[Child health in a developing population with changing patterns of belief (Gaza 1973-1983)]

The Gaza strip is an area in transition. 13 years ago it had a very high infant mortality of between 100-150 per 1000 live births, largely due to a combination of poverty and ignorance. As in most developing countries, this was compounded by the deep-set belief of both the general population and even medical staff, that this situation was an integral part of their destiny and could not be changed. Lack of confidence of the local population in modern medicine aggravated the situation. This resulted in a seemingly vicious cycle with no solution in sight. The apparently impossible task of improving child health was achieved by integration of pediatric services and their expansion into the community, involvement of the community, and implementation of legal procedures. With these measures the confidence of the population was gained. This resulted in a vaccination coverage of over 90% of the infant population, in a successful program of diarrhea control by oral rehydration, and in the establishment of neighborhood birth centers. The participation of lay and religious leaders in the program caused vaccination to become a kind of religious precept with noncompliance considered almost a sin. As a result of these activities, infectious diseases such as poliomyelitis, measles, and neonatal tetanus have virtually disappeared. Infant mortality in 1987 was down to only 29 per 1000 live births. We believe that a major reason for our success is that we did not antagonize the traditional leaders but succeeded in convincing them of the validity and importance of what we were doing. The moment their belief systems changed with regard to health, the battle was as good as won.