Postpartum depression symptoms: prevalence, risk factors, and childbirth experiences in Palestine.

BACKGROUND: Worldwide mothers are suffering from postpartum depression (PPD) which impairs mothers' well-being, children, and families, and leads to adverse outcomes for mothers and their growing newborns. Low and middle-income countries have a higher prevalence of PPD and limited studies about it. This study assessed the percentage of Palestinian mothers experiencing PPD nationally, identified mothers at a higher risk of PPD, and studied the correlation between PPD and mistreatment during childbirth. METHODS: The study is based on a secondary data analysis from a cross-sectional study in the occupied Palestinian territory (oPt). A total of 745 telephone-based interviews with mothers were done within 2-4 weeks post-childbirth. The Patient Health Questionnaire (PHQ-9) was used as a screening tool for PPD. The Statistical Package for Social Science (SPSS) was used for analyzing the data. RESULTS: In the context of descriptive epidemiology, we observed that 12.6% of the selected Palestinian mothers experienced PPD, with a higher occurrence of PPD among mothers living in the Gaza Strip, a politically and economically unstable region in Palestine, compared to mothers living in the West Bank (Adjusted Odd Ratio (AOD: 2.2, Confidence Interval (CI): 1.4-3.44). Older mothers were two times more likely to develop PPD compared to young mothers (AOR: 2.03, CI: 1.070-3.84). Mothers who experienced disrespectful behaviors represented by any abuse, negligence, abandonment, ineffective communication, or poor pain management in childbirth settings were more likely to report PPD than those who were not exposed to the disrespect. CONCLUSION: A notable percentage of Palestinian mothers were identified as experiencing PPD, especially among mothers who experienced mistreatment in childbirth settings. It is essential to support healthcare providers to improve their practices and attitudes to eliminate mistreatment and abusive behaviors of mothers during childbirth.

The association between labor companionship and obstetric violence during childbirth in health facilities in five facilities in the occupied Palestinian territory.

BACKGROUND: Studies show that the presence of companionship during childbirth leads to positive outcomes for women. This study investigates the protective effect of having a labor companion on obstetric violence in the health facilities of the Occupied Palestinian Territory. METHODS: A secondary analysis of a cross-sectional study of women who gave birth in five health centers in the occupied Palestinian territory up to 8 weeks following childbirth was performed. The presence of a labor companion was examined in relation to socioeconomic variables and physical abuse, verbal abuse or stigma or discrimination, failure to achieve professional standards, vaginal examinations, and pain relief. RESULTS: According to the findings, the total number of women with a labor partner or a birth companion present at any stage during the labor process was 92% in the West Bank, and 77.4% in the Gaza Strip. According to the timing of support, 23.5% of women had a labor companion present during labor, childbirth, and after childbirth whilst in the hospital. Women who did not have labor companions were more likely than women who did to report at least one sort of mistreatment, such as unconsented procedures. Women with a labor companion were less likely to report abuse (16%) compared to women without labor companion. In terms of informed permission for procedures, 75% of women who did not have a labor companion had unconsented episiotomy. CONCLUSION: Labor companionship assists women by providing them with companions who are less likely to be mistreated during labor. Efforts should be made to best implement the presence of labor companions, including the duration of the labor companionship and women's preferences.

The Impact of COVID-19 on Infection Control Measures in Dental Settings: A Cross-Sectional Study.

The COVID-19 pandemic has had a significant impact on every aspect of life, especially for healthcare professionals. Dentists are the most at risk of infection due to close contact with patients. This study aimed to assess the level of awareness, perception, and attitude of Palestinian dentists towards COVID-19 and infection control. A cross-sectional online survey was conducted from 17-30 July 2020, and 349 dentists from the West Bank participated. The survey assessed demographic variables, participation in infection control training, prevention methods used in dental clinics, patient preparation for dental work, cross-infection control and sterilization before and after the pandemic, and sources for guideline protocols for dental workers. The results of the study showed that 54 (14.4%) dentists had received training in infection control in dentistry and 121 (34.3%) had attended training specifically regarding COVID-19. During a partial lockdown, 60% of dentists treated only urgent cases. Overall, the dentists in the West Bank demonstrated good knowledge and a positive attitude towards COVID-19 and infection control measures in dental clinics, as there were significant differences between replacing a medical apron or mask and wearing a face shield, cover shoes, head cap, and goggles before and after COVID (p < 0.05). Moreover, there were significant differences between wrapping the chair and using purification devices to disinfect the clinic before and after COVID (p < 0.05). However, dentists' knowledge could be improved by increasing their accessibility to materials and provided training. Dental associations should provide guidelines regularly to dentists during a crisis to inform them of best practices and disease management. In conclusion, dentists need to update their knowledge, continuing education and training to guarantee the proper handling of COVID-19. The study's findings show the importance of updating infection control protocols and training programs that address the specific needs and challenges faced by dentists in the West Bank.

Sexual and reproductive health interventions geared toward adolescent males: A scoping review.

PROBLEM: Male adolescent sexual and reproductive health (SRH) interventions are rare worldwide. The high prevalence of sexually transmitted infections and pregnancies among female and male adolescents worldwide highlights the need for comprehensive interventions that include both genders in the educational process. OBJECTIVE: Our main focus is studying and analysing male-focused SRH interventions globally to include males in evidence-based interventions that improve SRH of adolescent males. ELIGIBILITY CRITERIA: This Review was conducted using the PRISMA extension for scoping reviews. The following databases were searched: PubMed, Embase, Web of science, Scopus, CINAHL and PsycInfo. INCLUSION CRITERIA: 1) No time or date limits; 2)all types of studies; 3)SRH campaign; 4)males; 5)10 to 19 years. SAMPLE: Five thousand and sixty-eight articles were identified and 166 peer-reviewed articles met the inclusion criteria. RESULTS: Family planning was identified as the primary domain covered for adolescents. While interactive activities was the most common method used to deliver information to adolescents about sexual health. SRH interventions for males were most prevalent in America. While in the Eastern Mediterranean region (EMR), no male interventions were found in our review. CONCLUSION: This scoping review emphasizes the need to include adolescent males in sexual and reproductive health interventions, particularly in low- and middle-income countries (LMICs) and the EMR. Policymakers should develop comprehensive programs that address male-specific needs, improve training for intervention providers, and enhance reporting processes to identify gaps and barriers to male inclusion. IMPLICATION: Future research should be directed toward the obstacles that prevent SRH interventions targeting males from being carried out.

Variation of caesarean section rates in Palestinian governmental hospitals.

BACKGROUND: Globally, the increased use of cesarean sections has become prevalent in high-income and low and middle-income countries. In Palestine, the rate had risen from 20.3% in 2014 to 25.1% in 2018. We have rates as high as 35.8% in some governmental hospitals and some as low as 15%. This study aimed to understand better why there is a variation in cesarean rates in governmental hospitals that use the same guidelines. METHODS: A qualitative and quantitative research approach was used. In-depth interviews were conducted with 27 specialists, obstetrics and gynecologists, and midwives in five government hospitals. The hospitals were selected based on the 2017 Annual Health Report reported cesarean section rates. The interview guide was created with the support of specialists and researchers and was piloted. Questions focused mainly on adherence to the obstetric guidelines and barriers to the use, sources of information, training for healthcare providers, the hospital system, and the factors that affect decision-making. Each hospital's delivery records for one month were analyzed to determine the reason for each cesarean section. RESULTS: The results indicated that each governmental hospital at the system level had a different policy on cesarean sections. The National Guidelines were found to be interpreted differently among hospitals. One obstetrician-gynecologist decided on a cesarean section at high-rate hospitals, while low-rate hospitals used collective decision-making with empowered midwives. At the professional level, all hospitals urged the importance of a continuous training program to refresh the medical team knowledge, in-house training of new members joining the hospital, and discussion of cases subjective to obstetrician-gynecologists interpretations. CONCLUSION: Several institutional factors were identified to strengthen the implementation of the national obstetric guidelines. For example, encouraging collective decision-making between obstetrician-gynecologists and midwives, promoting the use of a second opinion, and mandatory training.

Exploring women's experiences during childbirth in health facilities during COVID-19 pandemic in occupied palestinian territory: a cross-sectional community survey.

INTRODUCTION: This study aims to assess the prevalence of mistreatment during childbirth in the occupied Palestinian territory and to explore factors associated with mistreatment. METHODS: A cross-sectional study of women who gave birth in the West Bank and Gaza Strip health facilities. The survey was administered over the phone to women up to 8 weeks post-partum. Data collection took place between July 2020 and March 2021. RESULTS: A total of 745 women participated in the study, 36·25% were from the Gaza Strip and 63·75% from the West Bank. The prevalence of mistreatment was 18·8% in which women reported any verbal abuse, physical abuse, or stigma or discrimination during childbirth, with verbal abuse as the most common form of mistreatment reported. Physical abuse was more likely to be reported by women with no labour companion with them (OR: 3·11, 95%CI: 1·24 - 7·99). Verbal abuse was more likely to be reported by women with less than three live births (OR: 1·71, 95%CI: 1·06 - 2·76, women with no birth companion (OR: 2·72, 95%CI: 1·36 - 3·80) and more likely to be reported if curtains wre not used (OR: 2·55, 95%CI: 1·33 - 4·88). Women with less education were more likely to report long waiting times or delays in receiving services compared to women with higher education (OR: 1·40, 95%CI: 1·06 - 2·10). CONCLUSION: For the first time using the World Health Organisation (WHO) tool in the Eastern Mediterranean region, the study findings, show the occurrence of mistreatment and identify areas to be strengthened to ensure that all women have a respectful childbirth experience within health facilities.

Double Burden of COVID-19 Pandemic and Military Occupation: Mental Health Among a Palestinian University Community in the West Bank.

Background: The Covid-19 pandemic created major global health crises, with serious effects on all aspects of life. The pandemic reached the Israeli occupied West Bank of Palestine in early March 2020, and lockdown immediately ensued. Objectives: To assess the prevalence and predictors of distress and insecurity among Birzeit University's community during the COVID-19 pandemic and lockdown. Methods: An online survey completed in March-April 2020 using standardized and previously validated distress and insecurity scales. The survey was placed on the University portal accessed by students, faculty and employees, and was sent by email to faculty and employees. Data were weighted to reflect the University community's distribution. Findings: There were 1,851 participants in the study: 84% were undergraduate students, 10% graduate students, and 6% faculty and employees. Sixty two percent were women. Ages ranged from 17 to 70 years (mean 24 ± 9.7). Prevalence of moderate/high distress and insecurity were 40% and 48% respectively. Multiple logistic regression revealed that women, those under 35 years old and those with worse reported income, had significantly higher odds of distress and insecurity compared to their counterparts. Undergraduate students or living with a person at home with high risk of illness with COVID-19 were associated with higher odds of distress compared to their counterparts (OR = 1.56, 95%CI[1.13-2.15]) and (OR = 1.34, 95%CI[1.11-1.62]) respectively. A COVID-19 worry score was significantly associated with higher odds of distress and insecurity (OR = 1.77, 95%CI[1.46-2.14]) and (OR = 4.3, 95%CI[3.53-5.23]) respectively. Conclusion: This study emphasizes the need to pay attention not only to physical health but also to mental health during the COVID-19 pandemic, especially among young people, women, those with lower economic status, and those living with high risk persons during the pandemic. We hope that this study will inform the policies and interventions of the Palestinian Authority, local non-governmental organization, international groups working in the occupied Palestinian territory, and beyond.