Impact of Food Rations and Supplements on Micronutrient Status by Trimester of Pregnancy: Cross-Sectional Studies in the Maela Refugee Camp in Thailand

Abstract

Micronutrient fortified flour (MFF), supplementary food rations and micronutrient (MN) supplements may prevent deficiencies among pregnant women. Objectives of cross-sectional surveys in 2004 (n = 533) and 2006 (n = 515) were to assess the impact of new food rations (flour, oil) and supplements on MN status by trimester of pregnancy in the Maela refugee camp. Hemoglobin, iron status, zinc, retinol, β-carotene and tryptophan decreased, while α-/γ-tocopherol and 5-methyltetrahydrofolate (5-MTHF) increased from first to third trimester. In 2006, mean zinc and α-tocopherol for each trimester was significantly higher than in 2004. The weeks of supplemented thiamine and folic acid were positively correlated with thiamine diphosphate (TDP) and 5-MTHF, but not for ferrous sulfate as iron deficiency was observed in 38.5% of third-trimester women. Frequent consumption of fish paste and owning a garden or animal were associated with significantly higher iron status, retinol, β-carotene, and 5-MTHF. In conclusion, MFF and supplementary oil were most likely to explain improved zinc and α-tocopherol status, while thiamine and folate supplements ensured high TDP and 5-MTHF in late pregnancy. MN supplements, MN-rich staple food, small gardens, and programs to improve iron compliance are promising strategies to prevent MN deficiencies during pregnancy in vulnerable populations.

Longer exposure to a new refugee food ration is associated with reduced prevalence of small for gestational age: results from 2 cross-sectional surveys on the Thailand-Myanmar border

“…Data from these 2 surveys with regard to micronutrient status, but not neonatal outcomes, have been published (16, 27, 28). The first survey took place in June 2004, 1 mo before adding whole-wheat MFF in the refugee food basket in July 2004 ( Figure 1 ).…”

Forced international migration for refugee food: a scoping review

“…This category covered 8 studies 17,[20][21][22][23]25,27,28 which presented aspects related to social, cultural, political and economic difficulties of access to food in refugee detention centers, refugee camps and in settlement destination countries.…”

“…In study A16, it points out the need of supplementation of minerals, such as iron, in refugee camps in Thailand and the consumption reduction of traditionally cultural foods such as betel nut, a characteristic seed of Asia. In addition, it is important to point out that the participants of the study were assisted by humanitarian food donation programs, and some families still reported the raising of animals such as poultry, pigs and goats, as a way to obtain food diversity 27 .…”

“…This category covered 8 studies 12,13,15,16,19,24,27,28 that presented scenarios of emerging diseases, such as food deficiencies and nutritional disorders in refugee populations.…”

“…Study A16 showed that the high prevalence of anemia and iron deficiency in pregnant women living in Campo Maele, and even after the use of supplementation strategies. It suggests that the persistence of deficiencies may be related to helminth infection or deficiencies of other micronutrients, in camps where hygiene conditions are precarious and several families share the same sanitary, and considering the extremely restrictive feeding, being in charge of the refugees to purchase vegetables and fruits, that is to say, depending on purchasing power 27 . 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.…”