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1. Awareness of human papillomavirus and acceptability of the vaccine among women in Palestine: is it time for policy adjustment?

Author

Mohamedraed Elshami, Hanan Abukmail, Ibrahim Al-Slaibi, Mohammed Alser, Afnan Radaydeh, Alaa Alfuqaha, Mariam Thalji, Salma Khader, Lana Khatib, Nour Fannoun, Bisan Ahmad, Lina Kassab, Hiba Khrishi, Deniz Houssaini, Nour Abed, Aya Nammari, Tumodir Abdallah, Zaina Alqudwa, Shahd Idais, Ghaid Tanbouz, Ma’alem Hajajreh, Hala Abu Selmiyh, Zakia Abo-Hajouj, Haya Hebi, Manar Zamel, Refqa Najeeb Skaik, Lama Hammoud, Saba Rjoub, Hadeel Ayesh, Toqa Rjoub, Rawan Zakout, Amany Alser, Nasser Abu-El-Noor, and Bettina Bottcher

Subjects
Human papillomavirus, Cervical cancer, Vaccine, Vaccination, Health education, Awareness, Gynecology and obstetrics, RG1-991, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Progress has been made in the reduction of morbidity and mortality of cervical cancer by the implementation of human papillomavirus (HPV) vaccination programs. This study aimed to assess the awareness of Palestinian women about HPV as well as their knowledge and acceptability of the HPV vaccine and to examine the factors associated with good awareness. Methods This was a national cross-sectional study. Adult women were recruited from hospitals, primary healthcare centers, and public spaces in 11 Palestinian governorates using convenience sampling. A structured questionnaire was used for data collection. For each correctly answered question, one point was given. The total score was calculated and categorized into poor (0–10) and good awareness (11–21). Results The questionnaire was completed by 7223 women out of 8086 who were approached (response rate = 89.3%). A total of 7058 questionnaires were included in the final analysis; 4403 from the West Bank and Jerusalem (WBJ) and 2655 from the Gaza Strip. Women recruited from the Gaza Strip were younger, getting lower monthly incomes, and with fewer chronic diseases than women recruited from the WBJ. Only 33 women (0.5%) displayed good awareness of HPV and its vaccine with 0.7% of women from WBJ and only 0.2% of women from the Gaza Strip. Completing post-secondary education, being employed or a student, and having a higher monthly income were associated with an increase in the likelihood of having good awareness. Among women who had heard of HPV (n = 571, 8.1%), only 46 women (8.1%) reported familiarity with its vaccine. Women from the WBJ were more likely than women from the Gaza Strip to have heard about the HPV vaccine (0.9% vs. 0.2%). Most women agreed to receive the HPV vaccine themselves or for their daughters if it was given without cost or with a co-payment. No differences were found in the likelihood of agreeing to receive the HPV vaccine among women in the WBJ versus the Gaza Strip. Conclusion The overall awareness of HPV and its vaccine was extremely low. Inclusion of the HPV vaccine in the national immunization program could change this, especially as the HPV vaccine appeared to be acceptable.

Published
2022
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2. Knowledge of cervical cancer risk factors among Palestinian women: a national cross-sectional study

Author

Mohamedraed Elshami, Mariam Thalji, Hanan Abukmail, Ibrahim Al-Slaibi, Mohammed Alser, Afnan Radaydeh, Alaa Alfuqaha, Salma Khader, Lana Khatib, Nour Fannoun, Bisan Ahmad, Lina Kassab, Hiba Khrishi, Deniz Elhussaini, Nour Abed, Aya Nammari, Tumodir Abdallah, Zaina Alqudwa, Shahd Idais, Ghaid Tanbouz, Ma’alem Hajajreh, Hala Abu Selmiyh, Zakia Abo-Hajouj, Haya Hebi, Manar Zamel, Refqa Najeeb Skaik, Lama Hammoud, Saba Rjoub, Hadeel Ayesh, Toqa Rjoub, Rawan Zakout, Amany Alser, Nasser Abu-El-Noor, and Bettina Bottcher

Subjects
Cervical cancer, Prevention, Early detection, Survival, Risk factor, Awareness, Gynecology and obstetrics, RG1-991, Public aspects of medicine, RA1-1270
Abstract

Abstract Background High awareness of cervical cancer (CC) risk factors is important to decrease the morbidity and mortality associated with CC. This study aimed to assess the knowledge level of Palestinian women about CC risk factors and to determine the factors associated with good knowledge. Methods This was a national cross-sectional study. Adult women from hospitals, primary healthcare centers, and public spaces of 11 governorates in Palestine were recruited using a stratified convenience sampling. A translated-into-Arabic version of the validated CC awareness measure (CeCAM) was used to assess the knowledge about the 11 CC risk factors. For each correctly identified risk factor, the participant was given one point. The total score was calculated and was categorized into three categories: poor knowledge (0–3), fair knowledge (4–7), and good knowledge (8–11). Results A total of 7223 participants completed the Arabic CeCAM (response rate = 89.3%) and 7058 questionnaires were included in the final analysis: 2655 from the Gaza Strip and 4403 from the West Bank and Jerusalem. Participants recruited from the Gaza Strip were younger, getting lower monthly incomes, and with less chronic diseases than participants recruited from the West Bank and Jerusalem. The most frequently identified risk factor was ‘having a weakened immune system’ (n = 5458, 77.3%) followed by ‘infection with a sexually transmitted infection’ (n = 5388, 76.3%). The least identified risk factor was ‘having many children’ (n = 1597, 22.6%). Only 1670 women (23.7%) had good knowledge of CC risk factors. Women living in the Gaza Strip were more likely than women living in the West Bank and Jerusalem to have good knowledge (25.2% vs 22.7%). Completing a secondary or diploma degree, being employed, and having a monthly income of ≥ 1450 NIS (around $450) were all associated with lower likelihood of having good knowledge of CC risk factors. Conversely, knowing someone with cancer was associated with higher likelihood of having good knowledge. Conclusion The overall awareness of CC risk factors was low. There is a substantial need to establish educational programs to promote Palestinian women’s awareness of CC.

Published
2021
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3. Knowledge of Palestinian women about cervical cancer warning signs: a national cross- sectional study

Author

Mohamedraed Elshami, Ibrahim Al-Slaibi, Hanan Abukmail, Mohammed Alser, Afnan Radaydeh, Alaa Alfuqaha, Mariam Thalji, Salma Khader, Lana Khatib, Nour Fannoun, Bisan Ahmad, Lina Kassab, Hiba Khrishi, Deniz Elhussaini, Nour Abed, Aya Nammari, Tumodir Abdallah, Zaina Alqudwa, Shahd Idais, Ghaid Tanbouz, Ma’alem Hajajreh, Hala Abu Selmiyh, Zakia Abo-Hajouj, Haya Hebi, Manar Zamel, Refqa Skaik, Lama Hammoud, Siba Rjoub, Hadeel Ayesh, Toqa Rjoub, Rawan Zakout, Amany Alser, Nasser Abu-El-Noor, and Bettina Bottcher

Subjects
Cervical cancer, Early detection, Survival, Symptom, Warning sign, Awareness, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Timely presentation and diagnosis of cervical cancer (CC) are crucial to decrease its mortality especially in low- and middle-income countries like Palestine. This study aimed to evaluate the knowledge of Palestinian women about CC warning signs and determine the factors associated with good knowledge. Methods This was a national cross-sectional study conducted between July 2019 and March 2020 in Palestine. Stratified convenience sampling was used to recruit adult women from hospitals, primary healthcare centers, and public spaces of 11 governorates. A translated-into-Arabic version of the validated CC awareness measure (CeCAM) was used to assess women’s knowledge of 12 CC warning signs. Results Of 8086 approached, 7223 participants completed the CeCAM (response rate = 89.3%). A total of 7058 questionnaires were included in the analysis: 2655 from the Gaza Strip and 4403 from the West Bank and Jerusalem (WBJ). The median age [interquartile range] for all participants was 34.0 [24.0, 42.0] years. Participants recruited from the WBJ were older, getting higher monthly income, and having more chronic diseases than those recruited from the Gaza Strip. The most frequently identified warning sign was ‘vaginal bleeding after menopause’ (n = 5028, 71.2%) followed by ‘extreme generalized fatigue’ (n = 4601, 65.2%) and ‘unexplained weight loss’ (n = 4578, 64.9%). Only 1934 participants (27.4%) demonstrated good knowledge of CC warning signs. Participants from the Gaza Strip were slightly more likely than participants from the WBJ to have a good level of knowledge. Factors associated with having good knowledge included having a bachelor or postgraduate degree, being married, divorced, or widowed as well as knowing someone with cancer. Conclusion The overall awareness of CC warning signs was low. Educational interventions are needed to increase Palestinian women’s awareness of CC warning signs.

Published
2021
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4. معرفة المرأة الفلسطينية للعلامات التحذيرية لسرطان عنق الرحم: دراسة مقطعية وطنية

Author

Lana Khatib, Afnan Radaydeh, Bisan Ahmad, Zakia Abo-Hajouj, Shahd Idais, Bettina Böttcher, Nour Fannoun, Ibrahim Al-Slaibi, Manar Zamel, Nour Abed, Toqa Rjoub, Alaa Alfuqaha, Hala Abu Selmiyh, Lina Kassab, Ma’alem Hajajreh, Siba Rjoub, Hiba Khrishi, Refqa Najeeb Skaik, Mohamedraed Elshami, Lama Hammoud, Haya Hebi, Deniz Elhussaini, Mariam Thalji, Rawan Zakout, Nasser Ibrahim Abu-El-Noor, Mohammed Alser, Aya Nammari, Amany Alser, Salma Khader, Hanan Abukmail, Tumodir Abdallah, Hadeel Ayesh, Ghaid Tanbouz, and Zaina Alqudwa

Subjects
Adult, Health Knowledge, Attitudes, Practice, Palestine, medicine.medical_specialty, Survival, Cross-sectional study, Symptom, Uterine Cervical Neoplasms, Early presentation, Warning sign, Interquartile range, Surveys and Questionnaires, Epidemiology, medicine, Humans, Vaginal bleeding, Cervical cancer, business.industry, Research, Public health, Public Health, Environmental and Occupational Health, Early detection, Awareness, medicine.disease, Arabs, Menopause, Cross-Sectional Studies, Knowledge, Family medicine, Female, Public aspects of medicine, RA1-1270, Biostatistics, medicine.symptom, business
Abstract

"Background: Timely presentation and diagnosis of cervical cancer (CC) are crucial to decrease its mortality especially in low- and middle-income countries like Palestine. This study aimed to evaluate the knowledge of Palestinian women about CC warning signs and determine the factors associated with good knowledge. Methods: This was a national cross-sectional study conducted between July 2019 and March 2020 in Palestine. Stratified convenience sampling was used to recruit adult women from hospitals, primary healthcare centers, and public spaces of 11 governorates. A translated-into-Arabic version of the validated CC awareness measure (CeCAM) was used to assess women’s knowledge of 12 CC warning signs. Results: Of 8086 approached, 7223 participants completed the CeCAM (response rate = 89.3%). A total of 7058 questionnaires were included in the analysis: 2655 from the Gaza Strip and 4403 from the West Bank and Jerusalem (WBJ). The median age [interquartile range] for all participants was 34.0 [24.0, 42.0] years. Participants recruited from the WBJ were older, getting higher monthly income, and having more chronic diseases than those recruited from the Gaza Strip. The most frequently identified warning sign was ‘vaginal bleeding after menopause’ (n = 5028, 71.2%) followed by ‘extreme generalized fatigue’ (n = 4601, 65.2%) and ‘unexplained weight loss’ (n = 4578, 64.9%). Only 1934 participants (27.4%) demonstrated good knowledge of CC warning signs. Participants from the Gaza Strip were slightly more likely than participants from the WBJ to have a good level of knowledge. Factors associated with having good knowledge included having a bachelor or postgraduate degree, being married, divorced, or widowed as well as knowing someone with cancer. Conclusion: The overall awareness of CC warning signs was low. Educational interventions are needed to increase Palestinian women’s awareness of CC warning signs. Keywords: Cervical cancer, Early detection, Survival, Symptom, Warning sign, wareness, Knowledge, Early presentation, Palestine" "الخلفية: يعد تشخيص سرطان عنق الرحم وتشخيصه في الوقت المناسب أمرًا بالغ الأهمية لتقليل معدل الوفيات خاصة في البلدان المنخفضة والمتوسطة الدخل مثل فلسطين. هدفت هذه الدراسة إلى تقييم معرفة النساء الفلسطينيات بعلامات التحذير الخاصة بسرطان عنق الرحم وتحديد العوامل المرتبطة بالمعرفة الجيدة. الطرق: كانت هذه دراسة مقطعية وطنية أجريت بين تموز 2019 وآذار 2020 في فلسطين. تم استخدام عينات من النساء البالغات من المستشفيات ومراكز الرعاية الصحية الأولية والأماكن العامة في 11 محافظة. تم استخدام نسخة مترجمة إلى العربية من مقياس الوعي (CeCAM) الذي تم التحقق من صحته لتقييم معرفة النساء بـ 12 علامة تحذير من سرطان عنق الرحم. النتائج: أكمل 7223 مشاركًا CeCAM (معدل الاستجابة = 89.3 ٪). تم تضمين ما مجموعه 7058 استبانة في التحليل: 2655 من قطاع غزة و 4403 من الضفة الغربية والقدس. كان المشاركون من الضفة الغربية و القدس أكبر سناً ، ويحصلون على دخل شهري أعلى ، ولديهم أمراض مزمنة أكثر من أولئك الذين من قطاع غزة. كانت علامة التحذير الأكثر تحديدًا هي ""النزيف المهبلي بعد انقطاع الطمث"" (العدد = 5028 ، 71.2٪) يليه ""التعب الشديد العام"" (العدد = 4601 ، 65.2٪) و ""فقدان الوزن غير المبرر"" (العدد = 4578 ، 64.9٪) . أظهر 1934 مشاركًا (27.4 ٪) معرفة جيدة بعلامات التحذير من سرطان عنق الرحم. كان احتمال حصول المشاركين من قطاع غزة على مستوى جيد من المعرفة أكثر بقليل من المشاركين من الضفة الغربية. تشمل العوامل المرتبطة بالحصول على معرفة جيدة الحصول على درجة البكالوريوس أو الدراسات العليا ، والحالة الاجتماعية وكذلك معرفة شخص مصاب بالسرطان. الخلاصة: كان الوعي العام بعلامات التحذير من سرطان عنق الرحم منخفضًا. هناك حاجة إلى تدخلات تثقيفية لزيادة وعي المرأة الفلسطينية بعلامات التحذير من سرطان عنق الرحم. "

Published
2021
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5. Knowledge of cervical cancer risk factors among Palestinian women: a national cross-sectional study

Author

Lana Khatib, Shahd Idais, Nour Fannoun, Ibrahim Al-Slaibi, Haya Hebi, Hadeel Ayesh, Mariam Thalji, Hala Abu Selmiyh, Mohammed Alser, Bettina Böttcher, Refqa Najeeb Skaik, Aya Nammari, Amany Alser, Deniz Elhussaini, Ma’alem Hajajreh, Nasser Ibrahim Abu-El-Noor, Alaa Alfuqaha, Hiba Khrishi, Toqa Rjoub, Saba Rjoub, Afnan Radaydeh, Lama Hammoud, Salma Khader, Rawan Zakout, Hanan Abukmail, Zakia Abo-Hajouj, Tumodir Abdallah, Ghaid Tanbouz, Zaina Alqudwa, Bisan Ahmad, Manar Zamel, Nour Abed, Mohamedraed Elshami, and Lina Kassab

Subjects
Adult, medicine.medical_specialty, Health Knowledge, Attitudes, Practice, Palestine, Survival, Cross-sectional study, Reproductive medicine, Uterine Cervical Neoplasms, Early presentation, Adult women, Risk Factors, medicine, Humans, Risk factor, Child, Cervical cancer, Gaza strip, business.industry, Knowledge level, Research, Prevention, Obstetrics and Gynecology, Early detection, General Medicine, Gynecology and obstetrics, Awareness, medicine.disease, Arabs, Cross-Sectional Studies, Knowledge, Reproductive Medicine, RG1-991, Female, Public aspects of medicine, RA1-1270, business, Demography
Abstract

"Background: High awareness of cervical cancer (CC) risk factors is important to decrease the morbidity and mortality associated with CC. This study aimed to assess the knowledge level of Palestinian women about CC risk factors and to determine the factors associated with good knowledge. Methods: This was a national cross-sectional study. Adult women from hospitals, primary healthcare centers, and public spaces of 11 governorates in Palestine were recruited using a stratified convenience sampling. A translated-into-Arabic version of the validated CC awareness measure (CeCAM) was used to assess the knowledge about the 11 CC risk factors. For each correctly identified risk factor, the participant was given one point. The total score was calculated and was categorized into three categories: poor knowledge (0–3), fair knowledge (4–7), and good knowledge (8–11). Results: A total of 7223 participants completed the Arabic CeCAM (response rate = 89.3%) and 7058 questionnaires were included in the final analysis: 2655 from the Gaza Strip and 4403 from the West Bank and Jerusalem. Participants recruited from the Gaza Strip were younger, getting lower monthly incomes, and with less chronic diseases than participants recruited from the West Bank and Jerusalem. The most frequently identified risk factor was ‘having a weakened immune system’ (n = 5458, 77.3%) followed by ‘infection with a sexually transmitted infection’ (n = 5388, 76.3%). The least identified risk factor was ‘having many children’ (n = 1597, 22.6%). Only 1670 women (23.7%) had good knowledge of CC risk factors. Women living in the Gaza Strip were more likely than women living in the West Bank and Jerusalem to have good knowledge (25.2% vs 22.7%). Completing a secondary or diploma degree, being employed, and having a monthly income of ≥ 1450 NIS (around $450) were all associated with lower likelihood of having good knowledge of CC risk factors. Conversely, knowing someone with cancer was associated with higher likelihood of having good knowledge. Conclusion: The overall awareness of CC risk factors was low. There is a substantial need to establish educational programs to promote Palestinian women’s awareness of CC." "خلفية البحث: الوعي العالي بعوامل الخطر لسرطان عنق الرحم مهم لتقليل نسبة المرض والوفيات المرتبطة بسرطان عنق الرحم. هدفت هذه الدراسة إلى تقييم مستوى معرفة النساء الفلسطينيات حول عوامل خطر الإصابة بسرطان عنق الرحم وتحديد العوامل المرتبطة بالمعرفة الجيدة. منهجية البحث: كانت هذه دراسة مقطعية وطنية. تم اختيار المشاركات في هذا البحث من النساء البالغات و تم جمع البيانات من النساء من المستشفيات ومراكز الرعاية الصحية الأولية والأماكن العامة في 11 محافظة في فلسطين باستخدام عينة ملائمة طبقية. تم استخدام نسخة مترجمة إلى العربية من مقياس الوعي لسرطان عنق الرحم (CeCAM) لتقييم المعرفة حول عوامل الخطر ذات العلاقة بسرطان عنق الرحم. لكل عامل خطر تم تحديده بشكل صحيح ، تم إعطاء المشارك نقطة واحدة. تم حساب النتيجة الإجمالية وتم تصنيفها إلى ثلاث فئات: ضعف المعرفة (0-3) ، ومتوسطة (4-7) ، والمعرفة الجيدة (8-11). النتائج: أكمل ما مجموعه 7223 مشاركًا اختبار CeCAM باللغة العربية (معدل الاستجابة = 89.3٪) وتم تضمين 7058 استبيانًا في التحليل النهائي: 2655 من قطاع غزة و 4403 من الضفة الغربية والقدس. كان المشاركون من قطاع غزة أصغر سناً, ويحصلون على دخل شهري أقل ، ولديهم أمراض مزمنة أقل من المشاركين من الضفة الغربية والقدس. كان عامل الخطر الأكثر تحديدًا هو ""ضعف الجهاز المناعي"" (العدد = 5458 ، 77.3٪) متبوعًا بـ ""الإصابة بعدوى تنتقل عن طريق الاتصال الجنسي"" (العدد = 5388 ، 76.3٪). كان عامل الخطر الأقل تحديدًا هو ""إنجاب العديد من الأطفال"" (العدد = 1597 ، 22.6٪). فقط 1670 امرأة (23.7٪) لديهن معرفة جيدة بعوامل خطر الإصابة بالسكري. كانت النساء اللواتي يعشن في قطاع غزة أكثر عرضة من النساء في الضفة الغربية والقدس للحصول على معرفة جيدة (25.2٪ مقابل 22.7٪). إن إكمال الشهادة الثانوية أو الدبلوم ، والتوظيف ، والحصول على دخل شهري قدره 1450 شيكل إسرائيلي جديد (حوالي 450 دولارًا) ، كلها مرتبطة بانخفاض احتمالية امتلاك معرفة جيدة بعوامل خطر الإصابة بسرطان عنق الرحم. على العكس من ذلك ، ارتبطت معرفة شخص مصاب بالسرطان بارتفاع احتمالية امتلاك معرفة جيدة. الخلاصة: كان الوعي العام لعوامل الخطر ذات العلاقة بسرطان عنق الرحم منخفض. هناك حاجة جوهرية لإنشاء برامج تثقيفية لتعزيز وعي النساء الفلسطينيات ببرنامج سرطان عنق الرحم."

Published
2021

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