The food, fuel, and financial crises affect the urban and rural poor disproportionately: a review of the evidence

Effects of water, energy, and food security on household well-being

Water, energy, and food insecurity are significant challenges that affect both economies and households, particularly in developing countries. These resources have an effect on households wellbeing, businesses, and all sectors of the economy, making them critical to ensuring household well-being, which is frequently measured by quintile welfare. As a result, there has been a significant increase in interest in securitizing these resources in order to mitigate their negative effects on household's wellbeing This study provides an empirical investigation of the determinants of water, energy, and food (WEF) security and the effect of water, energy, and food security on household well-being in Ghana. This study provides an empirical investigation of the determinants of water, energy, and food (WEF) security and the effect of water, energy, and food security on household well-being in Ghana. The study used a sample of 2,735 households from the Ghana Living Standard Survey (GLSS) Wave 7. We applied an instrumental variable probit, complementary log-log and ordered Probit estimation techniques for analysis. Empirical analysis reveals several important findings. Firstly, factors such as age, credit access, household location, employment status, and livestock ownership positively contribute to household water security, while remittances, water supply management, water bills, and water quantity have negative impacts. Secondly, age, marital status, household size, remittances, and livestock ownership significantly influence household energy security. Thirdly, marital status, household income, credit access, and household size are crucial determinants of household food security, with residence and region of household location exerting negative effects. Additionally, while water and energy security have a relatively lower impact on household well-being, food security emerges as a key driver in promoting household wellbeing. The study recommends that policymakers and stakeholders design and implement robust programs and interventions to sustain households' water, energy, and food supply.

The cost of living crisis - how does it impact the health and life of individuals? A survey exploring perceptions in Italy, Germany, Sweden and the United Kingdom

BACKGROUND

The Cost of Living Crisis (CoLC), a real term reduction in basic income, risks individuals being unable to afford essentials such as heat, food and clothing. The impact of the CoLC is disproportionate - with different population sub-groups more likely to be negatively affected. The objective of this survey was to evaluate the perceived impact of the CoLC on the life and health of participants across four European countries.

METHODS

A survey housing two questions to investigate the relationship between the CoLC and its perceived impact on life and health was developed. Four European countries (U.K., Sweden, Italy and Germany) took part via the YouGov platform. Logistic regression models were created for each country and question to evaluate which population characteristics were associated with a negative reported impact of the CoLC.

RESULTS

A total of 8,152 unique individuals responded between 17th March and 30th March 2023. Each country was equally represented. Those aged 36-64 were more likely to report a negative impact of the CoLC on their life and health than younger participants (p < 0.001, p = 0.02 respectively). Across all countries, females were significantly more likely to report a negative impact on their life and health, however, when analysed according to country, in Sweden females were less likely to report a negative impact (p < 0.001). Those in lower income families or who reported poor health in the preceding 12 months were significantly more likely to report a negative impact of the CoLC on their life and health. There was no difference within the participant group on the reported impact of the CoLC based on location (rural vs. urban).

CONCLUSIONS

We demonstrate the disproportionate negative impact of the CoLC on both life and health in different population subgroups. Germany and Sweden appeared to be more resilient to the effects of the CoLC, particularly for certain population subgroups. It is important to understand the differing effects of a CoLC, and to learn from successful health and economic strategies in order to create targeted policy and create a population resilient to economic shocks.

Food insecurity in Brazil by household arrangements and characteristics between 2004 and 2022

Although food insecurity presents a decreasing trend worldwide, some regions recently observed an increase in hunger levels. Such was the case in Brazil between 2014 and 2018, during and after the great Brazilian recession, and between 2020 and 2021, during the COVID-19 pandemic. This paper describes the evolution of food insecurity in Brazil between 2004 and 2022 using Brazilian National Household Sample Survey (PNAD), Brazilian Household Budget Survey (POF) and Continuous PNAD. Households were classified in 20 types of arrangements, and the most vulnerable living arrangements between 2004 and 2018 were identified by multinomial logistic models. Overall, households headed by women (single blacks, whites or in couples) with or without children were the most prone to food insecurity. As for the evolution of food insecurity in Brazil between 2018 and 2022, logistic models were applied to estimate moderate and severe food insecurity levels among the 20 household types. Additionally, effects of the emergency aid and idiosyncrasies of the COVID-19 pandemic were estimated.

"If the food is finished after my brother eats then we (girls) sleep hungry." Food insecurity and dietary diversity among slum-dwelling adolescent girls and boys in Pakistan: A mixed methods study

To explore gender differences in food insecurity (FI) and minimum dietary diversity (MDD) among adolescent girls and boys in a slum community in Karachi, we employed an explanatory sequential mixed methods study that included a survey of 391 girls and boys of 10-19 years of age and followed by semi-structured interviews of eight purposely selected food insecure adolescents. Survey data was analyzed by Cox proportional algorithm and adjusted prevalence ratios (APR) with 95% confidence intervals (CI) were estimated for associated factors of FI and thematic analysis was undertaken for qualitative work. Meta inferences for mixed methods study were drawn by joint display analysis of survey results juxtaposed to qualitative findings. Overall, FI among adolescents was prevalent (46.5%) which was not different between boys (52.7%) and girls (47.3%) (APR 0.8, (95% CI 0.6, 1.2); p-value-0.4). MDD (5/10 food groups consumed) was achieved by only 23.0% and it was also not different between boys (25.1%) and girls (20.9%) (p-value-0.3). The survey found no significant difference in FI and MDD between boys and girls however, qualitative findings provided insight into the cultural practices at mealtimes that prefer boys. Qualitative results contrasted the survey results and revealed the increased vulnerability of girls towards FI and low MDD compared to boys due to gender norms.

Food insecurity and kidney disease: a systematic review

BACKGROUND

The risk of developing and worsening chronic kidney disease (CKD) is associated with unhealthy dietary patterns. Food insecurity is defined by a limited or uncertain availability of nutritionally adequate and safe food; it is also associated with several chronic medical conditions. The aim of this systematic review is to investigate the current knowledge about the relationship between food insecurity and renal disease.

METHODS

We selected the pertinent publications by searching on the PubMed, Scopus, and the Web of Science databases, without any temporal limitations being imposed. The searching and selecting processes were carried out through pinpointed inclusion and exclusion criteria and in accordance with the Prisma statement.

RESULTS

Out of the 26,548 items that were first identified, only 9 studies were included in the systemic review. Eight out of the nine investigations were conducted in the US, and one was conducted in Iran. The studies evaluated the relationship between food insecurity and (i) kidney disease in children, (ii) kidney stones, (iii) CKD, (iv) cardiorenal syndrome, and (v) end stage renal disease (ESRD). In total, the different research groups enrolled 49,533 subjects, and food insecurity was reported to be a risk factor for hospitalization, kidney stones, CKD, ESRD, and mortality.

CONCLUSIONS

The relationship between food insecurity and renal disease has been underestimated. Food insecurity is a serious risk factor for health problems in both wealthy and poor populations; however, the true prevalence of the condition is unknown. Healthcare professionals need to take action to prevent the dramatic effect of food insecurity on CKD and on other chronic clinical conditions.

Narrative review: food as medicine across the pediatric age continuum

PURPOSE OF REVIEW

Poor diet and food insecurity contribute to the dramatic rise in diet-related chronic disease and increasing cost of healthcare. The Food as Medicine (FAM) framework describes food-based interventions designed to prevent, manage, and treat diet-related diseases. However, FAM interventions have not been widely implemented or evaluated in pediatric populations, so critical questions remain about their optimal delivery and design, efficacy, and funding opportunities. We have reviewed the recent literature and offer insights into potential funding and implementation strategies for pediatric healthcare providers.

RECENT FINDINGS

Data from adult and population-level interventions provide evidence that FAM interventions positively impact diet quality, food security, health outcomes, and healthcare utilization and cost in adults and households with children. Evidence from recent pediatric-based FAM interventions and population data from recent changes to federal nutrition programs support the use of food-based interventions to improve child diet quality, food insecurity, and potentially impact long-term health and healthcare utilization and cost.

SUMMARY

Applying the entire spectrum of evidence-based FAM interventions in pediatric settings from prenatal to adolescent stages will offer the greatest opportunity to ensure all children have access to enough healthful food so they can achieve their highest potential in life.

The politics of agricultural policy and nutrition: A case study of Malawi's Farm Input Subsidy Programme (FISP)

The concept of food and nutrition policy has broadened from simply being an aspect of health policy, to policy interventions from across a wide range of sectors, but still with potentially important impact on nutritional outcomes. This wider and more complex conceptualisation involves policy with multiple objectives and stakeholder influences. Thus, it becomes particularly important to understand the dynamics of these policy processes, including policy design and implementation. To add to this literature, we apply the Kaleidoscope Model for understanding policy change in developing country contexts to the case-study of an agricultural input subsidy (AIS) programme in Malawi, the Farm Input Subsidy Programme (FISP), exploring the dynamics of the FISP policy process including nutritional impact. Over a three-month period between 2017 and 2019 we conducted in-depth interviews with key stakeholders at national and district levels, and focus groups with people from rural districts in Malawi. We also undertook a review of literature relating to the political economy of the FISP. We analysed the data thematically, as per the domains of the Kaleidoscope Model. The analysis across the FISP policy process including policy design and implementation highlights how stakeholders' ideas, interests and influence have shaped the evolution of FISP policy including constraints to policy improvement-and the nutritional impacts of this. This approach extends the literature on the tensions, contradictions and challenges in food and nutrition policy by examining the reasons that these occur in Malawi with the FISP. We also add to the political science and policy analysis literature on policy implementation, extending the concept of veto players to include those targeted by the policy. The findings are important for consideration by policymakers and other stakeholders seeking to address malnutrition in rural, food-insecure populations in Malawi and other low-income settings.

Food inflation and child undernutrition in low and middle income countries

The 21st Century has been marked by increased volatility in food prices, with global price spikes in 2007-08, 2010-11, and again in 2021-22. The impact of food inflation on the risk of child undernutrition is not well understood, however. This study explores the potential impacts of food inflation on wasting and stunting among 1.27 million pre-school children from 44 developing countries. On average, a 5 percent increase in the real price of food increases the risk of wasting by 9 percent and severe wasting by 14 percent. These risks apply to young infants, suggesting a prenatal pathway, as well as to older children who typically experience a deterioration in diet quality in the wake of food inflation. Male children and children from poor and rural landless households are more severely impacted. Food inflation during pregnancy and the first year after birth also increases the risk of stunting for children 2-5 years of age. This evidence provides a strong rationale for interventions to prevent food inflation and mitigate its impacts on vulnerable children and their mothers.

Effects of COVID-19 on dietary behavior of urban consumers in Nairobi, Kenya

The disruptions wrought by the COVID-19 pandemic on food systems worldwide have endangered food and nutrition security for many consumers. The resource-poor, especially those in urban areas, are more susceptible to pandemic-related disturbances. This study uses primary data collected from 2,465 households located in and outside of informal settlements (slums) in Nairobi, Kenya to assess how COVID-19 and related public-health measures have influenced diets of urban consumers, their purchasing patterns and overall food security. Questions about food security and consumption behavior, including household dietary diversity scores, were used to capture the pre- and mid-pandemic situation. The data show that low-income households in the informal settlements were more affected than middle-income households. About 90% of slum households reported dire food insecurity situations, including being unable to eat preferred kinds of food, eating a limited variety of foods, consuming smaller portions than they felt they needed, and eating fewer meals in a day. With a score of four food groups out of nine, household in the informal settlements have lower dietary diversity than middle-income households, whose score is five out of nine. The consumption of nutritious foods, including fruits, vegetables, and animal products, fell among people living in slums during the pandemic. In addition to assessing dietary changes, this study highlights the factors associated with quality food consumption during the pandemic period such as household income levels and male-vs-female headed households. Our research demonstrates the need to attend to slums and vulnerable, poor consumers when enacting mitigation measures or designing and implementing policy.

Rainfall shocks, child mortality, and water infrastructure

I study the effect of rainfall shocks on child mortality at a sub-national level for a global set of developing countries. I establish that negative (positive) shocks to rainfall lead to an increase (drop) in child deaths overall. Low-income countries (LICs) and the group of countries reliant on agriculture are affected the most due to negative rainfall shocks. In LICs, the impact of negative rainfall shocks is mitigated by around 60% in districts located downstream to dams, an effect predominant among less affluent districts; in addition, the effect of rainfall fluctuations is persistent, lasting for up to three years following the shock. Results remain robust to the inclusion of relevant controls, to the consideration of relevant issues such as selective fertility and migration, and various other robustness tests.

Corona was scary, lockdown was worse: A mixed-methods study of community perceptions on COVID-19 from urban informal settlements of Mumbai

The COVID-19 pandemic has magnified the multiple vulnerabilities of people living in urban informal settlements globally. To bring community voices from such settlements to the center of COVID-19 response strategies, we undertook a study in the urban informal settlements of Dharavi, Mumbai, from September 2020-April 2021. In this study, we have examined the awareness, attitudes, reported practices, and some broader experiences of the community in Dharavi with respect to COVID-19. We have used a mixed-methods approach, that included a cross-sectional survey of 468 people, and in-depth interviews and focus group discussions with 49 people living in this area. Data was collected via a mix of phone and face-to-face interviews. We have presented here the descriptive statistics from the survey and the key themes that emerged from our qualitative data. People reported high levels of knowledge about COVID-19, with television (90%), family and friends (56%), and social media (47%) being the main sources of information. The knowledge people had, however, was not free of misconceptions and fear; people were scared of being forcefully quarantined and dying alone during the early days of COVID-19. These fears had negative repercussions in the form of patient-related stigma and hesitancy in seeking healthcare. A year into the pandemic, however, people reported a shift in attitudes from 'extreme fear to low fear' (67% reported perceiving low/no COVID risk in October 2020), contributing to a general laxity in following COVID-appropriate behaviors. Currently, the community is immensely concerned about the revival of livelihoods, that have been adversely impacted due to the lockdown in 2020 as well as the continued 'othering' of Dharavi for being a COVID hotspot. These findings suggest that urban informal settlements like Dharavi need community-level messaging that counters misinformation and denial of the outbreak; local reinforcement of COVID-appropriate behaviours; and long-term social protection measures.

Food security, poverty and household resilience to COVID-19 in Burkina Faso: Evidence from urban small traders' households

Analyses of the effects of the COVID-19 pandemic on food security of urban households and their resilience are increasingly receiving scholarly interest. In Burkina Faso, urban households whose primary activity is trade were the most immediately impacted by COVID-19 due to the closure of markets. The objective of this research was to analyze the effect of income loss due to COVID-19 on food security and poverty among urban small traders' households by considering their resilience capacity. A survey was performed on 503 households of small traders operating in 5 markets in Ouagadougou. Objective and subjective indicators of food security were calculated, as well as several indices of resilience capacity. A simple logit model and ordered logit model were used for the socioeconomic analysis. Three main results emerge. First, COVID-19 has increased the likelihood of households being food insecure due to their lower food consumption scores. Second, estimates show that COVID-19 has reduced households' incomes by increasing their likelihood of entering poverty. Finally, at all levels of analysis, households with adaptive capacity were able to adjust to the shock, but social security was not a mitigating factor. Implications in terms of economic policies are discussed.

Spatial influence on qualitative food consumption in Colombia

Spatial location is a factor that may facilitate the consumption of processed foods due to the ease of access, especially in highly urbanized, high density populations. This study presents the differences in food consumption in populations with different densities and urban and rural characteristics, and income above and below ten dollars a day. A sample of 2,130 subjects was used from 9 populations that included the Capital of Colombia, outlying medium-sized municipalities, metropolitan-area municipalities and small villages. The results confirm that processed and ultra-processed foods are consumed more in cities and urban areas than in smaller and rural populations, and that there are differences in consumption generated by income.

Assessing equity and the determinants of socio-economic impacts of COVID-19: Results from a cross-sectional survey in three counties in Kenya

Background: COVID-19 mitigation measures have major ramifications on all aspects of people’s livelihoods. Based on data collected in February 2021, we present an analysis of the socio-economic impacts of COVID-19 mitigation measures in three counties in Kenya. Methods: We conducted a cross-sectional phone-based survey in three counties in Kenya to assess the level of disruption across seven domains: income, food insecurity, schooling, domestic tension/violence, communal violence, mental health, and decision-making. An overall disruption index was computed from the seven domains using principal component analysis. We used a linear regression model to examine the determinants of vulnerability to disruptions as measured by the index. We used concentration curves and indices to assess inequality in the disruption domains and the overall disruption index. Results: The level of disruption in income was the highest (74%), while the level of disruption for domestic tension/violence was the lowest (30%). Factors associated with increased vulnerability to the overall disruption index included: older age, being married, belonging in the lowest socio-economic tertile and receiving COVID-19 related assistance. The concentration curves showed that all the seven domains of disruption were disproportionately concentrated among households in the lowest socio-economic tertile, a finding that was supported by the concentration index of the overall disruption index (CI = - 0.022; p = 0.074). Conclusion: The COVID-19 mitigation measures resulted in unintended socio-economic effects that unfairly affected certain vulnerable groups such as those in the lowest socio-economic group and the elderly. Measures to protect households against the adverse socio-economic effects of the pandemic should be scaled up and targeted to the most vulnerable, with attention to the constantly evolving nature of the pandemic.

Viewpoint: High-frequency phone surveys on COVID-19: Good practices, open questions

Following the onset of the COVID-19 pandemic, face-to-face survey data collection efforts came to a halt due to lockdowns, limitations on mobility and social distancing requirements. What followed was a surge in phone surveys to fulfill rapidly evolving needs for timely and policy-relevant microdata for understanding the socioeconomic impacts of and responses to the pandemic. Even as the face-to-face survey data collection efforts are resuming in different parts of the world with COVID-19 safety protocols, the rapidly-acquired experience with phone surveys on the part of national statistical offices and survey practitioners in low- and middle-income countries appears to have formed the foundation for phone surveys to be more commonly implemented in the post-pandemic era, in response to other shocks and as complementary efforts to face-to-face surveys. Informed by the practical experience with the high-frequency phone surveys that have been implemented with support from the World Bank Living Standards Measurement Study (LSMS) to monitor the socioeconomic impacts of the COVID-19 pandemic, this paper provides an overview of options for the design and implementation of phone surveys to collect representative data from households and individuals. Further, the discussion identifies the requirements for phone surveys to be a mainstay in the toolkits of national statistical offices and the directions for future research on the design and implementation of phone surveys.

Blue food demand across geographic and temporal scales

Numerous studies have focused on the need to expand production of 'blue foods', defined as aquatic foods captured or cultivated in marine and freshwater systems, to meet rising population- and income-driven demand. Here we analyze the roles of economic, demographic, and geographic factors and preferences in shaping blue food demand, using secondary data from FAO and The World Bank, parameters from published models, and case studies at national to sub-national scales. Our results show a weak cross-sectional relationship between per capita income and consumption globally when using an aggregate fish metric. Disaggregation by fish species group reveals distinct geographic patterns; for example, high consumption of freshwater fish in China and pelagic fish in Ghana and Peru where these fish are widely available, affordable, and traditionally eaten. We project a near doubling of global fish demand by mid-century assuming continued growth in aquaculture production and constant real prices for fish. Our study concludes that nutritional and environmental consequences of rising demand will depend on substitution among fish groups and other animal source foods in national diets.

Gendered economic, social and health effects of the COVID-19 pandemic and mitigation policies in Kenya: evidence from a prospective cohort survey in Nairobi informal settlements

OBJECTIVES

COVID-19 may spread rapidly in densely populated urban informal settlements. Kenya swiftly implemented mitigation policies; we assess the economic, social and health-related harm disproportionately impacting women.

DESIGN

A prospective longitudinal cohort study with repeated mobile phone surveys in April, May and June 2020.

PARTICIPANTS AND SETTING

2009 households across five informal settlements in Nairobi, sampled from two previously interviewed cohorts.

PRIMARY AND SECONDARY OUTCOME MEASURES

Outcomes include food insecurity, risk of household violence and forgoing necessary health services due to the pandemic. Gender-stratified linear probability regression models were constructed to determine the factors associated with these outcomes.

RESULTS

By May, more women than men reported adverse effects of COVID-19 mitigation policies on their lives. Women were 6 percentage points more likely to skip a meal versus men (coefficient: 0.055; 95% CI 0.016 to 0.094), and those who had completely lost their income were 15 percentage points more likely versus those employed (coefficient: 0.154; 95% CI 0.125 to 0.184) to skip a meal. Compared with men, women were 8 percentage points more likely to report increased risk of household violence (coefficient: 0.079; 95% CI 0.028 to 0.130) and 6 percentage points more likely to forgo necessary healthcare (coefficient: 0.056; 95% CI 0.037 to 0.076).

CONCLUSIONS

The pandemic rapidly and disproportionately impacted the lives of women. As Kenya reopens, policymakers must deploy assistance to ensure women in urban informal settlements are able to return to work, and get healthcare and services they need to not lose progress on gender equity made to date.

Food Security and the Dynamics of Wheat and Maize Value Chains in Africa and Asia

There is an ongoing debate about how best to feed the growing world population in the long run and associated implications for research and development. Some call for a new Green Revolution to secure the supply of staple foods, whereas others emphasize the importance of diversifying and improving people's diets. We aim to contribute to this debate by reviewing the case of wheat and maize value chains and their contribution to food security in Africa and Asia. We first identify drivers transforming food systems. We then apply these to the cereal value chains and disentangle their effects on food security. We thereby add to the three strands in the literature around production, consumption, and food system transformation and point to different research needs and recommendations for the future. The review highlights: (1) Wheat and maize production will be increasingly impaired by ecological drivers such as land degradation, water scarcity and climate change. (2) There are promising innovations to increase and maintain productivity, but constraints in adopting these innovations have to be overcome (i.e., access to seeds, finance, and education/training). (3) The drivers affect all four dimensions of food security, but first and foremost they determine the availability and stability of maize and wheat. This indirectly also influences the economic and physical access of people to maize and wheat. (4) Research tends to focus on improving the productivity and sustainability of wheat and maize farming which is largely interlinked with the availability dimension of food security. (5) The stability and utilization dimension of food security merits continued yet increased support. First, to address climate change and implications for biotic and abiotic stresses. Second, to promote healthier diets and enable the equitable transformation of food systems.

Climate change and household welfare in sub-Saharan Africa: empirical evidence from Swaziland

The fifth assessment report of the Intergovernmental Panel on Climate Change and several studies suggest that climate change is expected to increase food insecurity and poverty in many parts of the world. In this paper, we adopt a microeconometric approach to empirically estimate the impact of climate change-induced hikes in cereal prices on household welfare in Swaziland (also Kingdom of Eswatini). We do so first by econometrically estimating expenditure and price elasticities of five food groups consumed by households in Swaziland using the Almost Ideal Demand System (AIDS), based on data from the 2009/2010 Swaziland Household Income and Expenditure Survey. Second, we use the estimated expenditure and compensated elasticities from the AIDS model, food shares from the household survey, and food price projections developed by the International Food Policy Research Institute (IFPRI) to estimate the proportionate increase in income required to maintain the level of household utility that would have prevailed absent an increase in food prices. Our results show increases in cereal prices due to climate change are expected to double extreme poverty in urban areas and increase poverty in rural areas of the country to staggering levels - between 71 and 75%, compared to 63% before the price changes. Income transfers of between 17.5 and 25.4% of pre-change expenditures are needed to avoid the welfare losses.

Prevalence of Underweight and Its Associated Factors among Reproductive Age Group Women in Ethiopia: Analysis of the 2016 Ethiopian Demographic and Health Survey Data

Background

Underweight is defined as being below the healthy weight range. Underweight in reproductive age group women not only affects women but also increases the risk of an intergenerational cycle of malnutrition and child mortality. Various factors are linked with underweight among women. However, studies on the prevalence of underweight and its associated factors among women are limited in Ethiopia. Hence, this study aimed to assess the prevalence of underweight and its associated factors among reproductive age group women in Ethiopia.

Methods

For this study, data were drawn from the 2016 Ethiopian demographic and health survey (EDHS). From the total, 15,683 women participants of the 2016 EDHS; a subsample of 2,848 participants aged 15-49 years who had a complete response to all variables of interest were selected and utilized for analysis. Data were analyzed using SPSS version 20 software program. Pearson's chi-squared test was used to assess the frequency distribution of underweight and is presented with different sociodemographic characteristics. Logistic regression models were applied for analysis. A two-sided p value of less than 0.05 was used to declare a statistically significant association between the independent variables and underweight among women.

Results

The prevalence of underweight among reproductive age group women in Ethiopia was 17.6%. The majority, 78.3% of underweight women, were rural dwellers. The odds of being underweight was higher among the young aged women, among those residing in rural areas, in those with higher educational status, and in those who have one or more children. On the other hand, the odds of underweight among respondents living in Benishangul, SNNPR, and Addis Ababa were less compared to those living in Dire Dawa. Similarly, the odds of underweight among participants with a higher level of husband or partner educational status and among those who chew Khat were less compared to their counterparts.

Conclusion

Underweight among reproductive age group women in Ethiopia is still a major public health problem, particularly among rural dwellers. Underweight was significantly associated with different sociodemographic variables. Hence, context-based awareness creation programs need to be designed on the prevention methods of underweight in Ethiopia, giving especial emphasis to those residing in rural areas.

What Is the Role of Civil Society in Multisectoral Nutrition Governance Systems? A Multicountry Review

Background:

Solutions to create enabling nutrition environments must come from within communities and involve multiple sectors. As vital actors in community mobilization, rights-based advocacy, and accountable public institutions, civil society organizations (CSOs) can help ensure nutrition programs and policies represent and reach all community members to achieve impact.

Objectives:

To review attributes of civic engagement in multisectoral nutrition governance systems and to provide recommendations to increase CSO participation.

Methods:

We reviewed 7 national case studies of Civil Society Networks involved with the Scaling Up Nutrition movement and characterized 6 functional attributes of CSOs in multisectoral nutrition governance: identify needs of all community members, mobilize and build civic capacity, advocate for political commitments, inform program design and evaluation, ensure accountability mechanisms in public institutions, and report challenges and successes using broad media campaigns.

Results:

All studies described government agencies involved with multisectoral nutrition governance systems, at national and subnational levels; however, there was limited evidence of subnational platforms for CSO engagement. Although countries increased investments in public institutions for nutrition, it was unclear whether nutrition service quality improved and none reported corresponding investments in civil society.

Conclusion:

Our characterization identifies strategies to engage CSOs in multisectoral nutrition governance at multiple ecological levels. We hope future adaptation and application of this characterization will increase community ownership and diverse representation in nutrition governance systems. Both of these are key to enabling national and international entities to address malnutrition’s underlying determinants in ways that align with local contexts, values, and systems change processes.

Individual and household influences on food security and dietary diversity in seven Dominican batey communities

BACKGROUND

To identify individual and household characteristics associated with food security and dietary diversity in seven Haitian-Dominican bateyes.

METHODS

A cross-sectional sample of 667 households were surveyed. Novel household food security scores were calculated from components of the Household Food Insecurity Assessment Scale, while the Food and Agricultural Organization's Household Dietary Diversity Score was utilized to calculate individual dietary diversity scores. Multivariable analyses were performed using ordinal logistic regression models to estimate the association between these scores and the covariate variables. Secondary dietary diversity analyses were performed after removing non-nutritious food groups.

RESULTS

Food security was significantly associated with being above the poverty line (OR 3.14, 95% CI 1.92 to 5.14), living in a rural batey (OR 1.44, 95% CI 1.02 to 2.03), receiving gifts and/or donations (OR 1.76, 95% CI 1.03 to 3.00) and having a salaried job (i.e., not being paid hourly; OR 1.67, 95% CI 1.05 to 2.64). Dietary diversity was significantly associated with living in a semi-urban batey (OR 1.70, 95% CI 1.26 to 2.30), living with a partner (OR 1.47, 95% CI 1.08 to 2.00), growing at least some of one's own food (OR 1.62, 95% CI 1.17 to 2.23), and receiving gifts and/or donations (OR 1.72, 95% CI 1.08 to 2.73).

CONCLUSIONS

Food insecurity and low dietary diversity are highly prevalent in Haitian-Dominican bateyes. The inclusion of sweets and non-milk beverages in dietary diversity calculations appear to skew scores towards higher levels of diversity, despite limited nutritional gains.

Predictors of complementary feeding practices in Afghanistan: Analysis of the 2015 Demographic and Health Survey

Despite improvements over the past 20 years, high burdens of child mortality and undernutrition still coexist in Afghanistan. Global evidence indicates that complementary feeding (CF) practices predict child survival and nutritional status. Our study aims to describe CF practices in Afghanistan and to discern underlying predictors of CF by analysing data from Afghanistan's 2015 Demographic and Healthy Survey. Multilevel models were constructed comprising potential predictors at individual, household, and community levels and four CF indicators: timely introduction of solid, semi-solid, or soft foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD) among breastfed children. INTRO prevalence among children aged 6-8 months was 56%, whereas the prevalence of MMF, MDD, and MAD among children aged 6-23 months was 55%, 23%, and 18%, respectively. Of the seven food groups considered, four were consumed by 20% or fewer children: eggs (20%), legumes and nuts (18%), fruits and vegetables (15%), and flesh foods (14%). Increasing child age and more antenatal care visits were significantly and positively associated with greater odds of meeting all CF indicators. Lower household wealth and lower community-level access to health care services were associated with lower odds of MDD and MAD. Disparities in achieving recommended CF practices were observed by region. CF practices in Afghanistan are poor and significant socioeconomic inequities in CF are observed across the country. Our study calls for urgent policy and programme attention to improve complementary feeding practices as an intrinsic part of the national development agenda.

Consumption of Traditional and Indigenous Foods and Their Contribution to Nutrient Intake among Children and Women in Botswana

In Botswana, traditional diets are gradually being replaced by westernized diets high in energy-dense and nutrient- poor, while micro nutrient deficiencies among the population remain. We determined the consumption of traditional and indigenous foods (TIF) and their contribution to nutrient intake among children and women in Botswana. TIF accounted for relatively high percentages of energy intake in children (41%) and women (36%) respectively. The mean intake of vitamin A in children and vitamin A and zinc in women was high from TIF compared to non-TIF. Research attention to determining the full potential of TIF in contributing to nutrition and health is warranted.

Social Norms Influencing the Local Food Environment as Perceived by Residents and Food Traders: The Heart Healthy Hoods Project

Exploring subjective elements of the food environment remains key to understand why and how residents purchase food. Our aim was to explore and describe the social norms relating to the local food environment and food purchasing behaviors, as perceived by residents and food traders in Madrid, Spain. This qualitative study took place in a middle socioeconomic status neighborhood of Madrid between January 2015 and May 2016. We conducted 35 semi-structured interviews. We used stratified purposive sampling to recruit residents, neighborhood workers (N = 20) and food traders (N = 15) representing different levels of involvement with food purchasing behaviors. We analyzed these data using an interpretative phenomenological analysis approach. Participants highlighted social aspects of the food environment in relation to food purchasing behaviors. First, interpersonal and relational food environment elements were emphasized, including trust and tradition. Participants also identified generational demographic trends in relation to changes in the way residents purchased food: the new pace of life and the lack of time to buy fresh food and to cook at home. All these elements were influenced by the economic crisis. Food environment interventions aiming to improve food purchasing behaviors and residents' diets should consider intermediate social aspects of the food environment like trust and tradition and the fast pace of life of younger generations.

The burden on public emergency departments during the economic crisis years in Greece: a two-center comparative study

OBJECTIVES

The effects of the Greek economic crisis on the emergency departments (EDs) of public hospitals have not been evaluated. The study aims to evaluate the burden of the financial crisis on public hospital's EDs.

STUDY DESIGN

The present study is a retrospective two-center comparative study.

METHODS

ED visits, related admissions per year, and the admissions/visits ratio at two public Greek hospitals, the Sismanogleio of Athens (SHA) and the University Hospital of Crete (UHC), from 2008 to 2016 were retrospectively studied. A linear model was fitted for each variable, and the slope values of the linear equations were calculated and compared between the two institutions.

RESULTS

ED visits of the UHC exhibited 8.9% increase during the study period, whereas related admissions and admissions/visits ratio increased by 23.4% and 12.5%, respectively. ED visits at the SHA exhibited 5.4% increase, whereas related admissions showed 6% decrease and the admissions/visits ratio was decreased by 8%. Significant differences between the rates of admissions (P < 0.001) and admissions/visits ratio (P = 0.001) among the two hospitals were observed.

CONCLUSIONS

Both institutions showed similarly increased ED visits. However, the UHC serving mainly rural, but also suburban and urban population, exhibited different changes regarding admissions and admissions/visits ratio compared with the SHA serving mainly an urban and suburban one, reflecting the way the crisis affected each social group. Depression has amplified the Greek National Health System structural problems and exposed the problematic urban primary health care. Improvement of primary urban health care, autonomy of EDs, and establishment of emergency medicine as independent specialty in Greece could serve better patients seeking care in public hospitals' EDs.

Spatial Disparity in Food Environment and Household Economic Resources Related to Food Insecurity in Rural Korean Households with Older Adults

Different contextual factors of a household and a community, such as access to resources and transportation, may influence the level of food insecurity. The objective of this study was to identify how food environmental factors and economic resources were related to food insecurity in Korean older adults residing in different contexts of rural areas. Face-to-face interviews with 248 older adults residing in land (n = 149) and mountain (n = 99) rural areas were performed. In both areas, risk of food insecurity was increased for households with limited community food accessibility measured by having difficulties in food purchasing due to food stores far from home. There were discrepancies in factors related to increased risks of food insecurity between households in land and mountain areas. The experience of reducing food expenditure resulting from burden of heating costs during the winter in households in a mountain area whereas the percent proportion of housing fee and household cook’s physical disability in households residing in the land area were found to be factors associated with increased risks of food insecurity. For households residing in mountain areas, the risk of food insecurity was decreased when economic resources measured by average monthly income for the last one year was increased and there was farming or home gardening activity. Such spatial disparity might affect household food insecurity in rural areas. In addition, food environmental factors and economic resources may affect household food insecurity differently according to the diverse contexts of rural areas. Better understanding of spatial challenges in food insecurity faced by seniors in a large rural area would help prepare programs or policy change to strengthen and improve their food environments.

A Global-Level Model of the Potential Impacts of Climate Change on Child Stunting via Income and Food Price in 2030

BACKGROUND

In 2016, 23% of children (155 million) aged [Formula: see text] were stunted. Global-level modeling has consistently found climate change impacts on food production are likely to impair progress on reducing undernutrition.

OBJECTIVES

We adopt a new perspective, assessing how climate change may affect child stunting via its impacts on two interacting socioeconomic drivers: incomes of the poorest 20% of populations (due to climate impacts on crop production, health, labor productivity, and disasters) and food prices.

METHODS

We developed a statistical model to project moderate and severe stunting in children aged [Formula: see text] at the national level in 2030 under low and high climate change scenarios combined with poverty and prosperity scenarios in 44 countries.

RESULTS

We estimated that in the absence of climate change, 110 million children aged [Formula: see text] would be stunted in 2030 under the poverty scenario in comparison with 83 million under the prosperity scenario. Estimates of climate change-attributable stunting ranged from 570,000 under the prosperity/low climate change scenario to [Formula: see text] under the poverty/high climate change scenario. The projected impact of climate change on stunting was greater in rural vs. urban areas under both socioeconomic scenarios. In countries with lower incomes and relatively high food prices, we projected that rising prices would tend to increase stunting, whereas in countries with higher incomes and relatively low food prices, rising prices would tend to decrease stunting. These findings suggest that food prices that provide decent incomes to farmers alongside high employment with living wages will reduce undernutrition and vulnerability to climate change.

CONCLUSIONS

Shifting the focus from food production to interactions between incomes and food price provides new insights. Futures that protect health should consider not just availability, accessibility, and quality of food, but also the incomes generated by those producing the food. https://doi.org/10.1289/EHP2916.

What Influences Urban Mothers' Decisions on What to Feed Their Children Aged Under Five-The Case of Addis Ababa, Ethiopia

Mothers carry the prime responsibility for childcare and feeding in low-income countries. Understanding their experiences in providing food for their children is paramount to informing efforts to improve the nutritional status of children. Such information is lacking in Sub-Saharan Africa. To understand what influences urban mothers' food acquisition and their motivations for selecting food for their children, 36 in-depth interviews were carried out with mothers having children under five years of age. Interviews were conducted in the local language, audio-recorded, transcribed, and translated into English. Data were analyzed using thematic analysis which led to the identification of four major themes: mothers give-in to a child-driven diet; quick-fix versus the privilege of planning; keen awareness on food safety, nutrition, and diet diversity; and social, familial, and cultural influences. The findings indicate that child feeding practices are influenced by interlinked social and environmental factors. Hence, nutrition education campaigns should focus on targeting not only families but also their children. Attention should also be given to food safety regulations, as well as to the much-needed support of mothers who are struggling to ensure their children's survival in low-income countries.

Development and validation of the Social Determinants of Health Questionnaire and implications for "Promoting Food Security and Healthy Lifestyles" in a complex urban food ecosystem

In this case study, a formative evaluation was conducted for "Promoting Food Security and Healthy Lifestyles" pilot intervention at a Community-Based Organization in a marginalized neighborhood in Bedford-Stuyvesant in New York City. Utilizing a rigorous, theoretically grounded, and mixed methods approach, a survey was designed to encompass the social, environmental, and behavioral determinants of food insecurity and health promotion for Emergency Food Assistance System users. The final survey tested well for face and content validity and meets the criteria for internal reliability. This will aid to develop culturally tailored programs and policies for low-income, food insecure populations facing social and health disparities in this large urban neighborhood.

How extractive industries affect health: Political economy underpinnings and pathways

A systematic and theoretically informed analysis of how extractive industries affect health outcomes and health inequities is overdue. Informed by the work of Saskia Sassen on "logics of extraction," we adopt an expansive definition of extractive industries to include (for example) large-scale foreign acquisitions of agricultural land for export production. To ground our analysis in concrete place-based evidence, we begin with a brief review of four case examples of major extractive activities. We then analyze the political economy of extractivism, focusing on the societal structures, processes, and relationships of power that drive and enable extraction. Next, we examine how this global order shapes and interacts with politics, institutions, and policies at the state/national level contextualizing extractive activity. Having provided necessary context, we posit a set of pathways that link the global political economy and national politics and institutional practices surrounding extraction to health outcomes and their distribution. These pathways involve both direct health effects, such as toxic work and environmental exposures and assassination of activists, and indirect effects, including sustained impoverishment, water insecurity, and stress-related ailments. We conclude with some reflections on the need for future research on the health and health equity implications of the global extractive order.

Food (In)Security in Rapidly Urbanising, Low-Income Contexts

Urbanisation in low and middle-income nations presents both opportunities and immense challenges. As urban centres grow rapidly, inadequate housing and the lack of basic infrastructure and services affect a large and growing proportion of their population. There is also a growing body of evidence on urban poverty and its links with environmental hazards. There is, however, limited knowledge of how these challenges affect the ways in which poor urban residents gain access to food and secure healthy and nutritious diets. With some important exceptions, current discussions on food security continue to focus on production, with limited attention to consumption. Moreover, urban consumers are typically treated as a homogenous group and access to food markets is assumed to be sufficient. This paper describes how, for the urban poor in low and middle-income countries, food affordability and utilisation are shaped by the income and non-income dimensions of poverty that include the urban space.

Complementary Feeding Practices of Mothers and Their Perceived Impacts on Young Children: Findings from KEEA District of Ghana

Objective Appropriate and timely complementary feeding practices are fundamental to a child's growth, health, and development during the first 2 years of life. This study aimed to understand (1) Ghanaian mother's complementary feeding practices, and (2) their perceived and observed impacts of complementary feeding on their children. Methods Ghanaian mothers with children 4-24 months of age were recruited from four communities in the Komenda Edina Eguafo Abrem district in the Central Region of Ghana (n = 99). A qualitative methodological approach with focus group interview discussions was used. Eleven focus group interviews were conducted, and were audio recorded and transcribed. The audio transcriptions were coded and analyzed into pertinent themes, meta-themes, and theoretical concepts. Results Over 80 % (85) of mothers reported poor knowledge about the effects of complementary feeding on their children and 45 % (45) of the children were undernourished, indicating inappropriate complementary feeding practices. Some mothers held misconceptions about the effect of food on children's health. Four overarching themes were identified: (1) mothers' background knowledge about food, child health and growth outcomes, (2) mothers' motivation in feeding their children, (3) barriers to feeding, (4) foods mothers offered their children. Conclusion for Practice Nutrition education on complementary feeding is needed for Ghanaian mothers. Health facilities and community outreach programs could be a venue to provide education to mothers regarding infant and young child feeding practices in Ghana.

Food Insecurity in Singapore: The Communicative (Dis)Value of the Lived Experiences of the Poor

Food insecurity is a form of health disparity that results in adverse health outcomes, particularly among disenfranchised and vulnerable populations. Using the culture-centered approach, this article engages with issues of food insecurity, health, and poverty among the low-income community in Singapore. Through 30 in-depth interviews, the narratives of the food insecure are privileged in articulating their lived experiences of food insecurity and in co-constructing meanings of health informed by their sociocultural context, in a space that typically renders them invisible. Arguing that poverty is communicatively sustained through the erasure of subaltern voices from mainstream discourses and policy platforms, we ask the research question: What are the meanings of food insecurity in the everyday experiences of health among the poor in Singapore? Our findings demonstrate that the meanings of health among the food insecure are constituted in culture and materiality, structurally constrained, and ultimately complexify their negotiations of health and health decision making.

Keystones affecting sub-Saharan Africa's prospects for achieving food security through balanced diets

Socio-economic dynamics determine the transition from diets characterized by the risk of famine, to those characterized by the risk of diet-related non-communicable disease (DR-NCD). This transition is of particular concern in Sub-Saharan Africa (SSA) in which key socio-economic interactions that influence diet include economic growth and rapid urbanization; inequality and a growing middle class; and obesogenic food environments and an increasing prevalence of DR-NCD. In each case, countries in SSA are among those experiencing the most rapid change in the world. These interactions, styled as 'keystones', affect the functioning of other components of the food system and the diets that result. Data from the wealthiest quartile of countries in SSA suggest that these keystones may be increasing the risk of DR-NCD, widening inequalities in health outcomes due to unbalanced diets. To address this, new consumer and government capabilities that address these keystones are required. Food sensitive urban planning, supporting food literacy and fiscal management of consumption are examples.

Coping strategies related to food insecurity at the household level in Bangladesh

Introduction

In connection to food insecurity, adaptation of new techniques or alteration of regular behavior is executed that translates to coping strategies. This paper has used data from food security and nutrition surveillance project (FSNSP), which collects information from a nationally representative sample in Bangladesh on coping behaviors associated with household food insecurity. To complement the current understanding of different coping strategies implemented by the Bangladeshi households, the objective of this paper has been set to examine the demographic and socio-economic characteristics of the food insecure households which define their propensity towards adaptation of different types of coping strategies.

Methodology

FSNSP follows a repeated cross-sectional survey design. Information of 23,374 food insecure households available from February 2011 to November 2013 was selected for the analyses. Coping strategies were categorized as financial, food compromised and both. Multinomial logistic regression was employed to draw inference.

Results

Majority of the households were significantly more inclined to adopt both multiple financial and food compromisation coping strategies. Post-aman season, educational status of the household head and household women, occupation of the household’s main earner, household income, food insecurity status, asset, size and possession of agricultural land were found to be independently and significantly associated with adaptation of both financial and food compromisation coping strategies relative to only financial coping strategies. The relative risk ratio of adopting food compromisation coping relative to financial coping strategies when compared to mildly food insecure households, was 4.54 times higher for households with moderate food insecurity but 0.3 times lower when the households were severely food insecure. Whereas, households were 8.04 times and 4.98 times more likely to adopt both food compromisation and financial relative to only financial coping strategies if moderately and severely food insecure respectively when compared to being mildly food insecure.

Conclusion

Households suffering from moderate and severe food insecurity, are more likely to adopt both financial and food compromisation coping strategies.

Effects of food price shocks on child malnutrition: The Mozambican experience 2008/2009

A propitiously timed household survey carried out in Mozambique over the period 2008/2009 permits us to study the relationship between shifts in food prices and child nutrition status in a low income setting. We focus on weight-for-height and weight-for-age in different survey quarters characterized by very different food price inflation rates. Using propensity score matching techniques, we find that these nutrition measures, which are sensitive in the short run, improve significantly in the fourth quarter of the survey, when the inflation rate for basic food products is low, compared to the first semester or three quarters, when food price inflation was generally high. The prevalence of underweight, in particular, falls by about 40 percent. We conclude that the best available evidence points to food penury, driven by the food and fuel price crisis combined with a short agricultural production year, as substantially increasing malnutrition amongst under-five children in Mozambique.

Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels: findings from the Prospective Urban Rural Epidemiology (PURE) study

BACKGROUND

Several international guidelines recommend the consumption of two servings of fruits and three servings of vegetables per day, but their intake is thought to be low worldwide. We aimed to determine the extent to which such low intake is related to availability and affordability.

METHODS

We assessed fruit and vegetable consumption using data from country-specific, validated semi-quantitative food frequency questionnaires in the Prospective Urban Rural Epidemiology (PURE) study, which enrolled participants from communities in 18 countries between Jan 1, 2003, and Dec 31, 2013. We documented household income data from participants in these communities; we also recorded the diversity and non-sale prices of fruits and vegetables from grocery stores and market places between Jan 1, 2009, and Dec 31, 2013. We determined the cost of fruits and vegetables relative to income per household member. Linear random effects models, adjusting for the clustering of households within communities, were used to assess mean fruit and vegetable intake by their relative cost.

FINDINGS

Of 143 305 participants who reported plausible energy intake in the food frequency questionnaire, mean fruit and vegetable intake was 3·76 servings (95% CI 3·66-3·86) per day. Mean daily consumption was 2·14 servings (1·93-2·36) in low-income countries (LICs), 3·17 servings (2·99-3·35) in lower-middle-income countries (LMICs), 4·31 servings (4·09-4·53) in upper-middle-income countries (UMICs), and 5·42 servings (5·13-5·71) in high-income countries (HICs). In 130 402 participants who had household income data available, the cost of two servings of fruits and three servings of vegetables per day per individual accounted for 51·97% (95% CI 46·06-57·88) of household income in LICs, 18·10% (14·53-21·68) in LMICs, 15·87% (11·51-20·23) in UMICs, and 1·85% (-3·90 to 7·59) in HICs (ptrend=0·0001). In all regions, a higher percentage of income to meet the guidelines was required in rural areas than in urban areas (p<0·0001 for each pairwise comparison). Fruit and vegetable consumption among individuals decreased as the relative cost increased (ptrend=0·00040).

INTERPRETATION

The consumption of fruit and vegetables is low worldwide, particularly in LICs, and this is associated with low affordability. Policies worldwide should enhance the availability and affordability of fruits and vegetables.

FUNDING

Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries.

Forests, Trees, and Micronutrient-Rich Food Consumption in Indonesia

Micronutrient deficiency remains a serious problem in Indonesia with approximately 100 million people, or 40% of the population, suffering from one or more micronutrient deficiencies. In rural areas with poor market access, forests and trees may provide an essential source of nutritious food. This is especially important to understand at a time when forests and other tree-based systems in Indonesia are being lost at unprecedented rates. We use food consumption data from the 2003 Indonesia Demographic Health Survey for children between the ages of one and five years and data on vegetation cover from the Indonesian Ministry of Forestry to examine whether there is a relationship between different tree-dominated land classes and consumption of micronutrient-rich foods across the archipelago. We run our models on the aggregate sample which includes over 3000 observations from 25 provinces across Indonesia as well as on sub-samples from different provinces chosen to represent the different land classes. The results show that different tree-dominated land classes were associated with the dietary quality of people living within them in the provinces where they were dominant. Areas of swidden/agroforestry, natural forest, timber and agricultural tree crop plantations were all associated with more frequent consumption of food groups rich in micronutrients in the areas where these were important land classes. The swidden/agroforestry land class was the landscape associated with more frequent consumption of the largest number of micronutrient rich food groups. Further research needs to be done to establish what the mechanisms are that underlie these associations. Swidden cultivation in is often viewed as a backward practice that is an impediment to food security in Indonesia and destructive of the environment. If further research corroborates that swidden farming actually results in better nutrition than the practices that replace it, Indonesian policy makers may need to reconsider their views on this land use.

Quantifying the impact of rising food prices on child mortality in India: a cross-district statistical analysis of the District Level Household Survey

BACKGROUND

Rates of child malnutrition and mortality in India remain high. We tested the hypothesis that rising food prices are contributing to India's slow progress in improving childhood survival.

METHODS

Using rounds 2 and 3 (2002-08) of the Indian District Level Household Survey, we calculated neonatal, infant and under-five mortality rates in 364 districts, and merged these with district-level food price data from the National Sample Survey Office. Multivariate models were estimated, stratified into 27 less deprived states and territories and 8 deprived states ('Empowered Action Groups').

RESULTS

Between 2002 and 2008, the real price of food in India rose by 11.7%. A 1% increase in total food prices was associated with a 0.49% increase in neonatal (95% confidence interval (CI): 0.13% to 0.85%), but not infant or under-five mortality rates. Disaggregating by type of food and level of deprivation, in the eight deprived states, we found an elevation in neonatal mortality rates of 0.33% for each 1% increase in the price of meat (95% CI: 0.06% to 0.60%) and 0.10% for a 1% increase in dairy (95% CI: 0.01% to 0.20%). We also detected an adverse association of the price of dairy with infant (b = 0.09%; 95% CI: 0.01% to 0.16%) and under-five mortality rates (b = 0.10%; 95% CI: 0.03% to 0.17%). These associations were not detected in less deprived states and territories.

CONCLUSIONS

Rising food prices, particularly of high-protein meat and dairy products, were associated with worse child mortality outcomes. These adverse associations were concentrated in the most deprived states.

A Systematic Review of the Effect of Remittances on Diet and Nutrition

BACKGROUND

Remittance income is rising rapidly in most low- and middle-income countries. Despite nutrition being a key policy priority for health and development, we know little about the effect of remittance income on diets and nutrition.

OBJECTIVE

To identify the effect of remittance income on nutrition.

METHOD

Systematic review of English-language studies providing information on the impact of remittances on food consumption, food expenditure, or measures of nutritional status, using a narrative synthesis approach for analysis. We searched the English-language published and gray literature using key words "remittances," "nutrition," and "diets."

RESULTS

This systematic review identified 20 studies that examined the effect of remittance income on food consumption, dietary intake, and nutritional status, 2 of which were qualitative studies. Overall, the quality of the studies was weak to moderate. These studies show that remittances can increase access to (purchased) food and may have a consumption smoothing effect, reducing households' vulnerability and leading to improved food security and reductions in underweight. However, remittances appear to have little effect on markers of chronic undernourishment. The studies also suggest that the extra income from remittances may compound trends toward purchasing less healthy (nontraditional) foods that are associated with the nutrition transition.

CONCLUSION

There is an urgent need for further research on the effect of remittances on nutrition and diets, with remittance income forecast to rise rapidly into the future. Programs to ensure that those households receiving remittances move beyond just meeting sufficient calories and improve dietary quality could create nutritional benefits.

Overweight and obesity decreased in Greek schoolchildren from 2009 to 2012 during the early phase of the economic crisis

AIM

We examined the weight status of Greek schoolchildren from November 2009 to May 2012, shortly before, and during the early years, of the Greek economic crisis.

METHODS

This was a mixed longitudinal study that formed part of the West Attica Growth Study and followed children at the ages of 6-7, 9-10, 12-13 and 15-16 years every six months for 2.5 years. Each child's height and weight were measured and their body mass index calculated. We were able to determine the weight status of 1327 children (53% boys) based on their first and last measurements. Overweight, obesity and underweight were defined using the International Obesity Task Force criteria.

RESULTS

During the 2.5-year study period, there was a decrease in the total prevalence of overweight and obesity, which reached a statistical significance for both sexes. It decreased from 43% to 37.3% (p = 0.02) in boys and from 33.4% to 26.9% (p = 0.0056) in girls. There was also a statistically significant increase in normal weight children and a slight but insignificant increase in underweight children of both sexes.

CONCLUSION

During the initial years of the Greek economic crisis, there was a statistically significant reduction in overweight and obesity in children from six to 16 years of age.

What Happens to Patterns of Food Consumption when Food Prices Change? Evidence from A Systematic Review and Meta-Analysis of Food Price Elasticities Globally

Recent years have seen considerable interest in examining the impact of food prices on food consumption and subsequent health consequences. Fiscal policies targeting the relative price of unhealthy foods are frequently put forward as ways to address the obesity epidemic. Conversely, various food subsidy interventions are used in attempts to reduce levels of under-nutrition. Information on price elasticities is essential for understanding how such changes in food prices affect food consumption. It is crucial to know not only own-price elasticities but also cross-price elasticities, as food substitution patterns may have significant implications for policy recommendations. While own-price elasticities are common in analyses of the impact of food price changes on health, cross-price effects, even though generally acknowledged, are much less frequently included in analyses, especially in the public health literature. This article systematically reviews the global evidence on cross-price elasticities and provides combined estimates for seven food groups in low-income, middle-income and high-income countries alongside previously estimated own-price elasticities. Changes in food prices had the largest own-price effects in low-income countries. Cross-price effects were more varied and depending on country income level were found to be reinforcing, undermining or alleviating own-price effects.