The double burden of obesity and malnutrition in a protracted emergency setting: a cross-sectional study of Western Sahara refugees.

BACKGROUND: Households from vulnerable groups experiencing epidemiological transitions are known to be affected concomitantly by under-nutrition and obesity. Yet, it is unknown to what extent this double burden affects refugee populations dependent on food assistance. We assessed the double burden of malnutrition among Western Sahara refugees living in a protracted emergency. METHODS AND FINDINGS: We implemented a stratified nutrition survey in October-November 2010 in the four Western Sahara refugee camps in Algeria. We sampled 2,005 households, collecting anthropometric measurements (weight, height, and waist circumference) in 1,608 children (6-59 mo) and 1,781 women (15-49 y). We estimated the prevalence of global acute malnutrition (GAM), stunting, underweight, and overweight in children; and stunting, underweight, overweight, and central obesity in women. To assess the burden of malnutrition within households, households were first classified according to the presence of each type of malnutrition. Households were then classified as undernourished, overweight, or affected by the double burden if they presented members with under-nutrition, overweight, or both, respectively. The prevalence of GAM in children was 9.1%, 29.1% were stunted, 18.6% were underweight, and 2.4% were overweight; among the women, 14.8% were stunted, 53.7% were overweight or obese, and 71.4% had central obesity. Central obesity (47.2%) and overweight (38.8%) in women affected a higher proportion of households than did GAM (7.0%), stunting (19.5%), or underweight (13.3%) in children. Overall, households classified as overweight (31.5%) were most common, followed by undernourished (25.8%), and then double burden-affected (24.7%). CONCLUSIONS: The double burden of obesity and under-nutrition is highly prevalent in households among Western Sahara refugees. The results highlight the need to focus more attention on non-communicable diseases in this population and balance obesity prevention and management with interventions to tackle under-nutrition. Please see later in the article for the Editors' Summary.

Assessment of Implementation of an Anaemia Reduction Initiative Including Blanket Supplementary Feeding Distributing LNS and MNP on Anaemia in a Protracted Refugee Situation.

Objectives: Micronutrient malnutrition, commonly manifested as stunting and anaemia, is a persistent public health problems in populations experiencing a protracted refugee situation like the Western Sahara refugees living in south-west Algeria. A UNHCR and partners' strategy to address this issue was to implement a blanket supplementary feeding programme providing lipid-based nutrient supplements (LNS) and micronutrient powders (MNP) to children aged 6-35 and 36-59 months, respectively. We present data on anaemia prevalence in children aged 6-59 months after two-years of implementation. Methods: Routine pre- (2010) and post-intervention (2012) cross-sectional nutrition surveys were conducted assessing anaemia (Hb<11g/dL) in four Western Sahara refugee camps. Data on coverage was obtained by questionnaire in the post-intervention nutrition survey. Results: Overall, we observed a significant reduction in anaemia prevalence in children 6-59 months between baseline (52.8%; 95%CI: 49.1-56.6) and end-line (28.4%; 95% CI: 25.7-31.0); and an increase in mean haemoglobin concentration from 10.7 g/dL (s.d.:1.7) to 11.6 g/dL (s.d.:1.4). A similar pattern of differences for anaemia prevalence was observed when the analysis was stratified by camp. Coverage for LNS among children aged 6-35 months was 70%, contrasting with 14% for MNP among children aged 36-59 months.