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n MOH centres, and UNRWA PHCs have well-established internal but poor external reporting systems. Absence of monitoring may have a role, and a lack of guidelines, protocols, and forms for reporting were mentioned by HCWs, medical health officers and information system managers, and the focus group. Some HCWs may not know their responsibilities (eg, to whom AEFI should be reported). Many other obstacles face HCWs, including fear of punishment and accountability. Therefore, HCWs must be encouraged to report adverse events without fear of penalty. In addition, lack of education on AEFI and lack of experience in identifying AEFI may affect reporting. Training of HCWs, development of guidelines and protocols, database construction and design, and monitoring of the AEFI surveillance system are highly recommended.
WHO EMRO.
WHO EMRO.
Hypertensive disorders affect 10% of all pregnant women and increase the risk of adverse maternal and neonatal outcomes and the psychological wellbeing and quality of life of women. This study is to the best of my knowledge the first to investigate these issues in the Gaza Strip. Commisterone I compared adverse effects in pregnancy between hypertensive and non-hypertensive women.
In this comparative study, eligible participants were hypertensive and non-hypertensive women attending health centres for postnatal care between August, 2016, and May, 2017. Six UNRWA health centres of 21 in Gaza Strip were selected randomly and quota sampling was applied after written informed consent was obtained. Data were collected by face-to-face interview and completion of the WHOQOL-BREF scale and SF-36 to assess quality of life. Additionally, data were extracted from patients' electronic primary medical records. Differences were analysed with Student's t test and the χ
test, using SPSS version 22.
430 mothers were enrolled, inclu compared with those born to women in the non-hypertensive group. Hypertensive mothers had a lower mean quality of life score than women in the non-hypertensive group (64·2 vs 71·3, p=0·001).
Neonatal admission in the hypertensive group and the caesarean section rates were lower than expected given the rates of preterm birth and low birthweight. These findings might be attributed to inadequate specialised management due to limited resources, blockade, receiving specialist treatment outside Gaza Strip, and political context. However, higher number of antenatal care visits suggests that hypertensive women receive more antenatal care from health-care providers at UNRWA clinics than non-hypertensive women. Secondary and tertiary maternal care in Gaza Strip need to be improved. A limitation of this study was poor documentation of some secondary health care data in electronic primary medical records but was overcome by reviewing hospital records.
None.
None.
Anti-D immunoglobulin (anti-D) therapy is cheaper and has a shorter infusion time than intravenous immunoglobulin G (IgG), but their comparative effects in the treatment of acute immune thrombocytopenia (ITP) have not been studied thoroughly. The aim of this study was to compare the effect of anti-D and intravenous IgG in the treatment of acute ITP in children.
The medical records of children diagnosed with acute ITP between January, 2008, and January, 2018, at Al-Rantisy Specialized Pediatric Hospital (a tertiary care centre) in Gaza were reviewed. Patients who received either intravenous anti-D (75 μg/kg, single dose) or intravenous IgG (2 g/kg, divided doses) as initial treatment for ITP were included in this retrospective study. Data on patient demographics, hospital stay period, and adverse drug reactions were collected for analysis. Laboratory results, including platelet counts and haemoglobin levels, were evaluated before treatment, and after 1, 3, 5, and 7 days of treatment. The therapy response wnge, 0·1-1·4 g/dL; intravenous IgG group, mean 0·5 g/dL, range, 0·2-1·2 g/dL; p=0·237), but increased on days 5 and 7 in both groups. The changes in haemoglobin after treatment were similar in both study groups. No patient developed severe anaemia requiring medical intervention. The average length of hospital stay was significantly shorter in the anti-D group than in the intravenous IgG group (1·8 days and 3·2 days, respectively; p<0·0001). Fewer adverse effects (headache, vomiting, chills) were reported in children who received anti-D therapy.
In this analysis, anti-D was as effective as intravenous IgG in the treatment of children with acute ITP. Given that patients in the anti-D group experienced fewer adverse effects and shorter hospitalisation times than patients in the intravenous IgG group, this suggests that anti-D is a good substitute for intravenous IgG in the treatment of children with acute ITP.
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None.
Pain management after caesarean delivery is important because acute pain in the postoperative period is associated with persistent pain, increased opioid use and postpartum depression, and delayed functional recovery. We investigated the role of nurse-supported care in acute pain management after caesarean delivery, which as far as we know has not previously been investigated in Gaza.
This was a comparative study done from March, 2018, to October, 2018, among women assigned to undergo caesarean delivery. Research nurses at the Al-Helal Al-Emirati Hospital, Rafah, Gaza Strip, occupied Palestinian territory, were trained to give supportive pain management care to women after caesarean delivery, including individualised care and educational sessions on pain, nutrition, exercise, and wound care. Women were randomly assigned to receive nurse-supported care or usual care. Pain assessment scales (range 1-5, where 1=no pain and 5=pain as bad as it could be) were used to record pain at 1, 6, 12, 18, and 24 h aftertion, and repeatability of the effects of nurse supportive care on pain perception and duration of hospital stay after caesarean delivery.
None.
None.
In 2016, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) changed from covering the full cost of secondary care in contracted public and private hospitals in Lebanon, Jordan, to requesting that these hospitals pay 10% of the costs. Meanwhile, services at UNWRA-contracted Palestine Red Crescent Society (PRCS) hospitals remained fully covered. We did a health economics analysis to assess the effects this policy change on the demand for secondary care in UNRWA hospitals.
We assessed the difference in use of different types of hospital (demand) from January to May, 2016, and June, 2016, to October, 2017, before and after the payment policy change. Data were collected by UNWRA from each hospital's database, including individual-level inpatient information for 22 193 Palestinian refugees in Lebanon who were admitted to secondary care at UNRWA-contracted hospitals (public, private, and PRCS). We used regression analyses to estimate the effects on demand for the different hospital types, length of stay, and total costs of treatment to UNWRA and patients.