An-Najah Staff

Objective: self-medication is practiced significantly worldwide. No data is available on the current status of self-medication practice in Palestine. The objective of this study is to assess the extent of self-medication practice among a random sample of An-Najah National University students.
Methods: this was a cross-sectional, anonymous, questionnaire-based survey that included 1581 students of different academic levels enrolled at different faculties at An-Najah National University. A pre-validated questionnaire with several open-ended and closed-ended questions was administered to the students. Data were coded, entered, and analyzed using SPSS version 13.
Results: sixty three percent of respondents were females enrolled at non-medical schools. The mean age of respondents was 19.9 years. Ninety-eight percent of respondents reported practicing self-medication. There was no statistical difference between respondents who reported practicing self-medication based on gender or type of school (medical vs. non medical). The average number of medications reported by self-medication practitioners was 2.63 ± 1.38 medications per respondent. Analgesics, decongestants, herbal remedies, and antibiotics were the most common classes reported in self-medication. Headache, sore throat, flu, and dysmenorrhea were the most common aliments for which respondents seek self-medication. The majority of respondents practiced self-medication because the ailments they had were simple or because they had previous experience. The majority of respondents had good medication knowledge but did not posses high self-care orientation. Neither medication knowledge, nor self-care orientation was a predicting factor associated with the practice of self-medication. However, in selecting a particular type of medication the type of school, gender, and self-care orientation were influential.
Conclusion: self-medication is very common among An-Najah students. This practice is common for treating clinical conditions that are either simple or previously experienced. Although, no significant predictors of self-medication did exist among the studied group, levels of self-care orientation and medication knowledge can be of value in analyzing the types of medications employed by self-medication practices.

Background and Objective: The patient package insert is an important source of drug information. The aim of this study was to evaluate and compare the PPI of the anti-infective agents manufactured in Palestine with the imported equivalents.
Method: The selection criteria generated 15 different anti-infective agents available as 36 locally manufactured products and 15 imported equivalents. The design of the patient package insert was evaluated in terms of the number of words used in eight main headings and the presence or absence of certain information regarding nine statements.
Results: Inserts of locally manufactured products have significantly fewer words than those of imported products with respect to warnings, dosage and administration, and side effects. The most significant difference was found in the warnings. Moreover, differences were found between inserts of local and imported products in terms of the presence of the nine informative statements. Locally manufactured products did not mention inactive ingredients, clinical pharmacology or date of last revision, but all of them provided information on the use of the drug during pregnancy and lactation and on the duration of therapy. However, in general they provided less information than the imported equivalents.
Conclusion: Palestinian authorities and local manufacturers should implement appropriate measures to regulate the quality and quantity of information in the patient package insert of locally produced anti-infective agents. PPI improvement will better direct health practices to the benefit of the patients.

Objectives The objectives of this study were to assess the knowledge and practices associated with pesticide use in an agricultural community in Palestine, and to determine the prevalence of self-reported health symptoms related to pesticide exposure.
Methods In this cross-sectional questionnaire study, agricultural farm workers in Nablus district, Palestine, were interviewed on their knowledge and practices of pesticide use. Comparisons of knowledge and practices of pesticide use between various groups were performed using the Mann–Whitney U-test or the Kruskal–Wallis rank test of variance. The program of the Statistical Package for Social Sciences (SPSS) version 15 was used for data analysis.
Results The questionnaire was completed by 381 farm workers. The mean age ± SD of the participants was 38.8 ± 11.8 years. The majority (97.9%) of the participants were male. The mean participant scores for knowledge and safety procedures were 2.8 ± 3.2 out of 8 and 9.8 ± 2.4 out of 15, respectively. There was a significant positive correlation (r = 0.323; P < 0.001) between the knowledge and safety procedure scores. Unsafe behaviors were identified as the storage of pesticide products at home, the preparation of pesticides in the kitchen, inadequate disposal of empty pesticide containers, eating and drinking during pesticide application, and using inadequate protective clothing. The most frequent self-reported toxicity symptoms associated with pesticide use were skin rash (37.5%), headache (37%), excessive sweating (24.9%), and diarrhea (21.3%). There was a strong significant negative correlation (r = −0.83; P < 0.001) between self-reported toxicity symptoms and scores for protective measures.
Conclusion The results of this study indicate that most farm workers in this district need more educational programs regarding the safety and use of pesticides. Legislation promoting the use of safer pesticides is also needed.

We investigated the prescription quality and prescribing trends of private clinicians in Nablus governorate, Palestine. A total of 363 prescriptions were collected from a random sample of 36 community pharmacies over a study period of 288 working hours. Data regarding elements in the prescription and the types of drugs prescribed were analysed. Physician-related variables were mostly noted, however, patient's address and weight were absent in all prescriptions and less than half included age and sex. Information regarding strength of the medications prescribed was missing in over 70% of prescriptions. Other drug-related variables like frequency and instruction of use were present in over 80% of prescriptions. Antimicrobial agents were the most commonly prescribed followed by NSAIDs/analgesics. Amoxicillin alone or in combination was the most commonly prescribed antimicrobial agents followed by cefuroxime. Prescription writing quality in Nablus is deficient in certain aspects and improvement is required.

Objective: The objective of this study was to investigate self-medication practices with antibiotics among school teachers in Palestine.
Methods: A survey was conducted via a structured questionnaire among governmental school teachers regarding their practices and attitude toward antibiotics. All data were entered and analyzed using SPSS 15.
Results: A total of 1039 teachers completed and returned the questionnaire; giving a response rate of 64.9%. Respondents were divided as follows: group I (19.4%) were those who used antibiotics through self-medication only, group II (12.4%) used antibiotics by prescription only, group III (44.7%) used antibiotics by self-medication and prescription while those in group IV (23.3%) were those who did not report using antibiotics in the past six months. Antibiotic utilization among respondents was 76.7% in the past six months. Respondents in the 4 groups had comparable demographic characteristics. Respondents in group I were more likely (42.2%) to administer antibiotics to children without medical consultation, store antibiotic leftover (52.3%) for further use, stack antibiotics at home (59.7%) to be used whenever needed and had the least attitude to finish the entire antibiotic course when prescribed to them (59.9%). Across the four groups, male and female respondents had comparable attitude toward antibiotic use except that males tend to store antibiotic leftover more than females while females tend to finish the entire antibiotic course when taken by self-medication more than males. Respondents in groups I and III mainly consulted pharmacists on self-medication and obtained the antibiotics mainly from community pharmacy. Penicillin was the major class utilized by respondent either by self-medication or by prescription in groups I (74.3%), II (70.5%) and III (68.9%). Sore throat was the most common (30.3%) clinical condition that respondents self-treat with antibiotics, followed by symptoms of common cold (24.4%).
Conclusion: Our study showed that self-medication practices with antibiotics are common and that most of these practices were inappropriate. These results should trigger health policy makers in Palestine to take action in order to prevent antibiotic misuse. Public awareness about proper use of antibiotics is needed. Furthermore, strengthening pharmacy laws and pharmacy control over non-prescription sale of antibiotics is highly recommended.

Macrovascular complications are common in diabetic hypertensive patients. Appropriate antihypertensive therapy and tight blood pressure control are believed to prevent or delay such complication.
Objective: To evaluate utilization patterns of antihypertensive agents and blood pressure (BP) control among diabetic hypertensive patients with and without ischemic heart disease (IHD).
Methods: Retrospective cohort study of all diabetic hypertensive patients attending Al-watani medical center from August 2006 until August 2007. Proportions of use of different antihypertensive drug classes were compared for all patients receiving 1, 2, 3, or 4 or more drugs, and separately among patients with and without IHD. Blood pressure control (equal or lower 130/80 mmHg) was compared for patients receiving no therapy, monotherapy, or combination therapy and separately among patients with and without IHD.
Results: 255 patients were included in the study; their mean age was 64.4 (SD=11.4) years. Sixty one (23.9%) of the included patients was on target BP. Over 60% of the total patients were receiving angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin receptor blocker (ARB), followed by diuretics (40.8%), calcium channel blockers (25.1%) and beta-blockers (12.5%). The majority (> 55%) of patients were either on mono or no drug therapy. More than 55% of patients with controlled BP were using ACE-I. More than half (50.8%) of the patients with controlled BP were on combination therapy while 42.3% of patients with uncontrolled BP were on combination therapy (p=0.24). More patient in the IHD achieved target BP than those in non-IHD group (p=0.019). Comparison between IHD and non-IHD groups indicated no significant difference in the utilization of any drug class with ACE-I being the most commonly utilized in both groups.
Conclusions: Patterns of antihypertensive therapy were generally but not adequately consistent with international guidelines. Areas of improvement include increasing ACE-I drug combinations, decreasing the number of untreated patients, and increasing the proportion of patients with controlled BP in this population.

Background: The aim of this study was to analyze the types and cost of medications prescribed at discharge for ischemic stroke survivors.
Methods: This is a descriptive study of medications prescribed for ischemic stroke survivors admitted to Al-watani hospital during a 6-month period.
Results: A total of 95 consecutive stroke patients were included in the study period; 78 (82.1%) survivors were having ischemic stroke subtype and were designated the study group. The average age of the survivors was 66.9 6 12.7 years. Survivors had prevalent risk factors such as diabetes mellitus (70%), hypertension (68%), and ischemic heart disease (34.6%). On average, survivors experienced a minimum of 0.73 complications (range 0-3) with the most common being infections (n 5 35, 44.8%). Forty-two per cent of the ischemic stroke survivors were taking antiplatelet drugs prior to the current attack. At discharge, ischemic stroke survivors were prescribed an average of 4.9 medications from 4.3 different drug classes. All ischemic stroke survivors were prescribed antiplatelet therapy at discharge. Aspirin monotherapy was prescribed for 61 survivors while the combination of aspirin/clopidogrel antiplatelet therapy was prescribed for 17 survivors. The average monthly cost for prophylactic therapy and for medications used to treat post-stroke complication was approximately 52 USD per survivor.
Conclusion: Most of the patients in the study group were having the traditional risk factors for ischemic stroke and were suffering form typical post-stroke complications. Lack of medical insurance will impose a heavy financial burden on stroke survivors in Palestine.

Background and aims:
Maternal intake of medications and supplements has changed over time, and it may be related to adverse reproductive outcomes. The purpose of this study was to evaluate the extent of utilization of supplements, medications, and herbs by pregnant women in Palestine and the expected effects.
Methods:
Pregnant women attending the prenatal clinic at Rafedia Governmental Hospital at Nablus/Palestine were interviewed using a questionnaire containing questions regarding medications intake and disease status. Data obtained from pregnant women were entered and analyzed using Statistical Package for Social Sciences (SPSS) version 10.
Results: Of the pregnant women attending Rafedia prenatal clinic, 70.2% were village residents, 89.9% of them had no chronic diseases at the time of pregnancy except for anemia which was a common condition. More than half of the pregnant women did take vitamins, iron, and calcium (56.4%, 63.3%, 57.8%, respectively) during pregnancy. Less than fifty percent of the pregnant women took folic acid. Nausea and vomiting were common but most women did not take any medications to treat it. Less than one third of the pregnant women took over the counter (OTC) medications, mainly analgesics, and more than two thirds took prescription only medications (POM), mainly antibiotics. Mean medication intake per pregnant woman was 1.6±0.9. Most of the women who took medications did take only one (44.5%), a lesser percentage took two (30.8%) or more (9.3%) medications. The medications taken belonged to categories B and C, and few belonged to category D. About 45% of pregnant women used herbal medications to treat mainly GIT problems such as upset stomach, diarrhea, and constipation. The majority of pregnant women in this study did not visit a dentist during their pregnancy.
Discussion and Conclusion:
In this study, utilization of OTC, POM, and herbal medications was common among pregnant women. Not all women received supplements, particularly folic acid. The majority of pregnant women were anemic yet they did not take iron as they should. Women and health care providers need to be educated about the importance of supplement intake during pregnancy. Self-medicating or doctors prescriptions of POM, OTC, and herbal medications during pregnancy support the importance of expanding the knowledge about the potential risks and benefits of such treatments.

Objective: The purpose of this study was to determine the availability and adequacy of antidote stocking at hospitals in north Palestine based on published guidelines for antidote stocking.
Methodology: This study is a cross sectional survey of all hospitals at north Palestine (n=11) using a questionnaire which was completed by the director of the pharmacy department at each hospital. The questionnaire was divided into 2 parts. The first part contained a list of 25 antidotes while the second part contained a list of 12 antidotes. This classification is based on the guideline proposed by the British Association for Emergency Medicine (BAEM). The net antidote stock results were compared with the American guidelines as well.
Result: The overall availability of each antidote in the first list varied widely from zero for glucagon to 100% for atropine. The number antidotes of the first list that were stocked in the 11 hospitals ranged from 5 to 12 antidotes but none of the hospitals stocked all the 25 antidotes. Additionally, availability of antidotes in the second list varied widely from zero for polyethylene glycol to 100% for dobutamine. The number of antidotes stocked ranged from 5 to 9 but none of the hospitals stocked all the 12 antidotes.
Discussion and Conclusion: hospitals in north Palestine do not have adequate stock of antidotes. Raising awareness of the importance of antidotes by education, regular review of antidote storage, distribution plans, and appropriate legislation might provide solutions. Coordination between Palestinian hospitals and the PCDIC at An-Najah National University is also important.

No studies were carried out in Palestine to investigate the prescribed antimicrobial agents in hospitalized pediatric patients. The objective of this study was to evaluate and therapeutically analyze the pattern of parenteral antimicrobial prescriptions among pediatric patients in Al-Watani Government Hospital in Palestine. Such audit will be of great value to clinicians and health policy makers.
Material and Methods: Data on antimicrobial prescribing were collected for 30 consecutive days for all pediatric patients admitted to Al-Watani government hospital. Data on antimicrobial prescribing were entered and analyzed using Statistical Package for Social Sciences (SPSS) program. Analysis was done for age, sex, diagnosis, site of infection, number of antimicrobial agents given, how many times the drug regimen has been changed and the frequency of individual drug use.
Results: Three hundred and forty pediatric patients were admitted to Al-Watani government hospital during the study period. Gastroenteritis was the most common cause of hospitalization, while upper respiratory tract infection (URTI) was the most common cause of parenteral antimicrobial agent administration. Two hundred and ten (61.8%) patients received parenteral antimicrobial agents while 16 (4.7%) received both parenteral and oral antimicrobial agents. Single antimicrobial agent was prescribed for (50.6%) patients. Cefuroxime was the main single antimicrobial agent used; it was administered to 70/226 (31%) patients.
Conclusion: Treatment patterns used for most patients were nearly according to current empiric therapeutic recommendations. However, improving the availability of rapid diagnostic methods to differentiate between viral and bacterial infections is suggested to reduce empiric therapy numbers by antimicrobial agents so as to decrease chance for drug resistance.