Stalled decline in infant mortality among Palestine refugees in the Gaza Strip since 2006

BACKGROUND: The United Nations Relief and Works Agency for Palestine refugees in the Near East (UNRWA) has periodically estimated infant mortality rates (IMR) among Palestine refugees in the Gaza Strip (Gaza). These surveys have recorded a decline from 127 per 1000 live births in 1960 to 20.2 in 2006. Thereafter, a survey revealed an IMR of 22.4 in 2011. Alerted by these findings, a follow up survey was conducted in 2015 to further assess the trend of IMR. METHODS: We used the same preceding-birth technique as in previous surveys to estimate IMR and neonatal mortality rate (NMR) per 1000 live births. All multiparous mothers who came to the 22 UNRWA health centers to register their last-born child for immunization were asked if their preceding child was alive or dead. We based our target sample size on the previous IMR of 22.4 and we interviewed 3126 mothers from September to November 2015. FINDINGS: The third survey estimated mortality rates in 2013. The IMR was 22.7 (95% CI 17.2–28.1) per 1000 live births. IMR did not decline since the estimated IMR of 20.2 (15.3–25.1) per 1000 live births in 2006 and 22.4 (16.4–28.3) per 1000 live births in 2011. NMR was 16.1 (11.6–20.7) per 1000 live births, which was not statistically significantly different from 2006 (12.1 (8.7–16.4)), and was lower than in 2011 (20.3 (15.3–26.2)). CONCLUSION: The estimated mortality rate in infants of Palestine refugees in Gaza has not declined since 2006. The stagnation of infant mortality rates indicates that further efforts are needed to investigate causes for this stagnation and ways of addressing the potentially preventable causes among Palestine refugee children in Gaza.