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    Epidemiological Review of Viral Hepatitis A in the West Bank
    (Al-Quds University, 2023-08-20) Alladin Nouraldin Abed Al-Shalalda; علاء الدين نور الدين عابد الشلالدة
    Hepatitis A Virus HAV has been a significant cause of infections among the children and adolescents of Palestine. The possibility of protection from HAV through vaccination made it necessary to identify the epidemiology changing of hepatitis A infection in Palestine and to understand the trends for HAV and possible age-specific prevalence transitions. This data-based cross-sectional study was conducted during the period April – July 2023 on 1,781 surveys from the records from the Preventive Medicine Department- Ministry of Health MoH in Palestine. The data collected were analyzed using SPSS against different variables (age, gender place of residents, environmental conditions, liver enzymes and HAV symptoms (Fever, chills, vomiting, Jaundice, and dark urine). The high mean incidence rate in the 5 – 9 years age group suggests that individuals within this age range are particularly vulnerable to contracting HAV; which indicate an epidemiology changing of hepatitis A infection in Palestine The study revealed the association of several risk factors for higher HAV incidence rates: (i) elder age groups; (ii) environmental and behavioral conditions. This study provided strong evidence for continuous transition of HAV epidemiology towards intermediate endemicity in Palestine, with adolescents and adults most at risk. Following the World Health Organization (WHO) recommendations for countries with intermediate endemicity, vaccination strategy against hepatitis A is recommended for children in Palestine. 
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    Evaluation of the Current Strategy for Prevention and Control of Cancer- Gaza Governorates
    (Al-Quds University, 2012-06-09) Wissam Abou Amer; وسام أبو عمرو
    Universally, cancer disease is considered as one of the first causes of premature death and disability and it is considered the third cause of death in Palestine. This study aims to evaluate the cancer control and prevention in Gaza Governorates in order to provide information that could contribute to identify the gaps in the strategy existence and development, to explore the implementation of the existing strategy and to shed light on the real situation on the ground that may be helpful to enhance any underperformance and identify future priorities. The study is a triangulated, descriptive and cross sectional one that was conducted in order to evaluate the cancer strategy and prevention in Gaza.. The qualitative data included interviews with key informants as well focus groups with cancer patients. The quantitative data was represented by four checklists that identified the number of the available beds and rooms for patients, available health care human resources, diagnostic equipment and exploring the completeness of cancer patient’s files. The results of the study revealed that there are gaps in the strategy of cancer control in Gaza Governorates starting from planning up to implementation. Those gaps are mainly related to poor financial and administrative coordination, shortages in health care human resources and inadequate staffing, inappropriate infrastructure of oncology buildings and deficiencies in necessary equipment and supplies. Moreover, there are heavy workloads on health personnel, prolonged waiting times for patients joined with poor privacy and comfort ability. In addition, the results showed the absence of clear guidelines and policies that should regulate the workflow and referral systems between health facilities. Regarding the prevention and screening services for cancer, they are limited to some sporadic programs and plans. In addition, Cancer diagnostic services are facing many barriers that lead to the delay in the diagnosis of the disease. There are obvious shortages in some facilities which are necessary for diagnosis as tumor marker test, Gamma Camera, Linear accelerator, MRI and CT scanners, and other factors related to poor awareness of patients, physician and health system role. Regarding the offered services to treat cancer disease, there are several obstacles that decrease the quality and completeness of care such as frequent shortages in essential chemotherapy medications, lack of specialized health human resources in specific types of cancer and the absence of radiotherapy treatment. This is joined by the absence of palliative care and poor provided support to the cancer patients and their families. The information system related to cancer diseases and services is also inadequate. There is an obvious poor support for the cancer registry. In addition, there are serious problems in the patient’s medical records. As an outcome, the cancer patient dissatisfaction is an important result associated with high anxiety, fear, and blaming. All of those factors would necessarily have its negative impacts on the overall quality of the health services provided to cancer patients. This is reflected by the patients’ deep dissatisfaction with the provided health care services that should decrease their anxiety, fear and hopelessness. The study recommended enhancing the available cancer strategy as well as adopting advanced policies for cancer prevention and palliative care. In addition, to improve the infrastructure of both facilities and human resources for cancer control. The study also recommended the importance of improving the communication between health personnel and cancer patients and to improve the existing information system such as cancer registry and to increase the research studies related to cancer management and control.
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    Rational Use of Neurological Computerized Tomography Scan at Shifa Hospital
    (Al-Quds University, 2012-03-04) Abdelrazeq Beram; عبد الرازق عبد القادر إبراهيم بيرم
    Computerized tomography (CT) scan utilization in Gaza strip has dramatically increased in recent years. This has likely reflected the improved diagnostic capability of CT scan. However, the utilization of CT is tempered by the high radiation exposure to patients as well as cost and long waiting list of patients. An increase in the number of neurological CT scan examinations has been noticed since the establishment of the CT scan department which is still form the biggest problem facing the work in the department. So the rational utilization of the CT scan is a goal of all CT scans’ health providers and radiology department administrators. This study aimed to assess the rational use of neurological CT scan examination in order to decrease the medical radiation exposure for patient and the cost of financial expenditure burden on the patient and Ministry of health. A triangulated cross sectional quantitative and qualitative study was conducted in order to assess the rational use of neurological CT scan examination at Shifa hospital. The instruments used in this study were 300 self-constructed questionnaires for patients who have had CT scans examination during the period of the study; reviewing of 1780 CTs requests for availability and completeness of these requests and in-depth interview for 8 stakeholders at AL Shifa hospital. A total of 2501 neurological CTs requests has been searched to detect the 1780 requests with a detective rate of 71%. The study findings show that multiple factors affect the decision of physicians to write a CT scan request; these are complex combination of considering patients or his family and patient-health provider relationship. Most of the physicians did not write the initial diagnosis and medical history in the CT scan requests. The study also shows that 90% of the patients didn’t have the previous examination before the physician writes the CT scan request for him. The study results also reveal that there is no clear and standard request which in turn affect the writing of CTs request. The study findings indicate that 2501 neurological CT scans were performed, of them 1129 brain CT scans were reviewed and males represented 57% of the patients. Headache was noted as the main reason for referral (31%) and the urgent requests represented 55% of the brain CT scan requests. The findings were completely normal in 56% of the CTs results. Patients between the ages of 0 to 9 years were exposed to radiation at higher rate than the other age groups with 28% from brain CTs examination which represents a serious problem because the infants and young children are the most vulnerable group to radiation risk. The study results also show that 615 spine CT scans were reviewed and males represented 47% of the patients. LBP with neurological sign was noted as the main reason for referral (64%) and urgent requests represented 11% of the CT scan requests. The findings were completely normal in 25% of the CTs results. Patients between the ages 40-49 were exposed to radiation at higher rate than the other age groups with 27% from spine CTs examinations. The researcher concluded that clear guidelines are not available and the physician has to use his best clinical judgment, taking into account multiple factors such as the patient-health providers' relationship and the patient-physician relationship. The main recommendations include: reforming the policy, establishing standard protocols in order to improve the quality of health care services, creating a standard CT scan request form, conducting a training course for the benefit versus risk of CT scan radiation dose for the health providers, conducting training course for physicians who write the request of CT scan on the proper way of completing CT scan requests, and finally, launching an awareness program to the public on the risk of medical radiation.
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    Risk Factors Associated with Vitamin A Deficiency among Children 12-59 Months Old Attending Ard El Insan Association-Gaza
    (Al-Quds University, 2012-05-02) Mohammad Abdel Kadder Abu Rayya; محمد عبد القادر أبو ريا
    Vitamin A is an essential micronutrient needed by humans for the normal functioning of visual system; growth and development; and maintenance of epithelial cellular integrity, immune function, and reproduction. The overall aim of this study is to identify the common risk factors associated with vitamin A deficiency among apparently healthy children aged 12-59 months attending Ard El Insan association, Gaza. The present study is a cross section study which comprised 150 children. Interview questionnaire with mothers is specially designed and prepared to compile information relating to the objectives. Blood samples were drawn for determination of serum vitamin A and hemoglobin concentrations by using CBC test. Serum vitamin A was measured by ELISA technique using human vitamin A, ELISA kit. Statistical analysis was performed using SPSS version 18. Depending on the scientific classification of vitamin A, it’s divided into 3 groups. Results, indicated that (57.3%) of children had vitamin A (deficiency) 200-500 nmol/L, (20.7%) of children had vitamin A (marginal deficiency) 501-699 nmol/L and (21.3%) of children had vitamin A (normal) >700 nmol/L. The mean ±SD of vitamin A and hemoglobin was 532.5 ±298.2 and 10.14 ±0.76 respectively. There was a significant relation between vitamin A category and address (P=0.013).Another significant relation appeared between the mean levels of vitamin A and gender (P=0.030) which showed that male were more than females. There was a significant decreases in the mean levels of vitamin A in anemic children (P=0.011). A significant relation between discontinuation of breastfeeding before 12 months and vitamin A deficiency (P=0.008).The relationship between vitamin A deficiency and child clinical status was not statistically significant (P-value>0.05). This study provides information on the nutritional status of children as a risk factor for vitamin A deficiency. Results, demonstrated that there are significant statistical relationships between anemia, gender, breastfeeding practices and vitamin A deficiency. And provides a set of recommendation such as exclusive breast feeding in the first six months, fortification of staple foods and supplementation program should be put in place at least for the short term. فيتامين ا هو احد أهم المغذيات الدقيقة والتي يحتاجها الجسم من اجل أداء وظائفه الحيوية. فيتامين ا له دور كبير في الجهاز البصري و في النمو والتطور وخاصة عملية تجديد وتكامل الخلايا خاصة الابيثيلية. فيتامين ا مهم جدا للجهاز المناعي و أيضا الجهاز التناسلي وعملية التكاثر. تهدف الدراسة إلى تحديد عوامل الخطر الشائعة والمصاحبة لنقص فيتامين ا في الأطفال الذين تتراوح أعمارهم من 12-59 شهرا في جمعية أرض الإنسان الفلسطينية الخيرية بمركز غزة. تشمل الدراسة على 150 طفل. تم إجراء مقابلة مع أمهات الأطفال لتعبئة الإستبانة كما تم سحب عينات دم وريدية من الأطفال من اجل قياس مستوى فيتامين ا والذي تم قياسه عن طريق تقنية ELISA ونسبة خضاب الدم التي تم تحديدها باستخدام فحص الدم الكامل. كما تم استخدام برنامج SPSS النسخة18 لعمل التحاليل الإحصائية اللازمة للدراسة. بناءً على التصنيف العلمي لنقص فيتامين أ الذي تم تقسيمه إلى ثلاث مجموعات. أوضحت النتائج أن57.3% من الأطفال لديهم نقص فيتامين أ ( 200-500 نانومول/لتر). في حين أن 20.7% من الأطفال كان تركيز فيتامين أ(501-699 نانومول/لتر) و21.3% من الأطفال كان تركيز فيتامين أ طبيعي (700< نانومول/لتر). كان متوسط تركيز فيتامين ا و الهيموجلوبين كالتالي 298.2 ± 532.5 0.76 ± 10.14علىالتوالي. لقد بينت الدراسة بأنه كانت هناك علاقة ذات دلالة إحصائية معنوية بين مكان السكن ونوع الجنس ونقص فيتامين أ (P=0.013) و (P=0.030)على التوالي. كما ان النقص فى تركيز فيتامين أ عند الأطفال الذين يعانون من فقر الدم ذو دلالة إحصائية معنوية P=0.011)). بينما كانت العلاقة ذات دلالة إحصائية معنوية بين قطع الرضاعة الطبيعية قبل مرور عام ونقص فيتامين ا (P=0.008). أما بالنسبة للعلاقة بين الحالة الصحية للأطفال ونقص فيتامين ا فلم تكن العلاقة ذات دلالة إحصائيةP-value>0.05)) لقد ساهمت هذه الدراسة بتسليط الضوء على الحالة التغذوية للأطفال وعوامل الخطر المرتبطة بنقص فيتامين أ حيث تم إيجاد علاقة إحصائية معنوية ما بين فقر الدم ونوع الجنس وممارسات الرضاعة الطبيعية من جهة وبين نقص فيتامين ا عند الأطفال من جهة أخرى.
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    Evaluation of Iron Deficiency Anemia Management among Preschool Children Attending UNRWA Health Centers in the Gaza Strip: A Mixed-Study Approach
    (Al-Quds University, 2023-08-02) Walaa Sabri Ashour Salama; ولاء صبري عاشور سلامة
    Iron deficiency anemia is considered the most common type of nutrient deficiency with a widespread public health concern affecting about 2 billion people in the world. Several studies conducted recently in the Gaza Strip (GS) revealed that a greater deterioration than previously in macro- and micronutrient levels among preschool children was being observed despite the implementation of large-scale programs targeted toward anemia management. This study aims to evaluate iron deficiency anemia management programs among preschool refugee children attending the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) in the GS. A mixed-methods design was used, involving both quantitative and qualitative data. The study began in February 2022, and it was completed in March 2023.The face-to-face interview questionnaire was used to collect quantitative data from mothers of anemic children under the age of five who received child health care services at UNRWA health care centers. In total, 400 mothers participated in the quantitative part of this study with a 100% response rate, and 100 child medical records were selected through systematic sampling technique and were reviewed, as well. Regarding the qualitative aspect, a non-probability purposive sample involving nine focus group discussions, comprising three with mothers of anemic children under the age of five who had recovered from anemia, three with mothers of anemic children under the age of five who had not yet recovered from anemia, and three with healthcare providers. Additionally, four key informative interviews were conducted with health managers working in the UNRWA health program. A consent form was created in accordance with the values of the Helsinki Ethical Declaration to ensure that participants' rights are safeguarded. The Statistical Package of Social Science software (SPSS) was used for the quantitative data entry and analysis, while MAXQDA analysis was used to analyze the qualitative data. Results of the study have shown that mothers of under-five anemic children had a high perception level of the threat of anemia in their young children with the average total percentage for perceived severity and perceived susceptibility were 72.2% and 65.2% respectively. Participants expressed a high percentage score for perceived benefits (78.4%) and a low percentage score for perceived barriers (45.8%) to integration in anemia management programs. From client’s perspectives, the main barriers to IDA management were poor infant and young children feeding practices (71.6%), affordability of iron-rich diet (54.6%), acceptability of iron supplement drops derived from their side effects (54.6%), and communication gaps between health care providers and beneficiaries (40.4%). A total of 76.8% of participants expressed their readiness to embrace healthier behaviors if prompted by a cue or stimulus, while 72.6% showed self-efficacy toward taking health action to manage IDA among their young children. Results of the medical records review revealed a high level of compliance of health care providers to the existing UNRWA policy for management IDA in children including the implementation of screening, prophylaxis, and treatment technical guidelines but need further improvement in the quality of documentation of multi‐disciplinary plan of care and in follow-up notes that tracking the progress in anemia management. UNRWA IDA prevention and control program was considered relevant, coherent, and effective but the impact of social determinants of health had affected anemia management, as well UNRWA’s financial crisis had its effect on the efficiency and sustainability of the program. Greater efforts are needed on health awareness about issues related to IDA prevention and management among young children in both community and clinic level measures to mitigate barriers to the service integration besides ensuring continuous in-service training and capacity-building of health staff as well as enhancing communication channels, monitoring, and effective supervision to provide more quality services. Further large-scale research studies are needed to evaluate anemia prevention and control programs provided by different stakeholders and to evaluate other strategies adopted by UNRWA such as food fortification, sanitation, and deworming programs.