Dietary Quality of Bhutanese Refugee Adults Eligible for the Supplemental Nutrition Assistance Program

Objectives To characterize nutrient intakes and identify key food sources among Bhutanese refugee adults eligible for SNAP (Supplemental Nutrition Assistance Program) benefits. Methods We recruited a convenience sample of Bhutanese refugee adults (n = 54, mean age = 47 y, 83% female) residing in New Hampshire. Diet was estimated from foods recorded using three 24-hr recalls. Selected nutrients included vitamins C, D, E, and K, thiamin, riboflavin, niacin, B6, folate, B12, pantothenic acid, calcium, magnesium, sodium, and saturated fat. Participants were categorized based on meeting the Recommended Dietary Allowance (RDA) or Adequate Intake (AI) of selected nutrients. For sodium and saturated fat, meeting recommendations was defined as consuming <2300 mg/d and <10% of energy, respectively. Study visits were conducted by a trained bicultural and Nepali-speaking community health worker in partnership with a community-based organization. Results More than half of participants (68% to 90%) met recommendations for K, thiamin, niacin, folate, sodium, and saturated fat. However, a lower proportion (0% to 46%) consumed recommended amounts of C, D, E, riboflavin, B6, B12, pantothenic acid, calcium, and magnesium. Legume dishes and vegetable curries were leading contributors to C (40%), E (33%), B6 (21%), pantothenic acid (18%), and magnesium (25%) intakes. Milk and yogurt were primary contributors to riboflavin (23%), B12 (40%), and calcium (31%) consumption, and parboiled rice for B6 (28%) and pantothenic acid (24%). Conclusions In this descriptive study of low-income Bhutanese refugee adults, the prevalence of meeting guidelines was high for some nutrients, but others fell short of recommendations. Culturally specific foods were found to be key sources of inadequately consumed nutrients, which can inform the tailoring of dietary recommendations for this community. Funding Sources The New Hampshire Agricultural Experiment Station.

Associations Between Dietary Quality and Inflammation Among Bhutanese Refugee Adults Eligible for the Supplemental Nutrition Assistance Program

Objectives To quantify the associations between adherence to U.S. dietary guidelines and inflammation among Bhutanese refugee adults who are eligible to receive SNAP (Supplemental Nutrition Assistance Program) benefits. Methods A convenience sample of Bhutanese refugee adults (n = 53, mean age = 47 ± 2 years, 83% female) residing in New Hampshire was recruited. A bilingual community health worker conducted study visits. We estimated diet using the average of three 24-hour recalls. Adherence to U.S. dietary guidelines was defined using the 2015 Healthy Eating Index (HEI), where a higher score indicates greater adherence to guidelines. A fasting blood sample was analyzed for inflammatory biomarkers, IL-6 and TNF-α. The HEI score and score components were expressed in tertiles, and related to biomarkers using ANCOVA. Food rankings were conducted to identify contributors to HEI components. Results On average, participants lived in the U.S. for 7.8 ± 0.5 years, with a household size of 3.8 ± 0.2 members. The prevalence of overweight/obesity and type 2 diabetes was 82% and 41%, respectively. In multivariate adjusted models, individuals with higher HEI scores had significantly lower IL-6 concentrations (3.1 ± 0.5 pg/mL, 2.5 ± 0.4 pg/mL, and 2.0 ± 0.5 pg/mL by increasing HEI tertile, P-trend = 0.019). In examining the individual HEI components, greater consumption of total fruit (P-trend = 0.02) and whole fruit (P-trend = 0.017) was related to lower IL-6 concentrations, whereas refined grains was associated with higher values (P-trend = 0.036). We observed null associations with TNF-α. The top 5 contributors to fruit consumption were bananas (21.5%), apples (15.5%), mangos (15%), avocados (9.6%), and kiwis (8.8%); those for refined grains included parboiled rice (78.8%), white rice (6.1%), pasta (4.6%), crackers (1.3%), and white bread (1.3%). Conclusions In this cross-sectional study of low-income Bhutanese refugee adults, greater adherence to U.S. Dietary Guidelines, particularly for fruit and refined grain consumption, was associated with lower IL-6 concentrations. Over 70% of fruit and 90% of refined grains were represented by only a few foods, which can inform cultural tailoring of SNAP Education interventions in this understudied population. Funding Sources The New Hampshire Agricultural Experiment Station.

Long-Term Physical Health Outcomes of Resettled Refugee Populations in the United States: A Scoping Review

Several studies describe the health of recently resettled refugee populations in the US beyond the first 8 months after arrival. This review summarizes the results of these studies. Scientific articles from five databases published from January 2008 to March 2019 were reviewed. Articles were included if study subjects included any of the top five US resettlement populations during 2008–2018 and if data described long-term physical health outcomes beyond the first 8 months after arrival in the US. Thirty-three studies met the inclusion criteria (1.5%). Refugee adults had higher odds of having a chronic disease compared with non-refugee immigrant adults, and an increased risk for diabetes compared with US-born controls. The most commonly reported chronic diseases among Iraqi, Somali, and Bhutanese refugee adults included diabetes and hypertension. Clinicians should consider screening and evaluating for chronic conditions in the early resettlement period. Further evaluations can build a more comprehensive, long-term health profile of resettled refugees to inform public health practice.

Implementation of telemedicine project in Bhutanese refugee camp in Nepal

While working with UNHCR (UN Refugee Agency) in Nepal, I faced the challenge of managing Bhutanese refugee health care programme with limited resources. Since 1993, UNHCR was providing health services to Bhutanese refugees living in seven camps. UNHCR Nepal had received limited budget due to emerging refugee crisis in other parts of the world in 2016. As a health focal person, I was assigned to look for new approaches to provide health services to refugees. After exploring several possibilities, telemedicine project was introduced in the camp in 2016 with the collaboration of tertiary hospital, B. P. Koirala Institute of Health Sciences. The main objective of the project was to reduce medical referral, which consumed most of the resources. From testing and prototyping, videoconference was considered as the most appropriate method to perform telemedicine in the camp. Telemedicine helped camp clinical staff to directly communicate with consultants in the tertiary hospital at distant and address the refugee health issue at camp level. After implementation of telemedicine, medical referral from camp clinic to hospitals in 2016 was reduced by 54.8 % in comparison to previous year 2015. Telemedicine project also enhanced the coordination and linkage of refugee and UNHCR with tertiary referral hospital. Regular monitoring visit from the expert helped to improve the telemedicine project significantly. The most important lesson learnt was that beneficiaries and camp health staff should be involved from beginning. Camp health workers must be trained on using telecommunications equipment. Telemedicine is cost-effective in refugee setting where internet access is strong. Regular monitoring and technical support from the expert, learning attitude of camp health workers and acceptance from refugee are vital for the success of the project. Telemedicine increased access of essential healthcare to the most disadvantaged communities and ultimately facilitated universal health coverage. Key messages Telemedicine is cost-effective way of providing health services to refugee at remote area where access to hospitals is challenging due to certain limitation such as distance, budget, transportation. Telemedicine not only save the cost of medical referral but also save opportunity cost, time and energy of refugees, which are invested while visiting hospital.