Under-Five Malnutrition Among Palestine Refugee Children Living in Camps in Jordan: A Mixed-Methods Study

Abstract

In 2019, a household mixed-methods study was conducted in Jerash and Souf Palestine refugees’ camps in Jordan. A random sample of 407 households, 20 in-depth interviews with the children’s mothers, and two focus groups for UNRWA staff, were used. Demographic, socioeconomics, food insecurity scores, diet quality, and anthropometric data were recorded using REDCap, with written consents. Descriptive analysis, bivariate, and multivariate analysis was performed for the quantitative data and deductive thematic coding for qualitative data. Approved IRB by Harvard Medical School and UNRWA, were obtained. The World Health Organization software (WHO-Anthro-Plus), was used to calculate the prevalence of stunting (Height-for-Age <-2SD) and overweight (Weight/Height-for-Age >+2SD). Written consents were obtained from the parents. Results: Out of 405 household participants approached, 367 were eligible, children age was (2.74±1.15yrs), 182(49.6%) were female. No significant differences in the prevalence of stunting between Jerash and Souf camp were found (23.6% vs. 20%, respectively). However, overweight was significantly higher in Jerash compared to Souf (18% vs. 7%, respectively). Food insecurity (scores>8) in both camps was 72.7% (276). Souf camp had less food insecurity, (OR 0.61 [0.35-1.05], p=0.07), and the less number of months with an income, in the last six months, was significant with food insecurity (OR 0.60 [0.51-0.71], p<0.001). Three thematic groups emerged from qualitative data, including (a) strategies for obtaining food or food aid, (b) factors impacting children’s nutritional status and diet quality, and (c) the central role of mothers as strategists and household managers. Conclusion: We found a moderate-to-high prevalence of stunting and overweight levels among Palestine refugee children in both camps, high food insecurity levels related to income. We believe that these findings are associated with the lack of meaningful livelihood among Palestine refugees living in both camps. This study constitutes an initial step for future studies among Palestine Refugee children in other camps.