Characteristics of the study area:

Location: (Nablus) districts, which located in the northern area of the West Bank in Palestine. Nablus lies on the mountains of Ebal and Jerzim. Nablus is famous for Nabulsi kanafa, soap and mosques. In Nablus, An-Najah National University. Nablus has a number of hospitals, two governmental and three private and two NGOS.

 

 

 

 

 

Description of the settings:

        In this study, the researcher selected all settings. The Major part of the (CP) care/services in north districts in Nablus is delivered by the Government, NGOS, and private sectors. Services offered in these centers.

 

1-UNRWA Services:

          The services are distributed in three refugee camps (Balata, Asqar, and Alain) camps. The centers provide their preventive & curative rehabilitation services to the Palestinian refugees who live in Nablus districts.  

 

                  

 

2- Public/ Government:

           The public /government services are operated by the Palestinian Ministry of Health, and Ministry of Social Affairs. The center provides its curative services to the insured Palestinians who live in the north districts.

 

 3-NGOS:

 The NGO’s services are distributed in all north districts .The major part of the services is in Nablus district. These centers often physiotherapy, Services provided at minimal cost and free of charge for the social cases.

                                                                                                           

4-Private:                                                                                                                                                                           

The private services are distributed in Nablus in the north districts .The major parts of the services are also in Nablus district. Most services are located in the center of the cities. The major part of the services in this sector.

 

 

 

 

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CHAPTER111

METHODOLOGY

 

1. Research Design:

        In this study the researcher has utilized a Retrospective design utilizing a structured questionnaire. Questions and information are taken from medical files from the birth register at the child care clinics and clinics from the computerto see the relationship between (SES) and (CP).  The study will cover all operating (CP) centers.

 

B. Identification of Population and Sample:

The target population includes All the children who were born in the city's hospitals from1 Jun2017-31 Dec2017 in Nablus district.

 

 

Sampling Methods:

        The study was undertaken using the computerized child health system in the hospital in Nablus district. The study sample comprised all live births to mothers resident in Nablus district between 1 January 2017 and 31 December 2017.AChild Health Record was routinely generated using information record concurrently by midwives and in the birth registration. Birth weight, gestation, plurality, register generals social class at birth (based on fathers occupation), and who were recorded as having a diagnosis of cerebral palsy, who routinely recorded the type and the severity of cerebral palsy. The diagnosis of cerebral palsy of the recording of type (classified as hemiplegic, diaplegia, quadriplegia and other) and severity (mild, moderate and sever, based on the degree of functional impairment.

 

 

 

 

 

C.  Setting:

            The researcher had chosen three sectors, (Government, NGOS, and Private) to conduct the study. These hospitals were selected according to specific criteria, which had located in Nablus district.

 

 

 

 

D.  Ethical Consideration:

       

  A formal Letter: From the dean of graduate studies- Al Najah University will be send to each center requesting the director, of the hospital as applicable, to allow the researcher to conduct the study.

 

  Explanatory Form: Every eligible manger or responsible in the study was given a full explanation about the research. Including the purpose, nature of study, importance of participation in addition to assuring of confidentiality of information and voluntary participation and that the providers was given the total freedom or accept or reject participate in the research .

 

E. Instrument:

       For the purpose of conducting, the researcher designed a semi-structured questionnaire. The aim of the questions is to find out the relationship between cerebral palsy and the condition. The questionnaire was written in Arabic language to be easily understood by providers. The instrument was divided into 6 questions; each question consisted of several items (Appendix1). It was designed to collect information falling under the categories of: -

    Question1: Related to the Socioeconomic.

Question2: Related to the Weight birth

Quation3: Items related to the Prematurity

Question4: Items related to the Gestation

Question5: Items related to the Types of (CP).

Question6: Items related to the Father occupation

 

F.  Pilot Testing:

        These items in the questionnaire were evaluated by advisors who had research back ground and by two qualified Physiotherapy for validity purposes.

            Three advisors who had research background and two qualified professionals evaluated the questionnaire for validity purposes. Pilot testing will be conducting before data collection since it was necessary to detect gaps prior to field implementation and to identify the time needed to complete the information.

 

 

G.  Data Collection: 

         The researcher had planned to spend one month in the field in Nablus district for collect the information from the files record. The  providers was first given a complete explanation about the purpose, nature of the study in addition to assure her/his confidentiality and that providers was free to accept or reject to participate in the study, To access the computer to take data

 

        Before starting the access the computer to take data, the questionnaire forms were prepared and serial by numbers. That was to secure the availability of all forms all the time. At the end of each access to take data, the researcher scanned the questionnaire to ensure adequate completion of all information. Thus any missing data was obtained before the provider left the compuer to confirm accuracy.

The study will implement by using the computerized child health system in Nablus district. The sample comprised all live birth to mothers resident in Nablus between 1 January 2017 and 31 December2017. A child health record is routinely generated using information recorded concurrently by midwives and in the birth registration. Birth weight, gestation, plurality, register general social class at birth (based on father’s occupation). Children with cerebral palsy were identified from the child health file, those who recorded as having a diagnosis of cerebral palsy confirmed at 2 years of age or older or who had died under the age of 2 and who were recorded as having  diagnosis of cerebral palsy, irrespective of whether the cerebral palsy was judged to have been  acquired pre- or postnatally. All children diagnosed  as having(CP)  had been seen by pediatricians’ in the community child health service who routinely recorded the type and severity of (CP). The diagnosis of (CP)  and the recording of type classified as (hemiplegia, diaplegia, quadriplegia and other) and severity (mild, moderate, and sever, based on the degree of functional impairment at the last visit) was made on clinical ground and not on basis of standardized criteria.

 

8.  Methodological Limitation:    

           Limitation of this study were related to

        1-The computerized health system not include all the information that needed in this research.

        2-Assessment of children is not carried out according to a formalized system.

      3- A diagnosis of (CP) cannot be made reliably before the age 2 years.

1. Method of Data Analysis:

The data will enter into the computer, while utilizing the statistical program SPSS.  The prevalence of (CP) in singleton will calculated for all live birth, multiple births and birth weight (<1500, 1500-2500, >2500g) and gestational age (<35, 35-40, >40 weeks). The prevalence of each type and grade of severity was also will recorded. AX square test for linear trend will used to examine the prevalence of (CP) and (SES). Separate logistic regression analyses will include birth weight, gestational age, as independent variables. Only children of families resident in Nablus city at the time of the child birth will include in the study.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUMMARY:

           This chapter gave an overview of the methodology that was used to answer the research questions, which included the research design, the target population, sampling, setting, instrument and methods of data collection and analysis.

 

 

 

Chapter VI

LITERATURE REVIEW

 

           The initial review of literature revealed that there was extensive literature on disabilities.

                                       

Review of Relevant Theoretical Literature     

    

          In 1980, the World Health Organization adopted an international classification of impairments, disabilities and handicaps, which suggested a more precise and at the same time relativistic approach. The International Classification of Impairments, Disabilities, and Handicaps make a clear distinction between impairment, disability, and handicap. It has been extensively used in areas such as rehabilitation, education, statistics, policy, legislation, demography, sociology, economics and anthropology. Some users have expressed concern that the classification, in its definition of the term handicap, may still be considered too medical and too centered on the individual, and may not adequately clarify the interaction between societal conditions or expectations and the abilities of the individual (4).

                                                                                                                                                                                                                                                                     

          The International Classification of Impairments, Disabilities and Handicaps were first published by the (WHO) in1980. The revision process has resulted in many changes to the original classification, including a change of the name Disability and rehabilitation to ‘International Classification of Functioning and disability’. This new name is accompanied by a change of emphasis from negative description of impairments, disabilities and handicaps to neutral descriptions of body structure and function, activities and participation.  (5).

          Socioeconomic status and birth weight retrospective cohort study. To compare the relation of birth weight with Socioeconomic status measured by an area- based measure of material deprivation and by the register general social class. A substantial proportion of births<2500g and <1500g are statistically attributable to social inequality. The results demonstrate that, using either socioeconomic measure, the likelihood of being born weighting >or=3500, the most advantageous group, is substantially greater in the socially advantaged. Using the area a based measure, an estimated 12% of birth <3500g could be ascribed to social inequalities whereas the same figure using social class was 7%. These findings suggest that this proxy measure of socioeconomic status may be a better discriminator in this study of pregnancy outcomes in this population than classification by occupational social class (6).

      Cerebral palsy effects of twinning, birth weight, and gestational age, to determine the effects of birth weight and gestational age on the risk of (CP) for multiple  and singleton births, the  increased risk to twins of (CP) is not entirely explained by their increased risk of prematurity and low birth weight (7).

      Contribution of socioeconomic status on the prevalence of (CP), the association between (SES) and (CP) remains controversial. Preterm birth, low weight birth and post natal injuries are accepted mediating risk factors for (CP), but the question remains whether (SES) confers additional risk. Twelve studies were included in the systematic review. Of these eight found low SES to be a risk factor for increased CP prevalence. Three studies detected statistically significant associations even after controlling for birth weight and gestational age as variables. Two of these studies also accounted for additional confounding variables (multiple births and timing of CP acquisition) and continued to detect contributing effects of SES. Linear negative correlations between CP prevalence and SES were shown by three studies (8).

          Changing socioeconomic inequality infant mortality in Cumbria. The risk of infant death in all categories was higher in the lower social class and more deprived communities, although inequality in risk of neonatal death declined after 1975 to such an extent that death rates by socioeconomic status in the most recent time period. By contrast there was no narrowing in socioeconomic inequality in postneonatal death risk over the study period. Community deprivation was associated with a significant increased risk of  postneonatal death after adjusting for individual status (9).

 

 

                                                          

       

 

B- Situation in West Bank and Gaza Strip:

The number of studies conducted in Palestine on rehabilitation and disabilities, in general and consumer assessment of rehabilitation services, in particular, are very limited.                         

         A retrospective study conducted on the West Bank district, Giacaman, et.al. (1989) With focus in the formulation of a rehabilitation policy for disabilities in the West Bank, found that 57 institutions were actively providing services to the physically and mentally disabled and those suffering from sensory disabilities. 61% were located in the central region of the West Bank (Bethlehem, Jerusalem, Ram Allah, and Jericho), 28% in the North (Nablus, Qalqiliya, Jenin, and Tulkarm) and 7%in the South. None of the institutions provided all the services. Obviously, the persons who provided the information did not think of this service as particularly important or as a separate and distinctly important activity. The financial problems were the most commonly listed problems that these institutions faced, followed by dealing with the families of the disabled, dealing with the employees motivation and their level of their awareness, and the problem of isolation of institutions. Many of the institutions, especially those dealing with the mentally handicapped, suffered from inadequate physical conditions and lacked programmatic action .The personnel involved in caring for the disabled in these centers either lacked adequate training or were not trained at all (10).

 

         Another study was conducted by (University of Calgary and Society for the Care of Handicapped Children, (1986), in Gaza Strip, where a house-to-house survey on a sample of the refuge population was conducted. This study yielded the figure of 2.4% for the prevalence of disability among preschool age and school age children. Of the total disabilities, 4% were for seizure disorders, about 8% related to the sight, 11% related to hearing loss, 5% related to poliomyelitis, 6% did-hemi and quadriplegias, and the rest a mixture of other types of disabilities. Assuming the total population of the West Bank and Gaza in order of 1.5 million people, the study estimated that about 15,0000 persons suffered from disabilities, ranging from very mild to very severe. Also the estimation that between 2-2.5% of the population is in need of rehabilitation in one-way or another (11).

         Another study was conducted by the Northern regional committee for rehabilitation (1994). The study included 22 Palestinian villages in the Jenin district with special reference to the needs of persons with disabilities. The surveyed communities included 1.9% persons with disability of the total population. The general lack of services and the relative underdevelopment characterizing the region have particularly difficult ramifications for this sector of the population. Apart from a very few secondary or mid level support services (most notably physiotherapy), persons with disabilities in the Jenin district lacked access to the most basic support and rehabilitation services. As in this case of basic service provision to the general population, the nongovernmental sector is responsible for the bulk of what little services are available. Only 57% of those with disabilities have ever sought such services and the majority of these received curative medical services only, to the exclusion of other types of vital services, such as educational, social, and rehabilitation services. Furthermore, 58% of those with disabilities (893) reported that they were without the technical aides they required. The study also researched that; only 8% of all males adult with disabilities are regularly employed. The researchers in this study recommended that rehabilitation projects must include vocational and other training projects towards the employment of persons with disabilities(12).

 

         Another study on 23 Palestinian villages in the central district of the West Bank with special reference to the needs of persons with disabilities conducted by the Central Regional Committee for Rehabilitation CRCR (1995), succeeded in identifying 1,056 disabled people living in these communities. The majority of the disabled were found to suffer from moderate and severe disabilities, with only 4% denoting their disability as of the mild type, and indicating the need for CBR projects in these communities. In total, 25% of the disabilities were related to movement, a high percentage of 44% were related to the sensory system –sight, hearing and speech and 31% were multiple in nature, mental mixed with other types of disabilities. The researchers in this study recommended that the central area CBR programmed takes the shape of not only individual assistance within homes, but also the shape of communal education and action. On the one hand, the disabled of the central area need assistance to solve their physical problems. On the other hand, an attempt to gradually change the negative perceptions of communities towards disability stigma and shame is very much part of disability rehabilitation, in addition to being a fundamental human right. Finally, disability rehabilitation is not merely a program of assistance but the researchers, the Palestinian experience has developed in such a way that it is also a programmer that is directed towards guaranteeing the fundamental human rights the of disabled (13).

         According to a study of 19 Palestinian communities in the South district of the West Bank (Bethlehem and Hebron regions), with the intention of informing the development of CBR programmer, launched by the Southern Regional Committee for Rehabilitation (SRCR, 1996). The surveyed communities included 2,729 persons with disabilities, or 2.4% of the total population, comparable to disability rates elsewhere in the developing world. The Hebron region recorded the highest rate of disability (2.5%), higher than Bethlehem (2.2%). In the total Southern Region, 2.5 skills per a disabled person need to be learned, with disabled persons in the Hebron region faring well than in Bethlehem, (2.6 versus 2.4 skills per person). These results indicate the need for CBR activities towards assisting the disabled, and their families in coping with daily life activities. However, the results of the study clearly demonstrated the need of CBR activities aimed at assisting the disabled and their families to maintain an optimal level of coping and social integration within communities, rather than continually seeking institutional care that offers the “magic cure” at high costs and in a sporadic fashion. In deed, CBR is the foundation upon which disability rehabilitation should be built, utilizing institutional care for specific purposes and for finite periods. The researchers recommended that CBR be the only way that is able to address needs at a minimal cost and in a humane manner (14).

          By PCBS, 2000, indicated that the percentage of disability prevalence in Palestine was 1.8%, of which 1.9% in the West Bank and 1.6% in Gaza Strip. The highest percentage of the disabilities in the West Bank was Qalqiliya and Tulkarm at 2.3% followed by Tubas district at 2.1% and Jerusalem & Al-Bireh, Jerico, and Hebron were found to have the same percentage of 1.7% (15).

 

 

 

 

 

 

CHAPTER VII

RESULTS

 

 

 

1. Data Analysis Procedure:

        Data collection was carried out in the period in March 2018. The population of the study different subjects. The subjects were from Government centers and clinic, Non Government centers, UNRWA centers, and Private centers in the Nablus district. Face to face interview technique was carried out, and 6 questionnaires will be completed ensuring 100% response rate as a frame reference. Data will be coded and entered into the computer by the researcher who was helped by a computer technician. The data will be double check through a comparison printout and code sheets. No discrepancy will be  detected.

 

Retrospective statistics for closed-ended questions was carried out using the (SPSS)

        For data analysis, the researcher used the following percentages:

 

 

 

 

CHAPTER VIII

DISCUSSION

 

 

 

BIBLIOGRAPHY

 

 

1- Palestinian Central Bureau of Statistics. (2011). Disable Persons In The Palestinian Territory: Statistical report series (N.204). Ramallah-West Bank

2-Carstairs V, Morris R. Deprivation and mortality: an alternative to social class? Community Med. 1989 Aug;11(3):210–219. [PubMed]

 

3- Spencer N, Bambang S, Logan S, Gill L. Socioeconomic status and birth weight: comparison of an area-based measure with the Registrar General's social class. J Epidemiol Community Health. 1999 Aug;53(8):495–498. [PMC free article].

 

4-Dowding VM, Barry C. Cerebral palsy: social class differences in prevalence in relation to birthweight and severity of disability. J Epidemiol Community Health. 1990 Sep;44(3):191–195.[PMC free article]

5- Carstairs V, Morris R. Deprivation and mortality: an alternative to social class? Community Med. 1989 Aug;11(3):210–219. [PubMed]

6- Nelson KB, Ellenberg JH. Predictors of low and very low birth weight and the relation of these to cerebral palsy. JAMA. 1985 Sep 20;254(11):1473–1479. [PubMed]

7- Pattenden S, Dolk H, Vrijheid M. Inequalities in low birth weight: parental social class, area deprivation, and "lone mother" status. J Epidemiol Community Health. 1999 Jun;53(6):355–358.[PMC free article]

8- Eames M, Ben-Shlomo Y, Marmot MG. Social deprivation and premature mortality: regional comparison across England. BMJ. 1993 Oct 30;307(6912):1097–1102. [PMC free article]

9-Bjornson KF, McLaughlin JF. The measurement of healthrelated quality of life (HRQL) in children with cerebral palsy. Eur J Neurol. 2001;8(suppl 5):183-93.

 

 

 

9-Giacaman, R, Deibes, I, Salem, H, Nammari, R, Waller, S. (1989).To wards the formulation of rehabilitation policy disability in the West Bank, p 1-23.

10-The University of Calgary and the Society for the Care of Handicapped Children, Gaza. (1986). Study of the Prevalence of Handicapping conditions Affecting Children, and a case Finding Intervention in the Refugee Camp Population of Gaza Strip, p18.

11-The Northern Regional Committee for Rehabilitation. (1994). A study of 22 Palestinian Villages in the Jenin District with Special Reference to the Needs of Persons with Disabilities, p66-67.

12-The Central Regional Committee for Rehabilitation. (1995). A study of 23 villages in the central district of the West Bank with special reference to the needs of persons with disabilities, p61-62.

13-The Northern Regional Committee for Rehabilitation. (1994). A study of 22 Palestinian Villages in the Jenin District with Special Reference to the Needs of Persons with Disabilities, p66-67.

14-The Southern Regional Committee for Rehabilitation. (1996). A study of 19- Palestinian communities in the southern district of the West Bank, with special reference to the needs of persons with disabilities, p31-85.

15-Palestinian Central Bureau of Statistics. (2000). Disable Persons In The Palestinian Territory: Statistical report series (N.084). Ramallah-West Bank.

 

 

العنوان

د. قيس نعيرات

الناشر

جرنال ، المؤتمر الدولي الرابع للعلاج الطبيعي

بلد الناشر

الأردن

نوع المنشور

Both (Printed and Online)

المجلد

4

السنة

2018

الصفحات

34