Both obesity and under-nutrition are common in women and children from the Western Sahara living in refugee camps in Algeria, highlighting the need to balance both obesity prevention and management with interventions to tackle under-nutrition in this population, according to a study by international researchers published in this week's PLOS Medicine.
The authors, led by Carlos Grijalva-Eternod and Andrew Seal from the UCL Institute of Child Health in London, surveyed 2005 households in this refugee population who have been living in four refugee camps since 1975 and measured and weighed 1,608 young children and 1,781 women. They found that obesity and overweight in women affected more households than acute malnutrition, stunting and underweight in children: 9.1% children had acute malnutrition, 29.1% were stunted, 8.6% were underweight and 2.4% were overweight, while among the women, 14.8% were stunted, 53.7% were overweight, and 71.4% had central obesity.
Overall, the authors classified a third of households as being overweight, a quarter as undernourished, and a quarter as affected by the double burden of obesity and malnutrition.
These results are important: 15.4 million refugees (based on 2010 figures) are dependent on host governments and international humanitarian agencies for their food, so it is essential that these governments and organizations provide appropriate food assistance programs to refugees, especially long-term refugees.
The authors say: "The results raise crucial and challenging issues for the design of refugee assistance programmes, and the future provision of care for obesity-associated co-morbidities among Sahrawi refugees and other similar populations."
They continue: "Careful policy and advocacy work will be required to convey the complexity of the situation, and to ensure that continued support for life-saving food assistance programmes and the tackling of under-nutrition and nutritional deficiencies is not jeopardised as the threat of obesity to refugee health receives the attention it deserves."
Funding: This work was partly funded by the European Community Humanitarian Office, the United Nations High Commissioner for Refugees (UNHCR), and the United Nations World Food Programme. Part of this work was undertaken at the Centre for Paediatric Epidemiology and Biostatistics, which benefits from funding support from the MRC in its capacity as the MRC Centre of Epidemiology for Child Health. The UCL Institute of Child Health receives a proportion of funding from the Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme. UNHCR personnel participated in the study design, data collection, data interpretation, and contributed revisions to the manuscript. All other sponsors of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report, and in the decision to submit the paper for publication.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Grijalva-Eternod CS, Wells JCK, Cortina-Borja M, Salse-Ubach N, Tondeur MC, et al. (2012) The Double Burden of Obesity and Malnutrition in a Protracted Emergency Setting: A Cross-Sectional Study of Western Sahara Refugees. PLoS Med 9(10): e1001320. doi:10.1371/journal.pmed.1001320
Carlos S. Grijalva-Eternod
Centre for International Health and Development
UCL Institute of Child Health
London, United Kingdom