Public Health

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Epidemiology of Aerobic Bacterial infections Among IUD (intrauterine Device) Users in The Northern West Bank
(2001) Mariam Amer Isma Al-Tell; Dr. Samar Ghazal; Dr. Mohammed Musmar
Intra Uterine Device (IUD) has been the most popular method of contraception among Palestinian women. It is one of the very effective contraceptive methods, with failure rate ranging from 0.5% to 3% (Hatcher et al, 1989) depending on the type of IUD. One of the main problems that face women using IUD is infection Our study is a comparative study of IUD users and non-users. The study sample was from the FP clinics of M01-1 in the 4 main districts of northern West Bank. The purpose was to highlight the epidemiological pattern of IUD related infections in Northern West Bank as a representative of Palestinian women. 200 women (134 case, 66 control) were interviewed, and cervical swabs were collected and cultured for aerobic bacteria. All data were analyzed by SPSS. In general the study findings were consistent with the literature. The following statements worth reporting: The prevalence rate of isolated bacteria was higher among the IUD users than non-users (p< .05), and there was no relation to the type of IUD or duration of use in these rates.(p=.o27) Regardless of the IUD use the study findings showed alteration in the vaginal discharge among women. However this alteration was significantly higher in IUD users (58%) compared to non-users (22%).(P=. 003) The study also showed that the presence of RTI related symptoms among IUD users (61%) compared to non-users (26%) was statistically significant (p=. 000). There was no relationship between the alteration of vaginal discharge with the type of bacteria isolated in both groups (IUD users and non-users). Among the IUD users (case group), isolation of different kinds of bacteria have no significant relation with the alteration of vaginal discharge, (p=. 105), (among the non-users p=0.667).
Human Brucellosis Status in Al-Jiftlik Area
(2002) Muntaser Mohammad Hamad Sobuh; Dr. Yahya Faydi; Dr. Suleiman Al-Khalil
An epidemiological study of the prevalence of human brucellosis in Al-Jiftlik area was carried out in the period between September and December, 2001.A total number of 370 patients attending Al-Jiftlik clinic and having the symptoms of brucellosis were included in the study, 201 (54.3%) males, and 169 (45.7%) females. Out of these 44 (11.9%) patients were infected with brucellosis. Seroprevalence of human brucellosis was not influenced by sex, (males 23 "11.4%", and females 21 "12.4%"). The prevalence rate of brucellosis was higher in older people 17 of 45 (37.8%), than in younger people 2 of 109 (1.8%). Prevalence rate of brucellosis among people was not associated with the economic status, but it was higher among people having lower education level, and families with larger family size. The overall seroprevalence was higher among farmers 24 of 115 (20.9%) and m ilk handlers 35 of 118 (18.6%) than in other occupations tested like labors 1 of 64 (1.6%), and students 2 of 67 (3%). The results of this study emphasized the importance of contact infections, namely with infected animals and their products, as a cause of human brucellosis.
The Major Risk Factors of Cerebral Stroke in Patients Admitted To The Hospitals of North West Bank Districts
(2002) Ahmed Juma Ibrahim Ali; Dr. Suleiman Al-Khalil; Dr. Mathhar Darwazeh
A retrospective study was aimed at assess the major risk factors of cerebral stroke in the North West Bank districts hospitals. The study included 522 cases of cerebral stroke that were admitted to the hospitals, during the year 1/1/2000 to 31/12/2000. Data collected from the medical records about risk factors, laboratory tests, brain CT reports, family history, and drugs before admission and smoking. The patients were classified into ischemic stroke, hemorrhagic stroke, and no apparent lesion and not available (not done or not found). The outcomes of cerebral stroke were by using discharge report. The study results showed that the most common risk factors of cerebral stroke were hypertension, previous stroke, diabetes mellitus, a trial fibrillation, myocardial infarction and transient ischemic attack. Other risk factors include family history and increase blood level sugar, platelets, cholesterol and packed cell volume. The study recommends further studies, on primary prevention of risk factors and medical follow up.
Assessment of Rehabilitation Services in the North Districts of West Bank in Palestine
(2002) Nasir Abu Khader; Dr. Suleiman Al-Khalil; Dr. Varsen Aghabekian
The purpose of this study was to assess the rehabilitation services in the North districts (Nablus, Salfit, Tulkarm, Qalqiliya, Tubas, and Jenin) of the West Bank in Palestine. The study population consisted of (43) providers who represented the institutions providing rehabilitation services. Exploratory descriptive design utilizing a structured questionnaire designed by the researcher and reviewed by 4 advisers with a research background was utilized. The questionnaire consisted of (13) sections: The first section was related to socio demographic variables (age, gender, education and experience.) Sections two to section eight covered types of rehabilitation, quality and quantity, size of rehabilitation services, financial matters, human resources, relation with administrative system, patient referring system, cooperation and coordination, national policies and rehabilitation policies. Section nine covered priority rehabilitation needs. Section ten covered the most serious problems that restrict development of services. Section eleven and twelve covered suggestions to develop rehabilitation policies, while section thirteen covered measures to improve quality of rehabilitation services. Data were collected through face-to-face interviews. The analysis of the data revealed that the majority of providers of rehabilitation services were young less than 35 years (58.1%). the majority (62.8%) had a Bachelor degree; with more than 10 years of experience (53.3%). • Physiotherapy is the most rehabilitation service provided in the north districts (86%). • There is duplication in providing services by different institutions, while some services are nonexistent such as Occupational therapy. • About90.6% of providers indicated needed to develop their work force. • Results indicated weak administrative measures and lack of laws. This restricts development of rehabilitation services. • In general the majority of providers suggested that the rehabilitation policy and services should be comprehensive and nationwide. There should be social assimilation of the disabled in their society and, studying of the factors that affect policy-making in the field of rehabilitation and to support rehabilitation institutions. Accordingly, an accepted policy and protocols by different settings: UNRWA, NGO's, government, and private sectors should be targeted in order to improve the quality of rehabilitation services and to ensure a better rehabilitation and well being of the Palestinians with special needs.
Osteoporosis Among The inhabitance of Jenin District
(2003) Islam Saleh Al-Hijawi; Prof. Ibrahim Wahdan Al-Hassan
Osteoporosis is a common metabolic bone disease; it is a major cause of illness, fractures and death in adults. The present study aimed at evaluating the status of this disease and tried to search for possible associated risk factors among the inhabitants of Jenin district, northern Palestine. To achieve our aims a total of 165 subjects (69M / 96F, aged 25-75) suffering from bone fractures, referrals of the orthopedic clinic at Jenin Hospital, were interviewed and data regarding their health status, family history of disease, physical activities and other related data was collected in a specially designed questionnaire. The findings among our study population showed that the highest rate of fractures occurred in spine (21.8%), followed by fractures of the hip (16.4%), wrist (14.5%) and ribs (10.9%). With respect to gender differences, females showed a higher frequency (60% of total fractures) compared to males. In general, a noticeable increase in fracture frequency was observed with increasing age. It was also found that with advanced age, there is a clear tendency towards loss of heights, while weight variations did not show any significant changes. Data on family history for affected patients seems to indicate that family history is a risk factor as all study population subjects were found to have sibs and parents with history of fractures at various sites. An interesting finding was the finding of more spine and hip fractures among mothers and sisters of patients, while fathers and brothers seems to show much higher frequency in wrist fractures. The finding with respect of secondary osteoporotic diseases among our study population showed that chronic rheumatic diseases were the most common (25.5%), followed by kidney related diseases (21.8%) and malabsorption (12.7%). Other secondary osteoporotic diseases related to hypo and hyper thyroidism and parathyroidism were represented by very small percentages. Early menarche and menopausal age seems to be risk factors for developing osteoporosis. The findings of the current study showed that around 50% of the female population were with early menopause and around 40% had early menarche. This finding partially explains the observed discrepancy in fracture occurrence among males and females in our population. Data on physical activity practices among study population seems to indicate that the majority of the patients have limited activities, thus rendering this group to be at high risk of developing osteoporosis. Our findings with respect to calcium rich diets indicates that the studied population have limited use of such diets (hard and soft cheese and milk; calcium supplementation) especially at ages below 25 years of age. Lack of proper balance diet especially at this age is a well-known risk factor of osteoporosis. Findings on milk consumption also indicate that the majority of the studied population consume limited amounts of milk at all stages of life, a situation which also considered as a risk of osteoporotic disease. The study also paid attention to other factor related to causes of osteoporosis such as oestrogen intake by females at menopausal age, breast feeding, and use of caffeine, soft drinks and others.
Lung Cancer and associated Risk Factors in The West Bank
(2003) Samer Ahmad Soliman Diab; Dr. Nael Abu-Hasan
Since no previous studies were carried out on large scale regarding lung cancer status and associated risk factors in Palestine, the current study aimed at evaluating the status of the disease and the possibly associated risk factors among the Palestinian inhabitance of the West Bank area. This was achieved through reviewing and analyzing the available patient's files form the period 1997-2000. Files for previous years were excluded due to several problems associated with the used filing systems prior the transfer of authority to the Palestinians. A total of 286 files were reviewed and the collected data was then analyzed using SPSS. The over all prevalence rate of lung cancer in the West Bank area excluding Jerusalem was 18/100,000. The highest rates were found in the districts of Jenin (24.4) and Tulakrem (22.9). This low prevalence, compared to the internationally reported, is due to multi factorial reasons among which is under-registration, details are shown in text. The most prevalent histological type in the study population was adenocarcenoma and was represented by 31.5% squamous cell carcinoma was the second common histological type (24.8%). Highest prevalent areas were found in Jenin and Tulkarem, where charcoal production in the former and industrial fumes in the later are significant, also farming is prodominant in both areas. In conclusion, we believe that there is an urgent need to have better national method for cancer registration as well as an urgent need to evaluate risk factors associated with the observed increased incidence of lung cancer in the districts of Tulkarem and Jenin.
Factors affecting the occurrence of Type II DM in Nablus City
(2003) Noha Kamal Ibraheem El- Barbari; Dr. Suleiman Al- Khalil; Dr. Ali Shaar
Type II diabetes has been described to have an epidemic-like spread all over the world with special emphasis on countries experiencing the transition to western lifestyle. Diabetes Mellitus affects more than 14 million cases In the US. and is the leading cause of new blindness and kidney disease. Diabetes also causes nerve disease, heart disease, and stroke each year At least 19000 people die from diabetes and its complication. People with higher than average risk Of type II diabetes are those who are overweight and people who are not physically active. About 317 people over the age of 35 were selected from Nablus community to participate in this study. Study participants were examined for type of work, diet and the extent to which they are involved in physical activity. They were also examined for weight, height fasting blood sugar and blood pressure. SPSS software was used to provide descriptive and cross-tabulation analysis of collected data, the also relationship between the risk factors to develop type 2 Diabetes Mellitus and one or more of lifestyle patterns was examined Almost all results were consistent with the findings of international literature especially those related to the neighboring countries like Saudi Arabia. Conclusions of our study confirms that: - Diabetes Type II can be prevented as in all other studies about the subject. - There is a significant relation between lifestyle, diet, and occurrence of Type 2 Diabetes. - Even though level of general education for study sample was good, knowledge about the disease was very low. -Males demonstrated to be more susceptible for type 2 diabetes than females of the same age group in the sample study.
Type 1 Diabetes Mellitus in Northern Palestinian Community
(2003) Majd Asa'd M. Abu-Ali; Dr. Suleiman Al-Khalil; Dr. Ali Al-Sha'ar
In Palestine, studies on diabetes and diabetic patient were limited. With respect to type 1 diabetes no available data of any nature is available. The current study aimed at evaluating the effect of health services provided by governmental clinics on type 1 diabetic patients in the northern parts of the West Bank area. All cases enrolled at the diabetic centers of the cities of Nablus, Jenin and Tulkarm were interviewed and the data was collected using a specially designed questionnaire. A total of 100 cases, representing all admitted cases over a period of 1 year (September 2000-September 2001), were enrolled. Data was analyzed using the Statistical Package for Social Sciences (SPSS). The findings of the current study showed that the study population was distributed as follows: 51 from Nablus diabetic center, 31 from Jenin center and 18 from Tulkarm center. Equal representation for both males and females was observed with a mean age of disease onset of 4.95 years. It was also found that 20% of the study population reported to have first degree relative with diabetes. Among the study population 84% were reported to have episodes of hypoglycemia, while 96% were reported to have episodes of hyperglycemia as complications associated with the disease. The findings on the association between recommended daily practices (changes in diet and physical activities, home monitoring of sugar level in blood and urine and blood sugar level adjustment through insulin and diet) and presence of complications (hypo-hyperglycemia) showed that no statistical significant association between such practices and improvement of health status of the patients. With respect to clinical (consultations with ideologist and dietitians) and educational services about diabetes, offered in these centers, and its effect on the control of patients’ blood sugar level, our findings showed that such services did not show any improvement on the health status of these patients. Our data shows that 46.0% of those who attended consultation sessions with dietitian were with controlled random blood sugar and 20.0% for those who attended consultation sessions with dialectologist were with controlled random blood sugar. Association with recommended health practices and control of blood sugar also showed no significant improvement on the health status of these patients with the exception of home monitoring of blood sugar level as 90% of those who practiced this activity were with controlled acceptable blood sugar levels. The effect of diabetic complication on the quality of life showed that less than 50% of the study population who had either hypo or hyperglycemia were able to cope with their normal life activities and around 18% of this group were able to cope with recommended diet regimes. With respect to patients satisfaction with the offered services, 87% of them seems to be satisfied with what is offered by their centers, although no any noticeable improvement on their health status.
The Level of Health Behaviors Among Palestinian University Students in West Bank
(2003) Mahmoud Fathi Mahmoud Jaber; Dr. Suleiman Al-Khalil
This current study aims to recognize the health behavior of the Nongovernmental Palestinian university students (An-Najah, Al-Quds, Bir-Zeit, Bethlehem and Arab-American university in Jenin) during the academic year 2001/2002 and the effect of variables Such as university, gender, the students' educational level, the students' cumulative average and parents' education on the level of health behavior. For this purpose, the researcher has proposed a questionnaire based on the survey of instruments in the field of health awareness such as (1999). The sample of the study, which was randomly chosen and personal interview —dependent, consisted of (1057) students (529) males and (528) females and formed (5%) of study population. Finding of our study showed that the level of health behavior of the student on total score was moderate (67.4%). Very high level of health behavior among students was only on smoking and alcohol domain (82%). The level of health behavior students was moderate on the following domain (nutrition (68.4%), managing stress (67.8%), and medical care (69.4%)). The level of health behavior among students was very low only on physical fitness domain (49.8%). The study showed that there were differences of statistical significance at the value (α=0.05) among the variables are that the result revealed, according to the university variable. That all differences were in favor of Arab-American University. Results, according to gender variables, showed that gender variable was, in all domains and total score between male and female students, in favor of female students, while in case of physical fitness domain it was in favor of male students. The College variable between scientific and humanity college was in favor of scientific college. Results also showed that all differences, according to cumulative average, were in favor of the higher cumulative average. The variables of fathers' and mothers' educational level revealed that differences were in favor of the higher education.(For fathers and mothers). Recommendations of this study, according to what the Researcher found, are to teach obligatory courses that take into consideration health awareness among college students and conducting other studies adopting other variable the researcher didn't use.
Job Stress Sources Among Palestinian Nurses Working in Northern West Bank District Hospitals
(2003) Yehia Abd-Aljoud Darwsh Joudeh; Dr. Suleiman Al-Khalil; Dr. Abed Assaf
The purpose of this study were first to identify the degree of job stress and its sources among Palestinian nurses working in Northern West Bank district hospitals, also to explore the role of study variables (sex, academic qualification, years of experience, marital status, place of living, kind of hospital, place of hospital, kind of word). To achieve this aims, a sample of (276) nurses were randomly selected for the study. Study tool “questionnaire” was validated by a number of referees and based on literature review when developed. Reliability was tested by using Alpha Cronbach Equation for internal consistency. Reliability was (0.90). For data analysis, the researcher used arithmetic means, frequencies, percentages, t-test of independent variables, One Way ANOVA, and scheffe test.
Poisoning Among Children at Jenin District
(2003) Ahed Ghaleb Ahed Moh’d; Dr. Ansam Sawalha
Poisoning is any unwanted effect on human body that can result due to exposure to natural or synthetic substances. Poisoning is highly related to the public awareness and the correct handling of these poisoning substances. This study was conducted to spot the light on the poisoning problem, mainly among children with an overall objective was to decrease the morbidity and mortality rates of children due to poisoning through better understanding of the causes, symptoms, and management of poisoning cases. The study was conducted on poisoning cases that were presented to the emergency room of Jenin Governmental Hospital and admitted to the pediatric unit during the period of January 2000 to August 2002. A total of 127 poisoning cases, up to 14 years old, were presented to Jenin Hospital during the study period. The results showed that the majority of cases were presented with mild to moderate poisoning symptoms, 74% of the cases aged from 1-5 years old, predominantly male. Most of the poisoning cases (85%) occurred at home and resulted from oral poisoning and with symptoms of digestive system poisoning. The majority of the poisoned cases were due to chemical products including pesticides and petroleum materials mainly kerosene. Our findings strongly indicate a lack of public awareness about handling of chemical materials (storage, labeling and first aid in case of poisoning). Carelessness and lack of parental knowledge might be one of the main factors that led to most of the poisoning cases, house was not calming oases in Palestine. Therefore, childproofing home and educational programs from the Ministry of Health and other Non-Governmental-Organizations could be the most effective prevention methods to decrease morbidity and mortality from accidental poisoning in children. In addition, the establishment of poison control center may have an essential role in controlling the poisoning problem.
The Effect of Israeli Actions During Al-Aqsa Intifada on Health Services Provided in the West Bank of Palestine
(2003) Tarif (M.T) Abed Al ftah Ashour; Dr. Samar Gazal; Dr. Mustafa Al Bargothi
Alaqsa Intifada which began on 28thof September 2000 has affected all the different aspects of the Palestinian lives especially the health sector, in this study we highlight the effect of the Israeli actions on the Palestinian health services by comparing these services provided to the Palestinian before and during Alaqsa Intifada. The study was done between the 1stof February 2002 and 28th of May of the same year. We used the questionnaire method which consists of two parts, the first one contains the personal data of the health workers and the second one includes 42 questions to be answered, these revolve around 3 domains, the effect on the health providers ,on the patients and who the health strategic planners coped with the new situation. The questionnaires distributed to the health workers according to the following percentage: male (60%) female (40%) working at governmental sector (53%) NGO’S (19%) UNRWA (10%) and the private sector (17%) including doctors (26%) nurse (30%) administrators (14%) and pharmacists (10%), we used the SPSS program to analyze the data. The study results show a significant effect of the Intifada on the health services, the following points worth concernment: - Overall the Israeli actions have negatively impact on the health services provided (29%), the health providers were negatively affected by (38%), the patients and health services recipients by (58%) and the strategic planners coping did not exceed (13%). -The impact of the Israeli actions on all health programs and aspects was significant including the health promotion, health education, immunization, and environmental and training programs. -There was statically significant difference of the level of health services according to sex, age, place of residence and the method of transportation to work, however the study shows no statically significant differences according to type and nature of job, nor to the place of job. Our recommendations in this study are the following: - The health authorities must open hospitals and clinics not only in cities, but in villages and rural areas which can help the people there to avoid the Israeli siege and closure. - Redistribution of health workers according to place of residence is highly recommended. - Drug store and distribution policy of the ministry of health needs to be revised with concentration on decentralization. - Planning on alternatives to deliver all essential health services especially vaccines by coordination between different health sectors and the local communities. - Health workers need special attention and support since they are carrying much heavier and more dangerous work load. - A strong need to establish health media center to cover accurately all the results of the Israeli actions on Palestinian health.
Nutrition of Elderly in the City of Nablus
(2004) Abeer Hasan Saeed Khwaireh; Dr. Samar Ghazal
The challenge of meeting the nutritional needs of elder population is compounded by the lack of research in this area, This challenge is augmented by the interaction of current and past social, economic, and psychological factors, a wide range of individual differences in the biologic process of aging. Nutritional requirements should, at least in part, be based on biologic changes caused by aging as well as requirements of disease processes prevalent in aging, such as cardiovascular disease. The goal of our study, the first of its kind in Palestine is to find out the nutrition status and it’s risk factors in elderly people in Palestine represented by elderly in Nablus. The study sample consisted of 223 elderly from the city of Nablus, who were randomly chosen. They were asked to answer a questionnaire about their social profile, health profile and risk factors affecting nutrition, also Body Mass Index (BMI) was measured. All data were analyzed using Statistical Package for Social Studies (SPSS version 10). Although some results were inconsistent with our expectation, especially those related to BMI and its relation with risk factors, we had very important positive results. There was an overall poor knowledge about nutrition among elderly that necessitates public education about nutrition facts. Our results highlight the need for more attention from the health policy makers to the relationship of nutrition and disease. More important role of professional nutrition specialists in the health system is called for.
An Epidemiological Study on the Effect of Water on Health in Tubas District
(2004) Baker Abu-Hejleh; Dr. Yahia Faydi; Dr. Issam Ahmad Al-Khateeb
The aim of this study was to investigate the relationship between water quality and health among the inhabitance of Tubas district. In order to achieve our aims, the following strategies were used: examination of available patients records from local governmental clinics; a random sample of school children (seventh grade students) and a specially designed questionnaire distributed to households. Collected data were then analyzed using the SPSS (Statistical Package for Social Sciences). With respect to water related diseases, diarrhea was the most common disease, especially among students, followed by eye and skin diseases. There was a significant relationship between hygienic conditions and the place of residence and this was clear among the inhabitance of the village of Tammon. The percentage of water related diseases in Tammon area was the highest among the different areas as it reached 43.39%, then Tubas, and then Aqqaba. Although, a high level of wariness was reported regarding the knowledge of importance of water and health (79.7%), practices does not reflect that as most of the study population do not practice the cleaning of their water storage resources (63.7%), and only (15.8%) seems to boil water as a method for disinfection. Other practices such as lack of proper use of chlorine, raising of animal at homes and ways of collected rain water, all seems to indicate a high risk for water pollution. Reviewing patients files also seems to indicate that the area in general is suffusing from several health related problems. A significant relationship between water- related diseases and the following variables: Place of residence, quantity of available water for use, methods of water collection, public awareness, existence of toilets, the distance between toilets and water source, raising of animals at home, distance between water storage sources and sepses was observed. In conclusion, the area is suffering from several water related diseases and lack of proper water supply.
Housing -Health Relationship in Al-Ain Refugees Camp in Palestine
(2004) Safaa Farook. Kayed Ibsaiss; Dr. Mohamed . J. Musmar; Dr. Issam Al-Khatib
Acute respiratory infections (ARI) represent one of the main health problems in children less than five years of age in developing countries. Every year, pneumonia causes the death of over 100,000 infants under one year of age, which is an average of 300 deaths every day. Ninety-nine percent of these deaths occur in developing countries. Another 40,000 deaths from pneumonia occur each year in children under five, which represents another 100 deaths from this disease each year in the Western Hemisphere Prevention of respiratory disease in children is an important public health matter in developed and developing countries. The relationship between housing and health has long been researched tracing when the ill–health of working class families, particularly their susceptibility to tuberculosis, was attributed to poor housing conditions. Our study was done to evaluate the impact of housing conditions on the health of the people at Al-Ain refugee camp in Nablus district, focusing on upper Respiratory Tract diseases One hundred and fourty nine houses from Camp No 1 were chosen randomly as a study sample, they were asked to answer a questionnaire about their family status, house, life style, and information of children affected by ARI& risk factors, all data were analyzed by SPSS. The following are important study results: 1. Poor housing conditions in refugee camp No 1, including overcrowded houses, and humidity in houses. 2. A high percent of Camp No 1 resided suffering from cold ,chronic cough ,throat ache ,influenza and otitis specially in age 1-6 years 3. The study divided the respiratory infection diseases to six diseases, cold, chronic cough ,throat ache ,influenza , bronchitis and otitis media. Association between these respiratory infection and housing conditions are the following: -Significant positive association chronic cough &the number of family members. -Significant positive association between influenza & the number of family members. -Significant positive association between throate ache & heating source, number of smokers in house.
Assessment of Perceived Health Care Service Quality at Palestinian Hospitals: A Model for Good Hospital Management Practice (GHMP)
(2004) Majd Abd Al-Rhman Fareed Al-Adham; Dr. Amjed Al- Ghanim
Over the last 20 years, the increasing complexity and technical intensiveness of healthcare in Palestine hospitals have increased the level of uncertainty in the process of care. The variables within the health care environment (demand, cost, system deregulation) are undergoing rapid changes. This study is the first of its kind to investigate beyond quality management approaches, the most important issue in health care management, and the need to implement new organizational model in response to the dynamic changes that are transforming the health care process in Palestine. The study was conducted during January-June 2004 and involved all hospitals working within the City of Nablus. The primary aim of this study was to investigate the possibility of applying quality management approaches into the health care system through the identification of the level of offered services in Nablus hospitals (Public, private and charity) and to search for possible factors affecting level of offered services. The study also aimed at finding out to what extent these hospitals implements the criteria and the standards of quality management system. To achieve our goals, two structured questionnaires especially designed for this purpose were used targeting both staff and patients. Collected data was analyzed using SPSS. Several hypotheses were formulated and tested based upon TQM principles. The results of the current study showed significant differences in the assessment of both staff members and patients and the level of offered services in the various departments within the same hospital and between different hospital sectors.Based upon the criteria level (Likert Scale) set for all hypothesis (3.5 out of 5 points, for good evaluation) most departments showed levels less than 3.5 indicating areas of weakness in most working departments with the exception of working departments in the private sector. A direct relationship between overall hospital delivery care processes and patient satisfaction, where patient satisfaction is directly related to the attitudes and perception of employee as they, in turn related to the hospital and its management practices was found. The results also showed that total quality management criteria are not considered as hospital priorities. With the exception of Rafidia hospitals none of the operating hospitals is applying any of the TQM principles. Departments applying such principles in Rafidia hospital (only 4) scored higher levels compared to Al-Watani hospital, thus indicating clear advantages in favor of TQM application. Furthermore, correlation analysis confirmed suggestions that further work is required for the establishment of a health care quality management model in hospitals. In conclusion, based upon the findings of the current study a proposed model for the improvement of the existing system was suggested.
Factors that Affect the Nutritional Status of Children Aged 9-18 Months in East Jerusalem
(2004) Manal Jamil Ahmad Salah; Dr. Obaida Qameihya; Dr. Asma Imam
In an attempt to assess the factors that might affect the children’s nutritional status in East Jerusalem, a descriptive, cross- sectional study was conducted in 5 clinics: United Nation Refugees and Work Agency (UNRWA) the clinics of Zaweyeh and Shufat, Makassed Islamic Charitable Society, Palestinian Red Crescent Society and Spafford Children Center. Mothers of 300 males and females ages (9-18) months, who attended the clinics were interviewed. Also anthropometric measurements were used to assess the nutritional status of children, while face-to-face interview were conducted with the mothers to assess attitudes and practices. Data was collected by a team of 12 field workers between the period of July to August 2003. Major results showed that 41.4% of the assessed children were anemic, 8.5% were wasted and 14.2% were stunted. It was also found that anemia was significantly higher among females (42.3%) than males (41.2%). Moreover, 9.6% of the assessed children were of low-weight for their age. Briefly, findings of this study showed that malnutrition (Anemia, lowweight, stunting, wasting) was considered a serious health problem in the early age. So stressing on health education program, within the community, and developing surveillance system in order to assess the hemoglobin status of children are recommended with more focus on nutrition educational sessions mainly for mothers.
Housing Environment and Women’s Health in the Palestinian Refugee Camps :a Case Study of Al-Ein
(2004) Rania Nabeel Fawzi Arafat; Dr. Mohamed Musmar; Dr. Issam Ahmad Al-Khateeb
A study of the housing environment and women’s health was carried out during January and February 2002 in 150 homes of Al- Ein Refugee Camp in Nablus city. Interviews were held with 150 women of different age groups and different marital status. One hundred and three of women were married and 47 were single. Information was collected about the social profile, health profile, housing conditions, health services, and the perception of women towards their health and its relation to the housing conditions. The results show a significance relationship.
Assessment of Microbial Quality of Food Samples in Nablus District
(2004) Omayya Morshed Mohammad Hammad; Dr.Yahya R. Faidy; Dr. Issam A. Al –Khatib
Data of microbiological food examination recorded between 1995- 2003 at Environmental Health Department of Ministry of Health were analyzed and studied for microbial contamination in order to assess the variations of bacterial quality of food by type, source, months, seasons, years. A total of 1052 samples were collected from Environmental Health Department of Ministry of Health for routine test of microbiological quality for public health issue by Environmental Health Inspectors of Nablus district during the period 1995-2003. This study showed that salads, meats and chickens and diary products had the highest percentages of unaccepted samples tested for TAC: these percentages are (62.1%), (14%) and (5.6%) respectively. This study showed that the restaurants had the highest percentages of unacceptable samples tested for TAC, TC, S aureus, Yeast and Moulds These percentages are (56.9%), (65.6%), (1%), (75.9%), and (3%) respectively. This study conclude that lack of monitoring in restaurants, and food factories, and unsystematic food sampling system, due to the current situation such as closure and separation of the Palestinian territories by military checkpoints has created a lot of difficulties facing reporting, food sampling and consequently food control. The study recommends conducting health education programs about food safety to food handlers, holding educational programs for public, and increasing the numbers of trained food inspectors.
Knowledge, Attitude and Practices of Palestinian Women in Refugee Camps of Nablus Area Towards Family Planning
(2004) Kanar Wael Amin Alqadi; Dr. Nael Abu-Hasan
The current study aimed at exploring and assessing the current level of knowledge, attitudes and practices among women in the refugee camps of Nablus governorate towards family planning as well as their fertility awareness. A specially designed questionnaire was prepared for this purpose and data were collected during the period October- April, 2004. A total of 500 women were interviewed and collected data were analyzed using SPSS. The mean age of the correspondents was 31 years and the mean age of first marriage was 18.7 years. Around 50% of the correspondents were with elementary educational level and 33.8% were with secondary level. Income of around 300 US $ was reported by 81.8% of the correspondents. Total carriages were 2501 and the average family size was 5.9. With respect to knowledge on family planning concept 77.4% of the correspondents were able to define it and 77.8% recognized health as a major benefit. The most common recognized modern methods of contraceptives were IUDs (96.4%), OCs (96.4%), condoms (69.8%) and injections (51%). Natural family planning methods were represented by 35.4% and 15.4% for breast feeding and withdrawal, respectively. The mainly recognized disadvantage of family planning was health side effects of contraceptives (53.6%). Low level of fertility awareness was observed for menstrual cycle, natural family planning methods and gamete survival. Results show that women are far away of knowing their basic fertile features, and time of ovulation, 45.5% reported to be fertile for 21 days, 52.4% believed that they can get pregnant any time of intercourse, and only one third recognized the first day of bleeding as the first day of the menstrual cycle. Withdrawal as a safe natural method for FP was recognized by 72.8% of the respondents. IUD’s, condoms, and OC’s were the main modern used contraceptives and represented by 25.2%, 21.4%, and 18.4%, respectively. Breast feeding (19.4%) and rhythm (10%) were the most natural used ones. Attitudes toward family planning seem to be positively high as 95% of the study population agreed strongly and encouraged it. It was also found that 85.6% of the surveyed women believed that their spouses encourage family planning as well. On the other hand 97% of them agree that FP is a joint partner decision and 80% believed that religion encourages family planning, which is contradictory to what is reported in some Muslim communities. In conclusion we believe that the highly observed positive attitude is not reflected on practices concerning FP as not good enough for effective outcomes of such programs.

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