COVID-19 in the Gaza Strip and the West Bank under the political conflict in Palestine

COVID-19 is a serious pandemic with variation of spread, morbidity, and fatalities between countries. Palestinians are facing the epidemic, with around 2 million inhabitants under siege in the highly populated Gaza Strip for the last 14 years. The siege may be the main threat for the spread of disease among the Palestinian population. The Palestinians faced the Corona epidemic with limited facilities in their hand. However, the risk factors remain multiple, the most important are overcrowding in the Gaza Strip, poor health care facilities, and the risk of workers moving between the West Bank and Israel. Palestinian Health authorities responded directly to the pandemic and took strict closure measures to prevent rapid spread. The Palestinian strategy has focused on social spacing, personal hygiene, control of border crossings and health preparedness to deal with medical cases while continuing to provide health services to the population. The difficult economic situation is the major obstacle facing Palestinians to overcome the disease spread where workers continue their jobs inside Israel and Gaza cannot enforce low-income workers to stay at home. More is needed to ensure community engagement, support coordination among all health care providers in Palestine, and take effective steps to promote social spacing. Friendly countries and international organizations can assist and support the Palestinian population in providing laboratory diagnostic materials, providing personal protective devices, strengthening intensive care units, and supporting outreach activities and training programmes. &nbsp

COVID-19 in the Gaza Strip and the West Bank under the political conflict in Palestine

COVID-19 is a serious pandemic with variation of spread, morbidity, and fatalities between countries. Palestinians are facing the epidemic, with around 2 million inhabitants under siege in the highly populated Gaza Strip for the last 14 years. The siege may be the main threat for the spread of disease among the Palestinian population. The Palestinians faced the Corona epidemic with limited facilities in their hand. However, the risk factors remain multiple, the most important are overcrowding in the Gaza Strip, poor health care facilities, and the risk of workers moving between the West Bank and Israel. Palestinian Health authorities responded directly to the pandemic and took strict closure measures to prevent rapid spread. The Palestinian strategy has focused on social spacing, personal hygiene, control of border crossings and health preparedness to deal with medical cases while continuing to provide health services to the population. The difficult economic situation is the major obstacle facing Palestinians to overcome the disease spread where workers continue their jobs inside Israel and Gaza cannot enforce low-income workers to stay at home. More is needed to ensure community engagement, support coordination among all health care providers in Palestine, and take effective steps to promote social spacing. Friendly countries and international organizations can assist and support the Palestinian population in providing laboratory diagnostic materials, providing personal protective devices, strengthening intensive care units, and supporting outreach activities and training programmes.   Conflicts of interest: None declared

Assessment of Sanitary Conditions in the Main Swimming Pools in Gaza Strip (2010 -2013): Palestine

Abstract. Approximately 1.7 million inhabitants of 378 km 2 areaofGazaStripdon'thaveenoughrecreationalareas,except Gaza beach which suffers from sewage pollution as well as some public and private swimming pools which considered as merely recreational places. The main objective of this study is to assess the microbiological quality of swimming pools water in Gaza Strip to assure its health safety for swimmers. Sampling and analysis were conducted by the Ministry of Health over a period of about four years (2010)(2011)(2012)(2013). Samples were collected from seven central swimming pools in Gaza Strip periodically and examined for Total Coliforms and Faecal Coliforms. In addition, Staphylococcus aureus, Faecal Streptococcus and Pseudomonas aeruginosa were isolated from the swimming pools samples with different percentages. Percentages of microbial contamination, concentration of free chlorine and pH level were examined in the studied swimming pools and compared with the international standards and the annual trends were demonstrated. The results show that, about 75% of the recorded data regarding pH level are unacceptable, while 100% of the recorded data about the concentration of free chlorine within the swimming pools are unacceptable. About 57% of the collected samples were contaminated by Total Coliforms, 39% were contaminated by Faecal Coliforms, 46% were contaminated by Staphylococcus aureus, 21% were contaminated by Pseudomonas aeruginosa and 18% were contaminated by Faecal streptococci. The annual trends show increase in percentage of contamination to be the worst during the year 2013. Therefore, proper intensive surveillance and water chlorination is needed periodically

EVALUATION OF THE RELATIONSHIP BETWEEN INTESTINAL PARASITIC INFECTION AND HEALTH EDUCATION AMONG SCHOOL CHILDREN IN GAZA CITY, BEIT-LAHIA VILLAGE AND JABALIA REFUGEE CAMP, GAZA STRIP, PALESTINE

This study aimed to test the impact of health education programmer's intervention on the prevalence of intestinal parasites among school children in Gaza city, Beit labia villages and Jabalia refugee camp "Gaza Strip" over 6 month. In this study 432 stool samples were collected from school children aged 6- 11 years old, each stool sample was examined using wet mount and formalether sedimentation technique. Of these 432 stool sample 125 were found to be positive with a prevalence of (28.9%). The infected children were treated with suitable anti- parasitic drug under the supervision of school of health in the ministry of health. Then the treated children were divided into two groups the first group remained on the treatment only but the second group received treatment and health education. After 6-month a second stool sample was collected from each child in the two groups then analyzed. The final result indicated that prevalence of intestinal parasites had declined from 21.5% to 5.1%. Ration was 3.4% in first group which received treatment only and 1.62% in second group which received treatment and health education. The rule of health education in decreasing prevalence of intestinal parasitic infection was statistically significancant (P= 0.001). The relationship between intestinal parasites and sex, residence, age, school, job, of father and other relations were investigated and studied

Understanding the concept and importance of the health research system in Palestine : a qualitative study

The importance of a health research system (HRS), namely an instrument for developing and enabling health systems, is increasing, particularly in developing countries. Assessing the perceptions of system performers is a necessary part of system analysis, which seeks to recognize a system's strengths and limitations aiming towards improvement. This study assesses the perceptions of policy-makers, academicians and experts regarding the HRS concept and its importance to generate insights for system strengthening. In Palestine, HRS is just emerging, helping to address the many public health-related challenges faced by the country.; The study was implemented from January until July 2016, targeting three sectors, namely relevant government institutions, schools of public health, and major local and international health agencies. Data was collected through 52 in-depth interviews and six focus group discussions (FGDs) with policy-makers, academics, directors and experts. Participants and institutions were selected based on stated criteria and peer review. Data were translated, transcribed, checked and then imported to a software program (MAXQDA 12) for thematic and content analysis.; A total of 104 experts participated, wherein 52 were interviewed and 52 participated in the six FGDs. The HRS concept, as defined by WHO, was conceptualized differently among participants with unclear delineations between various components. Inconsistencies appeared when participants attempted to conceptualize HRS in broader contexts, though HRS goals and functions were sufficiently delineated. The majority of participants agreed that HRS correlates with notions of 'improvement' and recognized HRS 'as a significant gain'. Neglect of HRS was perceived as a big loss.; The study revealed that the level of understanding of HRS among health experts in Palestine is inadequate and not sufficiently conceptualized for its application. Findings also underlined the need to establish a central governance coordination body that promotes HRS understanding, awareness and culture as an enabler for HRS strengthening

Assessment of differences on inflammatory and metabolic indicators between pre- and post-menopause women among hypertensive and/or diabetic patients

To assess the differences on inflammatory and metabolic indicators between pre-menopause and post-menopause women among hypertensive and/or diabetic type-2 women. A total of 236 obese women included in the study have chosen from Primary Health Care Centers in Gaza City, Palestine, through a cross-sectional study. Selection depended on health status hypertensive and/or diabetic type-2 (HT, T2DM, HT+T2DM). In HT group, post-menopause women had significant higher values than pre-menopause women on TC (200±47 vs. 172.5±55 mg dL–1, p<0.01) and TG (166±89 vs. 120.5±82 mg dL–1, p<0.01). In T2DM group, post-menopause women had significant higher values than pre-menopause women on SBP (132±24 vs. 120±20 mm Hg, p<0.01), TC (213±40 vs. 185±46 mg dL–1, p<0.05) and TG (196±118 vs. 136±64 mg dL–1, p<0.05). Finally, in HT+T2DM group, post-menopause women had significant higher value than pre-menopause women on SBP (144±21 vs. 133±14 mmHg, p<0.05), TC (214±54 vs. 181±55 mg dL–1, p<0.05), TG (231±83 vs. 158±85 mg dL–1, p<0.05), IL-6 (2.32±1.34 vs. 1.71±1.45 pg mL–1, p<0.05) and BMI (36.48±7.1 vs. 32.18±5.6 kg m‾ 2, p<0.05). Post-menopause women diseased of HT and T2DM accompanied with higher rates of BMI are at risk for developing inflammatory and metabolic morbidities

Atherosclerotic cardiovascular disease: a review of initiators and protective factors

Atherosclerotic cardiovascular disease (CVD) is a collective term comprising of a group of disorders of the heart and blood vessels. These diseases are the largest cause of morbidity and premature death worldwide. Coronary heart disease and cerebrovascular disease (stroke) are the most frequently occurring diseases. The two major initiators involved in the development of atherosclerotic CVD are vascular production of reactive oxygen species (ROS) and lipid oxidation. In atherosclerosis development, ROS is associated with rapid loss of anti-inflammatory and anti-atherogenic activities of the endothelium-derived nitric oxide (NO·) resulting in endothelial dysfunction. In part involving activation of the transcription factor NF-κB, ROS have been involved in signaling cascades leading to vascular pro-inflammatory and pro-thrombotic gene expression. ROS is also a potent activator of matrix metalloproteinases (MMPs), which indicate plaque destabilization and rupture. The second initiator involved in atherosclerotic CVD is the oxidation of low-density lipoproteins (LDL). Oxidation of LDL in vessel wall leads to an inflammatory cascade that activates atherogenic pathway leading to foam cell formation. The accumulation of foam cells leads to fatty streak formation, which is the earliest visible atherosclerotic lesion. In contrast, the cardiac sarco/endoplasmic reticulum Ca2+-ATPase (SERCA2a) and hepatic apolipoprotein E (apoE) expression can improve cardiovascular function. SERCA2a regulates the cardiac contractile function by lowering cytoplasmic calcium levels during relaxation, and affecting NO· action in vascular cells, while apoE is a critical ligand in the plasma clearance of triglyceride- and cholesterol-rich lipoproteins

A vision to strengthen resources and capacity of the Palestinian health research system: a qualitative assessment

The World Health Organization has proposed a global strategy to build a robust Health Research System Resources and Infrastructural Capacity (HRSRIC). Despite the growing research productivity, HRSRIC in Palestine has rarely been investigated.; To analyse perceptions of health research system performers to understand the status of HRSRIC, identify its gaps, and propose policy solutions to strengthen HRSRIC.; This qualitative study targeted 3 health sectors: government, academia, and local and international organizations. Fifty-two in-depth interviews and 6 focus group discussions were conducted with key informants who were selected purposively. Data were analysed using MAXQDA 12.; Despite the availability of competent personnel, the overall HRSRIC, such as human and financial resources, and facilities, forms a central challenge. HR financing is limited, unsustainable, and flows from external and individual sources. The public and private funds are largely in shortage with resources misallocation and donors' conditionality. HR quality is moderate while knowledge transfer and translation are not well conceptualized and inappropriately performed. Lack of governance, coordination, HRSRIC strategy, resource allocation, systematic and reliable data, evidence-informed culture, and environmental impacts are the main common gaps.; The overall status of HRSRIC in Palestine is still lacking and major challenges persist where the pace of strengthening efforts is steady. There is an emphasis that strengthening HRSRIC is an imperative step and real investment opportunity for building a successful health research system. Political commitment, consolidated leadership structure, operational capacity building strengthening strategy, resources mobilization, and sovereignty are key requirements

Mapping stakeholders of the Palestinian Health Research System: a qualitative study

There is a growing international and regional interest in Health Research Systems (HRSs) in light of a global strategy for HRS stakeholders' (HRSSHs) active involvement. HRSSHs in Palestine have rarely been investigated with regard to uncertainties.; This study aimed to analyse perceptions of HRSSHs in order to understand their roles and involvement, identify gaps, and offer policy solutions for stakeholders' engagement in the Palestinian HRS.; This qualitative study targeted three local Palestinian health sectors, government, academia, and local and international agencies. Data were collected through 52 in-depth interviews (IDIs) and 6 focus group discussions (FGDs) and then analysed using MAXQDA 12 software. Participants and institutions were selected purposively based on a set of criteria and peer review.; The overall HRS stakeholders' roles were unsatisfactory, with low involvement from society, the private sector, local and international sectors. The role of academia and the Ministry of Health is vital but observed moderate in health research while that of international agencies is weak due to conflicting agendas and lack of a guiding body. Most universities have poor representation in public decision-making and scarcity in health research potential and capacity. Interest-power imbalance among stakeholders is reported where political, organizational, and technical shortfalls were indicative of weak roles and low involvement, along with a lack of health research culture, structure, resources, defined roles, and network.; Tackling the inadequate roles, interests' disparity, and poor involvement of HRSSHs is imperative for HRS strengthening. Redefining HRSSHs' roles and involving all stakeholders is key through strategic dialogue, consolidated leadership, and resource mobilization