Project description:The burden of cancer is difficult to study in the context of the occupied Palestinian territory because of the limited data available. This study aims to evaluate the quality of mortality data and to investigate cancer mortality patterns in the occupied Palestinian territory's West Bank governorates from 1999 to 2009.Death certificates collected by the Palestinian Ministry of Health for Palestinians living in the West Bank were used. Direct and indirect age-standardised mortality rates were computed and used to compare different governorates according to total and specific cancer mortality. Furthermore, standardised proportional mortality ratios were calculated to compare mortality by urban, rural and camp locales.The most common cause of death out of all cancer types was lung cancer among males (22.8 %) and breast cancer among females (21.5 %) followed by prostate cancer for males (9.5 %) and by colon cancer for females (11.4 %). Regional variations in cancer-specific causes of death were observed. The central- West Bank governorates had the lowest mortality for most cancer types among men and women. Mortality for lung cancer was highest in the north among men (SMR 109.6; 95%CI 99.5-120.4). For prostate cancer, mortality was highest in the north (SMR 103.6; 95%CI 88.5-120.5) and in the south (SMR 118.6; 95%CI 98.9-141.0). Breast cancer mortality was highest in the south (SMR 119.3; 95%CI 103.9-136.2). Similar mortality rate patterns were found in urban, rural and camp locales.The quality of the Palestinian mortality registry has improved over time. Results in the West Bank governorates present different mortality patterns. The differences might be explained by personal, contextual and environmental factors that need future in-depth investigations.
Project description:Previous research indicates that social support is beneficial to cancer patients in adjusting to the stress of the disease. Drawing on a qualitative content analysis of 36 semi-structured interviews, this article explores sources and types of social support in Arab-Palestinian women with breast cancer. Results show that members of the immediate family, husbands in particular, are reported to be the most supportive social sources. Given the limitations that characterize access to cancer care in the occupied Palestinian territory (OPT) and the collectivistic values of the society, women with breast cancer seem to rely mainly on their husbands to handle emotional, functional and informational needs. Emotional support includes the provision of care, trust, reassurance, and companionship. Functional support includes the practical assistance that the cancer patients receive in terms of financial support, attendance during treatment or help with domestic chores and childcare. Accessing appropriate informational support can be quite challenging in the OPT since available information is not always reliable. The family plays a key role in mediating communication with doctors. Contact with breast cancer patients and survivors is also a source of supporting information, with however a possible negative impact in terms of emotional coping. In this context, the immediate family becomes a fundamental resource for coping and a relational space that mediates connections with others, including doctors, acting as a "proxy" between the patient and the social environment. Findings are discussed in light of the historical and sociocultural context of the OPT.
Project description:BackgroundIn order to set research priorities for reproductive health in the occupied Palestinian territory, it is vital to know what current research has been done in the field of reproductive health. The purpose of this scoping review is to examine the range and nature of reproductive health research in the occupied Palestinian territory and to identify research gaps in the existing literature.MethodsWe searched four databases: EMBASE, PubMed, CINAHL, and Popline. We included studies that: (i) are published (with an abstract); (ii) relevant to reproductive health; (iii) Palestinians living in Palestine; (iv) participants over the age of 15 years; and (v) restricted to human research. Three independent reviewers screened title and abstracts, and extracted data from included articles. We conducted quantitative and qualitative analyses.ResultsOf 1025 titles and abstracts screened, 145 articles were included. 52 (36%) articles were conducted in community setting and 34 (24%) were conducted in hospitals. There were 5 (3%) experimental studies. 15 articles had more than one main theme; 160 subthemes overall were identified. The most frequently studied theme was labor and delivery (n = 19; 12%). One article discussed adolescent reproductive health and menopause while no articles discussed men's reproductive health.Conclusions91% of the research conducted is observational. The focus of reproductive health research was to understand the topic, community and providers' perceptions and knowledge. Articles related to the quality of services were limited. It is also important to research the reproductive health of women outside of reproductive age, men, and adolescents.
Project description:ObjectivesTo achieve universal health coverage (UHC), countries must make difficult choices to optimize the use of scarce resources. There is a growing interest in using evidence-based priority setting processes, such as Health Technology Assessment (HTA), to inform these decisions. In 2020, the Palestinian Institute of Public Health (PNIPH) and the Norwegian Institute of Public Health (NIPH) initiated a pilot to test the feasibility of coproducing an HTA on breast cancer screening in the West Bank, occupied Palestinian Territory. Additionally, a secondary aim was to test whether using an adaptive HTA (aHTA) approach that searched and transferred published evidence syntheses could increase the speed of HTA production.MethodsThe applied stepwise approach to the HTA is described in detail and can be summarized as defining a core team, topic selection, and prioritization; undertaking the HTA including adaptation using tools from the European Network for HTA (EUnetHTA) and stakeholder engagement; and concluding with dissemination.ResultsThe aHTA approach was faster but not as quick as anticipated, which is attributed to (i) the lack of availability of local evidence for contextualizing findings and (ii) the necessity to build trust between the team and stakeholders. Some delays followed from the COVID-19 pandemic, which showed the importance of good risk anticipation and mitigation. Lastly, other important lessons included the ability of virtual collaborations, the value of capacity strengthening initiatives within low- and middle-income countries (LMICs), and the need for early stakeholder engagement. Overall, the pilot was successfully completed.ConclusionThis was the first HTA of its kind produced in Palestine, and despite the challenges, it shows that HTA analysis is feasible in this setting.
Project description:BackgroundThe COVID-19 pandemic threatens to overwhelm the capacity of a vulnerable healthcare system in the occupied Palestinian territory (oPt). We aimed to evaluate the availability of personal protective equipment (PPE) and the level of preparedness among HCWs in the oPt.MethodsA cross-sectional study was conducted using a validated online questionnaire distributed through convenient sampling between March 30, 2020 and April 12, 2020. Outcomes were availability of PPE, healthcare workers (HCWs) preparedness in oPt for COVID-19 pandemic, and regional and hospital differences in oPt in terms of availability of PPE and HCWs preparedness. Descriptive statistics and univariate analysis were used in this study.ResultsOf 138 respondents, only 38 HCWs (27.5%) always had access to facemasks and 15 (10.9%) always had access to isolation gowns. Most HCWs did not find eye protection (n = 128, 92.8%), N95 respirators (n = 132, 95.7%), and face shields (n = 127, 92%) always available. Compared to HCWs in West Bank, those in the Gaza Strip were significantly less likely to have access to alcohol sanitizers (p = 0.03) and gloves (p < 0.001). On average, governmental hospitals were significantly less likely to have all appropriate PPE than non-governmental institutions (p = 0.001). Only 16 (11.6%) surveyed felt confident in dealing with a potential COVID-19 case, 57 (41.3%) having received any COVID-19-related training, and 57 (41.3%) not having a local hospital protocol.ConclusionHCWs in oPt appear to be underprepared and severely lacking adequate PPE provision. The lack of PPE provision will exacerbate spread of COVID-19 and deepen the crisis, whilst putting HCWs at risk.
Project description:IntroductionThis study aims to assess the prevalence of mistreatment during childbirth in the occupied Palestinian territory and to explore factors associated with mistreatment.MethodsA cross-sectional study of women who gave birth in the West Bank and Gaza Strip health facilities. The survey was administered over the phone to women up to 8 weeks post-partum. Data collection took place between July 2020 and March 2021.ResultsA total of 745 women participated in the study, 36·25% were from the Gaza Strip and 63·75% from the West Bank. The prevalence of mistreatment was 18·8% in which women reported any verbal abuse, physical abuse, or stigma or discrimination during childbirth, with verbal abuse as the most common form of mistreatment reported. Physical abuse was more likely to be reported by women with no labour companion with them (OR: 3·11, 95%CI: 1·24 - 7·99). Verbal abuse was more likely to be reported by women with less than three live births (OR: 1·71, 95%CI: 1·06 - 2·76, women with no birth companion (OR: 2·72, 95%CI: 1·36 - 3·80) and more likely to be reported if curtains wre not used (OR: 2·55, 95%CI: 1·33 - 4·88). Women with less education were more likely to report long waiting times or delays in receiving services compared to women with higher education (OR: 1·40, 95%CI: 1·06 - 2·10).ConclusionFor the first time using the World Health Organisation (WHO) tool in the Eastern Mediterranean region, the study findings, show the occurrence of mistreatment and identify areas to be strengthened to ensure that all women have a respectful childbirth experience within health facilities.
Project description:BackgroundChild maltreatment is a global epidemic. It affects morbidity, mortality, social behavior, wellbeing, and quality of life of children. This study aims to assess prevalence of child abuse in the West Bank (WB) of the occupied Palestinian territory (oPt) and to determine some of its social and political associated factors.MethodsWe analyzed secondary data obtained from a cross sectional study conducted on a sample representing Palestinian children on the West Bank and using the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) tool. The ISPCAN Child Abuse Screening Tool for parents (ICAST-P) questionnaire was completed by 1107 Palestinian mothers to estimate physical and emotional child abusive practices at home for children aged 0-12 years. Univariate, bivariate, and multivariate binary logistic regression analyses were performed using the SPSS® version 20 to assess prevalence and predictors of child abuse.ResultsOverall, around 34% of the West Bank-children were abused by their mothers. Results of the logistic regression analysis indicated that male children, children of younger mothers, children whose fathers were with low levels of education, children whose mothers reported low levels of parental warmth, and children whose parents were exposed to political violence were at greater risk of being abused.ConclusionsChild abuse is highly prevalent among children of the Palestinian society in the West Bank. Policy makers need to pay more attention to this epidemic. The association between child abuse and political violence found in this study makes a just solution for Palestinians essential for improving the welfare of children and families.
Project description:ObjectivesThe purpose of the study was to estimate health expectancy for the Palestinian population and to evaluate changes that have taken place over the past 5 years.DesignMortality data and population-based health surveys.SettingThe Israeli-occupied Palestinian territory of the Gaza Strip and the West Bank.Participants17 034 and 38 071 adults aged 20 or over participating the Palestinian Family Health Surveys of 2006 and 2010. Death rates for 2007 and 2010 covered the entire population.Outcome measuresLife expectancy and expected lifetime with and without chronic disease were estimated using the Sullivan method on the basis of mortality data and data on the prevalence of chronic disease.ResultsLife expectancy at the age of 20 increased from 52.8 years in 2006 to 53.3 years in 2010 for men and from 55.1 years to 55.7 years for women. In 2006, expected lifetime without a chronic disease was 37.7 (95% CI 37.0 to 38.3) years and 32.5 (95% CI 31.9 to 33.2) years for 20-year-old men and women, respectively. By 2010, this had decreased by 1.6 years for men and increased by 1.3 years for women. The health status of men has worsened. In particular, lifetime with hypertension and diabetes has increased. For women, the gain in life expectancy consisted partly of years with and partly of years without the most prevalent diseases.ConclusionsHealth expectancy for men and women diverged, which could to some extent be due to gender-specific exposures related to lifestyle factors and the impact of military occupation.
Project description:BackgroundAdolescents are a critical demographic facing unique health challenges who are further impacted in humanitarian settings. This article focuses on the urgent need for a structured health information system (HIS) to address the gaps in data availability and evidence-based interventions for adolescent health. The study aims to identify opportunities and challenges in utilizing the HIS to enhance adolescent health in the West Bank by gathering insights from healthcare providers.MethodsSemi-structured key informant interviews were conducted with participants involved in the HIS regarding adolescent health in the West Bank. They were selected by purposive sampling. Nineteen interviews were conducted between July and October 2022, and thematic analysis was carried out using MAXQDA software.ResultsThe opportunities identified were the small-scale victories the participants described in building the HIS for adolescent health. These included institutional and individual capacity building, digitalizing parts of the HIS, connection fragmentation of adolescent health activities, multi-sectoral collaboration, reorienting services based on health information, working with limited resources, enhancing community engagement to encourage ownership and active participation, and taking strategic actions for adolescents for information. The challenges were the high workload of staff, lack of health information specialists, limited resources, lack of a unified system in data collection, lack of data on essential indicators, data quality, data sharing, and data sources and use.ConclusionThis study showed the potential of the HIS with capacity building, digitization, and collaborative initiatives; it also suffers from issues like staff shortages, non-standardized data collection, and insufficient data for essential indicators. To maximize the impact of the HIS, urgent attention to staff shortages through comprehensive training programs, standardization of data collection systems, and development of a unified core indicator list for adolescent health is recommended. Embracing these measures will allow the HIS to provide evidence-based adolescent health programs, even in resource-constrained and complex humanitarian settings.
Project description:ObjectiveTo identify factors related to women's delay in presenting with breast cancer symptoms to improve diagnosis in the occupied Palestinian territory (oPt).DesignCross-sectional.SettingTwo government cancer hospitals.ParticipantsA consecutive sample of 130 Palestinian women living in Gaza with newly diagnosed breast cancer were approached in the waiting rooms of cancer hospitals in Gaza between 1 January 2017 and 31 December 2017. 120 women took part and returned the completed questionnaire.Primary and secondary outcome measuresClinical information about breast cancer was collected from hospital cancer records. An interval of 3 months or more between women's self-discovery of symptoms and their first presentation to a medical provider was considered as a delay.Results94% (122/130) of women attending cancer hospitals in Gaza agreed to take part in the study. Their mean age was 51 years (range: 23-72), 33.6% (31/122) had a family history of breast cancer and 74.5% (41/55) of those whose cancer stage was known had been diagnosed at stage III or IV. Around one-half (62/122) said they had not recognised the seriousness of their breast changes but only 20% (24/122) of women delayed seeking healthcare by 3 months and more. The two only factors associated to late presentation were that the woman considered their symptoms not serious (p<0.001) and lack of pain (p=0.012). Lower socioeconomic status, older age, lower education and negative family history of breast cancer were not statistically associated with women's delay.ConclusionsWomen's awareness about the seriousness of breast changes and the critical importance of seeking prompt diagnosis needs to be improved using context-relevant and evidence-based awareness campaigns. This should be accompanied with training of female nurses on promoting early detection and improvement in diagnostic facilities to ensure timely diagnosis of cancer in the oPt.