Persistent Food Insecurity, but not HIV, is Associated with Depressive Symptoms Among Perinatal Women in Kenya: A Longitudinal Perspective

Food insecurity and depressive symptoms among young people living with HIV in Eastern Zambia

Background: Mental health problems are common among people living with HIV/AIDS and contribute to poor HIV-related outcomes, including AIDS-related mortality. We examined the association between severe food insecurity and depressive symptoms in young people living with HIV (YPLH) in Zambia. Methods: We sampled 120 youth living with HIV aged 18-21 years in the Eastern Province of Zambia. Household food insecurity was measured using the Household Food Insecurity Access Scale (HFIAS). Mental health was assessed using the Children's Depression Inventory-Short Form. We fitted linear regression models to assess whether food insecurity is associated with depressive symptoms. Results: The mean age was 19 years, and 63% were female. Overall, 43% were severely food insecure. After adjusting for sociodemographic variables and other confounders, severely food insecure participants were more likely to report depressive symptoms (β = 0.81, 95% Confidence Interval [CI] 0.07-1.55) and engagement in sex work (β = 1.78, 95% CI 0.32-3.25). Conclusion: Almost half of the sample reported severe food insecurity which was associated with depressive symptoms. Interventions aimed at improving food insecurity may have beneficial effects on mental health and HIV outcomes among young people living with HIV in resource-limited settings.

Food Insecurity and Health: Marital Status and Gender Variations

Existing research has established the detrimental effects of food insecurity on health. However, understanding of the social conditions that may moderate this relationship remains limited. To address this gap, the study investigates two questions: First, does marital status moderate the association between food insecurity and self-rated health? Second, if such moderation exists, does its impact vary based on gender? Data from the 2017-2018 Canadian Community Health Survey, a nationally representative survey conducted by Statistics Canada (n =101 647), were utilized for this investigation. The findings demonstrated that individuals living in food-insecure households reported poorer self-rated mental and general health. However, the negative impact of food insecurity on both health outcomes was less pronounced among married individuals than among their unmarried counterparts. Furthermore, the stress-buffering role of marriage was found to be more substantial among men than among women. In light of the significant stress-buffering role of marriage revealed in this study, it is crucial for policies to aim at providing comparable coping resources to unmarried individuals, particularly women.

Effects of improved on-farm crop storage on perceived stress and perceived coping in pregnant women-Evidence from a cluster-randomized controlled trial in Kenya

BACKGROUND

Food insecurity can be harmful to pregnant women, as pregnancy is a challenging period with increased maternal nutritional requirements to ensure optimal fetal development and health of the mother. Whether food insecurity negatively affects maternal health may depend on how stressful pregnant women perceive this food insecurity to be and how strongly they believe they can cope with it. In Sub-Saharan Africa (SSA), pregnant women from smallholder households suffer from food insecurity due to post-harvest losses (PHL), i.e., loss of crops because of inadequate storage. An agricultural intervention that improves crop storage has been shown to reduce food insecurity. However, it remains to be determined whether this agricultural intervention (treatment) has an additional positive effect on pregnant women's perceived stress levels and coping abilities. This study examines whether pregnant women from treatment households experience lower perceived stress levels and higher perceived coping abilities compared to pregnant women from control housholds.

METHODS AND FINDINGS

In a randomized controlled trial (RCT), short message service (SMS)-based mobile phone surveys were conducted to assess the causal effect of a food security intervention (improved on-farm storage of maize) on perceived stress and coping in pregnant women from smallholder households. Pregnant women were identified through these monthly surveys by asking whether someone in their household was currently pregnant. The significant results revealed that pregnant women from treatment households experienced more perceived stress but better perceived coping abilities compared to pregnant women from control households. Uncertainty due to lack of experience, this might have contributed to the higher perceived stress, as the women could not easily judge the benefits and risks of the new storage technology. However, the technology itself is a tangible resource which might have empowered the pregnant women to counteract the effects of PHL and thus food insecurity.

CONCLUSION

Our findings indicate that pregnant women from treatment households had higher perceived coping abilities but experienced more perceived stress. More research is needed on how this technology impacts maternal mental health in a broader sense and whether biological mechanisms, such as epigenetics, may underlie this association.

Food and Water Insecurity in Sexual and Gender Minority Groups Living With HIV in Lagos, Nigeria

BACKGROUND

Food and water insecurity are associated with poor health outcomes that may be exacerbated by social marginalization and barriers to health care experienced by sexual and gender minorities (SGM) in resource-limited settings. We explored factors associated with food and water insecurity in SGM with HIV.

SETTING

A longitudinal study of 357 men who have sex with men, transgender women, and other gender-identifying people in Lagos, Nigeria.

METHODS

Laboratory testing, interviews, food and water assessments, and anthropometry were performed quarterly. Robust Poisson regression with generalized estimating equations was used to evaluate factors potentially associated with food and water insecurity.

RESULTS

From 2014 to 2018, 357 SGM with HIV completed either the food or water assessments. At baseline, participants identified as cisgender men who have sex with men 265 (74.2%), transgender women 63 (17.7%), or as nonbinary/other gender 29 (8.1%). Food insecurity and water insecurity were reported by 63/344(18.3%) and 113/357(31.7%), respectively, at any visit. Food and water insecurity each decreased with ongoing study participation. Food insecurity was associated with nonpartnered relationship status, CD4 count <500 cells/mm 3 , and lack of access to piped water. Water insecurity was associated with age 25 years or older, living with a man, transactional sex, and food insecurity.

CONCLUSIONS

Food and water insecurity were common among SGM in Nigeria and decreased with continued study participation, suggesting amenability to intervention when SGM are successfully engaged in care. Targeted interventions to support food and water security may improve HIV-related outcomes, such as CD4 count.

Water insecurity, food insecurity and social capital associated with a group-led microfinance programme in semi-rural Kenya

ABSTRACTSocial capital predicts many positive health outcomes, including food and water access and sufficiency. Hence, increasing social capital has emerged as one potential strategy to improve food and water security. In this study, we investigate whether social capital generated through participation in a community-based microlending programme based in semi-rural Kenya is associated with water and food insecurity, and explore the interconnectedness of water and food insecurity through mediation analysis. Randomly-selected women participants of the community-based programme (n = 400) were interviewed in June 2018 and again in June 2019. Survey measures included water insecurity, food insecurity and an index of social capital constructs, namely group cohesion, trust, expectations of mutual support, sense of belonging and frequency of attendance in the programme. Random effects linear regression showed that an increase the social capital index was associated with lower water and food insecurity. The mediation analysis indicated that the association between social capital and food insecurity was completely mediated by water insecurity. This study demonstrates the need for further investigation into how social capital-generating programmes can contribute to systems approaches for collaborative food and water security programmes, especially among rural communities in low- and middle-income countries.

Growth and growth trajectory among infants in early life: contributions of food insecurity and water insecurity in rural Zimbabwe

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.

The Economic Toll of COVID ‐19: A Cohort Study of Prevalence and Economic Factors Associated with postpartum depression in Kenya

Objective

The aim of the study is to examine the risk of postpartum depression (PPD) among women who delivered during the COVID‐19 pandemic compared to women who delivered before the COVID‐19 pandemic and how economic challenges are associated with PPD.

Methods

Data were collected from 2332 women. This includes 1197 women from healthcare facilities in 2019 who were followed up at 2–4 and 10 weeks postpartum. Additionally, we recruited 1135 women who delivered from March 16, 2020 onward when COVID‐19 restrictions were mandated in Kenya in the same catchment areas as the original sample to compare PPD rates.

Results

Adjusting for covariates, women who delivered during COVID‐19 had 2.5 times higher odds of screening positive for PPD than women who delivered before COVID‐19 (95% confidence interval [CI] 1.92–3.15). Women who reported household food insecurity, required to pay a fee to cover the cost of PPE during labor and delivery and/or postnatal visit(s), and those who reported COVID‐19 employment‐related impacts had a higher likelihood of screening for PPD compared to those who did not report these experiences.

Conclusion

The COVID‐19 pandemic has greatly increased the economic vulnerability of women, resulting in increases in PPD.

The COVID‐19 pandemic has greatly increased the economic vulnerability of women and has increased PPD.

Water Insecurity is Associated with Lack of Viral Suppression and Greater Odds of AIDS-Defining Illnesses Among Adults with HIV in Western Kenya

Reliable access to safe and acceptable water in sufficient quantities (i.e., water security) is important for medication adherence and limiting pathogen exposure, yet prior studies have only considered the role of food security as a social determinant of HIV-related health. Therefore, the objective of this analysis was to assess the relationships between household water insecurity and HIV-related outcomes among adults living with HIV in western Kenya (N = 716). We conducted a cross-sectional analysis of baseline data from Shamba Maisha (NCT02815579), a cluster randomized controlled trial of a multisectoral agricultural and asset loan intervention. Baseline data were collected from June 2016 to December 2017. We assessed associations between water insecurity and HIV-related outcomes, adjusting for clinical and behavioral confounders, including food insecurity. Each five-unit higher household water insecurity score (range: 0-51) was associated with 1.21 higher odds of having a viral load ≥ 1000 copies/mL (95% CI 1.07, 1.36) and 1.26 higher odds of AIDS-defining illness (95% CI 1.11, 1.42). Household water insecurity was not associated with CD4 cell count (B: 0.27; 95% CI -3.59, 13.05). HIV treatment and support programs should consider assessing and addressing water insecurity in addition to food insecurity to optimize HIV outcomes.

"I Found Out I was Pregnant, and I Started Feeling Stressed": A Longitudinal Qualitative Perspective of Mental Health Experiences Among Perinatal Women Living with HIV

Globally, depressive symptoms among pregnant and postpartum (i.e., perinatal) women living with HIV (WLWH) are alarmingly high and associated with poor outcomes such as suboptimal adherence to antiretroviral therapy (ART), and early cessation of exclusive breastfeeding (EBF). Few qualitative studies have described the experience of perinatal depression among WLWH to identify the underlying social-structural determinants of poor mental health and potential strategies to intervene. We conducted a longitudinal qualitative study applying semi-structured interviews with 30 WLWH at three timepoints (28-38 weeks pregnant, 6-weeks postpartum and 5-7 months postpartum) to understand mental health experiences of perinatal WLWH in western Kenya. Financial insecurity emerged as the central theme impacting the mental health of women across time. Financial insecurity was often attributed to the loss of employment, related to pregnancy and the demands of breastfeeding and caring for an infant, as well as a lack of support from male partners. The loss of income and subsequent financial strain contributed to worsening levels of food insecurity and relationship stress and challenged engagement in HIV care. In this way, increased financial strain during the perinatal period negatively impacted the mental health of perinatal WLWH. Our findings suggest support to meet basic needs and remain engaged in HIV care during pregnancy and postpartum could improve perinatal mental health for WLWH in this setting.

Association between food insecurity and depression among older adults from low- and middle-income countries

BACKGROUND

To examine the association between self-reported food insecurity and depression in 34,129 individuals aged ≥50 years from six low- and middle-income countries (LMICs) (China, Ghana, India, Mexico, Russia, and South Africa).

METHODS

Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Self-reported past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview were used for the endorsement of past 12-month DSM-IV depression. Multivariable logistic regression analysis and meta-analysis were conducted to assess associations.

RESULTS

In total, 34,129 individuals aged ≥50 years [mean (SD) age, 62.4 (16.0) years; 52.1% females] were included in the analysis. Overall, the prevalence of moderate and severe food insecurity was 6.7% and 5.1%, respectively, while the prevalence of depression was 6.0%. Meta-analyses based on countrywise estimates showed that overall, moderate food insecurity (vs. no food insecurity) is associated with a nonsignificant 1.69 (95% confidence interval [CI] = 0.82-3.48) times higher odds for depression, while severe food insecurity is significantly associated with 2.43 (95% CI = 1.65-3.57) times higher odds for depression.

CONCLUSIONS

In this large representative sample of older adults from six LMICs, those with severe food insecurity were over two times more likely to suffer from depression (compared with no food insecurity). Utilizing lay health counselors and psychological interventions may be effective mechanisms to reduce depression among food-insecure populations. Interventions to address food insecurity (e.g., supplemental nutrition programs) may reduce depression at the population level but future longitudinal studies are warranted.