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Infant and child mortality rates among Palestinian refugee populations
RESEARCH LETTERS
Haifa H Madi We estimated infant and early child mortality rates among Palestinian refugees using maternal and child services in Jordan, Gaza, Lebanon, and Syria. Early childhood mortality per 1000 live births was 35 in Jordan, 36 in Gaza, 37 in Lebanon, and 32 in Syria. Infant mortality rates were 32 in Jordan, 33 in Gaza, 35 in Lebanon, and 29 in Syria.
Since 1950, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has provided education, health, and relief and social services to registered Palestinian refugees in Jordan, Gaza, the West Bank, Lebanon, and Syria (estimated at 3·4 million in 1997). Our study covered all health facilities in and outside camps run by UNRWA in Jordan, Gaza, Lebanon, and Syria. We targeted mothers of newborn infants who had two children or more, and came to the agency’s primary health-care facilities during the study period to register their newborn infants during a 3month period from March 1, 1997, to May 31, 1997. 18 727 women with more than one child who attended the agency’s primary health-care facilities to register their newborn babies in Jordan (n=7730), Gaza (7690), Lebanon (1797), and Syria (1510) participated in the study. The Preceding Birth Technique1,2 was used to estimate early childhood and infant mortality rates. This technique was used because the coverage of newborn registration/ immunisation at UNRWA health centres is high. The technique was modified to categorise the time of a child’s death as follows: during the first month, between months 1 and 12, and after 1 year. In that way neonatal, postneonatal, and infant mortality rates were calculated. This technique requires advanced knowledge of the birth interval, age of infants at registration, and the proportion of deaths that occurred during the birth interval. The field-specific mean birth intervals used in this study were: 31 months for Jordan, 27·6 months for Gaza, 36·7 months for Lebanon, and 37·3 months for Syria. These values were obtained from a previous study done in March, 1997.3 The mean age of infants at the time of registration was 10·3 days in Gaza, 29·9 days in Jordan, 18·6 days in Lebanon, and 25 days in Syria. 9436 (50·4%) were boys and 9291 (49·6%) were girls. For the proportion of deaths that occurred during the birth interval, childhood mortality was adjusted by a factor of 1·09 to account for the neonatal mortality rate of the study year. The age distribution of the target population was: 19 years or younger (3·8%); 20–34 years (81·6); 35–39 years (11·1); and 40 years or older (3·5). The percentage of women younger than age 19 years was highest in Gaza (5·1), followed by Lebanon (3·7), Jordan (2·3), and Syria (2·2). The death rate of preceding children was highest in Lebanon, followed by Gaza, Jordan, and Syria (table). 556 of 601 (92·5%) of deaths occurred during the first year, 363 (60.4%) during the first month of life, and 193 (32·1%) during the postneonatal period. The postneonatal mortality rate was highest in Gaza, 13 per 1000 live births, and lowest in Syria at nine per 1000 live births. There was little difference
Jordan Gaza Lebanon Syria
Infant mortality rates per 1000 (95% CI)
Child mortality rates per 1000 (95% CI)
Birth interval (years)
32 (28–36) 33 (29–37) 35 (26–44) 29 (21–37)
35 (31–39) 36 (32–40) 37 (28–46) 32 (24–40)
2·2 1·9 2·5 2·6
Infant and child mortality rates per 1000 live births
312
100
Key Neonatal
Number of refugees (%)
Infant and child mortality rates among Palestinian refugee populations
80
Postneonatal Older than 1 year
60
40
20
0 Jordan
Gaza Lebanon Country
Syria
Proportionate infant and early childhood mortality among Palestinian refugees (per 1000 live births)
among the four study areas (figure). The table presents the results of infant and child mortality rates. The infant mortality rate was highest in Lebanon, followed by Gaza, Jordan, and Syria. The probability of death during the birth interval followed the same pattern of infant mortality rates. The birth interval was 2·2 years in Jordan, 1·9 years in Gaza, 2·5 years in Lebanon, and 2·6 years in Syria. Based on birth intervals, the reference periods were as follows: January, 1995, for Syria; February, 1995, for Lebanon; May, 1995, for Jordan; and August, 1995, for Gaza. The infant mortality rate among the refugee population in the studied areas is similar to that for native populations4,5 and well below the WHO target of 50 deaths per 1000 live births in developing countries by the year 2000. Of all infant deaths, 363 (60·4%) of 601 occurred during the first month of life. 1
2
3
4 5
UNICEF Regional Office for the Middle East and North Africa. Measuring childhood mortality, a guide for simple surveys. Amman: UNICEF, 1990. Agutree A, Hill G. Childhood mortality estimates, using the Preceding Birth Technique: some applications and estimations. London: London School of Hygiene and Tropical Medicine, 1987. Madi HH. Current practices of contraceptive use among mothers of children 0–3 years of age attending UNRWA MCH Clinics. Beirut, 1997. Madi YH. Lebanon maternal and child health survey. Beirut, 1996. UNICEF and JFPPA. Interim report: a survey of infant and child mortality in the West Bank and Gaza Strip. Jerusalem: UNICEF, 1992.
United National Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) Headquarters, PO Box 140157 Amman, Jordan (HH Madi MD) Correspondence to: Dr Haifa H Madi
Severe digital arterial occlusive disease and acute parvovirus B19 infection D Dingli, D H Pfizenmaier, E Arromdee, P Wennberg, P C Spittell, A Chang-Miller, B L Clarke We report a case of arterial occlusive disease and digital ischaemia associated with acute parvovirus B19 infection. Treatment with intravenous epoprostanol improved her symptoms.
A 43-year-old white woman developed a flu-like illness with low-grade fever, myalgias, arthalgias, and a nonproductive cough. These symptoms resolved after a few days but were followed by pharyngitis, diffuse body aches,
THE LANCET • Vol 356 • July 22, 2000
For personal use only. Not to be reproduced without permission of The Lancet.
Haifa H Madi We estimated infant and early child mortality rates among Palestinian refugees using maternal and child services in Jordan, Gaza, Lebanon, and Syria. Early childhood mortality per 1000 live births was 35 in Jordan, 36 in Gaza, 37 in Lebanon, and 32 in Syria. Infant mortality rates were 32 in Jordan, 33 in Gaza, 35 in Lebanon, and 29 in Syria.
Since 1950, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has provided education, health, and relief and social services to registered Palestinian refugees in Jordan, Gaza, the West Bank, Lebanon, and Syria (estimated at 3·4 million in 1997). Our study covered all health facilities in and outside camps run by UNRWA in Jordan, Gaza, Lebanon, and Syria. We targeted mothers of newborn infants who had two children or more, and came to the agency’s primary health-care facilities during the study period to register their newborn infants during a 3month period from March 1, 1997, to May 31, 1997. 18 727 women with more than one child who attended the agency’s primary health-care facilities to register their newborn babies in Jordan (n=7730), Gaza (7690), Lebanon (1797), and Syria (1510) participated in the study. The Preceding Birth Technique1,2 was used to estimate early childhood and infant mortality rates. This technique was used because the coverage of newborn registration/ immunisation at UNRWA health centres is high. The technique was modified to categorise the time of a child’s death as follows: during the first month, between months 1 and 12, and after 1 year. In that way neonatal, postneonatal, and infant mortality rates were calculated. This technique requires advanced knowledge of the birth interval, age of infants at registration, and the proportion of deaths that occurred during the birth interval. The field-specific mean birth intervals used in this study were: 31 months for Jordan, 27·6 months for Gaza, 36·7 months for Lebanon, and 37·3 months for Syria. These values were obtained from a previous study done in March, 1997.3 The mean age of infants at the time of registration was 10·3 days in Gaza, 29·9 days in Jordan, 18·6 days in Lebanon, and 25 days in Syria. 9436 (50·4%) were boys and 9291 (49·6%) were girls. For the proportion of deaths that occurred during the birth interval, childhood mortality was adjusted by a factor of 1·09 to account for the neonatal mortality rate of the study year. The age distribution of the target population was: 19 years or younger (3·8%); 20–34 years (81·6); 35–39 years (11·1); and 40 years or older (3·5). The percentage of women younger than age 19 years was highest in Gaza (5·1), followed by Lebanon (3·7), Jordan (2·3), and Syria (2·2). The death rate of preceding children was highest in Lebanon, followed by Gaza, Jordan, and Syria (table). 556 of 601 (92·5%) of deaths occurred during the first year, 363 (60.4%) during the first month of life, and 193 (32·1%) during the postneonatal period. The postneonatal mortality rate was highest in Gaza, 13 per 1000 live births, and lowest in Syria at nine per 1000 live births. There was little difference
Jordan Gaza Lebanon Syria
Infant mortality rates per 1000 (95% CI)
Child mortality rates per 1000 (95% CI)
Birth interval (years)
32 (28–36) 33 (29–37) 35 (26–44) 29 (21–37)
35 (31–39) 36 (32–40) 37 (28–46) 32 (24–40)
2·2 1·9 2·5 2·6
Infant and child mortality rates per 1000 live births
312
100
Key Neonatal
Number of refugees (%)
Infant and child mortality rates among Palestinian refugee populations
80
Postneonatal Older than 1 year
60
40
20
0 Jordan
Gaza Lebanon Country
Syria
Proportionate infant and early childhood mortality among Palestinian refugees (per 1000 live births)
among the four study areas (figure). The table presents the results of infant and child mortality rates. The infant mortality rate was highest in Lebanon, followed by Gaza, Jordan, and Syria. The probability of death during the birth interval followed the same pattern of infant mortality rates. The birth interval was 2·2 years in Jordan, 1·9 years in Gaza, 2·5 years in Lebanon, and 2·6 years in Syria. Based on birth intervals, the reference periods were as follows: January, 1995, for Syria; February, 1995, for Lebanon; May, 1995, for Jordan; and August, 1995, for Gaza. The infant mortality rate among the refugee population in the studied areas is similar to that for native populations4,5 and well below the WHO target of 50 deaths per 1000 live births in developing countries by the year 2000. Of all infant deaths, 363 (60·4%) of 601 occurred during the first month of life. 1
2
3
4 5
UNICEF Regional Office for the Middle East and North Africa. Measuring childhood mortality, a guide for simple surveys. Amman: UNICEF, 1990. Agutree A, Hill G. Childhood mortality estimates, using the Preceding Birth Technique: some applications and estimations. London: London School of Hygiene and Tropical Medicine, 1987. Madi HH. Current practices of contraceptive use among mothers of children 0–3 years of age attending UNRWA MCH Clinics. Beirut, 1997. Madi YH. Lebanon maternal and child health survey. Beirut, 1996. UNICEF and JFPPA. Interim report: a survey of infant and child mortality in the West Bank and Gaza Strip. Jerusalem: UNICEF, 1992.
United National Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) Headquarters, PO Box 140157 Amman, Jordan (HH Madi MD) Correspondence to: Dr Haifa H Madi
Severe digital arterial occlusive disease and acute parvovirus B19 infection D Dingli, D H Pfizenmaier, E Arromdee, P Wennberg, P C Spittell, A Chang-Miller, B L Clarke We report a case of arterial occlusive disease and digital ischaemia associated with acute parvovirus B19 infection. Treatment with intravenous epoprostanol improved her symptoms.
A 43-year-old white woman developed a flu-like illness with low-grade fever, myalgias, arthalgias, and a nonproductive cough. These symptoms resolved after a few days but were followed by pharyngitis, diffuse body aches,
THE LANCET • Vol 356 • July 22, 2000
For personal use only. Not to be reproduced without permission of The Lancet.