P3.099: Malnutrition trends in displaced Rohingya children from 2017-2024: A critical eight-year analysis

Background: Over 1.1 million Rohingya refugees from Myanmar have been living in makeshift camps in southern Bangladesh since 2017, where malnutrition remains a critical concern among children. Fluctuating funding for refugee efforts has altered cash food voucher disbursements in the camps. Analyses of microeconomic trends and pediatric malnutrition remain unexplored, making the current study essential amid recent funding cuts.

Methods: A retrospective cohort of de-identified electronic health record (EHR) data of 9,503 Rohingya children (6-60 months) seen at two global non-profit Health and Education for All (HAEFA) clinics in Kutupalong and Balukhali camps (2017-2024) was studied. Mid-upper arm circumference (MUAC) was measured using Abbott MUAC tape, and WHO tables were used for LMS z-scores. Statistical analysis (Python v3.6.8, Pandas) incorporated inflation data and cash voucher allocations from the World Bank and World Food Programme.

Results: Among 9,503 children aged 6-60 months, 3448 (36.28%) were well-nourished, 4144 (43.61%) were at risk for malnutrition, 1645 (17.31%) had MAM, and 266 (2.80%) had SAM. Average MUAC z-scores were -1.15±0.95 for 6-24 months, -1.30±0.92 for 25-36 months, and -1.47±0.87 for 37-60 months (F(2,9500) = 93.77, p < 0.001; post-hoc p < 0.001). Yearly malnutrition (MAM+SAM) incidence declined from 26.26% in 2017 to 12.35% in 2024 (X2 = 52.45, p < 0.001) with a peak of 41.15% in 2020. Average MUAC z-scores decreased from -1.27 in 2017 to -1.80 in 2020 (Mann-Kendall z = -2.04, p = 0.04, Sen's slope = -0.18), then increased to -0.93 in 2024 (Mann-Kendall z = 2.45, p = 0.01, Sen's slope = 0.19). These findings correlate proportionally with monthly cash voucher amounts adjusted for exchange rate and inflation from 2017 to 2024, showing direct correlation.

Conclusion: This study is the largest and longest longitudinal assessment of malnutrition in displaced Rohingya children to date. It is also the first to identify that a decrease in cash voucher allocations corresponded with a proportional and statistically significant decline in MUAC z-scores and an increase in malnutrition incidence. This effect is seen more prominently in the highest age group likely due to increased energy requirements. These novel findings point to a potential link between the cash voucher system and child nutritional status, particularly when viewed in the context of prior studies that have highlighted these programs’ effectiveness and COVID-19 pandemic disruptions in nutritional resource allocation in 2020. Ultimately, these findings underscore the importance of cash vouchers for food security for the displaced Rohingya population at a critical juncture for humanitarian assistance.