Household food insecurity access scale and dietary diversity score as a proxy indicator of nutritional status among people living with HIV/AIDS, Bahir Dar, Ethiopia, 2017

Associated factors of diet quality among people living with HIV/AIDS in Ghana

INTRODUCTION

Nutrition is a very important element of a comprehensive care for people living with HIV/AIDS (PLHIV), especially in resource-constrained settings where malnutrition and food insecurity are common. Dietary diversity is a useful indication of nutritional adequacy (diet quality) in people of all ages. An optimally diverse diet strengthens the body's immune system.

OBJECTIVE

This study aimed to assess diet quality and its associated factors among PLHIV.

METHODS

A facility-based cross-sectional study design was employed to select 440 PLHIV from two hospitals in the Eastern Region of Ghana. Dietary intakes were determined using 24-hour recall. A stadiometer and bioimpedance analysis machine were used to obtain anthropometric and body composition data. Diet quality was assessed using FAO's individual dietary diversity score (IDDS) as a proxy. SPSS version 20 was used for analysis. Odds ratios and ordinal logistic regression were used to identify factors associated with diet quality among the PLHIV. P-value was set at 0.05.

RESULTS

Most of the PLHIV (73%) consumed from 'Starchy staple" food group. Less than 20% of the study sample consumed 'Fruits' and 'Vegetables' (17% and 14% respectively) a day before the survey. The mean IDDS was 4.11 (SD = 1.29). Overall, most of the PLHIV (56%) had medium IDDS which is equivalent to "diet needing improvement', 14% had higher IDDS (good diet), whiles about 31% of the participants actually had poor diet (lower IDDS). Associated factors of diet quality were age (AOR = 0.966: 95%CI: 0.936-0.997: p = 0.031), married (AOR = 4.634: 95%CI: 1.329-16.157: p = 0.0016), separated (AOR = 0.0203: 95%CI: .036-0.994: p = 0.049), and daily meal frequency (AOR = 0.441: 95%CI: .478-1.948: p = 0.020). Overall, the model accounts for about 20% of the variation in diet quality of the participants (pseudo-R square = 0.196).

CONCLUSION

This study demonstrates that most of the PLHIV did not consume good diet which may have an implication on their immune system, which is already under attack by HIV, and probably emerging infections. Age, marital status, and meal frequency were the variables that predicted diet quality among the study participants.

Nutritional Status in Leprosy Patients: A Systematic Review and Meta-analysis

BACKGROUND

Leprosy, a chronic mycobacterial disease, is frequently accompanied by malnutrition. However, it is important to regularly assess the nutritional state of leprosy patients in a resource-poor nation like India, where undernutrition is widespread.

OBJECTIVES

This study aimed to compare the nutritional status of leprosy patients to that of normal individuals using the body mass index.

METHODS

The electronic databases PubMed, Google Scholar, and Embase were used to conduct an open literature search. From 1st January 2000 to 31st January 2023, all articles were screened using the following MeSH terms: (nutrition OR body mass index OR body weight) AND (leprosy OR lepra) to find possibly relevant articles.

RESULTS

This meta-analysis includes five research studies with a total of 1173 individuals (363 patients in the leprosy group and 810 patients in the non-leprosy group). The weighted mean difference (WMD) for BMI studies was -17.88 (95% CI -27.65 to -8.12), showing that there was a significant difference in BMI < 18.5 between leprosy patients and non-leprosy patients. There was a significant difference in DDS score and HFIAS score between patients with leprosy and non-leprosy. In a total of 342 leprosy patients, 206 developed deformities.

CONCLUSION

This research increases our understanding of nutrition and leprosy. The results found that people with leprosy are nutritionally at a distinct disadvantage when compared to non-leprosy patients. It emphasises the several ways in which diet may generate circumstances that increase the risk of leprosy.

Household food security, child dietary diversity and coping strategies among rural households. The case of Kole District in northern Uganda

Household food security, feeding practices, dietary diversity and coping strategies to household food insecurity are largely interconnected. Using a cross sectional study approach involving 162 mothers and care givers of children 0-36 months of age in Kole district of northern Uganda, this study examined the household food security status, child dietary diversity and household coping strategies. The study revealed that a slight majority of the households (55%) were food secure although with a low level of child dietary diversity experienced (68.1% for children 6-23 months age group and 55.3% for 24-36 months age group). We found that starch-based foods derived from cereals, roots and tubers were the most predominantly used food group in child feeding (82%), with limited consumption of other essential food groups, notably fruits, vegetables, meats and dairy products (18% combined). Additionally, only 57% of children 0 to 6 months old were receiving exclusive breastfeeding, and the introduction of complementary foods is often delayed and not well planned for those above 6 months of age. Results also showed that a wide range of coping strategies are employed however the major ones were, reliance on less preferred food (54.9%), limiting portions of meals (35.2%), reducing number of meals taken in a day (29%), and gathering wild fruits and harvesting immature crops (29.6%). It was observed that household food security is a strong determinant of child dietary diversity, may influence feeding practices and the range of coping strategies applicable to households when they experience food insecurity. Furthermore, nutritional education, household size and livelihood diversity play a significant role in determining household food security status, child dietary diversity and coping with food insecurity within rural households. In conclusion, addressing household food security, and coping strategies can play an important role in improving child feeding practices and dietary diversity in rural communities.

Association Between Overweight/Obesity and ART Drug Regimen Among Adult HIV Patients in Gamo Zone Public Health Facilities Southern Ethiopia

Introduction

Overweight/obesity is an emerging public health problem in low income countries. Currently sub-Saharan African countries are facing a double burden of malnutrition. Evidence has shown that overweight/obesity is becoming a problem for people living with HIV. But little is known in our setting. Thus, this study is designed to assess the association between overweight/obesity and ART drug regimen among adult HIV patients in Gamo zone public health facilities southern Ethiopia.

Objective

To assess the association between overweight/obesity and ART drug regimen among adult HIV patients in Gamo zone public health facilities southern Ethiopia.

Methods

Institution-based cross-sectional study was conducted from April 10 to May 10, 2022, among systematically selected adult HIV patients. The data were collected by using a structured interviewer-administered questionnaire, patient record review, and physical measurements. Multivariate logistic regression model was used to assess the association between dependent and independent variables. A p-value <0.05 with its 95% CI was considered as a statistically significant and interpreted accordingly.

Results

The magnitude of overweight/obesity were 13.5% (95% CI:(10.4-17.2)). Being male (2.484(1.308, 4.716)), duration on ART (took for ≥5 years) ((2.249(1.218, 4.152)), and ART drug regime (3.789(1.965, 7.304)) were significantly associated with overweight/obesity.

Conclusion

Overweight/obesity is significantly associated to ART drug regimen type among adult HIV patients. Furthermore, sex and duration on ART drug were found significantly associated with overweight/obesity of adult HIV patients.

Magnitude and predictors of anemia among preschool children (36-59 months) in Atingo town, Jimma, Ethiopia

Introduction

Anemia is a serious public health concern that affects more than 25% of the world's population. It is still widespread and at its most severe in Ethiopia. This study pointed to identify the magnitude and predictors of anemia in preschool children in Atinago.

Method

A structured interview and anthropometric metrics had been used in a cross-sectional study to collect data from 309 preschool children using a systematic sampling strategy from May 10 to June 25, 2022. Frequencies, percentages, means, and a bar chart were created as descriptive statistics. Factors that were significant at the 25% level in univariate analysis were run through multiple logistic models. Odds ratios with respective 95% confidence intervals were developed to determine the relevant predictors.

Result

The majority (51.7%) of preschool children in Atinago town had anemia. The finding reveals that poor dietary diversity (adjusted odds ratio [AOR] = 1.77, 95% confidence interval [CI] = 1.02-3.07), children from families with food insecurity (AOR = 2.28, 95% CI = 1.31-3.9), child-mothers used iron folate for less than 3 months during pregnancy (AOR = 1.93, 95% CI = 1.07-3.48), households with more than five children (AOR = 1.880, 95% CI = 1.12-3.18), and stunted children (AOR = 1.78, 95% CI = 1.05-3.01) were highly susceptible to anemia.

Conclusion

The findings indicate that anemia was a serious issue among preschool children in Atinago. Therefore, stakeholders should provide community-based nutrition training on consuming diverse diets, dietary improvements in the home, consuming iron-rich meals, and the like; encourage mothers to participate in early ANC follow-up; and strengthen activities aimed at identifying households with food insecurity status.

A systematic literature review of indicators measuring food security

Measurement is critical for assessing and monitoring food security. Yet, it is difficult to comprehend which food security dimensions, components, and levels the numerous available indicators reflect. We thus conducted a systematic literature review to analyse the scientific evidence on these indicators to comprehend the food security dimensions and components covered, intended purpose, level of analysis, data requirements, and recent developments and concepts applied in food security measurement. Data analysis of 78 articles shows that the household-level calorie adequacy indicator is the most frequently used (22%) as a sole measure of food security. The dietary diversity-based (44%) and experience-based (40%) indicators also find frequent use. The food utilisation (13%) and stability (18%) dimensions were seldom captured when measuring food security, and only three of the retrieved publications measured food security by considering all the four food security dimensions. The majority of the studies that applied calorie adequacy and dietary diversity-based indicators employed secondary data whereas most of the studies that applied experience-based indicators employed primary data, suggesting the convenience of collecting data for experience-based indicators than dietary-based indicators. We confirm that the estimation of complementary food security indicators consistently over time can help capture the different food security dimensions and components, and experience-based indicators are more suitable for rapid food security assessments. We suggest practitioners to integrate food consumption and anthropometry data in regular household living standard surveys for more comprehensive food security analysis. The results of this study can be used by food security stakeholders such as governments, practitioners and academics for briefs, teaching, as well as policy-related interventions and evaluations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40066-023-00415-7.

Food Insecurity in the Informal Settlements of Inanda Households Living with Children under 60 Months in Ethekwini Municipality

Food insecurity is a continuing challenge for many households in South Africa. This challenge poses serious immediate and long-term health and development risks for children. Despite the intensive literature on household food insecurity, there is limited literature on the household food security status in South African informal settlements. Thus, the household food security status and dynamics in informal settlements are not clearly defined. Hence, this study assessed the food security status of households living with children under 60 months in the informal settlements of the Inanda area, eThekwini Municipality. This study employed a cross-sectional quantitative research approach. A non-probability sampling method was used, which used convenience sampling supplemented by a non-discriminative snowball sampling to obtain a sample size of 160 households with children under the age of five. Data was collected through face-to-face interviews, where questionnaires were administered to household child caregivers. Ethical considerations such as informed consent, anonymity, confidentiality, permission from authorities, and cultural considerations were obeyed in this study. The HFIAS and HDDS tools were used to estimate the household food security status. Data were coded and analysed in SPSS version 25 software. This study revealed that higher proportions of the surveyed informal households living with children under 60 months were food insecure. The HFIAS analysis showed that approximately 34, 31, and 28% were severely, mildly, and moderately food insecure, respectively. In contrast, a small (approximately 8%) proportion of the surveyed informal households was estimated to be food secure. The HDDS analysis revealed that most (approximately 77%) of the surveyed informal households had low dietary diversity (deemed food insecure). Cereal, roots, and fatty foods were the main dietary components in the informal settlements of Inanda. It is paramount to improve the food security status of informal households living with children under 60 months through an integrated approach. This study suggests government and private stakeholders' engagement in developing policies and programs directed at informal households living with children under 60 months to alleviate food insecurity.

Associations between parenting stress, parent feeding practices, and perceptions of child eating behaviors during the COVID-19 pandemic

The aim of this study was to explore associations between parenting stress, feeding practices, and perceptions of children's eating behaviors during the COVID-19 pandemic. Parents (n = 284) of children ages 4–6 years completed a cross-sectional online survey during the onset of pandemic-related stay-at-home mandates in the U.S. Parents reported current levels of parenting stress, feeding practices, and child eating behaviors. Parents also reported whether parenting stress had increased, stayed the same, or decreased since prior to the onset of pandemic-related stay-at-home mandates. Greater levels of parenting stress were associated with less desirable feeding practices, including greater odds of high use of food for emotional regulation (OR = 1.05, 95% CI = 1.03–1.08), food as a reward (OR = 1.05, 95% CI = 1.02–1.08), and pressure to eat (OR = 1.03, 95% CI = 1.01–1.06), and low use of encouraging a balanced diet (OR = 1.03, 95% CI = 1.01–1.06). Greater levels of parenting stress were also associated with greater perceptions that children exhibited problematic eating behaviors, including greater odds of high food fussiness (OR = 1.05, 95% CI = 1.02–1.08) and low enjoyment of food (OR = 1.05, 95% CI = 1.02–1.07). For parents who reported their parenting stress had increased, greater parenting stress was associated with more frequent use of pressure to eat (p = .009) and less frequent monitoring their child's diet (p = .028). In conclusion, parenting stress during the pandemic was associated with use of food for emotional and behavioral regulation and perceptions that children exhibited problematic eating behaviors. Further research is needed to understand how to mitigate parenting stress and promote healthy feeding practices during times of crisis.

Rural Market Food Diversity and Farm Production Diversity: Do They Complement or Substitute Each Other in Contributing to a Farm Household's Dietary Diversity?

Majority of undernourished people live in rural Asia and Africa, and many of them are smallholder farmers and consume a significant amount of what they produce. This is specifically true in India. However, in the context of increasing commercial production systems, it is not well-known how much food is consumed from a particular food group that was purchased, what proportion of food is from the production of farm households, and how their diets change seasonally. Furthermore, whether the rural market food diversity complements or substitutes farm production diversity in household's diets is unknown. We employed a mixed-methods research design to answer these questions. The research was conducted in three villages in Telengana State. The results reveal that crop diversity has significantly declined from a highly-diverse production system to a less diverse one. The Food Consumption Score results show that on average own-farm production contributes 23% of food (mainly starchy staples), while market purchases contribute 77% of calories consumed (from more diverse and nutritious foods). Therefore, in the study, villages' market food diversity is more important, and it is complementary to own-farm production. However, our study shows that mere market access (the most widely used proxy indicator in the literature) does not guarantee the availability of diverse nutritious foods to households who use that specific market. This is because market food diversity varies from market to market and across seasons. Therefore, we proposed that in commercial production systems improving crop diversity, and strengthening rural markets, are needed. Moreover, incentivizing retail business and subsidizing nutritious and/or biofortified food in rural areas must be part of strategies to improve nutrition in rural India.

Nexus between Coping Strategies and Households’ Agricultural Drought Resilience to Food Insecurity in South Africa

Farmers in Africa, including those in South Africa, rely on rain-fed agriculture, which exposes them to the risks of agricultural drought. Agricultural drought has become a major threat to agricultural production, including the extreme mortality of livestock in recent years, thus negatively impacting household food security. Hence, this paper is aimed at (i) assessing the coping strategies employed by smallholding livestock-farming households during food insecurity shocks, and (ii) assessing the relationship between coping strategies and agricultural drought resilience to food insecurity in the Northern Cape Province of South Africa. Interviews, more specifically survey interviews, were conducted with 217 smallholder livestock farmers. The data was analyzed using the agricultural drought resilience index (ADRI), the household food insecurity access scale (HFIAS), and structural equation modeling. Smallholder livestock farming households utilized various coping strategies, ranging from selling livestock (21%) to leasing out their farms (1%). The coping strategies of farming households included using alternative land (20%), storing food (20%), requesting feed for their animals (16%), searching for alternative employment (6%), migrating (6%), raising drought-tolerant breeds (5%), receiving relief grants (3%) and using savings and investments (2%). A statistically significant relationship between coping strategies and agricultural drought resilience to food insecurity means that these strategies have important policy implications. Implementing strategies that encourage households to protect their livelihood and utilize their assets (selling livestock) to increase their resilience is crucial for reducing food insecurity and achieving the Sustainable Development Goals (SDGs) to end hunger and poverty.

Household food insecurity and dietary diversity of women of reproductive age among smallholder farming households in northwest Bangladesh

Despite Bangladesh's remarkable progress in agricultural production over the past few decades, household food and nutrition insecurity persist, especially in rural areas. The nutrition security and dietary diversity are even more critical for women of reproductive age among smallholders. This study examined household food insecurity and dietary diversity of women of reproductive age in the rural areas of northwest Bangladesh. Using cross-sectional data collected from 252 smallholder households, we measured household food insecurity and dietary diversity of women of reproductive age by the Household Food Insecurity Access Scale and the Minimum Dietary Diversity for Women, respectively. Determinants of household food insecurity were examined, and associations between household food insecurity and low dietary diversity were determined. The majority of the households were mildly insecure (51.2%) followed by moderately insecure (27.4%). The households felt anxiety of food insecurity for more than six months a year (Food Security Index = 2.10 out of 4.00). The mean food group consumed by women was 4.63 indicating low dietary diversity and dominance of diets by grains and dark green leafy vegetables. The findings also indicate a significant and positive association between household food insecurity and low dietary diversity of women. Education of household heads, household size, access to information sources, access to credit support, and perceived impacts of climate change on crop production were identified as determinants of household food insecurity. The study recommends that appropriate interventions be formulated to improve the food and nutrition security in the study areas.

Performance of individual dietary diversity score to identify malnutrition among patients living with HIV in Ethiopia

There is a lack of uniformity in developing and validating indicators of nutritional status among People Living with Human Immunodeficiency Virus (PLHIV). Experiences from low and middle-income countries are scant, and differences in methodological and analytical approaches affect the comparability and generalizability of findings. Therefore, this study investigated the performance of individual diversity score (IDDS) as a proxy indicator of nutritional status among PLHIV. We conducted a facility-based cross-sectional study among 423 PLHIV who were under Antiretroviral Treatment (ART) at clinics in Bahir-Dar, Ethiopia. We collected data on sociodemographic, dietary, clinical, and anthropometric measures. Dietary intake was assessed using 24-Hour dietary recall. Body Mass Index (BMI) was calculated to assess the nutritional status of study subjects. The receiver operating characteristic (ROC) curve analysis was used to assess the ability of the IDDS and Minimum Dietary Diversity for Women (MDD-W) to detect poor nutritional status. Furthermore, sensitivity, specificity, Predictive Values (PPs), and Likelihood Ratios (LRs) were calculated at different cut-off points. IDDS showed good reliability with Cronbach’s Alpha of 0.76. The Area Under the Curve (AUC) of IDDS was 78.5 (95%CI 73.9–83.4). At the IDDS cut-off of 4, the sensitivity and specificity of IDDS to indicate nutritional status were 88.0% (95%CI 81.0–93.0) and 71.0% (95%CI 66.0–76.0), respectively. The AUC of MDD-W was 74.1%, and at the cut-off of 4 the sensitivity and specificity of MDD-W to indicate undernutrition were 73.0% and 72.0%, respectively. Both IDDS and MDD-W have good accuracy as a proxy indicator for measuring the nutritional status of PLHIV. In the prevention of undernutrition among PLHIV especially in a resource-limited setting, IDDS and MDD-W can be used to assess nutritional status.

Association between Dietary Diversity and Food Insecurity in Urban Households: A Cross-Sectional Survey of Various Ethnic Populations of Karachi, Pakistan

Background and Purpose

The world is experiencing a nutritional transition, yet some regions of South East Asia are still living under the shadows of catastrophic nutritional indicators. Pakistan bears a high dual burden of both communicable and chronic diseases. However, a major contributing factor of both is poor diet and nutrition. The causal pathway of stunting, underweight, wasting, and micronutrient deficiencies has beginnings in less dietary diversity and food insecurity. Current literature on Pakistan and other South Asian countries regarding food insecurity and dietary diversity largely focus on women and children aged less than 5 years; however, ethnic and cultural dynamics of the populace concerning their food and dietary practices in Pakistan have not been well explored. It is essential to have a clear insight into the factors involving malnutrition in different clusters, especially different cultures and ethnicities to target specific areas of interventional strategies versus a uniform approach for all. This study aimed to explore the level of food insecurity and dietary diversity in all major ethnic groups of Karachi, the largest city of Pakistan.

Methods

Using the multistage random sampling, 535 households from five major ethnic groups residing in Karachi were included in the study. To measure food insecurity and dietary diversity (primary and secondary outcome, respectively), we used a FAO standardized questionnaire (version 3, 2007) that was translated first into local languages, piloted, and employed to collect information.

Results

Severe food insecurity levels had an inverse relationship with the household dietary diversity, which persisted even after adjusting for other variables (β=−0.31, 95% CI=−0.65, −0.07). There was no statistically significant association of age, marital status, or education level on food diversity. The most food secure cultural people were those whose ancestors had migrated from India and were Urdu speaking communities, while Sindhi speakers were the least food secure community.

Conclusion

It is imperative to investigate more on the cultural causal factors leading to food insecurity to address the root causes of malnutrition and design new cultural-specific interventions that should be employed in large urban centers where different communities reside together.

Addressing the interaction between food insecurity, depression risk and informal work: findings of a cross-sectional survey among informal women workers with young children in South Africa

Background

There is a high burden of depression globally, including in South Africa. Maternal depression is associated with poverty, unstable income, food insecurity, and lack of partner support, and may lead to poor outcomes for mothers and children. In South Africa one-third of working women are in informal work, which is associated with socioeconomic vulnerability.

Methods

A cross sectional survey explored work setting and conditions, food security and risk of depression among informal working women with young children (0–3 years). Depression risk was assessed using the Edinburgh Postnatal Depression Score (EPDS) and Whooley score. Food insecurity was evaluated using Household Food Insecurity Access Scale. Data was analysed using SPSS and Stata.

Results

Interviews were conducted with 265 informal women workers. Types of work included domestic work, home-based work, informal employees and own account workers, most of whom were informal traders. Most participants (149/265; 56.2%) earned between US$70–200 per month, but some participants (79/265; 29.8%) earned < US$70 per month, and few earned > US$200 per month (37/265; 14.0%). Many participants experienced mild (38/267; 14.3%), moderate (72/265; 27.2%) or severe (43/265; 16%) food insecurity. Severe food insecurity was significantly higher among participants with the lowest income compared to those with the highest income (p = 0.027). Women who received financial support from the baby’s father were less likely to be food insecure (p = 0.03). Using EPDS scores, 22/265 (8.3%) women were designated as being at risk of depression. This was similar among postnatal women and women with older children. Household food insecurity was significantly associated with depression risk (p < 0.001).

Conclusions

Informal women workers were shown to be vulnerable with low incomes and high rates of food insecurity, thus increasing the risk for poor maternal health. However, levels of depression risk were low compared to previous estimates in South Africa, suggesting that informal workers may have high levels of resilience. Interventions to improve social protection, access to health services, and support for safe childcare in the workplace could improve the health and wellbeing of these mothers and support them to care for their children.

Food insecurity among women of reproductive age in Nepal: prevalence and correlates

BACKGROUND

Food insecurity is widely prevalent in certain sections of society in low and middle-income countries. The United Nations has challenged all member countries to eliminate hunger for all people by 2030. This study examines the prevalence and correlates of household food insecurity among women, especially Dalit women of reproductive age in Nepal.

METHODS

Data came from 2016 Nepal Demographic Health Survey, a cross-sectional, nationally representative survey that included 12,862 women between 15 and 49 years of age of which 12% were Dalit. Descriptive analysis was used to assess the prevalence of household food insecurity while logistic regression examined the relationship between women's ethnicity and the risk of food insecurity after accounting for demographic, economic, cultural, and geo-ecological characteristics.

RESULTS

About 56% of all women and 76% of Dalit women had experienced food insecurity. Ethnicity is strongly related to food insecurity. Dalit women were most likely to be food insecure, even after accounting for factors such as education and wealth. They were 82, 85, 89 and 92% more vulnerable to food insecurity than Muslims, Brahmin/Chhetri, Terai Indigenous, and Hill Indigenous populations, respectively. Education was a protective factor-women with secondary education (6th to 10th grade) were 39% less likely to be food insecure compared to their counterparts without education. With a more than 10th grade education, women were 2.27 times more likely to be food secure compared to their counterparts without education. Marriage was also protective. Economically, household wealth is inversely correlated with food insecurity. Finally, residence in the Mid-Western, Far-Western and Central Development regions was correlated with food insecurity.

CONCLUSION

To reduce food insecurity in Nepal, interventions should focus on improving women's education and wealth, especially among Dalit and those residing in the Far- and Mid-Western regions.