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World Health Organization (WHO)
1 November 2004
Health Inforum News
Volume 3, No.54, 1 November 2004
Welcome to the fifty-fourth issue of the Health Inforum Newsletter
Quote of the month
He who has health, has hope; and he who has hope, has
~ Arabian Proverb ~
• International day of diabetes
• Support to the elimination of iodine deficiency disorder in oPt
• Food Safety Program
• Coordination activities on Nutrition and Mental Health
• District Coordination Meeting in Qalqilya
• IDF missile hitting newborn care unit in Khan-Younis Hospital, Gaza Strip
• Strengthening Nutrition Management in the occupied Palestinian territory
• Milk for Preschoolers Program” assessment
Casualties & access incidents
During last October, 146 deaths (including 27 children) and 674 injuries (including 166 children) according to the Palestinian
Ministry of Health.
While during the same period, there were 24 incident of delay of ambulances (for a total delay of 33hrs) and 8 cases were totally denied to access
International Day of Diabetes
On 14th of November WHO is celebrating the “Diabetes Day”, drawing attention to one of the major risk factors for type 2 diabetes: obesity. Media events are organized by the International Diabetes Federation and supported by WHO. Recent figures from the WHO indicate that every year 3.2 million deaths worldwide are attributable to diabetes. According to the Palestinian Ministry of Health (MoH), in 2003 the prevalence rate of Diabetes mellitus in oPt was at 9%.
For more information
Back to WDD 2004 main pahttp://www.who.int/en/ge
Support to the elimination of Iodine Deficiency Disorders in oPt
A workshop on the elimination of iodine deficiency disorders (IDD) and universal salt iodization was held in Ramallah at the Public Health lab on October 6th. PA concerned ministries, NGOs and international organizations attended the workshop. UNICEF is ready to support the Palestinian Authority to map out and to implement the most relevant actions recommended during the workshop.
Food safety program
In October 30th WHO and the MoH started a 5-days training program on food safety for 23 PA professionals from the West Bank. A WHO international consultant facilitated the training of health inspectors from the MoH, ministry of agriculture, ministry of national economy and supply and the national institute for standards. On November 14th, 14 MoH food inspectors and senior staff from Gaza will participate to an intensive training course on food safety in the University of Crete, WHO affiliated.
Coordination activities on Nutrition and Mental Health
Two MoH-chaired steering Committee meetings, for Nutrition and for Mental Health have been organised on October 26th and 28th respectively.
In the Nutrition meeting, WHO nutrition consultants presented a plan of action envisaging WHO support to the MoH nutrition department in West Bank and Gaza for the production of a “State of Nutrition” analysis and a Nutrition Policy statement, by December 2004. Subsequently, the plan will focus on institutional development, technical assistance and coordination. At the meeting, nutrition protocols were presented by MoH (IMCI, Women Health), UNRWA, Maram, Ard El Insan.
The Mental Health (MH) meeting covered the following: updates on the three mental health projects (Italian, French, WHO), establishment of a Task Force for legislation, outcomes of task force on implementation of MH Service Organization, operational policy for MoH-run community MH services, costing of the MH system, strategies towards a single mental health directorate, inservice training.
District Coordination Meeting in Qalqilya
WHO/ Health Inforum and the MoH organized on 27 October 2004 the first district meeting in Qalqilya, where local authorities and health service providers (MoH, UNRWA, Union of Health Care Committees and Palestinian Medical Relief Society) presented an overview of the current health situation and needs in the district.
IDF missile hitting newborn care unit in Khan-Younis Hospital, Gaza Strip
On 24th of October, 2004 the IDF invaded Al-Namssawi area in the western edge of Khan Younis camp, in response to mortars fired at the Neve-Dekalim settlement two days before. The incursion lasted for three days. During the incursion, an IDF missile hit the newborn unit of Nasser hospital. The newborn babies that were in intensive care were evacuated to a different department within the hospital. The orthopedic department was also damaged.
For More information:
: “Strengthening Nutrition Management in the occupied Palestinian territory”
: World Health Organization
: US $ 296,800
: Norwegian Representative Office: US $ 25,000
: October 2004 - September 2005
: To address the nutritional needs of the population of the oPt by strengthening the capacity of
the Palestinian MoH in policy and planning, management, follow up and coordination of nutrition related issues.
Plan of implementation
a. Preparation of a “State of Nutrition for the oPt” document
The aim of the State of Nutrition document is to outline the main nutrition problems facing the oPt, identify potential causes and to describe existing nutrition structures, resources, programming, policy and strategy.
b. Preparation of a National Nutrition Policy Draft Statement for the oPt
The aim is to develop a draft short statement of intent that underpins the national nutrition strategy.
c. Engagement of WHO long-term international and national consultants
WHO will recruit one long-term international and two long-term national nutrition consultants (one in Gaza Strip and one in the West Bank). Terms of Reference have been agreed. The international consultant will divide time equally between the West Bank and Gaza Strip.
d. Production of a National Nutrition Strategic Plan of Action
A workshop will be organized by mid January. The aim of the workshop will be to develop the detail of the nutrition strategy in the form of a Plan of Action that covers priority activities, agency responsibilities, time-lines and resources available.
e. Capacity building of the Nutrition Department
The aim of capacity building is to ensure that the Nutrition Department have the adequate institutional and technical capacity to coordinate the implementation of the National Nutrition Strategic Plan of Action.
This activity constitutes the major part of the WHO-supported nutrition project and will be the main focus of the long-term international and national nutrition consultants. There are three elements to the capacity building: Institutional development; technical development; coordination.
• Development of a departmental plan
• Review of the management structure
• Development of job descriptions
• Identification of in-service and formal training needs
• Development of training plan
• Implementation of training plan
• Design Nutrition Surveillance System
• Implement Nutrition Surveillance System
• Review and develop role of Nutrition Steering Committee (NSC)
• Establish clear coordinating role for ND
• ND coordinating NSC
: All project activities will be carried out by the MoH/Nutrition Department (ND) through WHO training support, and are conceived with the dual intent of building the ND capacity and -at the same time- producing concerned outputs (State of Nutrition document, policy statement, plan of action, nutrition surveillance system, etc.). In fact, through guiding the ND staff all along the policy and planning processes, WHO will train, motivate and enable the staff to perform all essential tasks for a sustainable and effectively functioning body.
“Milk for Preschoolers Program” assessment
In 2003, the American Near East Refugee Aid (ANERA) initiated in Gaza Strip a pilot project, Milk for Preschoolers Program (MfP) to supply milk and high-energy biscuits to preschool children in needy communities. The Centre for Development in Primary Health Care (CDPHC) in Al Quds University was contracted to conduct pre- and post-nutritional assessments of the program at the beginning and end of the school year 2003/2004.
The MfP program was implemented in twenty-six preschools located throughout the Gaza Strip. At the time of the assessment in 2003, there were 2,256 children in the program. The program covered the five governorates of the Gaza Strip with a focus in the south – the least advantaged part of the Gaza Strip.
a) To estimate the prevalence of malnutrition and anemia among preschool children under 6 enrolled in the program both before and after the program’s implementation.
b) To provide tentative conclusions about the value and contribution of the intervention in improving the nutritional status of the concerned children, thus providing valuable information and recommendations for other future interventions.
c) To explore the strengths and weaknesses encountered in the management of the MfP as perceived by the selected preschools, enabling management to improve the performance of the program in the next school year.
At the time of pre intervention study, more than 2,000 children were registered in the 24 target preschools. A representative sample composed of 500 children was selected for hemoglobin measurement. All the children registered in the preschools were assessed for weight and height measurements pre- and post-intervention.
The total number of preschools included in the post-intervention assessment was 24 and the total number of children was 2,074. Of these, 1,735 had been included in the post intervention assessment.
The pre-intervention assessment revealed that more than 60% of families were living in crowded homes (more than two persons per room). About half of the mothers and fathers had either medium or high education levels. Considering a poverty line of two dollars per day, 79.2% of those families interviewed lived in poverty.
• The prevalence of stunting was 8.8% before implementation of the program and decreased to 6.4% after implementing the MfP.
• The prevalence of wasting among the preschool children in the Gaza Strip could not be considered a major public health problem. According to the results of the study, the MfP did not have any effect on the prevalence of wasting: it was 3% and 3.1% pre-and post-intervention respectively.
• The prevalence of underweight children decreased from 4.5% to 4.0% in all governorates of Gaza Strip except in North Gaza.
• The prevalence of global anemia among preschool children fell from 27.3% before implementing the MfP to 18.6% after the implementation of the program.
• Hemoglobin levels increased among 66% of the preschool children benefiting from the MfP, about 5% of the children did not have any improvement in their hemoglobin level, while hemoglobin level decreased among 29% of the children.
The MfP has contributed significantly to improving the nutritional status of children and significantly decreased the prevalence of stunting. Policy makers, preschools and donors could use the findings of this study in tackling the problem of stunting among preschool children in a way similar to the approach used by the MfP.
The MfP has also succeeded in decreasing the prevalence of anemia among children involved in the program, and the approach used in the program could be effectively implemented on a larger scale.
CASUALTIES AND HEALTH INCIDENTS
According to the Palestinian Health Information Center (MOH), during the month of
the total number of deaths and injuries reported in the West Bank and Gaza Strip was
146 deaths (including 27 children) and 674 injuries (Including 166 children)
During the same period, there were 24 episodes of ambulance delay (for a total delay of 33 hrs). In 8 cases the access was totally denied –according to PRCS.
The following diagram shows by area the total number of ambulance incidents, the time of ambulance delay and the episodes of denied access (D/A) at the checkpoints:
The diagram showes that in Beit Hanoun & Al Tufah checkpoints in Gaza, ambulances experienced the highest delay in crossing. In fact, there were 4 episodes of delayed access with a total time of delay of 725 minutes, which means almost 3 hrs per episode.
On 4th October, at Al Tufah checkpoint, the access of an ambulance that was transferring a woman to give birth was denied and the woman were obliged to give birth at the checkpoint inside the ambulance. (according to PRCS weekly press release for 2-8 October, 2004)
In Rafah- 5th October, an ambulance was delayed while transferring to the hospital a 13 years old in critical conditions that died upon arrival. (according to PRCS weekly press release for 2-8 October, 2004) This diagram shows the variation of incidents and delays in several months:
FOR MORE INFORMATION
Please feel free to contact us at:
Health Inforum, c/o Italian Cooperation/ Sheikh Jarrah, East Jerusalem, Tel: 02 532 7447, Fax: 02 532 2904
Health Inforum, c/o WHO Jerusalem office/ Sheikh Jarrah, East Jerusalem, Tel: 02 5400 595, Fax: 02 581 0193
Health Inforum, c/o WHO, Gaza office, Al-Bayed building, Al-Halbi Str. Tel: 08-2822033, Fax: 02-2845409
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