Gender differences in food insecurity and morbidity among adolescents in southwest Ethiopia

Pathways and policy options for food and nutrition gaps in arid agricultural farming systems in the Tigray Region, north Ethiopia

Food and nutrition security is a major global challenge especially indeveloping countries.Agriculture is main means of livelihoods and hunger is drastically increasing from time to time especially due to effects of climate change, conflict and other manmade and natural calamities in these countries. Similarly, the Tigray Region is one of the Ethiopia's most food and nutrition insecure regions with agriculture serving as the main source of income and employment. This study was therefore conducted to fill the gap in understanding the socioeconomic situation, bio-physical environment, institutional setting and policy landscape by analysing the existing circumstances in Tigray Region. This research employed quantitative data sets collected from 300 randomely selected Productive Saftey Net Program (PSNP) beneficiarieries and Non-PSNP households using probability proportional to size. The Household Dietary Diversity Score (HDDS) used as a proxy measure to nutrition security as our data is 24 h recall and food gap months as proxy to food security. Besides, Principal Component Analysis (PCA) method is used to construct household asset index. The results of the study revealed that there are clear and significant differences of the PSNP and Non-PSNP households, and gender in land holding (p<0.01%), asset ownership(p<0.01%), food gap months(p<0.01%), dietary diversity(p<0.01%), exposure to hazards and risks, copping strategies, yield, access to agricultural extension services, access to improved varieties (varietal diversification). The male headed households, and Non-PSNP households are better off than the female headed and PSNP households' counterparts. Thus, provision of practical training, conducting farmer's participatory research, field days, promoting and creating access to farmers' preferred high yielding improved varieties and management practices available in the research and extension consortium, support in research and development that develops and disseminate appropriate technologies to help farmers to lower their food gap months is highly important. In addition, sustainable intensification, off-farm employment alternatives, and engaging in agribusiness activities that create resilient livelihood options to those resource poor farm households, strengthening the formal and informal seed system would help to reduce food gap months, improve HDDS, build resilience of the food and nutrition insecure households. Therefore, customized extension services and packages are important for addressing the food and nutrition security gaps by setting goal, outcome and output indicators for future interventions in the research and development arena in filling food gap months, dietary diversity and household asset building through collaboration among relevant stakeholders in the food system.

"If the food is finished after my brother eats then we (girls) sleep hungry." Food insecurity and dietary diversity among slum-dwelling adolescent girls and boys in Pakistan: A mixed methods study

To explore gender differences in food insecurity (FI) and minimum dietary diversity (MDD) among adolescent girls and boys in a slum community in Karachi, we employed an explanatory sequential mixed methods study that included a survey of 391 girls and boys of 10-19 years of age and followed by semi-structured interviews of eight purposely selected food insecure adolescents. Survey data was analyzed by Cox proportional algorithm and adjusted prevalence ratios (APR) with 95% confidence intervals (CI) were estimated for associated factors of FI and thematic analysis was undertaken for qualitative work. Meta inferences for mixed methods study were drawn by joint display analysis of survey results juxtaposed to qualitative findings. Overall, FI among adolescents was prevalent (46.5%) which was not different between boys (52.7%) and girls (47.3%) (APR 0.8, (95% CI 0.6, 1.2); p-value-0.4). MDD (5/10 food groups consumed) was achieved by only 23.0% and it was also not different between boys (25.1%) and girls (20.9%) (p-value-0.3). The survey found no significant difference in FI and MDD between boys and girls however, qualitative findings provided insight into the cultural practices at mealtimes that prefer boys. Qualitative results contrasted the survey results and revealed the increased vulnerability of girls towards FI and low MDD compared to boys due to gender norms.

Risk factors and the nomogram model for malnutrition in patients with nasopharyngeal carcinoma

BACKGROUND

For patients with nasopharyngeal carcinoma (NPC), the incidence of malnutrition is quite high, and malnutrition has severe effects on NPC patients. However, there is currently no recognized gold standard or specific nutritional assessment tool available to assess malnutrition in NPC patients. Our objective was to develop and verify a new nomogram model for NPC patients.

METHODS

Data were collected from NPC patients. To evaluate risk factors for malnutrition, univariate and multivariate logistic regression analyses were used. Based on the risk factors, a new nomogram model was developed. The efficacy of the model was evaluated and validated.

RESULTS

Logistic regression analysis showed that age ≥ 65 years, the number of chemotherapy cycles completed ≥ 1, a high total radiation dose received, low body mass index (BMI), low albumin, and low chloride were the risk factors. The assessment effect of the new model was good by evaluation and validation; it can be used as an assessment tool for malnutrition in NPC patients.

CONCLUSIONS

Age ≥ 65 years, completing ≥ 1 chemotherapy cycles, a high total radiation dose received, low BMI, low albumin, and low chloride levels are risk factors for malnutrition in NPC patients. The assessment effect of the new model, developed based on these risk factors, is good, and it can be used as an assessment tool for malnutrition in NPC patients.

Food security status of Suchana-participating households in north-eastern rural Bangladesh

Despite achieving remarkable progress, food insecurity remains a major public health challenge in Bangladesh, and severe food insecurity status has not been reduced in susceptible areas and vulnerable regions in Bangladesh. Wetlands that are susceptible to flooding can be found in Bangladesh's north-eastern Sylhet division. Suchana, a large-scale nutrition programme, implemented nutrition-specific and sensitive interventions in poor and very poor households in Sylhet and Moulvibazar districts in the north-eastern region of Bangladesh. The aim of this article is to assess the association between the Suchana intervention and household food security status among poor and very poor households in north-eastern rural Bangladesh using the Suchana baseline and endline survey databases. The baseline survey was conducted between November 2016 and February 2017, while the endline survey was undertaken 3 years later, during the same months. The outcome variable in this analysis was household food security status, which was measured using the Food and Nutrition Technical Assistance's Guideline. Descriptive statistics were used to summarize the data; after controlling for the union as a cluster and relevant covariates, a multiple multinomial logistic regression model was used to estimate the independent effect of the Suchana intervention as an exposure. Overall, 14.0% of households were food secure at the baseline survey (intervention: 14.1%, control: 14.0%) and 22.0% were food secure (intervention: 26.6%, control: 20.2%) at the endline survey. For households in the intervention area in comparison to the control area, the odds of being moderately food insecure [aOR: 1.36 (1.05, 1.76), p < 0.05], mildly food insecure [aOR: 1.83 (1.33, 2.51), p < 0.001], or food secure [aOR: 2.21 (1.47, 3.33), p < 0.001] compared to being severely food insecure was significantly higher. Thus, we infer that the 3 years of Suchana intervention marginally increased household food security status among the socio-economically disadvantaged population in north-eastern rural Bangladesh. If concerns regarding gender equity, women's education, and income-generating activities are addressed, the population could experience even greater benefits in food security. In order to overcome these challenges, all stakeholders including programme implementers and policymakers should work together to implement the appropriate measures.

Women’s Empowerment, Income, and Nutrition in a Food Processing Value Chain Development Project in Touba, Senegal

To study the impacts of implementing a gender-sensitive value chain development (VCD) initiative in the agri-food sector, we conducted a mixed-methods study of a woman-owned food processing business and its associated value chain in Touba, Senegal. As a result of partnering with a USAID-funded project, the business began producing instant fortified flours, an innovative, higher-value product compared to traditional porridge, using extrusion and fortification techniques. Drawing on Senegalese women’s association networks, the business connected with local women who could work as processors and retailers. Our study’s goal was to explore how the project’s support of this food processing value chain has affected the lives of women processors and retailers, farmers, and medical personnel along the value chain. Particularly relevant to our study is the general lack of opportunities for women to earn their own incomes in the study region, especially outside of the home, and provide for their families. Through surveys, interviews, observations, and novel participatory focus group activities, our study provides qualitative and quantitative evidence of the perceived impacts of value chain development on women’s empowerment, income, and nutrition by key stakeholders in the value chain. We find an often cited barrier to women’s empowerment is the husband’s lack of understanding and limitations placed on women’s mobility, yet we also find perceptions of women’s empowerment in this conservative religious context. Our findings and discussion highlight the need for more research into VCD projects on the complex and, at times, contradictory processes of women’s empowerment. The women in our study expressed a desire for freedom to work outside of the home, and they expressed a need for childcare and contraception. Notably, the women discussed positive community changes, such as infrastructure and the creation of a childcare center, that implicate women’s collective empowerment. We also highlight a promising research opportunity in Senegal to explore the subnational variation in women’s empowerment through VCD.

Child undernutrition and associated factors among children 6-23 months old in largely food insecure areas of rural Ethiopia

Child malnutrition is the leading public health problem in Sub-Saharan Africa, resulting in poor health and economic losses. Ethiopia has one of the highest child undernutrition rates in the world that occurs to multifaceted factors, including food insecurity. Thus, we performed a cross-sectional study to assess the prevalence and risk factors for child undernutrition in largely food insecure areas of Ethiopia. Data were collected from 354 mother-child pairs from the Siraro district. Both bivariate and multivariate logistic regression was used for statistical analysis. Variables with a P-value of <0⋅05 in multivariate analysis were used to detect statistical significance at a 95 % confidence level. About 67 % of households are food insecure. The prevalence of stunting wasting and underweight were 42⋅7, 9⋅9 and 27⋅7 %, respectively. Female gender, higher age of the child (12-23 months v. 6-11 months), living in a household with five or more siblings, not getting therapeutic zinc supplement at least once, inadequate diet diversity, lack of growth monitoring service, and maternal own income increases the likelihood of child undernutrition. It can be concluded that child undernutrition is a severe public health problem in the study area. Improving primary healthcare services related to zinc supplementation, growth monitoring and promotion, and improving infant and child feeding practices can be considered as a strategy to address the problem.

Underweight and Associated Factors Among Teenage Adolescent Girls in Resource-poor Settings: A Cross-sectional Study

Background and Purpose

Understanding the undernutrition status of teenage adolescent girls living in urban slums and its associated factors is meaningful to formulate customized health strategies. This study aimed to determine the prevalence of being underweight and associated factors among teenage adolescent girls in urban slums.

Materials and Methods

In this cross-sectional study, we enrolled a total of 418 teenage adolescent girls from five of 210 urban slums of Varanasi district, Uttar Pradesh, India employing two-stage probability sampling for the selection of households and subjects, between September 2016 and July 2017. The study of underwight subjects was assessed with BMI for age using standard criteria. Factors associated with being underweight were determined by multivariable logistic regression analysis.

Results

Of 418 study subjects, 49.76% (208/418) were underweight. Results revealed that sociodemographic factors such as teenage adolescent girls who were from SC/ST (schedule caste/schedule tribe) caste/ethnicity (adjusted odds ratio (AOR)=2.02, 95%CI: 1.00–4.23), subjects whose father’s education level was primary or lower (AOR=1.87, 95%CI: 1.12–3.11), and number of people in the family >4 (AOR=2.18, 95%CI: 1.18–4.03) were associated with being underweight. Likewise, dietary behavior-related factors such as vegetarian (AOR=2.21, 95%CI: 1.25–3.92), and <3 meals per day (AOR=2.36, 95%CI: 1.40–3.98) than their counterparts were associated with being underweight. In addition, teenage adolescent girls from food-insecure households (AOR=3.33, 95%CI: 2.01–5.51) were more likely to be underweight than those from food-secure households.

Conclusion

The higher burden of underweight among teenage adolescent girls in Indian urban slums needs to be addressed through specific public health interventions such as by improving education, providing education regarding dietary behavior, and having access to sufficient, safe, and nutritious foods.

Food Security and Hygiene Practice among Adolescent Girls in Maiduguri Metropolitan Council, Borno State, Nigeria

Inadequate food security contributes to poor health outcome for all, including adolescent girls. The study aims at determining the level of food security and hygiene among adolescent girls. A school-based cross-sectional study was carried out among adolescent girls aged 10 to 19 years old from six schools in Maiduguri Metropolitan Council, Borno State. The instrument for data collection was a questionnaire using KoBoCollect Toolbox between June and July 2019. Multivariable logistic regression was used to identify the predictors of food security and hygiene among respondents. A majority of the respondents (73.5%) were in a very low food security level. Three factors were significantly associated with food security level, these included schools (p = 0.007), age of mother (p = 0.004), and occupation of mother (p < 0.001). School (p = 0.003), age (father p = 0.017; mother; p = 0.012), hygiene (p = 0.005), and occupation of mother (p = 0.002) were predictors of food security. About (46.6%) of respondents had poor hygiene practice, school (p = 0.016) was significantly associated with hygiene practice. School (p = 0.019; and p = 0.005) and food security (p = 0.009) were predictors of hygiene practice. This study reveals a high prevalence of low food security among adolescent girls.

Child Feeding Practice and Primary Health Care as Major Correlates of Stunting and Underweight among 6- to 23-Month-Old Infants and Young Children in Food-Insecure Households in Ethiopia

BACKGROUND

Child undernutrition is a major public health problem in Ethiopia. Stunting is highest in food-insecure areas and insufficient evidence may impair the design of suitable interventions.

OBJECTIVES

This study aimed to identify key factors contributing to undernutrition among 6- to 23-mo-old children.

METHODS

A community-based cross-sectional study in food-insecure areas of Amhara and Oromia regions in April-June, 2018, enrolled 464 mother-child dyads. Bivariate and multivariate logistic regression analyses were conducted.

RESULTS

The prevalence of stunting (43.1%), wasting (12.3%), and underweight (27.3%) were high. Factors significantly associated with both stunting and underweight were child age of 12-23 mo (vs 6-11 mo), female, more siblings, lack of zinc supplement for diarrhea, inadequate diet diversity, and lack of iodized salt in complementary food. Conclusions: Our findings support the need to emphasize appropriate child feeding practices and iodized salt utilization. Improvement of primary health care services related to micronutrient supplementation and family spacing also are important to address child undernutrition in the study area.

Intersecting inequalities, gender and adolescent health in Ethiopia

Background

Until recently, global public health initiatives have tended to overlook the ways that social factors shape adolescent health, and particularly how these dynamics affect the specific needs of adolescents in relation to information about puberty, menstruation and sexual health. This article draws on mixed methods data from rural and urban areas of Ethiopia to explore how access to health information and resources - and subsequently health outcomes - for adolescents are mediated by gender and age norms, living in different geographical locations, poverty, disability and migration.

Methods

Data was collected in 2017–2018 for the Gender and Adolescence: Global Evidence (GAGE) mixed-methods longitudinal research baseline in three regions of Ethiopia (Afar, Amhara and Oromia). Quantitative data was collected from over 6800 adolescents and their caregivers, with qualitative data obtained from a sub-sample of 220 adolescents, their families and communities. Adolescent participants shared their experiences of health, illness and nutrition over the previous year; their knowledge and sources of information about sexual and reproductive health and puberty; and their attitudes toward sexual and reproductive health. Regression analysis was used to explore differences by gender, age, rural/urban residence, and disability status, across a set of adolescents’ health knowledge and other outcomes in the quantitative data. Intersectional analysis was used in analysing the qualitative data.

Results

Analysis suggested that gender inequality intersects with age, disability and rural/urban differences to shape young people’s access to information about puberty, with knowledge about this topic particularly lacking amongst younger adolescents in rural areas. Drought and lack of access to clean water exacerbates health challenges for adolescents in rural areas, where a lack of information and absence of access to preventive healthcare services can lead to permanent disability. The research also found that gaps in both school-based and alternative sources of education about puberty and menstruation reinforce stigma and misinformation, especially in rural areas where adolescents have higher school attrition rates. Gendered cultural norms that place high value on marriage and motherhood generate barriers to contraceptive use, particularly in certain rural communities.

Conclusions

As they progress through adolescence, young people’s overall health and access to information about their changing bodies is heavily shaped by intersecting social identities. Structural disadvantages such as poverty, distress migration and differential access to healthcare intersect with gender norms to generate further inequalities in adolescent girls’ and boys’ health outcomes.

Psychological Distress among College Students: Role of Food Insecurity and Other Social Determinants of Mental Health

Food insecurity is a major social determinant of health and an assessment of how it may impact college students' mental health is imperative, as well as differential associations by self-identified gender. A cross-sectional survey was used among college students of a mid-size minority-serving institution with a final sample size of 302 participants aged 18 years or above. Descriptive, bivariate, and multivariable regressions were conducted, by gender, to assess the role of food insecurity (United States Department of Agriculture (USDA) six-item questionnaire), on mental health outcomes (Kessler-6 scale and self-perception). All the statistical analyses were conducted in SPSS version 24 (IBM, Corp.; Armonk, NY, USA) with an alpha less than 0.05 used to denote significance. Among those with food insecurity, the odds of reporting psychological distress (odds ratio (OR) = 3.645, p < 0.05) and an average to very poor self-perceived mental health status (OR = 2.687, p <0.05) were higher compared to their food-secure counterparts, with the results consistent in a gender-specific analysis as well. Compared to men, however, women had higher odds of psychological distress (OR = 2.280, p < 0.05), as well as reporting average to very poor self-perceived mental health statuses (OR = 2.700, p < 0.05). Among women, any alcohol use in the past 12 months (OR = 2.505, p < 0.05) and a low self-perceived physical health status (OR = 3.601, p < 0.05) were associated with an average to very poor self-perceived mental health status. Among men, a low perceived physical health status was associated with higher odds of psychological distress (OR = 3.477, p < 0.05). The results of our study highlight that food insecurity should be considered a social determinant of mental health wellbeing. In addition, gender-specific trends in mental health highlight the need for targeted interventions for prevention and treatment.

Adolescent food insecurity in rural Sindh, Pakistan: a cross-sectional survey

Background

Food insecurity (FI) is alarmingly high in developing countries including Pakistan. A quarter of Pakistan’s population consists of adolescents yet there is no information on their experience of FI. FI at adolescent age have long term effect on mental and physical health hence we aimed to determine the prevalence of food insecurity (FI) among adolescents and compare it with household FI, and assess social determinants of adolescent FI.

Methods

A cross-sectional survey on 799 households with unmarried adolescents was conducted from September 2015 to June 2016 in three union councils of Hyderabad, Pakistan. Unmarried 10–19 years old girls and boys were interviewed regarding their FI status using Household Food Insecurity Assessment Scale (HFIAS). Household-level FI was also assessed by interviewing mothers of adolescents, and it was compared with adolescent’s FI. Association of adolescent’s FI with socio-demographic determinants was explored through Cox regression using STATA version 14.0. and prevalence ratios were estimated.

Results

FI was found among 52.4% of the adolescents compared to 39% of the households. Thirty percent of the adolescents were food insecure within the food secure households. Female adolescents were found to be less food insecure (Adjusted Prevalence Ratio (APR) 0.4 95% CI [0.3, 0.5]) compared to males. Social determinants like socioeconomic status (SES), crowding index or education of parents were not associated with adolescents’ FI.

Conclusion

Half of the adolescents were found to be food insecure which raises concerns regarding their health in the long run. Gender is an important social determinant of FI among adolescents which suggests an in-depth exploration of social dynamics of adolescent FI. We recommend the mixed-methods study to develop contextually relevant interventions to reduce FI among this group and improve their health status.

Gender differences in nutritional status, diet and physical activity among adolescents in eight countries in sub-Saharan Africa

OBJECTIVE

The objective of this study was to evaluate gender differences in nutritional status, dietary intake, physical activity and hand hygiene among adolescents from diverse geographical settings in sub-Saharan Africa.

METHODS

This study utilised cross-sectional data from six countries (Burkina Faso, Ethiopia, Ghana, Nigeria, Tanzania and Uganda) within the ARISE Adolescent Health Survey (n = 7625). Body mass index (BMI) was calculated using measured heights and weights, and z-scores were calculated based on the 2007 WHO growth standards for age and sex. Information on demographics, diet and health behaviours was collected through face-to-face interviews using a standardised questionnaire. Site-specific and pooled prevalence ratios were determined.

RESULTS

The prevalence of underweight, overweight and stunting pooled across sites was 14.3%, 6.8% and 18.1%, respectively. Female sex was associated with a lower risk of being underweight (pooled prevalence ratio 0.66, 95% 0.57, 0.77) and stunted (pooled PR 0.63, 95% CI 0.55, 0.71), but a higher risk of being overweight (pooled PR 1.60, 95% CI 1.26, 2.06). Females were also less likely to exercise for 1 h or more per day (pooled PR 0.77, 95% CI 0.67, 0.88), and more likely to wash hands after using toilets or latrines and to wash hands with soap (pooled PRs 1.13, 95% CI 1.05, 1.21 and 1.35, 95% CI 1.23, 1.45, respectively).

CONCLUSION

Our results emphasise that sex is a key predictor of nutritional status among sub-Saharan African adolescents and suggest that gender-specific interventions may be required to reduce the double burden of under- and overnutrition.

Predictors of stunting among children 6-59 months of age in Sodo Zuria District, South Ethiopia: a community based cross-sectional study

Background

Despite the decline in the rate of stunting in Ethiopia, the prevalence is still high and needs immense efforts to achieve the target set to reduce the prevalence. It varies between localities due to individual level factors and dominant livelihood practice in the community.

Thus, the aim of this study was to determine the prevalence of stunting and identify factors associated with it in Sodo Zuria district in South Ethiopia.

Methods

A community based cross sectional study was conducted among 342 children aged 6–59 months paired with mothers/caretakers. Households were selected using systematic sampling. Structured questionnaire was used and mothers/caregivers were interviewed face to face. Standardized anthropometric measurements were used to measure length, and weight and height of a child. Data were entered into Epi Info software version 3.5.1 and exported to SPSS version 20 for analysis. Height for age Z score data were analyzed using WHO Anthro software. Multivariate logistic regression analysis was conducted to identify predictor variables. Statistical significance was considered at p < 0.05.

Results

The prevalence of stunting in this study was 24.9% with 7.9% being severely stunted. Being female (AOR = 2.8; 95% CI: 1.5, 5.3), children aged 12–23 months (AOR = 7.1; 95% CI: 2.3, 21.9), mother’s who do not use family planning (AOR = 2.5; 95% CI: 1.1,5.7), children with diarrheal morbidity (AOR = 2.5; 95% CI: 1.2,5.3), income of 750–1500 ETB and > 1500, and children who received pre-lacteal feeding (AOR = 3.8; 95% CI: 1.2–12.2) became predictors for stunting.

Conclusion

Significant proportion of stunting was found where one third of them were severely stunted. Being female, children aged 12–23 months, using family planning, children with diarrheal morbidity, income and pre-lacteal feeding became predictors for stunting. So Gender-based policies should be enacted in child feeding practice, interventions should focus on the utilization of family planning and appropriate child caring and feeding practices. Water, sanitation and hygiene interventions need to be strengthened.

Prevalence and risk factors of intimate partner violence among women in four districts of the central region of Ghana: Baseline findings from a cluster randomised controlled trial

Intimate partner violence (IPV) is a significant global public health problem. Understanding risk factors is crucial for developing prevention programmes. Yet, little evidence exists on population-based prevalence and risk factors for IPV in West Africa. Our objective was to measure both lifetime and past year prevalence of IPV and to determine factors associated with past year physical or sexual IPV experience. This population-based survey involved 2000 randomly selected women aged 18 to 49 years living in 40 localities within four districts of the Central Region of Ghana. Questionnaires were interviewer-administered from February to May 2016. Respondents were currently or ever-partnered, and resident in study area ≥12months preceding the survey. Data collected included: socio-demographics; sexual behavior; mental health and substance use; employment status; 12-month and lifetime experience of violence; household food insecurity; gender norms/attitudes; partner characteristics and childhood trauma. Logistic regression modelling was used to determine factors associated with sexual or physical IPV, adjusting for age and survey design. About 34% of respondents had experienced IPV in the past year, with 21.4% reporting sexual and or physical forms. Past year experience of emotional and economic IPV were 24.6% and 7.4% respectively. Senior high school education or higher was protective of IPV (AOR = 0.51[0.30-0.86]). Depression (AOR = 1.06[1.04-1.08], disability (AOR = 2.30[1.57-3.35]), witnessing abuse of mother (AOR = 2.1.98[1.44-2.72]), experience of childhood sexual abuse (AOR = 1.46[1.07-1.99]), having had multiple sexual partners in past year (AOR = 2.60[1.49-4.53]), control by male partner (AOR = 1.03[1.00-1.06]), male partner alcohol use in past year (AOR = 2.65[2.12-3.31]) and male partner infidelity (AOR = 2.31[1.72-3.09]) were significantly associated with increased odds of past year physical or sexual IPV experience. Male perpetrated IPV remains a significant public health issue in Ghana. Evidence-based interventions targeting women's mental health, disabilities, exposure to violence in childhood, risky sexual behavior and unequal power in relationships will be critical in reducing IPV in this setting.

The effect of food insecurity on health status of adolescents in Ethiopia: longitudinal study

BACKGROUND

The effect of food insecurity on health and wellbeing of a population has been the subject of much research. Yet, limited research has investigated its effect on adolescents' health and wellbeing in Ethiopia.

METHOD

We used data from the Jimma Longitudinal Family Survey of Youth which began tracking a cohort of adolescents in 2005 to examine the social, behavioral and economic determinants of their health and well-being. A total of 1,919 sample were included in the main analyses. All youths provided data related to their food insecurity experiences and their health status. A mixed effect logistic regression using random intercept and trend model was used to examine the relationship between food insecurity and their health status. Fixed effects estimates were also computed to check the parsimoniousness of the random intercept and trend model.

RESULTS

The results indicated that the mean (±SD) age of adolescents was 18.6(±1.4). Nine hundred twenty three (48.1%) of them were female. The magnitude of self-rated health status was relatively unstable ranging from 18.9%, 34.7% to 37.3% in each round. Similarly, 20.4%, 48.4% and 20.6% of adolescents were food insecure during each consecutive round of the survey respectively. Exposure to food insecurity is strongly associated with self-rated health status (β = 0.28, P < 0.001) and poor self-rated health was also more pronounced for some time (β =2.11, P < 0.001) and decline after a turning point (β = -0.38, P < 0.001).

CONCLUSIONS

These findings imply that any social, nutrition and public health interventions designed to improve adolescent health should consider underlying social determinants of health such as food insecurity.

Improving dietary diversity of school adolescents through school based nutrition education and home gardening in Jimma Zone: Quasi-experimental design

PURPOSE

The purpose of this operational study was to assess the effectiveness school-based health and nutrition intervention supported with backyard gardening on the dietary diversity among school adolescents.

METHODS

A total of 1000 school adolescents from 10 to 19years were selected randomly. The intervention involved peer-led behavior change communication and health promotion through school media and health clubs. Data were collected at baseline, midline and end-line using structured questionnaires. Multivariable logistic regression analyses were used to determine the independent effect of interventions.

RESULTS

There was a significant increment of proportion of school children consuming diversified diet among the intervention group from 34.8% at baseline through 65.6% at midline to 74.7% at the end-line (p<0.001). Among control group, there was no change from midline (49.4%) to endline (48.8%), though there was a change from baseline (32.1%) to midline (49.4%). A significant difference of dietary diversity intake was observed between intervention and control groups at midline (F=5.64, p=0.042) and endline (F=5.85, p<0.001) survey. Being in the intervention school (OR=2.55 [1.55, 3.50]), being a boy (OR=1.75 [1.91, 2.56]) and having farmer mothers (OR=2.58 [1.01, 6.87]) were independent positive predictors of a diversified diet intake. However, having a mother who attended secondary schools were inversely associated (OR=0.25 [0.06, 0.97]) with consuming a diversified diet.

CONCLUSION

Findings of this study demonstrated that there was a significant improvement in dietary diversity of adolescents in intervention schools. The results imply that school based nutrition education should be a part of comprehensive school health programs to reach students and potentially their families.

Food Insecurity and Common Mental Disorders among Ethiopian Youth: Structural Equation Modeling

Background

Although the consequences of food insecurity on physical health and nutritional status of youth living have been reported, its effect on their mental health remains less investigated in developing countries. The aim of this study was to examine the pathways through which food insecurity is associated with poor mental health status among youth living in Ethiopia.

Methods

We used data from Jimma Longitudinal Family Survey of Youth (JLFSY) collected in 2009/10. A total of 1,521 youth were included in the analysis. We measured food insecurity using a 5-items scale and common mental disorders using the 20-item Self-Reporting Questionnaire (SRQ-20). Structural and generalized equation modeling using maximum likelihood estimation method was used to analyze the data.

Results

The prevalence of common mental disorders was 30.8% (95% CI: 28.6, 33.2). Food insecurity was independently associated with common mental disorders (β = 0.323, P<0.05). Most (91.8%) of the effect of food insecurity on common mental disorders was direct and only 8.2% of their relationship was partially mediated by physical health. In addition, poor self-rated health (β = 0.285, P<0.05), high socioeconomic status (β = -0.076, P<0.05), parental education (β = 0.183, P<0.05), living in urban area (β = 0.139, P<0.05), and female-headed household (β = 0.192, P<0.05) were associated with common mental disorders.

Conclusions

Food insecurity is directly associated with common mental disorders among youth in Ethiopia. Interventions that aim to improve mental health status of youth should consider strategies to improve access to sufficient, safe and nutritious food.

The relationship between hunger and mental health outcomes among school-going Ecuadorian adolescents

PURPOSE

Mental health and food insecurity are major public health issues among adolescents in Ecuador. Our objective was to determine the relationship between hunger, symptoms of depression, and suicidal ideation among school-going Ecuadorian adolescents.

METHODS

We conducted crude and multivariable logistic regression models using data from the 2007 Global School-based Student Health Survey from Quito, Guayaquil, and Zamora, Ecuador (N = 5524). Hunger was defined as having gone hungry in the past 30 days due to lack of food in the home. Outcomes of interest were symptoms of depression and suicidal ideation with or without planning in the past year.

RESULTS

Overall, 41.2 % (2200/5467) of students reported experiencing hunger. In multivariable logistic regression models, hunger had an increasing exposure-response relationship with symptoms of depression [sometimes hungry odds ratio (OR) 1.80, P = 0.0001; most of the time or always hungry OR 2.01, P < 0.0001] and suicidal ideation with planning (sometimes hungry OR 1.55, P = 0.04; most of the time or always hungry OR 2.63, P = 0.001).

CONCLUSION

Hunger was associated with increased odds of symptoms of depression and suicidal ideation with planning. Strategies to improve mental health among adolescents in Ecuador should consider the potential contribution of hunger and food insecurity.

Household Food Insecurity and Mental Health Problems Among Adolescents: What Do Parents Report?

OBJECTIVE

To investigate whether adolescents living in households with food insecurity have poorer parent-reported mental health (MH) than peers.

METHODS

We analyzed cross-sectional data from ∼8600 adolescents who participated in the 2007 (8th grade) wave of the Early Childhood Longitudinal Study-Kindergarten. Household food insecurity (HFI) was assessed by parental report on the 18-item US Household Food Security Scale. Total Difficulties score >13 on the parent-reported Strengths and Difficulties Questionnaire (SDQ) indicated problems with adolescent MH. SDQ subscale scores (Emotional, Conduct, Hyperactivity, Peer Problems) were also calculated. Associations between HFI and MH were explored in bivariate and multivariable analyses. Interactions of HFI and gender and HFI and receipt of free/reduced-price school lunch were analyzed with regard to problems with MH.

RESULTS

A total of 10.2% of adolescents lived with HFI; 11.2% had SDQ >13. Adolescents with HFI had higher rates of overall MH problems (28.7% vs 9.2%), emotional problems (21.6% vs 6.6%), conduct problems (26.5% vs 11.6%), hyperactivity (22.4% vs 11.3%), and peer problems (19.8% vs 8.6%) (all P < .01). After adjustment for confounders, the association between HFI and overall MH problems (odds ratio 2.3; 95% confidence interval 1.6-3.3) remained. Interactions of HFI and gender and HFI and free/reduced-price school lunch were not significant.

CONCLUSIONS

HFI was associated with increased risk of parent-reported MH problems among both male and female adolescents. Free/reduced-price school lunch did not significantly alter this relationship. Effective interventions to promote MH and reduce HFI among adolescents are necessary.

Coping strategies for food insecurity among adolescent girls during the lean season in East Nusa Tenggara, Indonesia: a qualitative study

One in eight people suffer from chronic hunger, leading to an insecure food situation. Chronic hunger mostly occurs in developing countries and includes adolescent girls. Our qualitative study, with data collected in December 2012, provided the results of an exploration of the experiences and strategies implemented by fifteen adolescent girls who tried to cope with their condition of living in food-insecure families. The age of the girls ranged from 10 to 19 years. Their coping strategies were grouped into self-initiated and parent-initiated strategies. Self-initiated coping strategies that were the girls' own initiatives included eating only rice without any vegetables or side dish, eating less-desirable food, reducing portion size, skipping meals, saving pocket money and earning money to buy food. The parent-initiated coping strategies that were initiated by the parents and followed by the girls included selling their own field produce and livestock, asking for food, borrowing food and storing maize for 6 months up to 1 year. These results show that adolescent girls living in food-insecure areas implement several coping strategies in severe conditions, which parents may not be aware of, and such conditions may compromise their growth and health. The acknowledgement of such coping strategies and the girls' food insecurity condition can lead to a useful and suitable food insecurity alleviation programme for the girls and their families.

Household food insecurity and mental distress among pregnant women in Southwestern Ethiopia: a cross sectional study design

Background

There are compelling theoretical and empirical reasons that link household food insecurity to mental distress in the setting where both problems are common. However, little is known about their association during pregnancy in Ethiopia.

Methods

A cross-sectional study was conducted to examine the association of household food insecurity with mental distress during pregnancy. Six hundred and forty-two pregnant women were recruited from 11 health centers and one hospital. Probability proportional to size (PPS) and consecutive sampling techniques were employed to recruit study subjects until the desired sample size was obtained. The Self Reporting Questionnaire (SRQ-20) was used to measure mental distress and a 9-item Household Food Insecurity Access Scale was used to measure food security status. Descriptive and inferential statistics were computed accordingly. Multivariate logistic regression was used to estimate the effect of food insecurity on mental distress.

Results

Fifty eight of the respondents (9 %) were moderately food insecure and 144 of the respondents (22.4 %) had mental distress. Food insecurity was also associated with mental distress. Pregnant women living in food insecure households were 4 times more likely to have mental distress than their counterparts (COR = 3.77, 95 % CI: 2.17, 6.55). After controlling for confounders, a multivariate logistic regression model supported a link between food insecurity and mental distress (AOR = 4.15, 95 % CI: 1.67, 10.32).

Conclusion

The study found a significant association between food insecurity and mental distress. However, the mechanism by which food insecurity is associated with mental distress is not clear. Further investigation is therefore needed to understand either how food insecurity during pregnancy leads to mental distress or weather mental distress is a contributing factor in the development of food insecurity.

Gender differences in the association between food insecurity and insulin resistance among U.S. adults: National Health and Nutrition Examination Survey, 2005-2010

PURPOSE

To examine gender-specific associations between food insecurity and insulin resistance in a representative U.S.

METHODS

Data on 5533 adults of 20 years of age or more (2742 men and 2791 women) without diabetes from the 2005-2010 National Health and Nutrition Examination Survey were analyzed. Respondents were categorized as having full, marginal, low, or very low food security using a validated scale. Insulin-resistant individuals were defined as those with a homeostasis model assessment of insulin resistance value 2.5 or more.

RESULTS

Insulin resistance was higher in both normal-weight (P = .001) and overweight or obese (P < .001) women with lower food security, but no linear trend was found in men. In multiple logistic regression analyses, however, very low food security-compared with full food security-was associated with insulin resistance in normal-weight men (odds ratio, 3.99; 95% confidence interval, 1.71-9.33), and marginal food insecurity was associated with insulin resistance in overweight or obese men (odds ratio, 2.07; 95% confidence interval, 1.18-3.64) after adjusting for potential confounders. In women, the association between food insecurity and insulin resistance was no longer significant after adjustment.

CONCLUSIONS

Food insecurity is associated with insulin resistance in adults without diabetes, and this effect varies by gender in normal-weight and overweight or obese populations. Improving food security status may help reduce insulin resistance, an underlying risk factor for diabetes and cardiovascular disease.

Marginalized multilevel hurdle and zero-inflated models for overdispersed and correlated count data with excess zeros

Count data are collected repeatedly over time in many applications, such as biology, epidemiology, and public health. Such data are often characterized by the following three features. First, correlation due to the repeated measures is usually accounted for using subject-specific random effects, which are assumed to be normally distributed. Second, the sample variance may exceed the mean, and hence, the theoretical mean-variance relationship is violated, leading to overdispersion. This is usually allowed for based on a hierarchical approach, combining a Poisson model with gamma distributed random effects. Third, an excess of zeros beyond what standard count distributions can predict is often handled by either the hurdle or the zero-inflated model. A zero-inflated model assumes two processes as sources of zeros and combines a count distribution with a discrete point mass as a mixture, while the hurdle model separately handles zero observations and positive counts, where then a truncated-at-zero count distribution is used for the non-zero state. In practice, however, all these three features can appear simultaneously. Hence, a modeling framework that incorporates all three is necessary, and this presents challenges for the data analysis. Such models, when conditionally specified, will naturally have a subject-specific interpretation. However, adopting their purposefully modified marginalized versions leads to a direct marginal or population-averaged interpretation for parameter estimates of covariate effects, which is the primary interest in many applications. In this paper, we present a marginalized hurdle model and a marginalized zero-inflated model for correlated and overdispersed count data with excess zero observations and then illustrate these further with two case studies. The first dataset focuses on the Anopheles mosquito density around a hydroelectric dam, while adolescents' involvement in work, to earn money and support their families or themselves, is studied in the second example. Sub-models, which result from omitting zero-inflation and/or overdispersion features, are also considered for comparison's purpose. Analysis of the two datasets showed that accounting for the correlation, overdispersion, and excess zeros simultaneously resulted in a better fit to the data and, more importantly, that omission of any of them leads to incorrect marginal inference and erroneous conclusions about covariate effects.

Childhood vaccination in rural southwestern Ethiopia: the nexus with demographic factors and women's autonomy

Introduction

Vaccination can reduce child mortality significantly and is a cost effective way to improve child health.Worldwide, more than 22 million children do not receive the basic recommended vaccinations.Vaccination coverage in Ethiopia remains low. Research on child health has focused on socio-economic factors such as maternal education and access to health care, but little attention has been given to demographic factors and women's autonomy within the household. The purpose of this study was to examine the influences of demographic factors and women's autonomy on the completion of childhood vaccination in rural Ethiopia.

Methods

A cross-sectional community-based study was conducted in a Health and Demographic Survelliance System (HDSS) in southwestern Ethiopia. Data were drawn from a random sample of women with children aged 12-24 months (n = 889). Information on maternal socio-demographic characteristics and household variables were collected using an interviewer-administered structured questionnaire. Vaccination data were obtained from vaccination cards or mother's recall. Multivariate logistic regression was used to assess the association of independent variables with completion of childhood vaccination.

Results

Of 889 children aged 12-24 months, 690 (78%) had received at least one vaccination. Only 37% (95% CI, 33.5-39.9) were fully vaccinated. Women's decision making autonomy, number of under-five children in the household, mother's education, use of antenatal care services and proximity to health facility were the main factors associated with full vaccination status.

Conclusion

Completion of basic vaccination series is very low in the study area. Initiatives that enhance women's autonomy within the household and that promote healthy timing and spacing of pregnancies may help in improving child health through vaccination.

Food insecurity and linear growth of adolescents in Jimma Zone, Southwest Ethiopia

Background

Although many studies showed that adolescent food insecurity is a pervasive phenomenon in Southwest Ethiopia, its effect on the linear growth of adolescents has not been documented so far. This study therefore aimed to longitudinally examine the association between food insecurity and linear growth among adolescents.

Methods

Data for this study were obtained from a longitudinal survey of adolescents conducted in Jimma Zone, which followed an initial sample of 2084 randomly selected adolescents aged 13–17 years. We used linear mixed effects model for 1431 adolescents who were interviewed in three survey rounds one year apart to compare the effect of food insecurity on linear growth of adolescents.

Results

Overall, 15.9% of the girls and 12.2% of the boys (P=0.018) were food insecure both at baseline and on the year 1 survey, while 5.5% of the girls and 4.4% of the boys (P=0.331) were food insecure in all the three rounds of the survey. In general, a significantly higher proportion of girls (40%) experienced food insecurity at least in one of the survey rounds compared with boys (36.6%) (P=0.045).

The trend of food insecurity showed a very sharp increase over the follow period from the baseline 20.5% to 48.4% on the year 1 survey, which again came down to 27.1% during the year 2 survey.

In the linear mixed effects model, after adjusting for other covariates, the mean height of food insecure girls was shorter by 0.87 cm (P<0.001) compared with food secure girls at baseline. However, during the follow up period on average, the heights of food insecure girls increased by 0.38 cm more per year compared with food secure girls (P<0.066). However, the mean height of food insecure boys was not significantly different from food secure boys both at baseline and over the follow up period. Over the follow-up period, adolescents who live in rural and semi-urban areas grew significantly more per year than those who live in the urban areas both for girls (P<0.01) and for boys (P<0.01).

Conclusions

Food insecurity is negatively associated with the linear growth of adolescents, especially on girls. High rate of childhood stunting in Ethiopia compounded with lower height of food insecure adolescents compared with their food secure peers calls for the development of direct nutrition interventions targeting adolescents to promote catch-up growth and break the intergenerational cycle of malnutrition.

Predictors of chronic food insecurity among adolescents in Southwest Ethiopia: a longitudinal study

BACKGROUND

Evidence on the differential impacts of the global food crisis as it translates into chronic food insecurity locally is essential to design food security interventions targeting the most vulnerable population groups. There are no studies on the extent of chronic food insecurity or its predictors among adolescents in developing countries. In the context of increased food prices in Ethiopia, we hypothesized that adolescents in low income urban households are more likely to suffer from chronic food insecurity than those in the rural areas who may have direct access to agricultural products.

METHODS

This report is based on data from the first two rounds of the Jimma Longitudinal Family Survey of Youth (JLFSY). Both adolescents and households were selected using a stratified random sampling method. A total of 1911 adolescents aged 13-17 years were interviewed on their personal experiences of food insecurity both at baseline and at year two. Multivariable logistic regression analyses were used to compare chronic adolescent food insecurity by household income, household food insecurity, and socio-demographic variables after one year of follow-up.

RESULTS

Overall, 20.5% of adolescents were food insecure in the first round survey, while the proportion of adolescents with food insecurity increased to 48.4% one year later. During the one year follow up period, more than half (54.8%) of the youth encountered transient food insecurity - that is, either during the first or the second round survey. During the follow up period, 14.0% of adolescents had chronic food insecurity (i.e. were food insecure at both rounds). Multivariable logistic regression analysis showed that adolescents in the urban households with low (OR = 1.69, P = 0.008) and middle (OR = 1.80, P = 0.003) income tertiles were nearly twice as likely to suffer from chronic food insecurity compared with those in high income tertile, while this was not the case in rural and semi-urban households. Female sex of adolescents (P < 0.01), high dependency ratio (P < 0.05) and household food insecurity (P < 0.001) were independent predictors of chronic adolescent food insecurity in urban, semi-urban, and rural areas, while educational status of the adolescents was negatively associated with chronic food insecurity (OR = 0.047, P = 0.002) in urban areas.

CONCLUSIONS

In the context of increased food prices, household income is an independent predictor of chronic food insecurity only among adolescents in the low income, urban households. Female gender, educational status of primary or less and being a member of households with high dependency ratio were independent predictors of chronic food insecurity in urban, semi-urban, and rural areas. The fact that the prevalence of chronic food insecurity increased among adolescents who are members of chronically food insecure urban households as income tertiles decreased suggests that the resilience of buffering is eroded when purchasing power diminishes and food resources are dwindling. Food security interventions should target urban low income households to reduce the level of chronic food insecurity and its consequences.

Household capacities, vulnerabilities and food insecurity: shifts in food insecurity in urban and rural Ethiopia during the 2008 food crisis

The global food crisis of 2008 led to renewed interest in global food insecurity and how macro-level food prices impact household and individual level wellbeing. There is debate over the extent to which food price increases in 2008 eroded food security, the extent to which this effect was distributed across rural and urban locales, and the extent to which rural farmers might have benefited. Ethiopia's food prices increased particularly dramatically between 2005 and 2008 and here we ask whether there was a concomitant increase in household food insecurity, whether this decline was distributed equally across rural, urban, and semi-urban locales, and to what extent pre-crisis household capacities and vulnerabilities impacted 2008 household food insecurity levels. Data are drawn from a random sample of 2610 households in Southwest Ethiopia surveyed 2005/6 and again in mid to late 2008. Results show broad deterioration of household food insecurity relative to baseline but declines were most pronounced in the rural areas. Wealthier households and those that were relatively more food secure in 2005/6 tended to be more food secure in 2008, net of other factors, and these effects were most pronounced in urban areas. External shocks, such as a job loss or loss of crops, experienced by households were also associated with worse food insecurity in 2008 but few other household variables were associated with 2008 food insecurity. Our results also showed that rural farmers tended to produce small amounts for sale on markets, and thus were not able to enjoy the potential benefits that come from greater crop prices. We conclude that poverty, and not urban/rural difference, is the important variable for understanding the risk of food insecurity during a food crisis and that many rural farmers are too poor to take advantage of rapid rises in food prices.

Food insecurity and age at menarche among adolescent girls in Jimma Zone Southwest Ethiopia: a longitudinal study

BACKGROUND

Age at menarche is the reflection of cumulative pre-adolescent exposure of girls to either adverse environment such as food insecurity or affluent living conditions. Food insecurity could result in inadequate nutrient intake and stress, both of which are hypothesized to have opposing effects on the timing of menarche through divergent pathways. It is not known whether food insecure girls have delayed menarche or early menarche compared with their food secure peers. In this study we test the competing hypothesis of the relationship between food insecurity and age at menarche among adolescent girls in the Southwest Ethiopia.

METHODS

We report on 900 girls who were investigated in the first two rounds of the five year longitudinal survey. The semi-parametric frailty model was fitted to determine the effect of adolescent food insecurity on time to menarche after adjusting for socio-demographic and economic variables.

RESULTS

Food insecure girls have menarche one year later than their food secure peer (median age of 15 years vs 14 years). The hazard of menarche showed a significant decline (P = 0.019) as severity of food insecurity level increased, the hazard ratio (HR) for mild food insecurity and moderate/severe food insecurity were 0.936 and 0.496, respectively compared to food secure girls. Stunted girls had menarche nearly one year later than their non-stunted peers (HR = 0.551, P < 0.001).

CONCLUSION

Food insecurity is associated with delay of age at menarche by one year among girls in the study area. Stunted girls had menarche one year later than their non-stunted peers. Age at menarche reflects the development of girls including the timing of sexual maturation, nutritional status and trajectory of growth during the pre-pubertal periods. The findings reflect the consequence of chronic food insecurity on the development and well-being of girls in the study area.

Food insecurity, school absenteeism and educational attainment of adolescents in Jimma Zone Southwest Ethiopia: a longitudinal study

Background

Food insecurity not only affects physical growth and health of children but also their intellectual development, school attendance and academic performance. However, most evidences are based on studies in high income countries. Although food insecurity is common in Ethiopia, to what extent it affects school attendance and educational attainment of adolescents is not explored. We hypothesized that food insecure adolescents would be more likely to be absent from school and have lower grades attained after 1 year compared to their food secure peers.

Methods

We used data from 2009 adolescents in the age group of 13-17 years from two consecutive surveys of a five year longitudinal family study in Southwest Ethiopia. A stratified random sampling was used to select participants. Regression analyses were used to compare school absenteeism and the highest grade attained after 1 year of follow-up in food secure and insecure adolescents. The analysis was adjusted for demographic factors, reported illness and workload.

Results

Significantly more (33.0%) food insecure adolescents were absent from school compared with their food secure peers (17.8%, P < 0.001). Multivariable logistic regression analyses showed that after adjusting for gender, place of residence and gender of the household head, adolescent food insecurity [OR 1.77 (1.34-2.33)], severe household food insecurity [OR 1.62 (1.27-2.06)], illness during the past one month before the survey [OR 2.26 (1.68-3.06)], the highest grade aspired to be completed by the adolescent [OR 0.92 (0.88-0.96)], and the number of days that the adolescent had to work per week [OR 1.16 (1.07-1.26)] were independent predictors of school absenteeism. Similarly after controlling for household income and gender of the household head, adolescent food insecurity(P < 0.001), severe household food insecurity(P < 0.001), illness during the last month(P < 0.001) and rural residence(P < 0.001) were inversely associated with highest grade attained, while age of the adolescent(P < 0.001), the highest grade intended to be completed(P < 0.001) and residence in semi urban area(P < 0.001) were positively associated with the highest grade attained.

Conclusions

Adolescent and household food insecurity are positively associated with school absenteeism and a lower educational attainment. Programs aiming to achieve universal access to primary education in food insecure environments should integrate interventions to ensure food security of adolescents.