O0241 Oct.5: 10:15am - Effect of Maternal Duration in Refugee Camps on Infant Birthweight

Background: The proportion of global under-five mortality attributable to neonatal deaths is increasing, with the burden of neonatal morbidity and mortality greatest in the setting of complex humanitarian emergencies (CHE) and large-scale population displacement. Specifically, to our knowledge, maternal duration in refugee camps has not previously been investigated as a primary exposure affecting infant birthweight, a common predictor of infant mortality and short- and long-term health complications. A refugee camp may provide a more stable environment and more consistent access to healthcare.

HYPOTHESIS: We hypothesize that longer duration of time in a refugee camp is associated with a lower risk of low birthweight (LBW).

DESIGN/

Methods: We evaluated the association between mothers’ duration of time in camp and infant birthweight by secondary analysis of data from a cross-sectional survey of refugees in multiple UNHCR refugee camps in Chad and Cameroon. Female residents aged 15-49 who gave birth in the two years prior to the survey were randomly chosen to be study participants. Secondary exposures include incomplete/lack of antenatal care and iron/folate supplementation. Co-variates include maternal age, nationality, education, income, and number of lifetime pregnancies. Mixed-effects generalized linear regression models were used to estimate relative risks (RR) and 95% confidence intervals (CI); nested clustering by country and camp was accounted for via random effects.

Results: A total of 834 mothers (355 in Cameroon and 479 in Chad) gave birth to 872 infants (see Table 1 for study population characteristics). Twenty-three percent were LBW (<2500 grams). After adjusting for covariates, duration in camp of greater than five years was associated with a 23-29% lower risk of LBW compared to three or fewer years (p = 0.048). For each year in camp, there was 1% lower risk of LBW (p=0.033). In all models, Nigerian nationality appeared to be a protective factor for refugees in Cameroon (RR 0.71-0.79, p<0.001).

Conclusions: This study suggests that longer maternal duration of time in a refugee camp is associated with a decreased risk of infant LBW over time. Based on these results, it may be beneficial to consider duration of time in camp when apportioning resources to improve the maternal-fetal health of refugees. Additionally, future qualitative analyses should investigate potential correlates of country of origin, such as cultural perspective, ethnic practices, baseline and ongoing access to care, or effects of specific CHEs, and how they may relate to risk of LBW.