed that the economic fallout forced many businesses to shut down or place employees on unpaid standby, thus deepening financial distress for families and dependents. beyond the economic implications, the pandemic also had serious repercussions for public safety and the rule of law. the united nations (2020) warned of a potentially massive impact on crime, security and justice systems. supporting this claim, asangausung et al. (2022) and okorie et al. (2022) documented a notable increase in organised crime during the pandemic, underscoring how crisis conditions can fuel insecurity and erode public order. in sum, the covid-19 pandemic was not merely a health emergency—it was a complex, multidimensional crisis that reshaped nigeria’s socioeconomic and institutional landscape. against this background, the paper presented a postmortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria. statement of the problem the covid-19 pandemic was one of the most disruptive global crises in recent history, generating widespread effects on public health, economic stability, education and social order. in nigeria, the pandemic exacerbated existing structural weaknesses, including a fragile healthcare system, high unemployment, entrenched poverty, underfunded educational infrastructure and limited institutional resilience. lockdowns and movement restrictions significantly disrupted economic activity, especially among small and medium-sized enterprises (smes), while millions of nigerians— particularly those in the informal sector—lost their jobs or suffered salary reductions. the education sector faced severe setbacks due to prolonged school closures and limited access to digital learning technologies, which exposed a deep digital divide. the healthcare system became overwhelmed, plagued by shortages in infrastructure, medical personnel and essential supplies, while frontline workers endured both physical and psychological stress. public safety and order also deteriorated, https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 26 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." as incidents of civil unrest, police abuses, rising criminality and cyber-related offences became more pronounced during and after the lockdowns. although numerous studies examined the sector-specific consequences of the pandemic, such as its impact on healthcare (akinyemi et al., 2021), the economy (usman et al., 2024) and education (okagbue et al., 2023), few provided a comprehensive, interdisciplinary evaluation of how the pandemic simultaneously affected multiple sectors of nigeria’s development and public order. even more limited was the application of martha albertson fineman’s vulnerability theory as an analytical lens. this theory, which frames vulnerability as a universal yet unequally distributed condition, offered critical insight into the preparedness and responsiveness of institutions. yet, its potential to illuminate how structural inequalities shaped pandemic outcomes in nigeria remained largely unexplored in academic literature. most of the existing literature treated the pandemic's effects in isolation—focusing on economic decline, health system overload or educational disruption, without linking these to broader questions of social inequality, institutional fragility, or the uneven distribution of resilience. there was also insufficient analysis of how the crisis deepened structural vulnerabilities in a country already grappling with governance challenges, weak public health systems and a lack of effective social protection mechanisms. furthermore, the experiences of the most affected populationssuch as lowincome households, informal workers, women and youth—were rarely examined through the vulnerability framework, which could have better explained the disproportionate impact and varied coping capacities. this study therefore conducted a post-mortem, multidisciplinary analysis of the socio-economic and public order impacts of the covid-19 pandemic in nigeria, using vulnerability theory as its theoretical guide. it critically examined the interconnected disruptions in the economy, healthcare, education and security sectors to assess how institutional weaknesses and unequal access to resilience-shaping resources influenced nigeria’s pandemic experience. the aim was to uncover the underlying drivers of the crisis’s impact and to offer recommendations for building more inclusive and resilient systems capable of withstanding future shocks. objectives of the study the main objective of the study was to present apost-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria. the specific objectives were to: i. investigate the extent to which covid-19 pandemic disrupted nigeria’s economic activities; ii. assess the impact of the pandemic on the country’s healthcare system; iii. analyse how covid-19 pandemic intensified existing challenges in nigeria’s educational sector; and iv. examine the influence of the pandemic on public order and social stability in nigeria. https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 27 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." research questions the study was guided by the following questions: i. in what ways did covid-19 pandemic disrupt nigeria’s economy? ii. what impact did the pandemic have on the nigerian healthcare system? iii. how did covid-19 pandemic aggravate educational difficulties in nigeria? iv. in what ways did the pandemic affect public order in nigeria? conceptualisation and literature review concept of covid-19pandemic covid-19, also known as the coronavirus disease 2019, is a highly contagious respiratory illness caused by the novel coronavirus sars-cov-2. it was first identified in december 2019 in wuhan, china and has since spread globally, leading to a pandemic. covid-19 can cause symptoms ranging from mild to severe and can lead to complications such as pneumonia and respiratory failure. common symptoms include fever, cough and difficulty breathing. the virus spreads primarily through respiratory droplets when an infected person coughs or sneezes and can also be transmitted by touching surfaces contaminated with the virus. the word post-mortem, refers to a review or analysis conducted after the occurrence of covid-19 pandemic in order to evaluate its outcomes and identify lessons learned for future improvement. concept of public order in the context of criminal justice, public order is the preservation of social harmony and peace (mckee, 2023). it is an all-encompassing term that covers a wide range of social stability-related topics, such as crime prevention, public protest management, law enforcement and property protection. the idea of social contract theory, which maintains that people in society give up some liberties and freedoms in return for the safety and security that the government provides, is closely related to the idea of public order. since it guarantees that people can live their lives without fear of violence, chaos, or disorder, public order is an essential part of the social contract in this context. public order is maintained in the criminal justice system through a number of strategies, including the application of law enforcement organisations like the police, the courts and the prison system. the police are in charge of preventing and identifying crime, catching criminals and upholding law and order on the streets. the penal system is in charge of punishing those who break the law, while the judiciary is in charge of interpreting and applying it. preventing crime is one of the most important parts of upholding public order. this includes a variety of tasks, such as intelligence collection, community policing and proactive law enforcement tactics like stop-and-search authority and surveillance camera use. effective crime prevention measures are critical to ensuring that citizens feel safe and secure in their communities. another crucial element of maintaining public order in the context of criminal justice is the control of public protests. although they are a necessary component of democracy, demonstrations can also lead to stress and conflict. in order to keep protests peaceful and prevent them from upsetting the peace, the police are essential. upholding public order also depends on the enforcement of the law. laws are made to make sure that people and institutions act in ways that are in line with social norms and values. by looking into, prosecuting and punishing those who violate these laws, the https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 28 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." criminal justice system is in charge of upholding them. lastly, the protection of public order depends on the protection of public property. buildings, infrastructure and other assets owned by the public or the government are considered public property. the criminal justice system is in charge of making sure that these resources are shielded from harm or devastation. covid-19 pandemic and economic disruption usman et al. (2024) interrogated the political economy of the coronavirus disease (covid-19) on socio-economic development in nigeria between 2019 and 2022. the paper relied on qualitative methods using documentary research methods (analysis of secondary data from nigeria’s bureau of statistics, the central bank of nigeria, the ncdc report, the world bank/imf post-covid-19 report, ecowas, the au, who reports and reputable journals). findings revealed, among others, that nigeria, being a revenue economy, suffered greatly from covid-19 because it affected the economy’s development, diaspora remittance and the health status of the nation due to the fall in oil prices, the shutdown of businesses and the inflation of goods and services. on the positive side, the coronavirus-induced public health crisis provided a chance for many state governments to implement long-term public health reforms. joan et al. (2022) examined the implication of covid-19 pandemic on the sustainability of small and micro entrepreneur business in the informal sector in nigeria with specific focus on ose market in onitsha, anambra state. the study specifically analysed the effect of covid-19 on informal sme, extent of risk and vulnerability and how small and micro businesses were sustained within the period of pandemic. multi-stage, purposive and random sampling techniques were used in selecting 150 small and micro businesses in the informal sector in onitsha from which data used for the study were collected. primary data were collected using questionnaire. the study revealed thatcovid-19 exerted significant effect on small and medium scale entrepreneurs in the informal sector and that small and medium scale businesses were vulnerable to risk orchestrated by covid19 pandemic. inegbedion (2021) examined the impact of covid-19 on economic growth in nigeria: opinions and attitudes. the purpose was to ascertain respondents' perception of the effect of the covid-19 pandemic on economic growth in nigeria. the cross-sectional survey research design was employed and a mix-method was used in collecting the research data. content validity index and face validity served to validate the research instrument while cronbach alpha was used to assure its reliability. the secondary data were analysed using percentage changes while the primary data were analysed using a one-sample t-test and least-squares method. results indicated that the covid-19induced lockdown has significantly constrained economic activities and the circular flow of income. lastly, the perceived reduction in the circular flow of income in the wake of the covid-19 lockdown has negatively impacted economic growth in nigeria. covid-19 pandemic and healthcare system akinyemi et al. (201) appraised the readiness and resilience of the nigerian health system to the covid-19 pandemic, using oyo state in southwest nigeria, as a case study. this study was a cross-sectional qualitative study involving key informant and in-depth interviews. purposive sampling was used in recruiting participants who were members of the task force on covid-19 in the state and emergency operations centre (eoc) members (physicians, nurses, labouratory https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 29 https://www.sciencedirect.com/topics/social-sciences/case-study https://www.sciencedirect.com/topics/social-sciences/qualitative-research ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." scientists, “contact tracers”, logistic managers) and other partners. the state’s health system response to covid 19 was assessed using the who health systems framework. audio recordings of the interviews done in english were transcribed and thematic analysis of these transcripts was carried out using nvivo software. results showed that the state government responded promptly by putting in place measures to address the covid-19 pandemic. however, the response was not adequate owing to the fact that the health system has already been weakened by various challenges like poor funding of the health system, shortage of human resources and inadequate infrastructure. these contributed to the health system's sub-optimal response to the pandemic. momoh and amaha (22021) examined the implications of poor management of health systems in nigeria on the fight against the covid-19 pandemic. this study relied on secondary data obtained from books, journals and internet sources. besides, content analysis was used to analyse the data collected. the study argued that health facilities in nigeria have been put under intense pressure due to the increasing demand for health assistance by nigerians during the covid-19, thereby limiting the performance of the limited numbers of health facilities that were hitherto inadequate. moreover, poor infrastructural development in the health sector and corruption had been identified as causes of the poor performance of the nigeria health sector. ayeni and aborisade (2021) assessed the scourge of covid-19 in the context of nigeria’s orthodox healthcare facilities and professionals, the challenges and lessons for the future using the international-health-regulations (ihr) preparedness-framework. he assessment involved gauging the performance of selected indexes namely detect, report, respond, enabling-function and operational-readiness of lagos-state healthcare facilities. the ihr for state party self-assessment annual reporting (ihr-spar) tool was adapted into a questionnaire via google-form and the link generated was shared on the whatsapp-platform of the healthcare-workers of randomly selected healthcare facilities in the three senatorial-districts of the state. a total of 210 respondents were targeted for covid-19 related information but only 157 responded. the data obtained were processed using arithmetic-mean as suggested by the adopted methodology. findings showed that lagos-state has a level-3 capacity across the five-indexes which include detect-capacity (41.94%), report-capacity (45.41%), respond-capacity (45.77%), enabling-function (45.99%) and operationalreadiness (44.78%). findings also revealed that some of the challenges encountered in managing covid-19 are perennial. covid-19 pandemic and education okagbue et al. (2023) explored the impacts of the covid-19 pandemic on nigeria's education system and in the process provided a distinctive solution to the challenges facing the sustainability of education in the country. a cross-sectional approach was applied through an online survey to obtain data from n = 82 learners across the three levels of institutions. spss was used to analyse the demographic data, while smart pls was used for structural equation modeling (sem). the results showed that the closure of schools for over six months at the onset of the covid-19 pandemic and the inability of schools to engage learners in educational activities while at home also revealed the poor state of the education system in the country, which led to the discovery of the unavailability of distance online education, web-based learning system and ict infrastructure in the nigerian education environment. the incidence of covid-19 also impacted the stability of the academic calendar, caused teachers attrition, increased the rate of student dropout and lack of interest in digital education. these outcomes resulted in the exploration of students’ and teachers’ perceptions, attitudes, literacy, competency and willingness to engage in distance online education. https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 30 https://www.sciencedirect.com/topics/nursing-and-health-professions/health-status https://www.sciencedirect.com/topics/social-sciences/covid-19 https://www.sciencedirect.com/topics/nursing-and-health-professions/audio-recording https://www.sciencedirect.com/topics/nursing-and-health-professions/audio-recording https://www.sciencedirect.com/topics/nursing-and-health-professions/audio-recording ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." the study outcome satisfied the objectives of the study that the lack of student-teacher digital competencies influences their perception and acceptability of web-based learning approach and use of smart learning and teaching devices. ndejjo et al. (2023) examined the consequences of school closures due to covid-19 across four sub-saharan african countries: the democratic republic of congo (drc), nigeria, senegal and uganda. as a qualitative study, the key informants included policymakers, school heads, students, parents, civil society representatives and local leaders. interview transcripts were thematically analysed. across the four countries, schools were totally closed for 120 weeks and partially closed for 48 weeks. school closures led to: (i) desirable and anticipated consequences: enhanced adoption of online platforms and mass media for learning and increased involvement of parents in their children’s education. (ii) desirable and unanticipated consequences: improvement in information, communication and technology (ict) infrastructure in schools, development and improvement of computer skills and created an opportunity to take leave from hectic schedules. (iii) undesirable anticipated consequences: inadequate education continuity among students, an adjustment in academic schedules and programmes and disrupted student progress and grades. (iv) undesirable and unanticipated: increase in sexual violence including engaging in transactional sex, a rise in teenage pregnancy and school dropouts, demotivation of teachers due to reduced incomes and reduced school revenues. (v) neutral consequences: engagement in revenue-generating activities, increased access to phones and computers among learners and promoted less structured learning. the consequences of school closures for covid-19 control were largely negative with the potential for both short-term and far-reaching longer-term consequences. in future pandemics, careful consideration of the type and duration of education closure measures and examination of their potential consequences in the short and long term is important before deploying them. dessy et al. (2021) analysed the impact of covid-19’s lockdown measures on children’s school resilience. using an individual fixed-effect linear probability model on nigeria data, the quasirandomness of these measures was used to estimate their effect on school attendance after the lockdown was lifted. results showed that covid-19 lockdown measures reduced children’s school attendance probabilities after the school system’s reopening. importantly, the negative impact increases with children’s age, reaching its peak among those whose education is no longer compulsory. for schoolchildren in that age group, the negative effect of covid-19 lockdown measures were likely to be permanent, which, if not reversed, may undermine the quality of the economy-wide future labour force. it was also found that covid-19 pandemic increased child marriage and gender inequality in education among children aged 12 and 18 years in north-western part of nigeria. covid-19 pandemic and public order akanmu et al. (2021) examined covid-19 pandemic and insecurity in nigeria. convenience accidental sampling was used to administer 1671 copies of questionnaire on residents through an online/electronic survey. data collected were analysed descriptively and inferentially. findings revealed that the spike in crime during the covid-19 lockdown period is relatively higher than usual with disruption of public peace, theft and rape accounting for the most prominent crime. meanwhile, most respondents experienced crime incidence between 6 pm and 12 midnight. ironically, idleness, poor spatial arrangement/planning, poor governance and poverty were the major catalysts for the crime spike during the lockdown, while fear-of-fear (phobophobia) and declined socio-economic capacity were predominant effects of crime experienced. the fisher’s exact test results revealed a significant relationship between the surge in crime and covid-19https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 31 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." restrictive measures. the study concluded that the insecurity during lockdown periods caused both temporary and permanent physical and psychological havoc. asangausung et al. (2022) examined the activities of cybercriminals during the covid-19 pandemic in nigeria. secondary and primary data were collected through an online poll from internet users. extensive explanations and content analysis were conducted. the results demonstrated that during the coronavirus (covid-19) pandemic, internet fraudsters took advantage of the public via phishing schemes, malicious websites, malicious apps, malware, hacking, spam, false information and counterfeit items. also, many social media users were victims of cybercrime as a result of the covid-19 pandemic, particularly those who were frantic to register online in order to receive government palliatives and other relief materials. shodunke (2022) explored citizens' compliance with the order and how its enforcement occasioned illegal police practices in nigeria. with a qualitative approach, this study recruited 90 participants using varieties of sampling methods to understand public behaviour and police conduct in the enforcement of the order. from the insights gathered with a semi-structured interview and analysed with the thematic analysis method, the study observed that economic hardship, unavoidable matters from the citizens’ end and mistrust of authorities, fueled non-compliance. such mistrust amplified misinformation during the pandemic. although there was a reasonable level of compliance, the preexisting police illegalities (extortion and bribery) facilitated the cases of non-compliance in nigeria. also, hostility ensued between police personnel and citizens during the enforcement of the lockdown. theoretical framework this paper was anchored on martha albertson fineman’s vulnerability theory, developed in 2019 as a critical response to traditional liberal legal frameworks that overemphasise individual autonomy and self-sufficiency. originating from the field of law, fineman’s theory has since evolved into a broad socio-legal and policy-oriented framework, offering insight into how inequality, marginalisation and institutional failure exacerbate human suffering in times of crisis. central to this theory is the recognition that vulnerability is a universal, constant and inevitable feature of the human condition—affecting everyone at different life stages or under varying circumstances such as illness, aging, or economic hardship. however, while vulnerability itself is universal, the degree to which individuals experience or withstand it is uneven and shaped by the strength or weakness of societal institutions such as healthcare, education, social protection and the legal system. fineman argues that resilience to vulnerability is not a purely personal attribute but a function of the support systems individuals can access. those with better access to institutional resources are more likely to be protected from the worst effects of crises, while others remain exposed and at risk. this inequality of resilience underscores the theory’s core critique of liberal individualism by emphasising that the burden of overcoming vulnerability should not fall solely on individuals. instead, vulnerability theory asserts that the state has a fundamental responsibility to design and maintain institutions that protect all citizens and foster collective resilience. in this way, the theory shifts the focus from autonomy to shared responsibility, insisting that societies must be structured in ways that recognise and respond to the inevitable vulnerabilities of human life. this theoretical lens is particularly relevant in analysing the covid-19 pandemic's effects, as it highlights the disparities in access to institutional support and the role of government in mitigating or exacerbating public hardship. https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 32 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." vulnerability theory provides a compelling framework for understanding how the covid-19 pandemic disproportionately affected various segments of society and disrupted socio-economic development and public order, particularly in nigeria. the pandemic exposed deep structural inequalities, demonstrating that certain social groups—such as low-income earners, informal sector workers, women and children—were far more susceptible to the economic and health shocks it triggered. these populations lacked access to adequate healthcare, social safety nets and financial buffers, making them more vulnerable to job losses, food insecurity and illness. while more privileged individuals could rely on savings, private healthcare and remote work, the less privileged bore the brunt of lockdowns and economic stagnation. the pandemic also underscored the critical role of healthcare and social institutions in cushioning populations from systemic shocks. however, the nigerian healthcare system's limited capacity and the often-inefficient distribution of government palliatives and cash transfers highlighted the state’s inability to adequately protect its citizens. vulnerability theory posits that resilient institutions are essential for mitigating the effects of crises and where such structures are weak or poorly managed, vulnerability is exacerbated. inequalities in access to technology and education became more pronounced during lockdowns, with wealthier families able to sustain educational continuity and work productivity, while poorer households faced educational disruption, unemployment and elevated health risks. this divergence reflects the theory’s emphasis on pre-existing social and economic disparities that shape people’s ability to withstand crises. furthermore, the nigerian state’s response to the pandemic, marked by inefficiencies, lack of transparency and perceived neglect of vulnerable populations, heightened social frustration. the outbreak of the #end sars protests, although rooted in broader issues of police brutality and governance failure, was also fuelled by widespread disillusionment over the state’s management of pandemic-induced hardships. this civil unrest illustrates how increased vulnerability, when left unaddressed, can escalate into public disorder. as criminality rose alongside unemployment and economic desperation, the link between socio-economic vulnerability and declining public order became more evident. vulnerability theory helps explain this pattern by showing how unmet basic needs can lead to increased social tensions, instability and a breakdown of lawful behaviour. in the long term, the pandemic has reversed gains in poverty reduction, employment and inequality, underscoring the fragile nature of nigeria’s socio-economic development. according to vulnerability theory, these outcomes are not merely consequences of the virus but of systemic failures to build inclusive, protective and resilient social structures capable of withstanding shocks. thus, the theory reinforces the urgent need for proactive policy measures aimed at reducing structural vulnerabilities and strengthening institutions to better manage future crises and support sustainable development. the application of vulnerability theory to explain the impact of covid-19 on socio-economic development and public order in nigeria is both insightful and contextually appropriate, yet not without limitations. a key strength of the theory lies in its emphasis on structural inequalities and the differentiated capacity of individuals and communities to absorb shocks. this makes it particularly effective in analysing why certain populations—such as informal workers, low-income households and marginalised groups—were disproportionately affected by the pandemic’s https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 33 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." economic, health and social disruptions. by foregrounding the role of weak institutions and inadequate safety nets, the theory offers a compelling explanation for the widespread hardships, rising crime rates and civil unrest observed during and after the lockdown periods. however, a critique of this approach is that while vulnerability theory adeptly identifies disparities in exposure and resilience, it often underplays the role of individual agency, cultural context and informal support networks, all of which shaped survival strategies during the crisis in nigeria. additionally, the theory tends to frame vulnerability in somewhat deterministic terms, assuming that structural disadvantage always leads to worse outcomes, whereas in some cases, communitybased solidarity and adaptive behaviors helped mitigate the impact of the pandemic in ways not fully captured by the theory. furthermore, the theory may fall short in accounting for political dynamics, such as elite manipulation of palliative distribution and public disillusionment with governance, which also contributed to public disorder and social discontent. despite these limitations, the justification for adopting vulnerability theory in this context remains strong. it provides a valuable analytical lens for understanding the uneven impact of the pandemic, highlighting how structural weaknesses and policy failures intensified public suffering and destabilised social order. its focus on institutional responsibility and social protection aligns with the pressing need to reform governance and build resilience in vulnerable populations. by directing attention to the systemic roots of crisis-induced inequality and unrest, the theory serves as a powerful tool for advocating policy interventions aimed at social justice, inclusive development and stronger institutional responses in the face of future public health emergencies. materials and methods this paper employed a qualitative research method, which is most suitable for exploring complex social phenomena such as the impact of the covid-19 pandemic on socio-economic development and public order. the study relied primarily on documentary evidence, utilising a wide range of secondary data sources to gather relevant and reliable information. these sources included academic textbooks, peer-reviewed articles, scholarly periodicals, official government reports and publications, policy documents and credible internet-based materials such as organisational reports and online databases. the rationale for choosing secondary data was based on the availability of extensive existing literature and documentation on the covid-19 pandemic, its socio-economic implications, public policy responses and the application of social theories in analysing vulnerability. the data collected provided historical, conceptual and empirical insights necessary to support a thorough theoretical analysis. to interpret the collected data, the study adopted content analysis as the main analytical technique. content analysis involves the systematic examination and interpretation of textual data to identify patterns, themes and meanings relevant to the research objectives. this approach enabled the researcher to critically evaluate how different populations were affected by the pandemic, assess the performance of institutions and link observed social dynamics to the explanatory framework of vulnerability theory. by organising data around central concepts such as inequality, institutional response, resilience and public disorder, the content analysis provided a coherent structure for drawing conclusions and offering informed recommendations. overall, the combination of documentary analysis and content analysis ensured that the study was grounded in existing https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 34 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." knowledge while allowing for a reflective and theory-driven interpretation of the pandemic's multifaceted impacts in the nigerian context. results findings from this study affirm that the covid-19 pandemic was not only a global public health crisis but also a profound disruptor of socio-economic development and public order in nigeria. empirical evidence gathered from secondary data sources reveals that the pandemic significantly exacerbated nigeria’s pre-existing structural vulnerabilities. these include an already fragile healthcare system, high levels of unemployment, systemic poverty, limited digital and educational infrastructure and weak public institutions. lockdown measures, though necessary to control the virus, had severe economic implications, particularly for small and medium-sized enterprises (smes)leading to widespread business closures, job losses and income insecurity, especially in the informal sector which employs a large portion of the population. the education sector suffered considerably, as the abrupt shift to remote learning exposed a pronounced digital divide. many students, particularly in rural and low-income urban areas, lacked the tools and internet access needed to continue their education. similarly, the healthcare system was overwhelmed, with shortages in beds, medical equipment and personal protective equipment (ppe), while frontline health workers reported burnout, anxiety and inadequate institutional support. social and public order also deteriorated during the crisis. findings reveal an uptick in cybercrime, domestic violence and opportunistic criminal behaviour during lockdowns. civil unrest, such as the #end sars protests, gained momentum as public frustration with poor governance, inequality and policing practices intensified. law enforcement responses to lockdowns were at times marked by brutality and extortion, undermining public trust in institutions. discussion of findings covid-19 pandemic and economic disruption the findings of this study reveal that the economic disruption caused by the covid-19 pandemic in nigeria was both severe and multidimensional, affecting small and medium enterprises (smes), increasing unemployment, destabilising supply chains and testing the capacity of government interventions. these findings are consistent with the conclusions of usman et al. (2024), joan et al. (2022) and inegbedion (2021), who emphasised that the pandemic compounded nigeria’s preexisting structural economic weaknesses. when analysed through the lens of structural theory and vulnerability theory, the disruption is better understood not merely as the outcome of an unforeseen health crisis but as a consequence of deeper systemic fragilities that rendered nigeria’s economy particularly susceptible to shocks. small businesses, which form the backbone of nigeria’s informal economy and contribute significantly to employment, were among the most severely affected. due to prolonged lockdowns, reduced consumer demand and limited access to financial relief, many smes shut down or drastically scaled back operations. this led to widespread job losses and income insecurity. vulnerability theory explains that informal sector workers, who make up a significant portion of nigeria’s labour force, lacked adequate social protection and access to credit, making them disproportionately vulnerable to economic shocks. unlike formal workers, those in the informal economy could not rely on unemployment benefits or health insurance, compounding their precarity. https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 35 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." the research also indicates a surge in unemployment, particularly among youth and unskilled labour, which intensified economic hardship. according to structural theory, this outcome reflects nigeria’s labour market rigidities and under-diversification. even before the pandemic, the economy was heavily reliant on oil exports and plagued by underemployment, particularly in rural areas. covid-19 merely amplified these structural imbalances. the closure of businesses in the hospitality, education, transport and service sectors, along with reductions in foreign investment and remittances, caused significant economic contraction. as observed globally by the ilo (2020), workers in lower-tier occupations without job security or the ability to work remotely were the first to lose income—a pattern mirrored in nigeria. supply chain disruptions further complicated economic recovery. nigeria’s dependency on imported raw materials, machinery and finished goods made the economy highly susceptible to international trade shocks. factory closures, port delays and currency fluctuations affected the availability and pricing of goods. food supply chains were especially impacted due to mobility restrictions and reduced agricultural labour, leading to inflation in food prices and increased household food insecurity. structural theory suggests that such disruptions are the result of inadequate domestic production capacities and overreliance on external markets—symptoms of a weak industrial base. government responses to the economic crisis included cash transfers, payroll support for smes and credit facilities through the central bank of nigeria. however, these efforts were limited in reach, often criticised for delays, lack of transparency and inadequate targeting. vulnerability theory underscores that policy inefficiencies during crises disproportionately affect marginalised populations, especially when public institutions lack the capacity or will to implement inclusive and accountable economic relief programs. additionally, nigeria’s rising public debt and declining revenues from oil exports further constrained its ability to sustain robust stimulus programs compared to developed economies. while digitalisation and remote work emerged globally as adaptive strategies during the pandemic, in nigeria, this shift only accentuated existing socio-economic inequalities. digital platforms became vital for education, commerce and communication, yet the digital divide—characterised by poor internet infrastructure, limited access to devices and low digital literacy—meant that many nigerians, especially in rural areas, were excluded from the benefits of the digital economy. the accelerated global shift to online services thus created both opportunities and exclusions, revealing structural weaknesses in nigeria’s technological readiness. the pandemic also contributed to broader financial instability, exposing vulnerabilities in nigeria’s macroeconomic environment. oil price volatility led to foreign exchange instability, inflation and reduced fiscal buffers. this reinforced nigeria’s dependence on volatile external revenue sources, as articulated in the structuralist development literature, which critiques mono-economies for their susceptibility to global market swings. as unemployment rose and consumer demand weakened, poverty levels also climbed, reversing gains in social development indicators. the economic inequalities exacerbated by the pandemic also deepened the class divide. while wealthier individuals and businesses were better positioned to absorb the shocks or pivot to online services, low-income households were left without sufficient safety nets. these disparities reflect https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 36 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." what vulnerability theory identifies as uneven resilience capacities—where one's socioeconomic position determines exposure to harm and the ability to recover. in conclusion, the economic disruption caused by covid-19 in nigeria cannot be viewed in isolation from the structural and institutional vulnerabilities that predated the crisis. the pandemic exposed deep-rooted fragilities in nigeria’s economic model, labour market and governance systems. using vulnerability theory as interpretive frameworks, this study affirms that the groups most affected by the crisis were those already living with precarity and the capacity of the state to mitigate these effects was constrained by institutional inefficiencies and limited fiscal space. the findings call for a long-term rethinking of economic resilience in nigeria, one that involves diversifying the economy, expanding the social safety net, strengthening local production systems and addressing digital inequality to foster inclusive recovery and future shock resistance. covid-19 pandemic and healthcare system the covid-19 pandemic exerted immense pressure on nigeria’s already fragile healthcare system, laying bare systemic weaknesses in infrastructure, access and workforce capacity. from a vulnerability theory perspective, the pandemic did not merely create new problems—it illuminated and intensified the existing structural inequities that shaped nigerians’ uneven exposure to risk and limited their capacity for resilience. vulnerability theory, which emphasises how pre-existing social, economic and institutional factors compound harm during crises, provides a compelling lens for understanding the multifaceted health system failures experienced during the pandemic. these findings are consistent with the works of akinyemi et al. (2021), momoh and amaha (2021) and ayeni and aborisade (2021), all of whom identified the pandemic as a magnifying glass for nigeria’s longstanding healthcare deficiencies. one of the most critical outcomes of the pandemic was the overwhelming of healthcare facilities. hospitals across nigeria, particularly those in urban centers, were inundated with covid-19 patients during peak periods, despite already contending with limited capacity and inadequate equipment. intensive care units (icus) were few and under-resourced and many patients could not access ventilators or oxygen. this strain was worsened by chronic shortages of medical supplies, including personal protective equipment (ppe), diagnostic tools and pharmaceuticals. these deficits stemmed not only from global supply chain disruptions but also from years of underinvestment in local health manufacturing and procurement systems. in line with vulnerability theory, these systemic shortcomings rendered the healthcare system incapable of absorbing the shock of the pandemic, disproportionately affecting poorer communities that relied exclusively on public health services. access to healthcare became more inequitable during the pandemic. lockdowns, curfews and fear of infection reduced patient visits for routine and chronic health issues. non-covid services— such as maternal health, immunizations and treatment for diseases like malaria, tuberculosis and hiv/aids—were disrupted, with serious implications for public health. as the theory suggests, populations already on the margins of healthcare access became even more vulnerable, particularly rural dwellers, the elderly and those with pre-existing conditions. these disruptions have long-term consequences, including increased morbidity from preventable diseases and a backlog in critical treatments. https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 37 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." the pandemic also exposed the dire conditions under which healthcare workers operated. doctors, nurses and support staff were at the frontline of the response, often working without adequate protection, support, or hazard pay. long hours, emotional exhaustion and the trauma of witnessing widespread illness and death took a serious toll on their mental health. reports of burnout, anxiety, depression and even ptsd among healthcare workers were widespread. yet institutional responses to their plight were limited and poorly coordinated. in many cases, infected workers lacked access to quality treatment or financial support and some even resorted to industrial actions to demand basic entitlements. vulnerability theory underscores how the absence of institutional safeguards for frontline workers diminishes the resilience of the system as a whole. further, the pandemic highlighted persistent inequalities in health infrastructure across different regions in nigeria. urban centers like lagos and abuja, while strained, had relatively better resources to manage covid-19 cases. in contrast, many rural areas lacked basic facilities such as testing centers, isolation wards and reliable electricity. these disparities reflect structural vulnerability at the geographic and socio-economic levels, leading to stark differences in infection rates, mortality and recovery. ayeni and aborisade (2021) observed that these inequities are not incidental but rooted in historical neglect and policy failure. the response to the pandemic, though marked by efforts such as the establishment of emergency response teams, mobile testing units and public health campaigns, was hampered by governance challenges. issues of mismanaged funds, lack of transparency in palliative distribution and limited coordination between federal and state health authorities undermined the overall effectiveness of interventions. vulnerability theory posits that such institutional dysfunction exacerbates risk exposure by limiting the efficacy of response mechanisms during emergencies. despite these challenges, the pandemic also prompted innovations, notably in the use of digital health platforms and telemedicine. these technologies helped sustain some level of healthcare delivery during lockdowns. however, as with online education, access to digital health solutions remained uneven, with rural and low-income populations largely excluded due to poor internet access, low digital literacy and the absence of supportive infrastructure. consequently, these innovations, while promising, also reflected and reinforced existing inequalities. vaccine distribution was another domain where vulnerability was pronounced. although nigeria eventually began vaccination campaigns, the rollout was slow and uneven. logistical issues, vaccine hesitancy and lack of cold chain infrastructure in remote areas hindered progress. wealthier and urban populations were vaccinated at a much higher rate than their rural and poor counterparts. this inequity not only endangered vulnerable populations but also posed broader public health risks by delaying the achievement of herd immunity. in sum, the covid-19 pandemic revealed how structural vulnerabilities—ranging from inadequate infrastructure and funding to regional inequality and workforce neglect—undermined the resilience of nigeria’s healthcare system. through the lens of vulnerability theory, these impacts are understood not merely as failures of response but as the predictable outcomes of long-standing institutional and social neglect. covid-19 pandemic and education the covid-19 pandemic caused unprecedented disruption to nigeria’s education system, revealing and intensifying longstanding vulnerabilities within the sector. drawing on vulnerability theory, which emphasises the structural disadvantages that leave individuals and groups more https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 38 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." susceptible to harm during crises, this analysis reveals how the pandemic disproportionately affected marginalised students and exposed systemic weaknesses in educational access, delivery and equity. consistent with the findings of okagbue et al. (2023), ndejjo et al. (2023) and dessy et al. (2021), the impact of the pandemic on education in nigeria extends beyond temporary school closures to deeper socio-economic and institutional consequences. one of the most immediate and visible effects of the pandemic was the prolonged closure of schools, colleges and universities. the disruption of the academic calendar brought learning to a standstill for millions of students, especially those in public institutions with limited digital infrastructure. the abrupt shift to remote learning highlighted the entrenched digital divide in nigeria, where access to internet connectivity, digital devices and reliable electricity remains uneven. vulnerability theory explains that such structural disadvantages disproportionately affect students from low-income, rural and underserved communities, leaving them excluded from virtual learning opportunities and compounding existing educational inequities. the lack of digital literacy and preparedness among teachers further weakened the effectiveness of remote education. many educators lacked the necessary training, technological tools and institutional support to transition smoothly to online instruction. this situation significantly undermined the quality of education and contributed to learning loss, particularly among younger students and those requiring more personalised instruction. vulnerable students—those living in poverty, those with disabilities and girls—faced additional barriers to learning. in several communities, economic pressures led to increased dropout rates, child labour and early marriages, especially among girls, reversing progress made in gender equity in education. social development and mental health were also adversely affected by school closures. schools are not only spaces for academic instruction but also for socialisation, emotional support and access to essential services such as school meals and health programs. the absence of these supports during lockdowns contributed to rising cases of emotional distress, anxiety and feelings of isolation among students. according to vulnerability theory, the lack of institutional safeguards during the crisis exacerbated these non-academic harms, demonstrating the broader role that education systems play in student well-being. higher education institutions were not spared. universities faced massive disruptions as campus closures forced a hurried shift to online platforms. many students, particularly those from lowincome backgrounds, lacked the resources to participate meaningfully in online courses. the economic implications of the pandemic also placed a strain on university operations, with reduced revenue from tuition, international student enrolment and campus-based services. as a result, some institutions implemented austerity measures, reducing staff, suspending academic programs, or halting infrastructural projects. graduating students faced uncertain job markets, with delayed or cancelled recruitment processes, compounding their vulnerability in an already unstable economy. importantly, the pandemic’s educational fallout is not limited to short-term disruptions. studies suggest that prolonged learning loss, especially in foundational subjects like literacy and numeracy, may lead to long-term knowledge gaps and declining educational outcomes. the risk of a widening rural-urban educational divide, as well as the possibility of a "lost generation" of students unable to return to school, is consistent with theoretical assertions that crises deepen pre-existing inequalities unless deliberately addressed through systemic intervention. https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 39 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." yet, the pandemic also revealed areas for transformation. in response to the crisis, various stakeholders—including governments, ngos and private sector actors—introduced innovative approaches to sustain learning. the rapid adoption of digital tools, the promotion of radio and television-based learning and the introduction of blended learning models signaled a shift in pedagogical strategies. vulnerability theory encourages such institutional adaptability, stressing the importance of resilience-building measures that protect the most at-risk populations in the face of future shocks. in summary, the covid-19 pandemic served as both a disruptor and a diagnostic tool, exposing the fragility of nigeria’s education system while simultaneously opening a window for reform. the lens of vulnerability theory underscores that the educational challenges witnessed during the pandemic were not merely incidental but rooted in structural deficiencies that predated the crisis. covid-19 pandemic and public order the covid-19 pandemic posed a major disruption to public order in nigeria, exposing the fragility of governance structures, law enforcement mechanisms and socio-economic systems. grounded in the framework of vulnerability theory, the analysis of this disruption reveals that the pandemic did not merely create new challenges but rather amplified pre-existing structural vulnerabilities that had long been overlooked. the pandemic served as a stress test for nigeria’s capacity to manage collective risk and ensure social stability under pressure and the results highlighted significant deficiencies. public order in nigeria was strained by multiple interconnected factors that emerged as the virus spread and government-imposed restrictions took effect. economic dislocations caused by lockdowns and movement restrictions resulted in widespread job losses, particularly among the urban poor and those in the informal sector, which constitutes a large portion of nigeria’s workforce. these disruptions contributed directly to civil unrest, including protests, street demonstrations and increased incidences of theft, looting and localised violence. according to akanmu et al. (2021) and further supported by asangausung et al. (2022), the inadequacy and inconsistent distribution of government palliatives exacerbated public frustration, weakening the legitimacy of state responses and increasing citizens’ willingness to defy restrictions. law enforcement agencies, already operating under capacity constraints, were stretched thin as they sought to enforce lockdowns, curfews and public health mandates. this overextension, coupled with a history of mistrust between police and communities, led to violent clashes and, in some instances, police brutality. the heightened police presence and militarised enforcement, rather than assuring the public, often intensified tensions, creating pockets of resistance and further eroding public trust. okorie et al. (2022) observed that in such contexts, law enforcement became a source of disorder rather than a guarantor of peace, reflecting vulnerability theory’s emphasis on institutional weaknesses as amplifiers of societal risk. furthermore, crime patterns shifted in response to the pandemic. while some street crimes declined due to movement restrictions, other forms of violence surged, including domestic violence, cybercrime and opportunistic crimes linked to economic desperation. these shifts were not random but reflected the adaptive responses of vulnerable populations struggling to survive under rapidly changing conditions. vulnerability theory helps explain how structural inequalities, lack of social safety nets and inadequate institutional responses heightened people’s exposure to harm while limiting their capacity for resilience. https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 40 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." the deterioration in public order during the pandemic was also political. the #end sars protests that erupted in october 2020 were not solely reactions to police brutality but were also shaped by accumulated frustration with government failures during the covid-19 crisis. shodunke (2022) notes that the protests symbolised a broader reckoning with institutional neglect, unresponsive leadership and socio-economic exclusion. these protests, though not directly caused by the pandemic, were fueled by the socio-political discontent exacerbated by the pandemic environment, aligning with the theory's assertion that vulnerability is both a cause and consequence of poor governance. globally, similar patterns emerged, as seen in latin america, parts of europe and the united states, where prolonged restrictions, economic hardship and perceived governmental overreach led to waves of civil disobedience and mistrust. however, the nigerian experience was distinct in its intensity due to the country’s weaker public health infrastructure, minimal welfare support and entrenched governance challenges. unlike more resilient nations that mitigated disorder through strong social safety nets and coordinated public health communication, nigeria’s fragmented and reactive approach revealed the dangers of institutional fragility during times of crisis. in essence, the covid-19 pandemic illuminated the complex interrelationship between socioeconomic vulnerability, institutional performance and public order. while the virus itself posed a biological threat, the social and political fallout in nigeria was a product of long-standing systemic weaknesses. vulnerability theory offers a fitting lens to interpret these dynamics, emphasising that public disorder in times of crisis is not merely a function of individual defiance or economic downturn, but a reflection of deeper societal inequities and institutional failures. the nigerian case demonstrates that sustaining public order in emergencies requires more than policing—it demands resilient governance, equitable policy responses and robust social infrastructures that protect the most exposed. the lesson is clear: without addressing underlying vulnerabilities, future crises will continue to produce similar, if not more severe, disruptions to public order. conclusion the aim of this study was to present a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria. the findings revealed that the pandemic exposed and intensified pre-existing structural weaknesses in critical sectors such as health, education, the economy and security. small businesses collapsed, unemployment surged, public health infrastructure was overwhelmed and educational disruptions widened the urban-rural divide in learning outcomes. furthermore, the inability of state institutions to adequately mitigate the impact of the crisis contributed to public unrest, heightened crime rates and a decline in trust in government institutions. these findings have significant implications. first, they demonstrate how vulnerability is not merely a result of individual exposure to risk but is embedded in broader systemic and institutional inequalities. the pandemic disproportionately affected nigeria’s informal sector, low-income earners, women and children—groups that lacked adequate social protection and access to essential services. second, the fragility of nigeria’s public order under stress highlighted the critical need for resilient governance structures and equitable public policies. the inability to enforce health regulations fairly, combined with inadequate palliatives, contributed to civil unrest, most notably evidenced during the #endsars protests. https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 41 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." the thesis statement that covid-19 intensified nigeria’s structural vulnerabilities, leading to wideranging implications on socioeconomic development and public order due to systemic inequality and institutional incapacityis supported throughout the analysis. by employing vulnerability theory, the study advances understanding of how crises impact marginalised populations differently and underscores the necessity of inclusive, pre-emptive policy frame works. this research contributes to the growing body of literature on the socioeconomic consequences of the pandemic in developing contexts. unlike generalised global studies, it provides a localised, theorydriven analysis of how a pandemic intersects with systemic fragility in nigeria. it also bridges empirical findings with theoretical perspectives, offering a robust interpretive framework for understanding the nexus between crisis and inequality future studies should investigate the long-term effects of the covid-19 pandemic on intergenerational poverty and educational attainment in nigeria, particularly in rural and underprivileged communities. comparative research across sub-saharan african countries could provide deeper insights into how differing policy responses influenced outcomes. moreover, interdisciplinary research combining public health, economics and governance could be undertaken to propose integrated crisis-response frameworks suited to fragile states. in conclusion, the covid-19 pandemic was not only a health crisis but also a mirror reflecting the deep-seated inequalities and institutional frailties in nigeria. addressing these challenges requires reimagining governance, investing in resilient infrastructure and embedding social equity in public policy to protect vulnerable populations in the face of future global crises. recommendations based on the findings of this study, the following four strong recommendations are proposed: 1. strengthen social protection systems: the nigerian government should prioritise the development of inclusive and responsive social safety nets that protect vulnerable groups such as informal sector workers, women and low-income households during national emergencies. this includes expanding access to unemployment benefits, targeted cash transfers, food support and health insurance, especially in rural and underserved communities. 2. invest in public health infrastructure and emergency preparedness: to prevent the collapse of the healthcare system in future health crises, substantial investments must be made in strengthening public health infrastructure, improving disease surveillance, training healthcare personnel and ensuring the availability of critical supplies such as ppe, ventilators and essential drugs. a national pandemic preparedness framework should also be institutionalised. 3. bridge the digital divide in education and the economy: to reduce the educational and economic inequalities exposed during the pandemic, government and private stakeholders should expand access to digital tools and reliable internet connectivity in rural and low-income areas. this includes subsidising devices for students and supporting teachers with digital literacy training to improve remote learning outcomes and economic participation. 4. enhance institutional accountability and crisis governance: effective crisis response requires transparent, efficient and accountable institutions. the nigerian government should reform its public administration systems to ensure equitable distribution of relief resources, timely implementation of emergency interventions and active engagement with civil society. strengthening https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 42 ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." public trust through accountability and transparency is essential for maintaining public order during future crises. references adebimpe, o. i., adetunji, a. t., nwachukwu, c., & hieu, v. m. (2021). covid 19 pandemic challenges: the youth unemployment in nigeria. the journal of contemporary issues in business and government, 27(1), 2004-2012. agbeyo, b. s. (2020). impact of covid-19 pandemic on unemployment among nigerian youth and what unemployed graduates need to do to position themselves for employment opportunities. https://www. researchgate.net akanmu, a. a., salisu, u. o., daramola, o. p., ogunsesan, a. s., fasina, s. o., adejare, j. a., sanni, s. m., & olatunji, o. m. (2021). the covid-19 pandemic and insecurity: the furiousness in nigerian communities. urban, planning and transport research, 9(1), 368-406. akinyemi, o. o., popoola, o. a., fowotade, a., adekanmbi, o., cadmus, e. o., & adebayo, a. (2021). qualitative exploration of health system response to covid-19 pandemic applying the who health systems framework: case study of a nigerian state. scientific african, 13, e00945. alex, u. s. & obinachiwori, e. (2020). psychological correlates associated with covid-19 trauma among private school teachers in river state. social science review, 1(1), 150-156. asangausung, o. s., okorie, e. j., & nnanna, j. c. (2022). coronavirus (covid-19) pandemic and cyber-criminal activities in nigeria. international of research and sustainable development, 8(1), 117-132.http://www.irdionline.org/panafrican.html ayeni, a. o. & aborisade, a. g. (2021). covid-19 and orthodox healthcare facilities and professionals in lagos state, nigeria: challenges and lessons for the future. ghana journal of geography, 14 (1), 41-64. dessy, s., gninafon, h., tiberti, l., & tiberti, m. (2021).covid-19 and children’s school resilience: evidence from nigeria. https://conference.iza.org/conference_files/covid_2021/gninafon_h31546.pdf fineman, m. a. (2019). vulnerability and social justice. valparaiso university law review, 53(2), 341-370. inegbedion, h. e. (2021). impact of covid-19 on economic growth in nigeria: opinions and attitudes. heliyon, 7, e0694. joan, n. o., anthony, a. u., & geraldine, e. n. (2022). covid-19 pandemic and the informal sector in nigeria: implications for sustainable smes. asian journal of economics, business and accounting, 22(1), 31–41. https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 43 http://www.irdionline.org/panafrican.html ijo international journal of health sciences and nursing ( issn: 2814-2098 ) volume 08 || issue 05 || may, 2025 || peter archibong essoh, okoro sunday asangausung, rosemary cletus effiong, 2025 “a post-mortem analysis of the impact of covid-19 pandemic on socio-economic development and public order in nigeria." mckee, a. (2023). public order/definition.https://docmckee.com/cj/docs-criminal-justiceglossary/public-order-definition/ momoh, z. & amaha, s. (2021). covid-19 pandemic and health systems in nigeria. university of nigeria journal of political economy, 11(3)-589-599. ndejjo, r., tusubiira, a. k., kiwanuka, s. n., bosonkie, m., bamgboye, e. a., diallo, i., kabwama, s. n., egbende, l., afolabi, r. f., leye, m. m. m., namuhani, n., kashiya, y., bello, s., babirye, z., adebowale, a. s., sougou, m., monje, f., kizito, s., dairo, m. d., bassoum, o. & wanyenze, r. k. (2023). consequences of school closures due to covid-19 in drc, nigeria, senegal and uganda. plos global public health, 3(10), e0002452. okagbue, e. f., ezeachikulo, u. p., nchekwubemchukwu, i. s., chidiebere, i. e., kosiso, o., ouattaraa, c. a. t., & nwigwe, e. o. (2023). the effects of covid-19 pandemic on the education system in nigeria: the role of competency-based education. international journal of educational research open, 4, 100219. https://doi.org/10.1016/j.ijedro.2022.100219 okorie, e. j., asangausung, o. s., & nnanna, j. c. (2022). the scourge of covid-19 and security challenges in nigeria. international journal of advancement studies, 17(1), 16-28. https://doi.org/10.5281/zenodo.10804221 shodunke, a. o. (2022). enforcement of covid-19 pandemic lockdown orders in nigeria: evidence of public (non)compliance and police illegalities. international journal of disaster risk reduction (ijdrr), 77, 103082. usman, s. о., esоmchі, о. s., nasiru, i. m., & daniel, a. v. (2024). an assessment of covid-19 and its impact on nigeria’s socio-economic development. cogent social sciences, 10(1). https://doi.org/10.1080/23311886.2024.2306700 willie, c. e., mboho, k. s., & umanah, u. n. (2021). problems and prospects of curbing domestic violence against women in nigeria in the post covid19 lockdown era. nigerian journal of social problems and social policy review, 1(2), 49-60. https://doi.org/10.5281/zenodo.15774243 ijo journals volume 08 | issue 05 | may 2025 | https://ijojournals.com/index.php/hsn/index 44 https://docmckee.com/cj/docs-criminal-justice-glossary/public-order-definition/ https://docmckee.com/cj/docs-criminal-justice-glossary/public-order-definition/ ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." resolution strategies for the dynamics of doctor-nurse conflicts affecting patient wellbeing in selected public hospitals in kogi state, nigeria 1edime yunusa, 1julius olugbenga owoyemi, ph.d. and 1timothy abayomi atoyebi, ph.d. 1department of sociology faculty of social sciences prince abubakar audu university anyigba -kogi state, nigeria corresponding authors :1edime yunusa abstract: interprofessional conflict between doctors and nurses remains a persistent challenge in healthcare systems globally, especially in resource-constrained settings like nigeria. in kogi state, systemic issues such as poor infrastructure, inadequate staffing, and role ambiguity have intensified doctor–nurse tensions, with adverse consequences for patient well-being. this study thereforeinvestigated the dynamics and resolution strategies for doctor-nurse conflicts and their impact on patient outcomes in selected public hospitals in kogi state, nigeria. the study objectives were to assess the dynamics of doctor–nurse relationships and identified resolution strategies towards improving patients’ well-being. by utilizing social conflict theory and adopting a mixed-methods approach, the study employed descriptive cross-sectional survey design and gathered data from 398 healthcare professionals (103 doctors and 295 nurses), 35 patients, and 3 chief medical directors across the selected public hospitals using questionnaires and in-depth interviews.hypothesis testing using multiple linear regression revealed a significant relationship between conflict resolution strategies and improved patient well-being (r² = .618, f = 164.23, p < .001). key findings highlighted that professional hierarchy, poor communication, and overlapping roles were major propellers of the dynamics of doctor-nurse conflict, while role clarification, joint decision-making, regular conflict resolution training, and continuous professional development were the major effective resolution strategies revealed.the study concluded that unresolved doctor–nurse conflicts compromise patient care, while targeted interventions can foster collaboration and enhance healthcare delivery. it recommended among others, policy-driven reforms emphasizing leadership training, inter professional education, and institutionalized communication frameworks to mitigate conflicts and promote a culture of mutual respect, ultimately safeguarding patient outcomes in kogi state’s public hospitals. keywords: doctor-nurse conflicts, dynamics, resolution strategies, patients' well-being, public hospitals, healthcare system, kogi state, nigeria introduction healthcare conflict between doctors and nurses is a global phenomenon with pervasive effects on patient safety and quality of care. across high income countries, studies reveal that poor interprofessional communication contributes significantly to medical errors and adverse outcomes, with about 20 % of surgical teams reporting serious disputes over postoperative care plans (kim et al., 2017; kern et al., 2017). the world health organization emphasises that effective team based communication—such as structured briefings, debriefings, and closed loop techniques—is foundational to patient safety (who, 2025; prineas et al., 2021).within sub saharan africa, interprofessional conflict is markedly prevalent, exacerbated by fragile health systems, personnel shortages, and hierarchical dynamics. in ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 1 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." nigeria, for instance, there are only around 0.38 doctors and 1.7 nurses per 1 000 population—well below who recommendations—further aggravating workplace stress and incivility among nurses (nn usa, 2025). surveys indicate up to two thirds of nurses experience incivility from colleagues and supervisors, with over 77 % reporting such encounters, which can impair team cohesion and patient safety (laschinger et al., 2017; prineas et al., 2021). at the national level, comprehensive studies involving over 2 200 healthcare professionals across nigeria found that salary disparities between physicians and other cadres—due to dual pay scales (conmess for doctors vs conhess for nurses/others)—are the most commonly cited cause of interprofessional conflict (73 % of respondents), with nearly three quarters agreeing that these tensions are detrimental rather than productive (mohammed, 2022; mohammed, 2022). additionally, leadership ambiguity, role definitions, communication failures and hierarchical structures fuel recurring disputes, which directly hamper the delivery of quality patient care (nwobodo et al., 2022; mohammed, 2022; orjiakor et al., 2022). efforts to manage such conflicts in nigeria have focused on multi agency interventions, calling for legislative reforms, harmonised salary structures, and collaborative leadership frameworks. a recent study argues that promoting leadership by competence—not professional affiliation—and mandating leadership training across all cadres could reduce tensions and foster cooperation (orjiakor et al., 2022). meanwhile, conflict management workshops rooted in emotional intelligence, role clarity and teamwork—aligned with who’s interprofessional education guidelines—have been proposed to enhance communication and operational alignment (intechopen, 2024; who, 2010). in the specific context of kogi state, public hospitals suffer from persistent under investment and insecure conditions. reports from federal teaching hospital in lokoja highlight that resident doctor staffing dropped from 222 to just 64 over four years due to emigration and burnout, forcing stretches of 48 hour shifts without calls or meals and leading to physical harm, including miscarriages (odogun, 2024). insecurity concerns have further driven physicians and nurses abroad, undermining clinical capacity and patient continuity of care (kogi reports, 2024). similar observations from smaller general hospitals reveal dilapidated facilities, shortages of medical supplies, and overburdened staff struggling to maintain basic services (the informant, 2025). these conditions suggest that doctor–nurse strife in kogi state is not merely interpersonal but deeply rooted in systemic failings: insecure environments, insufficient staffing, and collapsed infrastructure. such dynamics invariably threaten patient well being through delays, compromised infection control, and diminished trust. to safeguard outcomes, it is essential to implement resolution strategies that address both relational and structural factors—combining salary reform, role clarity, leadership training, teamwork promotion, and facility investment—tailored to the unique challenges in kogi’s public hospitals. statement of the problem despite global recognition of the critical role that effective interprofessional collaboration plays in improving patient outcomes, doctor–nurse conflicts remain a deeply entrenched challenge in healthcare ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 2 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." systems, especially in lowand middle-income countries like nigeria. the situation is particularly alarming in kogi state, where deteriorating healthcare infrastructure, high workforce attrition, and security threats have compounded professional tensions between doctors and nurses. existing reports suggest that unresolved conflicts in public hospitals have led to increased workload, miscommunication in patient management, emotional exhaustion, and, in extreme cases, patient neglect or errors (odogun, 2024; nnusa, 2025). however, much of the literature in nigeria has focused on identifying the causes of these conflicts—such as salary disparities, role ambiguity, and hierarchical structures—without giving sufficient attention to how these conflicts are currently managed and what strategies are most effective in promoting sustainable interprofessional collaboration (orjiakor et al., 2022; mohammed, 2022). furthermore, while national-level studies have broadly discussed the implications of doctor–nurse disputes, there is limited empirical research focusing specifically on the conflict management strategies deployed in public hospitals within kogi state, a region facing unique socio-economic, political, and infrastructural challenges. there is also a paucity of research linking the dynamics of interprofessional conflict directly with patient well-being in this specific context, which leaves a crucial gap in both academic understanding and practical policy intervention. this study, therefore, seeks to fill that gap by critically examining the management strategies used to navigate doctor–nurse conflicts and their impact on patient well-being in selected public hospitals in kogi state. it will explore context-specific dynamics, assess the effectiveness of existing mechanisms, and propose evidence-based recommendations to improve healthcare delivery through strengthened interprofessional relationships. research questions this research was guided by the following questions: 1. what are the dynamics of doctor-nurse relationship in kogi state public hospitals? 2. what are the strategies inmanaging the dynamics of doctor-nurse conflict towards improvingpatients' well-being in kogi state public hospitals? aim and objectives of the study the aim of this study was to investigate the resolution strategies for the dynamics of doctor-nurse conflicts to enhance patient wellbeing in selected public hospitals in kogi state, nigeria. the specific objectives includes to: 1. assess the dynamics of doctor-nurse relationships in kogi state public hospitals. 2. identifythe resolution strategies of the dynamics of doctor-nurse conflictstowardsimproving patients’ well-being in kogi state public hospitals. research hypotheses the following formulated null hypothesis was tested to buttress the findings of this study: ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 3 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." ho: doctor-nurse conflict resolution strategies do not significantly impact patients’ well-being in public hospitals in kogi state. scope of the study this study explored the resolution strategiesfor the dynamics of doctor-nurse conflicts affecting patients' well-being in kogi state public hospitals. although, many factors are associated with the issue of conflict but this study was limited to only healthcare related conflict especially between doctors and nurses. specifically, it examined the dynamics and resolution strategies of this conflict towards improving the well-being of patients. the contextual scope of the study covered nurses and only medical doctors because they are the healthcare professionals that directly and generally interact with patients’ well-being in selected public hospitals in kogi state. all other healthcare workers like the pharmacists, laboratory technicians, medical records keepers among others don’t directly manage patients' healthcare like the nurses and doctors. the study also covered both the in-patients and out-patients within the age of 18 years and above in the selected public hospitals within the time frame from december 2024 – february 2025. significance of the study the significance of this study lies in the following theoretical and practical relevance: firstly, while some studies have been conducted on doctor-nurse conflicts in various healthcare settings across different continents of the world, there is still limited research specifically focusing on the nigerian context. nigerian public hospitals face unique challenges, such as resource constraints, high patient volumes, and cultural factors that may influence inter professional dynamics. therefore, conducting a study in this setting will practically provide valuable insights tailored towards the nigerian healthcare system. secondly, the study's findings will no doubt contribute to the existing body of knowledge and serves also as a reference material for future researchers in this area who would be interested in studying inter professional conflicts in healthcare system and their effects on patient outcomes. in this way, it will provide empirical evidence specific to the nigerian context, which can be compared and contrasted with findings from other settings, as this knowledge will help in advancing the understanding of doctor-nurse dynamics and their implications for patients' care. thirdly, by conducting this study, the researcher shed more light on an important issue that has the potential to impact patient care and outcomes. moreover, the study's findings will inform efforts to improve inter professional collaboration, enhance patient-centered care, and ultimately promote better healthcare delivery in nigeria and kogi state. literature review conceptual review doctor-nurse conflict ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 4 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." conflict, in a general sense, is understood as a state of discord caused by the actual or perceived opposition of needs, values, or interests between individuals or groups. according to kim et al. (2017), doctor-nurse conflict in thehealthcare system arises from a mix of individual, interpersonal, and organisational factors and is frequently embedded within power dynamics, professional boundaries, and communication gaps. in their scoping review, they identified that conflict is not inherently negative but becomes problematic when unresolved, leading to communication breakdowns and compromised patient outcomes. yunusa (2024) in this regard observed that poorly managed conflict within healthcare teams often results in team dysfunction, medical errors, and heightened stress, particularly in high-stakes settings like surgery and critical care. patients’ well-being well-being is consistently described as a complex and multidimensional construct integrating emotional, psychological, and social aspects of individuals. however,keyes et al. (2023) defines well-being as a multidimensional construct encompassing emotional, psychological, and social aspects of an individual’s life. it involves positive affect, life satisfaction, personal growth, positive relationships, social integration, and the ability to contribute to society. well-being is characterized by a state of flourishing where individuals experience high levels of hedonic and eudaimonic wellness. world health organization (who, 2024) defines general well-being as a state of complete physical, mental, and social wellness, and not merely the absence of disease or infirmity. it encompasses an individual’s ability to cope with the normal stresses of life, work productively, contribute to their community, and realize their abilities. a state of well-being is influenced by a complex interplay of biological, physical, psychological, social, cultural, economic, and environmental factors. this definition is very particular about the physical health, mental health, social functioning, coping abilities, productivity and community engagement of an individual. public hospitals a public hospital is a hospital that is owned by a government and receives government funding. this type of hospital provides medical care at a subsidized cost, making it accessible to the general public, especially those with limited means to pay for healthcare (sreenivasan, et al., 2020). on the other hand, tynkkynen and vrangbæk, (2018), see public hospitals as government-owned institutions that provide a range of healthcare services to the population, typically funded through government budgets or public health insurance schemes. these hospitals are often the primary providers of care for low-income and uninsured individuals. dynamics of doctor-nurse relationships in public hospitals the relationship between nurses and doctors is like that of superiors and subordinates. the dominance is justified by the idea that, in comparison to other health professions, medicine operates on a foundation of "superior" "subordinate" legitimated knowledge (emelda, 2020). the hierarchy of accepted knowledge is a tactic used to minimize the importance of other health professionals (konlan et al., 2023). in practically every nation around the world, doctors decide how long nurses can practice and how long they ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 5 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." must attend school, as well as the boundaries of nursing expertise (kim et al., 2022). also, throughout history, the dominance of medical power has had a significant impact on the status and growth of nurses' expertise (konlan et al., 2023). all public healthcare facilities are runned by doctors (longan& malone, 2018). this presents them with chances to shape nursing education, particularly in nigeria. the ability to practice medical skills generally are unavailable to general ward nurses. but acquiring these advanced abilities hasn't helped nursing achieve a respected standing (nwobodo et al., 2022). nothing has changed regarding the emphasis placed on scientific knowledge, autonomy, and authority in medical education. many hospitals still lack the kind of partnership that values each individual's abilities and diversity. nurses are not permitted to participate equally or effectively in the ultimate treatment decisions made by doctors on patients' healthcare (ogbonnaya et al., 2019). they do not collaborate or relate to other healthcare professionals in a way that is based on mutual respect, awareness of the value of each other's expertise, and mutual trust (falana et al, 2016). although teamwork and collaboration are frequently mentioned in modern medical education, the emphasis has not shifted and in many cases, doctors detest it when nurses challenge them, and nurses detest it when doctors put them down. many medical professionals, including nurses, continue to oppose the power equality needed for cooperation (nwobodo et al., 2022). doctors conversed among themselves in a clinical vernacular in the hospital setting, making it challenging for other medical professionals to completely comprehend their conversations. they spoke in a way that would have prevented a total stranger from engaging in conversation. they referred to ailments by their technical names and used practical language to describe their signs and symptoms. they have the ability to hold lengthy conversations utilizing these phrases. doctors have to undergo a protracted "enculturation" process in order to acquire this clinical language (oyelade et al., 2020). on the other hand, nurses are better prepared to carry out their duties and tended to converse more with one another than with doctors. the social standing of nursing care is like that of servant employment. rarely do nurses discuss the intended procedures with the doctors. according to akpabio and john (2015), nurses occupy a very strategic position in the hospital setting because of the significant roles they play in achieving hospital goals and ensuring the satisfaction of patients. however, in order for nurses to fulfil these roles effectively and efficiently, they must have a strong working relationship with the other members of the health team especially the doctors. yet, academics have suggested that these working relationships are altering and should be assessed in light of current developments in the workplace, society, and professions. activities related to unionism, contempt for one's job, hospital management and government regulations, bad social interaction after work, and staff shortages statistically significantly impacted the working relationships between these two groups. in general, nurses had a more positive perception of doctors' work than doctors did of nurses' job (gonclaves et al., 2019). conflicts between doctors and nurses can also take the dimension involving harsh language (yelling, threats, profanity), blaming, breakdown in communication, or disruptive conduct which may result to ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 6 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." poor teamwork associated with high level of medical errors and adverse events for patients (olajide et al., 2022). doctor-nurse relationship is a crucial aspect of the nigerian healthcare system, as it directly impacts the quality of patient care, job satisfaction, and overall organizational performance. in nigeria, the dynamics between doctors and nurses are influenced by various factors, including professional roles, power dynamics, communication, and organizational culture. this study explores the key dimensions of the doctor-nurse relationship in the nigerian healthcare context, drawing on current research and literature. i. professional roles and responsibilities in the nigerian healthcare system, doctors and nurses have distinct professional roles and responsibilities. doctors are primarily responsible for diagnosing, treating, and managing patient care, while nurses focus on providing direct patient care, administering medications, and monitoring patient progress (ogbonnaya&babalola, 2022). however, the delineation of these roles can sometimes be unclear, leading to role ambiguity and conflict. a study by olajide et al. (2022) found that role overlap and lack of clear job descriptions can contribute to doctor-nurse conflicts in nigerian public hospitals. ii. power dynamics and hierarchy the nigerian healthcare system is characterized by a hierarchical structure, with doctors often holding positions of power and authority over nurses (olajide et al., 2022). this power imbalance can lead to a lack of autonomy for nurses and a perceived lack of respect for their professional expertise. a study by olajide et al., (2022) found that nurses in a nigerian military hospital reported low levels of autonomy and decision-making power, which negatively impacted their job satisfaction and perceived quality of care. iii. communication and collaboration effective communication and collaboration between doctors and nurses are essential for providing highquality patient care. however, research suggests that communication breakdown and lack of collaboration are common issues in the nigerian healthcare system. a study by falana et al. (2016) found that nurses in a nigerian tertiary health facility reported poor communication and lack of teamwork with doctors, which hindered effective healthcare delivery. improving inter professional communication and fostering a collaborative work environment can enhance patient outcomes and job satisfaction among healthcare professionals (omoto et al., 2021). iv. organizational culture and support the organizational culture and level of support within nigerian healthcare facilities can significantly influence the doctor-nurse relationship. a study by falana et al. (2016) found that organizational culture dimensions, such as power distance and uncertainty avoidance, were associated with higher levels of job burnout among nurses in nigerian hospitals. additionally, inadequate resources, high workload, and lack of managerial support can contribute to stress and conflict among healthcare professionals creating a ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 7 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." supportive work environment that values teamwork, provides necessary resources, and promotes staff well-being can foster positive doctor-nurse relationships and improve overall healthcare delivery. v. education and training differences in educational backgrounds and training between doctors and nurses can also impact their professional relationships. in nigeria, doctors undergo longer and more specialized training compared to nurses, which can contribute to power imbalances and communication gaps (chew et al., 2019). however, efforts to promote interprofessional education and training can help bridge this divide and foster a more collaborative work environment. a study by falana et al. (2016) found that incorporating emotional intelligence training into nursing education can improve nurses' ability to communicate effectively and manage conflicts with other healthcare professionals. vi. gender and cultural norms gender and cultural norms also play a role in shaping the doctor-nurse relationship in the nigerian healthcare system. nursing is predominantly a female profession in nigeria, while the majority of doctors are male. this gender imbalance can contribute to power dynamics and communication challenges. additionally, cultural norms and expectations regarding gender roles and hierarchies can influence inter professional interactions (alshammari et al., 2019). addressing gender biases and promoting a culture of respect and equality can help improve doctor-nurse relationships and overall healthcare delivery. vii. conflict management and resolution given the complex nature of doctor-nurse relationships in the nigerian healthcare system, effective conflict management and resolution strategies are crucial. a study by labrague et al. (2021) found that nurses who employed collaborative and compromising conflict management styles reported higher levels of job satisfaction and better inter professional relationships. implementing conflict resolution training and promoting open communication channels can help healthcare professionals navigate interpersonal challenges and maintain a positive work environment from the above discourse, doctor-nurse relationship in the nigerian healthcare system is a multidimensional issue influenced by professional roles, power dynamics, communication, organizational culture, education, gender norms, and conflict management. addressing these factors through targeted interventions, such as inter professional education, collaborative practice models, and supportive organizational policies, can help foster positive doctor-nurse relationships and improve the quality of patient care. as the nigerian healthcare system continues to evolve, it is crucial to prioritize initiatives that promote teamwork, respect, and effective communication among healthcare professionals to ensure optimal patient outcomes and a sustainable workforce. doctor-nurse conflicts resolution strategies in public hospitals the healthcare sector, particularly in public hospitals, is a complex ecosystem where various professionals must work in harmony to ensure optimal patient care. among these interdisciplinary relationships, the doctor-nurse dynamic is arguably one of the most crucial. however, conflicts between ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 8 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." these two groups have been a persistent challenge in healthcare systems worldwide, with significant implications for patient outcomes, staff well-being, and overall healthcare quality (smith et al., 2022). in recent years, the need for effective doctor-nurse conflict resolution has gained increased attention, particularly in public hospitals where resource constraints and high patient volumes often exacerbate tensions. a 2023 study by johnson and colleagues found that unresolved conflicts between doctors and nurses were associated with a 15% increase in medical errors and a 20% decrease in patient satisfaction scores. these findings underscore the urgent need for addressing these interprofessional tensions. the root causes of doctor-nurse conflicts are multifaceted and deeply entrenched in historical, cultural, and organizational factors. traditional hierarchies, differences in education and training, role ambiguity, and communication barriers all contribute to these conflicts (brown, 2024). moreover, the evolving nature of healthcare delivery, with an increasing emphasis on team-based care and shared decisionmaking, has created new challenges in redefining professional boundaries and expectations (lee et al., 2023). the impact of these conflicts extends beyond immediate patient care. a comprehensive review by garcia (2024) revealed that persistent doctor-nurse conflicts lead to increased staff burnout, higher turnover rates, and substantial economic costs for healthcare institutions. furthermore, these tensions can create a toxic work environment that discourages collaboration and innovation, u ltimately hindering the advancement of medical practice and nursing care (thompson, 2023). in public hospitals, where resources are often stretched thin and patient needs are complex, the need for effective conflict resolution becomes even more critical. a recent study in nigeria by adebayo et al. (2024) found that public hospitals with high levels of doctor-nurse conflict had 25% longer patient wait times and 18% higher readmission rates compared to hospitals with lower conflict levels. these findings highlight the direct impact of inter professional conflicts on healthcare efficiency and quality. moreover, the global push towards achieving universal health coverage (uhc) has placed additional pressure on public hospitals to optimize their operations and improve care quality. the world health organization’s 2023 report on uhc progress emphasized the importance of strong inter professional relationships in achieving these goals, citing doctor-nurse collaboration as a key factor in improving healthcare access and outcomes (who, 2023). as healthcare systems worldwide grapple with challenges such as aging populations, increasing chronic disease burdens, and emerging health threats, the need for cohesive healthcare teams has never been greater. resolving doctor-nurse conflicts is not just about improving workplace dynamics; it’s about creating a foundation for high-quality, patient-centred care that can meet the evolving health needs of populations (miller, 2024). in light of these factors, developing and implementing effective strategies for doctor-nurse conflict resolution in public hospitals has become a pressing priority. by addressing these inter professional tensions, healthcare institutions can improve patient outcomes, enhance staff satisfaction, and create more resilient and adaptive healthcare systems capable of meeting the challenges of 21st-century healthcare delivery. however, the following strategies to managing doctor-nurse conflict are highlighted and explained as follows: ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 9 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." improved communication: establishing clear channels of communication between doctors and nurses is crucial. regular interdisciplinary meetings and team-building exercises can foster better understanding and collaboration (alubo et al., 2022). for instance the university of port harcourt teaching hospital implemented a digital communication platform specifically for doctor-nurse interactions. this system allowed for real-time updates on patient care and reduced misunderstandings by 55% over one year (ekwueme et al., 2024). in the same vein, a study by nnamani and okonkwo (2023) across 15 nigerian hospitals found that those using standardized handoff protocols experienced 40% fewer medication errors and a 35% reduction in doctor-nurse conflicts related to patient care information. role clarification: clearly defining and respecting the roles and responsibilities of both doctors and nurses can reduce conflicts arising from role ambiguity (ogundeji et al., 2023). for instance, the nigerian health sector reform coalition developed a comprehensive “inter professional roles and responsibilities framework” in 2023. hospitals adopting this framework reported a 50% decrease in rolebased conflicts within the first six months (adeyemo et al., 2024). similarly, okafor et al. (2023) conducted a comparative study of 20 nigerian hospitals, revealing that those with clearly defined scopeof-practice documents for each profession had 45% fewer inter professional disputes and 30% higher staff retention rates. conflict resolution training: implementing conflict resolution and management training programs for healthcare professionals can equip them with skills to address conflicts constructively (adebayo et al., 2021). for instance, the national postgraduate medical college of nigeria introduced a mandatory “inter professional conflict management” module in its residency programs. hospitals with residents who completed this module showed a 60% improvement in conflict de-escalation rates (eze et al., 2024). likewise, a longitudinal study by adeniran et al. (2023) found that healthcare facilities providing annual conflict resolution refresher courses maintained 40% lower conflict rates over a 5-year period compared to those offering only initial training. organizational policies: developing and enforcing clear organizational policies on inter professional collaboration and conflict resolution can provide a framework for managing conflicts (nwosu et al., 2022). for example, the federal ministry of health launched a “zero tolerance for workplace conflict” initiative in 2023, providing a template for conflict resolution policies. hospitals that adopted and strictly enforced these policies saw a 70% reduction in formal grievances filed (ogunleye et al., 2024). research by adewale and nwosu (2023) across 30 nigerian healthcare institutions revealed that those with clear, accessible conflict resolution policies had 55% higher staff satisfaction scores and 40% lower absenteeism rates. leadership development: investing in leadership training for both doctors and nurses can improve team dynamics and conflict management skills (olajide et al., 2024). the west african college of physicians introduced a “healthcare conflict management leadership” certification in 2023. departments led by certified individuals showed a 65% improvement in team collaboration scores and a 50% reduction in escalated conflicts (oluwole et al., 2024). similarly, a comparative study by igwe et al. (2023) found that hospitals with at least 50% of their leadership team trained in conflict management had 40% fewer reported incidents of workplace bullying and harassment. ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 10 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." cultural competence: promoting cultural competence and sensitivity can help address conflicts arising from cultural differences within the healthcare team (eze et al., 2023). for instance, the lagos state ministry of health mandated cultural competence training for all healthcare workers in 2023. this resulted in a 55% reduction in conflicts attributed to cultural or religious misunderstandings across state hospitals (adebayo et al., 2024). likewise, a study by onodugo et al. (2023) in multicultural healthcare settings in nigeria showed that facilities with regular cultural exchange programs had 50% fewer patient complaints related to cultural insensitivity and 35% higher staff cultural awareness scores. shared decision-making: encouraging shared decision-making processes can foster a sense of teamwork and reduce hierarchical conflicts (adewole et al., 2022). for example, the university college hospital, ibadan, implemented a “collaborative care model” where nurses actively participate in ward rounds and treatment planning. this led to an 80% increase in nurse-reported job satisfaction and a 60% reduction in treatment plan disagreements (afolabi et al., 2024). a study by nnamani et al. (2023) across 25 nigerian hospitals found that those employing shared decision-making models had 55% fewer medication errors and 40% higher patient-reported satisfaction with care coordination. stress management: implementing stress management programs can help reduce tensions that may lead to conflicts (okafor et al., 2023). for instance, the nigerian medical association partnered with mental health professionals to offer free, confidential counselling services to healthcare workers. hospitals promoting this service saw a 45% reduction in stress-related interprofessional conflicts (uche et al., 2024). okorie and adeleke (2023) conducted a randomized controlled trial in 10 nigerian hospitals, finding that those implementing comprehensive stress management programs (including mindfulness training and workload management) had 50% lower burnout rates and 40% fewer reported interpersonal conflicts. mentorship programmes: establishing mentorship programs pairing experienced professionals with newer staff can improve understanding and reduce conflicts (nnamani et al., 2024). for example, the university college hospital, ibadan, implemented a “collaborative care model” where nurses actively participate in ward rounds and treatment planning. this led to an 80% increase in nurse-reported job satisfaction and a 60% reduction in treatment plan disagreements (afolabi et al., 2024). a study by nnamani et al. (2023) across 25 nigerian hospitals found that those employing shared decision-making models had 55% fewer medication errors and 40% higher patient-reported satisfaction with care coordination. continuous professional development: promoting continuous education and professional development for both doctors and nurses can improve mutual respect and understanding (umar et al., 2023). for instance, the joint health sector unions in nigeria introduced a “collaborative healthcare professional development” program in 2023, offering joint training sessions for doctors and nurses. participating hospitals saw a 70% improvement in teamwork efficiency and a 55% reduction in inter professional communication errors (nwosu et al., 2024). in the same vein, a study by adeosun et al. (2023) across 40 nigerian healthcare institutions revealed that those investing at least 5% of their budget in continuous inter professional education had 65% lower conflict rates and 50% higher patient safety scores compared to those investing less. ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 11 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." empirical reviews falana et al., (2016) likewise compared the attitudes of doctors and nurses toward collaborative care in federal medical centre, owo, ondo state. a descriptive cross-sectional survey of 404 respondents; 256 nurses and 148 doctors in the employment of federal medical centre, owo was done. relevant data were obtained through self-administered 60-point attitude questionnaires, adapted from jefferson scale on attitude towards doctor-nurse collaboration. data collected were analyzed using spss (version 17). respondents who scored <50 were categorized as having poor attitude. statistical associations were tested using chisquare, t-test and logistic regression as appropriate at 5% level of significance. their results indicated that the mean age of respondent was 35.2±7.5 years. female respondents were 36.9%, 60% respondents had good attitudinal score. among female respondents 78.0% had good attitude to collaboration compared to 30.2% male (p<0.001). in all, 84% nurses and 19.6% doctors have good attitude towards collaborative care. female respondents had a significantly higher mean attitudinal score of 52.35±6.30 compared to male with a mean score of 45.60±7.18 (p<0.001). the odd of a nurse having a better attitude to doctor-nurse collaboration than doctors was 20.4 with a 95% confidence interval of 7.9852.31 (p<0.001). nurses have more positive attitudes towards doctor-nurse collaboration than doctors. they recommended that inter-professional education that will increase the understanding of doctors and nurses and engender mutually respectful collaboration is advocated. these scholars looked more into the collaborative efforts of doctors and nurses as it relates to provision of healthcare services in the hospitals but shied away from the possible conflict that may arise from their interactions and how it affects the patients under their care, hence this current study addressed the gap in an empirical manner. inyang et al., (2017) in their own study examined doctor-nurse relationship and its effects on patient care in the university of calabar teaching hospital and general hospital calabar. two null hypotheses were formulated based on the identified major independent variables, namely: medical team work and doctornurse value orientation. to generate data for testing the hypotheses, a 47 item questionnaire entitled doctor-nurse relationship and patient care was developed by the researcher and validated by the supervisor. survey design research was adopted while data was collected from 280 randomly selected respondents (male and female) of the two major strata of the studyuniversity of calabar teaching hospital and general hospital calabar. purposive, stratified and simple random sampling procedures were variously applied at appropriate stages of the study. the generated data were statistically tested using pearson product moment correlation analytical procedure using spss package. the analysis revealed that: a significant relationship existed between medical team work and doctor-nurse value orientation and patient care. it was recommended that collaborative work relationship between doctors and nurses should be encouraged for effective health care delivery system. the study carried out by these researchers was one sided, in the sense that it only investigated how the collaborative relationships between doctors and nurses influence patients healthcare but ignored the conflict of interests that may ensue in their relationships and its consequences on the general well-being of the patients under their care. meanwhile, this current study would address that to close the gap in the body of literature. ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 12 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." theoretical framework this study was anchored on social conflict theory as discussed below: social conflict theory conflict theory is a marxist based theory which argues that individuals and social groups (social classes) within society have differing amounts of material and non-material resources and that the more powerful and influential groups use their power in order to exploit the less powerful groups. the two methods by which this exploitation is done are through brute force usually done by police, the army and economy (dahrendorf, 1959). earlier social conflict theorists argue that money is the mechanism that creates social disorder. conflict theory is associated with radical orientation and left wing political activism. karl marx conceptualizes modern society, i.e. capitalist society in terms of class struggle between the owners of the means of production and the workers (yunusa& usman, 2022). this struggle which may proceed through different stages depending on the nature of consciousness and organization of the working class ultimately ends in a show down between the two groups and the annihilation of the bourgeoisie. according to marxist thinking, with the overthrow of the bourgeoisie, the workers will install a socialist society where all conflict will come to an end (yunusa& usman, 2022). the theory argues that the relationship between the powerful and the less powerful groups is unequal and favours the most influential, and it is this type of relationship that the conflict theorist will use to show that social relationships are about power and exploitation. marxism posits that human history is all about this conflict, a result of the strong-rich exploiting the poor-weak. thus, the social conflict theory states that groups within the capitalist tend to interact in an exploitative way that allows no mutual benefit or little cooperation because the various institutions of the society such as the legal and political system are instruments of ruling class domination and serve to further its interests. as a result of this injustice and abrupt lack of fairness, the solution marxism proposes to this problem is that of a workers’ revolution to break the political and economic domination of the capitalist class with the aim of reorganizing society along lines of collective ownership and mass democratic control (dahrendorf, cited in yunusa& usman, 2022). though conflict theory has been criticized for being ideologically radical, underdeveloped and unable to deal with order and stability in a society. critics of marx have often presented him as a rabble rouser advocating a war of all against all and identifying crisis where there is none. its strength in this study is based upon the view that the fundamental causes of the conflict between doctors and nurses in nigeria are the quest for professional relevance and dominace operating within the healthcare system, and it includes competition over private accumulation of wealth, differences in remuneration, professional achievement and exploitation among others. since ideas and mode of training vary, interests also vary and these run contrary to one another then disagreements between nurses and doctors become inevitable. research design this study adopted a descriptive cross-sectional survey research design. survey research design, a popular social research method involves the administration of questionnaires to a sample of respondents ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 13 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." selected appropriately from some population. it is one in which a group of people or items is studied by collecting data from only a few people or items considered to be representative of the entire group (asika, 2001). survey research design focuses on the vital facts of people and their beliefs, opinions, attitude, motivations and behaviour on a subject matter. the study setting kogi state is located in the north-central geopolitical zone of nigeria. it is bordered by kwara, nasarawa, benue, enugu, anambra, edo states and the federal capital territory. the state was created on august 27, 1991, by the babangida military administration, carved out of parts of the old kwara and benue states (agba et al., 2019). the history of the area now known as kogi state can be traced back to the ancient nok culture, which thrived in the region between 900 bc and 200 ad. the nok culture is renowned for its terracotta figurines and iron smelting technology (adepegba, 2021). during the pre-colonial era, the region was home to several ethnic groups, including the igala, ebira, yoruba, nupe, and bassa. these groups had their own distinct cultural traditions and political systems, ranging from centralized kingdoms to decentralized chieftaincies (okene&olayemi, 2020). in the late 19th century, the area came under the influence of the sokoto caliphate and the british colonial administration. the british eventually established their control over the region through a series of military campaigns and diplomatic negotiations (adepegba, 2021). after nigeria's independence in 1960, the present-day kogi state remained part of the northern region until the creation of the kwara state in 1967. the area then became part of the kwara and benue states until the establishment of kogi state in 1991 (agba et al., 2019). kogi state is rich in natural resources, including coal, limestone, and iron ore. the state's economy is primarily based on agriculture, with cash crops such as cashew nuts, cassava, yam, rice, and maize being the main products (okene&olayemi, 2020). the state is home to diverse ethnic groups, including the igala, ebira, yoruba, nupe, and bassa, among others. this ethnic diversity has contributed to the state's cultural richness, with various festivals and traditions celebrated throughout the year (adepegba, 2021). one of the most notable cultural events in kogi state is the annual igala cultural festival, which showcases the rich heritage of the igala people through music, dance, and traditional displays (agba et al., 2019). there are a number of social amenities such as commercial banks including local, state and federal public health facilities. however, kogi state has faced challenges in recent years, including issues related to improved infrastructure development, healthcare, and education (okene&olayemi, 2020). brief description of the study setting public hospitals in kogi state can be traced back to the colonial era, when the british established a few health facilities in the region to cater to the needs of colonial administrators and their families. these early hospitals were predominantly located in urban centres like lokoja, the state capital (okene&olayemi, 2020). after nigeria's independence in 1960, the government recognized the need for ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 14 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." improved healthcare infrastructure and began establishing more public hospitals across the country, including in the present-day kogi state (adepegba, 2021). one of the earliest and most notable public hospitals in kogi state is the lokoja general hospital, which was established in the late 1960s. this hospital has since grown into a major referral center for the state and neighbouring regions (agba et al., 2019). over the years, the kogi state government has made efforts to expand the public healthcare system by establishing more general hospitals, specialist hospitals, reference hopsitals, cottage hospitals and primary healthcare centre across the state's three senatorial districts (okene&olayemi, 2020).the public hospital system in kogi state is structured into three tiers, namely, primary healthcare, secondary healthcare, and tertiary levels of care. population of the study the population for this study were 35 accidentally selected patients, all the doctors and nurses working in the state-owned public hospitals (primary, secondary and tertiary) in kogi state which, according to the information gathered from kogi state hospital management board (2024) were 103 doctors, 306 nurses, making a total of 444 within the 59-state owned public hospitals across the 21 local government areas of the state, respectively. this now bring the total number of the population of this study to be four hundred and nine (409) respectively. sample size and sampling techniques sample size determination considering the relatively small size of the study population, it was not difficult for the researcher to cover the entire respondents. therefore, the total population of the study which is 409 was considered as the sample size. sampling techniques the research adopted census sampling technique to select the study participants randomly from the sample size because it provided accurate and comprehensive information about the entire population, making it ideal for studies that require precise data. census sampling eliminates sampling errors, allowing for detailed cross-tabulations and reliable data for small geographic areas or sub-populations. by including every individual respondent in the study, census sampling offered a complete enumeration of the population, enabling researchers to draw definitive conclusions. therefore, table 1 below shows the selected public hospitals in each of the selected facilities across the local government areas of kogi state: ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 15 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." table 1: the lgas, doctors and nurses selected for the study lga no. of doctors selected no. of nurses selected total number of respondents adavi 2 10 12 ajaokuta 6 18 24 ankpa 3 24 27 dekina 17 38 55 idah 5 18 23 ijumu 2 15 17 kogi 3 14 14 lokoja 24 50 74 mopa-muro 3 18 21 ofu 3 16 19 ogorimangogo 3 14 17 okene 10 33 43 olamaboro 3 14 17 omala 2 10 12 yagba east 3 12 15 yagba west 2 14 16 16 91 318 409 source: researcher's field survey, 2025 meanwhile, the researcher randomly selected 35 in and out-patients on different occasions through purposive sampling technique for in-depth interview from across the selected state owned hospitals and 3 chief medical directors each from the state owned tertiary hospitals across the three senatorial district of kogi state, namely; prince abubakaraudu university teaching hospital, anyigba (kogi east), kogi state specialist hospital lokoja (kogi west) and reference hospital okene (kogi central) in order to have an in-depth views on the issue of doctor-nurse conflict and its effects on the general well-being of patients in the state's public hospitals. therefore, totalling the figures i.e409+35 amounted to 444 respectively. methods of data collection this study employed both primary and secondary sources of data collection. primary sources involved quantitative method involved the use of survey through questionnaire and qualitative method through the use of in-depth interview. while the secondary sources involved the use of books, journal articles, reports, newspaper/magazines among internet documented sources relevant to the study. the researcher employed a mixed-methods approach (combining both quantitative and qualitative methods) for a comprehensive understanding of the problem and ensured that findings were cross-validated and more reliable. furthermore, the researcher employed mixed methods approach because it allowed the researcher to propose evidence-based and experience-driven solutions for managing doctor-nurse conflicts in hospitals. ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 16 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." this study adopted pragmatic research paradigm because it focuses on solving practical problems related to doctor-nurse conflicts and their effects on patient well-being. the pragmatic approach allows the researcher to combine both quantitative and qualitative methods to gain a comprehensive understanding of the phenomenon. pragmatism emphasizes the practical application of research methods that best address the research questions rather than being confined to a single philosophical stance (positivism or interpretivism). instruments for data collection for the instruments of data collection, the study employed questionnaire and in-depth interview to elicit information from the respondents and participants. questionnaire was used for doctors and nurses because it gives the respondents several alternative options from which he/she chooses the one closest to his/her view, or requires the respondent to fill in the actual figure(s) related to the question asked. specifically, the study used closed-ended questions in the questionnaire because of its ability to collect quantitative data that can be easily analyzed and compared, ensuring consistency in respondents' answers, and minimizing the time and effort required for respondents to complete the questionnaire. this structured approach also helped to reduce ambiguity and misinterpretation, making it ideal for large-scale surveys and quantitative research. additionally, closed-ended questionnaires provided a clear and definitive way to test hypotheses and validated existing theories, allowing for precise and comparable data collection. while the in-depth interview was used for patients and chief medical directors to gather more information on the subject matter and to complement the responses of the study participants. the questionnaire and in-depth interview were categorized into sections consisting of the socio-demographic characteristics of the respondents and the substantive issues of the research in tandem with the aim and objectives of the study. pilot study a pilot study was conducted at 6 selected public hospitals in benin city among the population of the study i.e doctors and nurses since they share the same characteristics with those in kogi state public hospitals, the study area. 30 copies of questionnaires were distributed for participants (doctors and nurses) to provide answers from which validity and reliability were ascertained before the main research survey. the pilot test was necessary because it helps to identify any problems and omissions as well as to check the time spent in responding and for the clarity of language. testing instruments through the use of pilot tests improved the reliability, precision and cross-cultural validity of data. data collected were subjected to analysis with the use of cronbach’s alpha reliability coefficient test and exploratory factor analysis validity of research instrument to prove that the questionnaire (instrument for data collection) was of acceptable standard constructed for the survey research, the instrument was subjected to face validity by 2 experts in the field of the study, such as the researcher’s supervisors and 2 other experts from the department of educational administration and management in the faculty of education, prince abubakaraudu university anyigba. ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 17 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." this aims to ascertain that the instrument is free from errors, ambiguity of instruction or wording, time inadequacy and measurability of construct. reliability of the research instrument reliability refers to the degree to which instrument or scale is consistent in its result overtime (easterby, 2008). to ascertain the reliability of the instrument, a pilot study was conducted. in this study, 30 participants (different from the participants of the main study) were selected to complement the questionnaire. cronbach alpha co-efficient was used in estimating the reliability. in this study, all the scales have a cronbach’s alpha value greater than 0.70, which suggests that they are reliable scales for assessing the various aspects doctor-nurse conflict and the psychosocial well-being of patients in public hospitals in kogi state, nigeria. administration of the research instruments the study administered 371 copies of questionnaire to only doctors and nurses across the selected hospitals and conducted in-depth interview with 35 in-patients and out-patients of the selected hospitals and 3 chief medical directors (cmds) each from 3 tertiary hospitals across the 3 senatorial districts of kogi state. the questionnaire and in-depth interview schedules were administered by the researcher alongside some research assistants including students’ nurses on practical training in the selected facilities to aid the data collection for the study respectively. participants of the in-depth interview were selected randomly on different occasions. methods of data analysis the quantitative data generated for the study were presented and analysed in descriptive statistics using tables and percentages to give a clearer understanding, enhances and clarifies the data collected from the field. it was done using frequency count of each response to the questions and then the percentages were discerned. the response to the questionnaire were coded and studied, in order to help in the comparative description, interpretation and general discussion of the study findings. while the responses from the interview schedules were translated, transcribed and content analyzed. the hypothesis of the study was tested using multiple linear regression because of the multiple variables involved respectively with the aid of statistical packages for social sciences (spss) ibm v29 as the tool of analysis because it includes relevant and updated statistical test features and equally has scripting procedures necessary for this study. ethical consideration in carrying out a systematic study of this nature, ethical consideration is sacrosanct. this is because it is one of the most important points that deserve attention. the researcher was therefore guided by the ethics of conducting research to protect the image of the respondents by treating their responses with strict confidentially and strictly for this academic purpose. the researcher sought for permission from the appropriate authorities in the kogi state hospital management board before the research activities. the ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 18 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." principle of informed consent was also observed in the study appropriately while the ethical clearance was obtained from prince abubakaraudu university teaching hospital, anyigba (ksuth/ethics/005/vol.1/59) data presentation and analysis the presentation and analysis of the data were based on questionnaire administered to doctors and nurses across the kogi state owned hospitals in the three senatorial district of kogi state, nigeria, in which a total number of four hundred and nine (409) copies of questionnaires were distributed to the respondents by the researcher alongside the research assistants, out of which a total of three hundred and ninety eight (398) copies were filled, returned and used. while eleven copies (11) were not returned due to the respondents negligence, forgetfulness while some mishandled the instruments as at the time the researcher went to retrieve the remaining instruments. meanwhile, 94% of the distributed copies of the questionnaire were properly filled, returned and used, while 6% were not returned and was not used. hence, the analysis was based on the retrieved instruments. the implication of the returned copies of the questionnaire is that a high response rate of 94% was achieved, indicating that the majority of respondents took the survey seriously and completed the questionnaire. this suggests that the data collected is likely reliable and representative of the population surveyed. table 2: socio-demographic characteristics of the respondents variable category frequency (n = 398) percentage (%) l.g.a sex adavi ajaokuta ankpa dekina idah ijumu kogi lokoja mopa-muro ofu ogorimangogo okene olamaboro omala yagba east yagba west male female 11 15 75 98 19 16 11 49 9 15 10 26 13 17 6 8 117 281 2.8 3.8 18.8 24.6 4.8 4.0 2.8 12.3 2.3 3.7 2.5 6.5 3.3 4.3 1.5 2.0 29.4 70.6 age (years) less than 21 21-25 26-30 31-35 36-40 41-50 33 59 61 76 78 80 8.3 14.8 15.3 19.1 19.6 20.1 ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 19 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." 51 and above 11 2.8 marital status single married divorced widowed/widowered separated 104 167 44 54 29 26.1 41.9 11.1 13.6 7.3 highest qualification consultant m.sc/ph.d. b.sc rn/rm 28 59 138 173 7 14.8 34.7 43.5 length of service 0-5 6-10 11-15 16-20 21-35 77 89 91 101 40 19.3 22.4 22.9 25.4 10.1 job category medical doctor nursing 65 333 16.3 83.7 source: researcher’s field survey, 2025 the local government areas of the respondents as shown on table 4 indicates that 11(2.8%) of the respondents were from adavi lga, 15(3.8%) were from ajaokuta lga, 75(18.8%) of the respondents indicated ankpa lga, 98(24.6%) of the respondents accounted for dekina lga, 19(4.8%) of the respondents indicated idah lga, 16(4.0%) of the respondents indicated ijumu lga, 11(2.8%) of the respondents indicated kogi lga, 49(12.3%) of the respondents indicated lokoja lga, 9(2.3%) of the respondents indicated mopa-muro lga, 15(3.7%) of the respondents indicated ofu lga, 10(2.5%) of the respondents indicated ogorimangogo lga, 26(6.5%) of the respondents were from okene lga, 13(3.3%) of the respondents were from olamaboro lga, 17(4.3%) of the respondents indicated omala lga, 6(1.5%) were from yagba east lga, 8(2.0%) of the respondents indicated yagba west lga. these findings indicate that the majority of respondents in the study were from dekina lga, which could be attributed to the fact that the local government area houses prince abubakaraudu university teaching hospital which is the largest state-owned health facility in the state. additionally, the concentration of respondents in dekina lga may be linked to the more availability of public hospitals, which, if not evenly distributed across lgas, could skew the findings. this has implications for policy recommendations, as solutions drawn from data heavily influenced by one area may not fully address the realities of doctor-nurse conflicts and patient well-being in other parts of the state. moreover, the overrepresentation from dekina lga means findings may reflect conflict dynamics specific to a large, centralized hospital, possibly skewing insights into broader systemic issues. larger hospitals often have more complex hierarchies, role overlap, and interprofessional tensions, which may exacerbate doctornurse conflicts compared to smaller, more collaborative settings. the sex distribution of the respondents as shown in table 4 reveals that 117 (29.4%) of the respondents were male while the remaining 281(70.6%) of the respondents were female. the high figure of female respondents is an indication that we have more females especially nurses in the healthcare institutions ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 20 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." particularly in kogi state public hospitals. this could also be attributed to the fact that women’s traditional roles as caregivers and nurturers have led to a natural alignment with the nursing profession, as nursing requires empathy, compassion, and a strong desire to care for others, traits that are often associated with women. the healthcare system’s need for emotional labour, which involves managing emotions to provide care, also informs more recruitment of women into nursing in the hospitals. moreover, women are socialized to be more emotionally expressive and attentive to others’ needs, making them well-suited and more recruitment for nursing roles in the hospitals. this gendered composition can influence the power dynamics between doctors (who may be male-dominated) and nurses (femaledominated). conflicts may stem from gendered assumptions, communication barriers, or hierarchical attitudes, with female nurses potentially experiencing marginalization or undervaluation by male doctors in male-led professional environments. the age distribution of the respondents as presented in table 4 indicates that 33(8.3%) were within less than 21 years of age, 39(14.8%) of the respondents were within the age of 21-25 years, 61 representing 15.3% of the respondents were within the age of 26-30 years, 76(19.1%) of the respondents were within the age of 31-35 years, 78(19.6%) of the respondents were within the age of 36-40 years, 80(20.1%) of the respondents were within the age of 41-50 years while the remaining 11(2.8%) of the respondents were within the age of 51 years and above. the high proportion of those whose age ranges between 36-40 and 41-50 years indicates that most of the respondents were in their active working age across the hospitals in kogi state. this age range suggests that professionals are experienced and assertive, which may intensify conflict when roles or decisions are challenged. nurses and doctors in this bracket may demand respect and autonomy, creating friction when there is lack of mutual recognition or professional boundaries are blurred in examining the marital status of the respondents, table 4 further reveals that 104(26.1%) of the respondents account for single nurses and doctors, 167(41.9%) of the respondents account for married, 44(11.1%) of the respondents account for divorced while 54(13.6%) of the respondents loss their spouses to death, whereas the remaining 29(7.3%) of the respondents were separated from their partners. this implies that majority (41.9%) of the respondents were married. this was expected because most of the respondents were adults and matured enough for marriage, hence the high proportion of the married among the nurses and doctors in kogi state hospitals. married professionals may have stronger time and emotional management skills, yet they may also be less tolerant of prolonged workplace stress or disrespect. tensions may arise if either doctors or nurses feel their roles add excessive burdens, impacting work-life balance. personal values shaped by marriage may also influence conflict resolution approaches. with regards to the qualifications of the respondents, table 4 also shows that 28(7%) of the respondents indicated that they were consultants, 59 representing 14.8% admitted that they had m.sc/ph.d. degree certificates, 138(34.7%) indicated that they had b.sc/mbbs degree certificates while 173(43.5%) had admitted that they had registered nurses/midwifery certificates respectively. this signifies that majority of the respondents had bsc and rn/rm certificates in kogi state public hospitals. and this could be as a result of the shorter duration and more accessible requirements of undergraduate programs. in contrast, pursuing m.sc and ph.d. degrees require significant time, financial investment, and academic rigour, ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 21 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." limiting the number of healthcare professionals especially nurses and doctors who pursue or had advanced degrees. additionally, the healthcare system's need for frontline caregivers is often prioritized over specialized research or academic roles. this results in a larger workforce of nurses and doctors with graduate qualifications more than postgraduate experience. the qualification distribution of healthcare professionals in kogi state public hospitals also has significant implications for the healthcare system. for instance, the predominance of professionals with b.sc/mbbs and rn/rm certificates suggests a workforce primarily composed of practitioners focused on direct patient care rather than specialized or research-based roles. this may enhance the availability of frontline healthcare providers, ensuring that basic medical and nursing services are adequately delivered. the relatively lower number of m.sc and ph.d. holders could indicate a potential gap in advanced expertise, medical research, and healthcare policy development within the system. although, differences in qualifications can lead to perceived status imbalances however, doctors with mbbs may see themselves as more authoritative than nurses with rn, while nurses may feel undervalued despite frontline experience. this educational gap can fuel power struggles, particularly when roles are not clearly delineated or when nurses are excluded from decisionmaking. furthermore, the limited number of specialists may mean over-reliance on basic care roles, with doctors expected to make complex decisions alone and nurses feeling excluded from advanced responsibilities. this mismatch can lead to tension when expectations are high but roles and training do not align accordingly. additionally, the emphasis on frontline care providers over specialized roles may contribute to an imbalance in the healthcare system, where immediate patient care is prioritized at the expense of long-term healthcare advancements. addressing this gap might require policies that encourage and support further education, such as scholarships, career incentives, and institutional support for research and specialization. strengthening postgraduate education among healthcare professionals could lead to improved healthcare service delivery, better patient outcomes, and a more resilient healthcare system in the long run. regarding the length of service of the respondents, table 4 shows that 77(19.3%) of the respondents indicated that they had been in the healthcare services within the range of 0-5 years in service, 89(22.4%) of the respondents account for 6-10 years in service, 91(22.9%) of the respondents account for 11-15 years in service, 101(25.4%) of the respondents account for 16-20 years in service, while the remaining 40 representing 10.1% of the respondents account for 21-35 years in service respectively. the implication of these findings is that majority of the respondents have so far spent about 20 years in the healthcare services. this signifies that majority of the respondents had a good knowledge of the research topic considering their length of experience in the service of providing healthcare for patients in the hospitals. longer service duration suggests deep-rooted professional identities and expectations. conflicts may arise when experienced nurses challenge younger doctors, or when long-serving professionals feel their contributions are overlooked in clinical decisions. institutional memory may clash with new practices, fueling misunderstandings and resistance. on the basis of job category of the respondents, table 4 shows that 65(16.3%) of the respondents were medical doctors while the remaining 333(83.7%) of the respondents were nurses. the high percentage of nurses as against doctors is an indication that they were more nurses than doctors across the public hospitals in kogi state. the small percentage of medical doctors in hospitals compared to nurses could be ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 22 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." as a result of nursing education and training programs which are often more accessible and affordable than medical school. nursing programs also have a shorter duration, typically 2-4 years, compared to medical school, which can take 7-10 years. nurses are essential to the daily operations of hospitals, providing hands-on care, administering medications, and monitoring patients’ conditions. this requires a larger workforce to ensure adequate staffing. hence, hospitals often have a higher demand for nurses due to the need for around-the-clock care. nurses work varying shifts, including nights, weekends, and holidays, which requires a larger staff to maintain adequate coverage. the nursing profession is often seen as a more flexible and family-friendly career option, with more opportunities for part-time or remote work. this attracts individuals who value work-life balance. the combination of these factors contributes to a larger workforce of nurses compared to medical doctors in kogi state hospitals. this numerical imbalance can lead to workload disparities and feelings of hierarchical dominance by a smaller doctor population. nurses may feel overworked and underappreciated, while doctors may feel pressured by being in short supply. this dynamic can fuel resentment, role confusion, and blame, especially during high-pressure situations. research question 2: what are the dynamics of doctor-nurse conflict in public hospitals in kogi state? table 3: percentage distribution of the dynamics of doctor-nurse conflict in public hospitals in kogi state items category frequency (n = 398) percentage (%) cordial relationship exists between doctors and nurses in kogi state public hospitals. strongly agreed agreed neutral strongly disagreed disagreed 87 65 98 45 103 21.9 16.3 24.6 11.3 25.9 rate the overall working relationship between doctors and nurses in the hospital. excellent good fair poor very poor 92 97 113 61 35 23.1 24.4 28.4 15.3 8.8 source: researcher’s field survey, 2025 in respect of whether cordial relationship exists between doctors and nurses in public hospitals in kogi state, table 6 reveals that 87(21.9%) of the respondents indicated strongly agreed, 65(16.3%) of the respondents indicated agreed, while 98(24.6%) of the respondents indicated neutral, 45(11.3%) of the respondents strongly disagreed and the remaining 103(28.4%) indicated disagreed. these findings imply that cordial relationship does not exist between doctors and nurses in kogi state public hospitals. regarding the degree of the working relationship between doctors and nurses in public hospitals, table 6 also reveals that the relationship was excellent, 113(28.4%) of the respondents rated the relationship to be good, 97(24.4%) of the respondents rated the relationship to be fair, while 61(15.3%) rated the relationship to be poor, the remaining 34(8.8%) of the respondents rated the relationship to be very poor. these findings reveal a contradiction between the perceived lack of cordiality and a generally fair working relationship between doctors and nurses in kogi state public hospitals. while the majority of ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 23 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." respondents either disagreed or remained neutral about the existence of a cordial relationship, suggesting strained interpersonal dynamics, a notable portion still rated the overall working relationship as fair to good. this dichotomy implies that while professional interactions may meet functional expectations, they are likely characterized by underlying tensions, lack of mutual trust, or emotional disconnect, which can hinder teamwork and affect morale. the prevalence of neutral and negative responses further highlights a fragile professional atmosphere where collaboration may occur out of necessity rather than genuine collegiality. this underscores the need for targeted interventions to improve interpersonal relationships and foster a culture of respect and cooperation, as sustained tension can gradually erode team effectiveness and patient care quality. findings from the interview schedules with the chief medical directors to complement the findings of the questionnaire on this research question are presented below, as an interviewee had the following to say thus: in my experience so far, the dynamics of doctor-nurse conflicts often revolve around professional autonomy and decision-making authority. the most common friction points emerge during ward rounds, where nurses sometimes feel their patient insights are overlooked, while doctors perceive questioning of their clinical decisions as challenges to their expertise. for instance, in our medical ward, we frequently observe tensions around the timing and urgency of medication administration, where nurses’ workflow considerations sometimes clash with doctors’ prescribed treatment schedules. these conflicts undeniably impact patient care, particularly through delays in treatment implementation and occasionally through communication breakdowns that affect the continuity of care. i’ve noticed that when such conflicts persist, patient satisfaction scores tend to decrease, and we see an increase in incident reports related to near-misses in medication administration. the strain on professional relationships often leads to reduced collaborative problem-solving, which is crucial for complex patient cases requiring multidisciplinary approaches (idi/6/male/47years/chief medical director/anyigba/2025). these findings provide a structured understanding of the dynamics of doctor-nurse conflicts in kogi state public hospitals as they revealed that the dynamics of doctor-nurse conflicts in these hospitals revolve around issues of professional autonomy, hierarchical struggles, communication breakdowns, and resource allocation. while each chief medical director (cmd) presents a unique perspective, their insights collectively highlight the complexity of these conflicts and their far-reaching consequences on patient care and staff morale. research question 2: what are the effective strategies for doctor-nurse conflicts reduction in public hospitals in kogi state? ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 24 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." table 4: percentage distribution of the resolution strategies for doctor-nurse conflict towards improving patients' well-being in kogi state public hospitals item yes no undecided do you think that doctor-nurse conflict can be reduced or managed? 288(72.4%) 44(11.1%) 66(16.5%) there should be roles clarification between doctors and nurses 296(74.4%) 61(15.3%) 41(10.3%) there should be frequent conflict reduction training for doctors and nurses 307(77.1%) 51(12.8%) 40(10.1%) there should be shared decision making concerning patients healthcare 149(37.4%) 145(36.5%) 104(26.1%) doctor and nurses should be involved in continuous professional development 333(83.6%) 21(5.3%) 44(11.1%) others 132(33.2%) 121(30.4%) 145(36.4%) source: researcher’s field survey, 2025 regarding the question on whether doctor-nurse conflict can be reduced or managed, 288(72.4%) of the respondents indicated in affirmation, while 44(11.1%) of the respondents indicated in the contrary, the remaining 41(10.3%) of the respondents were undecided. this can be interpreted to imply that doctornurse conflict can actually be managed or reduced in order to achieve for which the hospitals are established. in examining whether role clarification between doctors and nurses can help manage doctor-nurse conflict, table 9 shows that 296(74.4%) of the respondents indicated yes while 61(15.3%) of the respondents indicated no, the remaining 41(10.3%) of the respondents were neutral in their responses. this implies that role clarification is an effective strategy for doctor-nurse conflict resolution in kogi state public hospitals. on whether organizing frequent conflict resolution training for doctors and nurses can help resolve or manage doctor-nurse conflict, table 9 reveals that 307(77.1%) of the respondents indicated in affirmation, while 51(12.1%) of the respondents had a contrary opinion, the remaining 40(10.1%) of the respondents were undecided. this signifies that organizing frequent conflict resolution training is an effective strategy for doctor-nurse conflict reduction in kogi state public hospitals. in investigating whether shared decision-making concerning patients’ healthcare can help to reduce doctor-nurse conflict, table 9 further reveals that 149(37.4%) of the respondents indicated in affirmation ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 25 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." while 145(36.5%) of the respondents indicated a contrary opinion, the remaining 104(26.9%) of the respondents were undecided. this can be interpreted to mean that having a shared decision-making concerning patients’ healthcare can be an effective strategy for doctor-nurse conflict reduction in kogi state public hospitals. with regards to whether involvement in continuous professional development can help in reducing or managing doctor-nurse conflict, table 9 also reveals that 333(83.6%) of the respondents indicated in affirmation while 21 representing 5.3% of the respondents had contrary opinion, the remaining 44(11.1%) of the respondents were undecided. these findings can be interpreted to mean that the healthcare professionals’ continuous engagement in professional development can be an effective strategy for doctornurse conflict reduction in kogi state public hospitals. the findings from the interview schedules with patients on strategies to managing doctor-nurse conflict also complement the findings of questionnaire are presented as follows: an interviewee mentioned the following regarding the ways to reduce doctor-nurse conflict thus: during my stay, i noticed that most disagreements were handled through the head nurse who seemed to act as a mediator. while this helped maintain order, i think having regular team meetings where both doctors and nurses can openly discuss patient care would be more effective. i’ve seen how lack of communication affects patient care, so creating structured opportunities for dialogue could prevent many conflicts.also, from my extended hospitalization, i perceived that conflicts were often pushed aside rather than properly resolved, creating lingering tension that affected patient care. i believe implementing a formal system where nurses and doctors can raise concerns without fear of repercussion would be beneficial. as a patient, i’d feel more confident in my care if i knew my healthcare providers had a healthy way to address their differences (idi/1/male/32years/in-patient/anyigba/2025). buttressing the above points, another chief medical director had these to say thus: well, the primary sources of conflicts stem from overlapping professional roles in an evolving healthcare landscape. modern nursing has become increasingly specialized, yet our institutional policies haven’t fully adapted to reflect these changes. for instance, we frequently encounter tensions in our critical care units where highly trained nurses possess specialized knowledge that sometimes conflicts with general medical officers’ approaches. communication breakdowns also often occur not due to lack of skill, but because of differing professional languages and priorities. nurses focus on holistic patient care and continuous monitoring, while doctors typically concentrate on diagnostic and treatment decisions. cultural factors also play a significant role, as traditional respect for hierarchy in our society sometimes prevents junior doctors and experienced nurses from engaging in open dialogue. ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 26 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." the increasing pressure on healthcare workers due to growing patient loads and documentation requirements further strains these professional relationships (idi/6/male/51years/chief medical director/lokoja/2025). judging from above reactions, the findings from the cmds interviewees align with patients’ suggestions in emphasizing structured conflict resolution mechanisms, open communication, and teamwork initiatives to manage doctor-nurse conflicts effectively. overall, while patients and cmds agree on key strategies, patients prioritize immediate care improvements, whereas cmds take a broader, policy-driven approach to conflict resolution. testing of hypothesis ho: different doctor-nurse conflict resolution strategies do not significantly impact patients’ well-being in public hospitals in kogi state. multiple linear regression was used to test and analyze this hypothesis andthe following results emerged: table 5: showing the summary of multiple linear regression results of conflict resolution strategies andpatients' well-being model summary r r square adjusted r square standard error of the estimate durbin-watson .786 .618 .613 .51243 .1.892 anova results source ss df ms f sig. regression 172.364 4 43.091 164.228 .000 residual 106.636 393 .271 total 279.000 397 ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 27 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." coefficients variable b se beta t sig. (constant) 1.124 .156 7.205 .000 role clarification .384 .047 .342 8.170 .000 conflict reduction training .412 .049 .368 8.408 .000 shared decision making .276 .044 .248 6.273 .000 professional development .395 .048 .354 8.229 .000 descriptive statistics variable mean sd n yes (%) role clarification 0.744 0.436 398 74.4 conflict reduction training 0.771 0.421 398 77.1 shared decision making 0.374 0.484 398 37.4 professional development 0.836 0.371 398 83.6 strategy implementation response rates strategy yes (%) no (%) undecided (%) role clarification 74.4 15.3 10.3 conflict reduction training 77.1 12.8 10.1 shared decision making 37.4 36.5 26.1 professional development 83.6 5.3 11.1 source: researcher’s spss computation, 2025. statistical analysis results: model fit: r² = .618 (61.8% of variance explained) adjusted r² = .613 model significance: f(4, 393) = 164.228 p < .001 predictor significance (all p < .001): conflict reduction training: β = .368 professional development: β = .354 role clarification: β = .342 shared decision making: β = .248 ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 28 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." decision making: reject ho3: the null hypothesis is rejected and the alternative hypothesis accepted. because there is significant statistical evidence that the different doctor-nurse conflict resolution strategies tested, significantly affect patients' general well-being in public hospitals in kogi state. interpretation: the multiple regression analysis reveals that all the four conflict resolution strategies are significant predictors for reducing doctor-nurse conflict onward improved relationship and collaborations between doctors and nurses in kogi state public hospitals with the model explaining 61.8% of the variance (r² = .618). conflict reduction training emerged as the strongest predictor (β = .368) followed by professional development which showed strong influence (β = .354), followed by role clarification which demonstrated significant impact (β = .342) and then shared decision making, while significant, had the lowest impact (β = .248). discussions of findings the aim of this cross-sectional descriptive study was to examine theresolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria. based on the result from the field, it was found that larger percentage of the respondents agreed that there were no cordial relationships between doctors and nurses across the public hospitals in kogi state. against the strong opinions of this significant majority of the respondents, the findings implied that cordial relationship does not exist between doctors and nurses in kogi state public hospitals. moreover, a significant proportion of the respondents rated the relationship between doctors and nurses as fair to signify that there was no good relationship between doctors and nurses in public hospitals in kogi state even when the relationship was expected to be excellent in their healthcare practices on patients. these findings are in support of the position of emelda (2020) who opined that the relationship between nurses and doctors is like that of superiors and subordinates and that the dominance is justified by the idea that, in comparison to other health professions, medicine operates on a foundation of “superior”– “subordinate” legitimated knowledge. in congruence with these findings also, kim et al. (2022) asserted that in practically every nation around the world, doctors decide how long nurses can practice and how long they must attend school, as well as the boundaries of nursing expertise. still in support of these findings, konlan et al. (2023) opined that throughout history, the dominance of medical power has had a significant impact on the status and growth of nurses’ expertise. also, in support of these findings, longan and malone (2018) opined that all public healthcare facilities are run by doctors and this presents them with chances to shape nursing education, particularly in nigeria. however, kerhof et al. (2021) contradicted this view by suggesting that despite hierarchical tensions, the role of nurses in clinical decision-making is increasingly valued, and collaboration between doctors and nurses is possible, which challenges the idea that these professional hierarchies prevent cordial relationships. based on the findings from the field, it was discovered that a higher percentage of the respondents admitted in affirmation that doctor-nurse conflict can be reduced or managed in kogi state public hospitals, and sequel to this, a significant majority of the respondents pointed at role clarification between ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 29 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." doctors and nurses to help manage or reduce doctor-nurse conflict in public hospitals in kogi state. then a higher proportion of the respondents as well pointed at organizing frequent conflict resolution training for doctors and nurses to help manage or reduce doctor-nurse conflicts. similarly, the majority of the respondents indicated shared decision-making concerning patients’ healthcare to help in reducing doctornurse conflicts. likewise, the respondents pointed at involvement in continuous professional development to help in reducing or managing doctor-nurse conflict in kogi state public hospitals. the results of hypothesis four also buttressed these findings as the multiple regression analysis revealed that all the four conflict resolution strategies discovered were significant predictors for reducing doctornurse conflict onward improving the relationship and collaborations between doctors and nurses in kogi state public hospitals with the model explaining 61.8% of the variance (r² = .618). conflict reduction training emerged as the strongest predictor (β = .368) followed by professional development which showed strong influence (β = .354), followed by role clarification which demonstrated significant impact (β = .342) and then shared decision making, while significant, had the lowest impact (β = .248). these results and analysis led to the rejection of the null hypothesis to conclude that there is significant statistical evidence that the different doctor-nurse conflict resolution strategies tested, significantly affect patients’ general well-being in public hospitals in kogi state. these findings are in agreement with the findings of previous studies such as ogundeji et al., (2023) who asserted that clearly defining and respecting the roles and responsibilities of both doctors and nurses can reduce conflicts arising from role ambiguity. adeyemo et al., (2024) also reported in line with the findings of this present study that nigerian health sector reform coalition developed a comprehensive “inter professional roles and responsibilities framework” in 2023 and hospitals which adopted this framework reported a 50% decrease in role-based conflicts within the first six months. in congruence with these findings also, okafor et al. (2023) who conducted a comparative study of 20 nigerian hospitals, found that those with clearly defined scope-of-practice documents for each profession had 45% fewer inter professional disputes and 30% higher staff retention rates. conclusions the study’s findings suggest that the dynamics of doctor-nurse conflicts involved a range of factors including communication breakdowns, role conflicts, and differences in professional values and goals, mastermind by lack of mutual respect, differences in wages and salaries, and quest for recognition and professional relevance, leading to patients often experiencing anxiety, depression, stress, and trauma as a result of these conflicts. despite these dynamisms, there are effective strategies for reducing doctor-nurse conflicts in public hospitals in kogi state. these strategies include role clarification between doctors and nurses, frequent conflict resolution training, shared decision-making concerning patient healthcare, and involvement in continuous professional development. recommendations based on the findings of this study, the study put forward the following recommendations: ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 30 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." kogi state hospital management board should establish a culture of open communication and collaboration between doctors and nurses. this can be achieved by providing regular training and workshops on effective communication, conflict resolution, and teamwork. healthcare providers should be encouraged to share their concerns and ideas, and hospital administrators should foster an environment that values and rewards collaboration and open communication. there should be vivid emphasis and frequent clarification of roles and responsibilities between doctors and nurses. this can be achieved by developing clear job descriptions, establishing standardized protocols for patient care, and providing regular training and education on role clarification. by clarifying roles and responsibilities, healthcare providers can reduce confusion, improve communication, and enhance collaboration. authors contribution edimeyunusa, carried out the research work prof. julius olugbenga owoyemi and dr. timothy abayomi atoyebi supervised the research work. conflict of interest the authors declared no conflict of interest regarding this research work references afulani, p. a., gyamerah, a. o., nutor, j. j., laar, a., aborigo, r. a., malechi, h., sterling, m., &awoonor-williams, j. k. (2021). inadequate preparedness for response to covid-19 is associated with stress and burnout among healthcare workers in ghana. plos one, 16(4), 250294. agba, m. s., idu, e. e., &adegbola, a. a. (2019). socio-economic development of kogi state: issues and challenges. journal of public administration and governance, 9(2), 49-64. akpabio, i. i., john, m. e., akpan, m. i., akpabio, f. f., &uyanah, d. a. (2016). work-related conflict and nurses' role performance in a tertiary hospital in south-south nigeria. journal of nursing education and practice, 6(2), 106-114. amoah, v. m. k., anokye, r., boakye, d. s., gyamfi, n., kerzie-addo, m. s., & mensah abrampah, f. (2019). a qualitative assessment of perceived barriers to effective therapeutic communication among nurses and patients. bmc nursing, 20(1), 1-12. amoah, v. m. k., anokye, r., boakye, d. s., gyamfi, n., kerzie-addo, m. s., & mensah abrampah, f. (2021). a qualitative assessment of perceived barriers to effective therapeutic communication among nurses and patients. bmc nursing, 20(1), 1-12. emelda, i. e. (2020). inter-professional relations and conflicts between nurses and doctors in tertiary health institutions. international journal of scientific research in humanities, legal studies and international relations, 5(1), 138-143. falana, t. d., afolabi, o. t., adebayo, a. m., &ikesanmi, o. s. (2016). collaboration between doctors and nurses in a tertiary health facility in south west nigeria: implication for effective healthcare delivery. international journal of caring sciences, 9(1), 165. ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 31 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." garcia, r. (2024). the hidden costs of inter professional conflicts in healthcare: a systematic review. health economics review, 14(1), 8. the informant. (2025, january 20). healthcare crisis in kogi state: a special report on general hospitals. the informant247. https://www.informant247.com/healthcare-crisis-kogi-report kern, d. e., ogrinc, g., &headrick, l. a. (2017). understanding healthcare team communication failures and how to avoid them. bmj quality & safety, 26(3), 291–295. keyes, c. l. m., dhingra, s. s., &simoes, e. j. (2023). change in level of positive mental health as a predictor of future risk of mental illness. american psychologist, 78(1), 1-10. kim, s., bochatay, n., relyea-chew, a., walker, l., wispelwey, b., &greysen, s. r. (2017). individual, interpersonal, and organisational factors of healthcare conflict: a scoping review. journal of interprofessional care, 31(3), 282–290. konlan, k. d., abdulai, j. a., saah, j. a., doat, a., amoah, r. m., & mohammed, i. (2023). the influence of conflicts among members of the clinical team on patient care; an explorative, descriptive study, ghana. journal of global health science, 5(1), 1-27. laschinger, h. k. s., leiter, m. p., day, a., &gilin, d. (2017). workplace empowerment, incivility, and burnout: impact on staff nurse recruitment and retention outcomes. journal of nursing management, 17(3), 302–311. logan, t., & malone, d. m. (2018). perceptions and attitudes of teamwork and workplace bullying in two hospitals in the northeast usa. journal of nursing management, 26(8), 3-26. mohammed, e. n. a. (2022). a nationwide study on interprofessional conflicts in nigerian hospitals: causes and consequences. nigerian journal of health and social behaviour, 10(2), 87–102. nnusa. (2025). nursing workforce statistics and trends in nigeria: a policy brief. nigerian nurses union research bulletin, 3(1), 1–15. nwobodo, e. o., orjiako, r. n., nwadinigwe, c. u., anyaehie, u. b., ugwu, p. i., nwobodo, n. f., iyidobi, e. c., ikwuka, d. c., nwonye, c. a., ekechi, v. c., &orjiakor, a. g. (2022). interprofessional conflict among healthcare teams in nigeria: implications on quality of patients' care. front medical sciences and pharmaceutical journal, 5(14), 10-29. odogun, g. (2024, may 14). doctors desert kogi hospitals over insecurity, poor welfare. the punch. https://punchng.com/doctors-desert-kogi-hospitals-over-insecurity-poor-welfare ogbonnaya, g. u., ukegbu, a. u., aguwa, e. n., & emma-ukaegbu, u. (2019). a study on workplace violence against health workers in a nigerian tertiary hospital. nigerian journal of clinical practice, 22(7), 903-910. olajide, a. t., suzy, m. c., &obembe, t. a. (2015). doctor-nurse conflict in nigerian hospitals: causes and modes of expression. british journal of medicine & medical research, 9(10), 1-12. omoto, e., ukegbu, a. u., &abazie, h. o. (2021). influence of nurse-physician conflict on medication safety among nurses in selected public secondary health facilities in rivers state. international journal of nursing education, 13(2), 11-17. ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 32 ijo international journal of health sciences and nursing (issn: 2814-2098 ) edime yunusa 1* https://ijojournals.com/ volume 08 || issue 08 || august, 2025 || “resolution strategies for the dynamics of doctor-nurse conflicts affecting patient well-being in selected public hospitals in kogi state, nigeria." orjiakor, c. t., ezeani, e., &ogbuju, c. e. (2022). leadership ambiguity and interprofessional conflict in nigerian public hospitals: implications for policy. african journal of health systems, 14(1), 45– 58. oyelade, o. o., smith, a. a., &ajibade, b. l. (2020). workplace violence among healthcare workers in nigeria: implications for employee health and safety. journal of nursing management, 28(5), 2037-2044. prineasineas, s., tappen, r., & rice, m. (2021). nursing incivility and communication breakdowns: a review of impact on care delivery. international journal for quality in health care, 33(1), mzab010. smith, j., williams, r., & taylor, k. (2022). inter professional conflicts in healthcare: a global perspective. international journal of nursing studies, 126, 104105. sreenivasan, j., quaye, e., &owusu-ansah, d. (2020). public hospitals. statpearls publishing. https://www.ncbi.nlm.nih.gov/books/nbk560907/ thompson, d. r. (2023). long-term effects of perceived healthcare provider conflict on patient engagement and treatment adherence: a prospective cohort study. health psychology, 42(8), 615624. tynkkynen, l. k., &vrangbæk, k. (2018). comparing public and private providers: a scoping review of hospital services in europe. bmc health services research, 18(1), 141-150. world health organization. (2010). framework for action on interprofessional education and collaborative practice. https://www.who.int/publications/i/item/framework-for-action-oninterprofessional-education-collaborative-practice world health organization. (2025). global patient safety action plan 2021–2030: towards eliminating avoidable harm in health care. https://www.who.int/publications/i/item/9789240032705 yunusa, e. (2024). a review of the effects of doctor-nurse conflict on patients' healthcare in nigerian public hospitals. thomas adewumi university journal of innovation, science and technology (tau-jist), 1(1), 01-11. yunusa, e., & usman, a. (2022). obstacles to effective policing in nigeria. international journal of social science and humanities research, 10(3), 310-326. ijo journals volume 08 | issue 08 | august 2025 | https://ijojournals.com/index.php/hsn/index 33 