Adherence to UNRWA's anaemia treatment guidelines in the Jerash Camp Health Centre, Jordan: a retrospective observational study.

OBJECTIVE: The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides primary healthcare to 2.2 million Palestinian refugees in Jordan. This study aimed to measure patient and doctor adherence to the UNRWA guidelines for the prevention and treatment of iron deficiency anaemia in moderate to severe anaemia children, defined as haemoglobin (Hb) level <10.0 g/L. DESIGN, SETTING AND PARTICIPANTS: A retrospective observational study was conducted by analysing the electronic health records of 717 children (353 boys and 364 girls) children aged 12 months old in 2018 in the Jerash Camp Health Centre, Jordan. OUTCOME: Patient adherence to the UNRWA guidelines was calculated by the proportion of health centre visits and doctor adherence by the proportions of Hb tests and iron supplementation among moderate to severe anaemia children at screening, first, second and third follow-up visits, respectively using STATA. RESULTS: The prevalence of moderate to severe anaemia was 15.6% among 12-month-old children. After 1 month of iron supplementation, 83.7% of anaemic children improved their Hb status: mean±SD from 9.1±0.6 g/L to 10.1±1.0 g/L. Patient and doctor adherence to the UNRWA guidelines was above 80% at the screening visit but progressively decreased at follow-up visits, especially patient adherence at the third follow-up visit of 34.4%. The analysis revealed unnecessary health centre visits and iron supplementation being given to mildly anaemic children (Hb level=10.0 g/L-10.9 g/L). Additionally, children visited the health centre at an age significantly later compared with that recommended by the UNRWA guidelines for the screening, first and second follow-up visits (p-value<0.05). CONCLUSION: Adherence to the UNRWA guidelines was above 80% at screening but much lower at follow-up visits. Urgent action is needed to improve adherence at follow-up visits and to minimise any unnecessary health centre visits and iron supplementation to mildly anaemic children.

Dietary Inadequacy, Micronutrient Deficiencies, and Approaches to Preventing Poor Nutrition in the Gaza Strip.

Palestine refugees comprise the largest refugee population in the world, most of whom are encamped in Middle Eastern countries. In the Gaza Strip, where ∼1.4 million Palestinians reside, there are high prevalences of anemia and multiple micronutrient deficiencies (MNDs), including those of iron, zinc, vitamins A, B12, D, and E, ranging from 11.4% to 84.7% among pregnant women and 2.9% to 70.9% among preschool children. Dietary diversification and adequate food fortification are framed in policies but remain aspirational goals. Alternative, effective, targeted preventive approaches include, for women, replacement of antenatal iron-folic acid with multiple micronutrient supplementation, and for young children, point-of-use multiple micronutrient powder fortification to prevent anemia, both of which can reduce other MNDs and may bring additional health benefits. These interventions coupled with monitoring of dietary intakes, periodic assessment of MNDs, and implementation research to improve existing nutrition interventions are warranted to protect the health of the Middle East Palestinian diaspora.