Malnutrition trends in Rohingya children aged 6–59 months residing in informal settlements in Cox’s Bazar District, Bangladesh: An analysis of cross-sectional, population-representative surveys


Autoři: Eva Leidman aff001;  Md. Lalan Miah aff002;  Alexa Humphreys aff002;  Leonie Toroitich-van Mil aff002;  Caroline Wilkinson aff003;  Mary Chelang'at Koech aff004;  Henry Sebuliba aff005;  Muhammad Abu Bakr Siddique aff005;  Oleg Bilukha aff001
Působiště autorů: Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America aff001;  Action Against Hunger Bangladesh, Dhaka, Bangladesh aff002;  United Nations High Commissioner for Refugees, Geneva, Switzerland aff003;  United Nations High Commissioner for Refugees, UNHCR Sub-Office (BGDCO), Cox's Bazar, Bangladesh aff004;  United Nations Children’s Fund, Dhaka, Bangladesh aff005
Vyšlo v časopise: Malnutrition trends in Rohingya children aged 6–59 months residing in informal settlements in Cox’s Bazar District, Bangladesh: An analysis of cross-sectional, population-representative surveys. PLoS Med 17(3): e32767. doi:10.1371/journal.pmed.1003060
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003060

Souhrn

Background

More than 700,000 ethnic Rohingya have crossed the border from Rakhine State, Myanmar to Cox’s Bazar District, Bangladesh, following escalated violence by Myanmar security forces. The majority of these displaced Rohingya settled in informal sites on previously forested land, in areas without basic infrastructure or access to services.

Methods and findings

Three cross-sectional population-representative cluster surveys were conducted, including all informal settlements of Rohingya refugees in the Ukhia and Teknaf Upazilas of Cox’s Bazar District. The first survey was conducted during the acute phase of the humanitarian response (October–November 2017), and the second and third surveys were conducted 6 (April–May 2018) and 12 (October–November 2018) months later. Anthropometric indices (weight, height, mid-upper arm circumference [MUAC], oedema) and haemoglobin (Hb) were measured in children aged 6–59 months following standard procedures. Final samples for survey rounds 1, 2, and 3 (R1, R2, and R3) included 1,113, 628, and 683 children, respectively, of which approximately half were male (50.7%–53.5% per round) and a third were 6–23 months of age (32.4%–33.3% per round). Prevalence of global acute malnutrition (GAM) as assessed by weight for height in R2 (12.1%, 95% CI: 9.6–15.1) and R3 (11.0%, 95% CI: 8.4–14.2) represent a significant decline from the observed prevalence in R1 (19.4%, 95% CI: 16.8–22.3) (p < 0.001 for both comparisons). Overall, the prevalence of anaemia significantly declined (p < 0.001) between the first 2 rounds (47.9%, 95% CI: 44.1–51.7 and 32.3%, 95% CI: 27.8–37.1, respectively); prevalence increased significantly (p = 0.04) to 39.8% (95% CI, 34.1–45.4) during R3 but remained below R1 levels. Reported receipt of both fortified blended foods (12.8%) and micronutrient powders (10.3%) were low during R1 but increased significantly (p < 0.001 for both) within the first 6 months to 49.8% and 29.9%, respectively. Although findings demonstrate improvement in anthropometric indicators during a period in which nutrition programme coverage increased, causation cannot be determined from the cross-sectional design.

Conclusions

These data document significant improvements in both acute and micronutrient malnutrition among Rohingya children in makeshift settlements. These declines coincide with a scaleup of services aimed at prevention and treatment of malnutrition. Ongoing activities to improve access to nutritional services may facilitate further reductions in malnutrition levels to sustained below-crisis levels.

Klíčová slova:

Anemia – Bangladesh – Breast feeding – Fevers – Children – Malnutrition – Nutrition – Rations


Zdroje

1. International organization for Migration. Needs and Population Monitoring Site Assessment: Round 10. May 20, 2018 [cited 2018 Jun 1]. Available from: https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/assessments/npm_round_10_report_may_2018.pdf.

2. United Nations High Commissioner for Refugees (UNHCR). Population Data and Key Demographics. March 18, 2018 [cited 2018 May 27]. Available from: https://www.humanitarianresponse.info/en/operations/bangladesh/document/unhcr-rohingya-refugee-population-infographic.

3. White K. Rohingya in Bangladesh: an unfolding public health emergency. Lancet. 2017 Oct 28;390(10106):1947.

4. Ministry of Health and Sports—MoHS/Myanmar and ICF. Myanmar Demographic and Health Survey 2015–16. Nay Pyi Taw, Myanmar: MoHS and ICF. 2017 [cited 2018 Jun 1]. Available from: https://dhsprogram.com/publications/publication-fr324-dhs-final-reports.cfm.

5. Leidman E, Humphreys A, Greene Cramer B, et al. Acute Malnutrition and Anemia Among Rohingya Children in Kutupalong Camp, Bangladesh. JAMA. 2018 Apr 10;319(14):1505–1506. doi: 10.1001/jama.2018.2405 29634821

6. World Health Organization. Physical status: the use and interpretation of anthropometry Report of a WHO Expert Committee Technical Report Series No. 854. Geneva, Switzerland: World Health Organization; 2011 [cited 2018 Jun 1]. Available from: http://www.who.int/childgrowth/publications/physical_status/en/.

7. Action Against Hunger, Global Nutrition Cluster. Emergency Nutrition Assessment Final Report: October 22 –November 27, 2017 [cited 2020 Jan 2]. Available from: https://www.humanitarianresponse.info/en/operations/bangladesh/assessment/emergency-nutrition-assessment-round-1-final-report.

8. World Food Programme. Refuge influx Emergency Vulnerability Vulnerability Assessment. Cox's Bazar, Bangladesh. December 2017 [cited 2018 Jun 1]. Available from: https://www.wfp.org/news/news-release/new-rohingya-arrivals-bangladesh-risk-poor-diets.

9. Action Against Hunger, Global Nutrition Cluster. Emergency Nutrition Assessment Final Report: 20 October– 8 November, 2018 [cited 2020 Jan 2]. Available from: https://www.humanitarianresponse.info/en/operations/bangladesh/assessment/emergency-nutrition-assessment-round-3-final-report.

10. Feldstein L, Bennett S, Estivariz C, et al. Vaccination coverage survey and seroprevalence among forcibly-displaced Rohingya children, Cox’s Bazar, Bangladesh, 2018: A cross-sectional study. PLoS Med. 17(3): e1003071. https://doi.org/10.1371/journal.pmed.1003071.

11. United Nations Office for the Coordination of Humanitarian Affairs Financial Tracking Service. Bangladesh: Rohingya Refugee Crisis 2017. 2017 [cited 2018 Jun 1]. Available from: https://fts.unocha.org/appeals/628/summary.

12. Inter Sector Coordination Group. Bangladesh: Cox’s Bazar Refugee Population. [cited 2017 Oct 30 1]. Available from: https://www.humanitarianresponse.info/en/operations/bangladesh.

13. International organization for Migration. Needs and Population Monitoring Site Assessment: Round 9. March 25, 2018 [cited 2018 Apr 1]. Available from: https://www.humanitarianresponse.info/en/operations/bangladesh/assessment/iom-bangladesh-needs-and-population-monitoring-npm-site-0.

14. United Nations Department of Technical Co-Operation for Development and Statistical Office. How to weigh and measure children: assessing the nutritional status of young children in household surveys. New York, NY: United Nations; 1986.

15. World Health Organization. The WHO child growth standards: length/height-for-age, weight-for-age, weight-for-height and body mass index for- age: methods and development. Geneva, Switzerland: World Health Organization; 2006 [cited 2018 Jun 1]. Available from: http://www.who.int/childgrowth/standards.

16. World Health Organization. Haemoglobin concentration for the diagnosis of anaemia and assessment of severity. Geneva, Switzerland: World Health Organization; 2011 [cited 2018 Jun 1]. Available from: http://www.who.int/vmnis/indicators/haemoglobin.pdf.

17. Angdembe MR, Choudhury N, Haque MR, Ahmed T. Adherence to multiple micronutrient powder among young children in rural Bangladesh: a cross-sectional study. BMC Public Health 2015;15(440):1–10.

18. World Health Organization. Indicators for assessing infant and young child feeding practices. Washington, DC: World Health Organization; 2007 [cited 2018 Jun 1]. Available from: http://apps.who.int/iris/bitstream/10665/43895/1/9789241596664_eng.pdf.

19. Action Against Hunger, Global Nutrition Cluster. Emergency Nutrition Assessment Final Report: 28 April– 28 May, 2018 [cited 2020 Jan 2]. Available from: https://www.humanitarianresponse.info/ru/operations/bangladesh/assessment/emergency-nutrition-assessment-round-2-final-report.

20. ENA for SMART 2011. Version July 9, 2015 [cited 2017 Dec 1]. Available from: http://smartmethodology.org/survey-planning-tools/smart-emergency-nutrition-assessment/.

21. StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP.

22. Hassan N, Huda N, Ahmad K. Seasonal patterns of food intake in rural Bangladesh: Its impact on nutritional status. Ecol Food Nutr. 1985; 2(17):175–186.

23. Grellety E, Golden MH. The Effect of Random Error on Diagnostic Accuracy Illustrated with the Anthropometric Diagnosis of Malnutrition. PLoS ONE. 2016 Dec 28;11(12):e0168585. doi: 10.1371/journal.pone.0168585 28030627

24. World Health Organization, United Nations Children's Fund. WHO child growth standards and the identification of severe acute malnutrition in infants and children: A Joint Statement. Geneva, Switzerland; 2009.

25. Bangladesh Nutrition Sector. Admission and Discharge Criteria of Community based Management of Acute Malnutrition (CMAM) Programme. March 18, 2018 [cited 2019 Jan 2]. Available from: https://www.humanitarianresponse.info/en/operations/bangladesh/document.

26. Merrill RD, Shamim AA, Ali H, Labrique AB, Schulze K, Christian P, West KP Jr. High prevalence of anemia with lack of iron deficiency among women in rural Bangladesh: a role for thalassemia and iron in groundwater. Asia Pac J Clin Nutr. 2012;21(3):416–24. 22705433

27. World Food Programme and the Bangladesh Food Security Sector. Market Assessment in Cox’s Bazar Implications for market-based interventions targeted to Rohingya refugees and host communities. 2017 [cited 2020 Feb 1]. Available from: https://fscluster.org/sites/default/files/documents/20171123_rohingya_market_assessment_report.pdf.

28. Rogers E, Myatt M, Woodhead S, Guerrero S, Alvarez JL. Coverage of community-based management of severe acute malnutrition programmes in twenty-one countries, 2012–2013. PLoS ONE. 2015;10(6):e0128666. doi: 10.1371/journal.pone.0128666 26042827

29. World Health Organization. Global Early Warning and Response System: Epidemiological Highlights: Annex W37 2019 [cited 2019 Oct 1]. Available from: http://www.searo.who.int/bangladesh/ewarsw372019.pdf.

30. Save the Children. First downpours of 2018 hit Rohingya camps in Cox’s Bazar as monsoon season nears. 2018 [cited 2019 Oct 1]. Available from: https://reliefweb.int/report/bangladesh/first-downpours-2018-hit-rohingya-camps-cox-s-bazar-monsoon-season-nears.

31. National Institute of Population Research and Training (NIPORT), and ICF. Bangladesh Demographic and Health Survey 2017–18: Key Indicators. Dhaka, Bangladesh, and Rockville, Maryland, USA: NIPORT and ICF; 2019.

32. Azziz-Baumgartner E, Alamgir AS, Rahman M, Homaira N, Sohel BM, Sharker MA, Zaman RU, Dee J, Gurley ES, Al Mamun A, Mah-E-Muneer S, Fry AM, Widdowson MA, Bresee J, Lindstrom S, Azim T, Brooks A, Podder G, Hossain MJ, Rahman M, Luby SP. Incidence of influenza-like illness and severe acute respiratory infection during three influenza seasons in Bangladesh, 2008–2010. Bull World Health Organ. 2012 Jan 1;90(1):12–19. doi: 10.2471/BLT.11.090209 22271960

33. International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka (ICDDR,B), United Nations Children's Fund (UNICEF), Global Alliance for Improved Nutrition (GAIN), Institute of Public Health and Nutrition. National Micronutrients Status Survey 2011–12 Final Report. Dhaka, Bangladesh: Centre for Nutrition and Food Security and UNICEF Bangladesh; 2013.

Štítky
Interní lékařství

Článek vyšel v časopise

PLOS Medicine


2020 Číslo 3

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Kurzy Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

VIRTUÁLNÍ ČEKÁRNA ČR Jste praktický lékař nebo pediatr? Zapojte se! Jste praktik nebo pediatr? Zapojte se!

×