P2B149: Assessing the Nutritional Status of Displaced Rohingya Under Five-years-old in Southern Bangladesh

Background: 957,971 Rohingya living in refugee camps in Cox’s Bazar, Bangladesh have experienced decades of persecution and ethnic cleansing in Myanmar, leading to longstanding nutritional challenges. The displaced population living in Bangladesh skews young, with 16% being children under five-years-old. As these camps become more permanent, acute malnutrition issues have the potential to become chronic. The most recent assessment of child malnutrition was conducted in 2017 using mid-upper arm circumference (MUAC) measurements in 311 children in the Kutupalong camp. The prevalence of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) was 27% and 8.4%, respectively. Males had higher rates of both MAM and SAM. No nutritional assessments have been conducted on larger sample sizes. Given the population and resource fluctuations in the camps, a larger study is warranted.

Methods: A retrospective review of de-identified electronic health records (EHR) of 4,544 Rohingya 6-59 months of age was performed. The patients attended two primary health clinics for routine and urgent care visits in Kutupalong and Balukahli form October 2017 to October 2019. MUAC was measured using standard MUAC tape. Statistical analysis was performed using Python vs3.4 and 3.6.8 (Pandas and Statsmodels packages) and MedCalc Statistical Software v19.5.1. WHO MUAC curves were used as age-based reference points for analysis. A novel, fully encrypted, HIPAA-compliant, solar-powered EHR named NIROG was used in data collection.

Results: Of the 4,544 assessed, 2,216 children (46.79%) 6-59 months were well-nourished, 1,664 (36.62%) were at risk for malnutrition, 739 (16.26%) had MAM, and 15 (0.33%) had SAM (Figure 1 and Table 1). 57.05% of all females were at risk for malnutrition or diagnosed with MAM or SAM compared to 49.88% of males ([N-1]X2=23.34, p< 0.001). Females were more likely to be malnourished (MAM or SAM) than males (OR 1.60, 95%CI [1.36-1.87], p< 0.001).

Conclusion: The prevalence of malnutrition was higher in females than males across all categories, which contradicts prior assessments from a smaller sample size in Kutupalong. Malnutrition in early childhood has numerous adverse outcomes including irreversible damage to biological and cognitive development. It also increases the risk of diabetes mellitus, obesity, and cardiovascular diseases in adulthood. Interestingly, adult females in the camps were found to be more likely to be overweight, which could be secondary to malnutrition in childhood (unpublished data). As data was collected through clinic visits, it is possible that the data under-represents the true prevalence of malnutrition in this group, due to a potential self-selection bias. Additionally, MUAC measurements alone have been shown to undercount cases of acute malnutrition. Taken together, the data reflects a persistent issue of child malnutrition within the Rohingya refugee camps, highlighting an urgent need to re-examine resource allocation and nutritional programs for this vulnerable population.