Non-communicable Diseases

Non-communicable diseases (NCDs) are becoming increasingly common among refugees, including Somalis, resettled to the United States. A recent study among refugees of multiple ethnicities resettled to a northeastern US city (n=180) found that more than half (51.1%) of all adult refugees in the study had been diagnosed with at least one chronic NCD, and 9.5% had three or more NCDs [48]. Behavioral health diagnoses, such as depression and PTSD (15.0%), and hypertension (13.3%) were the most common NCDs [48]. Additionally, more than half of all adult refugees were overweight or obese (54.6%) [48]. Among Somali patients, researchers reported a high prevalence of cardiovascular risk factors, with a significantly higher prevalence of diabetes mellitus (12.1% vs 5.3%) and prediabetes (21.3% vs 17.2%) than non-Somali patients [49]. It is likely that changes in diet and physical activity related to migration and assimilation contribute to the high prevalence of obesity, diabetes mellitus, and cardiovascular risk factors among Somali immigrants and refugees [49].

Anemia

Anemia is common among Somali refugee children, and can be caused by iron deficiency, parasitic infections, thalassemias, and hemoglobinopathies [43]. In a study of refugee children resettled to Colorado, Philadelphia (Pennsylvania), Minnesota, and Washington State from 2006 to 2012, 21.4% (n=2,751) of Somali refugee children <18 years of age were anemic [43]. In this study population, anemia was prevalent in both male (20.4%) and female (22.5%) children, and was most common in children <5 years of age [43]. Domestic screening results from Minnesota also indicate a high prevalence of anemia among Somali refugees of all ages. From 1999 to 2016, 9,641 male Somali refugees and 9,447 female Somali refugees were screened for anemia. Screening revealed that 19% of all women and 7% of all men were anemic, according to reference ranges determined by WHO Cdc-pdf[PDF – 6 pages]External [42]. Overall, children <5 years of age had the highest prevalence of anemia, with 28% of boys and 25% of girls being anemic. Among adults 25–44 years of age, anemia prevalence differed significantly for men and women, with 2% of men and 29% of women classified as anemic [42].

Lead

Lead exposure and elevated blood lead levels are a concern among Somali refugee children, both before and after resettlement. Prior to arrival in the US, refugees may have been exposed cottage industries that use lead in an unsafe manner, and lead-containing products such as herbal remedies, cosmetics, or spices [50, 51]. In the US, refugees, including Somali refugees, often live in substandard housing, where environmental lead may be encountered. Additionally, imported cosmetics, candies, and herbal remedies may contain lead. Among 2,878 Somali refugee children living in Colorado, Minnesota, Washington, and Philadelphia (Pennsylvania), approximately 20% had blood lead levels >5 micrograms per deciliter, while 1.7% of those in this cohort had lead levels ≥10 micrograms per deciliter [43]. Within 3–6 months of resettlement, a follow-up blood lead test should be conducted on all refugee children aged 6 months–6 years of age, regardless of the initial screening BLL result. Complete lead screening recommendations for refugee children, and information on potential lead exposures, are provided in the CDC Lead Screening during the Domestic Medical Examination for Newly Arrived Refugees. For additional information on lead poisoning and prevention, see the CDC Lead website.

Malnutrition

Malnutrition is common in Somali refugees, especially children, due to lack of nutritious food. In a 2011 survey of Somali refugee children (<5 years old) in Bulo Bacte section of Dagahaley refugee camp in Dadaab, global acute malnutrition was observed in 13.4% (n=6,488) of children measuring 67 to <110 cm in height, while severe acute malnutrition was observed in 3.0% of children. Among children measuring 110 to 140 cm in height, 9.8% of those surveyed met criteria for entry into the camp nutritional program [52].

In a 2016 study looking at refugee children resettled in Washington State (n=219), researchers found that nearly half of all Somali refugee children (≤10 years of age) had some degree of stunting or wasting indicated in their overseas medical examination [53]. Table 4 outlines the nutritional status of Somali refugee children under 5 years of age, as well as children between 5 and10 years of age, before resettlement.

Table 4: Nutritional Status at Overseas Medical Examination among Somali Refugee Children Resettled to Washington State, July 2012–June 2014

Nutritional Status at Overseas Medical Examination among Somali Refugee Children Resettled to Washington State, July 2012–June 2014
 

Nutritional Status

<5 years
(n=99)
5–10 years
(n=120)
All ages
(n=219)
Stunting 26.2% 15.8% 20.5%
Wasting 23.2% 34.2% 29.2%
Healthy Weight 58.6% 59.2% 58.9%
Overweight 8.1% 4.2% 5.9%
Obesity 10.1% 2.5% 5.9%

Source: Dawson-Hahn et al. (2016) [53]

Overall, Somali refugee children have a significantly higher prevalence of wasting and stunting, and lower prevalence of obesity, than low-income children in Washington State [53].

References

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  11. Polonsky JA, Ronsse A, Ciglenecki I, et al. High levels of mortality, malnutrition, and measles, among recently-displaced Somali refugees in Dagahaley camp, Dadaab refugee camp complex, Kenya, 2011. Confl Health 2013 Jan 22;7(1):1.
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