Food Insecurity and Health Outcomes Other than Malnutrition in Southern Africa: A Descriptive Systematic Review

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.

Magnitude, Determinants, and Coping Strategies of Food Insecurity Among People Living With HIV/AIDS in Eastern Ethiopia

Background: Globally, over 2 billion people are affected by food insecurity linked to HIV/AIDS. In Africa, there are about 28.5 million people of all ages living with HIV/AIDS, of whom 2.2 million died of AIDS due to multiple factors that overlap, severe household food insecurity including inadequate food diversity, food intake less than three times a day, body mass index (BMI) of less than 18 kg per square meter, and inadequate food intake. Good nutrition is important for people with HIV because it helps strengthen the immune system and keeps people with HIV healthy and helps absorb HIV medicines. In sub-Saharan Africa, including Ethiopia, the high prevalence of starvation or famine exacerbated HIV/AIDS patients' mortality rates. National data from Ethiopia show that nearly 90% of HIV/AIDS-infected people are affected by food insecurity. The current study aimed to assess the magnitude, determinant factors, and coping strategies of food insecurity among adult people living with HIV/AIDS. Methods: An institutional-based cross-sectional study was conducted on 421 adult HIV positives who were attending antiretroviral treatment at public health facilities in both rural and semiurban areas. The study subjects were selected by a simple random sampling technique. A pretested, semistructured questionnaire was used. A bivariate and multivariate logistic regression model was fitted to identify the independent factors associated with food insecurity. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was estimated to measure the strength of the association. Results: Food insecurity was prevalent among 80.3% of HIV/AIDS patients in the study population. Living in a rural area, the presence of another family member with HIV, inadequate dietary diversity, low frequency of meals, and current high viral load in the last 12 months were some of the factors that significantly affect food insecurity among AIDS patients. Eating less preferred foods and reducing the number of meals were among common coping strategies. Conclusion: This study analyzed the overall magnitude of food insecurity among HIV/AIDS patients and found it to be higher, which may end up in a shortening of life expectancy. A national health policymaker needs to integrate long-term food and nutrition interventions for marginalized groups, specifically PLWHA to tackle factors negatively affecting food insecurity and highly erosive coping strategies among AIDS patients.

Does oral iron and folate supplementation during pregnancy protect against adverse birth outcomes and reduced neonatal and infant mortality in Africa: A protocol for a systematic review and meta-analysis?

Background: Globally, one-third of pregnant women are at risk of iron deficiency, particularly in the African region. While recent findings show that iron and folate supplementation can lower the risk of adverse birth outcomes and childhood mortality, our understanding of its impact in Africa remains incomplete due to insufficient evidence. This protocol outlines the systematic review steps to investigate the impact of oral iron and folate supplementation during pregnancy on adverse birth outcomes, neonatal mortality and infant mortality in Africa. Methods and analysis: MEDLINE, PsycINFO, Embase, Scopus, CINAHL, Web of Science, and Cochrane databases were searched for published articles. Google Scholar and Advanced Google Search were used for gray literature and nonindexed articles. Oral iron and/or folate supplementation during pregnancy is the primary exposure. The review will focus on adverse birth outcomes, neonatal mortality and infant mortality. Both Cochrane Effective Practice and Organization of Care and Newcastle-Ottawa Scale risk of bias assessment tools will be used. Meta-analysis will be conducted if design and data analysis methodologies permit. This systematic review and meta-analysis will provide up-to-date evidence about iron and folate supplementation's role in adverse birth outcomes, neonatal mortality and infant mortality in the African region. Ethics and dissemination: This review will provide insights that help policymakers, program planners, researchers, and public health practitioners interested in working in the region. PROSPERO registration number: CRD42023452588.

High prevalence of food insecurity in peri-urban communities in Karachi, Pakistan: The flood aftermath

BackgroundFood insecurity (FI) is at a steep risk, especially in low middle-income countries. FI is further compounded in areas that experience environmental and economic instability, thus a reassessment in such critical times is required for burden estimation and to propose targeted interventions.AimsThe objectives of this study were to assess the prevalence of, and sociodemographic factors associated with FI, as well as the coping strategies utilized in response to FI in peri-urban communities in Karachi, Pakistan.MethodsWe conducted a cross-sectional survey from November-December 2022 on 400 households in four peri-urban communities in Karachi, Pakistan. The Household Food Insecurity Access Scale (HFIAS) and reduced Coping Strategies Index (rCSI) questionnaire were used to assess FI. A Poisson regression was used to assess associations between sociodemographic factors and FI.ResultsThe overall prevalence of FI was found to be 60.2% (n = 241) of which 33.8% (n = 135) were severely food insecure. Age, women's and breadwinners' education, women's occupation, and parity were significantly associated with FI. Participants reported relying on less expensive foods (44%) and borrowing food or help from others (35%) as the most common coping strategies overall in the FI households.ConclusionWith more than half the households facing FI and adopting severe measures to cope in these communities, it is pivotal to design and test interventions that can withstand economic and climate catastrophes and help ensure a safety need for food security for the most vulnerable.

Impact of Consultation with Registered Dietitians on Reducing Inappropriate Weight Gain in Pregnant Patients with Food Insecurity

Background/Objectives: Screening for food insecurity, while common practice in pediatric populations, remains novel in pregnancy. Food insecurity during pregnancy is associated with medical comorbidities that in turn confer additional obstetric risks to the maternal-fetal dyad. Few studies have evaluated the impact of interventions for patients with food insecurity in the prenatal period. This study first demonstrates the ease of FI screening in pregnancy using the Hunger Vital Sign™ and next assesses if providing patients with a referral to a registered dietician decreases the incidence of inappropriate weight gain in pregnant patients with food insecurity. Methods: A retrospective chart review was conducted from November 2019 to March of 2021 at a United States Northeast inner-city hospital-based clinic to identify patients with food insecurity in the prenatal period. All pregnant patients who screened positive for food insecurity were given an educational pamphlet with resources and offered a referral to a registered dietician. We compared the incidence of appropriate weight gain among these patients depending on whether they attended an appointment with a registered dietician. We defined appropriate weight gain following the recommendations of the Institute of Medicine (IOM) based on pre-pregnancy body mass index. Inferential statistics were performed to compare differences using univariate statistics, and multivariate regression was conducted to control for confounders, with an alpha of 0.05. Results: In total, 139 patients screened positive for food insecurity (FI); 52 (37.4%) attended an appointment with a registered dietician. Overall, 88 (61.9%) patients had inappropriate weight gain during pregnancy. Fewer patients who attended a visit with a registered dietician had inappropriate weight gain than those who did not attend a visit (27 [30.7%] vs. 61 [69.3%], p = 0.031, respectively). Both study groups' demographics, comorbidities, and postpartum outcomes were comparable. Conclusions: We found that for pregnant individuals with food insecurity, consultation with a registered dietician was associated with a decrease in the incidence of inappropriate weight gain during pregnancy.

Impact of health education on knowledge retention among caregivers of hypertensive patients: A prospective cross-sectional study in rural Malawi

Hypertension is a widespread and life-threatening condition affecting one-third of adults globally. In low- and middle-income countries, like Malawi, the burden of hypertension is escalating due to inadequate healthcare resources and lifestyle changes. Family members often become primary caregivers, playing a crucial role in managing hypertension through support and adherence to treatment. This study examined caregivers' knowledge retention by evaluating their pre- and post-health education knowledge levels. This was a prospective cross-sectional study in Neno, Malawi, a rural setting. 422 caregivers were enrolled from the Integrated Chronic Care Clinic (IC3). A structured questionnaire was used to collect baseline, post-health education, and week six data. Using SPSS V 22.0, comparison of knowledge, attitude, and practices (KAP) scores, correlation between KAP and between KAP and social demographic characteristics were done using Wilcoxon signed-rank test, Pearson correlation, and independent t-test respectively. Among the 422 caregivers who participated in the study, 267 (63.2%) were females and mean age was 44.94 years. The baseline mean knowledge level score was 9.5 (38.0%) and rose to 21.08 (84.3%) p = 0.000 immediate post-health education and a 2.1% decrease 20.54 (82.2%) p<0.001 at week six from the immediate post health education score. Attitude improved from 16.76 (93.1%) at baseline to 17.74 (98.6%) at the six-week mark. Similarly, the mean practice score rose from 25.24 (78.9%) at baseline to 27.42 (85.7%) at week six. There was a positive correlation between KAP while age had a negative correlation with knowledge (r = -0.146; p = 0.003). There was a significant difference between different education levels on knowledge retention p = 0.009. There was a positive and good knowledge retention among caregivers of hypertensive patients after health education at the week six mark. With improved knowledge and the ability to retain it resulting in improved attitude and practices, caregivers are a cornerstone for continued and improved hypertension care for the patients.

Current trends in household food insecurity, dietary diversity, and stunting among children under five in Asia: a systematic review

Background

Household food insecurity (HFI) and poor dietary diversity (DD) are major public health challenges in Asia, greatly contributing to stunting among children under five. While previous research has focussed primarily on African regions, this systematic review provides novel insights into the association between HFI, DD, and stunting within the Asian context.

Methods

We searched across six major databases for studies published between 2019 and 2023 exploring the association between HFI, DD, and stunting in children under five across Asia. We then extracted their characteristics, evaluation methods, and outcomes related to stunting for analysis.

Results

From 3215 records, 37 met the inclusion criteria. Most studies were from South Asia (n = 22), followed by Southeast Asia (n = 8), with fewer from West (n = 4), East (n = 2), and Central Asia (n = 1), highlighting geographical research gaps. We found high stunting rates among children under five, especially in South and Southeast Asia. Stunting was strongly linked to HFI and poor DD, suggesting that these factors are critical in addressing malnutrition. Socioeconomic factors, maternal education, and access to clean water also influence stunting outcomes.

Conclusions

Current research on HFI, DD, and stunting in Asia shows substantial variation, with the highest stunting rates in South and Southeast Asia. Limited data from Central and East Asia highlights the need for more comprehensive research in these regions. Addressing HFI and improving DD is critical for reducing stunting and achieving global nutrition targets by 2030.

Determinants of hypertension-related knowledge, attitude, and practices (KAP) among caregivers in Neno, rural Malawi: A cross-sectional study

Background

Hypertension, a significant health concern, increases the risk of cardiovascular disease and premature mortality. Caregivers play a crucial role in ensuring optimal care for hypertensive patients and reducing associated complications. Caregivers' basic knowledge, good attitude, and relevant practices are necessary to ensure high-quality care for patients with hypertension. However, there is no research conducted in Malawi that investigated the knowledge, attitude, and practices of caregivers towards hypertension prevention and management.

Objective

The study aimed to assess knowledge, attitude, and practices towards hypertension and their determinants among caregivers of hypertensive patients in Neno, Malawi.

Methods

Our study, conducted in Neno, Malawi, involved 422 caregivers of hypertensive patients. We used a cross-sectional study design. Data was collected through a structured questionnaire and analyzed using SPSS Version 22.0.

Results

The participants had a mean age of 44.94 years (SD = 9.889), with 63.3 % being female. The mean KAP scores were 38 %, 93.3 %, and 78.7 %, respectively. Positive correlations were found between knowledge and practice (r = +0.252; p < 0.001) and knowledge and attitude (r = +0.255; p < 0.001). However, no significant relationship was observed between attitude and practice (r = +0.064; p = 0.190). Age showed a strong correlation with attitude (r = +0.233; p < 0.001) but not with knowledge or practice. On the other hand, occupation, education level, and caregiver-patient relationship significantly influenced knowledge and attitude but not practice. Gender also demonstrated a notable association with KAP regarding hypertension.

Conclusion

Caregivers demonstrated poor knowledge but engaged in good practices. Despite their limited understanding, they maintained an excellent attitude towards hypertension. This highlights the necessity for increased prevention, and control strategies within communities, emphasizing health education on lifestyle modifications and to address the gaps identified in caregivers' understanding in the prevention and management of hypertension.

Association between food insecurity and long COVID in adults from southern Brazil: findings of the PAMPA cohort

BACKGROUND

Social and economic factors, such as food insecurity, contribute to long coronavirus disease (COVID). During the pandemic, a significant rise in food insecurity was observed, both in Brazil and worldwide. We aimed to investigate the association between food insecurity and long COVID in Brazilian adults.

METHODS

Cross-sectional study nested within the Prospective study About Mental and Physical Health in Adults (PAMPA) Cohort. Participants completed an online questionnaire in June 2022. We assessed food insecurity using the Brazilian Scale of Food Insecurity. Long COVID was defined as any post-coronavirus disease 2019 symptoms that persisted for at least 3 months after infection.

RESULTS

A total of 956 participants were included (74.0% female, median age 36 (Interquartile Range [IQR] (29-45.7). The prevalence of food insecurity was 29.4%, and 77.8% had long COVID. Food insecurity was associated with an increased probability of long COVID (prevalence ratio [PR]: 1.15, 95% confidence interval [CI]: 1.08-1.22). Participants in food insecurity situations had a higher likelihood of experiencing neurological (PR: 1.19, 95% CI: 1.10-1.28), pulmonary (PR: 1.33, 95% CI: 1.17-1.52) and gastrointestinal (PR: 1.57, 95% CI: 1.31-1.88) symptoms after infection.

CONCLUSIONS

Food insecurity was associated with long COVID. Governments must plan public policies to mitigate the effects of long COVID and food insecurity.

Food Insecurity Is Common in Patients with Inflammatory Bowel Disease and Is Associated with Increased Ultra-Processed Food Intake

BACKGROUND/OBJECTIVES

Food insecurity (FI) is defined as the lack of consistent access to enough food for an active and healthy life. FI affects over 30 million Americans and is associated with poor clinical outcomes and impaired quality of life and drives significant health inequities. Despite the rising prevalence of FI and the federal focus on improving access to healthy food, there is a paucity of research on FI in patients with inflammatory bowel disease (IBD). Therefore, the goal of this study was to define FI in a cohort of IBD patients and determine whether FI was associated with changes in dietary patterns, including specifically an increase in ultra-processed food (UPF) consumption in this high-risk patient population.

METHODS

This was a single-center, retrospective cohort study of patients with a diagnosis of IBD who were 18 years of age or older and who were seen in a nutrition focused clinic. Patients were screened for FI using the Hunger Vital Sign™, a 2-question validated FI screening tool and underwent a 24-h dietary recall. The degree of food processing was assessed using the NOVA Food Classification System.

RESULTS

Among 128 patients with IBD, we observed that FI is increasingly prevalent, with 45% of patients reporting difficulty with sufficient grocery access at least "sometimes" in the last 12 months and 10% reporting decreased food access "often" in the prior year. In addition, the patients at high-risk for FI were significantly more likely to eat NOVA 4 UPFs (54% vs. 27%, p = 0.001) and were significantly less likely to eat NOVA 1 unprocessed foods (32% vs. 61%, p = 0.001) as compared to those not at risk for FI. Finally, only a small percentage of those at highest risk for FI were enrolled in a federal food assistance program for grocery support.

CONCLUSIONS

The prevalence of FI is increasing in patients with IBD and is associated with reduced dietary quality.

HIV in Eswatini: Climate Change Impacts and Adaptation Strategies

Purpose of Review

This review assessed the impact of climate change on HIV transmission and HIV care of children and adults in Eswatini, and what adaptation strategies can mitigate these impacts.

Recent Findings

The HIV crisis in Eswatini persists alongside the climate emergency, increasing poor health outcomes in individuals living with HIV. Although there is no clinical evidence of a direct influence of climate change on the biological effect of HIV, changing weather patterns have an effect on the livelihoods and sustenance of children, adults, and caregivers, which may consequently increase the likelihood of HIV transmission and disrupt HIV care.

Summary

Drought conditions-expected to increase with climate change-coupled with existing food insecurity and poverty are the main pathways linking HIV and climate change in Eswatini. Other climate-driven concerns for HIV treatment and care in Eswatini include heat waves, wildfires, floods, and storms.

Seasonal variations in household food security and consumption affect women's nutritional status in rural South Ethiopia

Food availability varies seasonally in most rural areas of developing nations, especially in areas affected by drought and climate change, with women being one of the most vulnerable groups. This study aimed to assess the effect of seasonal variation in household food security, adequate dietary diversity, food consumption, and wealth on the nutritional status of women of reproductive age in a rural community in South Ethiopia. Further, the study aimed at identifying associated factors with women's nutrition status. An open cohort study was conducted from June 2021 to June 2022, with follow-up visits every three months. Anthropometric measurements were carried out along with interviews. Data were analyzed using STATA version 15. Multilevel, multiple linear regressions were employed. Findings revealed that women's average body mass index (BMI) was 20.4 kg/m2 (95% CI: 20.4-20.5). The highest (20.6 kg/m2, 95% CI: 20.5-20.8) was observed in December, while the lowest (20.2 kg/m2, 95% CI: 20-20.3) occurred in September. During the main postharvest period in December, the household food insecurity score was the lowest (median: 4, Inter quartile range (IQR): 0-9), while the household dietary diversity score (median: 6, IQR: 5-7), and the household food consumption score were the highest (median: 50.5, IQR: 44-70). Factors such as household food security, food consumption, previous season BMI, age, marital status, and membership in safety net programs were identified as determinants of women's BMI. The study showed the vulnerability of women in drought-prone areas to seasonal undernutrition. We recommend collaborative work among stakeholders to ensure sustainable food access and minimize seasonal food shortages' effect on women's nutrition and overall well-being.

Association between food insecurity and chronic noncommunicable diseases in Brazil: a systematic review

OBJECTIVE

To analyze the association of food insecurity (FI) with chronic noncommunicable diseases (NCDs) in the Brazilian context.

METHODS

The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). The searches were conducted in LILACS and PubMed databases (September/2022). Observational studies carried out in the Brazilian population published since 2003 were included, in which: (1) the association of FI with NCDs was analyzed; and (2) the Brazilian Food Insecurity Scale was used. Studies on pregnant women and those that associated FI with cancer, sexually transmitted infections, and musculoskeletal and respiratory diseases were excluded. The studies were subjected to methodological quality assessment.

RESULTS

A total of 27 cross-sectional studies were included; nine used secondary data from national surveys, and the others used primary data. An association between FI and overweight and obesity in different age groups was verified in the studies.

CONCLUSION

The included articles did not produce evidence on other NCDs of interest to health in Brazil such as diabetes and high blood pressure. However, they corroborate the already-known relationship between obesity and FI. Studies on the topic, with a longitudinal design, should be encouraged.

Associated factors of diet quality among people living with HIV/AIDS in Ghana

INTRODUCTION

Nutrition is a very important element of a comprehensive care for people living with HIV/AIDS (PLHIV), especially in resource-constrained settings where malnutrition and food insecurity are common. Dietary diversity is a useful indication of nutritional adequacy (diet quality) in people of all ages. An optimally diverse diet strengthens the body's immune system.

OBJECTIVE

This study aimed to assess diet quality and its associated factors among PLHIV.

METHODS

A facility-based cross-sectional study design was employed to select 440 PLHIV from two hospitals in the Eastern Region of Ghana. Dietary intakes were determined using 24-hour recall. A stadiometer and bioimpedance analysis machine were used to obtain anthropometric and body composition data. Diet quality was assessed using FAO's individual dietary diversity score (IDDS) as a proxy. SPSS version 20 was used for analysis. Odds ratios and ordinal logistic regression were used to identify factors associated with diet quality among the PLHIV. P-value was set at 0.05.

RESULTS

Most of the PLHIV (73%) consumed from 'Starchy staple" food group. Less than 20% of the study sample consumed 'Fruits' and 'Vegetables' (17% and 14% respectively) a day before the survey. The mean IDDS was 4.11 (SD = 1.29). Overall, most of the PLHIV (56%) had medium IDDS which is equivalent to "diet needing improvement', 14% had higher IDDS (good diet), whiles about 31% of the participants actually had poor diet (lower IDDS). Associated factors of diet quality were age (AOR = 0.966: 95%CI: 0.936-0.997: p = 0.031), married (AOR = 4.634: 95%CI: 1.329-16.157: p = 0.0016), separated (AOR = 0.0203: 95%CI: .036-0.994: p = 0.049), and daily meal frequency (AOR = 0.441: 95%CI: .478-1.948: p = 0.020). Overall, the model accounts for about 20% of the variation in diet quality of the participants (pseudo-R square = 0.196).

CONCLUSION

This study demonstrates that most of the PLHIV did not consume good diet which may have an implication on their immune system, which is already under attack by HIV, and probably emerging infections. Age, marital status, and meal frequency were the variables that predicted diet quality among the study participants.

Association between household food insecurity and stunting in children aged 0-59 months: Systematic review and meta-analysis of cohort studies

Household food insecurity (HFI) during childhood is associated with poor dietary diversity and malnutrition, placing children's growth at risk. Children with growth disorders, such as stunting, are more likely to have poor cognition and educational performance, lower economic status, and an increased risk of nutrition-related chronic diseases in adulthood. Our study aimed to systematically review and conduct a meta-analysis of cohort studies investigating the association between HFI and stunting in children aged 0-59 months. Peer-reviewed and grey literature were systematically searched in electronic databases with no language or date restrictions. Two reviewers independently assessed the studies for pre-established eligibility criteria. Data were extracted using a standard protocol. Random-effects meta-analysis models were used, and I2 > 40% indicated high heterogeneity across studies. We used the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of the evidence. Nine cohort studies comprising 46,300 children were included. Approximately 80% (n = 7) of the studies found a positive association between HFI and stunting. Pooled odds ratio was 1.00 (95% confidence interval [CI]: 0.87-1.14; I2: 76.14%). The pooled hazard ratio between moderate and severe HFI and stunting was 1.02 (95% CI: 0.84-1.22; I2: 85.96%). Due to high heterogeneity, the quality of evidence was very low. Individual studies showed an association between HFI and stunting in children aged 0-59 months; however, this association was not sustained in the pooled analysis, possibly because of high heterogeneity across studies.

Estimate the burden of malnutrition among children with cerebral palsy in Sub-Saharan Africa: a systematic review with meta-analysis

Malnutrition is more prevalent among children with cerebral palsy and a major factor for child morbidity and mortality in children with different co-morbidity, especially in Sub-Saharan Africa: The main aim of this systematic review and meta-analysis was to estimate the burden of malnutrition among children with cerebral palsy in Sub-Saharan Africa. We searched PubMed, Web of Science, Google Scholar, Research Gate, and institutional repositories for papers that reported the proportion of malnutrition among children with cerebral palsy that were published between December 2010 and September 2023. Data were retrieved using the standardized JBI data extraction checklist through Microsoft Excel, and then exported to STATA 17 for further analysis. DerSimonian and Laird's estimator was used to calculate the pooled effect size in the random-effects model. Statistics such as the Cochran Q test and I2 test were employed to measure heterogeneity. Egger's test and the funnel plot were used to look for publication bias. This systematic review and meta-analysis used 16 studies from Sub-Saharan Africa to estimate the proportion of malnutrition among 2,120 children with cerebral palsy. The pooled proportion of malnutrition among children with cerebral palsy in Sub-Saharan Africa by using random-effects model analysis was found to be 59.7% (95% CI; 49.8-69.6). The proportion of malnutrition was also estimated by sample sizes categorized as ≤ 120 and > 120, and the proportion of malnutrition was found to be 54.0 (95% CI: 44.7-63.3) and 64.5 (95% CI: 50.5-78.5). Moreover, the proportion of malnutrition was estimated by accounting for the difference in the year of publication. In this regard, the study classified before ≤ 2017 and > 2017, and the proportion of malnutrition was found to be 53.7 (95% CI: 38.0-69.3) and 62.5 (95% CI: 49.7-75.3) in Sub-Saharan Africa respectively. Malnutrition among children with cerebral in Sub-Saharan Africa was found to be very high. Hence, enhancing and developing strategic guidelines for malnutrition screening, prevention, and nutritional support are crucial among children with cerebral palsy. Furthermore, systematic review, randomized control trials, and qualitative studies are recommended to understand the burden more among children with cerebral palsy in the continent.

Food insecurity is associated with low diet quality and unhealthy cooking and eating habits in Iranian women

BACKGROUND

Food insecurity affects diet and nutrition intakes. We explored the relationship between food insecurity and dietary intakes in a group of Iranian women.

METHODS

The cross-sectional study was performed on 190 healthy females aged 20-55 years attending primary healthcare centers in Shiraz. Food insecurity was evaluated by Household Food Insecurity Access Scale, which is a validated tool for assessing food insecurity in developing countries. Diet was assessed using a food frequency questionnaire. The association of dietary patterns and food insecurity was assessed by linear regression.

RESULTS

Assessment of dietary intakes revealed that consumption of red meat, poultry, fish, dairy, fruits, non-starchy vegetables, and nuts decreased whereas that of grains, processed meats, potato, and sugary foods increased with increasing food insecurity. Among nutrients, carbohydrates, fiber, vitamin A, vitamin C, folic acid, potassium, calcium, and magnesium decreased while fat and sodium increased as food insecurity increased. Three major dietary patterns were detected. Healthy dietary patterns showed inverse associations with food insecurity in the crude (β = -0.422 and - 0.435, P < 0.001) and adjusted (adjusted for age, marital status, and educational level) (β = -0.475 and - 0.341, P < 0.001) models of regression analysis but unhealthy pattern did not show an association with food insecurity. Compared to food secure participants, a higher percentage of food insecure individuals indicated unhealthy eating habits, such as skipping breakfast, lower snack ingestion, more fast and fried food consumption, and using unhealthy cooking methods.

CONCLUSION

Overall, this study showed that food insecurity was associated with less healthy diet and unhealthy cooking and eating habits.

Food insecurity, environment, institutional quality, and health outcomes: evidence from South Asia

BACKGROUND

Food insecurity and environmental degradation pose significant threats to health outcomes in South Asia, necessitating effective policy interventions. Therefore, this study aims to examine the impact of food insecurity and environmental degradation on health outcome indicators amidst global inflationary shocks and institutional quality arrangements. Additionally, it aims to explore the intricate moderating role of institutional quality on the relationship between food insecurity, endogenous variables, and external shocks.

METHOD

In alignment with the study's objectives, a set of panel data spanning from 2000 to 2021 is compiled for South Asia. The study introduces a novel variable representing inflationary shock, crafted through the integration of inflation datapoints and the application of the generalized autoregressive conditional heteroskedasticity model. Additionally, a distinctive aggregate institutional quality index is formulated, drawing from six key measures of the Worldwide Governance indicators. To scrutinize the effects of food insecurity, environmental degradation, and other explanatory variables, the study employs the two-step system generalized method of moment technique, offering a robust analytical approach to uncover complex relationships and dynamics in the region.

RESULTS

The results indicate that the prevalence of undernourishment, inequality in per capita calorie intake, and CO2 emissions significantly reduce life expectancy and increase mortality rates. Additionally, it shows that per capita kilocalorie supply, per capita GDP, per capita health expenditures, and urbanization are statistically significant for increasing life expectancy and decreasing mortality rates. The findings reveal that inflationary shocks severely affect food insecurity and environmental factors, exerting further pressure on contemporary life expectancy and mortality rates. In rebuttal, the institutional quality index is found to have significant effects on increasing and decreasing life expectancy and mortality rates, respectively. Furthermore, the institutional quality index is effective in moderating the nexus between food insecurity, environmental degradation, and health outcomes while also neutralizing the negative impact of inflationary shocks on the subject.

CONCLUSION

The results verify triple health constraints such as food insecurity, environmental factors, and economic vulnerability to global shocks, which impose severe effects on life expectancy and mortality rates. Furthermore, poor institutional quality is identified as a hindrance to health outcomes in South Asia. The findings suggest specific policy implications that are explicitly discussed.

Managing cirrhosis with limited resources: perspectives from sub-Saharan Africa

Cirrhosis represents the end stage of chronic liver disease. Sub-Saharan Africa, a resource-constrained region, has a high burden of chronic liver disease, with causes including chronic viral hepatitis, excessive alcohol use, and metabolic dysfunction-associated steatotic liver disease (MASLD), the risk of which is burgeoning. The development of liver cirrhosis predicts for morbidity and mortality, driven by both liver dysfunction and the consequences of portal hypertension. Compensated cirrhosis portends a better prognosis than decompensated cirrhosis, highlighting the need for the early diagnosis of cirrhosis and its causes. With resource challenges, the diagnosis and management of cirrhosis is demanding, but less costly and less invasive interventions with substantial benefits, ranging from simple blood tests to transient elastography, are feasible in such settings. Simple interventions are also available to manage the complex manifestations of decompensation, such as β blockers in variceal bleeding prophylaxis, salt restriction and appropriate diuretic use in ascites, and lactulose and generic rifaximin in hepatic encephalopathy. Ultimately, managing the underlying causative factors of liver disease is key in improving prognosis. Management demands expanded policy interventions to increase screening and treatment for hepatitis B and C and reduce alcohol use and the metabolic factors driving MASLD. Furthermore, the skills needed for more specialised interventions, such as transjugular intrahepatic portosystemic shunt procedures and even liver transplantation, warrant planning, increased capacity, and support for regional centres of excellence. Such centres are already being developed in sub-Saharan Africa, demonstrating what can be achieved with dedicated initiatives and individuals.

Examining the disparities: A cross-sectional study of socio-economic factors and food insecurity in Togo

BACKGROUND

Despite many interventions, Togo continues to have one of the highest rates of poverty and food insecurity in the sub-Saharan African region. Currently there is no systematic analysis of the factors associated with household food-insecurity in this country. This study aimed at exploring the factors associated with food insecurity in Togo.

METHODS

This was a cross-sectional study that used data from five waves (2014 to 2018) of the Gallup World Poll (GWP) for Togo. Sample size included 4754 participants, aged 15 and above. Food insecurity was measured using the Food Insecurity Experience Scale (FIES) questionnaire as per the Food and Agricultural Organization (FAO) guidelines. Our outcome variable was food insecurity, categorized as: 1) food secure (FIES score = 0-3), moderately food insecure (FIES score = 4-6), and severely food insecure (FIES score = 7-8). We did descriptive and multinomial regressions to analyze data using Stata version 16.

RESULTS

Between 2014 and 2018, the percentage of severe food insecurity fluctuated-42.81% in 2014, 37.79% in 2015, 38.98% in 2016, 45.41% in 2017, and 33.84% in 2018. Whereas that of moderate food insecurity increased from 23.55% to 27.33% except for 2016 and 2017 where the percentage increased to 32.33% and 27.46% respectively. In the logistic regression analysis, we found that respondents with lower than elementary education had a higher relative risk ratio of moderate (RRR = 1.45,95%CI = 1.22-1.72) and severe (RRR = 1.72, 95%CI = 1.46-2.02) food insecurity compared to those with secondary and higher education. Rural respondents had higher RRR of severe food insecurity (RRR = 1.37, 95%CI = 1.16-1.62) compared to those who lived in the urban areas. Compared with those in the richest wealth quintile, respondents in the poorest wealth quintile had 2.21 times higher RRR of moderate (RRR = 2.21, 95%CI = 1.69-2.87) and 3.58 times higher RRR of severe (RRR = 3.58, 95%CI = 2.81-4.55) food insecurity.

CONCLUSION

About two-thirds of participants experienced some level of food insecurity in 2018. Lower levels of education, rural residency and poorer household wealth index areas were associated with a higher risk of food insecurity. National food security programs should focus on promoting education and improving socioeconomic condition of people especially in rural areas.

Is food insecurity related to sustainable and healthy eating behaviors?

In this cross-sectional study, it was aimed to investigate the relationship between sustainable and healthy eating behaviors such as nutritional insecurity and a healthy and balanced diet, interest in regional and organic food products, consumption of seasonal food and avoidance of food waste, preference for locally produced foods, reduction of meat consumption, preference for eggs from free-range chickens, and sustainable fishery products, and consumption of low-fat food products in adults. The study included 410 adults who were reached through social media applications. Data were collected through an online questionnaire including the Descriptive Information Form, the Household Food Insecurity Access Scale (HFIAS), and the Sustainable Healthy Eating Behaviors Scale (SHEBS). The proportion of participants determined as mildly food insecure, moderately food insecure, and severely food insecure was 10.2%, 6.6%, and 7.6%, respectively. Linear regression analysis revealed that in Models 1, 2, and 3, there was a statistically significant negative association between food insecurity and the components of sustainable and healthy eating behaviors such as healthy and balanced diet (β - 0.226, p < 0.001), quality labels (β - 0.230, p < 0.001), seasonal foods, which are of avoidance of food waste (β - 0.261, p < 0.001), animal welfare (β - 0.174, p < 0.001), and fat intake (β - 0.181, p < 0.001). In conclusion, food insecurity negatively affects healthy and balanced diet behaviors, interest in regional and organic food products, seasonal food products consumption and avoidance of food waste, consumption of low-fat food products, and the choice of products such as free-range chicken eggs, and sustainable fisheries.

Food Insecurity and Associated Factors among Households in Maputo City

Food insecurity (FI) is a global concern and is one of the main causes of malnutrition in low- and middle-income countries. In Mozambique, the burden of FI and how various factors contribute to FI is not well known. This study aimed to investigate the prevalence of FI and its associated factors in southern Mozambique. Data from 1842 household heads in Maputo City were analyzed in a cross-sectional design. Food insecurity was measured using a modified version of the US Department of Agriculture Household Food Security scale, and its association with socio-demographic factors was assessed through multiple regressions. Altogether, 79% of the households were food insecure; of these, 16.6% had mild FI, 28.1% moderate and 34.4% severe FI. The study revealed that low-income households, those with less educated heads, and those engaged in informal work were significantly more prone to FI. Likewise, dietary diversity and the number of meals were also significant predictors of FI. These findings suggest the need for decent work and job creation, which calls for joint efforts from government, the private sector, and international institutions. Furthermore, these key drivers should be considered in the development of public health policies and programs designed to alleviate household FI and malnutrition in Mozambique.

Food Insecurity Is Associated with Dietary Consumption during the COVID-19 Pandemic: Data from the Korea National Health and Nutrition Examination Survey 2019-2020

Coronavirus disease 2019 (COVID-19) has become a pandemic and has affected people's dietary behaviors, including food insecurity. This study aimed to ascertain whether COVID-19 may alter the prevalence of food insecurity, and if such food security status may be associated with dietary intake among Koreans. The general characteristics, dietary intake and food security status data in the Korea National Health and Nutrition Examination Survey VIII (2019~2020) were analyzed. The prevalence of food insecurity and food group and nutrient consumption by food security status were analyzed before (2019) and after the start of the pandemic (2020). Findings suggested 4.3% of Koreans experienced food insecurity during the first year of the pandemic, yet it did not differ from that in the year before the pandemic. Before COVID-19, there was no significant difference in food group or nutrition consumption by food security status. However, in 2020, the fruit and vitamin C intake of the food-insecure group was significantly lower than that of the food-secure group. Additionally, the food-insecure group's ratio of subjects who did not meet the recommended level of fruits and the vitamin was higher compared to that of the secure group. In conclusion, COVID-19 did not affect food insecurity status, but did have a negative influence on dietary intake for food-insecure Koreans.

Examining mediators of associations of food insecurity and being bullied with suicide among in-school adolescents in Eswatini: a cross-sectional study

We examined the potential mediating roles of anxiety and loneliness on the association of concurrent food insecurity (FI) and being bullied (BB) with suicidal behavior (SB) in Eswatini, a lower-middle-income country. We used data from the Global School-based Student Health Survey (GSHS; N = 3264), which employed a two-stage cluster sampling: first, 25 schools were selected based on the proportionate probability of enrollment; second, classes were randomly selected. A self-reported 84-item GSHS questionnaire was used to collect data for students aged 13-17 years. FI was measured by requesting students to recall how often they went hungry because of a lack of food at home in the 30 days before the study. Multiple logistic regressions and binary mediation function was applied to examine mediating factors of SB. The prevalence of SB, FI, and BB among adolescents was 27.5%, 7.7%, and 30.2%, respectively. Moreover, the relationship between FI and BB with SB was partly (approximately 24%) mediated by anxiety and loneliness. Our results highlight the mediating roles of anxiety and loneliness in suicidal adolescents who experience FI and BB. In conclusion, interventions for alleviating SB in high-risk adolescents experiencing FI and BB should also be aimed at ameliorating anxiety and loneliness.

Coping Strategies for Household Food Insecurity, and Perceived Health in an Urban Community in Southern Mozambique: A Qualitative Study

In low- and middle-income countries, food insecurity (FI) is a living reality for many households, particularly among the most vulnerable groups. The burden of household FI in Mozambique and how FI and coping strategies relate to perceived health are unknown. This study investigated the lived experiences and coping strategies of food-insecure households, along with their perceived health. Altogether, 16 in-depth interviews were performed, audio-recorded, and transcribed verbatim. A qualitative content analysis was carried out and five themes emerged: lived experiences of FI, coping strategies used in situations of FI, food choices, climate change and food security, and FI and perceived health. A wide range of lived experiences and coping strategies were reported, including cooking whatever is available, skipping meals, receiving money or food from friends and relatives, eating unsafe and low-quality foods, taking on additional work, cooking least-preferred foods, and having a monotonous and less-nutritious diet. Furthermore, the participants reported emotional distress, anxiety and depression, substance use, and other negative health outcomes. Some had diagnoses of hypertension, diabetes or HIV/AIDS. The findings suggest the need for employment creation and women’s empowerment, as well as the implementation of appropriate policies and programmes to alleviate household FI.