1
|
Eleraky L, Stuetz W, Rybak C, Frank J, Biesalski HK, Mbwana H, Kinabo J, Lambert C. Potentials and limitations of a food group-based algorithm to assess dietary nutrient intake of women in rural areas in Tanzania. Int J Food Sci Nutr 2024; 75:436-444. [PMID: 38639183 DOI: 10.1080/09637486.2024.2335523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
The aim of this study was to evaluate the accuracy of nutrient intake assessment with the food group-based algorithm "Calculator of Inadequate Micronutrient Intake" (CIMI) in comparison to the established nutrition software NutriSurvey. Using Food Frequency Questionnaires and 24-h dietary recalls of 1010 women from two rural districts in Tanzania, 23 relevant typical Tanzanian food groups were identified and subsequently the dietary protocols assessed via CIMI algorithm were compared by bivariate correlations and Bland-Altman analysis with the results of the NutriSurvey software (reference) and were set in relation to blood biomarkers of 666 participants. CIMI and NutriSurvey calculations regarding macro- and micronutrient intakes were similar. The Bland-Altman analyses and correlation coefficients of energy (0.931), protein (0.898), iron (0.775) and zinc (0.838) confirm the agreement of both calculations. The food group based CIMI algorithm is a practical tool to identify the inadequacy of macro- and micronutrient intake at population level.
Collapse
Affiliation(s)
- Laila Eleraky
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
| | - Wolfgang Stuetz
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
| | - Constance Rybak
- Leibniz Centre for Agricultural Landscape Research (ZALF) e. V, Müncheberg, Germany
- Devision Urban Plant Ecophysiology, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Jan Frank
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
| | | | - Hadijah Mbwana
- Department of Food Science Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Joyce Kinabo
- Department of Food Science Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Christine Lambert
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
| |
Collapse
|
2
|
Stapleton F, Abad JC, Barabino S, Burnett A, Iyer G, Lekhanont K, Li T, Liu Y, Navas A, Obinwanne CJ, Qureshi R, Roshandel D, Sahin A, Shih K, Tichenor A, Jones L. TFOS lifestyle: Impact of societal challenges on the ocular surface. Ocul Surf 2023; 28:165-199. [PMID: 37062429 PMCID: PMC10102706 DOI: 10.1016/j.jtos.2023.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.
Collapse
Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia.
| | - Juan Carlos Abad
- Department of Ophthalmology, Antioquia Ophthalmology Clinic-Clofan, Medellin, Antioquia, Colombia
| | - Stefano Barabino
- ASST Fatebenefratelli-Sacco, Ospedale L. Sacco-University of Milan, Milan, Italy
| | - Anthea Burnett
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Geetha Iyer
- C. J. Shah Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Kaevalin Lekhanont
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Yang Liu
- Ophthalmology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Alejandro Navas
- Conde de Valenciana, National Autonomous University of Mexico UNAM, Mexico City, Mexico
| | | | - Riaz Qureshi
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Danial Roshandel
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia
| | - Afsun Sahin
- Department of Ophthalmology, Koc University Medical School, İstanbul, Turkey
| | - Kendrick Shih
- Department of Ophthalmology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Anna Tichenor
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| |
Collapse
|
3
|
Estimating the potential of spices for mineral provision in a refugee context in East Africa. SN APPLIED SCIENCES 2023. [DOI: 10.1007/s42452-022-05224-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
AbstractMicronutrient deficiency remains an enormous problem in refugee settings. Transforming refugees’ food systems through the scaling up of kitchen gardening and fortifying relief food crops with minor food components including nutrient-dense spices can help improve the quality of staple foods. Globally, spices are indispensable in the daily diet and play an important role in the socio-cultural setting of different communities. Forty turmeric and curry powder samples were collected from different market establishments and geographic locations in East Africa. The samples were analyzed for selected elements using Portable X-Ray Fluorescence (PXRF). The contents of potassium (K), calcium (Ca), zinc (Zn) and strontium (Sr) in turmeric powder were statistically different among geographic origins (Ethiopia, Kenya and Uganda). We also aimed to determine if a small portion of spices (turmeric (5 g) and curry (4 g)) would contribute to an adequate intake (AI) or recommended dietary allowance (RDA) for selected minerals, for refugee men and women aged between 19 and 50 years as defined by the Food and Nutrition Board of the Institute of Medicine (IOM). For the reference groups, the contributions of turmeric and curry powder to AI/RDA for K, Ca and Zn varied between 0.48 to 4.13%. On the other hand, turmeric was identified to contribute > 20% AI/RDA for refugee men and women aged between 19 and 50 years for two micro minerals: manganese (Mn) and iron (Fe). Considering turmeric and curry powder of East African origins are good sources of minerals and present acceptable toxic metal(loid)s loads coupled with low cost, these spices particularly turmeric should be more widely popularized and recommended for food-to-spice fortification among the refugee population located in East Africa.
Collapse
|
4
|
Iron deficiency, anemia and association with refugee camp exposure among recently resettled refugees: A Canadian retrospective cohort study. PLoS One 2022; 17:e0278838. [PMID: 36520858 PMCID: PMC9754286 DOI: 10.1371/journal.pone.0278838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 11/26/2022] [Indexed: 12/23/2022] Open
Abstract
Malnutrition and poor health are common among recently resettled refugees and may be differentially associated with pre-migration exposure to refugee camp versus non-camp dwelling. We aimed to investigate the associations of iron deficiency (ID), anemia, and ID anemia (IDA) with pre-migration refugee camp exposure among recently arrived refugees to Canada. To this end, we conducted a retrospective cohort study of 1032 adult refugees who received care between January 1, 2011, and December 31, 2015, within a specialized refugee health clinic in Calgary, Canada. We evaluated the prevalence, severity, and predictors of ID, anemia, and IDA, stratified by sex. Using multivariable logistic regression, we estimated the association of refugee camp exposure with these outcomes, adjusting for age, months in Canada prior to investigations, global region of origin, and parity. Among female refugees, the prevalence of ID, anemia, and IDA was 25% (134/534), 21% (110/534), and 14% (76/534), respectively; among males, 0.8% (4/494), 1.8% (9/494), and 0% (0/494), respectively. Anemia was mild, moderate, and severe in 55% (60/110), 44% (48/110) and 1.8% (2/110) of anemic females. Refugee camp exposure was not associated with ID, anemia, or IDA while age by year (ID OR = 0.96, 95% CI 0.93-0.98; anemia OR = 0.98, 95% CI 0.96-1.00; IDA OR = 0.96, 95% CI 0.94-0.99) and months in Canada prior to investigations (ID OR = 0.85, 95% CI 0.72-1.01; anemia OR = 0.81, 95% CI 0.67-0.97; IDA OR = 0.80, 95% CI 0.64-1.00) were inversely correlated with these outcomes. ID, anemia, and IDA are common among recently arrived refugee women irrespective of refugee camp exposure. Our findings suggest these outcomes likely improve after resettlement; however, given proportionally few refugees are resettled globally, likely millions of refugee women and girls are affected.
Collapse
|
5
|
Szklarz M, Gontarz-Nowak K, Matuszewski W, Bandurska-Stankiewicz E. Can Iron Play a Crucial Role in Maintaining Cardiovascular Health in the 21st Century? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11990. [PMID: 36231287 PMCID: PMC9565681 DOI: 10.3390/ijerph191911990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
In the 21st century the heart is facing more and more challenges so it should be brave and iron to meet these challenges. We are living in the era of the COVID-19 pandemic, population aging, prevalent obesity, diabetes and autoimmune diseases, environmental pollution, mass migrations and new potential pandemic threats. In our article we showed sophisticated and complex regulations of iron metabolism. We discussed the impact of iron metabolism on heart diseases, treatment of heart failure, diabetes and obesity. We faced the problems of constant stress, climate change, environmental pollution, migrations and epidemics and showed that iron is really essential for heart metabolism in the 21st century.
Collapse
|
6
|
Eleraky L, Issa R, Maciel S, Mbwana H, Rybak C, Frank J, Stuetz W. Anthropometrics, Hemoglobin Status and Dietary Micronutrient Intake among Tanzanian and Mozambican Pigeon Pea Farmers. Nutrients 2022; 14:nu14142914. [PMID: 35889871 PMCID: PMC9318270 DOI: 10.3390/nu14142914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 12/10/2022] Open
Abstract
Inadequate consumption of micronutrient-dense and protein-rich foods such as vegetables, legumes and meat is an important contributing cause for anemia and deficiencies of vitamin A and iron in rural communities of Tanzania and Mozambique. A cross-sectional study was conducted to assess the nutritional status (anthropometrics and hemoglobin) and diets in particular micronutrient intake of female and male pigeon pea farmers from Lindi, Tanzania, and Gurué, the Zambézia province of Mozambique. A total of 1526 farmers (669 from Tanzania, 857 from Mozambique) were studied, of whom 16% were overweight and 35% were anemic. The highest prevalence of overweight and anemia, at 35% and 48%, was observed in Tanzanian and Mozambican women, respectively. Overall, only a small proportion of women and men reached the recommended daily dietary intake of vitamin A (10%), iron (51%) and zinc (44%). Multiple regression models revealed that dark green leafy vegetables (DGLVs) highly predicted vitamin A intake, whereas legumes in Tanzania and starchy plants in Mozambique were actually the dominant sources of vitamin A. Cereals covered over half of the iron and the zinc intake in both countries. An increased consumption of micronutrient-rich DGLVs and legumes, while reducing the high amounts of refined maize or polished rice, is suggested to counteract the high prevalence of anemia and overweight among smallholder farmers in East and South Eastern Africa.
Collapse
Affiliation(s)
- Laila Eleraky
- Institute of Nutritional Sciences, University of Hohenheim, 70599 Stuttgart, Germany; (L.E.); (R.I.); (J.F.)
| | - Ramula Issa
- Institute of Nutritional Sciences, University of Hohenheim, 70599 Stuttgart, Germany; (L.E.); (R.I.); (J.F.)
- Faculty of Health Sciences, Lúrio University, Nampula 3100, Mozambique;
| | - Sónia Maciel
- Faculty of Health Sciences, Lúrio University, Nampula 3100, Mozambique;
| | - Hadijah Mbwana
- Department of Human Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro 3006, Tanzania;
| | - Constance Rybak
- Leibniz Centre for Agricultural Landscape Research (ZALF), 15374 Müncheberg, Germany;
| | - Jan Frank
- Institute of Nutritional Sciences, University of Hohenheim, 70599 Stuttgart, Germany; (L.E.); (R.I.); (J.F.)
| | - Wolfgang Stuetz
- Institute of Nutritional Sciences, University of Hohenheim, 70599 Stuttgart, Germany; (L.E.); (R.I.); (J.F.)
- Correspondence: ; Tel.: +49-711-459-24265; Fax: +49-711-459-23386
| |
Collapse
|
7
|
Woldetsadik D, Llorent-Martínez EJ, Gebrezgabher S, Njenga M, Mendum R, Castillo-López R, Fernández-de Córdova ML, Hailu H, Evans CT, Madani N, Mafika TP, Fleming DEB. Okra ( Abelmoschus esculentus) in a refugee context in East Africa: Kitchen gardening helps with mineral provision. SN APPLIED SCIENCES 2021; 4:32. [PMID: 34957376 PMCID: PMC8689287 DOI: 10.1007/s42452-021-04898-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/23/2021] [Indexed: 02/07/2023] Open
Abstract
Kitchen gardening is considered a way to reconnect with agriculture and complement the cereal-based relief food offered to refugees in East Africa. This work aimed at profiling mineral content of okra in four refugee camps and settlements located in Ethiopia and Uganda and its contribution to adequate intake (AIs) or recommended dietary allowances (RDAs) for young children and pregnant and lactating women (PLW). The study also evaluated the applicability of portable X-ray fluorescence (PXRF) as compared with inductively coupled plasma mass spectrometry (ICP-MS) for mineral profiling of okra powder samples. The contents of minerals (mg kg-1) from the ICP-MS readings were in the following ranges: K (14,385-33,294), Ca (2610-14,090), P (3178-13,248), Mg (3896-7986), Cu (3.81-19.3), Fe (75.7-1243), Zn (33-141) and Mn (23.1-261). Regardless of geographic origin, at low-end consumption probability (17 g day-1 for young children and 68 g day-1 for PLW), okra could contribute ˂ 15% (2.7-12.9%) AI for macro-minerals (K and Ca). In addition, the contributions to RDA values for Fe and Zn, elements of known public health interest, ranged from 4.5 to 34.7% for young children. Interestingly, regression lines revealed strong agreement between ICP-MS and PXRF readings for Mn and Zn, with R2 values > 0.91. This information is useful in support of nutrition-sensitive kitchen gardening programs through scaling culturally important crops in refugee settings. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s42452-021-04898-6.
Collapse
Affiliation(s)
- Desta Woldetsadik
- Department of Soil and Water Resources Management, Wollo University, Dessie, Ethiopia
| | - Eulogio J. Llorent-Martínez
- Department of Physical and Analytical Chemistry, Faculty of Experimental Sciences, University of Jaén, Campus Las Lagunillas, 23071 Jaén, Spain
| | | | - Mary Njenga
- World Agroforestry (ICRAF), Nairobi, Kenya
- Wangari Maathai Institute for Peace and Environmental Studies, University of Nairobi, Nairobi, Kenya
| | - Ruth Mendum
- Office of International Programs, College of Agricultural Sciences, Pennsylvania State University, State College, USA
| | - Roxana Castillo-López
- Department of Physical and Analytical Chemistry, Faculty of Experimental Sciences, University of Jaén, Campus Las Lagunillas, 23071 Jaén, Spain
| | - Maria L. Fernández-de Córdova
- Department of Physical and Analytical Chemistry, Faculty of Experimental Sciences, University of Jaén, Campus Las Lagunillas, 23071 Jaén, Spain
| | - Hillette Hailu
- Department of Soil and Water Resources Management, Wollo University, Dessie, Ethiopia
| | - Colby T. Evans
- Physics Department, Mount Allison University, Sackville, NB Canada
| | - Nelly Madani
- Physics Department, Mount Allison University, Sackville, NB Canada
| | - Tamlyn P. Mafika
- Physics Department, Mount Allison University, Sackville, NB Canada
| | | |
Collapse
|
8
|
Salami B, Fernandez-Sanchez H, Fouche C, Evans C, Sibeko L, Tulli M, Bulaong A, Kwankye SO, Ani-Amponsah M, Okeke-Ihejirika P, Gommaa H, Agbemenu K, Ndikom CM, Richter S. A Scoping Review of the Health of African Immigrant and Refugee Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073514. [PMID: 33800663 PMCID: PMC8038070 DOI: 10.3390/ijerph18073514] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 12/02/2022]
Abstract
Migration is a growing phenomenon around the world, including within the African continent. Many migrants, especially African children, face challenges related to health and social inclusion and can face increased health risks. A systematic scoping review of available literature on the health of African migrant children across the globe was conducted to offer insight into these health risks. The review was conducted over a 15-month period from January 2019 to April 2020, yielding 6602 articles once duplicates were removed. This search included electronic databases, reference lists of articles reviewed, and searches of libraries of relevant organisations. A total of 187 studies met the inclusion criteria, of which 159 were quantitative, 22 were qualitative, and 6 used mixed methods. The findings reveal decreased health in this population in areas of nutrition, infectious diseases, mental health, birth outcomes, sexual and reproductive health, physical and developmental health, parasitic infections, oral health, respiratory health, preventative health, endocrine disorders, health care services, and haematological conditions. The findings offer insights into factors influencing the health of African immigrant and refugee children. Further studies, especially qualitative studies, are needed to determine barriers to service access after migration and to investigate other underexplored and overlooked health concerns of African migrant children, including pneumonia and child maltreatment.
Collapse
Affiliation(s)
- Bukola Salami
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
- Correspondence:
| | - Higinio Fernandez-Sanchez
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
| | - Christa Fouche
- Faculty of Education and Social Work, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK;
| | - Lindiwe Sibeko
- Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts, 204 Chenoweth Laboratory, Amherst, MA 01003-9282, USA;
| | - Mia Tulli
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
| | - Ashley Bulaong
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
| | - Stephen Owusu Kwankye
- Regional Institute for Population Studies, University of Ghana, P.O. Box LG 96, Legon, Accra GA184, Ghana;
| | - Mary Ani-Amponsah
- School of Nursing, University of Ghana, P.O. Box LG 43, Legon, Accra GA184, Ghana;
| | | | - Hayat Gommaa
- Department of Nursing Science, Ahmadu Bello University, Sokoto Road, PMB 06, Zaria 810107, Nigeria;
| | - Kafuli Agbemenu
- School of Nursing, The State University of New York (SUNY), University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA;
| | | | - Solina Richter
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
| |
Collapse
|
9
|
Therapeutic Efficacy of Vitamin A in the Treatment of Idiopathic Microscopic Hematuria in Children. Nephrourol Mon 2021. [DOI: 10.5812/numonthly.111783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Hematuria is a symptom with a prevalence of 0.5% to 2% in those aged 5 - 12 years. Different factors can influence the severity of hematuria, including vitamin A (as a micronutrient). Objectives: The current study aimed to evaluate the therapeutic effect of vitamin A on hematuria in children. Methods: In this clinical trial study, 156 children aged 5 - 12 years with Idiopathic Microscopic Hematuria are studied. Participants were divided into two groups of treatment and control (each with 76 subjects). Those in the treatment group received vitamin A as a pearl of 25000 in 14 days, in addition to the routine treatment. The control group only received routine handling. The basic information of patients were recorded using an author-develop form by the supervisor and intern. Urine samples were collected on 14, 28, and 42 days. Data were analyzed using SPSS. Statistical significance was considered when P-value < 0.05. Results: There was no significant difference between the two groups concerning gender (P = 0.202), age (P = 0.330), father's education (P = 0.152), mother's education (P = 0.392), father's occupation (P = 0.125), mother's occupation (P = 0.265), and numbers of children in the family (P = 0.209) variables. Hematuria status on days 14 (P = 0.014), 28 (P = 0.001), and 42 after treatment (P = 0.001) was statistically more positive in the vitamin A group. Hence, there was a significant difference between the two groups. Conclusions: Vitamin A can reduce idiopathic microscopic hematuria. Hence, vitamin can be used as an alternative treatment to treat idiopathic hematuria in children.
Collapse
|
10
|
Gozalbo M, Guillen M, Taroncher-Ferrer S, Cifre S, Carmena D, Soriano JM, Trelis M. Assessment of the Nutritional Status, Diet and Intestinal Parasites in Hosted Saharawi Children. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E264. [PMID: 33260311 PMCID: PMC7760248 DOI: 10.3390/children7120264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/20/2020] [Accepted: 11/27/2020] [Indexed: 01/15/2023]
Abstract
Since the early 1990s, Spanish humanitarian associations have welcomed Saharawi children from the refugee camps in Tindouf (Argelia). These children are the most affected by the lack of food, water, hygienic measures and health care. The main objective of this study was to analyze the anthropometric, nutritional and parasitological data of 38 Saharawi boys and girls (from 10 to 13 years old) under a holiday host program in the city of Valencia. Our results confirm that malnutrition and multiparasitism are highly frequent, so it is understood that living conditions in refugee camps continue to be precarious with a lack of proper hygiene and nutrition. Furthermore, biochemical alterations, lactose malabsorption and the risk of celiac disease, also detected in our study as a secondary objective, will complicate nutritional management and restoration of health. For this reason, sustainable feeding alternatives and interventions from a hygienic and nutritional point of view are proposed, emphasizing in an improvement in the education of parents and children.
Collapse
Affiliation(s)
- Mónica Gozalbo
- Area of Nutrition and Bromatology, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, University of Valencia, 46100 Burjassot, Spain
| | - Marisa Guillen
- Area of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, University of Valencia, 46010 Valencia, Spain;
| | - Silvia Taroncher-Ferrer
- Clínica Universitària de Nutrició, Activitat física i Fisoteràpia (CUNAFF), Lluís Alcanyís Foundation-University of Valencia, 46010 Valencia, Spain;
| | - Susana Cifre
- Parasites and Health Research Group, Department of Pharmacy and Pharmaceutical Technology and Parasitology, University of Valencia, 46100 Burjassot, Spain; (S.C.); (M.T.)
| | - David Carmena
- Parasitology Reference and Research Laboratory, National Centre for Microbiology, Carlos III Health Institute, 28222 Majadahonda, Madrid, Spain;
| | - José M Soriano
- Observatory of Nutrition and Food Safety for Developing Countries, Food & Health Lab, Institute of Materials Science, University of Valencia, 46980 Paterna, Spain;
- Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, University of Valencia-Health Research Institute La Fe, 46026 Valencia, Spain
| | - María Trelis
- Parasites and Health Research Group, Department of Pharmacy and Pharmaceutical Technology and Parasitology, University of Valencia, 46100 Burjassot, Spain; (S.C.); (M.T.)
- Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, University of Valencia-Health Research Institute La Fe, 46026 Valencia, Spain
| |
Collapse
|
11
|
Knapp AP, Rehmus W, Chang AY. Skin diseases in displaced populations: a review of contributing factors, challenges, and approaches to care. Int J Dermatol 2020; 59:1299-1311. [PMID: 32686140 DOI: 10.1111/ijd.15063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 01/14/2023]
Abstract
There are 70.8 million persons displaced worldwide due to war, persecution, and violence. Eighty percent of displaced persons reside in low- and middle-income countries with limited healthcare resources. Cutaneous diseases are commonly reported among displaced persons owing to numerous interrelated factors such as inadequate housing, overcrowding, food insecurity, environmental exposures, violence including torture, and breakdown of healthcare infrastructure. Diagnosis and management of these conditions, as well as an understanding of the context in which they present, is crucial to providing dermatologic care for displaced populations worldwide. Herein, we define displaced populations and, within this context, review the epidemiology of skin diseases, discuss pertinent skin conditions, examine challenges to care provision, and present approaches for improving dermatologic care. Inflammatory and communicable infectious disorders are the most common skin diseases seen in displaced populations. Other relevant conditions include skin manifestations of heat injuries, cold injuries, immersion foot syndromes, macronutrient and micronutrient deficiencies, torture, and sexual and gender-based violence. Provision of dermatologic care to displaced populations is hampered by limited diagnostic and therapeutic resources and specialist expertise. Medical screening for cutaneous disorders, context-relevant dermatology training, and telemedicine are potential tools to improve diagnosis and management of skin diseases in displaced populations.
Collapse
Affiliation(s)
- Alexia P Knapp
- Department of Dermatology, International Foundation for Dermatology Migrant Health Dermatology Working Group, HealthPartners Institute, Saint Paul, Minnesota, USA
| | - Wingfield Rehmus
- Departments of Pediatrics and Dermatology, University of British Columbia, Vancouver, BC, Canada
| | - Aileen Y Chang
- Department of Dermatology, International Foundation for Dermatology Migrant Health Dermatology Working Group, University of California, San Francisco, USA
| |
Collapse
|
12
|
The Effect of Vitamin A on Clinical Manifestations of Recurrent Pyelonephritis in Children. Nephrourol Mon 2020. [DOI: 10.5812/numonthly.103278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Pyelonephritis as a life-threatening infection often leads to renal scarring, which presumably controls by minerals. Objectives: The aim of this study was pyelonephritis treatment by vitamin A in children. Methods: In the current study,106 cases from Imam Reza pediatric clinic and Amir-Kabir Hospital, considered a study group. Children divided into groups with or without urinary incontinence. Demographic data, clinical manifestations, and urinary biomarkers were evaluated and then statistically analyzed. Results: Our data showed that there is a statistical difference between study groups in terms of dysuria (P = 0.001), abdominal pain (P = 0.001), frequency (P = 0.003), incontinency (P = 0.001), urgency (P = 0.002), intermittency (P = 0.004) and fever (P = 0.002). Conclusions: It has been assumed that vitamin A as a therapeutic agent could be used in children with vesicoureteral reflux induced by Pyelonephritis and congenital anomalies.
Collapse
|
13
|
Kay A, Leidman E, Lopez V, Wilkinson C, Tondeur M, Bilukha O. The burden of anaemia among displaced women and children in refugee settings worldwide, 2013-2016. BMJ Glob Health 2019; 4:e001837. [PMID: 31798995 PMCID: PMC6861076 DOI: 10.1136/bmjgh-2019-001837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/29/2019] [Accepted: 09/22/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Displaced persons have a unique risk for developing anaemia due to often limited diets, overcrowding, new infections and inadequate sanitation and hygiene. The lack of anaemia prevalence estimates among the displaced inhibit global planning for anaemia reduction. Methods We analysed population representative, cross-sectional nutrition surveys from 2013 to 2016 conducted by the United Nations High Commissioner for Refugees and partner agencies. Included surveys measured haemoglobin concentration among children 6–59 months, non-pregnant women 15–49 years, or both groups. For each survey, we calculated mean haemoglobin and prevalence of total anaemia (<110 g/L in children, <120 g/L in women), and classified public health severity following WHO guidelines. Pearson correlations between indicators from women and children surveys were calculated where both subpopulations were measured. Results Analysis included 196 surveys among children and 184 surveys among women from 121 unique refugee settings in 24 countries. The median prevalence of total anaemia in children and women was 44% and 28%, respectively. Sixty-one per cent of child surveys indicated a problem of severe public health importance compared with 25% of surveys in women. The prevalence of total anaemia in children and women was strongly correlated (ρ=0.80). Median prevalence of total anaemia was approximately 55% greater and mean haemoglobin was 6 g/L lower among children age 6–23 months compared with children 24–59 months. West and Central Africa region had the highest median prevalence of anaemia both in women and children. Conclusion While the burden of anaemia is high among the displaced, it mirrors that of the general population. Haemoglobin should continue to be measured in nutrition surveys in refugee settings. Sustained, multisectoral efforts to reduce anaemia are needed, with specific focus on children under 2 years of age and refugee settings in the West and Central Africa region.
Collapse
Affiliation(s)
- Ariel Kay
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Eva Leidman
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Velma Lopez
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caroline Wilkinson
- Division of Programme Support and Management, Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Melody Tondeur
- Division of Programme Support and Management, Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Oleg Bilukha
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
14
|
Beukeboom C, Arya N. Prevalence of Nutritional Deficiencies Among Populations of Newly Arriving Government Assisted Refugee Children to Kitchener/Waterloo, Ontario, Canada. J Immigr Minor Health 2019; 20:1317-1323. [PMID: 29611017 DOI: 10.1007/s10903-018-0730-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study examined the variation among ethnic populations in prevalence of anemia, vitamin D and B12 deficiencies among refugee children. A retrospective chart review of 388 government assisted refugee children ≤ 16 years of age, seen at the Refugee Health Clinic in Kitchener, Canada from January 2009 to December 2014 was conducted. Vitamin D levels were only collected until December 1st 2010 (116 children). 15.7% were anemic (25% < 5 years, 8.7% 5-11 years, and 18.3% 12-16 years old) with Somali children having the lowest hemoglobin levels compared to those from Iraq, Afghanistan and Myanmar. 53.5% were vitamin D deficient (25(OH)D < 50 nmol/L), seen most commonly in Iraqis and Afghans. 11.2% had vitamin B12 levels < 150 pmol/L. Providers' knowledge of prevalence of nutritional deficiencies related to region of origin, can guide appropriate screening and treatment options to promote longer term cognitive, physical and developmental health.
Collapse
Affiliation(s)
- Carolyn Beukeboom
- School of Nursing, Western University, London, ON, Canada. .,School of Nursing, McMaster University, Hamilton, ON, Canada. .,, London, ON, Canada.
| | - Neil Arya
- Centre for Family Medicine Refugee Health Clinic, Waterloo, ON, Canada.,Family Medicine McMaster University, Hamilton, ON, Canada.,Family Medicine Western University, London, ON, Canada
| |
Collapse
|
15
|
Jablonka A, Wetzke M, Sogkas G, Dopfer C, Schmidt RE, Behrens GMN, Happle C. Prevalence and Types of Anemia in a Large Refugee Cohort in Western Europe in 2015. J Immigr Minor Health 2019; 20:1332-1338. [PMID: 29582203 DOI: 10.1007/s10903-018-0725-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Currently, vast numbers of migrants with largely unknown health statuses have been entering Europe. To improve care taking strategies, prevalence, severity and types of anemia in a large refugee cohort were assessed. Blood counts were performed in n = 787 inhabitants from six German refugee centers. Most included migrants were young, male adults. Anemia was present in 22.5% of subjects with an age-dependent prevalence increase (7.9% > 18 years vs. 30.8% > 50 years). More females than males were anemic (27.1% vs. 20.4%). The majority of affected migrants had mild anemia (86.2%) of either normocytic/normochromic (55.9%) or microcytic/hypochromic (20.9%) type. Observed anemia frequencies are in accordance with global anemia prevalence recently estimated by the WHO. However, the observed high rates of anemia particularly in female and older refugees emphasize the need for adapted care taking strategies in refugee medicine. Further evaluation of causes of anemia in the migrating population is needed.
Collapse
Affiliation(s)
- Alexandra Jablonka
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany. .,German Center for Infection Research, Hanover, Germany.
| | - Martin Wetzke
- Department of Pediatric Pneumology, Neonatology and Allergology, Hannover Medical School, Hanover, Germany
| | - Georgios Sogkas
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Christian Dopfer
- Department of Pediatric Pneumology, Neonatology and Allergology, Hannover Medical School, Hanover, Germany
| | - Reinhold Ernst Schmidt
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany.,German Center for Infection Research, Hanover, Germany
| | - Georg M N Behrens
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany.,German Center for Infection Research, Hanover, Germany
| | - Christine Happle
- Department of Pediatric Pneumology, Neonatology and Allergology, Hannover Medical School, Hanover, Germany.,German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH, Hanover, Germany
| |
Collapse
|
16
|
Engidaw MT, Wassie MM, Teferra AS. Anemia and associated factors among adolescent girls living in Aw-Barre refugee camp, Somali regional state, Southeast Ethiopia. PLoS One 2018; 13:e0205381. [PMID: 30308060 PMCID: PMC6181359 DOI: 10.1371/journal.pone.0205381] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 09/25/2018] [Indexed: 11/18/2022] Open
Abstract
Background Adolescent girls have a higher risk of anemia due to an increased requirement, low intake of hematopoietic nutrients and low intake of a nutrient that enhance absorption of these hematopoietic nutrients. Adolescent girls living in refugee camps are more vulnerable to anemia. The study aimed to determine the prevalence of anemia and associated factors among adolescent girls aged 10–19 years in Aw-Barre refugee camp, Somalia regional state, Southeast Ethiopia. Methods A cross-sectional study design was employed. Study participants were recruited using a simple random sampling technique. A structured questionnaire was used to collect the data. Hemoglobin level was tested using HemoCueHb 301 from 10μl finger prick blood samples. Adolescents with a hemoglobin level of <12.5gm/dl after altitude adjustment were classified as anemic. Data were entered using Epi Info version 7.0 and analyzed using SPSS version 20.0. Binary logistic regression was used to explore the association of independent variables with anemia. Variables having P—value ≤ 0.05 was considered to be statistically significant. Results Four hundred thirty-seven adolescent girls participated in the study with a response rate of 95.83%. The prevalence of anemia was 22% (95% CI (17.6, 26.1)). Late adolescents were 2 times more likely to have anemia as compared to early adolescents (AOR: 1.95, 95% CI (1.09, 3.47). Those who stayed ≥8 years in the camp were 3 times more likely to develop anemia (AOR: 2.92, 95% CI (1.14, 7.50)). Those who ate heme iron food sources less than one time per month were 11 times more likely to develop anemia compared to those who ate more than twice within a week (AOR: 11.42, 95% CI (3.42, 38.18)). Conclusions The prevalence of anemia among adolescent girls was a moderate public health problem. Education and awareness on adolescent nutrition with special attention of late adolescents and duration in the refugee camps is warranted. Moreover, promoting the intake of foods rich in heme iron is suggested.
Collapse
Affiliation(s)
- Melaku Tadege Engidaw
- Social and Population Health Unit, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- * E-mail:
| | - Molla Mesele Wassie
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Alemayehu Shimeka Teferra
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
17
|
Xu K, Watanabe-Galloway S, Qu M, Grimm B, Kim J. Common Diagnoses among Refugee Populations: Linked Results with Statewide Hospital Discharge Database. Ann Glob Health 2018; 84:541-550. [PMID: 30835394 PMCID: PMC6748192 DOI: 10.29024/aogh.2354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND According to the U.S. State Department's Refugee Processing Center and the U.S. Census Bureau, in the fiscal year 2016, among all states in the United States, Nebraska resettled the highest number of refugees per capita. OBJECTIVES The objectives of this study were to determine the most common reasons for refugees utilizing hospital services in Nebraska between January 2011 and September 2015, and to examine whether refugee patients had increased risks for adverse health conditions compared to non-refugee patients. METHODS Statewide linkage was performed between Nebraska Medicaid Program's immigration data, and 2011-2015 Nebraska hospital discharge data inpatient and outpatient files. The linkage produced 3017, 5460, and 775 cases for emergency department visits, outpatient clinic visits, and inpatient care for the refugee sample, respectively. FINDINGS Refugee patients were at increased risk for a number of diagnoses or medical conditions, including pregnancy complications, abdominal pain, upper respiratory infections, viral infections, mood disorders, disorders of teeth and jaw, deficiency and anemia, urinary system disorders, headache, nausea and vomiting, limb fractures, spondylosis, essential hypertension, and uncomplicated diabetes mellitus. CONCLUSIONS The findings suggest a greater emphasis on preventive healthcare, especially in areas of maternal health and perinatal outcomes, psychological counseling, screening for infectious diseases, nutrition and healthy eating, and oral health. Additionally, culturally appropriate measures to address prevention, health screening, and treatments should be adopted by health providers who care for refugees.
Collapse
Affiliation(s)
- Kerui Xu
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395, US
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395, US
| | - Ming Qu
- Division of Public Health, Nebraska Department of Health and Human Services, 301 Centennial Mall South, Lincoln, NE 68509-5026, US
| | - Brandon Grimm
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, US
| | - Jungyoon Kim
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE 68198-4350, US
| |
Collapse
|
18
|
Maharaj V, Tomita A, Thela L, Mhlongo M, Burns JK. Food Insecurity and Risk of Depression Among Refugees and Immigrants in South Africa. J Immigr Minor Health 2018; 19:631-637. [PMID: 26984226 DOI: 10.1007/s10903-016-0370-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
South Africa's refugee population has grown considerably over the last decade. Both food insecurity and mental illness are common in developing countries, but this relationship remains unexamined in an African refugee population. 335 adult refugees in Durban, South Africa were interviewed using a self-report of food insecurity and the Hopkins Symptom Checklist-25. The proportion of those who responded 'often true' to not having enough food and eating less was 23.1 and 54.3 %, respectively. The proportion of individuals with a significant level of anxiety and depressive symptomatology was 49.4 and 54.6 %, respectively. The adjusted logistic regression indicated that not eating enough was significantly associated with anxiety (aOR = 4.52, 95 % CI: 2.09-9.80) and depression (aOR = 4.51, 95 % CI: 2.01-10.09). Similarly, eating less was significantly associated with anxiety (aOR = 2.88, 95 % CI: 1.56-5.31) and depression (aOR = 2.88, 95 % CI: 1.54-5.39). The high prevalence of food insecurity, and its relationship to mental illness, highlight the importance of addressing basic needs among this population.
Collapse
Affiliation(s)
- Varsha Maharaj
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa.
| | - Andrew Tomita
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, USA.,Africa Centre for Health and Population Studies, University of KwaZulu-Natal, P.O. Box 198, Mtubatuba, Durban, 3935, South Africa
| | - Lindokuhle Thela
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa
| | - Mpho Mhlongo
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa
| | - Jonathan K Burns
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa
| |
Collapse
|
19
|
Affiliation(s)
- Siddharth Madan
- Department of Ophthalmology, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani Hospital & Kalawati Saran Children's Hospital, University of Delhi, New Delhi, India
| | - Sarita Beri
- Department of Ophthalmology, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani Hospital & Kalawati Saran Children's Hospital, University of Delhi, New Delhi, India
| |
Collapse
|
20
|
Assessment of the effectiveness of a small quantity lipid-based nutrient supplement on reducing anaemia and stunting in refugee populations in the Horn of Africa: Secondary data analysis. PLoS One 2017; 12:e0177556. [PMID: 28591166 PMCID: PMC5462343 DOI: 10.1371/journal.pone.0177556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/29/2017] [Indexed: 01/05/2023] Open
Abstract
Stunting and micronutrient malnutrition are persistent public health problems in refugee populations. UNHCR and its partner organisations implement blanket supplementary feeding programmes using a range of special nutritional products as one approach to address these issues. The evidence base for the efficacy and effectiveness of a small quantity lipid-based nutrient supplement, Nutributter®, in reducing stunting and anaemia is limited. Secondary data analysis was used to assess the effectiveness of Nutributter® distribution on anaemia and stunting in children aged 6–23 months (programme target group) and 6–59 months (the standard age group sampled in routine nutrition surveys). Analysis was conducted using routine pre and post-intervention cross-sectional nutrition survey data collected between 2008–2011 in five refugee camps in Kenya and Djibouti. Changes in total anaemia (Haemoglobin<110g/L), anaemia categories (mild, moderate and severe), and stunting (height-for-age z-score <-2) were explored using available data on the Nutributter® programme and contextual factors. A significant reduction in the prevalence of anaemia in children aged 6–23 months and 6–59 months was seen in four of five, and in all five camps, respectively (p<0.05). Reductions ranged from 12.4 to 23.0, and 18.3 to 29.3 percentage points in each age group. Improvements were largely due to reductions in moderate and severe anaemia and occurred where the prevalence of acute malnutrition was stable or increasing. No change in stunting was observed in four of five camps. The replicability of findings across five sites strongly suggests that Nutributter® distribution was associated with a reduction in anaemia, but not stunting, among refugee children in the Horn of Africa. Benefits were not restricted to the 6–23 month target group targeted by the nutrition programme. However, even following this intervention anaemia remained a serious public health problem and additional work to define and evaluate an effective intervention package is warranted.
Collapse
|
21
|
Jemal Y, Haidar J, Kogi Makau W. The magnitude and determinants of anaemia among refugee preschool children from theKebribeyahrefugee camp, Somali region, Ethiopia. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2017.1237446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
22
|
Hossain SMM, Leidman E, Kingori J, Al Harun A, Bilukha OO. Nutritional situation among Syrian refugees hosted in Iraq, Jordan, and Lebanon: cross sectional surveys. Confl Health 2016; 10:26. [PMID: 27872656 PMCID: PMC5111203 DOI: 10.1186/s13031-016-0093-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ongoing armed conflict in Syria has caused large scale displacement. Approximately half of the population of Syria have been displaced including the millions living as refugees in neighboring countries. We sought to assess the health and nutrition of Syrian refugees affected by the conflict. METHODS Representative cross-sectional surveys of Syrian refugees were conducted between October 2 and November 30, 2013 in Lebanon, April 12 and May 1, 2014 in Jordan, and May 20 and 31, 2013 in Iraq. Surveys in Lebanon were organized in four geographical regions (North, South, Beirut/Mount Lebanon and Bekaa). In Jordan, independent surveys assessed refugees residing in Za'atri refugee camp and refugees residing among host community nationwide. In Iraq, refugees residing in Domiz refugee camp in the Kurdistan region were assessed. Data collected on children aged 6 to 59 months included anthropometric indicators, morbidity and feeding practices. In Jordan and Lebanon, data collection also included hemoglobin concentration for children and non-pregnant women aged 15 to 49 years, anthropometric indicators for both pregnant and non-pregnant women, and household level indicators such as access to safe water and sanitation. RESULTS The prevalence of global acute malnutrition among children 6 to 59 months of age was less than 5 % in all samples (range 0.3-4.4 %). Prevalence of acute malnutrition among women 15 to 49 years of age, defined as mid-upper arm circumference less than 23.0 cm, was also relatively low in all surveys (range 3.5-6.5 %). For both children and non-pregnant women, anemia prevalence was highest in Za'atri camp in Jordan (48.4 % and 44.8 %, respectively). Most anemia was mild or moderate; prevalence of severe anemia was less than or equal to 1.1 % in all samples of children and women. CONCLUSIONS Despite the ongoing conflict, results from all surveys indicate that global acute malnutrition is relatively low in the assessed Syrian refugee populations. However, prevalence of anemia suggests a serious public health problem among women and children, especially in Za'atri camp. Based on these findings, nutrition partners in the region have reprioritized response interventions, focusing on activities to address micronutrient deficiencies such as food fortification.
Collapse
Affiliation(s)
- S M Moazzem Hossain
- Health and Nutrition, United Nations Children's Fund, Middle East and North Africa Region, P.O. Box 1551, Amman, 11821 Jordan
| | - Eva Leidman
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Building 2500, Mailstop E-22, 2500 Century Parkway NE, Atlanta, GA 30345 USA
| | - James Kingori
- Health and Nutrition, United Nations Children's Fund, Middle East and North Africa Region, P.O. Box 1551, Amman, 11821 Jordan
| | - Abdullah Al Harun
- Health and Nutrition, United Nations Children's Fund, Middle East and North Africa Region, P.O. Box 1551, Amman, 11821 Jordan
| | - Oleg O Bilukha
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Building 2500, Mailstop E-22, 2500 Century Parkway NE, Atlanta, GA 30345 USA
| |
Collapse
|
23
|
Abstract
Pediatric refugees are at an increased risk for growth and nutritional deficits. As more children are resettled to the United States, it is important to screen appropriately in order to identify any growth or nutritional issues. Resettled refugee children continue to be at risk for both over- and undernutrition, therefore culturally appropriate education and counseling should be provided to improve long-term health.
Collapse
|
24
|
Mannion CA, Raffin-Bouchal S, Henshaw CJ. Navigating a strange and complex environment: experiences of Sudanese refugee women using a new nutrition resource. Int J Womens Health 2014; 6:411-22. [PMID: 24790470 PMCID: PMC3998869 DOI: 10.2147/ijwh.s56256] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Refugees experience dietary changes as part of the daily challenges they face resettling in a new country. Sudanese women seek to care and feed their families, but face language barriers in the marketplace, limited access to familiar foods, and forced new food choices. This study aimed to understand the acceptability of a purse-sized nutrition resource, “The Market Guide”, which was developed to help recently immigrated Sudanese refugee women identify and purchase healthy foods and navigate grocery stores. Methods Eight women participated in a focus group, four of whom were also observed during accompanied grocery store visits. Individual interviews were conducted with four health care workers at the resettlement center to gather perceptions about the suitability of The Market Guide. Focus groups and interviews were audiotaped and transcribed. Data from field notes and transcripts were analyzed using grounded theory for preliminary open codes, followed by selective and theoretical coding. Results The Market Guide was of limited use to Sudanese women. Their response to this resource revealed the struggles of women acculturating during their first year in Calgary, Canada. We discovered the basic social process, “Navigating through a strange and complex environment: learning ways to feed your family.” Language, transportation, and an unfamiliar marketplace challenged women and prevented them from exercising their customary role of “knowing” which foods were “safe and good” for their families. The nutrition resource fell short of informing food choices and purchases, and we discovered that “learning to feed your family” is a relational process where trusted persons, family, and friends help navigate dietary acculturation. Conclusion Emergent theory based on the basic social process may help health care professionals consider relational learning when planning health promotion and nutrition activities with Sudanese families.
Collapse
|
25
|
Style S, Tondeur M, Wilkinson C, Oman A, Spiegel P, Kassim IAR, Grijalva-Eternod C, Dolan C, Seal A. Operational guidance on the use of special nutritional products in refugee populations. Food Nutr Bull 2014; 34:420-8. [PMID: 24605692 DOI: 10.1177/156482651303400407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stunting, acute malnutrition, and micronutrient malnutrition are persistent public health problems in refugee populations worldwide. In recent years there has been an increase in the availability and use of special nutritional products in emergency and development contexts to help address inadequate nutrient intakes from low-diversity diets. The availability of new special nutritional products, and the decision by the United Nations High Commissioner for Refugees (UNHCR) to use blanket supplementary feeding programs to prevent stunting and anemia, raised new challenges for designing, monitoring, and evaluating nutritional programs. OBJECTIVE To develop an Operational Guidance on the use of special nutritional products for the prevention of micronutrient malnutrition, stunting, and acute malnutrition in refugee populations. Methods. A literature review and a series of consultations with technical experts, operational organizations, and field staff were performed over a period of 2 years. The Operational Guidance was finalized and released in December 2011. RESULTS The Operational Guidance describes six stages for defining nutritionalproblems and identifying possible solutions; assessing and managing risks; testing acceptability and adherence, program design and implementation; and monitoring and evaluation. Key performance indicators are defined and a working nomenclature for new special nutritional products is described. CONCLUSIONS The UNHCR Operational Guidance has filled an important gap in helping field staff deal with the opportunities and challenges of preventing undernutrition through the use of new products in blanket supplementary feeding programs. The need for further integration of guidance on selective feeding programs is discussed.
Collapse
Affiliation(s)
- Sarah Style
- UCL Institute for Global Health, Institute of Child Health, London
| | - Melody Tondeur
- Office of the United Nations High Commissioner for Refugees, Geneva
| | | | - Allison Oman
- Office of the United Nations High Commissioner for Refugees, Geneva
| | - Paul Spiegel
- Office of the United Nations High Commissioner for Refugees, Geneva
| | | | | | | | - Andrew Seal
- UCL Institute for Global Health, Institute of Child Health, London
| |
Collapse
|
26
|
Abstract
BACKGROUND New Zealand accepts 750 refugees annually who enter via the Mangere Refugee Resettlement Centre. AIMS To evaluate the health needs of refugee children less than 5 years of age. METHODS Retrospective audit on the outcomes of health screening and referrals in children less than 5 years of age at the Mangere Refugee Resettlement Centre between 2007 and 2011. RESULTS Of the 343 children, the most common infectious diseases were latent tuberculosis (15%) and parasitic infections (15%). In those older than 1 year old who had rubella and measles serology information, immunity was found in 50% and 59%, respectively. Hepatitis B immunity was found in 68%. Complete vaccination certificates were available for 66% on arrival to New Zealand. Vaccinations were administered to 73% while at the Mangere Refugee Resettlement Centre. Iron deficiency and vitamin D deficiency were the main noninfectious diseases found and were present in 33% and 12%, respectively. The total requiring referral for further medical assessment or support was 58% with 19% requiring referral to more than one service. CONCLUSIONS Screening identified health needs in otherwise asymptomatic newly arriving refugee children. A proportion of children required access to multiple specialized medical services and may benefit from a comprehensive pediatric service.
Collapse
|
27
|
Dong C, Ge P, Ren X, Wang J, Fan H, Yan X, Yin SA. Prospective study on the effectiveness of complementary food supplements on improving status of elder infants and young children in the areas affected by Wenchuan earthquake. PLoS One 2013; 8:e72711. [PMID: 24039797 PMCID: PMC3767697 DOI: 10.1371/journal.pone.0072711] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 07/16/2013] [Indexed: 11/19/2022] Open
Abstract
Objective To prospectively evaluate the efficiency of daily providing complementary food supplements decreasing malnutrition and anemia prevalence in elder infants and young children living in areas affected by Wenchuan Earthquake. Design Using promotional probability sampling method, 250 to 300 children from six-randomized townships (30 to 50 children in each township) in Kang County affected by the Earthquake were randomly chosen for follow up to evaluate intervention effectiveness using anthropometric measurement and hemoglobin level at six, twelve and eighteen months after start of intervention. Setting and Subjects All children from 6 to 18 months of age in Kang County (in North Western China) were daily provided with complementary food supplements containing multiple vitamins and minerals for up to 24 months of age. The intervention period lasted for one and half year. Results At beginning of intervention, malnutrition prevalence, including underweight, stunting and wasting were respectively 4.5%, 8.9% and 3.5%; anemia prevalence was 74.3%. After one and half year intervention, the growth and anemia status were significantly improved; the percentages of wasting, stunting underweight prevalence were decreased from 3.5%, 8.9% and 4.5% to 1.7%, 5.0% and 3.3% respectively, and the anemia rates were significantly decreased. Conclusions Our results indicated that an intervention using complementary food supplements could improve nutritional status and elevate hemoglobin level in elder infants and young children, which would significantly decrease the prevalence of malnutrition and anemia.
Collapse
Affiliation(s)
- Caixia Dong
- Department of Chronic Diseases, Gansu Center for Disease Control and Prevention, Lanzhou City, Gansu Province, China
| | - Pengfei Ge
- Department of Chronic Diseases, Gansu Center for Disease Control and Prevention, Lanzhou City, Gansu Province, China
| | - Xiaolan Ren
- Department of Chronic Diseases, Gansu Center for Disease Control and Prevention, Lanzhou City, Gansu Province, China
| | - Jie Wang
- Department of Maternal and Child Nutrition, National Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haoqiang Fan
- Department of Chronic Diseases, Gansu Center for Disease Control and Prevention, Lanzhou City, Gansu Province, China
| | - Xiang Yan
- The Department of Geriatrics, The first Hospital of Lanzhou University, Lanzhou City, Gansu Province, China
| | - Shi-an Yin
- Department of Maternal and Child Nutrition, National Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail:
| |
Collapse
|
28
|
Thomas S, Williams T. Khat (Catha edulis): A systematic review of evidence and literature pertaining to its harms to UK users and society. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/2050324513498332] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of khat ( Catha edulis) has been associated with a large number of physiological and societal harms, leading to calls for it to be controlled in the UK. The evidence of these harms is often equivocal, limited by confounding factors, or entirely anecdotal: high-powered, quality-controlled studies are lacking. Regardless, the body of relevant literature indicates that the once socially-regulated use of khat has been eroded. Some individuals have developed excessive consumption patterns, either using khat daily or in binge-sessions, though daily consumption is not necessarily problematic per se. The majority of users seem to use khat in moderation, where the associated harms appear low. For excessive users, harms associated with khat are greater, particularly relating to mental health. Social harms also seem to be largely related to excessive khat use rather than khat use itself. Even in cases of excessive khat use, however, causal relationships between chewing and harms have not been described. More research is required to establish the role of khat in liver disease, coronary problems, cancers of the digestive tract and incidents of domestic violence. Studies should consider the likeliness that certain users are more vulnerable to developing patterns of excessive khat use due to an interwoven set of factors such as social health determinants and pre- and post-migration experiences.
Collapse
|
29
|
Seal A, Thurstans S. Derivation of Nutrient Requirements for Disaster-Affected Populations: Sphere Project 2011. Food Nutr Bull 2013; 34:45-51. [DOI: 10.1177/156482651303400106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Nutritional requirements have been previously calculated for emergency-affected populations and are widely used for planning and assessing the nutritional adequacy of humanitarian food assistance. The Sphere Project is an interagency collaboration that defines minimum standards and indicators for humanitarian responses, including food and nutrition. It last published population nutritional requirements in 2004, but a revision was required due to the release of new Reference Nutrient Intakes (RNIs) by the World Health Organization and Food and Agriculture Organization (WHO/FAO). Objective To review and revise the list of specified nutrients and recalculate population requirements using RNIs published by WHO/FAO. Methods Review of published normative documents, consultation with experts and participants in the Sphere revision process, construction of a reference demographic profile, and calculation of population nutrient requirements for use in designing emergency general rations. Results Twenty-one nutrients and energy were selected for inclusion, and a demographic profile was constructed to represent a typical beneficiary population. Compared with the previous version of the Sphere Handbook, population requirements for nine vitamins and minerals were found to have increased as a result of the new WHO/FAO RNIs. Conclusions The calculated requirements were adopted and published as part of the Sphere 2011 Handbook. The incorporation of these requirements into planning, monitoring, and evaluation practices for food assistance will help to ensure that populations receive appropriate nutritional support during crises.
Collapse
|
30
|
Grijalva-Eternod CS, Wells JCK, Cortina-Borja M, Salse-Ubach N, Tondeur MC, Dolan C, Meziani C, Wilkinson C, Spiegel P, Seal AJ. The double burden of obesity and malnutrition in a protracted emergency setting: a cross-sectional study of Western Sahara refugees. PLoS Med 2012; 9:e1001320. [PMID: 23055833 PMCID: PMC3462761 DOI: 10.1371/journal.pmed.1001320] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 08/21/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Households from vulnerable groups experiencing epidemiological transitions are known to be affected concomitantly by under-nutrition and obesity. Yet, it is unknown to what extent this double burden affects refugee populations dependent on food assistance. We assessed the double burden of malnutrition among Western Sahara refugees living in a protracted emergency. METHODS AND FINDINGS We implemented a stratified nutrition survey in October-November 2010 in the four Western Sahara refugee camps in Algeria. We sampled 2,005 households, collecting anthropometric measurements (weight, height, and waist circumference) in 1,608 children (6-59 mo) and 1,781 women (15-49 y). We estimated the prevalence of global acute malnutrition (GAM), stunting, underweight, and overweight in children; and stunting, underweight, overweight, and central obesity in women. To assess the burden of malnutrition within households, households were first classified according to the presence of each type of malnutrition. Households were then classified as undernourished, overweight, or affected by the double burden if they presented members with under-nutrition, overweight, or both, respectively. The prevalence of GAM in children was 9.1%, 29.1% were stunted, 18.6% were underweight, and 2.4% were overweight; among the women, 14.8% were stunted, 53.7% were overweight or obese, and 71.4% had central obesity. Central obesity (47.2%) and overweight (38.8%) in women affected a higher proportion of households than did GAM (7.0%), stunting (19.5%), or underweight (13.3%) in children. Overall, households classified as overweight (31.5%) were most common, followed by undernourished (25.8%), and then double burden-affected (24.7%). CONCLUSIONS The double burden of obesity and under-nutrition is highly prevalent in households among Western Sahara refugees. The results highlight the need to focus more attention on non-communicable diseases in this population and balance obesity prevention and management with interventions to tackle under-nutrition. Please see later in the article for the Editors' Summary.
Collapse
Affiliation(s)
- Carlos S. Grijalva-Eternod
- Centre for International Health and Development, UCL Institute of Child Health, London, United Kingdom
- Emergency Nutrition Network, Oxford, United Kingdom
| | - Jonathan C. K. Wells
- Medical Research Council Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom
| | - Mario Cortina-Borja
- Medical Research Council Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, United Kingdom
| | | | | | - Carmen Dolan
- Emergency Nutrition Network, Oxford, United Kingdom
| | - Chafik Meziani
- Tindouf Sub-Office, United Nations High Commissioner for Refugees, Tindouf, Algeria
| | - Caroline Wilkinson
- Public Health and HIV Section, Division of Programme Support and Management, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Paul Spiegel
- Public Health and HIV Section, Division of Programme Support and Management, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Andrew J. Seal
- Centre for International Health and Development, UCL Institute of Child Health, London, United Kingdom
- Emergency Nutrition Network, Oxford, United Kingdom
| |
Collapse
|
31
|
Bilukha O, Howard C, Wilkinson C, Bamrah S, Husain F. Effects of Multimicronutrient Home Fortification on Anemia and Growth in Bhutanese Refugee Children. Food Nutr Bull 2011; 32:264-76. [DOI: 10.1177/156482651103200312] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Anemia remains a significant public health problem in refugee settings. Home fortification with micronutrient powders has been proposed as a feasible option to alleviate micronutrient deficiencies; its efficacy in reducing anemia in children aged 6 to 24 months has been demonstrated in several trials. Objective To evaluate the effectiveness of a large-scale micronutrient powder distribution program in reducing anemia prevalence and promoting growth in refugee children aged 6 to 59 months. Methods Four representative cross-sectional surveys were conducted 13 months before and 7, 14, and 26 months after initiation of the supplementation program. Data collected on children aged 6 to 59 months included hemoglobin concentration, anthropometric indicators, morbidity, feeding practices, and information on the micronutrient distribution program. The study had a pre—post design with no control group. Results The overall prevalence of anemia in children did not change significantly between baseline (43.3%) and endpoint (40.2%). The prevalence of moderate anemia decreased over the same period from 18.9% to 14.4% ( p < .05). The levels of severe anemia were negligible (< 1%) in all surveys. The prevalence of stunting decreased significantly from 39.2% at baseline to 23.4% at endpoint ( p < .001), a relative decrease of 40%. Reported coverage, use, and acceptance of micronutrient supplements remained consistently high throughout the study. Conclusions In the absence of a control group, changes in key outcomes should be interpreted with caution. The minor effect on hemoglobin status requires further investigation of underlying causes of anemia in this population. The large positive effect on linear growth may be a significant benefit of supplementation if confirmed by future studies.
Collapse
|
32
|
Kroll J, Yusuf AI, Fujiwara K. Psychoses, PTSD, and depression in Somali refugees in Minnesota. Soc Psychiatry Psychiatr Epidemiol 2011; 46:481-93. [PMID: 20354676 DOI: 10.1007/s00127-010-0216-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 03/11/2010] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Initial clinical observation of Somali patients seen at a busy inner-city community clinic (CUHCC) suggested that, in addition to the expected pictures of Posttraumatic Stress Disorder (PTSD) and depression previously seen in the clinic's Southeast Asian refugee population from 1980 to 2000, there was an unusually high number of young Somali men presenting with acute psychotic disturbances. OBJECTIVES The aim of this study of health care utilization of Somali refugees (N = 600) seen in the mental health unit of the clinic from 2001 to 2009 was to investigate the major patterns of psychiatric disorders in this outpatient population and compare these findings with a cohort of non-Somali patients (N = 3,009) seen at the same outpatient clinic during the years 2007-2009. If the results supported the initial clinical observations that the rate of psychoses was higher among young Somali men than non-Somali men attending CUHCC clinic, then several areas of further research would recommend itself. First, since this study was not a study of prevalence of mental illness in the Somali community, the next step would be to undertake a study of community prevalence of mental illness among different age and gender cohorts. Second, further research should look into likely causative and contributory risk factors to explain the development of psychoses among Somali young men. METHODS Somali and non-Somali patients were diagnosed according to DSM-IV-R criteria. Main outcome measures (diagnoses, age cohort, sex) were analyzed by Chi-square tests. Patterns of illness and adjustment varied significantly by age and gender cohorts, reflecting the relevance of age and gender at time of trauma on different trauma and loss experiences and cultural and religious shaping of subsequent adjustment and symptoms. RESULTS The study confirmed that almost half of the Somali male patients are under age 30, 80% of whom presented with psychoses, compared with the rate of psychosis (13.7%) in the non-Somali control group of same-aged males at the clinic. The older male, and the majority of Somali female patients, show predominantly depressive and PTSD symptomatology. CONCLUSIONS War trauma experienced in childhood, early malnutrition from famines, head trauma, and excess Khat use in male adolescents provide partial explanations for the large number of young psychotic Somali men seen in the clinic from 2001 to 2009.
Collapse
Affiliation(s)
- Jerome Kroll
- Community-University Health Care Clinic, University of Minnesota Medical School, 2001 Bloomington Avenue South, Minneapolis, MN 55404, USA.
| | | | | |
Collapse
|
33
|
Gibson RS, Kafwembe E, Mwanza S, Gosset L, Bailey KB, Mullen A, Baisley K, Filteau S. A micronutrient-fortified food enhances iron and selenium status of Zambian infants but has limited efficacy on zinc. J Nutr 2011; 141:935-43. [PMID: 21411608 DOI: 10.3945/jn.110.135228] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Micronutrient-fortified, cereal-based infant foods are recommended for reducing multiple micronutrient deficiencies in low-income countries, but their nutritional quality is not always optimal. In a double-blind randomized trial, we compared the efficacy of a locally produced porridge based on maize, beans, bambaranuts, and groundnuts fortified with 19 (rich) or 9 (basal) micronutrients. Infants aged 6 mo from Lusaka, Zambia were randomized to receive the richly fortified (n = 373) or basal (n = 370) porridge daily for 12 mo along with routine vitamin A supplements. Baseline and final micronutrient status and inflammation (based on α-1-glycoprotein) were assessed using nonfasting blood samples. Baseline prevalence of anemia (39%) and zinc deficiency (51%) were a public health concern. There were overall treatment effects on hemoglobin (Hb) (P = 0.001), serum transferrin receptor (P < 0.001), serum ferritin (P < 0.001), and serum selenium (P = 0.009); biomarker responses for iron and zinc were modified by baseline concentrations, and for Hb and iron by socioeconomic status. At 18 mo, the adjusted odds of anemia, iron deficiency anemia (Hb <105 g/L and transferrin receptor > 11.0 mg/L), and iron deficiency were 0.37 (95% CI = 0.25, 0.55), 0.18 (0.09, 0.35), and 0.30 (0.18, 0.50) times those in the basal group, respectively. The rich level of fortification had no overall treatment effect on serum zinc (1.09; 0.66, 1.80) but improved serum zinc in children with lower Hb concentrations at baseline (P = 0.024). A locally produced cereal- and legume-based infant food richly fortified with micronutrients reduced anemia and improved iron and selenium status but may require reformulation to improve the biochemical zinc status of urban Zambian infants.
Collapse
Affiliation(s)
- Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Disorders of malnutrition among the Saharawi children. REVISTA ESPAÑOLA DE NUTRICIÓN HUMANA Y DIETÉTICA 2011. [DOI: 10.1016/s2173-1292(11)70003-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
35
|
McDougal L, Beard J. Revisiting sphere: new standards of service delivery for new trends in protracted displacement. DISASTERS 2011; 35:87-101. [PMID: 20722690 DOI: 10.1111/j.1467-7717.2010.01194.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The proportion of people living in protracted displacement, as well as the duration of this displacement, is increasing. International humanitarian standards for services provided in protracted displacement are based on the Sphere Standards, which were formulated using evidence and experience from acute phase emergencies. However, the majority of protracted emergencies are in the post-emergency phase. This paper discusses trends in displacement, outlines reasons why using the Sphere Standards as minimum standards of service provision in protracted displacement does not adequately meet the needs of these populations, and analyses areas where greater standards of service provision are necessary. An expansion of the evidence base regarding determinants of morbidity and mortality in protracted emergencies is needed. This, followed by a joint approach to designing new, effective standards focused on proactive policies, will allow the humanitarian community more appropriately to serve and enable the millions of people currently living in protracted displacement.
Collapse
Affiliation(s)
- Lotus McDougal
- Department of International Health, Boston University School of Public Health, Cambridge, United States.
| | | |
Collapse
|
36
|
Abstract
AbstractObjectiveTo assess anaemia prevalence and correlated social and biological determinants among pregnant women in the Occupied Palestinian Territory (oPt).DesignA cross-sectional survey conducted among pregnant women attending/accessing UNRWA (United Nations Relief and Works Agency for Palestine Refugees in the Near East) health centres in the Gaza Strip and the West Bank in September and October 2006.SettingFifty-five UNRWA health centres in the oPt (eighteen in the Gaza Strip and thirty-seven in the West Bank).SubjectsA random sample of 1740 pregnant women.ResultsOverall anaemia prevalence was 38·6 % (95 % CI 36·3, 40·9 %). A substantial difference in anaemia prevalence was observed between the Gaza Strip and the West Bank (44·9 % v. 31·1 %, respectively), as well as a significant increase in anaemia prevalence in the Gaza Strip compared with an Agency-wide survey conducted in 2004 (44·9 % v. 35·7 %, respectively). Anaemia prevalence was found to increase with age, parity and trimester of gestation.ConclusionsAnaemia still appears to be a public health problem among pregnant women in spite of UNRWA interventions. The West Bank shows prevalence rates similar to those observed in neighbouring countries, while the Gaza Strip has higher rates. Prevalence rates of anaemia among pregnant Palestinian women are more than two times higher than those observed in Europe.
Collapse
|
37
|
Shrimpton R, Thorne-Lyman A, Tripp K, Tomkins A. Trends in low Birthweight among the Bhutanese Refugee Population in Nepal. Food Nutr Bull 2009; 30:S197-206. [DOI: 10.1177/15648265090302s203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Although much is known about risk factors for low birthweight, an important cause of neonatal death, little is known about how to reduce or prevent low birthweight. Objective This study aimed to verify a low rate in the incidence of low birthweight reported in the Bhutanese refugee camps in Nepal and, if true, to try to understand how this came about. Methods Medical records from 1994 to 2001 were recovered for half of the refugee population, and birthweight and other maternal factors were analyzed. The adequacy of the food ration provided to the general population was assessed by comparing it with the nutrient requirements of pregnant women. Results The rates of low birthweight were indeed low in the refugee camps, averaging 11% in the years reviewed. Between 1996 and 1998, the mean rate of low birthweight fell from 16% to 8% and mean birthweight increased from 2.84 kg (SE, 2.80–2.87) to 3.0 kg (SE, 2.97–3.03). The increase in birthweight occurred following improvements in the micronutrient-to-energy ratios of the general ration. Conclusions Rates of low birthweight comparable to those in developed countries were achieved in an ethnic Nepali population within 5 years of settlement in refugee camps. These low rates were probably achieved because basic needs of mothers were met, including both the quantity and the micronutrient content of food, water and sanitation, antenatal care, and education. The improvement from 1996 to 1998 coincided with increased availability of micronutrients in the food ration. We hypothesize that increased periconceptional micronutrient intake may be responsible for the increase in birthweight.
Collapse
|
38
|
Acceptability and use of iron and iron-alloy cooking pots: implications for anaemia control programmes. Public Health Nutr 2009; 13:123-30. [PMID: 19476680 DOI: 10.1017/s1368980009005928] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the acceptability of iron and iron-alloy cooking pots prior to an intervention trial and to investigate factors affecting retention and use. DESIGN Pre-trial research was conducted on five types of iron and iron-alloy pots using focus group discussions and a laboratory evaluation of Fe transfer during cooking was undertaken. Usage and retention during the subsequent intervention trial were investigated using focus group discussions and market monitoring. SETTING Three refugee camps in western Tanzania. SUBJECTS Refugee health workers were selected for pre-trial research. Mothers of children aged 6-59 months participated in the investigation of retention and use. RESULTS Pre-trial research indicated that the stainless steel pot would be the only acceptable type for use in this population due to excessive rusting and/or the high weight of other types. Cooking three typical refugee dishes in stainless steel pots led to an increase in Fe content of 3.2 to 17.1 mg/100 g food (P < 0.001). During the trial, the acceptability of the stainless steel pots was lower than expected owing to difficulties with using, cleaning and their utility for other purposes. Households also continued to use their pre-existing pots, and stainless steel pots were sold to increase household income. CONCLUSIONS Pre-trial research led to the selection of a stainless steel pot that met basic acceptability criteria. The relatively low usage reported during the trial highlights the limitations of using high-value iron-alloy cooking pots as an intervention in populations where poverty and the availability of other pots may lead to selling.
Collapse
|
39
|
Evaluation of the effectiveness of stainless steel cooking pots in reducing iron-deficiency anaemia in food aid-dependent populations. Public Health Nutr 2009; 13:107-15. [PMID: 19335940 DOI: 10.1017/s1368980009005254] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of stainless steel (Fe alloy) cooking pots in reducing Fe-deficiency anaemia in food aid-dependent populations. DESIGN Repeated cross-sectional surveys. Between December 2001 and January 2003, three surveys among children aged 6-59 months and their mothers were conducted in 110 households randomly selected from each camp. The primary outcomes were changes in Hb concentration and Fe status. SETTING Two long-term refugee camps in western Tanzania. SUBJECTS Children (6-59 months) and their mothers were surveyed at 0, 6 and 12 months post-intervention. Stainless steel pots were distributed to all households in Nduta camp (intervention); households in Mtendeli camp (control) continued to cook with aluminium or clay pots. RESULTS Among children, there was no change in Hb concentration at 1 year; however, Fe status was lower in the intervention camp than the control camp (serum transferrin receptor (sTfR) concentration: 6.8 v. 5.9 microg/ml; P < 0.001). There was no change in Hb concentration among non-pregnant mothers at 1 year. Subjects in the intervention camp had lower Fe status than those in the control camp (sTfR concentration: 5.8 v. 4.7 microg/ml; P = 0.003). CONCLUSIONS Distribution of stainless steel pots did not increase Hb concentration or improve Fe status in children or their mothers. The use of stainless steel prevents rusting but may not provide sufficient amounts of Fe and strong educational campaigns may be required to maximize use. The distribution of stainless steel pots in refugee contexts is not recommended as a strategy to control Fe deficiency.
Collapse
|
40
|
Maize meal fortification is associated with improved vitamin A and iron status in adolescents and reduced childhood anaemia in a food aid-dependent refugee population. Public Health Nutr 2007; 11:720-8. [PMID: 18096105 DOI: 10.1017/s1368980007001486] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess changes in the Fe and vitamin A status of the population of Nangweshi refugee camp associated with the introduction of maize meal fortification. DESIGN Pre- and post-intervention study using a longitudinal cohort. SETTING Nangweshi refugee camp, Zambia. SUBJECTS Two hundred and twelve adolescents (10-19 years), 157 children (6-59 months) and 118 women (20-49 years) were selected at random by household survey in July 2003 and followed up after 12 months. RESULTS Maize grain was milled and fortified in two custom-designed mills installed at a central location in the camp and a daily ration of 400 g per person was distributed twice monthly to households as part of the routine food aid ration. During the intervention period mean Hb increased in children (0.87 g/dl; P < 0.001) and adolescents (0.24 g/dl; P = 0.043) but did not increase in women. Anaemia decreased in children by 23.4% (P < 0.001) but there was no significant change in adolescents or women. Serum transferrin receptor (log10-transformed) decreased by -0.082 microg/ml (P = 0.036) indicating an improvement in the Fe status of adolescents but there was no significant decrease in the prevalence of deficiency (-8.5%; P = 0.079). In adolescents, serum retinol increased by 0.16 micromol/l (P < 0.001) and vitamin A deficiency decreased by 26.1% (P < 0.001). CONCLUSIONS The introduction of fortified maize meal led to a decrease in anaemia in children and a decrease in vitamin A deficiency in adolescents. Centralised, camp-level milling and fortification of maize meal is a feasible and pertinent intervention in food aid operations.
Collapse
|
41
|
Abstract
PURPOSE OF REVIEW Recent studies raise controversies about the nature of psychotic illnesses, and the role of life experiences and drug abuse as causative agents in the onset of psychoses. RECENT FINDINGS Evidence from studies across many geographic locales and cultures finds increased risk of psychoses in first- and second-generation immigrant populations. Trauma incurred in war and civil unrest, trauma of child abuse, and the experience of being bullied in childhood are correlated with increased rates of psychoses in the populations at risk. The risk of onset of psychoses is increased by maternal and infant starvation, and by substance misuse (marijuana, khat) in late childhood and adolescence. These studies question the validity of a categorical distinction between the schizophrenic and affective illnesses. SUMMARY A variety of extrinsic factors, such as in-utero and infant malnutrition, substance abuse, and traumatic experiences, appear to be significant risk factors for the development of schizophrenia-like and psychotic affective disorders. These findings raise the issue of whether the present classification of the psychoses is in urgent need of reconceptualization.
Collapse
|
42
|
Abstract
OBJECTIVES To investigate, in asylum seekers' children in the Netherlands, biochemical iron status and the prevalence of iron deficiency (ID) and anemia in relation to age, region of origin, length of stay in the Netherlands, body mass index (BMI), and dietary iron intake. PATIENTS AND METHODS Hemoglobin (Hb) and plasma ferritin concentrations were determined in 122 asylum seekers' children (median age, 7.1 years; range, 2-12 y). ID was defined by plasma ferritin levels <15 microg/L. Anemia was defined by Hb levels <6.8 mmol/L (11 g/dL) for children <6 years of age and Hb levels <7.1 mmol/L (11.5 g/dL) for children between 6 and 12 years of age. Nutritional status of the children was assessed by BMI and dietary intake of iron was estimated by 24-hour recall. RESULTS Twenty percent of the children had compromised iron status (16% with ID, 4% with ID anemia [IDA]). Another 6% of the children had anemia caused by thalassemia. ID was significantly more prevalent in children <6 years of age and in children of African origin. The iron status was not significantly correlated with the length of stay in the Netherlands (r = 0.6; P = 0.48). Higher BMI z scores were positively correlated with iron status. Adequate or marginal dietary iron intake was not significantly related to the presence of ID (r = 0.02; P = 0.9) or anemia (IDA and thalassemia; r = 0.15; P = 0.9). CONCLUSIONS Iron deficiency is highly prevalent among the children of asylum seekers in the Netherlands. Our data indicate that systematic biochemical screening for ID is warranted in asylum seekers' children.
Collapse
|
43
|
Willis MS, Buck JS. From Sudan to nebraska: Dinka and Nuer refugee diet dilemmas. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2007; 39:273-80. [PMID: 17826347 DOI: 10.1016/j.jneb.2006.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Revised: 10/03/2006] [Accepted: 10/05/2006] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Examination of current dietary patterns of Dinka and Nuer refugees from Sudan to the United States prior to dental restoration and nutrition training. DESIGN Thirty-one participants were interviewed regarding current intake and knowledge of US food and nutrition principles. Twenty-nine completed three 24-hour food diaries. SETTING Refugee homes, campus offices, and classrooms in a midwestern city. PARTICIPANTS Eight Nuer females and 9 Nuer and 14 Dinka males participating in a program to replace lower front teeth traditionally extracted in childhood. PHENOMENON OF INTEREST Are refugees familiar with preparing and consuming US foods given that dental restoration will allow, for example, raw and/or tough food to be nipped or incised? Are diets substantively different from African ones, eg, sugar-rich, fat-rich, and dairy-poor? ANALYSIS Interview data and diet diaries were matched, and data were compared for common themes and patterns. RESULTS Refugees ate a monotonous diet, with few fruits, vegetables, and dairy products. All lacked familiarity with US foods and preparation techniques but ate convenience foods and sweetened beverages in large quantities. CONCLUSIONS AND IMPLICATIONS Refugees possessed limited understanding of "healthful" US food and were overwhelmed by choices. Regardless of dental status and time in the United States, few had selection and preparation skills for US foods. Nutrient deficiency and related disease are likely without intervention.
Collapse
Affiliation(s)
- Mary S Willis
- University of Nebraska-Lincoln, Lincoln, Nebraska 68588-0368, USA.
| | | |
Collapse
|