Nutritional Assessment of Resettled Paediatric Refugees in Western Australia.

King Edward Memorial Hospital, Subiaco, Australia, 2Refugee Health Service, Perth Children’s Hospital, Nedlands, Australia
BACKGROUND AND AIMS:
Nutritional deprivation, inadequate diet and food insecurity are common refugee experiences. The growth and nutritional status of paediatric refugees following resettlement, and related interplay with socioeconomic factors, remain less defined.
Methodology: Standardised dietary, medical and socio demographic health assessments of new refugee patients attending a multidisciplinary paediatric Refugee Health Service (RHS) in Western Australia between 2010-2015 were analysed. Data from 1131 paediatric refugees are described.
CHALLENGES IDENTIFIED:
The majority of the cohort required interpreters and resided in lowest socioeconomic areas, which influences access to affordable healthy food. Nutritional deficiencies were common but varied across ethnicities; vitamin D deficiency (50.3%), iron deficiency (12.5%) and anaemia (7.3%). Inadequate dairy intake was common (49.1%) and highest in children of Southeast Asian descent.
32.6% of children did not consume meat, which reflected accessibility not vegetarianism. Juice intake was excessive (53.4%). Infant breastfeeding was sustained (77.8%) and prolonged breastfeeding (44% aged 12-24 months) was significantly associated with increased risk of iron deficiency (OR 4.0, 95% confidence interval 1.4-11.6). Median body mass index increased significantly for those >24 months between referral and RHS assessment (median period 1.8 months).
The demonstrated post-resettlement weight gain potentially increases the risk for overweight, obesity and metabolic syndrome. Overall, 27.1% required additional formal dietetic follow-up, with nutritional concerns higher in refugee children <24 months compared to older patients.
Implications and conclusions: Identification of frequent post-settlement nutritional concerns have been captured through structured holistic multidisciplinary paediatric health screening. Our findings highlight ongoing socioeconomic impoverishment and access barriers that impact on families’ acculturation processes, possibly impacting malnutrition and future weight gain.
Specific screening for socioeconomic influencing factors including education, poverty and food insecurity within refugee clinical assessments is recommended. Development of targeted, culturally appropriate parental education resources and interventions may improve management following resettlement.