Nutritional Status of Rohingya Children in Kuala Lumpur

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1 : Nutitional Status of Rohingya Childen in Kuala Lumpu T Sok Teng & MS Zalilah* Depatment of Nutition and Dietetics, Faculty of Medicine and Health Sciences, Univesiti Puta Malaysia ABSTRACT The Rohingya is a goup of efugees fom Myanma who have been esiding in Malaysia since the 1980s. At pesent, thee is no published infomation on health and nutitional status of efugee childen in Malaysia. This study was conducted to assess nutitional status of the Rohingya childen aged 6 months to 12 yeas old (N=87) and to detemine the associations between nutitional status with socio-demogaphic, dietay divesity and health (bith weight, immunization and childhood illness) vaiables. Childen wee measued fo weight and height while thei guadians wee inteviewed fo socio-demogaphic, dietay divesity and health infomation. About 27.5% of the Rohingya childen wee undeweight, 11.5% stunted, 16.1% thin and 12.6% at isk of oveweight and oveweight. The pecentage of childen with low bith weight (< 2.5 kg) and no immunization was 17.8% and 11.5%, espectively. Feve (67.8%) and flu (62.1%) wee the most common childhood illnesses epoted in pevious month with 44-75% of the childen with these illnesses did not eceive any medical teatment. The mean dietay divesity scoe was out of a possible 14, with a highe scoe indicating a moe divese diet. Thee wee significant coelations between fequency of immunization eceived by the childen with weight-fo-age-z scoe ( s =0.27, p<0.05), height-fo-age-z scoe ( s =0.25, p<0.05) and BMI-fo-age-Z scoe ( s =0.24, p<0.05). Height-fo-age-z scoe was also positively coelated with childhood illness scoe ( p =0.24, p<0.05) and dietay divesity scoe ( p =0.23, p<0.05) in that childen with less common childhood illnesses and vaiety of foods in the diets had bette linea gowth. As efugees have limited access to health cae sevices, they ae at geate isk of health and nutitional poblems. Keywods: Nutitional status, efugee, Rohingya, immunization, dietay divesity INTRODUCTION A efugee is defined as a peson who owing to a well-founded fea of being pesecuted fo easons of ace, eligion, nationality, membeship of a paticula social goup o political opinion, is outside the county of his nationality and is unable o, owing to such fea, is unwilling to avail himself of the potection of that county; o who, not having a nationality and being outside the county of his fome habitual esidence as a esult of such events, is unable o, owing to such fea, is unwilling to etun to it [1, 2]. Globally, the total population of efugees is about 9.9 million [3]. In Malaysia, thee wee 41,400 efugees and asylum seekes egisteed with United Nations High Commissione fo Refugees in 2008 [4]. The majoity of these efugees came fom Indonesia and Myanma with the lagest ethnic goups being Acehnese (Indonesia), Chins (Myanma) and Rohingyas (Myanma). Since Malaysia has not atified the 1951 United Nations Convention Relating to the Status of Refugees [5], the Fedeal Govenment does not have the obligation to potect o gant any legal status to the efugees. Howeve, the govenment pemits the opeation of UNHCR in Malaysia and it is the esponsibility of UNHCR to gant the status of efugees in Malaysia as well as to povide potection and financial suppot to the efugee population. Compaed to the Rohingyas, the Acehnese and Chins have highe chances to etun home o be esettled in othe counties [6]. The Rohingya is a Muslim minoity ethnic goup fom the Rakhine state of Myanma. In 1978, the Rohingyas stated to flee Myanma to escape ethnic pesecution by the Myanma govenment. Since then, the Rohingyas have fled to its neighboing counties, including Bangladesh, Thailand and Malaysia [7]. Subsequently, the Rohingyas have been esiding in Malaysia fo moe than 20 yeas and the estimated population in mid-yea 2007 was 12708, compising 31.1% childen and 68.9% adults. As the Rohingyas do not have wok pemits, many ae illegal wokes suviving on pat time jobs with elatively low wages [8]. The childen do not have access to fomal education but they attend eligious o infomal schools oganized by UNHCR and othe non-govenmental agencies. Although the identity cads issued by UNHCR allowed the Rohingyas to have access to the govenment health cae sevices at a discounted ate [3], financial and social *Coesponding autho: zalilah@medic.upm.edu.my

2 42 T Sok Teng & MS Zalilah constaints may pevent them fom seeking medical cae. Lack of education and employment oppotunities as well as access to health cae sevices may place the Rohingyas at isk of poo health and nutitional status. The geneal health status of efugees in vaious counties is epoted to be poo with malnutition being the majo health poblem due to lack of access to sufficient food and nutient intakes [9, 10, 11]. Othe health poblems among efugees include mental illnesses, intestinal paasites, hepatitis B, tubeculosis, sexually tansmitted diseases, HIV/ AIDS, malaia and anemia [12]. Refugees may have difficulties to access health cae sevices due to easons such as unaffodable medical costs, language baies, difficulty to take wok leave, lack of tanspotation and discimination o ejection by health staff due to absence of legal documentation [13]. Consequently, efugees become hesitant to seek medical cae and this may exacebate thei health poblems. At pesent, thee is no published infomation on health and nutitional status of Rohingya population in Malaysia. This study was conducted to assess nutitional status of Rohingya childen and to detemine its association with sociodemogaphic, dietay divesity and health factos. METHODS This study was conducted in thee Rohingya concentated aeas in Ampang, Cheas and Setapak as ecommended by UNHCR (United Nations High Commissione fo Refugees) Malaysia. Rohingya infomal schools (madasah) and community centes in these aeas wee visited to ecuit male and female childen in the age goup of 6 months 12 yeas. A study infomation sheet and an infomed consent fom wee distibuted to all childen to be given to thei caegives. Only childen who met the study citeia (age 6 months-12 yeas, no physical defomity and fee fom health poblems such as asthma, diabetes mellitus and congenital diseases) and whose caegives wee willing to be inteviewed and allowed thei childen to be measued wee accepted as study subjects. The final sample consisted of 87 childen. The weight and standing height of the childen wee measued without shoes using TANITA weighing scale (to the neaest 0.1kg) and SECA body mete (to the neaest 0.1cm), espectively. Each weight and height was measued twice and the aveage value was ecoded as the final value fo analysis. The z-scoes fo weight-fo-age (WAZ) (aged 0 9 yeas), height-fo-age (HAZ) (aged 0 12 yeas) and BMI-fo-age (BMI Z) (aged 0 12 yeas) wee calculated and compaed to WHO gowth standad (0-60 months) [14] and WHO gowth efeence (5-19 yeas) [15]. Infomation on household demogaphic and socio-economic as well as childen s health status and dietay divesity wee obtained though an inteviewe-administeed questionnaie with the caegives. Childen s bith weight and immunization infomation wee obtained fom eithe caegive s ecall o official documents such as bith cetificate and immunization cad. Howeve, as a majoity of the caegives did not have childen s immunization cads o bith cetificates at the time of the inteviews, most of the infomation was based on ecalls. Bith weight was classified as low bith weight (less than 2.5kg) and nomal bith weight (equal to o moe than 2.5kg) accoding to WHO definitions (1990). The caegives wee also asked whethe thei childen had neve eceived immunization, eceived only once o eceived moe than once since bith (excluding the immunization eceived immediately afte bith). These categoies wee used as it was difficult fo the caegives to ecall the types of immunization eceived as well as the actual numbe of times they bought the childen to the clinics o hospitals fo immunization. The caegives wee also asked on the fequency of childen having 6 common childhood illnesses (feve, cough, diahea, vomiting, unny nose and asthma) in the pevious month. A scoing system was constucted in that 1 point was given to childen having the symptoms but wee not bought to the doctos, 2 points fo childen with symptoms and wee bought to the doctos and 3 points fo childen with no symptoms. The highe scoe indicates bette health status of the childen. The dietay divesity questions wee adapted fom individual dietay divesity questionnaie [16]. The instument consisted of 16 food goups ceeals (e.g. ice, glutinous ice, bead), vitamin A ich vegetables and tubes (e.g. pumpkin, caots, sweet potato), white tubes and oots (e.g. potato, cassava, yam), dak geen leafy vegetables (e.g. spinach, mustad leaves, swamp cabbage, geen shoots), othe vegetables (e.g. cucumbe, tomato, cabbage, boccoli), vitamin A ich fuits (e.g. mango, papaya), othe fuits (e.g. apple, pineapple, banana, oange), ogan meats, flesh meat (e.g. beef, mutton, chicken), eggs, fish (e.g. fesh fish, died fish, seafood), legumes/nuts/seeds, milk and milk poducts, oils and fats, sweets, coffee and tea. The examples of foods in each food goup wee modified as to epesent foods commonly consumed by Malaysians. The caegives wee asked on the childen s consumption fequency of each of the food goups in the past 7 days. One scoe was given to each food goup if it was consumed 3 times in the past week and 0 fo the food goup that was consumed less than 3 times in the past week. Dietay divesity scoe (DDS) was calculated as the sum of 14 food goups, excluding sweets, coffee and tea [17]. Ethical appoval fo this study was obtained fom the Medical Reseach Ethics Committee, Faculty of Medicine and Health Sciences, Univesiti Puta Malaysia. Pemission to conduct the study with Rohingya communities was ganted by UNCHR Malaysia. Rohingya community leades wee also consulted fo assistance to ecuit childen and caegives fo the study. Anthopometic assessments of childen and inteview of the caegives wee conducted in the madasah o community centes. Incentives wee given to the childen upon completion of all measuements.

3 Nutitional Status of Rohingya Childen in Kuala Lumpu 43 The Statistical Package fo the Social Sciences (SPSS) vesion 15 was used fo data analysis. Data wee pesented desciptively and associations between vaiables wee analyzed using Peason coelation (continuous data) and Point Bi-seial / Speaman Rank coelation (categoical data) tests. Significance level was set at p<0.05. Socio - demogaphic Chaacteistics RESULTS Table 1 shows the socio-demogaphic chaacteistics of the study sample. The mean age of the childen was 6.15 ± 2.86 yeas anging fom 9 months to 11 yeas 8 months. Thee wee almost equal numbes of male (50.6%) and female (49.4%) childen in the study. All of the caegives wee women and mothes to the childen. The caegives aveage yea of education was 2.54 ± 3.90 yeas with moe than half (63.2%) had no fomal schooling. The mean yea of esidence in Malaysia was 3.88 ± 1.48, with a ange of 1 to 10 yeas. Sixty five (74.7%) of the caegives wee unemployed and only 22 (25.3%) wee employed. The mean household size and numbe of childen was 6.16 ± 2.46 and 3.62 ± 1.78, espectively. Out of the 87 childen, 9 families (10.3%) had no fixed monthly household income while 66.6% had income between RM 401 RM 800. Families with no fixed household income depended on aids (monetay, food and non-food items) given by vaious non-pofit oganizations. The mean income pe capita was RM ± 63 with a majoity of the families (78.9%) wee living below the povety line income (PLI) of RM 155 pe month. Table 1. Socio-demogaphic chaacteistics of childen (N =87) Vaiable n (%) Mean ± SD Childen Sex Male 44 (50.6) Female 43 (49.4) Age (yeas) 6.15 ± months Male 1 (1.1) Female 0 (0) Male 19 (21.8) Female 18 (20.7) Male 20 (23.0) Female 21 (24.1) Male 4 (4.6) Female 4 (4.6) Caegives Age ± 8.38 Yeas esiding in Malaysia 3.88± 1.48 Education (yeas) 2.54 ± 3.90 Neve attended school 55 (63.2) Pimay school 14 (16.1) Seconday school 15 (17.2) Othes 3 (3.4) Employment status Employed 22 (25.3) Unemployed 65 (74.7) Household size 6.16 ± 2.46 Numbe of childen pe household 3.62 ± 1.78 Monthly household income (RM) ± No income 9 (10.3) RM (6.9) RM (28.7) RM (37.9) RM (16.1) Income pe capita (RM) ± < 155 a 68 (78.2) > (21.8) a Povety line income (9 th Malaysian Plan)

4 44 T Sok Teng & MS Zalilah Health Status Bith weight infomation was only available fo 45 childen based on ecall by the caegives. Fo the othe childen, the infomation could not be obtained as caegives could not ecall, the infomation was not available in the bith cetificate o seveal childen (n=16) wee bon at home in Myanma. The mean bith weight was 2.97 ± 0.69 kg with moe male (28.6%) than female (8.3%) childen had low bith weight (< 2.5 kg) (Table 2). Although the majoity of male (75.0%) and female (76.7%) childen wee taken moe than once to the clinics o hospitals fo immunization afte bith, about 24% of the childen wee not bought o bought only once fo immunization. Feve (67.8%), unny nose o cold (62.1%) and cough (51.7%) wee the most common childhood illnesses among the Rohingya childen. The pecentages of childen with common illnesses and wee not bought to the doctos wee 44% (feve), 53% (cough), 65% (diahea), 62% (vomiting), unny nose (44%) and 75% (asthma). The mean total scoe fo common childhood illnesses was (out of possible 18). Table 2. Health status of childen Vaiable Male n (%) Female n (%) Total Bith weight (Mean ± SD) (n=45) 2.92 ± ± ± 0.69 < 2.5 kg 6 (28.6) 2 (8.3) > 2.5 kg 15 (71.4) 22 (91.7) Immunization > Once 33 (75.0) 33 (76.7) Once 4 (9.1) 7 (16.3) Neve 7 (15.9) 3 (7.0) Childhood illnessa (Mean ± SD) 14.68± ± ± 3.06 Feve (n=59) Bought to the docto 16 (57.1) 17 (54.8) Did not bing to the docto 12 (42.9) 14 (45.2) Cold (n=54) Bought to the docto 15 (60.0) 15 (51.7) Did not bing to the docto 10 (40.0) 14 (48.3) Cough (n=45) Bought to the docto 12 (54.4) 9 (39.1) Did not bing to the docto 10 (45.6) 14 (60.9) Vomiting (n=26) Bought to the docto 6 (46.1) 4 (30.8) Did not bing to the docto 7 (53.9) 9 (69.2) Diahea (n=17) Bought to the docto 3 (37.5) 3 (33.3) Did not bing to the docto 5 (62.5) 6 (66.7) Asthma (n=8) Bought to the docto 2 (50.0) 0 (0.0) Did not bing to the docto 2 (50.0) 4 (100.0) a Only fo childen with the epoted symptoms in the pevious month Dietay divesity scoe Table 3 shows the fequency of food goups consumed by the childen in the last 7 days. Gain and ceeals (94.3%), dak geen leafy vegetables (79.3%), othe vegetables (81.4%), othe fuits (77.0%), eggs (66.7%), fish (71.3%), milk and milk poducts (67.8%), oils and fats (87.4%) and sweets (80.5%) wee consumed > 3 times in the last week by at least two thid of the childen. Ogan meats (92%), legumes/nuts and seeds (60.9%) and coffee/tea (57.5%) wee

5 Nutitional Status of Rohingya Childen in Kuala Lumpu 45 consumed less fequently (< 3 times last week). The aveage dietay divesity scoe fo all childen was 8.90 ± 3.19 (out of possible 14), with simila mean scoe fo male (8.90 ± 3.30) and female childen (8.89 ± 3.11). Table 3. Food Goup Dietay divesity of childen Eat < 3 times last week n (%) Eat > 3 times last week n (%) Gain and ceeal 5 (5.7) 82 (94.3) Vitamin A ich vegetables and tubes 43 (49.4) 44 (50.6) White tubes and oots 43 (49.4) 44 (50.6) Dak geen leafy vegetables 18 (20.7) 69 (79.3) Othe vegetables 16 (18.6) 70 (81.4) Vitamin A ich fuits 41 (47.1) 46 (52.7) Othe fuits 20 (23.0) 67 (77.0) Ogan meats 80 (92.0) 7 (8.0) Flesh meats 35 (40.2) 52 (59.8) Eggs 29 (33.3) 58 (66.7) Fish 25 (28.7) 62 (71.3) Legumes, nuts, seeds 53 (60.9) 34 (39.1) Milk and daiy poducts 28 (32.3) 59 (67.8) Oils and fats 11 (12.6) 76 (87.4) Sweets 17 (19.5) 70 (80.5) Coffee and tea 50 (57.5) 37 (42.5) Dietay Divesity scoe a (Mean+SD) 8.90 ± 3.19 Male 8.90 ± 3.30 Female 8.89 ± 3.11 a Total possible scoe =14 (sweets and coffee/tea ae not included in the total scoe) Nutitional status About 22.5% of the childen wee undeweight (UW), 11.5% stunted (S) and 16.1% thin (T) with moe male (UW=30%; S=13.6%; T=18.2%) than female childen (UW=15%; S=9.3%; T=14.0%) wee undeweight, stunted and thin (Table 4). The pecentages of childen who wee at isk of oveweight and oveweight wee 5.7% and 6.9%, espectively. Table 4. Indicatos Nutitional status of the childen Male n (%) Female n (%) Weight fo age (n=80) < -2SD (undeweight) 12 (30.0) 6 (15.0) -2SD < X < 2SD (nomal) 28 (70.0) 34 (85.0) Height fo age < -2SD (stunted) 6 (13.6) 4 (9.3) -2SD < X < 2SD (nomal) 38 (86.4) 39 (90.7) BMI fo age < -2SD (thinness) 8 (18.2) 6 (14.0) -2SD < X < 1SD (nomal) 31 (70.5) 30 (69.8) 1 SD < X < 2D (at-isk of oveweight) 3 (6.8) 2 (4.6) > 2SD (oveweight) 2 (4.5) 5 (11.6)

6 46 T Sok Teng & MS Zalilah Coelates of nutitional status Thee was no significant coelation between gowth status with any of the socio-demogaphic chaacteistic (Table 5). Table 6 shows that highe fequency of visits fo immunization was significantly associated with WAZ (=0.27, p<0.05), HAZ (=0.25, p<0.05) and BMI Z (=0.24, p<0.05) while common childhood illness scoe (=0.24, p<0.05) and dietay divesity scoe (=0.23, p<0.05) wee significantly associated with HAZ. Table 5. Coelations a between socio-demogaphic factos and nutitional status Vaiables Weight fo age (n=80) Height fo age (n=87) BMI fo age (n=87) Sex of childen Age of childen Age of caegives Yeas of education Occupation Household size Numbe of childen Monthly household income Total yeas esiding in Malaysia a Peason coelation Table 6. Coelations a between bith weight, immunization, common childhood illness, and dietay divesity with nutitional status Vaiables Weight fo age (n=80) Height fo age (n=87) BMI fo age (n=87) Bith weight Immunization b 0.27* 0.25* 0.24* Common childhood illness * 0.09 Dietay divesity * 0.18 a Peason coelation; bspeaman coelation; *p < 0.05 DISCUSSION Pevention of malnutition among the efugee populations is one of the stategic objectives of UNHCR [18]. Despite the effots to addess malnutition, the poblem still pesists especially among those esiding in potacted efugee camps. Among Myanma efugee childen living in Thailand camps, 33.7% wee undeweight, 36.4% stunted and 8.7% wasted [19]. In anothe study on 957 Myanma efugee childen esiding within camps along the Thailand/Myanma bode, 45.7% wee stunted and 64.9% had ion deficiency anemia [10]. Bei-bei, due to thiamine deficiency, was not only epoted to be pevalent among the Kaen efugees settled in camps along the westen bode of Thailand but also a majo cause of infant motality in this population [9]. In a coss-sectional suvey of efugee adolescents in the Noth Gaza Stip [11], undenutition and ovenutition coexisted in that 17.9%, 9.7% and 49.6% of the adolescents wee oveweight, stunted and anemic, espectively. Povety, poo sanitation, availability of high enegy-dense foods, insufficient miconutient-dense foods, physical inactivity, food beliefs and cultual pactices ae impotant deteminants of malnutition in these efugee populations. Although the majoity of Rohingya childen in this study wee living in povety, thei living conditions (ented low cost houses, flats and shop houses) wee much bette than that in the potacted efugee camps. Howeve, due to povety, the Rohingyas may be at geate isk of household food insecuity as well as living envionment associated

7 Nutitional Status of Rohingya Childen in Kuala Lumpu 47 with poo sanitation which could advesely affect the health and nutitional status of the childen. In geneal, the Rohingya childen have elatively poo gowth status compaed to uban Malay pimay school childen [20] and peschool childen fom low income households in Kuala Lumpu [21]. The pecentages of undeweight, stunting and wasting among 6-9 yea old Malay childen [20] wee 14.5 %, 16.7% and 9.2%, espectively. In this pesent study, 21.9% of Rohingya childen aged 6-10 yeas wee undeweight, 12.2% stunted and 14.6% thin. Zalilah and Ang [21] epoted that among peschooles enolled in Taman Sang Kancil peschools of City Hall Kuala Lumpu, 14.6% wee undeweight, 5.8% stunted and 4.6% wasted. The pecentages of undeweight, stunting and thinness in Rohingya childen below 6 yeas of age wee 17.9%, 7.6% and 12.8%, espectively. We also epoted that 12.6% of the Rohingya childen wee at isk of oveweight and oveweight. Changes in eating habits and lifestyles associated with uban living could contibute to oveweight and obesity in efugee population, not only in childen but also in adults. Although the diffeences in gowth attainment of Rohingya and Malay childen could be due to diffeent standads and indicatos used fo gowth categoization, the diffeences could also eflect the social and economic constaints expeienced by the Rohingya communities. Rohingya families may hesitate to seek health cae sevices due to easons such as fea of being detained, lack of access to health cae sevices and high medical costs [8]. As many of the Rohingya adults have low education level o neve attended school, they may have difficulty to undestand the health infomation conveyed by health pofessionals. In addition, thee may also be a language baie that could pevent them fom communicating with the health pofessionals. Poo gowth status of childen has been associated with being male child [22, 23], insufficient household income [24, 25], low education level of caegives [26, 27], lage household size and high numbe of childen [28]. In the pesent study, gowth status of the Rohingya childen was not significantly associated with any of the socio-demogaphic factos. Small sample size as well as homogeneity of sample socio-demogaphic chaacteistics could contibute to these non-significant findings. We showed that Rohingya childen with highe immunization scoe had bette gowth status. Complete immunization duing childhood will educe childen s isk of getting common childhood infections. Sickness in childen is always associated with loss of appetite and educed food intakes which could lead to significant weight loss. Studies showed that childen who had ecent feve o diahea wee moe likely to be undeweight and that childen with complete immunization befoe age 12 months wee less likely to be undeweight [29, 30]. In addition, fequent and epeated infections in childen which could be pevented by childhood immunization could advesely impact long tem gowth i.e stunting [24, 30]. Positive elationship between dietay divesity and child nutitional status has been consistently shown in many studies. In contempoay Afican communities, dietay divesity scoe was consistently and positively associated with vaious nutitional indicatos (height-fo- age, weight-fo-age, weight-fo-height, mid-uppe am cicumfeence and ticeps skinfold) of childen aged months [31]. Aimond and Ruel [32] epoted that among childen aged 6-23 months, dietay divesity was significantly coelated with childen s height-fo-age z scoes, independent of socioeconomic status. In olde childen, seveal studies have also documented that divesity in childen s diets educed thei isks of undeweight and stunting [33, 34]. In a ecent study among Oang Asli communities in Selango [35], childen with vaied diets wee moe likely to have highe enegy intake and less likely to be undeweight. This study is not without its limitations. As the categoization of immunization status of childen and the scoing of common childhood illnesses wee not validated pio to the study, these measuement appoaches might not be accuate to eflect the actual health conditions of the childen. Nevetheless, the significant coelations between nutitional status with immunization status and childhood illnesses obseved in this study povided some suppot to the validity of these measuement appoaches. The small sample size and the use of puposive sampling in this study could limit the genealization of the study findings to the Rohingya population in this county. Finally, thee might be eos o biases elated to ecall infomation. Despite these limitations, this study is the fist to epot on health and nutitional status of the Rohingya childen in Malaysia. CONCLUSION Ou study showed that the nutitional status of Rohingya childen was associated with immunization status, dietay divesity and childhood illnesses. Childen with bette immunization ecod, had vaiety of foods in the diets and wee less fequently sick, wee moe likely to have bette nutitional status. Refugee population in Malaysia may hesitate to seek health cae sevices due to fea of being detained, unaffodable health cae costs, language and cultual baies, lack of tanspotation as well as discimination by health pesonnel. In addition, having no pemanent jobs and low o no education may futhe constaint the efugees in thei health seeking behavios and undestanding of health and nutition infomation. These baies could put the efugees, especially women and childen at geate isks of health and nutitional poblems. To impove health and nutition of efugee population in Malaysia, thee should be conceted effots by vaious paties to ensue that the efugees have access to fee education, affodable health cae sevices as well as employment oppotunities.

8 48 T Sok Teng & MS Zalilah REFERENCES [1] UNHCR. Convention Relating to the Status of Refugees. United Nations High Commissione fo Refugees (UNHCR), [2] UNHCR. Potocol Relating to the Status of Refugees. United Nations High Commissione fo Refugees (UNHCR), [3] UNHCR. Statistical yea book 2005 tends in displacement, potection and solutions. United Nations High Commissione fo Refugees (UNHCR), [4] UNHCR. Statistic: Malaysia Accessed 2 Sept [5] UNHCR. States Paties to the 1951 Convention elating to the Status of Refugees and the 1967 Potocol. United Nations High Commissione fo Refugees (UNHCR), [6] UNHCR. Potecting efugees questions and answes. United Nations High Commissione fo Refugees (UNHCR), [7] Amnesty Intenational. Malaysia Refugees and immigants n=com&content&task=view&id=9. Accessed 2 Aug [8] Human Rights Watch Malaysia. Living in limbo: Bumese Rohingyas in Malaysia epots/2000/malaysia/mayb00804.htm#p929_ Accessed 31 July [9] Luxembuge C, White NJ, te Kuile F, Singh HM, Allie-Fachon I, Ohn M, Chongsuphajaisiddhi T, Nosten F. Bei-bei: the majo cause of infant motality in Kaen efugees. Tansactions of the Royal Society of Topical Medicine and Hygiene 2003; 97: [10] Kemme TM, Bovill ME, Kongsomnoon W, Hansch SJ, Geisle KL, Cheney C, Shell-Ducan BK, Dewnowski A. Ion deficiency is unacceptably high in efugee childen fom Buma. J Nut 2003; 133; [11] Abudayya A, Thoesen M, Abed Y, Holmboe-Ottesen G. Oveweight, stundting, and anemia ae public health poblems among low socio-economic goups in school adolescents (12-15 yeas) in the Noth Gaza Stip. Nut Res 2007; 27: [12] Kemp C, Rasbidge LA. Refugee and Immigant Health: A Handbook fo Health Pofessionals. Cambidge Univesity Pess, [13] Feld P, Powe B. Immigants access to health cae afte welfae efom: findings fom focus goups in fou cities. The Kaise Commission on Medicaid and the Uninsued, [14] WHO. The WHO child gowth standad standad/techinical_epot/en/ index.html. Accessed 16 Aug [15] WHO. WHO Refeence 2007: gowth efeence data fo 5 19 yeas Accessed 16 Aug [16] FAO/Nutition and Consume Potection Division. Individual dietay divesity questionnaie. Food and Agicultual Oganization, [17] FAO Nutition and Consume Potection Division. Guidelines fo measuing household and individual dietay divesity. Rome, Italy: Food and Agicultual Oganization, [18] UNHCR/WFP. Acute malnutition in potacted efugee situations: A global stategy. United Nations High Commissione fo Refugees (UNHCR) and Wold Food Pogamme (WFP), [19] Banjong O, Menefee A, Sanachaoenpong K, Chitchang U, Eg-kantong P, Boonpadem A, Tamachotipong S.

9 Nutitional Status of Rohingya Childen in Kuala Lumpu 49 Dietay assessment of efugees living in camps: acase study of Msae La Camp, Thailand. Food Nut Bull 2003; 24(4): [20] Zalilah MS, Bond JT, Johson NE. Nutitional status of pimay school childen fom low income households in Kuala Lumpu. Mal J Nut 2000; 6: [21] Zalilah MS, Ang, M. Assessment of food insecuity among low income households in Kuala Lumpu using Radime/Conell Food Insecuity Instument a validation study. Mal J Nut 2001; 7(1&2): [22] Thang NM, Popkin B. Child malnutition in Vietnam and its tansition in an ea of economic gowth. J Hum Nut Dietet 2003; 16: [23] Phengxay M, Ali M, Yagyu F, Soulivanh P, Kuoiwa C, Ushijima H. Risk factos fo potein-enegy malnutition in childen unde 5 yeas: study fom Luangpabang povince, Laos. Pediat Int 2007; 49: [24] Sakisaka K, Wakai S, Kuoiwa C, Cuada Floes L, Kai I, Mecedes Aagon M, Hanada K. Nutitional status and associated factos in childen aged 0-23 months in Ganada, Nicaagua. J Royal Ins Pub Health 2006; 120: [25] Oldewage-Theon W, Dicks EG, Napie CE. Povety, household food insecuity and nutition: Coping stategies in an infomal settlement in the Vaal Tiangle, South Afica. J Royal Ins Public Health 2006; 120: [26] Shah SM, Selwyn BJ, Lubby S, Mechant A, Bano R. Pevalence and coelates of stunting among childen in ual Pakistan. Pediat Int 2003; 45: [27] Seeebuta P, Solomons N, Aliyu MH, Jolly PE. Sociodemogaphic and envionmental pedictos of childhood stunting in ual Guatemala. Nut Res 2006; 26: [28] Fotso JC, Kuate-Defo B. Socioeconomic inequalities in ealy childhood malnutition and mobidity: Modification of the household-level effects by the community SES. Health & Place 2006; 11: [29] Balk D, Stoeygad A, Levy M, Gaskell J, Shama M, Flo R. Child hunge in the developing wold: An analysis of envionmental and social coelates. Food Policy. 2005; 30: [30] Casapía M, Joseph SA, Núñez C, Rahme E, Gyokos TW. Paasite isk factos fo stunting in gade 5 students in a community of exteme povety in Peu. Int J Paasitol 2006; 36: [31] Onyango AW. Dietay divesity, child nutition and health in contempoay Afican communities. Compaative Biochem Physiol 2003; 136: [32] Aimond M, Ruel MT. Pogess in developing an infant and child feeding index: An example using the Ethiopia demogaphic and health suvey U.S.A: Intenational Food Policy Reseach Institute, [33] Hatloy A, Hallund J, Diaa MM, Oshaug A. Food vaiety scoes, socio-economic status and nutitional statusin uban and ual aeas in Koutiala (Mali). Public Health Nut 2000; 3: [34] Steyn NP, Nel JH, Nantel G, kennedy G, Labadaios D. Food vaiety and dietay dievesity scoes in childen: ae they good indicatos of dietay adequacy? Public Health Nut 2006; 9: [35] Nufaizah S, Zalilah MS, Kho GL, Minalini K, Nawalyah AG, Heja AR. Food vaiety scoe is associated with dual buden of malnutition in Oang Asli (Malaysian indigenous peoples) household: implications fo health pomotion, Asia Pac J Clin Nut 2009; 18(3):

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