United Nations Relief And Works Agency Research Articles

Diabetes-Related Microvascular Complications in Primary Health Care Settings in the West Bank, Palestine.

Worldwide, retinopathy, nephropathy, and neuropathy are the major diabetes-related microvascular complications. In Palestine, a low-middle-income country, diabetes is the fourth reason for death. However, a few studies examined diabetes microvascular consequences and its management. Therefore, we carried out a national study that aims to investigate the factors associated with diabetes-related microvascular complications among individuals seeking care in primary healthcare settings of the West Bank of Palestine. Using a cluster systematic sampling technique, 882 participants with diabetes patients were chosen for a cross-sectional study from primary healthcare facilities operated by the Ministry of Health (PMoH), the United Nations Relief and Works Agency (UNRWA), and the Palestinian Medical Relief Society (PMRS). Data about patients related to diabetes-related complications, medication use, and other diseases were extracted from patients' medical records. In addition, an interview face-to-face questionnaire was used to collect information about patients' sociodemographic variables, medical history, smoking habits, duration of the disease, presence of concurrent conditions previous referrals, and hospital admissions, as well as their level of knowledge regarding diabetes, complications, and treatments. Approximately 34.4% of persons with diabetes patients in Palestine encounter at least one microvascular complication associated with diabetes. The most prevalent diabetes-related microvascular complication was retinopathy (17.3%), 23.4% of participants had more than one microvascular complication, and 29% of male patients had erectile dysfunction. A higher probability of having any microvascular complications was associated with older age (over 60 years). Participants with diabetes patients with fundoscopy or ophthalmology reports, according to diabetes follow-up guidelines, were less likely to develop retinopathy. Also, those who performed regular kidney function testing were less likely to have nephropathy, and those who performed a regular foot exam were less likely to develop diabetic foot. Diabetes-related microvascular complications were associated with patient age, low education level, residency location, and adherence to diabetes follow-up guidelines of diabetes management; i.e., having been tested for HbA1c, consulting with specialists, regular kidney function, and foot examination. These factors can be utilized in setting up proper management protocols to prevent or delay microvascular complications in many patients.

Mental health of health professionals and their perspectives on mental health services in a conflict-affected setting: a qualitative study in health centres in the Gaza Strip during the COVID-19 pandemic

ObjectivesTo explore how primary care health professionals perceive their own mental health in a conflict-affected setting during and beyond the COVID-19 pandemic and to explore their perspectives on mental health...

Fate of palestinian refugee camps in syria after the so called arab spring

The aim of this paper is to trace back the history of the Palestinian refugees’ camps in Syria from 1948 until today. It also aims to investigate the fate of such camps amidst of the so-called Arab Spring. Despite their hardship as diaspora, Palestinian refugees in Syria worked hard to manage their lives, with help from Syrian Government and United Nations Relief and Work Agency (UNRWA). Since 2011, Researchers found that Palestinian refugee camps witnessed various military actions from both the Syrian Army and oppositions groups. These actions resulted in the killing, imprisonment, and dispersal of most Palestinian refugees. In addition, their dispersal took place either inside Syria to neighboring countries or other parts of the World. Researchers believe that Palestinian refugees should peacefully return to their camps in Syria and one day they will exercise the return to their homeland in Palestine according to United Nations resolutions. Finally, United Nations has failed to implement durable solutions for Palestinian refugees, resulting in chronic suffering and displacement in various forms.

Palestinian Refugee Youth in Jordan: Parental Practices, Neighborhood Cohesion and Assistance, and Adolescent Wellbeing

In this study, a total of 335 Palestinian refugees (M = 15.5 years, SD = 1.05, 49% males), recruited from four United Nations Relief and Work Agency (UNRWA) schools at the Al-Baqa’a and Jabal Al-Hussein refugee camps in Jordan, rated their neighborhood physical environment and neighborhood support and cohesion, separately rated their mothers’ and fathers’ parenting on several dimensions, and reported on their adjustment to these circumstances (internalizing symptoms, self-concept clarity, and norm breaking). Living in more dangerous physical environments was associated with higher levels of refugee youths’ internalizing symptoms and norm breaking, but effects were not significant when parenting was considered. Our study showed that higher levels of psychological control–disrespect (significantly for fathers and marginally for mothers) and marginally, higher levels of maternal harsh punishment were associated with more teen internalizing symptoms. In addition, fathers’ greater psychological control and lower levels of support had a marginally significant effect on teens’ greater norm breaking. For behavioral control, only mothers’ greater behavioral control was associated with refugee youths’ greater self-concept clarity but not with paternal behavioral control. Thus, fathers’ psychological control and mothers’ behavioral control had the biggest association with adolescent outcomes.

Integration of Palestinian Refugee Children from Syria in UNRWA Schools in Lebanon.

Following the Syrian conflict that began in 2011, Lebanon received more than one million refugees including 44,000 Palestinian refugees from Syria (PRS). PRS children were integrated into existing schools run by the United Nations Relief and Works Agency (UNRWA). Despite efforts by UNRWA to integrate the newly displaced into its services in Lebanon, only 58% of 6–18-year-old PRS children were enrolled in school in 2014. Informed by ecological systems theory, we examined the role of parental characteristics in determining school enrollment among PRS children following displacement into Lebanon. Utilizing data from the 2014 UNRWA Vulnerability Assessment (N = 12,378 6–18-year-old children), we specified crude and adjusted logistic regression models to predict child school non-enrollment including a set of variables on head of family characteristics (gender, age, education, and presence/absence of chronic disease) and post-displacement household characteristics (crowding, wealth, camp residence, region, and type of dwelling). The results show that, adjusting for household characteristics, a child living in a family whose head has secondary education or higher is more likely to be enrolled in school compared to one living in a family headed by someone with less than secondary education. Parental education remains the strongest predictor of child school enrollment despite displacement-related household disadvantage. To break the cycle of intergenerational educational disadvantage, it is critical for UNRWA to proactively design school retention programs for PRS children living in families whose head had limited access to education.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12134-020-00793-y.

Foreign policy orientations post-war USSR (1945—1947)

The presented article is devoted to an important period of national history, its first postwar years (1945—1947). This paper raises the issue of the formation of the foreign policy segment in the life of the post-war Ukrainian Soviet Socialist Republic. Based on the analysis of the events of that time, the author gives a list of defining for the then Ukraine areas of foreign policy of the USSR and the USSR. Among the latter are the following: legitimization of the new western borders of Ukraine by signing the Soviet-Czechoslovak (June 29, 1945), Soviet-Polish (August 16, 1945) and Soviet-Romanian (February 10, 1947) agreements; formation of bilateral relations of the USSR with other countries of the world; Ukraine's participation in international humanitarian cooperation, in particular, its receipt of assistance from the United Nations Relief and Works Agency (UNRRA); the inclusion of Ukraine in the orbit of the newest Slavic movement, and in fact, actualized in the postwar period of Slavophilism, the homeland and ideological inspiration of which Ukraine, in fact, has been since the mid-nineteenth century; exposing the foreign policy activity of the Ukrainian SSR in relation to the Bandera movement, aimed at discrediting it internationally and finally exposing its treacherous nature in the eyes of the Ukrainian people. The presented article is written on the materials of the Book Chamber of Ukraine. The author presents the little-known and, in fact, unused Ukrainian Soviet socio-political magazine Modern and Future.

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

BackgroundInfants 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.MethodThis 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.ResultsThe 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.ConclusionsAddition 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 registrationISRCTN57594793; Date of registration: 20-03-2018 (Retrospectively registered).

E-health system characteristics, medical performance and healthcare quality at UNRWA-Palestine health centers

PurposeThis study aims to investigate how e-health system characteristics (information quality, system quality, perceived ease of use, perceived usefulness) contribute to the enhancement of medical staff performance, patient care, and doctor–patient relationships at UNRWA-Gaza healthcare centers. It aims at testing an integrative single model comprising Technology Acceptance Model (TAM), D&amp;M model and e-health system utilization.Design/methodology/approachThis study followed the quantitative methodology and the deductive research approach. Data were collected from 241 medical staff who use the system employed in 19 different healthcare centers across the Gaza Strip. Partial least square/structural equation modeling technique was used to analyze the collected data and to test study hypotheses.FindingsStudy concluded that information quality of the adopted Health Information System (HIS) has both direct and indirect positive impact on staff performance, only direct positive impact on patient care and only positive indirect impact on doctor–patient relationship. System quality, on the other hand, was found to have negative direct impact and positive indirect impact on staff performance and has both direct and indirect positive impact on both doctor-patient relationship and patient care.Research limitations/implicationsNoteworthy that HIS has availability, speed and error detection and error prevention issues. It is recommended that these shortfalls be addressed together with improving user perception towards ease of use and usefulness of the system.Practical implicationsManagement should also work to raise confidence in its medical staff to improve the effect of HIS on medical performance and patient care. It is also recommended that UNRWA should implement crowed management techniques such as queuing systems and on-phone booking to minimize patient waiting time.Originality/valueThe importance of the study stems from its context being conducted in a developing region (Gaza Strip-Palestine) which has a fragile economic, political and social environment with many other complexities. It is also conducted at United Nations Relief and Work Agency (UNRWA) healthcare centers, which provide medical services to Palestinian refugees. In addition, this study is among the few studies that address the impact of individual e-health success factors on both doctor-patient relationship and patient care constructs. Most previous studies concentrated on the impact of health system adoption as a whole on these two subject variables and one can hardly ever stop at studies that address effect of individual success factors on them. It also integrated both D&amp;M system success model and TAM model with some additional amendments creating and tested a new model.

Class Size, Cognitive Abilities, Bullying, and Violent Behavior: Evidence from West Bank Schools

This study uses rich administrative and survey data to investigate the effects of class size on students' cognitive tests as well as bullying and violent behavior. I use the maximum class size rule to create a regression discontinuity (RD) relation between cohort enrollment size and class size in the public and the United Nations Relief and Works Agency (UNRWA) school system in the West Bank. In addition, I provide evidence that there is no violation of the RD assumptions resulting from discontinuities in the relationship between enrollment and students' household background at cutoff points induced by a maximum class size rule. The main findings suggest that class size has no direct impact on students' cognitive skills except for those in grade six. However, class size reduction improves the quality of life for children by mitigating the bullying and violent behavior among pupils that may negatively affect their achievements. Finally, I point to peer relations and mental health problems as a potential mechanism through which class size affects children's self-reported bullying-victim instances and violent behavior.

ORGANISATIONAL AND LEGAL FRAMEWORK FOR THE UN’s ACTIVITY CONCERNING HUMAN RIGHTS EDUCATION

The article focuses on the foundation and development of the universal legal basis of human rights education, which is an essential part of general education as an integral part of human rights. The provisions of general international legal instruments guaranteeing the right to education are analysed, in particular: the Universal Declaration of Human Rights of 1948, the International Covenant on Economic, Social and Cultural Rights of 1966, the Convention on the Rights of the Child of 1989. Special attention is paid to the provisions of specialized acts on the regulation of education. In particular, the provisions of the Convention on the Elimination of Discrimination in Education of 1960, adopted by the UN Educational, Scientific and Cultural Organization (UNESCO), which defines the main components of the right to education, clarifies the term “discrimination” in the field of education, and state parties’ obligations to eliminate or prevent discrimination. The provisions of universal acts adopted within the World Conference on Human Rights, the World Education Forum are disclosed, in particular: the Vienna Declaration and the Action Plan, the World Declaration on Education for All and the basic framework for action to meet basic educational needs, the Dakar Framework for Action, education for everyone: fulfilling our collective commitments, the World Program in Education, the UN Declaration on Human Rights Education and Training, Education 2030 – Incheon Declaration – Towards inclusive and equitable quality education and lifelong learning for all and others. Emphasis is placed on the activity of the High Commissioner for Human Rights and his / her chairmanship (OHCHR) on the development of human rights education. The focus is on the practical component of UNESCO’s activity in this area. Programs that operate under the auspices of a specialized institution are characterized by: a program to prevent violent extremism through education, education about the Holocaust and genocide, the importance of language in education, the rule of law through education. It focuses on the functioning of the United Nations Relief and Works Agency (UNRWA), which aims to assist Palestinian refugees in providing access to quality education. Relevant conclusions are made.

Inclusive Education from the Teachers’ Perspectives in Palestine

The current study aimed at investigating the concept of inclusive education, the degree of implementing it in Palestine Schools. Additionally, the study handles the challenges that the school staff members face when implementing inclusive education in their schools. To achieve the study aims, the researcher used the descriptive approach. The researcher interviewed 30 teachers who were chosen from ten random United Nations relief and Works Agency (UNRWA) schools in the middle area of the Gaza Strip. The interview included six questions. The results were positive as the teachers employ the inclusive education initiative tools effectively. Teachers showed the obstacles they face when employing inclusion and they suggested some strategies and solutions to overcome such obstacles. The researcher recommends that stakeholders should provide school staff with suitable training of this initiative and equip schools with instruments and tools that help employ the initiative effectively.

Health system resilience in the face of crisis: analysing the challenges, strategies and capacities for UNRWA in Syria.

Health system resilience reflects the ability to continue service delivery in the face of extraordinary shocks. We examined the case of the United Nations Relief and Works Agency (UNRWA) and its delivery of services to Palestine refugees in Syria during the ongoing crisis to identify factors enabling system resilience. The study is a retrospective qualitative case study utilizing diverse methods. We conducted 35 semi-structured interviews with UNRWA clinical and administrative professionals engaged in health service delivery over the period of the Syria conflict. Through a group model building session with a sub-group of eight of these participants, we then elicited a causal loop diagram of health system functioning over the course of the war, identifying pathways of threat and mitigating resilience strategies. We triangulated analysis with data from UNRWA annual reports and routine health management information. The UNRWA health system generally sustained service provision despite individual, community and system challenges that arose during the conflict. We distinguish absorptive, adaptive and transformative capacities of the system facilitating this resilience. Absorptive capacities enabled immediate crisis response, drawing on available human and organizational resources. Adaptive capacities sustained service delivery through revised logistical arrangements, enhanced collaborative mechanisms and organizational flexibility. Transformative capacity was evidenced by the creation of new services in response to changing community needs. Analysis suggests factors such as staff commitment, organizational flexibility and availability of collaboration mechanisms were important assets in maintaining service continuity and quality. This evidence regarding alternative strategies adopted to sustain service delivery in Syria is of clear relevance to other actors seeking organizational resilience in crisis contexts.

Educating Palestinian Refugees: The Origins of UNRWA’s Unique Schooling System

AbstractThis article examines the origins of the unique schooling system for Palestinian refugees run by the United Nations Relief and Works Agency (UNRWA). Examining developments c. 1950–57, it illuminates the programme’s beginning and explores the objectives of those behind it. Using archival evidence from numerous international welfare organizations and testimonies from refugees themselves, this article argues that the parties providing education and the refugees receiving it often had conflicting objectives that were highly politicized on both sides. Despite the comparatively greater power and resources of the United Nations, the Palestinian refugees were able to make use of their limited leverage in order to shape the education system as they preferred. The UNRWA education programme thus serves as a revealing case study for explaining developmental aid to refugee populations and its inevitable intersection with politics.

Assessment of mental health and psycho-social support pilot program’s effect on intended stigmatizing behavior at the Saftawi Health Center, Gaza: a cross-sectional study

Background: In the midst of a global refugee crisis, addressing mental health is critical for refugee health care delivery. Understanding efficacy of mental health interventions is more important than ever.Aims: In this study, we aim to assess the efficacy of comprehensive mental health and psychosocial support services for refugees in Gaza by comparing intended stigmatizing behavior toward mental health disorders between two health centers (HCs)(Saftawi and Nasser).Methods: One year after these services by the United Nations Relief and Works Agency (UNRWA) for Palestine Refugees in the Near East were implemented at Saftawi HC, a randomly selected sample of HC patrons (n = 205) from Saftawi, and a comparable number from a control HC (n = 203 at Nasser) completed the Reported and Intended Behavior Scale (RIBS) regarding stigma towards mental illnesses. Multivariable linear regressions were used to determine the impact of these services in the HC on attitudes against mental health.Results: Saftawi respondents endorsed significantly less intended stigmatizing behavior compared to Nasser respondents (p < 0.001). Multivariable analysis demonstrated significantly less intended stigmatizing behavior at Saftawi compared to Nasser (p < 0.01) while controlling for demographic covariables.Conclusions: UNRWA primary care services and education implemented for refugees in Gaza was associated with reduced stigmatizing behavior toward mental health, which can help guide efficacious mental health care interventions within the Palestine refugee community and in other simiilar communities.

Recent changes in welfare indicators among Palestinian refugees in Lebanon: a comparative study of two cross-sectional datasets

BackgroundPalestinians in Lebanon have been protracted refugees for 70 years, but the Syrian crisis has caused shocks that threaten to destabilise their already fragile livelihoods. Over a million Syrian refugees and 42 000 Palestinian refugees from Syria have fled to Lebanon, adding pressure to an already weak infrastructure and labour market. The United Nations Relief and Works Agency (UNRWA), the main provider of health, education and relief services to Palestinian refugees, is exceptionally strained. This study examines changes in education, health, employment, food security, and poverty indicators for Palestinian refugees in Lebanon (excluding Palestinian refugees from Syria) using two nationally representative household surveys conducted in April, 2010, and July, 2015. MethodsThe surveys were conducted using multi-stage cluster random sampling. Both surveys included households residing in camps and gatherings. Health conditions were reported for all household members by a proxy survey respondent from among the household members. Food insecurity was assessed using the Arab Family Food Security Scale. The poverty lines (thresholds) were set at US$6·84 per person per day (upper poverty line) and US$2·47 per person per day (extreme poverty line) in 2015, and US$6 per person per day (upper poverty line) and US$2·17 per person per day (extreme poverty line) in 2010. The difference across the 2 years reflects adjustment for inflation rates within the 5-year period. Data were analysed using STATA13. The study was approved by the Institutional Review Board of the American University of Beirut. Informed verbal consent was obtained from the survey respondents. FindingsOf the eligible sampled households of Palestinian refugees in Lebanon, 88% (2974 of 3382) in 2015 and 99% (2593 of 2626) in 2010 gave informed consent and completed the questionnaire. Net enrolment rates for elementary education remained high (98% in 2015 and 95% in 2010), but failed to lead to better labour market outcomes. The unemployment rate increased from 8% in 2010 to 23% in 2015, and the fraction working in elementary occupations increased from 23% to 36%. Overall poverty remained unchanged but with considerable regional shifts: poverty increased by 9% and 11% in central Lebanon and north Lebanon, respectively, whereas it dropped by 8% and 9% in Saida and Tyre. Extreme poverty was halved from 7% to 3%. There was a high prevalence of chronic diseases in both years (37% in 2015 and 31% in 2010); and in 2015, out-of-pocket health expenditure was six times higher when the household reported at least one chronic condition (US$50·9 per capita per month compared with US$8·3 per capita per month). Despite the reduction in extreme poverty, 4% of households shifted from moderate to severe food insecurity. InterpretationPressures on UNRWA services come at a time when the organisation is operating with a large shortfall in funding. Recent US funding cuts may have dire repercussions for a population burdened by a high prevalence of chronic conditions and facing high healthcare costs. With additional budgetary strains and worsening labour market conditions, Palestinian refugees in Lebanon risk losing some of the ground that they have gained in net enrolment rates in education, access to health-care services and the reduction in extreme poverty that the UNRWA has worked towards for decades. FundingUNRWA funded the data collection for both surveys.

Prevalence of metabolic syndrome among school children aged 6–18 years in Ein Al-Helwa Palestinian Refugee Camp, Lebanon: a cross-sectional study

BackgroundMetabolic syndrome is characterised by the presence of several metabolic abnormalities, including hyperglycaemia, central obesity (also known as abdominal obesity), elevated blood pressure, and an abnormal blood lipid profile. The prevalence of metabolic syndrome is rising rapidly around the world as childhood obesity is increasing. The aim of this study is to determine the prevalence of metabolic syndrome in school children aged 6–18 years residing in Ein Alhelwe Refugee camp in Saida, Lebanon. MethodsSchool children aged 6–18 years from the first to twelfth grades from two United Nations Relief and Works Agency (UNRWA) schools were randomly chosen. We used a school-based cross-sectional study design with two stages. The first stage included measurements of weight, height, body mass index (BMI), waist circumference, and blood pressure. In the second stage, blood tests were carried out for fasting blood sugar, triglycerides, and high-density lipoprotein (HDL). Approval was obtained from the ethics committee at Al Hamshari Hospital in Saida, Lebanon. Written permission was obtained from the UNRWA and the principals of the two schools for the first stage, and informed written consent was obtained from parents on behalf of the children involved in the second stage of the study. FindingsThe first stage of the research included 487 participants (258 female, 229 male) and the second stage included 73 participants (36 overweight participants [12 male, 24 female] and 37 obese participants [19 male, 18 female]). The prevalence of overweight and obesity were 15·2% (74 of 487) and 14·4% (70 of 487) among all age groups, respectively. Among Palestinian refugee school children in Saida aged 10–18 years, the prevalence of metabolic syndrome was more pronounced when the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) definition was used (30·9%; 21 of 68) compared to the International Diabetes Federation (IDF) definition (11·8%; eight of 68), with no statistical differences between male and female participants. Note that the IDF definition can be applied to children aged 10–18 years, of whom there were 68 participants, and for comparison between IDF and NCEP ATP-III, prevalence of metabolic syndrome was calculated for participants in this age range. Low HDL cholesterol (52·1%; 38 of 73), central obesity (46·6%; 34 of 73), and raised blood pressure (42·5%; 31 of 73) were the leading three common metabolic abnormalities among children who were overweight or obese. InterpretationThis study has shown that metabolic syndrome is common among children who are obese or overweight, who are aged 10–18 years, living in Ein Al-Helwa Refugee Camp in Saida, Lebanon. These data raise the importance of early prevention and treatment of metabolic syndrome and its components (abdominal obesity, elevated triglycerides, reduced HDL cholesterol, elevated blood pressure, and elevated blood glucose) to reduce the risk of diabetes and cardiovascular complications in susceptible individuals. A potential limitation of this study is that the small sample size may not accurately reflect the prevalence of metabolic syndrome. FundingPalestinian Civil Society Organizations Commission, Life Hope Center, and Palestinian Red Crescent Society Al Hamshari Hospital.

Anaemia Among Refugees Pregnant Women in Gaza Strip: Perceptions, Awareness and Opinions and Attitudes

Anaemia in pregnancy is the most common public health concern in both developed and developing worlds like Palestine. Little is known about this significant health issue. Therefore, the purpose of this study was to investigate the perception, opinions and attitudes of anaemia among refugees pregnant women in Gaza strip. A cross-sectional study was employed among a random sample of 164 women or subjects, with a response rate of 81%. The survey was conducted at UNRWA antenatal health centers at refugee camps in Gaza strip. The study was approved by United Nations Relief and Work Agency (UNRWA) health department. The study elucidated that a higher rate of women were knowledgeable and had ideas on anaemia, however, some women had inadequate knowledge on anaemia during pregnancy. There were a concern and misconception regarding some issues on anaemia such as; lack of knowledge on the effect of drinking tea on iron absorption; and on the side effects of iron pills during pregnancy. Highly positive opinions and attitudes toward anaemia were observed in most women. The study found that a high proportion of women were dissatisfied with the volume of health education sessions on anaemia at UNRWA antenatal health centers and many women had not attended or joined such sessions. In general, the study declined to find a significant differences regarding anaemia between women with and those without health education sessions on anaemia. Finally, the study suggests that, an effective and a clear health education strategy is needed in order to improve women perceptions, awareness, opinions and attitudes regarding anaemia in Palestine. Further researches are important and needed in this scope.

Maternal weight gain during pregnancy and outcomes for the newborn child and mother in Tulkarem and in camps: a retrospective cohort study

BackgroundExcessive gestational weight gain appears to be a risk factor for low and high birthweight, preterm delivery, gestational diabetes, pre-eclampsia, caesarean section, and post-partum haemorrhage). The objective of this study was to determine the association between gestational weight gain and pregnancy outcomes. MethodsThis retrospective cohort study was done at a primary health-care centre supported by the Palestinian Ministry of Health in Tulkarem (one of the main cities in northern occupied Palestinian territory) and in two United Nations Relief and Works Agency (UNRWA) primary health-care centres (in the Tulkarem and Nourshams Camps) in 2016. Patient files of women who had given birth were reviewed, and sociodemographic data, medical history, body-mass index (BMI), and gestational weight gain were recorded. We used SPSS version 20 for statistical analysis. Significance was set at a p value of less than 0·05. This study was approved by the Institutional Review Board committee at An-Najah National University, and permission was obtained from the Ministry of Health and the UNRWA. Findings771 patient files were reviewed (326 from Tulkarem City, 274 from Tulkarem Camp, and 171 from Nourshams Camp). The mean age of mothers at first visit was 26·5 years (SD 5·81), and 328 (43%) women had attended tertiary education. 341 (44%) women had a normal BMI at first visit, 254 (33%) women were overweight, and 147 (19%) women were obese. 283 (37%) women gained weight within recommended levels, and 213 (28%) women gained more than the recommended weight. 210 (27%) women had a caesarean section. The incidences of preterm delivery, gestational diabetes, pre-eclampsia, and post-partum haemorrhage were 9%, 6%, 2%, and 10%, respectively. 405 (53%) newborn babies were boys and 366 (48%) were girls, with an overall mean birthweight of 3313 g (SD 511·83). 37 (5%) neonates had low birthweight, and 60 (8%) neonates had high birthweight. Bivariate analysis showed a significant association between gestational weight gain and BMI at first visit, high birthweight, and post-partum haemorrhage (p<0·001). Multivariate logistic regression showed that women who gained weight above recommendations had a higher risk of giving birth to a baby with high birthweight (odds ratio 3·4, 95% CI 1·65–7·00), whereas women who gained less than recommended had a lower risk of developing post-partum haemorrhage (odds ratio 0·44, 95% CI 0·199–0.996). InterpretationGaining more than the recommended weight during pregnancy is consistently associated with negative maternal and infant outcomes. These effects could be avoided if improved individualised care were systematically implemented in both ministry of health and UNRWA clinics to support women preconceptionally, prenatally, and post partum. FundingNone.

Determinants of bullying among Palestinian refugee students in Lebanon: a qualitative study

BackgroundDespite the high prevalence of bullying among Palestinian refugee students at schools of The United Nations Relief and Work Agency (UNRWA), estimated at 52·5% by Global School-based Students Health Survey done in 2010, little attention is given to it. Compared with worldwide prevalence of bullying, ranging between 7·1% and 70·2%, the prevalence of bullying at UNRWA schools is high. This study aims to understand the determinants behind bullying among Palestinian refugee students at UNRWA to be able to intervene and reduce the prevalence. MethodsQualitative methods for data collection were used. Three focus groups were interviewed at Haifa School in Lebanon among both female and male students of grades 7, 8, and 9 (aged 13–15 years). Every group contained ten students who were asked for both written parental consent and verbal consent. Findings were analysed with thematic analysis. FindingsOur findings showed that both individual and environmental factors were determinants of bullying being done among participants. Students' definition of bullying was different from what is accepted in the literature, being defined as physical abuse. Moreover, bullying was not regarded as a harmful behaviour, but instead a way of having fun and seeking a better self-image among their peers. These perceptions were the result of the camp environment. Our findings showed that Palestinian refugee students are exposed to violent acts—eg, hitting and use of guns in the refugee camp—which made them perceive bullying as an acceptable behaviour. Some students stated that they were raised on the idea of holding a gun or a knife to fight and protect themselves. This extreme exposure to violence made participants perceive kicking or hitting for the sake of making fun as being an acceptable behaviour as long as there is no injury. InterpretationThe determinants of bullying among Palestinian refugee students are different from those among non-refugee populations as shown in the published literature. Therefore, UNRWA schools should take these differences into consideration when planning future antibullying interventions. FundingThe United Nations Relief and Work Agency (UNRWA).

Assessment of diabetic care and patients' satisfaction: an exploratory study

BackgroundIt is expected that 438 million people will be affected by diabetes mellitus worldwide by 2030. Therefore, assessment of the quality of diabetic care from different dimensions, including patients' perspectives, is necessary. We did an exploratory study at Shouka Health Center, Gaza Strip, occupied Palestinian territory. MethodsWe collected medical records of patients with diabetes from August, 2011, to October, 2011, to assess completeness of diabetic files. We assessed nurses' and doctors' management plans using a modified United Nations Relief and Works Agency (UNRWA) Gaza Field Health Programme Checklist. Each item had three components; we summed scores for each item for the three components to produce an overall scaled index as a percentage for diabetic care. Additionally, we assessed patient satisfaction through exit interviews with five domains addressing health-provider care, health-provider communication, and self-care using a modified version of the Diabetic Continuity of Care Scale (Cronbach's α 0·75). We assessed differences between grouped variables using χ2 and t tests at a significance level of p<0·05. Statistical analysis was done with SPSS software (version 11.5). The study was approved by the ethics committee and written informed consent was obtained. FindingsWe collected 81 records. The overall scale of diabetic care quality was 85·5%. Overall patient satisfaction was 78·1% and satisfaction with doctors' care was 89·6%. Doctors' management plans scored the lowest satisfaction (77·9%) whereas completeness of patient records scored the highest (97·8%). We noted a significant positive correlation between doctors' management plans and overall satisfaction (r=0·24, p=0·03), completeness of files and overall satisfaction (r=0·27, p=0·02), doctors' management plans and access or care domain (r=0·28, p=0·01), and completeness of files and access or care domain (r=0·23, p=0·05). However, there was no significant correlation between the quality of diabetic care index and the overall satisfaction (r=0·16, p=0·19). Factor analysis showed that staff attitude was the most influential factor on overall satisfaction. InterpretationStaffs' attitude and their commitments seem important to patients' overall satisfaction. Training of doctors properly to manage diabetic patients should be intensified. The relationship between overall satisfaction and the diabetic care quality was obscured by self-care and other health professional care dissatisfaction. Limitations of our study include that exit interviews only capture patients who attend, and do not include those who do not attend, which might be affected by quality of the care. FundingNone.