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MacLeod C, Ngabirano L, N'Diaye DS, Braun L, Cumming O. Household-level water, sanitation and hygiene factors and interventions and the prevention of relapse after severe acute malnutrition recovery: A systematic review. MATERNAL & CHILD NUTRITION 2024; 20:e13634. [PMID: 38372439 PMCID: PMC11168358 DOI: 10.1111/mcn.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/20/2024]
Abstract
Severe acute malnutrition (SAM) is the most serious form of acute malnutrition and is associated with high mortality risk among children under 5. While the Community-based Management of Acute Malnutrition (CMAM) approach, recommended for treating cases of uncomplicated SAM, has increased treatment coverage and recovery outcomes, high relapse rates have been reported. Several risk factors for SAM relapse, such as insufficient food intake and high infectious disease burden in the community, have been identified. However, the role of household water, sanitation and hygiene (WASH) conditions remains unclear. This systematic review: (1) assesses the effectiveness of WASH interventions on preventing SAM relapse and (2) identifies WASH-related conditions associated with relapse to SAM among children aged 6-59 months discharged as recovered following SAM CMAM treatment. We performed electronic searches of six databases to identify relevant studies published between 1 January 2000 and 6 November 2023 and assessed their quality. After deduplication, 10,294 documents were screened by title and abstract, with 13 retrieved for full-text screening. We included three studies ranging from low- to medium-quality. One intervention study found that providing a WASH kit during SAM outpatient treatment did not reduce the risk of relapse to SAM. Two observational studies found inconsistent associations between household WASH conditions-unimproved sanitation and unsafe drinking water-and SAM relapse. Despite the paucity of evidence, the hypothesised causal pathways between WASH conditions and the risk of relapse remain plausible. Further evidence is needed to identify interventions for an integrated postdischarge approach to prevent relapse.
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Affiliation(s)
- Clara MacLeod
- Department of Disease ControlLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | | | | | - Laura Braun
- Department of Disease ControlLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Oliver Cumming
- Department of Disease ControlLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
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2
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Choudhary N, Brewis A, Schuster RC, Wutich A. Beyond WASH: Testing Additional Connections Between Household Water Insecurity and Child Nutrition Outcomes in Multi-Country Contexts. Ecol Food Nutr 2024; 63:435-468. [PMID: 38889358 DOI: 10.1080/03670244.2024.2366913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
This study identifies multiple pathways connecting household water insecurity with child nutrition. Using nationally representative samples for 18 countries, we examine the mediating role of child's dietary diversity as a function of household water status, while also accounting for sanitation. We construct a latent household water insecurity score (HWI) and use Structural Equation approach to model underlying pathways. HWI affected child's HAZ score and hemoglobin both directly and indirectly, with a mediation from child feeding alongside effects from sanitation. Broadening the conception of household water insecurity and accommodating the indirect effects of water could improve explanations of child under-nutrition.
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Affiliation(s)
- Neetu Choudhary
- School of Human Evolution and Social Change, Arizona State University, Tempe
| | - Alexandra Brewis
- School of Human Evolution and Social Change, Arizona State University, Tempe
| | - Roseanne C Schuster
- School of Human Evolution and Social Change, Arizona State University, Tempe
| | - Amber Wutich
- School of Human Evolution and Social Change, Arizona State University, Tempe
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3
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Chakraborty R, Armijos RX, Beidelman ET, Rosenberg M, Margaret Weigel M. Household food and water insecurity and its association with diarrhoea, respiratory illness, and stunting in Ecuadorian children under 5 years. MATERNAL & CHILD NUTRITION 2024:e13683. [PMID: 38873704 DOI: 10.1111/mcn.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/22/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
Household food and water insecurity has been previously associated with adverse health consequences in children. However, these relationships are understudied in middle-income Latin American populations such as in Ecuador, where a high prevalence of food and water insecurity has been reported. Using cross-sectional data from 2018 Ecuadorian National Health and Nutrition Survey, we examined the association of household food insecurity (HFI), household water insecurity (HWI), and concurrent HFI-HWI with diarrhoea, respiratory illness (RI), and stunting in 20,510 children aged ≤59 months. HFI was measured using the Food Insecurity Experience Scale. HWI was defined when households responded negatively to one or more of four drinking water indicators. Maternal caregivers reported on child diarrhoea and RI episodes during the previous 2 weeks. Measured length or height was used to assess stunting. We constructed log-binomial regression models to estimate the associations of HFI, HWI, and concurrent HFI-HWI with child outcomes. Moderate-severe HFI was associated with a higher prevalence of diarrhoea (PR = 1.39; 95% CI: 1.18, 1.63) and RI (PR = 1.34; 95% CI: 1.22, 1.47), HWI with a higher prevalence of RI (PR = 1.13; 95% CI: 1.04, 1.22), and concurrent HFI-HWI with a higher prevalence of diarrhoea (PR = 1.30; 95% CI: 1.05, 1.62) and RI (PR = 1.45; 95% CI: 1.29, 1.62). Stunting was not associated with HFI, HWI nor concurrent HFI-HWI. These findings suggest that HFI and HWI can independently and jointly act to negatively affect children's health. Policies and interventions aimed at alleviating both food and water insecurity are needed to bring sustained health improvements in Ecuadorian children.
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Affiliation(s)
- Rishika Chakraborty
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
| | - Rodrigo X Armijos
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Center for Latin American & Caribbean Studies, Indiana University, Bloomington, Indiana, USA
- Center for Global Health Equity, Indiana University, Indianapolis, Indiana, USA
| | - Erika T Beidelman
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
| | - M Margaret Weigel
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Center for Latin American & Caribbean Studies, Indiana University, Bloomington, Indiana, USA
- Center for Global Health Equity, Indiana University, Indianapolis, Indiana, USA
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Hoke MK, Long AM. Human biology and the study of precarity: How the intersection of uncertainty and inequality is taking us to new extremes. Am J Hum Biol 2024; 36:e24018. [PMID: 38053455 DOI: 10.1002/ajhb.24018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 12/07/2023] Open
Abstract
Inequality represents an extreme environment to which humans must respond. One phenomenon that contributes to this growing extreme is precarity or the intersection of uncertainty and some form of inequality. While precarity has an important intellectual history in the fields of sociology and sociocultural anthropology, it has not been well studied in the field of human biology. Rather human biologists have engaged with the study of closely related concepts such as uncertainty and resource insecurity. In this article, we propose that human biology take on the study of precarity as a novel way of investigating inequality. We first provide a brief intellectual history of precarity which is followed by a review of research on uncertainty and resource security in human biology which, while not exhaustive, illustrates some key gaps that precarity may aid us in addressing. We then review some of the pathways through which precarity comes to affect human biology and health and some of the evidence for why the unpredictable nature of precarity may make it a unique physiological stress. A case study based on research in Nuñoa, Peru provides an important example of how precarity can elucidate the influences of health in an extreme setting, albeit with insights that apply more broadly. We conclude that precarity holds important potential for the study of human biology, including helping us more effectively operationalize and study uncertainty, encouraging us to explore the predictability of resources and stressors, and reminding us to think about the intersectional nature of stressors.
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Affiliation(s)
- Morgan K Hoke
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anneliese M Long
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Tallman PS, Salmon-Mulanovich G, Archdeacon N, Kothadia A, Lopez Flores L, Castañeda K, Collins S, Rusyidi B, Cole S. "Gender-Based Water Violence": Cross-Cultural Evidence for Severe Harm Associated With Water Insecurity for Women and Girls. Violence Against Women 2024:10778012241230323. [PMID: 38311938 DOI: 10.1177/10778012241230323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
We examined how study participants in Indonesia and Peru viewed the relationship between water insecurity and women's health via thematic analysis of interviews and focus groups. Participants reported that water insecurity led to vaginal infections, miscarriage, premature births, uterine prolapse, poor nutrition, restricted economic opportunities, and intergenerational cycles of poverty. Participants in both countries stated that extreme burdens associated with water insecurity should be categorized as violence. Based on these findings, we developed the concept of "gender-based water violence," defined as the spectrum of stressors associated with water insecurity that are so severe as to threaten human health and well-being, particularly that of women and girls.
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Birhanu MT, Liga AD, Jabir YN. Practices of hygiene during complementary food feeding and associated factors among women with children aged 6-24 months in Dedo district, Southwest Ethiopia: A cross-sectional study. Health Sci Rep 2023; 6:e1771. [PMID: 38111740 PMCID: PMC10725999 DOI: 10.1002/hsr2.1771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023] Open
Abstract
Background and Aims Poor food handling practices contribute to food contamination, leading to food-borne illnesses and childhood diarrhea in developing countries like Ethiopia. This study examines hygienic complementary food feeding practices and associated characteristics among women with children ages 6-24 months in the Dedo District. Method A community-oriented cross-sectional study design was used in a multistage sampling strategy to gather information from 501 mothers of children between May 25 and July 10, 2022. There were absolute and relative frequencies assigned to each variable. Multiple logistic models have been used for factors that were 20% significant in univariate analysis. Odds ratios with corresponding 95% confidence intervals (CI) were produced to identify the important predictors. Results This study showed that mothers with a diploma (adjusted odds ratio [AOR]: 11.2; CI: 5.51-22.8), urban residency (AOR = 6.35; CI: 3.57-11.3), a positive attitude toward hygienic complementary food feeding (AOR = 2.23; CI: 1.19-4.20), good knowledge of complementary food feeding practices (AOR = 3.95; CI: 2.39-6.55), access to a hand washing facility close to the latrine (AOR = 2.60; CI: 1.55-4.36), and access to water close to their home (AOR = 2.42; CI: 1.27-4.59) were highly associated with good hygiene practices of mothers. Conclusion This study shows that mothers of children aged between 6 and 24 months have a very low overall prevalence of good hygienic complementary feeding practices. The concerned parties should therefore establish a healthcare educational program for mothers that emphasizes the importance of hand washing and informs them about the dangers of improper complementary feeding practices.
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Affiliation(s)
| | - Abebe D. Liga
- Department of Statistics, College of Natural and Computational SciencesWolkite UniversityWolkiteEthiopia
| | - Yasin N. Jabir
- Department of Statistics, College of Natural ScienceJimma UniversityJimmaEthiopia
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Rosinger AY, Broyles LMT. Water Insecurity Is a Structural, Often Invisible Barrier to Healthy Beverage Patterns and Nutritious Diets. J Nutr 2023; 153:3153-3155. [PMID: 37777115 DOI: 10.1016/j.tjnut.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023] Open
Affiliation(s)
- Asher Y Rosinger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, United States; Department of Anthropology, Pennsylvania State University, University Park, PA, United States.
| | - Lauren M T Broyles
- Population Research Institute, Pennsylvania State University, University Park, PA, United States
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Argaw TL, Fledderjohann J, Aurino E, Vellakkal S. Children's Educational Outcomes and Persistence and Severity of Household Food Insecurity in India: Longitudinal Evidence from Young Lives. J Nutr 2023; 153:1101-1110. [PMID: 36780944 PMCID: PMC10196702 DOI: 10.1016/j.tjnut.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/29/2022] [Accepted: 02/08/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Food insecurity is a pressing global challenge with far-reaching consequences for health and well-being. However, little attention has focused specifically on the experiences of children and adolescents over the age of 5 y in food insecure households. OBJECTIVES We examine whether the persistence and severity of household food insecurity are negatively associated with children's educational outcomes. METHODS We used data for the younger cohort of the longitudinal Young Lives data from rounds 3 (2009), 4 (2013), and 5 (2016), when children were aged 8 y, 12 y, and 15 y, respectively. Drawing on the Household Food Insecurity and Access Scale, we used descriptive statistics, graphical analysis, and multilevel regressions to document how the persistence and severity of household food insecurity are associated with children's educational outcomes (years of education, maths, and vocabulary [PPVT] test scores). We controlled for potentially confounding sociodemographic characteristics, including children's own baseline grade attained and test scores in "value-added" models, to provide robust estimates of household food insecurity in predicting children's educational outcomes. RESULTS Household food insecurity generally declined between 2009 and 2016. Fewer than 50% of households were food secure across the 3 rounds of data we examined. Our robust, multivariate, value-added models show that the persistence and severity of food insecurity are negatively associated with all 3 children's educational outcomes we examined. CONCLUSIONS We add to a small but growing literature exploring how household food insecurity is associated with children's educational outcomes in the Global South. Our findings on severity of food insecurity highlight the importance of understanding food insecurity along the severity continuum rather than as a dichotomous state, as previously done in existing literature. Addressing household food insecurity in childhood and adolescence may be a key factor to improve children's educational outcomes.
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Affiliation(s)
- Thomas Lemma Argaw
- Department of Sociology, Lancaster University, Lancaster, United Kingdom.
| | | | | | - Sukumar Vellakkal
- Department of Economic Sciences, Indian Institute of Technology Kanpur, Kanpur, India
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Charles I, Salinger A, Sweeney R, Batagol B, Barker SF, Nasir S, Taruc RR, Francis N, Clasen T, Sinharoy SS. Joint Food and Water Insecurity Had a Multiplicative Effect on Women's Depression in Urban Informal Settlements in Makassar, Indonesia during the COVID-19 Pandemic. J Nutr 2023; 153:1244-1252. [PMID: 36959077 PMCID: PMC10028453 DOI: 10.1016/j.tjnut.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Women living in urban informal settlements may be particularly vulnerable to the detrimental effects of the COVID-19 pandemic because of increased economic and psychosocial stressors in resource-limited environments. OBJECTIVES The objective of this study was to assess the associations between food and water insecurity during the pandemic and depression among women living in the urban informal settlements in Makassar, Indonesia. METHODS We implemented surveys at 3 time points among women enrolled in the Revitalizing Informal Settlements and their Environments trial. Depression was measured using the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) between November and December 2019 and again between February and March 2021. Food insecurity was measured using questions from the Innovation for Poverty Action's Research for Effective COVID-19 Reponses survey and water insecurity was measured using the Household Water Insecurity Experiences Short Form. Both were measured between August and September 2020. We built 3 multivariate quantile linear regression models to assess the effects of water insecurity, food insecurity, and joint food and water insecurity during the COVID-19 pandemic on CESD-10 score. RESULTS In models with the full sample (n = 323), food insecurity (β: 1.48; 95% CI: 0.79, 2.17), water insecurity (β: 0.13; 95% CI: -0.01, 0.26), and joint food and water insecurity (β: 2.40; 95% CI: 1.43, 3.38) were positively associated with CESD-10 score. In subgroup analyses of respondents for whom we had prepandemic CESD-10 scores (n = 221), joint food and water insecurity (β: 1.96; 95% CI: 0.78, 3.15) maintained the strongest relationship with CESD-10 score. A limitation of this study is that inconsistency in respondents from households across the survey waves reduced the sample size used for this study. CONCLUSIONS Our results find a larger association between depression and joint resource insecurity than with water or food insecurity alone, underlining the importance of addressing food and water insecurity together, particularly as they relate to women's mental health and well-being.
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Affiliation(s)
- Isabel Charles
- Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Rd NE, Emory University, Atlanta, GA, USA.
| | - Allison Salinger
- Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Rd NE, Emory University, Atlanta, GA, USA
| | - Rohan Sweeney
- Center for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Becky Batagol
- Monash Sustainable Development Institute and Faculty of Law, Monash University, Melbourne, Australia
| | - S Fiona Barker
- School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Sudirman Nasir
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Universitas Hasanuddin, Centre of Excellence for Interdisciplinary and Sustainability Sciences, Makassar, Indonesia
| | - Ruzka R Taruc
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Naomi Francis
- Monash Sustainable Development Institute and Faculty of Law, Monash University, Melbourne, Australia
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sheela S Sinharoy
- Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Rd NE, Emory University, Atlanta, GA, USA
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Young SL, Bethancourt HJ, Frongillo EA, Viviani S, Cafiero C. Concurrence of water and food insecurities, 25 low- and middle-income countries. Bull World Health Organ 2023; 101:90-101. [PMID: 36733622 PMCID: PMC9874369 DOI: 10.2471/blt.22.288771] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/23/2022] [Accepted: 10/21/2022] [Indexed: 02/04/2023] Open
Abstract
Objective To investigate how water and food insecurity were associated in nationally representative samples of individuals from 25 low- and middle-income countries. Methods We used data from the 2020 World Gallup Poll in which the Individual Water Insecurity Experiences Scale and the Food Insecurity Experience Scale had been administered to 31 755 respondents. These scales measure insecurity experiences in the previous 12 months. We classified individuals as water insecure if their score was ≥ 12 and food insecure if the Rasch probability parameter was ≥ 0.5. For estimating the proportions, we used projection weights. We estimated the relationships between binary and continuous measures of water insecurity and food insecurity for individuals within each country and region using multivariable logistic and linear regression models, adjusting for key socioeconomic characteristics including income, gender, age and education. Findings Among the 18.3% of respondents who experienced water insecurity, 66.8% also experienced food insecurity. The likelihood of experiencing moderate-to-severe food insecurity was higher among respondents also experiencing water insecurity (adjusted odds ratio, aOR: 2.69; 95% confidence interval, CI: 2.43 to 2.98). Similar odds were found in Asia (aOR: 2.95; 95% CI: 2.04 to 4.25), Latin America (aOR: 2.17; 95% CI: 1.62 to 2.89), North Africa (aOR: 2.92; 95% CI: 2.17 to 3.93) and sub-Saharan Africa (aOR: 2.71; 95% CI: 2.40 to 3.06). Conclusion Our results suggest that water insecurity should be considered when developing food and nutrition policies and interventions. However, more research is needed to understand the paths between these insecurities.
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Affiliation(s)
- Sera L Young
- Department of Anthropology, Northwestern University, 1819 Hinman Avenue, Evanston, Illinois, 60201United States of America (USA)
| | - Hilary J Bethancourt
- Department of Anthropology, Northwestern University, 1819 Hinman Avenue, Evanston, Illinois, 60201United States of America (USA)
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, USA
| | - Sara Viviani
- Statistics Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Carlo Cafiero
- Statistics Division, Food and Agriculture Organization of the United Nations, Rome, Italy
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Kirsch K, Nagel C, Iribagiza C, Ecklu J, Zawadi GA, Ntabaza PM, Barstow C, Lund AJ, Harper J, Carlton E, Javernick-Will A, Linden K, Thomas E. Study design and baseline to evaluate water service provision among peri-urban communities in Kasai Oriental, Democratic Republic of the Congo. PLoS One 2023; 18:e0283019. [PMID: 37053145 PMCID: PMC10101432 DOI: 10.1371/journal.pone.0283019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/28/2023] [Indexed: 04/14/2023] Open
Abstract
We present a study design and baseline results to establish the impact of interventions on peri-urban water access, security and quality in Kasai Oriental province of the Democratic Republic of the Congo. In standard development practice, program performance is tracked via monitoring and evaluation frameworks of varying sophistication and rigor. Monitoring and evaluation, while usually occurring nearly concurrently with program delivery, may or may not measure parameters that can identify performance with respect to the project's overall goals. Impact evaluations, often using tightly controlled trial designs and conducted over years, challenge iterative program evolution. This study will pilot an implementation science impact evaluation approach in the areas immediately surrounding 14 water service providers, at each surveying 100 randomly-selected households and conducting water quality assessments at 25 randomly-selected households and five water points every three months. We present preliminary point-of-collection and point-of-use baseline data. This study is utilizing a variety of short- and medium-term monitoring and impact evaluation methods to provide feedback at multiple points during the intervention. Rapid feedback monitoring will assess the continuity of water services, point-of-consumption and point-of-collection microbial water quality, household water security, household measures of health status, ability and willingness to pay for water and sanitation service provision, and service performance monitoring. Long-term evaluation will focus on the use of qualitative comparative analysis whereby we will investigate the combination of factors that lead to improved water access, security and quality.
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Affiliation(s)
- Kathleen Kirsch
- Mortenson Center in Global Engineering and Resilience, University of Colorado Boulder, Boulder, Colorado, United States of America
| | - Corey Nagel
- Department of Biostatistics, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Chantal Iribagiza
- Mortenson Center in Global Engineering and Resilience, University of Colorado Boulder, Boulder, Colorado, United States of America
| | - John Ecklu
- Mortenson Center in Global Engineering and Resilience, University of Colorado Boulder, Boulder, Colorado, United States of America
| | - Ghislaine Akonkwa Zawadi
- Mortenson Center in Global Engineering and Resilience, University of Colorado Boulder, Boulder, Colorado, United States of America
| | - Pacifique Mugaruka Ntabaza
- Mortenson Center in Global Engineering and Resilience, University of Colorado Boulder, Boulder, Colorado, United States of America
| | - Christina Barstow
- Mortenson Center in Global Engineering and Resilience, University of Colorado Boulder, Boulder, Colorado, United States of America
| | - Andrea J Lund
- Environmental and Occupational Health, Colorado School of Public Health, Denver, Colorado, United States of America
| | - James Harper
- Mortenson Center in Global Engineering and Resilience, University of Colorado Boulder, Boulder, Colorado, United States of America
| | - Elizabeth Carlton
- Environmental and Occupational Health, Colorado School of Public Health, Denver, Colorado, United States of America
| | - Amy Javernick-Will
- Mortenson Center in Global Engineering and Resilience, University of Colorado Boulder, Boulder, Colorado, United States of America
| | - Karl Linden
- Mortenson Center in Global Engineering and Resilience, University of Colorado Boulder, Boulder, Colorado, United States of America
| | - Evan Thomas
- Mortenson Center in Global Engineering and Resilience, University of Colorado Boulder, Boulder, Colorado, United States of America
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12
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Rosinger AY, Bethancourt HJ, Young SL. Tap Water Avoidance Is Associated with Lower Food Security in the United States: Evidence from NHANES 2005-2018. J Acad Nutr Diet 2023; 123:29-40.e3. [PMID: 35872245 PMCID: PMC10119945 DOI: 10.1016/j.jand.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/03/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Food insecurity has profound nutritional and public health consequences. Water insecurity may exacerbate food insecurity, yet little is known about the association between water and food insecurity in the United States or other high-income countries. OBJECTIVE This study aimed to estimate how tap water avoidance, a proxy of water insecurity, covaries with food insecurity; examine how the probability of food insecurity changed by tap water avoidance between 2005 and 2018; and test how the association between tap water avoidance and food insecurity differed across income and housing statuses. DESIGN This was a secondary analysis of the cross-sectional 2005-2018 National Health and Nutrition Examination Survey. PARTICIPANTS/SETTING Participants were 31,390 US adults 20 years and older. MAIN OUTCOME MEASURES The main outcome was food insecurity, using the US Food Security Survey Module. STATISTICAL ANALYSES Adjusted logistic regression models estimated how tap water avoidance was associated with the odds of food insecurity. Predicted probabilities of food insecurity over time and by income and housing status were plotted using marginal standardization. RESULTS Adults who avoided tap water had 21% higher odds (95% CI 1.09 to 1.34) of food insecurity compared with those who drank tap water. The probability of any food insecurity doubled between 2005-2006 and 2017-2018 and was consistently higher for tap water avoiders. Food insecurity decreased across both tap water drinkers and avoiders as income increased, but was higher among tap water avoiders at all income levels. Likewise, food insecurity was higher among renters than among homeowners but was higher among tap water avoiders in both housing groups. CONCLUSIONS Tap water avoidance is positively associated with food insecurity in the United States, and both insecurities have increased over time. Efforts to mitigate food insecurity should simultaneously address water insecurity issues, including tap water availability and quality, as these may be a modifiable contributors to food insecurity.
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Affiliation(s)
- Asher Y Rosinger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA; Department of Anthropology, Pennsylvania State University, University Park, PA.
| | - Hilary J Bethancourt
- Department of Anthropology, Northwestern University, Evanston, IL; Institute for Policy Research, Northwestern University, Evanston IL
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL; Institute for Policy Research, Northwestern University, Evanston IL
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Prall S, Scelza B. The dietary impacts of drought in a traditional pastoralist economy. Am J Hum Biol 2023; 35:e23803. [PMID: 36125188 DOI: 10.1002/ajhb.23803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/11/2022] [Accepted: 09/02/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Arid pastoralism is often understood as an adaptive strategy to marginal environments. As pastoralists become increasingly market integrated, novel dietary preferences and access to low quality market foods can erode traditional diets. These market-based dietary shifts are particularly problematic during sustained drought, where reductions in traditional foods make pastoralists increasingly reliant on a cash economy. Among the Himba of the Kunene region in Namibia, colonial policies prohibiting access to livestock markets inhibit access to a cash-based economy, leaving them vulnerable to food insecurity when nontraditional foods are needed to supplement traditional lifeways during drought. To understand the impacts of long-term drought on diet and food insecurity, we collected longitudinal survey data on diet breadth and food insecurity across 4 years during a multi-year drought. METHODS Participants completed a five-item food insecurity survey and recalled diet breadth survey over the course of 4 years (N = 191-234). Additionally, women completed a short survey of recent stressors, including health and resource stressors (N = 127). We used a set of multilevel models to estimate changes in food insecurity items and diet breadth changes over the course of the study period. RESULTS Multilevel models predicted score outcomes, as well as individual item responses, by year of data collection. Results indicate a 43% increase in average food insecurity and a 15% decline in average diet breadth over the study period. Dietary recall indicates that drought caused a reduction in sour milk intake, and an increase in nontraditional foods, but no change in meat or maize consumption. CONCLUSIONS Sustained drought in the Kunene region is having long-term impacts on food insecurity, which could result in dietary shifts that outlast the current period of drought. We consider the implications of this change, especially as it relates to increasing market integration and reliance on a cash-based over a subsistence-based economy.
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Affiliation(s)
- Sean Prall
- Department of Anthropology, University of Missouri, Columbia, Missouri, USA
| | - Brooke Scelza
- Department of Anthropology, University of California, Los Angeles, California, USA
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Koyratty N, Ntozini R, Mbuya MNN, Jones AD, Schuster RC, Kordas K, Li CS, Tavengwa NV, Majo FD, Humphrey J, Smith LE. Growth and growth trajectory among infants in early life: contributions of food insecurity and water insecurity in rural Zimbabwe. BMJ Nutr Prev Health 2022; 5:332-343. [PMID: 36619329 PMCID: PMC9813639 DOI: 10.1136/bmjnph-2022-000470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Stunting or linear growth faltering, measured by length-for-age Z-score (LAZ), remains a significant public health challenge, particularly in rural low-income and middle-income countries. It is a marker of inadequate environments in which infants are born and raised. However, the contributions of household resource insecurities, such as food and water, to growth and growth trajectory are understudied. Methods We used the cluster-randomised Sanitation Hygiene and Infant Nutrition Efficacy trial to determine the association of household-level food insecurity (FI) and water insecurity (WI) on LAZ and LAZ trajectory among infants during early life. Dimensions of FI (poor access, household shocks, low availability and quality) and WI (poor access, poor quality, low reliability) were assessed with the multidimensional household food insecurity and the multidimensional household water insecurity measures. Infant length was converted to LAZ based on the 2006 WHO Child Growth Standards. We report the FI and WI fixed effects from multivariable growth curve models with repeated measures of LAZ at 1, 3, 6, 12 and 18 months (M1-M18). Results A total of 714 and 710 infants were included in our analyses of LAZ from M1 to M18 and M6 to M18, respectively. Mean LAZ values at each time indicated worsening linear growth. From M1 to M18, low food availability and quality was associated with lower LAZ (β=-0.09; 95% -0.19 to -0.13). From M6 to M18, poor food access was associated with lower LAZ (β=-0.11; 95% -0.20 to -0.03). None of the WI dimensions were associated with LAZ, nor with LAZ trajectory over time. Conclusion FI, but not WI, was associated with poor linear growth among rural Zimbabwean infants. Specifically, low food availability and quality and poor food access was associated with lower LAZ. There is no evidence of an effect of FI or WI on LAZ trajectory.
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Affiliation(s)
- Nadia Koyratty
- Department of Poverty, Health and Nutrition, International Food Policy Research Institute, Washington DC, Washington DC, USA
| | - Robert Ntozini
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Mduduzi NN Mbuya
- Knowledge Leadership, Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Andrew D Jones
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Roseanne C Schuster
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York, USA
| | - Chin-Shang Li
- School of Nursing, University at Buffalo, Buffalo, NY, USA
| | - Naume V Tavengwa
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence D Majo
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura E Smith
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Department of Public and Ecosystem Health, Cornell University, Ithaca, New York, USA
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Part C, Filippi V, Cresswell JA, Ganaba R, Hajat S, Nakstad B, Roos N, Kadio K, Chersich M, Lusambili A, Kouanda S, Kovats S. How do high ambient temperatures affect infant feeding practices? A prospective cohort study of postpartum women in Bobo-Dioulasso, Burkina Faso. BMJ Open 2022; 12:e061297. [PMID: 36198451 PMCID: PMC9535177 DOI: 10.1136/bmjopen-2022-061297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine the effects of high ambient temperature on infant feeding practices and childcare. DESIGN Secondary analysis of quantitative data from a prospective cohort study. SETTING Community-based interviews in the commune of Bobo-Dioulasso, Burkina Faso. Exclusive breastfeeding is not widely practised in Burkina Faso. PARTICIPANTS 866 women (1:1 urban:rural) were interviewed over 12 months. Participants were interviewed at three time points: cohort entry (when between 20 weeks' gestation and 22 weeks' postpartum), three and nine months thereafter. Retention at nine-month follow-up was 90%. Our secondary analysis focused on postpartum women (n=857). EXPOSURE Daily mean temperature (°C) measured at one weather station in Bobo-Dioulasso. Meteorological data were obtained from publicly available archives (TuTiempo.net). PRIMARY OUTCOME MEASURES Self-reported time spent breastfeeding (minutes/day), exclusive breastfeeding of infants under 6 months (no fluids other than breast milk provided in past 24 hours), supplementary feeding of infants aged 6-12 months (any fluid other than breast milk provided in past 24 hours), time spent caring for children (minutes/day). RESULTS The population experienced year-round high temperatures (daily mean temperature range=22.6°C-33.7°C). Breastfeeding decreased by 2.3 minutes/day (95% CI -4.6 to 0.04, p=0.05), and childcare increased by 0.6 minutes/day (0.06 to 1.2, p=0.03), per 1°C increase in same-day mean temperature. Temperature interacted with infant age to affect breastfeeding duration (p=0.02), with a stronger (negative) association between temperature and breastfeeding as infants aged (0-57 weeks). Odds of exclusive breastfeeding very young infants (0-3 months) tended to decrease as temperature increased (OR=0.88, 0.75 to 1.02, p=0.09). There was no association between temperature and exclusive breastfeeding at 3-6 months or supplementary feeding (6-12 months). CONCLUSIONS Women spent considerably less time breastfeeding (~25 minutes/day) during the hottest, compared with coolest, times of the year. Climate change adaptation plans for health should include advice to breastfeeding mothers during periods of high temperature.
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Affiliation(s)
- Chérie Part
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Véronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jenny A Cresswell
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rasmané Ganaba
- Agence de Formation de Recherche et d'Expertise en Santé pour l'Afrique (AFRICSanté), Bobo-Dioulasso, Burkina Faso
| | - Shakoor Hajat
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Britt Nakstad
- Division of Child and Adolescent Health, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Nathalie Roos
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Kadidiatou Kadio
- Departement Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Matthew Chersich
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Adelaide Lusambili
- Department of Population Health, Medical College, Aga Khan University, Nairobi, Kenya
| | - Seni Kouanda
- Departement Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Sari Kovats
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Bethancourt HJ, Swanson ZS, Nzunza R, Young SL, Lomeiku L, Douglass MJ, Braun DR, Ndiema EK, Pontzer H, Rosinger AY. The co-occurrence of water insecurity and food insecurity among Daasanach pastoralists in northern Kenya. Public Health Nutr 2022; 26:1-11. [PMID: 35941080 PMCID: PMC9989708 DOI: 10.1017/s1368980022001689] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/23/2022] [Accepted: 07/19/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Water plays a critical role in the production of food and preparation of nutritious meals, yet few studies have examined the relationship between water and food insecurity. The primary objective of this study, therefore, was to examine how experiences of household water insecurity (HWI) relate to experiences of household food insecurity (HFI) among a pastoralist population living in an arid, water-stressed region of northern Kenya. DESIGN We implemented the twelve-item Household Water Insecurity Experiences (HWISE, range 0-36) Scale and the nine-item Household Food Insecurity Access Scale (HFIAS, range 0-27) in a cross-sectional survey to measure HWI and HFI, respectively. Data on socio-demographic characteristics and intake of meat and dairy in the prior week were collected as covariates of interest. SETTING Northern Kenya, June-July 2019. PARTICIPANTS Daasanach pastoralist households (n 136) from seven communities. RESULTS In the prior 4 weeks, 93·4 % and 98·5 % of households had experienced moderate-to-severe HWI and HFI, respectively. Multiple linear regression analyses indicated a strong association between HWI and HFI. Each point higher HWISE score was associated with a 0·44-point (95 % CI: 0·22, 0·66, P = 0·003) higher HFIAS score adjusting for socio-economic status and other covariates. CONCLUSIONS These findings demonstrate high prevalence and co-occurrence of HWI and HFI among Daasanach pastoralists in northern Kenya. This study highlights the need to address HWI and HFI simultaneously when developing policies and interventions to improve the nutritional well-being of populations whose subsistence is closely tied to water availability and access.
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Affiliation(s)
- Hilary J Bethancourt
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Institute for Research Policy, Northwestern University, Evanston, IL, USA
| | - Zane S Swanson
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA
| | | | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Institute for Research Policy, Northwestern University, Evanston, IL, USA
| | - Luke Lomeiku
- Department of Education and Outreach Programs, National Museums of Kenya, Nairobi, Kenya
| | - Matthew J Douglass
- College of Agricultural Sciences and Natural Resources and Agricultural Research Division, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - David R Braun
- Center for the Advanced Study of Human Paleobiology, Department of Anthropology, The George Washington University, Washington, DC, USA
- Department of Human Evolution, Max Planck Institute of Evolutionary Anthropology, Leipzig, Germany
| | - Emmanuel K Ndiema
- Department of Earth Sciences, National Museums of Kenya, Nairobi, Kenya
| | - Herman Pontzer
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA
- Global Health Institute, Duke University, Durham, NC, USA
| | - Asher Yoel Rosinger
- Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA16802, USA
- Department of Anthropology, The Pennsylvania State University, University Park, PA, USA
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Daher B, Hamie S, Pappas K, Roth J. Examining Lebanon's Resilience Through a Water-Energy-Food Nexus Lens. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2022.748343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Lebanon faces a mix of underlying political and economic challenges, shocks, and triggering events that threaten the sustainability and resilience of its interconnected resource systems. The complex nature of these pressures begs for a systems approach to better understand the existing interconnections and to support the co-creation of cross-sectoral solutions to address them. This article specifically aims to: 1) conduct a scoping review of the existing literature and current events to identify interconnections between water-, energy-, and food-related challenges as they relate to the underlying conditions and triggering events at play in the context of Lebanon; 2) highlight ways in which the Water-Energy-Food (WEF) Nexus is a useful lens through which to understand and act upon issues at different scales; and 3) identify emergent themes including decentralization and systems thinking and their roles as catalysts toward more resilient resource systems. The examination concludes with two main recommendations: first, to create platforms and opportunities for interactive resource planning and decision making to facilitate systems-thinking for top-down WEF management; and second, to empower decentralized initiatives at the local level to build resilient, bottom-up solutions to WEF challenges.
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Be like the running water: Assessing gendered and age-based water insecurity experiences with Six Nations First Nation. Soc Sci Med 2022; 298:114864. [PMID: 35240540 DOI: 10.1016/j.socscimed.2022.114864] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 01/29/2023]
Abstract
Indigenous households are 90 times more likely to be without running water than non-Indigenous households in Canada. Current primary indicators of water quality and security for Indigenous Peoples are based on federal boil water advisories, which do not disaggregate at household levels to identify who is most at risk within or between communities. A mixed methods approach was used to assess the level of water insecurity and perceptions of water access by gender and age for a sample of households in Six Nations of the Grand River First Nations in Ontario, Canada. A household survey captured water security using the Household Water InSecurity Experiences (HWISE) scale and Likert-type responses to perceptions of water access, contextualized using semi-structured individual and group interviews. From 2019 to 2020, 66 households participated in the survey, 18 individuals participated in semi-structured individual interviews, and 7 individuals participated in 3 semi-structured group interviews. The survey sample demonstrated high levels of household water insecurity (57.5%, n = 38). Interviews revealed that women were more dissatisfied with their drinking water situations due to quality, source, and cost, though they shared water sharing as a coping strategy. Women faced more physical and mental barriers accessing water for their households, due to their roles as caretakers of their family and knowledge protectors for their communities. Generational divides were found in interviews about what qualified as "good water," with older participants understanding it as relating to traditional water sourcing, and younger participants wanting clean, accessible tap water. Taken together, the participants demonstrated a frustration with the sub-standard drinking water on reserve.
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Nahalomo A, Iversen PO, Andreassen BA, Kaaya AN, Rukooko AB, Tushabe G, Nateme NC, Rukundo PM. Malnutrition and Associated Risk Factors among Children 6-59 Months Old in the Landslide-Prone Bududa District, Eastern Uganda: A Cohort Study. Curr Dev Nutr 2022; 6:nzac005. [PMID: 35198847 PMCID: PMC8856944 DOI: 10.1093/cdn/nzac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The United Nations Sustainable Development Goal 2.2 calls for an end to all forms of malnutrition. This might be derailed due to persistent landslide disasters in low-income countries like Uganda. OBJECTIVES The prevalence of malnutrition and the impact of seasonal variations and associated factors were assessed among children aged 6-59 mo in the landslide-affected households in Bududa District, eastern Uganda. METHODS A prospective cohort study using a 2-stage simple random technique was applied to select 422 households including 392 children during May-August (food-plenty season) 2019. After 6 mo, in January-March (food-poor season) 2020, 388 households and 366 children were assessed. Socioeconomic and demographic data were collected using structured questionnaires. Child malnutrition outcomes were defined according to WHO criteria. Factors associated with malnutrition outcomes were identified by bivariate and multivariate logistic regression. RESULTS Stunting, underweight, wasting, and overweight prevalences were 37.7%, 13.3%, 3.6%, and 4.3%, respectively, in the food-plenty season and 42.6%, 14.2%, 2.1%, and 2.7%, respectively, in the food-poor season. Residing in the landslide-affected sub-county increased the odds for stunting [adjusted OR (aOR): 1.68; 95% CI: 1.08, 2.59; P = 0.025] and underweight (aOR = 4.25; 95% CI: 1.10, 15.36; P = 0.032) for children in the food-plenty season. Child age, sex, breastfeeding status, a nonimproved drinking water source, migration of any household member, and parents' education were significant risk factors in the food-plenty season. In the food-poor season, parents' education status, loss of any household member, child sex, and child age were significant risk factors. CONCLUSIONS Stunting and underweight were more prevalent in the food-poor season while wasting and overweight were more prevalent in the food-plenty season. With the exception of child age, child sex, and parents' education, child malnutrition risk factors differed between food-plenty and food-poor seasons. There is a need to address seasonality factors in program interventions targeting children <5 y in landslide-prone areas.
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Affiliation(s)
| | | | | | - Archileo Natigo Kaaya
- School of Food Technology, Nutrition, and Bioengineering, Makerere University, Kampala, Uganda
| | | | - Gerald Tushabe
- School of Liberal and Performing Arts, Makerere University, Kampala, Uganda
| | - Nancy Catherine Nateme
- School of Food Technology, Nutrition, and Bioengineering, Makerere University, Kampala, Uganda
| | - Peter Milton Rukundo
- Department of Human Nutrition and Home Economics, Kyambogo University, Kampala, Uganda
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Miller JD, Workman CL, Panchang SV, Sneegas G, Adams EA, Young SL, Thompson AL. Water Security and Nutrition: Current Knowledge and Research Opportunities. Adv Nutr 2021; 12:2525-2539. [PMID: 34265039 PMCID: PMC8634318 DOI: 10.1093/advances/nmab075] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/22/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
Water is an essential nutrient that has primarily been considered in terms of its physiological necessity. But reliable access to water in sufficient quantities and quality is also critical for many nutrition-related behaviors and activities, including growing and cooking diverse foods. Given growing challenges to water availability and safety, including climate change, pollution, and infrastructure degradation, a broader conceptualization of water and its diverse uses is needed to sustainably achieve global nutrition targets. Therefore, we review empirical and qualitative evidence describing the linkages between water security (the reliable availability, accessibility, and quality of water for all household uses) and nutrition. Primary linkages include water security for drinking, food production and preparation, infant and young child feeding, and limiting exposure to pathogens and environmental toxins. We then identify knowledge gaps within each linkage and propose a research agenda for studying water security and nutrition going forward, including the concurrent quantification of both food and water availability, accessibility, use, and stability. By making explicit the connections between water security and nutritional well-being, we aim to promote greater collaboration between the nutrition and water, sanitation, and hygiene sectors. Interdisciplinary policies and programs that holistically address the water-nutrition nexus, versus those that focus on water and nutrition independently, are likely to significantly advance our ability to ensure equitable access to healthy foods and safe water for all.
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Affiliation(s)
- Joshua D Miller
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cassandra L Workman
- Department of Anthropology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Sarita V Panchang
- Social Research and Evaluation Center, Louisiana State University, Baton Rouge, LA, USA
| | - Gretchen Sneegas
- Department of Geography, Texas A&M University, College Station, TX, USA
| | - Ellis A Adams
- Keough School of Global Affairs, University of Notre Dame, Notre Dame, IN, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Amanda L Thompson
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Ahmed F, Shahid M, Cao Y, Qureshi MG, Zia S, Fatima S, Guo J. A Qualitative Exploration in Causes of Water Insecurity Experiences, and Gender and Nutritional Consequences in South-Punjab, Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312534. [PMID: 34886260 PMCID: PMC8657084 DOI: 10.3390/ijerph182312534] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
Abstract
Although water insecurity has been discussed in general, its impacts on mothers’ physical and mental health, and infants’ and young children’s feeding (IYCF), has largely been ignored. This study explores household water insecurity experiences and their association with optimal health and nutrition of women and children in the Rajanpur district of Punjab Province. Using focus group discussions (FGDs) and key informants (KIIs) interviews from an area with high maternal-child malnutrition prevalence, a qualitative study was conducted to describe local experiences of water acquirement and arrangement, and of the consequences of water insecurity. The findings highlight that rural Western marginalized populations of the Rajanpur district rely on brackish, canal, or flood surface water as the water supply is absent, which intensifies mothers’ work burden and stress, and often makes them victims of violence, stigma, and sickness. Water fetching impacts women in unforeseen ways, impacting the psychosocial and physical health of mothers engaged in maternal breastfeeding. Water insecurity, originally rooted in regional disparities, compounds with gender inequities, which leads to maternal stress and child sickness. Justice in water resources is imperative and urgent in the deprived South of Punjab province for improving public health nutrition.
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Affiliation(s)
- Farooq Ahmed
- Department of Anthropology, Quaid-I-Azam University, Islamabad 44000, Pakistan;
- Department of Anthropology, University of Washington, Seattle, WA 98105, USA
| | - Muhammad Shahid
- School of Insurance and Economics, University of International Business and Economics (UIBE), Beijing 100029, China;
| | - Yang Cao
- School of Insurance and Economics, University of International Business and Economics (UIBE), Beijing 100029, China;
- Correspondence: ; Tel.: +86-173-1948-0430
| | | | - Sidra Zia
- Independent Researcher, Islamabad 44000, Pakistan;
| | - Saireen Fatima
- Fazaia Medical College, Air University, Islamabad 44000, Pakistan;
| | - Jing Guo
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100091, China;
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22
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Piperata BA, Dufour DL. Food Insecurity, Nutritional Inequality, and Maternal–Child Health: A Role for Biocultural Scholarship in Filling Knowledge Gaps. ANNUAL REVIEW OF ANTHROPOLOGY 2021. [DOI: 10.1146/annurev-anthro-101819-110317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Food insecurity, a significant contributor to nutritional inequality, disproportionately affects women and children in low- and middle-income countries. The magnitude of the problem has inspired research on its impacts on health, especially on nutritional status and, more recently, mental well-being. Current research is dominated by surveillance-type studies that emphasize access, one of food security's four dimensions. Findings are inconclusive regarding the association between food insecurity and women and children's nutritional status, but some evidence indicates that it is a key contributor to mental distress in women. To understand these inconsistent findings, we emphasize the need for research on the strategies that people use to cope with inadequate access to food. We contend that biocultural approaches that recognize the importance of local contexts and the role of broader political-economic factors in shaping them are well suited for addressing current knowledge gaps.
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Affiliation(s)
- Barbara A. Piperata
- Department of Anthropology, The Ohio State University, Columbus, Ohio 43210, USA
| | - Darna L. Dufour
- Department of Anthropology, University of Colorado Boulder, Boulder, Colorado 80309, USA
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MUNTEANU C, TEOIBAS-SERBAN D, IORDACHE L, BALAUREA M, BLENDEA CD. Water intake meets the Water from inside the human body – physiological, cultural, and health perspectives - Synthetic and Systematic literature review. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.439] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Background. The average adult human body of 70 kilograms consists in about 67.85% water distributed evenly to an average of 70 % in all major organs of the body: skin, muscles, brain, spinal cord, liver, heart, lungs, spleen, kidneys, pancreas and gastro-intestinal tract. A smaller percentage is found in the bones (30%), teeth (5%) and fat tissue (50%).
Objective. This review article attempts to present different perspectives on the physiological properties of water in the human body. We describe from the ancient Chinese medicine theory about water being one of the 5 elements of nature and its harmonious interrelation with the other elements in order to balance the human body, to the successful experiments of researchers which demonstrated waters’ capability to change its molecular structure based on feelings, intentions and energy it was exposed to. We briefly describe the role of water for the human body and what effects can the lack of it have, especially dehydration with all the phases of severity. Also, we present the health benefits of drinking water and which type of water is best to consume. We shorty review the different types of natural mineral waters in Romania and the importance of the Romanian researches for balneology and how the waters cand be administrated in crenotherapy for different types of pathologies.
Methods. To elaborate our systematic review, we have searched for relevant open access articles and review articles in ISI Web of Science, published from January 2017 until August 2021. The terms used were water AND health in the title. Articles were excluded in the second phase if they did not reach the relevance citation criterion. The eligible articles were analyzed in detail regarding water importance for human health.
Results. Our search identified, first, 548 articles. After applying a PEDro like selection filter and, we selected 93 articles with a minimum of 8 points on our PEDro like filtering scale (good, very good, and excellent articles with a minimum of 5 citations per year). Detailed analysis of the 93 selected articles has conducted us to the elimination of 33 of them as being on a different subject than that of our article. To the 60 full articles retained for this systematic and synthetic article, we have added 10 articles found through a separate Google search, as being considered of high relevance for our subject and necessary to be included.
Conclusions. Water is essential for the entire planet and also indispensable for the survival of the human body.
Keywords: water intake, water balance, body water, water molecular structure, dehydration, crenotherapy
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Affiliation(s)
- Constantin MUNTEANU
- 1 University of Medicine and Pharmacy “Grigore T. Popa, 16 University Street, Iasi, Romania
| | | | - Liviu IORDACHE
- Clinical Emergency Regional Hospital Ilfov, Bucharest, Romania
| | | | - Corneliu-Dan BLENDEA
- Clinical Emergency Regional Hospital Ilfov, Bucharest, Romania 5. “Titu Maiorescu” University, Faculty of Medicine, Bucharest, Romania
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Young SL, Frongillo EA, Jamaluddine Z, Melgar-Quiñonez H, Pérez-Escamilla R, Ringler C, Rosinger AY. Perspective: The Importance of Water Security for Ensuring Food Security, Good Nutrition, and Well-being. Adv Nutr 2021; 12:1058-1073. [PMID: 33601407 PMCID: PMC8321834 DOI: 10.1093/advances/nmab003] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/21/2022] Open
Abstract
Water security is a powerful concept that is still in its early days in the field of nutrition. Given the prevalence and severity of water issues and the many interconnections between water and nutrition, we argue that water security deserves attention commensurate with its importance to human nutrition and health. To this end, we first give a brief introduction to water insecurity and discuss its conceptualization in terms of availability, access, use, and stability. We then lay out the empirical grounding for its assessment. Parallels to the food-security literature are drawn throughout, both because the concepts are analogous and food security is familiar to the nutrition community. Specifically, we review the evolution of scales to measure water and food security and compare select characteristics. We then review the burgeoning evidence for the causes and consequences of water insecurity and conclude with 4 recommendations: 1) collect more water-insecurity data (i.e., on prevalence, causes, consequences, and intervention impacts); 2) collect better data on water insecurity (i.e., measure it concurrently with food security and other nutritional indicators, measure intrahousehold variation, and establish baseline indicators of both water and nutrition before interventions are implemented); 3) consider food and water issues jointly in policy and practice (e.g., establish linkages and possibilities for joint interventions, recognize the environmental footprint of nutritional guidelines, strengthen the nutrition sensitivity of water-management practices, and use experience-based scales for improving governance and regulation across food and water systems); and 4) make findings easily available so that they can be used by the media, community organizations, and other scientists for advocacy and in governance (e.g., tracking progress towards development goals and holding implementers accountable). As recognition of the importance of water security grows, we hope that so too will the prioritization of water in nutrition research, funding, and policy.
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Affiliation(s)
- Sera L Young
- Department of Anthropology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Zeina Jamaluddine
- London School of Tropical Medicine and Hygiene, London, England
- American University of Beirut, Lebanon, Beirut
| | | | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Claudia Ringler
- Environment and Production Technology Division, International Food Policy Research Institute, Washington, DC, USA
| | - Asher Y Rosinger
- Department of Biobehavioral Health and Department of Anthropology, Pennsylvania State University, State College, PA, USA
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Choudhary N, Schuster RC, Brewis A, Wutich A. Household Water Insecurity Affects Child Nutrition Through Alternative Pathways to WASH: Evidence From India. Food Nutr Bull 2021; 42:170-187. [PMID: 34282660 DOI: 10.1177/0379572121998122] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Household water security matters greatly for child nutrition outcomes in the global South. Water's role in sanitation/hygiene, via diarrheal disease, is cited as a primary mechanism here. Yet, the relationship between Water along with Sanitation and Hygiene (WASH) and child stunting remains inconclusive. Water-related mechanisms outside of the traditional scope of WASH might assist with explaining this. OBJECTIVE We aim to test the mediating role of reduced dietary diversity as an additional potential mechanism in linking worse household water access to increased risk of early childhood stunting, separating its effects from sanitation and diarrhea among children (as a proxy for hygiene) and taking into account regional water availability. METHOD We use nationally representative India Demographic and Health Survey (2015-16) data for 58 038 children aged 6 to 23 months, applying generalized structural equation modelling to estimate water's direct and indirect effects (as mediated through dietary diversity and access to sanitation) on a child's likelihood of being stunted. RESULTS Suboptimal water access is significantly associated with elevated likelihood of child stunting. More than 30% of the effect is indirect. In the context of low water access and availability, children's dietary diversity alone mediates more than 20% of its total effect on child stunting. CONCLUSION Beyond the WASH mechanisms, household water access affects child stunting indirectly, mediated through its impacts on children's dietary diversity. These mediating effects are also moderated by regional water availability. Water interventions in low-water regions should help reduce children's risk of nutrition-related stunting in households with lowest water access.
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26
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Nounkeu CD, Dharod JM. Integrated Approach in Addressing Undernutrition in Developing Countries: A Scoping Review of Integrated Water Access, Sanitation, and Hygiene (WASH) + Nutrition Interventions. Curr Dev Nutr 2021; 5:nzab087. [PMID: 34268466 PMCID: PMC8275452 DOI: 10.1093/cdn/nzab087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
A scoping review of integrated water access, sanitation, and hygiene (WASH) plus nutrition interventions was conducted mainly to describe different components of intervention and examine their effectiveness in improving nutritional outcomes among children. Of the 8 small- to large-scale interventions, 6 were conducted in sub-Saharan Africa and the remaining 2 in South Asia. All the interventions were done in rural settings; the majority involved sanitation and hygiene deliverables along with the nutrition strategies, such as distribution of nutrition supplements. In assessing effectiveness, no significant improvements were seen in growth indicators; reduction in diarrheal rate among children was also not universal across interventions. Further strengthening of WASH, especially an improvement in "W", or water access, is warranted to ensure uptake of sanitation and hygiene behaviors and prevent the fecal-oral route among children. Improved water access will also enhance the effectiveness of nutrition initiatives, such as promoting vegetable gardening and utilization of child nutrient supplements.
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Affiliation(s)
| | - Jigna M Dharod
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC, USA
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27
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Koyratty N, Jones AD, Schuster R, Kordas K, Li CS, Mbuya MNN, Boateng GO, Ntozini R, Chasekwa B, Humphrey JH, Smith LE. Food Insecurity and Water Insecurity in Rural Zimbabwe: Development of Multidimensional Household Measures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6020. [PMID: 34205143 PMCID: PMC8199942 DOI: 10.3390/ijerph18116020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/26/2022]
Abstract
Background: With millions of people experiencing malnutrition and inadequate water access, FI and WI remain topics of vital importance to global health. Existing unidimensional FI and WI metrics do not all capture similar multidimensional aspects, thus restricting our ability to assess and address food- and water-related issues. Methods: Using the Sanitation, Hygiene and Infant Nutrition Efficacy (SHINE) trial data, our study conceptualizes household FI (N = 3551) and WI (N = 3311) separately in a way that captures their key dimensions. We developed measures of FI and WI for rural Zimbabwean households based on multiple correspondence analysis (MCA) for categorical data. Results: Three FI dimensions were retained: 'poor food access', 'household shocks' and 'low food quality and availability', as were three WI dimensions: 'poor water access', 'poor water quality', and 'low water reliability'. Internal validity of the multidimensional models was assessed using confirmatory factor analysis (CFA) with test samples at baseline and 18 months. The dimension scores were associated with a group of exogenous variables (SES, HIV-status, season, depression, perceived health, food aid, water collection), additionally indicating predictive, convergent and discriminant validities. Conclusions: FI and WI dimensions are sufficiently distinct to be characterized via separate indicators. These indicators are critical for identifying specific problematic insecurity aspects and for finding new targets to improve health and nutrition interventions.
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Affiliation(s)
- Nadia Koyratty
- Department of Epidemiology and Environmental Health, The State University of New York, University at Buffalo, Buffalo, NY 14214, USA; (N.K.); (K.K.)
| | - Andrew D. Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Roseanne Schuster
- Center for Global Health, School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85281, USA;
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, The State University of New York, University at Buffalo, Buffalo, NY 14214, USA; (N.K.); (K.K.)
| | - Chin-Shang Li
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY 14214, USA;
| | | | - Godfred O. Boateng
- Department of Kinesiology, College of Nursing and Health Innovations, The University of Texas at Arlington, Arlington, TX 76019, USA;
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; (R.N.); (B.C.); (J.H.H.)
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; (R.N.); (B.C.); (J.H.H.)
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; (R.N.); (B.C.); (J.H.H.)
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Laura E. Smith
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; (R.N.); (B.C.); (J.H.H.)
- Department of Population Medicine and Diagnostics, Cornell University, Ithaca, NY 14853, USA
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28
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Randell H, Grace K, Bakhtsiyarava M. Climatic Conditions and Infant Care: Implications for Child Nutrition in Rural Ethiopia. POPULATION AND ENVIRONMENT 2021; 42:524-552. [PMID: 34149138 PMCID: PMC8210853 DOI: 10.1007/s11111-020-00373-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 06/12/2023]
Abstract
We examine the relationships between climatic conditions, breastfeeding behavior, and maternal time use in Ethiopia. Infant feeding practices are important predictors of child nutrition that may be affected by a number of factors including mother's time engaging in agricultural labor, food security, cultural beliefs, and antenatal care. We use panel data from the Living Standards Measurement Study to investigate linkages between climatic conditions during a child's first year of life and year prior to birth and duration of exclusive breastfeeding. We then explore one potential mechanism: women's agricultural labor. Results indicate that rainfall during the primary agricultural season-kiremt-in a child's first year of life plays an important role in duration of exclusive breastfeeding. Experiencing 25 cm of average monthly kiremt rainfall, versus 5 cm, is associated with a 20-percentage-point decrease in the likelihood of being exclusively breastfed for the recommended six months. More kiremt rainfall is associated with a greater number of days that women spend planting and harvesting, and at high levels of rainfall women with infants do not engage in significantly fewer days of agricultural labor than those without infants. Lastly, we find that during the year before birth, greater rainfall during kiremt as well as the dry season is associated with a lower likelihood of six months of exclusive breastfeeding, potentially due to the early introduction of complementary foods. Our findings indicate that agricultural labor demands may in part drive breastfeeding behaviors, leading to "sub-optimal" feeding practices in the short-term, but resulting in improved household food security in the longer-term.
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Affiliation(s)
- Heather Randell
- Department of Agricultural Economics, Sociology, and Education, Pennylvania State University, 110-A Armsby Building, University Park, PA 16802
| | - Kathryn Grace
- Department of Geography, Environment, and Society, University of Minnesota-Twin Cities
| | - Maryia Bakhtsiyarava
- Department of Geography, Environment, and Society, University of Minnesota-Twin Cities
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29
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Atukunda P, Eide WB, Kardel KR, Iversen PO, Westerberg AC. Unlocking the potential for achievement of the UN Sustainable Development Goal 2 - 'Zero Hunger' - in Africa: targets, strategies, synergies and challenges. Food Nutr Res 2021; 65:7686. [PMID: 34262413 PMCID: PMC8254460 DOI: 10.29219/fnr.v65.7686] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background The UN Sustainable Development Goal (SDG) 2 ('Zero Hunger') aims to end all forms of hunger and malnutrition by 2030. Thus, a range of different strategies are needed to facilitate the achievement of SDG 2 to overcome challenges and enable synergies between various SDG targets. Objective The aim of this review is to highlight Africa's progress toward SDG 2, including targets, strategies, synergies and challenges. Methods We scrutinized published research articles in peer-reviewed journals, UN reports and in-country Africa reports (between 2015 and 2020) that were relevant to the current topic. Results Several hunger indicators are showing slow progress or even deterioration in Africa. The prevalence of undernourishment in the general population was 19.1% in 2019 and is expected to increase to 25.7% by 2030. Improvements in child stunting in several regions in Africa are slow, especially in sub-Saharan Africa where about 34% of under-fives were stunted in 2012 and 31% in 2019. In Eastern Africa, stunting prevalence decreased from 38% in 2012 to 34% in 2019. Major drivers of hunger are poor governance and state fragility, war and conflicts, increasing inequality, weak economic development, climate change, biodegradation - and now lately the Covid 19 pandemic - factors that all increase food insecurity. Conclusion Africa is off track to reach SDG - 'Zero Hunger' - by 2030. Current efforts and progress are insufficient. Africa must champion the SDG agenda on a national, regional and global level to facilitate synergies to unlock the potential for reaching 'Zero Hunger' throughout the continent.
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Affiliation(s)
| | | | | | - Per Ole Iversen
- Department of Nutrition, University of Oslo, Oslo, Norway.,Department of Haematology, Oslo University Hospital, Oslo, Norway.,Division of Human Nutrition, Stellenbosch University, Tygerberg, South Africa
| | - Ane C Westerberg
- Institute of Health Sciences, Kristiania University College, Oslo, Norway.,Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
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30
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Stoler J, Miller JD, Brewis A, Freeman MC, Harris LM, Jepson W, Pearson AL, Rosinger AY, Shah SH, Staddon C, Workman C, Wutich A, Young SL. Household water insecurity will complicate the ongoing COVID-19 response: Evidence from 29 sites in 23 low- and middle-income countries. Int J Hyg Environ Health 2021; 234:113715. [PMID: 33735823 PMCID: PMC7894133 DOI: 10.1016/j.ijheh.2021.113715] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/25/2021] [Accepted: 02/11/2021] [Indexed: 12/17/2022]
Abstract
In March 2020, the World Health Organization (WHO) issued a set of public guidelines for Coronavirus Disease 2019 (COVID-19) prevention measures that highlighted handwashing, physical distancing, and household cleaning. These health behaviors are severely compromised in parts of the world that lack secure water supplies, particularly in low- and middle-income countries (LMICs). We used empirical data gathered in 2017-2018 from 8,297 households in 29 sites across 23 LMICs to address the potential implications of water insecurity for COVID-19 prevention and response. These data demonstrate how household water insecurity presents many pathways for limiting personal and environmental hygiene, impeding physical distancing and exacerbating existing social and health vulnerabilities that can lead to more severe COVID-19 outcomes. In the four weeks prior to survey implementation, 45.9% of households in our sample either were unable to wash their hands or reported borrowing water from others, which may undermine hygiene and physical distancing. Further, 70.9% of households experienced one or more water-related problems that potentially undermine COVID-19 control strategies or disease treatment, including insufficient water for bathing, laundering, or taking medication; drinking unsafe water; going to sleep thirsty; or having little-to-no drinking water. These findings help identify where water provision is most relevant to managing COVID-19 spread and outcomes.
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Affiliation(s)
| | - Joshua D Miller
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | | | | | | | | | | | - Sameer H Shah
- University of British Columbia, Vancouver, BC, Canada.
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31
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Chilinda ZB, Wahlqvist ML, Lee MS, Huang YC. Optimal Household Water Access Fosters the Attainment of Minimum Dietary Diversity among Children Aged 6-23 Months in Malawi. Nutrients 2021; 13:nu13010178. [PMID: 33430102 PMCID: PMC7827850 DOI: 10.3390/nu13010178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/31/2020] [Accepted: 01/06/2021] [Indexed: 11/22/2022] Open
Abstract
Along with sanitation and hygiene, water is a well-known driver of child undernutrition. However, a more direct role of household (HH) water access in shaping dietary diversity remains unexplored. We assessed the association between HH water access and achievement of minimum dietary diversity (MDD) among young children. We utilized nationally-representative cross-sectional data from the 2015/16 Malawi Demographic and Health Survey, which included 4727 mother–child dyads, respectively, (26.8 ± 6.8 years, range 15–49 years) and (13.9 ± 4.9 months, range 6–23 months). HH water access was categorized as (1) basic or no access, (2) intermediate, or (3) optimal. MDD was defined as feeding a child, during the previous day, at least four of the food groups defined by the World Health Organization. Only 27.7% of the children achieved MDD standards; most of the children who achieved MDD were from HHs with optimal water access (58.4%, p < 0.001). However, only 5.9% of the mother–child dyads were from HHs with optimal water access. After adjusting for covariates, children from HHs with optimal water access had higher odds of achieving MDD than those from HHs with basic or no water access (aOR = 1.74, CI = 1.24–2.46). Our results highlight the need to incorporate water-based strategies into national nutritional policies to increase dietary diversity among Malawian infants and young children.
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Affiliation(s)
- Zizwani Brian Chilinda
- Graduate Institute of Public Health, China Medical University, 91 Hsueh-Shih Road, North District, Taichung City 40402, Taiwan;
| | - Mark L. Wahlqvist
- Department of Nutrition, China Medical University, 91 Hsueh-Shih Road, North District, Taichung City 40402, Taiwan;
- School of Public Health, National Defense Medical Center, No. 161, Section 6, Minquan East Road, Neihu District, Taipei City 11490, Taiwan;
- Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan
- Monash Asia Institute, Monash University, 5th Floor, H Building, 900 Dandenong Road, Caulfield East, Melbourne, VIC 3145, Australia
| | - Meei-Shyuan Lee
- School of Public Health, National Defense Medical Center, No. 161, Section 6, Minquan East Road, Neihu District, Taipei City 11490, Taiwan;
| | - Yi-Chen Huang
- Department of Nutrition, China Medical University, 91 Hsueh-Shih Road, North District, Taichung City 40402, Taiwan;
- Correspondence: ; Tel.: +886-4-2205-3366 (ext. 7523)
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Venkataramanan V, Geere JAL, Thomae B, Stoler J, Hunter PR, Young SL. In pursuit of 'safe' water: the burden of personal injury from water fetching in 21 low-income and middle-income countries. BMJ Glob Health 2020; 5:bmjgh-2020-003328. [PMID: 33115862 PMCID: PMC7592242 DOI: 10.1136/bmjgh-2020-003328] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/08/2020] [Accepted: 08/31/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Water fetching for household needs can cause injury, but documentation of the burden of harm globally has been limited. We described the frequency, characteristics and correlates of water-fetching injuries in 24 sites in 21 low-income and middle-income countries in Asia, Africa and Latin America and the Caribbean. METHODS In a survey of 6291 randomly selected households, respondents reported whether and how they had experienced water-fetching injuries. Responses were coded for injury type, mechanism, bodily location and physical context. We then identified correlates of injury using a multilevel, mixed-effects logistic regression model. RESULTS Thirteen per cent of respondents reported at least one water-fetching injury. Of 879 injuries, fractures and dislocations were the most commonly specified type (29.2%), and falls were the most commonly specified mechanism (76.4%). Where specified, 61.1% of injuries occurred to the lower limbs, and dangerous terrain (69.4%) was the most frequently reported context. Significant correlates included being female (aOR=1.50, 95% CI 1.15 to 1.96); rural (aOR=4.80, 95% CI 2.83 to 8.15) or periurban residence (aOR=2.75, 95% CI 1.64 to 4.60); higher household water insecurity scores (aOR=1.09, 95% CI 1.07 to 1.10) and reliance on surface water (aOR=1.97, 95% CI 1.21 to 3.22) or off-premise water sources that required queueing (aOR=1.72, 95% CI 1.19 to 2.49). CONCLUSION These data suggest that water-fetching injuries are an underappreciated and largely unmeasured public health challenge. We offer guidelines for comprehensive data collection on injuries to better capture the true burden of inadequate water access. Such data can guide the design of interventions to reduce injury risk and promote equitable water access solutions.
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Affiliation(s)
- Vidya Venkataramanan
- Center for Water Research and Department of Anthropology, Northwestern University, Evanston, Illinois, USA
| | - Jo-Anne L Geere
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK,Water Security Research Centre, University of East Anglia, Norwich, UK
| | - Benjamin Thomae
- Center for Water Research and Department of Anthropology, Northwestern University, Evanston, Illinois, USA
| | - Justin Stoler
- Department of Geography and Regional Studies and Department of Public Health Sciences, University of Miami, Coral Gables, Florida, USA
| | - Paul R Hunter
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK,Water Security Research Centre, University of East Anglia, Norwich, UK
| | - Sera L Young
- Center for Water Research and Department of Anthropology, Northwestern University, Evanston, Illinois, USA,Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
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33
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Wutich A, Brewis A, Tsai A. Water and mental health. WIRES WATER 2020; 7. [DOI: 10.1002/wat2.1461] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/21/2020] [Indexed: 08/30/2023]
Abstract
AbstractThere is a well‐established connection among water quality, sanitation, and physical health. The potentially important relationship between water and mental health is considerably less studied. Reviewing evidence from ethnography, geography, folklore, indigenous studies, rural medicine, drought research, and large‐n statistical studies, we argue there is now good theoretical rationale and growing evidence of water insecurity as a possible driver of mental ill‐health. Furthermore, some nascent evidence suggests that emotionally meaningful interactions with water might improve mental health outcomes. Leveraging these literatures, we address the many ways in which mental health outcomes are conceptualized and operationalized in water research, including as emotional distress, perceived stress, depressive symptoms, anxiety symptoms, somatic symptoms, and quality of life. We outline arguments supporting seven possible (and likely interlocking) mechanisms that could explain such a relationship: (a) material deprivation and related uncertainty, (b) shame of social failure, (c) worry about health threats, (d) loss of connections to people and places, (e) frustration around opportunity losses and restricted autonomy, (f) interpersonal conflict and intimate partner violence, and (g) institutional injustice or unfairness. However, we explain that as most existing studies are ethnographic, qualitative, or cross‐sectional, a causal relationship between water and mental ill‐health is yet to be confirmed empirically. More research on this topic is needed, particularly given that poorly understood connections may create barriers to achieving Sustainable Development Goals 3 (health) and 6 (water). We further suggest that tracking mental health indicators may provide unique and as‐yet underappreciated insights into the efficacy of water projects and other development interventions.This article is categorized under:
Engineering Water > Water, Health, and Sanitation
Human Water > Water as Imagined and Represented
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Affiliation(s)
- Amber Wutich
- School of Human Evolution & Social Change Arizona State University Tempe Arizona USA
| | - Alexandra Brewis
- School of Human Evolution & Social Change Arizona State University Tempe Arizona USA
| | - Alexander Tsai
- Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
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34
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Choudhary N, Schuster R, Brewis A, Wutich A. Water insecurity potentially undermines dietary diversity of children aged 6-23 months: Evidence from India. MATERNAL & CHILD NUTRITION 2020; 16:e12929. [PMID: 31999395 PMCID: PMC7083507 DOI: 10.1111/mcn.12929] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/17/2019] [Accepted: 11/19/2019] [Indexed: 01/22/2023]
Abstract
Dietary diversity is a crucial pathway to child nutrition; lack of diversity may deprive children of critical macro and micronutrients. Though water along with hygiene and sanitation is a known driver of child undernutrition, a more direct role of household water in shaping dietary diversity remains unexplored. Existing literature provides a sound theoretical basis to expect that water could affect dietary diversity among young children. Here, we test the proposition that suboptimal household access to water and low regional water availability associate with lower dietary diversity among young children. Using the nationally representative 2015-2016 India Demographic and Health Survey data, we conducted a probit analysis on the sample of 69,841 children aged 6-23 months to predict the probability that a child achieves minimum standards of dietary diversity (MDD). After controlling for relevant socioeconomic and gender-related covariates, we found that children in household with suboptimal household water access were two percentage points less likely to achieve MDD, when compared with those from households with optimal water access. Children in high water availability regions had nine percentage points greater probability of achieving MDD compared with children from low water availability regions, accounting for household water access. As dietary diversity is central to nutrition, establishing the role of water access in shaping early childhood dietary diversity broadens the framework on how household material poverty shapes child malnutrition-independent of sanitation and hygiene pathways. This provides additional window for nutrition planning and intervention wherein water-based strategies can be leveraged in multiple ways.
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Affiliation(s)
- Neetu Choudhary
- Center for Global Health, School of Human Evolution and Social ChangeArizona State UniversityTempeArizona
| | - Roseanne Schuster
- Center for Global Health, School of Human Evolution and Social ChangeArizona State UniversityTempeArizona
| | - Alexandra Brewis
- Center for Global Health, School of Human Evolution and Social ChangeArizona State UniversityTempeArizona
| | - Amber Wutich
- Center for Global Health, School of Human Evolution and Social ChangeArizona State UniversityTempeArizona
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35
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Leonard WR. Water & Human Biology and New Developments for the American Journal of Human Biology. Am J Hum Biol 2020; 32:e23389. [PMID: 31916639 DOI: 10.1002/ajhb.23389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- William R Leonard
- Department of Anthropology & Program in Global Health Studies, Northwestern University, Evanston, Illinois
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