Background Children entering first grade at United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) schools across the five fields of its operations (West Bank, Gaza, Lebanon, Jordan, and Syria) complete a comprehensive medical examination at UNRWA health centres as a requirement for their acceptance. Our study aimed to assess the prevalence of anaemia and undernutrition indicators in these children. Methods We conducted a cross-sectional study at 59 UNRWA health centres, targeting all children entering grade one at UNRWA schools in Gaza, West Bank, Syria, and Lebanon in 2017. The children included boys and girls living inside and outside Palestine refugee camps. Using Epi-Info V2000, a weighted sample of 2399 was calculated (Gaza, 961; West Bank, 982; Syria, 334; Lebanon, 622) based on the prevalence of anaemia in a previous study (2005) and the total number of first grade students at UNRWA schools during the school year 2016-2017, with a confidence level of 95% and precision of 3%. Descriptive statistics were obtained and chi squared tests were carried out using SPSS v22. Child growth z-scores were calculated using WHO Anthroplus software. Informed verbal consent was obtained from parents. Findings 2419 students (1278 females and 1141 males) aged 6•1 (SD 0•4) years were examined. The prevalence of anaemia (haemoglobin level of <11•5 mg/dL) was 25•0% (Gaza, 29•3%; West Bank, 22•0%; Syria, 30•0%; and Lebanon, 18•3%) with no significant differences between males and females (p=0•383). The mean haemoglobin level was 12•0 [SD 0•9] mg/dL. Stunting, underweight, and thinness were assessed according to WHO growth indicators. The overall prevalence of stunting, underweight, and thinness were 3•2%, 3•5%, and 5•6%, respectively, with the highest levels found in Syria (4•3%, 6•3%, and 10•1%, respectively). Interpretation The overall prevalence of anaemia in surveyed children (25•0%) was higher than in the 2005 study (19•5%). However, the prevalence in children in Gaza (29•3%) was lower than in 2005 (36•4%). Haemoglobin testing should be included as part of the medical examination for new school children. In addition, malnutrition among these children should be investigated further.
ObjectiveChildren entering first grade at the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) schools in West Bank, Gaza, Lebanon, Jordan and Syria complete a comprehensive medical examination at UNRWA health centres (HCs) as a requirement for their acceptance. Our study aimed to assess anaemia prevalence and undernutrition indicators among new entrant school children during their preschool medical examination.SettingsIn 2017, we conducted a cross-sectional study in 59 UNRWA HCs, targeting children entering first grade at UNRWA schools in four of UNRWA’s countries of operation (known as fields), namely Gaza, West Bank, Syria and Lebanon.Participants2419 completed the study. Boys and girls living inside or outside Palestine refugee camps were included. Verbal consent was obtained from their parents.Primary and secondary outcome measuresSociodemographic and anthropometric data on each child were collected. Underweight (weight-for-age z-score <−2 SD), stunting (height-for-age z-score <−2 SD), thinness (body mass index-for-age z-score <−2 SD) and obesity (body mass index-for-age z-score >+2 SD) were examined according to WHO growth indicators (5–10 years).Results2419 students (1278 girls and 1141 boys) aged 6.1±0.4 years were examined. The prevalence of anaemia (haemoglobin (Hb) <11.5 g/L) was 25.0% (Gaza: 29.3%; West Bank: 22.0%; Syria: 30.0%; Lebanon: 18.3%). The mean Hb level was 12.0±0.9 g/L. The overall prevalence of stunting, thinness and underweight was 3.2%, 3.5% and 5.6%, respectively, with the highest levels found in Syria (4.3%, 6.3% and 10.1%, respectively). The highest prevalence of overweight was in Lebanon (8.6%), and the lowest was in Gaza (2.6%). Significant differences were found among fields with regard to undernutrition indicators (p=0.001). Also, children with anaemia had significantly higher prevalence of being underweight (5.2%) in comparison with those without anaemia (p=0.001).ConclusionsThe prevalence of anaemia among the surveyed children increased to 25.0%, compared with the previous study conducted by UNRWA in 2005 (19.5%). Thus, it is recommended that Hb testing be included in the medical examination of new entrant school children attending UNRWA schools.
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