Dietary intake in asylum seeker children in The Netherlands, strongly related to age and origin.

OBJECTIVE: To monitor the dietary intake of energy, macro- and micronutrients in asylum seeker children. DESIGN AND SETTING: Cross-sectional study in three asylum seeker centres in The Netherlands. SUBJECTS: Hundred and sixteen children 2-12 years old (86% of the study cohort) provided a dietary history. METHOD: The dietary intake was estimated by 24 h recall, and the origin of the children was classified in three geographic regions: African (n=45), Central Asia (n=34) or Eastern Europe (n=37). RESULTS: The total energy intake from fat was in 24% of the children above 40En%. Seventy per cent of the children above 4 year of age had a saturated fat intake above 10En%. The children from Eastern Europe had a higher intake of fat and disaccharides than the children from the other regions. Among the children, an intake less than 80% of the recommended daily allowances of micronutrients was found for calcium (42%), iron (49%), vitamin A (45%) and vitamin D (80%). An inadequate dietary intake of iron and vitamin D was significantly more seen among the youngest children, whereas an inadequate intake of calcium and vitamin A was found more among the elder children. CONCLUSIONS: The dietary intake of a prominent proportion of these children contains too much fat and insufficient amounts of calcium, iron, vitamin A and vitamin D. The low micronutrient intake of the asylum seeker children can be considered as a nutritional risk. Nutritional education and strategies to improve the macro- and micronutrient intake of asylum seeker children is indicated.

Iron deficiency among children of asylum seekers in the Netherlands.

OBJECTIVES: To investigate, in asylum seekers' children in the Netherlands, biochemical iron status and the prevalence of iron deficiency (ID) and anemia in relation to age, region of origin, length of stay in the Netherlands, body mass index (BMI), and dietary iron intake. PATIENTS AND METHODS: Hemoglobin (Hb) and plasma ferritin concentrations were determined in 122 asylum seekers' children (median age, 7.1 years; range, 2-12 y). ID was defined by plasma ferritin levels <15 microg/L. Anemia was defined by Hb levels <6.8 mmol/L (11 g/dL) for children <6 years of age and Hb levels <7.1 mmol/L (11.5 g/dL) for children between 6 and 12 years of age. Nutritional status of the children was assessed by BMI and dietary intake of iron was estimated by 24-hour recall. RESULTS: Twenty percent of the children had compromised iron status (16% with ID, 4% with ID anemia [IDA]). Another 6% of the children had anemia caused by thalassemia. ID was significantly more prevalent in children <6 years of age and in children of African origin. The iron status was not significantly correlated with the length of stay in the Netherlands (r = 0.6; P = 0.48). Higher BMI z scores were positively correlated with iron status. Adequate or marginal dietary iron intake was not significantly related to the presence of ID (r = 0.02; P = 0.9) or anemia (IDA and thalassemia; r = 0.15; P = 0.9). CONCLUSIONS: Iron deficiency is highly prevalent among the children of asylum seekers in the Netherlands. Our data indicate that systematic biochemical screening for ID is warranted in asylum seekers' children.

Prevention of unhealthy behaviour by youth health care in The Netherlands.

BACKGROUND: In this study the effect is assessed of (repeated) well-care visits and freely accessible consultation hours at secondary schools on the prevalence of adolescent health-compromising behaviour and later obesity. METHODS: An ecological case-referent study design was used with data from the Netherlands Bureau of Statistics, the Ministry of Defence, the 1992 High-School Student Study, all youth health care departments in The Netherlands and relevant census. Data from the High-School Student Study included 4,569 students aged 12-18 years, of whom 4,167 had answered all questions on health-compromising behaviour and eating habits. The data from the Ministry of Defence included 1,004 cases with a body mass index greater than 27 of a total of 12 251 male conscripts. The census of 18- and 19-year-old males in the regions of the relevant youth health care departments served as referents. RESULTS: Except for the use of alcohol, the effect of more well-care visits was in all cases negative, and for the use of tobacco even significantly so [odds ratio (OR) = 1.15, 95 per cent confidence interval (CI) = 1.01-1.33]. The availability of open consultation hours had an adverse effect on use of alcohol (OR = 1.29, 95 per cent CI = 1.11-1.50). The OR for obesity in male conscripts showed an adverse effect of a greater number of well-care visits (OR = 2.46, 95 per cent Cl = 1.74-3.46) and the availability of open consultation hours (OR = 1.97, 95 per cent CI = 1.72-2.25). CONCLUSIONS: This study does not support the hypothesis that, at a population level, preventive activities of youth health care departments such as (more) frequent well-care visits or offering open consultation hours at secondary schools, have a beneficial effect on prevention of health-compromising behaviour or obesity.

Evaluation of community-wide interventions: the ecologic case-referent study design.

In a setting of long-standing, community-wide and generally accepted prevention activities like youth health care services in The Netherlands, evaluative research in the form of experimental studies is hardly possible. Furthermore, as most interventions will bear fruit only after several years and the effects are often described in rather vague terms, even non-experimental study designs are fraught with possible difficulties. Although a study design using aggregate data is generally considered inferior or 'incomplete', in many cases, especially in health services research, this approach can be the only one feasible to evaluate the effectiveness of preventive programmes and interventions. In this article we present the ecologic case-referent design as a potentially expedient and valid method for estimating the ecologic effect of a population-wide intervention on the outcome rate in those populations. In this case-referent design, many variables are measured at the individual level, whereas the main exposure variable is measured at an aggregate or ecologic level. Using recently published studies as an example, the advantages and drawbacks of the design are discussed using the randomised controlled trial design as the referent study design.

Prevention of suicide by youth health care.

The objective of this study was to examine the effect of freely accessible consultation hours in secondary schools by youth health care departments, on population rates for suicide and parasuicide. To this end, an ecologic case-referent study design was used, with data from the Netherlands Bureau of Statistics, the National Hospital Discharge Register, the High-School Students Study, the youth health care departments in the Netherlands and relevant census. Cases were 137 suicide victims aged 15-19 y and 182 12-18 y old subjects admitted to hospital because of parasuicide and additionally coded as having had surgery as a consequence of the attempted suicide or having a pertinent psychiatric disorder. The relevant census in the regions of the participating youth health care departments served as referents. The High-School Students Study included 4997 students aged 12-18 y of which 303 reported having attempted suicide at least once. In the ecologic case-referent studies the adjusted Odds Ratio for completed suicide in regions with open consultation hours was 0.98 (95% CI 0.69-1.38) and the weighted Odds Ratio for parasuicide was 1.30 (95% CI 0.97-1.75). Analysis of the data of the High-School Students Study resulted in an Odds Ratio of 0.96 (95% CI 0.72-1.26). The overall homogeneous Odds Ratio for (para)suicide in regions with open consultation hours for all three studies was 1.00 (95% CI 0.97-1.04); the heterogeneous Odds Ratio was 1.08 (95% CI 0.95 1.09). This study does not support the hypothesis that regions, where youth health care departments have instituted freely accessible consultation hours in secondary schools, show lower rates of suicide or parasuicide compared to regions where no consultation hours were implemented.