A qualitative study to understand how Ebola Virus Disease affected nutrition in Sierra Leone-A food value-chain framework for improving future response strategies

Qualitative exploration of the impact of COVID-19 on the food environment of urban informal settlements of Dhaka, Bangladesh

OBJECTIVE

Our study explored the impact of the COVID-19 pandemic on the food environment from the perspective of the urban poor and food vendors.

DESIGN

This was a qualitative study conducted during September 2020 and February 2021.

SETTING

The study was carried out in two purposively selected informal settlements of Dhaka City, Bangladesh.

PARTICIPANTS

We conducted 21 in-depth interviews with residents of informal settlements and 10 key informant interviews with food vendors and food aid workers.

RESULT

The availability of staple foods was not disrupted during the pandemic but some perishables foods became more expensive due to supply chain disruptions and increased transportation costs. Limited market hours affected market access and mobility restrictions adversely affected local vendors. Cart vendors selling perishables incurred business losses they could ill afford. Demand for food reduced as employment disruption lead to reduced purchasing power and, therefore, reduction of quantity, quality and desirability of foods purchased. Respondents reported skipping meals and going hungry. The aid received was considered inadequate to meet needs.

CONCLUSION

The food environment of the urban poor was disrupted from both supply and demand sides and the organisational response (both government and non-government) was severely inadequate. The social safety net needs to be extended and redesigned to ensure food security and health for the urban working poor in the future.

Health and economic implications of the ongoing coronavirus disease (COVID-19) pandemic on women and children in Africa

The coronavirus disease (COVID-19) pandemic continues to pose major health and economic challenges for many countries worldwide. Particularly for countries in the African region, the existing precarious health status resulting from weak health systems have made the impact of the pandemic direr. Although the number of the COVID-19 infections in Africa cannot be compared to that of Europe and other parts of the world, the economic and health ramifications cannot be overstated. Significant impacts of the lockdowns during the onset of the pandemic caused disruptions in the food supply chain, and significant declines in income which decreased the affordability and consumption of healthy diets among the poor and most vulnerable. Access and utilization of essential healthcare services by women and children were also limited because of diversion of resources at the onset of the pandemic, limited healthcare capacity, fear of infection and financial constraint. The rate of domestic violence against children and women also increased, which further deepened the inequalities among these groups. While all African countries are out of lockdown, the pandemic and its consequent impacts on the health and socio-economic well-being of women and children persist. This commentary discusses the health and economic impact of the ongoing pandemic on women and children in Africa, to understand the intersectional gendered implications within socio-economic and health systems and to highlight the need for a more gender-based approach in response to the consequences of the pandemic in the Africa region.

Long-term consequences of food insecurity among Ebola virus disease-affected households after the 2013-2016 epidemic in rural communities of Kono District, Sierra Leone: A qualitative study

The 2013-2016 Ebola virus disease (EVD) epidemic caused food insecurity during and immediately following local outbreaks in Sierra Leone, but longer-term effects are less well described, particularly among households with no EVD survivors. We conducted a qualitative sub-study in July 2018 in Kono District, Sierra Leone to understand the impact of food insecurity on EVD-affected households. Using data from a community-based cohort, we compiled a list of all households, within the sampled communities in Kono District, that had at least one EVD case during the epidemic. We used purposive sampling to recruit 30 households, inclusive of 10 households with no EVD survivors, to participate in the study. The research team conducted open-ended, semi-structured interviews with the head of each household. All 30 interviews were transcribed, translated, and analyzed using comparative content analysis consistent with a grounded theory approach. Most household members were facing persistent food insecurity as direct or indirect consequences of the EVD epidemic, regardless of whether they did or did not live with EVD survivors. Three major themes emerged as drivers and/or mitigators of EVD-related food insecurity. Financial instability and physical health complications were drivers of food insecurity in the population, whereas support provided by NGOs or governmental agencies was observed as a mitigator and driver of food insecurity after its removal. Among the EVD-households reporting long-term support through jobs and educational opportunities, there was sustained mitigation of food insecurity. EVD-affected households with and without survivors continue to face food insecurity three years after the EVD epidemic. Provision of support was a mitigator of food insecurity in the short term, but its removal was a driver of food insecurity in the longer term, suggesting the need for longer-term transitional support in affected households.

Epidemics, Lockdown Measures and Vulnerable Populations: A Mixed-Methods Systematic Review of the Evidence of Impacts on Mother and Child Health in Low-and Lower-Middle-Income Countries

BACKGROUND

The aim of this research was to synthetise the existing evidence on the impact of epidemic-related lockdown measures on women and children's health in low- and lower-middle-income countries (LLMICs).

METHODS

A mixed-methods systematic review was conducted of qualitative, quantitative and mixed-methods evidence. Between 1st and 10th of November 2021, seven scientific databases were searched. The inclusion criteria were that the paper provided evidence on the impact of lockdown and related measures, focused on LLMICs, addressed impacts on women and child's health, addressed epidemics from 2000-2020, was peer-reviewed, provided original evidence, and was published in English. The Joanne Briggs Institute's critical appraisal tools were used to assess the quality of the studies, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting. The evidence from the papers was grouped by type of lockdown measure and categories of impact, using a narrative data-based convergent synthesis design.

RESULTS

The review process identified 46 papers meeting the inclusion criteria from 17 countries that focussed on the coronavirus disease 2019 (COVID-19) and Ebola epidemics. The evidence on the decrease of utilisation of health services showed plummeting immunisation rates and faltering use of maternal and perinatal services, which was linked to a growth of premature deaths. Impacts on the mental health of children and women were convincingly established, with lockdowns associated with surges in depression, anxiety and low life satisfaction. Vulnerability may be compounded by lockdowns, as livelihoods were disrupted, and poverty levels increased.

CONCLUSION

Limitations included that searches were conducted in late-2020 as new research was being published, and that some evidence not published in English may have been excluded. Epidemic-related lockdown measures carry consequences for the health of women and children in lower-income settings. Governments will need to weigh the trade-offs of introducing such measures and consider policies to mitigate their impacts on the most vulnerable.

Hyperspectral imaging and machine learning in food microbiology: Developments and challenges in detection of bacterial, fungal, and viral contaminants

Hyperspectral imaging (HSI) is a robust and nondestructive method that can detect foreign particles such as microbial, chemical, and physical contamination in food. This review summarizes the work done in the last two decades in this field with a highlight on challenges, risks, and research gaps. Considering the challenges of using HSI on complex matrices like food (e.g., the confounding and masking effects of background signals), application of machine learning and modeling approaches that have been successful in achieving better accuracy as well as increasing the detection limit have also been discussed here. Foodborne microbial contaminants such as bacteria, fungi, viruses, yeast, and protozoa are of interest and concern to food manufacturers due to the potential risk of either food poisoning or food spoilage. Detection of these contaminants using fast and efficient methods would not only prevent outbreaks and recalls but will also increase consumer acceptance and demand for shelf-stable food products. The conventional culture-based methods for microbial detection are time and labor-intensive, whereas hyperspectral imaging (HSI) is robust, nondestructive with minimum sample preparation, and has gained significant attention due to its rapid approach to detection of microbial contaminants. This review is a comprehensive summary of the detection of bacterial, viral, and fungal contaminants in food with detailed emphasis on the specific modeling and datamining approaches used to overcome the specific challenges associated with background and data complexity.

Nurturing care during COVID-19: a rapid review of early evidence

OBJECTIVES

The COVID-19 pandemic has brought significant changes to family life, society and essential health and other services. A rapid review of evidence was conducted to examine emerging evidence on the effects of the pandemic on three components of nurturing care, including responsive caregiving, early learning, and safety and security.

DESIGN

Two academic databases, organisational websites and reference lists were searched for original studies published between 1 January and 25 October 2020. A single reviewer completed the study selection and data extraction with verification by a second reviewer.

INTERVENTIONS

We included studies with a complete methodology and reporting on quantitative or qualitative evidence related to nurturing care during the pandemic.

PRIMARY AND SECONDARY OUTCOME MEASURES

Studies reporting on outcomes related to responsive caregiving, early learning, and safety and security were included.

RESULTS

The search yielded 4410 citations in total, and 112 studies from over 30 countries met our eligibility criteria. The early evidence base is weighted towards studies in high-income countries, studies related to caregiver mental health and those using quantitative survey designs. Studies reveal issues of concern related to increases in parent and caregiver stress and mental health difficulties during the pandemic, which was linked to harsher and less warm or responsive parenting in some studies. A relatively large number of studies examined child safety and security and indicate a reduction in maltreatment referrals. Lastly, studies suggest that fathers' engagement in caregiving increased during the early phase of the pandemic, children's outdoor play and physical activity decreased (while screen time increased), and emergency room visits for child injuries decreased.

CONCLUSION

The results highlight key evidence gaps (ie, breastfeeding support and opportunities for early learning) and suggest the need for increased support and evidence-based interventions to ensure young children and other caregivers are supported and protected during the pandemic.

Impact of lockdown due to COVID-19 on nutrition and food security of the selected low-income households in Bangladesh

This study aims to explore the impact of COVID-19 pandemic lockdown on household food security and the nutritional status of the children and identify the risk factors associated with it. A cross-sectional study was conducted in 220 households having at least one under 5 children of Narayanganj district in Bangladesh. Household food insecurity, coping strategies and nutritional status of children were the main outcome variables. Multivariate logistic regression analysis was performed to investigate the significant determinants. A total of 93.2 % of households were food insecure, with 32.3% experiencing mild, 18.6% facing moderate, and 42.3% undergoing severe food insecurity. Forty seven percent households used high coping strategies and 93.2% of households consumed less expensive/preferable food as the common coping technique. Logistic regression analysis showed the variables significantly associated with moderate to severe food insecurity were low household income before COVID-19 (AOR = 46.07, CI: 13.68–155.10), more reduction of family income (AOR = 32.47, 95% CI: 9.29–113.41), maternal occupation as housewife (AOR = 7.73, CI: 2.59–23.07), losses of job (AOR = 4.28, CI: 1.31–13.98) and higher family members (AOR = 3.39, CI: 1.07–10.71). The prevalence of stunting, underweight and wasting in children under 5 years of age were 29.0%, 23.4% and 15.6%, respectively. Significantly the independent predictors of stunting were maternal occupation, education, age, household head occupation, child age, and the coping strategy score. Household dietary diversity score was an important independent predictor of underweight and wasting. In conclusion, social safety net initiatives for vulnerable households along with maternal education and employment should be strengthened to reduce hunger and malnutrition.

Qualitative evidence syntheses of attitudes and preferences to inform guidelines on infant feeding in the context of Ebola Virus Disease (EVD) transmission risk

Background

Breast-feeding holds considerable potential to reduce infant mortality. Feeding choices, already complex, take on additional complexity against a backdrop of the risk of transmissible Ebola Virus. This review describes the factors that influence infant feeding and attitudes of pregnant women, mothers, family members and health practitioners, policy makers and providers (midwives) concerning infant feeding when there is a risk of Mother-to-Child (MTC) transmission of Ebola Virus Disease (EVD).

Methodology

A systematic review of qualitative studies identified through rigorous searches of thirteen online databases and additional citation searches of included studies was undertaken. Search terms included breast-feeding, breast-feeding, infant feeding; Ebola; and qualitative, interview(s) and findings. Independent extraction of data by two reviewers using predefined extraction forms. Studies were assessed using the CASP Qualitative checklist.

Principal findings

5219 references were screened. 38 references related specifically to Ebola, and five papers met the inclusion criteria with data gathered from two settings: Guinea and Sierra Leone. The EVD outbreak had a significant impact on beliefs, attitudes, and resources to support infant feeding practices negatively affecting the nutritional status of children. The evidence from these studies highlight the need for guidance and appropriate psychosocial support need to be available to mothers who display symptoms and become infected and to front-line staff who are giving advice. Communities need to be engaged because stigma and fear may hinder uptake of appropriate interventions. The EVD outbreak caused multi-level system disruption akin to that seen following a natural disaster, meaning that logistics and coordination are critical and need adequate resourcing. Food production and distribution, and malnutrition screening are also disrupted and thereby compounding compromised nutritional status. The limited number of relevant studies highlights the need for further primary research, particularly in translation of messages to local settings.

Conclusions

An EVD outbreak causes multi-level disruption that negatively impacts infant feeding and child care practices. Negative impacts have multiple causes and successful planning for Ebola outbreaks requires that nutrition of infants and young children is a priority. Lessons from the Ebola pandemic have wider applicability to other pandemic contexts including Covid-19.

An Ebola outbreak has been likened to a natural disaster in its devastating impact on child health and nutritional status. The ease of transmission of a disease with a 50% mortality rate for those once infected raises particular challenges for breast-feeding women. This systematic review explored the attitudes and preferences of pregnant women, mothers, family members, health practitioners and policy makers concerning infant feeding during an Ebola epidemic as documented in qualitative studies. Participants reported confusion and inconsistent guidance regarding breast-feeding practice, together with difficulties in conveying recommendations to separate mothers infected with Ebola from their breast-feeding infants. Disruption impacted on access to supplementary and complementary feeds, health systems monitoring child growth and support to child health. Widespread distrust and suspicion of health professionals hindered health care provision. Wider family assumed roles in feeding and caring for young children, within the context of reduced access to nutritious foods and supplementary feeds. The work of humanitarian agencies, while valuable, lacked coordination. Planning for an Ebola outbreak requires advance preparation of health messaging for mothers and caregivers, coordinated provision of complementary feeds and support for families who assume caring responsibilities. Strategies to ensure linked up working between government and humanitarian agencies are essential.

The Effects of Pandemics on the Vulnerability of Food Security in West Africa—A Scoping Review

The purpose of this paper was to show the effects of the Ebola and COVID-19 pandemics on food security vulnerability in West Africa. The methodology is based on a scoping literature review using the PRISMA method. The study showed that food security was affected by the restrictive measures in the different West African countries. In addition, it shows that this region is highly vulnerable to such crises, which can combine their effects with those of other events such as climate change and civil unrest. In both pandemics, all pillars of food security were affected. The effects on urban and rural centers may be very different. The study suggests a better understanding of the differences between rural and urban centers and between men and women and how long-term restraint measures can affect rural areas where agriculture is the main lever for reducing food insecurity. Food security must be seriously considered by governments when implementing restrictive measures during a pandemic. Consideration of health factors alone at the expense of food security can greatly exacerbate health problems and even increase cases of disease.

Designing a food supply chain strategy during COVID-19 pandemic using an integrated Agent-Based Modelling and Robust Optimization

Coronavirus disease (COVID-19) has spread for over a year and affected many aspects, including the food supply chain. One of the ways COVID-19 has impacted the food supply chain is the food production capacity reduction. It is necessary to develop the optimum food supply chain strategy by determining the optimum food hub location and food network to maintain food security which robust against disruptions and uncertainties. In this study, Robust Optimization (RO) is applied to handle the uncertainties. Nevertheless, the actual uncertain data might be hard to be collected or even unavailable at the moment. Therefore, an innovative framework is proposed to integrate RO with Agent-Based Modelling (ABM). ABM is used to simulate the upstream actor of the food supply chain and predict the uncertain food production capacity, which RO later handles. Particularly, this study focused on rice supply chain. The result shows that the framework is able to handle the uncertain rice supply chain problem, in which the actual uncertain data might be unavailable, and give the robust optimum food hub location and food network. The food hub location and food network are obtained by solving the Robust Counterpart (RC) model with respect to the uncertainty set obtained from the ABM simulation result.

Impacts of the Filoviridae family

Over 40 filovirus disease outbreaks have been reported since the discovery of the first member of the Filoviridae family, and most of the outbreaks have occurred in Africa. In addition to deaths (primary impacts), there have also been health, social, economic, and political effects (secondary impacts) due to the outbreaks. Two large filovirus disease outbreaks have occurred in West and Central Africa in recent times, and direct and indirect repercussions resulting from the outbreaks underscores the need to strengthen the capacity of health services in disease hotspots.

Rapid Scoping Review on the Topic of Ensuring Social Protection and Basic Services to Inform the United Nations Framework for the Immediate Socioeconomic Response to COVID-19

This rapid scoping review has informed the development of the UN Research Roadmap for the COVID-19 Recovery on the topic of “Ensuring Social Protection and Basic Services.” The aim was to provide a robust synthesis of key concepts and existing evidence drawn from a wide range of disciplines to support the identification and appraisal of research priorities. An emergent theme has been the notion that measures implemented in response to COVID-19 merely ameliorate symptoms of entrenched, systemic gender-, age-, and race-based inequity, inequality, and exclusion. Key findings include the critical role of contextual and community-based knowledge for informing the design, development, and delivery of programs, as well as the urgent need for implementation science to move existing knowledge into action. This review also describes how the disruption associated with “shock events” such as the COVID-19 pandemic is often associated with unusually high levels of interest and willingness to invest in programs and policies to strengthen strained systems. As such, an unprecedented window of opportunity exists to leverage measures implemented in response to the COVID-19 pandemic to effect large-scale, sustainable change and thereby increase the resiliency of our interconnected systems for the future.

COVID-19 Pandemic, Determinants of Food Insecurity, and Household Mitigation Measures: A Case Study of Punjab, Pakistan

Policies centered to respond to the COVID-19 pandemic have created recessionary economic impacts. Adverse income shocks have caused malnutrition and food insecurity and have increased the need for food assistance. The present study examines the impact of the COVID-19 pandemic on food insecurity and investigates the determinants of food security and coping strategies in the Punjab province of Pakistan. Data were collected through the internet and received responses from 370 respondents. The household food insecurity access scale (HFIAS) model was applied to examine food insecurity, and a logit regression model was used to analyze its determining factors. The results illustrate that food insecurity substantially increased during the COVID-19 pandemic. Households' demographics and socioeconomic factors have influence on food insecurity. Households with a large family size and people in quarantine found more food insecurity during the COVID-19 pandemic, while financial assistance played a role in a decline in food insecurity. Households handle the negative income shocks by eating less preferred food and getting support from government and charity organizations. It is suggested that stakeholders and responsible institutes provide financial assistance to support low-income families in order to enhance food security. Furthermore, policymakers should strengthen social safety nets and aid programs such as the Ehsas income program in the province of the country.

Epidemics, Convergence, and Common Prosperity: Evidence from China

This article investigates the impact of previous epidemics on rural development and convergence, and identifies the impact's mechanism based on convergence tests. Using a balanced panel of 31 provinces, the empirical results from 2002 to 2019 show that epidemics decelerated convergence in rural per capita income. The mechanism analysis shows that the accelerated divergence in wages and the decelerated convergence in business income were the major drivers, which also led to decelerated convergence in rural per capita consumption. Although epidemics have not threatened rural food consumption and the Engel coefficient of rural households, these two indicators of basic living needs have failed to achieve convergence across regions. The overall impact of an epidemic on convergence in rural–urban income disparity has also been insignificant, indicating that epidemics have affected rural and urban development simultaneously. Finally, COVID‐19 is likely to decelerate convergence in rural income, rural consumption, and urban income.

Qualitative evidence synthesis of values and preferences to inform infant feeding in the context of non-HIV transmission risk

Background

Breastfeeding is recommended by many organisations, but feeding choices can take on complexity against a backdrop of a transmissible infection risk. The aim of this synthesis is to explore what is known about the values and preferences of pregnant women, mothers, family members and health practitioners, policy makers and providers (midwives) concerning feeding when there is a risk of Mother-to-Child transmission [MTCT] of an infectious disease (other than HIV/AIDS) to infants (0–2 years of age).

Methods

A qualitative evidence synthesis and GRADE CERQual assessment of relevant studies of values and preferences regarding infant feeding options in the context of non-HIV MTCT risk.

Results

The synthesis included eight qualitative studies. Four studies focussed on human T-cell lymphotropic virus type 1 (HTLV-1), three studies on Ebola, and one study on influenza vaccination. Mothers reported feeling sadness and guilt at not breastfeeding, while recognising that it was important for the health of their baby not to breastfeed. Mothers were reportedly appreciative of the provision of appropriate facilities, and the advice of those health professionals who knew about the diseases, but felt other professionals lacked knowledge about the transmission risk of conditions such as HTLV-1. All groups expressed concerns about social perceptions of not breastfeeding, as well as the alternatives. The evidence was coherent and relevant, but there were serious concerns about adequacy and methodological limitations, such as potential social desirability bias in some studies.

Conclusions

This synthesis describes the reported values and preferences of pregnant women, mothers, and others concerning feeding when there is a risk of Mother-to-Child transmission (MTCT) of an infectious disease (other than HIV/AIDS) to an infant when breastfeeding. However, the evidence in the peer-reviewed literature is limited both in quality and quantity.

Literacy is power: structural drivers of child malnutrition in rural Liberia

BACKGROUND

In Liberia, an estimated 32% of children under 5 are stunted. Malnutrition and hunger worsened during the country's civil war and were further exacerbated by the 2014-2016 outbreak of Ebola virus disease. Studies examining adherence to recommended infant and young child feeding practices frequently do so with an emphasis on the knowledge, attitudes and beliefs of mothers and caregivers. Often overlooked are the structural factors that enable or constrain their agency to practise evidence-based recommendations.

METHODS

Between July and December 2017, we surveyed 100 Liberian mothers to assess the sociodemographic factors associated with the risk of severe acute malnutrition in children in Maryland County, Liberia. We also conducted 50 in-depth interviews at two government health facilities to qualitatively explore mothers' experiences, as well as health workers' understandings of the determinants of malnutrition in the region. We applied logistic regression to analyse quantitative data and inductive content analysis to thematically interpret qualitative data.

RESULTS

Mothers were less likely to have a child with severe acute malnutrition if they had an income greater than US$50 per month (adjusted OR (aOR)=0.14, p<0.001), were literate (aOR=0.21, p=0.009) or exclusively breast fed during the first 6 months of life (aOR=0.18, p=0.049); they were more likely to have a child with severe acute malnutrition if they were married or in domestic partnerships (aOR=8.41, p<0.001). In-depth interviews elucidated several social, economic and programmatic factors that shaped suboptimal feeding practices, as well as decisions for and against seeking formal care for malnutrition.

DISCUSSION

The lived experiences of Liberian mothers and health workers illustrate that child malnutrition is a direct consequence of abject poverty, food insecurity, illiteracy, the precarious nature of formal and informal work, and the lack of robust social protection. Behaviour change and health education interventions that do not seek to alleviate structural barriers to compliance are unlikely to be effective.

The COVID-19 Pandemic and Global Food Security

We present scientific perspectives on the impact of the COVID-19 pandemic and global food security. International organizations and current evidence based on other respiratory viruses suggests COVID-19 is not a food safety issue, i.e., there is no evidence associating food or food packaging with the transmission of the virus causing COVID-19 (SARS-CoV-2), yet an abundance of precaution for this exposure route seems appropriate. The pandemic, however, has had a dramatic impact on the food system, with direct and indirect consequences on lives and livelihoods of people, plants, and animals. Given the complexity of the system at risk, it is likely that some of these consequences are still to emerge over time. To date, the direct and indirect consequences of the pandemic have been substantial including restrictions on agricultural workers, planting, current and future harvests; shifts in agricultural livelihoods and food availability; food safety; plant and animal health and animal welfare; human nutrition and health; along with changes in public policies. All aspects are crucial to food security that would require "One Health" approaches as the concept may be able to manage risks in a cost-effective way with cross-sectoral, coordinated investments in human, environmental, and animal health. Like climate change, the effects of the COVID-19 pandemic will be most acutely felt by the poorest and most vulnerable countries and communities. Ultimately, to prepare for future outbreaks or threats to food systems, we must take into account the Sustainable Development Goals of the United Nations and a "Planetary Health" perspective.

Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response

Four billion people worldwide have experienced coronavirus disease 2019 (COVID-19) confinement. Such unprecedented extent of mobility restriction to curb the COVID-19 pandemic may have profound impacts on how individuals live, travel and retain well-being. This systematic review aims to identify (i) the social consequences of mass quarantine-community-wide movement restrictions-during previous and current infectious disease outbreaks and (ii) recommended strategies to mitigate the negative social implications of COVID-19 lockdowns. Considering social determinants of health, we conducted a systematic review by searching five databases (Ovid-MEDLINE, EMBASE, PsycINFO, China National Knowledge Infrastructure and the World Health Organization COVID-19 database) for publications from inception to 9 April 2020. No limitation was set on language, location or study type. Studies that (i) contained peer-reviewed original empirical evidence and (ii) focussed on non-epidemiological implications of mass quarantine were included. We thematically synthesized and reported data due to heterogeneous disease and country context. Of 3067 publications found, 15 original peer-reviewed articles were selected for full-text extraction. Psychological distress, heightened communication inequalities, food insecurity, economic challenges, diminished access to health care, alternative delivery of education and gender-based violence were identified as negative social consequences of community-based quarantine in six infectious disease epidemics, including the current COVID-19 pandemic. In contrast, altruistic attitudes were identified as a positive consequence during previous quarantines. Diverse psychological and social consequences of mass quarantine in previous and current epidemics were evident, but individual country policies had been highly varied in how well they addressed the needs of affected individuals, especially those who are socially marginalized. Policymakers should balance the pros and cons of movement restrictions, facilitate multisectoral action to tackle social inequalities, provide clear and coherent guidance to the public and undertake time-bound policy evaluations to mitigate the negative impact of COVID-19 lockdowns and to establish preparedness strategies for future epidemics.

Moving health to the heart of agri-food policies; mitigating risk from our food systems

Our food systems are progressively more industrialized and consolidated with many modern food value chains involving multiple countries and continents, and as such being associated with changes in risk profile and impacts of emerging and re-emerging diseases. Disease outbreaks that sweep through a single region can have massive impacts on food supply, while severe outbreaks of human pathogens can disrupt agricultural labor supply or demand for products perceived as 'unsafe'. Market pressures have generally rewarded production of cash crops for fuel and energy dense, low nutrient processed foods over production of fruits and vegetables for local consumption. Climbing rates of food-related NCDs and pre-existing conditions leave the population increasingly susceptible to infectious diseases that are often driven by or arise from the food system. Therefore disease and diet from our food systems cause impacts on human health, and human health issues can impact on the functioning of the food system. The COVID-19 outbreak is the most recent example of food system driven disease emergence and of massive supply and demand shocks in the food system, experienced as a direct and indirect result of this disease. The effects of the food system on disease spread (and vice versa) must be addressed in future plans to prevent and mitigate large scale outbreaks. Health policies must acknowledge the food system as the base of our health system, as must agri-food policy recognize the pre-eminence of human health (directly and indirectly) in decision making.

Impacts of COVID-19 on Trade and Economic Aspects of Food Security: Evidence from 45 Developing Countries

The stability of food supply chains is crucial to the food security of people around the world. Since the beginning of 2020, this stability has been undergoing one of the most vigorous pressure tests ever due to the COVID-19 outbreak. From a mere health issue, the pandemic has turned into an economic threat to food security globally in the forms of lockdowns, economic decline, food trade restrictions, and rising food inflation. It is safe to assume that the novel health crisis has badly struck the least developed and developing economies, where people are particularly vulnerable to hunger and malnutrition. However, due to the recency of the COVID-19 problem, the impacts of macroeconomic fluctuations on food insecurity have remained scantily explored. In this study, the authors attempted to bridge this gap by revealing interactions between the food security status of people and the dynamics of COVID-19 cases, food trade, food inflation, and currency volatilities. The study was performed in the cases of 45 developing economies distributed to three groups by the level of income. The consecutive application of the autoregressive distributed lag method, Yamamoto's causality test, and variance decomposition analysis allowed the authors to find the food insecurity effects of COVID-19 to be more perceptible in upper-middle-income economies than in the least developed countries. In the latter, food security risks attributed to the emergence of the health crisis were mainly related to economic access to adequate food supply (food inflation), whereas in higher-income developing economies, availability-sided food security risks (food trade restrictions and currency depreciation) were more prevalent. The approach presented in this paper contributes to the establishment of a methodology framework that may equip decision-makers with up-to-date estimations of health crisis effects on economic parameters of food availability and access to staples in food-insecure communities.