CARE International Assessment finds high levels of Malnutrition, Anemia and Micro-nutrient Deficiencies in the West Bank and Gaza Strip
CARE International today released a 67-page report with findings of a Nutritional Assessment carried out in the West Bank and Gaza Strip. The survey indicates that Global Acute Malnutrition (GAM) for children aged 6-59 months stands at 13.3% in the Gaza Strip and 4.3% in the West Bank. In a normally nourished population, the figure would be 2.3%. Global Chronic Malnutrition (GCM) for the same age group is 17.5% in the Gaza Strip and 7.9% in the West Bank. These findings are based on a survey of 1,004 households randomly selected in the West Bank and Gaza Strip. Preliminary assessment results were released in August 2002.
The Assessment’s other findings provide important data regarding household level access to food, the ability of the market to provide various products and the ability of clinics to respond to the rising levels of malnutrition and anemia. These findings reveal that the current nutritional crisis is exacerbated by market disruptions from curfews, closures, military incursions, border closures, and checkpoints; decreased caloric and micronutrient intake by preschool aged children; and the fact that healthcare providers may not be adequately identifying and diagnosing malnutrition in their communities.
Unlike the levels of malnutrition, the prevalence of anemia among children 6-59 months of age varies little between the West Bank (43.8%) and the Gaza Strip (44%). Four of five children in both areas have inadequate iron and zinc intake, deficiencies which cause anemia and immune deficiencies, respectively. In both areas over half the children have inadequate caloric and vitamin A intake while half the children have inadequate folate intake. Non-urban areas of the Gaza Strip fared worse in all categories of intake. A large percentage of reproductive-aged non-pregnant women have deficiencies in energy, iron, folate, and zinc consumption, critical for healthy fetal development. Reproductive-aged women also show a 15-20% decrease in per diem calorie and protein intake compared to 2000.
The clinic portion of the Assessment reveals the inability of clinics to properly and accurately diagnose and treat malnutrition and anemia. The survey found that attention to growth and monitoring of children declines as the age of the child increases, so that only 18% of children 25-36 months had had their weight recorded in the previous six months prior to the interview. Despite the objective prevalence of malnutrition from the clinics’ own records, clinic managers subjectively estimated only 1% of preschool aged children were malnourished. The clinic survey covered a sample of 68 clinics, half of which did not have protocols or guidelines within the clinic setting to standardize the diagnosis and treatment of malnutrition and anemia, or the guidelines for counseling or follow-up for such cases. Further, 27.9% of all 68 clinics (19) and 40.7% of the 27 rural clinics (11) lack supplemental iron for children.
Finally, the market portion of the Assessment documented sustained major market disruption of infant formula and other high protein foods critical for growth. For West Bank retailers, incursions/curfews were cited as the major reason for disruption (53%) followed by road closures/checkpoints (38%). For West Bank wholesalers, road closures/checkpoints were cited as the major reason for disruption (52%) followed by incursions/curfews (34%). For both Gaza Strip retailers and wholesalers, border closures were cited as the major reason for disruption (60% and 63% respectively) followed by road closures/checkpoints (20% and 15% respectively). The market survey was a representative sample of 660 retailers and 140 wholesalers stratified by urban wholesale, urban retail, large village and refugee camp, and small village.
The report concludes with 6 pages of recommendations aimed at policymakers, donors and the humanitarian aid community. The authors caution against large bulk food distribution programs which would undermine functioning markets and further deflate prices and recommend instead limited targeted supplemental feeding programs. Other recommendations include micronutrient supplementation and health provider education.
The Assessment was funded and supported by CARE International with a grant from the US Agency for International Development (USAID). The survey was implemented by Al Quds University (Jerusalem) and the Global Management Consulting Group (Ramallah) with technical assistance from Johns Hopkins University (Baltimore).