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Obesity and Under-Nutrition among Western Sahara Refugees: The Emerging Threat of Double Burden of Malnutrition in Emergencies

Author(s): C.S. Grijalva-Eternod1,2, J.C.K. Wells3, M Cortina-Borja4, N. Salse-Ubach5,M. Tondeur2 ,C. Dolan2 ,C. Meziani6, C. Wilkinson7, P. Spiegel7, A.J. Seal1,2
Affiliation(s): 1Centre for International Health & Development, UCL Institute of Child Health, London, UK, 2Emergency Nutrition Network, Oxford, UK, 3MRC Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK,  4MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK, 5Independent Consultant, Barcelona, Spain, 6Tindouf Sub-Office, United Nations High Commissioner for Refugees, Tindouf, Algeria, 7Public Health and HIV Section, Division of Programme Support and Management, United Nations High Commissioner for Refugees, Geneva, Switzerland
1st country of focus: Not applicable
Relevant to the conference theme: Emergencies
Summary (max 100 words): We assessed under-nutrition and overweight prevalence in Western Sahara women (15-49 years) and children (6-59 months) living in refugee camps for over 35 years. Both were found highly prevalent - the former among children, the latter among women. At the household level, more households presented cases of overweight than underweight. The number of households presenting both was high (19.9%). The results highlight the need to focus attention on non-communicable diseases within the humanitarian sector with special focus on refugees living a protracted emergency.
Background (max 200 words): Vulnerable groups experiencing epidemiological transitions are known to suffer both under-nutrition and obesity. Yet, it is unknown whether this double burden affects food aid dependent refugees living in protracted emergencies.
Objectives (max 100 words): We aimed at assessing the double burden of malnutrition among Western Sahara refugees living in a protracted emergency for over 35 years.
Methodology (max 400 words): We implemented one stratified cluster nutrition survey in four Western Sahara refugee camps in Algeria. We sampled 2005 households collecting anthropometric indicators in 1608 children (6-59 months) and 1781 women (15-49 years). We estimated the prevalence of global acute malnutrition, stunting, underweight and overweight in children and the prevalence of underweight, overweight and central obesity in women. Households were first classified according to the presence of cases of each indicator. Households were later classified as underweight, overweight or double burden if they presented cases with under-nutrition or overweight, alone or in combination, or normal if no cases were found.
Results (max 400 words): In children, prevalence of global acute malnutrition was 9.1%, stunting 29.1%, underweight 18.6% and overweight 2.4%.; whereas in women 5.1% were underweight, 53.7% were overweight or obese and 71.4% had central obesity. A larger proportion of households presented cases of central obesity (47.2%) or overweight (38.8%) in women compared to those presenting stunting (19.5%) or underweight (13.3%) in children, nonetheless the latter were high. Overall, overweight (43.6%) households were most commonly followed by underweight (20.5%) and double burden-affected (19.9%) households. Similar results were found if households were classified as primarily obese instead of overweight.
Conclusion (max 400 words): Obesity and under-nutrition are highly prevalent and co-existing among Western Sahara refugees. The results highlight the need to focus attention on non-communicable diseases within the humanitarian sector. Results also raise the complex challenges of incorporating obesity prevention and treatment of associated co-morbidities into aid policies, without drawing resources away from providing essential life-saving interventions to tackle under-nutrition.

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