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Melaku EE, Urgie BM, Tilahun AT, Assefa HK, Abebe AA, Tefera AS. Prevalence of vitamin B 12 deficiency and associated factors among primary school children: North East Ethiopia: multicenter cross-sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:82. [PMID: 38867328 PMCID: PMC11170803 DOI: 10.1186/s41043-024-00568-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/11/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND The prevalence of Vitamin B12 deficiency is common and is more frequent in low- and middle-income countries with a poor or inadequate diet of animal foods. In Ethiopia, researches related to the status of micronutrients in children are limited. Therefore, this study aimed to assess the prevalence of vitamin B12 deficiency and associated factors among primary school children. METHODS A cross-sectional study design was conducted from January 10-February 30/2023. A total of 514 students were selected using a systematic random sampling technique. Face-to-face interviews using a structured questionnaire, document review, anthropometric measurement, and laboratory studies were implemented to collect data. Data was analyzed by STATA version 14 and summarized by using frequency tables and graphs. Logistic regression analysis was done to identify factors associated with vitamin B12 Deficiency. RESULTS About 34% of the students were found to have vitamin B12 deficiency. Not Consuming animal products (AOR = 1.83, 95% CI:1.20-2.79) and low body mass index (AOR = 1.62, 95% CI:1.05-2.47) were associated with vitamin B12 deficiency. CONCLUSIONS The study revealed a notable high deficiency of vitamin B12 in primary school students. Consumption of animal products and BMI were identified as statically significant associated factors with serum concentration of vitamin B12.
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Affiliation(s)
| | | | | | | | | | - Aklile Semu Tefera
- Department of Epidemiology, Debre Berhan University, Debre Berhan, Ethiopia
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Jafree SR, Nadir SMH, Mahmood QK, Burhan SK. The migrant Hazara Shias of Pakistan and their social determinants for PTSD, mental disorders and life satisfaction. J Migr Health 2023; 7:100166. [PMID: 36794096 PMCID: PMC9922968 DOI: 10.1016/j.jmh.2023.100166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 12/13/2022] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
Background Ensuring safety and wellbeing of all the minority populations of Pakistan is essential for collective national growth. The Pakistani Hazara Shias are a marginalized non-combative migrant population who face targeted violence in Pakistan, and suffer from great challenges which compromise their life satisfaction and mental health. In this study, we aim to identify the determinants of life satisfaction and mental health disorders in Hazara Shias and ascertain which socio-demographic characteristics are associated with post-traumatic stress disorder (PTSD). Methods We used a cross-sectional quantitative survey, utilizing internationally standardized instruments; with an additional qualitative item. Seven constructs were measured, including household stability; job satisfaction; financial security; community support; life satisfaction; PTSD; and mental health. Factor analysis was performed showing satisfactory Cronbach alpha results. A total of 251 Hazara Shias from Quetta were sampled at community centers through convenience method based on their willingness to participate. Results Comparison of mean scores shows significantly higher PTSD in women and unemployed participants. Regression results reveal that people who have low community support, especially from national and ethnic community, religious community, and other community groups, had higher risk of mental health disorders. Structural equation modeling identified that four study variables contribute to greater life satisfaction, including: household satisfaction (β = 0.25, p < 0.001); community satisfaction (β = 0.26, p < 0.001); financial security (β = 0.11, p < 0.05); and job satisfaction (β = 0.13, p < 0.05). Qualitative findings revealed three broad areas which create barriers to life satisfaction, including: fears of assault and discrimination; employment and education problems; and financial and food security issues. Conclusions The Hazara Shias need immediate assistance from state and society to improve safety, life opportunities, and mental health. Interventions for poverty alleviation, mental health, and fair education and employment opportunities need to be planned in partnership with the primary security issue.
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Affiliation(s)
- Sara Rizvi Jafree
- Associate Professor & Chair, Department of Sociology, Forman Christian College University, Pakistan,Corresponding author.
| | - Syed Mujtaba Hasnain Nadir
- Gastroenterology and Clinical Informatics Speciality Trainee Registrar, Health Education England, North West Deanery, UK
| | - Qaisar Khalid Mahmood
- Assistant Professor, Department of Sociology, International Islamic University, Pakistan
| | - Syeda Khadija Burhan
- Assistant Professor, Department of Education, Forman Christian College University, Pakistan
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3
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Nutritional and health status of adult Syrian refugees in the early years of asylum in Germany: a cross-sectional pilot study. BMC Public Health 2022; 22:2217. [PMID: 36447164 PMCID: PMC9706931 DOI: 10.1186/s12889-022-14684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Migration is usually accompanied by changes in the social, cultural, and religious environment, socioeconomic status, and housing conditions, all of which affect nutritional health. In a cross-sectional study, we assessed the dietary intake as well as nutritional and health situation in a population of Syrian refugees who have resided in Germany for at least six months up to four years since 2015. The primary aim of this pilot study was to evaluate the nutritional and health status in comparison to reference values. METHODS Between December 2018 and March 2020, 114 adult Syrian refugees were included in the study. The subjects filled out questionnaires on sociodemographic variables, exercise, and nutrition behavior (three-day nutrition record). After a fasting blood draw, the subjects were examined for anthropometric parameters (height, weight, body mass index, waist circumference, waist-hip ratio, and body composition via a bioelectrical impedance analyzer). Various blood markers including iron status, hematological parameters, Vitamin D status, lipid metabolism, glucose metabolism, and total homocysteine (tHcy) were measured. RESULTS About half of the participants (71 male, 43 female) had lived in Germany for less than three years. Over 60% of men and 30% of women were overweight (BMI 25-30 kg/m2) or obese (BMI > 30 kg/m2), while 79% of men and 74% of women observed an elevated body fat mass. The evaluation of the three-day nutrition records revealed an unfavorable supply situation for numerous critical nutrients. More than half of the women (53.5%) had depleted iron stores (serum ferritin < 15 µg/l). The 25-OH-Vitamin D blood levels showed a high prevalence of Vitamin D insufficiency (25-49.9 nmol/l: 38% of men and 21% of women) and deficiency (< 25 nmol/l: 44% of men and 70% of women). 83% of men and 67% of women showed tHcy levels in plasma > 10 nmol/l. Fasting insulin levels and the HOMA-IR index indicate a risk for insulin resistance. Hyperlipidemia was prevalent, especially in males with 24% showing hypertriglyceridemia (> 150 mg/dl) and LDL-hypercholesterolemia (> 130 mg/dl). CONCLUSIONS The nutritional and health status of the cohort of Syrian refugees in Germany examined in this study is unsatisfactory, and many of the investigated refugees are at risk for developing cardiovascular disease and type 2 diabetes mellitus. Further studies are required to investigate the nutritional and health situation of refugees. This is obligatory to find ways to avoid malnutrition with all its associated health, sociodemographic, and economic consequences.
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4
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Karki R, Perry C, Wilkinson J, Cole G. Prenatal Nutrition among Bhutanese Refugees in Utah: A Pilot Study. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2022.2032898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Reena Karki
- Research Project Manager, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Cassandra Perry
- Department of Public Health, Brigham Young University, Provo, Utah, USA
| | - Jessica Wilkinson
- Department of Public Health, Brigham Young University, Provo, Utah, USA
| | - Gene Cole
- Department of Public Health, Brigham Young University, Provo, Utah, USA
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5
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Saeedullah A, Khan MS, Andrews SC, Iqbal K, Ul-Haq Z, Qadir SA, Khan H, Iddrisu I, Shahzad M. Nutritional Status of Adolescent Afghan Refugees Living in Peshawar, Pakistan. Nutrients 2021; 13:3072. [PMID: 34578948 PMCID: PMC8469503 DOI: 10.3390/nu13093072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/22/2021] [Accepted: 08/28/2021] [Indexed: 11/23/2022] Open
Abstract
Pakistan has hosted millions of Afghan refugees over the last several decades. Due to poor socioeconomic status, food insecurity and inadequate access to health care, these refugees are considered to be at high risk of malnutrition. Previous studies on nutritional assessment of high-risk populations (refugees) have focused mainly on women and children (0-59 months). The current study aims to assess nutritional status of adolescent Afghan refugees; the population who are equally vulnerable to malnutrition and its consequences. In this cross sectional study, the nutritional status of 206 adolescent (10-19 years old) Afghans boys and girls living in a refugee camp in Peshawar, Pakistan was assessed using standard methods. The results indicate a prevalence of stunting, thinness, and overweight and obesity at 35.3%, 4.4% and 14.8%, respectively. Furthermore, there was a significantly high prevalence of micronutrient deficiencies (vitamin D, 80.5%; vitamin B12, 41.9%; and folate, 28.2%); and anemia (10.1%). Together, these findings indicate that this vulnerable population group suffers from the double burden of malnutrition and are thus at serious risk of impaired psychosocial cognitive development, general ill-health and diminished wellbeing. This study therefore highlights the urgent need to include adolescents in regular screening and intervention programs of such at-risk populations.
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Affiliation(s)
- Anum Saeedullah
- Kabir Medical College, Department of Biochemistry, Gandhara University, Canal Road University Town, Peshawar 25000, Pakistan;
| | - Muhammad Shabir Khan
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar 25120, Pakistan; (M.S.K.); (K.I.); (Z.U.-H.); (S.A.Q.); (H.K.)
| | - Simon C. Andrews
- School of Biological Sciences, Health and Life Sciences Building, University of Reading, Reading RG6 6AX, UK;
| | - Khalid Iqbal
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar 25120, Pakistan; (M.S.K.); (K.I.); (Z.U.-H.); (S.A.Q.); (H.K.)
| | - Zia Ul-Haq
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar 25120, Pakistan; (M.S.K.); (K.I.); (Z.U.-H.); (S.A.Q.); (H.K.)
| | - Syed Abdul Qadir
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar 25120, Pakistan; (M.S.K.); (K.I.); (Z.U.-H.); (S.A.Q.); (H.K.)
| | - Haris Khan
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar 25120, Pakistan; (M.S.K.); (K.I.); (Z.U.-H.); (S.A.Q.); (H.K.)
| | - Ishawu Iddrisu
- School of Biological Sciences, Health and Life Sciences Building, University of Reading, Reading RG6 6AX, UK;
| | - Muhammad Shahzad
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar 25120, Pakistan; (M.S.K.); (K.I.); (Z.U.-H.); (S.A.Q.); (H.K.)
- School of Biological Sciences, Health and Life Sciences Building, University of Reading, Reading RG6 6AX, UK;
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Amstutz D, Gonçalves D, Hudelson P, Stringhini S, Durieux-Paillard S, Rolet S. Nutritional Status and Obstacles to Healthy Eating Among Refugees in Geneva. J Immigr Minor Health 2020; 22:1126-1134. [PMID: 32940816 PMCID: PMC7683482 DOI: 10.1007/s10903-020-01085-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2020] [Indexed: 12/02/2022]
Abstract
Refugees face various nutritional challenges during and after migration. This cross-sectional, mixed-methods study seeks to investigate the prevalence of undernutrition and obesity among refugees in Geneva, and to identify barriers to healthy eating. Anthropometric measurements of 354 adult refugees were collected between 2017 and 2019 by trained nurses and dietitians. Seven focus group discussions totaling 51 participants, refugees and social workers, investigated conceptions and needs regarding diet. The mean Body Mass Index is 24.6 ± 4.8 kg/m2. Women are disproportionately affected by obesity compared to men (p < 0.001). Weight gain post-migration is correlated positively with length of stay in Geneva (p < 0.001). Major obstacles to healthy eating are economic and linguistic. For participants, cooking workshops and free physical activities are highly needed interventions. Post-migration lifestyle interventions should be implemented to prevent weight gain in this population. Such interventions must be multi-level, to overcome structural, social and behavioral barriers to healthy eating.
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Affiliation(s)
- Delphine Amstutz
- Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
| | - Daniela Gonçalves
- Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Patricia Hudelson
- Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Durieux-Paillard
- Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sylvie Rolet
- Clinical Nutrition, Geneva University Hospitals, Geneva, Switzerland.,Care Directorate, Geneva University Hospitals, Geneva, Switzerland
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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.
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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
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Estourgie-van Burk GF, van der Kuy PHM, de Meij TG, Benninga MA, Kneepkens CMF. Intranasal treatment of vitamin B 12 deficiency in children. Eur J Pediatr 2020; 179:349-352. [PMID: 31758311 DOI: 10.1007/s00431-019-03519-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 01/01/2023]
Abstract
Vitamin B12 deficiency is traditionally treated with intramuscular injections of cobalamin, which are stressful events for children. In adults, studies have shown adequate absorption of intranasally administered vitamin B12. To date, data concerning efficacy of intranasal administration of vitamin B12 in children are lacking. We report on ten cases of children with vitamin B12 deficiency who were successfully treated with intranasal administration of a spray containing hydroxocobalamin. The mean baseline vitamin B12 concentration increased from 126.3 pmol/l (SD 55.4) to 1914.7 pmol/l (SD 1509.7). No side effects were reported.Conclusion: In children, intranasal application of vitamin B12 seems a safe and effective alternative to intramuscular injections, leading to higher compliance and less burden to patients.What is Known:• Children with vitamin B12deficiency are traditionally treated with intramuscular cobalamin injections, which are costly and painful.• Studies in adults showed that intranasal application of hydroxocobalamin leads to normalisation of vitamin B12levels.What is New:• The intranasal application of vitamin B12resulted in a substantial increase of the mean baseline vitamin B12levels without any side effect.• These data encourage a systematic evaluation of intranasal treatment of vitamin B12deficiency in order to define safety, optimal dosage and administration frequency.
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Affiliation(s)
| | - P Hugo M van der Kuy
- Department of Clinical Pharmacy, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Tim G de Meij
- Department of Paediatric Gastroenterology and Nutrition, Amsterdam University Medical Centres, Location VU Medical Centre, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Amsterdam University Medical Centres, Location Academic Medical Centre/Emma Children's Hospital, Amsterdam, The Netherlands
| | - C M Frank Kneepkens
- Department of Paediatric Gastroenterology and Nutrition, Amsterdam University Medical Centres, Location VU Medical Centre, Amsterdam, The Netherlands
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9
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Newman K, O'Donovan K, Bear N, Robertson A, Mutch R, Cherian S. Nutritional assessment of resettled paediatric refugees in Western Australia. J Paediatr Child Health 2019; 55:574-581. [PMID: 30288837 DOI: 10.1111/jpc.14250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 08/19/2018] [Accepted: 09/07/2018] [Indexed: 11/26/2022]
Abstract
AIM Nutritional deprivation, inadequate diet and food insecurity are common refugee experiences. The growth and nutritional status of paediatric refugees following resettlement in developed countries and the related interplay with socio-economic factors remain less defined; this study aims to describe these features. METHODS Standardised dietary, medical and socio-demographic health assessments of new refugee patients attending a multidisciplinary paediatric Refugee Health Service (RHS) in Western Australia between 2010 and 2015 were analysed. RESULTS Demographic data from 1131 paediatric refugees are described (age 2 months to 17.8 years). The majority experienced socio-economic disadvantage, had limited parental education and required interpreters. Nutritional deficiencies were common but varied across ethnicities: iron deficiency (ID) (12.3%), anaemia (7.3%) and inadequate dairy intake (41.0%). A third of children (32.6%) did not consume meat. Infant breastfeeding was sustained (77.8%) in infants <12 months. Prolonged breastfeeding (44.9% aged 12-24 months) was associated with an increased risk of ID (odds ratio 4.0, 95% confidence interval 1.4-11.6). Median body mass index increased significantly for those >24 months between referral and RHS assessment (median period 1.8 months). Overall, 27.1% required additional formal dietetic follow-up, with higher nutritional concerns in refugee children <24 months compared to older patients. CONCLUSIONS Identification of frequent post-settlement nutritional concerns has been captured through structured multidisciplinary paediatric health screening. Specific screening for socio-economic influencing factors, including education, poverty and food insecurity, during refugee clinical assessments is recommended. Development of targeted, culturally appropriate parental education resources and interventions may improve management following resettlement. Longitudinal research assessing resettlement growth trajectories is required.
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Affiliation(s)
- Katie Newman
- Refugee Health Service, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Kelly O'Donovan
- Women and Newborn Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Natasha Bear
- Department of Clinical Research and Education, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Annie Robertson
- Refugee Health Service, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Raewyn Mutch
- Refugee Health Service, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Paediatrics, Faculty of Health and Medical Sciences, Perth, Western Australia, Australia
| | - Sarah Cherian
- Refugee Health Service, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Paediatrics, University of Western Australia, Perth, Western Australia, Australia
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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.
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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
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11
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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: 11] [Impact Index Per Article: 1.8] [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.
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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
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12
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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.
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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
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Molloy AM. Should vitamin B 12 status be considered in assessing risk of neural tube defects? Ann N Y Acad Sci 2018; 1414:109-125. [PMID: 29377209 PMCID: PMC5887889 DOI: 10.1111/nyas.13574] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/07/2017] [Accepted: 11/11/2017] [Indexed: 02/06/2023]
Abstract
There is a strong biological premise for including vitamin B12 with folic acid in strategies to prevent neural tube defects (NTDs), due to the closely interlinked metabolism of these two vitamins. For example, reduction of B12 deficiency among women of reproductive age could enhance the capacity of folic acid to prevent NTDs by optimizing the cellular uptake and utilization of natural folate cofactors. Vitamin B12 might also have an independent role in NTD prevention, such that adding it in fortification programs might be more effective than fortifying with folic acid alone. Globally, there is ample evidence of widespread vitamin B12 deficiency in low‐ and middle‐income countries, but there is also considerable divergence of vitamin B12 status across regions, likely due to genetic as well as nutritional factors. Here, I consider the evidence that low vitamin B12 status may be an independent factor associated with risk of NTDs, and whether a fortification strategy to improve B12 status would help reduce the prevalence of NTDs. I seek to identify knowledge gaps in this respect and specify research goals that would address these gaps.
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Affiliation(s)
- Anne M Molloy
- School of Medicine and School of Biochemistry and Immunology, Trinity College Dublin, Trinity Biomedical Sciences Institute, Dublin, Ireland
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Green R, Allen LH, Bjørke-Monsen AL, Brito A, Guéant JL, Miller JW, Molloy AM, Nexo E, Stabler S, Toh BH, Ueland PM, Yajnik C. Vitamin B 12 deficiency. Nat Rev Dis Primers 2017; 3:17040. [PMID: 28660890 DOI: 10.1038/nrdp.2017.40] [Citation(s) in RCA: 465] [Impact Index Per Article: 66.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Vitamin B12 (B12; also known as cobalamin) is a B vitamin that has an important role in cellular metabolism, especially in DNA synthesis, methylation and mitochondrial metabolism. Clinical B12 deficiency with classic haematological and neurological manifestations is relatively uncommon. However, subclinical deficiency affects between 2.5% and 26% of the general population depending on the definition used, although the clinical relevance is unclear. B12 deficiency can affect individuals at all ages, but most particularly elderly individuals. Infants, children, adolescents and women of reproductive age are also at high risk of deficiency in populations where dietary intake of B12-containing animal-derived foods is restricted. Deficiency is caused by either inadequate intake, inadequate bioavailability or malabsorption. Disruption of B12 transport in the blood, or impaired cellular uptake or metabolism causes an intracellular deficiency. Diagnostic biomarkers for B12 status include decreased levels of circulating total B12 and transcobalamin-bound B12, and abnormally increased levels of homocysteine and methylmalonic acid. However, the exact cut-offs to classify clinical and subclinical deficiency remain debated. Management depends on B12 supplementation, either via high-dose oral routes or via parenteral administration. This Primer describes the current knowledge surrounding B12 deficiency, and highlights improvements in diagnostic methods as well as shifting concepts about the prevalence, causes and manifestations of B12 deficiency.
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Affiliation(s)
- Ralph Green
- Department of Pathology and Laboratory Medicine, University of California Davis, 4400 V Street, PATH Building, Davis, California 95817, USA
| | - Lindsay H Allen
- USDA, ARS Western Human Nutrition Research Center, University of California Davis, Davis, California, USA
| | | | - Alex Brito
- USDA, ARS Western Human Nutrition Research Center, University of California Davis, Davis, California, USA
| | - Jean-Louis Guéant
- Inserm UMRS 954 N-GERE (Nutrition Génétique et Exposition aux Risques Environnementaux), University of Lorraine and INSERM, Nancy, France
| | - Joshua W Miller
- School of Environmental and Biological Sciences, Rutgers University, New Brunswick, New Jersey, USA
| | - Anne M Molloy
- School of Medicine and School of Biochemistry and Immunology, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Ebba Nexo
- Department of Clinical Medicine, Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Sally Stabler
- Department of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Ban-Hock Toh
- Centre for Inflammatory Diseases, Monash Institute of Medical Research, Clayton, Victoria, Australia
| | - Per Magne Ueland
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.,Section for Pharmacology, Department of Clinical Science, University of Bergen, Bergen, Norway
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Şimşek Z, Yentur Doni N, Gül Hilali N, Yildirimkaya G. A community-based survey on Syrian refugee women's health and its predictors in Şanliurfa, Turkey. Women Health 2017; 58:617-631. [PMID: 28430082 DOI: 10.1080/03630242.2017.1321609] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Reproductive characteristics, mental health symptoms, micronutrient deficiencies, and symptoms of sexually transmitted infections (STIs) were determined among married Syrian refugee women aged 15-49 years who were living outside of camps in 2015, using probability sampling. Of the 458 participants, 51.3 percent married before the age of 18 years. Early-age marriages and number of desired children increased after the war. In multivariable analyses, education (adjusted odds ratio [aOR] = 1.2; 95% confidence interval [CI] = 1.2-1.3) and length of stay in Şanlıurfa (aOR = 1.2; 95% CI = 1.1-1.2) were independently associated with early marriage. Approximately 16 percent of women were pregnant, and 26.7 percent of them had not received prenatal care; 47.7 percent had had a pregnancy loss; 50.8 percent reported symptoms of STIs. Of those who were sexually active, 37.8 percent were not using contraception. The prevalence of iron, B12, and folic acid deficiencies was 50 percent, 45.6 percent, and 10.5 percent, respectively. Early marriage (aOR = 2.2; 95% CI = 1.4-3.5) and number of desired children (aOR = 5.03; 95% CI = 3.2-7.9) were associated with not using contraception. Most (89.7 percent) women reported at least two mental health symptoms; lack of social support (aOR = 2.6; 95% CI = 1.3-5.3), language barrier (aOR = 2.3; 95% CI = 1.01-5.2), and B12 deficiency (aOR = 1.8; 95% CI = 1.01-3.4) were associated with such symptoms. The findings demonstrate the need for reproductive health and psychosocial services.
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Affiliation(s)
- Zeynep Şimşek
- a Public Health Department, Faculty of Medicine , Harran University , Şanliurfa , Turkey
| | | | - Nese Gül Hilali
- c Gynecology Department, Faculty of Medicine , Harran University , Şanliurfa , Turkey
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Ugah UI, Alo MN, Owolabi JO, Okata-Nwali OD, Ekejindu IM, Ibeh N, Elom MO. Evaluation of the utility value of three diagnostic methods in the detection of malaria parasites in endemic area. Malar J 2017; 16:189. [PMID: 28477621 PMCID: PMC5420404 DOI: 10.1186/s12936-017-1838-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/26/2017] [Indexed: 11/16/2022] Open
Abstract
Background Malaria is a debilitating disease with high morbidity and mortality in Africa, commonly caused by different species of the genus Plasmodium in humans. Misdiagnosis is a major challenge in endemic areas because of other disease complications and technical expertise of the medical laboratory staff. Microscopic method using Giemsa-stained blood film has been the mainstay of diagnosis of malaria. However, since 1993 when rapid diagnostic test (RDT) kits were introduced, they have proved to be effective in the diagnosis of malaria. This study was aimed at comparing the accuracy of microscopy and RDTs in the diagnosis of malaria using nested PCR as the reference standard. Four hundred and twenty (420) venous blood specimens were collected from patients attending different General Hospitals in Ebonyi State with clinical symptoms of malaria. The samples were tested with Giemsa-stained microscopy and three RDTs. Fifty specimens were randomly selected for molecular analysis. Results Using different diagnostic methods, the prevalence of malaria among the subjects studied was 25.95% as detected by microscopy, prevalence found among the RDTs was 22.90, 15.20 and 54.80% for Carestart, SD Bioline PF and SD Bioline PF/PV, respectively. Molecular assay yielded a prevalence of 32%. The major specie identified was Plasmodium falciparum; there was co-infection of P. falciparum with Plasmodium malariae and Plasmodium ovale. The sensitivity and specificity of microscopy was 50.00 and 70.59% while that of the RDTs were (25.00 and 85.29%), (25.00 and 94.12%) and (68.75 and 52.94%) for Carestart, SD Bioline PF and SD Bioline PF/PV, respectively. Cohen’s kappa coefficient was used to measure the level of agreement of the methods with nested PCR. Microscopy showed a moderate measure of agreement (k = 0.491), Carestart showed a good measure of agreement (k = 0.611), SD Bioline PF showed a fair measure of agreement (k = 0.226) while SD Bioline PF/PV showed a poor measure of agreement (k = 0.172). Conclusions This study recommends that the policy of malaria diagnosis be changed such that the routine diagnosis of malaria is done by a combination of both microscopy and a RDT kit of high sensitivity and specificity so as to complement the errors associated with either of the methods. The finding of P. ovale in the study area necessitates an expanded molecular epidemiology of malaria within the study area.
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Affiliation(s)
- Uchenna Iyioku Ugah
- Department of Microbiology, Faculty of Science, Federal University Ndufu-Alike Ikwo, PMB 1010, Abakaliki, Ebonyi State, Nigeria.
| | - Moses Nnaemeka Alo
- Department of Microbiology, Faculty of Science, Federal University Ndufu-Alike Ikwo, PMB 1010, Abakaliki, Ebonyi State, Nigeria
| | - Jacob Oluwabusuyi Owolabi
- Department of Microbiology, Faculty of Science, Federal University Ndufu-Alike Ikwo, PMB 1010, Abakaliki, Ebonyi State, Nigeria
| | - Oluchi DivineGift Okata-Nwali
- Department of Microbiology, Faculty of Science, Federal University Ndufu-Alike Ikwo, PMB 1010, Abakaliki, Ebonyi State, Nigeria
| | - Ifeoma Mercy Ekejindu
- Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Nancy Ibeh
- Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Michael Okpara Elom
- Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, Ebonyi State University, Abakaliki, Nigeria
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Kaplan I, Stolk Y, Valibhoy M, Tucker A, Baker J. Cognitive assessment of refugee children: Effects of trauma and new language acquisition. Transcult Psychiatry 2016; 53:81-109. [PMID: 26563891 DOI: 10.1177/1363461515612933] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Each year, approximately 60,000 children of refugee background are resettled in Western countries. This paper reviews the effects of the refugee experience on cognitive functioning. The distinctive influences for these children include exposure to traumatic events and the need to acquire a new language, factors that need to be considered to avoid overdiagnosis of learning disorders and inappropriate educational placements. Prearrival trauma, psychological sequelae of traumatic events, developmental impact of trauma, and the quality of family functioning have been found to influence cognitive functioning, learning, and academic performance. In addition, the refugee child may be semiproficient in several languages, but proficient in none, whilst also trying to learn a new language. The influence that the child's limited English proficiency, literacy, and school experience may have on academic and test performance is demonstrated by drawing on the research on refugees' English language acquisition, as well as the more extensive literature on bilingual English language learners. Implications for interventions are drawn at the level of government policy, schools, and the individual. The paper concludes with the observation that there is a major need for longitudinal research on refugee children's learning and academic performance and on interventions that will close the academic gap, thereby enabling refugee children to reach their educational potential.
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Affiliation(s)
- Ida Kaplan
- Victorian Foundation for Survivors of Torture, Australia
| | | | | | - Alan Tucker
- La Trobe University, AustraliaVictoria University, Australia
| | - Judy Baker
- Victoria State Government Department of Education and Training, Australia
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Rohani M, Noohi N, Talebi M, Katouli M, Pourshafie MR. Highly Heterogeneous Probiotic Lactobacillus Species in Healthy Iranians with Low Functional Activities. PLoS One 2015; 10:e0144467. [PMID: 26645292 PMCID: PMC4672925 DOI: 10.1371/journal.pone.0144467] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/18/2015] [Indexed: 12/21/2022] Open
Abstract
Background Lactic acid bacteria (LAB) have been considered as potentially probiotic organisms due to their potential human health properties. This study aimed to evaluate both in vitro and in vivo, the potential probiotic properties of Lactobacillus species isolated from fecal samples of healthy humans in Iran. Methods and Results A total of 470 LAB were initially isolated from 53 healthy individual and characterized to species level. Of these, 88 (86%) were Lactobacillus species. Biochemical and genetic fingerprinting with Phene-Plate system (PhP-LB) and RAPD-PCR showed that the isolates were highly diverse consisted of 67(76.1%) and 75 (85.2%) single types (STs) and a diversity indices of 0.994 and 0.997, respectively. These strains were tested for production of adhesion to Caco-2 cells, antibacterial activity, production of B12, anti-proliferative effect and interleukin-8 induction on gut epithelial cell lines and antibiotic resistance against 9 commonly used antibiotics. Strains showing the characteristics consistent with probiotic strains, were further tested for their anti-inflammatory effect in mouse colitis model. Only one L. brevis; one L. rhamnosus and two L. plantarum were shown to have significant probiotic properties. These strains showed shortening the length of colon compared to dextran sulfate sodium and disease activity index (DAI) was also significantly reduced in mouse. Conclusion Low number of LAB with potential probiotic activity as well as high diversity of lactobacilli species was evident in Iranian population. It also suggest that specific strains of L. plantarum, L. brevis and L. rhamnosus with anti-inflammatory effect in mouse model of colitis could be used as a potential probiotic candidate in inflammatory bowel disease to decrease the disease activity index.
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Affiliation(s)
- Mahdi Rohani
- Department of Microbiology, Pasteur Institute of Iran, Tehran, Iran
| | - Nasrin Noohi
- Department of Microbiology, Pasteur Institute of Iran, Tehran, Iran
| | - Malihe Talebi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Katouli
- Genecology Research Centre, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
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Yun K, Matheson J, Payton C, Scott KC, Stone BL, Song L, Stauffer WM, Urban K, Young J, Mamo B. Health Profiles of Newly Arrived Refugee Children in the United States, 2006-2012. Am J Public Health 2015; 106:128-35. [PMID: 26562126 DOI: 10.2105/ajph.2015.302873] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We conducted a large-scale study of newly arrived refugee children in the United States with data from 2006 to 2012 domestic medical examinations in 4 sites: Colorado; Minnesota; Philadelphia, Pennsylvania; and Washington State. METHODS Blood lead level, anemia, hepatitis B virus (HBV) infection, tuberculosis infection or disease, and Strongyloides seropositivity data were available for 8148 refugee children (aged < 19 years) from Bhutan, Burma, Democratic Republic of Congo, Ethiopia, Iraq, and Somalia. RESULTS We identified distinct health profiles for each country of origin, as well as for Burmese children who arrived in the United States from Thailand compared with Burmese children who arrived from Malaysia. Hepatitis B was more prevalent among male children than female children and among children aged 5 years and older. The odds of HBV, tuberculosis, and Strongyloides decreased over the study period. CONCLUSIONS Medical screening remains an important part of health care for newly arrived refugee children in the United States, and disease risk varies by population.
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Affiliation(s)
- Katherine Yun
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Jasmine Matheson
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Colleen Payton
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Kevin C Scott
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Barbara L Stone
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Lihai Song
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - William M Stauffer
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Kailey Urban
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Janine Young
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Blain Mamo
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
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Scott KC, Taylor EM, Mamo B, Herr ND, Cronkright PJ, Yun K, Altshuler M, Shetty S. Hepatitis B screening and prevalence among resettled refugees - United States, 2006-2011. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2015; 64:570-3. [PMID: 26042647 PMCID: PMC4584767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Globally, more than two billion persons have been infected at some time with the hepatitis B virus (HBV), and approximately 3.5 million refugees have chronic HBV infection. The endemicity of HBV varies by region. Because chronic hepatitis B is infectious and persons with chronic infection benefit from treatment, CDC recommends screening for HBV among all refugees who originate in countries where the prevalence of hepatitis B surface antigen (HBsAg; a marker for acute or chronic infection) is ≥2% or who are at risk for HBV because of personal characteristics such as injection drug use or household contact with an individual with HBV infection. Currently, almost all refugees are routinely screened for hepatitis B. However, prevalence rates of HBV infection in refugee populations recently resettled in the United States have not been determined. A multisite, retrospective study was performed to evaluate the prevalence of past HBV infection, current infection, and immunity among refugees resettled in the United States; to better characterize the burden of hepatitis B in this population; and to inform screening recommendations. The study incorporated surveillance data from a large state refugee health program and chart reviews from three U.S. sites that conduct medical screenings of refugees. The prevalence of HBV infection (current or past as determined by available titer levels) varied among refugees originating in different countries and was higher among Burmese refugees than among refugees from Bhutan or Iraq. Current or past HBV infection was also higher among adults (aged >18 years) and male refugees. These data might help inform planning by states and resettlement agencies, as well as screening decisions by health care providers.
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Affiliation(s)
- Kevin C. Scott
- Thomas Jefferson University, Philadelphia, Pennsylvania,Corresponding author: Kevin C. Scott, , 617-233-4269
| | - Eboni M. Taylor
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Blain Mamo
- Minnesota Department of Health, St. Paul, Minnesota
| | | | | | - Katherine Yun
- The Children’s Hospital of Philadelphia, Pennsylvania
| | | | - Sharmila Shetty
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
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Dang S, Yan H, Zeng L, Wang Q, Li Q, Xiao S, Fan X. The status of vitamin B12 and folate among Chinese women: a population-based cross-sectional study in northwest China. PLoS One 2014; 9:e112586. [PMID: 25390898 PMCID: PMC4229226 DOI: 10.1371/journal.pone.0112586] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 10/08/2014] [Indexed: 01/08/2023] Open
Abstract
Objective To assess the status of the vitamin B12 and folate of Chinese women living in northwest China. Methods A population-based cross-sectional study was conducted in 2008 among Chinese women aged 10–49 years living in Shaanxi province of northwest China. A stratified multistage random sampling method was adopted to obtain a sample of 1170 women. The women were interviewed for collection of their background information and their plasma vitamin B12 and folate were measured with the immunoassay method. The status of both vitamins was evaluated and the prevalence of deficiency was estimated. Results The median value of the women was 214.5 pg/mL for vitamin B12 and 4.6 ng/mL for folate. The urban women had a significantly higher vitamin B12 (254.1 vs. 195.9 pg/mL) but lower folate (4.4 vs. 4.7 ng/mL) than rural women. Total prevalence of deficiency was 45.5% (95% CI: 42.6%∼48.4%) for vitamin B12 and 14.7% (95% CI: 12.6%∼16.8%) for folate. About 36% of women presented vitamin B12 deficiency alone, 5.2% belonged to folate deficiency alone and 9.5% was combined deficiency in both vitamins. More than 25% of the women were in marginal vitamin B12 status (200–299 pg/mL) and 60% in marginal status of folate (3–6 ng/mL). About 75.2% of rural women with folate deficiency were deficient in vitamin B12 and 46% for urban women. Quantile regression model found decreasing coefficient of folate status across 73 different quantiles of vitamin B12, which indicated that the women with folate deficiency had lower vitamin B12 significantly compared with those with no deficiency. Conclusions The deficiency of vitamin B12 and folate is still prevalent among the Chinese women in northwest China. Vitamin B12 deficiency could be more serious and the improvement of poor vitamin B12 status should be invoked when practicing the supplementation of folate against the neural tube defects in northwest China.
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Affiliation(s)
- Shaonong Dang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Hong Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
- * E-mail:
| | - Lingxia Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Quanli Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Qiang Li
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Shengbin Xiao
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Xiaojing Fan
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
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Myanmarese Neuropathy: Clinical Description of Acute Peripheral Neuropathy Detected among Myanmarese Refugees in Malaysia. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:187823. [PMID: 27350989 PMCID: PMC4897496 DOI: 10.1155/2014/187823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/29/2014] [Accepted: 08/04/2014] [Indexed: 01/28/2023]
Abstract
Background. Since 2008, we have observed an increasing number of Myanmarese refugees in Malaysia being admitted for acute/subacute onset peripheral neuropathy. Most of them had a preceding history of starvation. Methods. We retrospectively studied the clinical features of all Myanmarese patients admitted with peripheral neuropathy from September 2008 to January 2014. Results. A total of 24 patients from the Chin, Rohingya, and Rakhine ethnicities (mean age, 23.8 years; male, 96%) had symmetrical, ascending areflexic weakness with at least one additional presenting symptom of fever, lower limb swelling, vomiting, abdominal pain, or difficulty in breathing. Twenty (83.3%) had sensory symptoms. Ten (41.6%) had cranial nerve involvement. Nineteen patients had cerebrospinal fluid examinations but none with evidence of albuminocytological dissociation. Neurophysiological assessment revealed axonal polyneuropathy, predominantly a motor-sensory subtype. Folate and vitamin B12 deficiencies were detected in 31.5% of them. These findings suggested the presence of a polyneuropathy related to nutrition against a backdrop of other possible environmental factors such as infections, metabolic disorders, or exposure to unknown toxin. Supportive treatment with appropriate vitamins supplementation improved functional outcome in most patients. Conclusion. We report a spectrum of acquired reversible neurological manifestations among Myanmarese refugees likely to be multifactorial with micronutrient deficiencies playing an important role in the pathogenesis.
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Sanati Pour M, Kumble S, Hanieh S, Biggs BA. Prevalence of dyslipidaemia and micronutrient deficiencies among newly arrived Afghan refugees in rural Australia: a cross-sectional study. BMC Public Health 2014; 14:896. [PMID: 25175525 PMCID: PMC4164708 DOI: 10.1186/1471-2458-14-896] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/26/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Afghanistan is the 15th least developed country in the world, with poor sanitation and high rates of infectious diseases and malnutrition. However, little is known about the health of young Afghan refugees resettling in Western countries. METHODS We used a cross-sectional study design to examine the health profile of newly arrived Afghan refugees presenting to a General Practice between 20th April 2010 and 22nd March 2013 in rural Australia. Data collected included information on nutritional status and prevalence of infectious diseases. Challenges associated with health screening in a General Practice setting in this population were also documented. RESULTS Data were available on 92 patients. Mean age of presentation was 22.6 years [SD 11.9], and the majority of patients were male (88%). Mean total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride concentrations were 4.4 mmol/L (95% CI, 2.9-7.3), 2.6 mmol/L (95% CI, 1.3-4.4), 1.24 mmol/L (95% CI, 0.7-2.0) and 1.19 mmol/L (95% CI, 0.4-4.7) respectively, and dyslipidaemia (defined as elevated total or low-density lipoprotein (LDL) cholesterol levels, or low levels of high-density lipoprotein (HDL) cholesterol) was seen in 27.5% of patients. There was also a high prevalence of vitamin D and B12 deficiency (50% and 18%, respectively) in this cohort. Issues that impacted on provision and access to health care for refugees included cost, language barriers, patient mobility and mental health issues. CONCLUSIONS Dyslipidaemia and micronutrient deficiencies are significant health issues in young recently settled Afghan refugees, and routine screening should be considered for this population.
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Affiliation(s)
| | | | | | - Beverley-Ann Biggs
- University of Melbourne, Melbourne Academic Centre, at the Peter Doherty Institute for Infection and Immunity, Melbourne 3010, Victoria, Australia.
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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.
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