Public Health الصحة العامة
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- ItemSoap contamination by Pseudomonas aeruginosa in hospitals care units in Bethlehem and Hebron (West Bank, Palestine)(Al-Quds Univeersity, 2026-01-03) Shahd Raed Helmi AL-Qaisse; شهد رائد القيسيBackground: Washing hands with contaminated soap can increase the exposure to opportunistic pathogens and may contribute to the transmission of bacteria in public environments. One of these pathogens is Pseudomonas aeruginosa a gram-negative environmental bacterium, that predominantly lives in humid environment. It is a major cause of nosocomial infections in hospitals and causes acute or chronic infections in immunocompromised individuals. In addition, P. aeruginosa has an inherent resistance to antimicrobial agents, which can be more aggressive and cause severe therapeutic problems. However, P. aeruginosa as an opportunistic pathogen can activate useful phenotypes under environmental stress and persist in harmful situations such as the presence of antibiotic or antiseptic substances. Aim: To investigate the prevalence of P. aeruginosa contamination in soaps across hospital care units in Bethlehem and Hebron, Palestine. Methods: Soaps samples (N=79) were collected from various sections including, Intensive care units, Internal medicine units, Cardiac care units, Pediatric Oncology Department, Dialysis units, Rehabilitation, Post-natal care, Delivery room, Postnatal unit and Surgery. All samples were cultured in cetrimide agar plates for the isolation of P. aeruginosa without prior dilution. Preliminary tests including Gram stain, oxidase and growth at 42°C, coupled with Biochemical Identification using API 20 NE, used as confirmation tests for P. aeruginosa. Results: Out of 79 soap samples collected from different care units, 15 (18.98%) samples tested positively for P. aeruginosa. From Bethlehem hospitals, out of forty-five samples there are 6 (7.59%) positive samples were detected. However, thirty-four samples from Hebron hospitals, 9 (11.39%) were positive samples contaminated with P. aeruginosa. On the other hand, the results showed that among the samples collected, only 3/15 (20%) positive samples used by medical staff, while 12/15 (80%) positive samples were used by patients and their companions. Conclusion and recommendations: All positive samples in this study were obtained from refilled soap dispensers; these findings support the notion that refillable soap dispensers are more susceptible to bacterial contamination likely due to accumulation of liquid in the pump head. Accordingly, positive samples in this study may be attributed to several factors including the presence of some soap bottles without a cover pump, unhygienic bathrooms, unclean sinks, or perhaps the contamination occurred in some way through tap water. In addition, the ability of P. aeruginosa to form biofilm may enhance its persistence, virulence and resist to antimicrobial agents. Antibiotic resistance represents a major and growing global public concern. Thus, reducing the transmission of bacterial pathogen among patients is essential to limit antibiotic use and slowing the antibiotic resistance. Hence, it is important to ensure that effective hand hygiene is the most effective method mainly in healthcare settings, washing hands with proper and uncontaminated soap by medical staff or patients can help to reduce nosocomial infections. Consequently, hospitals are strongly encouraged to replace refillable soap dispenser with disposable, sealed nonrefillable system to ensure sterile and effective hand washing practices.
- ItemSelf-Perceived Health Status and Sense of Coherence among Children with Cancer in the West Bank, Palestine(Al-Quds Univeersity, 2026-01-03) Donya Mohammad Sobhi Anbar; دنيا محمد صبحي عنبرAbstract Introduction: Self-perceived health status (SPHS) and sense of coherence (SOC) are important concepts in understanding the health experience of children with cancer. This study aims to identify the level of SPHS and SOC, identify the relationship between medical and sociodemographic characteristics and SPHS/SOC, and identify the relationship between SPHS and SOC among children aged 8 to 18 years with a cancer diagnosis. This study aims to fill that gap by exploring the relationship between SOC and SPHS in children with cancer in the West Bank, Palestine. Understanding these concepts will reveal the children's coping mechanisms and help healthcare providers improve SOC in routine care to enhance SPHS, assist policymakers in creating supportive programs, and ensure psychological needs are met, while also guiding future research. Methodology: A cross-sectional descriptive design was used. Two hundred participants completed the surveys, with a response rate of 54.1%. Participants were between 8 and 18 years old, had received a cancer diagnosis, were admitted to pediatric oncology/hematology wards or attended outpatient clinics at Najah National University Hospital (NNUH)/Nablus, Al-Istishari Hospital/Ramallah, and Beit-Jala Hospital/Bethlehem. Among the participants, 72% of children with cancer aged 8 to 18 years completed the PedsQL 3.0 Cancer Module Arabic Version, while 28% of children aged 13 to 18 years completed both the PedsQL 3.0 Cancer Module Arabic Version and the SOC-13 Arabic Version. The study period was from October 15, 2024, to December 16, 2025. Results: The findings revealed that the PedsQL mean was 52.02 (SD = 17.02) and had low SPHS; the highest score was in the domains of communication (mean = 67.96 ± 28.11), while the lowest SPHS was in the domains of worry (mean = 36.00 ± 29.02) and procedural anxiety (mean = 36.62 ± 27.68). Also, the SOC mean score was 55.02 (SD = 12.27), and 76.8% of participants had low SOC. The SOC domains were 19.54 ± 6.78 out of 35 for comprehensibility, 17.59 ± 3.86 out of 28 for manageability, and 17.89 ± 4.61 out of 28 for meaningfulness. Otherwise, Statistical analysis demonstrates a significant co-relationship between SPHS and SOC with r = 0.490, P-value < 0.01. Which means, high SOC indicates high SPHS, as a result, coping with stressors and living with cancer. Conclusion: The political situation in Palestine may negatively affect SOC in children overall, and specifically impact those with cancer, due to a lack of services and medication, and difficulty accessing healthcare. Tracking SPHS and SOC helps in understanding the impact of these barriers and assists caregivers in developing more effective interventions to improve the quality of care and support provided to these children. In summary, SOC is a key concept that affects SPHS among children with cancer. This shows that the psychological aspect in children is just as important as the medical aspect.
- ItemPrevalence and Risk Factors of Tuberculosis in the West Bank (2016-2024)(Al-Quds University, 2026-01-10) Rawan Moraweh Hussein Abdelhaq; روان مروح عبد الحقBackground: Tuberculosis (TB) remains a significant global public health concern, including in low-incidence but high-risk settings such as Palestine, where political constraints, limited diagnostic capacity, and socioeconomic hardship may mask the true burden of disease. Although the West Bank reports fewer than one case per 100,000 population, the actual burden may be underestimated due to diagnostic limitations, underreporting, and operational constraints within the health system. Understanding the epidemiological trends, risk factors, clinical characteristics, and household transmission patterns is essential to strengthening surveillance and improving TB control strategies. Methodology: A retrospective descriptive study was conducted using national TB surveillance data obtained from the Palestinian Ministry of Health for the years 2016–2024. Data were extracted from standardized investigation forms and DHIS2 databases. Descriptive statistics and bivariate analyses were performed to assess sociodemographic, socioeconomic, clinical, diagnostic, and household contact variables, and to determine factors associated with TB forms and diagnostic outcomes. Results: From 2016 to 2024, a total of 67 confirmed TB cases (49 PTB and 18 EPTB) aged ≥10 years were reported in the West Bank, corresponding to a very low but fluctuating incidence of 0.09-0.36 per 100,000 population and an overall prevalence of 2.01 per 100,000. Cases were predominantly male (65.7%) with a median age of 47 years; PTB was more common among older adults, whereas EPTB was relatively more frequent in younger adults. Bivariate analysis showed that occupation (notably doctors and digger-truck drivers) was significantly associated with TB classification (p = 0.026). At the same time, sex, housing conditions, and diagnostic delays were statistically associated with higher bacteriological positivity in selected tests, reflecting increased infectiousness in specific subgroups. Diagnostic pathways relied mainly on acid fast stain, culture, imaging, and Mantoux testing, with minimal use of GeneXpert and substantial underreporting of several diagnostic results and comorbidities. Among 139 household contacts, 23.1% had a positive Mantoux test. However, tuberculosis preventive therapy was documented for only about two-thirds of eligible contacts, and overall treatment outcomes for index cases were poorly recorded. Conclusion: Although TB incidence in the West Bank remains low, the study highlights key epidemiological and clinical patterns that warrant attention, including occupational-related risks, diagnostic delays, and potential household transmission. Strengthening diagnostic capacity, enhancing early detection, improving documentation quality, and implementing targeted prevention strategies may help reduce future TB burden and support national progress toward the WHO End TB goals.
- ItemAssessment of Healthcare Delivery for Hemophilia Patients in Palestine: Challenges, Gaps, and Opportunities for Improvement(2025-12-22) Nadi Hassan Abed Eid Zawahra; نادي حسن عبد عيد زواهرةBleeding disorders like hemophilia are rare inherited conditions. However, it still requires around-the-clock specialized multidisciplinary healthcare to prevent severe complications and maintain an acceptable quality of life. In resource-limited and politically constrained settings like Palestine, providing comprehensive hemophilia care continues to be extremely difficult. Therefore, this study sought to assess healthcare provision for West Bank/Palestine hemophilia patients, identify primary issues, and pinpoint gaps in care, in addition to addressing the potential to improve the accessibility and the tier of care provided, as well as equity for under-resourced patients. A cross-sectional, mixed-methods study was carried out from March 2024 to August 2025. Quantitative data was collected via a structured survey from 99 patients diagnosed with hemophilia A or B, equating to around 28% of the registered hemophilia population in the West Bank/Palestine. Patients were purposefully sampled from multiple governorates. Most respondents were male (93.9%), under the age of 35 (84.8%), and lived in rural areas (63.6%) and low-income households (59.6%) with income levels under USD 500 monthly. SPSS was utilized for descriptive and inferential statistical analyses (t-tests, one way ANOVA, correlation, multiple linear regression). Of the qualitative data collected through open-ended questions, thematic analyses were done to augment the quantitative data. The findings disclosed serious shortcomings in hemophilia health care. 79.8% of patients reported occasional shortages of clotting factor concentrates. Financial barriers were reported by 53.5% of patients, while 77.8% of patients experienced issues related to transportation. 57.6% of the participants received prophylaptic Repl in 94.9% of the patients that were sufficiently prepared to control the bleeding. 78.8% of the patients did not have regular orthopedic consultations, and 70.7% did not have psychological debriefing. More than 80% of patients felt that there were too few hemophilia treatment centers, diagnostic centers, and specialized healthcare workers. There was a mixed patient satisfaction with healthcare services, with only 35.3% of patients indicating satisfaction with the services they received. Results of the multiple regression analysis showed that the frequency of bleeding episodes, perceived healthcare service accessibility, and health education of the patient were significant predictors of satisfaction with the care quality (p<0.05). There was low awareness (18.2%) of national policies pertaining to the treatment of patients with hemophilia, and this awareness was related to lower household incomes. In summary, the obstacles to hemophilia care in the West Bank/Palestine include a lack of medications, a lack of specialized services, a lack of adequate services, a lack of patient education, a lack of policy dissemination, and a lack of policy dissemination. The maintenance of supply chain processes, the establishment of specialized treatment centers, the improvement of provider education, the enhancement of patient education, the enhancement of psychosocial support, and the adoption of national hemophilia guidelines of defined focus are needed to improve the inequities in health outcomes of hemophilia patients in Palestine.
- ItemEvaluation of Nurses Compliance to The National Palestinian Infection Prevention and Control Protocol at Governmental Hospitals in Hebron Governorate.(Al-Quds University, 2025-03-06) Mohammad Essa Mohammad Rasheed; محمد عيسى محمد رشيدHealthcare-associated infections (HAIs) pose a significant global public health challenge, particularly in resource-limited settings like Palestine. This descriptive-analytical cross-sectional study aimed to assess nurses' compliance level with the National Palestinian Infection Prevention and Control Protocol in governmental hospitals in Hebron Governorate. The study evaluated compliance levels, identified barriers to adherence, and explored factors influencing IPC practices. The research was conducted across five governmental hospitals in Hebron Governorate, representing diverse healthcare environments. A simple random sampling method was employed to select 212 nurses from a total population of 442. Data were collected using a structured questionnaire distributed, achieving a high response rate of 96%. Results revealed a high overall compliance rate of 88.3% among nurses with the National Palestinian IPC Protocol. Specific practices such as hand hygiene (95.8%), personal protective equipment use (94%), and safe disposal of sharp waste (93.9%) demonstrated particularly strong adherence. Nurses exhibited very high knowledge levels (88.7%) and positive attitudes (90% agreement) towards IPC practices. Despite high compliance, several barriers were identified. The most significant challenges included lack of time and work overload (62.7%), insufficient knowledge and education (61.3%), and shortages of critical materials like N95 masks (available in only 17% of departments). While 76% of nurses were aware of the Palestinian IPC protocol, only 59% had access to a copy of National Palestinian Infection Prevention and Control Protocol in their ward. Environmental factors such as inadequate infrastructure (47.6%) and lack of specialized isolation rooms (53%) further complicated adherence to IPC protocols. Organizational support varied, with 68% of nurses acknowledging management's adoption of supportive policies. However, only 20% reported receiving regular IPC training, highlighting a need for more consistent educational programs. Supervision and monitoring systems were present but inconsistent, with 78% reporting the existence of infection control committees but 45% unaware of surveillance systems for infection rates. The study found positive relationships between compliance and factors such as knowledge, attitudes, training, availability of resources, and supportive policies. Nurses working morning shifts, those in closed departments (e.g., ICUs), head nurses, and those vaccinated against Hepatitis-B exhibited higher compliance with IPC protocols. Based on these findings, the study recommends implementing regular, structured IPC training sessions, improving resource management to ensure access to essential materials, strengthening supportive policies including continuous auditing and feedback mechanisms, and investing in infrastructure improvements. Additionally, optimizing work conditions, promoting continuous education, and enhancing supervision and monitoring systems are crucial for sustaining and improving IPC compliance. This comprehensive assessment of IPC compliance in Hebron Governorate's governmental hospitals provides valuable insights for healthcare administrators and policymakers. By addressing the identified barriers and leveraging existing strengths, targeted interventions can be developed to enhance IPC practices, ultimately reducing the burden of HAIs and improving patient safety in Palestinian healthcare settings.