RESUMEN
Objectives: Stunting and micronutrient malnutrition are persistent public health problems in refugee populations. UNHCR and partners use blanket supplementary feeding programmes (BSFP) using Nutributter®, a low-quantity lipid-based nutrient supplement, as one of the approaches to confront these problems. However, the evidence base for the efficacy and effectiveness of Nutributter® is limited. This secondary analysis aimed to assess the impact on anaemia and stunting in children 6-23 months and 6-59 months of a blanket Nutributter® distribution implemented in Dadaab, Kakuma, and Ali Addeh refugee camps. Methods: A plausibility design using routine pre- and post-intervention cross-sectional nutrition survey data was conducted. Trends in total anaemia (Hb<11g/dl), anaemia categories (mild, moderate and severe), and stunting (HAZ<2) between 2008-2011 were explored and interpreted using available contextual, and Nutributter® programme monitoring data. Results: In all camps, a significant reduction was seen in the prevalence of anaemia in children 6- 23 and 6-59 months between baseline and endline; percentage point reduction ranged from 9.3% to 23%, and 18.3% to 29.3% for each age group, respectively. Improvements were largely due to reductions in moderate and severe anaemia. The prevalence of stunting remained similar for children 6-59 and 6-23 showing little change after introduction of the intervention. Conclusions: The replicability of findings suggests that Nutributter® distribution is associated with a reduction in anaemia, especially in its most severe forms, among refugees in the Horn of Africa. These results need to be interpreted taking into account other anaemia reduction activities implemented in the camps between 2008 - 2011.
RESUMEN
Objectives: 1) Describe the socioeconomic and health status of this population of pregnant women; 2) Determine the anaemia prevalence using a series of diagnostic markers (haemoglobin, sTFR, and ZPP); 3) Explore the relationship between a variety of socio-demographic, nutritional, and disease-related factors, and anaemia. Methods: This paper was developed using data collected during a longitudinal cohort study conducted between 2001-2002, which investigated the effectiveness of a new antenatal micronutrient supplement. A preliminary literature review identified known biological and socioeconomic risk factors associated with anaemia. Chi2, students t-test, correlation, and logistic regression analyses explored the strength of association between exposure variables and anaemia. Results: The prevalence of maternal anaemia in this population was 75% at 16-24 weeks gestation. Iron deficiency was similarly widespread; 65% and 45% of women exceeded the threshold for deficiency as defined by ZPP and sTFR indicators respectively. Malaria schistosomiasis, and hookworm infections were not significantly associated with anaemia in this population. MUAC and BMI were strongly correlated with anaemia, as was Somali ethnicity, iron deficiency (sTFR), and living in a rural context pre-displacement. Conclusions: The prevalence of anaemia and iron deficiency among pregnant women in Dadaab constituted a severe public health problem, as defined by the World Health Organisation. Since this study, a strategy for the control and reduction of anaemia has been developed by UNHCR and implemented in the Dadaab camps and elsewhere. However, data published more recently suggests that maternal anaemia remains a persistent problem (74%, 2005; 69%, 2008) that requires further attention and a continued response.