Infant and neonatal mortality among Palestine refugees in Gaza, West Bank, Lebanon, and Jordan: an observational study

Abstract

BackgroundUnited Nations Relief and Works Agency for Palestine refugees in the Near East (UNRWA) provides primary health care, including antenatal care, to Palestine refugees. Infant mortality and neonatal mortality are monitored periodically, to assess the progress of mortality reduction among Palestine refugees and to guide future strategic approaches. MethodsA cross-sectional survey was conducted using the same preceding birth technique as in previous surveys. All multiparous mothers who came to the 115 UNRWA health centres in Gaza, West Bank, Lebanon, and Jordan to register their most-recently born child for immunisation were asked if their preceding child was alive or dead. We based our target sample size on infant mortality in the previous survey and included 10 894 mothers from July, 2013, to May, 2014. All participants included in the survey gave informed consent. We used multiple logistic regression analysis to identify predictors of infant mortality. The ethics office of the UN Relief and Works Agency approved the research proposal and the consent procedure. FindingsInformation was collected for 10 951 preceding children. The period to which the mortality data refer is February to November, 2011. Infant mortality in the four areas combined was 20·7 (95% CI 18·0–23·7) per 1000 livebirths in 2006 and 18·0 (15·4–20·6) in 2011. Neonatal mortality in 2006 (14·0 per 1000 live births, 11·8–16·4) was similar to that in 2011 (13·7, 11·5–16·0). Potential risk factors for infant death were preterm birth (odds ratio 6·5, 95% CI 3·5–12·0), low birthweight (3·1, 1·6–6·2), consanguinity (2·5, 1·8–3·6), alert-risk pregnancy (1·8, 1·2–2·6), high-risk pregnancy (2·2, 1·4–3·6), less than 12 years of maternal education (1·6, 1·1–2·3), and six or more pregnancies (1·8, 1·1–2·9). InterpretationInfant and neonatal mortality among Palestine refugees has not fallen significantly since 2006. Strengthening health-care services for alert-risk and high-risk pregnancies and for preterm infants is recommended to reduce mortality rates among this population. Efforts should also be made to enhance public awareness on the consequences of consanguinity. FundingUN Relief and Works Agency for Palestine refugees in the Near East.