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Original research
Anaemia prevalence in children newly registered at UNRWA schools: a cross-sectional study
  1. Nada AbuKishk1,
  2. Yassir Turki1,
  3. Suha Saleh1,
  4. Shatha Albaik1,
  5. Majed Hababeh1,
  6. Zoheir el-Khatib2,
  7. Nimer Kassim3,
  8. Hasan Arab1,
  9. Khawalah Abu-Diab4,
  10. Wafaa Zeidan1,
  11. Akihiro Seita1
  1. 1Health Department, UNRWA HeadQuarters, Amman, Jordan
  2. 2Health, UNRWA, Gaza, Palestine, State of
  3. 3Health, UNRWA, Beirut, Lebanon
  4. 4Health, UNRWA, Jerusalem, Palestine, State of
  1. Correspondence to Nada AbuKishk; nada_abukishk{at}


Objective Children 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.

Settings In 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.

Participants 2419 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 measures Sociodemographic 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).

Results 2419 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).

Conclusions The 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.

  • anaemia
  • health policy
  • child protection

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  • Contributors NA designed the study, collected and interpreted the data, carried out data management, and wrote the text. YT wrote the abstract and revised the text. SS analysed the data, produced the tables and revised the transcript. SA analysed the data and produced the tables. MH interpreted the data and revised the text. ZK, NK, HA and KA-D collected and interpreted the data, and carried out data management. WZ designed the study methodology. AS interpreted the data and revised the abstract. All authors have seen and approved the final version of the text for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the UNRWA Health Department Ethical Review Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Data are not available due to the nature of this research being in a refugee settings and UNRWA's legal restrictions.

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