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.
- 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.
- ItemUnderstanding and Improving Epilepsy Care in Primary Healthcare: A Mixed-Methods Study in the West Bank, Palestine(Al-Quds University, 2025-08-24) Abeer Ali Mohammad Ghanayem; عبير علي محمد غنايمIntroduction: Epilepsy is a chronic neurological condition affecting over 70 million people worldwide, with the majority residing in low- and middle-income countries. In Palestine, epilepsy care is challenged by fragmented healthcare delivery, limited access to specialized services, inadequate provider training, and pervasive social stigma. Although primary healthcare centers are the main access point for people with epilepsy, care at this level remains underdeveloped, with no standardized treatment protocols or structured self-management support. Addressing these gaps requires a comprehensive understanding of the lived experiences of people with epilepsy, the readiness of the healthcare workforce, and the effectiveness of contextually tailored interventions. Aim: This study aimed to explore and improve epilepsy management in primary healthcare settings in the West Bank, Palestine, by examining patients’ experiences, assessing healthcare providers’ knowledge, attitudes, and practices, and evaluating the impact of an educational intervention based on the WHO Mental Health Gap Action Program. Methods: A sequential exploratory mixed-methods design was employed across three interrelated studies. Study I used Husserlian phenomenology to conduct in-depth interviews with 12 people with epilepsy recruited from governmental primary healthcare centers. Thematic analysis was used to identify essential themes of their lived experience. Study II utilized a cross-sectional survey to assess the knowledge, attitudes, and practices of 300 healthcare professionals working in primary healthcare facilities across the West Bank. Study III implemented a quasi-experimental intervention using mental health-based training, with 68 healthcare providers randomized into intervention and control groups. Pre- and post-training assessments were conducted to evaluate changes in knowledge, attitudes, and self-efficacy after two months. Results: Study I identified three major themes: emotional and existential disruption, social vulnerability and stigma, and unsatisfactory healthcare experiences. Participants reported living with fear, social exclusion, denial of diagnosis, and a lack of trust in the healthcare system. Stigma was a pervasive theme shaping concealment, low self-esteem, and reduced access to care. Study II revealed substantial gaps in healthcare providers’ knowledge and practices regarding epilepsy care. Pearson’s correlation revealed a significant negative relationship between practices and knowledge (r = -0.170, p < 0.01) and a positive association with attitudes (r = 0.279, p < 0.01). Nurses and less experienced staff scored significantly lower in all KAP dimensions p< 0.05. While attitudes were moderately positive, providers showed poor familiarity with epilepsy self-management, seizure triggers, and psychosocial aspects of care. Multivariate analysis showed that knowledge were negatively correlated with gender and specialty but positively with educational degree (OR = 0.640, 95 % CI: 1.260–0.020, p = 0.043; OR = 1.970, 95 % CI: 2.841–0.099, p < 0.001). Knowledge scores were lower among certain genders and specialties but increased with higher educational attainment (p < 0.05). Attitudes were positively associated with age (OR = 2.552, 95 % CI: 0.974–4.130, p = 0.002) and years of experience (OR = 2.387, 95 % CI: 0.546–4.227, p = 0.011). Study III demonstrated that the mhGAP training significantly improved knowledge (p < 0.001) and self-efficacy (p < 0.001) in the intervention group. However, attitudinal change was modest and not statistically significant, suggesting that longer-term or targeted interventions may be required to influence stigma and empathy. Conclusion: Epilepsy care in Palestinian primary healthcare settings is hindered by systemic fragmentation, insufficient provider training, and sociocultural barriers that limit access to quality care. People with epilepsy experience profound emotional and social burdens, while healthcare providers lack adequate preparation to deliver patient-centered epilepsy management. However, brief, context- sensitive training interventions like WHO mhGAP can effectively enhance provider knowledge and confidence in the short term. Keywords: Epilepsy, Primary Healthcare, Palestine, Phenomenology, mhGAP, Mixed Methods, Self-Management, Health Workforce, Stigma, Health Systems Strengthening.
- Itemتقيِّيم وتحسين جَوْدَةِ الطعام في المَقاصِف المدرسيَّة في منطقة ضواحي شرقِ القُدس الحكوميَّة: دراسةٌ شِبه تداخليَّة(Al-Quds University, 2025-01-12) سماح علي حسن عياد; Samah Ali Hasan Ayyadتهدفُ هذه الدراسة إلى تقيِّيم برنامج التغذية المدرسية بتحسين أداء المقاصف المدرسية بحرصها على تحقيق جودةِ الطعام المُقدَم من خلالها والاطلاع على توجهات ومعارف الطلبة التغذوية والاطلاع على سياسة التغذية المدرسيَّة في منطقةِ ضواحي شرقِ القدسِ الحكوميَّة، وقد بلغ عدد أفراد العينة المختارة (319) طالب وطالبة وكان عدد الطلاب في مجموعة التدخل (171) تمت توعيتهم وتقييم خياراتهم الغذائية وكانت مجموعة الضبط وعددها (148) لم يتلقوا أي تدخل لتطبيق البرنامج، وذلك ضمن إطار برنامج سياسةِ التغذيةِ المدرسيَّة التي تُنفذها وزارة التربيةِ والتعليم في المناطق المذكورة. مُشكلةُ الدراسة ومُبرِّراتها: تهدف هذه الدراسة أيضاً الى إيجاد حل لمشكلة اتِّباع العادات السلوكية غير الصحية المنتشرة بين الطلبة. حيث أن الالتزام بتقديم الغذاء الصحي يكون له الأثر الكبير في تحسين الصحة العامة للطلاب. وتوصي هذه الدراسةُ أيضاً بتقديم اقتراحات لتحسينِ جودةِ الوجباتِ وتطوير الإجراءات لتلبيةِ احتياجاتِ الطلابِ الغذائيَّة بشكلٍ صحيٍ أفضل. ووفقًا لمنظمة الصحة العالمية، فإن العادات الغذائية غير الصحيَّة هي مُشكلةٌ عالميةٌ خطيرةٌ تُهدد الصحَّة العامَّة وتؤدي الى سُوء التغذيةِ لدى الأطفال، وهذا منتشرٌ بشَكلٍ واضحٍ في المجتمع الفلسطيني، وتُشكِّلُ فئةُ الأطفال نصفَ السكانِ الفلسطينيين، وإنَّ أفضل سِنٍّ لتغيِّيرِ العاداتِ الغذائيَّةِ السيئة للأطفالِ هو في المراحلِ الدراسيةِ الأولى، لذلك يُوصَى بالتركيزِ على الأطفال في هذه المرحلةِ لمُساعدتهم على اتِّباع نظامٍ غذائيٍ صحيٍ للوقايةِ من سُوء التغذيةِ بأشكالها، وتغيِّير عاداتهم الغذائيَّةِ الضارةِ طويلةِ الأمدِ وتعزيز النمطِ الصحي لحياتهم. يوجد عدد كبير من الأطفال دون سن 18 عاماً الذين يتبعون عادات غذائية غير صحية، مثل تناول الأطعمة الجاهزة والوجبات السريعة، إضافة إلى المشروبات الغازية ومشروبات الطاقة، وهذه السلوكيات تُؤدي إلى مشكلات صحية متعددة على المستوى العالمي مثل ارتفاع نِسَبْ فقر الدم والسمنة، تعكس هذه الظواهر تحديات أوسع متعلقة بسوء التغذية، إذ ترتبط بانتشار الثقافة الاستهلاكية التي تعطي الأولوية للراحة على حساب جودة الغذاء مقابل تراجع الثقافة الإنتاجية التي تدعم الاستقلال الغذائي. انتقال هذه الثقافة إلى العالم الثالث أدى إلى تفاقم المشكلات الغذائية مِمَّا أثر على خطوط الإنتاج المحلية وغيَّر نمط الاستهلاك، حيث أصبح الاعتماد على المنتجات المستوردة وغير الصحية أكثر شيوعاً. في هذا السياق، يُصبح تعزيز سلوكيات التغذية السليمة في المدارس الفلسطينية والاستمرار في ترسيخها ضرورة لتحسين الصحة العامة ومواجهة هذه التحديات على المدى البعيد. إنَّ إيجادَ بيئةٍ صحيَّة في المَقاصِف المدرسيَّة سيُساعدُ في تغيِّير نمطِ حياةِ الطلاب الغذائيَّةِ وفي اكتساب المزيد من التحكُّم في سُلوكياتهم التغذويَّة، حيث أنَّ تزايد عادات تناولِ الطعام غير الصحي يُؤدي إلى سُوء التغذية والذي بدوره يُؤدِّي إلى مشاكلَ صحيَّة مثل: فقر الدم والسُّمنة المُفرطة. الهَدف: هَدفت الدراسةُ إلى تقيِّيم وتحسين جَوْدَةِ الطعام الذي تُقدِّمه مَقاصِف المدارسِ الحكوميَّة في إطار برنامجِ سياسةِ التغذية المدرسيَّة الصحي في منطقة ضواحي شرقِ القدس (خارجَ الجدار). ولتحقيقِ هذا الهدف، تم استخدام البيانات التي تم تجميعها لإنشاء دراسةٍ شبه تداخُليَّة (شبه تجريبية) من خلال البيانات التي تم جمعها من أداة الاستبانة لانتقاءِ المعلومات، لترسيخ استراتيجيَّات إدارةِ جَوْدَةِ الطعام المُعتمد الذي يتم تقديمه للطلاب. وبناءً على الخياراتِ الغذائيَّةِ للطلابِ تم تقيِّيم قُدرَةِ المدارس على تنفيذ الاستراتيجيَّات الغذائيَّة مُقارنةً بالنماذجِ المُعتمدة من وزارة التربية والتعليم. وتمّ توزيع الدراسة على عينة الدراسة التي تتكوّن من مدارس منطقة ضواحي شرق القدس والجمعيات النسوية والنساء العاملات بها. تم اختيار المدارس بطريقة عشوائية كمرحلة أولى، حيث تكوّنت العينة من (4) مدارس حكومية، تم اختيارها بناءً على وجود جمعيات نسوية داخلها، ويبلغ عدد هذه الجمعيات جمعيتين نسويتين. أما المرحلة الثانية فقد شملت اختيار الطلاب بشكلٍ عشوائي من داخل هذه المدارس لتكوين مجموعتي الدراسة: مجموعة التدخل والمجموعة الضابطة. أُجريت الدراسة في منطقة ضواحي القدس بموافقة وزارة التربية والتعليم، وهي: (مدرسة بنات العيزرية الثانوية، مدرسة بنات أبو ديس الثانوية، مدرسة أبو ديس الأساسية المختلطة، ومدرسة العيزرية الأساسية المختلطة). وطُبقت هذه الدراسة على طلاب المدارس الحكومية التي تقع في منطقة ضواحي شرق القدس خلال عامي 2023 و2024. تم استخدام تصميم شبه تجريبي، حيث عُرف مسبقًا الطلبة الذين سيشاركون في التدخل ضمن مجموعة التدخل، تم جمع ملاحظاتهم حول خيارات الأغذية وجودتها. أما الطلبة في المجموعة الضابطة، فلم يتم تطبيق أي تدخل عليهم، وذلك لقياس تأثير البرنامج المُطبق على مجموعة التدخل بدقة. النتائج: بعد إجراء عمليةِ التحليل الإحصائي أظهرتْ النتائج أنَّ برنامجَ التوعيةِ المُعَدّ من قِبَل الباحثةِ كان له دورٌ فعّالٌ في تحسين وعي الطلبةِ تجاهَ خياراتِ الطعام وجودة المَقاصِف وقُدرتهم على اتِّخاذ قراراتٍ غذائيةٍ صحيَّة. كما تبيَّن أنَّ درجةَ تقيِّيم الطلبةِ لكلٍ من: خياراتِ الطعام، جودة المَقاصِف المدرسية، وقُدرتهم على الاختيارِ الصحي لطعامهم كانت مرتفعةً بشكلٍ ملحوظٍ في التطبيقِ البَعدي مُقارنةً بالتطبيقِ القَبلي، مِمَّا يعكسُ التأثيرَ الإيجابي للتوعيةِ المُقدَّمة. وأظهرت النتائجُ أيضاً عدمَ وجودِ فُروقٍ ذاتَ دلالةٍ إحصائيةٍ عند مُستوى الدلالة (α ≤ 0.05) تُعزَى إلى بعضِ المُتغيِّرات مثل: الصف الدراسي، وعدد سنوات تعليم الأب، وعدد سنوات تعليم الأم. ومع ذلك، أظهرت النتائجُ وجودَ فُروقٍ ذات دلالةٍ إحصائيةٍ تُعزَى إلى مُتغيِّر توفر النقودِ مع الطلبة، مِمَّا يُشير إلى تأثيرِ هذا العامل على خياراتِ الطلاب الغذائية وتقيِّيمهم لجودة المَقاصِف المدرسية، بالإضافةِ إلى قُدرتهم على اتِّخاذ قراراتٍ غذائيةٍ صحيَّة. وفي نهايةِ الدراسة، أَوصتْ الباحثةُ بعدَّةِ توصيات، كان من أبرزها: العملُ على تحسينِ جودة المَقاصِف المدرسية، وتعميمِ برامجِ التوعيةِ على كافةِ المدارس، بما يشمل المدارس الخاصة والحكومية على حَدٍّ سواء. كما أَوصتْ بإشراكِ أَولياءِ الأمور في الأنشطةِ التوعوية لتعزيزِ الثقافةِ الصحيَّةِ داخل المجتمع المدرسي وخارجه. تم إدخالُ البياناتِ وإدارتها باستخدامِ الإصدار (25) من برنامج (SPSS) الإحصائي، ساعد خبيرُ الإحصاءِ في تحليلِ البيانات، وتم استخدام التحليل مُتعدِّد المُتغيِّرات حسب الحاجةِ لتطوير النموذج النهائي للدراسة. أخلاقيَّاتُ الدراسة: تم الحصول على موافقة لدخولِ المدارسِ والجمعياتِ النِسَويةِ للإشرافِ على جَوْدَةِ الطعام المُقدَّم للطُلابِ من جامعةِ القدس ووزارة التربيةِ والتعليم، وتم تقديمُ مُلخصٍ للدراسةِ وأهدافها للمُشاركين فيها دون الكشفِ عن المعلوماتِ الشخصيةِ للمُشارٍك، وتم أخذُ الموافقةِ المُسبقةِ من جميع المُشاركين لتعبئةِ الاستبيانات.