The effect of a simulation-based training program in basic life support on the knowledge of Palestinian nurses: a quasi-experimental study in governmental hospitals.

BACKGROUND: Basic Life Support (BLS) plays an important role in increasing the survival rate of hospitalized heart attack patients. There are no previous studies on the effect of BLS training among Palestinian nurses. This study aimed to evaluate the effect of simulation-based BLS training program on nurses' knowledge Palestinian nurses at governmental hospitals. METHODS: A quasi-experimental, pre & post-test design was used. 700 nurses were recruited proportionally using a simple random sampling method among 2980 nurses from 13 public hospitals in the Gaza Strip. This study was conducted from June to August 2022. A practical BLS test consisting of 10 multiple-choice questions according to American Heart Association guidelines (2020) was collected and sociodemographic characteristics. SPSS software, version 24 was used for the statistical analysis. Descriptive statistics and weighted mean were used. T-Test and One-way analysis of variance (ANOVA) were applied to determine differences in means among groups. RESULTS: Most of the participating nurses (55.7%) were male, while (44.3%) were female. The majority of nurses (84.4%) are under 40 years of age. The weighted mean scores in the pre-test ranged from 52.2 to 75.1% and the mean scores was (6.16 ± 1.97). After applying conventional BLS training, the weighted mean scores ranged from 85.6 to 97.3% and the mean scores was (9.19 ± 1.04). The study revealed that the nurses' knowledge increased after applying simulation-based training program. The mean of knowledge scores was statistically significant between the pre and post-test on the basis of the current work hospital (P-value < 0.001). CONCLUSION: This study affords significant evidence of the positive effects of the BLS training program in improving nurses' knowledge; we recommend advanced BLS training for all healthcare providers, doctors, and nurses working in hospitals and healthcare centers. Nursing managers can implement systematic strategies to enhance nurses' knowledge and practice in BLS to target low-scoring Governorates.

Effect of ISBAR Clinical Handover Application on Nurses' Perception of Communication and Attitudes toward Patient Safety at Emirates Maternity Hospital in Gaza Strip, Palestine.

Background: Good communication is necessary for safety and quality of health. This study aims to determine the effect of ISBAR communication on nurses' perception of communication and attitudes toward patient safety in the Emirates Maternity Hospital in the Gaza Strip, Palestine. Method: A single-group hospital-based intervention study (pre and posttest) was conducted. A census sample was used Participants opinions about the effect of ISBAR were gathered using two tools established by Shortell, Rousseau, Sexton, and Helmreich to assess the communication awareness and nurses' attitudes towards safety, respectively, before and after the use of the ISBAR program. Results: After the ISBAR application, nurses' perception of communication demonstrated a positive and significant increase in the three sub-items (openness, accuracy and understanding, and shift communication) in the nurse-nurse communication. Moreover, in four sub-items (openness, accuracy, and understanding, timeliness, and satisfaction) in nurse-doctor communication, (p < 0.05). Further, the nurses' attitudes toward patient safety showed a significant and positive increase in teamwork climate (p<0.001), safety climate (p = 0.007), job satisfaction and working condition (p<0.001), stress recognition (p= 0.008), and perception of management (p = 0.001). Conclusion: The results provide significant evidence of the positive effects of the ISBAR program in improving nurses' perceptions of communication and attitudes toward patient safety. It is recommended that healthcare providers use ISBAR communication in their practice. Moreover, periodic training programs are required for effective ISBAR communication among the healthcare team.

Association of Household Food Insecurity With Dietary Intakes and Nutrition-Related Knowledge, Attitudes, and Practices Among School-Aged Children in Gaza Strip, Palestine.

Background: The present study aimed to determine the association of household food insecurity with dietary intakes and nutrition-related knowledge, attitudes, and practices (KAP) among school-aged children. Methods: This cross-sectional study was conducted among a representative sample of school-aged children. A total of 380 children and their parents were selected from all Gaza strip governorates, using a random sampling method. The demographic and socioeconomic characteristics; the Radimer/Cornell food security scale; two non-consecutive days of 24-h dietary recall; anthropometric measurements; and the Food and Agriculture Organization KAP-questionnaire (Module 3) were employed. Statistical analysis was performed using SPSS version 25. Results: About 71.6% of school-aged children were household food-insecure, while 28.4% were household food-secure. Significant associations were found between living area, educational level, household monthly income, weight for age and BMI for age z-scores, underweight, malnutrition status, intakes of protein, iron, vitamin D, and zinc among household food-secure, and household food-insecure. After adjustment for confounding variables, having nutrition-related adequate KAP were associated with lower odds of being food-insecure household [OR = 0.519, 95% (CI = 0.320-0.841)], [OR = 0.510, 95% CI = (0.315-0.827)], and [OR = 0.466, 95% CI = (0.285-0.763), P < 0.05 for all], respectively. Conclusions: Low socioeconomic status, low anthropometric indices, poor dietary intakes may be associated with a high level of food-insecurity; while having nutrition-related adequate KAP may be protective against food-insecurity among school-aged children.

Households' Food Insecurity and Its Association with Demographic and Socioeconomic Factors in Gaza Strip, Palestine: A Cross-Sectional Study.

Background: This sudy aimed to identify the prevalence of household's food insecurity and its association with demographic and socioeconomic factors. Methods: A cross-sectional study was conducted in September 2021 among a representative sample of households in the Gaza strip governorates. A total of 1167 households randomly selected from all five governorates and were included in the study. The Radimer/Cornell food security scale was used to determine the prevalence and levels of household food insecurity. The household's demographic and socioeconomic characteristics were obtained using an interview-based questionnaire. Statistical analysis was performed using SPSS version 25. Results: The overall prevalence of household's food insecurity was 71.5%. The prevalence by governorates was highest in Gaza (30.8%), followed by Khanyounis (23.0%), North-Gaza (18.6%), Middle-Area (15.2%) and Rafah (12.4%). Regarding the food insecurity levels, 333 (28.5%) of the households were food secure, 422 (36.2%) had mild food insecurity, 161 (13.8%) had moderate food insecurity, and 251 (21.5%) had severe food insecurity. Significant associations were found between governorates, monthly income, homeownership, work status with the household's food insecurity, (Crude OR [COR] = 2.02, 95% CI = [1.02-3.98], P value < 0.05), (COR = 2.00, 95% CI = [1.04-2.75], P value < 0.05), (COR = 2.36, 95% CI = [1.39-3.99], P value < 0.05), and (COR = 1.14, 95% CI = [0.66-1.97], P value < 0.05), respectively. Conclusions: Our study demonstrates that food insecurity is highly prevalent in the Gaza strip and is associated with poor living conditions. Therefore, this high prevalence should be seriously discussed and urgently considered.

Association of household food insecurity with dietary intakes and nutrition-related knowledge, attitudes, and practices among parents, aged ≥ 18 years in Gaza Strip, Palestine: A descriptive study.

The purpose of this study was to examine the association between household food insecurity and dietary intake and nutrition-related knowledge, attitudes, and practices (KAP) among parents aged ≥18 years in the Gaza Strip, Palestine. The current cross-sectional study was carried out in 2021 among adults (mothers and fathers) aged ≥18 years. A total of 614 participants were selected from all Gaza Strip governorates using a cluster random sampling method. To assess the nutrition-related KAP, we employed the Food and Agriculture Organization (FAO) of the United Nations questionnaire (Modules 5, 6, 7, and 9). Data regarding household food security status, demographic and socioeconomic characteristics of the study participants, anthropometric measurements, and dietary intakes were obtained using standard questionnaires and methods. Statistical analysis was performed using SPSS version 25. About 71.5% and 28.5% of the study participants were household food-insecured and household food-secured, respectively. Significant associations were found between participants from household food-secured and household food-insecured concerning several socio-demographic variables, anthropometric measures, intakes of energy, protein, carbohydrate, and calcium; nutrition-related knowledge and attitudes toward undernutrition and vitamin A deficiency; nutrition-related KAP of iron deficiency anemia; and nutrition-related attitudes and practices of food safety (P-values < 0.05 for all). In conclusion, the demographic and socioeconomic status, anthropometric measurements, and poor dietary intakes may be associated with high levels of household food insecurity, while having nutrition-related adequate KAP may be associated with low levels of household food insecurity among parents aged ≥18 years.

Do Patients with Major Non-Communicable Diseases Receive Advice on Health Behaviors from Healthcare Professionals in the Gaza Strip, Palestine?

BACKGROUND: NCDs tend to be long-term and are caused by genetic, physiological, environmental, and behavioral factors. Currently, NCDs account for 71% of deaths globally. The current study aimed to explore whether patients with NCDs receive advice on health behaviors from healthcare professionals in the PHCs in the Gaza Strip, Palestine. METHODS: This research applied a cross-sectional survey design in five PHCs from October 2019 to December 2019, with 360 patients selected using a convenience sampling technique. A structured questionnaire on sociodemographic, history and patients' views on receiving advice on health behaviors from health care professionals was developed and collected. Data were analyzed using descriptive analyses and a One-way ANOVA test through SPSS-v22. RESULTS: The patients reported receiving advice as follows: in terms of regular physical activity (54.5% ±13.6), in terms of eating a heart-healthy diet (49.3% ±11.5), in terms of treatment adherence (86.1% ±8.1), and in terms of stop tobacco for smokers' patients (43.9% ±16.8). Statistically significant differences were found between the five Gaza strip governorates in terms of regular physical activity, eating heart-healthy, and treatment adherence (P values <.05 for all). CONCLUSION: Participants claimed that the vast majority of them had received advice from healthcare professionals regarding attending regular follow-up and treatment adherence. In contrast, participants reported receiving advice from health care professionals regarding regular physical activity, eating a healthy diet, and stopping tobacco are suboptimal. There is a need to develop a strategy to ensure that healthcare professionals are committed to providing advice on health behaviors.

Households' Food Insecurity and Their Association With Dietary Intakes, Nutrition-Related Knowledge, Attitudes and Practices Among Under-five Children in Gaza Strip, Palestine.

The present study aimed to determine the households' food insecurity and their association with dietary intakes, nutrition-related knowledge, attitudes and practices (KAP) among under-five children in the Gaza Strip, Palestine. This cross-sectional study was conducted in 2021 among a representative sample of under-five children. A total of 350 children and their proxy were selected from all Gaza strip governorates, using a cluster random sampling method. The Radimer/Cornell food-security scale was used. A 24-h dietary recall was employed for dietary intakes assessment. Nutrition-related KAP for feeding under-five children, anthropometric measurements, and demographic-socioeconomic characteristics were obtained with an interview-based questionnaire. Statistical analysis was performed using SPSS version 25. The children from food-insecure households had a high prevalence of moderate underweight (30.4%), stunting (32.8%), wasting (9.6%), and acute undernutrition (30.4%). Between food-insecure and food-secure groups there were significant differences in weight, height/length, mid-upper arm circumference, weight-for-age and mid-upper arm circumference z-scores, underweight, acute undernutrition, intakes of protein, fat, vitamin D, zinc, continued breastfeeding, having nutrition-related adequate knowledge, having nutrition-related positive attitudes, and achieved minimum dietary diversity score (P < 0.05 for all). Additionally, about (56.0%) food-insecure households have inadequate nutrition-related knowledge, (77.6%) have nutrition-related negative attitudes, and (95.2%) did not achieve a minimum dietary diversity score. In conclusion, the children from food-insecure households had a high prevalence of moderate underweight, stunting, wasting, and acute undernutrition. Moreover, low economic status, poor dietary intakes, low levels of nutrition-related KAP, and lack of dietary diversity could contribute to the high levels of food insecurity among under-five children.

Barriers toward the practice of healthy behaviors among patients with non-communicable diseases in Gaza Strip, Palestine.

OBJECTIVES: Non-communicable diseases are non-infectious health conditions caused by genetic, physiological, environmental, and behavioral factors. Currently, non-communicable diseases account for almost two-thirds of deaths globally. This study aimed to explore the patients' adherence level to the key recommendations, and the main barriers toward the practice of healthy behaviors among non-communicable diseases patients. METHOD: This cross-sectional study was conducted among a representative sample of non-communicable diseases patients, receiving care in five primary healthcare centers in the Gaza Strip, Palestine. An interview-based questionnaire about demographics, medical history, and barriers toward the practice of healthy behaviors was developed and collected based on the health belief model and the theory of planned behaviors. Independent samples t-test, one-way analysis of variance, chi-square, and Fisher's exact test were used for analysis. RESULTS: Four hundred patients with non-communicable diseases, aged (53.06 ± 10.03) years old, (56.8% females and 43.3% males) were included in this study. The patient's adherence was reported as 50.1%, standard deviation = 18.3 in terms of attended regular physical activity, and 44.0%, standard deviation = 15.4 in terms of eating a healthy diet. The main barriers to being active among patients were lack of accessibility to materials, lack of social support, and lack of reminder; while in terms of eating a healthy diet were lack of accessibility to materials, lack of social support, and lack of self-efficacy. CONCLUSION: The non-communicable diseases patients' adherence to healthy behaviors is suboptimal. Varied implementation strategies targeting the main barriers are extremely required to enhance the access to physical activity infrastructure, affordable healthy diet options, and to reinforce the change toward healthy behaviors at all levels.

The fear of COVID-19 outbreak among health care professionals in Gaza Strip, Palestine.

INTRODUCTION: The emergence of the COVID-19 and its consequences has led to fears, worries, and anxiety among individuals, particularly among healthcare professionals. The present study aimed to assess the fear of COVID-19 among different healthcare professionals in the Gaza Strip, Palestine. METHODS: A cross-sectional, snowball sampling technique and an online questionnaire were employed among healthcare professionals. A total of 300 participants completed the questionnaire. The validated fear of COVID-19 Scale Arabic version was used. Statistical analysis was performed using SPSS version 22. RESULTS: The sample fear mean score was 17.53 ± 5.78; more than half of the study participants (54.3%) consider it as low levels of fear and 45.7% of the participants consider it as high levels of fear. Statistically significant differences were found between males and females, and different healthcare professional's disciplines. Females have a higher mean score compared to males. The highest fear mean scores were found among Lab-Technicians (20.19 ± 7.42), followed by X-ray-Technicians (17.95 ± 3.96), Nurses (17.1 ± 5.55), and Physicians (16.25 ± 4.66). CONCLUSION: The fear of COVID-19 was high among female healthcare professionals compared to males, as well as, among Lab-Technicians compared to Physicians and Nurses. There is a need to establish a strategy to continues measuring the psychological effect of COVID-19 among healthcare professionals especially females.

Barriers of Adherence among Palestinian Healthcare Professionals towards the Protocol of Health Education and Counselling on Healthy Behaviours for Non-Communicable Diseases.

BACKGROUND: Despite the huge numbers of the universally produced and employed protocols, the adherence with them is still low to moderate in the healthcare settings. This study was employed to assess the attitudes of Palestinian healthcare professionals in Gaza Strip to health education and counseling on healthy behaviours protocol (WHO-PEN Protocol 2), for patients with non-communicable diseases in the Ministry of Health primary healthcare centers. METHODS: This cross-sectional study was conducted with a census sample of all governmental family physicians and nurses (n=175). The study questionnaire was developed based on Cabana theoretical framework. The Arabic version questionnaire was developed based on the cross-cultural adaptation framework. The psychometric properties of the Arabic version questionnaire was finally evaluated. RESULTS: The psychometric properties of the Arabic version questionnaire showed good construct validity and internal consistency reliability. The overall adherence level to WHO-PEN Protocol 2 was 70.0, SD=6.9. The main perceived barriers were lack of incentive, patients' factors, and lack of time. In general, most of healthcare professional respondents had a positive attitude toward the protocol, but this attitude was not predictor to protocol adherence. CONCLUSION: The good validity and reliability of the questionnaire can provide support for the accuracy of the study results. Varied implementation strategies targeting the major barriers derived from the study are extremely required for addressing the lack of incentives, patients' factors and time constraints.

Public Sector Capacity to Prevent and Control of Noncommunicable Diseases in Twelve Low- and Middle-Income Countries Based on WHO-PEN Standards: A Systematic Review.

This review was conducted to assess the capacity of the public sector to prevent and control noncommunicable diseases (NCDs) in low-and middle-income countries (LMIC) based on WHO-PEN standards. A PRISMA systematic search appraisal of PubMed, Scopus, and Embase was conducted during May-2020 for original articles conducted in LMIC and reported the capacity of the public sector to prevent and control NCDs. The country readiness score was calculated as the mean score of items for each domain. The indices were compared to an agreed cutoff at 80% the WHO optimal target of availability of affordable essential medicines and basic technologies required to treat NCDs. The literature search yielded 5 original studies, conducted in twelve countries, and surveyed 304 public health facilities. All countries failed to reach the WHO optimal target of availability of affordable essential medicines and basic technologies. The readiness index score according to WHO-PEN standards among countries in terms of essential medicines, diagnostic investigations, and basic equipment were range from 13.5% to 51%, 0.0% to 59.4%, and 29.2% to 51.2% respectively. This review revealed critical gaps in the twelve LMIC public sector capacity to prevent and control of NCDs in terms of essential medicines, basic equipment, and diagnostic investigations.

Multiple micronutrient supplementation improves growth and reduces the risk of anemia among infants in Gaza Strip, Palestine: a prospective randomized community trial.

BACKGROUND: Infants and young children 6-24 months of age are the most nutritionally vulnerable groups, as their needs for vitamins and minerals are high relative to the amount of food they consume. This study determines the effect of Micronutrient Powder Supplementation (MNP) on growth and hemoglobin of infants in Gaza Strip, Palestine. METHOD: This was a two-arm parallel-group randomized controlled trial conducted in two health care clinics of the United Nations Relief and Work Agency (UNRWA) at the Middle Area governorate of Gaza Strip, Palestine. A total of 200 healthy infants aged 6-month-old were recruited and randomized to receive 3 sachets/week of MNP for 12 months alongside with the National Micronutrient Supplement (NMS) (n = 100) or NMS alone (n = 100). Weight, length, blood hemoglobin, and dietary intakes were measured at 6, 9, 12, 15, 18, and 21 (3 months after the end of intervention) months of age. Analysis was by intention to treat. RESULTS: The experimental group had a higher concentration of hemoglobin at 12 and 15 months than did the control group, and a significant difference (p <  0.05) was observed at 15 months only. Significantly greater weight, length, weight-for-age, length-for-age, and weight-for-length z-scores were observed in the experimental group than that in the control group at 12 and 15 months (p <  0.05). The prevalence of anemia (18% vs. 52%) and stunting (1% vs. 11%) were higher in the control than the experimental group, respectively. After controlling for sex, similar findings were reported. CONCLUSIONS: Addition of MNP to the existing NMS program improved the nutritional status of young children. The potential benefits of MNP supplementation on physical growth and hemoglobin should be considered in the existing NMS program. TRIAL REGISTRATION: ISRCTN57594793 ; Date of registration: 20-03-2018 (Retrospectively registered).

Capacity of Palestinian primary health care system to prevent and control of non-communicable diseases in Gaza Strip, Palestine: A capacity assessment analysis based on adapted WHO-PEN tool.

The prevalence of non-communicable diseases (NCDs) are increasing in low-income countries including Palestine. This study was conducted to assess the capacity of Palestinian primary health care system to prevent and control of NCDs. This cross-sectional study in which, the World Health Organization package of essential NCDs interventions (WHO-PEN) tool, was used to assess the capacity of primary health care centers (PHCs) to prevent and control of NCDs. All governmental PHCs (n = 52) in Gaza Strip, Palestine were included in the final analysis. The centers readiness score was calculated as the average of domains indices. Then, the indices were compared to an agreed cutoff at 70%. Statistical analysis was performed using SPSS version 22. Out of 52 PHCs, only 21 (40.4%) were considered ready to prevent and control of NCDs; the highest readiness score was 79.4% and the lowest score was 29.2%. Furthermore, all governorates were not ready to prevent and control of NCDs (The readiness scores were < 70%), distributed as follow: 68.6%, 68.1%, 67.7%, 62.5% and 56.4%, for Rafah, Gaza, Khan-Yunis, Deir Al Balah and North Gaza, respectively. The governorates were differed significantly in terms of availability of aneroid blood pressure measuring devices, electrocardiography devices, Glibenclamide and Salbutamol tablets, patients counseling for diabetes self-management, patients education for self-administration of insulin (P values <.05 for all). The current study demonstrated critical gaps in the governmental PHCs capacity to prevent and control of NCDs, as most of PHCs failed to reach the minimum threshold of the WHO-PEN standards.

Dietary Pattern and Their Association With Level of Asthma Control Among Patients With Asthma at Al-Shifa Medical Complex in Gaza Strip, Palestine.

BACKGROUND: This study was conducted to identify major dietary patterns and their association with level of asthma control among patients with asthma in Gaza Strip, Palestine. METHODS: This cross-sectional study was conducted among a representative sample of Palestinian patients with asthma (both sex, aged 19-64 years) receiving care in chest department at Al-Shifa Medical Complex. Asthma control level was obtained using asthma control test. Data regarding other variables were obtained using an interview-based questionnaire and a semi-quantitative food frequency questionnaire. Statistical analysis was performed using SPSS version 20. RESULTS: Two major dietary patterns were identified including (1) Prudent pattern characterized by a high intake of whole grains, beans and legumes, fish and shellfish products, vegetables, tomatoes, fruits, and vegetable oils, and (2) Western pattern characterized by a high intake of refined grains, red meat, poultry, fast foods, eggs, low-fat dairy product, high-fat dairy products, hydrogenated fats, olive, sugar, sweets, desserts, and snacks. After adjustment for confounding variables, patients in the lowest tertile (T1) of Prudent pattern had a lower odds for poorly controlled asthma (odds ratio [OR] = 0.044, 95% confidence interval [CI] = [0.002-1.316], P value < 0.05), whereas patients in the lowest tertile (T1) of Western pattern had a higher odds for poorly controlled asthma (OR = 2.499, 95% CI = [1.288-4.850], P value < 0.05), compared with those in the highest tertile (T3). CONCLUSION: A Prudent pattern may be associated with a lower prevalence of poorly controlled asthma, whereas a Western pattern may be associated with a higher prevalence of poorly controlled asthma.

Growth patterns of Palestinian children from birth to 24 months.

BACKGROUND: Growth faltering in early life can adversely affect health in later childhood and adulthood. Growth monitoring of children can provide evidence to help formulate effective strategies to address growth problems but such information on Palestinian children is lacking. OBJECTIVES: This study aimed to determine the growth patterns of children under 2 years in Gaza, Palestine. METHODS: This retrospective cohort study was conducted in 2014 in 10 randomly selected primary health care clinics in 5 governorates of Gaza. Weight and length data were obtained from the health cards of children born in 2012, and z-scores were calculated and compared with the WHO Growth Standard (2006). RESULTS: A total of 2 632 children's cards were included at the beginning of the study. Weight-for-age and weight-forlength decreased from birth to 6 months to about -0.40 SD but increased afterwards to -0.11 SD and 0.34 SD at 24 months respectively. Length-for-age declined after 6 months, reaching -0.85 SD at 24 months. At 6 months, the prevalence of underweight and stunting were 5% and 9% but at 24 months, the prevalence was 4% and 20% respectively. Wasting was highest at 6 months (10%) but decreased to 3% at 24 months. Significantly more girls were stunted at 9, 12 and 18 months (P < 0.001), underweight at 24 months (P < 0.05) and wasted at 12 months (P < 0.05). Early life faltering in length was more pronounced than weight, with stunting occurring in one fifth of boys and girls by 2 years of age. CONCLUSIONS: Preventive strategies are urgently needed to address early life causes of undernutrition, particularly stunting, in Palestinian children in Gaza.