Rapidly rising food prices and the experience of food insecurity in urban Ethiopia: Impacts on health and well-being

Navigating food price shocks in a pandemic: Food insecurity and coping mechanisms in Burkina Faso

Global food prices rose substantially after the start of the COVID-19 pandemic. This paper examines the impact of rising food prices during the pandemic on food security in Burkina Faso. We aim to answer two primary questions. First, how do food price shocks affect household food insecurity? Second, what coping strategies do households adopt in response to these price shocks? Leveraging country-wide high-frequency longitudinal data, we employ household fixed effect models to examine the effects. In the absence of direct information on local food prices, we use household-reported price shocks to capture province-level price increases and show that the results are consistent with national-level price increases. We find significant and immediate increases in food insecurity following the price shocks, and this effect persists for at least two months. The price shocks most acutely affected the poorest households. Furthermore, food insecurity increased more in rural areas than in urban areas. The higher proportion of poorer households in rural areas explains part of this difference. We find that households primarily cope with the shock by relying on increased assistance from relatives in Burkina Faso and abroad. This study is the first to use panel data with household fixed effects to examine the repercussions of the rise in food prices during the pandemic on food insecurity in a developing country and to examine the coping mechanisms employed by households. Given that food prices are likely to remain high globally for an extended period, our findings carry implications for the broader developing world. Furthermore, given the disproportionate effect on the poorest and those living in rural areas, the findings highlight the need for policies to mitigate the negative impacts of the price shocks and enhance overall food security in countries like Burkina Faso.

The strategies pursued by urban households to cope with food insecurity: Insights from selected towns in Southern Ethiopia

INTRODUCTION

Food security has become a major global concern, particularly in urban areas where households are struggling to address the issue of basic necessities mainly food that crucially dictates human health. Overcoming these challenges will require effective management mechanisms to inform policy interventions and enhance resilience at both local and global levels.

OBJECTIVES

This study aimed to explore the coping strategies (CS) pursued by urban households in the Southern Ethiopia. Furthermore, the focus is on how households to cope with food insecurity and how using these strategies varies within households.

METHODS

A household survey questionnaire was conducted using a cross-sectional design, combining both qualitative and quantitative methods to collect data. A total of 310 household heads were targeted for the required data acquisition with: The coping strategy index (CSI) to capture how people perceive and cope with food insecurity that threatens human health.

RESULTS

The results indicate that households used the top seven CS to address the problem of food insecurity: limiting the size of portions at mealtimes (83.9%), depending on less expensive or seasonal foods (68.1%), reducing adult consumption (66.1%), reducing the amount of food consumed (65.8%), purchasing food on credit (60.3%), renting household assets (54.8%), and migrating household members for wage labor (53.5%).

CONCLUSION

Moreover, the finding shows that the frequency of CS used by urban households in response to food insecurity is rated differently as never, rarely, sometimes, and more than 4 times per week. Therefore, targeted support programs for vulnerable groups should be implemented to ensure they receive adequate food during times of food insecurity wherein the victims' health status is imperatively to be bettered.

Food prices and the wages of the poor: A cost-effective addition to high-frequency food security monitoring

The affordability of nutritious food for "all people, at all times" is a critically important dimension of food security. Yet surprisingly, timely high-frequency indicators of food affordability are rarely collected in any systematic fashion despite price volatility emerging as major source of food insecurity in the 21st Century. The 2008 global food crisis prompted international agencies to invest heavily in monitoring domestic food prices in low and middle income countries (LMICs). However, food price monitoring is not sufficient for measuring changes in diet affordability; for that, one must also measure changes either in income or in an income proxy. We propose using the wages of unskilled workers as a cheap and sufficiently accurate income proxy, especially for the urban and rural non-farm poor. We first outline alternative measures of "food wage" indices, defined as wages deflated either by consumer food price indices or novel healthy diet cost indices. We then discuss the conceptual strengths and limitations of food wages. Finally, we examine patterns and trends in different types of real food wage series during well-known food price crises in Ethiopia (2008, 2011 and 2022), Sri Lanka (2022) and Myanmar (2022). In all these instances, food wages declined by 20-30%, often in the space of a few months. In Myanmar, the decline in real wages during 2022 closely matches declines in household disposable income. We strongly advocate tracking the wages of the poor as a timely, accurate and cost-effective means of monitoring food affordability for important segments of the world's poor.

The practice of key essential nutrition actions among pregnant women in southwest Ethiopia: implications for optimal pregnancy outcomes

BACKGROUND

Nutrition during pregnancy is a major determinant of human health and child development, and the role of promoting essential nutrition actions (ENA) is of a paramount importance for the health of the mother and newborn. However, the practice of ENA could be hampered by many factors, which need to be understood for tailored actions. This study assessed the practice of key ENAs and associated factors among pregnant mothers in southwest Ethiopia.

METHOD

A community-based cross-sectional study was employed among 373 pregnant mothers. A simple random sampling method was used to select the study participants. The data was entered into EpiData Manager and exported to SPSS version 21 for analysis. A bivariable logistic regression was conducted to explore the association between independent variables and the outcome variable. Variables with p-values less than 0.25 during bivariable analysis were entered into a multivariable logistic regression model. Level of statistical significance was declared at a p-value below 0.05. The crude and adjusted odds ratios, along with the 95% CI, were estimated to measure the strength of the association between the dependent variables and independent variables.

RESULT

In this study, 373 pregnant mothers have participated, with a response rate of 97%. A total of 275 (73.7%; 95% CI: 68.9-78.0) women practiced key essential nutrition actions at optimal level. Monthly household income of 2500 ETB (AOR = 0.45, 95% CI: 0.23, 0.89), rural residence (AOR = 2.31, 95% CI: 1.25, 4.4), and poor knowledge of key ENA messages (AOR = 3.36, 95% CI: 1.81, 6.26) were factors that were significantly associated with poor practice of key ENA messages.

CONCLUSIONS

The practice of key ENA messages was poor and closely linked to household income, residence, and knowledge of pregnant women's on ENA key messages. Therefore, nutritional intervention with a focus on intensified nutritional counseling is needed for better adoption of key ENA practices.

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.

The Impact of Drought on HIV Care in Rural South Africa: An Interrupted Time Series Analysis

This analysis investigates the relationship between drought and antiretroviral treatment (ART) adherence and retention in HIV care in the Hlabisa sub-district, KwaZulu-Natal, South Africa. Data on drought and ART adherence and retention were collated for the study period 2010-2019. Drought was quantified using the 3-month Standard Precipitation Evapotranspiration Index (SPEI) and Standard Precipitation Index (SPI) from station data. Adherence, proxied by the Medication Possession Ratio (MPR), and retention data were obtained from the public ART programme database. MPR and retention were calculated from individuals aged 15-59 years who initiated ART between January 2010 and December 2018 and visited clinic through February 2019. Between 01 January 2010 and 31 December 2018, 40,714 individuals started ART in the sub-district and made 1,022,760 ART visits. The SPI showed that 2014-2016 were dry years, with partial recovery after 2016 in the wet years. In the period from 2010 to 2012, mean 6-month MPR increased from 0.85 in July 2010 to a high of 0.92 in December 2012. MPR then decreased steadily through 2013 and 2014 to 0.78 by December 2014. The mean proportion retained in care 6 months after starting ART showed similar trends to MPR, increasing from 86.9% in July 2010 to 91.4% in December 2012. Retention then decreased through 2013, with evidence of a pronounced drop in January 2014 when the odds of retention decreased by 30% (OR = 0.70, CI = 0.53-0.92, P = 0.01) relative to the end of 2013. Adherence and retention in care decreased during the drought years.

Children's Educational Outcomes and Persistence and Severity of Household Food Insecurity in India: Longitudinal Evidence from Young Lives

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.

Food Insecurity and Dietary Deprivation: Migrant Households in Nairobi, Kenya

The current study focuses on food consumption and dietary diversity among internal migrant households in Kenya using data from a city-wide household survey of Nairobi conducted in 2018. The paper examined whether migrant households are more likely to experience inferior diets, low dietary diversity, and increased dietary deprivation than their local counterparts. Second, it assesses whether some migrant households experience greater dietary deprivation than others. Third, it analyses whether rural-urban links play a role in boosting dietary diversity among migrant households. Length of stay in the city, the strength of rural-urban links, and food transfers do not show a significant relationship with greater dietary diversity. Better predictors of whether a household is able to escape dietary deprivation include education, employment, and household income. Food price increases also decrease dietary diversity as migrant households adjust their purchasing and consumption patterns. The analysis shows that food security and dietary diversity have a strong relationship with one another: food insecure households also experience the lowest levels of dietary diversity, and food secure households the highest.

Measuring food insecurity: An introduction to tools for human biologists and ecologists

OBJECTIVE

Food insecurity is a significant and growing concern undermining the wellbeing of 30% of the global population. Food in/security is a complex construct consisting of four dimensions: availability, access, utilization, and stability, making it challenging to measure. We provide a toolkit human biologists/ecologists can use to advance research on this topic.

METHODS

We review the strengths and limitations of common tools used to measure food access and utilization, the two dimensions most proximate to people's lived experience, and emphasize tools that provide data needed to best link food security with human biological outcomes. We also discuss methods that provide contextual data human biologists/ecologists will find useful for study design, ensuring instrument validity, and improving data quality.

RESULTS

Food access is principally measured using experience-based instruments that emphasize economic access. Social access, such as food sharing, is under-studied and we recommend using social network analysis to explore this dimension. In terms of utilization, emphasis has been on food choice measured as dietary diversity. Food preparation and intrahousehold distribution, also part of the utilization dimension, are less studied and standardized instruments for measuring both are lacking. The embodiment of food insecurity has focused on child growth, although a growing literature addresses adult mental wellbeing and chronic and infectious disease risk.

CONCLUSIONS

We see the potential to expand outcomes to include reproductive and immune function, physical activity, and the gut microbiome. Human biologists/ecologists are well-positioned to advance understanding of the human health impacts of food insecurity and provide data to support intervention efforts.

The Migration Response to Food Insecurity and Household Shocks in Southwestern Ethiopia, 2005–2008

This article examines how severe food insecurity and other shocks impact internal and international migration in southwestern Ethiopia using longitudinal survey data collected between 2005 and 2008 from a random sample of urban and rural households. We found an elevated risk of internal and international migration among sons and daughters in households that experienced severe food insecurity or farm loss. A household member's illness or death also significantly increased the risk of internal migration regardless of a household member's relationship with the household head. We also found that the effects of severe food insecurity and the other shocks were additive. With each additional shock, the risks of migration incrementally increased. This article provides compelling evidence of an international and an internal migration response to food insecurity and other shocks in a context where the prevalence of international migration is increasing and the potential for future international migration is substantial. These results challenge conventional wisdom in the migration literature that food insecurity and other household shocks will have larger relative effects on internal compared to international migration.

Perceptions of COVID-19 shocks and adoption of sustainable agricultural practices in Ghana

Most studies on the novel COVID-19 pandemic have focused mainly on human health, food systems, and employment with limited studies on how farmers implement sustainable agricultural practices (SAPs) in response to the pandemic. This study examines how perceptions of COVID-19 shocks influence the adoption of SAPs among smallholder farmers in Ghana. We find that perceptions of COVID-19 shocks influence the probability and intensity of SAPs adoption. Secondly, households who anticipated COVID-19 shocks recorded heterogeneity effects in the combinations (complementarity and substitutability) of SAPs. Farmers who anticipated an increase in input prices and loss of income due to COVID-19 recorded the highest complementarity association between pesticide and zero tillage while farmers who expected limited market access reported the highest complementarity between mixed cropping and mulching. Farmers who projected a decrease in output prices complements pesticides with mixed cropping. The findings suggest that understanding the heterogeneity effects in the combinations of SAPs due to COVID-19 shocks is critical to effectively design, target and disseminate sustainable intensification programs in a post-pandemic period.

Religion, Fetal Protection, and Fasting during Pregnancy in Three Subcultures

Fasting during pregnancy is an enigma: why would a woman restrict her food intake during a period of increased nutritional need? Relative to the costs to healthy individuals who are not pregnant, the physiological costs of fasting in pregnancy are amplified, with intrauterine death being one possible outcome. Given these physiological costs, the question arises as to the socioecological factors that give rise to fasting during pregnancy. There has been little formal research regarding the emic perceptions and socioecological factors associated with such fasting. This study therefore took an emic approach and investigated the types of fasts that are common in pregnancy, women's perceptions of the consequences of fasting, and the socioecological models of pregnancy fasting in three Indian communities. This cross-sectional study took place in Bhubaneshwar, Odisha state, and Mysore, Karnataka state, among two populations of Hindu women and one population of Muslim women (N = 85). In total, 64% of women fasted in prior pregnancies. Findings revealed variation in the number and types of fasts that are common in pregnancy across the three communities. Each community reported differences in positive and negative consequences of fasting, with varied emphasis on reproductive health, religiosity, and general health and well-being. Finally, quantitative analyses indicated that the best-fitting model for fasting during pregnancy was religiosity, and the poorest-fitting models were resource scarcity and general health. This study provides insight into motivations for such fasting and highlights the need to investigate the relationship between supernatural beliefs and maternal-fetal protection further, as well as social functions of pregnancy fasting within the family and community.

Systematic evidence and gap map of research linking food security and nutrition to mental health

Connections between food security and nutrition (FSN) and mental health have been analytically investigated, but conclusions are difficult to draw given the breadth of literature. Furthermore, there is little guidance for continued research. We searched three databases for analytical studies linking FSN to mental health. Out of 30,896 records, we characterized and mapped 1945 studies onto an interactive Evidence and Gap Map (EGM). In these studies, anthropometry (especially BMI) and diets were most linked to mental health (predominantly depression). There were fewer studies on infant and young child feeding, birth outcomes, and nutrient biomarkers related to anxiety, stress, and mental well-being. Two-thirds of studies hypothesized FSN measures as the exposure influencing mental health outcomes. Most studies were observational, followed by systematic reviews as the next largest category of study. One-third of studies were carried out in low- and middle-income countries. This map visualizes the extent and nature of analytical studies relating FSN to mental health and may be useful in guiding future research.

There is a broad range of research available on the relationship between food security and mental health. Here the authors carry out a systematic mapping of evidence on food security and nutrition related to mental health and identifies trends in themes, setting, and study design over the 20 year period studied.

Water Sharing Is a Distressing Form of Reciprocity: Shame, Upset, Anger, and Conflict Over Water in Twenty Cross-Cultural Sites

Anthropological theories of reciprocity suggest it enhances prestige, social solidarity, and material security. Yet, some ethnographic cases suggest that water sharing-a form of reciprocity newly gaining scholarly attention-might work in the opposite way, increasing conflict and emotional distress. Using cross-cultural survey data from twenty global sites (n=4,267), we test how household water reciprocity (giving and receiving) is associated with negative emotional and social outcomes. Participation in water sharing as both givers and receivers is consistently associated with greater odds of reporting shame, upset, and conflict over water. Water sharing experiences in a large, diverse sample confirm a lack of alignment with predictions of classic reciprocity theories. Recent ethnographic research on reciprocity in contexts of deepening contemporary poverty will allow development of ethnographically informed theories to better explain negative experiences tied to water reciprocity.

Predictors of Major Dietary Patterns Among Pregnant Women Attending Public Health Facilities in Eastern Ethiopia: A New Epidemiological Approach

Background

Dietary pattern analysis is a robust statistical procedure that efficiently characterize the dietary intakes of individuals. However, there is a lack of robust dietary intake evidence beyond nutrient intake in Ethiopia. This study was to answer, what are the major dietary consumption patterns and its predictors among pregnant women in Ethiopia.

Methods

A facility-based survey among 380 randomly selected pregnant women using a contextualized food frequency questionnaire (FFQ) over 1 month recall was used. The frequency of food consumption was standardized to daily frequency equivalents, and a sequential exploratory factor analysis was used to derive major dietary patterns. A multivariable ordinary logistic regression model was fitted with all its assumptions.

Results

Three major dietary patterns (“fruits and animal-source foods,” “cereals, tubers, and sweet foods,” “legumes and vegetables”), explaining 65% of the total variation were identified. Women snacks (AOR = 1.93; 1.23–2.75), without food aversion (AOR = 1.59; 1.08–2.35), non-fasting (AOR = 0.75; 1.12–2.12), and receiving nutritional counseling (AOR = 1.96; 1.25–3.07) were significantly positively associated with a higher tercile of fruits and animal-source food consumption. Non-working mothers (AOR = 1.8;1.23–2.76), chronic disease (AOR = 1.88; 1.14–3.09), or received nutritional counseling (AOR = 1.33; 0.88–2.01), were fasting (AOR = 1.33;0.88–2.01), and no food cravings (AOR = 4.27;2.67–6.84), and aversion (AOR = 1.60;1.04–2.44) had significantly higher odds of consuming cereals, tubers, and sweet foods. Literacy (AOR = 1.87; 1.14–3.09), urban residence (AOR = 2.10; 1.10–3.93), low socioeconomic class (AOR = 2.68; 1.30–5.23), and skipping meals (AOR = 1.73; 1.15–2.62) were associated with higher odds of legume and vegetable consumption.

Conclusion

Socioeconomic class, literacy, occupation, getting nutritional counseling, habits of food craving, food aversion, and fasting can predict a woman’s dietary pattern.

Understanding the drivers of food security among agriculture-based households in Gurué District, Central Mozambique

BACKGROUND

The prevalence of food insecurity in Mozambique is alarming, despite progress made during the 2010s. Several studies apply different proxy indicators of food security (FS) to assess the FS situation. However, these studies overlook the factors affecting FS, using only a single data point that results in an incomplete picture of FS. Food security is expected to fluctuate, being better and worse than what studies suggest. Using a sample of 296 households to assess FS, key drivers conditioning households' capacity to achieve FS in Gurué District, Central Mozambique, are identified. Data were collected in the pre-harvest period and during the harvest period to capture relevant interseasonal variation of FS. Household FS is assessed using three standard indicators: Household Dietary Diversity Score (HDDS), Household Food Consumption Score (HFCS), and Months of Adequate Household Food Provisioning (MAHFP).

RESULTS

Each household was classified into a specific FS status depending on the indicator applied. Generally, most households were classified as being severely or moderately food insecure during the pre-harvest season, while during the harvest season, medium and high levels of FS predominated. Nevertheless, varying outcomes were found depending on the indicator used to assess FS. MAHFP and HDDS are more related to the consumption of farm-sourced food, while HFCS responds more strongly to purchased food. Gender and age of the household head, geographic location, size and quality of land, staples production (especially cassava), livestock and crop diversity, as well as cash crops had a statistically significant effect on FS indicators.

CONCLUSIONS

The study concludes that the decision whether farmers should rely on staple foods production for increasing their FS status or specialize on cash crops production to generate income and buy food depends on the indicator used to assess FS, since each indicator captures a specific domain of food security. Thus, one central recommendation derived from our results is that policy makers should promote a balance between market-oriented agriculture and subsistence production to achieve FS.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s40066-021-00344-3.

Impact of COVID-19 and Nationwide Lockdowns on Vegetable Prices: Evidence from Wholesale Markets in China

In this paper, we employ a combination of time regression discontinuity design method (T-RD) and the difference-in-difference method (DID) to identify and quantify the causal effects of the strict lockdown policy on vegetable prices using multiple-year daily price data from 151 wholesale markets of Chinese cabbage. We find that the lockdown policy caused a large and immediate surge in price and price dispersion of Chinese cabbage, though they fluctuated smoothly for the same period in normal years. The DID results further show that the price surge peaked in the fourth week of lockdown but gradually came down to the level of a normal year by week 11. However, the price rose again (though to a much smaller extent) in response to the resurgence of COVID-19 in a few provinces in early-mid April but quickly returned to the normal level in week 15 when the lockdown measures were largely removed. We also find that the supply chain disruption is the driving factor for the price hike. Policy implications are drawn.

Unpacking the "black box" of global food insecurity and mental health

Food insecurity is a global concern. While it was once characterized mainly as a problem of undernutrition, it is now recognized that a person may be food insecure without experiencing hunger. Numerous studies have demonstrated that food insecurity is strongly related to poor mental health around the world, but the mechanisms that underpin that relationship remain poorly understood. One body of research from nutritional sciences posits that nutrient deficiency impacts brain function, producing symptoms of depression and anxiety. Another body of research from the social sciences posits that the social consequences of having to eat non-preferred foods or obtain food in socially unacceptable ways may compromise mental health through stress. This study was designed to clarify the mechanisms linking food insecurity and mental health using case studies in rural Brazil and urban Ethiopia. Working with samples consisting of about 200 adult household decision-makers (mostly female) recruited between 2015 and 2019 at each site, we tested for nutritional and social mediation of the food insecurity-mental health relationship using multivariable linear regression and mediation analysis. Our analyses found no evidence of mediation in either setting. Moreover, there was no association between nutritional status variables and food insecurity. These findings suggest that food insecurity likely impacts mental health directly through forms of basic needs deprivation, such as worrying about where one's next meal will come from, rather than by acting as a social signal or even by impacting nutritional status. These results underscore the power of basic-needs deprivation for impacting mental health.

Pregnancy Fasting in Ramadan: Toward a Biocultural Framework

Pregnancy fasting poses a paradox: why would a woman restrict her diet during a period of increased nutritional need? This qualitative, cross-sectional study applied biological and cultural evolutionary theories of pregnancy diet to emic models of fasting with the aim of establishing a testable biocultural framework of pregnancy fasting. The research took place with Muslim women residing in Mysore, India. In-depth interviews were conducted with pregnant women who have experience and knowledge of fasting during during the holy month of Ramadan. Our findings indicate that pregnancy fasting is socially acquired via multiple modes of transmission and that women do not fast according to mainstream evolutionary theories of pregnancy diet, but perhaps to gain moral capital.

The impact of food insecurity on mental health in Africa: A systematic review

In 2018, 676.1 million people in Africa (52.5% of the population) were moderately or severely food insecure. This exceptionally high prevalence continues to increase as Africa experiences conflict, climate change, and economic declines. When Sustainable Development Goal 2.1 set out to end hunger and ensure access to sufficient food, particularly for vulnerable populations, by 2030, food insecurity emerged as a global priority. Food insecurity has been hypothesized to negatively impact mental health, a stigmatized area of health in Africa for which care is often inaccessible. This systematic review examines existing literature on the relationship between food insecurity and mental health in Africa, where progress remains to be made on both fronts. A systematic search of seven databases (EMBASE, Web of Science, CINAHL, PsychINFO ProQuest, Medline Ovid, Scopus, and Nursing and Allied Health) was conducted. Results were limited to studies examining food insecurity and mental health, written in English and published between January 2000 and May 2020. After title, abstract, full-text review, and quality appraisal using tools from the National Heart, Lung, and Blood Institute, 64 studies remained. Findings were summarized using a narrative synthesis approach. Studies unanimously highlighted that food insecurity is associated with poor mental health. This relationship was dose-responsive and independent of the measured mental health outcome. Two highly represented groups in the literature were women around pregnancy and people affected by HIV/AIDS. Factors which mediated the relationship included age, sex, social interactions, physical health, seasonality, and rural residence. The findings suggest that the relationship is likely amplified in specific populations such as women and seniors, and interventions which target livelihood as opposed to income may be more effective. Further research is needed which compares food insecurity's effect on mental health between at-risk populations, in order to guide resource allocation and context-specific policy making.

Drying Climates and Gendered Suffering: Links Between Drought, Food Insecurity, and Women's HIV in Less-Developed Countries

HIV/AIDS represents the leading cause of death among women of reproductive age globally, and gender inequalities in the burden of HIV/AIDS are most pronounced in poorer countries. Drawing on ideas from feminist political ecology, we explore linkages between suffering from drought, food insecurity, and women's vulnerability to HIV. Using data from 91 less-developed countries, we construct a structural equation model to analyze the direct and indirect influence of these factors, alongside other socio-economic indicators, on the percentage of the adult population living with HIV that are women. We find that droughts are significant in shaping gender inequalities in the HIV burden indirectly through increased food insecurity. We draw on prior research to argue that due to gendered inequalities, food insecurity increases women's vulnerability to HIV by intensifying biological susceptibilities to the disease, reducing access to social and health resources, and motivating women to engage in risky sexual behaviors, such as transactional sex. Overall, our findings demonstrate that droughts serve as an important underlying factor in promoting HIV transmission among vulnerable women in poor countries, and that food insecurity is a key mechanism in driving this relationship.

Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements

The informal settlements of the Global South are the least prepared for the pandemic of COVID-19 since basic needs such as water, toilets, sewers, drainage, waste collection, and secure and adequate housing are already in short supply or non-existent. Further, space constraints, violence, and overcrowding in slums make physical distancing and self-quarantine impractical, and the rapid spread of an infection highly likely. Residents of informal settlements are also economically vulnerable during any COVID-19 responses. Any responses to COVID-19 that do not recognize these realities will further jeopardize the survival of large segments of the urban population globally. Most top-down strategies to arrest an infectious disease will likely ignore the often-robust social groups and knowledge that already exist in many slums. Here, we offer a set of practice and policy suggestions that aim to (1) dampen the spread of COVID-19 based on the latest available science, (2) improve the likelihood of medical care for the urban poor whether or not they get infected, and (3) provide economic, social, and physical improvements and protections to the urban poor, including migrants, slum communities, and their residents, that can improve their long-term well-being. Immediate measures to protect residents of urban informal settlements, the homeless, those living in precarious settlements, and the entire population from COVID-19 include the following: (1) institute informal settlements/slum emergency planning committees in every urban informal settlement; (2) apply an immediate moratorium on evictions; (3) provide an immediate guarantee of payments to the poor; (4) immediately train and deploy community health workers; (5) immediately meet Sphere Humanitarian standards for water, sanitation, and hygiene; (6) provide immediate food assistance; (7) develop and implement a solid waste collection strategy; and (8) implement immediately a plan for mobility and health care. Lessons have been learned from earlier pandemics such as HIV and epidemics such as Ebola. They can be applied here. At the same time, the opportunity exists for public health, public administration, international aid, NGOs, and community groups to innovate beyond disaster response and move toward long-term plans.

Dietary diversity and associated factors among adolescents in eastern Uganda: a cross-sectional study

BACKGROUND

Globally adolescents constitute over 16% but in SSA, they make up 23% of the population. While little is known about diets of these adolescents, rapid changes in physiological and social processes undergone require adequate diets. This study aimed to determine dietary diversity and associated factors among adolescents residing in the Iganga -Mayuge HDSS.

METHODS

As part of the African Research, Implementation Science, and Education (ARISE) Network, we analysed collected data among 598 adolescents to assess the health status and adolescents' behaviour. Dietary diversity was scored using the 9 food group categories as per the Food and Agriculture Organization -WDDS. Crude and adjusted prevalence rate ratios were estimated using the modified Poisson regression model to identify associated factors.

RESULTS

Among the participants, 45.3% had a low dietary diversity score. Proportions of adolescents who consumed from the different food categories over a 24-h period were; cereals/roots/tubers (99.7%), fats & oils (87.0%), spices & beverages (84.1%), sweets (77.1%), legumes (66.2%), other non-vitamin A-rich vegetables (53.8%), dark green leafy vegetables (42.3%), meat/poultry/fish (33.1%), dairy products (32.9%), eggs (11.2%), vitamin A-rich fruits and vegetables (33.4%) and other fruits (8.2%). Staying with a single parent or guardian, low socio-economic class, and dependency on home meals was associated with low dietary diversity.

CONCLUSIONS

Adolescents diets were low in diversity and characterised with low micronutrients source foods, but plenty of fats and oils. Interventions to address contributing factors to the burden ought to target the parenting contexts of the adolescents residing in rural eastern Uganda.

Tranquility is a child with a full belly: Pathways linking food insecurity and maternal mental distress in Nicaragua

A growing body of literature identifies food insecurity (FI) as a critical social determinant of mental health. Across settings, quantitative studies report positive correlations between FI and mental distress, especially among women. Less understood are the pathways by which FI undermines women's mental well-being. To address this gap, we conducted six focus group discussions with 45 Nicaraguan mothers. Thematic analysis identified three themes linking the management of FI and maternal mental well-being in this setting. The theme, la lucha, underscored how the chronicity of FI served as a constant mental strain by demanding mothers strategize on a daily basis to resolve it. The themes "tranquility is a child with a full belly" and "the despairing and frustrated mother" emphasized how FI challenged women's abilities to fulfill the responsibilities of motherhood and served as a reminder of social status. Our findings advance earlier quantitative work by identifying how the management of food insecurity undermines maternal mental well-being in a low-middle income setting and indicate that policies aimed at combating food insecurity can concomitantly improve maternal mental well-being if they bolster women's agency and work to reduce the stigma associated with being food insecure.

Psychosocial distress among unpaid community health workers in rural Ethiopia: Comparing leaders in Ethiopia's Women's Development Army to their peers

There is a growing critical social science literature on volunteering in health programs in non-western, low-income countries, yet few have mixed quantitative and qualitative methods to examine the psychological and social wellbeing of unpaid community health workers in such contexts. We address this issue with data from unpaid community health workers (CHWs) and other women who comprise Ethiopia's state-organized Women's Development Army. We draw on qualitative and cross-sectional survey data collected between 2013 and 2016 to test links between various aspects of psychosocial and economic wellbeing and volunteer status in a rural context. We surveyed 422 adult women in Amhara state, 73 of whom were unpaid CHWs in the "Army". We also conducted interviews and focus group discussions with health officials, salaried Health Extension Workers, volunteer CHWs, and other adult women. Analyses of our qualitative and quantitative datasets show that volunteer CHWs are actually worse off than their peers in various psychosocial and economic respects, and that CHW recruitment processes are the most likely explanation for this difference. Additionally, the unpaid CHW position adds work to already burdened shoulders, and makes women-especially unmarried women-vulnerable to negative gossip and high levels of psychological distress. To a limited extent, the volunteer CHW position also bolsters married women's subjective socioeconomic status and confidence in achieving future gains in status. By showing that unpaid CHWs do not necessarily enjoy psychosocial benefits, and may experience harm as a result of their work, these findings reinforce the recommendation that CHWs in contexts of poverty be paid and better supported.

Food insecurity, mental distress and suicidal ideation in rural Africa: Evidence from Nigeria, Uganda and Ghana

BACKGROUND

In sub-Saharan Africa, mental and substance-related disorders account for 19% of all years lived with disability, yet the intersection between poverty and mental distress is poorly understood since most psychiatric research is conducted in high-income countries.

AIMS

To examine the prevalence of and associations between food insecurity, mental distress and suicidal ideation in three rural village clusters in sub-Saharan Africa.

METHOD

Cross-sectional multivariate analysis of sociodemographic variables associated with mental distress and suicidal ideation in three countries. The sample included 1,142 individuals from three rural village clusters in Nigeria ( n = 380), Uganda ( n = 380) and Ghana ( n = 382). Food insecurity was measured based on the number of months in the previous year that the respondent's family reported being 'unable to eat two square meals per day'. Mental distress was assessed using the Kessler non-specific psychological distress scale (K6) and suicidal ideation was measured using an item from PRIME-MD. Other sociodemographic variables included gender, age, literacy and occupation.

RESULTS

The prevalence of individuals with moderate or severe mental distress in Nigeria, Uganda and Ghana were higher than previously reported in the literature: 35.5%, 30.8% and 30.4%, respectively, and suicidal ideation rates were 29.7%, 21.3% and 10.9%. No differences were observed in mental distress between men and women in any of the sites. Being a farmer (vs student or other) was protective for mental distress in two sites (Uganda and Ghana) but no other social indicators, such as age, gender, literacy and food insecurity, were significantly associated with mental distress. Risk for suicidal ideation differed across sites: it was associated with food insecurity in Nigeria, female gender in Uganda, and older age in Uganda.

CONCLUSIONS

Mental distress and suicidal ideation were highly prevalent in three settings of extreme poverty across all groups, in ways that were not always consistent with the global literature. These findings suggest that more research is needed in to better understand the social etiology of mental distress in sub-Saharan Africa.

Food Insecurity and Subjective Wellbeing Among Arab Youth Living in Varying Contexts of Political Instability

PURPOSE

To investigate associations between food insecurity experience and subjective wellbeing in Arab youth, across different political stability settings.

METHODS

Data from the Gallup World Poll (2014-2015) were extracted for youth aged 15-24 years living in 19 Arab countries (n = 8,162). Food insecurity was assessed using the Food Insecurity Experience Scale. Life Evaluation Score and Affect Balance were used as indicators of youth wellbeing. The 2014 Political Stability and Absence of Violence and Terrorism score was used to stratify Arab countries into three categories; high, medium, and low political stability. Multivariable regressions were performed to explore the relationship between food insecurity and wellbeing indices adjusting for socio-demographic and socio-economic factors, across different political stability settings.

RESULTS

The prevalence of food insecurity among Arab youth ranged between 3.1% in Lebanon to 91.3% in South Sudan. Food insecurity (moderate and severe) was negatively correlated with life evaluation (β: -0.74 for moderate food insecurity; -1.28 for severe food insecurity, p-value <0.001), and affect balance (β: -22.03 for moderate food insecurity; -33.88 for severe food insecurity, p-value <0.001). These results were consistent across political stability groups, independently from socio-demographic and socio-economic factors. Fewer factors were correlated with life evaluation and affect balance in low as compared to medium and high political stability settings.

CONCLUSIONS

Food insecurity is an independent risk factor for Arab youth wellbeing. Efforts to improve youth wellbeing can be channelled through food security interventions.

Household food insecurity and coping strategies among pensioners in Jimma Town, South West Ethiopia

Background

Ethiopia is currently facing new challenges related to food insecurity among the urban poor. Pensioners are segments of the population with reduced income and working capacity because of advancement of age and other related problems. There is no empirical evidence on Jimma Town pensioner’s household food insecurity and coping strategies.

Methods

A cross-sectional study was conducted among households in Jimma Town living on an income obtained from a pension from March 01–28, 2017. Data were collected from 399 randomly selected participants. Data were entered into EPi-Data version 3.1 and analyzed using SPSS Version 20.0. Variables with p ≤ 0.25 in the bivariate analyses were entered into a multivariable regression model to control for confounding variables.

Results

Nearly, 83.5% of households were food insecure. The odds of food insecurity among households with heads attending secondary school and above was 78% lower when compared to that of households with uneducated household heads (AOR = 0.22, 95% CI: 0.97 to 0.49). The odds of food insecurity among households headed by merchants was 91% lower when compared to that of households headed by guards (AOR = 0.09, 95% CI: 0.03, 0.29). Food insecure households were using coping strategies such as changing consumption patterns (44%), eating inexpensive foods (72.4%), reducing meal frequency (62.4%) and selling household assets, such as household food utensils (30.8%). The odds of food insecurity among households having large family size (≥ 7) was 3.74 times higher when compared to that of households with family size less than three (AOR = 3.74(1.27_, 10.99).

Conclusions

Household food insecurity was associated with having households headed by uneducated, widowed and guard household heads and having large family size. Food insecure households used both consumption and asset-based coping strategies such as eating less preferred, lower quality or less expensive foods and receiving donation from relatives or friends. Government policies should consider revising the current social protection scheme for pensioners. Special attention should be given to widow pensioners and pensioners with low educational status and with large family sizes.

The impact of rising food prices on obesity in women: a longitudinal analysis of 31 low-income and middle-income countries from 2000 to 2014

OBJECTIVES

To examine whether changes in food prices are associated with changes in obesity prevalence among women in developing countries, and assess effect modification by individual socioeconomic status (SES).

METHODS

Longitudinal study of country-level food price inflation temporally and geographically linked to anthropometric data on non-pregnant adult women (n = 295,984) in 31 low-income and middle-income countries over the 2000-2014 time period, using separate multivariable multilevel growth models of five SES indicators. Post-estimation analysis computed the relationship between food price inflation and predicted mean probabilities of being obese, by SES.

RESULTS

Rising food price inflation was strongly associated with women's obesity prevalence, and SES consistently modified the relationship. Regardless of indicator used, higher food price inflation was positively associated with obesity among women in top SES categories, but was flat or negative among women in low SES categories, averaging over time. The SES differences were widest across educational strata and were most pronounced when food price inflation was highest. Overall, for every 1-unit increase in food price inflation, predicted mean obesity prevalence was between 0.02 and 0.06 percentage points greater in women of high SES compared to low SES women.

CONCLUSION

There is a strong link between food price inflation and obesity in adult women in developing countries which is clearly modified by individuals' SES. Greater food price inflation was associated with greater obesity prevalence only among women in higher SES groups, who may be net food buyers most at risk of obesity in low-income and middle-income countries.

Social connectedness is associated with food security among peri-urban Peruvian Amazonian communities

BACKGROUND

Food insecurity is a major global public health issue. Social capital has been identified as central to maintaining food security across a wide range of low- and middle-income country contexts, but few studies have examined this relationship through sociocentric network analysis.

OBJECTIVE

We investigated relationships between household- and community-level social connectedness, household food security, and household income; and tested the hypothesis that social connectedness modified the relationship between income and food security.

METHODS

A cross-sectional census with an embedded questionnaire to capture social relationships was conducted among eleven peri-urban communities. Community connectedness was related to study outcomes of food security and per-capita income through regression models.

RESULTS

Of 1520 households identified, 1383 were interviewed (91.0%) and 1272 (83.9%) provided complete data. Households in the youngest communities had the most total contacts, and the highest proportion of contacts outside of the community. Household income was also associated with more outside-community contacts (0.05 more contacts per standard deviation increase in income, p<0.001).Less food secure households reported more contacts nearby (0.24 increase in household food insecurity access scale (HFIAS) for each additional contact, p<0.001). After adjusting for household-level socioeconomic status, membership in an older, larger, and better-connected community, with a greater proportion of residents engaged in rural livelihood strategies, was associated with greater food security (-0.92 decrease in HFIAS for each one-unit increase in community mean degree, p=0.008). There was no evidence that social connectedness modified the relationship between income and food security such that lower-income households benefited more from community membership than higher-income households.

CONCLUSIONS

Although households reported networks that spanned rural villages and urban centers, contacts within the community, with whom food was regularly shared, were most important to maintaining food security. Interventions that build within-community connectedness in peri-urban settings may increase food security.

Food Insecurity and Risk of Depression Among Refugees and Immigrants in South Africa

South Africa's refugee population has grown considerably over the last decade. Both food insecurity and mental illness are common in developing countries, but this relationship remains unexamined in an African refugee population. 335 adult refugees in Durban, South Africa were interviewed using a self-report of food insecurity and the Hopkins Symptom Checklist-25. The proportion of those who responded 'often true' to not having enough food and eating less was 23.1 and 54.3 %, respectively. The proportion of individuals with a significant level of anxiety and depressive symptomatology was 49.4 and 54.6 %, respectively. The adjusted logistic regression indicated that not eating enough was significantly associated with anxiety (aOR = 4.52, 95 % CI: 2.09-9.80) and depression (aOR = 4.51, 95 % CI: 2.01-10.09). Similarly, eating less was significantly associated with anxiety (aOR = 2.88, 95 % CI: 1.56-5.31) and depression (aOR = 2.88, 95 % CI: 1.54-5.39). The high prevalence of food insecurity, and its relationship to mental illness, highlight the importance of addressing basic needs among this population.

Volunteers in Ethiopia's women's development army are more deprived and distressed than their neighbors: cross-sectional survey data from rural Ethiopia

BACKGROUND

Many Community Health Workers (CHWs) experience the same socioeconomic and health needs as their neighbors, given that they are by definition part of their communities. Yet very few studies aim to measure and characterize experiences of deprivation, poverty, and wellbeing among community health workers. This study quantitatively examines deprivation and wellbeing in Ethiopia's Women's Development Army (WDA), a massive unpaid community health workforce intended to improve population health and modernize the country.

METHODS

We conducted a survey of 422 volunteer WDA leaders and community members in rural Amhara state, part of a mixed-methods ethnographic study of the experiences of women in the WDA. The survey asked a variety of questions about respondents' demographics, education, assets, and access to government services. We also used survey measures to evaluate respondents' levels of household food and water security, stressful life events, social support, work burden, and psychological distress.

RESULTS

Volunteer WDA leaders and community members alike tend to have very low levels of schooling and household assets, and to be heavily burdened with daily work in several domains. Large proportions are food and water insecure, many are in debt, and many experience stretches of time with no money at all. Our survey also revealed differences between volunteer WDA leaders and other women that warrant attention. Leaders are less likely to be married and more likely to be divorced or separated. Leaders are also more likely to experience some aspects of food insecurity and report greater levels of psychological distress and more stressful life events. They also report slightly less social support than other women.

CONCLUSIONS

In rural Amhara, women who seek out and/or are sought and recruited for leader roles in the WDA are a population living in precarity. In several domains, they experience even more hardship than their neighbors. These findings highlight a need for careful attention and further research into processes of volunteer CHW selection, and to determine whether or not volunteering for CHW programs increases socioeconomic and health risks among volunteers. CHW programs in settings of poverty should stop using unpaid labor and seek to create more paid CHW jobs.

Household food insecurity and its association with morbidity report among school adolescent in Jimma zone, Ethiopia

Background Household food insecurity has a substantial contribution to poor health outcomes among young children and adolescents. Food insecurity also affects optimal cognitive development and physiological function of these vulnerable groups. There is a gap of documented data regarding the association of food insecurity and morbidity among school adolescents in Ethiopia. Objective The aim of this study is to assess the interrelationship of household food insecurity and morbidity report among school adolescent in Jimma zone, Ethiopia. Methods A community based cross-sectional study was done from October to November, 2013. Data were gathered using structured questionnaires through interview of students and their caregivers. A total of 1000 students were selected by using simple random sampling methods using their rosters as a frame. Data were also checked for missing values and outliers, and analyzed using SPSS version 16.0. Regression analyses were used to see the strength of association between independent and dependent variables using odds ratios and 95% of confidence intervals. Results Adolescents from food insecure households had more reported illness (39.3%) than adolescents from food secure households (24.7%) (p < 0.001). Adolescents from food insecure households were two times more exposed to morbidity [AOR = 2.04(1.32, 3.14)] than adolescents from food secure households. This study also showed that males had 48% less reported illness [AOR = 0.52(0.01, 0.23)] than females. Adolescents who had attended health education had less reported illness [AOR = 0.57(0.38, 0.86)] than those who did not ever attend. This study also showed that having a farmer [AOR = 0.46(0.28, 0.74)] and government employee [AOR = 0.33 (0.17, 0.64)] father were inversely associated with adolescent morbidity. Conclusion The findings of this study showed that household food insecurity, female gender and lack of attending health education had a significant contribution to adolescent morbidity. Therefore, there is a need to improve household income earning capacity and strengthen school based health and nutrition education to prevent adolescent morbidity. The findings of this study can also be used to lead the development of programs aimed at preventing adolescent morbidity by notifying policymakers and other stakeholders about the association of morbidity with household food insecurity.

Household water insecurity after a historic flood: Diarrhea and dehydration in the Bolivian Amazon

While 884 million people worldwide lack access to clean water, millions live in flood-prone regions. Unexpected flooding increases risk of diarrheal diseases and is expected to occur with increased frequency in the 21st century. Water insecurity is linked to mental distress in water scarce regions, yet this construct has not been examined closely among populations living in flood-prone regions. This paper examines how differences in water sources and lifestyle among Tsimane' forager-horticulturalists in lowland Bolivia are related to water insecurity after a historic flood in 2014, and in turn, how water insecurity is associated with diarrhea and dehydration. Pre-flood data come from qualitative interviews with 36 household heads, anthropometrics, participant observation, and water quality analysis between September 2013-January 2014 used to create a locally-adapted water insecurity questionnaire. Water insecurity was measured after the historic flood; no pre-flood water insecurity measures are available. Post-flood data were collected through surveys, water quality analysis, and health exams using near-exhaustive sampling in two villages, yielding 118 adults and 115 children (aged 2-12 years) in 62 households between March-April 2014. Overall, 89% of adults reported medium or high water insecurity. Only hand-pumps tested negative for pathogenic bacteria both pre- and post-flood. Tobit regressions suggest that hand-pumps (when available) and adult age were associated with lower water insecurity scores. Multiple logistic regressions suggest that adults with high water insecurity were more likely to report diarrhea than adults with low (Odds Ratio [OR] 9.2; 95% CI: 1.27-67.1). Children from households with medium (OR: 6.8; 95% CI: 1.41-32.5) or high (OR: 14.0; 95% CI: 2.40-81.5) water insecurity had significantly higher odds of dehydration than children in households with low water insecurity. Catastrophic flooding may systematically increase dimensions of household water insecurity. This research suggests an experience-based measure of water insecurity is associated with objective health outcomes.

Food (In)Security in Rapidly Urbanising, Low-Income Contexts

Urbanisation in low and middle-income nations presents both opportunities and immense challenges. As urban centres grow rapidly, inadequate housing and the lack of basic infrastructure and services affect a large and growing proportion of their population. There is also a growing body of evidence on urban poverty and its links with environmental hazards. There is, however, limited knowledge of how these challenges affect the ways in which poor urban residents gain access to food and secure healthy and nutritious diets. With some important exceptions, current discussions on food security continue to focus on production, with limited attention to consumption. Moreover, urban consumers are typically treated as a homogenous group and access to food markets is assumed to be sufficient. This paper describes how, for the urban poor in low and middle-income countries, food affordability and utilisation are shaped by the income and non-income dimensions of poverty that include the urban space.

Food Insecurity and Mental Health Status: A Global Analysis of 149 Countries

INTRODUCTION

This study sought to determine the association of individual-level food insecurity (FI) with mental health status across all global regions.

METHODS

Cross-sectional data were analyzed in 2016 from the 2014 Gallup World Poll, a series of globally implemented, nationally representative surveys. FI was assessed using the Food Insecurity Experience Scale Survey Module for Individuals, an eight-question psychometric scale reporting individuals' experiences of FI. Individual-level composite indices of mental health, the Negative Experience Index and Positive Experience Index (0-100 scale), were calculated based on responses to five questions of respondents' recent negative and positive experiences, respectively, associated with depression and mental distress.

RESULTS

The prevalence of any FI ranged from 18.3% in East Asia to 76.1% in Sub-Saharan Africa. In global analyses (149 countries) using adjusted multiple regression analyses, FI was associated in a dose-response fashion with poorer scores on the mental health indices (coefficient [95% CI]: Negative Experience Index: mild FI, 10.4 [9.5, 11.2]; moderate FI, 17.7 [16.4, 19.0]; severe FI, 24.5 [22.7, 26.3]; Positive Experience Index: mild FI, -8.3 [-9.3, -7.4]; moderate FI, -12.6 [-13.8, -11.3]; severe FI, -16.2 [-17.9, -14.5]). Within-region analyses (11 regions) consistently demonstrated the same trends.

CONCLUSIONS

FI is associated with poorer mental health and specific psychosocial stressors across global regions independent of SES. The numerous pathways via which FI may contribute to common mental disorders, and the broad social implications of FI linked to cultural norms and self-efficacy, may contribute to the cross-cultural consistency of the findings.

A Cross-Sectional Survey in Rural Bihar, India, Indicates That Nutritional Status, Diet, and Stimulation Are Associated with Motor and Mental Development in Young Children

Background: Many malnourished children in resource-poor settings fail to fulfill their developmental potential.Objective: The objectives of this analysis were to examine the nutritional, psychosocial, environmental, and household correlates of child development in Bihar, India, and identify mediators between dietary diversity and mental development.Methods: Using 2-stage cluster randomized sampling, we surveyed 4360 households with children 6-18 mo of age in the West Champaran district of Bihar. We measured motor and mental development with the use of the Developmental Milestones Checklist II. In a random subsample (n = 2838), we measured anthropometric characteristics and hemoglobin. Cluster-adjusted multiple linear regression analysis was used to examine the associations between nutrition indicators and development scores. Sobel's test was used to assess significant mediators in the association between diet diversity and development scores. Analyses were stratified by children 6-11 and 12-18 mo of age.Results: In all children, length-for-age z score (LAZ), dietary diversity, and psychosocial stimulation were significant (P < 0.05) correlates of motor development scores [(β coefficient ± SE) in children 6-11 mo: LAZ = 0.46 ± 0.08, dietary diversity = 0.43 ± 0.09, and stimulation = 0.15 ± 0.04; in children 12-18 mo: LAZ = 0.73 ± 0.07, dietary diversity = 0.30 ± 0.09, and stimulation = 0.31 ± 0.05] and mental development scores [(β coefficient ± SE) in children 6-11 mo: LAZ = 0.57 ± 0.10, dietary diversity = 0.84 ± 0.13, and stimulation = 0.54 ± 0.07; in children 12-18 mo: LAZ = 0.54 ± 0.11, dietary diversity = 0.40 ± 0.16, and stimulation = 0.62 ± 0.09]. Stimulation, gross motor development, and fine motor development were significant mediators in the relation between dietary diversity and mental development.Conclusion: Strategies to improve dietary diversity and psychosocial stimulation could have important implications for child development of young North Indian children. This trial was registered at clinicaltrials.gov as NCT02593136.

Poverty and perceived stress: Evidence from two unconditional cash transfer programs in Zambia

INTRODUCTION

Poverty is a chronic stressor that can lead to poor physical and mental health. This study examines whether two similar government poverty alleviation programs reduced the levels of perceived stress and poverty among poor households in Zambia.

METHOD

Secondary data from two cluster randomized controlled trials were used to evaluate the impacts of two unconditional cash transfer programs in Zambia. Participants were interviewed at baseline and followed over 36 months. Perceived stress among female caregivers was assessed using the Cohen Perceived Stress Scale (PSS). Poverty indicators assessed included per capita expenditure, household food security, and (nonproductive) asset ownership. Fixed effects and ordinary least squares regressions were run, controlling for age, education, marital status, household demographics, location, and poverty status at baseline.

RESULTS

Cash transfers did not reduce perceived stress but improved economic security (per capita consumption expenditure, food insecurity, and asset ownership). Among these poverty indicators, only food insecurity was associated with perceived stress. Age and education showed no consistent association with stress, whereas death of a household member was associated with higher stress levels.

CONCLUSION

In this setting, perceived stress was not reduced by a positive income shock but was correlated with food insecurity and household deaths, suggesting that food security is an important stressor in this context. Although the program did reduce food insecurity, the size of the reduction was not enough to generate a statistically significant change in stress levels. The measure used in this study appears not to be correlated with characteristics to which it has been linked in other settings, and thus, further research is needed to examine whether this widely used perceived stress measure appropriately captures the concept of perceived stress in this population.

Food Insecurity and Its Association With School Absenteeism Among Rural School Adolescents in Jimma Zone, Ethiopia

Studies showed that poor health and nutrition among school adolescents are major barriers to educational access and achievements in low-income countries. This school-based study was aimed to assess the association of school absenteeism and food insecurity among rural school adolescents from grades 5 to 8 in Jimma zone, Ethiopia. Regression analyses were used to see the strength of association between dependent and independent variables using odds ratio and 95% confidence intervals. Multivariable logistic regression analysis was used to identify the predictor of school absenteeism. Validated tools are used to collect household food insecurity data. Results showed that school absenteeism is significantly high among adolescents from food insecure households when compared to adolescents from food secure households ( P <.001). School absenteeism was negatively associated with male sex (adjusted odds ratio [AOR] = -0.91, 95% CI -1.85 to -0.03), household food security (adjusted odds ratio = -1.85, 95% CI -3.11 to -0.59), being an elder sibling (AOR = -0.37, 95% CI, -0.62 to -0.12), and mother involvement in decision making (AOR = -0.68, 95% CI, -1.33 to -0.03) while male-headed household was positively associated (AOR = 2.46, 95% CI, 1.37 to 4.56). Generally, this study showed that household food insecurity has significant contribution to school absenteeism among rural adolescents. Therefore, efforts should be made to improve household income earning capacity to reduce the prevalence of school absenteeism among rural school adolescents.

Household food insecurity and its association with school absenteeism among primary school adolescents in Jimma zone, Ethiopia

Background

Household food insecurity and lack of education are two of the most remarkable deprivations which developing countries are currently experiencing. Evidences from different studies showed that health and nutrition problems are major barriers to educational access and achievement in low-income countries which poses a serious challenge on effort towards the achieving Sustainable Development Goals. Evidence on the link between food security and school attendance is very important to address this challenge. This study aimed to assess to what extent food insecurity affects school absenteeism among primary school adolescents.

Methods

A school based cross-sectional study was conducted among primary school adolescents in Jimma zone from October-November, 2013. Structured questionnaire was used to collect data on the household food security and socio-demographic variables. Data were analyzed using SPSS for windows version 16.0 after checking for missing values and outliers. Multivariable logistic regression analyses were used to determine the association of school absenteeism and food insecurity with independent variables using odds ratio and 95 % of confidence intervals. Variables with p ≤ 0.25 in the bivariate analyses were entered into a multivariable regression analysis to control for associations among the independent variables.

Results

The frequency of adolescent school absenteeism was significantly high (50.20 %) among food insecure households (P < 0.001) compared to their peers whose households were food secure (37.89 %). Findings of multivariable logistic regression analysis also showed that household food insecurity [AOR = 2.81 (1.70, 4.76)] was positively associated with poor school attendance while female-headed household [AOR = 0.23 (0.07, 0.72)], urban residence [AOR = 0.52 (0.36, 0.81)] and male-gender [AOR = 0.64 (0.54, 0.74)] were inversely associated with school absenteeism. Household food insecurity was positively associated with lack of maternal education [AOR = 2.26 (0.57, 8.93)] and poor household economic status [AOR = 1.39 (1.18, 2.83)]. However, livestock ownership [AOR = 0.17 (0.06, 0.51)] was negatively associated with household food insecurity.

Conclusions

Findings of this study showed that household food insecurity has strong linkage with adolescent school absenteeism. Maternal education and household economic status were significantly associated with household food security status. Therefore, national policies and programs need to stress on how to improve family income earning capacity and socioeconomic status to handle household food insecurity which is a key contributor of adolescent school absenteeism.

Maternal resources and household food security: evidence from Nicaragua

OBJECTIVE

Women (especially mothers) are theorized as critical to reducing household food insecurity through their work and caregiver roles. The present study tests these assumptions, assessing how maternal economic and social resources are associated with food insecurity in households with young children.

DESIGN

Data from a population-based sample of households was collected in León, Nicaragua (n 443). Data include a newly validated measure of household food insecurity (ELCSA), maternal resource measures, and household economic status and demographics. Regression analysis tests the statistical associations (P<0·05) of maternal resources with household, adult-specific and child-specific food insecurity.

SETTING

Municipality of León, Nicaragua.

SUBJECTS

Households with children aged 3-11 years in rural and urban León.

RESULTS

Only 25% of households with young children were food secure, with 50% mildly food insecure and 25% moderately/severely food insecure. When mothers contributed substantially to household income, the odds of moderate/severe household food insecurity were 34% lower than when their spouse/partner was the main provider. The odds of food insecurity were 60% lower when mothers managed household money, 48% lower when mothers had a secondary (v. primary) education, 65% higher among single mothers and 16% lower with each indicator of social support. Results were similar for adult- and child-specific food insecurity.

CONCLUSIONS

This research provides new evidence that maternal economic and social resources are important for reducing household food insecurity and adult- and child-specific food insecurity. Women's social status, social support and access to economic resources need to be enhanced as a part of policies aimed to reduce food insecurity in high-poverty settings.

Vulnerability to food insecurity in urban slums: experiences from Nairobi, Kenya

Food and nutrition security is critical for economic development due to the role of nutrition in healthy growth and human capital development. Slum residents, already grossly affected by chronic poverty, are highly vulnerable to different forms of shocks, including those arising from political instability. This study describes the food security situation among slum residents in Nairobi, with specific focus on vulnerability associated with the 2007/2008 postelection crisis in Kenya. The study from which the data is drawn was nested within the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), which follows about 70,000 individuals from close to 30,000 households in two slums in Nairobi, Kenya. The study triangulates data from qualitative and quantitative sources. It uses qualitative data from 10 focus group discussions with community members and 12 key-informant interviews with community opinion leaders conducted in November 2010, and quantitative data involving about 3,000 households randomly sampled from the NUHDSS database in three rounds of data collection between March 2011 and January 2012. Food security was defined using the Household Food Insecurity Access Scale (HFIAS) criteria. The study found high prevalence of food insecurity; 85% of the households were food insecure, with 50% being severely food insecure. Factors associated with food security include level of income, source of livelihood, household size, dependence ratio; illness, perceived insecurity and slum of residence. The qualitative narratives highlighted household vulnerability to food insecurity as commonplace but critical during times of crisis. Respondents indicated that residents in the slums generally eat for bare survival, with little concern for quality. The narratives described heightened vulnerability during the 2007/2008 postelection violence in Kenya in the perception of slum residents. Prices of staple foods like maize flour doubled and simultaneously household purchasing power was eroded due to worsened unemployment situation. The use of negative coping strategies to address food insecurity such as reducing the number of meals, reducing food variety and quality, scavenging, and eating street foods was prevalent. In conclusion, this study describes the deeply intertwined nature of chronic poverty and acute crisis, and the subsequent high levels of food insecurity in urban slum settings. Households are extremely vulnerable to food insecurity; the situation worsening during periods of crisis in the perception of slum residents, engendering frequent use of negative coping strategies. Effective response to addressing vulnerability to household food insecurity among the urban poor should focus on both the underlying vulnerabilities of households due to chronic poverty and added impacts of acute crises.

Socioeconomic status, food security, and dental caries in US children: mediation analyses of data from the National Health and Nutrition Examination Survey, 2007-2008

OBJECTIVES

We examined associations of household socioeconomic status (SES) and food security with children's oral health outcomes.

METHODS

We analyzed 2007 and 2008 US National Health and Nutrition Examination Survey data for children aged 5 to 17 years (n = 2206) to examine the relationship between food security and untreated dental caries and to assess whether food security mediates the SES-caries relationship.

RESULTS

About 20.1% of children had untreated caries. Most households had full food security (62%); 13% had marginal, 17% had low, and 8% had very low food security. Higher SES was associated with significantly lower caries prevalence (prevalence ratio [PR] = 0.77; 95% confidence interval = 0.63, 0.94; P = .01). Children from households with low or very low food security had significantly higher caries prevalence (PR = 2.00 and PR = 1.70, respectively) than did children living in fully food-secure households. Caries prevalence did not differ among children from fully and marginally food-secure households (P = .17). Food insecurity did not appear to mediate the SES-caries relationship.

CONCLUSIONS

Interventions and policies to ensure food security may help address the US pediatric caries epidemic.