Adolescent anaemia status and non-haem iron source food use at the Beddawi refugee camp in North Lebanon : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Sciences at Massey University, Manawatū, New Zealand

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Palestinian refugees at long-term Lebanese camps are at increased anaemia risk. Adolescent Palestinians at these camps, with their disproportionately high poverty burdens, are at particular risk, though little-to-no data are available to describe this. Anaemia in Lebanon has been attributed, largely, to inadequate intake of bioavailable iron. This may occur when a population is reliant on non-haem iron food sources to meet nutrient needs, as is often the case in long-term camp settings. No studies are currently available that describe adolescent Palestinian diets at Lebanese camps. There is also a dearth of studies exploring food preparation practices that may be harnessed to optimise iron bioavailability from consumed foods at these camps. This study used an embedded mixed-methods design to evaluate anaemia prevalence, iron source food consumption, and micronutrient dietary diversity (DDS-M) for a group of adolescent Palestinians (n = 66) at the Beddawi refugee camp in North Lebanon. The study also explored household plant-food use and preparation, with particular reference to dark leafy greens, and plant-food valuation with household food preparers (FPs). Anaemia prevalence for adolescents was 29%. Median DDS-M was 4 [IQR = 1.63, range = 2-6]. Grain-based foods were consumed by the largest proportion of adolescents (100%), followed by milk source foods (84.8%) and fruits (59.1%). Jute mallow, chicory, parsley and spinach were the dark leafy greens used by the largest proportions of households (> 80%). Household use of a subset of dark leafy greens was positively associated with adolescent DDS-M (rho = 0.31, S = 14303, p-value = 0.03). All FPs reported plant food valuation; however, FPs in households with non-anaemic adolescents related plant food valuation responses with more detailed nutrient and health rationales than FPs in households with anaemic adolescents. Lemon juice, capsicum and chilli were among foods commonly reported to be co-consumed with plant meals described by FPs. Soaking pulses ahead of use was also reported. Anaemia is a moderate public health concern for this group of adolescents, and the micronutrient content of their diets is insufficiently diverse. Increased consumption of accessible dark leafy greens and co-consumption of reported vitamin C-rich foods with non-haem iron meals, in combination with extending pulse-soaking practices to additional grains may contribute to optimising dietary and biochemical iron status for these adolescents.
Anemia, Risk factors, Teenagers, Palestinian Arab, Refugees, Palestinian Arab, Health and hygiene, Nutrition, Lebanon