30.  Pappagallo, S. and Bull, D. L. Operational Problems of an Iron Supplementation Programme for Pregnant Women: An Assessment of UNRWA Experience. Bulletin of the World Health Organization 1996; 74,1: 25-33.

This article describes a retrospective survey of antenatal records in UNRWA clinics in the West Bank, Gaza, Syria, Jordan and Lebanon. The aim of the survey is to assess the iron supplementation program of pregnant women run by UNRWA. Operational problems identified include: late registration for antenatal care, high drop-out rate from antenatal care, low compliance in following hemoglobin testing, and failure to improve the hemoglobin status of pregnant women, either by treatment or prophylactic doses. The article argues that routine iron supplementation of all pregnant women should be considered only where severe anemia is prevalent and should be coupled with other effective interventions. Alternatively, attention should be directed towards changing relevant dietary habits. One initial test is recommended to detect cases of severe anemia. Repeated testing during pregnancy is considered unwarranted.