FADA - Birzeit University

Hassan, Sahar

Husseini, Abdullatif

Abstracts
18 www.thelancet.com
Published Online 
December 5, 2013
For all Palestine Abstracts and 
accompanying Comments see 
http://www.thelancet.com/
health-in-the-occupied-
palestinian-territory-2013
Institute of Community and 
Public Health, Birzeit 
University, Ramallah, West 
Bank, occupied Palestinian 
territory (S Hassan MSN, 
A Husseini PhD); Public Health 
Program, Department of 
Health Sciences, Qatar 
University, Doha, Qatar 
(A Husseini); Section of 
Preventive Medicine and 
Epidemiology (S Hassan, 
Prof E Bjertness PhD), and 
Section of International 
Community Health 
(Prof J Sundby PhD), 
Department of Community 
Medicine, University of Oslo, 
Oslo, Norway; and Tibet 
University Medical College, 
Lhasa, Tibet, China 
(Prof E Bjertness)
Correspondence to: 
Dr Sahar Hassan, Institute of 
Community and Public Health, 
Birzeit University, PO Box 14, 
Ramallah, West Bank, occupied 
Palestinian territory
sjamal@birzeit.edu
Medicalisation of childbirth in the occupied Palestinian 
territory: an operational study
Sahar Hassan, Johanne Sundby, Abdullatif Husseini, Espen Bjertness
Background Almost all births in the occupied Palestinian territory happen in hospitals, and births without 
complications are assisted by midwives. The application of evidence-based treatment and care during normal 
childbirth is inadequate. We report changes in practices during normal childbirth through the implementation of 
interventions aimed at reducing the frequency of intravenous ﬂ uid administration, bladder catheterisation, analgesia, 
artiﬁ cial rupture of membranes, oxytocin use for augmentation, vaginal examinations, and episiotomy, and increasing 
mobility, oral intake of ﬂ uids, and initiation of immediate breastfeeding. 
Methods We undertook operational research in three phases (baseline [6 months], intervention [18 months], and 
postintervention [12 months]) in one governmental hospital in the West Bank between 2005 and 2010. We assessed 
2345 women—134 in the baseline phase, 1860 in the intervention phase, and 351 in the postintervention phase. During 
the baseline phase, 2 weeks in 2006, we interviewed all women (mean age 26·1 years [5·8]) after they gave birth but 
before their discharge from the hospital. In 2007–08, we implemented the interventions, including on-the-job training, 
auditing, feedback, and meetings with staﬀ . We used a checklist to document the details of care for all pregnant 
women with singleton pregnancies (n=2146), who went into labour and delivered between 0700 h and 1600 h (when all 
physicians and consultants are on duty), 2–3 days per week. We excluded 286 women from the analysis because of pre-
existing complications, breech, gestational age less than 37 weeks, birth before arrival, and labour during the 3 months 
of strike in the public health sector. In the postintervention phase (2010), 9 months after the completion of the 
intervention, we used the same checklist for a sample of 383 women to assess the sustainability of the changes. The 
changes in practices were tested with χ2 and Fisher’s exact tests. We analysed data with IBM SPSS Statistics (version 
18.0). We obtained permission from the Palestinian Ministry of Health to interview women in the hospital. All women 
provided verbal informed consent before they were interviewed.
Findings Improvements from baseline to the postintervention phase were signiﬁ cant (p<0·05) and sustained for 
seven  of ten practices: oxytocin use to augment normal labour (43 [32·1%] of 134 women vs 62 [17·7%] of 351 women; 
improvement 14·4%), artiﬁ cial rupture of membranes (98 [73·1%] vs 182 [51·9%]; 21·2%), intravenous ﬂ uids 
(103 [76·9%] vs 97 [27·6%]; 49·3%), oral intake of ﬂ uids during labour (ﬁ ve [3·7%] vs 39 [11·1%]; 7·4%), mobility 
during labour (41 [30·6%] vs 120 [34·2%]; 3·6%), four to seven (65 [48·5%] vs 130 [37·0%]; 11·5%) and eight to 
22 vaginal examinations (20 [14·9%] vs 23 [6·6%]; 8·3%), episiotomy for ﬁ rst pregnancy (24 [80·0%] of 30 vs 34 [39·1%] 
of 87; 40·9%) or second and subsequent pregnancies (six [5·8%] of 104 vs nine [3·4%] of 264; 2·4%), and immediate 
breastfeeding (77 [57·5%] of 134 vs 328 [93·4%] of 351; 35·9%). The improvements in the mobility and oral intake of 
ﬂ uids during labour were not sustained 9 months after the completion of the intervention phase. The use of analgesia 
during labour did not change (ﬁ ve [3·7%] vs 13 [3·7%] women).
Interpretation A limitation of our analysis was the small sample size in the baseline phase. Some changes in the 
practices during normal childbirth were sustainable during the 9 months after the completion of the intervention. 
On-the-job training, auditing, and feedback were non-threatening, and a provider-friendly approach enabled 
integration of evidence into practice with the available resources. In a low-resource setting, supportive supervision, 
on-the-job training, and regular clinical audit are essential low-cost methods to increase adherence by midwives to the 
best available evidence and enhance their professional capacities to keep birth normal.
Funding Theodor-Springmann Foundation, Quota Scheme from Lånekassen, and University of Oslo.
Contributors
SH conceptualised, designed, and piloted the research methods; gathered the data for the assessment; designed, supervised, and participated in the 
implementation of the interventions; supervised data gathering, entry, and analysis; and wrote the ﬁ rst draft of the Abstract. EB and AH contributed 
to the conceptualisation, design, analysis, and interpretation of the analysis. JS contributed to the conceptualisation, analysis, and interpretation of 
the ﬁ ndings. All authors have approved the ﬁ nal version of the Abstract for publication.
Conﬂ icts of interest
We declare that we have no conﬂ icts of interest.
Acknowledgments
The study was funded by the Theodor-Springmann Foundation, Cologne, Germany, Quota Scheme from Lånekassen, Oslo, Norway, and the 
University of Oslo, Oslo, Norway. We thank the women, midwives' ﬁ eld work assistants, and midwives in the hospital whom without their 
enthusiasm this study would not be possible.


Medicalisation of childbirth in the occupied Palestinian territory: an operational study

البطاط، محمد خضر محمد

 أ‌ 
BIRZEIT UNIVERSITY 
The Geomorphological and Eenvironmental characteristics of the basin of 
Wadi Al Samin, Al Thahrieh, Abu Al Assja and Abu Al Ghozlan as         
a case  study in South Hebron. 
 ة‌ 
The Geomorphological and Environmental Characteristics of the Basin of 
Wadi Al Samin, Al Thahrieh, Abu Al Assja and Abu Al Ghozlan as 
 a Case  Study in South Hebron. 
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The Geomorphological and Eenvironmental characteristics of the 
basin of Wadi Al Samin, Al Thahrieh, Abu Al Assja and Abu Al 
Ghozlan as  
a case  study in South Hebron. 
 
Abstract 
The study aims at identifying  the reasons and factors causing pollution  
in the  valleys of  Wadi Al Samin, Al Thahrieh, Abu Al Assja and the 
influence on the surrounding communities. In additon, it aims at detecting 
the environmental effects resulted from the stone quarries. So as to 
introduce suitable solutions to get rid of the environmental dangers  of 
Wadi Al Samin sewage  water at  Al Thahrieh, Abu Al Assja and Abu Al 
Ghozlan. The descriptive approach is used to achieve the goals of this 
study to describe the area and its environmental characteristics and 
changes. In addition to that, the study  aims at studying  the behavior of 
the residents   around the valleys and measure  their environmental 
awareness and whether they are involved in polluting the valley or not. 
The study focuses on creating simple and cheap solutions. The analytical 
and field method is implemented during this study to cover the area 
through observation to get clear and right data.  
Many geomorphological forms  appeared in the study due to 
environmental factors ,like dissolvement processes that result from the 
interaction between the waste water and lime stones that cause  stone to 
disitntesate into fragments  especially in summer because of  floods of 
Wadi An Nar in Al Thahrieh that causes soil erosion and poisoning 
sedimentation in the area of the study.  
Another sample from the soil was taken from the settlements of  Karyat 
Arbaa and stone quarries in the industrial zone of Hebron to study the 
percentage of the heavy minerals so as to  compare them  with the 
international standards. The study shows that the soil of Wadi Al 
Thahrieh, Abu Al Assja is heavily polluted with heavy materials, 
compared with the percentage of change accerdaing to  percentage of the 
World Health Organization .The increase of pollution because of  the 
waste water comes from the Israeli settlements. The samples included 
Chromium, Cadmium, zinc, manganese and lead. The increase of high 
 ظ‌ 
pollution comes from the waste water mixed with dangerous active 
materials from detergents, aluminum and quagents eretrries of the 
settlement of Karyat Arbaa. This causes dangers on peoples’ health and 
the  soil fertility like destroying more than 450 dunnums(Applied 
Research Institute _ARIJ-2012) of farming lands and the destruction of 
olive and apricots trees as a result of sludge from stone quarries. 
 
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References: 
 Al-Khatib, Issam et.al  (2003):“Water health relation in developing 
 contries: Acase study in Tulkarem district in Palestine.  
International Journal of Environmental Heath 13, pp199-206. 
 Amir, A 2009: Temporal and spatial variation of wastewater  
quality Along open stream of Wadi Al_Nar and its 
 suitability for irrigation Purposes, Thesis, Alquds Uneversity_ Palestine. 
 Awadallah, wa;el, maher, owaiwi (2005): Spring and dug wells of  
hebron district. Ramallah: Palestinian hydrology group. 
 Botkin,D (2007): Essntial Enironmental scieanc,john Wiley,New York 
 Daas, et.al (1994):  “Waste water Quality and Quantity 
 of Nablus”, Birzet University, August. 
 Mclean ,E.O.2002.      Soil pH and lime requirement .P 199-224, In A.L 
 .Page (ed.),Methods of soil analysis ,Parts Chemical  
and miobiological parpeties .Am.Soc .Agron Madison ,WI,USA. 
 Mckeangan,J.A .(ed.) (1978): Mannal on Soil 
 sampling and methods of analsis Canaian Society of Soil Science:66_68. 
 Murad , A (2012): Phytoremediation of Agricultural Land Polluted with HeavyMetals in 
Wadi-Alsamin- Hebron-Palestine” Thesis, Bir zeit Uneversity_ Palestine 
 
 
. 
 
 
 
 
 
 
 
 
 
 
 ظ‌ظ‌
ظ‌ظ‌
ظ‌ 
 
 
 
 
 
 
 
 
 
 
 www.environment.gov.ps/2010 
 www.insanonline.net/2010 
 http://www.palestinerememberd.com/2010 
 www.poica.org-poica/2010 
 http://www.maanctr.org/issue12/Alrased/2011 
 www. womenforlife.org/2010 
 http://al3lmia.com/2010 
  
 
 
 
 
  
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The geomorphological and environmental characteristics of the basin of Wadi Al Samin, Al Thahrieh, Abu AL Assja and Abu Al Ghozlan as a case study in South Hebron

جامعة بيرزيت. العلاقات العامة

الغدير : مجلة دورية تصدر عن مكتب العلاقات العامة في جامعة يرزيت

Helen,Mason:Glasgow Caledonian University
Martin,O'Flaherty:University of Liverpool
Abdullatif,Husseini:Community and Public Healt

Shoaibi, Azza

Ghandour, Rula

Khatib, Rana

Mason, Helen

O'Flaherty, Martin

Capewell, Simon

See	discussions,	stats,	and	author	profiles	for	this	publication	at:	https://www.researchgate.net/publication/259240629
Salt	reduction	as	a	population-based
intervention	for	the	prevention	of	coronary	heart
diseases:	an	economic	assessment
Conference	Paper		in		The	Lancet	·	December	2013
DOI:	10.1016/S0140-6736(13)62605-7
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Birzeit	University
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Martin	O'Flaherty
University	of	Liverpool
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Abdullatif	Husseini
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[Close]
The Lancet, Volume 382, Issue , Page S33, 5 December 2013 
doi:10.1016/S0140-6736(13)62605-7
Copyright © 2013 Elsevier Ltd All rights reserved.
Salt reduction as a population-based intervention for the 
prevention of coronary heart diseases: an economic assessment
Azza Shoaibi MPH a , Rula Ghandour MPH a, Rana Khatib PhD a, Helen Mason PhD c, Martin O'Flaherty PhD d, Prof Simon 
Capewell MD e, Abdullatif Husseini PhD a b
Background
The incidence of coronary heart diseases is increasing in the occupied Palestinian territory (oPt) and hence poses a growing 
challenge for treatment. Reduction in the intake of dietary salt is a potentially cost-effective approach to reduce the burden 
of coronary heart diseases. Here, we report the results of an economic assessment of three interventions of salt reduction in 
the oPt.
Methods
We did the analysis from a societal perspective of three salt-reduction interventions—population-wide health promotion 
campaigns, mandatory labelling of food packaging, and mandatory reduction of salt content of processed food. These 
interventions were assessed individually, and in combinations of two and all three together. We estimated the costs of 
policies using past experiences, expert opinion, and hospital records, and costs of health care with a standardised unit cost 
for treatments. We considered the financial implications for the food industry and public sectors. The total cost of 
implementation of each policy was compared with the do-nothing scenario. We used data reported in reviews of 
epidemiological studies as estimates of the expected reduction of the current sodium salt consumption attributable to each 
policy. The expected change in salt intake was then converted into a change in mean population blood pressure based on 
estimates reported in a meta-analysis. The change in blood pressure was used to estimate the number of deaths prevented 
or postponed in 10 years, using the Palestinian IMPACT policy model for coronary heart disease. The estimates were 
compared with the number of deaths from coronary heart disease that would have been expected in relation to the number 
in the baseline year. This policy model is an epidemiological model that was used to analyse mortality associated with 
coronary heart disease and risk factor trends in the West Bank, oPt, between 1998 and 2009, and project mortality trends for 
the future. We used Microsoft Excel 2010 for our analyses.
Findings
All policies resulted in a reduction in salt intake of 5—30%, leading to changes of 1—20 mm Hg in systolic blood pressure. All 
scenarios were cost effective compared with the do-nothing scenario. The cost-effectiveness of the scenarios for per life-
year gained was $134·57—1430·62 (purchasing power parity at 2010 exchange rates). Policies for the labelling of food and 
use of the three interventions together were the most cost effective. These two scenarios were estimated to save costs ($9 
million and $6 million) and resulted in 945 life-years gained and 2682 life-years gained, respectively.
Interpretation
Page 1 of 2Salt reduction as a population-based intervention for the prevention of coronary heart dise...
12/5/2013http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62605-7/fulltext?versi...
Reduction of salt intake reduces the long-term burden of coronary heart diseases. In the oPt, population-based interventions 
to reduce salt intake are not only cost effective but also cost saving. We recommend a population-wide health promotion 
campaign, mandatory labelling of food packaging, and mandatory reduction of salt content of processed food.
Funding
European Community's Seventh Framework Programme.
Contributors
AS contributed to the study design, helped in the data analysis, and wrote the first and final drafts of the Abstract. All co-
authors contributed to the conceptualisation, design, and data analysis, and reviewed and commented on the Abstract.
Conflicts of interest
We declare that we have no conflicts of interest.
For all Palestine Abstracts and accompanying Comments see http://www.thelancet.com/health-in-the-occupied-
palestinian-territory-2013
Acknowledgments
This research was funded by the European Community's Seventh Framework Programme (FP7/2007—2013), under grant 
agreement number 223075—the MedCHAMPS project.
a Institute of Community and Public Health, Birzeit University, Ramallah, West Bank, occupied Palestinian territory
b Public health Program, Department of Health Sciences, Qatar University, Doha, Qatar
c Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
d Department of Public Health and Policy, University of Liverpool, Liverpool, UK
e Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
 Correspondence to: Mr Azza Shoaibi, Institute of Community and Public Health, Birzeit University, PO Box 14, Ramallah, West Bank, 
occupied Palestinian territory
Copyright © 2013 Elsevier Limited. All rights reserved. The Lancet® is a registered trademark of Reed Elsevier Properties S.A., used under licence
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Page 2 of 2Salt reduction as a population-based intervention for the prevention of coronary heart dise...
12/5/2013http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62605-7/fulltext?versi...


Salt reduction as a population-based intervention for the prevention of coronary heart diseases: an economic assessment

Khatib, Issam

Nawahdah, Mamoun

Inoue, Tomoo

جامعة بيرزيت. المكتبة الرئيسية

نشرة المكتبة الإخبارية : العدد الثالث و العشرون

Birzeit University

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Medicalisation of childbirth in the occupied Palestinian territory: an operational study

The geomorphological and environmental characteristics of the basin of Wadi Al Samin, Al Thahrieh, Abu AL Assja and Abu Al Ghozlan as a case study in South Hebron

الغدير : مجلة دورية تصدر عن مكتب العلاقات العامة في جامعة يرزيت

Salt reduction as a population-based intervention for the prevention of coronary heart diseases: an economic assessment

نشرة المكتبة الإخبارية : العدد الثالث و العشرون

Private partnership of soild waste managemnet in the Palesinian Municipalities

1,699

5,324