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Broyles LMT, Huanca T, Conde E, Rosinger AY. Water insecurity may exacerbate food insecurity even in water-rich environments: Evidence from the Bolivian Amazon. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 954:176705. [PMID: 39389144 DOI: 10.1016/j.scitotenv.2024.176705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 10/01/2024] [Accepted: 10/01/2024] [Indexed: 10/12/2024]
Abstract
Globally, challenges with water and food are two of the most pressing problems people face. Yet hydrologically water-rich environments and rural environments are often overlooked in these discussions due to abundance of natural water resources. Here we test the relationship between water and food insecurity among 270 Tsimane' households in the Bolivian Amazon. Water challenges were evaluated with the Household Water Insecurity Experiences Scale (HWISE), water quality perception, objective water quality analyses, and water access via the JMP drinking water ladder. Food insecurity was measured with the Household Food Insecurity Access Scale (HFIAS), and quantitative measures of food frequency recall were used to further test the water and food insecurity relationship. Using multilevel mixed-effects linear regression, each point increase in HWISE score was associated with 0.47 point (95 % CI: 0.30, 0.62, p < 0.001) higher food insecurity, and households with access to improved water sources had between 1.25 and 1.36 points (95 % CI: -2.61, -0.01, p < 0.05) lower food insecurity compared to households reliant on surface water. These relationships held true independent of quantitative measures of both fish and meat consumption. Using mixed-effects logistic regression analyses, each point increase in HWISE score was associated with 43 % (95 % CI: 1.25-1.66, p < 0.001) increased odds of experiencing severe food insecurity. Households changing what was eaten due to experienced water problems was associated with 2.33 points (95 % CI: 0.41, 4.25, p < 0.05) higher food insecurity. This relationship held true independent of perceived water quality, indicating other structural water problems may be important here in the household water and food insecurity relationship. These results demonstrate that even in water-rich environments, like the Amazon, water and food insecurity are interconnected. Further, despite the challenging conditions, equitable structural interventions, like the development of improved water infrastructure, are critical for the provision of clean drinking water and may simultaneously help alleviate food insecurity.
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Affiliation(s)
- Lauren M T Broyles
- Population Research Institute, Pennsylvania State University, University Park, PA 16802, United States of America.
| | - Tomas Huanca
- Centro Boliviano de Investigación y Desarrollo Socio Integral, San Borja, Bolivia
| | - Esther Conde
- Centro Boliviano de Investigación y Desarrollo Socio Integral, San Borja, Bolivia
| | - Asher Y Rosinger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA 16802, United States of America; Department of Anthropology, Pennsylvania State University, State College, PA 16802, United States of America.
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Perkins JM, Kakuhikire B, Baguma C, Meadows M, Abayateye R, Rasmussen JD, Satinsky EN, Gumisiriza P, Kananura J, Namara EB, Bangsberg DR, Tsai AC. Water Treatment Practices and Misperceived Social Norms among Women Living with Young Children in Rural Uganda. Am J Trop Med Hyg 2024; 111:627-637. [PMID: 38981491 PMCID: PMC11376185 DOI: 10.4269/ajtmh.23-0723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/26/2024] [Indexed: 07/11/2024] Open
Abstract
Access to water safe for consumption is critical for health and well-being, yet substantial structural barriers often necessitate household action to make water safer. Social norms about water treatment practices are understudied as a driver of personal water treatment practice. This study assesses reported and perceived water treatment practices among women in a rural, water insecure setting. We used cross-sectional data from a population-based study of women living with children under 5 years old across eight villages in southwest Uganda. Participants reported their typical household water treatment practices and what they perceived to be the common practices among most other women with young children in their own village. Modified multivariable Poisson regression models estimated the association between individual behavior and perceptions. Of 274 participants (78% response rate), 221 (81%) reported boiling water and 228 (83%) reported taking at least one action to make water safer. However, 135 (49%) misperceived most women with young children in their village not to boil their water, and 119 (43%) misperceived most to take no action. Participants who misperceived these norms were less likely to practice safe water treatment (e.g., for boiling water, adjusted relative risk = 0.80; 95% CI 0.69-0.92, P = 0.002), adjusting for other factors. Future research should assess whether making actual descriptive norms about local water treatment practices visible and salient (e.g., with messages such as "most women in this village boil their drinking water") corrects misperceived norms and increases safe water treatment practices by some and supports consistent safe practices by others.
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Affiliation(s)
- Jessica M Perkins
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Meredith Meadows
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee
| | | | | | - Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychology, University of Southern California, Los Angeles, California
| | | | - Justus Kananura
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- VinUniversity, Hanoi, Vietnam
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
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Ahmed F, Malik NI, Bashir S, Noureen N, Ahmad JB, Tang K. Political Economy of Maternal Child Malnutrition: Experiences about Water, Food, and Nutrition Policies in Pakistan. Nutrients 2024; 16:2642. [PMID: 39203779 PMCID: PMC11357590 DOI: 10.3390/nu16162642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/07/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024] Open
Abstract
This study examined access to water, food, and nutrition programs among marginalized communities in Southern Punjab, Pakistan, and their effects on nutrition. Both qualitative and quantitative data were used in this study. We held two focus group discussions (one with 10 males and one with 10 females) and conducted in-depth interviews with 15 key stakeholders, including 20 mothers and 10 healthcare providers. A survey of 235 households was carried out to evaluate water and food insecurity, with the data analyzed using Wilcoxon's rank-sum test, t-test, and Pearson's chi-square test. The results revealed that 90% of households experienced moderate-to-severe water insecurity, and 73% faced moderate-to-severe food insecurity. Household water and food insecurity were positively correlated with each other (correlation coefficient = 0.205; p = 0.004). Greater household water (p = 0.028) and food insecurity (p < 0.001) were both associated with higher perceived stress. Furthermore, lower socioeconomic status was strongly related to higher levels of water (p < 0.001) and food insecurity (p < 0.001). Qualitative findings highlight the impact of colonial and post-colonial policies, which have resulted in water injustice, supply issues, and corruption in water administration. Women face significant challenges in fetching water, including stigma, harassment, and gender vulnerabilities, leading to conflicts and injuries. Water scarcity and poor quality adversely affect sanitation, hygiene, and breastfeeding practices among lactating mothers. Structural adjustment policies have exacerbated inflation and reduced purchasing power. Respondents reported a widespread lack of dietary diversity and food quality. Nutrition programs face obstacles such as the exclusion of people with low social and cultural capital, underfunding, weak monitoring, health sector corruption, and the influence of formula milk companies allied with the medical community and bureaucracy. This study concludes that addressing the macro-political and economic causes of undernutrition should be prioritized to improve nutrition security in Pakistan.
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Affiliation(s)
- Farooq Ahmed
- Department of Anthropology, The Islamia University of Bahawalpur, Bahawalpur 63100, Pakistan
| | - Najma Iqbal Malik
- Department of Psychology, University of Sargodha, Sargodha 40100, Pakistan;
| | - Shamshad Bashir
- Department of Psychology, Lahore Garrison University, Lahore 54920, Pakistan;
| | - Nazia Noureen
- Department of Psychology, Foundation University Rawalpindi Campus, Rawalpindi 58001, Pakistan;
| | - Jam Bilal Ahmad
- Taxila Institute of Asian Studies, Quaid-i-Azam University, Islamabad 45320, Pakistan;
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
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Mata MMD, Santana ABC, Martins FP, Medeiros MATD. Quality and access to water for human consumption: a look at the state of Amazonas, Brazil. CIENCIA & SAUDE COLETIVA 2024; 29:e05442023. [PMID: 39140536 DOI: 10.1590/1413-81232024298.05442023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/21/2023] [Indexed: 08/15/2024] Open
Abstract
Surveillance indicators of the quality of water for human consumption in the Amazon were analysed from 2016 to 2020 using 185,528 samples from 11 microregions. Of the samples analysed, 93.20% were from urban areas, 66.65% were from the public water supply system (WSS), 31.02% were from the Collective Alternative Solution-CAS, and 2.33% from the Individual Alternative Solution-IAS. There was an increase in the number of records by the WSS, with a downwards trend and fluctuations in records for the CAS and the IAS. The quality indicators of chemical and physical parameters for urban areas were higher than those for rural areas and traditional communities. Most of the samples presented pH values below the recommended level. In the quantification of microbiological parameters, a higher presence of total coliforms and E. coli was identified in samples from rural areas and in traditional communities. In conclusion, there were inadequacies in the chemical, physical and microbiological parameters as well as problems related to the supply, storage and surveillance of water distributed for human consumption. These findings indicate the need to build an agenda for public management to address water insecurity and its likely effects on food insecurity in the region.
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Affiliation(s)
- Mayline Menezes da Mata
- Programa de Pós-Graduação em Nutrição, Universidade Federal de São Paulo. São Paulo SP Brasil
| | | | - Flavio Pinheiro Martins
- Bartlett School of Sustainable Construction, Faculty of the Built Environment, University College London. Londres Reino Unido
| | - Maria Angélica Tavares de Medeiros
- Programa de Pós-Graduação em Nutrição, Universidade Federal de São Paulo. São Paulo SP Brasil
- Departamento de Políticas Públicas e Saúde Coletiva, Instituto Saúde e Sociedade, Universidade Federal de São Paulo. R. Silva Jardim 136, Vila Mathias. 11015-020 Santos SP Brasil.
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Chakraborty R, Armijos RX, Beidelman ET, Rosenberg M, Margaret Weigel M. Household food and water insecurity and its association with diarrhoea, respiratory illness, and stunting in Ecuadorian children under 5 years. MATERNAL & CHILD NUTRITION 2024:e13683. [PMID: 38873704 DOI: 10.1111/mcn.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/22/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
Household food and water insecurity has been previously associated with adverse health consequences in children. However, these relationships are understudied in middle-income Latin American populations such as in Ecuador, where a high prevalence of food and water insecurity has been reported. Using cross-sectional data from 2018 Ecuadorian National Health and Nutrition Survey, we examined the association of household food insecurity (HFI), household water insecurity (HWI), and concurrent HFI-HWI with diarrhoea, respiratory illness (RI), and stunting in 20,510 children aged ≤59 months. HFI was measured using the Food Insecurity Experience Scale. HWI was defined when households responded negatively to one or more of four drinking water indicators. Maternal caregivers reported on child diarrhoea and RI episodes during the previous 2 weeks. Measured length or height was used to assess stunting. We constructed log-binomial regression models to estimate the associations of HFI, HWI, and concurrent HFI-HWI with child outcomes. Moderate-severe HFI was associated with a higher prevalence of diarrhoea (PR = 1.39; 95% CI: 1.18, 1.63) and RI (PR = 1.34; 95% CI: 1.22, 1.47), HWI with a higher prevalence of RI (PR = 1.13; 95% CI: 1.04, 1.22), and concurrent HFI-HWI with a higher prevalence of diarrhoea (PR = 1.30; 95% CI: 1.05, 1.62) and RI (PR = 1.45; 95% CI: 1.29, 1.62). Stunting was not associated with HFI, HWI nor concurrent HFI-HWI. These findings suggest that HFI and HWI can independently and jointly act to negatively affect children's health. Policies and interventions aimed at alleviating both food and water insecurity are needed to bring sustained health improvements in Ecuadorian children.
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Affiliation(s)
- Rishika Chakraborty
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
| | - Rodrigo X Armijos
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Center for Latin American & Caribbean Studies, Indiana University, Bloomington, Indiana, USA
- Center for Global Health Equity, Indiana University, Indianapolis, Indiana, USA
| | - Erika T Beidelman
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
| | - M Margaret Weigel
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Center for Latin American & Caribbean Studies, Indiana University, Bloomington, Indiana, USA
- Center for Global Health Equity, Indiana University, Indianapolis, Indiana, USA
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Graham E, Thorne-Lyman AL, McGready J, Mui Y, Manohar S, Neupane S, Fanzo J, West KP. Measuring Community Urbanicity and Its Influence on Household Food Security Across Nepal's Agroecological Zones. Curr Dev Nutr 2024; 8:103773. [PMID: 38948107 PMCID: PMC11214172 DOI: 10.1016/j.cdnut.2024.103773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/20/2024] [Accepted: 05/09/2024] [Indexed: 07/02/2024] Open
Abstract
Background Urbanization influences food systems and food security, but research on these associations in low- and middle-income countries remain limited, partly because of the binary and unstandardized "urban compared with rural" classifications. Objectives To develop a community urbanicity scale, to assess its associations with household food security, and to explore whether agricultural occupation modifies this relationship across the 3 agroecological zones (mountain, hill, Tarai) of Nepal. Methods Data came from a nationally and agroecologically representative, multistaged 2013 agri-food system survey of 4285 households with children <5 y in 63 communities (wards) in Nepal. A novel community-level urbanicity scale was constructed using factor analysis that included 8 domains. Multilevel mixed effects logistic regression was used to assess associations between urbanicity and household food security (measured using the validated Household Food Insecurity Access Scale), and to investigate modifying effects of agricultural occupation. Results Urbanicity scores ranged between 13 and 69, of a possible 80 points. Most agricultural households in the mountains (67%) and hills (54%) were categorized food insecure. Increases in urbanicity were negatively associated with food insecurity, controlling for other factors (odds ratio [OR] per 10-unit urbanicity difference OR: 0.82; confidence interval [CI]: 0.71, 0.94; P ≤ 0.05). Agricultural occupation may have positively influenced this association though was not a statistically significant effect measure modifier (P = 0.07). Conclusions The novel scale shows more nuance within Nepal's agroecological zones, which had similar urbanicity-to-food security relationships as well as overlapping urbanicity score distributions. Research and policy efforts should consider using scales providing more precise urbanicity measurement, and thus informative assessments on its role in predicting food insecurity, especially in agriculturally reliant populations.
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Affiliation(s)
- Elizabeth Graham
- Global Alliance for Improved Nutrition, Washington DC, United States
| | - Andrew L Thorne-Lyman
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - John McGready
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Yeeli Mui
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Swetha Manohar
- Climate School, Columbia University, New York, NY, United States
| | - Sumanta Neupane
- Nutrition, Diets and Health Division, International Food Policy Research Institute, Washington DC, United States
| | - Jessica Fanzo
- Nutrition, Diets and Health Division, International Food Policy Research Institute, New Delhi, India
| | - Keith P West
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Elshahat S, Moffat T, Iqbal BK, Newbold KB, Gagnon O, Alkhawaldeh H, Morshed M, Madani K, Gehani M, Zhu T, Garabedian L, Belahlou Y, Curtay SAH, Zhu IHC, Chan C, Duzenli D, Rajapaksege N, Shafiq B, Zaidi A. 'I thought we would be nourished here': The complexity of nutrition/food and its relationship to mental health among Arab immigrants/refugees in Canada: The CAN-HEAL study. Appetite 2024; 195:107226. [PMID: 38266714 DOI: 10.1016/j.appet.2024.107226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/12/2023] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
Nutritional psychiatry suggests that diet quality impacts one's mental health (MH). The relationship between food/nutrition and MH may be particularly salient for immigrants/refugees who often experience high risk for household food insecurity and MH challenges. An innovative collaborative community-based participatory research and integrated knowledge translation approach was adopted to explore food/nutrition needs as they relate to MH among Arab immigrants/refuges (AIR) in Ontario, Canada. The goal was to co-identify areas that require social change and co-produce applicable knowledge for service improvement. The CAN-HEAL study used a multi-methodological approach, employing qualitative interviews, photovoice and a questionnaire survey. A combination of three sampling approaches (convenience, snowball and purposive) was used to recruit sixty socio-demographically-diverse adult AIR participants. The research was guided by an integrated bio-psycho-socio-cultural framework. Participants reported various socio-economic and structural barriers to nutritious eating. Food quality/safety was a significant concern and source of anxiety among AIR; food mislabeling, the widespread presence of genetically/chemically modified foods and expired/rotten food products were associated with negative MH. Participants experienced an alarming prevalence of food insecurity (65%), which was associated with negative MH. Intersections among age, gender, religion, socio-economic status, parenthood, disability, and place of residence played a considerable role in how nutrition, food security, and dietary intake impacted AIR's MH and caused substantial disparities within the AIR community. The food/nutrition-MH relationship among AIR is multi-faceted, and various psycho-socio-cultural pathways/processes were found to shape MH. Intersectoral collaboration between health and non-health sectors is needed to implement a co-proposed socio-political and community-level action plan to achieve nutrition and health equity for AIR and other similar marginalized groups.
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Affiliation(s)
- Sarah Elshahat
- Department of Anthropology, Faculty of Social Sciences, McMaster University, Hamilton, ON, L8S 4L9, Canada.
| | - Tina Moffat
- Department of Anthropology, Faculty of Social Sciences, McMaster University, Hamilton, ON, L8S 4L9, Canada
| | - Basit Kareem Iqbal
- Department of Anthropology, Faculty of Social Sciences, McMaster University, Hamilton, ON, L8S 4L9, Canada
| | - K Bruce Newbold
- School of Earth, Environment & Society, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Olivia Gagnon
- Department of Neuroscience, Faculty of Science, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - Haneen Alkhawaldeh
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Mahira Morshed
- Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Keon Madani
- Integrated Biomedical Engineering and Health Sciences Faculty, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Mafaz Gehani
- Department of Psychological and Health Sciences, University of Toronto, Scarborough, ON, M1C 1A4, Canada
| | - Tony Zhu
- Department of Criminology & Sociolegal Studies, Faculty of Arts and Science, University of Toronto, Toronto, ON, M5S 1A1, Canada
| | - Lucy Garabedian
- Department of Biomedical and Molecular Sciences, Faculty of Arts and Science, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Yasmine Belahlou
- Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Sarah A H Curtay
- School of Nursing, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Irene Hui-Chen Zhu
- School of Food and Nutritional Sciences, University of Western Ontario, Brescia University College, London, ON, N6A 3K7, Canada
| | - Charlotte Chan
- School of Food and Nutritional Sciences, University of Western Ontario, Brescia University College, London, ON, N6A 3K7, Canada
| | - Deniz Duzenli
- Department of Biology, Faculty of Science, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | | | - Bisma Shafiq
- School of Food and Nutritional Sciences, University of Western Ontario, Brescia University College, London, ON, N6A 3K7, Canada
| | - Amna Zaidi
- Department of Political Science, Faculty of Social Sciences, McMaster University, Hamilton, ON, L8S 4L8, Canada
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Gibb JK, Williams S, Mikelsteins K, Charles J, McKinnon L, Beach L, McKerracher L, Fields J. Queering food security research: A critical analysis of 2SLGBTQ+ People's experiences of food insecurity in Toronto during the COVID-19 pandemic. Soc Sci Med 2024; 345:116709. [PMID: 38422687 DOI: 10.1016/j.socscimed.2024.116709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Household food insecurity (HFI), stress, isolation, and discrimination are major determinants of health that disproportionately affect 2SLGBTQ + people. The COVID-19 pandemic potentially exacerbated these inequities. This study investigates HFI rates among 2SLGBTQ + adults living in diverse household conditions during the pandemic and explores the idea that heteronormative conceptions of the "household" may affect measurement of HFI. METHODS Cross-sectional survey responses were collected from 437 self-identified 2SLGBTQ + people from Toronto, Canada between March and July 2021. The survey measured HFI, sexual/gender identities, socio-demographic factors, household composition, and psycho-social stress/distress. Multinomial logistic regression was used to assess variation in odds of marginal, moderate, and severe HFI in relation to sexual/gender identities, household composition, psycho-social distress, and socio-demographic covariates. RESULTS Forty-two percent of respondents reported some level of HFI, with severe HFI higher among respondents who were bisexual, transgender/gender diverse, and/or assigned-female-at-birth. Living alone was associated with decreased odds of reporting marginal HFI but increased odds of moderate or severe HFI compared to living with a partner, family, or roommates; living with children was associated with decreased odds of both marginal and severe HFI. One indicator of psycho-social distress (perceived discrimination) was associated with higher odds of all levels of HFI, while the other (isolation) was associated with decreased odds of marginal HFI. CONCLUSION These findings highlight the high prevalence of HFI linked with discrimination among 2SLGBTQ + individuals during the pandemic. The complicated results regarding household composition and social isolation may suggest a need to revise definitions of the household when measuring, monitoring, and seeking to mitigate HFI in 2SLGBTQ + communities.
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Affiliation(s)
- James K Gibb
- Department of Anthropology, Northwestern University, Evanston, USA; Department of Health & Society, University of Toronto Scarborough, Toronto, Canada.
| | - Sarah Williams
- Department of Anthropology, University of Connecticut, Storrs, USA
| | - Kaspars Mikelsteins
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada
| | - Jada Charles
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada; Department of Sociology, University of British Columbia, Vancouver, Canada
| | - Leela McKinnon
- Department of Anthropology, University of Toronto, Toronto, Canada
| | - Laura Beach
- Department of Anthropology, University of Toronto, Toronto, Canada
| | - Luseadra McKerracher
- Aarhus Institute for Advanced Studies and Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jessica Fields
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada; Department of Sociology, University of Toronto, Toronto, Canada
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Tallman PS, Salmon-Mulanovich G, Archdeacon N, Kothadia A, Lopez Flores L, Castañeda K, Collins S, Rusyidi B, Cole S. "Gender-Based Water Violence": Cross-Cultural Evidence for Severe Harm Associated With Water Insecurity for Women and Girls. Violence Against Women 2024:10778012241230323. [PMID: 38311938 DOI: 10.1177/10778012241230323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
We examined how study participants in Indonesia and Peru viewed the relationship between water insecurity and women's health via thematic analysis of interviews and focus groups. Participants reported that water insecurity led to vaginal infections, miscarriage, premature births, uterine prolapse, poor nutrition, restricted economic opportunities, and intergenerational cycles of poverty. Participants in both countries stated that extreme burdens associated with water insecurity should be categorized as violence. Based on these findings, we developed the concept of "gender-based water violence," defined as the spectrum of stressors associated with water insecurity that are so severe as to threaten human health and well-being, particularly that of women and girls.
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10
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Kochupurackal Ulahannan S, Srinivas PN, Soman B. Social Determinants of Child Undernutrition in Adivasi Population in Northern Kerala: A Study Using Syndemic Framework. Indian J Pediatr 2023; 90:77-84. [PMID: 37462817 PMCID: PMC7615388 DOI: 10.1007/s12098-023-04720-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/05/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES To understand the complex interaction of structural inequalities, co-occurring health conditions, and child undernutrition among the Adivasi population in North Kerala, India. METHODS A mixed-method approach was employed in this study, which combined a cross-sectional survey and a case study design. A multistage cluster sampling method was used to select 167 children aged 24 to 60 mo from the study population. The mothers of these children were interviewed using a structured questionnaire to assess individual, parental, and household-level factors associated with child undernutrition. Two Paniya settlements, one with a high prevalence of child undernutrition (HPS) and the other with a low prevalence (LPS), were chosen as the primary units of the case study. RESULTS The study found that the absence of a kitchen garden with fruits and vegetables [adjusted odds ratio (AOR) 2.85; 95% confidence interval (CI): 1.04-7.81] and a history of cough and fever (AOR 2.93; 95% CI: 1.24-6.93) were both associated with a higher risk of undernutrition in children. The case studies revealed that Adivasi children are undernourished due to a complex set of factors that persist throughout their lives, including unequal access to social capital, healthcare, and food security, as well as differences in hygiene practices due to the lack of access to clean water and sanitation. CONCLUSIONS The findings underscore the need for social interventions to complement the current focus almost entirely on food supplementation programmes. Equitable action on Adivasi child malnutrition requires urgent policy and programmatic attention to social inequalities and access to basic amenities in Adivasi areas.
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Affiliation(s)
- Sabu Kochupurackal Ulahannan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
- Health Equity Cluster, Institute of Public Health, Bengaluru, India
| | | | - Biju Soman
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Toivettula A, Varis O, Vahala R, Juvakoski A. Making waves: Mental health impacts of inadequate drinking water services - From sidenote to research focus. WATER RESEARCH 2023; 243:120335. [PMID: 37516073 DOI: 10.1016/j.watres.2023.120335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/30/2023] [Accepted: 07/09/2023] [Indexed: 07/31/2023]
Abstract
The paramount significance of the harmful impacts of poor drinking water services on physical health have been recognized for decades. Besides, over the past twenty years, an additional body of literature on their negative mental health impacts has emerged. With this brief review, we summarise the findings of the scholarship to advance addressing overall health (physical, mental, and social) in the water sector. We furthermore review the key policy documents of this field with a focus on mental health aspects and give recommendations for practitioners and decision-makers on addressing mental health in water service delivery. We reviewed the existing published works (42) assessing psychological impacts of deficient drinking water services in low-income settings. We then identified and compared the different mechanisms causing negative mental health outcomes described in them. For these purposes, we used a water insecurity experience -model and the vulnerability-stress model of clinical psychology. Next, we probed key international and national guiding documents of the water sector to analyse how mental health issues resulting from poor services are addressed today. We found that according to the literature, poor quality and quantity of water was predictably one of the most important psychosocial stressors to users. Surprisingly, however, various kinds of water-service-related inequalities (e.g. between genders, communities or socio-economic groups) showed up as equally significant stressors. Our analysis with the vulnerability-stress model furthermore indicates that insufficient drinking water services may predispose to common mental disorders particularly through external stress. Existing field guidelines have evolved to highlight the values of non-discrimination and participation, whilst mental health aspects remain ignored. This should not be the case. Therefore, practices for addressing mental health effectively in documentation and water service development should be further researched. But already in the light of the existing literature, we urge stakeholders to focus more on the negative mental health impacts of unequal service provision for users and nearby people left without improved services.
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Affiliation(s)
- A Toivettula
- Department of Built Environment, School of Engineering, Aalto University, PO Box 15200, FI-00076 Aalto, Finland.
| | - O Varis
- Department of Built Environment, School of Engineering, Aalto University, PO Box 15200, FI-00076 Aalto, Finland
| | - R Vahala
- Department of Built Environment, School of Engineering, Aalto University, PO Box 15200, FI-00076 Aalto, Finland
| | - A Juvakoski
- Department of Built Environment, School of Engineering, Aalto University, PO Box 15200, FI-00076 Aalto, Finland.
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Kahn CB, John B, Shin SS, Whitman R, Yazzie AS, Goldtooth-Halwood R, Hecht K, Hecht C, Vollmer L, Egge M, Nelson N, Bitah K, George C. Teacher and Caregiver Perspectives on Water Is K'é: An Early Child Education Program to Promote Healthy Beverages among Navajo Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6696. [PMID: 37681836 PMCID: PMC10487536 DOI: 10.3390/ijerph20176696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/08/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023]
Abstract
The Water is K'é program was developed to increase water consumption and decrease consumption of sugar-sweetened beverages for young children and caregivers. The pilot program was successfully delivered by three Family and Child Education (FACE) programs on the Navajo Nation using a culturally centered curriculum between 2020 to 2022. The purpose of this research was to understand teacher and caregiver perspectives of program feasibility, acceptability, impact, and other factors influencing beverage behaviors due to the pilot program. Nine caregivers and teachers were interviewed between June 2022 and December 2022, and a study team of four, including three who self-identified as Navajo, analyzed the data using inductive thematic analysis and consensus building to agree on codes. Five themes emerged, including feasibility, acceptability, impact, suggestions for future use of the program, and external factors that influenced water consumption. The analysis showed stakeholders' strong approval for continuing the program based on impact and acceptability, and identified factors that promote the program and barriers that can be addressed to make the program sustainable. Overall, the Water is K'é program and staff overcame many challenges during the COVID-19 pandemic to support healthy behavior change that had a rippled influence among children, caregivers, teachers, and many others.
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Affiliation(s)
- Carmella B. Kahn
- College of Population Health, University of New Mexico, Albuquerque, NM 87131, USA
| | - Brianna John
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Community Outreach and Patient Empowerment Program, Gallup, NM 87301, USA
| | - Sonya S. Shin
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Community Outreach and Patient Empowerment Program, Gallup, NM 87301, USA
| | - Rachel Whitman
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Community Outreach and Patient Empowerment Program, Gallup, NM 87301, USA
| | - Asia Soleil Yazzie
- Community Outreach and Patient Empowerment Program, Gallup, NM 87301, USA
| | | | - Ken Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
| | - Christina Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
| | - Laura Vollmer
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
- Cooperative Extension, Division of Agriculture and Natural Resources, University of California, Davis, CA 95618, USA
| | | | | | - Kerlissa Bitah
- T’iis Nazbas Community School, Teec Nos Pos, AZ 86514, USA
| | - Carmen George
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Community Outreach and Patient Empowerment Program, Gallup, NM 87301, USA
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Logan AC, Berman BM, Prescott SL. Vitality Revisited: The Evolving Concept of Flourishing and Its Relevance to Personal and Public Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5065. [PMID: 36981974 PMCID: PMC10049456 DOI: 10.3390/ijerph20065065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
Human flourishing, the state of optimal functioning and well-being across all aspects of an individual's life, has been a topic of philosophical and theological discussion for centuries. In the mid-20th century, social psychologists and health scientists began exploring the concept of flourishing in the context of health and high-level wellness. However, it is only in recent years, in part due to the USD 43 million Global Flourishing Study including 22 countries, that flourishing has entered the mainstream discourse. Here, we explore this history and the rapid acceleration of research into human flourishing, defined as "the relative attainment of a state in which all aspects of a person's life are good" by the Harvard University's Flourishing Program. We also explore the construct of "vitality", which refers to a sense of aliveness, energy, and motivation; we contend that this has been neglected in the flourishing movement. We explore why incorporating measures of vitality, together with a broader biopsychosocial approach, considers all dimensions of the environment across time (the total exposome), which will greatly advance research, policies, and actions to achieve human flourishing.
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Affiliation(s)
| | - Brian M. Berman
- Nova Institute for Health, Baltimore, MD 21231, USA
- Family and Community Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Susan L. Prescott
- Nova Institute for Health, Baltimore, MD 21231, USA
- Family and Community Medicine, University of Maryland, Baltimore, MD 21201, USA
- Medical School, University of Western Australia, Nedlands, WA 6009, Australia
- The ORIGINS Project, Telethon Kids Institute, Nedlands, WA 6009, Australia
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Young SL, Bethancourt HJ, Frongillo EA, Viviani S, Cafiero C. Concurrence of water and food insecurities, 25 low- and middle-income countries. Bull World Health Organ 2023; 101:90-101. [PMID: 36733622 PMCID: PMC9874369 DOI: 10.2471/blt.22.288771] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/23/2022] [Accepted: 10/21/2022] [Indexed: 02/04/2023] Open
Abstract
Objective To investigate how water and food insecurity were associated in nationally representative samples of individuals from 25 low- and middle-income countries. Methods We used data from the 2020 World Gallup Poll in which the Individual Water Insecurity Experiences Scale and the Food Insecurity Experience Scale had been administered to 31 755 respondents. These scales measure insecurity experiences in the previous 12 months. We classified individuals as water insecure if their score was ≥ 12 and food insecure if the Rasch probability parameter was ≥ 0.5. For estimating the proportions, we used projection weights. We estimated the relationships between binary and continuous measures of water insecurity and food insecurity for individuals within each country and region using multivariable logistic and linear regression models, adjusting for key socioeconomic characteristics including income, gender, age and education. Findings Among the 18.3% of respondents who experienced water insecurity, 66.8% also experienced food insecurity. The likelihood of experiencing moderate-to-severe food insecurity was higher among respondents also experiencing water insecurity (adjusted odds ratio, aOR: 2.69; 95% confidence interval, CI: 2.43 to 2.98). Similar odds were found in Asia (aOR: 2.95; 95% CI: 2.04 to 4.25), Latin America (aOR: 2.17; 95% CI: 1.62 to 2.89), North Africa (aOR: 2.92; 95% CI: 2.17 to 3.93) and sub-Saharan Africa (aOR: 2.71; 95% CI: 2.40 to 3.06). Conclusion Our results suggest that water insecurity should be considered when developing food and nutrition policies and interventions. However, more research is needed to understand the paths between these insecurities.
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Affiliation(s)
- Sera L Young
- Department of Anthropology, Northwestern University, 1819 Hinman Avenue, Evanston, Illinois, 60201United States of America (USA)
| | - Hilary J Bethancourt
- Department of Anthropology, Northwestern University, 1819 Hinman Avenue, Evanston, Illinois, 60201United States of America (USA)
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, USA
| | - Sara Viviani
- Statistics Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Carlo Cafiero
- Statistics Division, Food and Agriculture Organization of the United Nations, Rome, Italy
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Rosinger AY, Bethancourt HJ, Young SL. Tap Water Avoidance Is Associated with Lower Food Security in the United States: Evidence from NHANES 2005-2018. J Acad Nutr Diet 2023; 123:29-40.e3. [PMID: 35872245 PMCID: PMC10119945 DOI: 10.1016/j.jand.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/03/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Food insecurity has profound nutritional and public health consequences. Water insecurity may exacerbate food insecurity, yet little is known about the association between water and food insecurity in the United States or other high-income countries. OBJECTIVE This study aimed to estimate how tap water avoidance, a proxy of water insecurity, covaries with food insecurity; examine how the probability of food insecurity changed by tap water avoidance between 2005 and 2018; and test how the association between tap water avoidance and food insecurity differed across income and housing statuses. DESIGN This was a secondary analysis of the cross-sectional 2005-2018 National Health and Nutrition Examination Survey. PARTICIPANTS/SETTING Participants were 31,390 US adults 20 years and older. MAIN OUTCOME MEASURES The main outcome was food insecurity, using the US Food Security Survey Module. STATISTICAL ANALYSES Adjusted logistic regression models estimated how tap water avoidance was associated with the odds of food insecurity. Predicted probabilities of food insecurity over time and by income and housing status were plotted using marginal standardization. RESULTS Adults who avoided tap water had 21% higher odds (95% CI 1.09 to 1.34) of food insecurity compared with those who drank tap water. The probability of any food insecurity doubled between 2005-2006 and 2017-2018 and was consistently higher for tap water avoiders. Food insecurity decreased across both tap water drinkers and avoiders as income increased, but was higher among tap water avoiders at all income levels. Likewise, food insecurity was higher among renters than among homeowners but was higher among tap water avoiders in both housing groups. CONCLUSIONS Tap water avoidance is positively associated with food insecurity in the United States, and both insecurities have increased over time. Efforts to mitigate food insecurity should simultaneously address water insecurity issues, including tap water availability and quality, as these may be a modifiable contributors to food insecurity.
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Affiliation(s)
- Asher Y Rosinger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA; Department of Anthropology, Pennsylvania State University, University Park, PA.
| | - Hilary J Bethancourt
- Department of Anthropology, Northwestern University, Evanston, IL; Institute for Policy Research, Northwestern University, Evanston IL
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL; Institute for Policy Research, Northwestern University, Evanston IL
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16
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Sliwa K, Viljoen CA, Hasan B, Ntusi NAB. Nutritional Heart Disease and Cardiomyopathies: JACC Focus Seminar 4/4. J Am Coll Cardiol 2022; 81:S0735-1097(22)07308-9. [PMID: 36599756 DOI: 10.1016/j.jacc.2022.08.812] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 01/03/2023]
Abstract
This JACC Focus Seminar provides an overview of and highlights recently published research on cardiomyopathies and nutritional heart disease that have a higher prevalence in tropical regions. The development of tropical cardiomyopathies and nutritional cardiovascular disease (CVD) is complicated by high rates of poverty, fragmented health care systems, and suboptimal access to health care because of socioeconomic inequalities, leading to the fact that children, adolescents, and young adults are disproportionally affected. Such tropical cardiomyopathies and nutritional CVD that have not been prevalent in high-income countries in the past decades are now reemerging. When treating migrants or refugees, it is important for attending physicians to consider the burden of endemic diseases in the countries of origin and the likelihood that such patients might be affected. In this review, the authors propose an approach for adequate diagnostic work-up leading to appropriate care for those with suspected or confirmed tropical cardiomyopathies and nutritional CVD.
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Affiliation(s)
- Karen Sliwa
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Charle Andre Viljoen
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Babar Hasan
- Division of Cardio-Thoracic Sciences, Sindh Institute of Urology and Transplant, Karachi, Pakistan
| | - Ntobeko A B Ntusi
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; South African Medical Research Council Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, Cape Town, South Africa
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17
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Herrera-Cuenca M, Landaeta-Jiménez M, Hernandez P, Sifontes Y, Ramírez G, Vásquez M, Maingon T. Exploring food security/insecurity determinants within Venezuela's complex humanitarian emergency. DIALOGUES IN HEALTH 2022; 1:100084. [PMID: 38515908 PMCID: PMC10954010 DOI: 10.1016/j.dialog.2022.100084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 03/23/2024]
Abstract
Introduction The complex humanitarian emergency that Venezuela has been going through for several years has deteriorated the quality of life of its citizens, deepened food insecurity in households and has promoted migratory movements of almost six million people to neighboring countries. Objective To analyze food security in Venezuelan households to identify the determinant factors that might contribute to the design of evidence-based public policies. Materials and methods A non-probabilistic survey of national scope was used in 2,041 urban and non-urban households. A descriptive statistical test was performed to analyze demographic variables and the three component indicators of the food security index (FSI): food consumption, economic vulnerability and coping strategies. The FSI was built according to the World Food Program (WFP) methodology, and a segmentation analysis was applied using the Chi-squared Automatic Interaction Detection (CHAID) algorithm to specify the influence of some variables as the best predictor at each level. Results Only 9% of the households presented food security, 69% classified as marginally secure, and 22% presented moderate or severe food insecurity. The food consumption score (FCS) was the variable that best discriminated the level of food security, followed by coping strategies and the percentage of spending on food. Conclusion: Most of the households studied sacrifice their livelihoods to feed themselves and cover the minimum of their nutritional requirements. This needs attention to stop and reverse the deterioration within a framework of respect for the human rights to health and food.
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Affiliation(s)
- Marianella Herrera-Cuenca
- Center for Development Studies (CENDES), Central University of Venezuela, Neverí Av., Fundavac Building, Colinas de Bello Monte. ZIP: 1080, Caracas, Venezuela
- José María Bengoa Foundation for Food and Nutrition, Centro Seguros La Paz Building, 4th floor, Office E-41C, La California sector, Francisco de Miranda Av., ZIP: 1071, Caracas, Venezuela
- Venezuelan Health Observatory, Neverí Av., Fundavac Building, Colinas de Bello Monte. ZIP: 1080, Caracas, Venezuela
| | - Maritza Landaeta-Jiménez
- José María Bengoa Foundation for Food and Nutrition, Centro Seguros La Paz Building, 4th floor, Office E-41C, La California sector, Francisco de Miranda Av., ZIP: 1071, Caracas, Venezuela
- Venezuelan Health Observatory, Neverí Av., Fundavac Building, Colinas de Bello Monte. ZIP: 1080, Caracas, Venezuela
| | - Pablo Hernandez
- Venezuelan Health Observatory, Neverí Av., Fundavac Building, Colinas de Bello Monte. ZIP: 1080, Caracas, Venezuela
- Nutrition and Dietetics School, Central University of Venezuela, Address: El Rectorado Av. Res. 2-B, 3th floor, University City of Caracas, Los Chaguaramos. ZIP: 1041-A, Caracas, Venezuela
| | - Yaritza Sifontes
- José María Bengoa Foundation for Food and Nutrition, Centro Seguros La Paz Building, 4th floor, Office E-41C, La California sector, Francisco de Miranda Av., ZIP: 1071, Caracas, Venezuela
- Nutrition and Dietetics School, Central University of Venezuela, Address: El Rectorado Av. Res. 2-B, 3th floor, University City of Caracas, Los Chaguaramos. ZIP: 1041-A, Caracas, Venezuela
| | - Guillermo Ramírez
- Postgraduate Area in Statistics, Universidad Central de Venezuela, Address: El Rectorado Av. Res. 3-A, 3th floor, University City of Caracas, Los Chaguaramos. ZIP: 1041-A, Caracas, Venezuela
| | - Maura Vásquez
- Postgraduate Area in Statistics, Universidad Central de Venezuela, Address: El Rectorado Av. Res. 3-A, 3th floor, University City of Caracas, Los Chaguaramos. ZIP: 1041-A, Caracas, Venezuela
| | - Thais Maingon
- Center for Development Studies (CENDES), Central University of Venezuela, Neverí Av., Fundavac Building, Colinas de Bello Monte. ZIP: 1080, Caracas, Venezuela
- Venezuelan Health Observatory, Neverí Av., Fundavac Building, Colinas de Bello Monte. ZIP: 1080, Caracas, Venezuela
- Metropolitan University. Address: Distribuidor Universidad. Boyacá Av. with Petare-Guarenas highway. Terrazas del Ávila Urb., Caracas, -Miranda State. ZIP: 1073. Caracas, Venezuela
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Koyratty N, Mbuya MNN, Jones AD, Schuster RC, Kordas K, Li CS, Tavengwa NV, Majo FD, Chasekwa B, Ntozini R, Humphrey JH, Smith LE. Implementation and maintenance of infant dietary diversity in Zimbabwe: contribution of food and water insecurity. BMC Nutr 2022; 8:136. [PMCID: PMC9673371 DOI: 10.1186/s40795-022-00622-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Inadequate food and water resources negatively affect child health and the efficiency of nutrition interventions.
Methods
We used data from the SHINE trial to investigate the associations of food insecurity (FI) and water insecurity (WI) on mothers’ implementation and maintenance of minimum infant dietary diversity (MIDD). We conducted factor analysis to identify and score dimensions of FI (poor access, household shocks, low availability & quality), and WI (poor access, poor quality and low reliability). MIDD implementation (n = 636) was adequate if infants aged 12 months (M12) ate ≥ four food groups. MIDD maintenance (n = 624) was categorized into four mutually exclusive groups: A (unmet MIDD at both M12 and M18), B (unmet MIDD at M12 only), C (unmet MIDD at M18 only), and D (met MIDD at both M12 and M18). We used multivariable-adjusted binary logistic and multinomial regressions to determine likelihood of MIDD implementation, and of belonging to MIDD maintenance groups A-C (poor maintenance groups), compared to group D, respectively.
Results
Low food availability & quality were negatively associated with implementation (OR = 0.81; 0.69, 0.97), and maintenance (ORB = 1.29; 1.07, 1.56). Poor water quality was positively associated with implementation (OR = 1.25; 1.08, 1.44), but inconsistently associated with maintenance, with higher odds of infants being in group C (OR = 1.39; 1.08, 1.79), and lower odds of being in group B (OR = 0.80; 0.66, 0.96).
Conclusion
Food security should be prioritized for adequate implementation and maintenance of infant diets during complementary feeding. The inconsistent findings with water quality indicate the need for further research on WI and infant feeding.
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Workman CL, Stoler J, Harris A, Ercumen A, Kearns J, Mapunda KM. Food, water, and sanitation insecurities: Complex linkages and implications for achieving WASH security. Glob Public Health 2022; 17:3060-3075. [PMID: 34506263 DOI: 10.1080/17441692.2021.1971735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Food, water and sanitation insecurities are complex, multi-dimensional phenomena that entail more than availability and access; food, water, and sanitation resources must be safe and culturally appropriate. Researchers and implementers concerned with these insecurities have demonstrated that there are notable interactions between them resulting in significant psychological and biological outcomes. Recent randomised controlled trials (RCTs) in Bangladesh, Kenya (WASH Benefits) and Zimbabwe (SHINE) demonstrated no effect from water, sanitation and hygiene (WASH) interventions on linear growth, and mixed evidence on enteropathogen burden and risk of diarrhoea in young children. These data suggest a need for a more comprehensive understanding of WASH security. The risks posed by multiple resource insecurities shift depending on the individual, their movement throughout their day, their economically and socially prescribed roles, and ecological features such as seasonality and precipitation. By more fully integrating food, water and sanitation security in interventions and subsequent impact evaluations, we can achieve WASH security-one that addresses myriad transmission pathways and co-occurring diseases-that ultimately would improve health outcomes throughout the world. In this critical review, we outline the complexity of combined resource insecurities as a step towards transformative WASH.
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Affiliation(s)
| | | | - Angela Harris
- North Carolina State University, Raleigh, North Carolina
| | - Ayse Ercumen
- North Carolina State University, Raleigh, North Carolina
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McCall SJ, El Khoury T, Salibi N, Abi Zeid B, El Haddad M, Alawieh MF, Abdulrahim S, Chaaya M, Ghattas H, Sibai AM. Development of a Prediction Model for the Management of Noncommunicable Diseases Among Older Syrian Refugees Amidst the COVID-19 Pandemic in Lebanon. JAMA Netw Open 2022; 5:e2231633. [PMID: 36227600 PMCID: PMC9561955 DOI: 10.1001/jamanetworkopen.2022.31633] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
IMPORTANCE Older Syrian refugees have a high burden of noncommunicable diseases (NCDs) and economic vulnerability. OBJECTIVES To develop and internally validate a predictive model to estimate inability to manage NCDs in older Syrian refugees, and to describe barriers to NCD medication adherence. DESIGN, SETTING, AND PARTICIPANTS This nested prognostic cross-sectional study was conducted through telephone surveys between September 2020 and January 2021. All households in Lebanon with Syrian refugees aged 50 years or older and who received humanitarian assistance from a nongovernmental organization were invited to participate. Refugees who self-reported having chronic respiratory disease (CRD), diabetes, history of cardiovascular disease (CVD), or hypertension were included in the analysis. Data were analyzed from November 2021 to March 2022. MAIN OUTCOMES AND MEASURES The main outcome was self-reported inability to manage any NCD (including CRD, CVD, diabetes, or hypertension). Predictors of inability to manage any NCD were assessed using logistic regression models. The model was internally validated using bootstrapping techniques, which gave an estimate of optimism. The optimism-adjusted discrimination is presented using the C statistic, and calibration of the model is presented using calibration slope (C slope). RESULTS Of 3322 older Syrian refugees, 1893 individuals (median [IQR] age, 59 [54-65] years; 1089 [57.5%] women) reported having at least 1 NCD, among whom 351 (10.6% overall; 18.6% of those with ≥1 NCD) had CRD, 781 (23.7% overall; 41.4% of those with ≥1 NCD) had diabetes, 794 (24.1% overall; 42.2% of those with ≥1 NCD) had history of CVD, and 1388 (42.3% overall; 73.6% of those with ≥1 NCD) had hypertension. Among individuals with NCDs, 387 participants (20.4%) were unable to manage at least 1 of their NCDs. Predictors for inability to manage NCDs were age, nonreceipt of cash assistance, household water insecurity, household food insecurity, and having multiple chronic diseases, with an adjusted C statistic of 0.650 (95% CI, 0.620-0.676) and C slope of 0.871 (95% CI, 0.729-1.023). The prevalence of nonadherence to medication was 9.2%, and the main reasons for nonadherence were unaffordability of medication (40.8%; 95% CI, 33.4%-48.5%) and the belief that they no longer required the medication after feeling better (22.4%; 95% CI, 16.4%-29.3%). CONCLUSIONS AND RELEVANCE In this cross-sectional study, the predictors of inability to manage NCDs among older Syrian refugees in Lebanon were mainly related to financial barriers. Context-appropriate assistance is required to overcome financial barriers and enable equitable access to medication and health care.
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Affiliation(s)
- Stephen J. McCall
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Tanya El Khoury
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Noura Salibi
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Berthe Abi Zeid
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Maria El Haddad
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Sawsan Abdulrahim
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Monique Chaaya
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hala Ghattas
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Abla M. Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Bethancourt HJ, Swanson ZS, Nzunza R, Young SL, Lomeiku L, Douglass MJ, Braun DR, Ndiema EK, Pontzer H, Rosinger AY. The co-occurrence of water insecurity and food insecurity among Daasanach pastoralists in northern Kenya. Public Health Nutr 2022; 26:1-11. [PMID: 35941080 PMCID: PMC9989708 DOI: 10.1017/s1368980022001689] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/23/2022] [Accepted: 07/19/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Water plays a critical role in the production of food and preparation of nutritious meals, yet few studies have examined the relationship between water and food insecurity. The primary objective of this study, therefore, was to examine how experiences of household water insecurity (HWI) relate to experiences of household food insecurity (HFI) among a pastoralist population living in an arid, water-stressed region of northern Kenya. DESIGN We implemented the twelve-item Household Water Insecurity Experiences (HWISE, range 0-36) Scale and the nine-item Household Food Insecurity Access Scale (HFIAS, range 0-27) in a cross-sectional survey to measure HWI and HFI, respectively. Data on socio-demographic characteristics and intake of meat and dairy in the prior week were collected as covariates of interest. SETTING Northern Kenya, June-July 2019. PARTICIPANTS Daasanach pastoralist households (n 136) from seven communities. RESULTS In the prior 4 weeks, 93·4 % and 98·5 % of households had experienced moderate-to-severe HWI and HFI, respectively. Multiple linear regression analyses indicated a strong association between HWI and HFI. Each point higher HWISE score was associated with a 0·44-point (95 % CI: 0·22, 0·66, P = 0·003) higher HFIAS score adjusting for socio-economic status and other covariates. CONCLUSIONS These findings demonstrate high prevalence and co-occurrence of HWI and HFI among Daasanach pastoralists in northern Kenya. This study highlights the need to address HWI and HFI simultaneously when developing policies and interventions to improve the nutritional well-being of populations whose subsistence is closely tied to water availability and access.
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Affiliation(s)
- Hilary J Bethancourt
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Institute for Research Policy, Northwestern University, Evanston, IL, USA
| | - Zane S Swanson
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA
| | | | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Institute for Research Policy, Northwestern University, Evanston, IL, USA
| | - Luke Lomeiku
- Department of Education and Outreach Programs, National Museums of Kenya, Nairobi, Kenya
| | - Matthew J Douglass
- College of Agricultural Sciences and Natural Resources and Agricultural Research Division, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - David R Braun
- Center for the Advanced Study of Human Paleobiology, Department of Anthropology, The George Washington University, Washington, DC, USA
- Department of Human Evolution, Max Planck Institute of Evolutionary Anthropology, Leipzig, Germany
| | - Emmanuel K Ndiema
- Department of Earth Sciences, National Museums of Kenya, Nairobi, Kenya
| | - Herman Pontzer
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA
- Global Health Institute, Duke University, Durham, NC, USA
| | - Asher Yoel Rosinger
- Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA16802, USA
- Department of Anthropology, The Pennsylvania State University, University Park, PA, USA
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22
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Vuong TN, Dang CV, Toze S, Jagals P, Gallegos D, Gatton ML. Household water and food insecurity negatively impacts self-reported physical and mental health in the Vietnamese Mekong Delta. PLoS One 2022; 17:e0267344. [PMID: 35511953 PMCID: PMC9071150 DOI: 10.1371/journal.pone.0267344] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/06/2022] [Indexed: 12/17/2022] Open
Abstract
Introduction Household food insecurity and inadequate water, sanitation, and hygiene (WASH) contribute to ill health. However, the interactions between household food insecurity, WASH and health have been rarely assessed concurrently. This study investigated compounded impacts of household food insecurity and WASH on self-reported physical and mental health of adults in the Vietnamese Mekong Delta. Materials and methods This cross-sectional survey interviewed 552 households in one northern and one southern province of the Vietnamese Mekong Delta. The survey incorporated previously validated tools such as the Short Form 12-item Health Survey, Household Food Insecurity Assessment Scale, and the Access and Behavioural Outcome Indicators for Water, Sanitation, and Hygiene. Physical and mental health were quantified using the physical health composite score (PCS) and mental health composite score (MCS), respectively. These measures were the dependent variables of interest for this study. Results Statistical analysis revealed that household food insecurity and using <50 litres of water per person per day (pppd) were independently associated with lower PCS (p<0.05), after adjusting for socio-economic confounders. Household food insecurity and lack of food availability, using <50 litres of water pppd, and the use of untreated drinking water were associated with lower MCS (p<0.05), with water usage being an effect modifier of the relationship between household food insecurity and MCS. The results indicate that being food insecure and having limited potable quality water had a compounding effect on MCS, compared to being individually either food insecure or having limited water. Conclusion This study is one of only a few that have established a link between potable water availability, food insecurity and poorer physical and mental health. The results also indicate a need to validate national data with fine-scale investigations in less populous regions to evaluate national initiatives with local populations that may be at higher risk. Adopting joint dual-action policies for interventions that simultaneously address water and food insecurity should result in larger improvements in health, particularly mental health, compared to targeting either food or water insecurity in isolation.
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Affiliation(s)
- Thuy Ngoc Vuong
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Public Health in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Chinh Van Dang
- Institute of Public Health in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Simon Toze
- Urban Water Futures, Brisbane, QLD, Australia
| | - Paul Jagals
- Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Danielle Gallegos
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Woolworths Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- * E-mail:
| | - Michelle L. Gatton
- School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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23
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Miller JD, Workman CL, Panchang SV, Sneegas G, Adams EA, Young SL, Thompson AL. Water Security and Nutrition: Current Knowledge and Research Opportunities. Adv Nutr 2021; 12:2525-2539. [PMID: 34265039 PMCID: PMC8634318 DOI: 10.1093/advances/nmab075] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/22/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
Water is an essential nutrient that has primarily been considered in terms of its physiological necessity. But reliable access to water in sufficient quantities and quality is also critical for many nutrition-related behaviors and activities, including growing and cooking diverse foods. Given growing challenges to water availability and safety, including climate change, pollution, and infrastructure degradation, a broader conceptualization of water and its diverse uses is needed to sustainably achieve global nutrition targets. Therefore, we review empirical and qualitative evidence describing the linkages between water security (the reliable availability, accessibility, and quality of water for all household uses) and nutrition. Primary linkages include water security for drinking, food production and preparation, infant and young child feeding, and limiting exposure to pathogens and environmental toxins. We then identify knowledge gaps within each linkage and propose a research agenda for studying water security and nutrition going forward, including the concurrent quantification of both food and water availability, accessibility, use, and stability. By making explicit the connections between water security and nutritional well-being, we aim to promote greater collaboration between the nutrition and water, sanitation, and hygiene sectors. Interdisciplinary policies and programs that holistically address the water-nutrition nexus, versus those that focus on water and nutrition independently, are likely to significantly advance our ability to ensure equitable access to healthy foods and safe water for all.
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Affiliation(s)
- Joshua D Miller
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cassandra L Workman
- Department of Anthropology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Sarita V Panchang
- Social Research and Evaluation Center, Louisiana State University, Baton Rouge, LA, USA
| | - Gretchen Sneegas
- Department of Geography, Texas A&M University, College Station, TX, USA
| | - Ellis A Adams
- Keough School of Global Affairs, University of Notre Dame, Notre Dame, IN, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Amanda L Thompson
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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24
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Koyratty N, Jones AD, Schuster R, Kordas K, Li CS, Mbuya MNN, Boateng GO, Ntozini R, Chasekwa B, Humphrey JH, Smith LE. Food Insecurity and Water Insecurity in Rural Zimbabwe: Development of Multidimensional Household Measures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6020. [PMID: 34205143 PMCID: PMC8199942 DOI: 10.3390/ijerph18116020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/26/2022]
Abstract
Background: With millions of people experiencing malnutrition and inadequate water access, FI and WI remain topics of vital importance to global health. Existing unidimensional FI and WI metrics do not all capture similar multidimensional aspects, thus restricting our ability to assess and address food- and water-related issues. Methods: Using the Sanitation, Hygiene and Infant Nutrition Efficacy (SHINE) trial data, our study conceptualizes household FI (N = 3551) and WI (N = 3311) separately in a way that captures their key dimensions. We developed measures of FI and WI for rural Zimbabwean households based on multiple correspondence analysis (MCA) for categorical data. Results: Three FI dimensions were retained: 'poor food access', 'household shocks' and 'low food quality and availability', as were three WI dimensions: 'poor water access', 'poor water quality', and 'low water reliability'. Internal validity of the multidimensional models was assessed using confirmatory factor analysis (CFA) with test samples at baseline and 18 months. The dimension scores were associated with a group of exogenous variables (SES, HIV-status, season, depression, perceived health, food aid, water collection), additionally indicating predictive, convergent and discriminant validities. Conclusions: FI and WI dimensions are sufficiently distinct to be characterized via separate indicators. These indicators are critical for identifying specific problematic insecurity aspects and for finding new targets to improve health and nutrition interventions.
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Affiliation(s)
- Nadia Koyratty
- Department of Epidemiology and Environmental Health, The State University of New York, University at Buffalo, Buffalo, NY 14214, USA; (N.K.); (K.K.)
| | - Andrew D. Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Roseanne Schuster
- Center for Global Health, School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85281, USA;
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, The State University of New York, University at Buffalo, Buffalo, NY 14214, USA; (N.K.); (K.K.)
| | - Chin-Shang Li
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY 14214, USA;
| | | | - Godfred O. Boateng
- Department of Kinesiology, College of Nursing and Health Innovations, The University of Texas at Arlington, Arlington, TX 76019, USA;
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; (R.N.); (B.C.); (J.H.H.)
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; (R.N.); (B.C.); (J.H.H.)
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; (R.N.); (B.C.); (J.H.H.)
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Laura E. Smith
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; (R.N.); (B.C.); (J.H.H.)
- Department of Population Medicine and Diagnostics, Cornell University, Ithaca, NY 14853, USA
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25
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Miller JD, Frongillo EA, Weke E, Burger R, Wekesa P, Sheira LA, Mocello AR, Bukusi EA, Otieno P, Cohen CR, Weiser SD, Young SL. Household Water and Food Insecurity Are Positively Associated with Poor Mental and Physical Health among Adults Living with HIV in Western Kenya. J Nutr 2021; 151:1656-1664. [PMID: 33709134 PMCID: PMC8243794 DOI: 10.1093/jn/nxab030] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/04/2021] [Accepted: 01/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Household food insecurity (FI) and water insecurity (WI) are prevalent public health issues that can co-occur. Few studies have concurrently assessed their associations with health outcomes, particularly among people living with HIV. OBJECTIVES We aimed to investigate the associations between FI and WI and how they relate to physical and mental health. METHODS Food-insecure adult smallholder farmers living with HIV in western Kenya were recruited to participate in a cluster-randomized controlled trial of a multisectoral agricultural and asset loan intervention. We used baseline data on experiences of FI (using the Household Food Insecurity Access Scale, range: 0-27) and WI (using a modified scale developed for this region, range: 0-51) in the prior month (n = 716). Outcomes included probable depression (using the Hopkins Symptom Checklist), fatigue and diarrhea in the prior month, and overall mental and physical health (using the Medical Outcomes Study HIV Health Survey, range: 0-100). We first assessed Pearson correlations between FI, WI, and sociodemographic characteristics. We then developed 3 regressions for each health outcome (control variables and FI; control variables and WI; control variables, FI, and WI) and compared model fit indexes. RESULTS Correlations between household FI, WI, and wealth were low, meaning they measure distinct constructs. FI and WI were associated with numerous physical and mental health outcomes; accounting for both resource insecurities typically provided the best model fit. For instance, when controlling for FI, each 10-point higher WI score was associated with a 6.42-point lower physical health score (P < 0.001) and 2.92 times greater odds of probable depression (P < 0.001). CONCLUSIONS Assessing both FI and WI is important for correctly estimating their relation with health outcomes. Interventions that address food- and water-related issues among persons living with HIV concurrently will likely be more effective at improving health than those addressing a single resource insecurity. This trial was registered at clinicaltrials.gov as NCT02815579.
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Affiliation(s)
- Joshua D Miller
- Department of Anthropology, Northwestern
University, Evanston, IL, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior,
University of South Carolina, Columbia, SC, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research
Institute, Nairobi, Kenya
| | - Rachel Burger
- Department of Obstetrics, Gynecology & Reproductive
Sciences, University of California San Francisco, San
Francisco, CA, USA
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research
Institute, Nairobi, Kenya
| | - Lila A Sheira
- Department of Medicine, University of California San
Francisco, San Francisco, CA, USA
| | - A Rain Mocello
- Department of Obstetrics, Gynecology & Reproductive
Sciences, University of California San Francisco, San
Francisco, CA, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research
Institute, Nairobi, Kenya
- Department of Obstetrics, Gynecology & Reproductive
Sciences, University of California San Francisco, San
Francisco, CA, USA
| | - Phelgona Otieno
- Centre for Clinical Research, Kenya Medical Research
Institute, Nairobi, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive
Sciences, University of California San Francisco, San
Francisco, CA, USA
| | - Sheri D Weiser
- Department of Medicine, University of California San
Francisco, San Francisco, CA, USA
| | - Sera L Young
- Department of Anthropology, Northwestern
University, Evanston, IL, USA
- Institute for Policy Research, Northwestern
University, Evanston, IL, USA
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26
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Workman CL, Cairns MR, de los Reyes FL, Verbyla ME. Global Water, Sanitation, and Hygiene Approaches: Anthropological Contributions and Future Directions for Engineering. ENVIRONMENTAL ENGINEERING SCIENCE 2021; 38:402-417. [PMID: 34079211 PMCID: PMC8165478 DOI: 10.1089/ees.2020.0321] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/20/2021] [Indexed: 06/12/2023]
Abstract
Anthropologists contribute key insights toward a comprehensive understanding of water, sanitation, and hygiene (WASH) as a multidimensional, multiscalar, and culturally embedded phenomenon. Yet, these insights have yet to be sufficiently operationalized and implemented in WASH development and wider WASH access-related paradigms. Ensuring WASH security requires a comprehensive approach to identifying both human health risk and environmental impact of WASH-related programs and strategies. It requires an understanding of how sanitation is integrated into households and communities and how individuals within particular cultural contexts practice sanitation and hygiene. This work facilitates that goal by outlining the major contributions of anthropology and allied social sciences to WASH, as well as outlining key considerations for future work and collaboration. We identify six major themes that, if applied in future engineering approaches, will more equitably integrate stakeholders and multiple vantage points in the successful implementation of WASH projects for marginalized and diverse groups. These include a critical understanding of previous approaches, culturally aware interventions, capacity building that considers (un)intended impact, co-created technology, collaboration between fields such as anthropology and engineering, and challenge-ready initiatives that respond to historic and emergent social and environmental inequity.
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Affiliation(s)
- Cassandra L. Workman
- Department of Anthropology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Maryann R. Cairns
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Francis L. de los Reyes
- Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - Matthew E. Verbyla
- Department of Civil and Environmental Engineering, San Diego State University, San Diego, California, USA
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