title: Iron deficiency is unacceptably high in refugee children from Burma.
abstract: 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 micro mol 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.
authors.affiliation: Center for Disaster and Humanitarian Assistance Medicine, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. tkemmer@usuhs.mil
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Kemmer
authors.forename: Maria E
authors.initials: ME
authors.lastname: Bovill
authors.forename: Wantanee
authors.initials: W
authors.lastname: Kongsomboon
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hansch
authors.forename: Karen L
authors.initials: KL
authors.lastname: Geisler
authors.forename: Carrie
authors.initials: C
authors.lastname: Cheney
authors.forename: Bettina K
authors.initials: BK
authors.lastname: Shell-Duncan
authors.forename: Adam
authors.initials: A
authors.lastname: Drewnowski
mesh_terms: D017677:Age Distribution; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology; D002675:Child, Preschool; D003677:Deficiency Diseases / Q000453:epidemiology; D003710:Demography; D005260:Female; D006304:Health Status; D006801:Humans; D007223:Infant; D000090463:Iron Deficiencies; D019266:Iron, Dietary / Q000008:administration & dosage; D016015:Logistic Models; D008297:Male; D002052:Myanmar / Q000453:epidemiology; D015995:Prevalence; D012036:Refugees / Q000706:statistics & numerical data*
chemical_list: D019266:Iron, Dietary