
==== Front
BMC Public Health
BMC Public Health
BMC Public Health
1471-2458
BioMed Central London

19791
10.1186/s12889-024-19791-1
Research
The effect of socioeconomic factors on malnutrition in Syrian children aged 0–6 years living in Turkey: a cross-sectional study
http://orcid.org/0000-0002-7714-9087
Değer Vasfiye Bayram vasfiyebayramdeger@artuklu.edu.tr

1
http://orcid.org/0000-0003-3297-2931
Çifçi Sema 1
http://orcid.org/0000-0002-9721-9695
Ertem Melikşah 2
1 grid.449079.7 0000 0004 0399 5891 Mardin Artuklu University/faculty of health sciences/public health nursing, Mardin, Turkey
2 https://ror.org/05wyxj832 grid.449831.3 0000 0004 7435 2500 Melikşah Ertem (MD), Public of Health, Medicine Faculty, University Of Kyrenia, Kyrenia, Kıbrıs, Turkey
11 9 2024
11 9 2024
2024
24 247210 3 2024
13 8 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Background

This study was conducted to examine the prevalence of malnutrition in Syrian immigrant children living in Turkey.

Methods

The study was carried out in the city of Mardin, which is one of the cities with a high Syrian immigrant population in Turkey. Height, body weight and BMI values were recorded to determine the malnutrition status of the children. Z-scores of children were calculated using the malnutrition assessment WHOAntro program.

Results

The data show that 30.5% of Syrian children between the ages of 0 and 6 months are male, making up 55.8% of the total, and that 55.3% do not follow a regular breakfast schedule. The percentages of body weight for height, height for age, and BMI for age of Syrian children with a score between − 2 and + 2 SD Number were (89.3%), (74.3%), and (79.3%), respectively. Girls are more likely than boys to experience stunting and low body weight in the context of Syrian children (Stunting OR: 0.855(0.761–1.403), Underweight OR: 0.705(0.609-1,208)). Additionally, there is a link between levels of stunting and underweight and elements like the mother’s educational level and the family’s income. Contrary to the situation of adequate nutrition, it was discovered that the likelihood of stunting and low body weight in children increased by 0.809 and 1.039 times, respectively, when access to an adequate food supply was not available within the family (p < 0.05).

Conclusion

s According to the results of the study, gender, family income, mother’s education level and access to food affected the severity of malnutrition in children. Migration is an imporatnt factor affecting children’s health. In this study malnutrition was found high im immigrant children. Programs should be developed to monitor the growth and development of disadvantaged children and to support their nutrition.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-024-19791-1.

Keywords

Syrian immigrant children
Malnutrition
Z scores
Stunnting
Underweight
issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
==== Body
pmcBackground

The effects of migration are particularly striking for children, who typically have little influence over their decision to migrate and are therefore thought to have done so against their will [1]. Children are thought to be the group most negatively impacted by migration because they are still growing and developing, are dependent on at least one parent, and are at risk due to their physical and intellectual deficiencies [2]. Children are denied their right to health, nutrition, shelter, and education, which are the cornerstones of their right to life, during this migration process [3]. Following migrations, hygiene and nutrition issues that arise from failing to meet the society’s needs for adequate shelter and nutrition can result in a number of diseases. Even though all refugees run the risk of having nutritional issues, babies and young children need special attention [4–7]. The majority of people with disabilities, growth retardation, and chronic diseases are children exposed to migration because malnutrition impairs physical and mental development [8]. Acute malnutrition has been linked to a number of major causes of morbidity [8] and mortality [1], with children under the age of five most frequently affected, according to studies done with refugees [9]. The study conducted in Lebanon showed that the children most affected by malnutrition were between 0 and 1 years of age [9]. Acute malnutrition was most prevalent in children under the age of five, according to a study done in 2019 among refugees living in camps [10]. According to UNICEF 2016 data, a moderate acute malnutrition was discovered in the refugee child as a result of the nutritional screening of more than 2200 Syrian refugee children [11] Children were also included in the treatment program, and special situations involving child nutrition, food safety, water quality, and sanitation were addressed with nutrition education [12]. Developmental delay brought on by malnutrition and malnutrition are the most frequent health issues in children after migration [5].

The Syrian civil war, which commenced in 2011, led to the displacement of over 10 million families who were compelled to seek refuge in neighboring nations [13]. Turkey is the nation to which Syrian migrants relocate in a quantity tenfold. Based on official documentation, an estimated population of around 5 million individuals from Syria currently resides within the borders of Turkey. Mardin, a bordering city in Turkey, is recognized as a prominent settlement for immigrants. The city of Mardin is home to an estimated population of around 10,000 Syrian refugees. The unresolved issues pertaining to language, economic, and health challenges faced by Syrian immigrants who have relocated to Turkey remain in need of a lasting resolution [14]. Numerous significant challenges exist, particularly within the realms of education, housing, nutrition, and healthcare provisions. It is imperative to conduct essential research, particularly focusing on vulnerable populations, in order to facilitate their access to these services. It is evident that the offspring of families compelled to migrate from Syria encounter significant challenges pertaining to their educational attainment and nutritional well-being. It has been observed that prolonged nutritional deficiencies, particularly, lead to the occurrence of malnutrition in children [14]. A study conducted in 2019 revealed that a significant proportion of children experience either obesity or a severe developmental delay as a result of poor dietary habits [15]. The significance of conducting research in this particular discipline in relation to the advancement of nutrition and health policies should not be disregarded.

The purpose of this study is to shed light on the prevalence of malnutrition among children aged 0 to 6 years old in Syrian families who were forcibly displaced and to highlight the ways in which these families differ from the local society.

Methods

The research was carried out between February and May 2021 with volunteer families with 0–60 month-old children living with their families in the borders of Mardin Province. Within the scope of the study, a total of 400 mothers who have children between the ages of 0–6 were interviewed. The questionnaire form was applied by face-to-face interview method. The consent form was read and signed by the legal representatives of the children before applying the questionnaire. Data collection continued until we reached 400 children for each group. During the research, 32 Syrian mothers and 45 Turkish mothers contected were not included in the study because they didn’t give informed consent. Mothers with cognitive decline were excluded from the study.

This study was accepted by the authorities of these locations, approved by the Ethics Committee of the Mardin Artuklu University Scientific Research Ethics Committee (Turkey) (14.06.2019 ) (No-1-2019), and followed the procedure established by the U.S. National Bioethics Advisory Commission and European Commission was used to obtain written parental or guardian consent, while oral consent was obtained from mothers responsible for children. The necessary work permit was obtained from the Mardin Provincial Directorate of Migrant Health to carry out the study.

Collection of study data

General information about the parents of all children aged 0–60 months, nutritional status of children from birth (breast milk intake, use of nutritional support, starting complementary feeding and the foods given) are included. In addition, a data collection form including anthropometric measurements of children at birth and present, such as body weight (kg), height. Monthly incomes of individuals were recorded in Turkish lira, but as a result of the analyzes made, they were given in dollars ($).The questionnaire used in the research was developed by the researchers.

Characteristics of mothers

The mothers interviewed within the scope of the study, who had no communication problems, who could speak and understand Turkish and who declared that they participated in the study voluntarily, were included.

Characteristics of children

The children who were born full-term, were born with a single pregnancy, had no congenital anomalies, and did not have any chronic and metabolic diseases were included in the study. Children who lost their parents were not included in the study. One child from each family was included in the study.

Food consumption frequencies of children included in the study

Taking Anthropometric Measurements: The heights and body weights of all children participating in the study were measured.

Body Weight

The body weights of babies aged 0–24 months were measured with a sensitive baby scale sensitive to 0.1 kg, by removing the thick clothes. Children aged between 24 and 60 months were asked to stay in the lightest clothing possible before their body weight was measured. The measurements were recorded in grams by paying attention to the conditions such as placing the scale on a horizontal, flat and hard surface and making the calibration before weighing [16, 17].

Height

The height of infants between 0 and 24 months was measured in lying position with an infantometer, and the height of children between 24 and 60 months was measured in cm with a stadiometer [17, 18].

Evaluation of anthropometric measurements

In this study we aimed to compare children from two different societies. Therefore, we prefer to use a standard evaluation method. In addition WHO stnadards were used instead of local standards to ensure that our study was compatible with the international literature. Anropometric measurements were evaluated according to WHO-MGRS 2006 and 2007 growth standards with the help of the WHOANTRO program version 3.2.2, January 2011 (The WHO Anthro Survey Analyzer). Findings are given by classifying them according to the intersection points as percentiles and Z-score values. The intersection points used in the classification are as follows (Table 1) [19–21].

Table 1 Z-score values. The intersection points used in the classification

Too thin(wasting )/ Too short (stunting)	<-2SD (Z-score) or < 3. Percentile	
Thin/ Short stature	-2SD –(-1SD) or 3–15. interth percentile	
Normal	-1SD to 1SD or 15th to 85th percentiles	
Overweight/Tall	1SD to 2SD or 85th to 97th percentiles	
Fat (obese)/Too tall	≥ 2SD or ≥ 97. Percentile	

Stunting (height for age), wasting (weight for height) and underweight (weight for age) were three major anthropometric indicators used to measure malnutrition association with response variables.

Food consumption frequency

In the study, in order to determine the food consumption frequency of children, the “Food Consumption Frequency Form” was applied with the information received by the mothers. Frequency of food consumption is a method often used to determine food intake. Frequency of food consumption; It is a method used to determine the daily, weekly, monthly or annual consumption frequency of food or food groups and to determine the consumption amounts. The food consumption frequency of children was defined as ‘everyday’, ‘sometimes’, ‘sometimes’, never using the “Food Consumption Frequency Determination Form”. Foods were examined in six groups: milk and dairy products, meat, eggs and legumes, bread and cereals, vegetables and fruits, fatty and sugary foods and beverages. Within the scope of the study, the consumption frequency of 19 foods containing the basic food groups was taken [22]. Dietary reference intakes (DRIs) recommendations were used in daily nutritional intake values.

Statistical analysis

Mean and standard deviation (SD) were calculated for continuous variables. The normality of the variables was analyzed with the Shapiro-Wilk test. Frequency distribution ratios of categorical variables were found in the study. The statistical significance level was accepted as p < 0.05. SPSS 22.0 statistical package program was used in the statistical analysis of all data. To significant socioeconomic factors linked by child malnutrition used in this study were age, gender, mother education (none/pre-school, primary, middle, secondary and higher), family income (lowest, secondary, middle, higher and highest), family size, food access. Multivariate logistic regression analysis methods were used to identify factors associated with stunting and underweight to account for potential confounding factors. All models were adjusted for the covariates of child malnutrition.

Results

Table 2 shows the general characteristics of the mothers of the children in the study. The immigrants from Syria in the study at marriage age was 20.47 ± 3.23 years, and their mean age at 27.15 ± 5.65 years. Turks marry at 24.99 ± 4.93 years, and their mean age is 29.11 ± 4.93.

Mothers of Syrian children are 99.0% unemployed, 36.3% have only completed elementary school, 74.5% have 1–3 children, 46.8% have ‘5–6’ family members, 93.8% have monthly income equal to their expenses, with a monthly average income level of 175.5542.12 $, and 57.75% of them claiming to have food restrictions. Syrian immigrants reported an average length of residence in Mardin of 6.04 1.44 (Min: 2 Max: 12) years. In contrast, 79.82% of Turkish mothers of children do not work, 21% have only completed their primary education, 84.5% have 1–3 children, 31.0% have ‘5–6’ people in the family, and 41.3% have monthly income, which is equal to 203.2524.55 $ monthly income; 86.25% of them reported having a food restriction.

Table 2 Characteristics of the mothers of the children in the study

		Turkish	Syrian	
Characteristics of the Mothers		n	%	n	%	
Mother age mean ± SD		29.11 ± 4.93	27.15 ± 5.65	
Mother age	18 and Under	1	0.3	7	1.8	
Ages 19–29	242	60.5	263	65.8	
30–39 Ages	146	36.5	115	28.8	
Over 40	11	2.8	15	3.8	
*Mother Marriage mean age ± SD		24.99 ± 4.93	20.47 ± 3.23	
Mother Marriage age	under 18 years old	51	12.8	113	28.3	
Ages 19–29	338	84.5	284	71.0	
Over 30	11	2.8	3	0.8	
Mother Working Status	Yes	81	20.3	4	1.0	
No	319	79.8	396	99.0	
Mother Education Status	Illiterate	29	7.3	79	19.8	
Primary school graduate	84	21.0	145	36.3	
Secondary School Graduate	51	12.8	108	27.0	
High school graduate	137	34.3	60	15.0	
Graduated from a Universty	99	24.8	8	2.0	
Number of children	1–3	338	84.5	298	74.5	
4 and Above	62	15.5	102	25.5	
Number of Persons in the Household	3–4 Persons	239	59.8	151	37.8	
5–6 Persons	124	31.0	187	46.8	
7 and Above	37	9.3	62	15.5	
Monthly Income	Income Less Than Expenses	216	54.0	23	5.8	
Income Equal to Expense	165	41.3	375	93.8	
Income More Than Expenses	19	4.8	2	0.5	
Monthly Income mean ± SD($)		203.25 ± 24.55	175.55 ± 42.12*	
Food access						
	Food restriction	345	86.25	231	57.75	
	Sufficient Food	55	13.75	169	42.25	
	Total	400	100	400	100	
Living in Turkey years mean ± SD		-	6.04 ± 1.44 (Min: 2 Max:12)	
*p < 0.05 (The charateristics of Syrian mothers were compared with Turkish mothers. When p value was below 0,05, it was accepted that the difference was statisticaly significant)

Table 3 presents an overview of the fundamental attributes pertaining to the children who were included in the study. According to the data, it is observed that 30.5% of Syrian children aged between 0 and 6 months, specifically, 55.8% of these children are male, while 55.3% do not adhere to a regular breakfast routine. Furthermore, it is noted that 81.0% of these children do not experience a loss of appetite, and 90.0% do not suffer from any diseases. Additionally, 36.0% of the children reported having at least one episode of diarrheal infection in the previous year, while 46.8% experienced at least one lung infection. Moreover, a significant majority of 95.3% of these children were exclusively breastfed, while 55.3% were introduced to complementary foods alongside breast milk during the first 6 months of their lives. Among the participants from Turkey, 36.5% of the children fell within the age range of 0–6 months. Additionally, 54.0% of the participants were male, while 51.8% did not adhere to a consistent breakfast routine. Furthermore, 72.3% of the children did not report a loss of appetite, and 89.3% did not have any existing medical conditions. It was reported that 8.5% of the individuals experienced at least one instance of diarrhea infection within the preceding year. Additionally, 12.8% of the participants encountered at least one lung infection. Furthermore, a significant majority, specifically 98.8%, received breast milk. Moreover, a considerable proportion, amounting to 33.8%, consumed both breast milk and other foods exclusively for the initial six months.

Table 3 Characteristics of children aged 0–60 months in the study

		Turkish	Syrian	p*	
Characteristics of Children		n	%	n	%		
Age group of the child	0–6 Months	146	36.5	122	30.5	0.478	
7–12 Months	47	11.8	67	16.8	
13-24Months	39	9.8	93	23.3	
25–36 Months	52	13.0	47	11.8	
37–48 Months	44	11.0	31	7.8	
49–60 Months	39	9.8	24	6.0	
Over 60 Months	33	8.3	16	4.0	
Sex of the child	Female	184	46.0	177	44.3	0.201	
Male	216	54.0	223	55.8		
Breakfast Habit	Yes	193	48.2	179	44.8	0.191	
No	207	51.8	221	55.3		
Lack of appetite Status	Yes	111	27.8	76	19.0	0.042*	
No	289	72.3	324	81.0		
Sickness Status	Yes	43	10.8	40	10.0	0.368	
No	357	89.3	360	90.0		
Diarrhea in the last year	Yes	34	8.5	144	36.0	0.001*	
No	366	91.5	256	64.0		
How Many Times Has Diarrhea Occurred	1 time	19	52.8	133	77.8	0.023*	
2 times	9	25.0	26	15.2	
Three times	7	19.4	7	4.8	
4 times and Above	1	2.8	5	0.3	
Diarrhea in the last 15 days	Yes	19	4.8	60	15.0	0.003*	
No	381	95.3	340	85.0		
Respiratory Tract Infection in the Last Year	Yes	51	12.8	187	46.8	0.002*	
No	349	87.3	213	53.3		
Frequency of Respiratory Tract Infection	1 time	31	58.5	120	56.3	0.091	
2 times	11	20.8	59	27.7	
Three times	6	11.3	25	11.7	
4 times and Above	5	9.4	9	4.8	
Respiratory Tract Infection in the Last 15 Days	Yes	36	9.0	86	21.5	0.005*	
No	364	91.0	314	78.5		
Breastfeeding Status	Yes	395	98.8	381	95.3	0.861	
No	5	1.3	19	4.8		
The First Six Months: Breastfeeding and Other Foods	Yes	135	33.8	221	55.3	0.027	
No	265	66.3	179	44.8		
	Total	400	100	400	100		
p*: pearson chi square value and p < 0,05

Fig. 1 Food consumption frequencies of children included in the study

The study’s findings regarding the frequencies of food consumption among the children are presented in Fig. 1. Foods suitable for child nutrition used in studies were questioned. According to the data, Syrian children’s daily consumption consists of 61.0% milk, 40.3% yogurt, and 35.8% biscuits. Furthermore, it was ascertained that the children did not partake in the consumption of foods from the meat group, as well as vegetables and fruits, on a daily basis, with a prevalence of 0%. Nevertheless, it was ascertained that the individuals in question regularly ingested food items resembling fast food, including Cake (35.3%), Chips (30.0%), Confectionery (18.8%), Turkish delight (16.8%), Wafer (17.0%), and Chocolate (17.0%), on a daily basis, albeit at different frequencies.

Z-Scores of Body Weight for Height, Height for Age, BMI for Age of individuals participating in the study showed in Table 4. Having a score between − 2 and + 2 SD Number the percentages of body weight for height, height for age, and BMI for age of Syrian children were (89.3%), (74.3%) and (79.3%) respectively. For Turkish children, these values were respectively (85.8%), (74.0%) and (79.0%). The study assessed the prevalence of stunted growth among children in Syria and Turkey, finding that 8.3% and 6.0% of Syrian and Turkish children, respectively, had a height-for-age below − 3 SD Z score. The study revealed that the prevalence of individuals with BMI exceeding a Z score of + 3 SD for their respective age groups was 4.3% for Syrian children and 4.0% for Turkish children.

Table 4 Z-scores of body weight for height, height for age, bmı for age of children in the study

	Syrian children	Turkısh children	
	Body Weight by Height	Height for age	BMI by Age	Body Weight by Height	Height for age	BMI by Age	
Z-Scores	n	(%)	n	(%)	n	(%)	n	(%)	n	(%)	n	(%)	
Less than − 3 SD	12	3.0	33	8.3	20	5.0	14	3.5	24	6.0	15	3.8	
Between − 3 and − 2 SD Number(%)	27	6.8	50	12.5	24	6.0	24	6.0	39	9.8	31	7.8	
Between − 2 and + 2 SD Number(%)	357	89.3	297	74.3	317	79.3	343	85.8	296	74.0	316	79.0	
Between + 2 and + 3 SD Number(%)	4	1.0	12	3.0	22	5.5	13	3.3	24	6.0	22	5.5	
More than + 3SD Number(%)	0	0	8	2.0	17	4.3	6	1.5	17	4.3	16	4.0	
Total	400	100	400	100	400	100	400	100	400	100	400	100	

Table 5 presents the effects of socio-demographic factors on the prevalence of stunting and underweight among the children participating in the study. In the context of Syrian children, it has been observed that girls face a higher susceptibility to stunting and low body weight compared to boys (Stunting OR: 0.855(0.761–1.403), Underweight OR: 0.705(0.609-1,208)). Furthermore, there exists a correlation between the levels of underweight and stunting and factors such as the educational attainment of the mother and the income of the family. In contrast to the condition of sufficient nutrition, the absence of access to an adequate food supply within the family was found to elevate the likelihood of stunting and low body weight in children by 0.809 and 1.039 times, respectively (p < 0.05). In Turkish children, it was observed that girls tended to have a lower average weight compared to boys. The ORs for being underweight is 0.582 (CI: 0.450–1.239) with a p < 0.05. It has been observed that maternal illiteracy is associated with both stunting and low body weight in children. Additionally, children born to mothers aged between 19 and 29 years have an increased risk of being underweight. Children from families with low income and limited access to food were found to have an increased risk of stunting and underweight. The ORs for stunting were 0.809 (95% CI: 0.569–1.309) and 1.093 (95% CI: 0.907–1.609) for low family income and insufficient access to food, respectively. Similarly, the ORs for underweight were 1.201 (95% CI: 0.909–1.706) and 1.194 (95% CI: 0.706–1.591) for low family income and insufficient access to food, respectively. These findings suggest a significant association between socioeconomic factors and the risk of stunting and underweight in children (p < 0.05).

Table 5 Socio-demographic parameters estimates of logistic regression model and factors affecting stunting and underweight

	All children	Syrian Children	Turkish Children	
Parameters	Stunting		Underweight		Stunting		Underweight		Stunting		Underweight		
	Odd ratio (95% CI)	p value	Odd ratio (95% CI)	p value	Odd ratio (95% CI)	p value	Odd ratio (95% CI)	p value	Odd ratio (95% CI)	p value	Odd ratio (95% CI)	p value	
Gender													
Female	0.787(0.628–0.987)	0.001	0.201(0.194–0.899)	0.004	0.855(0.761–1.403)	0.001	0.705(0.609–1.208)	0.041	0.809(0.674–0.982)	0.099	0.455(0.359–0.524)	0.025	
Maleref.	1												
Children Age													
0–6 Months	1.247(0.555–1.547)	0.001	0.489(0.322–0.991)	0.006	0.901(0.604–1.201)	0.201	0.255(0.202–0.601)	0.279	0.501(0.301–0.699)	0.355	0.507(0.430–0.677)	0.290	
7–12 Months	1.183(0.819–1.407)	0.202	0.399(0.221–0.726)	0.411	0.344(0.104–0.709)	0.991	0.607(0.331–0.944)	0.994	0.677(0.424–0.839)	0.225	0.582(0.349–0.765)	0.861	
13-24Months	1.247(0.787–2.781)	0.334	0.901(0.801-1.200	0.348	0.656(0.441–0.801)	0.602	0.822(0.599–1.241)	0.618	0.577(0.439–0.903)	0.675	0.591(0.385–0.642)	0.575	
25–36 Months	1.201(0.767–1.904)	0.455	0.802(0.566–1.112)	0.425	0.801(0.556–0.902)	0.089	0.541(0.389–0.707)	0.225	0.455(0.402–0.571)	0.080	0.501(0.442–0.992)	0.091	
37–48 Months	0.694(0.476–1.087)	0.001	0.304(0.244–0.901)	0.015	0.788(0.491–0.993)	0.099	0.421(0.404-681)	0.089	0.489(0.342–0.659)	0.991	0.706(0.609–0.803)	0.721	
49–60 Months ref.	1	-	-	-	-								
Family size													
1–3 person	0.689(0.331–2.715)	0.201	1.101(0.907–1.703)	0.021	0.708(0.612–0.903)	0.376	0.309(0.189–0.569)	0.301	0.871(0.803–0.997)	0.301	0.992(0.881–1.451)	0.309	
4–6 person	0.709(0.611–4.089)	0.054	1.204(0.857–1.405)	0.098	0.655(0.449–0.882)	0.531	0.766(0.241–0.789)	0.545	0.809(0.406–0.994)	0.525	0.889(0.642–0.993)	0.505	
7 or more person ref.	1												
Mothers age													
18 and Under Age	1.174(1.204–3.375)	0.002	1.001(0.712–1.809)	0.048	0.307(0.175–0.538)	0.341	0.201(0.129–0.659)	0.003	0.590(0.361–0.903)	0.367	0.976(0.740–0.994)	0.375	
19–29 Age	1.802(1.208–2.025)	0.048	0.809(0.566–1.903)	0.055	0.708(0.539–0.851)	0.290	0.804(0.476–0.912)	0.056	0.582(0.450–1.239)	0.034	0.903(0.572–0.992)	0.191	
30–39 Age	1.217(0.826–1.474)	0.021	0.765(0.404–1.702)	0.033	0.941(0.391–1.403)	0.428	0.871(0.606–1.309)	0.400	0.709(0.201–1.305)	0.023	0.945(0.823–1.306)	0.425	
Over 40 age ref.	1												
Mother marriage age													
under 18 years old	1.050(1.010–3.418)	0.001	0.455(0.199–0.706)	0.901	0.965(0.821–1.202	0.241	0.309(0.242–0.671)	0.256	1.001(0.845–1.402)	0.201	0.823(0.460–0.902)	0.278	
Age 19–29	1.202(1.075–2.011)	0.014	0.344(0.245–0.554)	0.075	0.802(0.755–1.113)	0.301	0.478(0.386–0.691)	0.334	1.002(0.781–1.371)	0.579	1.109(0.938–1.450)	0.003	
Over 30 age ref.	1												
Mother education													
İlliterate	1.158(0.531–1.373)	0.021	0.901(0.605–1.113)	0.332	0.901(0.844–1.407)	0.002	0.659(0.238–0.960)	0.006	0.607(0.549–1.309)	0.045	0.672(0.467–1.507)	0.025	
Primary school graduate	1.219(0.673–1.041)	0.298	1.201(0.998–1.409)	0.201	0.898(0.651–1.034)	0.078	0.541(0.441–0.599)	0.081	0.772(0.561–0.893)	0.085	0.781(0.562–0.892)	0.091	
Secondary School Graduate	0.719(0.559–1064)	0.078	1.102(0.872–1.785)	0.107	0.455(0.360–0.561)	0.608	0.204(0.139–0.460)	0.639	0.455(0.349–0.561)	0.691	0.951(0.680–1.206)	0.634	
High school graduate	1.058(0.631–2.073)	0.067	1.304(0.901–1.677)	0.089	0.567(0.462–0.782)	0.671	0.844(0.458–0.941)	0.089	0.560(0.241–0.673)	0.578	0.988(0.549–1.292)	0.589	
Graduated from a Universty ref.	1												
Monthly Income													
Spending more than what you earn	0.687(0.464–2.327)	0.045	0.201(0.155–0.677)	0.505	0.764(0.439–0.893)	0.001	0.656(0.470–0.938)	0.001	0.809(0.569–1.309)	0.015	1.201(0.909–1.706)	0.001	
Income and expenses are the same	0.548(0.481–1.347)	0.091	0.404(0.204–0.891)	0.083	0.791(0.551–0.952)	0.201	0.590(0.231–0.671)	0.032	0.903(0.459–0.951)	0.001	0.902(0.708–1.109)	0.003	
Income is more than expenses ref.	1												
Food access													
Food restriction	0.783(0.457–2.047)	0.012	0.607(0.408–0.812)	0.025	0.809(0.755–1.405)	0.038	1.039(0.975–1.641)	0.044	1.093(0.907–1.609)	0.001	1.194(0.706–1.591)	0.044	
Sufficient Food ref.	1												

Discussion

This study represents the first attempt to compare the nutritional status of Syrian immigrant children in Turkey with that of local children, as previous research on the nutritional status of Syrian immigrants in Turkey has been conducted in recent years. The study encompassed a total of 800 children. The study’s data offers a comprehensive analysis of stunting and low body weight among Syrian immigrant children residing in Turkey. The practical requirements articulated by refugees themselves are effectively supplemented by this socioeconomic standpoint. Burge and Dharod have reported comparable results, suggesting that nutrition interventions targeting refugees should encompass various aspects such as the importance of maintaining a nutritious diet, effective grocery shopping practices, and efficient management of food budgets [23]. Culturally appropriate nutrition initiatives, especially those developed in collaboration with refugees, are of paramount importance [24].

It was observed that mothers of Syrian children included in the study had a lower average age at marriage than mothers of Turkish children, and this difference was statistically significant. According to a study done in Iran, women get married on average 5 years earlier than in western societies [25]. Another study found that Syrian immigrant women frequently get married before turning 18 years old. The findings of our study are consistent with those of these studies. It has been noted that there are more people living together in Syrian families than in Turkish participants’ families. In a study done in Pakistan, it was discovered that families typically had 6–7 members or more [26]. Another study revealed that the average family size of Syrian immigrants is 2.2 times larger than that of German families [27]. This may be the case because immigrants frequently live with other family members besides their own parents and child(ren). Additionally, in developing nations, grandparents frequently reside with their married children [28].

When compared to Turkish people, it has been found that the family’s monthly income for Syrians is incredibly low. Families have a much lower level of income than the average in this country, according to studies on the income level of immigrants in İranian [25], America [29], the Netherlands [4], and Germany [27]. This circumstance demonstrates that immigrants often accept lower-paying jobs. According to the study’s findings, Syrian immigrant mothers in Turkey face many difficulties in establishing and upholding a healthy diet and feeding routine for their kids and families. It was noted that the nutritional requirements were imposed on both the Syrian and Turkish participants. But it was found that Turkish participants had more dietary restrictions. Because they live in their own culture and nation and because this situation may result in food restrictions, the Turkish participants try to maintain their eating habits. All participants’ experiences with food restrictions are attributed to Turkey’s ongoing inflation and unequal income distribution.

The present study reported that most of mothers were age 19–29 years, literate and had low month income. Better education means more knowledge and a higher probability to earn more, proper management of resources, practice better health promoting behaviors specifically better food choices, and might develop better children centered caring practices. This study findings is in line with preceding literature evidence which revealed that the level of education of the mothers was considered as major predictors of malnutrition, increasing the risk of undernutrition due to illiterate parents. An estimated average cost of food per month in Turkey for one person ranges from $50 to $100, depending on age. Increase in household sizes might lead to decrease in the availability of food in the household [30].

According to findings of this study, most of the participants were food restriction that is, they were food insufficient. Food restriction increases the chances of malnutrition occurring. This is because, there is not enough food (calories and nutrients) thereby increasing the risk of unhealthy eating. The prevalence of food restriction from this study was higher when compared with the prevalence of 13% of a carried out in January 2019 by World Food Program to assess household food security in North West Region [31].

According to the dietary diversity assessment, vegetables, dairy and meat products, cereals, and legumes make up the four major food groups consumed by children. Fruits, vegetables, eggs, and meat products, however, were the least popular food categories. More than half of the children had a low dietary diversity score of less than four, and the average child’s diet consisted of 1.2 food groups. i.e., they consumed fewer types and varieties of food than the WHO-recommended food groups over the course of the previous 24 h. The most popular methodological approach involved constructing height-for-age and weight-for-height ratios using weight, height, and age, from which the prevalence of stunting and wasting was determined. The WHO’s anthropological definitions were largely used in studies to gauge the severity of wasting and/or stunting. Stunting levels ranged from 7.3 (in Drama and Kavala, Greece) to 29% (in Western Sahara, Algeria) [32, 33]. From 1.2 (in Za’atari, Jordan [34]) to 5.5% (in four refugee camps in Northern Greece [35]), wasting prevalence ranged. Children who participated in the study had their body weight for height, height for age, and BMI for age of Z scores examined. It has been demonstrated that stunting and underweight as indicated by anthropometric measurements increase the risk of infectious disease-related death in children. Similar to earlier analyses, mortality was higher in all stages of stunting and underweight, and the risk rose as Z scores dropped. In a synergistic relationship with infectious diseases, undernutrition can be considered the cause of death; if the undernutrition hadn’t existed, the deaths wouldn’t have happened [36]. Increased risks of death from diarrhea, pneumonia, and the measles were noted for all anthropometric measures of undernutrition; the association was also noted for other infectious diseases [37]. Numerous cross-sectional studies have linked stunting to delays in motor and cognitive development, making it a well-known risk factor for poor child development. Stunting before the ages of 2–3 years has been linked to worse cognitive and educational outcomes in later childhood and adolescence, according to a number of longitudinal studies [38].

Inadequate dietary intake, inadequate care, infectious diseases, and unequal food distribution at the household level are the main factors that increase children’s vulnerability to malnutrition. Male children had a higher incidence of wasting, stunting, and underweight than female children in this study, which could be partially explained by the fact that males are thought to be more vulnerable due to health inequalities to early childhood illnesses and health issues than female children [39]. These findings agree with earlier research by [39–41]. These results are contrary to the studies of [42, 43], and it is possible that the community with lower socioeconomic status and less delivery of health services is the cause of the increased risk of malnutrition in children under the age of one year and those who are frequently stunted, wasting, and underweight at age four. Family size has a strong correlation with malnutrition status, including wasting, stunting, and underweight. This correlation is due to the fact that as families grow, resources become more scarce and children’s nutrition and care are given less attention. These results contrast with studies [44, 45] while being consistent with studies [41, 42]. Because educated mothers are more knowledgeable about child health, nutrition, and the use of health services, there is a significant relationship between mother education and reducing stunting. These results concur with those of the studies from [46–49].

There is an inverse relationship between the income status of families and the frequency of malnutrition in both Syrian and Turkish children. The most important reason for this is that access to adequate health services, adequate food and hygiene are associated with income status. These results are similar with the studies of [43, 50].

Households with food restriction were higher prevalence of malnutrition (stunting and underweight) in children rather than children adequate access of food. Adequate nutrition promotes health and resistance against diseases, while inadequate nutrition causes to increase severity of stunting and underweight. These findings are consistent with the study of [20].

Conclusion

The assessment of the prevalence of malnutrition in children from Syrian and Turkish was conducted through the evaluation of Z scores. This study aimed to investigate the various factors that contribute to the occurrence of stunting and low body weight resulting from malnutrition. According to this study, there is a significant relationship between childhood malnutrition in Syrian migrant children and gender, age, maternal education level, family income, family size, and access to adequate food. Girls are more vulnerable to malnutrition than boys are, so it is important to pay attention to the nutritional requirements of boys to lessen this risk. In order to combat malnutrition, it is necessary to increase public awareness of the nutritional value of foods, illnesses associated with nutritional deficiencies, and the significance of maternal education, particularly in terms of education and training for all people. Migration causes important public health problems. In order to protect and improve children’s health children’s growth and development should be constantly monitored. Nutrition of children living in disadvantged groups such as immigrants should be supported.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Acknowledgements

The author thank to all participants.

Author contributions

Concept: VBD, ME, SÇ.;Supervision - VBD, ME, SÇ.; Materials - VBD, ME, SÇ; Data Collection and/or Processing – VBD, SÇ.; Analysis and/ or Interpretation - VBD, ME Writing - VBD, ME, SÇ.

Funding

The authors (s) received no financial support for the research, authorship, or publication of this article.

Data availability

The data are available upon request (SPSS FİLE). Please contact the corresponding authors for further details.

Declarations

Ethics approval and consent to participate

This study was accepted by the authorities of these locations, approved by the Ethics Committee of the Mardin Artuklu University Scientific Research Ethics Committee (Turkey) (14.06.2019 ) (No-1-2019), and followed the procedure established by the U.S. National Bioethics Advisory Commission and European Commission was used to obtain written parental or guardian consent, while oral consent was obtained from mothers responsible for children. The consent form was read and signed by the legal representatives of the children before applying the questionnaire. The study was conducted in accordance with the Declaration of Helsinki, and consent was obtained from the participants by asking “I agree to participate in the study” as the first question of the Google form. The participants were provided with detailed information on the research, including its objectives, procedures, potential risks, and benefits. Additionally, they were informed about their right to withdraw from the study at any time without repercussion. All participants agreed to participate in the study, and provided written consent. The necessary work permit was obtained from the Mardin Provincial Directorate of Migrant Health to carry out the study. All steps of the study were carried out according to the Helsinki 2013 declaration.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
==== Refs
References

1. Lebano A Hamed S Bradby H Migrants’ and refugees’ health status and healthcare in Europe: a scoping literature review BMC Public Health 2020 20 1 1 22 10.1186/s12889-020-08749-8 31898494
Lebano A, Hamed S, Bradby H, et al. Migrants’ and refugees’ health status and healthcare in Europe: a scoping literature review. BMC Public Health. 2020;20(1):1–22.31898494 10.1186/s12889-020-08749-8
2. Aydın D Şahin N Akay B Effects of immigration on children’s health J Behçet Uz Children’s Hosp 2017 7 1 8 14 10.5222/buchd.2017.008
Aydın D, Şahin N, Akay B. Effects of immigration on children’s health. J Behçet Uz Children’s Hosp. 2017;7(1):8–14. 10.5222/buchd.2017.008.10.5222/buchd.2017.008
3. Brandenberger J Tylleskär T Sontag K A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries-the 3 C model BMC Public Health 2019 19 1 1 11 10.1186/s12889-019-7049-x 30606151
Brandenberger J, Tylleskär T, Sontag K, et al. A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries-the 3 C model. BMC Public Health. 2019;19(1):1–11.30606151 10.1186/s12889-019-7049-x
4. Benjeddi H Kwee D Gruppen M van der Kuip M van Hensbroek MB Furth MT Nutritional status of refugee children living in temporary settlements in Europe and MENA region: a systematic review and meta-analysis Eur J Pediatrics 2023 182 8 3397 404 10.1007/s00431-023-04999-x
Benjeddi H, Kwee D, Gruppen M, van der Kuip M, van Hensbroek MB, Furth MT. Nutritional status of refugee children living in temporary settlements in Europe and MENA region: a systematic review and meta-analysis. Eur J Pediatrics. 2023;182(8):3397–404. 10.1007/s00431-023-04999-x.10.1007/s00431-023-04999-x
5. Nowak AC Namer Y Hornberg C Health care for refugees in Europe: a scoping review Int J Environ Res Public Health 2022 19 3 1278 10.3390/ijerph19031278 35162300
Nowak AC, Namer Y, Hornberg C. Health care for refugees in Europe: a scoping review. Int J Environ Res Public Health. 2022;19(3):1278.35162300 10.3390/ijerph19031278
6. Matsangos M Ziaka L Exadaktylos AK Klukowska-Rötzler J Ziaka M Health status of Afghan refugees in Europe: policy and practice implications for an optimised healthcare Int J Environ Res Public Health 2022 19 15 9157 10.3390/ijerph19159157 35954518
Matsangos M, Ziaka L, Exadaktylos AK, Klukowska-Rötzler J, Ziaka M. Health status of Afghan refugees in Europe: policy and practice implications for an optimised healthcare. Int J Environ Res Public Health. 2022;19(15):9157. 10.3390/ijerph19159157.35954518 10.3390/ijerph19159157
7. Khuri J Wang Y Holden K Fly AD Mbogori T Mueller S Kandiah J Zhang M Dietary intake and nutritional status among refugees in host countries: a systematic review Adv Nutr 2022 13 5 1846 65 10.1093/advances/nmac051 35561746
Khuri J, Wang Y, Holden K, Fly AD, Mbogori T, Mueller S, Kandiah J, Zhang M. Dietary intake and nutritional status among refugees in host countries: a systematic review. Adv Nutr. 2022;13(5):1846–65. 10.1093/advances/nmac051.35561746 10.1093/advances/nmac051
8. Ankomah A Byaruhanga J Woolley E Boamah S Akombi-Inyang B Double burden of malnutrition among migrants and refugees in developed countries: a mixed-methods systematic review PLoS ONE 2022 17 8 e0273382 10.1371/journal.pone.0273382 35981085
Ankomah A, Byaruhanga J, Woolley E, Boamah S, Akombi-Inyang B. Double burden of malnutrition among migrants and refugees in developed countries: a mixed-methods systematic review. PLoS ONE. 2022;17(8):e0273382. 10.1371/journal.pone.0273382.35981085 10.1371/journal.pone.0273382
9. Mroue T Heras B Soriano JM Morales-Suarez-Varela M Prevalence of malnutrition among Syrian Refugee children from Lebanon Life (Basel) 2023 13 2 453 10.3390/life13020453 36836811
Mroue T, Heras B, Soriano JM, Morales-Suarez-Varela M. Prevalence of malnutrition among Syrian Refugee children from Lebanon. Life (Basel). 2023;13(2):453. 10.3390/life13020453.36836811 10.3390/life13020453
10. Kumar A Menezes L Ahson M Assessment of Growth in Pediatric Syrian Refugee populations in Jordan Avicenna J Med 2021 11 04 167 71 10.1055/s-0041-1736544 34881199
Kumar A, Menezes L, Ahson M. Assessment of Growth in Pediatric Syrian Refugee populations in Jordan. Avicenna J Med. 2021;11(04):167–71.34881199 10.1055/s-0041-1736544
11. UNICEF-2016. Syrian Children in Turkey. http://unicef.org.tr/files/bilgimerkezi/doc/T%C3%BCrkiyedeki%20Suriyeli%20%C3%87ocuklar_Bilgi%20Notu%20Kasim%202015.pdf
12. Al Masri F Müller M Straka D Hahn A Schuchardt JP Nutritional and health status of adult Syrian refugees in the early years of asylum in Germany: a cross-sectional pilot study BMC Public Health 2022 22 1 2217 10.1186/s12889-022-14684-7 36447164
Al Masri F, Müller M, Straka D, Hahn A, Schuchardt JP. Nutritional and health status of adult Syrian refugees in the early years of asylum in Germany: a cross-sectional pilot study. BMC Public Health. 2022;22(1):2217. 10.1186/s12889-022-14684-7.36447164 10.1186/s12889-022-14684-7
13. UNHCR. Syria Refugee Crisis Explained. https://www.unrefugees.org/news/syria-refugee-crisis-explained/
14. Directorate of Migration Management. Temporary Protection, Statistics. https://www.goc.gov.tr/gecici-koruma5638
15. Sanyaolu A Okorie C Qi X Locke J Rehman S Childhood and adolescent obesity in the United States: a Public Health concern Glob Pediatr Health 2019 6 2333794X19891305 10.1177/2333794X19891305 31832491
Sanyaolu A, Okorie C, Qi X, Locke J, Rehman S. Childhood and adolescent obesity in the United States: a Public Health concern. Glob Pediatr Health. 2019;6:2333794X19891305. 10.1177/2333794X19891305.31832491 10.1177/2333794X19891305
16. Hulst JM Huysentruyt K Joosten KF Pediatric screening tools for malnutrition: an update Curr Opin Clin Nutr Metabolic Care 2020 23 3 203 9 10.1097/MCO.0000000000000644
Hulst JM, Huysentruyt K, Joosten KF. Pediatric screening tools for malnutrition: an update. Curr Opin Clin Nutr Metabolic Care. 2020;23(3):203–9.10.1097/MCO.0000000000000644
17. World Health Organization (WHO) Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development, 2006.
18. Lelijveld N Beedle A Farhikhtah A Elrayah EE Bourdaire J Aburto N Systematic review of the treatment of moderate acute malnutrition using food products Matern Child Nutr 2020 16 1 e12898 10.1111/mcn.12898 31667981
Lelijveld N, Beedle A, Farhikhtah A, Elrayah EE, Bourdaire J, Aburto N. Systematic review of the treatment of moderate acute malnutrition using food products. Matern Child Nutr. 2020;16(1):e12898. 10.1111/mcn.12898.31667981 10.1111/mcn.12898
19. Mekonen J Addisu S Mekonnen H Prevalence and associated factors of chronic undernutrition among under five children in Adama town, Central Ethiopia: a cross-sectional study design BMC Res Notes 2019 12 1 1 6 10.1186/s13104-019-4552-1 30602384
Mekonen J, Addisu S, Mekonnen H. Prevalence and associated factors of chronic undernutrition among under five children in Adama town, Central Ethiopia: a cross-sectional study design. BMC Res Notes. 2019;12(1):1–6.30602384 10.1186/s13104-019-4552-1
20. Piniel A. Factors contributing to severe acute malnutrition among the under five children in Francistown-Botswana. University of the Western Cape; 2016.
21. Aguayo V Badgaiyan N Singh K How do the new WHO discharge criteria for the treatment of severe acute malnutrition affect the performance of therapeutic feeding programmes? New evidence from India Eur J Clin Nutr 2015 69 4 509 13 10.1038/ejcn.2014.197 25226818
Aguayo V, Badgaiyan N, Singh K. How do the new WHO discharge criteria for the treatment of severe acute malnutrition affect the performance of therapeutic feeding programmes? New evidence from India. Eur J Clin Nutr. 2015;69(4):509–13.25226818 10.1038/ejcn.2014.197
22. Sugianto R Chan MJ Wong SF Shek LP Tan KH Chong YS Godfrey KM Tai BC Chong MF Evaluation of a quantitative food frequency questionnaire for 5-Year-old children in an Asian Population J Acad Nutr Diet 2020 120 3 437 44 10.1016/j.jand.2019.09.021 31866358
Sugianto R, Chan MJ, Wong SF, Shek LP, Tan KH, Chong YS, Godfrey KM, Tai BC, Chong MF. Evaluation of a quantitative food frequency questionnaire for 5-Year-old children in an Asian Population. J Acad Nutr Diet. 2020;120(3):437–44. 10.1016/j.jand.2019.09.021.31866358 10.1016/j.jand.2019.09.021
23. Burge C Dharod JM What are the nutrition education needs of refugees: assessment of food choices, shopping and spending practices of South-Asian refugees in the USA J Int Migration Integr 2018 19 555 64 10.1007/s12134-018-0565-1
Burge C, Dharod JM. What are the nutrition education needs of refugees: assessment of food choices, shopping and spending practices of South-Asian refugees in the USA. J Int Migration Integr. 2018;19:555–64.10.1007/s12134-018-0565-1
24. Haidar MK Farhat JB Saim M Morton N Defourny I Severe malnutrition in infants displaced from Mosul, Iraq Lancet Glob Health 2017 5 12 e1188 10.1016/S2214-109X(17)30417-5 29132612
Haidar MK, Farhat JB, Saim M, Morton N, Defourny I. Severe malnutrition in infants displaced from Mosul, Iraq. Lancet Glob Health. 2017;5(12):e1188. 10.1016/S2214-109X(17)30417-5.29132612 10.1016/S2214-109X(17)30417-5
25. Pakravan-Charvadeh MR Vatanparast H Mahasti Khakpour, Cornelia Floraet. Food insecurity status of Afghan refugees is linked to socioeconomic and resettlement status, gender disparities and children’s health outcomes in Iran Child Indic Res 2021 14 5 1979 2000 10.1007/s12187-021-09827-y
Pakravan-Charvadeh MR, Vatanparast H. Mahasti Khakpour, Cornelia Floraet. Food insecurity status of Afghan refugees is linked to socioeconomic and resettlement status, gender disparities and children’s health outcomes in Iran. Child Indic Res. 2021;14(5):1979–2000.10.1007/s12187-021-09827-y
26. Hossain FB Shawon MSR Al-Abid MSU Mahmood S Adhikary G Bulbul MMI Double burden of malnutrition in children aged 24 to 59 months by socioeconomic status in five south Asian countries: evidence from demographic and health surveys BMJ Open 2020 10 3 e032866 10.1136/bmjopen-2019-032866 32184304
Hossain FB, Shawon MSR, Al-Abid MSU, Mahmood S, Adhikary G, Bulbul MMI. Double burden of malnutrition in children aged 24 to 59 months by socioeconomic status in five south Asian countries: evidence from demographic and health surveys. BMJ Open. 2020;10(3):e032866. 10.1136/bmjopen-2019-032866.32184304 10.1136/bmjopen-2019-032866
27. Rahimitabar P Kraemer A Bozorgmehr K Ebrahimi F Takian A Health condition of Afghan refugees residing in Iran in comparison to Germany: a systematic review of empirical studies Int J Equity Health 2023 22 1 16 10.1186/s12939-023-01832-7 36681845
Rahimitabar P, Kraemer A, Bozorgmehr K, Ebrahimi F, Takian A. Health condition of Afghan refugees residing in Iran in comparison to Germany: a systematic review of empirical studies. Int J Equity Health. 2023;22(1):16. 10.1186/s12939-023-01832-7.36681845 10.1186/s12939-023-01832-7
28. Anderson J The impact of family structure on the health of children: effects of divorce Linacre Q 2014 81 4 378 87 10.1179/0024363914Z.00000000087 25473135
Anderson J. The impact of family structure on the health of children: effects of divorce. Linacre Q. 2014;81(4):378–87. 10.1179/0024363914Z.00000000087.25473135 10.1179/0024363914Z.00000000087
29. Dawson-Hahn EE Pak-Gorstein S Hoopes AJ Matheson J Comparison of the Nutritional Status of Overseas Refugee Children with Low Income Children in Washington State PLoS ONE 2016 11 1 e0147854 10.1371/journal.pone.0147854 26808275
Dawson-Hahn EE, Pak-Gorstein S, Hoopes AJ, Matheson J. Comparison of the Nutritional Status of Overseas Refugee Children with Low Income Children in Washington State. PLoS ONE. 2016;11(1):e0147854. 10.1371/journal.pone.0147854.26808275 10.1371/journal.pone.0147854
30. TUIK. Official Statistics Program 2022–2026. https://ms.hmb.gov.tr/uploads/sites/3/2023/08/2022_2026_RIP.pdf
31. Rose ES Blevins M González-Calvo L Ndatimana E Green AF Lopez M Olupona O Vermund SH Moon TD Determinants of undernutrition among children aged 6 to 59 months in rural Zambézia Province, Mozambique: results of two population-based serial cross-sectional surveys BMC Nutr 2015 1 41 10.1186/s40795-015-0039-1 27182448
Rose ES, Blevins M, González-Calvo L, Ndatimana E, Green AF, Lopez M, Olupona O, Vermund SH, Moon TD. Determinants of undernutrition among children aged 6 to 59 months in rural Zambézia Province, Mozambique: results of two population-based serial cross-sectional surveys. BMC Nutr. 2015;1:41. 10.1186/s40795-015-0039-1.27182448 10.1186/s40795-015-0039-1
32. Grammatikopoulou MG Theodoridis X Poulimeneas D Maraki MI Gkiouras K Tirodimos I Dardavessis T Chourdakis M Malnutrition surveillance among refugee children living in reception centres in Greece: a pilot study Int Health 2019 11 1 30 5 10.1093/inthealth/ihy053 30053024
Grammatikopoulou MG, Theodoridis X, Poulimeneas D, Maraki MI, Gkiouras K, Tirodimos I, Dardavessis T, Chourdakis M. Malnutrition surveillance among refugee children living in reception centres in Greece: a pilot study. Int Health. 2019;11(1):30–5. 10.1093/inthealth/ihy053.30053024 10.1093/inthealth/ihy053
33. Grijalva-Eternod CS Wells JC Cortina-Borja M Salse-Ubach N Tondeur MC Dolan C Meziani C Wilkinson C Spiegel P Seal AJ The double burden of obesity and malnutrition in a protracted emergency setting: a cross-sectional study of western sahara refugees PLoS Med 2012 9 10 e1001320 10.1371/journal.pmed.1001320 23055833
Grijalva-Eternod CS, Wells JC, Cortina-Borja M, Salse-Ubach N, Tondeur MC, Dolan C, Meziani C, Wilkinson C, Spiegel P, Seal AJ. The double burden of obesity and malnutrition in a protracted emergency setting: a cross-sectional study of western sahara refugees. PLoS Med. 2012;9(10):e1001320. 10.1371/journal.pmed.1001320.23055833 10.1371/journal.pmed.1001320
34. Hossain SMM Leidman E Kingori J Nutritional situation among Syrian refugees hosted in Iraq, Jordan, and Lebanon: cross sectional surveys Confl Health 2016 10 1 1 11 10.1186/s13031-016-0093-6 26865857
Hossain SMM, Leidman E, Kingori J, et al. Nutritional situation among Syrian refugees hosted in Iraq, Jordan, and Lebanon: cross sectional surveys. Confl Health. 2016;10(1):1–11. 10.1186/s13031-016-0093-6.26865857 10.1186/s13031-016-0093-6
35. Walpole SC Abbara A Gunst M Harkensee C Cross-sectional growth assessment of children in four refugee camps in Northern Greece Public Health 2018 162 147 52 10.1016/j.puhe.2018.05.004 30075409
Walpole SC, Abbara A, Gunst M, Harkensee C. Cross-sectional growth assessment of children in four refugee camps in Northern Greece. Public Health. 2018;162:147–52. 10.1016/j.puhe.2018.05.004.30075409 10.1016/j.puhe.2018.05.004
36. Das AC Childhood mortality and child nutritional status of Bangladesh: a review on demographic and Health Survey J Curr Adv Med Res 2015 2 2 42 6 10.3329/jcamr.v2i2.24878
Das AC. Childhood mortality and child nutritional status of Bangladesh: a review on demographic and Health Survey. J Curr Adv Med Res. 2015;2(2):42–6.10.3329/jcamr.v2i2.24878
37. Hashmi AH Nyein PB Pilaseng K Paw MK Darakamon MC Min AM Charunwatthana P Nosten F McGready R Carrara VI Feeding practices and risk factors for chronic infant undernutrition among refugees and migrants along the Thailand-Myanmar border: a mixed-methods study BMC Public Health 2019 19 1 1586 10.1186/s12889-019-7825-7 31779599
Hashmi AH, Nyein PB, Pilaseng K, Paw MK, Darakamon MC, Min AM, Charunwatthana P, Nosten F, McGready R, Carrara VI. Feeding practices and risk factors for chronic infant undernutrition among refugees and migrants along the Thailand-Myanmar border: a mixed-methods study. BMC Public Health. 2019;19(1):1586. 10.1186/s12889-019-7825-7.31779599 10.1186/s12889-019-7825-7
38. Akombi-Inyang B Nazmul Huda MD Byaruhanga J Renzaho A Double burden of Malnutrition among migrants and refugees in developed countries Social Sci Protocols 2021 4 1 13 10.7565/ssp.v4.5394
Akombi-Inyang B, Nazmul Huda MD, Byaruhanga J, Renzaho A. Double burden of Malnutrition among migrants and refugees in developed countries. Social Sci Protocols. 2021;4:1–13. 10.7565/ssp.v4.5394.10.7565/ssp.v4.5394
39. Demissie S Worku A Magnitude and factors associated with malnutrition in children 6–59 months of age in pastoral community of Dollo Ado District, Somali region, Ethiopia Sci J Public Health 2013 1 4 175 83 10.11648/j.sjph.20130104.12
Demissie S, Worku A. Magnitude and factors associated with malnutrition in children 6–59 months of age in pastoral community of Dollo Ado District, Somali region, Ethiopia. Sci J Public Health. 2013;1(4):175–83.10.11648/j.sjph.20130104.12
40. Gebre A Reddy PS Mulugeta A Sedik Y Kahssay M Prevalence of Malnutrition and Associated factors among under-five children in Pastoral communities of Afar Regional State, Northeast Ethiopia: A Community-based cross-sectional study J Nutr Metab 2019 2019 9187609 10.1155/2019/9187609 31275645
Gebre A, Reddy PS, Mulugeta A, Sedik Y, Kahssay M. Prevalence of Malnutrition and Associated factors among under-five children in Pastoral communities of Afar Regional State, Northeast Ethiopia: A Community-based cross-sectional study. J Nutr Metab. 2019;2019:9187609. 10.1155/2019/9187609.31275645 10.1155/2019/9187609
41. Kavosi E Hassanzadeh Rostami Z Kavosi Z Nasihatkon A Moghadami M Heidari M Prevalence and determinants of under-nutrition among children under six: a cross-sectional survey in Fars Province, Iran Int J Health Policy Manag 2014 3 2 71 6 10.15171/ijhpm.2014.63 25114945
Kavosi E, Hassanzadeh Rostami Z, Kavosi Z, Nasihatkon A, Moghadami M, Heidari M. Prevalence and determinants of under-nutrition among children under six: a cross-sectional survey in Fars Province, Iran. Int J Health Policy Manag. 2014;3(2):71–6. 10.15171/ijhpm.2014.63.25114945 10.15171/ijhpm.2014.63
42. Alom J Islam MA Quddus MA Socioeconomic factors influencing nutritional status of under-five children of agrarian families in Bangladesh: a multilevel analysis Bangladesh J Agricultural Econ 2009 32 454–2016–36445 63 74
Alom J, Islam MA, Quddus MA. Socioeconomic factors influencing nutritional status of under-five children of agrarian families in Bangladesh: a multilevel analysis. Bangladesh J Agricultural Econ. 2009;32(454–2016–36445):63–74.
43. Tadesse A Hailu D Bosha T Nutritional status and associated factors among pastoralist children aged 6–23 months in Benna Tsemay Woreda, South Omo Zone, Southern Ethiopia Int J Nutr Food Sci 2018 7 1 11 23 10.11648/j.ijnfs.20180701.13
Tadesse A, Hailu D, Bosha T. Nutritional status and associated factors among pastoralist children aged 6–23 months in Benna Tsemay Woreda, South Omo Zone, Southern Ethiopia. Int J Nutr Food Sci. 2018;7(1):11–23.10.11648/j.ijnfs.20180701.13
44. Khan GN Turab A Khan MI Rizvi A Shaheen F Ullah A Prevalence and associated factors of malnutrition among children under-five years in Sindh, Pakistan: a cross-sectional study BMC Nutr 2016 2 1 7 10.1186/s40795-016-0112-4
Khan GN, Turab A, Khan MI, Rizvi A, Shaheen F, Ullah A, et al. Prevalence and associated factors of malnutrition among children under-five years in Sindh, Pakistan: a cross-sectional study. BMC Nutr. 2016;2:1–7. 10.1186/s40795-016-0112-4. https://bmcnutr.biomedcentral.com/articles/.10.1186/s40795-016-0112-4
45. Babatunde RO Iyabo OF Fakayode SB Prevalence and determinants of malnutrition among under-five children of farming households in Kwara State, Nigeria J Agric Sci 2011 3 3 173 81
Babatunde RO, Iyabo OF, Fakayode SB. Prevalence and determinants of malnutrition among under-five children of farming households in Kwara State, Nigeria. J Agric Sci. 2011;3(3):173–81.
46. Babar NF Muzaffar R Khan MA Imdad S Impact of socioeconomic factors on nutritional status in primary school children J Ayub Med Coll Abbottabad 2010 22 4 15 8 22455252
Babar NF, Muzaffar R, Khan MA, Imdad S. Impact of socioeconomic factors on nutritional status in primary school children. J Ayub Med Coll Abbottabad. 2010;22(4):15–8.22455252
47. Beyene TT Predictors of nutritional status of children visiting health facilities in Jimma Zone, South West Ethiopia Int J Adv Nurs Sci Pract 2012 1 1 1 13
Beyene TT. Predictors of nutritional status of children visiting health facilities in Jimma Zone, South West Ethiopia. Int J Adv Nurs Sci Pract. 2012;1(1):1–13.
48. Habyarimana F. Key determinants of malnutrition of children under five years of age in Rwanda: simultaneous measurement of three anthropometric indices. Afr Popul Stud. 2016;30(2).
49. Mahmood S Nadeem S Saif T Mannan M Arshad U Nutritional Status and Associated factors in under-five children of Rawalpindi J Ayub Med Coll Abbottabad 2016 28 1 67 71 27323566
Mahmood S, Nadeem S, Saif T, Mannan M, Arshad U. Nutritional Status and Associated factors in under-five children of Rawalpindi. J Ayub Med Coll Abbottabad. 2016;28(1):67–71.27323566
50. Ullah H Ullah B Karim S Tariq I Khan AK Mir S Baseer A Azhar S Murtaza G Ullah H Malnutrition amongst under-five years children in Swat, Pakistan: prevalence and risk factors Trop J Pharm Res 2014 13 8 1367 70 10.4314/tjpr.v13i8.24
Ullah H, Ullah B, Karim S, Tariq I, Khan AK, Mir S, Baseer A, Azhar S, Murtaza G, Ullah H. Malnutrition amongst under-five years children in Swat, Pakistan: prevalence and risk factors. Trop J Pharm Res. 2014;13(8):1367–70.10.4314/tjpr.v13i8.24
