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Weiser SD, Sheira LA, Weke E, Zakaras JM, Wekesa P, Frongillo EA, Burger RL, Mocello AR, Thirumurthy H, Dworkin SL, Tsai AC, Kahn JG, Butler LM, Bukusi EA, Cohen CR. An agricultural livelihood intervention is associated with reduced HIV stigma among people with HIV. AIDS 2024; 38:1553-1559. [PMID: 38752558 DOI: 10.1097/qad.0000000000003928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
OBJECTIVE HIV stigma undermines antiretroviral treatment (ART) adherence and viral suppression. Livelihood interventions may target drivers of negative attitudes towards people with HIV (PWH) by improving their health and strengthening their economic contributions. We examined the effects of a multisectoral agricultural livelihood intervention on HIV stigma among PWH in western Kenya. DESIGN Sixteen health facilities were randomly allocated (1 : 1) to intervention or control arms in Shamba Maisha , a cluster randomized controlled trial that aimed to improve HIV-related health through behavioral, mental health, and nutritional pathways. METHODS The intervention included a farming loan and agricultural and financial training. Participants had access to farmland and surface water and were at least 18 years old, on ART for more than 6 months, and moderately-to-severely food insecure. We measured internalized, anticipated, and enacted HIV stigma semiannually over 2 years using validated scales. In blinded intent-to-treat analyses, we compared changes in scores over 24 months by study arm, using longitudinal multilevel difference-in-differences linear regression models that accounted for clustering. RESULTS Of 720 enrolled participants (354 intervention), 55% were women, and the median age was 40 years [interquartile range 34-47 years]. Two-year retention was 94%. Compared with the control arm, the intervention resulted in significant decreases ( P < 0.001) of 0.42 points [95% confidence interval (CI) -0.52 to -0.31) in internalized stigma, 0.43 points (95% CI -0.51 to -0.34) in anticipated stigma, and 0.13 points (95% CI -0.16 to -0.09) in enacted stigma over 24 months. CONCLUSION The agricultural livelihood intervention reduced HIV stigma among PWH. Poverty-reduction approaches may be a novel strategy for reducing HIV stigma.
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Affiliation(s)
- Sheri D Weiser
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Lila A Sheira
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jennifer M Zakaras
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, Discovery I, University of South Carolina, Columbia, SC
| | - Rachel L Burger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Adrienne Rain Mocello
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, Philadelphia, PA
| | - Shari L Dworkin
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA
| | - James G Kahn
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Lisa M Butler
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
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Exavery A, Kirigiti PJ, Balan RT, Charles J. Multivariate mixed-effects ordinal logistic regression models with difference-in-differences estimator of the impact of WORTH Yetu on household hunger and socioeconomic status among OVC caregivers in Tanzania. PLoS One 2024; 19:e0301578. [PMID: 38626125 PMCID: PMC11020529 DOI: 10.1371/journal.pone.0301578] [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: 08/14/2023] [Accepted: 03/19/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Although most of the livelihood programmes target women, those that involve women and men have been evaluated as though men and women were a single homogenous population, with a mere inclusion of gender as an explanatory variable. This study evaluated the impact of WORTH Yetu (an economic empowerment intervention to improve livelihood outcomes) on household hunger, and household socioeconomic status (SES) among caregivers (both women and men) of orphaned and vulnerable children (OVC) in Tanzania. The study hypothesized that women and men respond to livelihood interventions differently, hence a need for gender-disaggregated impact evaluation of such interventions. METHODS This is a secondary analysis of longitudinal data, involving caregivers' baseline (2016-2019) and follow-up (2019-2020) data from the USAID Kizazi Kipya project in 25 regions of Tanzania. Two dependent variables (ie, outcomes) were assessed; household hunger which was measured using the Household Hunger Scale (HHS), and Socioeconomic Status (SES) using the Principal Component Analysis (PCA). WORTH Yetu, a livelihood intervention implemented by the USAID Kizazi Kipya project was the main independent variable whose impact on the two outcomes was evaluated using multivariate analysis with a multilevel mixed-effects, ordinal logistic regression model with difference-in-differences (DiD) estimator for impact estimation. RESULTS The analysis was based on 497,293 observations from 249,655 caregivers of OVC at baseline, and 247,638 of them at the follow-up survey. In both surveys, 70% were women and 30% were men. Their mean age was 49.3 (±14.5) years at baseline and 52.7 (±14.8) years at the follow-up survey. Caregivers' membership in WORTH Yetu was 10.1% at the follow-up. After adjusting for important confounders there was a significant decline in the severity of household hunger by 46.4% among WORTH Yetu members at the follow-up compared to the situation at the baseline (adjusted Odds Ratio (aOR) = 0.536, 95% Confidence Interval (CI) [0.521, 0.553]). The decline was 45.7% among women (aOR = 0.543 [0.524, 0.563]) and 47.5% among men (aOR = 0.525 [0.497, 0.556]). Regarding SES, WORTH Yetu members were 15.9% more likely to be in higher wealth quintiles at the follow-up compared to the situation at the baseline (aOR = 1.159 [1.128, 1.190]). This impact was 20.8% among women (aOR = 1.208 [1.170, 1.247]) and 4.6% among men (aOR = 1.046 [0.995, 1.101]). CONCLUSION WORTH Yetu was associated with a significant reduction in household hunger, and a significant increase in household SES among OVC caregivers in Tanzania within an average follow-up period of 1.6 years. The estimated impacts differed significantly by gender, suggesting that women and men responded to the WORTH Yetu intervention differently. This implied that the design, delivery, and evaluation of such programmes should happen in a gender responsive manner, recognising that women and men are not the same with respect to the programmes.
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Affiliation(s)
- Amon Exavery
- Department of Mathematics and Statistics, College of Natural and Mathematical Sciences (CNMS), The University of Dodoma, Dodoma, Tanzania
- Pact Tanzania, Dar es Salaam, Tanzania
| | - Peter J. Kirigiti
- Department of Mathematics and Statistics, College of Natural and Mathematical Sciences (CNMS), The University of Dodoma, Dodoma, Tanzania
| | - Ramkumar T. Balan
- Department of Mathematics and Statistics, College of Natural and Mathematical Sciences (CNMS), The University of Dodoma, Dodoma, Tanzania
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Masa R, Zimba M, Zimba G, Zulu G, Zulu J, Operario D. The Association of Emotional Support, HIV Stigma, and Home Environment With Disclosure Efficacy and Perceived Disclosure Outcomes in Young People Living With HIV in Zambia: A Cross-Sectional Study. J Assoc Nurses AIDS Care 2024; 35:17-26. [PMID: 37994517 PMCID: PMC10842355 DOI: 10.1097/jnc.0000000000000442] [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] [Indexed: 11/24/2023]
Abstract
ABSTRACT This study examined the association of various forms of social support, attitudes toward living at home, and HIV stigma experiences with HIV self-disclosure efficacy and perceived negative disclosure outcomes. We analyzed cross-sectional data from 120 young people with HIV (YPWH) aged 18-21 years receiving outpatient care in Eastern Province, Zambia. Perceived negative disclosure outcomes and disclosure self-efficacy were measured using an adapted version of the Adolescent HIV Disclosure Cognitions and Affect Scale. Explanatory variables included parental or caregiver support, emotional support, instrumental support, HIV stigma experiences, and attitudes toward living at home. Findings suggest that YPWH's confidence in their ability to self-disclose their HIV status and their assessment of negative outcomes associated with HIV disclosure are influenced by emotional support, experiences of HIV stigma, and the quality of the home environment.
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Affiliation(s)
- Rainier Masa
- Rainier Masa, PhD, is an Associate Professor, School of Social Work University of North Carolina, Chapel Hill, North Carolina, USA. Mathias Zimba, MA, is a Director, Rising Fountains Development Program, Chipata, Zambia. Gilbert Zimba, DipTh, is Project Coordinator, Rising Fountains Development Program, Lundazi, Zambia. Graham Zulu, MSW, is a Research Associate, Global Social Development Innovations, University of North Carolina, Chapel Hill, North Carolina, USA. Joseph Zulu, PhD, is an Associate Professor, School of Public Health, University of Zambia, Lusaka, Zambia. Don Operario, PhD, is a Professor, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Celeste-Villalvir A, Then-Paulino A, Armenta G, Jimenez-Paulino G, Palar K, Wallace DD, Derose KP. Exploring feasibility and acceptability of an integrated urban gardens and peer nutritional counselling intervention for people with HIV in the Dominican Republic. Public Health Nutr 2023; 26:3134-3146. [PMID: 37905447 PMCID: PMC10755388 DOI: 10.1017/s1368980023002264] [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: 11/21/2022] [Revised: 08/04/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Food security interventions with people living with HIV (PLHIV) are needed to improve HIV outcomes. This process evaluation of a pilot intervention involving urban gardening and peer nutritional counselling with PLHIV assesses feasibility, acceptability and implementation challenges to inform scale-up. DESIGN Mixed methods were used, including quantitative data on intervention participation and feasibility and acceptability among participants (n 45) and qualitative data from a purposive sample of participants (n 21). Audio-recorded interviews were transcribed and coded using a codebook developed iteratively. SETTING An HIV clinic in the northwest-central part of the Dominican Republic. RESULTS The intervention was feasible for most participants: 84 % attended a garden workshop and 71 % established an urban garden; 91 % received all three core nutritional counselling sessions; and 73 % attended the cooking workshop. The intervention was also highly acceptable: nearly, all participants (93-96 %) rated the gardening as 'helpful' or 'very helpful' for taking HIV medications, their mental/emotional well-being and staying healthy; similarly, high percentages (89-97 %) rated the nutrition counselling 'helpful' or 'very helpful' for following a healthy diet, reducing unhealthy foods and increasing fruit/vegetable intake. Garden barriers included lack of space and animals/pests. Transportation barriers impeded nutritional counselling. Harvested veggies were consumed by participants' households, shared with neighbours and family, and sold in the community. Many emphasised that comradery with other PLHIV helped them cope with HIV-related marginalisation. CONCLUSION An urban gardens and peer nutritional counselling intervention with PLHIV was feasible and acceptable; however, addressing issues of transportation, pests and space is necessary for equitable participation and benefit.
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Affiliation(s)
- Alane Celeste-Villalvir
- University of Massachusetts Amherst, Department of Health Promotion and Policy, Amherst, MA01003, USA
| | - Amarilis Then-Paulino
- Universidad Autónoma de Santo Domingo, Facultad de Ciencias de la Salud, Av. Alma Mater, Santo Domingo, Dominican Republic
| | - Gabriela Armenta
- RAND Corporation and Pardee RAND Graduate School, Santa Monica, CA90401, USA
| | - Gipsy Jimenez-Paulino
- Universidad Autónoma de Santo Domingo, Facultad de Ciencias de la Salud, Av. Alma Mater, Santo Domingo, Dominican Republic
| | - Kartika Palar
- University of California, San Francisco, Department of Medicine, San Francisco, CA94143, USA
| | - Deshira D Wallace
- University of North Carolina at Chapel Hill, Department of Health Behavior, Chapel Hill, NC27599, USA
| | - Kathryn P Derose
- University of Massachusetts Amherst, Department of Health Promotion and Policy, Amherst, MA01003, USA
- RAND Corporation and Pardee RAND Graduate School, Santa Monica, CA90401, USA
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Santos WND, Silva RSD, Souza FMDLC, Santos RSDC, Oliveira ICD, Silva RARD. Ineffective health control: concept analysis. Rev Bras Enferm 2021; 74:e20190158. [PMID: 33787772 DOI: 10.1590/0034-7167-2019-0158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/05/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to identify and synthesize the concept of Ineffective Health Control. METHODS Concept Analysis from the perspective of Walker and Avant, operationalized by an integrative review in the databases Scopus, LILACS, PubMed, CINAHL, Web of Science, Science Direct e Cochrane, using the descriptors: Adhesion to Medication; Cooperation and Adherence to Treatment and Acquired Immunodeficiency Syndrome. RESULTS five critical attributes were identified for the concept, namely: patient's refusal to follow the therapeutic plan; abandoning treatment and worsening signs and symptoms; difficulty in reaching agreed goals; difficulty following health professionals' guidelines; multifactorial and dynamic process. CONCLUSIONS the concept of Ineffective Health Control is characterized by a multifactorial and dynamic process evidenced by the patient's refusal to follow a therapeutic plan, favouring the abandonment of treatment and resulting in the worsening of signs and symptoms and failure to reach goals.
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Kumsa DM, Tucho GT. The Impact of Formal and Informal Institutions on ART Drug Adherence. J Int Assoc Provid AIDS Care 2020; 18:2325958219845419. [PMID: 31109220 PMCID: PMC6748520 DOI: 10.1177/2325958219845419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A successful antiretroviral therapy (ART) drug adherence is achieved when patients follow
their prescribed regimen. This is determined by patient’s motivation that is influenced by
resources associated with the patient, society, and relevant institutions. The aim of this
study is to assess the impact of formal and informal actors on patients’ ART drug
adherence. A qualitative study approach was conducted through face-to-face in-depth
interviews of HIV-infected patients and key informants. The analysis was guided by a
salutogenic model focusing on generalized resistance resources and a sense of coherence.
The finding shows that 76% of the study participants achieved the recommended 95%
adherence level. Several resources attributed to individuals, society, and public
institutions influencing patients’ day-to-day life and their drug adherence were
identified. Patients who are able to use the available resources easily develop sense of
coherence and follow their prescribed drug regimen. Therefore, encouraging HIV-infected
patients through formal and informal actors can enhance ART drug adherence.
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Affiliation(s)
- Diribe Makonene Kumsa
- 1 Department of Sociology, College of Social Sciences and Humanities, Jimma University, Jimma, Ethiopia
| | - Gudina Terefe Tucho
- 2 Department of Environmental Health Sciences and Technology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Masa R, Chowa G. The Association of Material Hardship with Medication Adherence and Perceived Stress Among People Living with HIV in Rural Zambia. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2019; 6:17-28. [PMID: 31788412 PMCID: PMC6884321 DOI: 10.1007/s40609-018-0122-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The intersection of poverty and HIV/AIDS has exacerbated socioeconomic inequalities in Zambia. For example, the downstream consequences of HIV/AIDS are likely to be severe among the poor. Current research has relied on multidimensional indicators of poverty, which encompass various forms of deprivation, including material. Although comprehensive measures help us understand what constitutes poverty and deprivation, their complexity and scope may hinder the development of appropriate and feasible interventions. These limitations prompted us to examine whether material hardship, a more practicable, modifiable aspect of poverty, is associated with medication adherence and perceived stress among people living with HIV (PLHIV) in Zambia. We used cross-sectional data from 101 PLHIV in Lundazi District, Eastern Province. Data were collected using a questionnaire and hospital records. Material hardship was measured using a five-item scale. Perceived stress was measured using the ten-item perceived stress scale. Adherence was a binary variable measured using a visual analog scale and medication possession ratio (MPR) obtained from pharmacy data. We analyzed the data with multivariable linear and logistic regressions using multiply imputed datasets. Results indicated that greater material hardship was significantly associated with MPR nonadherence (odds ratio = 0.83) and higher levels of perceived mental distress (β = 0.34). Our findings provide one of the first evidence on the association of material hardship with treatment and mental health outcomes among PLHIV. The findings also draw attention to the importance of economic opportunities for PLHIV and their implications for reducing material hardship and improving adherence and mental health status.
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Affiliation(s)
- Rainier Masa
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
- Global Social Development Innovations, University of North Carolina, Chapel Hill, NC, USA
- Centre for Social Development in Africa, University of Johannesburg, Auckland Park, South Africa
| | - Gina Chowa
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
- Global Social Development Innovations, University of North Carolina, Chapel Hill, NC, USA
- Centre for Social Development in Africa, University of Johannesburg, Auckland Park, South Africa
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Maughan-Brown B, Harrison A, Galárraga O, Kuo C, Smith P, Bekker LG, Lurie MN. Factors affecting linkage to HIV care and ART initiation following referral for ART by a mobile health clinic in South Africa: evidence from a multimethod study. J Behav Med 2019; 42:883-897. [PMID: 30635862 DOI: 10.1007/s10865-018-0005-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 12/08/2018] [Indexed: 11/25/2022]
Abstract
Linkage to care from mobile clinics is often poor and inadequately understood. This multimethod study assessed linkage to care and antiretroviral therapy (ART) uptake following ART-referral by a mobile clinic in Cape Town (2015/2016). Clinic record data (N = 86) indicated that 67% linked to care (i.e., attended a clinic) and 42% initiated ART within 3 months. Linkage to care was positively associated with HIV-status disclosure intentions (aOR: 2.99, 95% CI 1.13-7.91), and treatment readiness (aOR: 2.97, 95% CI 1.05-8.34); and negatively with good health (aOR: 0.35, 95% CI 0.13-0.99), weekly alcohol consumption (aOR: 0.35, 95% CI 0.12-0.98), and internalised stigma (aOR: 0.32, 95% CI 0.11-0.91). Following linkage, perceived stigma negatively affected ART-initiation. In-depth interviews (N = 41) elucidated fears about ART side-effects, HIV-status denial, and food insecurity as barriers to ART initiation; while awareness of positive ART-effects, follow-up telephone counselling, familial responsibilities, and maintaining health to avoid involuntary disclosure were motivating factors. Results indicate that an array of interventions are required to encourage rapid ART-initiation following mobile clinic HIV-testing services.
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Affiliation(s)
- Brendan Maughan-Brown
- Southern Africa Labour and Development Research Unit (SALDRU), University of Cape Town, Private Bag, Rondebosch, Cape Town, 7701, South Africa.
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Omar Galárraga
- Department of Health Services, Policy and Practice (HSPP), Brown University School of Public Health, Providence, RI, USA
| | - Caroline Kuo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Philip Smith
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Mark N Lurie
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Wambogo EA, Ghattas H, Leonard KL, Sahyoun NR. Validity of the Food Insecurity Experience Scale for Use in Sub-Saharan Africa and Characteristics of Food-Insecure Individuals. Curr Dev Nutr 2018; 2:nzy062. [PMID: 30191202 PMCID: PMC6121128 DOI: 10.1093/cdn/nzy062] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/06/2018] [Accepted: 07/09/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The Food Insecurity Experience Scale (FIES) is a UN FAO-Voices of the Hungry project (FAO-VoH) metric of food insecurity (FI). The FAO-VoH tested the psychometric properties of FIES with the use of global 2014 Gallup World Poll (GWP) data. However, similarities in its psychometric structure in sub-Saharan Africa (SSA) to allow aggregation of SSA results were untested. OBJECTIVES We aimed to 1) assess the validity of FIES for use in SSA, 2) determine the prevalence of FI by country, age group, and gender, and 3) examine the sociodemographic and economic characteristics of individuals with FI. METHODS The Rasch modeling procedure was applied to data collected by GWP in 2014 and 2015 on 57,792 respondents aged ≥19 y in SSA. RESULTS FIES largely met the Rasch model assumptions of equal discrimination and conditional independence. However, 34.3% of countries had high outfits (≥2.0) for the item "went without eating for a whole day." Four countries had significant correlations for the items "were hungry but did not eat" and "ran out of food." The overall prevalence of severe FI (SFI) was 36.4%, ranging from 6.0% in Mauritius to 87.3% in South Sudan. Older adults were at significantly higher risk of SFI than younger adults (38.6% and 35.8%, respectively, P < 0.0001), and women more than men (37.3% and 35.4%, respectively, P < 0.0001). Higher proportions of individuals with SFI were rural residents, less educated, lower income, unemployed, and lived in households with many children under the age of 15 y. CONCLUSIONS FIES has acceptable levels of internal validity for use in SSA. However, the item "went without eating for a whole day" may need cognitive testing in a few SSA countries. For countries with correlated items, 1 of the items may be excluded.
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Affiliation(s)
- Edwina A Wambogo
- Departments of Nutrition and Food Science, University of Maryland, College Park, MD
| | - Hala Ghattas
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Kenneth L Leonard
- Departments of Agriculture and Resource Economics, University of Maryland, College Park, MD
| | - Nadine R Sahyoun
- Departments of Nutrition and Food Science, University of Maryland, College Park, MD
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Masa R, Graham L, Khan Z, Chowa G, Patel L. Food insecurity, sexual risk taking, and sexual victimization in Ghanaian adolescents and young South African adults. Int J Public Health 2018; 64:153-163. [PMID: 30105507 DOI: 10.1007/s00038-018-1155-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/16/2018] [Accepted: 08/03/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The objectives of this study were to examine whether food insecurity is associated with sexual risk taking and victimization in young people (aged 16-24); and to investigate whether the relationship of food insecurity with sexual risk taking and victimization is moderated by gender. METHODS Cross-sectional data were obtained in 2014 from a sample of Ghanaian adolescents (n = 773) and in 2015 from young South African adults (n = 823). We used multilevel logistic regression given the study's binary outcome and clustered data. We tested a moderation effect of gender by including an interaction between gender and food insecurity. RESULTS Food insecurity was highly prevalent (72% in Ghana and 83% in South Africa). Food insecurity was significantly associated with unwanted sexual contact among Ghanaian adolescents (OR 1.05, 95% CI 1.02, 1.08) and age-disparate sex among young South African adults (OR 1.03, 95% CI 1.00, 1.06). Results indicated no moderating effect of gender. CONCLUSIONS Our findings underscore the importance of food access on young people's sexual health, regardless of gender. Prevention efforts may be more relevant when integrated with food security interventions that target vulnerable adolescents and young adults, irrespective of gender.
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Affiliation(s)
- Rainier Masa
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB #3550, Chapel Hill, NC, 27599, USA. .,Global Social Development Innovations, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Centre for Social Development in Africa, University of Johannesburg, Auckland Park, South Africa.
| | - Lauren Graham
- Centre for Social Development in Africa, University of Johannesburg, Auckland Park, South Africa
| | - Zoheb Khan
- Centre for Social Development in Africa, University of Johannesburg, Auckland Park, South Africa
| | - Gina Chowa
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB #3550, Chapel Hill, NC, 27599, USA.,Global Social Development Innovations, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Centre for Social Development in Africa, University of Johannesburg, Auckland Park, South Africa
| | - Leila Patel
- Centre for Social Development in Africa, University of Johannesburg, Auckland Park, South Africa
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