1
|
Linnemayr S, Wagner Z, Saya UY, Stecher C, Lunkuse L, Wabukala P, Odiit M, Mukasa B. Behavioral Economic Incentives to Support HIV Care: Results From a Randomized Controlled Trial in Uganda. J Acquir Immune Defic Syndr 2024; 96:250-258. [PMID: 38534162 PMCID: PMC11192614 DOI: 10.1097/qai.0000000000003420] [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: 08/01/2023] [Accepted: 03/01/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND This study tests behavioral economics incentives to improve adherence to antiretroviral treatment (ART), with 1 approach being low cost. SETTING Three hundred twenty-nine adults at Mildmay Hospital in Kampala, Uganda, on ART for at least 2 years and showing adherence problems received the intervention for about 15 months until the study was interrupted by a nation-wide COVID-19 lockdown. METHODS We randomized participants into 1 of 3 (1:1:1) groups: usual care ("control" group; n = 109) or 1 of 2 intervention groups where eligibility for nonmonetary prizes was based on showing at least 90% electronically measured ART adherence ("adherence-linked" group, n = 111) or keeping clinic appointments as scheduled ("clinic-linked"; n = 109). After 12 months, participants could win a larger prize for consistently high adherence or viral suppression. Primary outcomes were mean adherence and viral suppression. Analysis was by intention-to-treat using linear regression. This trial is registered with ClinicalTrials.gov, NCT03494777 . RESULTS Neither incentive arm increased adherence compared with the control; we estimate a 3.9 percentage point increase in "adherence-linked" arm [95% confidence interval (CI): -0.70 to 8.60 ( P = 0.10)] and 0.024 in the "clinic-linked" arm [95% CI: -0.02 to 0.07 ( P = 0.28)]. For the prespecified subgroup of those with initial low adherence, incentives increased adherence by 7.60 percentage points (95% CI: 0.01, 0.15; P = 0.04, "adherence-linked") and 5.60 percentage points (95% CI: -0.01, 0.12; P = 0.10, "clinic-linked"). We find no effects on clinic attendance or viral suppression. CONCLUSIONS Incentives did not improve viral suppression or ART adherence overall but worked for the prespecified subgroup of those with initial low adherence. More effectively identifying those in need of adherence support will allow better targeting of this and other incentive interventions.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Mary Odiit
- Mildmay Uganda Hospital, Kampala, Uganda
| | | |
Collapse
|
2
|
Ujah OI, Ocheke AN, Olagbuji BN. Is household food insecurity associated with social attitudes accepting of physical intimate partner violence against women in Nigeria? A population-level cross-sectional study. BMJ Open 2024; 14:e082760. [PMID: 38866566 PMCID: PMC11177683 DOI: 10.1136/bmjopen-2023-082760] [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: 12/02/2023] [Accepted: 05/28/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVES Although prior research suggests that household food insecurity (HFI) is associated with intimate partner violence against women (IPVAW), there is a paucity of research regarding its impact on attitudes accepting of IPVAW. We examined whether individuals experiencing HFI are more likely to accept physical IPVAW, whether the association varies by gender and whether it persists when models are adjusted for other confounders. DESIGN Population-level cross-sectional analysis. SETTING This study used the round 6 of the UNICEF-supported Multiple Indicator Cluster Survey (MICS) conducted in Nigeria. PARTICIPANTS The sample included 23 200 women and 7087 men, aged 15-49 years, who were currently married or in union and responded to the attitudes towards domestic violence and HFI modules in the MICS. OUTCOME MEASURES AND STATISTICAL ANALYSIS Attitudinal acceptance of physical IPVAW (specific forms and overall). We conducted weighted multivariable logistic regression to estimate the OR and their corresponding 95% CIs of the associations of food insecurity (FI) with attitudinal acceptance of physical IPVAW, adjusting for potential confounders. RESULTS Multivariable results indicate that severe HFI was positively associated with attitudinal acceptance physical IPVAW in at least one of the scenarios presented (aOR=1.11; 95% CI: 1.01 to 1.22). Individuals experiencing severe HFI had higher odds of physical IPVAW acceptance when wife neglects the children (aOR=1.15; 95% CI: 1.02 to 1.31). The likelihood of physical IPVAW acceptance if wife burns the food was lower for women experiencing moderate HFI (aOR=0.86; 95% CI: 0.74 to 0.99). Stratified analyses indicated heterogeneity in the association between HFI and attitudinal acceptance of physical IPVAW by gender. CONCLUSION Our findings indicate that, depending on the severity, FI status may be associated with attitudinal acceptance of physical IPVAW, with potential variations based on gender. The public health implications are discussed.
Collapse
Affiliation(s)
- Otobo I Ujah
- Department of Obstetrics and Gynaecology, Federal University of Health Sciences Otukpo, Otukpo, Nigeria
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Amaka N Ocheke
- Department of Obstetrics and Gynecology, University of Jos, Jos, Plateau, Nigeria
| | - Biodun N Olagbuji
- Department of Obstetrics and Gynecology, Ekiti State University, Ado Ekiti, Ekiti, Nigeria
| |
Collapse
|
3
|
Amoak D, Antabe R, Braimah JA, Agyemang-Duah W, Sano Y, Luginaah I. Exploring the association of self-rated oral health with self-rated general and mental health among older adults in a resource-poor context: Insights for advancing Sustainable Development Goal 3. SPECIAL CARE IN DENTISTRY 2024. [PMID: 38863160 DOI: 10.1111/scd.13033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/27/2024] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Older adults in Ghana have been disproportionately affected by oral health issues such as caries and periodontitis. This situation calls for comprehensive attention within health and healthcare policies, due to the established connections between oral health and other aspects of health and well-being in high-income countries, including physical and mental health. However, there is a significant gap in the literature when it comes to exploring the association of oral health with physical and mental health in resource-constrained settings like Ghana. METHODS To address this void, we collected a cross-sectional sample comprising older adults aged 60 and above (n = 1073) and analyzed self-rated health measures to investigate the relationship between oral health and general and mental health in Ghana. RESULTS The results of our logistic regression analysis revealed a significant association: older adults who reported poor oral health were more likely to rate their general (OR = 5.10; p < .001) and mental health (OR = 4.78, p < .001) as poor, compared to those with good oral health, even after accounting for demographic and socioeconomic variables. CONCLUSIONS Based on these findings, we discuss the policy implications of our findings, especially in the context of advancing Sustainable Development Goal 3 in Ghana and other resource-constrained settings.
Collapse
Affiliation(s)
- Daniel Amoak
- Department of Geography and Environment, Western University, London, Canada
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Canada
| | | | | | - Yujiro Sano
- Department of Sociology and Anthropology, Nipissing University, North Bay, Canada
| | - Isaac Luginaah
- Department of Geography and Environment, Western University, London, Canada
| |
Collapse
|
4
|
Amoak D, Antabe R, Sano Y. Toward Ending Violence Against Women: The Association of Intimate Partner Violence With Food Security Status Among Ever-Married Women in Cameroon. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241255731. [PMID: 38808963 DOI: 10.1177/08862605241255731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Despite an extensive body of literature that explores potential mechanisms explaining the factors associated with intimate partner violence (IPV) experienced by women, very few studies have studied the association of food security status with women's experience of IPV in sub-Saharan Africa countries, including Cameroon. Using data from the 2018 Cameroon Demographic and Health Survey (n = 4,690), we explore the association between food security status and three distinct forms of IPV (i.e., emotional, sexual, and physical IPV) among ever-married women in Cameroon. Adjusting for socioeconomic, demographic, and attitudinal and behavioral characteristics, we found that women with severe (odds ratio [OR] = 2.09, p < .01), moderate (OR = 1.88, p < .05), and mild (OR = 1.76, p < .05) food insecurity were more likely to experience sexual IPV, compared to those without any food insecurity, whereas women with severe food insecurity were more likely to experience physical IPV (OR = 1.89, p < .001). Although women with severe (OR = 1.51, p < .01) and moderate (OR = 1.67, p < .001) food insecurity had a higher likelihood of experiencing emotional IPV at a bivariate level, we found that these associations became no longer significant in our adjusted model. These findings suggest that food insecurity is a critical risk factor for IPV among ever-married women in Cameroon. Addressing IPV requires a comprehensive strategy that places special emphasis on households experiencing food insecurity. There is also an urgent need to implement educational programs to increase awareness of the interconnection between food insecurity and IPV and to allocate resources to community-based initiatives that empower women both economically and socially.
Collapse
|
5
|
Anjum A, Mousum S, Ratan ZA, Salwa M, Khan MMH, Islam MT, Arafat SMY, Haque MA. Health-related quality of life (HRQoL) and associated factors in Bangladeshi adolescents during COVID-19. Health Sci Rep 2024; 7:e1927. [PMID: 38390353 PMCID: PMC10883089 DOI: 10.1002/hsr2.1927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/12/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Background and Aims The COVID-19 pandemic and its accompanying countermeasures significantly disrupt the health-related quality of life (HRQoL) of adolescents. We aimed to estimate the status and associated factors related to HRQoL of adolescents during the COVID-19 pandemic from the community population of Bangladesh. Methods This cross-sectional study followed two-stage sampling. From eight administrative divisions of Bangladesh, 2030 adolescents were enrolled. The KIDSCREEN-10 index was used to measure the HRQoL of adolescents. In addition to this, adolescents' data on sociodemographics, mental well-being, parenting style, insomnia, food insecurity, depression, anxiety and stress, resilient coping, screen-based activity, and anthropometry were taken for finding out the factors associated with HRQoL of adolescents. The hierarchical multilinear regression was performed to assess the association. Results More than 47% of adolescents were found to have moderate and high HRQoL, while 4.7% of adolescents experienced low HRQoL during data collection. Higher age (B: -0.671), having more siblings (B: -0.316), food insecurity (B: ‒2.010), depression (B: ‒0.321), anxiety (B: ‒0.362), and stress (B: ‒0.150) were found to have significantly negative associations with adolescents' HRQoL during the COVID-19 pandemic. Whereas, positive parenting (B: 0.409), inconsistent parenting discipline (B: 0.266), good mental health (B: 5.662), resilient coping (B: 0.306) were found to have significant positive relationships. Conclusions The findings from this study indicate that over 52% of the adolescents reported a moderate and lower level of HRQoL. In light of these results, it may be beneficial to prioritize interventions targeting psychological factors such as depression, anxiety, and stress.
Collapse
Affiliation(s)
- Afifa Anjum
- Department of Psychiatry University of Cambridge Cambridge UK
- Department of Public Health and Informatics Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh
| | - Sabrina Mousum
- Department of Public Health and Informatics Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh
| | - Zubair Ahmed Ratan
- Department of Biomedical Engineering Khulna University of Engineering and Technology Khulna Bangladesh
- School of Health & Society, Faculty of The Arts, Social Sciences and Humanities University of Wollongong Wollongong New South Wales Australia
| | - Marium Salwa
- Department of Public Health and Informatics Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh
| | - Md Maruf H Khan
- Department of Public Health and Informatics Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh
| | - Mohammad Tanvir Islam
- Department of Internal Medicine Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh
| | - S M Yasir Arafat
- Department of Psychiatry Enam Medical College and Hospital Dhaka Bangladesh
| | - M Atiqul Haque
- Department of Public Health and Informatics Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh
| |
Collapse
|
6
|
Al-kassab-Córdova A, Villarreal-Zegarra D, Bendezu-Quispe G, Robles-Valcárcel P, Herrera-Añazco P, Benites-Zapata VA. Socio-demographic, migratory and health-related determinants of food insecurity among Venezuelan migrants in Peru. Public Health Nutr 2023; 26:2982-2994. [PMID: 37944992 PMCID: PMC10755391 DOI: 10.1017/s1368980023002513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/23/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To evaluate the factors associated with food insecurity (FI) among Venezuelan migrants residing in Peru. Secondarily, to evaluate the psychometric properties of the Food Insecurity Experience Scale (FIES). DESIGN A cross-sectional study based on secondary data analysis of the 2022 Venezuelan Population Residing in Peru Survey (ENPOVE-2022, from the Spanish acronym) was conducted. FI was measured with the FIES, whose properties were tested using the Rasch model. Multinomial logistic regression was performed to estimate relative prevalence ratios with their corresponding 95 % confidence intervals. SETTING This survey was conducted in February and March 2022 in the eight cities most populated by Venezuelan migrants and refugees in Peru. PARTICIPANTS Venezuelan migrants and refugees over the age of 18 years living in Peru. RESULTS A total of 7727 participants were included. Rasch reliability was adequate (0·73). The prevalence of mild, moderate and severe FI was 36·71 %, 31·14 % and 10·48 %, respectively. Being aged 25-34 and 35-44 years, unemployed, uninsured, having no formal education or secondary, illegal status, living in a dwelling with 2-4 and more than 4 people, presenting one or more than one chronic disease, residing in Peru for 0-6 months and perceived discrimination were associated with a higher probability of moderate FI. Furthermore, having secondary education, being unemployed, uninsured, never married, illegal, residing in Tumbes, presenting one or more than one chronic disease and perceived discrimination were significantly associated with severe FI. CONCLUSION Four out of ten Venezuelan migrants residing in Peru presented moderate to severe FI. The FIES showed adequate psychometric properties. Differences in the socio-demographic, health and migratory factors associated with FI levels were found. Inter-sectoral and multi-sectoral interventions are needed and should be focused on addressing the determinants of FI.
Collapse
Affiliation(s)
| | | | - Guido Bendezu-Quispe
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Filial de Ica, Ica, Peru
| | | | | | | |
Collapse
|
7
|
Chapagain R, Giri B, Bhattarai T, Dhungana J, Walters M, Damasco E, Blanco J, Ladas KD, Antoniades A, Ladas E. A cross-sectional study evaluating the prevalence and predictors of malnutrition among children and adolescents visiting an urban academic hospital in Nepal. Public Health Nutr 2023; 26:2738-2747. [PMID: 37811557 PMCID: PMC10755450 DOI: 10.1017/s136898002300188x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To examine the prevalence of malnutrition among children and adolescents visiting Kanti Children’s Hospital (KCH) and identify predictors associated with malnutrition. Results will guide the development of a newly established nutrition programme at KCH. DESIGN This cross-sectional pilot study recruited children and adolescents over a 1-month period. Nutritional anthropometrics (height, weight and mid-upper arm circumference (MUAC)) and socio-demographic questionnaires were administered. Clinical data were abstracted from the medical chart. SETTING KCH in Kathmandu, Nepal. PARTICIPANTS 370 children and adolescents. RESULTS Most participants were male (65·1 %); mean age was 3·9 years (±3·4 years). The prevalence of stunting was 25·9 %, wasting was 17·3 % and 24·0 % when classified by BMI-for-age Z-score or MUAC, respectively. Two percent of participants were overweight. Notably, 32·1 % of children ≥5 years were classified with wasting based on MUAC-for-age Z-score, which is higher than that observed in children <5 (20·2 %). Food insecurity was reported among 58·2 % of children with stunting and 34·0 % with wasting. Chronic medical conditions predicted stunting and wasting. The lowest level of wealth predicted stunting, while ethnicity predicted wasting. Ethnicity and education level predicted food insecurity. CONCLUSIONS We found that the prevalence of stunting and wasting at KCH are higher than previously published studies in Nepal. Malnutrition persists beyond 5 years, and we identified several predictors of malnutrition. Increased provision of and access to clinical nutrition programmes is an essential need for KCH. Twinning programs that provide local clinicians with increased opportunities for education and mentorship of local staff remains a pressing need in Nepal.
Collapse
Affiliation(s)
- Ram Chapagain
- Department of Paediatrics, Kanti Children’s Hospital, National Academy of Medical Sciences (NAMS), Kathmandu, Nepal
| | - Bishnu Giri
- Oncology Unit, Kanti Children’s Hospital, Kathmandu, Nepal
| | - Tribhuwan Bhattarai
- Department of Paediatrics, Kanti Children’s Hospital, National Academy of Medical Sciences (NAMS), Kathmandu, Nepal
| | - Juna Dhungana
- Oncology Unit, Kanti Children’s Hospital, Kathmandu, Nepal
| | - Michelle Walters
- Division of Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University, Irving Medical Centre, 3959 Broadway, CHN 10-06A, New York, NY10032, USA
| | - Erika Damasco
- Division of Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University, Irving Medical Centre, 3959 Broadway, CHN 10-06A, New York, NY10032, USA
| | - Jessica Blanco
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Kyriaki D Ladas
- Aristotle University School of Medicine, Thessaloniki, Greece
| | | | - Elena Ladas
- Division of Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University, Irving Medical Centre, 3959 Broadway, CHN 10-06A, New York, NY10032, USA
| |
Collapse
|
8
|
Kota K, Chomienne MH, Yaya S. Examining the disparities: A cross-sectional study of socio-economic factors and food insecurity in Togo. PLoS One 2023; 18:e0294527. [PMID: 38011188 PMCID: PMC10681261 DOI: 10.1371/journal.pone.0294527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Despite many interventions, Togo continues to have one of the highest rates of poverty and food insecurity in the sub-Saharan African region. Currently there is no systematic analysis of the factors associated with household food-insecurity in this country. This study aimed at exploring the factors associated with food insecurity in Togo. METHODS This was a cross-sectional study that used data from five waves (2014 to 2018) of the Gallup World Poll (GWP) for Togo. Sample size included 4754 participants, aged 15 and above. Food insecurity was measured using the Food Insecurity Experience Scale (FIES) questionnaire as per the Food and Agricultural Organization (FAO) guidelines. Our outcome variable was food insecurity, categorized as: 1) food secure (FIES score = 0-3), moderately food insecure (FIES score = 4-6), and severely food insecure (FIES score = 7-8). We did descriptive and multinomial regressions to analyze data using Stata version 16. RESULTS Between 2014 and 2018, the percentage of severe food insecurity fluctuated-42.81% in 2014, 37.79% in 2015, 38.98% in 2016, 45.41% in 2017, and 33.84% in 2018. Whereas that of moderate food insecurity increased from 23.55% to 27.33% except for 2016 and 2017 where the percentage increased to 32.33% and 27.46% respectively. In the logistic regression analysis, we found that respondents with lower than elementary education had a higher relative risk ratio of moderate (RRR = 1.45,95%CI = 1.22-1.72) and severe (RRR = 1.72, 95%CI = 1.46-2.02) food insecurity compared to those with secondary and higher education. Rural respondents had higher RRR of severe food insecurity (RRR = 1.37, 95%CI = 1.16-1.62) compared to those who lived in the urban areas. Compared with those in the richest wealth quintile, respondents in the poorest wealth quintile had 2.21 times higher RRR of moderate (RRR = 2.21, 95%CI = 1.69-2.87) and 3.58 times higher RRR of severe (RRR = 3.58, 95%CI = 2.81-4.55) food insecurity. CONCLUSION About two-thirds of participants experienced some level of food insecurity in 2018. Lower levels of education, rural residency and poorer household wealth index areas were associated with a higher risk of food insecurity. National food security programs should focus on promoting education and improving socioeconomic condition of people especially in rural areas.
Collapse
Affiliation(s)
- Komlan Kota
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Marie-Hélène Chomienne
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| |
Collapse
|
9
|
Feyisa BB, Dabu GT. Determinant of under nutrition among under five children in Ambo town during covid 19 pandemic in 2020. A community-based cross-sectional study. BMC Nutr 2023; 9:103. [PMID: 37715228 PMCID: PMC10504691 DOI: 10.1186/s40795-023-00762-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/03/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND About 8 to 44% of all child mortality in Africa is associated with undernutrition. To alleviate this problem, it is necessary to determine the magnitude and determinants of undernutrition during Covid 19 pandemic. However, there is scarce evidence in an urban setting like Ambo town. Therefore, this study assessed the magnitude and factors associated with undernutrition among under-five children in Ambo town, west Ethiopia. METHODS AND PATIENTS A community-based cross-sectional study was conducted in Ambo town from March 01-30, 2020. The child and mother/caregiver socio-demographic characteristics, child illness and health care utilization, and child feeding practice-related data were collected using the standardized tool adopted from similar studies conducted in Ethiopia. Anthropometric measurements of the child were made using a calibrated scale. A systematic sampling technique was employed to select 363 mothers/caregivers of the child as a source of data. Nutritional status indices were generated using ENASMART software. After testing for collinearity, variables with a p-value < 0.25 in binary logistic regression were interred to backward multiple logistic regressions at a level of significance of p < 0.05. RESULTS A total of 363 participants were included in this study providing a 100% response rate and providing the following result. The mean (+ SD) age of children was 28.85 (+ 14.17) months and that of mothers/caregivers was 28.12 + 48 years. This study found 16.00%, 25.30%, and 19.00% of the study participants were underweight, wasted, and stunted respectively. Decisions making on major food purchases, who usually care for the child, the age at which the child starts complimentary food, late introduction of complementary food were positively associated with wasting. Diarrhea, birth weight, child age, age at which the child starts complimentary food, consumption of milk and milk product, and who usually care for the child were significantly associated with being underweight. Consumption of milk and milk products, household food security level, and birth weight were independent determinants of stunting. CONCLUSION This study identified a high prevalence of undernutrition, especially wasting. Childbirth weight, age, diarrhea, feeding practice, household (HH) food security, Decision making on major food purchases, late introduction of complementary food were found to be the potential determinants of undernutrition. Thus there should be an effort to improve the nutritional status of children in the study area by focusing on these factors.
Collapse
Affiliation(s)
- Beshadu Bedada Feyisa
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, PO box 19, Ambo, Ethiopia.
| | - Getu Taresa Dabu
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, PO box 19, Ambo, Ethiopia
| |
Collapse
|
10
|
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
|
11
|
Silva A, Astorga A, Faundez R, Santos K. Revisiting food insecurity gender disparity. PLoS One 2023; 18:e0287593. [PMID: 37582082 PMCID: PMC10426994 DOI: 10.1371/journal.pone.0287593] [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: 11/28/2022] [Accepted: 05/16/2023] [Indexed: 08/17/2023] Open
Abstract
Previous research has shown that woman-headed households, more than man-headed ones, experience food insecurity. The purpose of this article is to contribute on the determinants that are linked to this gender disparity. Using a nationally representative dataset from Chile, we found that food security household head gender disparity is associated with marital status (having or not a partner) and household composition (having children or seniors). In contrast, gender disparity is not strongly associated with household income and household head educational differences. In this way, we expect to bring evidence to inform new alternatives that help mitigate food security gender disparity.
Collapse
Affiliation(s)
- Andres Silva
- Escuela de Nutricion y Dietetica, Facultad de Ciencias para el Cuidado de la Salud, Universidad San Sebastian, Santiago, Chile
| | - Andres Astorga
- Escuela de Economia, Facultad de Economia, Gobierno y Comunicaciones, Universidad Central de Chile, Santiago, Chile
| | - Rodrigo Faundez
- Escuela de Economia, Facultad de Economia, Gobierno y Comunicaciones, Universidad Central de Chile, Santiago, Chile
| | - Karla Santos
- Escuela de Nutricion y Dietetica, Facultad de Ciencias para el Cuidado de la Salud, Universidad San Sebastian, Santiago, Chile
| |
Collapse
|
12
|
Wemakor A, Kwaako M, Abdul-Rahman A. Nutritional, health and socio-demographic determinants of anaemia in adolescent girls in Kumbungu District, Ghana. BMC Nutr 2023; 9:90. [PMID: 37480139 PMCID: PMC10362769 DOI: 10.1186/s40795-023-00749-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/12/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Anaemia is a serious health problem among adolescent girls in Ghana. The aims of this study were to measure the prevalence and identify the nutritional, health, and socio-demographic determinants of anaemia in adolescent girls in Kumbungu District, Northern Region, Ghana. METHOD An analytical cross-sectional study involving 370 adolescent girls residing in Kumbungu district, selected using multi-stage sampling procedure, was conducted. A semi-structured questionnaire, 24-hr dietary recall, food frequency questionnaire, Food Insecurity Experience scale, and anthropometry were used to gather information on socio-demographic characteristics, nutrition knowledge, dietary diversity score, food consumption score, food consumption frequency, household food insecurity, and waist and hip circumferences. Haemoglobin was measured using a portable HemoCue hg 301 + Analyzer. Anaemia in the adolescent girls was defined as haemoglobin concentration less than 12 g/dl. Chi-square test and binary logistic regression analysis were used to identify the determinants of anaemia. RESULTS The mean (± SD) age was 13.95 (± 2.94) years, and the majority of the girls were in school (79.5%) and lived in a rural area (81.1%). The mean (± SD) haemoglobin was 11.27 (± 1.19) g/dl, and 74.6% of the respondents had anaemia, with 1.6% having severe anaemia. The health determinant of anaemia was frequency of feeling nervous in the past 6 months [Adjusted Odds Ratio (AOR): 2.12: 95% Confidence Interval (CI): 1.17-3.89; p: 0.014], and the socio-demographic determinants were residential community status (AOR: 0.42; 95% CI: 0.24-0.75; p: 0.003), and fathers' educational qualification (AOR: 2.57, 95% CI: 1.17-5.65, p: 0.019). No nutritional determinants of anaemia were identified for this study population. CONCLUSION The prevalence of anaemia was very high and the frequency of feeling nervous in the past 6 months, residential community status, and fathers' educational qualification were associated with anaemia among adolescent girls in Kumbungu district, Ghana. The prevalence of anaemia measured highlights the need for intensification of anaemia prevention and management interventions in the district.
Collapse
Affiliation(s)
- Anthony Wemakor
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Tamale, Ghana.
| | - Matilda Kwaako
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Tamale, Ghana
| | - Adinan Abdul-Rahman
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Tamale, Ghana
| |
Collapse
|
13
|
Wemakor A, Bukari M, Atariba R. Household food insecurity, low maternal social support and maternal common mental disorders in East Mamprusi Municipality, Ghana. BMC Public Health 2023; 23:1255. [PMID: 37380991 DOI: 10.1186/s12889-023-16157-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/20/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION Both household food insecurity and maternal common mental disorders are public health concerns in Ghana but studies on them, and their interrelatedness are scarce. Social support is an independent determinant of mental health but can also moderate the link between risk factors and mental illness. Identifying the risk factors of mental illness may provide opportunities for intervention and help reduce disease burden and impact. This study examined the association between household food insecurity or low maternal social support and maternal common mental disorders in East Mamprusi Municipality, Ghana. METHODS This was a community-based, cross-sectional study involving 400 mothers with children 6-23 months selected using multi-stage sampling. Summary scores for household food insecurity, maternal social support, and maternal common mental disorders were measured using Food Insecurity Experience Scale (FIES), Medical Outcome Study Social Support Scale (SSS), and WHO Self-Reporting Questionnaire 20 items (SRQ-20) respectively in personal interviews. Poisson regression models were fitted to determine the association of household food insecurity or low maternal social support with maternal common mental disorders, controlling for selected socio-demographic variables. RESULTS The mean age of the participants was 26.7 (± 6.68) years, and the mean FIES, SSS, and SRQ-20 scores were 5.62 [95% Confidence Interval (CI): 5.29-5.96] out of 8, 43.12 (95% CI: 41.34-44.90) out of 100, and 7.91 (95% CI: 7.38-8.45) out of 19 respectively. About two-thirds of the households (71.9%), and 72.7% and 49.5% of the women had food insecurity, low social support and probable common mental disorder respectively. In the adjusted analyses, a unit increase in FIES score was associated to a 4% increment in the predicted SRQ-20 score [Incident Risk Ratio (IRR) 1.04; 95% Confidence Interval (CI): 1.02, 1.06; p = 0.001], and the predicted SRQ-20 score of the women belonging to low social support category was 38% higher compared to that of women of high social support category (IRR 1.38; 95% CI: 1.14, 1.66; p = 0.001). CONCLUSION The prevalence of household food insecurity and common mental disorders among mothers are high, and both household food insecurity and low social support are significantly related to common mental disorders in women. Interventions to reduce both household food insecurity, and common mental disorders in women are warranted, and should include social support for women.
Collapse
Affiliation(s)
- Anthony Wemakor
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana.
| | - Mohammed Bukari
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana
| | - Raymond Atariba
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana
| |
Collapse
|
14
|
Jubayer A, Islam S, Nowar A, Nayan MM, Islam MH. Validity of Food insecurity experience scale (FIES) for use in rural Bangladesh and prevalence and determinants of household food insecurity: An analysis of data from Bangladesh integrated household survey (BIHS) 2018-2019. Heliyon 2023; 9:e17378. [PMID: 37426788 PMCID: PMC10329118 DOI: 10.1016/j.heliyon.2023.e17378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/21/2023] [Accepted: 06/14/2023] [Indexed: 07/11/2023] Open
Abstract
"Access" dimension of Food insecurity (FI) is directly measured by the Food Insecurity Experience Scale (FIES). The current study assessed the appropriateness of the FIES for measuring FI in rural Bangladesh, followed by an assessment of FI prevalence and its correlates utilizing Bangladesh Integrated Household Survey (BIHS) data. The internal validity of the FIES and the prevalence of FI were investigated using the Rasch modeling approach. We utilized equating procedure to calibrate the study's result to the global FIES reference scale and determined FI prevalence rates that were comparable across countries. The external validity of the FIES was evaluated by examining its association with other FI measures using Spearman's rho correlation analysis. With an overall Rasch reliability of 0.84, the FIES met the Rasch model assumptions of conditional independence and equal discrimination, and as well as the fit statistics standards for all eight items. Infit statistics were within the allowed limit for all FIES items indicating good internal validity. However, we noted a high outfit (>2) for the "unable to eat healthy and nutritious food" item indicating the presence of some unusual response patterns. Our analysis found no significant (>0.4) correlation between FIES items. We also found a significant correlation between FIES and other FI proxies, e.g., the Household hunger scale (HHS), Food consumption score (FCS), and Household dietary diversity score (HDDS). Overall, the prevalence of moderate or severe FI was 18.92% in rural Bangladesh. Geographic areas, access to electricity, household ownership, access to sanitation, livestock ownership, family size, education level, and monthly per capita food expenditure significantly explained the variation in FI. Our analyses suggest that the FIES is internally and externally valid for FI measurement in rural Bangladesh. However, FIES questions may need to be reordered to more accurately evaluate lower levels of FI, and the item "unable to eat healthy and nutritious food" may need cognitive testing.
Collapse
Affiliation(s)
- Ahmed Jubayer
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, 1000, Bangladesh
- Bangladesh Institute of Social Research (BISR) Trust, Dhaka, 1207, Bangladesh
| | - Saiful Islam
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Abira Nowar
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, 1000, Bangladesh
| | | | - Md. Hafizul Islam
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, 1000, Bangladesh
| |
Collapse
|
15
|
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
|
16
|
Olivieri-Mui B, Hoeppner SS, Tong Y, Kohrt E, Quach LT, Saylor D, Seeley J, Tsai AC, Reynolds Z, Okello S, Asiimwe S, Flavia A, Sentongo R, Tindimwebwa E, Meyer AC, Nakasujja N, Paul R, Ritchie C, Greene M, Siedner MJ. Associations of the COVID-19 pandemic with quality of life: A cross-sectional study of older-age people with and without HIV in rural Uganda. J Glob Health 2023; 13:06003. [PMID: 36655920 PMCID: PMC9850875 DOI: 10.7189/jogh.13.06003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background COVID-19-related lockdowns and other public health measures may have differentially affected the quality of life (QOL) of older people with and without human immunodeficiency virus (HIV) in rural Uganda. Methods The Quality of Life and Aging with HIV in Rural Uganda study enrolled people with and without HIV aged over 49 from October 2020 to October 2021. We collected data on COVID-19-related stressors (behavior changes, concerns, interruptions in health care, income, and food) and the participants' QOL. We used linear regression to estimate the associations between COVID-19-related stressors and QOL, adjusting for demographic characteristics, mental and physical health, and time before vs after the lockdown during the second COVID-19 wave in Uganda. Interaction between HIV and COVID-19-related stressors evaluated effect modification. Results We analyzed complete data from 562 participants. Mean age was 58 (standard deviation (SD) = 7); 265 (47%) participants were female, 386 (69%) were married, 279 (50%) had HIV, and 400 (71%) were farmers. Those making ≥5 COVID-19-related behavior changes compared to those making ≤2 had worse general QOL (estimated linear regression coefficient (b) = - 4.77; 95% confidence interval (CI) = -6.61, -2.94) and health-related QOL (b = -4.60; 95% CI = -8.69, -0.51). Having access to sufficient food after the start of the COVID-19 pandemic (b = 3.10, 95% CI = 1.54, 4.66) and being interviewed after the start of the second lockdown (b = 2.79, 95% CI = 1.30, 4.28) were associated with better general QOL. Having HIV was associated with better health-related QOL (b = 5.67, 95% CI = 2.91,8.42). HIV was not associated with, nor did it modify the association of COVID-19-related stressors with general QOL. Conclusions In the context of the COVID-19 pandemic in an HIV-endemic, low-resource setting, there was reduced QOL among older Ugandans making multiple COVID-19 related behavioral changes. Nonetheless, good QOL during the second COVID-19 wave may suggest resilience among older Ugandans.
Collapse
Affiliation(s)
- Brianne Olivieri-Mui
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, USA
| | - Susanne S Hoeppner
- College of Science and Mathematics, University of Massachusetts Boston, Boston, USA,Harvard Medical School, Boston, USA,Department of Psychiatry, Massachusetts, General Hospital, Boston, USA
| | - Yao Tong
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - Emma Kohrt
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, USA
| | - Lien T Quach
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alexander C Tsai
- Harvard Medical School, Boston, USA,Department of Psychiatry, Massachusetts, General Hospital, Boston, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Zahra Reynolds
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - Samson Okello
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA,Mbarara University of Science and Technology
| | - Stephen Asiimwe
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, USA,Mbarara University of Science and Technology,Kabwohe Clinical Research Centre, Kabwohe Town, Uganda
| | | | | | | | | | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Robert Paul
- Department of Psychological Sciences, University of Missouri-St Louis, St. Louis, USA
| | - Christine Ritchie
- Harvard Medical School, Boston, USA,Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, USA,Center for Aging and Serious Illness, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - Meredith Greene
- Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, USA
| | - Mark J Siedner
- Harvard Medical School, Boston, USA,Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, USA,Mbarara University of Science and Technology
| |
Collapse
|
17
|
MacCarthy S, Wagner Z, Saya U, Ghai I, Karamagi Y, Odiit M, Mukasa B, Linnemayr S. Food Insecurity During the COVID-19 Pandemic: A Longitudinal Mixed-Methods Study from a Cohort of HIV Clients in Uganda. AIDS Behav 2023; 27:2216-2225. [PMID: 36629972 PMCID: PMC9838483 DOI: 10.1007/s10461-022-03953-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/12/2023]
Abstract
The COVID-19 pandemic threatens the food security of people in low-income countries. This is important for people living with HIV (PLWH) because HIV medication should be taken with food to avoid side-effects. We used survey data (n = 314) and qualitative interviews (n = 95) to longitudinally explore how the pandemic impacted food insecurity among PLWH in Kampala, Uganda. Prior to March 2020, 19.7% of respondents were food insecure. Our regression models estimate that food insecurity rose by 9.1 percentage points in our first round of surveys (June-September 2020; p < 0.05; t = 2.17), increasing to 17.2 percentage points in the second round of surveys (July-November 2021; p < 0.05; t = 2.32). Qualitative interviews reveal that employment loss and deteriorating support systems led to reduced meals and purchasing of cheaper foods. Respondents reported continuing to take their HIV medication even in the presence of food insecurity. Strategies for ensuring that PLWH have enough food should be prioritized so that the millions of PLWH in sub-Saharan Africa can take their medication without experiencing uncomfortable side-effects.Clinical Trials Registration Number NCT03494777.
Collapse
Affiliation(s)
- Sarah MacCarthy
- grid.265892.20000000106344187Department of Health Behavior, University of Alabama, Birmingham, Birmingham, AL USA
| | - Zachary Wagner
- grid.34474.300000 0004 0370 7685RAND Corporation, Santa Monica, CA 90401 USA
| | - Uzaib Saya
- grid.34474.300000 0004 0370 7685RAND Corporation, Santa Monica, CA 90401 USA
| | - Ishita Ghai
- grid.468886.c0000 0001 0683 0038Pardee RAND Graduate School, Santa Monica, USA
| | - Yvonne Karamagi
- grid.463428.f0000 0004 0648 1159Mildmay Uganda, Kampala, Uganda
| | - Mary Odiit
- grid.463428.f0000 0004 0648 1159Mildmay Uganda, Kampala, Uganda
| | - Barbara Mukasa
- grid.463428.f0000 0004 0648 1159Mildmay Uganda, Kampala, Uganda
| | - Sebastian Linnemayr
- grid.34474.300000 0004 0370 7685RAND Corporation, Santa Monica, CA 90401 USA
| |
Collapse
|
18
|
Carries S, Mkhwanazi Z, Sigwadhi L, Moshabela M, Nyirenda M, Goudge J, Govindasamy D. An economic incentive package to support the wellbeing of caregivers of adolescents living with HIV during the COVID-19 pandemic in South Africa: a feasibility study protocol for a pilot randomised trial. Pilot Feasibility Stud 2023; 9:3. [PMID: 36624520 PMCID: PMC9827020 DOI: 10.1186/s40814-023-01237-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The mental and financial strain linked to unpaid caregiving has been amplified during the COVID-19 pandemic. In sub-Saharan Africa, carers of adolescents living with HIV (ALHIV) are critical for maintenance of optimum HIV treatment outcomes. However, the ability of caregivers to provide quality care to ALHIV is undermined by their ability to maintain their own wellbeing due to multiple factors (viz. poverty, stigma, lack of access to social support services) which have been exacerbated by the COVID-19 pandemic. Economic incentives, such as cash incentives combined with SMS reminders, have been shown to improve wellbeing. However, there is a lack of preliminary evidence on the potential of economic incentives to promote caregiver wellbeing in this setting, particularly in the context of a pandemic. This protocol outlines the design of a parallel-group pilot randomised trial comparing the feasibility and preliminary effectiveness of an economic incentive package versus a control for improving caregiver wellbeing. METHODS Caregivers of ALHIV will be recruited from public-sector HIV clinics in the south of the eThekwini municipality, KwaZulu-Natal, South Africa. Participants will be randomly assigned to one of the following groups: (i) the intervention group (n = 50) will receive three cash payments (of ZAR 350, approximately 23 USD), coupled with a positive wellbeing message over a 3-month period; (ii) the control group (n = 50) will receive a standard message encouraging linkage to health services. Participants will be interviewed at baseline and at endline (12 weeks) to collect socio-demographic, food insecurity, health status, mental health (stigma, depressive symptoms) and wellbeing data. The primary outcome measure, caregiver wellbeing, will be measured using the CarerQoL instrument. A qualitative study will be conducted alongside the main trial to understand participant views on participation in the trial and their feedback on study activities. DISCUSSION This study will provide scientific direction for the design of a larger randomised controlled trial exploring the effects of an economic incentive for improving caregiver wellbeing. The feasibility of conducting study activities and delivering the intervention remotely in the context of a pandemic will also be provided. TRIAL REGISTRATION PACTR202203585402090. Registry name: Pan African Clinical Trials Registry (PACTR); URL: https://pactr.samrc.ac.za/ ; Registration. date: 24 March 2022 (retrospectively registered); Date first participant enrolled: 03 November 2021.
Collapse
Affiliation(s)
- Stanley Carries
- grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Zibuyisile Mkhwanazi
- grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Lovemore Sigwadhi
- grid.11956.3a0000 0001 2214 904XBiostatistics Unit, Stellenbosch University, Stellenbosch, South Africa
| | - Mosa Moshabela
- grid.16463.360000 0001 0723 4123School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Makandwe Nyirenda
- grid.16463.360000 0001 0723 4123School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa ,grid.415021.30000 0000 9155 0024Burden of Disease Unit, South African Medical Research Council, Cape Town, South Africa
| | - Jane Goudge
- grid.11951.3d0000 0004 1937 1135Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | - Darshini Govindasamy
- grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| |
Collapse
|
19
|
Kumar SS, Schreinemachers P, Pal AA, Manickam R, Nair RM, Srinivasan R, Harris J. The continued effects of COVID-19 on the lives and livelihoods of vegetable farmers in India. PLoS One 2023; 18:e0279026. [PMID: 36595541 PMCID: PMC9810155 DOI: 10.1371/journal.pone.0279026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 11/28/2022] [Indexed: 01/04/2023] Open
Abstract
India experienced a rapid rise in COVID-19 infections from March 2021. States imposed varying levels of lockdowns and curfews to curb the spread of the disease. These restrictions severely affected the functioning of food systems. The objective of this study was to analyze how COVID-19 continues to affect agricultural production, food security and household diets of vegetable farmers. A phone-based survey was conducted with 595 vegetable farmers in the states of Andhra Pradesh, Assam, Jharkhand, Karnataka and Odisha, 60% of whom had been interviewed a year earlier. Overall, 60% of farmers experienced decreased vegetable production; over 80% reported a reduction in consumption of at least one food group; and 45% reported some level of food insecurity between May 2020 and May 2021. Farmers who reported decreased staples production, difficulty accessing seeds/seedlings, or reduced their household spending were more likely to report decreased vegetable production. Vegetable consumption was positively associated with receipt of COVID-19 relief benefits, borrowing money, or having home gardens. Farmers who received public agricultural assistance, or had reduced expenses, were more likely to have lower vegetable consumption. Greater severity of food insecurity was associated with farmers belonging to underprivileged social groups, non-Hindus, or those who experienced decrease in livestock production, weather related disruptions or received COVID-19 assistance. This is one of few studies that have conducted a longitudinal assessment of the impacts across multiple waves of COVID-19. COVID-19 is seen to be one among several shocks experienced by farm households, and exacerbated existing issues within agriculture and food security. There is a need for public policy support to strengthen both production and consumption of vegetables.
Collapse
Affiliation(s)
- Sandhya S. Kumar
- World Vegetable Center, South and Central Asia, Patancheru, Telangana, India
- * E-mail:
| | | | - Arshad Ahmad Pal
- World Vegetable Center, South and Central Asia, Patancheru, Telangana, India
| | | | | | | | - Jody Harris
- World Vegetable Center, East and Southeast Asia, Bangkok, Thailand
| |
Collapse
|
20
|
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
|
21
|
Abas M, Mangezi W, Nyamayaro P, Jopling R, Bere T, McKetchnie SM, Goldsmith K, Fitch C, Saruchera E, Muronzie T, Gudyanga D, Barrett BM, Chibanda D, Hakim J, Safren SA, O'Cleirigh C. Task-sharing with lay counsellors to deliver a stepped care intervention to improve depression, antiretroviral therapy adherence and viral suppression in people living with HIV: a study protocol for the TENDAI randomised controlled trial. BMJ Open 2022; 12:e057844. [PMID: 36576191 PMCID: PMC9723911 DOI: 10.1136/bmjopen-2021-057844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
INTRODUCTION Non-adherence to antiretroviral therapy (ART) is the main cause of viral non-suppression and its risk is increased by depression. In countries with high burden of HIV, there is a lack of trained professionals to deliver depression treatments. This paper describes the protocol for a 2-arm parallel group superiority 1:1 randomised controlled trial, to test the effectiveness and cost effectiveness of the TENDAI stepped care task-shifted intervention for depression, ART non-adherence and HIV viral suppression delivered by lay interventionists. METHODS AND ANALYSIS Two hundred and ninety people living with HIV aged ≥18 years with probable depression (Patient Health Questionnaire=>10) and viral non-suppression (≥ 1000 HIV copies/mL) are being recruited from HIV clinics in towns in Zimbabwe. The intervention group will receive a culturally adapted 6-session psychological treatment, Problem-Solving Therapy for Adherence and Depression (PST-AD), including problem-solving therapy, positive activity scheduling, skills to cope with stress and poor sleep and content to target barriers to non-adherence to ART. Participants whose score on the Patient Health Questionnaire-9 remains ≥10, and/or falls by less than 5 points, step up to a nurse evaluation for possible antidepressant medication. The control group receives usual care for viral non-suppression, consisting of three sessions of adherence counselling from existing clinic staff, and enhanced usual care for depression in line with the WHO Mental Health Gap intervention guide. The primary outcome is viral suppression (<1000 HIV copies/mL) at 12 months post-randomisation. ETHICS AND DISSEMINATION The study and its tools were approved by MRCZ/A/2390 in Zimbabwe and RESCM-18/19-5580 in the UK. Study findings will be shared through the community advisory group, conferences and open access publications. TRIAL REGISTRATION NUMBER NCT04018391.
Collapse
Affiliation(s)
- Melanie Abas
- Section of Epidemiology, Health Services and Population Research Department, King's College London, London, UK
| | - Walter Mangezi
- Department of Primary Health Care Sciences, Unit of Mental Health, University of Zimbabwe, Harare, Zimbabwe
| | - Primrose Nyamayaro
- Department of Primary Health Care Sciences, Unit of Mental Health, University of Zimbabwe, Harare, Zimbabwe
| | - Rebecca Jopling
- Section of Epidemiology, Health Services and Population Research Department, King's College London, London, UK
| | - Tarisai Bere
- Department of Primary Health Care Sciences, Unit of Mental Health, University of Zimbabwe, Harare, Zimbabwe
| | - Samantha M McKetchnie
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Kimberley Goldsmith
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Calvin Fitch
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Emily Saruchera
- Department of Primary Health Care Sciences, Unit of Mental Health, University of Zimbabwe, Harare, Zimbabwe
| | - Thabani Muronzie
- Department of Primary Health Care Sciences, Unit of Mental Health, University of Zimbabwe, Harare, Zimbabwe
| | - Denford Gudyanga
- Department of Primary Health Care Sciences, Unit of Mental Health, University of Zimbabwe, Harare, Zimbabwe
| | - Barbara M Barrett
- Health Service and Population Research Department, Institute Of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dixon Chibanda
- Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - James Hakim
- Medical School Clinical Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| |
Collapse
|
22
|
The role of multi-dimensional women's empowerment in agriculture to improve the nutritional status of under-five children in rural cash crop producing, resource-limited settings of Ethiopia. J Nutr Sci 2022; 11:e92. [PMID: 36337985 PMCID: PMC9607879 DOI: 10.1017/jns.2022.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/26/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022] Open
Abstract
Little is known about the relation between the women empowerment in agriculture index, and health and nutrition outcomes among under-five children in Ethiopia. The study's objective was to examine women's empowerment in agriculture and its association with the nutritional status of children (6-59 months) in rural, cash crop producing, and resource-limited settings of Ethiopia. A community-based cross-sectional study was conducted employing 422 households; having women of reproductive age group and children under-five. Stratified simple random sampling was used to identify households; a simple random sampling was used to select villages and households. Women empowerment in agriculture was measured by the abbreviated women empowerment in agriculture index. Even if the overall multi-dimensional five domains of empowerment index (5DE) was not a significant predictor of nutritional status in children (P > 0⋅05), sub-indicators had a pivotal role in child nutritional status. Disempowerment in decisions about input into production [AOR = 8⋅85], empowerment on control of income [AOR = 0⋅35] and availability of livestock [AOR = 0⋅38] were predictors of child stunting, whereas women's disempowerment in production decisions seems beneficiary for wasting, disempowered women have 84 % less likely to have wasted child than empowered women [AOR = 0⋅16]. Dietary and agricultural diversity [particularly livestock farming], and women's empowerment in production decisions were predictors of better nutritional outcomes in children. Therefore, a concentrated effort is needed towards strengthening the multi-dimensional empowerment of women in agriculture emphasising women's input into production decisions, dietary and agricultural diversification, mainly livestock farming.
Collapse
|
23
|
Trujillo C, Ferrari G, Ngoga G, McLaughlin A, Davies J, Tucker A, Randolph C, Cook R, Park PH, Bukhman G, Adler AJ, Pierre J. Evaluating implementation of Diabetes Self-Management Education in Maryland County, Liberia: protocol for a pilot prospective cohort study. BMJ Open 2022; 12:e060592. [PMID: 36253048 PMCID: PMC9577905 DOI: 10.1136/bmjopen-2021-060592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Achieving glycaemic targets for people living with diabetes (PLWD) is challenging, especially in settings with limited resources. Programmes need to address gaps in knowledge, skills and self-management. Diabetes Self-Management Education (DSME) is an evidence-based intervention to educate and empower PLWD to improve self-management activities. This protocol describes a pilot study assessing the feasibility, acceptability and effect on clinical outcomes of implementing DSME in clinics caring for people living with insulin-dependent diabetes in Liberia. METHODS AND ANALYSIS Our protocol is a three-phased, mixed-methods, quasi-experimental prospective cohort study. Phase 1 focuses on (a) establishing a Patient Advisory Board and (b) training providers in DSME who provide care for PLWD. In phase 2, clinicians will implement DSME. In phase 3, we will train additional providers who interact with PLWD.We will assess whether this DSME programme can lead to increased provider knowledge of DSME, improvements in diabetes self-management behaviours, glycaemic control, diabetes knowledge and psychosocial well-being, and a reduction in severe adverse events. Primary outcomes of interest are implementation outcomes and change in frequency of self-management behaviours by patients. Secondary outcomes include change in haemoglobin A1c, psychosocial well-being, severe adverse events and change in provider knowledge of DSME. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Liberia Institutional Review Board (IRB) and the Brigham and Women's Hospital IRB. Findings from the study will be shared with local and national clinical and programmatic stakeholders and published in an open-access, peer-reviewed journal.
Collapse
Affiliation(s)
- Celina Trujillo
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- NCD Synergies Project, Partners In Health, Boston, Massachusetts, USA
| | - Gina Ferrari
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- NCD Synergies Project, Partners In Health, Boston, Massachusetts, USA
| | - Gedeon Ngoga
- NCD Synergies Project, Partners In Health, Boston, Massachusetts, USA
- NCD Program, Partners In Health, Kigali, Rwanda
| | - Amy McLaughlin
- NCD Synergies Project, Partners In Health, Boston, Massachusetts, USA
- NCD Program, Partners In Health Liberia, Harper, Maryland, Liberia
| | - Joe Davies
- NCD Program, Partners In Health Liberia, Harper, Maryland, Liberia
| | | | - Cyrus Randolph
- NCD Program, Partners In Health Liberia, Harper, Maryland, Liberia
| | - Rebecca Cook
- NCD Program, Partners In Health Liberia, Harper, Maryland, Liberia
- Division of Global Health, Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Paul H Park
- Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- NCD Synergies Project, Partners In Health, Boston, Massachusetts, USA
| | - Gene Bukhman
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Alma J Adler
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jacquelin Pierre
- NCD Program, Partners In Health Liberia, Harper, Maryland, Liberia
| |
Collapse
|
24
|
Appiah-Twumasi M, Asale MA. Crop diversification and farm household food and nutrition security in Northern Ghana. ENVIRONMENT, DEVELOPMENT AND SUSTAINABILITY 2022; 26:1-29. [PMID: 36267607 PMCID: PMC9568956 DOI: 10.1007/s10668-022-02703-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Farm households in Africa adopt resource allocation tools such as crop diversification to minimize risk exposure and safeguard their food and nutrition security. This study uses primary data and an ordered probit model to examine how crop diversification impacts the food security outcomes of rural farmers in northern Ghana. The findings revealed that along with other factors like access to extension services and use of soil fertility management practices, crop diversification increased food access and reduced the food insecurity experience of households. As a result, policies targeted at improving the food and nutrition security of peasant households should promote adoption of diversified crop production and use of sustainable soil management practices like composting.
Collapse
Affiliation(s)
- Mark Appiah-Twumasi
- Department of Agricultural and Food Economics, Faculty of Agriculture, Food and Consumer Sciences, University for Development Studies, Tamale, Ghana
| | - Maxwell Anamdare Asale
- Department of Agricultural and Food Economics, Faculty of Agriculture, Food and Consumer Sciences, University for Development Studies, Tamale, Ghana
| |
Collapse
|
25
|
Tsegaye AT, Pavlinac PB, Turyagyenda L, Diallo AH, Gnoumou BS, Bamouni RM, Voskuijl WP, van den Heuvel M, Mbale E, Lancioni CL, Mupere E, Mukisa J, Lwanga C, Atuhairwe M, Chisti MJ, Ahmed T, Shahid AS, Saleem AF, Kazi Z, Singa BO, Amam P, Masheti M, Berkley JA, Walson JL, Tickell KD. The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6-23 Months in Sub-Saharan Africa and South Asia. Nutrients 2022; 14:3481. [PMID: 36079736 PMCID: PMC9460249 DOI: 10.3390/nu14173481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Current guidelines for the management of childhood wasting primarily focus on the provision of therapeutic foods and the treatment of medical complications. However, many children with wasting live in food-secure households, and multiple studies have demonstrated that the etiology of wasting is complex, including social, nutritional, and biological causes. We evaluated the contribution of household food insecurity, dietary diversity, and the consumption of specific food groups to the time to recovery from wasting after hospital discharge. Methods: We conducted a secondary analysis of the Childhood Acute Illness Network (CHAIN) cohort, a multicenter prospective study conducted in six low- or lower-middle-income countries. We included children aged 6−23 months with wasting (mid-upper arm circumference [MUAC] ≤ 12.5 cm) or kwashiorkor (bipedal edema) at the time of hospital discharge. The primary outcome was time to nutritional recovery, defined as a MUAC > 12.5 cm without edema. Using Cox proportional hazards models adjusted for age, sex, study site, HIV status, duration of hospitalization, enrollment MUAC, referral to a nutritional program, caregiver education, caregiver depression, the season of enrollment, residence, and household wealth status, we evaluated the role of reported food insecurity, dietary diversity, and specific food groups prior to hospitalization on time to recovery from wasting during the 6 months of posthospital discharge. Findings: Of 1286 included children, most participants (806, 63%) came from food-insecure households, including 170 (13%) with severe food insecurity, and 664 (52%) participants had insufficient dietary diversity. The median time to recovery was 96 days (18/100 child-months (95% CI: 17.0, 19.0)). Moderate (aHR 1.17 [0.96, 1.43]) and severe food insecurity (aHR 1.14 [0.88, 1.48]), and insufficient dietary diversity (aHR 1.07 [0.91, 1.25]) were not significantly associated with time to recovery. Children who had consumed legumes and nuts prior to diagnosis had a quicker recovery than those who did not (adjusted hazard ratio (aHR): 1.21 [1.01,1.44]). Consumption of dairy products (aHR 1.13 [0.96, 1.34], p = 0.14) and meat (aHR 1.11 [0.93, 1.33]), p = 0.23) were not statistically significantly associated with time to recovery. Consumption of fruits and vegetables (aHR 0.78 [0.65,0.94]) and breastfeeding (aHR 0.84 [0.71, 0.99]) before diagnosis were associated with longer time to recovery. Conclusion: Among wasted children discharged from hospital and managed in compliance with wasting guidelines, food insecurity and dietary diversity were not major determinants of recovery.
Collapse
Affiliation(s)
| | | | | | - Abdoulaye H. Diallo
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou 03BP7021, Burkina Faso
| | - Blaise S. Gnoumou
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou 03BP7021, Burkina Faso
| | - Roseline M. Bamouni
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou 03BP7021, Burkina Faso
| | - Wieger P. Voskuijl
- Amsterdam UMC, University of Amsterdam, Amsterdam Centre for Global Child Health & Emma Children’s Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Meta van den Heuvel
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Emmie Mbale
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 265, Malawi
| | - Christina L. Lancioni
- Department of Pediatrics, Oregon Health and Science University, Portland, OR 97239, USA
| | - Ezekiel Mupere
- Uganda-CWRU Research Collaboration, Kampala P.O. Box 663, Uganda
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala P.O. Box 7072, Uganda
| | - John Mukisa
- Uganda-CWRU Research Collaboration, Kampala P.O. Box 663, Uganda
| | | | | | - Mohammod J. Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, Bangladesh
| | - Abu S.M.S.B. Shahid
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, Bangladesh
| | - Ali F. Saleem
- Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Zaubina Kazi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | | | - Pholona Amam
- Kenya Medical Research Institute, Nairobi 54840, Kenya
| | - Mary Masheti
- Kenya Medical Research Institute, Nairobi 54840, Kenya
| | - James A. Berkley
- KEMRI/Wellcome Trust Research Programme, Kilifi 80108, Kenya
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi 184742, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Judd L. Walson
- Departments of Global Health, University of Washington, Seattle, WA 98195, USA
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi 184742, Kenya
| | - Kirkby D. Tickell
- Departments of Global Health, University of Washington, Seattle, WA 98195, USA
| |
Collapse
|
26
|
Saya U, Wagner Z, Mukasa B, Wabukala P, Lunkuse L, Linnemayr S. The role of material deprivations in determining ART adherence: Evidence from a conjoint analysis among HIV-positive adults in Uganda. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000374. [PMID: 36962701 PMCID: PMC10022174 DOI: 10.1371/journal.pgph.0000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 06/30/2022] [Indexed: 11/19/2022]
Abstract
Despite sustained global scale-up of antiretroviral therapy (ART), adherence to ART remains low. Less than half of those in HIV care in Uganda achieve 85% adherence to their ART medication required for clinically meaningful viral suppression, leaving them at higher risk of transmission. Key barriers to ART adherence include poverty-related structural barriers that are inter-connected and occur simultaneously, making it challenging to examine and disentangle them empirically and in turn design effective interventions. Many people living with HIV (PLWH) make tradeoffs between these various barriers (e.g., between expenses for food or transportation) and these can influence long-term health behavior such as adherence to ART. To be able to estimate the distinct influence of key structural barriers related to poverty, we administered a conjoint analysis (CA) to 320 HIV-positive adults currently taking ART at an urban clinic in Uganda between July 2019 and September 2020. We varied the levels of four poverty-related attributes (food security, sleep deprivation, monthly income, and physical pain) that occur simultaneously and asked respondents how they would adhere to their medication under different combinations of attribute levels. This allows us to disentangle the effect of each attribute from one another and to assess their relative importance. We used regression analysis to estimate the effects of each attribute level and found that food security impacts expected adherence the most (treatment effect = 1.3; 95% CI 1.11-1.49, p<0.001), followed by income (treatment effect = 0.99; 95% CI 0.88-1.10, p<0.001. Sleep and pain also impact adherence, although by a smaller magnitude. Sub-group analyses conducted via regression analysis examine heterogeneity in results and suggest that the effects of material deprivations on expected adherence are greater among those with high levels of existing food insecurity. Results from this CA indicate that external factors inherent in the lives of the poor and unrelated to direct ART access can be important barriers to ART adherence. This study applies a CA (typically administered in marketing applications) among PLWH to better understand individual-level perceptions relating to poverty that often occur simultaneously. Policy interventions should address food insecurity and income to improve adherence among HIV-positive adults.
Collapse
Affiliation(s)
- Uzaib Saya
- Pardee RAND Graduate School, Santa Monica, California, United States of America
- RAND Corporation, Santa Monica, California, United States of America
| | - Zachary Wagner
- Pardee RAND Graduate School, Santa Monica, California, United States of America
- RAND Corporation, Santa Monica, California, United States of America
| | - Barbara Mukasa
- Mildmay Uganda, Mildmay Hospital and Institute of Health Sciences, Kampala, Uganda
| | - Peter Wabukala
- Mildmay Uganda, Mildmay Hospital and Institute of Health Sciences, Kampala, Uganda
| | - Lillian Lunkuse
- Mildmay Uganda, Mildmay Hospital and Institute of Health Sciences, Kampala, Uganda
| | - Sebastian Linnemayr
- Pardee RAND Graduate School, Santa Monica, California, United States of America
- RAND Corporation, Santa Monica, California, United States of America
| |
Collapse
|
27
|
Rudin-Rush L, Michler JD, Josephson A, Bloem JR. Food insecurity during the first year of the COVID-19 pandemic in four African countries. FOOD POLICY 2022; 111:102306. [PMID: 35783573 PMCID: PMC9234064 DOI: 10.1016/j.foodpol.2022.102306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 06/01/2023]
Abstract
We document trends in food security up to one full year after the onset of the COVID-19 pandemic in four African countries. Using household-level data collected by the World Bank, we highlight differences over time amid the pandemic, between rural and urban areas, and between female-headed and male-headed households within Burkina Faso, Ethiopia, Malawi, and Nigeria. We first observe a sharp increase in food insecurity during the early months of the pandemic with a subsequent gradual decline. Next, we find that food insecurity has increased more in rural areas than in urban areas relative to pre-pandemic data within each of these countries. Finally, we do not find a systematic difference in changes in food insecurity between female-headed and male-headed households. These trends complement previous microeconomic analysis studying short-term changes in food security associated with the pandemic and existing macroeconomic projections.
Collapse
Affiliation(s)
- Lorin Rudin-Rush
- Department of Agricultural and Resource Economics, University of Arizona Economic Research Service, United States of America
| | - Jeffrey D Michler
- Department of Agricultural and Resource Economics, University of Arizona Economic Research Service, United States of America
| | - Anna Josephson
- Department of Agricultural and Resource Economics, University of Arizona Economic Research Service, United States of America
| | - Jeffrey R Bloem
- U.S. Department of Agriculture, Economic Research Service, United States of America
| |
Collapse
|
28
|
Wagner GJ, Wagner Z, Gizaw M, Saya U, MacCarthy S, Mukasa B, Wabukala P, Linnemayr S. Increased Depression during COVID-19 Lockdown Associated with Food Insecurity and Antiretroviral Non-Adherence among People Living with HIV in Uganda. AIDS Behav 2022; 26:2182-2190. [PMID: 34570315 PMCID: PMC8475428 DOI: 10.1007/s10461-021-03371-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 12/14/2022]
Abstract
The health and economic threats posed by the COVID-19 pandemic can be sources of great distress among people living with HIV, which in turn can impact the management of their HIV disease. We examined change in depression from pre- to post-lockdown restrictions and correlates of elevated depressive symptoms, including antiretroviral therapy (ART) adherence. Participants enrolled in a randomized controlled trial of an ART adherence intervention in Uganda. The month-12 follow-up assessment was fully administered just prior to the start of the pandemic-related lockdown in March 2020; at the conclusion of the lockdown three months later, we administered a mixed-methods phone-based assessment. ART adherence was electronically monitored throughout the study period, including during and after the lockdown. Depression was assessed with the 8-item Patient health questionnaire (PHQ-8), on which scores > 9 signify a positive screen for elevated depressive symptoms. A sample of 280 participants completed both the month-12 and post-lockdown assessments. Rates of elevated depressive symptoms nearly tripled from month 12 (n = 17, 6.1%) to the post-lockdown assessment (n = 50, 17.9%; McNemar test < .001). Elevated depressive symptoms at post-lockdown were associated with being female, indicators of economic struggles at month 12 (unemployment, low income, high food insecurity), and lower ART adherence during the 3-month lockdown period [mean of 71.9% (SD = 27.9) vs. 80.8% (SD = 24.1) among those not depressed; p = .041] in bivariate analysis. In multiple regression analysis, higher food insecurity [adj. OR (95% CI) = 4.64 (2.16–9.96)] and perception that the pandemic negatively impacted ART adherence [adj. OR (95% CI) = 1.96 (1.22–3.16)] remained associated with a greater likelihood of elevated depressive symptoms, when other correlates were controlled for. Qualitative data suggested that economic stressors (lack of food, work, and money) were key contributors to elevated depressive symptoms, and these stressors led to missed ART doses because of lack of food and stress induced forgetfulness. Elevated depressive symptoms significantly increased during the COVID-19 lockdown and was associated with food insecurity and reduced ART adherence. Mechanisms for identifying and treating depression and food insecurity are needed to help PLHIV cope with and mitigate the harmful effects of unexpected crises that may impede disease management and access to food.
Collapse
Affiliation(s)
| | - Zachary Wagner
- RAND Corporation, 1776 Main St., Santa Monica, CA 90407 USA
| | - Mahlet Gizaw
- RAND Corporation, 1776 Main St., Santa Monica, CA 90407 USA
| | - Uzaib Saya
- RAND Corporation, 1776 Main St., Santa Monica, CA 90407 USA
| | | | | | | | | |
Collapse
|
29
|
Kumar A, Mishra AK, Saroj S, Rashid S. Government transfers, COVID-19 shock, and food insecurity: Evidence from rural households in India. AGRIBUSINESS (NEW YORK, N.Y.) 2022; 38:636-659. [PMID: 35937589 PMCID: PMC9347629 DOI: 10.1002/agr.21746] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 01/31/2022] [Accepted: 04/21/2022] [Indexed: 06/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has decimated the lives and livelihoods of people worldwide. The impact of COVID-19 has been especially devastating for low-income families in rural areas of India. Soon after the nationwide lockdown was announced, food insecurity became pervasive in rural areas, as many families relied on daily wage work to fund necessities. By providing cash transfers and additional foodgrains, Indian policymakers acted swiftly to reduce the financial impact on family income and consumption. This paper investigates the factors affecting rural families' participation in the cash transfer program and the effect of government cash transfers on food insecurity. Results indicate that India's government cash transfer program decreased moderate food insecurity by 2.4% and severe food insecurity by about 0.92% [EconLit Citations: O12, I31, I32, I38].
Collapse
Affiliation(s)
- Anjani Kumar
- International Food Policy Research Institute, South Asia OfficeNew DelhiIndia
| | - Ashok K. Mishra
- Kemper and Ethel Marley Foundation Chair, Morrison School of Agribusiness, W.P. Carey School of BusinessArizona State UniversityMesaArizonaUSA
| | - Sunil Saroj
- International Food Policy Research Institute, South Asia OfficeNew DelhiIndia
| | - Shahidur Rashid
- International Food Policy Research Institute, South Asia OfficeNew DelhiIndia
| |
Collapse
|
30
|
Hemerijckx LM, Janusz K, Van Emelen S, Tumwesigye S, Davis J, Lwasa S, Van Rompaey A. Food accessibility of different socioeconomic groups in sub-Saharan African cities: a mixed-method analysis in Kampala, Uganda. Food Secur 2022. [DOI: 10.1007/s12571-021-01248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
31
|
Robbiati C, Armando A, da Conceição N, Putoto G, Cavallin F. Association between diabetes and food insecurity in an urban setting in Angola: a case–control study. Sci Rep 2022; 12:1084. [PMID: 35058483 PMCID: PMC8776869 DOI: 10.1038/s41598-022-04888-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022] Open
Abstract
Diabetes is common in urban settings in Sub-Saharan Africa. Household food insecurity has been suggested to increase the chance of developing diabetes among adults. The relationship between diabetes and food insecurity has not been explored in Angolan urban settings so far. This case–control (1:2) study investigated the association between diabetes and food insecurity among adults attending six healthcare facilities in Luanda (Angola) between April 2019 and September 2019. All subjects with fasting blood glucose (FBG) levels ≥ 126 mg/dl were included as cases. For each case, the next two subjects with FBG levels < 110 mg/dl were included as controls, to warrant the achievement of the set 1:2 ratio. Food insecurity was assessed using the Food Insecurity Experience Scale (FIES). A total of 663 participants (221 cases and 442 controls) were enrolled in the study. Median FIES raw score was 7 (IQR 1–8) in cases and 5 (IQR 2–8) in controls (p = 0.09). The distribution of FIES levels (0–3; 4–6; 7–8) was different between cases and controls (p < 0.0001), with highest FIES scores (7–8) recorded in 53.0% of cases and 38.2% of controls. Our findings revealed an association between diabetes and severe food insecurity among adults attending healthcare facilities in the capital city of Angola.
Collapse
|
32
|
Wagner Z, Mukasa B, Nakakande J, Stecher C, Saya U, Linnemayr S. Impact of the COVID-19 Pandemic on Use of HIV Care, Antiretroviral Therapy Adherence, and Viral Suppression: An Observational Cohort Study From Uganda. J Acquir Immune Defic Syndr 2021; 88:448-456. [PMID: 34757973 PMCID: PMC8575089 DOI: 10.1097/qai.0000000000002811] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Recent studies project thousands of additional AIDS-related deaths because of COVID-19-related disruptions in HIV care. However, the extent to which disruptions in care have materialized since the start of the pandemic is not well understood. METHODS We use electronic health records to investigate how the pandemic has affected clinic visits, patients' antiretroviral therapy (ART) supply, and viral suppression for a cohort of 14,632 HIV clients from a large HIV clinic in Kampala, Uganda. We complement this with an analysis of electronically measured longitudinal ART adherence data from a subcohort of 324 clients. RESULTS Clinic visits decreased by more than 50% after a national lockdown started. The risk of patients running out of ART on a given day increased from 5% before the lockdown to 25% 3 months later (Relative Risk Ratio of 5.11, 95% confidence interval: 4.99 to 5.24) and remained higher than prelockdown 6 months later at 13% (Relative Risk Ratio of 2.60; 95% confidence interval: 2.52 to 2.70). There was no statistically significant change in electronically measured adherence or viral suppression. CONCLUSION We document substantial gaps in HIV care after the start of the COVID-19 pandemic in Uganda. This suggests that measures to improve access should be explored as the pandemic persists. However, ART adherence was unaffected for the subcohort for whom we measured electronic adherence. This suggests that some clients may have stockpiles of ART tablets from previous prescriptions that allowed them to keep taking their medication even when they could not visit the clinic for ART refills.
Collapse
Affiliation(s)
- Zachary Wagner
- Department of Economics, Sociology and Statistics, RAND Corporation, Santa Monica, CA
- Pardee RAND Graduate School, Santa Monica, CA
| | | | | | - Chad Stecher
- College of Health Solutions, Arizona State University, Tempe, AZ
| | - Uzaib Saya
- Pardee RAND Graduate School, Santa Monica, CA
| | - Sebastian Linnemayr
- Department of Economics, Sociology and Statistics, RAND Corporation, Santa Monica, CA
- Pardee RAND Graduate School, Santa Monica, CA
| |
Collapse
|
33
|
Saha S, Behnke A, Oldewage-Theron W, Mubtasim N, Miller M. Prevalence and Factors Associated with Food Insecurity among Older Adults in Sub-Saharan Africa: A Systematic Review. J Nutr Gerontol Geriatr 2021; 40:171-196. [PMID: 34669566 DOI: 10.1080/21551197.2021.1988027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Food insecurity has been undermining the health and well-being of a growing number of older adults in Sub-Saharan Africa. This review aimed to examine the prevalence of food insecurity and the related contributing factors of food insecurity among older adults in Sub-Saharan Africa. We used PubMed, Scopus, ScienceDirect, and Web of Science Core Collection as our search engines and included 22 articles for data extraction. Prevalence of severe and moderate food insecurity in households with older adults ranged from 6.0 to 87.3% and from 8.3 to 48.5%, respectively. Various socio-economic (e.g., low education level, being widowed, low income, lower wealth position of households, living in a rental house, living in rural areas, lack of social grants or pensions), demographic (e.g., female, Black racial group, larger family size), and health and nutrition status-related (e.g., self-reported poor health status, having a functional and mobility-related disability, psychological disorders) factors influence food insecurity in older adults in Sub-Saharan Africa. The findings of this review can help stakeholders to prioritize the issue of food insecurity, design and implement policies and programs to improve food security among older adults in Sub-Saharan Africa.
Collapse
Affiliation(s)
- Sanjoy Saha
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.,School of Family and Consumer Sciences, Texas State University, San Marcos, TX, USA
| | - Andrew Behnke
- School of Family and Consumer Sciences, Texas State University, San Marcos, TX, USA
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA.,Office of the Dean, Faculty of Natural and Agricultural Sciences, University of the Free State, Bloemfontein, South Africa
| | - Noshin Mubtasim
- Department of Biological Sciences, Texas Tech University, Lubbock, TX, USA
| | | |
Collapse
|
34
|
|
35
|
Talleh Nkobou A, Ainslie A, Lemke S. Broken promises: a rights-based analysis of marginalised livelihoods and experiences of food insecurity in large-scale land investments in Tanzania. Food Secur 2021. [DOI: 10.1007/s12571-021-01195-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AbstractProponents of large-scale land investments (LSLI) still promote them as a development opportunity, which can lead, among other benefits, to job creation and enhanced food security for local communities. However, there is increasing evidence that these investments often deprive affected communities of their access to land, with multiple negative impacts on livelihoods, food security and on the environment. This paper relies on empirical data to present an analysis of LSLI and food (in)security – crucially at the level of individuals in two villages in the Ruvuma region, Tanzania, over 10 years after the acquisition of village land within the Southern African Growth Corridor of Tanzania (SAGCOT). We introduce an innovative framework that permits an integration of a rights-based approach with the Sustainable Livelihoods Framework to explore smallholders’ livelihoods and experiences of food insecurity. Our paper demonstrates how this integration, along with attention we have given to the FAO’s PANTHER principles, adds the missing yet crucial dimension of accountability on the part of national governments as duty bearers. Our findings show that in the case of these two villages, the human rights principles of participation, accountability, transparency and empowerment are severely undermined, with women bearing the brunt in all these domains. This overall state of affairs is, we argue, due to inadequate monitoring and evaluation of LSLI processes themselves and low levels of commitment on the part of institutions in Tanzania to monitor the promises made by investors. This in turn demonstrates an accountability deficit on the part of duty-bearers within LSLIs, and limited capacity of affected community members to claim their rights. Individual food insecurity experience in the two communities correlates, among other characteristics, with lack of land ownership, employment and income-generating activities. The rights-based livelihoods framework applied in this study points to serious deficiencies in the LSLI model as presently endorsed in SAGCOT, and emphasises the fact that access to land in Tanzania is a precondition for the realisation of the right to adequate food and thus a critical requirement for achieving and maintaining food and nutrition security. We conclude by arguing that progressive coalitions within and beyond national states must devise policies and institutions that empower individuals and civil society actors to make demands on their governments to respect, protect and fulfil their obligations regarding the legally enforceable right to food.
Collapse
|
36
|
Adjognon GS, Bloem JR, Sanoh A. The coronavirus pandemic and food security: Evidence from Mali. FOOD POLICY 2021; 101:102050. [PMID: 36570061 PMCID: PMC9758592 DOI: 10.1016/j.foodpol.2021.102050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 05/10/2023]
Abstract
This paper documents some of the first estimates of changes in experienced food insecurity associated with the coronavirus pandemic in a low-income country. It combines nationally representative pre-pandemic household survey data with follow-up phone survey data from Mali and examines sub-national variation in the intensity of pandemic-related disruptions between urban and rural areas. Although rural households are more likely to experience food insecurity prior to the pandemic, we find that food insecurity increased more in urban areas than in rural areas. Just three months after the onset of the pandemic, the rural-urban gap in experienced food insecurity completely vanished. These findings highlight that understanding effect heterogeneity is critically important to effectively designing and targeting post-pandemic humanitarian assistance.
Collapse
Affiliation(s)
| | - Jeffrey R Bloem
- United States Department of Agriculture, Economic Research Service, MS9999, Beacon Facility, P.O. Box 419205, Kansas City, MO 64141, United States
| | - Aly Sanoh
- Poverty and Equity Global Practice, The World Bank Group, Bamako, Mali
| |
Collapse
|
37
|
Sheikomar OB, Dean W, Ghattas H, Sahyoun NR. Validity of the Food Insecurity Experience Scale (FIES) for Use in League of Arab States (LAS) and Characteristics of Food Insecure Individuals by the Human Development Index (HDI). Curr Dev Nutr 2021; 5:nzab017. [PMID: 33937614 PMCID: PMC8059488 DOI: 10.1093/cdn/nzab017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 02/12/2021] [Accepted: 02/23/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Food Insecurity Experience Scale (FIES) is a UN FAO Voices of the Hungry (FAO-VoH) experiential metric of food insecurity (FI). It was pilot tested in some countries but not in Arab speaking ones and validated using global data. Yet, its psychometric properties may vary in the League of Arab States (LAS) due to cultural and linguistic differences. OBJECTIVES 1) assess the validity of FIES for use in the LAS region, 2) determine the prevalence of FI, by gender, age group, and the human development index (HDI), and 3) examine sociodemographic characteristics of severe FI individuals. METHODS To assess the psychometric properties of FIES, Rasch modeling was applied to the 2014-2015 Gallop World Poll (GWP) in the LAS. Prevalence and characteristics of severely FI individuals were assessed using the 2014-2017 GWP data of 62,261 respondents. RESULTS Overall, FIES met the Rasch model assumptions of equal discrimination and conditional independence. Infit statistics for FIES items, in most LAS countries, were <1.3, indicating good internal validity. In Syria and Sudan, the item "worried about not having enough food to eat" had infits >1.3. Outfit statistics >2.0, indicating erratic responses, were noted in 26% of the LAS countries. Significant correlations were found (≥0.4) between items in Algeria, Tunisia, and Lebanon. The overall prevalence of severe FI was 15.7%. At highest risk were those aged ≥50 y compared with younger adults (16.5% versus 15.5%, respectively, P <0.02), women compared with men (17.6% versus 14.1%, respectively, P <0.0001), and those in countries with low HDI compared with high HDI (24.9% versus 8.3%, respectively, P <0.0001). CONCLUSIONS Overall, FIES is valid for measuring FI in the LAS. Cognitive testing of items with high outfit statistics and omission of correlated ones may improve the scale. Populations vulnerable to severe FI include older adults and women. These populations should be examined further.
Collapse
Affiliation(s)
- Olfat B Sheikomar
- Department of Nutrition and Food Science, University of Maryland, College Park, MD, USA
| | - Wesley Dean
- Department of Food and Resource Economics, University of Copenhagen, Copenhagen, Denmark
| | - Hala Ghattas
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Nadine R Sahyoun
- Department of Nutrition and Food Science, University of Maryland, College Park, MD, USA
| |
Collapse
|
38
|
Cañari-Casaño JL, Cochachin-Henostroza O, Elorreaga OA, Dolores-Maldonado G, Aquino-Ramírez A, Huaman-Gil S, Giribaldi-Sierralta JP, Aparco JP, Antiporta DA, Penny ME. Social predictors of food insecurity during the stay-at-home order due to the COVID-19 pandemic in Peru. Results from a cross-sectional web-based survey. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.02.06.21251221. [PMID: 33564796 PMCID: PMC7872391 DOI: 10.1101/2021.02.06.21251221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Stay-at-home orders and social distancing have been implemented as the primary tools to reduce the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, this approach has indirectly lead to the unemployment of 2·3 million Peruvians, in Lima, Perú alone. As a result, the risk of food insecurity may have increased, especially in low-income families who rely on a daily wage. This study estimates the prevalence of moderate or severe food insecurity (MSFI) and identifies the associated factors that explain this outcome during the stay-at-home order. METHODS A cross-sectional web-based survey, with non-probabilistic sampling, was conducted between May 18 and June 30, 2020, during the stay-at-home order in Peru. We used social media advertisements on Facebook to reach 18-59-year-olds living in Peru. MSFI was assessed using the Food Insecurity Experience Scale (FIES). Rasch model methodology requirements were considered, and factors associated with MSFI were selected using stepwise forward selection. A Poisson generalized linear model (Poisson GLM), with log link function, was employed to estimate adjusted prevalence ratios (aPR). FINDINGS This analysis is based on 1846 replies. The prevalence of MSFI was 23·2%, and FIES proved to be an acceptable instrument with reliability 0·72 and infit 0·8-1·3. People more likely to experience MSFI were those with low income (less than 255 US$/month) in the pre-pandemic period (aPR 3·77; 95%CI, 1·98-7·16), those whose income was significantly reduced during the pandemic period (aPR 2·27; 95%CI, 1·55-3·31), and those whose savings ran out in less than 21 days (aPR 1·86; 95%CI, 1·43-2·42). Likewise, heads of households (aPR 1·20; 95%CI, 1·00-1·44) and those with probable SARS-CoV2 cases as relatives (aPR 1·29; 95%CI, 1·05-1·58) were at an increased risk of MSFI. Additionally, those who perceived losing weight during the pandemic (aPR 1·21; 95%CI, 1·01-1·45), and increases in processed foods prices (aPR 1·31; 95%CI, 1·08-1·59), and eating less minimally processed food (aPR 1·82; 95%CI, 1·48-2·24) were more likely to experience MSFI. INTERPRETATION People most at risk of MSFI were those in a critical economic situation before and during the pandemic. Social protection policies should be reinforced to prevent or mitigate these adverse effects.
Collapse
Affiliation(s)
- Jorge L Cañari-Casaño
- Clima, Latin American Center of Excellence for Climate Change and Health, Universidad Peruana Cayetano Heredia
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia
| | | | - Oliver A Elorreaga
- Clima, Latin American Center of Excellence for Climate Change and Health, Universidad Peruana Cayetano Heredia
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia
- GMINIS Research Group, Pontificia Universidad Católica del Perú
| | - Gandy Dolores-Maldonado
- Escuela Profesional de Nutrición, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | | | - Sindy Huaman-Gil
- Escuela Profesional de Nutrición, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
- Sociedad Científica de Estudiantes de Nutrición, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Juan P Giribaldi-Sierralta
- Escuela Profesional de Nutrición, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
- Sociedad Científica de Estudiantes de Nutrición, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Juan Pablo Aparco
- Centro Nacional de Alimentación y Nutrición, Instituto Nacional de Salud, Lima, Perú
- Universidad San Ignacio de Loyola, Carrera de Nutrición y Dietética, Lima, Perú
| | - Daniel A Antiporta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | |
Collapse
|
39
|
Confirmatory factor analysis to validate a new measure of food insecurity: perceived and actual constructs. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s11135-020-00982-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
40
|
Taylor SFW, Roberts MJ, Milligan B, Ncwadi R. Measurement and implications of marine food security in the Western Indian Ocean: an impending crisis? Food Secur 2019. [DOI: 10.1007/s12571-019-00971-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Ten percent of the world’s population depends on the ocean for a readily accessible source of protein and employment. Coastal ecosystems and the communities that rely upon them are facing extreme challenges of increases in ocean pollution, loss of habitat, ocean warming, and changes in ocean productivity. With the whole system under mounting pressure, governments need to scale down food security analyses to the coastal community level to avoid overseeing rising levels of food insecurity. This paper provides an alternative view and analysis of food security at both a national and community level taking into account these marginalised communities. The results propose a refined definition of marine food security and new quantitative methods to measuring direct and indirect reliance on fish within developing countries. Application of this concept and methods reveals that aggregated national statistics mask the extreme levels of dependence on fish for food security in coastal communities within Kenya and Madagascar. The Comoros, Mauritius, Mozambique, and Somalia appear to be the most vulnerable to increasing sea surface temperature, population, and fluctuation in total catch and will be severely affected by a changing Western Indian Ocean from a national, community, and individual perspective. Overall, the study highlights that governments need to disaggregate fisheries data and redefine measurements of food security to more accurately reveal the severity of the potential marine food insecurity crisis at hand.
Collapse
|