Vitamin Deficiencies among Resettled Refugees in Buffalo, NY
Evans, Tyler B.
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Background Micronutrient deficiency in the developing world is a considerable public health issue that is often overlooked. Refugees are some of the most vulnerable populations, since they rely almost exclusively on the nutrition provided by refugee camps. Multiple studies to date have assessed this problem among refugee populations either prior to or following the process of resettlement in the developed world. The results have been alarming and have begun to shift public health focus on this serious problem. Vitamins A, B12, D and iron have been most commonly researched. Buffalo, NY resettles the fourth largest number of refugees per capita among cities in the United States (US). Jericho Road Family Practice (JRFP), a family medicine clinic on the west side of Buffalo, offers primary care to refugees. We examined the prevalence of vitamin A, B2, B12, and D deficiencies among refugees who had been recently resettled to Buffalo, NY and referred to this practice for assessment. Our exploratory objective was to examine potential differences in the prevalence of vitamin deficiencies among those living in specific refugee camps. Methods Study Design: Retrospective chart review. Study Population: Refugees between the ages of 2 and 75 and resettled in Buffalo between December 2012 and March 2013 who were registered patients at JRFP, underwent medical evaluation <90 days of resettlement and successfully completed blood draws for ≥ 2 vitamin levels. Independent Variables: Age, gender, country of origin, country of refugee camp refugee, length of time in US prior to medical evaluation, length of time in refugee camp. Dependent Variables: % of deficiencies among vitamin A, B2, B12 and D levels. Data Collection: We reviewed all medical charts meeting criteria using a standardized form to abstract necessary independent and dependent variables. Data Analysis: Descriptive summary of subjects by age group, gender, countries of origin and refuge, respectively. Descriptive reporting of the prevalence of vitamin deficiencies. Fisher Exact Tes t was used to examine differences in the reported prevalence of vitamin deficiency. ANOVA was further used to examine which variables had a significant influence on the length of time refugees spent in camps, as well as on the length of time spent in the US prior to medical evaluation, respectively. Results The majority of our subjects were males (57.1%) between the ages of 18 and 39 years (47.9%) and generally resided in camps in either East Asia or East Africa. The mean length of time spent in refugee camps was 13.6 years. Age was the only variable that explained a significant portion of the variance in length of time spent in refugee camps (p=0.0003). However, age, country of origin, and country of refuge all (p<0.0001) significantly explained some portion of the variance in the length of time spent in the US prior to medical evaluation ( x =41.7 days). There were no reported cases of vitamin A deficiency and only 4 cases of vitamin B2 deficiency (5.7%). Alternatively, vitamin B12 and D were deficient in 41.2% (p<0.0001) and 65.5% (p<0.0001) of samples, respectively. Discussion There are concerning deficiencies noted for vitamin B12 and D levels among these refugees resettled in Buffalo, NY. In contrast, none of these subjects were noted to be vitamin A deficient; and very few were vitamin B2 deficient. This suggests a positive impact from current micronutrient supplementation programs (i.e. vitamin A). There was also significant variation in the prevalence of vitamin B12 and D deficiency between countries of refuge. These analyses suggest that vitamin B12 and D deficiency is a considerable issue in refugees resettled in NYS and should be addressed by local clinicians involved in the post-resettlement care of these populations.