An-Najah Staff

Background: In Arab and Muslim-dominated countries, spirituality and religiosity shape the belief and practices toward chronic illnesses. No previous studies were published to assess adherence to and satisfaction with antipsychotic medications in persons with schizophrenia in the Arab world.
Objective: To assess medication adherence and treatment satisfaction with antipsychotics in a sample of Palestinian people with schizophrenia. Methodology: Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8). Treatment satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). Psychiatric symptoms were assessed using the expanded Brief Psychiatric Rating Scale (BPRS-E). Data were entered and statistically analyzed using SPSS 16 for windows. Results: A convenience sample of 131 persons with schizophrenia was studied. Based on MMAS-8, 44 persons (33.6%) had a low rate, 58 (44.3%) had a medium rate and 29 (22.1%) had a high rate of adherence. Age was significantly correlated (P=0.028) with adherence score. However, variables like use of monotherapy or atypical or depot antipsychotics were not significantly associated with higher adherence. The means of satisfaction with regard to effectiveness, side effects, convenience and global satisfaction were 72.6 ± 20.5, 67.9 ± 31.47, 63.2 ± 14.3 and 63.1 ± 18.8 respectively. There was a significant difference in the means of effectiveness (P < 0.01), convenience (P < 0.01), global satisfaction (P < 0.01), but not side effects domains (P=0.1) among persons with different levels of adherence. Furthermore, there was a significant difference in the means of positive symptom score (P < 0.01), manic (P < 0.01) and depression (P < 0.01) but not negative symptom score (P=0.4) among persons with different levels of adherence.
Conclusions: Medication nonadherence was common and was associated with low treatment satisfaction scores and poor psychiatric scores. Medication related factors had insignificant effects on adherence scores

OBJECTIVES: Diabetes mellitus is a chronic progressive disease characterized by numerous health complications. Medication adherence is an important determinant of therapeutic outcome. Few studies on medication adherence have been published from the Arab countries. Therefore, the objective of this pilot study was to assess hypoglycemic medication adherence and its association with treatment satisfaction. SETTING: Military Medical Services clinic in Nablus, Palestine.
METHODS: This is a cross sectional descriptive study. A convenience sample of 131 diabetic patients was studied. The 8-item Morisky Medication Adherence Scale (MMAS-8) and Treatment Satisfaction Questionnaire for Medication were used to assess adherence and treatment satisfaction, respectively. Statistical Package for Social Sciences was used for statistical analysis.
MAIN OUTCOME MEASURE: Level of adherence, treatment satisfaction and association between adherence and treatment satisfaction among diabetic patients.
RESULTS: According to MMAS-8, 50 patients (38.5%) had a high adherence, 58 (44.6%) had a medium adherence and 22 (16.9%) had a low adherence rate. The mean scores of satisfaction domains were 71 ± 17.6 and 95 ± 16.4 for effectiveness (EFF) and side effects (SE), respectively. Adherence score was a positively and significantly correlated with EFF satisfaction domain (P < 0.01) and age (P = 0.01). Similar significant correlation was found between adherence level and duration of illness (P = 0.047). However, adherence was not significantly associated with gender (P = 0.2), number of hypoglycemic medications (P = 0.5) or SE satisfaction domain (P = 0.2).
DISCUSSION AND CONCLUSION: The majority of diabetic patients in this pilot study were non-adherent. Improving patients' treatment satisfaction will improve treatment adherence.

Objective  Reports about medication adherence and satisfaction in patients with epilepsy in Arab countries are lacking. The objective of this study was to assess medication adherence and its relationship with treatment satisfaction, number of antiepileptic drugs (AEDs) taken, and epilepsy control in a sample of Palestinian patients.
Methods  This cross-sectional descriptive study was carried out at Al-Makhfya Governmental Outpatient Center in Nablus, Palestine, during the summer of 2010. A convenience sampling method was used to select patients over the study period. Medication adherence was measured using the eight-item Morisky Medication Adherence Scale (MMAS); treatment satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). Epilepsy was arbitrarily defined as “well controlled” if the patient had had no seizures in the last 3 months and was defined as “poorly controlled” if he or she had had at least one seizure in the last 3 months.
Results  A convenience sample of 75 patients was studied. On the basis of the MMAS, 11 patients (14.7%) had a low rate, 37 (49.3%) had a medium rate, and 27 (36%) had a high rate of adherence. Adherence was positively and significantly correlated with age (P = 0.02) and duration of illness (P = 0.01). No significant difference in adherence was found between patients with well-controlled and those with poorly controlled epilepsy. Similarly, there was no significant difference in adherence between patients on monotherapy and those on polytherapy. Mean satisfaction with respect to effectiveness, side effects, convenience, and global satisfaction were 73.6 ± 20.7, 82.4 ± 29.8, 69.5 ± 15.5, and 68.4 ± 18.3, respectively. There were significant differences in mean values in the effectiveness (P < 0.01) and convenience (P < 0.01) domains, but not the side effect (P = 0.1) and global satisfaction (P = 0.08) domains among patients with different levels of adherence. Patients on monotherapy had significantly higher satisfaction in the effectiveness domain (P = 0.04) than patients on polytherapy. Similarly, patients with well-controlled epilepsy scored significantly higher in the Effectiveness (P = 0.01) and Global Satisfaction (P = 0.01) domains than those with poorly controlled epilepsy.
Conclusion  In our convenience sample, we found that adherence to and satisfaction with AEDs were moderate and were not associated with seizure control or number of AEDs.

A study of tinea capitis was carried out during October 1998, involving 8531 school children aged 6–14 years (4718 males and 3813 females), attending 12 primary schools located in urban, rural, and refugee camp communities in the Nablus district in the Palestinian Authority. A total of 1389 of the school children aged 6–12 years (724 males and 665 females) were also surveyed on three occasions at 2–3 month intervals, over a 9-month period (October 1998–May 1999) using the hair brush technique, for prevalence of asymptomatic tinea capitis carriage. Twenty-three (0.27%) mycologically proven cases of tinea capitis were detected

Groundwater is the major source of water to the Palestinians. Efficient management of this resource requires a good understanding of its status. This understanding necessitates a characterization of the quality of the utilizable volumes. This paper focuses on the assessment of nitrate concentrations in the aquifers of the West Bank, Palestine. A preliminary statistical analysis is carried out for the spatial and temporal distributions of the nitrate concentrations. GIS is utilized to facilitate the analysis and to efficiently account for the spatiality of nitrate concentrations. The analysis was carried out at different spatial levels and key parameters including soil type, watersheds, depth, population, and rainfall. It is observed that elevated nitrate concentrations in the groundwater greatly coincide with increasing rainfall, particularly in the last few years. Results confirm that the annual mean nitrate concentration in the Western groundwater basin has an increasing trend over the period from 1982 to 2004 indicating its vulnerability to contamination. This result can be attributed to the agricultural activities along with the high groundwater recharge. However, leaking septic and sewer systems are considerably causing nitrate contamination of groundwater in populated areas. Overall, the recommendations call for an immediate intervention to manage the quality problems in the West Bank aquifers.

Solid waste management (SWM) is one of the most challenging issues faced by developing countries that suffer from serious pollution problems caused by the generation of large waste quantities. This paper presents the case study of SWM in the Nablus district – Palestine. Surveys for household residents' and SWM program operators, field investigations, on-site waste measurements and characterizations were conducted. Per capita waste generation rates varied between different localities although trends were similar. Overall, the majority of waste was organic (65.1% by weight), suggesting a strong resource recovery potential in terms of animal feed or compost. Recyclable waste (plastic, paper and card) made up 16.7% by weight the waste composition suggesting an incentive to introduce source separation. Household attitudes complemented the waste characterization study, revealing the main problems faced. SWM operators quoted on the current status, highlighting problems with disposing in unsanitary landfills, ineffective solid waste fees system, increasing solid waste quantities and lacking equipment and experienced personnel. To enhance sustainable SWM, public awareness, funding, expertise, equipment and facilities and other provisions currently lacking or inappropriate must be provided.

Gaza coastal aquifer (GCA) is the major source of fresh water for the 1.5 million residents of Gaza Strip, Palestine. The aquifer is under deteriorating quality conditions mainly due to the excessive application of fertilizers. The intrinsic vulnerability of GCA to contamination was assessed using the well-known DRASTIC method. Detailed analysis of the intrinsic vulnerability map of GCA was carried out and did consider different relationships between the vulnerability indices and the on-ground nitrogen loadings and land use classes. In addition, correlation between vulnerability values and the nitrate concentrations in GCA was studied. Based on the vulnerability analysis, it was found that 10% and 13% of Gaza Strip area is under low and high vulnerability of groundwater contamination, respectively, while more than 77% of the area of Gaza Strip can be designated as an area of moderate vulnerability of groundwater contamination. It was found that the density of groundwater sampling wells for nitrate concentration is high for the moderate and high vulnerability zones. The highest first quartile, median, mean, and third quartile of nitrate concentrations are reported in the high vulnerability zones. Results of sensitivity analysis show a high sensitivity of the high vulnerability index to the depth to water table.

In this paper, lumped-parameter models (LPMs) were developed and utilized to simulate nitrate concentration in the groundwater of Gaza City and Jabalia Camp (GCJC) in the Gaza Coastal Aquifer (GCA) in Palestine. In the GCJC area, nitrate levels exceed the maximum contaminant level (MCL) of 10 mg/L NO3-N (45 mg/L NO3) in many wells. Elevated nitrate concentrations in the groundwater of GCJC area are due to the disposal of untreated wastewater, the existence of heavy agriculture in the surrounding areas, and the use of cesspits for wastewater disposal. The developed LPMs utilize monthly time steps and take into consideration all the sources and sinks of water and nitrate in the study area. The main outcomes of the LPMs are the average temporal water table elevation and nitrate concentration. In order to demonstrate LPMs usability, a set of management options to reduce nitrate concentration in the groundwater of the study area were proposed and evaluated using the developed LPMs. Four broad management options were considered where these options tackle the reduction of nitrate concentration in the lateral inflow, rehabilitation of the wastewater collection system, reduction in cesspit usage, and the restriction on the use of nitrogen-based fertilizers. In addition, management options that encompass different combinations of the single management options were taken into account. Different scenarios that correspond to the different management options were investigated. It was found based on the LPMs that individual management options were not effective in meeting the MCL of nitrate. However, the combination of the four single management options with full rehabilitation and coverage of the wastewater collection network along with at least 60% reduction in both nitrate concentration in the lateral inflow and the use of nitrogen-based fertilizers would meet the MCL constraint by the end of the management period.