Nutritional and dietary diversity status of under-5 children and adolescent girls among forcibly displaced Myanmar nationals living in Bhasan Char relocation camp, Bangladesh: a cross-sectional survey

The hidden crisis: double burden of malnutrition among refugee children in South Asia - a systematic review and meta-analysis from observational studies

Background

Children living in refugee camps in South Asian countries suffer from undernutrition. However, the emerging prevalence of double burden of malnutrition could potentially cause a crisis in the healthcare of the refugee population. Double burden increases the risk for co-morbidities, poor functional health, and increased risk for premature death among these children. The study aims to assess the prevalence of malnutrition among refugee children in South Asia.

Methods

This systematic review and meta-analysis followed the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines using CoCoPop mnemonic approach. We searched JSTOR, Scopus, PubMed, Web of Science, and MEDLINE databases for studies on the prevalence of malnutrition in refugee children from 1984 to August 2024 with restricted English language. The screening of research articles was undertaken using COVIDENCE 2.0 software. The JBI checklist was used to assess the methodological quality of the included articles. The meta analysis was carried out using MedCalc 22.018 software. The gray literature was manually searched from the reputed organizations focusing on refugee children and was narratively analyzed for malnutrition statistics. Furthermore, the corroboration of primary research articles and gray literature was conducted for comprehensive understanding.

Results

The review included 10 full-text research articles, all with cross-sectional study design and 11 gray literatures. The 10 studies covered a total of 4,274 participants with 3,536 urban and 738 rural refugee children aged between 0 and 19 years [refugee children (n = 8) and refugee adolescents (n = 2)]. The sample size of the included studies varied between 58 and 1,087 and mostly from Bangladesh. The prevalence of stunting ranged from 3.9-75.4% in the included studies [pooled prevalence: 31.8% (95% CI: 18.6-46.6%)]; wasting between 0.3-24.3% [pooled prevalence:10.1% (95% CI: 4.6-17.3)]; underweight between 4.4-65% [pooled prevalence: 19.1% (95% CI: 10.8-29.2%)]; and overweight between 3 and 24% [pooled prevalence: 6.5% (95% CI: 2.6-12.1%)]. Time trend analysis of the prevalence of malnutrition showed a decreasing trend in underweight, an increasing trend for stunting and wasting, and overweight including a rising prevalence of dual burden of under-and overnutrition.

Discussion

The study indicates a high prevalence of undernutrition and a rising prevalence of overnutrition -the Asian paradox of the double burden of malnutrition in refugee children living in South Asia. The coexisting double burden of malnutrition among refugee children calls for comprehensive programs and policies for the prevention and management of the double burden of malnutrition.

Prevalence and influencing factors with knowledge, attitude, and practice toward anemia among school-going adolescent girls in rural Bangladesh

BACKGROUND

Anemia is a major public health concern; however, research on anemia and its contributing variables is scarce. To address the gap, we investigated the prevalence and associated factors of anemia in school-aged adolescent girls in rural Bangladesh.

METHODS

We conducted a cross-sectional study in two secondary schools at Chandpur, Bangladesh, from January to April 2022. We randomly selected 422 adolescent girls based on prevalence rates from existing research to ensure reliable estimates and a robust study representation. We performed interviews with a semi-structured questionnaire after receiving ethical permission and written informed consent. In addition, physical examination and anthropometric measurements were done, followed by blood testing to identify anemia. Blood hemoglobin was measured using a spectrophotometric method, and quality control was ensured by validated results with control samples. Univariate with multiple logistic regression was employed for analysis to find the association between anemia and all other variables that were adjusted to control the potential effect of confounding variables.

RESULTS

The overall prevalence of anemia was 37.7% (mild- 33.8% and moderate- 3.9%). In the univariate analysis having a working mother (OR 3.84; 95% CI 1.31-11.26), undernutrition (OR 2.40; 95% CI 1.27-4.52), and irregular lunch consumption (OR 2.15; 95% CI 1.00-4.60) were associated with anemia. Conversely, being a user of a slab latrine (OR 0.61; 95% CI 0.40-0.93) and not weekly consumption of pure milk (OR 0.62; 95% CI 0.41-0.92) were negatively associated with anemia. In multivariate logistic regression analysis, associated factors for prevalent anemia were working mother [adjusted odds ratio (aOR) 7.65; 95% CI 1.97-29.50], slab latrine user (aOR 0.46; 95% CI 0.26-0.79), and irregular lunch consumption (aOR 2.92; 95% CI 1.21-7.03).

CONCLUSION

The prevalence of anemia among adolescent girls in rural Bangladesh remains high with undernutrition. Anemia is associated with working mothers, slab latrine users, and irregular lunch consumers within the studied population.' Thus, policymakers may promote school-based nutritional education and lunch programs with iron supplementation and improve sanitary facilities.

Prevalence of undernutrition among migrant, refugee, internally displaced children and children of migrated parents in lower-middle-income countries: A meta-analysis of published studies from last twelve years

BACKGROUND AND AIMS

This review aims to estimate the prevalence of undernutrition among migrants, refugees, internally displaced children, and children of migrated parents living in lower-middle-income countries.

METHODS

PubMed, Scopus, Science-Direct, CINAHL-Plus, & Google Scholar were searched for peer-reviewed evidence published between January 2010 to March 2023. Two researchers independently examined the studies and retrieved the data. The internal and external validity of the studies was assessed using the NIH quality assessment tool, and a checklist adapted from Downs & Black, Bracht & Glass, and Del Siegle's guidelines. A random effect model was chosen to pool the estimates. Subgroup analysis, Meta-regression, and sensitivity analysis were done to explore the source of heterogeneity and the robustness of estimates.

RESULTS

Among the 1978 records initially searched, 21 studies were selected for analysis. The pooled prevalence estimates for stunting, wasting, and underweight were estimated to be 29.39% (Confidence Interval [CI] 21.69-37.73; I2 99%; p < 0.01), 12.76% (CI 7.84-18.68; I2 99%; P < 0.01), and 24.05% (CI 16.17-32.94; I2 100%; p < 0.001) respectively. Among different WHO regions, all three undernutrition estimates were higher in LMICs belonging to the Southeast Asian region (Stunting 37.62%; wasting 14.28% and underweight 31.24%). Undernutrition among migrant Indian children was 43.55%, 18.71%, and 37.45% respectively. High heterogeneity was noted across all estimates with I2-value >90%. Sensitivity analysis across indicators showed the stability of our estimates.

CONCLUSIONS

The extent of undernutrition, particularly wasting was high among migrant/refugee children living in lower-middle-income countries. Measures should be taken to strengthen the government-subsidized public food distribution system, increase healthcare outreach, and ensure public health insurance coverage among the migrant population.