Anaemia, iron status and vitamin A deficiency among adolescent refugees in Kenya and Nepal

Woodruff, Bradley A.; Blanck, Heidi M.; Slutsker, Laurence; Cookson, Susan T.; Larson, Mary Kay; Duffield, A; Bhatia, Rita

doi:10.1079/phn2005825

Cited by 40 publications

(33 citation statements)

References 21 publications

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“…Both the prevalences observed in our study and in the US are below the cutoff established by WHO to determine ‘no prevalence' of ID, that is, 10% (WHO, 2004). Both are also far lower than that observed in other parts of the world as in Nepal, with an ID prevalence of 56% observed in adolescents girls (Woodruff et al , 2006). The slightly lower prevalence in our study may, in part, result from a different approach to define ID.…”

Section: Discussionmentioning

confidence: 62%

“…Abnormal values for iron indicators were defined as concentration <15 μg/l for low SF (WHO, 2004), >200 μg/l and >150 μg/l (boys and girls, respectively) for high SF (WHO, 2004; severe risk of iron overload) and >8.5 mg/l for high sTfR (Cook et al , 1993). A participant was considered to have active inflammation, if the CRP concentration exceeded 5 mg/l (Woodruff et al , 2006). The methodology to classify the iron status is described in Table 1.…”

Section: Methodsmentioning

confidence: 99%

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Evaluation of iron status in European adolescents through biochemical iron indicators: the HELENA Study

et al. 2011

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Background/Objectives:To assess the iron status among European adolescents through selected biochemical parameters in a cross-sectional study performed in 10 European cities.Subjects/Methods:Iron status was defined utilising biochemical indicators. Iron depletion was defined as low serum ferritin (SF<15 μg/l). Iron deficiency (ID) was defined as high-soluble transferrin receptor (sTfR>8.5 mg/l) plus iron depletion. Iron deficiency anaemia (IDA) was defined as ID with haemoglobin (Hb) below the WHO cutoff for age and sex: 12.0 g/dl for girls and for boys aged 12.5–14.99 years and 13.0 g/dl for boys aged ⩾15 years. Enzyme linked immunosorbent assay was used as analytical method for SF, sTfR and C-reactive protein (CRP). Subjects with indication of inflammation (CRP >5 mg/l) were excluded from the analyses. A total of 940 adolescents aged 12.5–17.49 years (438 boys and 502 girls) were involved.Results:The percentage of iron depletion was 17.6%, significantly higher in girls (21.0%) compared with boys (13.8%). The overall percentage of ID and IDA was 4.7 and 1.3%, respectively, with no significant differences between boys and girls. A correlation was observed between log (SF) and Hb (r=0.36, P<0.01), and between log (sTfR) and mean corpuscular haemoglobin (r=−0.30, P<0.01). Iron body stores were estimated on the basis of log (sTfR/SF). A higher percentage of negative values of body iron was recorded in girls (16.5%) with respect to boys (8.3%), and body iron values tended to increase with age in boys, whereas the values remained stable in girls.Conclusions:To ensure adequate iron stores, specific attention should be given to girls at European level to ensure that their dietary intake of iron is adequate.

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Section: Discussionmentioning

confidence: 62%

Section: Methodsmentioning

confidence: 99%

Evaluation of iron status in European adolescents through biochemical iron indicators: the HELENA Study

et al. 2011

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“…Rates of anemia have ranged from 12% to 55% according to previous investigators [8, 33–35] depending on the migrants’ native country. Herein low ferritin levels were observed in 17.3% of the overall population and were more frequent among the group of immigrants (22.1% vs. 13.1%; p = 0.044).…”

Section: Discussionmentioning

confidence: 99%

“…These include malnutrition and secondary nutritional deficiency diseases, lead poisoning, various infections and transmissible diseases as well as psychiatric disorders, the latter as a result of stress [2–8]. …”

Section: Introductionmentioning

confidence: 99%

Clinical and laboratory evaluation of new immigrant and refugee children arriving in Greece

et al. 2017

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BackgroundMigrant children are a population at risk for various health problems. Despite the increased inflow of migrants in Greece, data regarding their health assessment are lacking. This study aims to describe the clinical and certain laboratory characteristics and identify possible associations in a group of new immigrant (I) and refugee (R) children, arriving in Athens, Greece.MethodsA prospective, cross- sectional study was performed in a migrant outpatient clinic of a tertiary Children’s hospital. All immigrant and refugee children, examined to obtain a health certificate, within 3 months of their arrival in the country, were enrolled. Clinical and laboratory information was collected in a pre- designed form. We applied multiple logistic regression models to investigate the association between the child’s status (immigrant vs refugee) and health indicators controlling for possible confounding effects, mainly of age and area of origin.ResultsFrom 2010 to 2013, a total of 300 children (I/R:138/162) with a mean age of 7.08 (range 1–14) years were included. Overall, 79.3% presented unknown vaccination status, 21.3% dental and 7.3% additional clinical problems. Latent tuberculosis was identified in 2.7%, while anemia, low serum ferritin and eosinophilia were found in 13.7%, 17.3%, and 22.7% of subjects, respectively. 57.7% had protective antibodies to hepatitis B surface antigen (anti-HBs ≥ 10 IU/L) and 30.6% elevated blood lead levels (EBLLs). Immigrants had less likely unknown immunization (OR = 0.25, p < 0.001), but had increased odds of low ferritin (OR = 1.97, p = 0.043), EBLLs (OR = 2.97, p = 0.001) and protective anti-HBs (OR = 1.79, p = 0.03). Age was inversely associated with anemia (OR = 0.0.89, p = 0.017), low ferritin (OR = 0.91, p = 0.027), EBLLs (OR = 0.86, p = 0.001) or positive anti-HBs (OR = 0.92, p = 0.025). Children from Europe or Africa presented decreased probability of EBLLs (OR = 0.31, p = 0.001, and OR = 0.15, p = 0.005, respectively) compared to those from Asia.ConclusionsNew immigrant and refugee children presented distinct clinical problems and certain laboratory abnormalities. Some of these health issues differed according to their migration status, age and geographic area of origin. These findings provide evidence that may assist the optimal approach of this vulnerable population.

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“…Both forms of undernutrition have been frequently documented among emergency-affected populations who face limited livelihood opportunities or access to diversified diets, poor sanitation, recurrent illness and infection, and often use suboptimal infant feeding practices[1–7]. Anaemia and stunting adversely affect physical growth, cognitive development, and immune status [8, 9] and severely stunted children have an even higher mortality risk than moderately wasted children [10].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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Anaemia, iron status and vitamin A deficiency among adolescent refugees in Kenya and Nepal

Cited by 40 publications

References 21 publications

Evaluation of iron status in European adolescents through biochemical iron indicators: the HELENA Study

Evaluation of iron status in European adolescents through biochemical iron indicators: the HELENA Study

Clinical and laboratory evaluation of new immigrant and refugee children arriving in Greece

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

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