Assessment of the Effectiveness of Nutributter® Distribution on Anaemia and Stunting in Refugee Populations in Djibouti and Kenya
Sarah Style
UCL Institute for Global Health, London, UK.
Melody Tondeur
United Nations High Commissioner for Refugees, Geneva, Switzerland.
Carlos Grijalva-Eternod
UCL Institute for Global Health, London, UK.
Josephine Pringle
UCL Institute for Global Health, London, UK.
Caroline Wilkinson
United Nations High Commissioner for Refugees, Geneva, Switzerland.
Ismail Kassim
United Nations High Commissioner for Refugees, Geneva, Switzerland.
Allison Oman
United Nations High Commissioner for Refugees, Geneva, Switzerland.
Carmel Dolan
Emergency Nutrition Network, Oxford, UK.
*Author to whom correspondence should be addressed.
Abstract
Objectives: Stunting and micronutrient malnutrition are persistent public health problems in refugee populations. UNHCR and partners use blanket supplementary feeding programmes (BSFP) using Nutributter®, a low-quantity lipid-based nutrient supplement, as one of the approaches to confront these problems. However, the evidence base for the efficacy and effectiveness of Nutributter® is limited. This secondary analysis aimed to assess the impact on anaemia and stunting in children 6-23 months and 6-59 months of a blanket Nutributter® distribution implemented in Dadaab, Kakuma, and Ali Addeh refugee camps.
Methods: A plausibility design using routine pre- and post-intervention cross-sectional nutrition survey data was conducted. Trends in total anaemia (Hb<11g/dl), anaemia categories (mild, moderate and severe), and stunting (HAZ<2) between 2008-2011 were explored and interpreted using available contextual, and Nutributter® programme monitoring data.
Results: In all camps, a significant reduction was seen in the prevalence of anaemia in children 6-23 and 6-59 months between baseline and endline; percentage point reduction ranged from 9.3% to 23%, and 18.3% to 29.3% for each age group, respectively. Improvements were largely due to reductions in moderate and severe anaemia. The prevalence of stunting remained similar for children 6-59 and 6-23 showing little change after introduction of the intervention.
Conclusions: The replicability of findings suggests that Nutributter® distribution is associated with a reduction in anaemia, especially in its most severe forms, among refugees in the Horn of Africa. These results need to be interpreted taking into account other anaemia reduction activities implemented in the camps between 2008 - 2011.