METHODS: This was a cross-sectional study, for which we conveniently recruited 100 adult Rohingyas, 50 from each country; the majority was males. Rohingyas in Bangladesh fled Myanmar's Rakhine State following a major military crackdown in 2017, whereas Rohingyas in Malaysia fled Rakhine gradually over the last three decades because of recurrent violence and military operations. We assessed trauma (cumulative trauma, direct trauma, and indirect trauma), PTSD, depression, generalized anxiety, and everyday functioning of the participants using traumatic event questionnaire, PTSD-8, PHQ-9, GAD-7, and WHODAS-2.0.
RESULTS: The Bangladeshi cohort experienced more types of traumatic events (i.e., cumulative trauma) than did the Malaysian cohort (d = 0.58). Although the two cohorts did not differ in terms of indirect exposure to traumatic incidents (i.e., indirect trauma), the Malaysian cohort had direct exposure to traumatic events (i.e., direct trauma) more frequently than did the Bangladeshi cohort (d = 1.22). The Bangladeshi cohort showed higher PTSD (d = 1.67), depression (d = 0.81), generalized anxiety (d = 1.49), and functional impairment (d = 2.51) than those in Malaysia. Hierarchical linear regression analyses showed that after controlling for demographic variables, both direct and indirect trauma significantly predicted PTSD, depression, and functional impairment among Rohingyas in Bangladesh, with direct trauma being the stronger predictor. However, similar analyses showed that only indirect trauma predicted PTSD among Rohingyas in Malaysia, while all other effects were nonsignificant. The results also showed that the predictive relationship between direct trauma and PTSD was different across the two countries. With the same level of direct trauma, a participant from Malaysia would score 0.256 points lower in PTSD than a participant from Bangladesh.
CONCLUSION: The recently experienced direct and indirect trauma have impaired mental health and everyday functioning among the Bangladeshi cohort. However, only indirect trauma was active to cause PTSD in the Malaysian cohort as direct trauma was weakening due to the time elapsed since migration. We discuss the results in the context of the current theories of trauma and mental health and suggest therapeutic interventions for the refugee population.
OBJECTIVES: We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child hemoglobin (Hb), anemia, and inflammation-adjusted micronutrient status outcomes.
METHODS: We conducted a 2-stage meta-analysis of individual participant data from 13 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 15,946). We generated study-specific and subgroup estimates of SQ-LNSs compared with control, and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine potential study-level effect modifiers.
RESULTS: SQ-LNS provision decreased the prevalence of anemia (Hb < 110 g/L) by 16% (relative reduction), iron deficiency (plasma ferritin < 12 µg/L) by 56%, and iron deficiency anemia (IDA; Hb < 110 g/L and plasma ferritin <12 µg/L) by 64%. We observed positive effects of SQ-LNSs on hematological and iron status outcomes within all subgroups of the study- and individual-level effect modifiers, but effects were larger in certain subgroups. For example, effects of SQ-LNSs on anemia and iron status were greater in trials that provided SQ-LNSs for >12 mo and provided 9 (as opposed to <9) mg Fe/d, and among later-born (than among first-born) children. There was no effect of SQ-LNSs on plasma zinc or retinol, but there was a 7% increase in plasma retinol-binding protein (RBP) and a 56% reduction in vitamin A deficiency (RBP