Assessment of the effectiveness of a small quantity lipid-based nutrient supplement on reducing anaemia and stunting in refugee populations in the Horn of Africa: Secondary data analysis

Abstract

Stunting and micronutrient malnutrition are persistent public health problems in refugee populations. UNHCR and its partner organisations implement blanket supplementary feeding programmes using a range of special nutritional products as one approach to address these issues. The evidence base for the efficacy and effectiveness of a small quantity lipid-based nutrient supplement, Nutributter®, in reducing stunting and anaemia is limited. Secondary data analysis was used to assess the effectiveness of Nutributter® distribution on anaemia and stunting in children aged 6–23 months (programme target group) and 6–59 months (the standard age group sampled in routine nutrition surveys). Analysis was conducted using routine pre and post-intervention cross-sectional nutrition survey data collected between 2008–2011 in five refugee camps in Kenya and Djibouti. Changes in total anaemia (Haemoglobin<110g/L), anaemia categories (mild, moderate and severe), and stunting (height-for-age z-score <-2) were explored using available data on the Nutributter® programme and contextual factors. A significant reduction in the prevalence of anaemia in children aged 6–23 months and 6–59 months was seen in four of five, and in all five camps, respectively (p<0.05). Reductions ranged from 12.4 to 23.0, and 18.3 to 29.3 percentage points in each age group. Improvements were largely due to reductions in moderate and severe anaemia and occurred where the prevalence of acute malnutrition was stable or increasing. No change in stunting was observed in four of five camps. The replicability of findings across five sites strongly suggests that Nutributter® distribution was associated with a reduction in anaemia, but not stunting, among refugee children in the Horn of Africa. Benefits were not restricted to the 6–23 month target group targeted by the nutrition programme. However, even following this intervention anaemia remained a serious public health problem and additional work to define and evaluate an effective intervention package is warranted.

The prevalence of stunting among children and adolescents living in the Middle East and North Africa region (MENA): A systematic review and meta-analysis

“…Of the 58 studies included in the systematic review, according to the Development Human Index, 24 (41.4%) were conducted in regions with very high development human index (Bahrain, Emirates, Kuwait, Oman, Qatar, Saudi Arabia) or high development human index (Egypt, Iran, Jordan, Lebanon, Libya, Tunisia, Algeria) [ 13 , 21 , 23 , 25 , 28 , 32 , 33 , 35 , 36 , 44 , 46 - 49 , 53 , 55 , 59 , 60 , 62 , 64 , 65 , 68 ], 21 (36.2%) were conducted in regions with a medium development human index (Iraq, Morocco, Pakistan, Palestine) [ 14 , 17 - 20 , 26 , 29 , 31 , 34 , 37 , 38 , 42 , 43 , 51 , 52 , 54 , 56 , 58 , 63 , 67 , 70 ], and 13 (22.4%) were conducted in regions with a low development human index (Afghanistan, Djibouti, Sudan, Syria, Yemen, Somalia) [ 15 , 16 , 22 , 27 , 30 , 39 - 41 , 45 , 50 , 57 , 61 , 66 ].…”

“…Of the 58 observational studies included in the systematic review, eight (13.8%) were conducted in countries involved in a civil war [ 15 , 29 , 30 , 39 , 40 , 45 , 50 , 61 ], 42 (72.4%) were reported from both urban and rural areas, 8 (13.8%) were conducted in urban areas only [ 14 , 24 , 26 , 35 , 36 , 53 , 62 , 67 ], and 8 (13.8%) in rural areas only [ 18 , 32 , 37 , 39 , 42 , 43 , 66 , 70 ]. Also, 7 (12.1%) studies involved refugees [ 15 , 16 , 20 , 22 , 27 , 34 , 65 ].…”

Okra (Abelmoschus esculentus) in a refugee context in East Africa: Kitchen gardening helps with mineral provision

“…Being anemic in young age, whether it is from iron deficiency, or parasitic infections, can have negative health consequences in both the short and long runs [118][119][120]. In another cross-sectional study in children residing in Kakuma refugee settlement in northern Kenya, the overall prevalence of anemia ranged between 44 and 77.1% [122]. On the other hand, Gemede et al [34] revealed that there are some accessions with high Fe contents among locally cultivated varieties in western Ethiopia.…”

Forced international migration for refugee food: a scoping review

“…In A18 the effectiveness of introducing a small lipid-based supplement to reduce anemia in refugee children from 0 to 59 months of age, not altering the state of dwarfism or acute malnutrition of this population, living in camps in the Horn of Africa. Noting that despite the efforts with fortification and supplementation programs, in addition to food basket donations, to alleviate food and nutritional deficits in refugee camps, malnutrition and macro and micronutrient deficiencies are still perennial 29 .…”