Predicted efficacy of the Palestinian wheat flour fortification programme: complementary analysis of biochemical and dietary data.

OBJECTIVE: To utilize complementary biochemical and dietary data collected before the initiation of national flour fortification to (i) identify micronutrient insufficiencies or deficiencies and dietary inadequacies in Palestinian women and children in vulnerable communities and (ii) assess the suitability of the current wheat flour fortification formula. DESIGN: Quantitative dietary intake questionnaires were administered and fasting venous blood samples collected in randomly selected households in Gaza City and Hebron. The impact of fortification was simulated by estimating the additional micronutrient content of fortified wheat flour. SETTING: Households in Gaza City and Hebron that were not receiving food aid from social programmes. SUBJECTS: Non-pregnant women (18-49 years) and children aged 36-83 months. RESULTS: The micronutrients with highest prevalence of insufficiency were vitamin D in women (84-97 % with serum 25-hydroxyvitamin D <50 nmol/l) and vitamin B12 in women and children (43-82 % with serum B12 <221 pmol/l). Deficiencies of vitamin A, Fe and Zn were also of public health concern. Current levels of wheat flour fortificants were predicted to improve, but not eliminate, micronutrient intake inadequacies. Modification of fortificant concentrations of vitamin D, thiamin, vitamin B12, Zn and folic acid may be indicated. CONCLUSIONS: Micronutrient insufficiencies or deficiencies and intake inadequacies were prevalent based on either biochemical or dietary intake criteria. Adjustments to the current fortification formula for wheat flour are necessary to better meet the nutrient needs of Palestinian women and children.

Microbiological quality of food samples from restaurants and sweet shops in developing countries: a case study from the Occupied Palestinian Territory.

The aim of this paper is to review the microbiological quality of food samples taken from a wide range of cooked and raw foods obtained from restaurants and sweet shops in the Ramallah and al-Bireh district, and to identify the gaps in food inspection and handling that can be realistically improved. Utilizing food sample test results of the Palestinian Ministry of Health, records pertaining to the years 1995, 1996, 2000, 2002, and the first 2 months of the year 2003 reveal that only 60.9%, 44.0%, 63.8%, 93.6%, 51.8%, 83.8%, and 50.4% of the food samples tested for total aerobic count, total Coliform, faecal Coliform, Staphylococcus aureus, faecal Streptococci, moulds, and yeasts respectively are within the limits of the Palestinian and International standards. None of the tested samples for Salmonellae or Clostridium perfringes were positive. Analysis of the data indicates an irregular rather than systematic process to testing. For example, 60.4% of the tested food samples in 2000 came from sweet shops, while the relative percentage of sweet shops is 21.4% out of the total restaurants and sweet shop figures in the area at the time. In contrast to what would be expected, most of the samples were collected during the cold season, raising questions as to the suitability of testing procedures and guidelines. Systemic and procedural gaps were identified by the analysis that can be addressed to at least contain, if not completely eliminate the presence of foods in the market that are unacceptable for consumption.