Changes in nutrition among residents and refugees in Sarajevo during the war

Abstract

Objective: To assess how food shortage has been reflected in changes in nutritional status and dietary intake of resident and refugee populations in wartime Sarajevo.

Design: Longitudinal observations were carried out on residents (who stayed in their homes) and refugees (living in collective centres). Three out of four municipal areas of Sarajevo were covered in the sample and households and collective centres in close proximity to the homes of fieldworkers were selected. The same households were visited in October 1992-March 1993 and November 1993-January 1994.

Setting: The study took place in besieged Sarajevo.

Subjects: In the first round 362 households (170 resident and 192 refugee) were visited and in the second round 324 households (146 resident and 178 refugee) were visited.

Interventions: Nutritional information was gathered through anthropometric measurements, medical examination and questionnaires which included a seven day dietary recall.

Results: Nutritional status was assessed by calculating body mass index (BMI) (weight/height2) in adults and weight for age percentiles in children (2-18 years of age). Undernutrition in adults was defined as BMI < 18.5 and in children as weight for age < 25th percentile. Results from the first round of data collection showed a higher level of undernutrition among refugees (15.0%) compared to residents (5.3%). The second round revealed higher levels of undernutrition among residents (8.1%) than refugees (7.0%). Daily energy intake in the first round met only half recommended dietary allowances for the former Yugoslavia which is 2700 kcals per day. Refugees were found to consume slightly higher quantities of energy (1500 kcals) compared to residents (1272 kcals). In the second round, energy intake had increased both among refugees (1832 kcals) and residents (1630 kcals).

Conclusions: The population of Sarajevo have been forced to eat a monotonous diet during the war which is deficient both in quantity and quality. Nevertheless the nutritional status of the resident and refugee populations has been maintained. Dietary intake was found to be low but this may have been partly due to under-reporting. The accuracy of data obtained through dietary intake surveys in emergency conditions may be questionable.