Below are some pre-arrival and post-arrival considerations to take into account when performing a nutritional screening. Below are some ‘key points’ for performing an assessment. Pre-arrival factors to consider in nutrition screening:
- Poverty or lack of education
- Inadequate food (quality, quantity, variety) for a prolonged period, contaminated water
- Parasitic infections and other chronc infections, malabsorption and chronic diarrhoea
- Dental problems
- Low birth weight and nutritional insult during early childhood
- Number of pregnancies
- Menstruation patterns
Post arrival factors to consider in nutrition screening:
- Lack of familiarity with Australian foods and how to prepare them
- Lack of access to traditional foods
- Low English print literacy resulting in difficulty reading labels and writtten guidelines/dietary advice
- Cultural issues – in some commuities it is women who shop and cook, therefore unaccompanied men, especially minors, may find cooking/shopping unfamiliar. Cultural eating patterns (e.g. reduced meat intake for womena and children, a vegan diet, lack of fresh vegetables, religious fasting)
- Food knowledge – including water safety – for example knowing that tap water is safe to drink, safe food storage and food handling
- Shift work and irregular or individual household eating routines.
Recommended nutritional assessment for refugee background clients
The following factors for performing a nutritional assessment have been recommended by refugee health specialist clinicians:
- Take a detailed dietary (and general) history and ascertain access to and quantity/quality of food overseas and after settlements. Be aware that malnutrition and food insecurity after resettlement are common in refugee communities, including in Australia, sometimes even years after settlement (Southcombe 2008; Gallegos, Ellies, Wright 2008)
- Routine ‘Refugee Health Assessment‘ bloods will provide information on anaemia, iron deficiency, vitamin D status and may indicate organic disease.
- Consider organic diseases such as gastrointestinal infections (Helicobacter Pylori, Giardia and other parasites), other infections (including TB), low vitamin D/rickets and dental disease (leading to difficulty chewing).
- Body mass index: less than 18.5 suggests risk of malnutrition in adults (may differ according to musculature and ethnic group), percentile charts for children are available in Promoting Refugee Health.
- 10% reduction in body weight in 6 months requires follow up
- Low serum albumin suggests chronic protein deficiency
- Anaemia may be due to iron deficiency, also consider vitamin B12 in some groups
- Specific nutrient deficiencies may need expert assessment and referral
- Address general diet and lifestyle issues.
- Iron deficiency anaemia and vitamin D deficiency are the most common nutrient deficiencies among recent arrivals, especially women and children.
- Refer early to a dietitian.
- Emphasise the need for a balanced diet with a wide variety of fruits and vegetables; importance of physical activity; to avoid junk food and sweetened drinks.
- For newly arrived refugees who have come from refugee camps and situations of dire poverty, provision of general multivitamin and mineral supplement may be necessary.
*This information has been adapted from Promoting Refugee Health: A guide for doctors, nurses and other health care providers caring for people from refugee backgrounds pp.104-109. Return to the Nutrition page.