Background
Methods
Description of target population and sampling design
Recruitment
Variables
Health-related quality of life assessment
Child and Household Measures
Child age
Nutritional status
Child mental health
Exposure to violence
Confrontation level
Deprivation
Social support
Maternal mental health
Maternal self-rated health
Analysis
Results
Sample characteristics
% (unless otherwise indicated) | ||
---|---|---|
Study sample (N = 350) | Beit Hanoun (N = 35) | |
Child factors
| ||
Age in months [mean (SD)] | 59 (8%) | 61 (7%) |
Females | 49 | 60 |
Low birth weight (< 2.5 Kg) | 7 | 9 |
Adequate nutrition 1
| 37 | 29 |
Stunting 2
| 15 | 9 |
Number of exposures to violence [mean (SD)] | 6 (3%) | 12 (3%) |
Children with normal mental health | 40 | 14 |
Children with poor mental health | 37 | 69 |
Household factors
| ||
Maternal age [mean (SD)] | 31 (6%) | 31 (5%) |
Maternal elementary schooling only Education | 10 | 26 |
Maternal self-rated health as fair or poor | 32 | 40 |
Poor maternal mental health 3 | 60 | 89 |
Reported any form of social support 4 | 38 | 63 |
Living in a direct military confrontation area | 25 | 94 |
Family moved in the past 2 years | 19 | 29 |
Reported any form of deprivation 5 | 23 | 54 |
Receiving food assistance on regular basis | 51 | 91 |
Average household income in US dollars * [mean (SD)] | 205 (174%) | 136 (169%) |
Family size [mean (SD)] | 8 (4%) | 10 (4%) |
Number of persons in household above 18 years [mean (SD)] | 3 (2%) | 4 (3%) |
Number of children < 18 years [mean (SD)] | 5 (3%) | 6 (2%) |
Number of children < 5 years [mean (SD)] | 2 (1%) | 3 (1%) |
Experience | Study Sample (N = 350)% | Study sample excluding those from Beit Hanoun (N = 315)% | Beit Hanoun (N = 35)% | P-value |
---|---|---|---|---|
Heard sonic sounds of jetfighters | 94 | 94 | 94 | 0.94 |
Watched mutilated bodies or injured people on TV | 93 | 93 | 94 | 0.83 |
Heard shelling by artillery | 84 | 83 | 100 |
0.007
|
Witnessed signs of shelling on ground | 50 | 45 | 97 |
< 0.001
|
Witnessed bombardment at houses | 42 | 36 | 97 |
< 0.001
|
Witnessed assignation of people by rockets | 28 | 23 | 77 |
< 0.001
|
Deprived of food, water and electricity during incursion | 25 | 19 | 86 |
< 0.001
|
Witnessed firing on houses | 24 | 16 | 97 |
< 0.001
|
Detained in house during incursion | 23 | 17 | 86 |
< 0.001
|
Heard of killing of a close relative | 23 | 20 | 46 |
0.001
|
Heard of a killing of a friend | 16 | 15 | 31 |
0.01
|
Witnessed of firing on your house | 13 | 8 | 60 |
< 0.001
|
Prevented from using toilet and getting out of his room during incursion | 12 | 7 | 54 |
< 0.001
|
Destruction and stealing of his personal things by soldiers | 7 | 2 | 54 |
< 0.001
|
Exposed to firing in an attempt to scare him | 6 | 4 | 26 |
< 0.001
|
Injured due to bombardment of his house | 5 | 4 | 17 |
< 0.001
|
Was beaten during incursion | 5 | 3 | 17 |
< 0.001
|
Threatened of killing one of family members during incursion | 4 | 2 | 23 |
< 0.001
|
Used as a barrier in the process or arresting a neighbor | 2 | 2 | 6 | 0.15 |
% | |
---|---|
No meat/chicken/fish most days of week | 56 |
No fruits and vegetables most days of week | 61 |
Insufficient food most days of the week | 42 |
On food assistance | 51 |
Shortage of money for living expenses | 12 |
No money to pay bills | 18 |
Mother thought her child was deprived | 16 |
Feasibility, reliability, and correlates of PedsQL 4.0 in Palestinian children
Mean scores in HRQOL, psychosocial, and physical health
Scale | Study Sample mean (N = 350)a
| Beit Hanoun sample mean (N = 35)b
| ||||
---|---|---|---|---|---|---|
Mean | SD | Mean | SD | Differences | Beit Hanoun vs. Study sample2
| |
Total Score 1
| 62 | 16 | 54 | 17 | b < a** | 0.5 |
Physical Health | 69 | 20 | 66 | 20 | b < a | 0.2 |
Psychosocial Health | 58 | 16 | 48 | 18 | b < a*** | 0.6 |
Emotional Functioning | 50 | 16 | 35 | 16 | b < a*** | 0.9 |
Social Functioning | 63 | 24 | 54 | 28 | b < a* | 0.4 |
School Functioning | 61 | 21 | 55 | 25 | b < a | 0.3 |
Scale | Reference values1
| Sample mean (N = 350)2
| ||||
---|---|---|---|---|---|---|
Mean | SD | Mean | SD | Differences | Sample vs. Reference Effect Size3
| |
Total Score 2
| 81 | 16 | 62 | 16 | b < a* | 1.2 |
Physical Health | 83 | 20 | 69 | 20 | b < a* | 0.7 |
Psychosocial Health | 80 | 16 | 58 | 16 | b < a* | 1.4 |
Emotional Functioning | 80 | 17 | 50 | 16 | b < a* | 1.8 |
Social Functioning | 82 | 20 | 63 | 24 | b < a* | 0.9 |
School Functioning | 77 | 20 | 61 | 21 | b < a* | 0.8 |
Group differences in PedsQL scores (Tables 6 and 7)
PedsQL 4.0 Total Score | Difference | Psycho-social Health | Difference | Physical Health | Difference | ||
---|---|---|---|---|---|---|---|
N | Mean (SD) | Mean (SD) | Mean (SD) | ||||
Demographics
Gender | |||||||
Female a
| 170 | 63 (16) | b < a | 59 (16) | b < a | 71(20) | b < a |
Male b
| 180 | 61(15) | 57 (16) | 68(20) | |||
Age | |||||||
Toddler (3-4) a
| 184 | 64 (16) | b < a | 60 (17) | b < a | 72(20) | b < a* |
Young child (5-6) b
| 166 | 60 (15) | 56 (16) | 67(19) | |||
Correlates
Nutritional status | |||||||
Stunting a
| 52 | 64 (14) | b < a | 64 (14) | b < a* | 71(18) | b < a*** |
Moderate b
| 168 | 62 (16) | c < a | 58 (17) | c < a* | 62(16) | c < a*** |
Adequate c
| 130 | 62 (16) | 58 (16) | 58(16) | c < b* | ||
Child mental health1
| |||||||
Poor a
| 129 | 57 (15) | a < b** | 52 (16) | a < b** | 66(19) | a < b |
Borderline b
| 82 | 63(16) | a < c*** | 59 (15) | a < c*** | 71(21) | a < c |
Normal c
| 139 | 66 (15) | b < c | 63 (15) | b < c | 72(19) | b < c |
Maternal mental health2
| |||||||
Poor a
| 209 | 61(16) | a < b | 57 (17) | a < b | 66(19) | a < b |
Normal b
| 141 | 64(15) | 61(15) | 71(20) | |||
Maternal self-rated health | |||||||
Fair or poor a
| 112 | 61 (16) | a < b | 57 (16) | a < b | 70(20) | b < a |
Good/very good/excellent b
| 238 | 63(16) | 59 (16) | 69(20) | |||
Level of Exposure to traumatic events | |||||||
Level 1 : (1-4 traumatic events) a
| 158 | 65 (16) | b < a* | 62(16) | b < a** | 72(20) | |
Level 2: (5-9 traumatic events) b
| 145 | 61(14) | c < a*** | 57(14) | c < a*** | 68(20) | |
Level 3: (10-19 traumatic events) c
| 47 | 55(16) | c < b* | 50 (18) | c < b** | 67(18) | |
Maternal education | |||||||
Elementary a
| 34 | 55(14) | a < b** | 52 (15) | a < b* | 61(19) | a < b |
Above elementary b
| 316 | 63(16) | 59 (16) | 70(20) | |||
Living in direct military confrontation area | |||||||
Yes a
| 88 | 58(15) | a < b** | 52 (16) | a < b*** | 69(17) | a < b |
No b
| 262 | 64 (16) | 61(16) | 70(20) | |||
Moved in the past 2 years | |||||||
Yes a
| 65 | 62 (16) | 58 (17) | 69(20) | a < b | ||
No b
| 285 | 62(16) | 58 (16) | 70(20) | |||
Deprivation | |||||||
Yes a
| 83 | 59(15) | a < b | 54 (16) | a < b** | 69(18) | a < b |
No b
| 267 | 63(16) | 60 (16) | 70(20) | |||
Social support | |||||||
No a
| 218 | 62(15) | 59 (16) | b < a | 69(19) | a < b | |
Yes b
| 132 | 62(16) | 57 (17) | 70(20) | |||
Total score
|
350
|
62(16)
|
58 (16)
|
69(20)
|
Emotional functioning | Difference | Social functioning | Difference | School functioning | Difference | ||
---|---|---|---|---|---|---|---|
N | Mean (SD) | Mean (SD) | Mean (SD) | ||||
Demographics
| |||||||
Gender | |||||||
Femalea
| 170 | 51(17) | b < a | 65(24) | b < a | 62(22) | b < a |
Maleb
| 180 | 50(16) | 62(24) | 61(20) | |||
Age | |||||||
Toddler (3-4)a
| 184 | 51(16) | b < a | 66(24) | b < a* | 63(22) | b < a |
Young child (5-6)b
| 166 | 49(16) | 60(23) | 59(19) | |||
Correlates
| |||||||
Nutritional status | |||||||
Stuntinga
| 52 | 51(14) | b < a | 68(24) | b < a | 63(19) | b < a |
Moderateb
| 168 | 49(17) | b < c | 63(23) | c < b | 61(21)(22) | c < b |
Adequatec
| 130 | 51(16) | 62(24) | c < a | 60(22) | c < a | |
Child mental health1
| |||||||
Poor a
| 129 | 43(16) | a < b*** | 57(25) | a < b* | 58(21) | a < b |
Borderline b
| 82 | 53(15) | a < c*** | 65(22) | a < c*** | 59922) | a < c*** |
Normal c
| 139 | 55(14) | b < c | 69(22) | b < c | 66(19) | b < c* |
Level of Exposure to traumatic events | |||||||
Level 1 : (1-4 traumatic events) a
| 158 | 55(15) | b < a*** | 67(24) | b < a | 64(20) | b < a* |
Level 2: (5-9 traumatic events) b
| 145 | 49(15) | c < a*** | 64(22) | c < a*** | 59(20) | c < a* |
Level 3: (10-19 traumatic events) c
| 47 | 38(17) | c < b*** | 52(25) | c < b** | 59(24) | |
Maternal mental health2
| |||||||
Poor a
| 209 | 48(18) | a < b** | 62(25) | a < b | 60(21) | a < b |
Normal b
| 141 | 53(14) | 65(22) | 63(20) | |||
Maternal self-rated health | |||||||
Fair or poor a
| 112 | 45(17) | a < b*** | 65(23) | b < a | 60(21) | a < b |
Good/very good/or excellentb
| 238 | 53(15) | 63(24) | 62(21) | |||
Maternal education | |||||||
Elementary a
| 34 | 44(17) | a < b* | 55(25) | a < b* | 59(18) | a < b |
Above elementary b
| 316 | 51(16) | 64(24) | 61(21) | |||
Living in direct military confrontation area | |||||||
Yes a
| 88 | 42(17) | a < b*** | 56(23) | a < b*** | 57(22) | a < b* |
No b
| 262 | 53(15) | 66(23) | 63(20) | |||
Moved in the past 2 years | |||||||
Yes a
| 65 | 51(17) | b < a | 64(23) | b < a | 59(21) | a < b |
No b
| 285 | 50(16) | 63(24) | 62(21) | |||
Deprivation | |||||||
Yes a
| 83 | 43(18) | a < b*** | 61(23) | a < b | 58(23) | a < b |
No b
| 267 | 52(15) | 64(24) | 62(20) | |||
Social support | |||||||
No a
| 218 | 52(15) | b < a*** | 63(23) | a < b | 62(20) | b < a |
Yes b
| 132 | 47(18) | 65(24) | 60(22) | |||
Total Score
|
350
|
50(16)
|
63(24)
|
61(21)
|
Child factors
Household factors
Multivariable model for HRQOL, physical health, and psychosocial health
Health-related quality of life total score | |||
---|---|---|---|
Beta | SE Beta | p-value | |
Child age (month)1
| -0.26 | 0.10 | 0.01 |
Child gender (male)2
| -3.16 | 1.61 | 0.05 |
Number of exposure to traumatic events3
| -1.31 | 0.25 | < 0.001 |
Psychosocial health | Physical health | |||||
---|---|---|---|---|---|---|
Beta | SE Beta | p-value | Beta | SE Beta | p-value | |
Child age (month) | -0.221
| 0.10 | 0.03 | -0.322
| 0.12 | 0.01 |
Being deprived of food, water, and electricity during incursion (Yes/No) | -8.253
| 1.96 | 0.00 | -8.104
| 2.36 | < 0.001 |
Witnessed assassination of people by rockets (Yes/No) | -3.705
| 1.90 | 0.05 | |||
Heard of a killing of a friend (Yes/No) | -5.986
| 2.36 | 0.03 |