The data reported in this study represents a sample of vulnerable immigrant children living in extremely poor settings in Rome, the capital city of Italy. The vulnerability of this population, referring to nutritional status, is already well known in literature, with immigrants likely to be most exposed to malnutrition, especially under-nutrition [19–20]. Our data highlights the high prevalence of under-nutrition in Roma children living in authorized and unauthorized extra-urban settings since their birth. At the time of birth, our sample showed already a 19.2% prevalence of low weight (<-2.5kg), confirming that Roma infants are more likely to be under-nourished weight than non-Roma [21]. The UNICEF’s report, showed that in Bosnia and Herzegovina the proportion of low birth weight for Roma infants was over four times that of non-Roma, being around 14% in 2015. As well known, newborn’s weight is a good indicator of a mother’s health and nutritional status, as well as of their chances for survival, growth, long-term health and psychosocial development. Consequentially the high prevalence of low birthweight reported in the present study might be a significant risk factor associated with poor child development outcomes. As regard malnutrition in Roma under-five children, in Fig. 1 we have compared our findings with the results from some other studies, reported by the UNICEF, conducted in different Balkan settlements [21]. The present study reports similar data on chronic malnutrition and highest prevalence of acute malnutrition, in particular underweight. Our results confirm that Roma children under the age of five are most vulnerable to under-nutrition.
The highest rate of malnutrition, especially in Roma children, was observed for chronic malnutrition-stunting, in agreement with other published studies in Eastern Europe [21]. Levels of chronic malnutrition in our group is comparable to the Roma Serbian’s study [22–23], as well as some low- and middle-income countries [24]. The faltering in linear growth of Roma children under-five is an expression of protracted food insecurity, and a lack of the mothers’ knowledge in feeding practices in the first years of age. In the specific context of extra-urban camps, the lack of access to basic services, the economic barriers, the poor mothers’ education are the main drivers of child malnutrition [25].
A very high prevalence of underweight was found among Roma children (14%), nearly doubling that reported in the Serbian study, with a similar prevalence to that of the Vojvodina region (10.8%) [22]. Our findings are comparable with the level of underweight in low-middle income countries, where the World Bank reports a prevalence of 14.5% in 2019 [26].
As expected, even the prevalence of wasting was significantly higher in Roma children, similar to the Serbian study, emphasizing the disparity in terms of poverty and health conditions between Roma children living in camps and non-Roma living in urban settings.
The trends in malnutrition for under-five children reflect findings of a previous study conducted in a similar population in the city of Rome, which highlighted that the Roma children presented all anthropometric indices significantly lower with respect to the entire immigrant population [27].
A recent study, conducted in Italy on immigrant children reported that children living without access to basic water and sanitation services, as well as household commodities (i.e. heater, refrigerator, electricity) increased the risk of these children being stunted [28]. The prevalence of malnutrition was confirmed even in the school aged children, with significant differences when considering the two kinds of malnutrition: under-nutrition and over-nutrition. Compared to the youngest group, for Roma children the risk of being underweight was confirmed, while a lower rate of stunting was detected, with a prevalence at school-age of 5.8%. School-aged immigrant children presented the lowest rate of underweight, comparable to rates found for Italian children living in socioeconomic inequality contexts, as reported by Buonomo et.al. [28].
Our findings exceed the results of a similar study conducted in the Republic of Macedonia (Fig. 2), that reports the lowest level of malnutrition among Roma school-aged children, versus non-Roma [29].
Underweight was detected in the Republic of Macedonia in 1.9% of Roma children vs. 0.7% of non-Roma, while stunting was assessed in only 1.9% (vs. 0%). When considering BAZ<-2, our findings were quite similar to the Macedonia study, where the 4.8% of Roma children were affected by the low BMI for age (vs. 1.8% non-Roma). The same study found a prevalence of chronic malnutrition in Roma children of 2%.
As regards overweight, the Macedonia study reports a prevalence of 19.5% in first grade school-aged non-Roma children (6–9 years) vs the 8.1% in Roma children. As regards the latter, similar results were found in our study, underlining that in Roma camps the main challenge is the persistent food insecurity related to poverty and lack of food.
The COVID-19 pandemic is exacerbating food insecurity in marginalized populations and researchers are calling policy makers for more nutrition-related assistance [30]. Further investigations, including predictors of malnutrition coupled by early assessment of growth velocity [31], are essential to better understand the role of food insecurity and food habits in this underprivileged population.