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Community and International Nutrition

Iron Deficiency Is Unacceptably High in Refugee Children from Burma^1,2,3

Teresa M. Kemmer^*,,4, Maria E. Bovill^**, Wantanee Kongsomboon, Steven J. Hansch^*,, Karen L. Geisler, Carrie Cheney^,4, Bettina K. Shell-Duncan^# and Adam Drewnowski

^* Center for Disaster and Humanitarian Assistance Medicine, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Walter Reed Army Medical Center, Washington, D.C.; ^** Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA; Relief and Community Health Bureau, Thai Red Cross Society, Bangkok, Thailand; World Health Organization, Geneva, Switzerland, Emergency Consultant; and Department of Nutritional Sciences, School of Public Health and ^# School of Anthropology, University of Washington, Seattle, WA

⁴To whom correspondence should be addressed. E-mail: tkemmer{at}usuhs.mil.

Iron-deficiency anemia (IDA) in refugees is reported to be among the major medical problems worldwide. Because food rations are typically inadequate in iron, long-term reliance is a key predictor of anemia among displaced people. Comprehensive nutritional assessments of refugee children from Burma have not previously been completed. Refugee children aged 6–59 mo were studied to determine 1) the prevalences of anemia, iron deficiency (ID) and IDA and 2) the factors associated with anemia and ID. Cluster sampling in three camps and convenience sampling in two additional camps were used. Hemoglobin (Hb) levels were measured and µmol zinc protoporphyrin/mol heme were determined in 975 children. Logistic regression analyses (95% CI) determined predictors of anemia and ID. The prevalences of IDA, anemia and ID in these refugee children were 64.9, 72.0 and 85.4%, respectively. Predictors of anemia included young age (P < 0.001), food ration lasting <1 mo (P = 0.001), daily consumption of dietary iron inhibitors (P < 0.05), weight-for-height Z-score of <-2 (P < 0.05), male gender (P < 0.05) and uneducated father (P < 0.001). Predictors of ID were young age (P < 0.001) and recently reported illness (P < 0.05). Laboratory tests confirmed that anemia and ID are major health problems among these refugee children and that ID is the leading cause of anemia. A comprehensive nutrition and public health-focused approach to combating anemia and ID is essential. Following the presentation of results to policy makers, the improvement of the micronutrient content of rations has been initiated.

KEY WORDS: • anemia • iron deficiency • refugee • micronutrient • zinc protoporphyrin

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