Nutritional status of Palestinian preschoolers in the Gaza Strip: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>The authors examined factors associated with nutritional resilience/vulnerability among preschoolers in the Gaza Strip in 2007, where political violence and deprivation are widespread.</p> <p>Methods</p> <p>This cross-sectional study was carried out in 2007 using random sampling of kindergartens in order to select 350 preschoolers. Binary logistic regression was used to compare resilient (adequate nutrition) and vulnerable (stunted) groups with those with moderate nutrition.</p> <p>Results</p> <p>Approximately 37% of the subjects demonstrated nutritional resilience and 15% were vulnerable. Factors associated with nutritional resilience were child younger age, normal birth weight, actively hand- or spoon-feeding when the child was below two years, and residential stability in the past two years. The only factor associated with nutritional vulnerability was lower total score on the mother's General Health Questionnaire, which we interpret as a marker of maternal mental health.</p> <p>Conclusions</p> <p>Children with low-birth weight and older children had worse nutritional resiliency outcomes. Further, poorer outcomes for children were associated with lower maternal mental health status, as well as increased family residential instability. Our results add to the large literature on the pervasive effects of violence and instability on children and underscore the need for resources for early intervention and for the urgent resolution of the Palestinian and other armed conflicts.</p

Health-related quality of life of Palestinian preschoolers in the Gaza Strip: a cross-sectional study

Abstract Background Research on children's responses to wartime trauma has mostly addressed Post-Traumatic Stress Disorder (PTSD). However, PTSD is only one aspect of a complex set of responses. This study proposes to expand knowledge of well-being in children exposed to political violence through widening the conceptualization of well-being beyond PTSD, morbidity, and mortality by measuring health-related quality of life (HRQOL) and its facets, physical health, and psychosocial health. Methods In 2007, we used a cross-sectional random sample of kindergartens to examine factors associated with HRQOL, as measured by the PedsQL 4.0, in 350 preschoolers in the Gaza Strip, Palestine, where political violence and deprivation are widespread. Results About 65% of the mothers reported severely impaired psychosocial and emotional functioning in their children. Preschoolers had lower HRQOL than the US reference sample and samples of children in other low income countries with large effect size. HRQOL was comparable to those of US children with several chronic diseases. Factors associated with lower HRQOL were older child age, male gender, and more exposures to traumatic events. Factors associated with HRQOL subscales were for lower psychosocial health: older child age, history of food, water, and electricity deprivation during incursion, and witnessing assassination of people by rockets. For lower physical health: older child age, history of food, water, and electricity deprivation during incursion, and having heard of a killing of a friend by soldiers. Conclusions HRQOL, including psychosocial health and emotional functioning is often severely impaired among preschoolers in the Gaza Strip. Exposure to both violent and non-violent negative events was associated with HRQOL in preschoolers.</p

Substance use among Palestinian youth in the West Bank, Palestine: a qualitative investigation

Abstract Background Youth health risk behaviors, including substance use (psychoactive substances including alcohol and illicit drugs), have been the subject of relatively limited study to date in Middle Eastern countries. This study provides insights into the perceived prevalence and patterns of alcohol and drug use among Palestinian youth. Methods The study was based on ten focus groups and 17 individual interviews with youth aged 16–24 years (n = 83), collected as part of the formative phase of a cross-sectional, population representative study of risk taking behaviors among Palestinian youth in the West Bank in 2012. Qualitative analysis was used to code detailed notes of focus groups and interviews. Results Most participants reported that substance use exists, even in socially conservative communities. Almost all participants agreed that alcohol consumption is common and that alcohol is easily available. The top alcoholic drinks referred to by the study participants were vodka, whisky, beer, and wine. Most participants claimed that they drink alcohol to cope with stress, for fun, out of curiosity, to challenge society, and due to the influence of the media. Participants were familiar with illicit drugs and knew of youth who engaged in drug use: marijuana, cocaine, and heroin were mentioned most frequently. Study participants believed that youth use drugs as a result of stress, the Israeli occupation, inadequate parental control, lack of awareness, unhappiness, curiosity, and for entertainment. Many participants were unaware of any local institutions to support youth with substance use problems. Others expressed their distrust of any such institution as they assumed them to be inefficient, profit-driven, and posing the risk of potential breaches of confidentiality. Conclusions Although this study uses a purposive sample, the results suggest that substance use exists among Palestinian youth. Risk behaviors are a concern given inadequate youth-friendly counseling services and the strong cultural constraints on open discussion or education about the impact of high risk behaviors. These barriers to treatment and counseling can exacerbate the health and social consequences of alcohol abuse and illicit drug use

Metabolic Syndrome among Refugee Women from the West Bank, Palestine : A Cross-Sectional Study

This study was carried out among Palestinian refugee women in the West Bank to provide data on the prevalence of metabolic syndrome (MetS) and its correlates. Data were obtained from a cross-sectional study of 1694 randomly selected refugee women from the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) health centers throughout the West Bank during June and July 2010. In this cohort, 30% of the refugee women were overweight, 39% were obese, and 7% were extremely obese. Based on World Health Organization (WHO) criteria, the age-adjusted prevalence of MetS was 19.8%. The results of the binary logistic regression analysis indicated that older age and younger marital age were significantly associated with an increased likelihood of MetS in the women. The high prevalence of obesity and MetS mandates the implementation of national policies for its prevention, notably by initiating large-scale community intervention programs for 5.2 million refugees in Palestine, Jordan, Lebanon, and Syria, to tackle obesity and increase the age at marriage

Alarmingly high prevalence of high-risk drug use among palestinian males: a cross-sectional study

Abstract Background The unique socioeconomic context in Palestine, characterized by political and economic tensions, creates conditions that facilitate the spread of illicit drug use among Palestinians. This paper presents findings from a 2017 survey of high-risk drug use (HRDU) among males in four regions in Palestine: the West Bank (north, middle, and south) and the Gaza Strip. These findings are essential for developing effective policies to respond to the increasing use of drugs among Palestinians. Methods Eligible participants were males aged 15 years and above who used at least one drug other than non-synthetic hashish or marijuana during the previous week. Participants underwent a face-to-face interview and had their drug use verified by urinalysis. Data were collected using respondent-driven sampling and data were analyzed using the successive sampling estimator. Multivariate regression analysis was conducted to examine factors associated with ever seeking rehabilitation services for illicit drug use in the West Bank and the Gaza Strip. Results A total of 400 males who use drugs were sampled in Gaza, plus 299 in the south, 300 in the north, and 299 in the middle region of the West Bank. It is estimated that there are 26,500 male HRDUs in Palestine comprising 1.8% of the male population aged 15 and above. Findings indicate that polydrug use is a serious issue in Palestine, especially in the West Bank, and that synthetic marijuana is prevalent among teenagers and young adults. Conclusions Palestine must strengthen its national efforts to scale up harm reduction and treatment and care options for people suffering from drug use disorders, especially those involved in polydrug use. Additional measures are needed to prevent substance use among children and youth, support the families of people who use drugs, and ensure the continuity of HRDU services during emergencies

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit