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巴勒斯坦被占领土上的妇女健康:对主观和客观健康指标的背景影响。

Women's health in the occupied Palestinian territories: Contextual influences on subjective and objective health measures.

作者信息

Bates Katie, Leone Tiziana, Ghandour Rula, Mitwalli Suzan, Nasr Shiraz, Coast Ernestina, Giacaman Rita

机构信息

Department of Social Policy, LSE, London, United Kingdom.

Department of International Development, LSE, London, United Kingdom.

出版信息

PLoS One. 2017 Oct 27;12(10):e0186610. doi: 10.1371/journal.pone.0186610. eCollection 2017.

Abstract

The links between two commonly used measures of health-self-rated health (SRH) and self-reported illness (SRI)-and socio-economic and contextual factors are poorly understood in Low and Middle Income Countries (LMICs) and more specifically among women in conflict areas. This study assesses the socioeconomic determinants of three self-reported measures of health among women in the occupied Palestinian territories; self-reported self-rated health (SRH) and two self-reported illness indicators (acute and chronic diseases). Data were obtained from the 2010 Palestinian Family Health Survey (PFHS), providing a sample of 14,819 women aged 15-54. Data were used to construct three binary dependent variable-SRH (poor or otherwise), and reporting two SRI indicators-general illness and chronic illness (yes or otherwise). Multilevel logistic regression models for each dependent variable were estimated, with individual level socioeconomic and sociodemographic predictors and random intercepts at the governorate and community level included, to explore the determinants of inequalities in health. Consistent socioeconomic inequalities in women's reports of both SRH and SRI are found. Better educated, wealthier women are significantly less likely to report an SRI and poor SRH. However, intra-oPt regional disparities are not consistent across SRH and SRI. Women from the Gaza Strip are less likely to report poor SRH compared to women from all other regions in the West Bank. Geographic and residential factors, together with socioeconomic status, are key to understanding differences between women's reports of SRI and SRH in the oPt. More evidence is needed on the health of women in the oPt beyond the ages currently included in surveys. The results for SRH show discrepancies which can often occur in conflict affected settings where a combination of ill-health and poor access to health services impact on women's health. These results indicate that future policies should be developed in a holistic manner by targeting physical and mental health and well-being in programmes addressing the health needs of women, especially those in conflict affected zones.

摘要

在低收入和中等收入国家(LMICs),尤其是在冲突地区的女性中,人们对两种常用的健康衡量指标——自我评估健康状况(SRH)和自我报告疾病(SRI)——与社会经济及环境因素之间的联系了解甚少。本研究评估了巴勒斯坦被占领土上女性自我报告的三种健康衡量指标的社会经济决定因素;自我报告的自我评估健康状况(SRH)以及两个自我报告的疾病指标(急性和慢性疾病)。数据来自2010年巴勒斯坦家庭健康调查(PFHS),提供了一个由14819名年龄在15 - 54岁之间的女性组成的样本。数据被用于构建三个二元因变量——SRH(差或其他),以及报告两个SRI指标——一般疾病和慢性疾病(是或其他)。针对每个因变量估计了多层次逻辑回归模型,纳入了个体层面的社会经济和社会人口学预测因素以及省和社区层面的随机截距,以探究健康不平等的决定因素。在女性对SRH和SRI的报告中发现了一致的社会经济不平等现象。受教育程度更高、更富有的女性报告SRI和不良SRH的可能性显著更低。然而,在被占领巴勒斯坦领土内的区域差异在SRH和SRI方面并不一致。与约旦河西岸所有其他地区的女性相比,加沙地带的女性报告不良SRH的可能性更低。地理和居住因素,连同社会经济地位,是理解被占领巴勒斯坦领土内女性对SRI和SRH报告差异的关键。除了目前调查所涵盖的年龄之外,还需要更多关于被占领巴勒斯坦领土内女性健康状况的证据。SRH的结果显示出差异,这种差异在受冲突影响的环境中经常出现,在这种环境中,健康不佳和获得医疗服务的机会有限共同影响着女性的健康。这些结果表明,未来的政策应以整体方式制定,在解决女性健康需求的方案中,特别是在受冲突影响地区的女性中,关注身心健康和福祉。

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