Fighting anaemia and malnutrition in Hebron (Palestine): impact evaluation of a humanitarian project.

Iron supplementation in children is recommended by WHO when prevalence of anaemia is above 40%. In Palestine, due to the emergency situation caused by the outburst of the second intifada, the nutritional situation of children is worsening and iron deficiency anaemia represent one of the most serious problem. An emergency project which included universal iron supplementation (for 12,300 children), free treatment for common diseases and food supplementation to vulnerable families (for 3,275 children found anaemic or/and malnourished) and community health education was implemented in part of Hebron governorate. To evaluate project's impact we performed two random surveys: one before and one after the project. Before the project 30.1% of children (CI 95%=24.5-35.6%) were found anaemic (<11 g/dl), while after the prevalence was 18.8% (CI 95%=14.8-22.8%; decrease of 38%, p=0.001). Levels and reduction in anaemia prevalence were different according to geographical areas: where prevention activities had been implemented in previous years, prevalence of anaemia was 17.1% and remained stable at lower levels (14.7%). In other areas it sharply declined from 47.4 to 21.7% (p<0.0005): the declined was present only for children who received iron supplementation. Comparison of anthropometrics index before versus after the project showed that low "weight for age" declined from 10.9 to 3.8% (p=0.0006), low "weight for height" declined from 6.0 to 1.4% after (p=0.0025). With simple epidemiological tools we could demonstrate and measure the effectiveness of our interventions on the health status of the general population: a 50% reduction of anaemia and a 70% reduction of global acute malnutrition.