أطروحات الدكتوراه (Doctoral Dissertations)

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Browsing أطروحات الدكتوراه (Doctoral Dissertations) by Author "Amani Saleem Ahmad Salim"

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    Incidence, Prevalence, and Maternal Journeys: Investigating Preterm Births in the West Bank, Palestine -PHD
    (Al-Quds Univeersity, 2026-07-15) Amani Saleem Ahmad Salim; أماني سليم أحمد سليم
    Background: Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality worldwide. In the West Bank, Palestine, limited evidence exists on PTB incidence, determinants, and maternal experiences. Aim: To determine the incidence, prevalence, risk factors, and neonatal outcomes of preterm births in the West Bank and explore mothers’ experiences caring for preterm infants in Neonatal Intensive Care Units (NICUs). Methodology: A multi-methods approach included three studies: (1) a hospital-based cohort of 18,760 live births (January 2023–May 2024) to assess PTB incidence and risk factors, (2) a cross-sectional study of 1,235 mothers (April–August 2025) examining prevalence, maternal characteristics, and neonatal outcomes, and (3) a qualitative study with 18 mothers exploring experiences in NICUs. Quantitative analyses used descriptive statistics and multivariable logistic regression; qualitative data were analysed using content analysis. Results: In the cohort, 1,427 (7.6%) births were preterm, mostly moderate to late preterm (7.0%). Higher PTB risk occurred in mothers <20 (aOR 1.53) or ≥35 years (aOR 1.32), male infants (aOR 1.16), and multiple pregnancies (twins aOR 4.98; triplets aOR 17.28). Ramallah had the highest PTB rates (aOR 23.5). In the cross-sectional study, PTB prevalence was 14.1%, with 75.3% moderate to late, 16.1% very, and 8.6% extremely preterm. Significant risk factors included maternal age 19–34, household size <3, history of stillbirth (aOR 9.84), assisted conception (aOR 2.18), short interpregnancy interval (aOR 1.89), chronic disease (aOR 3.50), PROM >18 hours (aOR 3.00), preeclampsia (aOR 3.33), antepartum hemorrhage (aOR 2.93), placental abnormalities (aOR 5.97), miscarriage history (aOR 3.55), and one prior caesarean (aOR 1.90). Primigravida women had lower odds (aOR 0.42). Safe healthcare access was protective (aOR 0.67). Preterm infants were more likely to be admitted to NICU (19.0% vs 8.5%) and had low/very low birth weight (43.7% vs 7.6%). The qualitative study revealed one overarching theme: living between fear and hope while struggling for maternal identity, with four main themes: (1) entering motherhood through emotional turmoil and perceived threat, (2) disruption and reconstruction of the maternal role, (3) navigating support and stress in interactions with healthcare providers, and (4) transforming maternal identity through meaning and strength. Mothers’ initial anxiety and identity disruption evolved into competence and adaptive coping via caregiving, professional/family support, and spiritual meaning-making. Conclusion: PTB in the West Bank is influenced by maternal, obstetric, and household factors and linked to adverse neonatal outcomes. Mothers face emotional and identity challenges, but can develop resilience through support and caregiving. Findings emphasize the need for targeted maternal–neonatal interventions and culturally sensitive NICU support.