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Background Progress has been made in the reduction of morbidity and mortality of cervical cancer by the implementation of human papillomavirus (HPV) vaccination programs. This study aimed to assess the awareness of Palestinian women about HPV as well as their knowledge and acceptability of the HPV vaccine and to examine the factors associated with good awareness. Methods This was a national cross-sectional study. Adult women were recruited from hospitals, primary healthcare centers, and public spaces in 11 Palestinian governorates using convenience sampling. A structured questionnaire was used for data collection. For each correctly answered question, one point was given. The total score was calculated and categorized into poor (0–10) and good awareness (11–21). Results The questionnaire was completed by 7223 women out of 8086 who were approached (response rate = 89.3%). A total of 7058 questionnaires were included in the final analysis; 4403 from the West Bank and Jerusalem (WBJ) and 2655 from the Gaza Strip. Women recruited from the Gaza Strip were younger, getting lower monthly incomes, and with fewer chronic diseases than women recruited from the WBJ. Only 33 women (0.5%) displayed good awareness of HPV and its vaccine with 0.7% of women from WBJ and only 0.2% of women from the Gaza Strip. Completing post-secondary education, being employed or a student, and having a higher monthly income were associated with an increase in the likelihood of having good awareness. Among women who had heard of HPV (n = 571, 8.1%), only 46 women (8.1%) reported familiarity with its vaccine. Women from the WBJ were more likely than women from the Gaza Strip to have heard about the HPV vaccine (0.9% vs. 0.2%). Most women agreed to receive the HPV vaccine themselves or for their daughters if it was given without cost or with a co-payment. No differences were found in the likelihood of agreeing to receive the HPV vaccine among women in the WBJ versus the Gaza Strip. Conclusion The overall awareness of HPV and its vaccine was extremely low. Inclusion of the HPV vaccine in the national immunization program could change this, especially as the HPV vaccine appeared to be acceptable.

Background The majority of lung cancer (LC) cases are diagnosed at an advanced stage. Poor awareness of LC symptoms is a contributor to late diagnosis. This study aimed to assess the awareness of LC symptoms among Palestinians, and to examine the factors associated with displaying good awareness. Methods Participants were recruited from hospitals, primary healthcare centers and public spaces using convenience sampling. A translated-into-Arabic version of the validated LC awareness measure was used to assess recognition of 14 LC symptoms. One point was given for each recognized symptom. The total score was calculated and categorized based on the number of symptoms recognized: poor (0–4), fair (5–9), and good (10–14). Multivariable logistic regression was used to examine the association between participant characteristics and having good awareness. The multivariable analysis adjusted for age-group, gender, education, monthly income, occupation, residence, marital status, any chronic disease, knowing someone with cancer, smoking history, and site of data collection. Results Of 5174 potential participants approached, 4817 completed the questionnaire (response rate = 93.1%) and 4762 were included in the final analysis. Of these, 2742 (56.9%) were from the West Bank and Jerusalem (WBJ) and 2020 (43.1%) were from the Gaza Strip. Participants from the WBJ were older, had higher monthly income but lower education, and suffered from more chronic diseases. The most recognized respiratory LC symptom was ‘worsening in an existing cough’(n = 3884, 81.6%) while the least recognized was ‘a cough that does not go away for two or three weeks’(n = 2951, 62.0%). The most recognized non-respiratory LC symptom was ‘persistent tiredness or lack of energy’(n = 3205, 67.3%) while the least recognized was ‘persistent shoulder pain’(n = 1170, 24.6%). A total of 2466 participants (51.8%) displayed good awareness of LC symptoms. Participants from both the Gaza Strip and the WBJ had similar likelihoods to have good awareness levels. Factors associated with a higher likelihood to display good awareness included female gender, having post-secondary education, being employed, knowing someone with cancer, and visiting hospitals and primary healthcare centers. Conclusion About half of the study participants displayed a good level of awareness of LC symptoms. Further improvement in public awareness of LC symptoms by educational interventions might reduce LC mortality by promoting early diagnosis.

"Background: Timely presentation and diagnosis of cervical cancer (CC) are crucial to decrease its mortality especially in low- and middle-income countries like Palestine. This study aimed to evaluate the knowledge of Palestinian women about CC warning signs and determine the factors associated with good knowledge. Methods: This was a national cross-sectional study conducted between July 2019 and March 2020 in Palestine. Stratified convenience sampling was used to recruit adult women from hospitals, primary healthcare centers, and public spaces of 11 governorates. A translated-into-Arabic version of the validated CC awareness measure (CeCAM) was used to assess women’s knowledge of 12 CC warning signs. Results: Of 8086 approached, 7223 participants completed the CeCAM (response rate = 89.3%). A total of 7058 questionnaires were included in the analysis: 2655 from the Gaza Strip and 4403 from the West Bank and Jerusalem (WBJ). The median age [interquartile range] for all participants was 34.0 [24.0, 42.0] years. Participants recruited from the WBJ were older, getting higher monthly income, and having more chronic diseases than those recruited from the Gaza Strip. The most frequently identified warning sign was ‘vaginal bleeding after menopause’ (n = 5028, 71.2%) followed by ‘extreme generalized fatigue’ (n = 4601, 65.2%) and ‘unexplained weight loss’ (n = 4578, 64.9%). Only 1934 participants (27.4%) demonstrated good knowledge of CC warning signs. Participants from the Gaza Strip were slightly more likely than participants from the WBJ to have a good level of knowledge. Factors associated with having good knowledge included having a bachelor or postgraduate degree, being married, divorced, or widowed as well as knowing someone with cancer. Conclusion: The overall awareness of CC warning signs was low. Educational interventions are needed to increase Palestinian women’s awareness of CC warning signs. Keywords: Cervical cancer, Early detection, Survival, Symptom, Warning sign, wareness, Knowledge, Early presentation, Palestine" "الخلفية: يعد تشخيص سرطان عنق الرحم وتشخيصه في الوقت المناسب أمرًا بالغ الأهمية لتقليل معدل الوفيات خاصة في البلدان المنخفضة والمتوسطة الدخل مثل فلسطين. هدفت هذه الدراسة إلى تقييم معرفة النساء الفلسطينيات بعلامات التحذير الخاصة بسرطان عنق الرحم وتحديد العوامل المرتبطة بالمعرفة الجيدة. الطرق: كانت هذه دراسة مقطعية وطنية أجريت بين تموز 2019 وآذار 2020 في فلسطين. تم استخدام عينات من النساء البالغات من المستشفيات ومراكز الرعاية الصحية الأولية والأماكن العامة في 11 محافظة. تم استخدام نسخة مترجمة إلى العربية من مقياس الوعي (CeCAM) الذي تم التحقق من صحته لتقييم معرفة النساء بـ 12 علامة تحذير من سرطان عنق الرحم. النتائج: أكمل 7223 مشاركًا CeCAM (معدل الاستجابة = 89.3 ٪). تم تضمين ما مجموعه 7058 استبانة في التحليل: 2655 من قطاع غزة و 4403 من الضفة الغربية والقدس. كان المشاركون من الضفة الغربية و القدس أكبر سناً ، ويحصلون على دخل شهري أعلى ، ولديهم أمراض مزمنة أكثر من أولئك الذين من قطاع غزة. كانت علامة التحذير الأكثر تحديدًا هي ""النزيف المهبلي بعد انقطاع الطمث"" (العدد = 5028 ، 71.2٪) يليه ""التعب الشديد العام"" (العدد = 4601 ، 65.2٪) و ""فقدان الوزن غير المبرر"" (العدد = 4578 ، 64.9٪) . أظهر 1934 مشاركًا (27.4 ٪) معرفة جيدة بعلامات التحذير من سرطان عنق الرحم. كان احتمال حصول المشاركين من قطاع غزة على مستوى جيد من المعرفة أكثر بقليل من المشاركين من الضفة الغربية. تشمل العوامل المرتبطة بالحصول على معرفة جيدة الحصول على درجة البكالوريوس أو الدراسات العليا ، والحالة الاجتماعية وكذلك معرفة شخص مصاب بالسرطان. الخلاصة: كان الوعي العام بعلامات التحذير من سرطان عنق الرحم منخفضًا. هناك حاجة إلى تدخلات تثقيفية لزيادة وعي المرأة الفلسطينية بعلامات التحذير من سرطان عنق الرحم. "