An analysis of cross sectional survey data of stunting among Palestinian children less than five years of age.

The object of this study is to report on determinants of stunting, defined as low height for age, among children in the occupied Palestinian territories. Using 2006-2007 cross sectional survey data collected by the Palestine Central Bureau of Statistics and using multivariate mixed model techniques for logistic regression, the relationships of stunting to characteristics of 9,051 Palestinian children less than 5 years of age living in the Palestinian territories were estimated. These characteristics included demographic and social characteristics of the child, geographic region, type of location (urban, rural, refugee camp) and food insecurity for each governorate. Listed in order of the greater contribution to the explained variation in stunting, children with lower birth weight (P < 0.0001), age greater than 12 months (P < 0.0001), higher levels of food insecurity (P < 0.0001), lower socio-economic status (P < 0.0001), mother illiterate (P = 0.004), urban areas (P = 0.008), and absence of supplementation to breast feeding during the first 4 months of the child's life (P = 0.04) have significantly more stunting. Children living in refugee camps have lower rates of stunting than urban areas; however the difference does not reach statistical significance. The relationship between the child's gender and stunting is not statistically significant. Lack of food security is directly linked to stunting. The continuing incidence of food insecurity means that the deleterious effects of under-nutrition will continue to affect the children of Palestine. Removing the avoidable causes of food insecurity in the occupied Palestinian territories will alleviate under-nutrition and its deleterious effects.

Maternal and child health in the occupied Palestinian territory.

The Countdown to 2015 intervention coverage indicators in the occupied Palestinian territory are similar to those of other Arab countries, although there are gaps in continuity and quality of services across the continuum of the perinatal period. Since the mid 1990s, however, access to maternity facilities has become increasingly unpredictable. Mortality rates for infants (age

Child health in the West Bank: Experiences from implementing a paediatric course for Palestinian doctors and nurses working in primary care.

Child health issues are of high importance in the occupied Palestinian territories, where half of the population are children. The Royal College of Paediatrics and Child Health have developed a comprehensive paediatric training programme for primary healthcare providers with the aim of improving child health in the area. The course has taken 8 years to develop with the pilot running in 2005-2007 and is now being extended to other centres in the region. In this article, we describe the process through which this course has developed, some of the difficulties faced and the final teaching programme as it has evolved. A number of lessons have been learnt, over the years, which are of potential value to others designing similar teaching programmes. Its greatest strength lies in the partnership developed with local paediatricians, which encourages us to believe that sustainability has been achieved. Evaluation confirms that the course is meeting the needs of local doctors and nurses and improving their paediatric skills. Although developed specifically for the occupied Palestinian territory, our experience offers a process and design for a teaching programme that could be adapted for use in other countries around the world.

Comparing disciplinary methods used by mothers in Palestine and Qatar.

This paper explores child disciplinary methods used by parents in Qatar and Palestine. In this study ICAST-P, an internationally recognized tool, was used with mothers reporting on one of their children up to their 12th birthday. It questions about disciplinary methods: nonviolent; physical: moderate and severe; and psychological methods that had been used in the previous year on the index child in the family. A comparative national cross-sectional household survey of mothers aged 25-50 years old was conducted in both Qatar and Palestine, both Arabic Muslim states, but with very different socio-economic and political contexts that place Qataris in a much more advantageous position. Our results show that the 1299 Palestinian mothers interviewed were younger, had more children and less education compared to the 1018 Qatari mothers. Fewer mothers from Palestine were working. The index child in Palestine tended to be younger with 60% being under 5 years, while 73.7% of Qatari children were over 5 years of age. Severe physical disciplinary methods were reported significantly more often, in Palestine, e.g. Kicking the child (P value < 0.001), using hand or pillow to prevent breathing (P value < 0.001) and hitting child with object or fist (P value < 0001). Moderate as well as psychological disciplinary methods were also significantly higher among Palestinian mothers (P value < 0.001). Our results suggest that challenging circumstances that Palestinian mothers experience, as compared to their Qatari peers, are associated with greater prevalence of the harsher forms of discipline. Our findings have policy implications and preventative strategies for child maltreatment in both countries.

Child discipline in Qatar and Palestine: A comparative study of ICAST-R.

To compare the nature and determinants of child discipline in Qatar and Palestine among young adults through retrospective survey to develop legislation, policies and interventions for effective prevention of child maltreatment, and educational materials to promote positive discipline among parents and caregivers. Cross-sectional random household surveys were conducted in each country (Qataris N=697, Palestinians N=2064) using ISPCAN Child Abuse Screening Tool-Retrospective (ICAST-R) for young adults (18-24 years), to investigate child discipline methods into the maltreatment range. Qatari young adults were more educated (p<0.001) and had more full-time employment (p=0.004) than Palestinian young adults. Qatar reported lower physical and emotional abuse compared to their counterparts in Palestine, e.g. Hit/Punch, Kick (p<0.001) and Insult/Criticize, Threaten to be hurt/killed (p<0.001). Qatari participants found any harsh discipline they received in childhood was not reasonable and not justified compared to Palestinian participants. The more advantaged Qatari population was less likely to experience disciplinary methods that experts developing the ICAST-R defined as abuse compared to Palestinians where the higher incidence of child abuse could be attributed to lower economic advantage, lower level of education and greater exposure to violence. Suggestions are made for future studies in Qatar and Palestine to develop survey methodology with a more culturally appropriate level of intrusion, such as indirect yet meaningful child maltreatment questions.

The impact of the intifada on the health of a nation.

This article describes the nature and extent of non-fatal injuries sustained by Palestinians during the first three months of the second intifada in late 2000 by looking at two sets of data. 10,279 cases were obtained from the records of the Red Crescent Organization, which provides first level emergency care via ambulance crews in the West Bank and Gaza Strip. For 6,071 cases in the West Bank, additional information was available from the Ministry of Health, which keeps records of first and second emergency level care provided at hospitals and health points. The Ministry of Health cases were classified by type of weapon, site of injury and level of treatment provided. Fifty-eight per cent of injuries occurred in young men 18-34 years, but 25 per cent occurred in school children, ten per cent in people over 50 years and five per cent in females. Fifty-nine per cent of the injuries were caused by bullets and 76 per cent of these affected the upper part of the body; 13.4 per cent of the injuries were severe, with major implication for disability and the need for long-term care and support.

Determinants of birthweight: gender based analysis.

The objective of this cross sectional study is to look at determinants of birth weight and their association with the gender of the baby in 2,795 full term children living in the occupied Palestinian territory, derived from a stratified random sample of 2,994 households in the West Bank and 2,234 households in the Gaza Strip. The response rate was 85%. Multivariable analysis using analysis of variance for mixed models showed that sex and birth order, maternal age and education and to a lesser extent region were determinants of birth weight for all children. The effect of maternal education on birth weight differed for female and male infants, tending to be relatively unchanged for male infants and with mean birth weights increasing with maternal education in female infants. The effect of birth order differed by maternal age, with mean birth weight increasing with maternal age for first and second births; but being unaffected by maternal age for infants of birth order greater than two. We conclude that birth weight is influenced by common biological determinants across cultures, but is also influenced by social, ethnic, and environmental factors that are culture specific, of which some might be gender related.