IntroductionThe United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) is the main primary healthcare provider and provides assistance and protection to around 5 million Palestine refugees in Jordan, Lebanon, Syria, West Bank and Gaza. Diabetes mellitus (DM) is a common problem among Palestine refugees, with a prevalence of 11.0%. In 2014, UNRWA embarked on a diabetes campaign to assist both patients with DM and staff in improving diabetes care management, by building the capacity of UNRWA’s health staff and improving the knowledge and lifestyle behaviors among Palestine refugees with DM.MethodUsing a quasiexperimental study, we randomly selected 50 patients with diabetes from the 32 largest UNRWA health centers (HC); a total of 1600 participants were enrolled. Each HC conducted weekly group sessions for 6 months, including education, healthy cooking, and physical exercise. Body measurements, 2-hour postprandial glucose test, blood pressure and session attendance were collected on a weekly basis. Demographical data, pre/postquestionnaires and cholesterol levels were collected before and after the campaign. Paired t-test in SPSS V.21 was used.ResultsOut of 1600 patients, 1598 (1186 (74.0%) females and 412 (26.0%) males) completed the campaign; 576 (36.0%) patients had diabetes type 2 (DMII), 960 (60.0%) had DMII and hypertension and 62 (4.0%) had diabetes type 1 (DMI). After the campaign, the average weight loss was 2.6 kg (95% CI 2.4 to 2.7). In addition, 22% lost ≥5%, 25% lost 3%–5%, and 30% lost 1%–3% of their weight. Significant improvements were seen in blood glucose, cholesterol and waist circumference (WC) (p≤0.001 for all). The session attendance rate was 70.6% in total.ConclusionsThis campaign focused on raising healthy lifestyle awareness and practices among Palestine refugees with DM. It was associated with reduction cardiometabolic risk factors. Similar campaigns need to be sustained and expanded. Local community and non-governmental organization partnerships observed during the campaign should be strengthened and sustained.

Background: UNRWA provides primary healthcare for around 5.9 million Palestine refugees (PRs) in Jordan, Lebanon, Syria, West Bank and Gaza. In 2015, UNRWA started, in cooperation with Microclinic International (MCI), to implement an innovative diabetes program, aiming at improving awareness about diabetes care among PRs with Diabetes Mellitus (DM). This program takes advantage of a unique model of "microclinic" MCI social network program, a novel social network based on diabetes education intervention. Methods: A quasi-experimental study was conducted to evaluate the impact of the UNRWA-MCI program in 115 UNRWA's HCs in Jordan, Lebanon, West Bank and Gaza. 1000 participants were randomly selected from around 60,000 participants in the program. After training 996 nurses on UNRWA-MCI diabetes care modules, groups of 10-15 participants with their social networks (around 20 participants in each group) attended eight weekly sessions, during which the program was introduced. Anthropometric and blood pressure (BP) measurements were collected on weekly basis, while glycated hemoglobin (HbA1c) was tested before involvement in the program and after completion of sessions with a three month period between both measurements. SPSS Version 22 was used for data analysis. The study protocol was reviewed and cleared by UNRWA, Health Department ethical committee. Results: Out of 1000 patients randomly selected for the evaluation of the impact of the program, 969 (81.9% females, 18.1% males) have completed the study. The average weight loss was 2.0 ± 4.6 Kg and significant improvements were seen in waist circumference (WC), HbA1c and BP (p ≤ 0.001 for all).

Background Children entering first grade at United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) schools across the five fields of its operations (West Bank, Gaza, Lebanon, Jordan, and Syria) complete a comprehensive medical examination at UNRWA health centres as a requirement for their acceptance. Our study aimed to assess the prevalence of anaemia and undernutrition indicators in these children. Methods We conducted a cross-sectional study at 59 UNRWA health centres, targeting all children entering grade one at UNRWA schools in Gaza, West Bank, Syria, and Lebanon in 2017. The children included boys and girls living inside and outside Palestine refugee camps. Using Epi-Info V2000, a weighted sample of 2399 was calculated (Gaza, 961; West Bank, 982; Syria, 334; Lebanon, 622) based on the prevalence of anaemia in a previous study (2005) and the total number of first grade students at UNRWA schools during the school year 2016-2017, with a confidence level of 95% and precision of 3%. Descriptive statistics were obtained and chi squared tests were carried out using SPSS v22. Child growth z-scores were calculated using WHO Anthroplus software. Informed verbal consent was obtained from parents. Findings 2419 students (1278 females and 1141 males) aged 6•1 (SD 0•4) years were examined. The prevalence of anaemia (haemoglobin level of <11•5 mg/dL) was 25•0% (Gaza, 29•3%; West Bank, 22•0%; Syria, 30•0%; and Lebanon, 18•3%) with no significant differences between males and females (p=0•383). The mean haemoglobin level was 12•0 [SD 0•9] mg/dL. Stunting, underweight, and thinness were assessed according to WHO growth indicators. The overall prevalence of stunting, underweight, and thinness were 3•2%, 3•5%, and 5•6%, respectively, with the highest levels found in Syria (4•3%, 6•3%, and 10•1%, respectively). Interpretation The overall prevalence of anaemia in surveyed children (25•0%) was higher than in the 2005 study (19•5%). However, the prevalence in children in Gaza (29•3%) was lower than in 2005 (36•4%). Haemoglobin testing should be included as part of the medical examination for new school children. In addition, malnutrition among these children should be investigated further.

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