Assessment of the Effectiveness of Nutributter® Distribution on Anaemia and Stunting in Refugee Populations in Djibouti and Kenya

Abstract

Background and objectives: Stunting and micronutrient malnutrition are persistent public health problems in refugee populations. One of the approaches adopted by UNHCR and partners, is blanket supplementary feeding programmes (BSFP) using Nutributter, a low-quantity lipid-based nutrient supplement. However, the evidence base for the efficacy and effectiveness of Nutributter is limited. This secondary analysis aimed to assess the effectiveness of blanket Nutributter distribution on anaemia and stunting in children 6-23 months and to assess trends in children 6-59 months, in Dadaab, Kakuma, and Ali Addeh refugee camps. Methods: A plausibility design using routine pre and postintervention cross-sectional nutrition survey data was conducted. Trends in total anaemia (Hb<11g/dl), anaemia categories (mild, moderate and severe), and stunting (HAZ<2) from 2008- 2011 were explored and interpreted using available contextual, and Nutributter programme monitoring data. Data was cleaned and analysed using Emergency Nutrition Assessment for SMART software (July 2012), and Epi Info (v3.5.4). Results: In all camps anaemia prevalence was reduced by at least 20% in children 6-59 (UNHCR short-term target) (p<0.05), however there was variation between camps in how quickly this was achieved, and total anaemia remained of high public health significance (>40%). A reducing trend in the prevalence of anaemia in children 6-23 months was seen. Improvements in anaemia were largely due to reductions in moderate and severe anaemia; mild anaemia (10