Nutritional assessment of resettled paediatric refugees in Western Australia

Abstract

Aim Nutritional deprivation, inadequate diet and food insecurity are common refugee experiences. The growth and nutritional status of paediatric refugees following resettlement in developed countries and the related interplay with socio‐economic factors remain less defined; this study aims to describe these features. Methods Standardised dietary, medical and socio‐demographic health assessments of new refugee patients attending a multidisciplinary paediatric Refugee Health Service (RHS) in Western Australia between 2010 and 2015 were analysed. Results Demographic data from 1131 paediatric refugees are described (age 2 months to 17.8 years). The majority experienced socio‐economic disadvantage, had limited parental education and required interpreters. Nutritional deficiencies were common but varied across ethnicities: iron deficiency (ID) (12.3%), anaemia (7.3%) and inadequate dairy intake (41.0%). A third of children (32.6%) did not consume meat. Infant breastfeeding was sustained (77.8%) in infants <12 months. Prolonged breastfeeding (44.9% aged 12–24 months) was associated with an increased risk of ID (odds ratio 4.0, 95% confidence interval 1.4–11.6). Median body mass index increased significantly for those >24 months between referral and RHS assessment (median period 1.8 months). Overall, 27.1% required additional formal dietetic follow‐up, with higher nutritional concerns in refugee children <24 months compared to older patients. Conclusions Identification of frequent post‐settlement nutritional concerns has been captured through structured multidisciplinary paediatric health screening. Specific screening for socio‐economic influencing factors, including education, poverty and food insecurity, during refugee clinical assessments is recommended. Development of targeted, culturally appropriate parental education resources and interventions may improve management following resettlement. Longitudinal research assessing resettlement growth trajectories is required.

Use of professional interpreters for children and families with limited English proficiency: The intersection with quality and safety

“…Ongoing relative national socio‐economic disadvantage following resettlement is also a consideration as reflected by ISRD quintile distribution. These factors have also been demonstrated in previous research . For cohort 2 patients, who were not ex‐Refugee Health Service patients, background socio‐economic information, parental education language and literacy were not obtained in clinical histories; vulnerabilities which therefore may not have been considered by health staff.…”

“…These factors have also been demonstrated in previous research. [9][10][11][12] For cohort 2 patients, who were not ex-Refugee Health Service patients, background socio-economic information, parental education language and literacy were not obtained in clinical histories; vulnerabilities which therefore may not have been considered by health staff.…”

“…26 They are more likely to suffer from medication errors and other adverse events. 9,12,27 Low English proficiency families report lower satisfaction with care, lower perceived quality of care [28][29][30] and less willingness to return to hospital. 31 Conversely, patients provided an interpreter in the ED have a shorter length of stay relative to low English proficiency patients without an interpreter.…”

Special Aspects in Pediatric Surgical Inpatient Care of Refugee Children: A Comparative Cohort Study

“…Anemia is common in refugee children around the world [21,22,23,24]. This finding is most likely due to poor nutrition and iron deficiency, but other factors, such as vitamin deficiency [25], unrecognized metabolic conditions [26], infections, or hematologic disorders [27], may also play a role.…”

Ortadoğulu Göçmen ve Mülteci Çocuklarda Aneminin Değerlendirilmesi

“…The access of refugees to food safely in a newly resettled country is related to several factors. These are language proficiency and literacy, housing facilities, financial means, transportation opportunities, and food insecurity (20). Food insecurity means insufficient micronutrient, fiber, fruit and vegetable consumption with increased obesity and excess weight (21).…”