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1.
Background
The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) supports the hospitalisation of Palestine refugees with country-specific policies in five fields of operation; Jordan, Lebanon, Syria, Gaza, and the West Bank. The objective of this study was to compare caseloads and percentage vulnerability generated by the different policies.Methods
A comparative snapshot analysis was conducted on diagnoses for hospitalized patients (13?818 patients in total) for selected months in 2016 and 2017, categorized according to UNRWA-defined criteria (lifesaving, urgent, or non-urgent surgeries, and vaginal delivery or caesarian section). The vulnerability criterion was the Social Safety Net Program (SSNP) status of Palestine refugees (enrolment in the UNRWA SSNP). Data were processed in Excel. Ethical approval was granted from the UNRWA Department of Health.Findings
In Jordan, 85% of support (1905 of 2242 cases) was provided for deliveries (vaginal delivery or caesarian section). In Lebanon, 66% (2662 of 4064) were lifesaving and urgent interventions, 26% (1051) non-urgent surgeries, and 7% (284) deliveries. In Syria, 40% (637 of 1594) were urgent, 38% (605) non-urgent surgeries, and 19% (303) deliveries. In Gaza, 26% (675 of 2657) were urgent, 35% (924) non-urgent surgeries, and 40% (1058) deliveries. In the West Bank, 43% (1412 of 3261) were urgent, 10% (333) non-urgent surgeries, and 42% (1367) deliveries. The percentage of vulnerable cases reflects the safety net role of UNRWA: 16% (351) in Jordan, 20% (817) in Lebanon, 46% (738) in Syria, and 19% (506) in Gaza. In the West Bank, only 3% (106) of patients were vulnerable.Interpretation
The profile of patients that used the UNRWA hospitalisation support programme is consistent with hospitalisation policies in UNRWA's fields of operation and the different access that Palestine refugees have to local health services. There is reasonable health-care provision for Palestine refugees in Jordan, whereas UNRWA is the only health-care provider for most Palestine refugees in Lebanon. Ongoing conflict limits access to health care in Syria. Mixed caseloads reflect that priority is given to surgeries and deliveries in Gaza and that UNRWA is the alternative to Ministry of Health services in the West Bank, as the mixed UNRWA caseloads in the West Bank match those of government-supported hospitalisation services, suggesting that people use either one or another. In the case of Gaza, UNRWA-supported hospitals focus on those services most requested by potential users, non-urgent surgeries and deliveries, which become complementary to government services. UNRWA should improve its data collection to have more accurate and up-to-date data. More analysis is needed to understand the financial implications of the differences in policies and how to perform strategic interventions.Funding
None. 相似文献2.
3.
Majed Hababeh Amjad Matooq Abdalla Odattalla Asa&#x;ad Na&#x;jeh Hanan diab Imad Burbara Amjad khoury Zaki Saleh Ayoub Ayoub Mohammad Salameh Mohammad Hadi Saleh Ali Khader Akihiro Seita Patricia Di Caccamo Lilia Biscaglia Mari Antonietta Arrica Cristiana Zerosi Guglielmo Campus 《Lancet》2019
Background
The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) School Health Programme provides preventive oral health services to school students through regular dental screening of new entrants and fourth and seventh grade students, in addition to the health education activities and treatment of decayed teeth provided by dental surgeons in health centres and by mobile dental teams. The main focus of UNRWA oral health services continues to be prevention rather than treatment. The objective of this follow-up survey was to calculate decayed, missing, and filled teeth (DMFT), and decayed, missing, and filled surfaces (DMFS) indices among seventh grade UNRWA schoolchildren in all five areas in which UNRWA operates (Gaza, Jordan, Lebanon, Syria, and West Bank), and to compare the results of this survey globally, locally and with a previous survey conducted in 2010 and 2011.Methods
A cross-sectional survey was conducted by calibrated examiners between March, 2016, and May, 2016. Two-stage sampling was used, with schools selected during the first stage and classes selected in the second stage. The sample size was calculated based on the number of students registered in each area. The confidence level was 95%, power 80%, and precision 5%. A total of 1550 children participated (100% response rate), 383 in Jordan, 390 in Lebanon, 340 in West Bank, and 437 in Gaza. All participants provided verbal informed consent. Data were analysed using Epi Info 7. Multiple logistic regression was used to analyse caries experience, prevalence of caries, and the most relevant behavioural and sociodemographic indicators. A p value of less than 0·05 was considered statistically significant.Findings
The prevalence of dental caries among examined children was 72·8% (1129 of 1550; 95% CI 70·5–75·0); the highest prevalence was in the West Bank (79·7%; 271 of 340) and lowest was in Jordan (68·4%; 262 of 383). The prevalence of untreated decayed surfaces was 69·4% (1076 of 1550; 95% CI 67·0–71·7); the highest prevalence was in the West Bank (76·8%; 261 of 340) and lowest was in Jordan (64·0%; 245 of 383). The percentage of children with one or more sealed permanent teeth was 9·8% (8·4–11·4), compared with 6·8% in 2011, and with wide variation between areas; the highest prevalence was in Lebanon (31.5%), while in Gaza and the West Bank the prevalence was less than 2·0%. The percentage of children who did not use a toothbrush and toothpaste was 19·1%, compared with 22·0% in 2011. The percentage of children who cleaned their teeth after every meal was 59·3% (919 of 1550), compared with 31·6% in 2011. Overall, 18·3% (284 of 1550) of children had never attended a dentist, and 83·1% (1289 of 1550) had experienced toothache in the past. In the total sample, 66·0% (1022 of 1550) of children were used to drinking soft drinks during meals. This habit was less frequent in Gaza (37·5%; 164 of 437) than in Jordan (71·1%; 272 of 383), the West Bank (75·0%; 255 of 340), and Lebanon (75·0%; 292 of 390).Interpretation
The prevalence of dental caries remains very high in Palestinian refugee school children, of whom only 27·2% are free of caries. The high percentage of untreated dental caries and the low percentage of sealed teeth call for increased efforts, refinement, and completion of the preventive strategies of the UNRWA. The main behavioural factors relating to the prevalence and severity of caries were frequency of sugar intake between meals and soft drink consumption.Funding
None. 相似文献4.
Mervett Isbeih Mahima Venkateswaran Tamara Awwad Buthaina Ghanem Khadija Abu-Khader Taghreed Hijaz Mohammad Baniode Eatimad Abbas Rand Salman Asad Ramlawi Binyam Bogale J Frederik Frøen 《Lancet》2019
Background
Good quality data from health systems can benefit several stakeholders, including policy makers, care providers, clients, and researchers. Conventional data collection methods for maternal and child health, such as household surveys, may not be suitable to assess processes of service delivery. The electronic maternal and child health registry (MCH eRegistry) has been implemented in 182 governmental primary care clinics in Palestine. Here we present the data in the MCH eRegistry.Methods
We processed the raw data in the MCH eRegistry from the West Bank, and documented validation rules for crude data points (time of entry, values allowed). Definitions and appropriate categorisations were created for core process indicators. Data from the MCH eRegistry and the electronic health information system in governmental hospitals were linked using statistical software.Findings
As per the second quarter of 2018, the MCH eRegistry contained raw data on 69?793 antenatal care visits, 27?304 postpartum care visits and 40?264 newborn care visits. From antenatal care, data on core process indicators were available for screening of anaemia (n=48?542), hypertension (n=66?814), diabetes (n=18?013), asymptomatic bacteriuria (n=31?757), as well as antenatal ultrasound (n=55?453). Distributions of raw data on haemoglobin and blood pressures had no extreme outliers. Links had been established between antenatal care and delivery data in governmental hospitals for 51% of births.Interpretation
The MCH eRegistry contains data from antenatal to postpartum and newborn care. These data have been successfully linked with delivery data, resulting in a large data set on continuity of care and birth outcomes. Furthermore, the data are accessible, of good quality, and can be used for studies of quality of care and maternal and newborn epidemiology, among others. Researchers are invited to use this resource in working towards improving the health system and the health of Palestinians.Funding
European Research Council and Research Council of Norway. 相似文献5.
Background
Leader–member exchange (the relationship between the manager and his or her employees) is important for the sustained growth of any organisation, and contributes to the organisation's goals and achievements. This study explores the relationship between leader–member exchange and two managerial domains—organisational citizenship behaviour and organisational commitment—among UNRWA health staff in Gaza governorates.Methods
A triangulated study design was used. Self-administered questionnaires were completed by 315 employees; a response rate of 93% (291 of 315). The data collector used the international scales for leader–member exchange, organisational commitment and organisational citizenship behaviour. In addition, seven key informant interviews and two focus groups with employees (18 across the two groups) were conducted. Informed written consent was obtained from all participants.Findings
There were high scores in leader–member exchange (77% of employees [241 of 315] scored 4 and 5 on the Likert scale of 1 to 5), organisational commitment (76%; 239 of 315), and particularly in organisational citizenship behaviour (86%; 270 of 315). We also scored factors influencing these three main dimensions (for example, for leader–member exchange, the factors scored were affect, loyalty, perceived contribution, and professional respect). For leader–member exchange, affect (mutual affection or interpersonal attraction influencing cooperation) scored the highest (83%; 260 of 315). Within organisational commitment, normative commitment (sense of duty, obligation, and loyalty towards the organisation) scored the highest (78%; 245 of 315). With regard to organisational citizenship behaviour, courtesy (discretionary behaviour to avoid work-related conflict) scored the highest (91%; 286 of 315). Inferential analysis showed that employees holding lower qualifications (secondary school and below), those who intended to stay at UNRWA until retirement, and those who performed higher in appraisals (those achieving “best performer” status, as opposed to “fully meets expectations” or “does not fully meet expectations”) had statistically higher mean scores in leader–member exchange than their colleagues. Findings also show that employees older than 45 years, those with more than 20 years' experience, and those intending to stay at UNRWA until retirement had statistically higher scores in organisational commitment and organisational citizenship behaviour than their colleagues. There were no statistically significant differences in the scores of the three scales in relation to participants' gender, marital status, place of work, level of the health centre (main health centre or small health centre [sub-centre]) and job position. However, there were significant correlations between leader–member exchange and the two other managerial domains: organisational commitment and organisational citizenship behaviour. This suggests that if the leader–member exchange approach is positively perceived by employees, it would be associated with high organisational commitment and high organisational citizenship behaviour. In addition, there was overall satisfaction with respect to specific work-related variables.Interpretation
Leader–member exchange, organisational commitment, and organisational citizenship behaviour are high among UNRWA employees. However, there is room for improvement. It is important to monitor these important morale-related issues and to constantly consider means to improve managerial practices, especially supervision, considering that supervision is key in leader–member exchange.Funding
None. 相似文献6.
Background
There are limited studies about optimal duration and benefits of breastfeeding—and in particular, exclusive breastfeeding—on infant health and growth in the occupied Palestinian territory. This study aimed to evaluate the effect of exclusive breastfeeding on the health of infants in the Gaza Strip (at age 9 months), in terms of anthropometric measurements, growth, and morbidity.Methods
This study targeted mothers with infants attending primary health centres for vaccination at 9 months of age. Eight primary health centres were randomly selected from United Nation for Relief and Work Agency and Ministry of Health primary health centres in four regions of the Gaza Strip. Of 343 mother–infant pairs, in the first 6 months of life 251 infants received mixed feeding and 92 were exclusively breastfed.Findings
There were significant differences between the head circumferences of infants who were exclusively breastfed and those who received mixed feeding (44·1 cm [SD 1·39] and 43·7 cm [SD 1·15], respectively; p=0·007). There were no significant differences in the length and weight of infants between the two groups. Infants who were exclusively breastfed had a significantly lower frequency of gastrointestinal infections than infants who received mixed feeding (48% and 80%, respectively; p=0·001), as well as greater protection against respiratory tract infection (47% and 83%, respectively; p=0·001), lower incidence of otitis media (18% and 38%, respectively), and a significantly lower risk of urinary tract infection (5% and 65% respectively; p=0·001).Interpretation
Human milk is unique, and breastfeeding is the healthiest practice for healthy term infants for approximately the first 6 months after birth, providing ideal nutrition and supporting optimal growth and development. It also provides reasonable protection against infectious diseases. Thus, breastfeeding is the reference model against which all alternative feeding methods must be measured, with respect to growth, and short-term and long-term health outcomes. Infants should be introduced to nutrient-rich, solid foods (with particular attention to iron) at 6 months, with continued breastfeeding for up to 2 years. Every effort should be made to maintain breastfeeding rather than using formula or other milk substitute.Funding
None. 相似文献7.
Noortje Gerritsma Iman Alshanti Ibtissam Ouaali Maisa Dawoud Majed Hababeh Akihiro Seita 《Lancet》2019
Background
Maternal mortality rates in Palestine refugees in Jordan increased by 16% between 2013 and 2016. Action is needed to prevent future maternal deaths. Risk factors for maternal mortality are a young mother (below 20 years of age) and pregnancies that are close together (interval of less than 18 months), which can be prevented through the use of contraception. Contraceptive discontinuation rates increased among Palestine refugees in Jordan by 3% between 2015 and 2016. Sociocultural factors are important in access to contraception. This study assesses sociocultural barriers and opportunities to accessing contraception among Palestine refugees in Jordan.Methods
Focus group discussions were conducted in June, 2017, with female and male patients and health-care workers in rural and urban communities in Jordan. Patients were selected using opportunistic sampling at health centres; health centres and health-care workers were selected using purposive sampling. Only participants who signed the informed consent form were included. Discussions were moderated by a local researcher, tape-recorded, transcribed, translated, and analysed with MaxQDA. Analysis was conducted by two researchers independently using predetermined and emergent themes. Approval was obtained from the UNRWA Ethics Office.Findings
12 discussions were conducted with 84 participants, seven participants per discussion; 40 females, 27 males, and 17 health workers with an age range of 18–67 years. Perceived barriers to accessing or using contraception included husband or family-in-law opposition to contraception use; preferences in terms of the sex of children; pride in having many children; fear of infertility; incorrect use of contraception; a lack of health-care workers to provide contraception; reluctance of staff to provide contraception to females without spousal consent; and costs involved in using contraception. Perceived benefits included the financial advantage of a smaller family; and birth spacing for women's mental and physical health.Interpretation
Despite the use of opportunistic sampling, this study shows that both sociocultural barriers and benefits to accessing contraception exist for Palestine refugees in Jordan. More resources are needed to improve access by further researching sociocultural dynamics related to contraception use.Funding
Share-Net International, Royal Tropical Institute (KIT), the Netherlands. 相似文献8.
Kumiko Takai Yasuhiko Kamiya Majed Hababeh Ali Khader Akiko Kitamura Wafaa Zeidan Akihiro Seita 《Lancet》2019
Background
WHO and UNICEF recommend early initiation of breastfeeding, within the first hour after delivery, and exclusive breastfeeding (EBF) in the first 6 months of infant life. The most recent data available (from 2001) show that the EBF prevalence among Palestinian refugee infants under 4 months in Jordan was 24%. The study objectives were to estimate the current prevalence of EBF and early initiation, and to examine factors associated with EBF among refugees from Palestine in Jordan registered with UNRWA.Methods
A cross-sectional facility-based study was conducted between April and June, 2017, in all areas of operation of UNRWA in Jordan; North Amman, South Amman, Irbid, and Zarqa. The study targeted Palestinian refugee mothers of children under 6 months of age surveyed at five UNRWA health centres. One health centre was randomly selected from each area (but two from Zarqa) with proportionate probability, excluding those for which there were problems of accessibility. All eligible mothers who attended maternal and child health services on the day of the survey and agreed to participate were recruited, and the process repeated until the required number of participants was achieved. A structured questionnaire was used to collect data. We used the WHO definition of EBF to measure the proportion of infants under 6 months of age that were breastfed exclusively in the previous 24 hours. Bivariate and multivariate logistic regression analysis were employed to identify the independent predictors of EBF. The study protocol was approved by UNRWA and Nagasaki University. Informed written consent was obtained from each participant prior to the interview.Findings
A total of 307 participants (mean age, 27·4 years; range 17–45) were included in the analysis. Nearly one third (31%; 95 out of 307) lived in a refugee camp. The prevalence of EBF in infants under 6 months was 34% (105 out of 307; 95% CI 29–40), and 49% (148 out of 307; 95% CI 43–54) of mothers started breastfeeding within 1 hour after delivery. The rate of EBF was significantly higher in younger infants. Multiparous mothers (adjusted odds ratio 2·38; 95% CI 1·23–4·59) and mothers who did not have problems with breastfeeding (2·12; 95% CI, 1·25–3·57) were more likely to breastfeed exclusively.Interpretation
The prevalence of EBF has improved since 2001, but is still below the WHO recommendation of 50%. Providing adequate support, especially to first-time mothers, mothers who have problems (eg, difficulty in latching on and mastitis), and mothers of older infants, may be a feasible strategy to improve the prevalence of EBF among refugees from Palestine in Jordan.Funding
Jointly funded by Nagasaki University and UNRWA. 相似文献9.
Nisreen Salti Jad Chaaban Hala Ghattas Alexandra Irani Karin Seyfert Tala Ismail Salma Khedr 《Lancet》2019
Background
Palestinians in Lebanon have been protracted refugees for 70 years, but the Syrian crisis has caused shocks that threaten to destabilise their already fragile livelihoods. Over a million Syrian refugees and 42?000 Palestinian refugees from Syria have fled to Lebanon, adding pressure to an already weak infrastructure and labour market. The United Nations Relief and Works Agency (UNRWA), the main provider of health, education and relief services to Palestinian refugees, is exceptionally strained. This study examines changes in education, health, employment, food security, and poverty indicators for Palestinian refugees in Lebanon (excluding Palestinian refugees from Syria) using two nationally representative household surveys conducted in April, 2010, and July, 2015.Methods
The surveys were conducted using multi-stage cluster random sampling. Both surveys included households residing in camps and gatherings. Health conditions were reported for all household members by a proxy survey respondent from among the household members. Food insecurity was assessed using the Arab Family Food Security Scale. The poverty lines (thresholds) were set at US$6·84 per person per day (upper poverty line) and US$2·47 per person per day (extreme poverty line) in 2015, and US$6 per person per day (upper poverty line) and US$2·17 per person per day (extreme poverty line) in 2010. The difference across the 2 years reflects adjustment for inflation rates within the 5-year period. Data were analysed using STATA13. The study was approved by the Institutional Review Board of the American University of Beirut. Informed verbal consent was obtained from the survey respondents.Findings
Of the eligible sampled households of Palestinian refugees in Lebanon, 88% (2974 of 3382) in 2015 and 99% (2593 of 2626) in 2010 gave informed consent and completed the questionnaire. Net enrolment rates for elementary education remained high (98% in 2015 and 95% in 2010), but failed to lead to better labour market outcomes. The unemployment rate increased from 8% in 2010 to 23% in 2015, and the fraction working in elementary occupations increased from 23% to 36%. Overall poverty remained unchanged but with considerable regional shifts: poverty increased by 9% and 11% in central Lebanon and north Lebanon, respectively, whereas it dropped by 8% and 9% in Saida and Tyre. Extreme poverty was halved from 7% to 3%. There was a high prevalence of chronic diseases in both years (37% in 2015 and 31% in 2010); and in 2015, out-of-pocket health expenditure was six times higher when the household reported at least one chronic condition (US$50·9 per capita per month compared with US$8·3 per capita per month). Despite the reduction in extreme poverty, 4% of households shifted from moderate to severe food insecurity.Interpretation
Pressures on UNRWA services come at a time when the organisation is operating with a large shortfall in funding. Recent US funding cuts may have dire repercussions for a population burdened by a high prevalence of chronic conditions and facing high healthcare costs. With additional budgetary strains and worsening labour market conditions, Palestinian refugees in Lebanon risk losing some of the ground that they have gained in net enrolment rates in education, access to health-care services and the reduction in extreme poverty that the UNRWA has worked towards for decades.Funding
UNRWA funded the data collection for both surveys. 相似文献10.
Background
Policy development, one of the core functions of public health, is often achieved through professional associations leveraging disciplinary expertise and values via their official policy statements. The 140-year-old American Public Health Association (APHA) has adopted hundreds of policy statements, including several focused on the health implications of war and armed conflict, both in general, and in Iran, Iraq, the Persian Gulf, Nicaragua, El Salvador, and Vietnam. Yet, despite four attempts, the APHA has failed to pass a resolution addressing the health consequences of the Israeli occupation of Palestine. Here, we document the need for solidarity between health professionals in the USA and occupied Palestinian territory, and identify mechanisms predicting success of professional advocacy based on a commitment to international health justice.Methods
We conducted a case study, drawing on extensive literature review, historical analysis, examination of APHA procedures and documents, and interviews with organisations that have been successful in professional advocacy in addressing US policy as it relates to occupied Palestinian territory.Findings
Findings point to four factors within US academic institutions that underlie the advancement of policies relating to occupied Palestinian territory: (1) the moment in history and the political environment; (2) the organisation's history of taking controversial policy stands; (3) the rhetorical strategies deployed; (4) the organisation's structure and process of decision making. We applied these factors to our case study.Interpretation
Findings reveal profound differences in understanding among US public health professionals regarding the effects of the occupation of Palestinian territory on public health in the region. Results suggest that fear of controversy interferes with what should otherwise be an obvious response for US public health professionals. For public health resolutions that are deemed politically controversial, advocates need to adjust the language to respond to the historical moment, and history and culture of the organisation, to effectively counter deflective rhetorical strategies, and to acknowledge the formal and informal power of stakeholders within governing structures.Funding
None. 相似文献11.
Background
Diabetes is of growing concern, as the global prevalence of this disease in adults over 18 years of age has risen from 4·7% in 1980 to 8·5% in 2014. Type 2 diabetes makes up approximately 90% of global diabetes cases and is largely the result of unhealthy lifestyle. The aim of this study was to assess the risk factors for developing diabetes in the Palestinian population residing in Lebanon, with the intention of helping to prevent diabetes in this population.Methods
A cross-sectional study was conducted in 18 UNRWA centres randomly selected from across Lebanon between April and May, 2016, involving 1162 people aged 18–74 years (all eligible people in this age range who attended the health centres and agreed to be enrolled in this survey). A questionnaire based on a modified version of the Canadian Diabetes Risk Survey was used to collect and score information about BMI, waist circumference, age, gender, physical activity, fruit and vegetable intake, level of education, and family history of diabetes. Informed verbal consent was obtained from all participants.Findings
Of the Palestine refugees in Lebanon aged 18–74 years, 25·8% (299 of 1162) were at risk of diabetes. For these individuals, the risk factors were obesity or being overweight (68·4%), large waist circumference (>92 cm for males >80 cm for females; 62·3%), low physical activity (eg, walking for less than 30 minutes per day; 49·9%), low fruit and vegetable intake (46·0% ate fruits and vegetables every day), and family history of diabetes (68·5%). These risk factor levels have been associated with high risk of developing diabetes within 10 years in other populations. In our sample population, the risk of developing diabetes is higher with age (60·6% for people aged 45 years or over vs 3·1% for people under 45 years), male sex (36·9% risk vs 26% for females), and lower level of education (31·2% for people with preparatory and secondary level of education (school grades 1 to 9) vs 12·7% for people with a high school (school grades 10 to 12; pre-university) or university degree.Interpretation
Risk factors for developing diabetes are widely present among Palestine refugees in Lebanon, leading to a relatively high risk of developing diabetes (for example, compared to Canada). Awareness campaigns and educational sessions should be conducted at community level. Topics will include simple lifestyle modifications that have been shown to be effective in preventing or delaying the onset of type 2 diabetes and its complications.Funding
None. 相似文献12.
Naser Shraim Tasneem Al Taha Rawan Qawasmeh Hiba Jarrar Maram Shtaya Lama Shayeb Waleed Sweileh 《Lancet》2019
Background
Generic substitution of medicines has become common practice in many countries and is considered to be a key method to contain pharmaceutical expenditure without compromising health-care quality. However, the safety and quality of generic products are of concern to health professionals. This study aimed to investigate community pharmacists' knowledge, attitudes, and practices in relation to generic medicines in Palestine.Methods
A cross-sectional observational study was carried out using a convenience sampling technique to distribute a data collection form to practicing pharmacists in the West Bank. In Palestine, the majority of pharmacists work in private retail pharmacies called community pharmacies. Other forms of professional pharmacy in Palestine include pharmacists in industry, in the regulatory governmental sector, and in hospitals and other clinical settings. Here, a sample of licensed community pharmacists completed the questionnaire, which consisted of four main sections: demographic and practice details of the participants, and their knowledge of, attitudes towards, and factors influencing their selection and dispensing of generic medicines. The Mann–Whitney U test or Kruskal–Wallis test were used, as appropriate. A p value of less than 0·05 was considered significant.Findings
A total of 302 community pharmacists were interviewed, of whom 52% (157 out of 302) were male. The participants' mean knowledge score in relation to generic medicines was 5·91 (SD 1·27), and the highest score was 8 out of 10 (the maximum possible score was 10). Knowledge score was not significantly associated with any of the sociodemographic characteristics. Most pharmacists in the study (87%; 264 out of 302) agreed that they should be given the right to substitute with generic medicines, and the majority (62%; 188 out of 302) supported generic substitution for brand name drugs in all situations in which a generic medicine is available. The main two factors affecting pharmacists' selection and dispensing of generic medicines were personal faith in the product (86%; 260 of 302) and cost effectiveness of generic medicines (84%; 269 of 302).Interpretation
Participant community pharmacists in Palestine had basic knowledge with regard to generic medicines. In particular, their knowledge score pertaining to the technical and regulatory aspects of bioequivalence and pharmacokinetic parameters was insufficient. These data suggest a demand for interventions to develop pharmacists' awareness of these important matters underlying the safety, quality, and efficacy of generic medicines.Funding
None. 相似文献13.
14.
Background
Low birthweight (LBW), defined as a birthweight of less than 2500 g, is a leading cause of infant morbidity and mortality worldwide. Previous studies have shown that the risk of LBW is higher in vulnerable populations, such as refugees. Few studies have assessed the prevalence and associated risk factors of LBW in refugee populations using routine monitoring data. This study sought to measure the prevalence of LBW and associated risk factors in refugees in Al-Wehdat Camp in Jordan using routine monitoring data.Methods
The study examined a dataset that included 3916 births from mothers registered in the UNRWA e-Health database between June 1, 2016, and June 30, 2017. The dataset was cleaned and variables were analysed. The variables were parity, mother's age, maternal education level, marital status, mother's occupation, multiple pregnancies, presence of complications, diastolic hypertension above 90 mm Hg, place of delivery, number of antenatal visits, sex of infant, infant year of birth, infant month of birth, and type of service received (family planning or antenatal services). Continuous variables were grouped into categorical (eg, parity, number of antenatal visits, mother's age) or binary variables (eg, infant's birthweight). Bivariable and multivariable logistic regression were employed to evaluate the association between previously identified potential risk factors and LBW outcomes. The resulting odds ratios (ORs) and adjusted ORs were evaluated.Findings
The prevalence of LBW was 6·3% (246 of 3916). In the crude analysis, significant associations were found between the presence of maternal complications (OR 2·86; 95% CI 2·02–4·04) with LBW outcomes. Significant associations were also found between women that did not receive full antenatal services (OR 1·36; 95% CI 1·03–1·78) and LBW outcomes. Multivariable analyses showed that LBW outcomes were higher with maternal complications (adjusted OR 2·85; 95% CI 2·10–4·24) and receipt of full antenatal services over receiving only family planning (1·37; 95% CI 1·04–1·81), when adjusting for the a priori confounders.Interpretation
The study identified positive associations between LBW outcomes and maternal complications and the type of health service received. No other associations were significant, but some variables confounded the relationship between maternal complications and LBW outcomes. The study supports findings from previous studies, such as an increased risk of LBW outcomes when maternal complications are coupled with no family planning. The implications of this study are that prevention of maternal complications should be improved and that there should be better care of women with such complications. In addition, family planning services should be available to all women. Further research is required to form robust policies to reduce the burden of LBW in the context of vulnerable Palestinian refugees.Funding
None. 相似文献15.
Background
This exploratory qualitative study investigated self-perceived risk and protection factors that can determine the ability of children living in the Gaza Strip to adjust to a traumatic and risky life context characterised by loss and dispossession.Methods
A cluster sampling procedure was used to represent refugee children from four areas of the Gaza Strip (North Gaza, Gaza, Dheir el-Balat, and Rafah). The sample comprised 200 Palestinian children recruited at primary schools in four refugee camps (Bureij, Gaza Beach Camp, Jabalia, and Rafah Camp) in the Gaza Strip in 2012. Of these children, 104 were boys (mean age 8·6 years [SD 2·3], range 6–11) and 96 girls (9·6 years [2·7], 6–11). The children were engaged in activities aimed at eliciting narratives of military violence and traumatic experiences, and individual, familial, and community-related resources that they had mobilised during the war to cope with traumas. Thematic content analysis was applied to written materials and narratives using Nvivo10 software. The main objective was to identify in detail the dimensions of wellbeing present in the narratives, and perceptions of risk and protective factors. The inter-rater agreement ranged from 74% to 95%.Findings
Both boys (78%; 81 of 104) and girls (52%; 50 of 96) reported having directly experienced traumatic events related to war, episodes of political violence (39% of boys [41 of 104], 38% of girls [36 of 96]), domestic violence (31% of boys [32 of 104], 3% of girls [three of 96]), or community violence (6% of boys [six of 104], 2% of girls [two of 96]). Thematic content analysis led to the identification of ten main themes: relationship with peers, family, and other significant adults, affect balance, constraints on movement, play, health, school, personal satisfaction, and spirituality. In boys, the most severe self-reported risks were related to constraints on movement and affect balance, followed by relationship with family, and health. Play, personal resources, relationship with other significant adults, and school were perceived to be protective factors. The girls reported more sources of protection than risks, conversely, boys perceived themselves to be more at risk than protected.Interpretation
Children deal with ongoing suffering and discomfort by means of subjective and intersubjective agency in multiple domains of their life, showing psychological adaptability.Funding
None. 相似文献16.
Ron J Smith 《Lancet》2019
Background
The 1990s were dubbed the sanctions decade, typified by the situation in Iraq. The past 10 years have seen continued use of siege, ostensibly in the interest of promoting political change. For this decade, the Gaza Strip has been the model of siege. Siege regimes have also been imposed on Yemen, and to a lesser extent on Qatar, Iran, and areas of Syria. This paper examines the consequences of siege for those in the field of health-care provision, and what responsibilities medical staff have in the face of the human rights crises that accompany siege. Can public health needs be served without an explicit agenda that promotes sovereignty and liberation of populations under siege?Methods
The primary source of data for this paper is secondary literature, popular media and non-governmental organisation (NGO) reports dealing with the effects of siege on health-care provision in Gaza, Yemen, Iraq during the Sanctions period, and Iran. These primary data are supported by participant observation and interviews with medical staff in the Gaza Strip. These data were analysed using a critical political economy framework. Ethics approval was obtained from the Institutional Review Board of Bucknell University.Findings
Siege continues to be promoted as an alternative to warfare in the press and in academic writing. Medical and other NGOs document the strain that blockades represent as they record the extent of health-care crises, but they do not confront the coalitions that impose siege. Discussions of the importance of sovereignty to the promotion of health care remain sidelined within a discourse of wars on terror.Interpretation
Familiarity and engagement with geopolitical practices of isolation and resistance is important for health-care providers in territories under siege. As health-care providers represent front line witnesses of the effects of siege on local populations, their testimonies represent a substantial challenge to the status quo. International and local health workers should coordinate with activists and academics to create a global health paradigm of liberation by promoting local sovereignty and international solidarity.Funding
Bucknell University. 相似文献17.
Background
Labour induction is a commonly used obstetric procedure that has specific indications and may result in complications. This audit evaluated the adherence to the Palestinian Ministry of Health guidelines for labour induction at Al-Helal Al-Emarati Maternity Hospital in the Gaza Strip, and considered the implications.Methods
Data were collected retrospectively from patients' medical records at Al-Helal-Al-Emirati Maternity Hospital from Aug 25 to Oct 7, 2017, including all patients who underwent induction of labour. Local practice was compared to the Palestinian Ministry of Health guidelines. Patient confidentiality was maintained and ethics approval was obtained from the Palestinian Ministry of Health.Findings
In total, 101 patients were identified, with a mean age of 26·6 years (SD 5·3 years). The modified Bishop score was documented in 86% of women (87 of 101). The most frequent indication for induction was prolonged pregnancy (for 28% of women; 28 of 101). Of these women, 82% (23 out of 28) were induced at 41 or 42 weeks. Pre-labour rupture of membranes was the indication for induction in 25% of the cases (25 of 101). The prostaglandin misoprostol was used for induction in 99% of women (100 of 101), given orally as a 50 μg tablet in accordance with the Palestinian Ministry of Health guidelines. Cardiotocography was performed before and 1 h after misoprostol (in accordance with guidelines) in 43% of cases (43 out of 101), whereas 49% of women (49 out of 101) had cardiotocography only after misoprostol. Four women had cardiotocography only before misoprostol, three women had no cardiotocography, and documentation was missing for two women. Cervical evaluation was carried out before each dose of misoprostol (in accordance with guidelines) in 42% of women (42 out of 101). The mean duration between initiation of induction and delivery was 20·9 h (SD 21·94 h). Informed written consent for induction was obtained from three women, but none of the women were informed about the risks and benefits of induction.Interpretation
Adherence to local guidelines was poor, particularly with respect to the care that women received prior to and during induction, including cervical assessment and performance of cardiotocography. Further weaknesses were insufficient patient education combined with a lack of formal consent and poor documentation. These findings highlight deficiencies in involving patients in their care and decision making processes, which are widespread in the Gaza Strip. These results were shared with the team. Performance improvements are being implemented and a re-audit is planned to assess progress.Funding
None. 相似文献18.
Background
In their quest for universal health coverage (UHC), many developing countries explore alternative financing strategies to address the potential budgetary impact of health coverage expansion (for example, deferred debt versus current finance through taxation or premiums). Given the limited fiscal space, these policies may have different implications for fiscal sustainability and may worsen intergenerational inequality.Methods
We assessed the impact of UHC on fiscal sustainability and intergenerational inequality using an overlapping generations model within a general equilibrium framework, which we calibrate using data from the Palestinian Expenditures and Consumption Survey (PECS-2011) and the Social Accounting Matrix (SAM-2011). Fiscal sustainability is assessed using a prudent debt–GDP level of 39%. Intergenerational inequality induced by different policies is assessed by comparing the relative incremental burden (RIB) borne by each generation following the policy adjustment.Findings
In the absence of any policy adjustment, an ad hoc expansion of health coverage would increase the debt–GDP level to 15% above the prudent level. This indicates that the UHC fiscal stance may be financially unsustainable in the long run, therefore calling for a policy adjustment. Among the policies we examined, UHC finance through the increase of premiums (whether current or deferred) seems to be unsustainable and may further widen intergenerational inequality (RIB∈[3,6]). By contrast, current finance through indirect taxes helps to restore a prudent debt–GDP level and seems to be associated with a lower level of intergenerational inequality than deferred-debt finance through direct taxation (RIB of 1·25 and 5, respectively).Interpretation
Among the policy options assessed, the current indirect taxation emerged as the best policy option in terms of its impact on both fiscal sustainability and intergenerational inequalities. However, from a policy perspective, the capacity of governments to raise additional revenues might be constrained in the short-term. Under such circumstances, deferred-debt finance may be preferred—a situation in which policy makers may have to trade fiscal sustainability against intergenerational inequality.Funding
The A*MIDEX project (number ANR-11-IDEX-0001-02) funded by the French Government programme Investissements d'avenir, managed by the French National Research Agency (ANR). 相似文献19.
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