Hostname: page-component-76fb5796d-vvkck Total loading time: 0 Render date: 2024-04-26T01:56:38.444Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  02 January 2007

Bradley A Woodruff*
Affiliation:
Maternal and Child Nutrition Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop K-25, Atlanta, GA 30341, USA
Heidi Michels Blanck
Affiliation:
Chronic Disease Nutrition Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
Laurence Slutsker
Affiliation:
Malaria Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
Susan T Cookson
Affiliation:
State and Local Public Health Systems Branch, National Center for Health Marketing, Centers for Disease Control and Prevention, Atlanta, GA, USA
Mary Kay Larson
Affiliation:
Country Program Support Branch, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
Arabella Duffield
Affiliation:
Save the Children UK, London, UK
Rita Bhatia
Affiliation:
World Food Programme Regional Bureau for Asia, Bangkok, Thailand
*
*Corresponding author: Email BWoodruff@cdc.gov
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective

To investigate the prevalence of anaemia (haemoglobin < 11.0 to 13.0 g dl−1 depending on age and sex group), iron deficiency (transferrin receptor concentration > 8.3 μg ml−1) and vitamin A deficiency (serum retinol < 0.7 μmoll−1) in adolescent refugees.

Design

Cross-sectional surveys.

Setting

Kakuma refugee camp in Kenya and seven refugee camps in Nepal.

Subjects

Adolescent refugee residents in these camps.

Results

Anaemia was present in 46% (95% confidence interval (CI): 42–51) of adolescents in Kenya and in 24% (95% CI: 20–28) of adolescents in Nepal. The sensitivity of palmar pallor in detecting anaemia was 21%. In addition, 43% (95% CI: 36–50) and 53% (95% CI: 46–61) of adolescents in Kenya and Nepal, respectively, had iron deficiency. In both surveys, anaemia occurred more commonly among adolescents with iron deficiency. Vitamin A deficiency was found in 15% (95% CI: 10–20) of adolescents in Kenya and 30% (95% CI: 24–37) of adolescents in Nepal. Night blindness was not more common in adolescents with vitamin A deficiency than in those without vitamin A deficiency. In Kenya, one of the seven adolescents with Bitot's spots had vitamin A deficiency.

Conclusions

Anaemia, iron deficiency and vitamin A deficiency are common among adolescents in refugee populations. Such adolescents need to increase intakes of these nutrients; however, the lack of routine access makes programmes targeting adolescents difficult. Adolescent refugees should be considered for assessment along with other at-risk groups in displaced populations.

Type
Research Article
Copyright
Copyright © The Authors 2006

References

1Woodruff, BA, Duffield, A. Adolescents: Assessment of Nutritional Status in Emergency-affected Populations. Geneva: Administrative Committee on Coordination/Subcommittee on Nutrition, 07 2000.Google Scholar
2Institute of Medicine. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: National Academy Press, 1998.Google Scholar
3Beard, JL, Connor, JR. Iron status and neural functioning. Annual Review of Nutrition 2003; 23: 4158.CrossRefGoogle ScholarPubMed
4Singh, P, Toteja, GS. Micronutrient profile of Indian children and women: summary of available data for iron and vitamin A. Indian Pediatrics 2003; 40(5): 477–9.Google Scholar
5Pathak, P, Singh, P, Kapil, U, Raghuvanshi, RS. Prevalence of iron, vitamin A, and iodine deficiencies amongst adolescent pregnant mothers. Indian Journal of Pediatrics 2003; 70(4): 299301.CrossRefGoogle ScholarPubMed
6Ene-Obong, HN, Odoh, IF, Ikwuagwu, OE. Plasma vitamin A and C status of in-school adolescents and associated factors in Enugu State, Nigeria. Journal of Health, Population, and Nutrition 2003; 21(1): 1825.Google Scholar
7Christian, P, West, KP Jr, Khatry, SK, LeClerq, SC, Kimbrough-Pradhan, E, Katz, J, et al. Maternal night blindness increases risk of mortality in the first 6 months of life among infants in Nepal. Journal of Nutrition 2001; 131(5): 1510–2.CrossRefGoogle ScholarPubMed
8Christian, P, West, KP Jr, Khatry, SK, Kimbrough-Pradhan, E, LeClerq, SC, Katz, J, et al. Night blindness during pregnancy and subsequent mortality among women in Nepal: effects of vitamin A and β-carotene supplementation. American Journal of Epidemiology 2000; 152(6): 542–7.CrossRefGoogle ScholarPubMed
9West, KP Jr, Katz, J, Khatry, SK, LeClerq, SC, Pradhan, EK, Shrestha, SR, et al. Double blind, cluster randomised trial of low dose supplementation with vitamin A or β-carotene on mortality related to pregnancy in Nepal. The NNIPS-2 Study Group. British Medical Journal 1999; 318(7183): 570–5.CrossRefGoogle ScholarPubMed
10Ross, DA. Recommendations for vitamin A supplementation. Journal of Nutrition 2002; 132(9 Suppl.): 2902S–6S.CrossRefGoogle ScholarPubMed
11Tomashek, KM, Woodruff, BA, Gotway, CA, Bloland, P, Mbaruku, G. Randomized intervention study comparing several regimens for the treatment of moderate anemia among refugee children in Kigoma Region, Tanzania. American Journal of Tropical Medicine and Hygiene 2001; 64(3–4): 164–71.CrossRefGoogle ScholarPubMed
12Nieburg, P, Waldman, RJ, Leavell, R, Sommer, A, DeMaeyer, EM. Vitamin A supplementation for refugees and famine victims. Bulletin of the World Health Organization 1988; 66(6): 689–97.Google ScholarPubMed
13Weise Prinzo, Z, de Benoist, B. Meeting the challenges of micronutrient deficiencies in emergency-affected populations. Proceedings of the Nutrition Society 2002; 61(2): 251–7.CrossRefGoogle ScholarPubMed
14Toole, MJ. Micronutrient deficiencies in refugees. Lancet 1992; 339(8803): 1214–6.CrossRefGoogle ScholarPubMed
15World Health Organization (WHO). Physical Status: Thex Use and Interpretation of Anthropometry. Report of a WHO Expert Committee. Geneva: WHO, 1995.Google Scholar
16International Rescue Committee. Nutritional Status of School Aged Children in Kakuma Refugee Camp: April 1997. Nairobi: International Rescue Committee, 1997.Google Scholar
17World Food Programme (WFP)/United Nations High Commissioner for Refugees (UNHCR)/Ministry of Home Affairs. Report of the Joint WFP/UNHCR/Donor Food Needs Assessment Mission, Kenya: 21 October 1997 to 7 November 1997. Rome/ Geneva/ Nairobi: WFP/UNHCR/Ministry of Home Affairs, 1997.Google Scholar
18World Food Programme (WFP). Protracted refugee and displaced person project Kenya 4961.04: Food assistance for Somali and Sudanese refugees. Rome: WFP, 121505 1998.Google Scholar
19Blanck, HM, Bowman, BA, Serdula, MK, Khan, LK, Kohn, W, Woodruff, BA. Angular stomatitis and riboflavin status among adolescent Bhutanese refugees living in southeastern Nepal. American Journal of Clinical Nutrition 2002; 76(2): 430–5.CrossRefGoogle ScholarPubMed
20Woodruff, BA, Duffield, A. Anthropometric assessment of nutritional status in adolescent populations in humanitarian emergencies. European Journal of Clinical Nutrition 2002; 56(11): 1108–18.CrossRefGoogle ScholarPubMed
21Sowell, AL, Huff, DL, Yeager, PR, Caudill, SP, Gunter, EW. Retinol, α-tocopherol, lutein/zeaxanthin, β-cryptoxanthin, lycopene, α-carotene, trans -β-carotene, and four retinyl esters in serum determined simultaneously by reversed-phase HPLC with multiwavelength detection. Clinical Chemistry 1994; 40(3): 411–6.CrossRefGoogle ScholarPubMed
22World Health Organization (WHO)/United Nations Children's Fund (UNICEF)/United Nations University (UNU). IDA: Prevention, Assessment and Control. Report of a Joint WHO/UNICEF/UNU Consultation. Geneva: WHO, 1998.Google Scholar
23World Health Organization (WHO). Indicators for Assessing Vitamin A Deficiency and their Application in Monitoring and Evaluating Intervention Programmes. Micronutrient Series, Report No. WHO/NUT/96.10. Geneva: WHO, 1996.Google Scholar
24Dean, AG, Dean, JA, Coulombier, D, Brendel, KA, Smith, DC, Burton, AH, et al. Epi Info, Version 6: A Word Processing, Database, and Statistics Program for Epidemiology on Microcomputers. Atlanta, GA: Centers for Disease Control and Prevention, 1994.Google Scholar
25Food and Agriculture Organization (FAO)/World Health Organization (WHO). Human Vitamin and Mineral Requirements. Report of a Joint FAO/WHO Expert Consultation, Bangkok, Thailand. Bangkok: FAO/WHO, 2001.Google Scholar
26McBurney, R, Seal, A, Creeke, P, Ruth, L. Anthropometric and Micronutrient Nutrition Survey: Kakuma Refugee Camp, NW Kenya, 22 March–12 April 2001. New York/Geneva/London: International Rescue Committee/UN High Commissioner for Refugees/Institute for Child Health, 2001.Google Scholar
27Ahmed, F. Vitamin A deficiency in Bangladesh: a review and recommendations for improvement. Public Health Nutrition 1999; 2(1): 114.CrossRefGoogle ScholarPubMed
28Carlier, C, Etchepare, M, Ceccon, JF, Amedee-Manesme, O. Assessment of the vitamin A status of preschool and school age Senegalese children during a cross-sectional study. International Journal for Vitamin and Nutrition Research 1992; 62(3): 209–15.Google ScholarPubMed
29Gies, S, Brabin, BJ, Yassin, MA, Cuevas, LE. Comparison of screening methods for anaemia in pregnant women in Awassa, Ethiopia. Tropical Medicine and International Health 2003; 8(4): 301–9.CrossRefGoogle ScholarPubMed
30Desai, MR, Phillips-Howard, PA, Terlouw, DJ, Wannemuehler, KA, Odhacha, A, Kariuki, SK, et al. Recognition of pallor associated with severe anaemia by primary caregivers in western Kenya. Tropical Medicine and International Health 2002; 7(10): 831–9.CrossRefGoogle ScholarPubMed
31Stoltzfus, RJ, Edward-Raj, A, Dreyfuss, ML, Albonico, M, Montresor, A, Dhoj Thapa, M, et al. Clinical pallor is useful to detect severe anemia in populations where anemia is prevalent and severe. Journal of Nutrition 1999; 129(9): 1675–81.CrossRefGoogle ScholarPubMed
32Christian, P. Recommendations for indicators: night blindness during pregnancy – a simple tool to assess vitamin A deficiency in a population. Journal of Nutrition 2002; 132(9 Suppl.): 2884S–8S.CrossRefGoogle ScholarPubMed
33Gorstein, J, Shreshtra, RK, Pandey, S, Adhikari, RK, Pradhan, A. Current status of vitamin A deficiency and the National Vitamin A Control Program in Nepal: results of the 1998 National Micronutrient Status Survey. Asia Pacific Journal of Clinical Nutrition 2003; 12(1): 96103.Google ScholarPubMed
34Christian, P, West, KP Jr, Khatry, SK, Katz, J, Shrestha, SR, Pradhan, EK, et al. Night blindness of pregnancy in rural Nepal–nutritional and health risks. International Journal of Epidemiology 1998; 27(2): 231–7.CrossRefGoogle ScholarPubMed
35Brilliant, LB, Pokhrel, RP, Grasset, NC, Lepkowski, JM, Kolstad, A, Hawks, W. Epidemiology of blindness in Nepal. Bulletin of the World Health Organization 1985; 63(2): 375–86.Google ScholarPubMed
36Sommer, A, West, KP Jr, Olson, JA, Ross, AC. Vitamin A Deficiency. New York: Oxford University Press, 1996.CrossRefGoogle Scholar
37Stephensen, CB, Gildengorin, G, Ross, AC. Serum retinol, the acute phase response, and the apparent misclassification of vitamin A status in the third National Health and Nutrition Examination Survey. American Journal of Clinical Nutrition 2000; 72(5): 1170–8.CrossRefGoogle ScholarPubMed