Public Health الصحة العامة
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- ItemDeterminants of Periodontal Disease Among 9th-Grade Students and Their Teachers in the Northern West Bank and the Effectiveness of an Interactive Oral Health Education Program in Nablus, Palestine(Al-Quds Univeersity, 2026-05-03) Sura Ibrahim Al-Hassan; سرى إبراهيم وهدان الحسنBackground: Periodontal disease (PD) is one of the most common chronic inflammatory oral conditions globally and poses an emerging public health concern, especially in low- and middle-income regions where preventive oral health programs are limited. In Palestine, evidence on periodontal health among adolescents and school personnel is scarce, and the effectiveness of school-based educational interventions has not been sufficiently explored. Aims: This dissertation sought to: (1) assess the prevalence of PD among 9th-grade students in the northern governorates of the West Bank; (2) examine socioeconomic, behavioral, and lifestyle determinants associated with PD among students. (3) assess periodontal health status and associated factors among 9th-grade teachers; and (4) evaluate the effectiveness of interactive oral health education on periodontal health outcomes and related behaviors among both students and teachers. Methods: A mixed-phase design was employed. Phase I used a cross-sectional epidemiological design, employing proportional stratified random sampling of schools, students, and teachers across the Nablus, Jenin, and Tulkarm governorates. Periodontal status was assessed using the Community Periodontal Index for Treatment Needs (CPITN), while oral hygiene status was measured using the Simplified Oral Hygiene Index (S-OHI). Phase II applied a true experimental control design in selected schools in Nablus City to evaluate a structured interactive oral health education program. Baseline and two-month follow-up assessments were conducted for intervention and control groups. Statistical analyses included bivariate testing and multivariable logistic regression to identify predictors of PD. T-tests were used to evaluate the effects of the intervention. Results: The dissertation demonstrated a substantial burden of PD among both students and teachers. Among students, 86.8% presented with periodontal problems, with gingival bleeding and calculus being the most frequent findings. Oral care habits and inadequate oral hygiene were the most significant predictors of periodontal diseases. Among teachers, only a small proportion exhibited healthy gingiva (11.8%), with oral hygiene practices, smoking, and dietary patterns significantly influencing periodontal outcomes. Following the interactive educational intervention, significant improvements were observed in periodontal health indicators, oral hygiene status, and health behaviors among intervention participants compared with controls. Improvements were evident in CPITN and S-OHI scores, oral hygiene practices, dietary habits, and smoking behaviors in both student and teacher groups. Conclusion: PD represents a significant public health challenge among Palestinian school communities, driven largely by modifiable behavioral and lifestyle determinants. The results indicate that interactive oral health education in schools can lead to noticeable enhancements in periodontal health and associated behaviors for both adolescents and teachers. The research advocates incorporating comprehensive preventive oral health education into school curricula and emphasizes the importance of policy-level approaches to address common socio-behavioral factors that contribute to the prevalence of periodontal disease in Palestine.
- ItemEnhancing Acute Kidney Injury Management in Southern West Bank Governmental Hospitals: Risk Triage, Novel Biomarkers, and Electronic Health Alerts A Mixed-Methods Study PHD(Al-Quds Univeersity, 2026-01-17) Bilal Abdulrahman Nimer Jawabreh; بلال عبد الرحمن نمر جوابرةBackground: Acute kidney injury (AKI) is a major driver of hospital-based morbidity and mortality, with the burden disproportionately higher in low- and middle-income countries. In Palestine, delayed recognition, nephrology workforce shortages, and the absence of national AKI protocols contribute to fragmented care and poor outcomes. These system-level gaps demand scalable, context-sensitive strategies that integrate early detection and improved care pathways. Aim: This study evaluated the effectiveness and feasibility of an integrated AKI detection and management model in Southern West Bank hospitals, assessing its clinical impact and implementation context. Methods: A mixed-methods design was used. The qualitative phase involved interviews with all 13 board-certified nephrologists in the West Bank to explore readiness and perceived barriers. The quantitative phase consisted of a prospective quasi-experimental cohort study design in two hospitals: an intervention hospital and a control hospital. A total of 469 inpatients with AKI were enrolled. The intervention combined electronic alerts, risk triage, and biomarker testing (including neutrophil gelatinase-associated lipocalin, NGAL). Results: The intervention group showed significantly improved acute kidney injury recognition (68.4% vs. 37.8%, p < 0.001), with higher detection of stage 1 cases and earlier nephrology consultations. Kidney recovery was higher (33% vs. 20.5%, p = 0.001) and dialysis need was reduced (7.9% vs. 16.5%, p = 0.005). NGAL emerged as a key biomarker, with moderate diagnostic accuracy (cutoff = 90.2 ng/mL, AUC = 0.736, sensitivity =56.7%, and specificity = 80.3%, p = 0.001), and NGAL levels above 300 ng/mL were linked to poor outcomes. In addition, neutrophil gelatinase-associated lipocalin level and 3 injuries were significantly associated in the univariate analysis. Also, risk triage scores were significantly associated with AKI severity, aiding in early stratification and targeted intervention. Multivariable analysis identified circulatory shock, sepsis, and ≥3 AKI episodes within three months as independent predictors of mortality. Discontinuation of angiotensin receptor blockers significantly improved short-term recovery (hazard ratio = 2.12, p = 0.031), while diabetes was associated with delayed recovery (hazard ratio = 0.69, p = 0.045). Process indicators showed significantly better documentation, medication safety, fluid adjustment, and follow-up testing in the intervention group. In the qualitative study, the interviews revealed strong support for the model, citing ministry-level backing, trends in preventive care, and digital innovation as key enablers. Barriers included governance fragmentation, workforce shortages, and the absence of national renal registries. Participants emphasized the importance of policy reform, specialist training, and public awareness to sustain improvements in kidney care. Conclusion: The integration of risk triage, early biomarkers, and electronic alert care pathways significantly improved acute kidney injury outcomes and care processes. Combining technological innovation with clinical and policy engagement offers a scalable strategy for advancing kidney care in resource-constrained settings.
- 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.