Household energy insecurity: dimensions and consequences for women, infants and children in low- and middle-income countries

Exploring the consequences of housing insecurity on HIV treatment outcomes: Qualitative insights from Kisumu, Kenya

Housing insecurity (HI) is inextricably linked to poor health outcomes. Evidence suggests people living with HIV are more likely to experience poor psychological, physical, and nutritional health challenges. However, how housing insecurity might impact treatment outcomes among people living with HIV is under-explored. We examined the consequences of HI on treatment outcomes among people living with HIV in rural Kenya. Between July and August 2023. we purposively recruited and conducted 30 in-depth interviews and four focus group discussions (n = 35) with adult men and women living with HIV. Guided by grounded theory, the data were analyzed in Dedoose and organised into themes. The structural violence framework was then used to contextualise the findings. We found that HI exacerbated poor health outcomes through perceived adherence challenges and increased occurrence of opportunistic diseases such as malaria, diarrhoea, and cough due to housing conditions. Additionally, we found that the cost of rebuilding and maintaining took away resources from other household needs. Improving HI thus may play a critical role in enhancing HIV treatment outcomes. Given the variety of ways housing, food, water, and HIV affect health, gaining insight into the relationships between these factors has tremendous implications for care and treatment.

Readiness for a clean energy future: Prevalence, perceptions, and barriers to adoption of electric stoves and solar panels in New York City

Adoption of electric stoves and rooftop solar can reduce fossil-fuel reliance and improve health by decreasing indoor air pollution and alleviating energy insecurity. This study assessed prevalence and perceptions of these clean-energy technologies to increase adoption in New York City (NYC). A representative survey of 1,950 NYC adults was conducted from February 28 to April 1, 2022. Fourteen percent of people had an electric stove; 86% had gas stoves. Black, Latino/a, and lower-income residents were more likely to have electric stoves than White and higher-income residents. Only 14% of residents were interested in switching from gas to electric stoves. Of the 71% with gas stoves uninterested in switching, nearly half (45%) preferred gas cooking, particularly among White and higher-income residents, indicating a large opportunity to shift preferences. About 5% used solar for their home or building; another 77% were interested in solar. Of the 18% uninterested in solar, reasons included lack of agency, confusion about operation, and costs. Education about health and cost benefits, induction technology, how to transition, available subsidies, and other efforts to reduce adoption barriers can support clean technology uptake. Residential clean energy metrics should be tracked regularly to ensure that technology adoption proceeds equitably.

Exploring the Anemia Ecology: A New Approach to an Old Problem

Our ability to identify anemia and all its permutations demands an approach that integrates the key elements of a complex "ecology," which intertwines biology and mechanistic aspects of nutrients with both the health status and underlying factors-physical, economic, social, behavioral, demographic, and environmental. The complexity of anemia demands an ecologic approach that appreciates systems biology, translates sensitive and specific assessment methodologies and interventions, and ultimately improves clinical and public health outcomes. This series of technical papers on anemia by the U.S. Agency for International Development (USAID) Advancing Nutrition Anemia Task Force (ATF) is a first step in translating our ecologic approach to anemia with a view toward balancing research with its translation to effective programs, interventions, and policy. This introductory overview describes the components of our ecologic approach-linking the biology of anemia with its assessment and using the learning from that confluence to devise context-specific interventions. This introductory review briefly discusses the topics that underlie the biology and primary etiologies of anemia and presents a framework for public health assessment of anemia, leading to appropriate public health interventions. The other 3 manuscripts in the supplement provide the details of the arguments laid out in the introduction.

A comprehensive review of the production, adoption and sustained use of biomass pellets in Ghana

Ghana's Renewable Energy Master Plan of 2019 includes the production and use of biomass pellets. However, pellets have neither been developed commercially nor included in Ghana's energy mix. This paper reviewed the prospect of production, adoption and sustained use of pellets in Ghana. Besides having abundant biomass resources, Ghana has high market demand and relevant policies for pellet development. The production of pellets can significantly replace traditional household biomass demand and improve environmental and health quality. However, the production and use of pellets are limited due to technical, financial, social and policy issues. Our estimates show that 3% of the annual national average household income will be spent on pellet demand for cooking, with the highest burden on rural households in Ghana. Practical measures are required since the cost of pellets and gasifier stoves may limit pellet adoption and use in Ghana. Based on study findings, it is recommended that the government of Ghana establishes a robust supply chain and provides infrastructure for pellet production and use. Existing renewable energy policies should be reviewed to remove ambiguities, attract investment, and build capacity in the renewable energy sector. Apart from raising public awareness of the benefits of pellets use, the government of Ghana should ensure that continuous and thorough impact assessments are undertaken to assess the implications of pellet production and use. This review will inform policymaking on achieving sustainable production, adoption and use of pellets and assess Ghana's contribution to achieving the United Nations' sustainable development goals.

A data-driven approach to quantify disparities in power outages

This research proposes a data-driven approach to identify possible disparities in a utility's outage management practices. The approach has been illustrated for an Investor-Owned Utility located in the Midwest region in the U.S. Power outage data for approximately 5 years between March 2017 and January 2022 was collected for 36 ZIP/postal codes located within the utility's service territory. The collected data was used to calculate the total number of outages, customers affected, and the duration of outages during those 5 years for each ZIP code. Next, each variable was normalized with respect to the population density of the ZIP code. After normalizing, a K-means clustering algorithm was implemented that created five clusters out of those 36 ZIP codes. The difference in the outage parameters was found to be statistically significant. This indicated differential experience with power outages in different ZIP codes. Next, three Generalized Linear Models were developed to test if the presence of critical facilities such as hospitals, 911 centers, and fire stations, as socioeconomic and demographic characteristics of the ZIP codes, can explain their differential experience with the power outage. It was found that the annual duration of outages is lower in the ZIP codes where critical facilities are located. On the other hand, ZIP codes with lower median household income have experienced more power outages, i.e., higher outage counts in those 5 years. Lastly, the ZIP codes with a higher percentage of the White population have experienced more severe outages that have affected more customers.

Food insecurity and its socioeconomic and health determinants in pregnant women and mothers of children under 2 years of age, during the COVID-19 pandemic: A systematic review and meta-analysis

Background

The COVID-19 pandemic has reduced access to adequate food in terms of quality and quantity, especially for the most vulnerable population groups. The objective of this study was to evaluate the prevalence of Food Insecurity and its main socioeconomic and health determinants in pregnant women and mothers of children under 2 years of age, during the COVID-19 pandemic.

Methods

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021278033). The descriptors "Pregnant Woman", "Postpartum Women", "Breastfeeding Women", "COVID-19", "Food Insecurity", "Food Security" were combined in Scopus (Elsevier), Medline/PubMed (via National Library of Medicine), Embase (Elsevier), Web of Science and Science Direct independently by two researchers in September 2022. Original articles about Food Insecurity in households with pregnant women and mothers of children under 2 years of age during the COVID-19 pandemic were included. The meta-analysis of the prevalence of Food Insecurity was conducted using the RStudio software (4.0.4).

Results

The initial search resulted in 539 records, and 10 articles met the proposed criteria and were included in this review. The prevalence of Food Insecurity ranged from 11.5 to 80.3% and in the meta-analysis it was 51% (IC: 30-71) (I 2 = 100.0%). The main socioeconomic and health determinants were ethnicity, domain language, low education, low income, informal employment, unemployment, occurrence of mental disorders, domestic violence, in addition to the unavailability of food in markets and lack of transport. The inclusion of studies with data collection by telephone stands out as a limitation, due to the non-inclusion of vulnerable groups without access to this means of communication.

Conclusion

It is necessary to implement and strengthen specific public policies for the maternal and child group with the objective of protecting and strengthening the rights of women to maintain the physical and mental integrity of this group and guarantee Food Security.

The body politics of successful ageing in the nexus of health, well-being and energy consumption practices

In this paper, we introduce the idea of the bio-socio-material body to think through the body politics that emerge within the nexus of health, well-being and domestic energy consumption as people age. Our work draws upon an ethnographic study with older Australians in regional New South Wales, Australia. We enrich social practice theory conceptualisations by foregrounding the body as a dynamic bio-socio-material entity that shapes and is shaped by practices. In doing so, we draw attention to the body politics of managing health, well-being and energy consumption while trying to age successfully. We identify that the bio-socio-material dimensions of the body play an important role in how health, well-being and energy practices are performed. Energy practices are bound up in understandings of health and well-being as an ongoing and contingent process. Here, the use of energy and appliances becomes integral to how people negotiate and work towards successful ageing. We found that embodied practices of health, well-being and energy consumption are linked to biological, emotional, affective, social and material concerns that create body politics. These include tensions and challenges relating to health and vitality, caring for the sick and the dying, maintaining good mental health, the affordances of buildings and appliances, energy affordability and billing anxiety, social connectedness, and pleasures and pains. We raise questions emerging from our research on the implications for successful ageing. We call for attention to how health, well-being and energy are imbricated and for policy and programmes that better support older people to navigate the nexus of health, well-being and energy consumption as they age.

How limitations in energy access, poverty, and socioeconomic disparities compromise health interventions for outbreaks in urban settings

Low-income households (LIHs) have experienced increased poverty and inaccess to healthcare services during the COVID-19 pandemic, limiting their ability to adhere to health-protective behaviors. We use an epidemiological model to show how a households' inability to adopt social distancing, owing to constraints in utility and healthcare expenditure, can drastically impact the course of disease outbreaks in five urban U.S. counties. LIHs suffer greater burdens of disease and death than higher income households, while functioning as a consistent source of virus exposure for the entire community due to socioeconomic barriers to following public health guidelines. These impacts worsened when social distancing policy could not be imposed. Health interventions combining social distancing and LIH resource protection strategies (e.g., utility and healthcare access) were the most effective in limiting virus spread for all income levels. Policies need to address the multidimensionality of energy, housing, and healthcare access for future disaster management.

•

Energy and socioeconomic constraints and public health interventions are discussed

•

Utility and health costs constrain a county's ability to enact public health policies

•

Securing household utilities is essential to low-income households' health and safety

•

Affordable energy and healthcare for vulnerable communities are a critical policy issue

COVID-19 impacts on household energy & food security in a Kenyan informal settlement: The need for integrated approaches to the SDGs

This longitudinal study presents the joint effects of a COVID-19 community lockdown on household energy and food security in an informal settlement in Nairobi, Kenya. Randomly administered surveys were completed from December 2019-March 2020 before community lockdown (n = 474) and repeated in April 2020 during lockdown (n = 194). Nearly universal (95%) income decline occurred during the lockdown and led to 88% of households reporting food insecurity. During lockdown, a quarter of households (n = 17) using liquefied petroleum gas (LPG), a cleaner cooking fuel typically available in pre-set quantities (e.g. 6 kg cylinders), switched to polluting cooking fuels (kerosene, wood), which could be purchased in smaller amounts or gathered for free. Household size increases during lockdown also led to participants' altering their cooking fuel, and changing their cooking behaviors and foods consumed. Further, households more likely to switch away from LPG had lower consumption prior to lockdown and had suffered greater income loss, compared with households that continued to use LPG. Thus, inequities in clean cooking fuel access may have been exacerbated by COVID-19 lockdown. These findings demonstrate the complex relationship between household demographics, financial strain, diet and cooking patterns, and present the opportunity for a food-energy nexus approach to address multiple Sustainable Development Goals (SDGs): achieving zero hunger (SDG 2) and universal affordable, modern and clean energy access (SDG 7) by 2030. Ensuring that LPG is affordable, accessible and meets the dietary and cooking needs of families should be a policy priority for helping improve food and energy security among the urban poor.

COVID-19 impacts on household energy & food security in a Kenyan informal settlement: The need for integrated approaches to the SDGs

This longitudinal study presents the joint effects of a COVID-19 community lockdown on household energy and food security in an informal settlement in Nairobi, Kenya. Randomly administered surveys were completed from December 2019-March 2020 before community lockdown (n = 474) and repeated in April 2020 during lockdown (n = 194). Nearly universal (95%) income decline occurred during the lockdown and led to 88% of households reporting food insecurity. During lockdown, a quarter of households (n = 17) using liquefied petroleum gas (LPG), a cleaner cooking fuel typically available in pre-set quantities (e.g. 6 kg cylinders), switched to polluting cooking fuels (kerosene, wood), which could be purchased in smaller amounts or gathered for free. Household size increases during lockdown also led to participants' altering their cooking fuel, and changing their cooking behaviors and foods consumed. Further, households more likely to switch away from LPG had lower consumption prior to lockdown and had suffered greater income loss, compared with households that continued to use LPG. Thus, inequities in clean cooking fuel access may have been exacerbated by COVID-19 lockdown. These findings demonstrate the complex relationship between household demographics, financial strain, diet and cooking patterns, and present the opportunity for a food-energy nexus approach to address multiple Sustainable Development Goals (SDGs): achieving zero hunger (SDG 2) and universal affordable, modern and clean energy access (SDG 7) by 2030. Ensuring that LPG is affordable, accessible and meets the dietary and cooking needs of families should be a policy priority for helping improve food and energy security among the urban poor.

Persistent Food Insecurity, but not HIV, is Associated with Depressive Symptoms Among Perinatal Women in Kenya: A Longitudinal Perspective

Food insecurity (FI) is an understudied risk factor for depression among perinatal women in sub-Saharan Africa. We therefore explored the longitudinal relationship between FI and depressive symptoms among a cohort of perinatal women of mixed HIV status (n = 371) in Kenya (NCT02974972, NCT02979418). Using longitudinal linear and logistic regressions with random effects, we assessed bivariate and adjusted associations between maternal FI and depressive symptoms. HIV status was also assessed as a potential effect modifier. At baseline, 58% of pregnant women had probable depression (CES-D score > 16) and 84% were severely food insecure. In adjusted analyses, severely food-insecure women had 5.90 greater odds (95% CI 2.32, 15.02, p < 0.001) of having probable depression and scored 4.58 points higher on the CES-D scale (SE: 1.04, p < 0.001) relative to food-secure women. HIV status did not modify the association between FI and depressive symptoms. Interventions to reduce FI may reduce perinatal depression, benefiting mothers and their infants.

Household Energy Insecurity and COVID-19 Have Independent and Synergistic Health Effects on Vulnerable Populations

Household energy insecurity (HEINS) is detrimental to the health of the poor and most vulnerable in resource-poor settings. However, this effect amidst the COVID-19 pandemic and the uneven implementation of restrictions can create a synergistic burden of diseases and health risks for the most vulnerable in low- and middle-income countries, exacerbating the health equity gap. Based on existing literature, this paper develops three key arguments: (1) COVID-19 increases the health risks of energy insecurity; (2) HEINS increases the risk of spreading COVID-19; and (3) the co-occurrence of COVID-19 and HEINS will have compounding health effects. These arguments make context-specific interventions, rather than a generic global health approach without recourse to existing vulnerabilities critical in reducing the spread of COVID-19 and mitigating the effects of energy insecurity. Targeted international efforts aimed at financing and supporting resource security, effective testing, contact tracing, and the equitable distribution of vaccines and personal protective equipment have the potential to ameliorate the synergistic effects of HEINS and COVID-19 in resource-poor countries.