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Basu S, Yudkin JS, Jawad M, Ghattas H, Hamad BA, Jamaluddine Z, Safadi G, Ragi ME, Ahmad RES, Vamos EP, Millett C. Reducing non-communicable diseases among Palestinian populations in Gaza: A participatory comparative and cost-effectiveness modeling assessment. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003168. [PMID: 38696423 PMCID: PMC11065248 DOI: 10.1371/journal.pgph.0003168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/02/2024] [Indexed: 05/04/2024]
Abstract
We sought to assess the effectiveness and cost-effectiveness of potential new public health and healthcare NCD risk reduction efforts among Palestinians in Gaza. We created a microsimulation model using: (i) a cross-sectional household survey of NCD risk factors among 4,576 Palestinian adults aged ≥40 years old in Gaza; (ii) a modified Delphi process among local public health experts to identify potentially feasible new interventions; and (iii) reviews of intervention cost and effectiveness, modified to the Gazan and refugee contexts. The survey revealed 28.6% tobacco smoking, a 40.4% prevalence of hypertension diagnosis (with a 95.6% medication treatment rate), a 25.6% prevalence of diabetes diagnosis (with 95.3% on treatment), a 21.9% prevalence of dyslipidemia (with 79.6% on a statin), and a 9.8% prevalence of asthma or chronic obstructive pulmonary disease (without known treatment). A calibrated model estimated a loss of 9,516 DALYs per 10,000 population over the 10-year policy horizon. The interventions having an incremental cost-effectiveness ratio (ICER) less than three times the GDP per capita of Palestine per DALY averted (<$10,992 per DALY averted)(<$10,992 per DALY averted) included bans on tobacco smoking in indoor and public places [$34 per incremental DALY averted (95% CI: $17, $50)], treatment of asthma using low dose inhaled beclometasone and short-acting beta-agonists [$140 per DALY averted (95% CI: $77, $207)], treatment of breast cancer stages I and II [$730 per DALY averted (95% CI: $372, $1,100)], implementing a mass media campaign for healthier nutrition [$737 per DALY averted (95% CI: $403, $1,100)], treatment of colorectal cancer stages I and II [$7,657 per DALY averted (95% CI: $3,721, $11,639)], and (screening with mammography [$17,054 per DALY averted (95% CI: $8,693, $25,359)]). Despite high levels of NCD risk factors among Palestinians in Gaza, we estimated that several interventions would be expected to reduce the loss of DALYs within common cost-effectiveness thresholds.
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Affiliation(s)
- Sanjay Basu
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, California, United States of America
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - John S. Yudkin
- Division of Medicine, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Hala Ghattas
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | | | - Zeina Jamaluddine
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Gloria Safadi
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Marie-Elizabeth Ragi
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Raeda El Sayed Ahmad
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Eszter P. Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
- National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
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Elshami M, Jaber I, Alser M, Al-Slaibi I, Jabr H, Ubaiat S, Tuffaha A, Khader S, Khraishi R, Arafeh ZA, Al-Madhoun S, Alqattaa A, Yaseen A, El Hadi AA, Barhoush O, Hijazy M, Eleyan T, Alser A, Hziema AA, Shatat A, Almakhtoob F, Mohamad B, Farhat W, Abuamra Y, Mousa H, Adawi R, Musallam A, Albarqi SI, Abu-El-Noor N, Bottcher B. Common misconceptions and myths about ovarian cancer causation: a national cross-sectional study from palestine. BMC Public Health 2024; 24:1027. [PMID: 38609950 PMCID: PMC11015600 DOI: 10.1186/s12889-024-18437-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Women's inability to recognize ovarian cancer (OC) causation myths to be incorrect may lead to behavioral changes that could distract them from actual risk factors and impact their treatment decision making. This study examined Palestinian women's recognition of OC mythical causes, and explored factors associated with good recognition. METHODS A national cross-sectional study was conducted. Adult Palestinian women were recruited from hospitals, primary healthcare facilities, and public areas in 11 governorates. The Cancer Awareness Measure-Mythical Causes Scale was modified and utilized for data collection. Awareness level was determined based on the number of myths around OC causation recognized to be incorrect: poor (0-4), fair (5-9), and good (10-13). RESULTS A total of 5618 participants agreed and completed the questionnaire out of 6095 approached (response rate = 92.1%), and 5411 questionnaires were included in the final analysis. The most recognized food-related myth was 'drinking from plastic bottles' (n = 1370, 25.3%) followed by 'eating burnt food' (n = 1298, 24.0%). The least recognized food-related myth was 'eating food containing additives' (n = 611, 11.3%). The most recognized food-unrelated myth was 'having a physical trauma' (n = 2899, 53.6%), whereas the least recognized was 'using mobile phones' (n = 1347, 24.9%). Only 273 participants (5.1%) had good awareness of OC causation myths as incorrect. Earning higher monthly incomes as well as visiting governmental healthcare facilities were associated with a decrease in the likelihood of exhibiting good awareness. CONCLUSION The overall recognition of OC causation myths was low. Addressing mythical beliefs should be included in OC prevention strategies and public health interventions to improve women's understanding of OC risk factors versus mythical causes.
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Affiliation(s)
- Mohamedraed Elshami
- Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7100, 44106, Cleveland, OH, USA.
- Ministry of Health, Gaza, Palestine.
| | - Inas Jaber
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Mohammed Alser
- United Nations Relief and Works Agency for Palestine Refugees (UNRWA), Gaza, Palestine
| | | | | | - Sara Ubaiat
- Faculty of Medicine, Al-Quds University, Bethlehem, Palestine
| | | | - Salma Khader
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Reem Khraishi
- Faculty of Medicine, An-Najah National University, Nablus, Palestine
| | | | | | - Aya Alqattaa
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Areej Yaseen
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Ola Barhoush
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Maysun Hijazy
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Tamara Eleyan
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Amal Abu Hziema
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Amany Shatat
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Balqees Mohamad
- Doctors Without Borders (Médecins Sans Frontières), Hebron, Palestine
| | - Walaa Farhat
- Faculty of Medicine, Al-Azhar University-Gaza, Jenin, Palestine
| | - Yasmeen Abuamra
- Faculty of Medicine, Al-Azhar University-Gaza, Gaza, Palestine
| | - Hanaa Mousa
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Reem Adawi
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | | | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
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Ammar-Shehada W, Bracke P. The influence of socio-demographic factors on the stage at which women's breast cancer is diagnosed and treatment prescribed in the Gaza Strip, occupied Palestinian territory. Ecancermedicalscience 2023; 17:1522. [PMID: 37113708 PMCID: PMC10129395 DOI: 10.3332/ecancer.2023.1522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Indexed: 04/29/2023] Open
Abstract
Background One of every three women diagnosed with breast cancer (BC) in Gaza does not live for more than 5 years. They are faced by unreliable treatment plans. Radiotherapy is not available locally and there are chronic shortages in the chemotherapy medications. This paper aims to provide understanding of how socio-demographic factors affect the stage at which the cancer is diagnosed and what treatment is prescribed. Methods Data were collected through a cross-sectional survey targeting women living in Gaza who had been diagnosed with BC at least once. The survey was self-administered and distributed to 350 women between 1 March 2021 and 30 May 2021. Multinomial logistic regression (SPSS, version 28.0) was used to explore the association between stage of the cancer at diagnosis and socio-demographic characteristics. The relationship between the stage at diagnosis and prescribed treatment was explored using a cluster analysis and crosstabulations. Findings Socio-demographic inequalities were reflected in stage at diagnosis and varied by age, education, employment, marital status, and refugee status. Breast cancer was less likely to be detected at an advanced stage among educated respondents (women with primary education OR = 0.093, p = 0.008 and women with preparatory education OR = 0.172, p = 0.005), employed women (OR = 0.056, p = 0.022). It was more likely to be detected at an early stage (OR = 3.954, p = 0.011) in women aged 41-50. In widowed and separated/divorced women, it was less likely to be detected at an early stage (OR = 0.217, p = 0.029) and (OR = 0.294, p = 0.028) respectively, than among married women. Among refugee women, it was less likely to be detected at early stage than among non-refugee women (OR = 0.251, p = 0.007). Among the total respondents, only 30% of the full prescribed treatment was available locally. Conclusion Our research showed various levels of inequalities at the stage of diagnosis by age, marital status, education, employment and refugee status. Most of the survivors needed treatment that was unavailable locally.
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Affiliation(s)
| | - Piet Bracke
- Health and Demographic Research, Ghent University, 9000 Ghent, Belgium
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Bouquet B, Muhareb R, Smith R. "It's Not Whatever, Because This Is Where the Problem Starts": Racialized Strategies of Elimination as Determinants of Health in Palestine. Health Hum Rights 2022; 24:237-254. [PMID: 36579312 PMCID: PMC9790962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
In this paper, we examine the social construction of race as a determinant of health inequities in Palestine. Race myths about Palestinians conform to the "logic of elimination" integral to settler colonialism, predicated on the dispossession and removal of the Indigenous people from the land. Racialized legal categorizations of Palestinians are deployed in strategies of elimination that include policies and practices of extrajudicial killing, maiming, and excessive use of force; displacement, dispossession, isolation, and containment; and arbitrary detention and movement restrictions. Differential freedoms and entitlements derive from the deployment of racialized legal categorizations, regulating the material conditions of life and exposure to deliberate bodily harm that make up intermediary determinants of health. Our iterative model outlining the symbolic and systemic constitution of racialized health inequities in Palestine aims to support analysis of the root causes of human rights violations, essential to a human rights-based approach to health. Root-cause analysis confers appropriate recommendations for action. The radical dismantling of systematic racial oppression and domination in Palestine, tantamount to apartheid, is a precondition for realizing the right to health for all.
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Affiliation(s)
- Benjamin Bouquet
- A PhD candidate in health and human rights at the Population Health Sciences Institute and School of Law at Newcastle University, Newcastle, United Kingdom.,Please address correspondence to Benjamin Bouquet. .
| | - Rania Muhareb
- An Irish Research Council and Hardiman PhD scholar at the Irish Centre for Human Rights in the School of Law, University of Galway, Ireland
| | - Rhona Smith
- A professor of international human rights at the School of Law at Newcastle University, Newcastle, United Kingdom
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Alkhaldi M, Coghlan R, Miller S, Basuoni AA, Tanous O, Asi YM. State Accountability for the Good Health of Palestinians Has Failed: What Can the Global Health Community Do Next? Health Hum Rights 2022; 24:77-84. [PMID: 35747282 PMCID: PMC9212828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Mohammed Alkhaldi
- Scientific collaborator at the Faculty of Medicine and Health Sciences, Najah National University, Nablus, Palestine.,Please address correspondence to Mohammed Alkhaldi. .
| | - Rachel Coghlan
- PhD student at the Centre for Humanitarian Leadership, Faculty of Arts and Education, Deakin University, Victoria, Australia
| | - Simon Miller
- Independent human rights lawyer, Melbourne, Australia
| | - Aisha Al Basuoni
- Head of projects unit at the Gaza Community Mental Health Programme, Gaza, Palestine
| | - Osama Tanous
- 2020–2021 Hubert H. Humphrey Fellow at the Rollins School of Public Health, Emory University, Atlanta, USA
| | - Yara M. Asi
- Assistant professor at the School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA
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Amer F. Al-Nawati tragedy: a 16-year-old patient with leukaemia and no access to cancer care. Lancet Oncol 2022; 23:447-449. [DOI: 10.1016/s1470-2045(22)00091-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/05/2022] [Accepted: 02/09/2022] [Indexed: 10/18/2022]
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