Food Insecurity and the Double Burden of Malnutrition of Indigenous Refugee Épera Siapidara

Triple burden of malnutrition among mother-child pairs in low-income and middle-income countries: a cross-sectional study

OBJECTIVE

This study aimed to assess the prevalence and determinants of the triple burden of malnutrition among mother-child pairs in low-income and middle-income countries.

DESIGN

Cross-sectional study.

SETTING

Low-income and middle-income countries.

PARTICIPANTS

Women and children.

PRIMARY OUTCOME

Triple burden of malnutrition (overweight/obese mother with undernourished and anaemic under 5 years child).

METHODS

Data for this study were drawn from recent 22 low-income and middle-income countries Demographic and Health Surveys. A total weighted sample of 116 795 mother-child pairs was included in the study. STATA V.14.2 was used to clean, code and analyse the data. Multilevel logistic regression was employed to identify factors associated with the problem. Adjusted OR (AOR) with 95% CI and a p<0.05 was reported to indicate statistical association. Model fitness and comparison were done using intraclass correlation coefficient, median OR, proportional change in variance and deviance.

RESULT

The pooled prevalence of the triple burden of malnutrition among mother-child pairs was 11.39%. It showed statistically significant positive associations with mothers aged ≥35 years (AOR 2.25, 95% CI 2.08 to 2.44), family size >10 (AOR 1.17, 95% CI 1.08 to 1.26), delivery by caesarean section (AOR 1.93, 95% CI 1.83 to 2.03), the richest household (AOR 1.72, 95% CI 1.56 to 1.88), grand multiparous (AOR 1.62, 95% CI 1.46 to 1.81), age of child 36-47 months (AOR 1.77, 95% CI 1.64 to 1.90), at a p<0.05. Whereas breast feeding (AOR 0.94, 95% CI 0.89 to 0.99), married mothers (AOR 0.87, 95% CI 0.78 to 0.96), female children (AOR 0.88, 95% CI 0.84 to 0.92), improved toilet (AOR 0.23, 95% CI 0.17 to 0.29), improved source of drinking water (AOR 0.28, 95% CI 0.21 to 0.35), rural residents (AOR 0.66, 95% CI 0.62 to 0.69) had a contrasting relationship with the triple burden of malnutrition.

CONCLUSION

About 1 out of 10 households suffer from the triple burden of malnutrition in low-income and middle-income countries. This study revealed that several maternal, child, household and community-level factors have a significant impact on the triple burden of malnutrition among mother-child pairs.

Food insecurity and its association with mental health among Syrian refugees resettled in Norway: a cross-sectional study

Background

Refugees are at a higher risk of food insecurity than the general population in high-income resettling countries. Simultaneously, the prevalence rates of mental ill health among refugees surpasses the general population in receiving countries both in high- and low-income settings. This study aims to estimate the prevalence of food insecurity and to study the association between food insecurity and mental health among Syrian refugees resettled in Norway.

Methods

As part of the CHART study (Changing Health and health care needs Along the Syrian Refugees' Trajectories to Norway), 353 Syrian refugees resettled in Norway for approximately one year participated in a structured telephone survey. We assessed food insecurity with the Household Food Security Survey Module (HFSSM) and mental health (symptoms of anxiety and depression) with the Hopkins Symptom Checklist (HSCL-10). We used descriptive statistics to estimate food insecurity overall, and among women, men, and children separately. The association between food insecurity and mental health symptoms was studied using logistic regression.

Results

One year after resettlement in Norway food insecurity was reported among 22% of adult Syrian refugees and 24% of their children. The most frequently reported problems were that food did not last or that they skipped meals often or sometimes (approximately 15% for each parameter). Respondents also worried that food would run out before they got money to buy more (15%), had not been eating balanced food in the past 12 months (9%), and had been eating less than before (7%). A few participants reported that they had not been eating for a whole day (5%), had been hungry (4%), or had lost weight during the last year (3%). Most of the women did not report any food insecurity among children in their households (76%), some reported that their children were moderate food insecure (13%), and a few that their children were severely food insecure (10%). Among adults, mental ill health was significantly associated with severe food insecurity (odds ratio (OR) 6.6, 95% confidence interval (CI) 2.1-20.5) but not with moderate food insecurity (OR 1.5, 95% CI 0.4-5.8).

Conclusion

Food insecurity among refugees and their children after resettlement to high-income countries should be acknowledged and systematically targeted. The association with mental health reinforces the need to consider food insecurity in public health strategies towards refugees.

Dietary Intake and Nutritional Status among Refugees in Host Countries: A Systematic Review

Refugees remain vulnerable to acute food insecurity, malnutrition, and critically inadequate food and nutrient intake after migration, regardless of the economic level of the host country. We conducted this systematic review to summarize and evaluate the dietary intake and nutritional status among refugees resettled in non-camp settings worldwide. We searched PubMed and Web of Science databases to review relevant studies published between 2009 and 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We also conducted an additional manual search through PubMed and Google Scholar. Studies that evaluated both dietary intake and nutritional status of refugees in host countries were included. A total of 15 articles from 10 countries were included and assessed for study quality and outcomes. Poor dietary diversity and insufficient intake of specific food groups were reported. In addition to these dietary patterns, a high prevalence of stunting, underweight, and anemia was reported, particularly among children. A double burden of malnutrition was also observed across and within studies. Post-resettlement dietary intake and nutritional status of refugees are both influenced by factors at the pre- and post-resettlement stages as refugees transition to their host countries. Those factors, including pre-resettlement experiences, host country resources, socioeconomic status, acculturation, and food security, were summarized and presented in a conceptual model. There is a need for comprehensive dietary and health screening as well as culturally appropriate and sustainable nutrition education resources and interventions for refugees to improve their diet and nutrition. Longitudinal studies and novel methodological approaches are also suggested to measure changes in refugees' food intake and nutritional status as well as to further investigate factors associated with these 2 components.

The "Double Burden of Malnutrition" in the Amazon: dietary change and drastic increases in obesity and anemia over 40 years among the Awajún

Undernutrition and overnutrition are interconnected. Yet few studies have examined the "double burden of malnutrition" (DBM) over time in indigenous communities. We investigated changes in the food systems and nutritional health of Awajún communities in the Peruvian Amazon in the 1970s and in 2013. Methods included ethnography, 24 hr food recalls, and biological measures. In 2013, the number of traditional foods consumed decreased to 10% of levels in the 1970s and the number of market foods consumed increased 40-fold. Rates of anemia and obesity were also substantially higher in 2013 compared to the 1970s (23% vs 6% for anemia and 30% vs. 0% for obesity) indicating a DBM has emerged. Examining the predictors of hemoglobin levels and body mass indices in the 2013 sample reveals that this DBM is differentially impacting women and that risk for obesity among the Awajún is associated with multiple proxies of market integration beyond just the consumption of market foods. These findings highlight the complex pathways by which rapid lifestyle changes are creating gendered health inequalities within indigenous communities over time.

The association of serum levels of zinc and vitamin D with wasting among Iranian pre-school children

PURPOSE

Wasting is a main indicator of Child's undernutrition that is associated with several non-communicable diseases and child mortality. This is the first population-based study which evaluated the association of serum zinc and vitamin D levels with wasting in a Middle East region. We also reported the prevalence of vitamin D and zinc deficiencies among Iranian pre-school children aged 6 years.

METHODS

This was a multicenter cross-sectional study that included 425 children aged between 5 and 7 years (on average 6 years) with BMI-for-age Z-scores of < - 1 SD resident in urban and rural areas of Iran in the spring of 2012 as part of the National Integrated Micronutrient Survey 2 (NIMS-2). Anthropometric measurements and blood sampling were obtained. The prevalence of vitamin D and zinc deficiencies together with the correlations of these variables with the increase of BMI-for-age Z-scores were evaluated.

RESULTS

The prevalence of vitamin D and zinc deficiencies was 18.8% and 12.7%, respectively. In addition, 31.1% of children were wasted. Children in the second tertile of 25(OH)D levels were less likely to have wasting compared with those in the first tertile in both crude and adjusted models (OR 0.47, 95% CI 0.27-0.83). A significant inverse association was found between serum levels of zinc and wasting (OR 0.57, 95% CI 0.34-0.96); such that after adjusting for confounders, children in the highest tertile of serum zinc had 47% less odds of wasting compared with those in the first tertile (OR 0.53, 95% CI 0.31-0.91).

CONCLUSION

The prevalence of vitamin D and zinc deficiencies among Iranian pre-school children aged 6 years was 18.8 and 12.7%, respectively. Serum levels of vitamin D and zinc were inversely associated with wasting either before or after controlling for confounders.

LEVEL OF EVIDENCE

Level III, case-control analytic studies.

Association Between Vitamin D Status and Undernutrition Indices in Children: A Systematic Review and Meta-Analysis of Observational Studies

Introduction: Undernutrition, defined as stunting, wasting, and underweight, still implicates millions of infants and children worldwide. Micronutrients have pivotal effects on growth rate. The outcomes of vitamin D deficiency on undernutrition indices have stayed controversial. The object of current study is to answer this question: is there any association between vitamin D status and undernutrition indices? Methods: The international databases were used for a systematic search to identify relevant observational studies in English up to January 2021. A random-effect model was applied to combine the results of included essays. Results: Among 3,400 citations, 7 observational studies (4 cohorts and 3 cross-sectional) were eligible to enter in meta-analysis. Analysis of the lowest 8,295 children indicated that low vs. high serum level of vitamin D is directly associated with a higher risk of wasting (Summary Risk Estimate: 1.30; 95% CI: 1.04, 1.62; I ² = 0%). However, there is no significant association between vitamin status and risk of stunting (Summary Risk Estimate: 1.10; 95% CI: 0.72, 1.70; I ² = 81.6%) and underweight (Summary Risk Estimate: 1.12; 95% CI: 0.81, 1.56; I ² = 49.2%). Conclusion: When comparing low and high serum vitamin D concentration categories, there is an inverse link between vitamin D status and wasting, but no relationship with stunting as well as underweight. However, further prospective and trial studies are required to deepen our understanding of these associations.

Caracterización de la alimentación del pueblo indígena Épera Siapidara en Ecuador

Las poblaciones indígenas y campesinas son los que más han sufrido las consecuencias del conflicto armado en Colombia. Tras un proceso de despojo de tierras y desplazamiento, el pueblo Épera Siapidara se asentó en Ecuador y se encuentra en una grave situación de inseguridad alimentaria. El objetivo de este estudio fue caracterizar la alimentación del pueblo Épera Siapidara en Ecuador. Tras la aplicación de 3 R24h a 111 Épera Siapidara, se seleccionaron las preparaciones más consumidas en base al número de apariciones. Las recetas (ingredientes y cantidades) fueron estandarizadas por 6 mujeres de la comunidad. Su composición nutricional se calculó con el software Nutriplato 2.0 y, para un tamaño medio de ración, se comparó con las recomendaciones de ingesta dietética (IDR). Se calculó la contribución de macronutrientes a la energía total de cada plato. Como resultado, 30 preparaciones y 3 guarniciones fueron seleccionadas (85,6% de los registros). El tamaño de ración medio fue 197,84g ± 7,54g (bebida), 225,04g ±50,53g (sopa), 79,89g ± 27,01g (plato principal) y 157,05g ±14,22g (guarnición). En relación al aporte a las IDR, destacan sopa de res y encocado de iguana (54% y 43% IDR proteína), tapado de carne de monte (25% IDR hierro) y sopa de verduras (99% y 89% IDR vitaminas A y C). Diseñar políticas públicas integrales que permitan potenciar las fortalezas de su sistema alimentario tradicional y atenuar riesgos asociados a la alimentación será clave para mejorar su seguridad alimentaria.