1
|
Pengpid S, Peltzer K. Longitudinal Associations Between Food Insecurity and Mental Health in Aging Adults in South Africa. Clin Gerontol 2024:1-9. [PMID: 38600746 DOI: 10.1080/07317115.2024.2341328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVES The aim of this study was to assess the longitudinal unidirectional and bidirectional associations between food insecurity and mental health among aging adults in South Africa. METHODS The analysis utilized data from the South African 7-year longitudinal Health and Ageing in Africa (HAALSI) study. RESULTS The proportion of food insecurity was 20.2% in 2015, 24.1% in 2019 and 18.4% in 2021/2022. Food insecurity was positively associated depressive symptoms, poor life satisfaction, poor sleep quality, PTSD, loneliness, impaired cognition, and current tobacco use. Compared to without food insecurity in all three study waves, having food insecurity in one wave and/or two to three waves was positively associated with incident depressive symptoms, incident poor life satisfaction, incident poor sleep quality, incident PTSD, incident loneliness, incident current tobacco use, and incident current heavy alcohol use. PTSD, impaired cognition, current tobacco use and current heavy alcohol use were positively associated with incident food insecurity. CONCLUSION We found that food insecurity was unidirectionally associated with depressive symptoms, poor life satisfaction, poor sleep quality and loneliness, and bidirectionally associated with PTSD, impaired cognition, current tobacco use and current heavy alcohol use. CLINICAL IMPLICATIONS Enhanced screening and management of food insecurity may reduce mental ill-health in South Africa.
Collapse
Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| |
Collapse
|
2
|
Osei-Owusu C, Dhillon S, Luginaah I. The impact of food insecurity on mental health among older adults residing in low- and middle-income countries: A systematic review. PLoS One 2024; 19:e0301046. [PMID: 38530847 PMCID: PMC10965102 DOI: 10.1371/journal.pone.0301046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
Over the past few years, food insecurity has been increasing globally due to the COVID-19 pandemic, climate change, economic downturns and conflict and a number of other intersecting factors. Older adults residing in low- and middle-income countries are more vulnerable to food insecurity. While the impacts of food insecurity on physical health outcomes have been thoroughly researched, the effect on mental health outcomes remains under-researched, especially among older adults. Hence, this systematic review aims to investigate existing literature to assess how food insecurity impacts the mental health of older persons residing in LMICs. A systematic search of six databases and Google for studies was conducted. The search was limited to studies written in English and published between 2000 to the present. We identified 725 studies, out of which 40 studies were selected for a full-text review and 12 studies were included for a final analysis. The significant finding in all the included studies was that food insecurity is associated with the worsening mental health of older adults. We also found a complex interplay of factors such as gender, age, rural/urban and health conditions associated with the aggravation of several mental health outcomes. The findings of this study illuminate the need for improved food programs to improve food security and, consequently, mental health among older adults.
Collapse
Affiliation(s)
- Cornelius Osei-Owusu
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Satveer Dhillon
- Department of Geography and Environment, Western University, London, Ontario, Canada
| | - Isaac Luginaah
- Department of Geography and Environment, Western University, London, Ontario, Canada
| |
Collapse
|
3
|
Phulkerd S, Thapsuwan S, Chamratrithirong A, Gray RS, Pattaravanich U, Ungchusak C, Saonuam P. Financial Hardship on Food Security in Ageing Populations. Int J Public Health 2023; 68:1605755. [PMID: 38155688 PMCID: PMC10752981 DOI: 10.3389/ijph.2023.1605755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 11/29/2023] [Indexed: 12/30/2023] Open
Abstract
Objective: This study investigated the prevalence of food security, and the association of food security with financial hardship and socio-demographic characteristics among the ageing population in Thailand. Methods: The study extracted data on 1,197 persons age 60 years or older from a nationally-representative sample survey of Thai households. The food security data were collected using the Food Insecurity Experience Scale (FIES), developed by the Food and Agriculture Organization. Multiple regression analysis was used to investigate the association between financial hardship, socio-demographic characteristics, and food security. Results: Of the total sample, 71% had food security. The least probability of having food security was observed in the respondents who sometimes and often had income problems (p < 0.001), and felt dissatisfied with their financial situation (p < 0.001). The respondents who were female, at oldest-old age, with lower than primary school education and in the Northeast were less likely to have food security. Conclusion: These findings suggest the need for government assistance for those who are experiencing financial hardship to help them manage their finances and food security more effectively, taking into account different socio-demographic characteristics.
Collapse
Affiliation(s)
- Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Salaya, Thailand
| | - Sasinee Thapsuwan
- Institute for Population and Social Research, Mahidol University, Salaya, Thailand
| | | | | | | | | | | |
Collapse
|
4
|
Alum EU, Obeagu EI, Ugwu OP, Samson AO, Adepoju AO, Amusa MO. Inclusion of nutritional counseling and mental health services in HIV/AIDS management: A paradigm shift. Medicine (Baltimore) 2023; 102:e35673. [PMID: 37832059 PMCID: PMC10578718 DOI: 10.1097/md.0000000000035673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection is a public health challenge that can degenerate into acquired immunodeficiency syndrome (AIDS) if not properly managed. HIV infection shortens life expectancy to about 5 to 10 years compared to noninfected individuals. People living with HIV/AIDS (PLWHA) are prone to several health challenges as a result of a deranged immune system culminating in high morbidity and mortality. Depression is a common feature of PLWHA. Depression heightens the emergence of opportunistic infections in HIV-infected individuals, accelerates the progression to AIDS, and increased suicidal tendencies, morbidity, and mortality. Food insecurity with its resultant undernutrition contributes to HIV/AIDS-related deaths. Undernourished PLWHA are more prone to opportunistic infections due to poor immunity. Interestingly, proper diet intake can boost immunity, slow the progression of AIDS and opportunistic infections, enhance body weight, and retard depression tendencies. Undernutrition can also be ameliorated by incorporating nutritional counseling and oral nutrient supplementation in routine HIV/AIDS checkups. Therefore, to increase HIV/AIDS management outcomes, the integration of nutrition counseling, dietary supplements, and mental health services should be embraced. Thus, HIV/AIDS care centers should amplify these services. In this article, we isolated relevant studies from various databases, illuminated the interwoven relationship between HIV/AIDS, depression, and undernutrition, and also reemphasized the need for adequate nutritional intervention in the battle against HIV/AIDS. Thus, this study provides a reawakening call to focus on incorporating nutritional guides and mental health care in HIV/AIDS management protocols.
Collapse
Affiliation(s)
- Esther U. Alum
- Department of Publications and Extension, Kampala International University, Kampala, Uganda
- Department of Biochemistry, Faculty of Science, Ebonyi State University, Ebonyi State, Nigeria
| | | | - Okechukwu P.C. Ugwu
- Department of Publications and Extension, Kampala International University, Kampala, Uganda
| | | | | | - Mariam O. Amusa
- Department of Botany and Plant Biotechnology, University of Johannesburg, Johannesburg, South Africa
| |
Collapse
|
5
|
Ogbu CE, Oparanma CO, Ogbu SC, Ujah OI, Chinenye NS, Ogbu CP, Kirby RS. Neighborhood Unsafety, Discrimination, and Food Insecurity among Nigerians Aged 15-49. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6624. [PMID: 37681764 PMCID: PMC10487487 DOI: 10.3390/ijerph20176624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023]
Abstract
We investigated the association between discrimination, neighborhood unsafety, and household food insecurity (FI) among Nigerian adults, as well as the gender-specific differences in these associations. Our analysis utilized data from the 2021 Multiple Indicator Cluster Survey (MICS), comprising 56,146 Nigerian adults aged 15-49 (17,346 males and 38,800 females). For bivariate analysis, we employed the Rao-Scott chi-square test to examine the relationship between predictors (discrimination, neighborhood unsafety, and a composite variable of both) and the outcome variable (FI). Food insecurity was assessed using both a dichotomous measure (food insecure vs. food secure) and a multinomial variable (food secure, mild FI, moderate FI, and severe FI). To model the association between predictors and FI while controlling for potential confounding factors, we utilized weighted binary and multinomial logistic regression. Among Nigerian adults, the prevalence of having ever experienced FI was 86.1%, with the prevalence of mild FI, moderate FI, and severe FI being 11.5%, 30.1%, and 44.5%, respectively. In the binary model, experiencing discrimination (OR = 1.36, 95% CI = 1.19-1.55), living in an unsafe neighborhood (OR = 1.33, 95% CI = 1.14-1.54), and facing both discrimination and unsafe neighborhood conditions (OR = 1.97, 95% CI = 1.57-2.48) were significantly associated with FI. In the multinomial model, discrimination, neighborhood unsafety, and experiencing both remained associated with moderate and severe FI. In the gender-specific models, discrimination and neighborhood unsafety were found to be significantly associated with FI in women but not in men. This study underscores the importance of implementing policies and programs that address the underlying causes of food insecurity, with specific attention to discrimination and neighborhood safety concerns, particularly for Nigerian women.
Collapse
Affiliation(s)
- Chukwuemeka E. Ogbu
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA; (C.E.O.); (O.I.U.)
| | - Chisa O. Oparanma
- Department of Medicine, Kharkiv National Medical University, 61022 Kharkiv, Ukraine;
| | - Stella C. Ogbu
- Department of Biomedical Science, School of Medicine, Tulane University, New Orleans, LA 70112, USA;
| | - Otobo I. Ujah
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA; (C.E.O.); (O.I.U.)
| | - Ndugba S. Chinenye
- Department of Medical Sciences, University of Arizona, Tucson, AZ 85721, USA;
| | - Chidera P. Ogbu
- Department of Biochemistry, Saint Joseph’s University, Philadelphia, PA 19074, USA;
| | - Russell S. Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA; (C.E.O.); (O.I.U.)
| |
Collapse
|
6
|
Amoak D, Braimah JA, Agyemang-Duah W, Sano Y, Osei-Kye N, Anfaara FW, Antabe R, Dassah E. Understanding the association between unmet dental care needs and household food security status among older people in Ghana. BMC Oral Health 2023; 23:323. [PMID: 37231472 DOI: 10.1186/s12903-023-03019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023] Open
Abstract
The literature recognizes food insecurity as a barrier to access to health care services. However, we know very little about the association between food insecurity and unmet dental care needs among older people in Ghana. To address this void in the literature, this study uses a representative survey of adults aged 60 or older from three regions in Ghana to examine whether older people who experienced household food insecurity differently report unmet dental care needs in comparison to their counterparts without any food insecurity. We find that 40% of older adults reported unmet dental care needs. Results from logistic regression analysis show that older people who experienced severe household food insecurity were more likely to report unmet dental care needs, compared to those who did not experience any type of food insecurity, even after accounting for theoretically relevant variables (OR = 1.94, p < 0.05). Based on these findings, we discuss several implications for policymakers and directions for future research.
Collapse
Affiliation(s)
- Daniel Amoak
- Department of Geography and Environment, Western University, London, Canada
| | | | | | - Yujiro Sano
- Department of Sociology, Nipissing University, North Bay, ON, Canada
| | - Nancy Osei-Kye
- Department of Gender, Sexuality, and Women's Studies, Western University, London, Canada
| | - Florence Wullo Anfaara
- Department of Gender, Sexuality, and Women's Studies, Western University, London, Canada
| | - Roger Antabe
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada
| | - Ebenezer Dassah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| |
Collapse
|
7
|
Militao EMA, Uthman OA, Salvador EM, Vinberg S, Macassa G. Food Insecurity and Associated Factors among Households in Maputo City. Nutrients 2023; 15:nu15102372. [PMID: 37242255 DOI: 10.3390/nu15102372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Food insecurity (FI) is a global concern and is one of the main causes of malnutrition in low- and middle-income countries. In Mozambique, the burden of FI and how various factors contribute to FI is not well known. This study aimed to investigate the prevalence of FI and its associated factors in southern Mozambique. Data from 1842 household heads in Maputo City were analyzed in a cross-sectional design. Food insecurity was measured using a modified version of the US Department of Agriculture Household Food Security scale, and its association with socio-demographic factors was assessed through multiple regressions. Altogether, 79% of the households were food insecure; of these, 16.6% had mild FI, 28.1% moderate and 34.4% severe FI. The study revealed that low-income households, those with less educated heads, and those engaged in informal work were significantly more prone to FI. Likewise, dietary diversity and the number of meals were also significant predictors of FI. These findings suggest the need for decent work and job creation, which calls for joint efforts from government, the private sector, and international institutions. Furthermore, these key drivers should be considered in the development of public health policies and programs designed to alleviate household FI and malnutrition in Mozambique.
Collapse
Affiliation(s)
- Elias M A Militao
- Department of Health Sciences, Faculty of Humanities, Mid Sweden University, Holmgatan 10, 851 70 Sundsvall, Sweden
- Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, Kungsbacksvägen 47, 801 76 Gävle, Sweden
- Department of Biological Sciences, Faculty of Science, Eduardo Mondlane University, 3453 Julius Nyerere Avenue, Maputo 257, Mozambique
| | - Olalekan A Uthman
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Health Sciences, Stellenbosch University, Francie van Zijl Drive, Cape Town 7505, South Africa
| | - Elsa M Salvador
- Department of Biological Sciences, Faculty of Science, Eduardo Mondlane University, 3453 Julius Nyerere Avenue, Maputo 257, Mozambique
| | - Stig Vinberg
- Department of Health Sciences, Faculty of Humanities, Mid Sweden University, Holmgatan 10, 851 70 Sundsvall, Sweden
| | - Gloria Macassa
- Department of Health Sciences, Faculty of Humanities, Mid Sweden University, Holmgatan 10, 851 70 Sundsvall, Sweden
- Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, Kungsbacksvägen 47, 801 76 Gävle, Sweden
- EPI Unit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal
| |
Collapse
|
8
|
Dent E, Wright ORL, Woo J, Hoogendijk EO. Malnutrition in older adults. Lancet 2023; 401:951-966. [PMID: 36716756 DOI: 10.1016/s0140-6736(22)02612-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 01/29/2023]
Abstract
Malnutrition is a highly prevalent condition in older adults, and poses a substantial burden on health, social, and aged-care systems. Older adults are vulnerable to malnutrition due to age-related physiological decline, reduced access to nutritious food, and comorbidity. Clinical guidelines recommend routine screening for malnutrition in all older adults, together with nutritional assessment and individually tailored nutritional support for older adults with a positive screening test. Nutritional support includes offering individualised nutritional advice and counselling; oral nutritional supplements; fortified foods; and enteral or parenteral nutrition as required. However, in clinical practice, the incorporation of nutritional guidelines is inadequate and low-value care is commonplace. This Review discusses the current evidence on identification and treatment of malnutrition in older adults, identifies gaps between evidence and practice in clinical care, and offers practical strategies to translate evidence-based knowledge into improved nutritional care. We also provide an overview of the prevalence, causes, and risk factors of malnutrition in older adults across health-care settings.
Collapse
Affiliation(s)
- Elsa Dent
- Research Centre for Public Health, Equity & Human Flourishing, Torrens University Australia, Adelaide, SA, Australia.
| | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Jean Woo
- Department of Medicine and Therapeutics and Centre for Nutritional Studies, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong Special Administrative Region, China
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science and Department of General Practice, Location VU University Medical Center, Amsterdam UMC, Amsterdam, Netherlands; Amsterdam Public Health research institute and Ageing & Later Life Research Program, Amsterdam UMC, Amsterdam, Netherlands; Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| |
Collapse
|
9
|
Cai J, Bidulescu A. The association between chronic conditions, COVID-19 infection, and food insecurity among the older US adults: findings from the 2020-2021 National Health Interview Survey. BMC Public Health 2023; 23:179. [PMID: 36703149 PMCID: PMC9880360 DOI: 10.1186/s12889-023-15061-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND This study aims to examine how the presence of chronic conditions or positive COVID-19 infection (as exposures) is related to food insecurity (as an outcome) in the older population and whether there is a dose-response relationship between the number of chronic conditions and the severity of food insecurity. METHODS Cross-sectional data of 17,977 older adults (≥ 65 years) from the 2020-2021 National Health Interview Survey were analyzed. Chronic conditions included physical health conditions (i.e., arthritis, coronary heart diseases, hypertension, stroke, prediabetes, diabetes, asthma, chronic obstructive pulmonary disease, and disability) and mental health conditions (i.e., anxiety and depression disorder). COVID-19 infection status was determined by a self-reported diagnosis of COVID-19. Household food insecurity was measured using the 10-item US Department of Agriculture (USDA) Food Security Survey Module with a 30-day look-back window. Multinomial logistic regression models were used to examine the association between health conditions and food insecurity controlling for socio-demographic factors. RESULTS Our results indicated that 4.0% of the older adults lived in food-insecure households. The presence of chronic conditions was significantly associated with higher odds of being food insecure independent of socio-demographic factors (AOR ranged from 1.17 to 3.58, all p < 0.0001). Compared with participants with 0-1 chronic condition, the odds of being (low or very low) food insecure was 1.09 to 4.07 times higher for those with 2, or ≥ 3 chronic conditions (all p < 0.0001). The severity of food insecurity significantly increased as the number of chronic conditions increased (p for trend < 0.0001). Besides, COVID-infected participants were 82% more likely to be very low food secure than the non-infected participants (AOR = 1.82, 95% CI: 1.80, 1.84). CONCLUSIONS The presence of chronic conditions or positive COVID-infection is independently associated with household food insecurity. Clinical health professionals may help identify and assist individuals at risk of food insecurity. Management and improvement of health conditions may help reduce the prevalence and severity of food insecurity in the older population.
Collapse
Affiliation(s)
- Jiahui Cai
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, USA.
| | - Aurelian Bidulescu
- grid.411377.70000 0001 0790 959XDepartment of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN USA
| |
Collapse
|
10
|
Amoak D, Braimah JA, Agyemang-Duah W, Kye NO, Anfaara FW, Sano Y, Antabe R. Understanding the Link between Household Food Insecurity and Self-Rated Oral Health in Ghana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010121. [PMID: 36612441 PMCID: PMC9819873 DOI: 10.3390/ijerph20010121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 05/31/2023]
Abstract
There is increasing scholarly attention on the role of food insecurity on the health of older adults in sub-Saharan Africa, including Ghana. Yet, we know very little about the association between food insecurity and self-rated oral health. To address this void in the literature, this study uses a representative survey of adults aged 60 or older from three regions in Ghana to examine whether respondents who experienced household food insecurity rated their oral health as poor compared to their counterparts who did not. We found that 34% of respondents rated their oral health as poor, while 7%, 21%, and 36% experienced mild, moderate, and severe food insecurity, respectively. Moreover, the results from the logistic regression analysis showed that older adults who experienced mild (OR = 1.66, p < 0.05), moderate (OR = 2.06, p < 0.01), and severe (OR = 2.71, p < 0.01) food insecurity were more likely to self-rate their oral health as poor, compared to those who did not experience any type of food insecurity. Based on these findings, we discuss several implications for policymakers and directions for future research.
Collapse
Affiliation(s)
- Daniel Amoak
- Department of Geography and Environment, Western University, London, ON N6A 5C2, Canada
| | - Joseph Asumah Braimah
- Department of Health and Society, University of Toronto Scarborough, Scarborough, ON M1C 1A4, Canada
| | | | - Nancy Osei Kye
- Department of Gender, Sexuality, and Women’s Studies, Western University, London, ON N6A 5B8, Canada
| | - Florence Wullo Anfaara
- Department of Gender, Sexuality, and Women’s Studies, Western University, London, ON N6A 5B8, Canada
| | - Yujiro Sano
- Department of Sociology and Anthropology, Nipissing University, North Bay, ON P1B 8L7, Canada
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Scarborough, ON M1C 1A4, Canada
| |
Collapse
|