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Female Genital Mutilation: Impact on Knowledge, Attitude, Sexual Score Domains and Intention of Females in Northern Upper Egypt

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Research Article

Female Genital Mutilation: Impact on Knowledge, Attitude, Sexual Score Domains and Intention of Females in Northern Upper Egypt

  • Fatima Hosny Abd-ELhakam 1
  • Rasha El-Syed Ebrahim 1
  • Momen Zakria Mohammed 2
  • Hanan Elzeblawy Hassan 1*

*Corresponding Author: Hanan Elzeblawy Hassan, Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt.

Citation: Fatima Hosny Abd-ELhakam, Rasha El-Syed Ebrahim, Momen Zakria Mohammed and Hanan Elzeblawy Hassan , (2022) Rel Female Genital Mutilation: Impact on Knowledge, Attitude, Sexual Score Domains and Intention of Females in Northern Upper Egypt. Archives of Medical Case Reports and Case Study, 6(5); DOI:10.31579/2692-9392/161

Copyright: © 2022, Hanan Elzeblawy Hassan. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 25 November 2022 | Accepted: 12 December 2022 | Published: 30 December 2022

Keywords: female genital mutilation; knowledge; attitude; intention; sexual domains

Abstract

Background: Female genital mutilation/cutting is extensively done in societies where it is believed to promote marriageability. As a result, the practice of FGM/C will continue because parents believe it will provide a better future for their daughters, and some girls may even desire to be mutilated to find a husband.

Aim: The aim of this study was Estimate effect of FGM on Females' knowledge, Attitude, Sexual Score Domains, and Intention in Northern Upper Egypt.

Subject & Methods: A descriptive cross-sectional study was used. The study population consisted of 2837 females in family health centers (FHCs) in different sitting at Beni-Suef.

Tool: Α Structured Interviewing Questionnaire sheet was used to collect data related females' knowledge, attitude, and intention. Female Sexual Function Index (FSDI) to assess female sexual function.

Results: The prevalence of Female Genital Mutilation (FGM/C) among total participants at Beni-Suef is 71.4%. Good knowledge score (27%) was more prevalent among non-mutilated females. Unfavorable and neutral attitude score (49.3%) was more prevalent among females with FGM. that there was a significantly higher Desire domain (5.8±1.8), Arousal domain (13.7±2.9), Lubrication domain (16±3.4), Orgasm domain (11.7±2.6), Satisfaction domain (13.3±2.4), and Total score among not circumcised married participants than circumcised ones but the Pain domain didn't differ significantly between circumcised (9.7±3.3), and not circumcised (9.3±2.2). About 79.4% of females who experienced FGM/C had the intention to mutilate their daughters in the future.

Conclusion: Good knowledge score was more prevalent among non-mutilated females. There was a significant relationship between FGM and knowledge, attitude, Sexual Score Domains, and intention to mutilate their daughters in the future (p-value <0.001).

1. Introduction

More than 31 countries in Africa, a few in Asia, and the Middle East all practice female genital mutilation or circumcision. (UNICEF, 2018). According to UNICEF, FGM/C global databases (February 2020), the prevalence of FGM/C in Uganda became 0% compared to a quarter within the update on February 2018. The prevalence of FGM/C among females aged 15 - 49 years ranged from 1% in Cameroon to 98% in Somalia, while among girls aged 0 - 14 years it has ranged between 0.1% in Benin and 83% in Mali (UNICEF, 2020). The prevalence of FGM/C exceeds 90% in Guinea, Djibouti, and Mali, while it is about 10% in Niger, Ghana, Togo, and Benin (UNICEF, 2020).

In Egypt, although the prevalence of FGM/C among females aged 15- 49 declined from 97% in 1985 to 87% in 2015, the prevalence remains high despite governmental efforts (MOHP, et al., 2015). The prevalence of FGM/C among adolescent girls and women has dropped from 94% in 2008 to 88% in 2014(Alkhalaileh, et al., 2018).

Female genital mutilation/cutting has complicated social and cultural foundations that outweigh the requirements and ideas of individuals. Female genital mutilation/cutting is seen as a normal part of female socialization in societies that practice it. The reasons for continuing FGM/C in these societies include religious obligations, beauty in the form of smooth and small genitalia, delighting future families and sexual partners, having social significance, and being accepted for marriage (Matanda, et al., 2018). 

Female genital mutilation/cutting is extensively done in societies where it is believed to promote marriageability. As a result, the practice of FGM/C will continue because parents believe it will provide a better future for their daughters, and some girls may even desire to be mutilated to find a husband. The hypothesis also suggests that in places where FGM/C is a part of the culture, no one will want to stop doing it because families are afraid of deviating from community norms (UNICEF, 2016).

2. AIM OF THE STUDY

The present study was carried find out about FGM in Beni-Suef Governorate through:

  1. Estimate effect of FGM on Females' knowledge in Northern upper Egypt
  2. Estimate effect of FGM on Females' Attitude in Northern upper Egypt
  3. Estimate effect of FGM on Females' Sexual Score Domains in Northern upper Egypt
  4. Estimate effect of FGM on Females' Intention in Northern upper Egypt
    1. Research Questions
  5. Does exposure to FGM can affect Females' knowledge in Northern Upper Egypt?
  6. Does exposure to FGM can affect Females' Attitude in Northern Upper Egypt?
  7. Does exposure to FGM can affect Females' Sexual Score Domains in Northern Upper Egypt?
  8. Does exposure to FGM can affect Females' Intention in Northern Upper Egypt?

3. Subjects and Methods

3.1.    Research Design: A Descriptive Cross-sectional study was used to achieve the aim of the current study.

3.2.    Subjects & Setting: 

3.2.1. Setting: The study was conducted in family health centers (FHCs) in different sitting at Beni-Suef Governorate. Beni-Suef governorate is divided into seven sectors. From every sector the MCH was randomly selected to geographically represent the sector. As the following mention:

Salah Salem MCH and Eastern MCH, Taha Bosh MCH was selected, Beba Medical Center, Tarshoup, Bani Saleh MCH, Al-shantour MCH, El-Mamalik MCH, Elnouira MCH, Kamen El-Arouse MCH. 

3.2.2. Sample:

3.2.2.1. Sample Type:

  1. A Convenient sample was used. The study sample was selected according to the following Inclusion criteria: 18-60 years old women. Can read and write

3.2.2.2. Sample size:

The study population consisted of all females who were accepted to participate in the study at the time of data collection (A period of six months from the start of data collection) and will be included in the study.

3.3. Tools of Data Collection: 

A pre-designed structured questionnaire was used to collect data. Data were collected through personal interviews. The questionnaire is divided into six sections:

Section I: А Structured Interviewing Questionnaire sheet which includes the following parts: age, residence, level of education, marital status, occupation and experience with mutilation, etc……

Section II: Knowledge of females regarding FGM/C: Females' knowledge was assessed using both single-response and multiple-response questions.

a. Single response questions:

They included knowledge of females about the spread, types, and procedures of FGM/C, side effects, and health consequences of FGM/C and FGM/C in Egyptian law.

Scoring system

  • It received (0) if the answers were wrong or don't know
  • It received (1) if the answers were incomplete correct
  • It received (2) if the answers were complete correct

Multiple response questions:

They included knowledge of females regarding the immediate and long-term health consequences of FGM/C. Participants were expected to select the right responses and not select the wrong responses.

Scoring system

  • It received (0) if less than 25% of the answers were correct. 
  • It received (1) if ≥25 percent to less than 50% of the responses were correct.
  • It received (2) if ≥50% of the answers were correct.

The scores are then turned into percentages, and the overall score is divided into the following categories:

  • Good level of knowledge ≥75%.
  • A fair level of knowledge is ≥50% to <75>
  • Poor level of knowledge <50>

Section III: Attitudes of females regarding FGM/C:

A Likert scale was used to assess attitudes, ranging from agree to disagree. FGM/C from a social standpoint; FGM/C and its effect on female genitalia; FGM/C violation and disability; FGM/C from a religious standpoint; FGM/C practice encouragement in society; FGM/C and marriage; and finally, FGM/C law were all included.

Scoring system

  • It received (1) if participants have bad attitude
  • It received (2) if participants have neutral attitude 
  • It received (3) if participants have favorable attitude

The scores are then turned into percentages, and the overall score is divided into the following categories:

  • Favorable attitude ≥75%.
  • Neutral attitude ≥50% to <75>
  • Unfavorable attitude <50>

Section IV: Intention to practice FGM/C: It included questions about the following:

  • Planning to mutilate their daughter(s).
  • Supporting the practice of FGM/C.
  • Confiscating information about mutilating daughters (age of the daughter, any health consequences, who perform mutilation, intention for mutilation of daughters in future).
  • Facing social pressure from family or neighbors to have their daughter undergo FGM/C.
  • Is there anyone in the area who does or wants to conduct FGM/C?

Section V: Reasons for practicing FGM/C and reasons for refusing FGM Section 

VI: Female Sexual Function Index (FSDI).

A four-week self-reported questionnaire that examines the key characteristics of female sexual function. It consists of 19 multiple-choice questions that assess six domains. Each dimension was rated on a scale of 0/1 (no sexual activity or sexual dysfunction) to 5 (complete sexual activity).

Researchers used the Arabic version of the FSFI, which was translated by (Anis, et al., 2011), to determine the full-scale score. The domain score is calculated by summing the scores of the domain's questions and multiplying the total by the domain factor. (=2 to 36). It was approved for use among Egyptians.

For the Arabic version of the FSFI, a total score of 28.1 was used as the cutoff point to distinguish between women with FSD and those with normal functions (sensitivity 96.7%, specificity 93.2%). The scale has been translated into Arabic.

Scoring system for (Female Sexual Function Index) (FSDI):

A formula can be used to calculate the FSFI's individual domain scores and full-scale (overall) scores. Add the scores of the individual items that make up the domain and multiply the total by the domain factor.

For the Arabic version of the FSFI, a total score of 28.1 was used to discriminate between women with FSD and those with normal functions. A domain score of 0 implies that the subject reported no sexual activity in the previous month within the specific domains.

3.4. Validity of the Tool 

All tools were tested for content validity by а jury of five experts in the obstetrics and gynecological nursing, pediatric nursing professor and one from biostatistics field.

3.6. Reliability of the Tool 

Reliability of tools was tested by using Cronbаch’s Alphа coefficient test. Consisted of relatively homogenous items as indicated by high reliability which was (0.405) for knowledge and (0.764) for attitude.

3.7. Ethical Considerations:

Informed consent was taken from each female to participate in the study after explaining the purpose of the study, and its importance for her, it will haven’t any harmful effect on them, the information will be confidential and they can withdraw from the study at any time.

3.8. Administrative Considerations:

Official permission was obtained by submission of an official letters from the Faculty of Nursing, Beni-Suef University to the responsible authorities of the study setting (family health centers (FHCs)) to obtain their permission for data collection for our study. These letters provided the study's goal as well as photocopies of data collecting materials to obtain their consent and assistance with data collection.

3.9. Pilot Study 

The pilot study was conducted on 10.0% of the total sample to test the feasibility & the applicability of the tool, find out the possible obstacles or problems that might face the researchers and interfere with data collection, detect any problems peculiar to the statements as sequence of questions, clarity and estimate the time needed for data collection.  The  samples of  the  women included  in  the pilot  study  were excluded  from  the main  study  sample

3.10. Field Work 

The process of data collection was carried out in the period from November 2021 and completed by April 2022, 3 days/week Saturday, Tuesday and Thursday from 9am to 2pm in three phases: The researcher begins filling out the interviewing questionnaire to assess women's demographic characteristics, knowledge of FGM/C, attitudes toward FGM/C, intention to practice FGM/C, reasons for practicing FGM/C, and reasons for refusing FGM/C, and Female Sexual Function Index (FSDI). The instruction was given to each woman individually for 3 sessions each session ranging from 15-20 minutes on an individual.

3.11. Statistical Analysis

All data were collected, tabulated and statistically analyzed using IBM SPSS 25. Data was supplied, and appropriate analysis was performed for each parameter based on the type of data obtained.

3.11.1. Descriptive Statistics data were expressed as:

  • Count and percentage: Used for describing and summarizing categorical data 
  • Arithmetic mean (X-), Standard deviation (SD): Used for normally distributed quantitative data, these are used as measurements of central tendency and dispersion.

3.11.2. Analytical Statistics:

  1. Cronbach alpha and Spearman-Brown coefficients: The internal consistency of the generated tools was measured to assess their reliability.
  2. Chi-square (χ2): used to see if there's a link between two category variables or to see if two or more proportions differ. For Race tables, Monte Carlo exact probability was used wherever 2 was present.

3.11.3. Graphical presentation: 

  1. Data visualization was done with graphs:
  • Colum chart
  • Bie in 3D chart

4. Results

Figure (1): Presents Female Genital Mutilation Experience among Participant Study Sample. The prevalence of Female Genital Mutilation (FGM/C) among total participants (2837) at Beni-Suef is 71.4%.

Figure (1): Female Genital Mutilation Experience among Participant Study Sample

Figure (2) showed an association between participants' total knowledge and their exposure to FGM. Good knowledge score (27%) was more prevalent among non-mutilated females. Also, fair knowledge was more prevalent (51.9%) among un-circumcised ones. While poor knowledge score (37.1%) was more prevalent among females with FGM There was a significant relationship between circumcision and participant knowledge (p-value <0>

Figure (2): Participants’ Experience of FGM and Total Knowledge Score

Figure (3): Presents Association between Participants’ Experience of FGM and their Total Attitude score. It showed an association between experience of FGM and total Attitude score among participant females. Unfavorable and neutral attitude score (49.3%) was more prevalent among females with FGM, while the favorable attitude (52%) was associated with the absence of FGM. There was a significant relationship between FGM and the participant's attitude.

Figure (3): Participants’ Experience of FGM and Total Attitude Score

Figure (3): Participants’ Experience of FGM and Total Attitude Score

Table (1) Presents the Association between FGM and the Sexual Score Domains and Total Score. It showed that there was a significantly higher Desire domain (5.8±1.8), Arousal domain (13.7±2.9), Lubrication domain (16±3.4), Orgasm domain (11.7±2.6), Satisfaction domain (13.3±2.4), and Total score among not circumcised married participants than circumcised ones but the Pain domain didn't differ significantly between circumcised (9.7±3.3), and not circumcised (9.3±2.2).

*P-value is significant (p less than 0.001)

Figure (4): Presents Participants’ Experience of FGM and Intention of Mutilating their Daughters. An association between females' intention of mutilating their daughters and their mutilation experience was found. About 79.4% of females who experienced FGM/C had the intention to mutilate their daughters in the future, while only 20.6% of females who did not experience FGM/C had the intention to mutilate their daughters in the future.

Figure (4): Participants’ Experience of FGM and Intention of Mutilating their Daughters

5.Discussion

The results of the current study revealed that the prevalence of Female Genital Mutilation (FGM/C) among total participants was 71.4%. This result is in accordance with other researches. In Nigeria, according to a 2013 Department of Health (DHS)  report, one in every four women aged 15 to 49 has had FGM, with 82% of the procedures occurring before the age of five. The prevalence of FGM in Nigerian women aged 15 to 49 has been steadily decreasing, from 30% in 2008 to 25% in 2013 (Ogbuoji, 2017). According to a study conducted in 2020 in the southern-eastern part of Nigeria, FGM was found to be 13.4% prevalent (Obijiofor, et al., 2020).

A study of Iraqi Kurdish females indicated that 70.3 percent of the participants had undergone FGM/C, but only 58.6 percent of them had been mutilated when clinically assessed. Female genital mutilation was most common in Erbil (62.9%) and Sulaimany (55.8%) governorates in Iraq's Kurdistan Region (Shabila, 2019). According to a study conducted in Iran, FGM was found to be prevalent in 50.5% of the population between the ages of 21 and 30 (Bahrami, et al., 2018).

Several nations, including Sudan, Ethiopia, and Nigeria, have conducted studies on females' knowledge of FGM. FGM is viewed differently by girls and women in different countries. Mali, Sierra Leone, Guinea, and Somalia had the highest levels of support for FGM, with more than half of the female population believing the practice should continue (Abolfotouh, S. M & Abolfotouh, M. A, 2015).

Significant statistical relationship between participants' experiences to FGM and their total score of knowledge was revealed (p-value <0>

The understanding of females, males, midwives, and health care practitioners regarding FGM/C was the subject of much of the research, which was largely conducted in African countries. They intended to look at their participants' basic knowledge and attitudes about FGM/C, as well as its determinants, to see whether any intervention strategies could assist abolish the practice (Adigüzel, et al., 2019). Other research was conducted in the Eastern Mediterranean region, Europe, and the United States (Ahmed, et al., 2018; González-Timoneda, et al., 2018).

Regarding the association between attitudes and FGM, the result of the current study revealed that unfavorable attitude score was more prevalent among mutilated females, while the favorable attitude was associated with the absence of FGM. There was a significant relationship between FGM and the participant's attitude(p-value <0>

FGM/C is extensively done in societies where it is believed to promote marriageability. As a result, the practice of FGM/C will continue because parents believe it will provide a better future for their daughters, and some girls may even desire to be mutilated to find a husband. The hypothesis also suggests that in places where FGM/C is a part of the culture, no one will want to stop doing it because families are afraid of deviating from community norms (UNICEF, 2016).

Regarding the effect of FGM/C on Female Sexual Function there was a significantly significant total score of among not mutilated married participants than mutilated ones. This is agreeing with other studies that reported that un-mutilated subjects scored considerably higher on desire, arousal, lubrication, orgasm, and satisfaction than the mutilated participants. Regarding the sexual pain domain, no apparent difference between the two groups was reported. (Anis, et al., 2012; Ismail, et al., 2017) According to a study conducted by KHEIR, et al., (2017); the study suggests that FSFI domains were significantly lower in women with FGM: for desire, arousal, lubrication, orgasm, satisfaction, and pain (Pérez-López, et al., 2020). In contrast, in a study conducted in Sudan, there were no discernible differences between mutilated and non-mutilated women in terms of desire arousal, orgasm, or pain. This lack of discernible changes could be attributed to the traditional obligation of most women to conceal these experiences (KHEIR, et al., 2017).

Concerning participants’ experience of FGM and intention of mutilating their daughters; an association between females' intention of mutilating their daughters and their mutilation experience was found. Most of females who experienced FGM/C had the intention to mutilate their daughters in the future, while females who did not experience FGM/C had the intention to mutilate their daughters in the future. This may attribute to that culture, education, and residence play a curial role in individual intention. This is close to a study conducted in Iran that revealed that intention decrease with an increased level of education (Pashaei, et al., 2012).

Conclusion

Good knowledge score was more prevalent among non-mutilated females. There was a significant relationship between FGM and knowledge, attitude, Sexual Score Domains, and intention to mutilate their daughters in the future (p-value <0>

Recommendations

1.Study Knowledge, attitude, and practice of medical care providers regarding FGM/C.

2.Inter-sectorial cooperation is being used by the MOHP, the Ministry of Justice, and the National Counsel for Women, the Egyptian Medical Syndicate, and the media to carry out a national program aimed at stopping FGM/C by healthcare professionals. 

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Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

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Virginia E. Koenig

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

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Delcio G Silva Junior

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

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Ziemlé Clément Méda

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

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Mina Sherif Soliman Georgy

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

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The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

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Orlando Villarreal

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

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Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

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Pedro Marques Gomes

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

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Bernard Terkimbi Utoo

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

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Prof Sherif W Mansour

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

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Hao Jiang

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

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Dr Shiming Tang

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

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Raed Mualem

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

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Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

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Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

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Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

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Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

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Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

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Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

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Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

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Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

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Husain Taha Radhi

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S Munshi

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Tania Munoz

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George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

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Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

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Khurram Arshad

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

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Gomez Barriga Maria Dolores

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

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Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

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Maria Dolores Gomez Barriga

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

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Dr Maria Dolores Gomez Barriga

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

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Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.

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Dr Marcelo Flavio Gomes Jardim Filho

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

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Zsuzsanna Bene

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

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Dr Susan Weiner