Public Health الصحة العامة

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Acute Kidney Injury in Hospitalized Patients with COVID-19: Data from Two Centers in Palestine
(Al-Quds University, 2023-01-02) Doaa Jamil Diab Albasha; دعاء جميل دياب الباشا
كان العالم بأسره يكافح من أجل النجاة من أزمة كوفيد-19 الشديدة. لا تؤثر الإصابة بالعدوى على الجهاز التنفسي فحسب بل ترتبط أيضًا بتأثيرات على أجهزة الجسم الأخرى. أشارت بعض التقارير إلى أن وظائف الكلى قد تتأثر أيضاً و تبدو مرتبطة بمدى حدة عدوى كوفيد -19 ونتائجه. الطريقة: دراسة جماعية بأثر رجعي لجميع الحالات التي تم قبولها في مراكز رعاية كوفيد-19 في مستشفى المطلع ومستشفى المقاصد خلال فترة الوباء بأكملها من آذار 2020 إلى آذار 2022. قمنا بتقييم عوامل الخطر المرتبطة بحدة عدوى كوفيد-19 بالاشتراك مع شدة القصور الكلوي والنتائج داخل المستشفى ومعدل الشفاء عند الخروج. النتائج: 140 من أصل 435 مريضاً يعانون من القصور الكلوي (32.2٪). كان لدى معظمهم (79.3٪) علامات قصور كلوي عند الدخول مقابل 20.7٪ أثناء الإقامة في المشفى .(p <0.001) .بنسبة 60 ٪ من الذكور ، و 70.7 ٪ من المرضى يعانون من عدوى حادة الخطورة من كوفيد-19 ، و 45 ٪ من المرضى كانوا بحاجة إلى الانتقال إلى العناية المركزة خلال الإقامة بالمشفى. كان معدل الوفيات في مجموعة التي أصابهم قصور كلوي 35.7% (50 من 140). حوالي (20.7٪) من المرضى طوروا القصور الكلوي الحاد أثناء العلاج بالمشفى بينما حدثت 79.3٪ من الحالات عند الدخول. استند تصنيف (AKI) القصور الكلوي إلى معاييرKDIGO ، حيث كانت النسبة حوالي 60.0٪ من المرضى في المرحلة الأولى ، و (21.4٪) من المرضى في المرحلة الثانية ، و 18.5٪ من المرضى في المرحلة 3 مع 11.4٪ منهم بحاجة إلى علاج بديل كلوي (RRT) . تعافى 63.6٪ من المرضى بحيث استعادوا وظائفهم الكلوية إلى ما قبل الإصابة، واحتاج 10٪ إلى علاج بديل للكلى ، و 26.4٪ كان لديهم قصور كلوي مستمر ولم يستعيدوا وظائف الكلى إلى ما قبل الإصابة. الغالبية و بنسبة 64.3٪ تعافوا وعادوا لمنازلهم وتوفي 35.7٪. تم التوصل إلى أنّ شدة القصور الكلوي مرتبطة بحاجة المريض للمتابعة في وحدة العناية المركزة OR9.8 . [95%CI 3.2 - 30.4] (p <.0001) ، والحاجة إلى التنفس الاصطناعي (p <.0001) ، تعرض المراحل الأعلى من القصور الكلوي الحاد المرضى في نتائج أسوأ في المستشفى من حيث التعرض للوفاة والحاجة للعناية المستمرة والتنفس الاصطناعي. المناقشة / الاستنتاج: أظهرنا أنّ القصور الكلوي منتشر بين مرضى كوفيد-19 الذين يكونون بحاجة للدخول للمشفى وأنّ البعض يتدهور إلى الحاجة المستمرة للعلاج بديل الكلوي ( (RRTبالإضافة إلى ذلك ، كان هناك ارتباط بين شدّة القصور الكلوي والمزيد من المضاعفات داخل المشفى وخطر الوفاة. تشير نتائجنا إلى وجود حاجة مُلحّة للمراقبة الدقيقة والتعامل الدقيق مع مرضى القصور الكلوي الحاد (AKI) بالإضافة إلى تحسين حالة السوائل والهيموداينميكية لاستبعاد ومعالجة القصور الكلوي الحاد وفي نفس الوقت تجنب فرط حجم السوائل لدى هؤلاء المرضى لمنع تدهور حالة الجهاز التنفسي. يجب أن يتم ذلك في الساعات والأيام الأولى في التعامل مع المريض عند الدخول وكذلك طوال فترة مكوثه في المشفى إلى جانب تجنب إخراج المريض للمنزل دون تأكيد استعادة وظائف الكلى لمنع أي مضاعفات محتملة دائمة أو عابرة في الجهاز الكلوي. لذلك، هناك حاجة مؤكدة لمتابعة الناجين من عدوى كوفيد-19 مع علامات على القصور الكلوي (AKI) المرتبط بهم لفهم التأثير طويل المدى على وظائف الكلى وصحة الكلى. الكلمات المفتاحية: القصور الكلوي، عدوى كوفيد-19، العاوامل المؤثرة
Adherence to Infection Prevention and Control Protocols in the Neonatal Intensive Care Units in the Governmental Hospitals in Gaza Governorates
(Al-Quds University, 2009-02-02) Nisren Hamdi Awad; نسرين حمدي صالح عوض
Newborns in intensive care units are more susceptible for infection; most deaths in the late neonatal period are due to infections. This study aimed to assess the adherence to infection prevention and control protocols in the neonatal intensive care units in the Ministry of Health hospitals in Gaza governorates. This study is descriptive analytical cross-sectional conducted on neonatal intensive care unites, study sample consist of 128 subject physicians and nurses working in the NICUs. Data were collected by three instruments; self administered structure questionnaires, assessment structured checklist of physical environment in the NICU and structured observation checklist, with response rate was 92%. The findings revealed that 54% of respondents were male, and 32% were physicians, 68% were nurses, most of respondents did not have a copy of IPC protocol, and most of them (73%) did not know about the existence of the Palestinian infection prevention and control protocol, and not have know the contents of the prtocol. Seventy three percent of health care workers have knowledge about the standard precautions; most of health care workers received hepatitis B vaccination; while 78% of HCWs were exposed to sharp instruments injuries. The study also revealed that hospitals don’t provide training to the health care workers, and lack of continuous update information and instructions about infection prevention and control. The majority of health care workers reported not have system of performance feedback about infection prevention and control, also revealed shortage of availability of appropriate physical environment regarding the infection prevention and control in NICUs. The study clarifies that the practices of infection prevention and control was 56%; while the attitudes is high. The reasons of non adherence to infection prevention and control according to the health care workers perception were the absence of a training program and lack of knowledge and education. The study showed that there statistically significant differences between practices and the hospitals, and no statistically significant differences between practices and year's of experience, type of profession, and gender in relation to infection prevention and control. No statistically significant relationship between attitudes and year's of experience, type of profession, hospitals and gender were found. The researcher recommend to create a national Infection Prevention and Control Program, comprehensive program of regular training, and training as part of on-the-job, to include all HCWs , and as part of orientation program in the NICUs. To conduct specific policies and measure, provide and maintain adequate supplies, resources, and equipment.
Assessing Preventing Behaviors of COVID-19 among Palestinian High School Students Using Health Belief Model
(Al-Quds University, 2022-01-16) EMAN MOUSA AHMAD ALBARBARAWI; ايمان موسى احمد البربراوي
خلفية الدراسة:إن الانتشار السريع لفيروس كوروناأدى لتحوله إلى وباءٍ عالمي، الأمر الذي عمل على تظافر كل الجهود العالمية لمنع انتشار هذا المرض المقلق بين أوساط المجتمعات. ولعل التجمعات الطلابية في المدارس هي من أكثر الأمور التي خلقت قلقا وتوترا للدول على اختلافها؛ لذلك قامت المؤسسات التعليمية بوضع مجموعة من البروتوكولات الصحية التي يجب على الطلبة الالتزام بها كحاجة ملحة للممارسات الوقائية بسبب عودةالطلبة للمدارس.من هنا هدفت هذه الدراسة إلى استكشاف السلوكيات الوقائية تجاه فيروس كورونا، باستخدام نموذج المعتقد الصحي المستخدم كإطار مفاهيمي، لتقليل الإصابة بفيروس كورونا من ناحية ومن أجل تطوير أنشطة تعزيزية للصحة في المدارس. المبرر: ستساعد هذه الدراسة على فهم سلوكيات الطلبة الوقائية تجاه فيروس كورونا، من أجل تشكيل استراتيجيات للتحكم بآثار هذا المرض، ولوضع برامج تعزيز الصحة في وزارة الصحة والمؤسسات الأخرى. علاوة على ذلك، ستكون هذه الدراسة مرجعا لخطط التدخل السريع للمدارس في حال انتشار هذا المرض بين صفوف طلبتها. الغرض والهدف: هدفت الدراسة إلى فهم السلوكيات الوقائية لدى طلبة الصفوف السابع إلى العاشر في مدارس مديرية التربية والتعليم شمال الخليل تجاه فيروس كورونا. عن طريق أربعة أهداف؛ تقييم معرفة الطلاب وممارسات السلوكيات والسلوكيات الوقائية تجاه فيروس كورونا، اضاقة الى معرفة العلاقة بين المتغيرات الاجتماعية والديموغرافية والسلوكيات الوقائية تجاه فيروس كورونا وذلك باستخدام نموذج المعتقدات الصحية. المنهجية: أجريت دراسة وصفية مقطعية باستخدام استبيان عبر الإنترنت من جزأين في الفصل الدراسي الثاني من العام الدراسي 2020/2021 بين طلاب الصف السابع إلى العاشر المسجلين في المدارس الحكومية التابعة لمديرية التربية والتعليم شمال الخليل. استخدمت الدراسة طريقة العينة المتوفرة، وقد استندت أداة الدراسة على نموذج المعتقد الصحي. النتائج: تكونت العينة من 331 طالباً وطالبة. حيث 122 (36.9٪) طالبا من الذكور و209 (63.1٪) طالبة من الإناث من الصف السابع إلى العاشر. وقد أظهرت النتائج أن الطلبة لديهم معرفة معتدلة حول فيروس كورونا وحول السلوكيات الوقائية المتبعة للوقاية من هذا المرض. وعند دراسة تلك النتائج تبين أن المصدر الرئيسي لمعرفة الطلبةحول فيروس كورونا كان وزارة الصحة بنسبة (65.9٪)، تليها المدارس / المعلمين ووسائل التواصل الاجتماعي بنسبة (42.6٪) و (42.3٪) على التوالي. سجل المشاركون درجات عالية في المواقف الإيجابية تجاه فيروس كورونا ومتوسطة في السلوكيات. علاوة على ذلك، سجل الطلاب درجات معتدلة تجاه مكونات نموذج المعتقد الصحي؛ حيث كانت أعلى نسبة هي الكفاءة الذاتية المتصورة بدرجة عالية جدًا (M = 4.38، SD ± 0.49). وأقلها كانت حواجز التباعد الاجتماعي بدرجة منخفضة (M = 2.26، SD ± 1.18). أظهر الانحدار اللوجستي أحادي المتغير ومتعدد المتغيرات أن مكان الإقامة، وعمل الآباء في مهن صحية، وإدراك القابلية، وإدراك الخطورة، والقدرة على السلوكيات الوقائية (الإجراءات الفعلية) لها دلالة احصائية في سلوكيات الطلاب الوقائية تجاه فيروس كورونا. الاعتبارات الأخلاقية: قدم البحث للجنة البحثية بكلية الصحة العامة بجامعة القدس، بعد أن تم الحصول على الموافقة الأخلاقية من مركز جامعة القدس للبحوث والاخلاقيات، كذلك تم الحصول على إذن لإجراء الدراسة من وزارة التربية والتعليم. الخلاصة والتوصيات: تشير النتائج إلى الحاجة لزيادة معرفة الطلاب والسلوكيات الوقائية باستخدام الكفاءة الذاتية وقابلية التأثر، وهناك حاجة إلى مزيد من الدراسات لاستكشاف معرفة الطلاب ومواقفهم وسلوكهم تجاه فيروس كورونا حيث لا يزال الوباء مستمراً، ولازالت المتحورات لهذا الفيروس في تطور بين يوم وآخر، مع عدم وجود حل فعال للقضاء على هذا المرض سوى من خلال تعزيز السلوكيات والممارسات الوقائية. من هنا وجب على صانعي القرار والمؤسسات ذات الصلة بالصحة بناء استراتيجيات وخطط تدخل سريع لتعزيز السلوك الوقائي العام تجاه فيروس كورونا. الكلمات المفتاحية: المعرفة، السلوكيات، السلوكيات الصحية الوقائية، فيروس كورونا، نموذج المعتقدالصحي،الصحة المدرسية، الطلبة، الأساسي العليا،فلسطين، الضفة الغربية.
Assessment of antenatal care services provided to pregnant women with gestational diabetes mellitus at UNRWA health centers in Gaza governorates
(Al-Quds University, 2008-06-09) Mariam Abd-el-Kader; مريم حسن اسماعيل عبد القادر
الرعاية الصحية للسيدات الحوامل تعتبر من الوسائل الأساسية لضمان حمل آمن و مواليد أصحاء، بالأخص في حالات الحمل الخطر و منها سكري الحمل. هذه الدراسة تهتم بتقييم الرعاية الصحية ما قبل الولادة المقدمة للسيدات الحوامل اللاتي بعانين من سكري الحمل في مراكز وكالة الغوث في محافظات غزة، و تهدف إلى رفع مستوى الخدمة الصحية و تقليل مضاعفات سكري الحمل على الأم و جنينها. لقد اشتملت عينة الدراسة على فئتين هما مقدمي خدمة رعاية السيدات الحوامل(الحمل ألخطر) العاملين في مراكز وكالة الغوث الصحية و عددهم 103 مقدم للخدمة، و السيدات الحوامل المصابات بسكري الحمل خلال فترة إجراء الدراسة وعددهم 151 سيدة، و قد كانت نسبة الاستجابة 96.1% بالنسبة للسيدات الحوامل و 98.1% بالنسبة لمقدمي الخدمة. تم جمع البيانات من خلال استبيانين، الأولى خاصة بمقدمي الخدمة و الثانية خاصة بالسيدات الحوامل تعبأ من قبل الباحث أو المساعدين. لوحظ من خلال الدراسة إن السيدات الحوامل المصابات بسكري الحمل و اللاتي يتلقين الخدمة في مراكز وكالة الغوث كن في المعظم ربات منزل، ذوات مستوى تعليمي متدني، و دخل شهري اقل من المتوسط. وجدت الدراسة إن خدمات الرعاية الصحية للحوامل المقدمة للسيدات المصابات بسكري الحمل في مراكز الغوث متاحة لجميع السيدات من المنظور الجغرافي و من خلال وجود نظام مواعيد واضح حيث ذكر ما نسبته 70.4% من السيدات وجود نظاما مواعيد باليوم و الوقت المحددين. بالنسبة للسيدات اللاتي بعانين من سكري الحمل محدودية المعرفة بسكري الحمل من حيث المضاعفات و طرق العلاج تعتبر مشكلة ضخمة تؤدي إلى عدم تقدير حجم المشكلة التي يواجهنها حيث وجدت الدراسة إن معظم السيدات لديهم مستوى من ضعيف إلى متوسط من المعرفة حول سكري الحمل. وجدت الدراسة انه يوجد علاقة ذات دلالة إحصائية بين مستوى المعرفة حول سكري الحمل و المستوى التعليمي للسيدة الحامل و لكن لا يوجد علاقة بين هذه المعرفة و مستوى الدخل، و العمر أو مكان السكن. بالنسبة لمقدمي الخدمة وجدت الدراسة أن معظمهم من الإناث بنسبة 97%، و متوسط عمر مقدمي الخدمة كان 40.95 سنة بمتوسط خبرة يعادل 14.7 سنوات. 23.8% من مقدمي الخدمة كانوا أطباء و الباقون من الممرضات. أكد 70.3% من مقدمي الخدمة أنهم تلقوا تدريبا خلال السنوات الخمس الماضية، منهم حوالي النصف تلقوا تدريبا عن رعاية الحمل الخطر. جميع الأجهزة و الأدوات و التحاليل المخبرية و الأدوية اللازمة لرعاية مرضى سكري الحمل وجد أنها متوفرة و تعمل بشكل سليم في جميع مراكز وكاله الغوث الصحية. بالنسبة لمقدمي الخدمة، كان مستوى المعرفة بسكري الحمل، مضاعفاته و علاجه اقل بكثير من المتوقع حيث وجد أن 18.8% من هذه المجموعة لديهم مستوى متدني من المعرفة بسكري الحمل. لم يكن هناك علاقة ذات دلالة إحصائية بين مستوى المعرفة و العمر، التدريب، المحافظة أو سنوات الخبرة. بينما وجد أن هناك علاقة واضحة بين مستوى المعرفة بسكري الحمل و المؤهلات العلمية وكذلك الاطلاع على تعليمات و كاله الغوث المكتوبة للتعامل مع سكري الحمل. خلصت الدراسة إلى عدة توصيات أهمها التركيز على برامج التدريب و التقييم المستمر لمقدمي الخدمة لما لها من بالغ الأثر على تطوير مستوى المعرفة لديهم و ذلك تحسيننا لمستوى الخدمة التي يقدمونها. يجب على المسئولين العمل على زيادة الطاقم الصحي العامل في رعاية الحوامل و ذلك لحل مشكلة الانتظار الطويل و زيادة وقت الاستشارة الطبية. تحسين خدمات التوعية الصحية للسيدات الحوامل حول سكري الحمل هو من أهم الحلول لمشكلة فقر المعرفة لديهم لذلك يجب العمل على تكثيف الإرشاد الصحي للنساء الحوامل واللاتي بعانين من سكري الحمل مع زيادة نشرات التوعية الخاصة بسكري الحمل .
Assessment of Interprofessional Collaboration amongHealthcare Providers inthe Provision of Health Services at GovernmentalHospitals- Gaza Governorates
(Al-Quds University, 2016-02-01) Iyad Ibrahim Shaqura; اياد ابراهيم شقورة
Universally, there is a growing interest in studying interprofessional collaborative care; whereas, most studies have shown that interprofessional collaborative care has positive outcomes on patient,provider and health system levels. Interprofessional collaboration becomes one of the important priorities for World Health Organization as well as scientific research in Palestine. This study ascertains the assessment of health providers collaboration in providing services at governmental hospitals in Gaza governorates. A mixed-methods approach was used, in which data has been triangulated. In total, 340 randomly selected healthcare providers from six hospitals who were eligible and consented to participate in the quantitative part of the study with 95.7% response rate. In addition, seven interviews and three focus group discussions were conducted with purposively selected 30 participants. Quantitative data were collected first through self-administered questionnaire and preliminary findings derived from the analysis of the questionnaires had directed the qualitative data collection. The researcher used the Collaborative Assessment Practice Tool. The overall reliability was (Cronbach's Alpha 0.815). The statistical Package for Social Sciences software was used for the quantitative data entry and analysis while open coding thematic technique was used to analyze the qualitative data in addition to cross hospital analysis. Findings reveal that 59.12% of participants were male and 79.7% were married at the time of data collection. Nearly half (52.1%) of respondents were nurses, 30.6% physicians, 5.6% lab. Technicians, 4.7% pharmacists, 3.8% radiology technicians and 3.2% physiotherapists 58.2% were bearing bachelors certificate. 40.3% were working at Al-Shifaa medical complex, 22.4% at EGH, 13.8% at Al- Aqsa, 10.9% at Kamal Adwan, 7% at Al-Rantisy and 5.6% at Al-Hilal hospital. 84.75% of participants were working in open departments. Around 84% were experience for 1-15 years. Nearly two thirds (64.1%) were regular employees without high administrative positions. Study participants proposed variations in their responses in relation to the 56 items of the eight domains of interprofessional collaboration. The domain of general relationships elicited the highest mean among other domains (3.943) whereas the mean of community linkages and coordination of care was the least (3.181) as this was referred to the centralized committee that is responsible for that issue. The domain of mission, meaningful purpose and goals was achieved by 74.5% which was mainly attributed to the problematic prioritization of interprofessional goals. Other domains were; patient involvement (68.96%), decision making and conflict management (68.96%), team leadership (69.88%), communication and information exchange (70.8%), and general role responsibilities and autonomy (71.9%). This means that all domains ranged from low to moderate in their current status. The overall perceived interprofessional collaboration was moderate as it was achieved by 71.66%. Inferential statistics show that gender, age, specialty and position had elicited statistically significant variations among healthcare providers (P value less than 0.05). The domains of interprofessional collaboration (except general relationships) also influenced by some independent variables and there were resultant significant variations. Post hoc tests reported some statistically significant differences among the groups of variables. Males and expert healthcare providers inversely affect general role responsibilities and autonomy. Older health professionals, Al-Hilal hospital as a workplace and regular employees positively influenced decision making and conflict management. Professionals bearing diploma certificate and nurses were positively influencing factors on patient involvement. Nurses were better off than pharmacists in communication and information exchange. The health providers who were having more experience years showed highest in community linkages and coordination of care. In addition, interviews and focus group discussions reported enablers and barriers to the interprofessional collaboration among healthcare providers at governmental hospitals. The study concluded that interprofessional collaboration is a new multi-faceted concept to healthcare professionals at governmental hospitals in Gaza governorates and then interventions aiming to enhance it, must be multi-level. Emphasis should be directed at establishing system-level policies, promoting organizational environment, supporting healthcare professional development and greater patients’ involvement in the track of providing quality health services and improving health outcomes.
Assessment of Management Training Needs Among Health Managers in Governmental Hospitals
(Al-Quds University, 2008-10-05) Naeem Hassan Mohamed AlGhareeb; نعيم حسن محمد الغريب
تحديد الاٍحتياجات التدريبية الإدارية للمدراء في مستشفيات وزارة الصحة، 2008م" ملخص الإدارة في أي مستوى هي من الوظائف المعقدة وتحتاج إلي مهارات محددة ومتعددة وإلي المعرفة, وكثير من هذه الصفات يتم تنميتها بالخبرة, ولكن تعلم كيفية أن تكون مديرا فاعلاً ليس بالشيء الصعب وهي كالرحلة, وبرامج التدريب تلعب دورًا مهمًا في التطوير الإداري, وإن تطوير مهارة جديدة وترسيخ معرفة جديدة من شأنه أن يزداد ببرامج التدريب, والهدف من هذه الدراسة هو لفهم وإدراك ما هي المعرفة والمهارات التي يحتاجها المدراء في المستشفيات الحكومية في قطاع غزة لتساعدهم في إنجاز وأداء أفضل في إداراتهم ولأقسامهم. الإستبيانات تم توزيعها علي 180 من مدراء الإدارة الوسطى والإدارة الدنيا في مستشفيات وزارة الصحة الفلسطينية في محافظات قطاع غزة بطريقة العينة العشوائية المنتظمة وإستخدام برنامج الرزم الإحصائية للعلوم الاجتماعية (SPSS) لتحليل العينة. ومن هؤلاء كان 45 طبيبًا و34 من الإداريين و88 من التمريض. وكان من أهم نتائج الدراسة أن 56.9% من المدراء المبحوثين لم يتلقوا أي تدريب في المجال الإداري والبقية تلقوا بعض التدريب في دروس وفي ورشات عمل لمدة بضعة أيام فقط, بشكل عام مدى إدراك ومعرفة المدراء بمسؤولياتهم منخفضة علي وجه الخصوص بالنسبة35.4% منهم, ومعظم الذين إستجابوا للمسح لم يكونوا واثقين في مواضيع التخطيط و التنظيم و الإشراف والمتابعة للخدمات الصحية, عدم الثقة هذا يعكس مدي الإنخفاض (75%) في المعرفة بدائرة التخطيط, بصفة عامة هناك معرفة محدودة بأهمية نظام المعلومات للإدارة الصحية وإستخداماتها, وهذا يعكس غياب نظام هدفه التقييم وكان 47.3% من المبحوثين أعطوا أولوية لمنطقة نظام المعلومات للإدارة الصحية من ضمن إحتياجاتهم الإدارية التدريبية. بشكل عام القسم الأكبر والغالبية من الإحتياجات الإدارية كانت واضحة وملائمة للإحتياج الحقيقي للمدراء الصحيين في كل من التخطيط (75%) , التنظيم ( 58.1%), الإشراف والمتابعة (56.9%), التوجيه (50.9%), نظام المعلومات الصحية (47.3%), التقييم ومراقبة الجودة (43.7%). بسبب أهمية الدور الذي تلعبه برامج التدريب لتحسين والرقي بالمعرفة والمهارة والسلوك لكل من الموظفين والمدراء, لذلك يجب بذل جهد أكثر لتغطية جميع جوانب برامج التدريب ومن ضمنها تقييم وتحديد الإحتياجات التدريبية عن طريق إجراء أبحاث ودراسات تهتم بهذا النشاط علي مستوي الدولة و علي مستوي المؤسسة وأيضا علي مستوي الموظفين ليكونوا مدركين أكثر بأهمية هذا النشاط بالنسبة لهم. وإهتمام أكثر يجب أن يعطى لعملية تقييم وتحديد الإحتياجات التدريبية, بمعنى أن يتم إختيار طرق عملية أكثر, اَخذين بالحسبان مظاهر البيئة المحيطة بعمل الموظفين و إختيار أفضل لمدراء مؤهلين وقادرين علي تحمل مسؤولية مثل هذه النشاطات.
Assessment of nurses knowledge, attitudes, and practices (KAP) regarding of Health Care Acquired Infections (HCAI) In Hebron Hospitals
(Al-Quds University, 2020-12-22) Lo’ai Sa’di Abu-Rayyan; لؤي سعدي ابو ريان
Background: Nurses are health care professionals who play an important role to protect patients from acquiring infections while hospitalized or while in a health care set up or after discharge. According to World Health Organization WHO, Health Care-Associated or Acquired Infection (HCAI), also referred to as "nosocomial" or "hospital" infection, is an infection occurring for a patient during the process of care in a hospital or other health care facility which was not present or incubated at the time of admission. And the HCAI can be occurred anywhere at any hospital, so all health care providers are at risk for it. Aim: This study aims to assess nurse’s knowledge, attitudes, and practices (KAP) regarding hospitals acquired infections (HCAI) in Hebron hospitals. The study outcomes may help in setting strategies, protocols and plans to decrease these acquired infections. Methodology: A descriptive cross sectional design with a sample consisted of 409 nurses was conducted at 6 hospitals in Hebron district, three of them were governmental hospital, two were non- governmental and the last one was a private hospital. All nurses in these hospitals were targeted. Data was collected by using self-administered questionnaire that consisted of 69 items to construct six sections covering social demographics, determinants and health care worker activities, knowledge, attitudes, and practices of nurses toward HCAI, and finally institutional measures to control HCAI. Findings: in this study, 426 questionnaires were distributed, 409 participants completed the questionnaires, with a response rate of 96%. Most of participants were males; 58.2% (n= 238) while 41.8 % (n=171) were females. The majority of nurses aged between 26 to 30 age group (n= 136, 33.3%). The knowledge score showed a mean of 4.10 with a SD of 0.44. It therefore indicated that nurses had adequate knowledge on infection prevention and control. The attitude score showed a mean of 4.04 with a SD of 0.41. Therefore, it also indicated that nurses had positive attitudes towards infection prevention and control. The practice score was lower than knowledge and attitudes with a mean of 3.60 and SD of 0.45. Furthermore, nurses IV ‘perception toward their institutional measures was good with regard to infection prevention and control (a mean of 3.39 with a SD of 0.49). Conclusion: HCAI can be managed considering nursing KAP level, in addition to hospital institutional measurements. The findings of the study concluded that the participants (nurses) had a high level of knowledge, positive attitude and intermittent level of practice. On the other hand, the health institutional measurement affected positively nursing KAP in order to prevent HCAI in Hebron hospitals. So, it is suggested to keep our nurses staff and health care workers up to date with infection prevention precautions measures to enhance their KAP.
Assessment of physicians' and patients' satisfaction with the implementation of ISO 15189 in Palestinian Medicare Private Medical Laboratories
(Al-Quds University, 2023-12-27) Dina Mrwan Mohammad Abu Zayyad; دينا مروان محمد ابو زياد
Recently, all medical laboratories have become interested in ISO 15189, the first quality management ISO system for medical laboratories. To enhance and deliver high-quality healthcare services, it is important to understand patients’ and Physicians' satisfaction levels. International laboratory standards stipulate that the clinical laboratory must monitor customer satisfaction as a crucial metric of the quality management system. However, baseline information on the level of physician and patient satisfaction with laboratory services in privately owned medical laboratories that adhere to ISO 15189 is lacking in Palestine. Aim: The present study aims to assess patients’ and physicians’ satisfaction with the implementation of ISO 15189 in Palestinian Medicare Private Medical Laboratories. Methods: The study employed a quantitative approach, utilizing a cross-sectional study design involving a survey conducted on 191 patients selected conveniently from a monthly average of 6,300 patients in eight branches of Medicare laboratories (Ramallah, Tulkarm, Hebron, Nablus, Jericho, Al-Eizariya, Bethlehem, and Jenin). Additionally, 123 physicians were conveniently selected from the total of 325 physicians who referred patients to the previously mentioned branches of Medicare laboratories each month. This study covered eight branches of Medicare laboratories in Palestine, all adhering to ISO 15189 standards. A structured questionnaire, self-administered, was used to collect data, and analysis was performed using SPSS1. Participants rated their satisfaction on a 5-point Likert scale, with 1 denoting the lowest and 5 the highest satisfaction levels. Statistical significance was determined at a p-value less than 0.05. 1 SPSS (Statistical Package for the Social Sciences) is a software package used for the analysis of statistical data iv Results: The study demonstrated high satisfaction levels among patients (89%) and physicians (85%) in Medicare Private Medical Laboratories adhering to ISO 15189 standards. Patient satisfaction correlated positively with factors like work environment, result accuracy and reliability, and service accessibility, but not with socio-demographic variables. Similarly, physician satisfaction is linked to result quality and laboratory accessibility, with no correlation to socio-demographic variables. The results highlight the positive influence of ISO 15189 implementation on the quality of medical laboratory service. Conclusion: The findings from the study highlighted how the implementation of ISO 15189 positively affected the quality of medical laboratory services. This emphasizes the significance of encouraging policymakers to strive to apply ISO 15189 in Palestinian medical laboratories as a tool of assessment. This adoption aims to guarantee that national medical laboratories consistently achieve and maintain higher standards of practice.
Assessment of Primary Health Care Professionals' Knowledge and Practices Regarding the Integrated Management of Childhood Illness-Gaza Strip
(Al-Quds University, 2005-01-17) Younis Ramadan Awadallah; يونس رمضان عوض الله
Acute respiratory infections and diarrhoeal diseases affecting the children under age five are considered the most causative diseases correlating to mortality and morbidity. As a reflection on that, the World Health Organization/United Nations Children's Fund standardized protocols were activated by many countries including Palestine to improve the standard case management implementation. Therefore, the overall aim of this study is to assess knowledge and practices of the primary health care physicians in Ministry of Health and United Nations Relief and Works Agency about the integrated management of childhood illness, mainly acute respiratory infections and childhood diarrhoeal diseases protocols. This study is a descriptive, correlational, cross-sectional one conducted in the years "2003-2004". A sum of 185 physicians represented the entire study population were asked to complete a structured interviewed questionnaire and 540 randomly selected facility prescriptions were reviewed, with a response rate of 100%. The study revealed low level of compliance with the implementation of the protocols in general, especially with the classification step (25%) and the treatment step (40%) according to the protocols. Of the study population, 49% reported currently using the protocols in their practice. Only 15% of the physicians were had copies of protocols and 53% had received training on the protocols. There were obvious variations in practices and compliance with protocols among physicians in relation to their organizational and demographic characters such as female physicians were more compliant than males ones and physicians from United Nations Relief and Works Agency were more complaint than physicians from the Ministry of Health. The study showed inadequacy of the material and equipment needed for implementation of the protocols such as wall charts, timers, ENT sets and so on. Moreover, the study pointed to the main obstacles preventing physicians from following the protocols such as inadequate training, lack of resources required, work overload, lack of supervision and feedback. The study provided several tentative recommendations that could improve physician's practices such as, designing and implementing more in-service training, provision of the needed equipment and supplies, empowering the management capacity of the health care system such as follow up, supervision and referral services. Conscious efforts are needed to tackle the conclusions of this study in order to support the implementation and the adherence to the concerned protocols.
Assessment of Quality of life of parents who have children with disability in Hebron area, Palestine
(Al-Quds University, 2020-08-16) Mirfit Mahmoud Amleh; مرفت محمود محمد عمله
Background: The birth of a child with disabilities is a challenging event for parents and can have profound implications for the whole family. Raising children with disabilities affects parents' lives, their daily activities, and their well-being. Therefore, this will affect the quality of life of the parents (QOL). There is a need to assess the quality of life of parents of children with disabilities, especially in Palestine because of the high prevalence of children who suffer from a disability. This research explores an important topic well researched in western countries but not well researched in Arab world and in occupied countries as Palestine. It has significant global relevance in regard to parents of children with disabilities. Objective: To assess the quality of life (QOL) in parents of children with disabilities, from their perception, aged from 0 -18 years old in the Hebron area. Method: A cross-sectional study was conducted using a purposive sample, 179 parents of children with disabilities in the Hebron area between the ages of 0 and 18 years based on inclusion and exclusion criteria. Data were collected using the World Health Organization QOL-BREF and a socio-economic status questionnaire. Data was collected between the end of September 2019 and the end of December 2019. Findings: Analysis of parents’ characteristics showed that 44.7% of the 179 participants were males, 70.9% of the participants aged from 30 to 49 years. However, 49.4% were from town, 42.7% were from city. Around half of participants had preparatory and high school education (27.4%, 25.7%, respectively). While 11.2% of participants were illiterate. Furthermore, the result indicates 23.6% of participants had no income, 21.9% of them their income less than 1000 NIS, and only 7.9% their monthly income more than 3000 NIS. 54.2% of the sample was not work at all. 44.8% of it was paid employed. 80.34% of the sample reported that they have no illness and only 2.81 have physical and psychological illnesses together. 57% of children with disabilities were males. Moreover, 64.2% of them their age from 10 to 18 years old. 32.63% have a multiple disability 29.24% of children have intellectual disabilities, 53.81% of the children with disabilities have a moderate degree of disabilities. 30.8% of participants rate their QOL as good and very good, 35.8 % responded neither poor nor good, and 33.5% answered poor and very poor. About satisfaction with their health 44.1% of them being satisfied and very satisfied, 32.4% stated that neither satisfied nor dissatisfied and 23.4% said dissatisfied and extremely dissatisfied. All health domains affected by the presence of children with disabilities noticed that the psychological domain least affected with the mean score of 55.4. Moreover, no significant differences have been found between QOL of parents of children with disabilities and children’s gender, parents’ age, the number of children with disability, disability severity and types of disability (physical, visual, hearing, and intellectual disabilities or have multiple disabilities). While significant correlation has been found between parents’ QOL and parents' monthly income, parents’ education level, place of residence, parents’ physical illness, and children type of disability (speech disability). Conclusion and Recommendations: This study concluded that the presence of children with disability in the family negatively affected the quality of life of their parents. This section of society needs the support of society and the government to reduce the effects of having children with disability on their life. The findings of the study need more attention from parents, health care providers, society, government, and decision-makers.
Assessment of Quality of Services Provided in Radiology and Medical Imaging Departments in the West Bank Hospitals
(AL-Quds University, 2011-05-21) ميسرة علي احمد رمان; Mysara Ali Ahamd Rumman; اسمى الإمام; معتصم حمدان; Ali Sha ar
Assessment of Readiness of Radiology Departments in Palestinian Hospitals in Light of the Corona Virus (COVID -19) Pandemic
(Al-Quds University, 2021-08-02) Anas Abd Alrauof Ahmad Khateeb; أنس عبد الرؤوف احمد خطيب
The study aims to identify the measures to be taken by the Medical Imaging departments at hospitals in order to limit the spread of Coronavirus – COVID 19 by analyzing a group of studies related to this topic and where radiography is a critical matter in assessing the severity of the disease and its progression so working physicians in the Medical Imaging department must to be fully aware of the photographers' manifestations related to COVID19. This study sheds light on epidemiological matters and Medical Imaging to detect symptoms of Coronavirus syndromes in addition to identifying the changes that have occurred in the procedures and general safety precautions for the Medical Imaging department employees to be taken with infected people or suspected of having the disease. The results of the study include populations of radiographers in Palestinian hospitals showed that the degree of readiness of medical imaging departments in Palestinian hospitals in light of the spread of the Coronavirus (COVID-19) were all moderate , The averages ranged between (3.24) and (3.36) which are for (Workers and patients) and (Workplace and equipment). By reviewing the study literature , the researcher found out the important role of computed Medical Imaging in the early diagnosis of COVID 19. In particular, the typical results that make it possible to identify the disease and distinguish it from bacterial causes of infection and to determine which group of patients may benefit from computerized tomography in addition to the precautions that must be taken when performing the tests to prevent the spread of infection. The results also showed that there are unprecedented challenges to COVID19 pandemic, the necessity of making changes, providing services and their maintenance and the need for these changes to achieve protection for employees and unaffected patients. The study concluded that the experiences of the countries affected by the pandemic can help guide those who suffer from the effects of the pandemic through guidance for radiographers to help meet the demands of their services.
Assessment of Service Quality Provided at Al Naser Ophthalmic Hospital
(Al-Quds University, 2016-08-15) Amani Akram Habib; اماني اكرم حبيب
Performance assessment is just the starting point for quality improvement, inspire raising questions, improving data collection procedures, understanding results, and identifying actions for improvement. It should be embedded in a comprehensive quality improvement strategy and used as a quality management tool for the evaluation and improvement of hospital services. This is the first study aims to assess the current service quality provided at Al Naser Ophthalmic Hospital (NOH). The study appraises service quality from staff, patients and managers perspectives, explores quality performance standards at NOH and assess quality of provided services using Performance Assessment Tool for Quality Improvement in Hospitals (PATH). Moreover it identifies strengths and weaknesses areas in the light of quality performance indicators, and provide NOH with a flexible and comprehensive framework for the assessment of hospital performance. The study is a quantitative and qualitative cross sectional analytical descriptive one. The target populations was the working staff, discharged patients, key managers, and medical records at the hospital. Main study's tool was PATH with sub dimensional modifications. Different sub-tools were used. Self administered questionnaire, designed for staff where instrument reliability test (Cronbach’s Alpha) was high; ranged from (0.924) to (0.848), with 85.83% response rate (103 employee). Questionnaire designed for discharged patients' interviews where instrument reliability was moderate and ranged from (0.705) to (0.611), with 92% response rate (230 patients). Questions for mangers discussion group(5 key managers). Final tool was records review for hospital statistics and annual reports and 3checklists for (350) patients' files (inpatients' files and outpatient's files). Statistical Package for the Social Sciences Program (SPSS) has been used for data analysis. The study revealed different strengths and weakness areas regarding sub dimensional indicators. Clinical effectiveness and safety showed strengths areas regarding good effective visual outcome of cataract surgeries and low 30 day readmission rate (0.96%), while indicators flagged with inadequate effectiveness was reported in ECCE to Phaco rate, rate of intraoperative acquired infections (acute endophthalmitis rate), low day surgery rate (8.92%). Documentation indicator showed good results regarding cataract surgical file, while moderate results regarding files for patients whom admitted for medical treatment were reported. Moreover outpatient glaucoma files showed weaknesses regarding documentation of essential measures and parameters. Efficiency dimensions showed inefficient service in respect to rate of attendance to appointments (63.31%), while surgical cancellation rate was accepted (16.14%), and high efficient care regarding low length of stay (2.25 days). Responsive governance dimension showed that quality improvement was included at NOH's structure, but performance indicators and measurements were inadequate, while good responsive quality activities was reported regarding patients and provided service and less responsiveness for staff needs. V Staff orientation dimension showed many weakness areas regarding lack of training expenditure, inadequate work conditions regarding (enabling healthcare/work circumstances managerial practices, and training) from staff perspectives, while (72.4%) exposed to work related injuries and safety related practices was not fair enough to keep staff safe during care delivery. Moreover high burnout status was reported among about half of NOH's staff regarding emotional exhaustion domain and depersonalization. Strength areas reported regarding low rate of excessive working hours, low turnover rate, and low absenteeism rate among the majority of staff members . Patient centerednes dimension reported strengthens areas where patient perspectives showed adequate access to care and adequate meeting of expectations. The status of service quality at NOH is acceptable, but it still needs efforts to enhance the situation through developing a culture of measurements and using of performance indicators, monitoring, and continuous quality improvement. In addition NOH management has to enhance responsiveness regarding staff as well as for the patients to provide high quality care.
Association between Diabetes and the Outcome of COVID-19 in Bethlehem- Palestine: A Case-Control Study
(Al-Quds University, 2023-01-02) Mohammad Jumah Mahmoud Zeer; محمد جمعة محمود زير
خلفية الدراسة: أظهرت الأمراض المزمنة مثل أمراض الرئة المزمنة وأمراض القلب والأوعية الدموية والسكري وارتفاع ضغط الدم والفشل الكلوي ارتباطًا إيجابيًا مع حدة الاصابة بكوفيد-19 وزيادة العرضة للاصابة بالفشل الرئوي وحتى الوفاة. لا توجد دراسة تبحث في العلاقة بين مرض السكري وحدة الاصابة بكوفيد-19ٌ في فلسطين , لذلك هدفت هذه الدراسة الى تحديد تأثير الاصابة بكوفيد-19 على مرضى السكري من خلال دراسة العديد من المتغيرات مثل الاجتماعية والديموغرافية والاعراض والعلامات الحيوية والفحوصات المخبرية. منهجية الدراسة: الدراسة عبارة عن دراسة للحالات والضوابط , اجريت الدراسة بين 417 مشاركًا (198 حالة ، 219 ضابطة) تم ادخالهم الى المركز الوطني الفلسطيني للتأهيل في فترة ما بين شهر مارس /2020 الى شهر حزيران 2021. كانت الحلات عبارة عن ذوي النتيجة الإيجابية للاصابة بمرض كوفيد- 19 ومريض سكري بينما كانت الضوابط ممكن كانت لهم نتيجة إيجابية للاصابة بكوفيد-19 وغير مصابين بمرض السكري,وتم استخدام ملقات المرضى لجمع المعلومات التي تجيب عن اسئلة الدراسة. النتائج: أظهرت النتائج ان متوسط عمر المشاركين 58 ، تتراوح أعمارهم بين 17 إلى 98 سنة ، وكانت نسبة الذكور أعلى من الإناث في هذه الدراسة (53.5٪) من المشاركين ، بناءً على نتائج المرضى فان عدد الوفيات كان 59 مريضاً ,وبلغ معدل الوفيات (14.2٪)، 39 منهم من مرضى السكري ، 24 مريضا يعانون من أمراض القلب والأوعية الدموية (5.7٪) ، 140 مريضا يعانون من ارتفاع ضغط الدم (33.6٪) و 27 مريضا يعانون من أمراض الكلى (6.5٪). وقد تبين بعد عمل التحليل متعدد المتغيرات للمقارنة بين مرضى السكري وغير المصابين بمرض السكري والذي أظهر أن مرضى السكري كانوا معرضين لخطرلإصابة بفيروس كوفيد-19 بنسب (1.63) مرة أكثر من غير مرضى السكري. الخلاصة: هذه الدراسة هي الأولى التي بحثت في العلاقة بين مرض السكري والاصابة بكوفيد-19 في فلسطين, و تم استخدام دراسة حالات و الضوابط للإجابة على اسئلة الدراسة, حيث يعتبر مرض السكري أحد عوامل التي ترتبط بحدة الاصابة بكوفيد-19 ،و تتوافق معظم نتائج هذه الدراسة مع الدراسات الدولية الأخرى التي تفحص تأثير كوفيد-19 على مرضى السكري مع اختلاف بسيط في العدد و النسبة المئوية. وقد ظهرت علاقة ارتباط بين العمر وضغط الدم ,ضيق النفس,والحاجة الى تزويد بالاكسجين,كذلك فحوصات وظائف الكلى وايام المكوث بالمستشفى مع حدة الاصابة بكوفيد-19 بينما لم تكون علاقة بين الجنس ومرضى القلب وفحوصات الكبد مع حدة الاصابة بكوفيد-19.
the association between early marriage and pre-maturity among newborns in Gaza Governorates
(Al-Quds University, 2004-02-16) Nahed R.Eid; ناهض راغب حسين عيد
Attitudes of mental health workers towards patients with schizophrenia in the Gaza Strip
(Al-Quds University, 2016-01-02) Omar Yousef Sudkar; عمر يوسف سكر
This study was designed to examine the attitude of mental illness professionals toward individuals with schizophrenia within Gaza Strip. 13 Psychiatrist, 11 Clinical Psychologist, 16 Psychologist, 16 Clinical Social Worker, 35 Psychiatric Nurse and 13 Other (Directorates and Pharmacists ) Professionals were assessed using the General Attribution Questionnaire (G-AQ-23) with eight factors Fear, Dangerousness, Avoid, Anger, Pity, Responsible, Help and Improvable. Of the 104 participants working on General Directorate of Mental Health Ministry of Health MOH included in the convenient sample, 46 were female (44.2%) and 58 were male (55.8%), with ages ranging from 21 through 60 (M = 37.71 years, SD = 8.67 years). Although no statistically significant differences were found between male and female on 5 attitudinal factors, differences were found on 3 factors assessing the emotional responses of fear and help toward persons with schizophrenia, as well as avoid. The result showed that female attitude were more negative on two factors fear and avoid but the female were more positive on help factor. In addition, significant differences were found between the attitudes held by participants with Diploma degree and participants with Master or Doctoral degree on factor of Fear, the diploma were more negative, significant differences were also found between participants with Bachelor’s degree and participants with Master or Doctoral degree on the measure of Anger the Bachelors were more negative on anger factor. One-way ANOVA's test was conducted to understand the differences on attitudes for participants with different position/occupation. the results showed there are significant differences between participants whom reported their positions as Psychiatrist and participants were identified as Psychologist on the factor of Fear. Significant differences were also found between participants whom reported their positions as Psychiatrist and participants were identified as Psychologist, Clinical Social Worker or other on the measure of Responsible. Pearson correlation coefficients were used to determine the strength of relationship between age of participants and their attitudes toward patients with schizophrenia the results showed there are a significant negative correlation between age and all attitudes, except responsible and improvable were insignificantly negatively correlated with age. These results indicate that older professional hold significantly more positive attitudes toward people with schizophrenia than younger participants. Results also indicate that older age, being female, higher education level, and more years of experience providing direct clinical services to persons with schizophrenia have a positive effect on attitude factor. The strength of relationship between years of experience of participants and their attitudes toward patients with schizophrenia were also investigated by Pearson correlation coefficients, correlation analysis showed significant negative correlation between years of experience and all attitudes, except responsible and improvable were insignificantly negatively correlated with years of experience. The findings are congruent with past research findings and support the position that increased knowledge of and more experience with mental illness person is associated with more favorable views.
Breastfeeding patterns and practice among women in the north of gaza
(Al-Quds University, 2005-05-18) Sa'eed Mohammad Ibrahim; سعيد محمد ابراهيم
This study was carried out to evaluate the breastfeeding status by identifying its patterns and practice among women in the North of Gaza and the factors that disrupt the practicing of breastfeeding. A total of 205 mothers with their infants of age 4-24 months, distributed over four Primary Health Care Centers belonged to the Ministry Of Health (MOH) and the United Nations (UNRWA) which provide the Maternal and child Health services in the North of Gaza, were selected randomly to represent the study population. The findings indicated that only19.1% of infants were exclusively breastfed for 4-6 months, and prolonged breastfeeding rate of 12.2%, while 66.3% were mixed breastfeeding. Hence the initiation rate was 97.6 %, the pure bottle feeding rate among infants less than 6 months was 2.4%. There were differences in the feeding patterns related to the study variables , but the main differences in breastfeeding patterns were related to the areas of residency, locality ,citizenship and clinic type, which reached statistical significant level p value = 0.00. As for area of residency the mixed feeding was more frequent in areas inhabited by citizens such as Jabalia city, Beit lahia and Beit hanoon cities 79.3%, 75%, 67.91% respectively compared with Jabalia camp 49.3%, while the exclusive breastfeeding was more frequent in areas inhabited by refugees such as Jabalia camp 31% and parts of Beit hanoon25% compared with 2.1%, 15.5% of Beit lahia and Jabalia cities. In the mean time formula and prolonged patterns were 3.6%, 4.2%, 0, 3.4% and 3.5%,18.7%,19.7%, 1.7% for Beit hanoon, Beit lahia, Jabalia camp, and Jabalia city respectively . Differences in breastfeeding related to locality reached also significant level where the mixed pattern was widely practiced in cities 75.8% while in camps was 49.4%, and the exclusive was the highest in camps 30.1% compared with 12.9% in cities .while formula and prolonged feeding patterns were 0, 3.8% and 20.5%, 7.6% in camps and cities respectively. Differences related to citizenship were high and reached significant level where the mixed and exclusive feeding patterns were 56.3%, 78.5% and 27.7%, 8.6% respectively for refugees and citizens in which the mixed were more dominant among citizens and the exclusive was more practiced by refugees, while formula and prolonged patterns 0.9%, 4.3% and 15.2%, 8.6% were practiced by refugees and citizens consequently.Differences related to clinic type also showed statistical significant level, where the exclusive pattern appeared to be more frequent among women served by health centers administrated by UNRWA, than those who received service from centers belonged to MOH with 29.9%, 9.3% respectively, while the mixed one was practiced more wide by women served by MOH than those who receive service from UNRWA with 77.8% and 53.6% respectively. In the mean time formula and prolonged feeding patterns were 3.7%, 9.3% and 1%, 15.5% for MOH and UNRWA served visitors. Differences in breastfeeding patterns related to friendship type reached also statistical significant level with p value = 0.01, where women with worm friendships had exercised the exclusive pattern 20.2% more than those with no or normal friendship 19.4%, 7.1% respectively, while the mixed feeding pattern was practiced nearly similar for no, worm and normal relationships 61.2%, 69.2%, 64.3% respectively , also the formula and prolonged feeding pattern was 0%, 2.4%,14.3% and 19.4%, 8.1%,14.3% consequently for no, worm and normal relationship. The last differences which reached statistical significant level was related to birth weight/age with p value of 0.05 where mixed feeding pattern among infants of weights: small for gestational age, appropriate for gestational age and large for gestational age was more frequent with rates of 81%, 65.5%, 50% in comparison with rates of exclusive feeding pattern 9.5 %,19%, 40% respectively, formula feeding pattern 9.5%, 1.7%, 0% and prolonged feeding pattern 0%, 13.8%,10% respectively. Differences related to house type and family problems did not reach statistical significant level with p values of 0.07, 0.06 respectively which reflect the domination of mixed feeding pattern in both relationships in comparison with the other patterns. In addition the results showed other differences which also did not reach statistical significant level, but reflect indicators which ensure the decrease of the breastfeeding status and the tendency toward formula milk which invaded the Palestinian market. So, in spite of the study results which represent baseline data for follow up and research, the study also highlighted the risks of the formula invasion of breastfeeding field and the contraction of exclusive breastfeeding rate in the Palestinian community, which need a comprehensive strategies to promote breastfeeding and to protect our children from missing such important nutritional value existing in the breast milk.
Cesarean Section in the Gaza Strip: Factors and Implications
(Al-Quds University, 2020-06-07) Samah Ahmad khalil AL-Attar; سماح أحمد خليل العطار
Statistics about the rates of cesarean section in Gaza are showing an alarming increase in the past 10 years, almost double than the internationally recommended figures. This study identifies factors behind the increased rate of cesarean section in Gaza. A mixed- method approach was used, in which data have been triangulated. In total, 160 (census study) relevant physicians had participated in the quantitative part with 90% response rate, and 390 beneficiaries’ records were reviewed. In addition, five in-depth interviews were conducted with purposively selected key informants. Quantitative data were collected through self-administered questionnaire and abstraction sheet were used in records review. The preliminary findings derived from the quantitative part had informed the qualitative data collection. The statistical Package for Social Sciences software was used for the quantitative data entry and analysis while the open coding thematic technique was used to analyze the qualitative data. Results showed that repeated CS, fetal distress, malpresentation, IVF and obstructed labor were the most common indications for CS as reported by physicians (83.3%, 77.6%, 73.6%, 61.1% and 45.8% respectively). Records review confirmed these factors. Nearly quarter of respondents (24.3%) admitted that there is no written protocol for management of CS at their work. Work overload, too much duties and lack of supervision (25.8%, 13.4%, 13.4% respectively), were the most commonly reported reasons behind not applying the protocol. Furthermore, fear of litigation was the most common organizational related factor that affects CS, followed by continuous electronic fetal monitoring, lack of protocols and inadequate supervision (53.5%, 45.1%, 39.6% and 39.6% respectively). Inferential analysis from records review showed that non-governmental hospital has statistically significant higher rate of primary CS than governmental hospitals (p=0.001). Results from the qualitative study were supportive to the quantitative findings as key informants reported that the rate of CS is increasing. Fear of litigation and social pressure in addition to private sector were among the reasons behind increase the rate. Findings emphasized the importance of standardization of management of intrapartum CTGabnormalities according to national Obstetric Guidelines and Labor Ward Protocols, enhance Vaginal Birth After Cesarean and pay more attention to decrease primary CS. Moreover, implementation of monitoring, evaluation, accountability and learning system in all health facilities and practices will help to rationalize the use of CS.
Clinical Characteristics and Risk Factors for COVID-19 Deaths in West Bank
(Al-Quds University, 2023-05-23) Duha Issa Hammad Hamamdeh; ضحى عيسى حماد حمامده
Many risk factors have been associated with severe outcomes and death from COVID-19 disease. In Palestine, the incidence of COVID-19 was 8.96%, the COVID-19 mortality rate was 0.1%, and deaths due to COVID-19 showed case fatality ratio of 1.04% until the 31st of December 2021. Study Problem & Justification: The mortality rate among the population in West Bank related to COVID-19 requires an accurate analysis of risk factors causing death, and MOH has published statistics about active, recovered, and fatal cases, but without any analysis of the exposures or causes. Therefore, we would like to conduct a study in Palestine to understand clinical characteristics and risk factors for deaths. Aim & objectives: This study aims to understand the clinical characteristics and risk factors for COVID-19 that resulted in death in West Bank. Its objectives are understanding the demographic characteristics, medical history, and complications of COVID-19 deaths. In addition, analyzing indicators of COVID-19 progression and evaluating the correlation between a medical intervention and deaths in different hospitals. Study methodology: A retrospective cohort study targeted the files of 1001 COVID-19 deaths 15 hospitals in West Bank from March 1, 2020 to December 31, 2021. Descriptive, univariate at p-value < 0.05, and multivariate analysis with (95% CI) were performed using SPSS software. Results: The mean age of sample was 68 years, with range 17-100 years, half of them were males (57.5%). A+ blood group was dominant (33.6%). The mean of stay duration in the hospital was 12.9 days, while the mean of survival days was 15.9 days. Also, 99.1% of patients received supplemental oxygen, 94.6% received non-invasive O2 while 56.3% received invasive O2, and the mean of initiation of giving the non-invasive O2 was one day from admission while the mean of initiation the intubation was 7 days from admission. All patients had signs and symptoms, 82.9% of patients had comorbidities. Pulmonary infiltrates were the most reported radiological finding with percentage of 60.2%. Also, on average, the first abnormal laboratory test results manifested by day 4 following the admission. In terms of medications, Dexamethasone was administrated to 82.7% of patients while Enoxaparin was received by 83.5% of them. Additionally, antibiotics were given to 97.1% of the patients, despite only 19.1% of them having co-infection. Also, the analysis showed a significant relationship through comparison between age and gender with the variables, and the findings indicated that individuals in the age range of 61-8- years, having diabetes, having cancer, and developing septic shock experienced a significant decrease (95% CI) in survival days, with reductions of 1.27 folds (127%), 1.202 folds (120%), 1.320 folds (132%), and 1.309 folds (130%) respectively. On the other hand, living in the southern West Bank, receiving intubation, having hypothyroidism, and receiving Tocilizumab experienced a significant increase (95% CI) in survival days, with increase of 0.799 folds (79.9%), 0.74 folds (74%), 0.46 folds (46%), 0.74 folds (74%) respectively. Conclusion: This study is the first one in Palestine that highlighted the COVID-19 deaths from all governorates of West Bank and identified their clinical characteristics and investigated the possible risk factors related to COVID-19 deaths attending the hospitals. Most of our findings were consistent with other international studies. Based on the findings of this study, it was observed that the old age, male, A+ blood group, comorbidities, and additional complications were related to COVID-19 mortality. Each of age and gender had an effect on some study variables. The indicators such as radiological investigation and laboratory tests showed abnormal findings that predicted to worse COVID-19 prognosis. In addition, the time factor clearly appeared in our study, as survival days, duration days in hospitals, and O2 supply timing as some variables significantly affected survival days since COVID-19 diagnosis. Therefore, the timely identification of COVID-19 severity by biomarkers would help to provide the appropriate intervention on time. Regarding intervention, the majority of hospitals adopted a similar treatment protocol, involving the administration of corticosteroids, anticoagulants, mineral and vitamin supplements, antivirals, and antibiotics. However, these treatments did not show a substantial impact on survival days, with the exception of Tocilizumab
Co-payment Effect on Drug Rational Use and Cost Coverage at Governmental Primary Health Care in Gaza Governorates
(Al-Quds University, 2009-02-25) Khalid M. Abu Saman; خالد محمد محمود ابو سمعان
Drug expenditure represents large amount of health care spending in most countries. Large spending on drugs causes loss of resources which could be deployed to other health care services. Also, the irrational use of drugs can lead to wasting of resources and health hazards as well. This study aimed to study the effect of co-payment on patients' drugs utilization, and also to study drugs cost coverage at the governmental PHC sector in Gaza Strip. The researcher used a descriptive, analytical, cross sectional design. A retrospective multistage sample of 1620 prescriptions was taken from randomly selected 15 PHC clinics from the different geographical areas and the different PHC levels. 108 prescriptions from each selected clinic were taken. Additionally, the researcher reviewed the pharmacy registry at the targeted clinics to ascertain drug cost coverage and drugs availability. The study showed that, there are drugs exploitation particularly for the exempted patients, where the average number of drugs prescribed per prescription was 2.9 (4.5 for exempted, 2.2 for under 3 years and 2 for over 3 year); the average percent of prescriptions including antibiotics per clinic was 64% (79.1% for exempted, 66.3% for under 3 years and 47% for over 3 years). The availability of key drugs was 82.8%. The percent of attendants treated with drugs is 75.4% (88.2% for under 3 year, and 70% for over 3 year visitors). The average drug cost covered by drug co-payment was 84%, more in rural areas than urban ones and the average prescription cost per clinic was 4.9 NIS (1.4US$) more in urban than rural areas. The study concluded that the introduction or increasing co-payment will decrease the quantity of the consumed drugs; helping in drug rational use. The study recommends reviewing the current exemption and co-payment system. Additionally, interventions to increase patient and physician knowledge about economical and healthy adverse effect for irrational drug use are needed

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