Conflict exposure and health: Evidence from the Gaza Strip.
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ABSTRACT:
SUBMITTER: Di Maio M
PROVIDER: S-EPMC8453537 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionThe emergence of the COVID-19 and its consequences has led to fears, worries, and anxiety among individuals, particularly among healthcare professionals. The present study aimed to assess the fear of COVID-19 among different healthcare professionals in the Gaza Strip, Palestine.MethodsA cross-sectional, snowball sampling technique and an online questionnaire were employed among healthcare professionals. A total of 300 participants completed the questionnaire. The validated fear of COVID-19 Scale Arabic version was used. Statistical analysis was performed using SPSS version 22.ResultsThe sample fear mean score was 17.53 ± 5.78; more than half of the study participants (54.3%) consider it as low levels of fear and 45.7% of the participants consider it as high levels of fear. Statistically significant differences were found between males and females, and different healthcare professional's disciplines. Females have a higher mean score compared to males. The highest fear mean scores were found among Lab-Technicians (20.19 ± 7.42), followed by X-ray-Technicians (17.95 ± 3.96), Nurses (17.1 ± 5.55), and Physicians (16.25 ± 4.66).ConclusionThe fear of COVID-19 was high among female healthcare professionals compared to males, as well as, among Lab-Technicians compared to Physicians and Nurses. There is a need to establish a strategy to continues measuring the psychological effect of COVID-19 among healthcare professionals especially females.
| S-EPMC8182173 | biostudies-literature
Project description:ObjectivesTo explore how primary care health professionals perceive their own mental health in a conflict-affected setting during and beyond the COVID-19 pandemic and to explore their perspectives on mental health services.MethodsThe Gaza Strip faces a chronic humanitarian crisis and is suffering from the consequences of the COVID-19 pandemic; United Nations Relief and Works Agency (UNRWA) health centres were used to recruit participants for this study. Semistructured interviews were conducted with 29 health professionals in UNRWA health centres who were sampled using maximum variation sampling. Transcripts were translated, double checked and analysed via thematic analysis.ResultsFrom the analysis, a thematic map was developed showing how health professionals perceive their mental health impacts. This included difficulties due to the COVID-19 pandemic, as well as the socioeconomic processes stemming from the on-going conflict.Another thematic map was developed showing the perceived strengths and challenges of the health services. The strengths included positive impact of the services to the service users and health professionals. In terms of challenges, health professionals identified socioeconomic processes and aspects of remote service provision during COVID-19.ConclusionsBased on the findings, we suggest that an improved signposting mechanism should be developed to address many of the challenges that emergencies bring about; in particular, this could support the health professionals' mental health, as well as improve the response to patients' socioeconomic challenges. We further suggest recommendations for improving mental health services when delivered remotely to increase their resiliency during various emergencies.
| S-EPMC10471847 | biostudies-literature
Project description:Background:Breast cancer is a major public health problem and the first leading cause of cancer deaths among females in Palestine. Early diagnosis of breast cancer contributes to reduction of morbidity and mortality rates. This study aimed to explore system-related factors affecting the timely diagnosis of breast cancer in the Gaza Strip. Method and Materials:A mixed method, sequential explanatory design was employed. A quantitative study was conducted first, and it was cross-sectional in nature, followed by a qualitative study. An interviewed questionnaire and an abstraction sheet were used to collect necessary quantitative data among 122 females diagnosed with breast cancer. A purposive sample of five medical specialists were selected for in-depth interview. Descriptive and inferential analyses were used to find differences between variables. Odds ratio and confidence interval at 95% were presented, and P < 0.05 was considered statistically significant. Results:Around 12.3% of women experienced diagnostic delay for 3 months and more, and 6.6% reported a delay in referral for more than 2 weeks. Regarding imaging delay, around 8.2% and 2.7% of women had reported a delay in performing mammography and ultrasound, respectively. Moreover, one-fourth reported delay in performing biopsy for more than 14 days, and 46.3% reported delay more than 14 days in getting histopathology report. In addition, 9% missed the follow-up after benign findings of the previous breast imaging and no national protocols are available for the diagnosis of breast cancer in the Gaza strip. Conclusion:There is a long appointment time for diagnostic tools especially in biopsy. The nonmalignant findings from mammography or ultrasound could affect diagnosis time. It is an urgent need to have a national protocol for diagnosis and management of breast cancer and to adopt screening, diagnostic, and follow-up programs under the supervision of the Ministry of Health.
| S-EPMC6927013 | biostudies-literature
Project description:Breast cancer (BC) is the main common cause of cancer mortality among women in the world. This study aims at investigating BC epidemiology and identifying the different risk factors associated and the most affecting ones among women in the Gaza Strip, Palestine. This study was a hospital-based case-control (1:2), as the study was carried out over the period of October 2014 to February 2015. A total of 105 BC patients, chosen from Al-Shifa Hospital in Gaza City and European hospital for the south governorate, were the case and compared to 209 women as a control group who matched the cases in age, residence, and with no history of breast problems. The age of the enrolled cases and controlled ranged between 18 to 60 years. The face-to-face interview was conducted during the patient visit to the oncology department and the control visit in their home. The result illustrated that women who had late pregnancy (> 35 years) (odds ratio [OR], 11.56; 95% confidence interval [CI], 1.64-81.35), or high body mass index (BMI; ≥ 30 kg/m2) (OR, 4.70; 95% CI, 1.62-13.69), or first-degree family history of BC (OR, 2.7; 95% CI, 1.04-7.20), or hypertensive patients (OR, 12.13; 95% CI, 1.93-76.10), or diabetic (OR, 6.84; 95% CI, 1.77-26.36) were more likely to have increased BC risk. The findings of the present study suggest that positive family history of BC, high BMI, and some common diseases (hypertension, diabetes mellitus) may be the epigenetic factors promoting the occurrence of BC.
| S-EPMC5539210 | biostudies-other
Project description:BACKGROUND:The United Nations Relief and Works Agency for Palestine refugees in the Near East (UNRWA) has periodically estimated infant mortality rates (IMR) among Palestine refugees in the Gaza Strip (Gaza). These surveys have recorded a decline from 127 per 1000 live births in 1960 to 20.2 in 2006. Thereafter, a survey revealed an IMR of 22.4 in 2011. Alerted by these findings, a follow up survey was conducted in 2015 to further assess the trend of IMR. METHODS:We used the same preceding-birth technique as in previous surveys to estimate IMR and neonatal mortality rate (NMR) per 1000 live births. All multiparous mothers who came to the 22 UNRWA health centers to register their last-born child for immunization were asked if their preceding child was alive or dead. We based our target sample size on the previous IMR of 22.4 and we interviewed 3126 mothers from September to November 2015. FINDINGS:The third survey estimated mortality rates in 2013. The IMR was 22.7 (95% CI 17.2-28.1) per 1000 live births. IMR did not decline since the estimated IMR of 20.2 (15.3-25.1) per 1000 live births in 2006 and 22.4 (16.4-28.3) per 1000 live births in 2011. NMR was 16.1 (11.6-20.7) per 1000 live births, which was not statistically significantly different from 2006 (12.1 (8.7-16.4)), and was lower than in 2011 (20.3 (15.3-26.2)). CONCLUSION:The estimated mortality rate in infants of Palestine refugees in Gaza has not declined since 2006. The stagnation of infant mortality rates indicates that further efforts are needed to investigate causes for this stagnation and ways of addressing the potentially preventable causes among Palestine refugee children in Gaza.
| S-EPMC5999100 | biostudies-literature
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.
| S-EPMC3532998 | biostudies-literature
Project description:BackgroundIn low-income settings, cancer is often diagnosed in advanced stages due to late presentation. Good public awareness of cancer signs and symptoms has a positive impact on the time patients take before they present to healthcare professionals. Therefore, this study examined public knowledge of cancer signs and symptoms as well as risk factors in Gaza.MethodsThis was a cross-sectional study. Participants were recruited from adult visitors (?18?years) to governmental hospitals covering all five governorates of Gaza, and adolescent students (15 to 17?years) from 10 high schools in corresponding locations. An Arabic version of the Cancer Awareness Measure (CAM) was completed in a face-to-face interview. It described demographic data and knowledge of: cancer prevalence, age-related risk, signs and symptoms as well as risk factors both in recall and recognition questions.ResultsOf 3033 participants invited, 2886 completed the CAM (response rate?=?95.2%). Adult mean age?±?standard deviation was 33.7?±?11.7?years and that of adolescents was 16.3?±?0.8?years. Half of the participants (n?=?1457, 50.5%) were adolescent (781 females; 53.6%) and 1429 (49.5%) were adult (702 females; 49.1%). About two thirds (n?=?1885) thought about cancer as unrelated to age. Only 196 participants (6.8%) identified colorectal cancer as the most common cancer among men. Awareness of cancer signs/symptoms was poor to fair, where ‘lump’ was most commonly recognized (n?=?2227, 77.2%) and ‘change of bowel habit’ the least (n?=?670, 23.2%). Only 217 participants (7.5%) had a good level of recognizing risk factors with ‘smoking’ being the most identified and ‘eating less than five portions of fruits and vegetables a day’ the least. There was a higher likelihood for adults to identify most cancer signs/symptoms and risk factors than adolescents, except for recalling ‘unexplained pain’, ‘persistent cough/hoarseness’, ‘non-healing ulcer’, ‘smoking’, and ‘eating less than five portions of fruits and vegetables a day’.ConclusionPublic awareness of cancer signs/symptoms and risk factors needs to improve to facilitate early presentation and diagnosis in Gaza. Combining the delivery of public campaigns with tailored education to population groups, including the youth, may increase their knowledge and maintain its impact.
| S-EPMC7106782 | biostudies-literature
Project description:BackgroundRemarkably high carriage prevalence of a community-associated meticillin-resistant Staphylococcus aureus (MRSA) strain of sequence type (ST) 22 in the Gaza strip was reported in 2012. This strain is linked to the pandemic hospital-associated EMRSA-15. The origin and evolutionary history of ST22 in Gaza communities and the genomic elements contributing to its widespread predominance are unknown. Methods: We generated high-quality draft genomes of 61 ST22 isolates from Gaza communities and, along with 175 ST22 genomes from global sources, reconstructed the ST22 phylogeny and examined genotypes unique to the Gaza isolates. Results: The Gaza isolates do not exhibit a close relationship with hospital-associated ST22 isolates, but rather with a basal population from which EMRSA-15 emerged. There were two separate resistance acquisitions by the same MSSA lineage, followed by diversification of other genetic determinants. Nearly all isolates in the two distinct clades, one characterised by staphylococcal cassette chromosome mec (SCCmec) IVa and the other by SCCmec V and MSSA isolates, contain the toxic shock syndrome toxin-1 gene. Discussion: The genomic diversity of Gaza ST22 isolates is not consistent with recent emergence in the region. The results indicate that two divergent Gaza clones evolved separately from susceptible isolates. Researchers should not assume that isolates identified as ST22 in the community are examples of EMRSA-15 that have escaped their healthcare roots. Future surveillance of MRSA is essential to the understanding of ST22 evolutionary dynamics and to aid efforts to slow the further spread of this lineage.
| S-EPMC6113745 | biostudies-literature
Project description:BACKGROUND:Health care workers (HCWs) are essential for the delivery of health care services in conflict areas and in rebuilding health systems post-conflict. OBJECTIVE:The aim of this study was to systematically identify and map the published evidence on HCWs in conflict and post-conflict settings. Our ultimate aim is to inform researchers and funders on research gap on this subject and support relevant stakeholders by providing them with a comprehensive resource of evidence about HCWs in conflict and post-conflict settings on a global scale. METHODS:We conducted a systematic mapping of the literature. We included a wide range of study designs, addressing any type of personnel providing health services in either conflict or post-conflict settings. We conducted a descriptive analysis of the general characteristics of the included papers and built two interactive systematic maps organized by country, study design and theme. RESULTS:Out of 13,863 identified citations, we included a total of 474 studies: 304 on conflict settings, 149 on post-conflict settings, and 21 on both conflict and post-conflict settings. For conflict settings, the most studied counties were Iraq (15%), Syria (15%), Israel (10%), and the State of Palestine (9%). The most common types of publication were opinion pieces in conflict settings (39%), and primary studies (33%) in post-conflict settings. In addition, most of the first and corresponding authors were affiliated with countries different from the country focus of the paper. Violence against health workers was the most tackled theme of papers reporting on conflict settings, while workforce performance was the most addressed theme by papers reporting on post-conflict settings. The majority of papers in both conflict and post-conflict settings did not report funding sources (81% and 53%) or conflicts of interest of authors (73% and 62%), and around half of primary studies did not report on ethical approvals (45% and 41%). CONCLUSIONS:This systematic mapping provides a comprehensive database of evidence about HCWs in conflict and post-conflict settings on a global scale that is often needed to inform policies and strategies on effective workforce planning and management and in reducing emigration. It can also be used to identify evidence for policy-relevant questions, knowledge gaps to direct future primary research, and knowledge clusters.
| S-EPMC7259645 | biostudies-literature
Project description:BackgroundGaza has been under land, sea, and aerial closure for 13 years, during which time Palestinian patients from Gaza have been required to obtain Israeli-issued permits to access health facilities in the West Bank (including east Jerusalem), as well as in Israel and Jordan. Specific groups, like cancer patients, have a high need for permits due to lack of services in Gaza. The approval rate for patient permits to exit Gaza dropped from 94% in 2012 to 54% in 2017. We aimed to assess the impact of access restrictions due to permit denials/delays on all-cause mortality for cancer patients from Gaza referred for chemotherapy and/or radiotherapy.MethodsThis study matched 17,072 permit applications for 3,816 cancer patients referred for chemotherapy and/or radiotherapy from 1 January 2008 to 31 December 2017 with referrals data for the same period and mortality data from 1 January 2008 to 30 June 2018. We carried out separate analyses by period of first application (2008-14; 2015-17), in light of varying access to Egypt during these times. Primary analysis compared survival of patients according to their first referral decision (approved versus denied/delayed) using Kaplan-Meier method and Cox regression.FindingsMortality in patients unsuccessful in permit applications from 2015-17 was significantly higher than mortality among successful patients, with a hazard ratio of 1·45 (95% CI: 1·19-1·78, p<0.001), after adjusting for age, sex, type of procedure, and type of cancer. There was no significant difference in mortality risk for the two groups in the 2008-2014 period.InterpretationLimitations to patient access due to unsuccessful applications for permits to exit the Gaza Strip had a significant impact on mortality for cancer patients applying for chemotherapy and/or radiotherapy in the period 2015-17. The substantially higher number of annual unsuccessful permit applications from 2015, combined with severely limited alternatives to access chemotherapy and radiotherapy during these years, may be important factors to explain the difference in the impact of permits delays/denials between the two study periods.
| S-EPMC8172025 | biostudies-literature