Hjern A, Kocturk-Runefors T, Jeppson 0. Food habits and infant feeding in newly resettled refugee families from Chile and the Middle East. Scand J Prim Health ...
Scand J Prim Health Care 1990; 8: 145-50
Food Habits and Infant Feeding in Newly Resettled Refugee Families from Chile and the Middle East ANDERS HJERN, TAHIRE KOCTURK-RUNEFORS and O L L E JEPPSON
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Karolinska Institutet, Department of pediatrics, Huddinge Universify Hospital, Sweden
Hjern A, Kocturk-Runefors T, Jeppson 0.Food habits and infant feeding in newly resettled refugee families from Chile and the Middle East. Scand J Prim Health Care 1990; 8: 145-50. Food habits and infant feeding patterns of 45 newly resettled refugee families from Chile and the Middle East were studied in the suburbs of Stockholm. The social background of the sample was mixed and the level of maternal education high with the exception of the rural Kurds from firkey. Children from rural Middle East areas had been breastfed for longer periods than the children from urban areas. Solid and semi-solid foods were introduced late in the Middle East. Chileans had a characteristic meal pattern, emphasizing lunch and often replacing dinner with a light meal. Resettled Chileans and Middle Easterners had a varied and well balanced diet with the characteristics of each culture. Foods containing sucrose were consumed frequently in both refugee groups. Key words: immigrants, food habits, infant feeding, refugee children, breastfeeding. Anders Hjern, MD, Skinegatan 59, 11637 Stockholm, Sweden.
Knowledge of different food cultures has become increasingly important in Swedish primary health care work. Since the 1960s the population of first and second generation immigrants in Sweden has steadily grown. In the 1980s the majority of immigrants were resettled refugees. In 1987 a total of 31000 refugees arrived in Sweden, including approximately 8000 minors below the age of 16. The majority came from the Middle East and Chile, but quite a few also came from eastern Europe, Africa, and Asia. During 1986-88 a study was carried out among newly resettled refugee families in Stockholm with the object of describing the current health and the psychological and nutritional status of the children. The following is a presentation of social background, food habits, meal pattern, and infant feeding pattern of the two largest groups in the study; the Chileans and the Middle Easterners. MATERIAL During 13 months in 1986-87 all newly arrived refugee families, with children one to fifteen years of age, who settled in a sector of southwestern Stock-
holm were approached through their social worker and given the offer of taking part in the study. Two families (four children) did not wish to participate in the study, and another two children were excluded because of severe disabling disease. The study comprised the remaining 103 children. The children from Lebanon, Turkey, and Iran were grouped together as a Middle East group because of similar food traditions.
METHODS Social background: As soon as possible (0-5 months) after the arrival in Sweden, a doctor (A.H. or O.J.) conducted a structured interview about the social background of each family. Food interviews were performed by a Turkish community nutritionist (T.K). Interviews were made 6-9 months after the arrival in Sweden. Interpreters were used in all interviews except in the Turkish group. Food history: Mothers were interviewed about the food history of each child. Questions were asked Scand I Prim Health Care 1990: 8
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Table I. Social and demographic data of the refugee families included in the food interviews.
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Age on arrival in Sweden Mean age of children 1-6.49 years (preschool) 6.50-15 years (school) Maternal mean age Maternal education None Primary (4-8 years) Secondary (9-12 years) University Eather’s profession 1. Professionals 2. Officials, skilled workers, officers 3. Workers, farmers, soldiers Domicile in home country City > 1 million City < 1 million Rural area
Chile
Middle East
4.9 yrs
7.1 yn 18 18
40 11 27
30
0%
41%
13% 58% 29%
23YO 23YO
10%
10%
48YO 43yo
48YO
95% 5 YO
50%
0
30%
12%
42%
20%
about breastfeeding duration, introduction of solids and semi-solids, vitamins during infancy, and difficulties of acquiring food in the home country. Food consumption frequency: Mothers were interviewed about the consumption of different foods of the children (1-15 yrs) in the family. Interviews were made in the homes of all families doing their own cooking at the time of the interview. The questionnaire registered the frequency of consumption as “never”, “once a month”, “several times a month”, “once a week”, “several times a week”, “once a day”, “several times a day”. Meal pattern: The number of individual and total meals for each child was analysed in 24-hour recall interviews using the following definitions: Breakfast: The first meal of the day, consisting of milkkocodsoured milWformula/porridge with or without sandwiches or cereals, or tea and sandwiches. Lunch: A meal served between 10 a.m. and 2 p.m. of prepared warm food or a substantial cold meal consisting of a liberal portion of soured milk or porridge with sandwiches a n d o r fruit. Dinner: The same definition as for lunch, but served between 2 p.m. and 8 p.m. Light meal: A small meal consisting, for example, Scand J Prim Health Care 1990: 8
of milWsoured milWformula and/or fruit/j uice and/or sandwiches or several types of fruit. Snacks: Nibbling of ice-cream, buns, cakes, biscuits, sweets or fruit and occasional intake of such drinks as juice or soft drinks. RESULTS
Dropouts 16 children, 10 from Chile and 6 from the Middle East, were lost before food interviews since they had returned to their home country or left Stockholm for refugee camps in other parts of Sweden. Social and demographic data Social and demographic data are presented in Table I. 45 families were included in the food interviews; 32 families with 51 children from Chile, 5 families with 9 children from Iran, 4 families with 12 children from Lebanon, and 4 Kurdish families with 15 children from Turkey. All Chileans and Lebanese were Christians. The refugees from Iran and Turkey were Moslems but did not obey Moslem rules in a fundamentalist way. The majority of the refugees came from urban areas. Santiago de Chile, Valparaiso, Beirut, and Teheran were common cities of origin. The vast majority of the families were allowed to resettle in Stockholm because they had relatives in the greater Stockholm area. Infant feeding Data regarding infant feeding practices in the home country are presented in Figure 1 and Table 11. Refu-
Stockholm l988
