Suchergebnisse

Background Individuals' maturity, independence, and freedom of choice involve five risky behaviours; smoking is the one that most seriously affects individual and public health. Since OSLO accord in 1993, 60% of the West Bank has been under Israeli military control (known as Area C) and is home to about 300000 Palestinians and a settler population of at least 325500 people. Israel retains the area to serve military training, economic interests, and settlement development, potentially affecting Palestinian people's life course. We aimed to compare smoking and lifecourse events among youths aged 14–29 years in 2010 living in Palestinian areas under Palestinian control (PA) of the West Bank and Gaza Strip (population 837099 youths) with those residing in Area C (population 90000 youths) in the West Bank. Methods We used data from the Palestinian Family Health Survey (which was done by the Palestinian Centre Bureau of Statistics in 2010), in which smoking was the dependent variable. A youth's life-course events, including school enrolment, employment status, marital status, combined with employment (ie, married and employed), and waiting (ie, not married, employed, or studying), were regarded as independent variables in addition to other important factors using SPSS software (version 17). Findings 25 484 youths were included in the analyses (1714 [7%] living in Area C and 24132 [93%] living in PA). 255 (15%) youths in Area C were smokers compared with 3163 (13%) in PA. Bivariate analyses showed a significant association between smoking statuses and sex (p≤0·05), age (p≤0·05), life course (p≤0·05), region of residency (p≤0·05), wealth-index quintiles (p≤0·05), and area (p≤0·05). Logistic regression showed that youths living in Area C were more likely to smoke than those living in PA (odds ratio [OR] 1·55, 95% CI 1·29–1·86). Moreover, more youths reported to be smokers who were employed and married (41·6%) than workers not married (38·9%) and waiting (19·1%). Youths older than 17 years were more likely to smoke (aged 18–25 years: OR 4·19, 95% CI 3·63–4·85; aged 26–29 years: OR 5·45, 4·55–6·53) than were those aged younger than 17 years. Those living in the West Bank were more likely to smoke than those living in Gaza (4·70, 4·19–5·27). Living in rural refugee camps doubled the probability of being smokers than living in urban camps (1·48 1·27–1·72). Finally, men had an increased probability to be smokers compared with women (74·02, 57·70–94·98). Of youths living in Area C, only students were most likely to smokers. In PA, unemployed youths and students were both most likely to be smokers. Interpretation Additional in-depth research is needed to understand the coping mechanisms used by youths to reach adulthood under stressful situations. A limitation of our study was that socioeconomic status was not included in the statistical model.

Background The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013.GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically. Findings The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100 000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disabilityadjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high body weight and systolic blood pressure affected older people (aged 60–80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred. Interpretation Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts.

Abstract
Background
During the Covid-19 epidemic, the increased number of people seeking medical attention worsened hospital shortages. This shortage required reallocating the workforce, personal protective equipment (PPE), medical equipment, medical disposables, and hospital wards. This reallocation delayed a number of elective surgeries. This study explored the financial, physical, and psychological implications of deferring elective surgeries on Palestinians in three West Bank hospitals during the pandemic.


Methods
This cross-sectional study included 398 patients from tertiary hospitals in Palestine whose elective surgical procedures were deferred due to the COVID-19 pandemic. Between 8/8/2021 and 6/9/2021, data were collected on patients who had elective surgery deferral at three government hospitals in the West Bank of the Palestinian territories. There were five parts to the study tool; personal information, access to the health system, physical affection, financial effect, and psychological effect. Statistical analysis included a univariate, bivariate and multivariate.

Results
The healthcare system's response to the COVID-19 epidemic directly affected patients whose surgeries were deferred. The healthcare system's response was the cause of the delay in 91.5% of the cases. Orthopedic and neurological surgeries account for 48.3% of deferred surgery. Other than delayed surgeries, 30.2% of patients were unable to get additional health care services. Physically, 55.5% of patients were impacted, 45% were anxious, and 29.6% were depressed.

Conclusions
Patients who had procedures deferred as a result of the healthcare system's response to the COVID-19 epidemic were impacted physically, financially, and psychologically. There should bea better crisis management strategyto ensure that certain hospitals are able to operate regularly despite the situation.

Article in International Journal of Radiation Oncology, vol. 98, no. 3 ; The availability of basic cancer treatment services, including surgery, chemotherapy, and radiation therapy, along with a clear referral system for these services, is crucial to building a comprehensive cancer service. Radiation therapy for cancer patients is limited and inaccessible in middle- and low-income countries, respectively, although desperately needed, especially when cancer is diagnosed at advanced stages, as happens in these countries. Radiation therapy is the most cost-effective treatment for curative and palliative cancer care, especially when combined with surgery.

Rouham,Yamout:American University of Beirut Rita,Giacaman:Community and Public Health ; With the creation of the state of Israel in 1948, about 700 000 Palestinians were dispossessed and dispersed, mostly to neighbouring countries. Roughly 100 000 Palestinians fled to Lebanon and now 400 000 are living there, most in refugee camps. Although tolerated by the Lebanese Government and population, with their basic needs supported by the UN Relief and Works Agency for Palestine Refugees in the Near East, Palestinian refugees are subjected to regulations that hinder their opportunities to seek employment and ownership of property, thereby restricting their integration into society and compromising their wellbeing. In a study of the quality of life and wellbeing of Palestinians living in the occupied Palestinian territory, a team from Birzeit University, Ramallah, West Bank, investigated classic and war-related indicators of insecurity in the Gaza Strip 6 months after the Israeli war during the winter of 2008—09, using locally developed scales for the measurement of insecurity and individual distress. We assessed the relevance and validity of the two scales as measures of wellbeing for Palestinian refugees living in camps in Lebanon. Methods Researchers from Lebanon undertook six focus group discussions to investigate notions of relevance to the quality of life and wellbeing of Palestinian refugees in Lebanon, and modified the questionnaire used in the Gaza Strip, without changing its psychometric properties and without modifying the questions in the scales to be studied. In this pilot study, households were selected from four Palestinian refugee camps in Lebanon to represent the different areas—north, south, Beirut, and Dbayeh (only functional refugee camp hosting Christian Palestinians, whereas the refugees in the others are Sunni Muslim). Every other household was selected in Beddawi and one in every three households in Burj el-Barajneh and Ein el-Helweh, and all households were approached in Dbayeh. In the camps of Beddawi, Burj el-Barajneh, and Ein el-Helweh, the fieldworkers stopped gathering data when the sample size of 100 individuals was attained, whereas in Dbayeh this number could not be achieved. One adult respondent from every household was randomly selected according to Kish tables, with alternating of men and women—ie, the person answering the door was asked to list the male or female adult members of the household. Indicators of insecurity and individual distress were analysed after application of the cutoffs used in the Gaza Strip study. χ2 and logistic regression analyses were done to identify the association between the dependent variable—reports of high insecurity—with demographic, socioeconomic, and health factors, and with objective and subjective factors related to the political and legal conditions of Palestinian refugees in Lebanon. This study was approved by the Institute of Community and Public Health Ethical Review Committee, West Bank. Data gatherers obtained verbal informed consent from the household members selected before their participation in the study. Findings 356 (94%) of 378 adults who were approached by the fieldworkers responded—101 in Beddawi, 100 in Burj el-Barajneh, 100 in Ein el-Helweh, and 55 in Dbayeh. All the indictors of insecurity and distress were the same as in the study undertaken in the Gaza Strip, with Chronbach's α showing good internal consistency for the insecurity scale (0·84) and for the individual distress scale (0·86). 134 (38%) respondents reported moderate to high amounts of individual distress and 121 (34%) reported high intensity of insecurity. A first logistic model, including demographic and socioeconomic variables, showed that insecurity was associated with living at Burj el-Barajneh refugee camp (49 [49%] of 100 vs 72 [28%] of 256 living in the other three camps surveyed), displacement of the family from another refugee camp (28 [55%] of 51 vs 92 [30%] of 303 whose families had not been displaced), and the respondents thinking that the camp was overcrowded (86 [43%] of 202 vs 35 [24%] of 148 who did not have a problem with the camp crowding). The results of a second model of all the variables that were significant in the bivariate analysis and adjusted for age, sex, and employment, showed that the odds of individuals reporting high insecurity were significantly higher in Palestinians living in the refugee camp at Burj el-Barajneh than in those living at Dbayeh (49 [49%] of 100 vs eight [15%] of 55, respectively; odds ratio 5·95, 95% CI 2·05—17·29); in individuals whose families had been displaced from another refugee camp than in those who had not been displaced (28 [55%] of 51 vs 92 [30%] of 303, respectively; 5·62, 2·67—11·85); in Palestinians who felt deprived than in those who did not (50 [43%] of 115 vs 69 [29%] of 237, respectively; 2·18, 1·22—3·89); and in individuals who felt estranged from their homeland than in those who did not (95 [41%] of 234 vs 23 [21%] of 109, respectively; 2·41, 1·28—4·53) Interpretation The security and distress measures developed in the Gaza Strip showed good internal consistency when applied to Palestinians living in refugee camps in Lebanon. Furthermore, high intensities of insecurity and distress were noted in Palestinians living in refugee camps in Lebanon, raising questions about the legal, political, and social conditions imposed on these individuals as determinants of their insecurity, life quality, and wellbeing. The results encourage testing and validation of the security and distress scales in Palestinian refugees in other Arab countries, and in other migrants, refugees, and people living in zones affected by war and conflict. Funding Medical Aid for Palestinians. Contributors RY is the principal investigator and drafted the Abstract. SF did the data analysis. NMEAR and RG participated in the concept and design of the study and reviewed the data analysis and the drafts. DH reviewed the consecutive drafts of the Abstract. All authors have read and approved the final Abstract for publication. Conflicts of interest We declare that we have no conflicts of interest.

Hanan,Farraj:Qatar University Laura,Wick:Community and Public Health ; Objective—Against the backdrop of a rise in cesarean section deliveries from 6.0% in 1996 to 14.8% in 2006, the objective of this study was to investigate socio-demographic, clinical and servicerelated factors associated with cesarean sections in the occupied Palestinian territory. Methods—Data from the Palestinian Family Health Survey 2006 were used to examine last births in the 5 years preceding the survey to women aged 15–49 years. Bivariate and multivariate associations between type of delivery (dependent variable) and selected factors were analyzed using logistic regression. Selected maternal outcomes were also investigated with type of delivery as the independent variable. Results—Cesarean section deliveries were significantly associated with maternal age (35+ years), primiparity, low birth weight and residence area in the West Bank and Gaza. There was no significant difference in the prevalence of cesarean deliveries by sector in the West Bank, but in Gaza, they were significantly more common in the governmental sector. Conclusions—There is a need for detailed audits of cesarean section deliveries, nationally and at the facility level, in order to avoid unnecessary interventions in the context of high fertility, rising poverty and fragmented health services. Variations by governorate should be studied further for focused interventions.

Niveen,Abu-Rmeileh:Community and Public Health Laura,Wick:Community and Public Health ; Background: Analysing the Palestinian Central Bureau of Statistics (PCBS) Demographic and Health Survey 2004 (DHS-2004) data, this article focuses on the question of where women living in the Occupied Palestinian Territory give birth, and whether it was the preferred/place of choice for delivery. We further identify some of the determinants of women's dissatisfaction with childbirth location. Methods: A total of 2158 women residing in the West Bank and Gaza Strip were included in this study. Regression analysis established the association between dissatisfaction with the place of birth and selected determinants. Results: A total of 3.5% of women delivered at home, with the rest in assisted facilities. Overall, 20.5% of women reported that their childbirth location was not the preferred place of delivery. Women who delivered at home; in governmental facilities; in regions other than the central West Bank; who had sudden delivery or did not reach their preferred childbirth location because of closures and siege; because of costs/the availability of insurance; or because there were no other locations available, were significantly more likely to be dissatisfied with their childbirth location compared to those who birthed in private facilities, the central West Bank, and in locations with better and more available services. Conclusion: The findings demonstrate that Palestinian women's choice of a place of birth is constrained and modified by the availability, affordability, and limited access to services induced by continuing closures and siege. These findings need to be taken into consideration when planning for maternity services in the Occupied Palestinian Territory.

The main thrust of our article entails pointing to humiliation as prevalent during war and conflict, and to its association with health outcomes. Humiliation seems to be given insufficient attention by the Anglo-Saxon public health literature on conflict-affected zones, perhaps because humiliation is a construct that has diverse meanings and significance to identity and self-worth in different cultures. We understand the particular conceptualization cited by Neria and Neugebauer,3 but we also question how humiliation (a feeling or internal experience) could ever be rated independently of the study participant's own assessment. The use of inter-rater reliability3 is worrisome, given that 'levels of loss, humiliation, entrapment, and danger were rated contextually using a five-point scale', taking into account descriptive information provided in the interview itself, the narrative summary and the tape-recorded interview. However, reports of emotional reactions were ignored. Brown et al.3 did not explain how separation of the narrative from the emotional reaction is possible, and how this process is viewed as 'objective'.

Abstract
Background
Exposure to violence in youth may be associated with substance use and other adverse health effects. This study examined cigarette smoking in two middle-income areas with different levels and types of exposure to violence.

Methods
Association of exposure to verbal and physical violence with cigarette smoking in the West Bank oPt (2008) and in Jujuy Argentina (2006) was examined using cross-sectional surveys of 14 to 17-year old youth in 7th to 10th grade using probabilistic sampling.

Results
Violence exposure rates were more than double for Palestinian girls (99.6% vs. 41.2%) and boys (98.7% vs. 41.1%) compared with Argentinians. The rate of current cigarette smoking was significantly higher among Argentinian girls compared with Palestinian girls (33.1% vs. 7.1%, p < 0.001). Exposure to verbal violence from family and to physical violence increased the odds of current cigarette smoking, respectively, among Argentinian girls (aOR = 1.3, 95% CI = 1.0–1.7; aOR = 2.5, 95%CI = 1.7–3.8), Palestinian girls (aOR 2.2, 95%CI = 1.1–2.4; aOR = 2.0, 95%CI = 1.1–3.6) and Argentinian boys (aOR = 1.5, 95%CI = 1.1–2.0; aOR = 2.2, 95%CI = 1.6–3.0), but not among Palestinian boys.

Conclusion
Findings highlight the importance of producing context and gender specific evidence from exposure to violence, to inform and increase the impact of targeted smoking prevention strategies.

Luis,Duque: Eliseo,Perez-Stable: ; Background Despite efforts to reduce the prevalence of tobacco smoking, cessation is a major challenge for adolescents and teenagers in low-income and middle-income countries. Smoking prevalence and the association between it and selected determinants, including violence, in adolescents and teenagers were investigated in the occupied Palestinian territory (oPt), Colombia, and Argentina. Methods Three cross-sectional surveys were undertaken in 2006 in Jujuy, Argentina, and in 2008 in West Bank, oPt, and Medellin, Colombia. Children (aged 12–17 years) were selected by use of cluster sampling of schools in all three countries, and neighbourhoods in Colombia. They completed a self-administered questionnaire that included questions about smoking habits, demographic characteristics, and exposure to violence. The main analyses were χ² test and logistic regression, and were restricted to the questions for the comparable age group (14–15 years) in the three settings. Findings 3238 (86%) of 3765 Argentinian children, 3107 (99%) of 3138 Palestinian children, and 1998 (99%) of 2018 Colombian children participated in the study. Prevalence of smoking was 325 (23%) of 1386 Palestinian, 688 (31%) of 2254 Argentinian, and 104 (8%) of 1324 Colombian children. Minor differences were noted in smoking prevalence between Colombian (42 [7%] of 644 girls vs 62 [9%] of 680 boys; 3%, 95% CI –1 to 6) and Argentinian boys and girls (357 [29%] of 1238 vs 331 [33%] of 1015; 4%; –3 to 11), whereas the difference was greater between Palestinian boys (283 [37%] of 770) and girls (42 [7%] of 616; 30%, 20 to 39). Palestinian and Argentinian children tried smoking before the age of 8 years with prevalences of 28 (9%) of 323 and 63 (9%) of 688, respectively, compared with 15 (4%) of 412 Colombian children. 130 (40%) of 323 Palestinian, 180 (44%) of 412 Colombian, and 313 (46%) of 684 Argentinian children smoked cigarettes most often when aged 12–13 years. Palestinian children more often reported exposure to physical (554 [40%] of 1386) and verbal (585 [42%] of 1386) violence by their parents than did Argentinian children (582 [26%] of 2241 and 312 [14%] of 2241, respectively). Palestinian and Argentinian children reported similar amounts of exposure to physical violence from strangers (178 [13%] of 1386 vs 291 [13%] of 2243, respectively) and weapons (136 [10%] of 1386 vs 190 [8%] of 2243, respectively). The prevalence of smoking among Argentinian children who reported exposure to physical violence from strangers (soldiers or gang members) was 158 (54%) of 291 (odds ratio for smoking vs non-smoking children 3·21, 2·50 to 4·13) and 96 (51%) of 190 (2·55, 1·89 to 3·43) in those exposed to weapons compared with 98 (55%) of 178 (3·08, 2·17 to 4·39) and 72 (53%) of 136 Palestinian children (2·79, 1·91 to 4·08), respectively. Interpretation The results indicate international differences, but support the association between exposure to violence and smoking habits. Policy makers and educators need to give attention to the high prevalence of smoking among adolescents and teenagers living under conflict.

INTRODUCTION: In Palestine (West Bank and Gaza), there have been more than 320 890 known cases of COVID-19, resulting in 3452 deaths. The detrimental effects of the virus can be seen in the nation's health, economy and government operations, leading to radical uncertainty that is exacerbated by the absence of any definitive treatment or vaccines. The level of knowledge about and trust in treatment and vaccination varies worldwide. This study aims to assess the willingness of Palestinians to receive a COVID-19 vaccine and their knowledge about such vaccines. METHODS: An online survey of adults over 18 years old (n=1080) was conducted in Palestine in October 2020. Using multivariate logistic regression, we identified correlates of participants' willingness to get a COVID-19 vaccine. RESULTS: We found that about 63% of participants were willing to get a COVID-19 vaccine. However, acceptance varied with the specific demographic variables that were investigated. Women, married participants and those aged 18–24 years are more likely to take the vaccine. Further, participants with good knowledge about the vaccine and its side effects are more willing to get the vaccine. CONCLUSION: The availability of a safe and effective COVID-19 vaccine in Palestine is crucial to decrease the burden of COVID-19 morbidity and mortality. In addition, to ensure a high vaccination rate, health awareness campaigns should target those who are not willing to get the vaccine, especially those who are more vulnerable and the elderly.

Objective: To explore rates and review practices regarding induction of labor (IOL) among singleton pregnancies in Palestine. Design: A prospective population-based cohort study. Setting: Six secondary and tertiary governmental hospitals located in the two regions of Palestine: West Bank and Gaza. Participants: Singleton pregnancies who had IOL in participating units during the study period were included (n=8290). Women having multiple gestations (1004), planned cesarean births (703), those admitted with cervical dilation >6cm (11228), and pregnancies with no record of cervical dilation and/or gestational age on admission (219) were excluded. Primary outcome measure: Rates of IOL in participating units and regions. Results: There were a total of 33,402 singleton births during the study period with an IOL rate of 24.8%. Rates of IOL significantly varied between units, ranging from 12.9% to 45.6% (P-value <0.05). The majority of women with no previous uterine scar were induced at gestational ages ≤40 weeks where 43.8% were induced at 39–40 gestational weeks (29.9% multiparous; 13.9% nulliparous) and 17.7% were induced between 37 and 38 gestational weeks (11.9% multiparous; 5.8% nulliparous). Conclusion: Significant variations in IOL practices between Palestinian hospitals and regions suggest overuse of IOL among singleton pregnancies in some units with the majority of these being performed before 40 weeks' gestation. These findings indicate a gap between implementation of best evidence and current clinical practice.

Sahar Hassan,1 Katariina Laine,2,3 Erik Fosse,4,5 Niveen ME Abu-Rmeileh,6 Hadil Y Ali-Masri,4,5,7 Mohammed Zimmo,4,5,8 Kaled Zimmo,4,5,9 Åse Vikanes,4 Khaled M Ismail10,11 1Department of Nursing, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Ramallah, Palestine; 2Department of Obstetrics, Oslo University Hospital, Ullevål, Oslo, Norway; 3Department of Health Management and Health Economics, Institute for Health and Society, University of Oslo, Oslo, Norway; 4Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway; 5Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; 6Institute of Community and Public Health, Birzeit University, Ramallah, Palestine; 7Department of Obstetrics, Palestine Medical Complex, Ramallah, Palestine; 8Department of Obstetrics, Al Shifa Hospital, Gaza, Palestine; 9Department of Obstetrics, Al Aqsa Martyrs Hospital, Gaza, Palestine; 10Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic; 11Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech RepublicCorrespondence: Sahar HassanDepartment of Nursing, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, PO Box 14, Ramallah 627, PalestineTel +972599830158Email sjamal@birzeit.eduObjective: To explore rates and review practices regarding induction of labor (IOL) among singleton pregnancies in Palestine.Design: A prospective population-based cohort study.Setting: Six secondary and tertiary governmental hospitals located in the two regions of Palestine: West Bank and Gaza.Participants: Singleton pregnancies who had IOL in participating units during the study period were included (n=8290). Women having multiple gestations (1004), planned cesarean births (703), those admitted with cervical dilation >6cm (11228), and pregnancies with no record of cervical dilation and/or gestational age on admission (219) were excluded.Primary outcome measure: Rates of IOL in participating units and regions.Results: There were a total of 33,402 singleton births during the study period with an IOL rate of 24.8%. Rates of IOL significantly varied between units, ranging from 12.9% to 45.6% (P-value <0.05). The majority of women with no previous uterine scar were induced at gestational ages ≤40 weeks where 43.8% were induced at 39–40 gestational weeks (29.9% multiparous; 13.9% nulliparous) and 17.7% were induced between 37 and 38 gestational weeks (11.9% multiparous; 5.8% nulliparous).Conclusion: Significant variations in IOL practices between Palestinian hospitals and regions suggest overuse of IOL among singleton pregnancies in some units with the majority of these being performed before 40 weeks' gestation. These findings indicate a gap between implementation of best evidence and current clinical practice.Keywords: childbirth, cohort study, induction of labor, Palestine, singleton, variations