The aim of the study, conducted in April 2007, was to determine dental caries prevalence among representative sample of 12-year-old schoolchildren in Northern West-Bank, Palestine with a view of determining DMFT mean and Care Experience Index of the studied population. Dental caries was screened according to the WHO method. Out of the 357 children in the age group, 300 children (84%) had dental caries experience as expressed with DMFT index. Only 16% of children were caries free. Female children had higher mean DMFT score of 3.94 compared with 3.04 for males and 3.45 as a mean DMFT for the overall of the sample. Care experience index for the children was very low as only they had a care experience index of 6.7% fluctuates between 7.5% for males and 5.8% for females. Cost of management, defects in establishing and applying of school oral health programs, and Israeli occupation's obstacles, had been identified as some of the factors militating against their obtaining good oral hygiene. The results of this study recommended to improve the situation of school oral health programs, and to focus on dental health education and preventive measures campaigns; fissure sealant, fluoride application as examples.
Saturday, January 16, 2010
Iron Deficiency Anemia among Pregnant Women in Nablus District; Prevalence, Knowledge, Attitude and Practices
The current study aimed to estimate the prevalence of iron deficiency anemia (IDA) among pregnant women who attend governmental antenatal care centers in Nablus district and to explore and assess knowledge, attitude, and practices of pregnant women towards IDA. The study was conducted during the period June- August, 2006 and the sample consisted of 207 pregnant women (207; 110 second trimester, 97 third trimesters) in the age group (17-41) years. Out of 207 participants 137 were city inhabitance and 70 were village residence. Blood samples were collected from each pregnant woman and a questionnaire was completed at the time of blood collection. Hemoglobin (Hb), and serum ferritin were determined, and the collected data was analyzed using SPSS. The overall prevalence rate of iron deficiency anemia was (21.7%). Iron deficiency anemia was most prevalent in the third trimester (69%) compared to second trimester pregnancy (31%). The prevalence rate among city inhabitance (25.5%) was higher that found among village inhabitance (14.3%), however differences in the prevalence rates were of no statistically significant value (P = 0.). Younger age group (? 24) shows the highest prevalence rate of IDA (35.6%) among IDA group. Years of education, working status, number of family members and monthly income seems to have no effect on the status of IDA as working women, those with more years of education, high monthly income and those with large number of family members were with lower prevalence of IDA. Slight increase in the prevalence rates of IDA was found with increased number of pregnancies; however, increased years of spacing did not show this effect. Neither smoking status, nor previous history of chronic disease or weight of last born baby seems to show any association with IDA status. Previous and current use of iron supplements as a main preventive measure for IDA seems to have limited effect in lowering the prevalence rate of IDA, a situation that might be due to problems of compliance or any other hidden factors. Early registration and increased number of visits also found to have no effect on improving the status of IDA; a situation might draw the attention to the role and effectiveness of the health care system in the area. The study showed a high level of knowledge with respect to causes, symptoms, iron rich food sources, importance of iron supplements and iron absorption in relation to IDA among both IDA and non IDA groups. However, poor knowledge was found with respect to the effect of IDA and mother and fetal health and the use of iron supplements and absorption. Highly positive attitudes and practices were also found in respect to the importance of regular visits to maternal care centers, use of iron supplement and multiple pregnancies. In conclusion, although the adopted strategy concerning primary health care seems to be well planned and based on international recommendations, it seems to have no noticeable effect on the improvement of the prevalence of IDA and there is a great need for further health education promotional programs in this respect.
Improving Health Services for Diabetic Pregnant Women who are Attending Governmental Clinics in Nablus and Jenin Districts
Diabetes is often detected in women during their childbearing years and can affect the health of both the mother and her baby. Poor control of diabetes in a pregnant woman increases the chances for birth defects and other problems for the baby. It might also cause serious complications for the woman. Proper health care, before and during pregnancy, will help prevent birth defects and other poor outcomes, such as miscarriage and stillbirth. The risk factors, associated with diabetes during the childbearing age among women in Nablus and Jenin district, were studied in addition to the complications facing both the woman and her baby. The researcher also assessed women's knowledge about diabetes. A random sample of 200 diabetic pregnant women was chosen, of these, 117 of women, included in the sample had developed gestational diabetes, another 38 had pre-gestational diabetes (Type 1) and another 45 had pre-gestational diabetes (Type 2). Data were collected for the purpose of filling the questionnaires using the files available at the health clinics. Data included personal information, obstetric history information and medical information. All data of the questionnaire for 200 subjects were entered into the computer and computed using SPSS program. After data collection and analysis, it was found that, according to BMI: 15.8% of women who had pre-gestational diabetes (Type 1) were over weight, and 15.8% were obese .The results according to age of onset were : about 10.5% of them (the age of onset) were between 5-15, 63.2% of them (the age of onset) were between 15.1-25, 21.1% of them (the age of onset) were between 25.1-35 and 5.3% of them (the age of onset) was more than 35. Pertaining to family history of diabetes, 71.1% of them had first degree relatives. In contrast, according to BMI, of all women who had pre gestational diabetes (Type2), 40% of them were over weight, 42.2% were obese and 6.7% had morbid obesity. According to age of onset, 8.9% of them (the age of onset) were between 15.1-25, 66.7% of them (the age of onset) were between 25.1-35 and 24.4% of them (the age of onset) were more than 35 years old. Pertaining to family history of diabetes, 88.9% of them had first degree relatives. Also, it was found that 27.4% of women who had gestational diabetes were over weight, 39.3% were obese and 7.7% had morbid obesity. According to age of onset, 15.4% of them (the age of onset) were between 15.1-25, 41.0% of them (the age of onset) were between 25.1-35, and 43.6% of them (the age of onset) were more than 35 years old. Concerning family history of diabetes, 76.1% of them had first degree relatives.
Assessment of the Actual Treatment Abroad Department at Palestinian Ministry of Health (MOH)
Based on the policy of "Health for all in the twenty-first century adopted by the world community in may 1998, to realize the vision of the World Health Assembly at the Alma-Ata conference in 1978, World Health Organization (WHO) had develop the World Health Survey (WHS) as a mean of providing low-cost, valid, reliable and comparable information. (WHS) served as an evidence base to monitor the efficiency of different health systems in meeting the desired goals. Thus providing policy makers with the evidence they might need to adjust their policies, strategies, and programs as necessary. This study aims to assess the performance of treatment abroad department in the Ministry of Health (MOH), to rationalize spending cost and to find options to decrease this cost by providing alternatives for replacing treatment abroad by treatment in Palestinian health care facilities to demonstrate the importance of having centers of excellence and comprehensive health care services in Palestine. The study was conducted during the period of January-May, 2006. To achieve our goal and objectives, data was collected through structured interviews utilizing a questionnaire for five key informants, one for decision maker of MOH, another for chair person of treatment abroad department, physicians and policy makers in public sector (governmental), physicians and administrative persons in private sector, NGOS and UNRWA, and the last one for patients who receive treatment abroad inside Palestine (in private sector, NGOS, UNRWA hospitals), and outside Palestine (in Jordan and Israel). The sample of the study was (191) patients, (92) collected from Jordan hospitals, (99) patients from west bank, (40) employees from private and public sector, one for decision maker and one for chair person of treatment abroad department. Quantitative collected data was analyzed using SPSS while other qualitative data was analyzed manually. Several hypotheses were formulated and tested, the results of the current study showed the highest percent of reason for referral abroad have been tumor disease with 33%, then cardiac disease with 17%, organs transplantation with 5.8%and 1.6%invitro fertilization. In relation to reason of referral cases abroad, the highest cause that the treatment not available in Palestine with percent 43.6%, second because services were not of good quality26.7%, the third reason there was a long waiting list for intervention 14.1%, 4.7%no trust for medical team in Palestine. From analysis of patient questionnaire there was relationship between disadvantages of referral abroad and suggestions to avoid referral treatment abroad, ministry of health should provide an inclusive medical health system. The result also showed that questionnaire for other key informant illustrate the importance and need of integration between all health care providers sectors in Palestine and encourage treatment abroad inside Palestine rather than outside Palestine.
Prevalence of Iron Deficiency Anemia among School Children in Salfeet District
A cross-sectional study conducted in the second semester of the academic year 2005 to investigate the prevalence of iron deficiency anemia in school children aged 6 to 18 years, who live in the district of Salfeet in the West Bank area of Palestine. The study sample consisted of 144(49.7 %) male students, and 146 (50.3 %) female students. Complete blood count (CBC) was performed and blood samples with main corpuscular volume (MCV) value less than 80um³(FL) were subjected to serum iron test. The prevalence of iron deficiency was 26.7% (12.7% with anemia, and 14% without anemia). The prevalence of iron deficiency among females was 30.5%, and among males was (21.6%). Iron deficiency was apparent in all studied age groups. The prevalence of 32.4% was observed among the age group 6- 8 years, 35.3% among age group 9-11 years, 25.9% among 12-14 years and 12.1% among 15-18 years old. Differences in prevalence rates were statistically significant (P= 0.01 at ? = 0.05). According to place of residency, there was statistically significant difference between the overall prevalence of iron deficiency among children living in villages compared to children living in the city (22.8% versus 32.6% respectively, P <>
Assessment of Myocardial Infarction Risk Among Patients in Nablus District
The idea of assessment of myocardial infarction risk factors among patients comes while more and more patients in Palestine are dying from accelerated cardiovascular disease. While myocardial infarction has been described to have an epidemic-like spread all over the world with special emphasis on countries experiencing the transition to western lifestyle, it is important to evaluate the life style and behaviors of those patients after the onset of myocardial infarction. The risk factors of myocardial infarction among patients life in Nablus district were assessed. About 150 patients were selected randomly from Nablus community to participate in this study (108 Male, 42 Female). Those are patients with myocardial infarction selected from three main hospitals in Nablus city. Al-Watani hospital (MOH) n=50, Nablus specialty hospital, (private sectors) n=50, and CCU unit in Al-Arabi hospital, (private sectors). n=50. Microsoft Excel and SPSS software were used to analyze the data collected and to obtain results. Most of sample study participants were more than 50 years old. The majorities of participants live in Nablus city, finished their secondary level of education and had no university degree level. The results according to the gender were 64.81%of males and 66.67% of females of the study sample were diabetic, and 80.56% of males and 71.42% of female of the study sample were hypertensive, while 59.26% of males and 64.29% of females of the study sample relatives had cardiac diseases. All participants were surveyed for diet, physical activity, smoking, stress, knowledge, attitude, practice, and drugs compliance. They were also tested for blood pressure, FBS, cholesterol, triglyceride, HDL, LDL, weight, length, and BMI. Most of patients have no physical activity (86% of males and 98% of females), no control diet (65% of males and 48% of females),while percent of smoking patients were high according to their health situation (60% of males and 21% of females), they also had impaired fasting blood sugar, and high fasting lipids. The political and economical situations of Patients in Nablus city, and lack of health education among patients and their families, were the major reason of the lifestyle impairment. Patients who survived acute myocardial infarction need more attention and rehabilitation programs, this needs the efforts of both primary health care physicians and cardiologists.
Adequacy of Hemodialysis among End Stage Renal Disease Patients at Al-Watani Hospital
End stage renal disease is defined as total loss of kidney function, it is common problem worldwide caused by multitude of kidney disease either diabetes or hypertension, it is diagnosed by several laboratory and imaging diagnostic procedures. Hemodailysis is one of the treatment options in renal replacement therapy and many studies have shown strong correlation between hemodialysis dose and clinical outcome measured by kt/v. In the West Bank area of Palestine there are 8 dialysis centers serving 350 patients (at present), these units lack well trained technicians nephrologists and machines. The nurse patient ratio is 1:5 and due to limited access to dialysis units patients are noncompliance. The current study, aimed at evaluating hemodialysis adequacy among hemodialysis patients (88; 56.8% males, 43.2% females) enrolled at Al-Watani Hospital center at the city of Nablus. Data collected during June through July 2006 in a specially designed questionnaire. Data collected through direct interview after reviewing medical records of each patient and recirculation test carried out at the same dialysis session. The results showed inadequate dialysis dose among 64% of the enrolled patients. Females showed a better clearance rate (44.7%) compared to males (32%). Percentage differences for kt/v values among males and females were statistically insignificant (P = 0.429). It was difficult to link between the other tested demographic variables and clearance rates estimated by kt/v value. A strong association between higher clearance rates and both increased dialysis duration of each session (4hours; 69.2%) and frequency of dialysis per week (3 times/week; 48.3%) was noted and differences for both variables were statistically significant (P = 000). There was clear trend in improvement in kt/v values with increased ultra filtration. Low recirculation resulted in better dialysis adequacy (0-10%; 70.8% with kt/v ? 1.2). Diabetic nephropathy represented 44.3% with a clearance rate of 28.2% (kt/v ? 1.2). Clearance rates of 42.9% and 71.4% found among those suffering from glomerulonephrities and gouty, respectively. Hypertension cases represented by 2.3% of the study population, thus indicating that hypertension is not a major cause of ESRD among our population. The results also showed that 68.2% of the study population was with AVF access for circulation and 42.3% of this group was with an acceptable clearance rates (kt/v ? 1.2). Subclavian access was the major access among the rest of the patients with a clearance rate of 28.5%. Better clearance rates found in association with absence of patient complains (45.8% versus 29.7%). The findings of better clearance rates among those without any residual kidney function (44.3%) compared to those with some residual function (22.2%) was not clear and requires further investigations. Our findings clearly showed that with increasing time and frequency of dialysis, blood flow rates, low recirculation percentages and reduction of intradialytic complain are associated with better dialysis adequacy. In accordance with such findings, the need for adoption and implementation of internationally used practice guidelines is essential in our dialysis system.