Palestinians face health risks due to micronutrient deficiencies - Reports by a national survey

Micronutrient deficits among Palestinians can have serious effects on health as well as social & economic evolution. Research by the World Bank has revealed constraints in the fight against micronutrient shortages. To enhance the populace's micronutrient level, multi-sectoral & innovative approaches are required.

The Palestinian population's poor nutritional status is concerning, with a significant frequency of micronutrient deficiencies amongst populations that require special attention including children under the age of five as well as pregnant and postnatal women.

There are numerous reasons for this: Increased food insecurity in the West Bank and Gaza creates a loss of micronutrient consumption and impoverished households, in particular, have restricted access to micronutrient-rich foods including red meat, fresh vegetables and milk.

Other constraints, such as structural barriers that impede access to health care services and protracted periods of insecurity, preclude many micronutrient-deficiency-related activities from having much of an impact. If nothing is done, the continually high incidence of micronutrient deficiency will have serious ramifications for human health and socio-economic development.

Poor dietary intake and/or uptake of micronutrients; an enhanced requirement for micronutrients (associated with childhood growth or chronic illness); the existence of parasitic, viral, and bacterial infections; and other environmental stressors are all causes of micronutrient deficiencies. 

Micronutrient deficits are linked to an increased risk of morbidity and mortality among women and children. They harm not only one's health but also one's overall productivity.

Deficiencies in micronutrients are a public health concern

Anemia occurs when the body's healthy red blood cells are insufficient to transport oxygen to tissues. A deficiency of iron and other micronutrients might cause it. Anemia is a serious public health issue in Gaza.

 As per the health ministry and national nutrition surveys done in 2018 and 2020, over half of the pregnant women and children aged 6–23 months were found anemic. In the West Bank, anemia is a moderate public health concern, as 1 in 4 pregnant women and 1 in 4 children under 6 months of age suffer from anemia.

Vitamins A, D, and E, which are important for vision, bone health, and immunological function, are lacking in huge portions of the Palestinian population.

We are grateful to the World Bank for its assessment of research aimed at improving nutritional status. The importance of supplementing oils with vitamins A, D, and H was demonstrated in the study. We hope to continue working together on additional analysis and technical assistance in many sections of the health sector to aid the decision-making and policy-making process in the Palestinian health sector. 

Low plasma vitamin A was found in 72 percent of children (6–59 months old) and 47 percent to 58 percent of pregnant women (depending on the trimester of pregnancy) in the most recent survey conducted by the Department of health in 2013—the most accurate and consistent source of data on micronutrient status to date. Low vitamin D levels were found in 54% to 68% of children (6–59 months old) and 99% of pregnant women (18–43 years old) in the second and third trimesters. 

Low vitamin E levels were found in 65% of children (6–59 months old) and 16% to 42% of pregnant women (based on the trimester of pregnancy). Despite the MOHs efforts over the last decade, the problem persists.

The Ministry of Health requested assistance from the World Bank in identifying the factors preventing improvements in micronutrient levels and developing practical, innovative solutions that were tailored to the local situation. Between 2019 and 2021, the World Bank undertook two extensive assessments: (1) to identify bottlenecks in anemia prevention and control initiatives; and (2) to assess the viability of an edible oil fortification project.

In these two multi-sectoral studies, nutrient intake, supply chain, consumer habits, market distribution, and product & service delivery methods were all investigated. The assessments' findings show that a considerable number of Palestinians suffer from persistent nutritional deficiencies. The World Bank team's recommendations can help expand the scope and quality of initiatives in the West Bank and Gaza Strip.

In the direction of healthier nutrition

Modern anemia prevention and management services are aimed at the most susceptible, such as pregnant women & breastfeeding mothers, as well as children under the age of five. Existing measures, including iron and folic acid supplements for pregnant women as well as a national flour fortification scheme, appear to have no impact on blood micronutrient levels.

Effective treatments are possible, but they require additional technical and financial assistance. To enhance outcomes, stock maintenance of iron supplements must be updated, nutrition counseling quality must be improved, and public knowledge of the necessity of proper micronutrient intake must be raised. For service delivery as well as fortification enforcement, measurement and reporting systems are also required.

Interactive education workshops for pregnant women as well as other caregivers of children aged three and under might be used to provide participants with guidance on avoiding anemia and the necessity of adhering to recommended health measures.

Vitamin A, D, and E fortified edible oil could be a foundation for improving vitamin A, D, and E consumption in the general public. Strengthening the capacity of local labs, conducting spot checks of materials, and establishing or revising technical norms should all get technical and financial support. 

More capacity is also required for checking vitamin content at ports of entry, such as repacking facilities & marketplace retail stores, as well as supplying repacking factories with the premix required to strengthen edible oils with vitamins.