| Abstract |
Children are vital to the nation’s development. Over the years, evidence has shown that
good physical and psychological health during childhood sets the stage for positive and
healthy choices to be made during adulthood. Children have begun to be recognized not
only for who they are today but for their future roles in creating families and powering
the workforce. In order to reinforce this perspective, the Health Behavior of School Aged
Children Project (HBSC) project was developed by researchers from England, Finland
and Norway and was adopted by the WHO Regional Office for Europe in 1983. The goal
of HBSC is to obtain data about adolescent behavior, concerning health, and to make this
information available so as to enable the improvement of health services and programs
for youth.
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In Palestine, there is little literature about children’s attitudes, behaviours, physical or
psychological well-being. As a result, Al-Quds University decided in 1995 to join the
HBSC project in an effort to adequately assess and monitor the health of Palestinian
children. The purpose of this thesis is to discuss two themes of the HBSC project in
Palestine 1- nutrition and obesity, 2- unintentional injuries. While theme one aims to
determine the distribution of obesity in the Mediterranean region in general and assess
the nutrition status of Palestinian school aged children in Jerusalem in particular, theme
two aims to describe nonfatal injuries and documenting the prevalence and nature of
unintentional injuries.
Methodology
To achieve the purpose for theme one, a meta-analysis was conducted for 102 articles
cited during the period (1997–2007) in Medline database (for 17 Mediterranean
countries) searched during the summer of 2007 using the word ‘obesity’ and its related
keywords. As the scope of the study was to assess the prevalence of obesity in the
Mediterranean region, the continents were used as the unit of analysis rather than
countries. Also data from the 2002/2003 school-based cross-sectional study targeting
313 adolescents at random from both public and private schools in Jerusalem was
analyzed. A previously validated and reliable questionnaire was administered through
interviews that included anthropometric and hemoglobin measurements, 24-h dietary
intake recall and a physical activity.
In theme two, data from the 2006 “Palestinian Health Behaviour in School-aged
Children” (HBSC) cross-sectional survey was used. Students of grades 6, 8, 10, and 12
self-completed a modified version of the international HBSC questionnaire, resulting in
15,963 students (47.3% boys and 52.7% girls) included in this study (56.9% from the
West Bank and 43.1% from Gaza). From the total selected children, 6458 (40.8%)
completed an optional package related to labor.
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Results
Analysis for theme one showed that adults were more obese than children in all
Mediterranean continents and in different levels of income. The prevalence of obesity
among European children was higher than among Asians. In Jerusalem, the nutrition
assessment had shown that being overweight (24.3%) or obese (9.9%) coexisted with
being underweight (4.8%) and/or anemic (23.3%). Less than one in four (22.4%) of the
Palestinian students reported engaging in physical activity more than 5 days a week with
boys being more physically active (P<0.01). The majority of children met less than 80%
of the recommended daily allowances (RDA) for most micronutrients. Although
malnutrition was evident in the sample, 80% of children rated their health as excellent
with boys reporting themselves as healthier (p<0.01).
Analysis for theme two showed that injury is a leading cause of poor health among
Palestinian children across the country. Of the total 15,963 adolescents, 47.6% were
injured, boys (53.5%) being statistically more likely to be injured than girls (42.1%)
(𝑃<0.001). The prevalence of those injured more than once decreased by age and was
also found significantly higher in boys than in girls (27.3% and 17.9%, resp.) (𝑃< 0.001).
Children living in low family affluence scale (FAS) showed significantly lower ratios of
injuries than those living in moderate and high FAS families (𝑃< 0.001). Injuries while
biking were significantly higher among boys (46.3%) than girls (41.7%) (𝑃<0.001), and
injuries while walking/running were more prevalent among girls (32.5%) than boys
(28.0%) (𝑃<0.001). Approximately 73.8% of the students who filled the optional
package reported working during the last 12 months, from whom 79.1% sustained a work
related injury. Work injuries were significantly higher among boys, younger children,
children enrolled in UNRWA Schools and living in Gaza Strip (P<0.05). Children
working more than 3 hours a day were more likely, by a factor of 1.73 (95% CI, 1.53-
1.95), to experience injuries than those working less than 3 hours a day. About half of the
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children worked in retail trade (51.5%), while 20% worked in agriculture and 11.4% were
in the field of cleaning (11.4%). Injury types were related to the type of work performed.
Conclusion
In Palestine, the extent, risk factors, and preventability of child obesity and how they
relate to injuries are not extensively appreciated. Findings from this thesis fill a
recognized void in the Palestinian adolescent health literature, in that it provides new
information about their eating habits and risk of injuries. It is hoped that the results of the
present study can provide guidelines for designing awareness and school education
programs that encourage healthy dietary habits combined with physical activity. As well
as the development of a National Injury Prevention and Intervention Programs aimed at
enhancing the safety of Palestinian adolescents.
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