Food insecurity and COVID-19 risk in low- and middle-income countries

Rural household vulnerability and COVID-19: Evidence from India

The coronavirus disease 2019 (COVID-19) pandemic has affected vulnerable households' livelihoods in developing countries. Using high-frequency phone survey data from the World Bank, we assess rural Indian households' vulnerability and poverty status during the pandemic. Results reveal that over three-fifths of Indian rural households are vulnerable to poverty in the context of COVID-19, despite India's evident progress in mitigating poverty in the pre-pandemic era. Poverty plays a major role in accounting for variations in household vulnerability; however, the impact of risks on household welfare is not negligible. On average, households with more members, older household heads, and more outmigrants are more vulnerable to poverty during the pandemic. The impacts of the gender of the household head, access to masks, consumption loans, and COVID-related information are nevertheless insignificant. Results stress the urgent necessity of deploying concerted interventions to strengthen household vulnerability in rural India.

Seasonality of associations between production of indigenous foods and food security status of mother-child dyads in Kisumu County, Kenya

BACKGROUND

Food insecurity is a major predicament for rural populations, especially mothers and children, whose livelihoods are often dependent on rain-fed agriculture. Indigenous foods have the potential of mitigating food insecurity as they can thrive in poor agro-ecological conditions. However, the associations between indigenous food production and food security status of mothers and children drawn from rural contexts has not been expansively assessed. Food insecurity evident by high food poverty rates remain high in Kisumu County due to over-reliance on food imports from other counties. The objective of the study was to assess seasonality in associations between production of selected indigenous foods (kidney beans, soya beans, millet, cassava, sweet potatoes, groundnuts, green grams, cow peas, amaranth leaves, spider plant leaves, black night shade leaves, mangoes, guavas, lime, and tamarind) and food security status of mothers and children during planting and harvesting seasons.

METHODS

We used a longitudinal study design adopting both quantitative and qualitative data collection methods. A structured questionnaire assessed production of selected indigenous foods in the sampled households, Household Food Insecurity Access Scale for mother's food security status and Prevalence of Underweight for children's food security status. Ordinal logistic regression was used to derive odds ratio (OR), which assessed strength of associations between dependent variables (mother's and children's food security status) and independent variables (production of selected indigenous foods). Significance was determined at α ≤ 0.05.

RESULTS

Results demonstrated that during planting season, production of kidney beans decreased the odds of mothers being severely food insecure by 53% (OR = 0.469, 95% CI = 0.228-0.964, p = 0.039). In the same season, sorghum production demonstrated 3.5 times increase in odds of children being severely food insecure (OR = 3.498, 95% CI = 1.454-8.418, p = 0.005). During harvesting season, production of kidney beans was associated with a 62% reduction in the odds of children being severely food insecure (OR = 0.379, 95% CI = 0.190-0.754, p = 0.006).

CONCLUSIONS

Production of some of the selected indigenous foods demonstrated significant odds of predicting mother's and children's food security status across both study seasons. An intervention-based study approach that would best establish causal associations of indigenous food production and food security status is recommended.

Effects of the COVID-19 pandemic on sales of sexual and reproductive health products: an ecological study of pharmacies in Kenya

OBJECTIVES

To examine how sales of sexual and reproductive health (SRH) products varied among pharmacies in Kenya using administrative data, leveraging natural variation in the COVID-19 pandemic and accompanying policy restrictions between 2019 and 2021.

DESIGN AND SETTING

Ecological study of pharmacies in Kenya.

PARTICIPANTS

761 pharmacies using the Maisha Meds product inventory management system (capturing 572 916 products sold).

OUTCOMES

Sales quantity, price and revenue of SRH products sold per pharmacy per week.

RESULTS

COVID-19 deaths were associated with a -2.97% (95% CI -3.82%, -2.11%) decrease in sales quantity, a 1.09% (95% CI 0.44%, 1.72%) increase in sales price and a -1.89% (-1.00%, -2.79%) decrease in revenues per pharmacy per week. Results were similar when considering new COVID-19 cases (per 1000) and the Average Policy Stringency Index. Results differed substantially between individual SRH products-a large decrease in sales quantity in pregnancy tests, injectables and emergency contraception, a modest decrease in condoms and no change in oral contraception. Sales price increases were similarly varied; four of the five most sold products were revenue neutral.

CONCLUSIONS

We found a robust negative association between SRH sales at pharmacies in Kenya and COVID-19 reported cases, deaths and policy restriction. Although our data cannot definitively point to reduced access, existing evidence from Kenya regarding unchanged fertility intentions, increases in unintended pregnancies and reported reasons for non-use of contraceptives during COVID-19 suggests a prominent role of reduced access. While policymakers may have a role in sustaining access, their role may be limited by broader macroeconomic problems, such as global supply chain disruptions and inflation, during supply shocks.

The Gendered Consequences of COVID-19 for Internal Migration

Scant evidence exists to identify the effects of the pandemic on migrant women and the unique barriers on employment they endure. We merge longitudinal data from mobile phone surveys with subnational data on COVID cases to examine whether women were left more immobile and vulnerable to health risks, relative to men, during the pandemic in Kenya and Nigeria. Each survey interviewed approximately 2000 men and women over three rounds (November 2020-January 2021, March-April 2021, November 2021-January 2022). Linear regression analysis reveals internal migrants are no more vulnerable to knowing someone in their network with COVID. Rather, rural migrant women in Kenya and Nigeria were less vulnerable to transmission through their network, perhaps related to the possible wealth accumulation from migration or acquired knowledge of averting health risks from previous destinations. Per capita exposure to COVID cases hinders the inter-regional migration of women in both countries. Exposure to an additional COVID case per 10,000 people resulted in a decline in women's interregional migration by 6 and 2 percentage points in Kenya and Nigeria, respectively.

Do referrals improve the representation of women in mobile phone surveys?

Random digit dial surveys with mobile phones risk under-representation of women. To address this, we compare the characteristics of women recruited directly with those of women recruited through referrals from male household members. The referral process improves representation of vulnerable groups, such as young women, the asset poor, and those living in areas with low connectivity. Among mobile phone users, we show a referral (rather than a direct dial) protocol includes more nationally representative proportions of women with these attributes. While seeking intra-household referrals may improve representation, we show that it does so at a higher cost.

Food insecurity and health outcome nexus: empirical evidence from the informal sector enterprises in Bangladesh

BACKGROUND

Food insecurity indicates the difficulty of constantly obtaining adequate food because of limited economic resources. Food insecurity challenges the desired health outcomes. Although extensive literature has examined the associations between food security and health, low-wage informal sector workers have been less frequently addressed in this topic. The present study has focused on food insecurity among the workers working in the informal sector enterprises who experienced entrenched disadvantage during COVID-19 and examines the relationship between food insecurity and health status as measured by self-reported physical and mental health conditions.

METHODS

This study has utilized cross-sectional data collected from workers working in informal manufacturing and business enterprises in Dhaka city of Bangladesh. The Food Insecurity Experience Scale (FIES) with eight items is used to screen for food insecurity, and the Short Form 12v2 (SF12v2) scale with 12 questions, and validated for use with Bengali respondents, is used to measure the health status of the informal workers. A health production function has been constructed where the health status (both physical and mental) of workers is associated with food insecurity and other socio-economic and health care factors. Empirical analyses of the study have included descriptive statistics, mean score comparisons, and multivariate regression analyses to identify the predictive factors of the physical and mental health status of the workers.

RESULTS

A moderate to severe food insecurity is found to be responsible for the poor health status (both physical and mental) of the selected working group population. Moreover, age over 40 years, having a large family, dissatisfaction with the work place, and the prevalence of occupational health risks are linked to lower physical health, while dissatisfaction with the work place and the incidence of severe diseases contribute to poor mental health status along with food insecurity.

CONCLUSIONS

Extending social and economic protection towards health coverage and basic consumption is suggested as an immediate action to save lives and ensure productivity of the informal workers. Besides, an increase in income and ensuring decent working conditions are also recommended for the health, safety and satisfaction of workers working in informal sector enterprises.

Did Household Income Loss Have an Immediate Impact on Animal-Source Foods Consumption during the Early Stage of the COVID-19 Pandemic?

The outbreak of COVID-19 in 2020 caused extensive impact on household income and foods consumption. However, little attention has been paid to the immediate impact of income loss on animal-source foods consumption in the early stage of the COVID-19 pandemic. This paper aims to narrow this gap, and a total of 1301 valid samples of household food consumption surveys in Wuhan and Nanjing were obtained through specially designed online questionnaires. The surveys show that there were 69.6% (Wuhan) and 42.2% (Nanjing) of surveyed households whose animal-source foods consumption were affected, and there were 47.4% (Wuhan) and 18.9% (Nanjing) of surveyed households who suffered income loss. Furthermore, this paper makes an empirical study on the linkage between income loss and animal-source foods consumption. The results show that the pandemic affected household income, resulting in an immediate impact on animal-source foods consumption. This immediate impact may have been due to the combination of price increases, income loss and insufficient savings, which led to a "perfect storm" for animal-source foods consumption. Moreover, household income loss affected various animal-source foods consumption differently. For households suffering income losses, the odds of pork, beef and mutton, poultry, aquatic products, eggs and dairy products consumption being affected were increased by a factor of 1.894, 2.140, 2.773, 2.345, 1.802, 2.835, respectively, holding other variables constant. The results may be related to residents' consumption habits and food prices. During the COVID-19 pandemic, the reduction of animal-source foods consumption may have led to a state of tension concerning an increase in the development of nutrition intake and health, which may have led to increased food security risks.

On the forecastability of food insecurity

Food insecurity, defined as the lack of physical or economic access to safe, nutritious and sufficient food, remains one of the main challenges included in the 2030 Agenda for Sustainable Development. Near real-time data on the food insecurity situation collected by international organizations such as the World Food Programme can be crucial to monitor and forecast time trends of insufficient food consumption levels in countries at risk. Here, using food consumption observations in combination with secondary data on conflict, extreme weather events and economic shocks, we build a forecasting model based on gradient boosted regression trees to create predictions on the evolution of insufficient food consumption trends up to 30 days in to the future in 6 countries (Burkina Faso, Cameroon, Mali, Nigeria, Syria and Yemen). Results show that the number of available historical observations is a key element for the forecasting model performance. Among the 6 countries studied in this work, for those with the longest food insecurity time series, that is Syria and Yemen, the proposed forecasting model allows to forecast the prevalence of people with insufficient food consumption up to 30 days into the future with higher accuracy than a naive approach based on the last measured prevalence only. The framework developed in this work could provide decision makers with a tool to assess how the food insecurity situation will evolve in the near future in countries at risk. Results clearly point to the added value of continuous near real-time data collection at sub-national level.

The Adverse Outcome Pathway Framework Applied to Neurological Symptoms of COVID-19

Several reports have shown that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has the potential to also be neurotropic. However, the mechanisms by which SARS-CoV-2 induces neurologic injury, including neurological and/or psychological symptoms, remain unclear. In this review, the available knowledge on the neurobiological mechanisms underlying COVID-19 was organized using the AOP framework. Four AOPs leading to neurological adverse outcomes (AO), anosmia, encephalitis, stroke, and seizure, were developed. Biological key events (KEs) identified to induce these AOs included binding to ACE2, blood–brain barrier (BBB) disruption, hypoxia, neuroinflammation, and oxidative stress. The modularity of AOPs allows the construction of AOP networks to visualize core pathways and recognize neuroinflammation and BBB disruption as shared mechanisms. Furthermore, the impact on the neurological AOPs of COVID-19 by modulating and multiscale factors such as age, psychological stress, nutrition, poverty, and food insecurity was discussed. Organizing the existing knowledge along an AOP framework can represent a valuable tool to understand disease mechanisms and identify data gaps and potentially contribute to treatment, and prevention. This AOP-aligned approach also facilitates synergy between experts from different backgrounds, while the fast-evolving and disruptive nature of COVID-19 emphasizes the need for interdisciplinarity and cross-community research.

Prevalence and factors associated with food insecurity in eight high-altitude cities in Peru during the second wave of the COVID-19 pandemic: a retrospective, cross-sectional study

Background

Food insecurity has increased during the COVID-19 pandemic, affecting an estimated 260 million people. However, little evidence is available on how pandemic-related characteristics influence food security in a high-altitude population. The objective of this study was to assess factors associated with food insecurity in high-altitude Peruvian cities during the second epidemic wave of COVID-19.

Methods

A retrospective, cross-sectional study was conducted in eight Peruvian cities over 1,500 m above sea level. An online survey measuring food security, presence of anxiety & depressive symptoms, sleep quality, post-traumatic stress disorder (PTSD), resilience, and sociodemographic characteristics was disseminated through social networks between December 2020 and February 2021. Generalized linear models were used to identify an association between the study variables.

Results

Of 700 participants, the median age was 23 years, and more than half were female (56.7%). The prevalence of food insecurity was 37.1%. Anxiety symptoms, depressive symptoms, and PTSD were present in 72.7%, 64.1%, and 15% of respondents, respectively. The prevalence of food insecurity was higher in people with fair (PR: 1.60, 95% CI: 1.23–2.07) and very bad perception of their health (PR: 4.06, 95% CI: 2.63–6.26), individuals seeking mental health support (PR: 1.42, 95% CI: 1.25–1.62), and in those who lost their job due to the pandemic (PR: 1.82, 95% CI: 1.62–2.04). Having moderate (PR: 1.52, 95% CI: 1.26–1.83) and moderate to severe depressive symptoms (PR: 1.58, 95% CI: 1.11–2.27) also increased the prevalence of food insecurity.

Conclusion

During the pandemic, the prevalence of food insecurity has increased in the Peruvian high-altitude population, revealing the need for preventive strategies. Identification of pandemic-related characteristics that influence food insecurity can guide interventions in at-risk individuals and reduce the long-term impact of this problem on overall health and quality of life.

The Global Burden of Food Insecurity Due to COVID-19

The insurgence of the COVID-19 pandemic has demonstrated that no country or region was prepared to face such a devastating emergency, nor have researchers uncovered permanent solutions to solve this everlasting crisis thus far [...]

Food insecurity during the first year of the COVID-19 pandemic in four African countries

We document trends in food security up to one full year after the onset of the COVID-19 pandemic in four African countries. Using household-level data collected by the World Bank, we highlight differences over time amid the pandemic, between rural and urban areas, and between female-headed and male-headed households within Burkina Faso, Ethiopia, Malawi, and Nigeria. We first observe a sharp increase in food insecurity during the early months of the pandemic with a subsequent gradual decline. Next, we find that food insecurity has increased more in rural areas than in urban areas relative to pre-pandemic data within each of these countries. Finally, we do not find a systematic difference in changes in food insecurity between female-headed and male-headed households. These trends complement previous microeconomic analysis studying short-term changes in food security associated with the pandemic and existing macroeconomic projections.

Food Supply Chain Shocks and the Pivot Toward Local: Lessons From the Global Pandemic

Studies of how consumers acquired food provisions during the COVID-19 lockdown indicate that some US consumers and institutional provisioners pivoted to locally produced food. In some locations local food system organizations, along with state governments, created the infrastructure to enable this pivot. Research on this phenomenon—what we call “the local pivot”—has been extensive. However, evidence collected so far has mostly been reports of case studies looking at particular communities. Using Google Trends and Twitter data, we examine whether “the local pivot” was evident as a general trend in the US during the depth of the COVID-19 food supply crisis in 2020, and whether places with high local food infrastructure allowed more people to pivot to local food provisioning. Our Google Trends analysis indicated a temporary rise in searches for local food. However, we found very little discussion of local food systems on Twitter. We then compared three states with a “high,” “medium,” and “low” local food infrastructure based on the Union of Concerned Scientists rankings. We found a weak but positive relationship between places that were classified as high local food system infrastructure and a pivot toward local food reflected on Twitter. We did, however, find strong support for local restaurant businesses during this period on Twitter, although this support did not necessarily reflect a local food system pivot. We acknowledge that Twitter results are not generalizable to the entire population: local food system actors may not be using Twitter in their interactions, so Twitter activity may not reflect local food system activity in general, or COVID food sourcing behavior in particular. However, our results do indicate the need for more research on whether or not the evidence of a pivot to local food systems during COVID in the United States reflected a larger national movement or occurred in just a few scattered communities. Further research on this topic can help ascertain the ability of local food system infrastructure to provide a resilient response to future global food supply chain crises.

The Impact of the COVID-19 Pandemic on Rural Food Security in High Income Countries: A Systematic Literature Review

Prior to the COVID-19 pandemic, rural-dwelling people in high-income countries were known to have greater challenges accessing healthy food than their urban counterparts. The COVID-19 pandemic has impacted food supplies across the world, and public health restrictions have changed the way people shop for food, potentially exacerbating food insecurity. This systematic literature review aimed to synthesize the available evidence on the impact of the COVID-19 pandemic on aspects of food insecurity in rural populations residing in high-income countries. Five electronic databases were searched, identifying 22 articles that assessed food insecurity prevalence or data on food availability, access, utilization and the stability of the food supply in rural populations during the COVID-19 pandemic. Ten studies examined the prevalence of food insecurity in rural populations, with the reported prevalence ranging from 15% to 95%. Where rural/urban comparisons were presented, most studies (n = 5; 71%) reported that food insecurity was significantly higher in rural regions. Five studies examined the availability of food and eight studies examined access to food, identifying that rural populations often had lower food availability and access to food during the pandemic. In contrast, two studies identified positive effects such as more gardening and increased online access to food. Rural populations experienced multiple changes to food utilization, such as reduced diet quality and food safety observed in eight studies, but this was not shown to be different from urban populations. Additionally, the food supply in rural regions was perceived to be affected in two studies. The results of this review may be used to inform region-specific mitigation strategies to decrease the impact of the current COVID-19 pandemic and future global events on food security. However, the lack of consistency in study outcomes in research on rural populations limits the identification of priority areas for intervention at a global-scale.

The COVID-19 pandemic and food security in low- and middle-income countries: a review

We review findings from the emerging microeconomic literature on observed changes in food insecurity associated with the COVID-19 pandemic. To do so, we focus our review on studies in low- and middle-income countries that include household survey data measuring food insecurity collected both before and after the onset of the COVID-19 pandemic. We first focus on several studies—seven from countries in Sub-Saharan Africa and one from India—that estimate immediate changes in food insecurity associated with the COVID-19 pandemic. Next, we review subsequent analysis studying longer term changes in food insecurity associated with the COVID-19 pandemic. This review, therefore, complements existing macroeconomic projections of food insecurity based on expected changes in income and prices.