Nutritional and dietary diversity status of under-5 children and adolescent girls among forcibly displaced Myanmar nationals living in Bhasan Char relocation camp, Bangladesh: a cross-sectional survey

**Background:** Following the August 2017 attacks in Myanmar's Rakhine state, nearly 890,000 Rohingya refugees (termed forcibly displaced Myanmar nationals, FDMN) fled to Bangladesh and are living in camps in Cox's Bazar. Citing overcrowding and security concerns, the Government of Bangladesh began relocating FDMN to Bhasan Char, an island in the Bay of Bengal. By the time of the survey, 17,698 FDMN had been relocated, including approximately 3,997 under-5 children and 5,000 adolescent girls. Prior to this study, no baseline data existed on the nutritional and dietary diversity status of these vulnerable groups in the relocation camp, limiting the ability to design appropriate nutrition programmes.

**Methods:** This cross-sectional survey was conducted from 7–12 November 2021 in the Bhasan Char relocation camp. A sampling frame of eligible households (containing at least one under-5 child or one adolescent girl) was created, and households were randomly selected using computer-generated random numbers. Only one participant per household was recruited. The final sample comprised 248 under-5 children (6–59 months) and 299 adolescent girls (11–17 years). The response rate was 100%. Trained field research assistants collected sociodemographic data, anthropometric measurements (length/height, weight, MUAC, head circumference), and dietary intake using validated tools and pretested questionnaires. WHO growth standards were used to define undernutrition. Minimum dietary diversity (MDD) for children was defined as consumption of at least 4 of 8 defined food groups in the preceding 24 hours. For adolescents, the Women's Dietary Diversity Score (WDDS, range 0–9) was used following FAO guidelines. Linear and logistic regression analyses assessed associations between nutritional status and dietary diversity.

**Key Results:** The mean age of adolescent girls was 13.66±1.73 years; mean age of children was 28.82±13.82 months. All participants had access to improved water and sanitation. Among adolescent girls: 6.69% (95% CI 3.86–9.52%) had severe thinness (BMI-for-age z-score <−3), 10.03% (95% CI 7.2–12.87%) had moderate thinness, 4.01% were overweight, and 0.67% were obese. Severe thinness was more prevalent in older adolescents (15–17 years: 3.92%) than younger (11–14 years: 2.02%). Stunting was highly prevalent: 14.05% (95% CI 11.21–16.87%) severe stunting and 28.76% (95% CI 25.93–31.59%) moderate stunting. Adolescents consumed a mean of 3.10 (SD 1.03) out of 9 food groups. Nearly all (98%) consumed starchy staples, 79% consumed dark green leafy vegetables, but very few consumed animal-source foods or vitamin A/iron-rich foods. Among under-5 children: 8.50% (95% CI 5.60–11.33%) were severely stunted and 23.08% (95% CI 20.24–25.90%) moderately stunted; 4.43% (95% CI 1.60–7.27%) severely underweight and 22.98% (95% CI 20.15–25.81%) moderately underweight; 1.21% (95% CI 0.00–4.04%) severely wasted and 10.88% (95% CI 8.05–13.72%) moderately wasted. Moderate acute malnutrition (MUAC 11.5–12.5 cm) was present in 8.46% of children, and only 2 children had severe acute malnutrition. Only 25% (95% CI 22.97–28.64%) of under-5 children achieved minimum dietary diversity. Diets were predominantly carbohydrate-based across all nutritional status categories. Regression analyses showed no statistically significant associations between anthropometric indices and dietary diversity scores in either group (p>0.05).

**Clinical Implications:** This study provides the first baseline evidence of malnutrition among relocated FDMN in Bhasan Char. The prevalence of global acute malnutrition (WHZ <−2) in under-5 children exceeded the global emergency threshold of 10%. Undernutrition rates were higher than national estimates for the host country Bangladesh (stunting 31% vs 32%, underweight 22% vs 27%, wasting 8% vs 12%). The presence of a double burden (thinness alongside overweight/obesity in 5% of adolescents) raises concerns about future non-communicable disease risk. The uniformly poor dietary diversity — predominantly starchy staples with minimal animal-source foods — indicates widespread micronutrient inadequacy. The authors recommend moving beyond short-term nutrition support to a nutrition-specific approach including promotion of exclusive breastfeeding, introduction of diverse complementary foods, blanket micronutrient supplementation, and distribution of diversified, micronutrient-fortified rations. Limitations include the brief 1-week data collection period (minimizing seasonal variability but potentially missing usual intake patterns) and reliance on 24-hour dietary recall.