Double burden of malnutrition among migrants and refugees in developed countries: A mixed-methods systematic review

Mental Health of Host and Refugee Youth in the Turkish Education System: The Role of Daily Material Stress, Well-Being, Social Support and Resilience

Refugee youth across the world cope with the complexity of fulfilling developmental tasks and cultural adaptation requirements while struggling with different stressors and problems. This situation has been pointed out in scientific studies that refugee youth are vulnerable in terms of mental health. However, refugees may differ in the severity of their mental health problems due to certain personal or interpersonal factors. To examine these factors, we linked mental health to psychological stress in a sample of Turkish and refugee youth. We discussed the potential roles of daily material stress, well-being, perceived social support and resilience among Turkish and refugee youth. 552 Turkish host youth and 500 refugee youth participated in the study. Questionnaires were prepared for Turkish and bilingual refugees, and Turkish youth participated in the study face-to-face. The findings revealed that the perception of well-being may have different meanings for refugees and Turkish youth: while refugees associate well-being with basic needs like nutrition and inclusion in education, Turkish youth often see systemic challenges in education as obstacles to well-being, which increases their stress levels. The study points to factors that need to be considered in explaining and protecting the mental health of refugees and Turkish youth involved in the Turkish education system.

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.

Nutritional Status of 8,128,014 Chilean and Immigrant Children and Adolescents Evaluated by the National Board of School Aid and Scholarships (JUNAEB) Between 2013 and 2023

INTRODUCTION

Nutritional issues, including overweight and obesity, along with the rising number of immigrants facing their own nutritional problems, continue to keep Chile on alert.

OBJECTIVE

To evaluate the epidemiological and nutritional status changes among Chilean and immigrant boys, girls, and adolescents (BGA) in schools evaluated by the National Board of School Aid and Scholarships (JUNAEB) from 2013 to 2023.

METHODS

This descriptive study analyzed individual, anonymous, and de-identified data on the nutritional status of BGA in pre-kindergarten, kindergarten, first grade, fifth grade, and the first year of high school using the JUNAEB Nutritional Map.

RESULTS

The sample consisted of 8,128,014 BGA, 49.2% women and 50.8% men. In 2013, immigrant BGA represented 0.4% of the total number of children evaluated, and by 2023, this percentage increased to 7.9%. It was observed that Chilean BGA had a lower proportion of thinness, risk of thinness, stunting, and normal weight, but a higher proportion of overnutrition compared to immigrants, similar to observations made during the COVID-19 pandemic. Comparisons by sex showed that Chilean and immigrant women had a lower percentage of thinness, risk of thinness, obesity, severe obesity, and stunting, and a higher proportion of normal weight when compared to men.

CONCLUSIONS

The rise in immigrant BGA within the Chilean school system, together with the nutritional differences between both groups, highlights the need to consider these particularities when designing nutritional public policies in the health and education sectors.

Improving nutrition for migrant children in Europe through policy: A scoping review

Nutrition research concerning migrant populations is abundant, with a surplus of prevalence data related to diverse aspects of malnutrition. However, there is a lack of studies on European country interventions. This gap is more pronounced when examining interventions specific to children. The challenges are clear, but the policy impetus for solving them is not. Examining European interventions on nutrition in refugee and asylum-seeking (RAS) children and families allows for an assessment of the unmet needs in the United Kingdom regarding migration, nutrition, child support, and food security. This scoping review followed the guidelines in the PRISMA Extension for Scoping Reviews, and 20 documents which covered a mixture of policy interventions were eligible. Meaningful comparisons can be made by assessing the interventions made in migrant nutrition from various European countries with varying political approaches to immigration. This creates a fuller picture of the policy landscape for paediatric migrant nutrition, and in due course, policy decisions can be taken. This scoping review found a lack of diversity in RAS nutrition policies across Europe and a lack of transparency in those in place, likely rooted in the challenging political landscape of increasing RAS populations in Europe. Improving nutrition interventions requires separating food and health from politics. No interventions focusing on the double burden of malnutrition were found. However, policies addressing the double burden in RAS children should be considered as they may be more politically palatable and financially beneficial to implement.

Assessment of the quality and content of clinical practice guidelines for vitamin D and for immigrants using the AGREE II instrument: global systematic review

BACKGROUND

Worldwide, more immigrants experience vitamin D (vitD) deficiency than non-immigrants. Recommendations in current clinical practice guidelines (CPGs) concerning vitD are inadequate to address vitD deficiency among immigrants, and there are concerns regarding the quality of guidance in these CPGs.

OBJECTIVES

This study aimed to identify and evaluate the quality of published CPGs addressing vitD and immigrants' health using the Appraisal of Guidelines for Research and Evaluation-II (AGREE II) tool and clarify the recommendations pertaining to vitD and immigrant populations in these CPGs.

METHODS

We performed a systematic search to identify the most recent CPGs across various databases (Ovid MEDLINE ALL, Embase and Turning Research Into Practice), guideline repositories and grey literature. Two reviewers independently conducted study selection and data abstraction and evaluated the quality of the included guidelines using the AGREE II tool.

RESULTS

We identified 25 relevant CPGs; 21 focused on vitD and 4 covered immigrants' health. Around one-quarter of the included CPGs were high quality (≥60% in at least four of the six domains, including 'rigour of development'). The highest mean scores among the six AGREE II domains were for 'clarity of presentation' and 'scope and purpose'. About 4.8% (1/21) of the CPGs on vitD had immigrant-related recommendations. VitD recommendations were emphasised in one out of the four immigrant health CPGs (25%). CPGs covering immigrants' health and vitD were inadequately systematically appraised. Moreover, recommendations regarding vitD were insufficient to address the growing epidemic of vitD deficiency among immigrant populations.

CONCLUSION

The insufficient recommendations for vitD fail to address the rising vitD deficiency among immigrants, highlighting a critical gap in healthcare provisions. Urgent national and international efforts are needed to develop comprehensive CPGs, bridging research, policy and practice disparities. Future guidelines must prioritise routine vitD screening, supplementation protocols for vulnerable immigrant groups, and culturally appropriate interventions to improve health outcomes for immigrants globally.

PROSPERO REGISTRATION NUMBER

CRD42021240562.

The effect of socioeconomic factors on malnutrition in Syrian children aged 0-6 years living in Turkey: a cross-sectional study

BACKGROUND

This study was conducted to examine the prevalence of malnutrition in Syrian immigrant children living in Turkey.

METHODS

The study was carried out in the city of Mardin, which is one of the cities with a high Syrian immigrant population in Turkey. Height, body weight and BMI values were recorded to determine the malnutrition status of the children. Z-scores of children were calculated using the malnutrition assessment WHOAntro program.

RESULTS

The data show that 30.5% of Syrian children between the ages of 0 and 6 months are male, making up 55.8% of the total, and that 55.3% do not follow a regular breakfast schedule. The percentages of body weight for height, height for age, and BMI for age of Syrian children with a score between - 2 and + 2 SD Number were (89.3%), (74.3%), and (79.3%), respectively. Girls are more likely than boys to experience stunting and low body weight in the context of Syrian children (Stunting OR: 0.855(0.761-1.403), Underweight OR: 0.705(0.609-1,208)). Additionally, there is a link between levels of stunting and underweight and elements like the mother's educational level and the family's income. Contrary to the situation of adequate nutrition, it was discovered that the likelihood of stunting and low body weight in children increased by 0.809 and 1.039 times, respectively, when access to an adequate food supply was not available within the family (p < 0.05).

CONCLUSION

s According to the results of the study, gender, family income, mother's education level and access to food affected the severity of malnutrition in children. Migration is an imporatnt factor affecting children's health. In this study malnutrition was found high im immigrant children. Programs should be developed to monitor the growth and development of disadvantaged children and to support their nutrition.

Prevalence and risk factors of food insecurity among Syrian refugees in Türkiye

BACKGROUND

Although Türkiye (Turkey) hosts the largest number of Syrian refugees, studies on food insecurity are limited. This study examined the prevalence and risk factors of food insecurity among Syrian refugees living in Istanbul, which has the highest number of refugees in Türkiye.

METHODS

A cross-sectional survey was conducted among Syrian refugees in Istanbul between September 2021 and March 2022. The main income earners of 103 households were interviewed by a research dietitian, with the assistance of an Arabic speaking interpreter through hour-long face-to-face. Data on sociodemographic characteristics (age, gender, nationality, marital status, educational status, the family income, the major source of family income, and the number of family members living in the household etc.) and household food insecurity status were collected. Household food insecurity status was assessed with the eighteen-item Household Food Security Survey Module.

RESULTS

The household food insecurity rate was 90.3%, and those of adults and children were 88.4% and 84.8%, respectively. It was observed that family income level was significantly associated with food insecurity. A one-unit increase in monthly income increased food security by 0.02 times (p < 0.001). The number of employed refugees in the food security group was higher than that in the food insecurity group (p = 0.018). A significant difference was found in the rate of occupation type of the major income earner between the groups (p = 0.046).

CONCLUSIONS

High rates of food insecurity, particularly severe food insecurity, were found among Syrian refugees living in Istanbul. While more research is warranted to explore the root causes and efficacy of the current support system, it requires the immediate attention of policymakers at the national and international levels to implement effective policies and interventions.

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.

Effects of Sociodemographic Factors on Access to and Outcomes in Congenital Heart Disease in the United States

Congenital heart defects (CHDs) are complex conditions affecting the heart and/or great vessels that are present at birth. These defects occur in approximately 9 in every 1000 live births. From diagnosis to intervention, care has dramatically improved over the last several decades. Patients with CHDs are now living well into adulthood. However, there are factors that have been associated with poor outcomes across the lifespan of these patients. These factors include sociodemographic and socioeconomic positions. This commentary examined the disparities and solutions within the evolution of CHD care in the United States.

Prevalence of stunting among under-five children in refugee and internally displaced communities: a systematic review and meta-analysis

Background

A pooled estimate of stunting prevalence in refugee and internally displaced under-five children can help quantify the problem and focus on the nutritional needs of these marginalized groups. We aimed to assess the pooled prevalence of stunting in refugees and internally displaced under-five children from different parts of the globe.

Methods

In this systematic review and meta-analysis, seven databases (Cochrane, EBSCOHost, EMBASE, ProQuest, PubMed, Scopus, and Web of Science) along with "preprint servers" were searched systematically from the earliest available date to 14 February 2023. Refugee and internally displaced (IDP) under-five children were included, and study quality was assessed using "National Heart, Lung, and Blood Institute (NHLBI)" tools.

Results

A total of 776 abstracts (PubMed = 208, Scopus = 192, Cochrane = 1, Web of Science = 27, Embase = 8, EBSCOHost = 123, ProQuest = 5, Google Scholar = 209, and Preprints = 3) were retrieved, duplicates removed, and screened, among which 30 studies were found eligible for qualitative and quantitative synthesis. The pooled prevalence of stunting was 26% [95% confidence interval (CI): 21-31]. Heterogeneity was high (I2 = 99%, p < 0.01). A subgroup analysis of the type of study subjects revealed a pooled stunting prevalence of 37% (95% CI: 23-53) in internally displaced populations and 22% (95% CI: 18-28) among refugee children. Based on geographical distribution, the stunting was 32% (95% CI: 24-40) in the African region, 34% (95% CI: 24-46) in the South-East Asian region, and 14% (95% CI: 11-19) in Eastern Mediterranean region.

Conclusion

The stunting rate is more in the internally displaced population than the refugee population and more in the South-East Asian and African regions. Our recommendation is to conduct further research to evaluate the determinants of undernutrition among under-five children of refugees and internally displaced populations from different regions so that international organizations and responsible stakeholders of that region can take effective remedial actions.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387156, PROSPERO [CRD42023387156].

The assessment of geriatric malnutrition, geriatric depression and associated co-morbidities among forcibly displaced Myanmar nationals in Bangladesh

OBJECTIVE

To assess the nutritional status and depression of the elderly forcibly displaced Myanmar nationals (FDMN) in Bangladesh and determine the associated factors of geriatric depression (GD).

DESIGN

This was a community-based, cross-sectional study among elderly FDMN. The Mini Nutritional Assessment Short-Form (MNA@-SF) and Geriatric Depression Scale Short-Form (GDS-15 SF) were used to determine malnutrition and GD, respectively.

SETTING

The study was conducted between November 2021 and March 2022 in Kutupalong Refugee Camp, Cox's Bazar, Bangladesh.

PARTICIPANTS

The study participants were elderly FDMN aged ≥ 60 years (n 430).

RESULTS

The mean age and BMI were 71·7(±7·8) years and 21·94(±2·6) kg/m2, respectively. There was a high prevalence of self-reported diabetes mellitus (32·1 %), hypertension (26·7 %), hypotension (20 %), skin diseases (28·4 %) and chronic obstructive pulmonary disease (16·5 %). The prevalence of malnutrition was 25·3 %, and another 29·1 % were at risk. The prevalence of GD was 57·9 %, and co-occurrences of GD and malnutrition were seen in 17·5 % of participants. GD was significantly higher among elderly people with malnutrition (adjusted OR, AOR = 1·71, 95 % CI: 1·01, 2·89). FDMN aged ≥ 80 years were at higher risk of GD (AOR = 1·84, 95 % CI: 1·01, 3·37), and having fewer than five members in the household was an independent predictor of GD. Diabetes mellitus (AOR = 1·95, 95 % CI: 1·24, 3·08) and hypotension (AOR = 2·17, 95 % CI: 1·25, 2·78) were also significantly associated with an increased risk of GD.

CONCLUSION

A high prevalence of GD and malnutrition was observed among elderly FDMN in Bangladesh. The agencies working in Cox's Bazar should focus on geriatric malnutrition and GD for the improvement of the health situation of FDMN in Bangladesh.