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.
Prevalence of Asthma and Allergy and Their Risk Factors Among An–Najah National University Students - Nablus - Palestine
Asthma and allergic conditions have become more prevalent during the past three decades. Asthma causes significant morbidity and mortality and has resulted in a towering public health burden. Inhalant allergic conditions such as seasonal and perennial allergic rhinitis are also quite common. The effect of asthma and allergy on an individual's quality of life and the extent to which it may restrict daily activities is often overlooked. Controlling allergies can significantly decrease health care cost as the purpose of asthma and allergy treatment is to manage the disease in order to live as normal a life as possible and this also can be done by providing community and professional education. The purpose of this study, a first of its kind in this age group in Palestine, is to estimate the prevalence of asthma and allergy among young adult population in Palestine represented by An- Najah University students. The study sample consisted of around 1000 randomly selected students from all colleges of the University. The researcher collected the data through student group interview. Self reported questionnaire were filled, then PEF measurement was done based on the expert panel report 2.The results were recorded and the level of error was corrected for by using equation for PEF derived by Millar et al 1992. Predicted values were calculated for each individual with the Persian equations & Nunn and Gregg equations. All data of the questionnaire and PEF measurement for the study sample were entered into the computer and computed using SPSS program and applying Chi–square test, with 95 % level of significant (P value = 0.05).Although some results were inconsistent with the literature, especially those related to global asthma and allergy risk factors, we had important positive results. The following points worth reporting: • Physical diagnosis asthma prevalence was 0.33% and the prevalence of ever wheezing was 0.46%, the prevalence of allergic rhinitis, skin allergy, latex rubber allergy, food allergy, drug allergy and insect sting allergy were 3.1 % 2.5% 0.26% 0.88% 0.67% and 2.5% respectively. • The prevalence of asthma and allergy in Palestine was markedly lower than that of Israel; however, our results were close to another study carried out in Duzce in Turkey. • Our results indicate male predominance for those who have asthma & skin allergy. • Upon the distribution of allergic disease for study samples according to their residence, the results show that the highest percentage of asthmatic subjects were from villages, and the highest percentage for those who have skin allergy were from the camps. • Prevalence of asthma in our study doesn't appear to be related to the social or environmental factor. • Neither gender nor residence & environmental factors have statistically significant relationship with allergic rhinitis. • Poor housing conditions of refugee camps dampness (which encourages the growth of moulds, dust, mites, ect.) might explain the double percentage of skin allergy in refugee camps than other places. • Adult Palestinian have minimally lower peak expiratory flow value and prediction equations based on European population may not perform well for them .Adoption of Persian equation for PEF seems to be more accurate for young adult Palestinians. Further studies on large scale for asthma and allergy in Palestine, and the proper use & value of PEF for Palestinians are called for.
Utilization of Antibiotics in Nablus City-Palestine Pharmaco-epidemiological Study
Few studies have studied the frequency of over the counter acquisition of antibiotics in Arabic countries. In order to provide an insight into these practice we investigate the frequency of self –medication in Nablus city- Palestine and factors influencing this practice . Pharmacy based interviewed and observation data were collected from 9207purchares sampled from 24 privet pharmacy in the area. 1702 of 9207 customers purchased antibiotics without prescription (18.48) in a two week period . our data show that people likely to follow this practice are from low income families (workers and employee). Also data show that the risk of buying antibiotics without prescription was associated with education at university level. The perception that it is expensive to consult doctors and low satisfaction with medical practitioners. The antibiotics were mainly self-administered for upper respiratory tract infection (URTI) symptoms particularly sore throat with community pharmacies being source of about 70% of cases. The study indicates the needs for educational campaigns on proper antibiotics use among Palestinian general public, also the need of other studies about this problem.
Risk Factors Associated with the Occurrence of Premature Delivery at Al- Maqassed Hospital between 2000-2002
Newborns are considered to be premature if they are born before 37 weeks old. The neonatal period is the period of the greatest mortality rate in childhood, and the highest risk occurs during the first 24 hours. Factors affecting gestational period and delivery, as well as the post-natal period, have a major impact on the health of both the fetus and neonate (Augusta Victoria Hospital study – 1994. In this study we targeted the Al-Makassed Hospital in Jerusalem district. About 215 premature babies were surveyed between January 2000 and December 2002. The study sample was selected from labor ward, all premature babies who were born at Al-Makassed Hospital from five areas of West bank (east, west, north, south and middle). All participants filled out a questionnaire through telephone interviews. The main results of this study are the following: 1. About 60.9% of the total sample is from Jerusalem, 10.7% is from south and 22.8% is from north. 2. This study showed that 67.4% of the women who had premature babies are from 36 to 43 years old, 31.2% of them between 19 to 35 years, and 1.4% around 18 years old. 3. There were some variations in this study related to the number of family members. Half of the women who had premature babies have 3-5 members, 34.4% 6-8 members, and 19.5% 9-11 members in the family. 4. This study also showed that the women who delivered premature babies, approximately 40% of them have a Tawjihi degree, about 31.2% have a secondary degree, 20% have a university degree and 8.8% have a primary degree. 5. About 90.7% of the women who had premature babies don’t have a job and 8.4% have a job. 6. Some variations were found in results related to the child spacing period. 44.2% had one year spacing, 32.6% had two years spacing period, 8.8% had three years spacing period, and 5.1% had four years spacing. 7. About 88.8% of the mothers who had premature babies, their husband were the only financial provider in the family. 8. There were some variations in this study related to having loans, around 30% of the women took loans, and around 19% of the women sold home assets. 9. Some results indicated that there was low percentage of smoking among the women who had premature babies (4%); this is probably due to cultural attitudes towards smoking of the females, about 59% of the women who had premature babies had someone in the house that smoked; this is probably due to mal-information about the effect of passive smoking which might be a risk factor for having premature baby.
Friday, January 15, 2010
Patient’s Satisfaction With Hospital Services At Nablus District, West Bank, Palestine
Abstract
Patient satisfaction is an attitude of person's general orientation towards a total experience of health care. Satisfaction comprises both cognitive and emotional facets and relates to previous experiences, expectations and social networks. It is a positive evaluation of distinct dimensions of health care.
A cross sectional study was conducted at Nablus hospitals (governmental and non-governmental), from January to March, 2008, to measure patients' satisfaction with services provided at Nablus hospitals, and to determine factors affecting patients' satisfaction including room services, technical quality and interpersonal skills of health care providers, accessibility and availability of services.
A total of 365 adult inpatients chosen randomly by a stratified random sampling were interviewed using a comprehensive questionnaire to rate the level of satisfaction of services received by 5- point Likert Scale. The questionnaire was filled by direct face to face interview and the data were analyzed using SPSS program.
The patients in non-governmental hospitals were more satisfied than patients in governmental hospitals. About 70.2% of respondents rated their general satisfaction with governmental hospitals as good to very good. While in non-governmental hospitals, more than 90 % rated it as good to very good.
The results indicated that older patients were more satisfied than the younger ones, females were found more satisfied than males. In addition to this, patients with high income were more satisfied than others with low income. Also healthier patients were more satisfied than sicker patients. However, patients who were waiting long time (more than one hour) in the reception area, to get a bed in the hospital, were less satisfied than the others, while obstetric patients were found to be the most satisfied.
Major Causes of Traumatic Brain Injuries in Patients Admitted to Rafidia, Al-Ittihad and Specialized Arab Hospitals (2006-2007)
Abstract
According to the World Health Organization (WHO), Traumatic Brain Injury (TBI) is one of the 21st century epidemics similar to malaria and HIV/AIDS; and it is not only restricted to the developed world1. In Palestine, since the outbreak of Al-Aqsa Intifada in 2000, there has been an increase in the number of assaults by bullet injuries used by Israeli soldiers. Morbidity and mortality reports showed that high numbers of injuries were in the head; consequently, the Traumatic Brain Injuries (TBIs) are considered a major public health problem in Palestine.
Objectives of the study
The main aim of the study was to determine the major causes of TBI in patients admitted to Rafidia, Al-Ittihad, and the Specialized Arab hospitals between 2006- 2007.
Subjects and Methods
The study was carried out retrospectively by reviewing the medical records of TBI patients admitted to the three targeted hospitals in Nablus in 2006 and 2007. Gathering data for 312 TBI patients from their medical records by filling of case survey sheet for each patient. Glasgow Coma Scale (GCS) was used to assess the level of severity of TBI.
Results
The study showed that the major causes of TBI were assaults (33%), followed by falls (32.1%), road traffic accidents (29.8%), and hits by heavy objects (3.2%). Falls and hits by heavy objects were more common among children aged less than 5 years old, while assaults and road traffic accidents were more common among age group 19-29 years. Males were found to be more exposed to the causes of TBI than females.
The study also showed that about 29.2% of the study population had sustained functional disability, and 6.7% had been fatally injured as outcome following TBI at hospital discharge. Among the admitted patients with head injuries, 66.7% had died due to assaults, 19% due to road traffic accidents, 9.5% due to falls, and 4.8% due to hits by heavy objects.
Conclusion
Assaults are the major leading cause of TBI. Majority of them, assaults were caused by bullets and head blows of Israeli forces. Assaults were associated with more severe injuries compared to the others. Morbidity and mortality are very high among assaults victims.
Key Words: Traumatic Brain Injury (TBI), Assaults.
Prevalence and Risk Factors affecting polypharmacy among elderly patients in the North of West Bank
Abstract
Chronic diseases are common among the older population, the rate of drug related problems and inappropriate medication use in the elderly is disturbing. The heavy use of medications in this population has increased. The rate of drug interactions decreased the quality of life, and the financial consequences of the problem are enormous. Information about polypharmacy and pattern of drug use by community dwelling elderly is scant.
This study aimed to investigate the prevalence of polypharmacy and factors affecting it among home-dwelling elderly Palestinians in the Northern West Bank districts, aged 65 years or over by using a cross-sectional study (n=317). Elderly were defined for the purpose of this study as those who are aged ≥ 65, Polypharmacy was defined as the concomitant use of 5 or more medications.
Results found that the percent prevalence of polypharmacy among the study population of the three districts (Nablus, Tulkarm, and Jenin) is 41%. Mean number of medications used by each elder of the study population was 4.48 (SD 2.249). The commonest disease affecting elderly is hypertension, followed by joint diseases, diabetes mellitus, and cardiovascular disease. The study’s findings showed that polypharmacy is affected significantly by gender (p = 0.015), no statistically significant relationship between polypharmacy and other factors (Age, place of residence, marital status, level of education, and income). The study also showed that elderly patients are unaware of consequences of polypharmacy; (non-adherence, medication errors, adverse drug reactions, drug-drug interactions, increased risk of hospitalization, and increased cost of treatment).
The study results showed that medication counseling is mainly done by physicians, whith minimal role for pharmacists or nurses. Prescribers need to be aware of increasing polypharmacy. Regular assessment of indications is needed to avoid overuse of drugs. Geriatric knowledge is needed to support health centers and specialized units in this demanding task. Community pharmacists’ role in reducing this phenomenon needs to be enhanced. Physicians, nurses, pharmacists, and all health providers who have a direct contact with the elders should be aware of polypharmacy, they should work as a team to educate community elderly about consequences of polypharmacy. Polypharmacy is a complex and worrying phenomenon that merits more research.
Key words: Elderly, Polypharmacy, Aging, Palestine, prevalence, drug interactions.
Factors Affecting Pain Intensity Post Caesarean Section in Governmental Hospitals in the West Bank-Palestine
Abstract
There has been a gradual increase in cesarean births over the past 30 years. In November 2005, the Centers for Disease Control and Prevention (CDC) reported that the international cesarean birth rate was the highest ever at 29.1%, which is over a quarter of all deliveries; The CDC has made it a national goal to get the number down for "low-risk" mothers by 2010. In the West Bank, there is no clear information (specific statistics) about the percentage of caesarean section ( CS). In Rafedia Surgical Hospital in Nablus the C.S was about 11% in the seventies and jumped to 13-14% in the eighties and nineties of this century. According to hospital records, in the last 4 years this percentage has been about 14-15%. During the AL-AQSA Uprising in 2000-2004 this percentage remained the same till the incursion of Nablus city in 2002; the percentage jumped to about 21% as women demanded at their own choice or request caesarean delivery to avoid delay at check points. This study aims to identify factors affecting pain intensity postoperative in women undergoing caesarean section. The study was conducted during the period from February-March, 2007. It was implemented in three governmental hospitals in the cities of Nablus, Jennie and Ramallah. The patient questionnaire was conducted through face to face interviews and patients files. Several hypotheses were formulated and tested through SPSS, multiple comparison analysis and Microsoft office excel. At power of 0.05 there were significant statistical differences between pain intensity and the following variables: source of information about pain, history of pain post caesarean section, length of operation, type of stitches, nurse approach with pain and fatigue, way of pain reflection, ambulation post caesarean section, and bad events related to patients directly.
However, at the same power, there were no significant statistical differences between pain intensity and the following variables: family support, baby weight, baby gender, health team, place of living, profession, income, qualification, anti-natal care, number of pregnancies, smoking, drinking tea, drinking coffee, route of medication used.Pain management has been established as one of the benchmarks of quality health care.
A high percentage of 75.7% represents pain severity (6-10) on Visual Analogue Scales (0-10) post CS in this study; this result requires more attention for pain management post operative and the quality of hospital care now must include the assessment of pain relief. Our data showed that source of information and past history of pain have a strong association to pain intensity. The result also showed that operation technique and its time affected on pain intensity and let the lady to be early ambulation. This enabled the mother to take care of her baby. In conclusion findings showed that pain severity was high in most of the cases of pain on scale ( 6-10). Attention should be given for these factors which affect pain intensity post caesarean section.
Keywords: Caesarean section, pain intensity, pain management postoperative.
Relationship between factor V Leiden mutation and poor pregnancy outcomes
Abstract
Pregnancy is a hypercoagulable state, with increased tendency for thrombus formation. That is increased if pregnancy is combined with thrombophilia. Thrombophilia could be acquired or inherited. Among the inherited types is Factor V Leiden mutation, an autosomal dominant disorder. The mutation is believed to be a major inherited risk factor for venous thrombosis. Recently, it was suggested that this mutation, through stimulation of venous and placental thrombosis events, were strongly associated with different pregnancy adverse outcomes, including PET, recurrent miscarriages, IUGR, IUFD, abruption placenta, and others. Although other studies disputed such a link. The aim of our study was to investigate the relationship between Factor V Leiden mutation and some adverse pregnancy outcomes, namely recurrent miscarriages and PIH. In this case-control study where 137 participants with adverse pregnancy outcomes (66 First trimester RM, 25 second trimester RM, 26 with IUFD & 20 with PIH) were compared to 155 women with uncomplicated pregnancies. Blood samples were collected from participants for DNA extraction; and Factor V Leiden mutation was identified using PCR The mutation was confirmed in 35 cases out of 137 (25.5%), and in 13 out of 155 controls (8.4%). .The relationship between the mutation and recurrent miscarriages was established using SPSS analysis version 15 [Odds ratio was 3.75 p-value=0.000] Comparing those with first trimester abortion cases and the control group odds ratio was 2.45 p-value=0.029, while the ratio was 10.5 and p value was 0.00 when comparing those with second trimester abortions cases to the control, a comparison between women with IUFD and the control group in relative to the Factor V Leiden mutation, the odds ratio was 4.5 and p-value was 0.000. Finally comparing women with PIH to controls, in relative to the prevalence of Leiden mutation no significant difference existed between the two groups
These results suggest a strong correlation between recurrent miscarriages and Factor V mutation in our population.
The effect of Smoking on increasing the risk of Type II Diabetes Mellitus and Hypertension
Abstract
The current study aims at exploring the effect of cigarette smoking on the susceptibility to develop Type2 DM and hypertension among adult males in the refugee population in the northern area of West Bank, in period from the 1st of December to 30th of March 2005-2006, for cases not known to have Type2 diabetes or hypertension. The objectives of the study were set to assist public health practitioners in developing health education program aiming at the prevention of smoking and reduce the risks for developing hypertension
We notice from this screening test that 36.2% of the cases have high BP. 13.1% have high RBS. This indicates that there are a high percentage of people who have hypertension & Type 2 DM, this study provides baseline data on these diseases in refugee people in Palestine. Information that is essential for the implementation of national planning and service provision.
It was found that cigarette smoking can increase the risk of Type 2 DM & there were no statistical effect of smoking on hypertension but smoking can increases cardiovascular disease which lead to HTN disease. Increasing BMI can increase the risk of the HTN & Type 2 diabetes mellitus.
FH especially in first degree relatives can increase the risk of HTN, & genetic predisposition was found to be low in Type 2 DM in this study, also practicing sport play a role in decreasing the risk of Type2 DM.
Administrative Decentralization Practical Model for Jenine Hospital
Abstract:
Decentralization has become popular management strategy in many health care systems all over the world.
The strategy of applying decentralization in many institutions in the world seems as away to dissolve major problems that face these institutions in finance, social, technical, and mainly administrative manner.
Many studies make distinctions between high quality assurance and decentralization to mange services in any organization.
Palestinian authority was made concern about decentralization concepts and techniques ,so many institutions in different fields was try to study an apply parts of its strategies as decentralization manner.
To day, academics, practitioners and development stakeholders universally recognize the importance of good governance practices for alleviating chronic poverty and injustice .Simultaneously, the world has increasingly turned towers the practice of decentralization to assure democratic governance for human development.
The main question of the study is: How can decentralization increase the quality of heath team and work by improving the administrative frame work of the institution? And what is their opinion on that?
This study contains six sections, the first one deal with subject and describes the place and the main problem. The second section was assessed the structures and types of decentralization, and assess the political, economical, social, clinical, and equity impacts of alternative decentralization strategies in Jenine hospital. The third section of the study, was evaluated the existing patterns of the implementation of decentralization in different regions in the world and as contrast on the theoretical advantages of decentralization found in the literature with practical experience in the hospital. The fourth section of this study was deal with the methodology and research out line. The fifth section of study was translated the main results of the collected data that was discussed the purpose of applying decentralization in the hospital, and the benefits of implemented this type of administrative strategy. The methodology of this was discussed in section four, which contains the data collection and data analysis by statistical systems on (SPSS) .The study has number of annexes contains proposed frame works to be hold out in the process of institutional development .The sixth section was presented some recommendations to be taken in considerations.
The target population of this study was contained about of (73) of Jenine hospital members only (36)who picked up as target group, and (3)of them was hold off because of technical points ,and (33) questionnaires was banked on to be as target group, divided as (23)mails, and(10) females .The study depends on four variables ;sex, qualification, license, experience. AT the end of study concluded in some recommendations as ;there is need to change the managerial system of the hospital, the administrative manner and policy couldn’t meet the hospital and team needs ,and to be part of hospital basic development this system must be changed to decentralization one. It proposed managerial frame work, to be presented to health policy makers, and to form a centralize board to follow up the decentralization process in the hospital, and drown the decentralization map in order to promote health sector reform, and hospital quality of team and work.
Epidemiology of Prostate Cancer In North-West – Bank, Palestine1998-2006
OBJECTIVE: To evaluate the magnitude of prostate cancer in the North West-Bank, and to shade light on risk factors affecting its distribution.
DESIGN /METHODS: In a descriptive and retrospective study, we conducted a large study among hospitalized patients. Data were collected from Teaching Hospitals (Al Watani, Beit Jala and Jinnen hospitals), during the period (1998-2006). The total population number were 750.000, of whom 70.000 men, 40 years or older were our target. Analysis based on patient admissions, and statistical methods were (ANOVA Test, T-test, Correlation, Chi squire test, Descriptive statistics and frequencies and percentile methods).
RESULTS: 78 prostate cancers were reported with incidence rate of 10.4 per 100.000 populations. We revealed that the majority of patients (64.1%) were diagnosed in Nablus and the lowest (6.4%) in tulkarem city The highest percentage was among: [Non-smokers vs. smokers (61.5% vs 37.2% respectively), industrial workers vs. Doctors (42.3% vs 5.1%), families of seven children or over vs. less than three (56.4% vs. 5.1%), patients over 65 years, with high PSA serum levels (20ng/ml or over), (64.1%)]. Person Chi Square df, significant values of PSA categorized and dependent variables (Occupation, no. of children and Age), showed a Pearson correlation and statistical significance at P-Value = 0.05 which was respectively (0.016, 0.018, 0.003). Significant relationship was found between age and infection (P-value = 0.032) and between cancer stage and age (0.021).
CONCLUSION: Prostatic carcinoma in the West-Bank, disproportionately strikes in different towns in West-Bank, with high prevalence in Nablus and low prevalence in tulkarem. This prevalence is low compared to Western Countries despite the high intake of calories.Iron Deficiency Anemia among Pregnant Women in Nablus District; Prevalence, Knowledge,
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.
Full Article
Improving Health Services for Diabetic Pregnant Women who are Attending Governmental Clinics in Nablus and Jenin Districts.
Abstract
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.
Knowledge and attitudes of An-Najah National University students in Reproductive health issues
This study aims to examine Al-Najah university students’ knowledge and understanding of Health Productivity، as this topic is neither addressed in the school curricula nor within the family matters. Consequently، students incline to gather information and learn about it by recurring to unreliable and unhealthy sources of information.
It’s well-known that improving and caring about the young health is one of the main objectives that nations and peoples throughout the world are caring about. In this context، the Palestinian community، among others، is looking for improving and caring about the young health and providing necessary information and knowledge in order to create healthy young future generations، with a special sense of concern on basic knowledge about health productivity.
The young in the Palestinian community represents 32% of the total average of the population in Palestine according to the Palestinian Statistics Center. Such a high percentage is highly needed to be served and cared about.
For the purpose of the study، the researcher establishes a questionnaire to examine different aspects relevant to Health Productivity، including: knowledge about health productivity، family planning، religious beliefs، Culture productivity، Sexual health، Woman’s Education، Early marriage، genetic diseases، relatives’ marriage، abortion، and the impact and role of mass media، traditions and men-women relations in the Palestinian community، as essential to a better understanding and improvement of Health productivity in the Palestinian community.
A representative sample of (400) male and female students of the total population of the study was selected. The study sample encompasses students with different majors. 88.4% of the questionnaires were approved، coded and analyzed.
The study examines if there is no statistical differences at the level (0.05) related to students’ understanding and perspective in reference to health productivity due to their sex، age، the university year ، place of residence in the West bank، major، area of residence، and degree of religion.
The sample population consists of (400) students، (48.2%) of the population are males and (51.8 %) are females. The average age was 19 yeas old، consisting (71.4%) of the students of the north of the West Bank. The majority of the population of the study is Muslims.
Findings
o (64.4%) of the surveyed students prefer to have less than four children.
o Both male and female students state that the typical age of marriage is 20 years old.
o Regrinding their understanding and definition of Heath Productivity، it was clear for both males and females students that it is not limited to sex.
o The Islamic Law concerning manipulatation wasn’t clear for both male and female students. Therefore، there is a need to clarify and explain the Islamic Law about this issue.
o Religion beliefs and doctrines concerning Health productivity and family planning were clear and understood.
o Most of the surveyed students differentiate between family planning and
o A high percentage of the surveyed students indicate that the main source of knowledge and information of their way of life should stem from the family، and then it should be fostered in school thought the designed curricula. Besides، they believe that Offspring culture and norms assist in protecting of infectious sexual diseases.
o Both males and females students indicate that adults marks are known and clear for both of them.
o (86 %) of the surveyed students show no objection about educating women، and they support educating women، as the more women are educated، the more safety of healthy productivity will have the woman and her family.
o Both males and females students agree that men and women can have the same level of education، and it doesn’t matter if men are more educated than women، but the other way round is refused.
o Both males and females students register their objection of early and relatives’ marriage. They manifest that both of them are aware of the dangers of such marriages. They agree to do blood test before marriage to avoid genetic diseases.
o The Islamic law regarding abortion is not clear. There is a need to clarify the Islamic rules concerning this issue.
In reference to the study variables، there was a strong connection between students’ majors and the study hypotheses. Hence، there is a necessity to integrate Health Productivity concepts and definitions in the school curricula for all braches.
Microbial Water Quality
Abstract
The objective of this study was to evaluate drinking water quality to decide if drinking water is safe for drinking.
Data of microbial drinking water examination in Nablus district in the year 1997, 2000. 2001 and 2003 at Environmental Health Department, Ministry of Health were analyzed and studied for the microbial contamination in order to assess drinking water quality.
A total of 4031 samples were collected from the city, villages and camps in Nablus district and analyzed. Both the percentage of total coliform count and fecal coliform count (E-coli) were used as indicators for water quality, also the free chlorine residual was needed to be tested.
Both indicators gave percentage higher than the recommended as safe drinking water by the WHO and PSI. The percentage of total coliform count (n/ 100 ml) were 23% in 1997, 30.6% in 2000, 11.5% in 2001 and 10.3% in 2003. The percentage of fecal coliform count (n/ 100 ml) were 43.1% in 1997, 33% in 2000, 10.4% in 2001 and 12.4% in 2003.
Based on the percentage count of both indicators, a significant variation were observed on the quality of drinking water in areas studied. The percentage of total coliforms count (n/ 100 ml) were 13% in the city, 30.5% in villages and 18.7% in camps. While the percentage of fecal coliforms count (n/ 100 ml) were 16% in the city, 29.9% in villages and 25% in camps.
Premature Delivery at Al- Maqassed HospitalRisk Factors Associated with the Occurrence of Between 2000-2002
Abstract Newborns are considered to be premature if they are born before 37 weeks old. The neonatal period is the period of the greatest mortality rate in childhood, and the highest risk occurs during the first 24 hours. Factors affecting gestational period and delivery, as well as the post-natal period, have a major impact on the health of both the fetus and neonate (Augusta Victoria Hospital study – 1994. In this study we targeted the Al-Makassed Hospital in Jerusalem district. About 215 premature babies were surveyed between January 2000 and December 2002. The study sample was selected from labor ward, all premature babies who were born at Al-Makassed Hospital from five areas of West bank (east, west, north, south and middle). All participants filled out a questionnaire through telephone interviews. The main results of this study are the following:
Miscarriage among Women in Nablus
Abstract
The current study was aimed at evaluating status of miscarriage among women in Nablus governorate. The study investigated the miscarriage categories, causes and possible associated risk factors. The study population included all pregnant women, suffering from vaginal bleeding, admitted to Rafedia Hospital for the years 1999, 2003 (hospital records) and all cases admitted all hospital concerned in obstetric and gynecology in the city of Nablus during the period January-April 2004. Total number of admitted cases for the year 1999 and 2003 was 412 and 672, respectively. While, total number of women admitted during the first 3 month of the year were 202.
The findings of the current study clearly showed a dramatic increase in abortion rate in association with increased maternal age. It was also found that incomplete (43.6%) and missed (23.8%) miscarriage categories were the most prominent categories among current study population (2004). Similar findings in this regard were observed among admitted cases for the years 1999 and 2003.
Differences in miscarriage rates according place of residence were statistically significant (P = 0.001). It was also found that 70.3% of the current study population suffered from previous abortions. Although consanguineous marriages were represented by 46%, none seems to suffer from recurrent abortions, thus excluding a significant role of either genetic or immunological factors. History of chronic disease including diabetes, hypertension and endocrine disorders was found among 45% of current study population. Complications from previous abortions included bleeding; infections and surgery were represented by 20%, 16.8% and 5.8%, respectively.
Although 91.6% of the study population reported that they have had medical follow up during pregnancy, the findings strongly indicates low level of pregnancy awareness as 49% reported to have unplanned pregnancies, 40% did not take folic acid and 76.2% report the use of medications. With respect to possible risk factors, 28.7%, 91.1%, 66.3%, 83.7% and 74.3% reported active smoking, passive smoking, recurrent genitourinary tract infectio
An Epidemiological Study on the Effect of Water on Health in Tubas District
Abstract
The aim of this study was to investigate the relationship between water quality and health among the inhabitance of Tubas district. In order to achieve our aims, the following strategies were used: examination of available patients records from local governmental clinics; a random sample of school children (seventh grade students) and a specially designed questionnaire distributed to households. Collected data were then analyzed using the SPSS (Statistical Package for Social Sciences).
With respect to water related diseases, diarrhea was the most common disease, especially among students, followed by eye and skin diseases. There was a significant relationship between hygienic conditions and the place of residence and this was clear among the inhabitance of the village of Tammon. The percentage of water related diseases in Tammon area was the highest among the different areas as it reached 43.39%, then Tubas, and then Aqqaba. Although, a high level of wariness was reported regarding the knowledge of importance of water and health (79.7%), practices does not reflect that as most of the study population do not practice the cleaning of their water storage resources (63.7%), and only (15.8%) seems to boil water as a method for disinfection. Other practices such as lack of proper use of chlorine, raising of animal at homes and ways of collected rain water, all seems to indicate a high risk for water pollution. Reviewing patients files also seems to indicate that the area in general is suffusing from several health related problems.
A significant relationship between water- related diseases and the following variables: Place of residence, quantity of available water for use, methods of water collection, public awareness, existence of toilets, the distance between toilets and water source, raising of animals at home, distance between water storage sources and sepses was observed.
In conclusion, the area is suffering from several water related diseases and lack of proper water supply.
Housing Environment and Women’s Health in the Palestinian Refugee Camps :a case study of Al-Ein
Housing Environment and Women’s Health in the Palestinian Refugee Camps: a case study of Al- Ein Refugee Camp in Nablus City
By
Rania Nabeel fawzi Arafat
Supervisor:
Dr. Mohamed Musmar
Co- Supervisor:
Dr. Issam A. Al Khatib (Birzeit University)
AbstractA study of the housing environment and women’s health was carried out during January and February 2002 in 150 homes of Al- Ein Refugee Camp in Nablus city. Interviews were held with 150 women of different age groups and different marital status. One hundred and three of women were married and 47 were single. Information was collected about the social profile, health profile, housing conditions, health services, and the perception of women towards their health and its relation to the housing conditions. The results show a significance relationshi
Job Stress Sources Among Palestinian Nurses Working in Northern West Bank District Hospitals
Job Stress Sources Among Palestinian Nurses Working in Northern West Bank District Hospitals By Yehia A. Joudeh Supervisor Dr.Suleiman Al-Khalil Dr. Abed Assaf
Abstract
The purpose of this study were first to identify the degree of job stress and its sources among Palestinian nurses working in Northern West Bank district hospitals, also to explore the role of study variables (sex, academic qualification, years of experience, marital status, place of living, kind of hospital, place of hospital, kind of word).
To achieve this aims, a sample of (276) nurses were randomly selected for the study. Study tool “questionnaire” was validated by a number of referees and based on literature review when developed. Reliability was tested by using Alpha Cronbach Equation for internal consistency. Reliability was (0.90).
For data analysis, the researcher used arithmetic means, frequencies, percentages, t-test of independent variables, One Way ANOVA, and scheffe test .
Knowledge, Attitude and Practices of Palestinian Women in Refugee Camps of Nablus AreaTowards Family Planning
The current study aimed at exploring and assessing the current level of knowledge, attitudes and practices among women in the refugee camps of Nablus governorate towards family planning as well as their fertility awareness. A specially designed questionnaire was prepared for this purpose and data were collected during the period October- April, 2004. A total of 500 women were interviewed and collected data were analyzed using SPSS. The mean age of the correspondents was 31 years and the mean age of first marriage was 18.7 years. Around 50% of the correspondents were with elementary educational level and 33.8% were with secondary level. Income of around 300 US $ was reported by 81.8% of the correspondents. Total carriages were 2501 and the average family size was 5.9. With respect to knowledge on family planning concept 77.4% of the correspondents were able to define it and 77.8% recognized health as a major benefit. The most common recognized modern methods of contraceptives were IUDs (96.4%), OCs (96.4%), condoms (69.8%) and injections (51%). Natural family planning methods were represented by 35.4% and 15.4% for breast feeding and withdrawal, respectively. The mainly recognized disadvantage of family planning was health side effects of contraceptives (53.6%).
Low level of fertility awareness was observed for menstrual cycle, natural family planning methods and gamete survival. Results show that women are far away of knowing their basic fertile features, and time of ovulation, 45.5% reported to be fertile for 21 days, 52.4% believed that they can get pregnant any time of intercourse, and only one third recognized the first day of bleeding as the first day of the menstrual cycle. Withdrawal as a safe natural method for FP was recognized by 72.8% of the respondents. IUD’s, condoms, and OC’s were the main modern used contraceptives and represented by 25.2%, 21.4%, and 18.4%, respectively. Breast feeding (19.4%) and rhythm (10%) were the most natural used ones.
Attitudes toward family planning seem to be positively high as 95% of the study population agreed strongly and encouraged it. It was also found that 85.6% of the surveyed women believed that their spouses encourage family planning as well. On the other hand 97% of them agree that FP is a joint partner decision and 80% believed that religion encourages family planning, which is contradictory to what is reported in some Muslim communities.
In conclusion we believe that the highly observed positive attitude is not reflected on practices concerning FP as not good enough for effective outcomes of such programs.
The Effect of Health Promotion Education Program on Reproductive Health Knowledge Attitudes and Practices (KAP) Among Reproductive Age Women in Rur
The current study aimed at evaluating the effect of health promotion education program on reproductive health knowledge, attitudes and practices among reproductive age women in rural Palestinian community in Gaza and northern and southern regions of the West Bank area. To achieve our goals a specially designed questionnaire was prepared and the study was conducted at two phases. The first phase was carried out prior to the intervention of the health promotion educational program and the second was carried out after this intervention program. The study was conducted during the period 2001-2002. Data was collected through personal interview with the targeted groups and included 1,347 women (743 first phase and 604-second phase). In the pre phase, Gaza region was represented by 107 (14.4%) women while the southern and northern regions were represented by 291 (39.2%) and 345 (46.4%) cases, respectively. The sample was selected using simple random stratified method and the data was analyzed using the software SPSS (Statistical Package for Social Sciences).
Similar age mean was found among the participants in both phases (29.9 year, for pre intervention and 30.3 for post phase). It was found that 55.2% were less than 18 years of age among the first phase group and the rate of 57.3% among the second group. This indicates a high percentage of early marriage in the rural areas and the mean age at marriage among both groups was 18.8 years. The findings of the study also showed a very low level of education in these areas as the average number of years of education was 7.83 and 8.84 for the pre and post intervention groups, respectively. It was also found that 93% of the study population in both phases did not exceed the secondary stage of education.
The findings of the study showed a very low level of knowledge with respect to postnatal health care and it seems that the health promotion educational program did not improve knowledge in this field. Attitudes were highly positive and improvements in practices were also noted with the exception of practices concerning routine check up of new the born.
With respect to family planning issue, noticeable improvements was observed among the second phase participants, however, low level of knowledge concerning the concept of family planning was observed among both study groups (below 50%). Higher levels of positive attitudes with respect to use of family planning methods were observed among the first phase group (75.9%) compared to the second phase group (72.2%) indicating a limited use of family planning methods and this is also clear from the findings on number of pregnant women during the study period (79.3% and 78.1%) for pre and post phases, respectively. With respect to availability of family planning services, 93% (post phase) and 64.1% (pre phase) reported easy access to such services.
Low level of improvement was observed with respect to knowledge concerning sexually transmitted infections among participants of the second phase as 90% were unable to recognize disease symptoms, 85% were unable to provide two examples of such diseases, 70% did no know preventive methods and 50% were unable to name three organs of the female reproductive system. Practices in this field seem to be acceptable among both study groups.
With respect to regional differences, low knowledge levels were observed with respect to postnatal care in all regions, while highly positive attitudes were reported in the various regions concerning all studied variables in this field. This was very clear in Gaza region with respect to giving birth in hospitals (61.6% pre; 86.1% post), however, both the northern (90% pre; 84.8% post) and southern regions (89% pre; 83.1% post) showed low levels of positive attitudes towards giving birth in hospitals under medical care. Improvement in practices in this field was reported in all studied regions.
Low knowledge levels concerning family planning was found in Gaza with respect to all studied variables among participant of the second phase and levels did not exceed 52%. Attitudes were highly positive in all regions.
The findings also indicates improvements in practices concerning family planning and the highest reported rates of use of family planning methods was found among participants of northern region of the West Bank and lowest levels were reported by participants from Gaza region. This was evident form the number of children under the age of five years as the northern region was with the lowest mean value compared to the other two regions.
Low knowledge levels were also found among participants from Gaza region with respect to sexually transmitted infections as only 3.7% were able to identify symptoms associated with such diseases. Improvement among second phase participants in the southern region was noted especially with respect to the need of treating affected partners, organs of female reproductive system, however limited knowledge was observed concerning other tested variables. With respect to attitudes towards sexually transmitted infections, highly positive attitudes were noted in all studied regions. Practices in this field were within acceptable levels in all regions. In general, these highly positive attitudes did not reflect on neither the poor practices nor the poor knowledge level in all studied regions and among both study groups.
Although some improvements were observed in the post intervention group was found compared to the pre intervention phase of the educational program, the findings clearly indicate the need for further studies concerning priorities in heath education programs.
Housing -Health Relationship in Al-Ain Refugees Camp in Palestine
Housing -Health Relationship in Al-Ain
Refugees Camp in Palestine
Prepared by
Safaa Farook. Kayed Ibsaiss
Supervisor
Dr. Mohamed . J. Musmar
Dr. Issam Al-Khatib
Abstract
Acute respiratory infections (ARI) represent one of the main health problems in children less than five years of age in developing countries.
Every year, pneumonia causes the death of over 100,000 infants under one year of age, which i
Assessment of Perceived Health Care Service Quality at Palestinian Hospitals: A Model for Good Hospital Management Practice (GHMP)
Over the last 20 years, the increasing complexity and technical intensiveness of healthcare in Palestine hospitals have increased the level of uncertainty in the process of care. The variables within the health care environment (demand, cost, system deregulation) are undergoing rapid changes. This study is the first of its kind to investigate beyond quality management approaches, the most important issue in health care management, and the need to implement new organizational model in response to the dynamic changes that are transforming the health care process in Palestine. The study was conducted during January-June 2004 and involved all hospitals working within the City of Nablus. The primary aim of this study was to investigate the possibility of applying quality management approaches into the health care system through the identification of the level of offered services in Nablus hospitals (Public, private and charity) and to search for possible factors affecting level of offered services. The study also aimed at finding out to what extent these hospitals implements the criteria and the standards of quality management system. To achieve our goals, two structured questionnaires especially designed for this purpose were used targeting both staff and patients. Collected data was analyzed using SPSS. Several hypotheses were formulated and tested based upon TQM principles. The results of the current study showed significant differences in the assessment of both staff members and patients and the level of offered services in the various departments within the same hospital and between different hospital sectors. Based upon the criteria level (Likert Scale) set for all hypothesis (3.5 out of 5 points, for good evaluation) most departments showed levels less than 3.5 indicating areas of weakness in most working departments with the exception of working departments in the private sector. A direct relation ship between over all hospital delivery care processes and patient satisfaction, where patient satisfaction is directly related to the attitudes and perception of employee as they, in turn related to the hospital and its management practices was found. The results also showed that total quality management criteria are not considered as hospital priorities. With the exception of Rafidia hospitals none of the operating hospitals is applying any of the TQM principles. Departments applying such principles in Rafidia hospital (only 4) scored higher levels compared to Al-Watani hospital, thus indicating clear advantages in favor of TQM application. Furthermore, correlation analysis confirmed suggestions that further work is required for the establishment of a health care quality management model in hospitals. In conclusion, based upon the findings of the current study a proposed model for the improvement of the existing system was suggested.
Prevalence of Hydatid Cyst Disease in West Bank - Palestine
Abstract Hydatidosis is a zoonotic disease that occurs throughout the world and causes considerable economic losses and public health problems in many countries, it is a major helminthes parasitic infection in West Bank . The current study aims to explore the size of the problem in sheep of West-Bank and answering the question : what is the prevalence of sheep hydatidosis in Palestine ?. A total of 1000 indigenous sheep carcasses were selected from the municipalities abattoirs and slaughterhouses of Nablus, Jenin and Tubas districts . Each animal carcass was inspected carefully, cysts of each organ ( liver , lung …) were counted, measured and examined microscopically to determine the fertility .The total prevalence of hydatid cyst was 9 %, distributed according to age of sheep as : 0.6% in hoggets ( ≤ 1 year ), 10 % in 1-2 years, 24% in 2-3 years, 27% in >3 years age . Our research showed that liver was the most infected organ, 51% of cysts infected both liver and lung together (mixed infection ), 31% were liver cases alone, while involvement of lung alone was observed in 13 % of the cases .The lower number was in spleen 3% and viscera 1% . Microscopic examination of infected cysts revealed that 17% of organs had fertile cysts . 61% of cysts size were <4>4 cm .
Poisoning Among Children at Jenin District
Poisoning is any unwanted effect on human body that can result due to exposure to natural or synthetic substances. Poisoning is highly related to the public awareness and the correct handling of these poisoning substances. This study was conducted to spot the light on the poisoning problem, mainly among children with an overall objective was to decrease the morbidity and mortality rates of children due to poisoning through better understanding of the causes, symptoms, and management of poisoning cases. The study was conducted on poisoning cases that were presented to the emergency room of Jenin Governmental Hospital and admitted to the pediatric unit during the period of January 2000 to August 2002. A total of 127 poisoning cases, up to 14 years old, were presented to Jenin Hospital during the study period. The results showed that the majority of cases were presented with mild to moderate poisoning symptoms, 74% of the cases aged from 1-5 years old, predominantly male. Most of the poisoning cases (85%) occurred at home and resulted from oral poisoning and with symptoms of digestive system poisoning. The majority of the poisoned cases were due to chemical products including pesticides and petroleum materials mainly kerosene. Our findings strongly indicate a lack of public awareness about handling of chemical materials (storage, labeling and first aid in case of poisoning). Carelessness and lack of parental knowledge might be one of the main factors that led to most of the poisoning cases, house was not calming oases in Palestine. Therefore, childproofing home and educational programs from the Ministry of Health and other Non-Governmental-Organizations could be the most effective prevention methods to decrease morbidity and mortality from accidental poisoning in children. In addition, the establishment of poison control center may have an essential role in controlling the poisoning problem.