Palestine Country Report

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Palestine Country Report

• Regional Workshop on Growth Curves
• Muscat, Oman
• 12-14 September 2005
• WHO

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Palestine
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Palestine

• Population 3,762,005
• West Bank 2,372,216
• Gaza Strip 1,389,789
• Main Cities Jerusalem, Jericho, Nablus, Jenin,
  Tulkarm, Qalqilia, Hebron, Bethlehem,
  Ramallah,Gaza, and Rafah.

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Demographic Indicators

• 46 of population is under 15 years of age.
• Adult literacy rate 15 years and over 91.
• Education attendance 89.

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Health Economical Indicators

• Infant Mortality Rate per 1000 live births 24.
• Maternal mortality rate per 100,000 live births
  for 15-49 years of age females 12.7.
• Live Expectancy at birth 72.3
• males 70.7 females 73.8

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Growth Charts

• CDC Atlanta (Chronic Disease Control
• Prevention Center).
• Percentile System including
• Weight for Age
• Height for Age
  
• Weight for Height
• Head Circumference for Age
• This chart has been used for the last 2 years.

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Measurements

• Height
• Weight
• Head Circumference
• Are taken on a monthly basis for the first
  year of a childs age, every 2 months in the
  second year of age, and twice per year in the 3rd
  year.
• Visits usually are synchronized with the
  immunization schedule of a child.

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Growth Charts
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Growth Charts (cont.)
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Implementation

• Growth Charts are implemented by the Palestinian
  Ministry of Health at Mother and Child Health
  Centers (233 MCH centers and 95 Community Health
  Room in the West Bank and 54 PHC centers in
  Gaza).
• Coverage rate of 53.35 of total deliveries in
  Palestine in 2004.
• Target population males and females aged 0-3
  years.
• Other health providers provide this service in
  Palestine, such as UNRWA, NGOs, and the private
  sector.

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Tools and Equipment

• Weight scales, meters, pencils, rulers, and
  special measuring tables are needed to take these
  measurements.
• Nurses, midwives, and\or community health workers
  take these measurements.
• All measurements are plotted manually on the
  chart.

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Interpretation of Data

• Data is used to detect early malnutrition such as
  underweight, overweight, stunting, and wasting.
• Any measurement bellow 5 percentile or above 95
  percentile is considered abnormal.
• Information about breast feeding and
  complementary feeding practices is obtained.
• Detect nutrition related trends in order to
  identify problems and therefore plan proper
  interventions, allocate resources, and design
  needed training and research.

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Action taken

• Health education.
• Counseling.
• Supplements.
• Some cases are referred to higher level of care
  to be managed by Pediatrician and\or
  Nutritionist.

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Problems

• No effective referral system no feed back.
• No standardization of measurements (taking into
  consideration also the human error factor).
• No computerized system all is manual.
• Shortage of proper equipment.

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Problems- cont.

• Time constrains for work-overloaded nurses and
  midwives.
• Data is not fully analyzed and interpreted.
• Follow up and monitoring need to be addressed
  more thoroughly and comprehensively.

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Recommendations

• The following are needed to improve the use of
  Growth Charts
• Upgrading current system.
• Use of proper tools and equipment.
• Standardization of measurements.
• Computerized network system.

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Recommendations- cont.

• Capacity building of staff in relation to
• proper use of equipment, computer skills, use
  of health statistics programs, community
  mobilization, health education and promotion, and
  supervision, monitoring and evaluation.

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Interpretation

• Presence of protocols and guidelines.
• Referral system.
• Data analyses and interpretation.
• Research needs and surveys.
• Reallocation of resources.
• Advocacy targeting also decision makers.