Chaudhry Aeysha Bushra, Hajat Shakoor, Rizkallah Najwa, Abu-Rub Ala'a
1The London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.
UNICEF Iraq Country Office, 100 mt street, UN Compound, Erbil, Iraq.
Confl Health. 2018 Apr 2;12:13. doi: 10.1186/s13031-018-0148-y. eCollection 2018.
Vitamin A and D are essential for the proper growth and development of a child. Due to the complex political circumstances in the state of Palestine, research on micronutrient deficiency is scarce.
The Palestinian Ministry of Health (MOH) and UNICEF conducted a national cross-sectional survey in 2013 after the implementation of various micronutrient supplementation and fortification programs. Risk factors for levels of vitamin A ( = 1054) and vitamin D ( = 150) were assessed among children aged 6 to 59 months using chi-square tests and logistic regression with each of the outcome variables, vitamin A and D deficiencies. A child was considered to be deficient in vitamin A and D if he/she had a serum level < 1.05 μmol/L and < 50 nmol/L respectively. Multiple logistic regression models were developed to identify independent risk factors for vitamin deficiencies.
The prevalence of vitamin A and D deficiency was 73.1% and 60.7% respectively. Children in Gaza were 1.34 (95%CI 0.78-2.31) and 1.96 times (95%CI 0.67-5.71) more likely to be deficient in vitamin A and D respectively compared to children in the West Bank. Anaemic children were 1.5 times more likely to be deficient in vitamin A (95%CI 1.08-2.10). Older children (> 1 year-old) were more likely to be deficient in vitamin D, and females were 2.72 times more likely to be deficient than males (95%CI 1.21-6.01). Results suggest no association between maternal education levels, feeding practices such as breastfeeding and complementary feeding and vitamin A and D deficiency. Although not reaching conventional levels of statistical significance, it was observed that children who received their vitamin drops from the MOH were more likely to have vitamin A and D deficiencies than those children receiving the supplements from the United Nations Relief and Works Agency for Palestine Refugees (UNRWA).
Using these results, the MOH may consider specifically targeting at risk children to increase adherence to the full supplementation regimen. Further research into effective methods of service delivery by health service providers is needed including an in depth look at the UNRWA maternal counselling and supplement provision protocols.
维生素A和D对儿童的正常生长发育至关重要。由于巴勒斯坦国复杂的政治环境，关于微量营养素缺乏的研究很少。
巴勒斯坦卫生部（MOH）和联合国儿童基金会在实施各种微量营养素补充和强化计划后，于2013年进行了一项全国性横断面调查。使用卡方检验和逻辑回归，对6至59个月大儿童的维生素A（n = 1054）和维生素D（n = 150）水平的危险因素与维生素A和D缺乏这两个结果变量分别进行了评估。如果儿童血清水平分别<1.05 μmol/L和<50 nmol/L，则被认为维生素A和D缺乏。建立了多个逻辑回归模型以确定维生素缺乏的独立危险因素。
维生素A和D缺乏的患病率分别为73.1%和60.7%。与约旦河西岸的儿童相比，加沙地带的儿童维生素A和D缺乏的可能性分别高1.34倍（95%可信区间0.78 - 2.31）和1.96倍（95%可信区间0.67 - 5.71）。贫血儿童维生素A缺乏的可能性高1.5倍（95%可信区间1.08 - 2.10）。年龄较大的儿童（>1岁）维生素D缺乏的可能性更大，女性缺乏的可能性是男性的2.72倍（95%可信区间1.21 - 6.01）。结果表明，母亲教育水平、母乳喂养和辅食喂养等喂养方式与维生素A和D缺乏之间没有关联。尽管未达到传统的统计学显著性水平，但观察到从卫生部获得维生素滴剂的儿童比从联合国近东巴勒斯坦难民救济和工程处（近东救济工程处）获得补充剂的儿童更有可能出现维生素A和D缺乏。
利用这些结果，卫生部可考虑专门针对高危儿童，以提高对完整补充方案的依从性。需要对卫生服务提供者提供服务的有效方法进行进一步研究，包括深入研究近东救济工程处的孕产妇咨询和补充剂提供方案。
