33. Husseini, S., Karakashian, A., Khan, A.A. and McCarthy, B.J. The Risk Approach in Maternal and Child Health Care Applied to The Camp Refugee Population in the West Bank, Jordan. WHO, Regional Office for the Mediterranean, 1987, 65 pp.

The study covered the camp populations of the West Bank, and was aimed at answering three main questions: what are the main trends in infant mortality in relation to birth weight; which subsections of the population have a high risk of infant mortality, and how does this relate to the provision of services by UNRWA.

The method used was reviewing ante-natal records between January of 1980 and June of 1982, each case was followed up for a minimum period of one year. Infant mortality for this population was investigated in relation to 30 biological and socioeconomic variables, and the statistical results were presented in some detail in relation to some of these variables.  The overall infant mortality rate for a total of 6,364 births was 33.5 deaths/1000 live births.

The analysis was followed up by random selection of a sample of infant deaths to investigate for deficiencies in the services provided h.

The main inadequacies identified include the following:

- for antenatal clinics: inadequate record keeping for proper patient management; unreliable determination of hemoglobin levels using the outdated Talquist method and lack of proper referrals for high risk pregnancies.

- for the delivery system: an inappropriate willingness of camp birth attendants to handle difficult deliveries at home, failure to refer high risk women to hospital for birth, lack of coordination between health centers and hospitals, inaccessibility of hospitals to residents of remote areas, lack of facilities in hospitals for management of neonatal problems, and lack of skill and knowledge at the hospital level.

- for the child care clinics: inadequate record keeping leading to misclassification of high risk infants and early introduction of bottle milk.

In the discussion, the paper compares infant mortality in different birth weight groups with the risks for the same groups in the USA.

A curious finding was that low birth weight infants in the West Bank were apparently less likely to die than their American counterparts. The report suggests that this result may indicate that there is a substantial high risk sub-population in the camps which does not receive UNRWA services and which is, therefore, unknown to UNRWA.

Finally a series of recommendations are made to improve the both the services provided and the monitoring system used by UNRWA.