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Snoubar M, Kasim S, Badawi M, Shaban Q, AbuAlrub I, Hunjul M, Khelfeh N, Abuhassan A, Hanani A, Bilbeisi S, Damiri B. High-risk drug use among Palestinian adolescent refugees in the North West Bank Palestine. J Ethn Subst Abuse 2023:1-20. [PMID: 37698173 DOI: 10.1080/15332640.2023.2255850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Palestinian adolescent refugees are at increased risk for behaviors that can lead to poor health outcomes, such as high-risk substance use. This research focuses on the prevalence of substance use and its relationship with depression among adolescent male refugees in Palestine's North-West Bank. A cross-sectional study was conducted in five of seven refugee camps to gather data using a proportional stratified sampling technique. A structured questionnaire-based interview was conducted to gather sociodemographic data, self-reported substance use, and depression scale information. Additionally, urine screening tests were used to detect the presence of different drugs in participants' urine samples. The final sample size was 386 refugee males; 24.0% were workers, and 13.7% worked previously. For self-reported substance use, 26.9%;12.4%; 28.0%; 37.0%; and 60.4%, 2.6% of adolescents reported current users of cigarettes, e-cigarettes, waterpipe, coffee, energy drinks (ED), and alcohol, respectively. Moreover, 3.4% tested positive for at least one drug. The drugs that tested positive were as follows: PCP (5%), MDMA (1.8%), THC (1.6%), BZO (0.5%), and MET (0.5%). The adjusted logistic regression showed an increased risk of depression among workers (OR = 3.777; p-value = 0.008), cigarette smokers (OR = 2.948; p-value = 0.04), waterpipe smokers (OR = 4.458; p-value = 0.041), and coffee users (OR = 2.883, p-value = 0.046). In conclusion, Palestinian adolescent refugees are at increased risk for behaviors that can lead to poor health outcomes, such as high-risk substance use, including illicit drugs, alcohol use, tobacco smoking, and ED intake. The results of this study reveal alarming figures on drug use associated with depression in refugee camps which demand controlling interventions.
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Affiliation(s)
| | - Salih Kasim
- An-Najah National University, Nablus, Palestine
| | | | | | | | | | | | | | | | - Saed Bilbeisi
- Opioid Substitution Therapy Unit, Ramallah, Palestine
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Jamal Z, ElKhatib Z, AlBaik S, Horino M, Waleed M, Fawaz F, Loffreda G, Seita A, Witter S, Diaconu K. Social determinants and mental health needs of Palestine refugees and UNRWA responses in Gaza during the COVID-19 pandemic: a qualitative assessment. BMC Public Health 2022; 22:2296. [PMID: 36482403 PMCID: PMC9733234 DOI: 10.1186/s12889-022-14771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Due to pre-existing difficulties, refugees are especially susceptible to the negative effects of the pandemic; nonetheless, the pandemic's effect on this group is still unclear. The purpose of this study was to determine the effects of the COVID-19 pandemic on the mental health of Palestine refugees in Gaza by identifying the role of social determinants. During the pandemic, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) enacted a number of policies and measures. The purpose of this research was to assess their efficacy and acceptability. METHODS This qualitative study took place between August and November 2020. Twenty-nine key-informant interviews were conducted remotely with UNRWA Headquarters, field and clinical staff in Gaza and with community members, aged ≥18 years and residing in Rafah and Jabalia camps. We sought informed consent verbally or via email. Data was coded based on the framework for social determinants of mental health. RESULTS Interview results indicated that the relationship might be unidirectional, with COVID-19 causing the degradation of living conditions and vice versa, with living conditions exacerbating the COVID-19 situation by facilitating virus transmission. In other instances, the association between mental health determinants and COVID-19 might be bidirectional. In terms of experiencing violence and anxieties, women, children, and daily-paid employees were significantly more disadvantaged than other groups in the community. UNRWA modified its service delivery techniques in order to continue providing essential services. In general, UNRWA's strategies throughout the pandemic were deemed beneficial, but insufficient to meet the needs of Gazans. CONCLUSION The pandemic highlights the need to go beyond disease treatment and prevention to address social determinants to improve refugees' health and reduce their susceptibility to future shocks. UNRWA has rapidly implemented telemedicine and mental telehealth services, making it imperative to assess the efficacy of these novel approaches to provide care at a distance. A long-term option may be to employ a hybrid strategy, which combines online and in-person therapy.
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Affiliation(s)
- Zeina Jamal
- grid.104846.fInstitute for Global Health and Development, Queen Margaret University, Musselburgh EH21 6UU Edinburgh, Scotland, UK
| | - Zoheir ElKhatib
- The United Nations for the Relief and Works Agency in the Near East (UNRWA) Field Office, Gaza, Palestine
| | - Shatha AlBaik
- grid.501184.90000 0001 2173 1062The United Nations for the Relief and Works Agency in the Near East (UNRWA) Headquarters, Amman, Jordan
| | - Masako Horino
- grid.501184.90000 0001 2173 1062The United Nations for the Relief and Works Agency in the Near East (UNRWA) Headquarters, Amman, Jordan ,grid.21107.350000 0001 2171 9311Center for Human Nutrition and Sight & Life Global Nutrition Research Institute, Dept of Int’l Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Mohammed Waleed
- The United Nations for the Relief and Works Agency in the Near East (UNRWA) Field Office, Gaza, Palestine
| | - Farah Fawaz
- grid.501184.90000 0001 2173 1062The United Nations for the Relief and Works Agency in the Near East (UNRWA) Headquarters, Amman, Jordan
| | - Giulia Loffreda
- grid.104846.fInstitute for Global Health and Development, Queen Margaret University, Musselburgh EH21 6UU Edinburgh, Scotland, UK
| | - Akihiro Seita
- grid.501184.90000 0001 2173 1062The United Nations for the Relief and Works Agency in the Near East (UNRWA) Headquarters, Amman, Jordan
| | - Sophie Witter
- grid.104846.fInstitute for Global Health and Development, Queen Margaret University, Musselburgh EH21 6UU Edinburgh, Scotland, UK
| | - Karin Diaconu
- grid.104846.fInstitute for Global Health and Development, Queen Margaret University, Musselburgh EH21 6UU Edinburgh, Scotland, UK
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Alduraidi H, Abdulla Aqel A, Saleh Z, Almansour I, Darawad M. UNRWA's role in promoting health outcomes of Palestinian refugees in Jordan: A systematic literature review. Public Health Nurs 2021; 38:692-700. [PMID: 33715186 DOI: 10.1111/phn.12889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The mandate of the United Nations Relief and Work Agency in the Near East (UNRWA) includes education and health services of registered Palestinian refugees in Jordan and other countries. UNRWA is facing limited funding because of unstable political circumstances. This review aims to spotlight the importance of UNRWA's role in promoting Palestinian refugees' health inside and outside camps in Jordan. METHOD This systematic review was conducted through iteratively searching electronic research databases for original, recent, full-text literature regarding the health and social outcomes of Palestinian refugees in Jordan. RESULTS The 12 reviewed studies showed that UNRWA's programs through its clinics and schools have a crucial role in improving Palestinian refugees' health outcomes such as adolescents' cigarette smoking prevalence, infant mortality, non-communicable disease management, health-related quality of life, mental/psychological health services, and reproductive health. Access to UNRWA's health services may account for better or comparable health outcomes among Palestinian refugees. CONCLUSION Despite the short funding and political pressures, UNRWA has provided aid and services to Palestinian refugees inside and outside refugee camps in Jordan. UNRWA's role is crucial in maintaining decent health outcomes in this vulnerable, underserved population. The further limiting of UNRWA funding may jeopardize the health of millions.
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Affiliation(s)
- Hamza Alduraidi
- Accreditation Department, Accreditation & Quality Assurance Center, The University of Jordan, Amman, Jordan.,Community Health Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
| | - Ahmad Abdulla Aqel
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
| | - Zyad Saleh
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
| | - Issa Almansour
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
| | - Mohammad Darawad
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
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Damiri B, Khatib O, Nazzal Z, Sanduka D, Igbaria S, Thabaleh A, Farhoud A, Saudi L, Belkebir S, Al Ali R, Alili M, Hamdan M, Safarini OA, Younis O. Metabolic Syndrome Associated with Tobacco and Caffeine Products Use Among Refugee Adolescents: Risk of Dyslipidemia. Diabetes Metab Syndr Obes 2021; 14:4121-4133. [PMID: 34616165 PMCID: PMC8487859 DOI: 10.2147/dmso.s329675] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/21/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Due to their stressful lives, Palestinian refugees are prone to use cognitive enhancers (CE) and psychostimulant substances (PS). Recognising health problems associated with CE/PS use can indicate how preventive programs should be directed towards adolescents. Unfortunately, research has not thoroughly investigated the health problems related to tobacco and caffeine products, the most socially acceptable CE/PS among Palestinian refugee adolescents. METHODOLOGY In 2021, schoolchildren from five Palestinian refugee camps (N=271) aged 12-<16 years agreed to give blood samples and to be interviewed to address the association between metabolic syndrome (MetS) and tobacco smoking, coffee, energy drinks (ED), black tea, and chocolate consumption. MetS was diagnosed based on International Diabetic Federation Criteria. To address the association, we used binary logistic regression models adjusted to age, gender, BMI, and central obesity. RESULTS The prevalence of MetS was [17 (6.3%)]; (7.4%) in males, (5.1%) in females. The prevalence of substance use was as follows: ED [163 (48.9%)], coffee [255 (76.6%)], black tea [295 (89.1%)], cigarette [35 (10.5%)], waterpipe [59 (17.7%)], and chocolate [309 (93.6%)], with male predominance. Cigarette smokers have increased central obesity (p-value=0.024), and decreased HDL-cholesterol (p-value=0.015) than non-smokers. Similar results were observed for waterpipe smokers besides the increased levels of triglycerides (p-value=0.01). ED consumers have increased central obesity (p-value=0.03) and fast blood sugar (p-value=0.003) than non-consumers. Chocolate consumers have decreased central obesity (p-value=0.008) and increased HDL levels (p-value=0.04) than non-consumers. ED consumers were significantly at higher risk of MetS (OR=9.97, p-value=0.019) than non-consumers and chocolate consumers were at lower risk of MetS (OR=0.14, p-value=0.046) than non-consumers. Waterpipe smokers were at a higher risk of having increased plasma triglycerides than non-consumers (OR=3.4, p-value=0.03). CONCLUSION The high prevalence of ED consumption and waterpipe smoking in Palestinian refugee adolescents is problematic. Their use was associated with higher odds of MetS, dyslipidemia, and central obesity, which justifies greater attention.
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Affiliation(s)
- Basma Damiri
- Medicine & Health Science Faculty, Drug, and Toxicology Division, An-Najah National University, Nablus, 00970, Palestine
- Correspondence: Basma Damiri Faculty of Medicine and Health Sciences, Drug and Toxicology Division, An-Najah National University, P.O. Box 7, Nablus, 00970, PalestineTel +972592234270 Email
| | - Omar Khatib
- Medicine & Health Science Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Zaher Nazzal
- Medicine & Health Science Faculty, Family and Community Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Diala Sanduka
- Medicine & Health Science Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Siwar Igbaria
- Medicine & Health Science Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Ammar Thabaleh
- Medicine & Health Science Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Ahmad Farhoud
- Medicine & Health Science Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Lubna Saudi
- Medicine & Health Science Faculty, Family and Community Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Souad Belkebir
- Medicine & Health Science Faculty, Family and Community Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Rayyan Al Ali
- Medicine & Health Sciences Faculty, Forensic Medicine Institute, An-Najah National University, Nablus, 00970, Palestine
| | - Mohammed Alili
- Medicine & Health Science Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Mahmoud Hamdan
- Medicine & Health Science Faculty, Graduate School, Clinical Laboratory Science Program, An-Najah National University, Nablus, 00970, Palestine
| | - Omar A Safarini
- Medicine & Health Science Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine
| | - Omar Younis
- Medicine & Health Science Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine
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Jamal Z, Alameddine M, Diaconu K, Lough G, Witter S, Ager A, Fouad FM. Health system resilience in the face of crisis: analysing the challenges, strategies and capacities for UNRWA in Syria. Health Policy Plan 2020; 35:26-35. [PMID: 31625558 DOI: 10.1093/heapol/czz129] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2019] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Zeina Jamal
- Institute for Global Health and Development, Queen Margaret University, Edinburgh EH21 6UU, UK
| | - Mohamad Alameddine
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, P.O. Box 11-0236, Riad El-Solh/Beirut 1107 2020, Lebanon
| | - Karin Diaconu
- Institute for Global Health and Development, Queen Margaret University, Edinburgh EH21 6UU, UK
| | - Graham Lough
- Institute for Global Health and Development, Queen Margaret University, Edinburgh EH21 6UU, UK
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh EH21 6UU, UK
| | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University, Edinburgh EH21 6UU, UK
| | - Fouad M Fouad
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, P.O. Box 11-0236, Riad El-Solh/Beirut 1107 2020, Lebanon
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Turki Y, Saleh S, Albaik S, Barham Y, van de Vrie D, Shahin Y, Hababeh M, Armagan M, Seita A. Assessment of the knowledge, attitudes, and practices (KAP) among UNRWA* health staff in Jordan concerning mental health programme pre-implementation: a cross-sectional study. Int J Ment Health Syst 2020; 14:54. [PMID: 32760442 PMCID: PMC7392824 DOI: 10.1186/s13033-020-00386-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 07/21/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mental health is a major public health priority, especially among refugees. The United Nations Relief and Works Agency for Palestine Refugees (UNRWA) started to integrate mental health and psychosocial support (MHPSS) into its primary healthcare services in Jordan in late 2017. In this study, we aimed to assess of the knowledge, attitudes, and practices (KAP) among UNRWA health staff (HS) in Jordan concerning mental health programme pre-implementation, and their perceived barriers about this MHPSS programme. METHODS A cross-sectional study was conducted among doctors, dentists, nurses, and midwives who work at 16 of the 25 UNRWA health centres in Jordan. The assessment was made using a validated self-administered questionnaire. Data analysis was performed using SPSS (version 22). RESULTS Of the participants, 73% (161 of 220) believed that their knowledge of MHPSS programmes was insufficient, with no significant difference (p = 0·116) between different categories of staff. Furthermore, 88% (194 of 220) said that they needed more training, 67% (147 of 220) reported that the number of mental health cases is increasing, and 50% (110 of 220) that dealing with these cases is difficult. Reflecting on the past 12 months, 31% of staff (69 out of 220) reported meeting between one and ten children, and 45% (100 out of 220) reported meeting between one and ten adults suspected of having mental illnesses. The most suspected condition was depression (84%; 150 of 220), followed by epilepsy (64%; 140 of 220). The main perceived barriers to implementation included the limited availability of MHPSS policies (87%; 192 of 220), MH professionals (86%; 190 of 220), resources (86%; 189 out of 220), and lack of privacy (14%; 31 out of 220). CONCLUSIONS Most health staff had positive attitudes towards MHPSS programme implementation but felt they lacked the required knowledge. There is a need for training and clear technical guidelines. Perceived barriers to MHPSS programme implementation were consistent with the previous studies and need to be tackled with a structured plan of action.
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Affiliation(s)
- Yassir Turki
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan
| | - Suha Saleh
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan
| | - Shatha Albaik
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan
| | - Yasmeen Barham
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan
| | - Dorien van de Vrie
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan
| | - Yousef Shahin
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan
| | - Majed Hababeh
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan
| | - Merve Armagan
- College of Fine Arts, Humanities and Social Sciences, The University of Massachusetts Lowell, Lowell, United States
| | - Akihiro Seita
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan
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Nasir S, Goto R, Kitamura A, Alafeef S, Ballout G, Hababeh M, Kiriya J, Seita A, Jimba M. Dissemination and implementation of the e-MCHHandbook, UNRWA's newly released maternal and child health mobile application: a cross-sectional study. BMJ Open 2020; 10:e034885. [PMID: 32156767 PMCID: PMC7064073 DOI: 10.1136/bmjopen-2019-034885] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES In April 2017, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) released the electronic Maternal andChildHealth Handbook, the e-MCH Handbook application. One of the first mobile health (m-Health) interventions in a refugee setting, the application gives pregnant women and mothers access to educational information and health records on smartphones. This study investigated factors associated with the dissemination and implementation of m-Health in the refugee setting. SETTING AND PARTICIPANTS A cross-sectional study was conducted in 9 of 25 UNRWA health centres for Palestine refugees in Jordan. Self-administered questionnaires were distributed for 1 week to pregnant women and mothers with children aged 0-5 years. OUTCOME MEASURES The outcomes were whether participants knew about, downloaded or used the application. Multiple regression analyses were conducted to determine factors associated with application download and usage. RESULTS 1042 participants were included in the analysis. 979 (95.5%) had a mobile phone and 862 (86.9%) had a smartphone. 499 (51.3%) knew about, 235 (23.8%) downloaded and 172 (17.4%) used the application. Having other mobile applications (OR 6.17, p<0.01), staff knowledge of the application (OR 11.82, p<0.01), using the internet as a source of medical information (OR 1.63, p=0.01) and having internet access at home (OR 1.46, p=0.05) were associated with application download. The age of the husband was associated with application usage (OR 1.04, p=0.11). CONCLUSIONS Though m-Health may be a promising means of promoting health in refugees, multiple barriers may exist to its dissemination and implementation. Those who regularly use mobile applications and get medical information from the internet are potential targets of m-Health dissemination. For successful implementation of a m-Health intervention, health staff should have thorough knowledge of the application and users should have access to the internet. Husband-related factors may also play a role.
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Affiliation(s)
- Seif Nasir
- University of Nebraska Medical Center, Omaha, Nebraska, USA
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East, Amman, Jordan
| | - Ryunosuke Goto
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East, Amman, Jordan
- Department of Pediatrics, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | | | - Sahar Alafeef
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East, Amman, Jordan
| | - Ghada Ballout
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East, Amman, Jordan
| | - Majed Hababeh
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East, Amman, Jordan
| | - Junko Kiriya
- Department of Community and Global Health, The University of Tokyo, Graduate School of Medicine, Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Akihiro Seita
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East, Amman, Jordan
| | - Masamine Jimba
- Department of Community and Global Health, The University of Tokyo, Graduate School of Medicine, Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
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Abu Kishk N, Shahin Y, Mitri J, Turki Y, Zeidan W, Seita A. Model to improve cardiometabolic risk factors in Palestine refugees with diabetes mellitus attending UNRWA health centers. BMJ Open Diabetes Res Care 2019; 7:e000624. [PMID: 31497303 PMCID: PMC6708257 DOI: 10.1136/bmjdrc-2018-000624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 05/21/2019] [Accepted: 06/18/2019] [Indexed: 01/27/2023] Open
Abstract
Introduction The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) is the main primary healthcare provider and provides assistance and protection to around 5 million Palestine refugees in Jordan, Lebanon, Syria, West Bank and Gaza. Diabetes mellitus (DM) is a common problem among Palestine refugees, with a prevalence of 11.0%. In 2014, UNRWA embarked on a diabetes campaign to assist both patients with DM and staff in improving diabetes care management, by building the capacity of UNRWA's health staff and improving the knowledge and lifestyle behaviors among Palestine refugees with DM. Method Using a quasiexperimental study, we randomly selected 50 patients with diabetes from the 32 largest UNRWA health centers (HC); a total of 1600 participants were enrolled. Each HC conducted weekly group sessions for 6 months, including education, healthy cooking, and physical exercise. Body measurements, 2-hour postprandial glucose test, blood pressure and session attendance were collected on a weekly basis. Demographical data, pre/postquestionnaires and cholesterol levels were collected before and after the campaign. Paired t-test in SPSS V.21 was used. Results Out of 1600 patients, 1598 (1186 (74.0%) females and 412 (26.0%) males) completed the campaign; 576 (36.0%) patients had diabetes type 2 (DMII), 960 (60.0%) had DMII and hypertension and 62 (4.0%) had diabetes type 1 (DMI). After the campaign, the average weight loss was 2.6 kg (95% CI 2.4 to 2.7). In addition, 22% lost ≥5%, 25% lost 3%-5%, and 30% lost 1%-3% of their weight. Significant improvements were seen in blood glucose, cholesterol and waist circumference (WC) (p≤0.001 for all). The session attendance rate was 70.6% in total. Conclusions This campaign focused on raising healthy lifestyle awareness and practices among Palestine refugees with DM. It was associated with reduction cardiometabolic risk factors. Similar campaigns need to be sustained and expanded. Local community and non-governmental organization partnerships observed during the campaign should be strengthened and sustained.
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Affiliation(s)
| | | | - Joanna Mitri
- Joslin Center, Harvard Medical School, Boston, Massachusetts, USA
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Ewen M, Al Sakit M, Saadeh R, Laing R, Vialle-Valentin C, Seita A, Bunders J. Comparative assessment of medicine procurement prices in the United Nations Relief and Works Agency for Palestine Refugees in the Near East ( UNRWA). J Pharm Policy Pract 2014; 7:13. [PMID: 25379183 DOI: 10.1186/2052-3211-7-13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/08/2014] [Indexed: 11/10/2022] Open
Abstract
Objectives The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), the main primary healthcare provider for 4.9 million Palestinian refugees, spent USD18.3 million on essential medicines dispensed free-of-charge through clinics in five areas of operation (‘fields’): Gaza, Jordan, Lebanon, Syria, and the West Bank (2010). Faced with budget contraints and an increasing demand for medicines to treat chronic conditions, the objective of our study was to assess UNRWA’s medicine procurement prices to see if savings could be possible. Methods In July 2011, data was collected from UNRWA headquarters in Jordan. Price analyses focused on the top 80 medicines by value, accounting for 93% of pharmaceutical expenditure from the General Fund, with comparisons to international, regional and national references. Prices were also compared for the few medicines procured both through UNRWA’s central tender (centrally) and by the fields directly (locally). Results Central procurement prices did not differ markedly from reference prices: median ratios of UNRWA prices to Management Sciences for Health’s International Drug Price Indicator Guide, Jordan’s Joint Procurement Department, Gulf Cooperation Council, and IDA Foundation bulk packs were 0.99, 1.00, 0.98 and 1.12 respectively. Applying the lowest comparator price to five comparatively higher priced medicines would yield savings of USD1.4 million. Local procurements were generally less cost-effective than central tender procurement, with notable differences across fields and medicines. Conclusions Overall, UNRWA’s procurement prices were competitive despite the relatively small quantities procured. Regular monitoring of procurement prices and quantities is needed in order to make informed decisions. Our evaluation also underscores the heavy burden of antidiabetic medicines and antimicrobials on UNRWA procurement expenditure.
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