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Disability and food insufficiency in the Palestinian refugee population in Lebanon: A household survey

Salti N. Nuwayri-Salti N. & Ghattas H. (2013)

The Lancet, 382, S31.


Background: According to the available data, Palestinian refugees in Lebanon have higher disability rates (4·4% in 2010) than do the Lebanese population (2·0% in 2004), and the Palestinian population in the occupied Palestinian territory (2·7% in 2011). However, the sociodemographic characteristics of the Palestinian refugees with disabilities are still not known. In this study, we describe their sociodemographic profile by type and cause of disability, and quantify the risk of disability associated with food insufficiency.

Methods: Data for 2631 households, including their socioeconomic and demographic characteristics, health, disability, food consumption, and food security, were from the 2010 Socio-Economic Survey of Palestine Refugees in Lebanon. Missing data for individual variables resulted in reduced sample sizes in bivariate analyses. We did not impute missing values and report findings with available data. Using Stata (version 10.0), we regressed household food consumption on disability, controlling for geographical region, household size, age composition, wealth, expenditures, sex and education of the head of the household, chronic illnesses, and participation in social assistance programmes. We also undertook multinomial logistic regression of disability by cause—food insufficiency and food security. Food security was assessed with a six-item food security scale adapted from the US Household Food Security Survey Module and the Yemen National Food Insecurity and Vulnerability Information and Mapping Systems Survey, and modified to the context of refugees living in Lebanon. Food insufficiency was defined as a positive response to a threshold question from the food security scale: “The food that we bought did not last and we didn't have money to buy more?” We regarded “most of the time” and “sometimes” as a positive response. The household survey was approved by the institutional review board of the American University of Beirut, Beirut, Lebanon. We obtained verbal informed consent from the household proxy respondent who responded to the questionnaire.

Findings: 402 (15%) of 2631 Palestinian households had a member with a disability. 302 (64%) of 475 individuals with a disability were men (vs 4810 [46%] of 10 458 able-bodied individuals), and 260 (55%) of 470 with a disability had a chronic illness (vs 3096 [30%] of 10 418 individuals without a disability). 92 (29%) of 320 cases of disability were due to birth defects, 66 (21%) to accidents, 56 (18%) to war, 27 (8%) to work, and 79 (25%) to other causes. The sex distribution in the 24% of individuals with a disability due to other causes was less skewed than in those with a disability due to birth defects, accidents, or work (41 [53%] of 77 were men vs 175 [73%] of 241, respectively). The prevalence of chronic illnesses was higher in people with a disability caused by disease who were younger than 65 years than in those older than 65 years (35 [78%] of 45 vs 121 [50%] of 242). Regression analysis showed that disability of any cause was significantly associated with food insufficiency (p=0·023) and insecurity (p=0·008). However, food insufficiency was associated with a significantly higher risk of disability only when the disability was due to disease (p=0·05).

Interpretation: Our findings confirm the impoverishing effect of disability irrespective of the cause. Food insufficiency was associated with disability only when the disability was caused by disease. Interventions to ensure food sufficiency and adequate nutrition can play a part in the prevention of disability in the Palestinian refugee population and break the cycle of poverty, poor nutrition, and poor health.

Mots clés

Disability; Food insufficiency; Palestinian refugee