A cross-sectional household survey was carried out to determine the prevalence and distribution of malnutrition and intestinal infections among Jordan Valley children and their mothers. Form each randomly selected household; all children 1- 12 years were selected.
The Jordan Valley comprises approximately 30% of the land area of the West Bank, occupied Palestinian territories (oPt), and is home to an estimated 60,000 Palestinians. The ongoing Israeli occupation creates widespread consequences for Palestinians in the area, including movement restrictions, limited access to potable water, poverty, persistent threats of forced relocation and home demolitions, and lack of minimal human security measures.1 Furthermore, since much of the Jordan Valley lies within Israeli-controlled Area C, nearly 87% of the land is under full Israeli military or settlement jurisdiction and is prohibited for Palestinian use.2 These factors have a significant impact on healthcare quality and access, affecting the overall health status of the population. Because of these unique political, economic, and social circumstances, there is an urgent need to better characterize and improve the health status of the population in the Jordan Valley.
Our aim in this research project was to examine the prevalence and determinants of malnutrition and intestinal infections among children and their mothers living in the Jordan Valley. We utilized a structured household survey implemented from November 2014–March 2015. We gathered data at the child, maternal, household, and community levels to examine factors associated with our primary outcomes of interest: childhood stunting, anemia, underweight, overweight/obesity, and intestinal infections as well as maternal anemia and obesity. In addition to anthropometric measures, we examined clinical data derived from stool and blood samples.
Our final study sample consisted of 1,501 children from 587 households in 25 localities of the Jericho, Nablus, and Tubas districts. More than 75% of the children in our sample lived in the Jericho district, and more than 67% of the families in our survey reported living below the poverty line.
Our main findings suggest that 11.3% of children in the Jordan Valley are stunted (16% in the <5 population), approximately half (49.3%) of children are anemic (27.3% moderately or severely anemic), 8.4% are obese or overweight, and 2.3% of children <10 years of age are underweight. Among mothers, we found that 19.1% were anemic and 40.2% were obese. In our study of parasitic infection rates among children, 8.9% of the sample tested positive for Giardia cyst, the highest percentage 4 Prevalence and Determinants of Malnutrition and Intestinal Infections among Children and their Mothers in the Jordan Valley among the parasitic infections, and 16.5% tested positive for any parasite and/or worm in the stool. No children in our study sample tested positive for Taenia worm, 0.4% of children tested positive for Shigella, 0.9% tested positive for Salmonella, and 1.8% tested positive for Hymenolepis nana (H.nana) worm.
Children residing in Bedouin communities had a higher prevalence of stunting compared to children in villages and camps. Similarly, children in households exposed to any form of forced displacement had higher prevalence of stunting than children who had never been forcibly displaced. There was significant variability in stunting status by maternal education level. Children whose mothers had no schooling or less than a high school education had higher rates of stunting than children whose mothers had a high school education or more.
We also found that anemia was more prevalent among children in the Jericho district compared to those in Nablus and Tubas, and children in Bedouin and village communities had a higher prevalence of anemia than children living in camps. Children whose mothers had completed beyond a high school education had lower prevalence of anemia compared to their counterparts.
In terms of overweight and obesity, children whose mothers were overweight or obese also had a higher prevalence of overweight or obesity. Additionally, prevalence of overweight/obesity differed by the following factors: self-reported anemia, diarrhea in the two weeks prior to the survey, child stunting, district of residence, type of residence, and maternal obesity. In terms of double burden at the household level, of the 587 total households in our study, 45% included children that were anemic and children that were overweight/obese, and 11% of households included children that were stunted and children that were overweight/obese.
A higher prevalence of children living in households exposed to any form of forced displacement tested positive for a Giardia cyst infection. Children living in the Nablus district had higher prevalence of infection compared to children in Jericho and Tubas, and children living in Bedouin communities had greater prevalence of infection compared to children living in village and camp localities. We found no evidence of an association between rates of Salmonella and households raising cattle or poultry, and source of drinking water was not associated with self-reports 5 of diarrhea.
With respect to maternal health, there was a high prevalence of anemia in the sample of mothers. Although only 19.1% of mothers self-reported anemia, based on blood tests taken for the study, 58.1% of all 587 mothers in the sample had confirmed anemia. Specifically, 1.5% had severe anemia, 31.9% had moderate anemia, and 24.7% had mild anemia. The prevalence of overweight (defined as a BMI ≥25 and <30) and obesity (defined as a BMI ≥30) in the study sample of mothers was 33.6% and 40.2%, respectively. The prevalence of central obesity (defined as a waist circumference ≥ 88cm) was 66.4%.
In summary, our study on the prevalence and determinants of malnutrition in the Jordan Valley found rates of anemia among children and rates of obesity and anemia among mothers to be of serious concern, as current trends could have a potentially devastating public health impact. The coexistence of malnutrition and obesity among members of the same household presents an important challenge for the Palestinian public health system. Further research to inform effective public health interventions to address this complicated double burden should be encouraged. Ultimately, a political solution is necessary in the Jordan Valley and in the occupied Palestinian territories in order to address the structural barriers—including the persistent exposure to violence meted out by the Israeli occupation—that make full achievement of health difficult at best and unattainable at worst. Concerted and coordinated efforts by both governmental and nongovernmental organizations to holistically address the proximate and distal causes of malnutrition and obesity in this population is warranted. 6 Prevalence and Determinants of Malnutrition and Intestinal Infections among Children and their Mothers in the Jordan Valley.