Supervised Machine Learning-Based Models for Predicting Raised Blood Sugar.

Raised blood sugar (hyperglycemia) is considered a strong indicator of prediabetes or diabetes mellitus. Diabetes mellitus is one of the most common non-communicable diseases (NCDs) affecting the adult population. Recently, the prevalence of diabetes has been increasing at a faster rate, especially in developing countries. The primary concern associated with diabetes is the potential for serious health complications to occur if it is not diagnosed early. Therefore, timely detection and screening of diabetes is considered a crucial factor in treating and controlling the disease. Population screening for raised blood sugar aims to identify individuals at risk before symptoms appear, enabling timely intervention and potentially improved health outcomes. However, implementing large-scale screening programs can be expensive, requiring testing, follow-up, and management resources, potentially straining healthcare systems. Given the above facts, this paper presents supervised machine-learning models to detect and predict raised blood sugar. The proposed raised blood sugar models utilize diabetes-related risk factors including age, body mass index (BMI), eating habits, physical activity, prevalence of other diseases, and fasting blood sugar obtained from the dataset of the STEPwise approach to NCD risk factor study collected from adults in the Palestinian community. The diabetes risk factor obtained from the STEPS dataset was used as input for building the prediction model that was trained using various types of supervised learning classification algorithms including random forest, decision tree, Adaboost, XGBoost, bagging decision trees, and multi-layer perceptron (MLP). Based on the experimental results, the raised blood sugar models demonstrated optimal performance when implemented with a random forest classifier, yielding an accuracy of 98.4%. Followed by the bagging decision trees, XGBoost, MLP, AdaBoost, and decision tree with an accuracy of 97.4%, 96.4%, 96.3%, 95.2%, and 94.8%, respectively.

Understanding coverage of antenatal care in Palestine: Cross-sectional analysis of Palestinian Multiple Indicator Cluster Survey, 2019-2020.

INTRODUCTION: Antenatal care is an essential component of primary healthcare, providing opportunities to screen, prevent, and treat morbidity to preserve the health of mothers and offspring. The World Health Organization now recommends a minimum of eight antenatal care contacts, instead of four, which is challenging in countries exposed to political violence and structural disparities in access to social, economic and healthcare resources as exist in Palestine. This study examines the compliance of the recommend standard of antenatal care in Palestine. METHODS: We analyzed data from the UNICEF's Palestinian Multiple Indicator Cluster Survey (MICS) 2019-2020. The eligible sample consisted of 2,028 women, 15-49 years of age, living in Palestine, on whom data were available on reported antenatal care services received during the most recent pregnancy within the last two years. Outcome variables of interest were the reported frequencies of antenatal care visits, gestational timing of 1st visit, and services received. Potential risk factors were assessed in women attending less than eight versus eight or more antenatal contacts, as recommended by WHO, by estimating prevalence ratios with 95% Confidence Intervals. RESULTS: Overall, 28% of women did not meet the WHO's recommendation of eight or more antenatal contacts, varying from 18% in Central West Bank to 33% in South West Bank across the four areas of Palestine (North, Central, and South West Bank and Gaza Strip). Twelve percent of women reported having had no antenatal contacts in the 1st trimester, and these women were two- to three-folds more unlikely to meet WHO recommendation of antenatal contacts than mothers who initiated the antenatal contact in the 1st trimester. Women who had less than eight antenatal contacts were generally poorer, higher in parity, lived in North and South West Bank, sought ANC from either doctor or nurse/midwife only, and initiated antenatal contact in 2nd-to-3rd trimesters. CONCLUSION: There were considerable socioeconomic and geographic inequalities in the prevalence of not meeting WHO recommended number of antenatal contacts in Palestine, offering the opportunity to inform, improve and continuously reassess coverage of antenatal care.

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

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.

Israel's spatial and a-spatial strategy of dispossessing the Jordan Valley's Palestinian Inhabitants.

The Jordan Valley's territorial extent is defined for this study as an elongated stretch of border area, located west of Jordan's boundary with the West Bank, Palestine. This region along with the West Bank was conquered by the Israeli Army during the June 1967 War and has been held by Israel since. Almost 88% of its 200,000 Palestinian population then living in the region were expelled and turned overnight into refugees in Jordan and elsewhere. In the subsequent 56 years since, the region, declared by Israel as a highly militarized zone, has often been discursively publicized as the front line of Israel's eastern defense. This paper seeks to refute such a notion that indirectly gave Israel justification to subject the remaining Palestinian inhabitants residing there (currently numbering ca. 60,000) to a harsh discriminatory regimen of surveillance and control under military occupation. At the same time, the Israeli government has over decades privileged the ca. 10,000 incoming Jewish settlers, now living in some 30 Israeli Jewish settlements in the Jordan Valley. Employing a grounded theory approach in our study provided an opportunity for the local Palestinians to have their voices heard, shedding needed analytical light on their difficult situation on the ground.

Improving newborn health in countries exposed to political violence: An assessment of the availability, accessibility, and distribution of neonatal health services at Palestinian hospitals.

INTRODUCTION: Geopolitical segregation of Palestine has left a fragile healthcare system with an unequal distribution of services. Data from the Gaza Strip reflect an increase in infant mortality that coincided with a significant increase in neonatal mortality (12.0 to 20.3 per 1,000 live births). OBJECTIVE: A baseline study was carried out to evaluate available resources in neonatal units throughout Palestine. STUDY DESIGN: A cross-sectional, hospital-based study was conducted in 2017 using the World Health Organization's "Hospital care for mothers and newborn babies: quality assessment and improvement tool." Data on the main indicators were updated in 2018. RESULTS: There were 38 neonatal units in Palestine: 27 in the West Bank, 3 in East Jerusalem, and 8 in the Gaza Strip. There was an uneven geographic distribution of incubators in relation to population and births that was more marked in the Gaza Strip; 79% of neonatal units and 75% of incubators were in the West Bank. While almost all hospitals with neonatal units accepted very and extremely low birth weight and admitted out-born neonatal cases, there was a shortage in the availability of incubators with humidifiers, high-frequency oscillatory ventilation, mechanical ventilators with humidifiers and isolation wards. There was also a considerable shortage in neonatologists, neonatal nurses, and pediatric subspecialties. CONCLUSION: Almost all the neonatal units accepted extremely low birth weight neonatal cases despite not being ready to receive these newborns due to considerable shortages in human resources, equipment, drugs, and essential blood tests, as well as frequent disruptions in the availability of based amenities. Together, these factors contribute to the burden of providing quality care to newborns, which is further exacerbated by the lack of referral guidelines and challenges to timely referrals resulting from Israeli measures. Ultimately, this contributes to suboptimal care for neonates and negatively impacts future health outcomes.

Micronutrient status of Palestinian school children following salt and flour fortification: a cross-sectional study.

BACKGROUND: In 1996 and in 2006, Palestine initiated salt iodization and multiple micronutrient fortification of wheat flour, respectively as a strategy to prevent deficiencies of these nutrients. In 2009, we assessed the impact of these interventions on the health and nutritional status of schoolchildren residing in the West Bank. METHODS: We surveyed a sample of 22 schools run by the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the Palestinian Government. We randomly selected students from the first (mean age 6.7 years [SD 0.5]), sixth (11.8 years [0.6]), and ninth grades (14.8 years [0.6]). Data were obtained from 1484 (99%) of 1500 students planned for enrollment. RESULTS: Our results suggest that iodine intake appears adequate and there was essentially no iodine deficiency. As to the status of other micronutrients, the main nutritional micronutrient risks for schoolchildren in the West Bank continue to be low serum levels of iron, zinc, and vitamin B-12; folate levels were seemingly high. The overall prevalence of anemia was 9.6%, but there were pockets of anemia in certain districts. Almost 42% of the anemia in our sample was explained by iron deficiency. There were significant differences in iron deficiency between girls and boys, 29.5% vs. 15.7%, respectively (p = 0.0001). There were no cases of lead toxicity in the studied sample. CONCLUSIONS: Wheat flour and salt fortification has had a major influence on improving the micronutrient status of Palestinian children, for some but not all micronutrients. The recommended key blood and biochemical parameters to be incorporated in the surveillance system are iron, zinc, and vitamin B12.

Exposure to violence and its relationship to mental health among young people in Palestine.

BACKGROUND: Exposure to violence is a significant risk factor for the development of psychopathology in young people. Research on the mental health consequences of violence exposure in youth has focused mostly on post-traumatic stress disorder, however, the association with depression and anxiety has also been established. As a result of the longstanding Israeli-Palestinian conflict, young Palestinians are vulnerable to exposure to various types of violence. AIMS: We examined psychiatric symptomatology and its relationship to direct and indirect forms of violence exposure. METHODS: A representative household survey of 2481 Palestinian youth was conducted in 2014. Self-report measures included psychiatric symptomatology (global distress, depression, anxiety) and violence exposure (personal victimization, witnessed, vicariously heard about). RESULTS: The proportion of elevated symptoms of global distress (46%), depression (55%), and (37%) anxiety was high; 47% had been a personal victim, 71% had witnessed violence, and 69% had heard about violence experienced by someone close to them. In logistic regression analysis, controlling for other bivariate correlates, exposure to any violence event, as well as any of the 3 types of violence exposure, were independently associated with each of the 3 measures of elevated psychiatric symptomatology. Females were 4 times more likely to report elevated psychopathology, despite being less likely to experience each type of violence. CONCLUSIONS: These findings suggest the need for services that cater to the mental health needs of youth in settings of high violence exposure, and that gender-specific strategies may be useful.

Accuracy of mortality statistics in Palestine: a retrospective cohort study.

OBJECTIVE: To examine the accuracy of mortality statistics in Palestine, to identify gaps and to provide evidence-based recommendations to improve mortality statistics in Palestine. STUDY DESIGN AND SETTING: A retrospective death registry-based study that examined a stratified random sample of death notification forms (DNFs) of patients who died in hospitals in Palestine was reported in 2012. We randomly selected 600 deceased from the Cause of Death Registry: 400 from the West Bank and 200 from the Gaza Strip. Analysis was based on the randomly selected deaths that we were able to retrieve the medical records for; 371 deaths in the West Bank and 199 deaths in the Gaza Strip. RESULTS: Data in the Palestinian Health Information Centre (PHIC) registry had a low degree of accuracy: less than half of the underlying causes stated the correct cause of death. In general, deaths due to malignant neoplasms were more accurately reported on DNFs than other causes of death, and metabolic diseases (including diabetes) were the most problematic. Issues with coding and classification at the PHIC were most apparent for perinatal conditions and congenital anomalies. CONCLUSION: Procedures for coding and classification at the PHIC deviate considerably from the international norms defined in the International Statistical Classification of Diseases and Related Health Problems (ICD) and account to a considerable extent for the discrepancies between the cause of death determined on the medical data on the death extracted from the deceased patient's hospital records and the cause of death coded by the PHIC. We recommend the introduction of international coding software for coding and classification, and a review to improve data handling in hospitals, especially those with electronic patient records.

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.

Perceived peer norms, health risk behaviors, and clustering of risk behaviors among Palestinian youth.

Relatively little is known about patterns of health risk behaviors among Middle Eastern youth, including how these behaviors are related to perceived peer norms. In a sample of approximately 2,500 15-24 year old Palestinian youth, perceived engagement of general peers in alcohol consumption, drug use and sexual activity was substantially greater than youths' own (self-reported) engagement in these activities, suggesting a tendency to overestimate the prevalence of risk-taking behavior among peers. Individual participation in a risk behavior strongly covaries with the perceived levels of both friends' and peers' engagement in that behavior (p = 0.00 in each case). In addition, significant clustering of risk behaviors is found: youth who participate in one risk behavior are more likely to participate in others. These findings for a rare representative sample of Middle Eastern youth are strikingly similar to those in the US and Europe. The clustering of behaviors suggests that prevention programs should be structured to deal with a range of connected risk behaviors for which certain youth may be at risk. The findings also suggest that adjusting expectations about peers' behavior may reduce young Palestinians' engagement in risk taking.

Health risk behaviours of Palestinian youth: findings from a representative survey.

BACKGROUND: There is little systematic information about health risk behaviours among youth in Middle Eastern countries, leaving public health authorities unprepared to deal with emerging public health threats at a time of major social change. AIM: The Palestinian Youth Health Risk study investigates patterns of risk behaviours among Palestinian youth, their perceptions of the risks and benefits of such behaviours, and the relationship of exposure to violence with mental health and engagement in risk behaviours. METHODS: We conducted a representative survey among 2500 individuals aged 15-24 years in the West Bank and East Jerusalem, permitting reliable comparison across sex and rural-urban divisions. A stratified 2-stage random sample was drawn from the 2007 population census, with strata formed by crossing the 12 governorates with urban, rural and refugee camp locations. Within strata, 208 survey clusters were sampled with probability proportional to size. Within each cluster, 14 households with youth of the appropriate age were sampled. RESULTS: Among youth aged 20-24 years, 22.4% of males and 11.6% of females reported trying alcohol; 10.5% of males and 4.3% of females reported trying drugs. Almost one quarter of unmarried youth aged 20-24 years reported any sexual experience. Tobacco use is high, even among younger youth (45.4% of males and 21.2% of females aged 15-19 smoke). Risk behaviours are higher among males, older youth and in urban areas and refugee camps. CONCLUSION: While smoking is of particular concern, prevention outreach for all behaviours should be directed at subgroups and areas identified as highest risk.

Factors associated with depression in patients with type 2 diabetes in the Gaza Strip: a cross sectional study.

BACKGROUND: About 9% of the world's population has diabetes. Most people with diabetes live in developing countries. Diabetes is the fourth leading cause of death in the occupied Palestinian territory. The likelihood of diabetes complications increases with depression. Worldwide, about half of patients with diabetes have severe depression that has been misidentified by health providers. The aim of this study was to examine factors associated with depression in patients with type 2 diabetes in the Gaza governorate. METHODS: This cross-sectional study included patients attending three primary health centres in 2016. A convenient purposive approach to sampling was used to select three centres from the 15 centres in the Gaza governorate, covering the east (border), middle, and west areas. Since 2014, all patients with type 2 diabetes have been screened for depression using the Patient Health Questionnaire 9. Data on demographic, socioeconomic, and health status and on patients' beliefs were collected during interviews with structured questionnaires, and medical data were collected from patient records. χ2 tests and logistic regression were used to test associations between dependent and independent variables. FINDINGS: 380 patients were included in the study. 255 participants were women with type 2 diabetes and older than 40 years. The median age of participants was 59 years (IQR 13). 285 (75%) participants were married, and 221 (58%) had not completed high school. 103 (27%) participants screened positive for depression. Factors positively associated with depression were age (people younger than 50 years were at greater risk than people aged 50 years and older [odds ratio 2·25, 95% CI 1·2-4·2]), being single (2·04, 1·68-3·55), not believing that they can manage the disease (2·9, 1·6-5·6), and living in border areas (3·6, 2·0-6·2). INTERPRETATION: More attention should be given to young, single patients and to those living in border areas. Treatment options and care for patients with depression should be strengthened with counselling and medications. FUNDING: Palestinian National Institute of Public Health.

Health risk behaviours of Palestinian youth: findings from a representative survey

Background: There is little systematic information about health risk behaviours among youth in Middle Eastern countries, leaving public health authorities unprepared to deal with emerging public health threats at a time of major social change. Aim: The Palestinian Youth Health Risk study investigates patterns of risk behaviours among Palestinian youth, their perceptions of the risks and benefits of such behaviours, and the relationship of exposure to violence with mental health and engagement in risk behaviours. Methods: We conducted a representative survey among 2500 individuals aged 15–24 years in the West Bank and East Jerusalem, permitting reliable comparison across sex and rural–urban divisions. A stratified 2-stage random sample was drawn from the 2007 population census, with strata formed by crossing the 12 governorates with urban, rural and refugee camp locations. Within strata, 208 survey clusters were sampled with probability proportional to size. Within each cluster, 14 households with youth of the appropriate age were sampled. Results: Among youth aged 20–24 years, 22.4% of males and 11.6% of females reported trying alcohol; 10.5% of males and 4.3% of females reported trying drugs. Almost one quarter of unmarried youth aged 20–24 years reported any sexual experience. Tobacco use is high, even among younger youth [45.4% of males and 21.2% of females aged 15–19 smoke]. Risk behaviours are higher among males, older youth and in urban areas and refugee camps. Conclusion: While smoking is of particular concern, prevention outreach for all behaviours should be directed at subgroups and areas identified as highest risk

Contexte : Il existe peu de données systématiques sur les comportements à risque pour la santé chez les jeunes au Moyen-Orient. Les autorités de santé publique ne sont donc pas préparées aux menaces de santé publique émergentes en période de changement social majeur. Objectif : L'Étude des risques sanitaires chez les jeunes palestiniens examine les schémas comportementaux à risque parmi les jeunes palestiniens, leurs perceptions des risques et des bénéfices tirés de tels comportements, la relation entre l'exposition à la violence et la santé mentale, et l'adoption de comportements à risque. Méthodes : Nous avons réalisé une enquête représentative auprès de 2500 individus âgés de 15 à 24 ans en Cisjordanie et à Jérusalem-Est, ce qui nous a permis de procéder à une comparaison fiable en fonction du sexe ainsi qu'entre zones rurale et zones urbaines. Un échantillon aléatoire stratifié à deux niveaux a été prélevé dans le recensement de population de 2007, avec des strates formées en sélectionnant les zones urbaines, rurales, et les camps de réfugiés au sein des 12 gouvernorats. Dans les strates, 208 foyers d'étude ont été échantillonnés, avec une probabilité proportionnelle à la taille. Au sein de chaque foyer, 14 ménages comptant des jeunes ayant l'âge approprié ont été échantillonnés. Résultats : Parmi les jeunes âgés de 20 à 24 ans, 22,4 % des garçons et 11,6 % des filles ont rapporté avoir déjà essayé l'alcool, et 10,5 % des garçons et 4,3 % des filles ont signalé avoir déjà essayé les drogues. Près d'un quart des jeunes célibataires âgés de 20 à 24 ans ont rapporté n'avoir eu aucune expérience sexuelle. Le tabagisme est très élevé, même chez les plus jeunes [45,4 % des garçons et 21,2 % des jeunes filles âgés de 15 à 19 ans fument]. Les comportements à risque sont plus élevés parmi les garçons, chez les jeunes plus âgés, dans les zones urbaines et dans les camps de réfugiés. Conclusion : Si le tabagisme est particulièrement préoccupant, des activités de prévention pour l'ensemble des comportements devraient être menées dans les sous-groupes et les zones identifiés à haut risque

الخلفية: لا تتوفر سوى معلومات منهجية ضئيلة عن كثير من السلوكيات التي تنطوي على مخاطر صحية بين شباب الشرق الأوسط. الهدف: توفير هذه الدراسة تقديرات لمستويات وأنماط السلوكيات الخطرة بين الشباب الفلسطينيين استناداّ إلى مسح ذو طابع تمثيلي واسع النطاق. طرق البحث: استُهدفت عينة من 2500 فرداً في الفئة العمرية 15-24 عاماً في الضفة الغربية والقدس الشرقية لإجراء مسح ذي طابع تمثيلي.النتائج: أفاد 22.4 % من الشبان الذكور في الفئة العمرية20-24 عاما و 11.6% من الشابات بتجربة المشروبات الكحولية - 8.1% و 3.6% - بالنسبة للشبان و الشابات فى الفئة العمرية 15-19 عاماوافاد 10.5% من الشبان فى الفئة العمرية 20-24 عاما 4.3% من الشابات بتجربة المخدرات 3.8% و 1.6% بالنسبة للشبان و الشابات فى الفئة 15-19 عاما كما افاد 9.3% من الشبان غير المتزوجين و 6.7% من الشابات غير المتزوجات فى الفئة العمرية 20-24 عاما بممارسة الجنس و لئن افاد نحو ربع هذه النسبة من كلا الجنسين بعدم وجود خبرة جنسية لديهموتبين ارتفاع مستوى تعاطي التبغ بصورة بالغة، حتى بين الشباب الأصغر سناً ) 45.5 % من الذكور و 21.2 % من الإناث في الفئة العمرية19-15 عاماً هم من المدخنين(، كما تبيّ انتشار العنف المتبادل بين الأفراد )الشجار( بصورة كبيرة. وتبيّ ارتفاع مستوى السلوكيات الخطرة فيما بينالشبان والشباب الأكبر سناً وفي المناطق الحضرية )لا سيَّما القدس( وفي مخيمات اللاجئين مقارنة بالمناطق الريفية. كما تبدو مستويات انخراط الشبابالفلسطينيين من المناطق الأخرى في تعاطي الكحوليات والمخدرات وممارسة الأنشطة الجنسية، بما في ذلك الجماع، أقل من غيرهم في جميع النتائج،ولكن ينقلب الوضع فيما يتعلق بالتدخين والعنف المتبادل بين الأفراد.الاستنتاجات: يمثل التدخين شاغلاً مهماً، إلا أنه ينبغي توجيه أنشطة التوعية على الوقاية من جميع السلوكيات الخطرة إلى المجموعات الفرعيةوالمناطق التي يتم تحديدها باعتبارها عالية المخاطر

Political violence and mental health of Bedouin children in the West Bank, Palestine: a cross-sectional study.

The Bedouin population is among the most vulnerable in Palestine, subject to forced relocation and lacking basic necessities, including water and electricity. To our knowledge, there are no studies on the mental health of Palestinian Bedouin children. A cross-sectional household survey was conducted examining exposures to traumatic events and mental health among 455 refugee children between the ages of 5-16 years old, and randomly selected from 18 Bedouin communities throughout the West Bank, including East Jerusalem. Mental health status was measured using the Strength and Difficulties Questionnaire. Based on reports by mothers, teachers and children, 44% of the participants in the study had a probable psychiatric disorder. Exposure to traumatic events, fair/poor maternal self-rated mental health, and younger age were positively associated with child mental health problems. The findings highlight the importance of maternal mental health as a contributing factor affecting children's vulnerability. Bedouin mothers and their children need immediate psychosocial intervention, as well as the protection of their basic human rights.

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

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.

Double Burden of Undernutrition and Obesity in Palestinian Schoolchildren: A Cross-Sectional Study.

BACKGROUND: The coexistence of underweight and overweight (double burden) remains a major problem in many developing countries. Little is known about the factors associated with the double burden of malnutrition in Palestinian children. OBJECTIVE: To assess factors associated with undernutrition and overnutrition in 1500 schoolchildren aged 5 to 16 years, in the West Bank. METHODS: We surveyed a sample of 22 schools run by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the Palestinian government. Binary logistic regression was used to examine the factors associated with malnutrition. The hunger index, a composite score from 8 questions, was used to measure food insecurity. RESULTS: In the 1484 children enrolled in UNRWA and government schools in the West Bank, the prevalence of stunting was 7% and underweight 3%. Around 12% of students were overweight and 6% obese. The hunger index was negatively associated with height for age. Factors associated with being underweight were male sex, mother being unemployed, and households not having enough food to eat for at least 2 days in the previous month. Factors associated with obesity were older age and time spent watching television. When overweight and obesity were combined in the analysis, they were inversely associated with increasing number of days spent playing sports. CONCLUSION: Our results show that the important nutritional risks for school-age children in the West Bank would seem to be the simultaneous occurrence of undernutrition and obesity. The study highlights the need to balance obesity management and prevention with interventions to tackle undernutrition.

Perceptions of sexual risk behavior among Palestinian youth in the West Bank: a qualitative investigation.

BACKGROUND: Young people in the Middle East and North Africa (MENA) are profoundly affected by violence, high unemployment, and economic hardship. Experiences of community-level violence and personal trauma increase the likelihood that young people will engage in risky behaviors that include smoking, drug use, and unsafe sex. Little is known about the sexual behavior of young people in the region, particularly in the occupied Palestinian territory (oPt). Our aim in this study was to gain an insight into the perceived prevalence and patterns of sexual behavior among Palestinian youth. METHODS: The study was based on ten focus groups and 17 in-depth interviews with young people aged 16-24 years as part of the formative phase of a cross-sectional representative study of risk behaviors in the West Bank, including Jerusalem, in 2012. The sample was selected using a combination of purposive and convenience sampling. Qualitative analysis was used to code detailed notes of focus groups and interviews. RESULTS: Based on participants' reports, different types of sexual activity outside marriage were not uncommon, even in conservative communities. The most reported sexual activity was non-penetrative sex: oral and anal intercourse, and virtual sex. Some young people had sexual intercourse with sex workers; they went to brothels in Israel and to brothels operating clandestinely in the West Bank, including East Jerusalem. Most respondents were of the opinion that young people did not usually use protection during sexual intercourse. Many reported that youth engage in different types of sexual activity outside marriage for several reasons: to challenge the culture, financial constraints and inability to marry, basic human need, personal pleasure, suppression, to kill boredom, and to prove manhood. CONCLUSIONS: In contrast with the conservative social context of the occupied Palestinian territory (oPt), the findings suggest that sexual activities outside marriage may be more common than is currently assumed. Sexual behavior in the oPt is a concern because of the low awareness of the potential health consequences. The results draw attention to the need to incorporate sexual reproductive health into the national agenda and ensure that it is included in the programs of national institutions.

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

BACKGROUND: The authors examined factors associated with nutritional resilience/vulnerability among preschoolers in the Gaza Strip in 2007, where political violence and deprivation are widespread. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

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

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.

Impact of housing conditions on the health of the people at al-Ama'ri refugee camp in the West Bank of Palestine.

Al-Ama'ri camp is situated to the south of Ramallah city in the West Bank of Palestine. It is densely populated, with a total population of 4046, divided into 760 households, on a surface area of 93 dunums (93000 m(2)). In this research, the relationship between the housing conditions at Ama'ri camp and the prevalence and incidence rates of upper respiratory tract diseases has been studied. The diseases and symptoms most encountered in winter, and those include: common cold, cough, pharyngitis, influenza, ear infection, asthma and bronchitis have been studied. It was found that these are diseases directly related to poor housing conditions. Cold housing, presence of dampness and moulds, dust and smoke, burning of biomass fuel, crowding, poor ventilation and inadequate lighting problems are commonly found in the houses of this refugee camp.