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Food insecurity affects billions of individuals annually and contributes to myriad poor health outcomes. Experiences of food insecurity may be particularly harmful during the first 1000 days, but literature on the topic has not been synthesized. We therefore aimed to characterize all available studies examining associations between food insecurity and nutritional, psychosocial, physical and economic well-being among parents and children during this period. We implemented a standardized search strategy across 11 databases. Four researchers screened 10,257 articles, 120 of which met the inclusion criteria. Most studies were conducted in Sub-Saharan Africa (43.3%), followed by North America (20.8%). Studies were primarily quantitative (95.8%), cross-sectional (70.0%) and focused on women (pregnant or post-partum, 48.3%) or women and children (15.8%). Physical health outcomes were the most investigated (n = 87 studies), followed by nutritional (n = 69), psychosocial (n = 35) and economic well-being (n = 2). The most studied associations were between food insecurity and stunting (n = 15), maternal depression (n = 12), child dietary diversity (n = 7) and maternal body mass index (n = 6). The strength of evidence for the observed associations varied across populations as well as within and between examined outcomes. We recommend that future studies recruit more diverse study populations, consider temporality of relationships, use instruments that facilitate cross-site comparisons, measure individual-level food insecurity and outcomes most likely to be impacted by food insecurity, evaluate contextual factors that may modify the effects of food insecurity and employ analytic techniques that permit assessment of causal pathways.
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Dieta , Abastecimiento de Alimentos , Niño , Embarazo , Femenino , Humanos , Estudios Transversales , Padres , Inseguridad AlimentariaRESUMEN
Objective: To investigate how water and food insecurity were associated in nationally representative samples of individuals from 25 low- and middle-income countries. Methods: We used data from the 2020 World Gallup Poll in which the Individual Water Insecurity Experiences Scale and the Food Insecurity Experience Scale had been administered to 31 755 respondents. These scales measure insecurity experiences in the previous 12 months. We classified individuals as water insecure if their score was ≥ 12 and food insecure if the Rasch probability parameter was ≥ 0.5. For estimating the proportions, we used projection weights. We estimated the relationships between binary and continuous measures of water insecurity and food insecurity for individuals within each country and region using multivariable logistic and linear regression models, adjusting for key socioeconomic characteristics including income, gender, age and education. Findings: Among the 18.3% of respondents who experienced water insecurity, 66.8% also experienced food insecurity. The likelihood of experiencing moderate-to-severe food insecurity was higher among respondents also experiencing water insecurity (adjusted odds ratio, aOR: 2.69; 95% confidence interval, CI: 2.43 to 2.98). Similar odds were found in Asia (aOR: 2.95; 95% CI: 2.04 to 4.25), Latin America (aOR: 2.17; 95% CI: 1.62 to 2.89), North Africa (aOR: 2.92; 95% CI: 2.17 to 3.93) and sub-Saharan Africa (aOR: 2.71; 95% CI: 2.40 to 3.06). Conclusion: Our results suggest that water insecurity should be considered when developing food and nutrition policies and interventions. However, more research is needed to understand the paths between these insecurities.
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Países en Desarrollo , Abastecimiento de Alimentos , Humanos , Factores Socioeconómicos , Renta , Inseguridad AlimentariaRESUMEN
BACKGROUND: Infants who are HIV-exposed and uninfected have suboptimal growth patterns compared to those who are HIV-unexposed and uninfected. However, little is known about how these patterns persist beyond 1 year of life. OBJECTIVES: This study aimed to examine whether infant body composition and growth trajectories differed by HIV exposure during the first 2 years of life among Kenyan infants using advanced growth modeling. METHODS: Repeated infant body composition and growth measurements (mean: 6; range: 2-7) were obtained from 6 weeks to 23 months in the Pith Moromo cohort in Western Kenya (n = 295, 50% HIV-exposed and uninfected, 50% male). Body composition trajectory groups were fitted using latent class mixed modeling (LCMM) and associations between HIV exposure and growth trajectories were examined using logistic regression analysis. RESULTS: All infants exhibited poor growth. However, HIV-exposed infants generally grew suboptimally than unexposed infants. Across all body composition models except for the sum of skinfolds, HIV-exposed infants had a higher likelihood of belonging to the suboptimal growth groups identified by LCMM than the HIV-unexposed infants. Notably, HIV-exposed infants were 3.3 times more likely (95% CI: 1.5-7.4) to belong to the length-for-age z-score growth class that remained at a z-score of < -2, indicating stunted growth. HIV-exposed infants were also 2.6 times more likely (95% CI: 1.2-5.4) to belong to the weight-for-length-for-age z-score growth class that remained between 0 and -1, and were 4.2 times more likely (95% CI: 1.9-9.3) to belong to the weight-for-age z-score growth class that indicated poor weight gain besides stunted linear growth. CONCLUSIONS: In a cohort of Kenyan infants, HIV-exposed infants grew suboptimally compared to HIV-unexposed infants beyond 1 year of age. These growth patterns and longer-term effects should be further investigated to support the ongoing efforts to reduce early-life HIV exposure-related health disparities.
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Infecciones por VIH , Complicaciones Infecciosas del Embarazo , Embarazo , Femenino , Humanos , Lactante , Masculino , Estudios Prospectivos , Kenia/epidemiología , Infecciones por VIH/epidemiología , Trastornos del Crecimiento/epidemiología , Composición CorporalRESUMEN
BACKGROUND: Water security is necessary for good health, nutrition, and wellbeing, but experiences with water have not typically been measured. Given that measurement of experiences with food access, use, acceptability, and reliability (stability) has greatly expanded our ability to promote food security, there is an urgent need to similarly improve the measurement of water security. The Water InSecurity Experiences (WISE) Scales show promise in doing so because they capture user-side experiences with water in a more holistic and precise way than traditional supply- side indicators. Early use of the WISE Scales in Latin American & the Caribbean (LAC) has revealed great promise, although representative data are lacking for most of the region. Concurrent measurement of experiential food and water insecurity has the potential to inform the development of better-targeted interventions that can advance human and planetary health. MAIN TEXT: On April 20-21, 2023, policymakers, community organizers, and researchers convened at Universidad Iberoamericana in Mexico City to discuss lessons learned from using experiential measures of food and water insecurity in LAC. At the meeting's close, organizers read a Declaration that incorporated key meeting messages. The Declaration recognizes the magnitude and severity of the water crisis in the region as well as globally. It acknowledges that traditional measurement tools do not capture many salient water access, use, and reliability challenges. It recognizes that the WISE Scales have the potential to assess the magnitude of water insecurity more comprehensively and accurately at community, state, and national levels, as well as its (inequitable) relationship with poverty, poor health. As such, WISE data can play an important role in ensuring more accountability and strengthening water systems governance through improved public policies and programs. Declaration signatories express their willingness to promote the widespread use of the WISE Scales to understand the prevalence of water insecurity, guide investment decisions, measure the impacts of interventions and natural shocks, and improve public health. CONCLUSIONS: Fifty-three attendees endorsed the Declaration - available in English, Spanish and Portuguese- as an important step to making progress towards Sustainable Development Goal 6, "Clean Water and Sanitation for All", and towards the realization of the human right to water.
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Política Pública , Inseguridad Hídrica , Humanos , América Latina , Reproducibilidad de los Resultados , Región del CaribeRESUMEN
Pica, the urge to consume items generally not considered food, such as dirt, raw starch, and ice, are particularly common among pregnant women. However, the biology of pica in pregnancy is not well understood. Therefore, this study aimed to assess how pica relates to endocrine stress and immune biomarkers in a cohort of pregnant Latina women in Southern California. Thirty-four women completed a structured pica questionnaire. Maternal urinary cortisol and plasma cytokine levels were measured between 21 and 31 weeks' gestation. Associations between pica during pregnancy and biomarkers were assessed using linear regression models adjusting for gestational age. Twelve (35.3%) of the pregnant women reported pica (geophagy and amylophagy) during pregnancy. In multivariate models, those who engaged in pica had higher levels of cortisol (ß: 0.37, 95% CI: 0.01, 0.073) and lower levels of IL-1ß (ß: -0.06, 95% CI: -0.11, -0.02), IL-8 (ß: -0.30, 95% CI: -0.56, -0.05), IL-21 (ß: -0.35, 95% CI: -0.63, -0.08), and type-1 inflammation composite (ß: -0.29, 95% CI: -0.44, -0.14) than women who did not engage in pica. These results suggest that biological stress and immune response differ for women with pica compared to those without. This study suggests novel physiological covariates of pica during pregnancy. Further research is needed to better understand the mechanisms and temporality underlying the observed associations between pica and endocrine and immune biomarkers.
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OBJETIVO: Identificar la viabilidad de la Escala de Experiencias de Inseguridad del Agua en el Hogar (Household Water Insecurity Experiences Scale, HWISE, por sus siglas en inglés) como herramienta para evaluar las experiencias de hogares mexicanos en relación con la inseguridad en el acceso al agua. Material y métodos. La escala fue integrada en la Encuesta Nacional de Salud y Nutrición Continua 2021 (Ensanut Continua 2021) y se utilizaron tres criterios para evaluar su viabilidad: 1) Consistencia interna: Se aplicó la prueba Alfa de Cronbach para estimar la correlación entre los ítems de la escala. Se consideró un punto de corte de al menos 0.80 como criterio de confiabilidad; 2) Equivalencia de los ítems para distintos indicadores sociodemográficos; y 3) Variables asociadas con inseguridad del agua. RESULTADOS: La escala HWISE mostró: 1) Buena confiabilidad o consistencia interna (Alfa de Cronbach de 0.928); 2) comportamiento equivalente de los ítems en los contextos urbano y rural, en nueve regiones del país y por terciles de condiciones de bienestar; y 3) asociación significativa con variables predictoras de inseguridad del agua. CONCLUSIONES: La escala HWIS, adaptada para México, es apropiada para su uso en evaluar la condición de inseguridad del agua en hogares mexicanos.
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Reliable access to safe and acceptable water in sufficient quantities (i.e., water security) is important for medication adherence and limiting pathogen exposure, yet prior studies have only considered the role of food security as a social determinant of HIV-related health. Therefore, the objective of this analysis was to assess the relationships between household water insecurity and HIV-related outcomes among adults living with HIV in western Kenya (N = 716). We conducted a cross-sectional analysis of baseline data from Shamba Maisha (NCT02815579), a cluster randomized controlled trial of a multisectoral agricultural and asset loan intervention. Baseline data were collected from June 2016 to December 2017. We assessed associations between water insecurity and HIV-related outcomes, adjusting for clinical and behavioral confounders, including food insecurity. Each five-unit higher household water insecurity score (range: 0-51) was associated with 1.21 higher odds of having a viral load ≥ 1000 copies/mL (95% CI 1.07, 1.36) and 1.26 higher odds of AIDS-defining illness (95% CI 1.11, 1.42). Household water insecurity was not associated with CD4 cell count (B: 0.27; 95% CI -3.59, 13.05). HIV treatment and support programs should consider assessing and addressing water insecurity in addition to food insecurity to optimize HIV outcomes.
RESUMEN: El acceso seguro al agua potable en cantidades suficientes (es decir, seguridad hídrica) es importante para la adherencia a la medicación y para limitar la exposición a patógenos; sin embargo, estudios anteriores solo han considerado el papel de la seguridad alimentaria como un determinante social de salud relacionado con el VIH. Por lo tanto, el objetivo de este análisis fue evaluar las relaciones entre la inseguridad hídrica en hogares y los resultados relacionados con el VIH en adultos que viven con VIH en el oeste de Kenia (N = 716). Realizamos un análisis transversal de los datos basales de la iniciativa Shamba Maisha (NCT02815579), un ensayo controlado aleatorio por conglomerados de una intervención multisectorial de créditos para insumos agrícolas. Los datos basales se recopilaron de junio de 2016 a diciembre de 2017. Evaluamos las asociaciones entre la inseguridad hídrica y resultados relacionados con el VIH, ajustando por factores de confusión clínicos y conductuales, incluyendo inseguridad alimentaria. Cada cinco unidades superiores de puntajes de inseguridad hídrica doméstica (rango: 0-51) fue asociado con 1.21 mayores probabilidades de tener una carga viral más alta ≥ 1000 copias / ml (CI 95%: 1,07-1,36) y con 1.26 mayores probabilidades de factores determinantes del SIDA (CI 95%: 1,11-1,42). La inseguridad de hídrica doméstica no se asoció con el recuento de células CD4 (B: −0,27; CI 95%: -13,59-13,05). Los programas de tratamiento y de apoyo al VIH deben considerar evaluar y abordar la inseguridad hídrica además de la inseguridad alimentaria para optimizar los resultados del VIH.
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Síndrome de Inmunodeficiencia Adquirida , Infecciones por VIH , Estudios Transversales , Abastecimiento de Alimentos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Kenia/epidemiología , Inseguridad HídricaRESUMEN
OBJECTIVE: Water plays a critical role in the production of food and preparation of nutritious meals, yet few studies have examined the relationship between water and food insecurity. The primary objective of this study, therefore, was to examine how experiences of household water insecurity (HWI) relate to experiences of household food insecurity (HFI) among a pastoralist population living in an arid, water-stressed region of northern Kenya. DESIGN: We implemented the twelve-item Household Water Insecurity Experiences (HWISE, range 0-36) Scale and the nine-item Household Food Insecurity Access Scale (HFIAS, range 0-27) in a cross-sectional survey to measure HWI and HFI, respectively. Data on socio-demographic characteristics and intake of meat and dairy in the prior week were collected as covariates of interest. SETTING: Northern Kenya, June-July 2019. PARTICIPANTS: Daasanach pastoralist households (n 136) from seven communities. RESULTS: In the prior 4 weeks, 93·4 % and 98·5 % of households had experienced moderate-to-severe HWI and HFI, respectively. Multiple linear regression analyses indicated a strong association between HWI and HFI. Each point higher HWISE score was associated with a 0·44-point (95 % CI: 0·22, 0·66, P = 0·003) higher HFIAS score adjusting for socio-economic status and other covariates. CONCLUSIONS: These findings demonstrate high prevalence and co-occurrence of HWI and HFI among Daasanach pastoralists in northern Kenya. This study highlights the need to address HWI and HFI simultaneously when developing policies and interventions to improve the nutritional well-being of populations whose subsistence is closely tied to water availability and access.
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BACKGROUND: There are urgent calls for the transformation of agriculture and food systems to address human and planetary health issues. Nutrition-sensitive agriculture and agroecology promise interconnected solutions to these challenges, but evidence of their impact has been limited. OBJECTIVES: In a cluster-randomized trial (NCT02761876), we examined whether a nutrition-sensitive agroecology intervention in rural Tanzania could improve children's dietary diversity. Secondary outcomes were food insecurity and child anthropometry. We also posited that such an intervention would improve sustainable agricultural practices (e.g., agrobiodiversity, intercropping), women's empowerment (e.g., participation in decision making, time use), and women's well-being (e.g., dietary diversity, depression). METHODS: Food-insecure smallholder farmers with children aged <1 y from 20 villages in Singida, Tanzania, were invited to participate. Villages were paired and publicly randomized; control villages received the intervention after 2 y. One man and 1 woman "mentor farmer" were elected from each intervention village to lead their peers in agroecological learning on topics including legume intensification, nutrition, and women's empowerment. Impact was estimated using longitudinal difference-in-differences fixed-effects regression analyses. RESULTS: A total of 591 households (intervention: n = 296; control: n = 295) were enrolled; 90.0% were retained to study end. After 2 growing seasons, the intervention improved children's dietary diversity score by 0.57 food groups (out of 7; P < 0.01), and the percentage of children achieving minimum dietary diversity (≥4 food groups) increased by 9.9 percentage points during the postharvest season. The intervention significantly reduced household food insecurity but had no significant impact on child anthropometry. The intervention also improved a range of sustainable agriculture, women's empowerment, and women's well-being outcomes. CONCLUSIONS: The magnitude of the intervention's impacts was similar to or larger than that of other nutrition-sensitive interventions that provided more substantial inputs but were not agroecologically focused. These data suggest the untapped potential for nutrition-sensitive agroecological approaches to achieve human health while promoting sustainable agricultural practices.
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Dieta , Abastecimiento de Alimentos , Agricultura , Antropometría , Niño , Femenino , Seguridad Alimentaria , Humanos , Masculino , Estado Nutricional , TanzaníaRESUMEN
BACKGROUND: Household food insecurity (FI) and water insecurity (WI) are prevalent public health issues that can co-occur. Few studies have concurrently assessed their associations with health outcomes, particularly among people living with HIV. OBJECTIVES: We aimed to investigate the associations between FI and WI and how they relate to physical and mental health. METHODS: Food-insecure adult smallholder farmers living with HIV in western Kenya were recruited to participate in a cluster-randomized controlled trial of a multisectoral agricultural and asset loan intervention. We used baseline data on experiences of FI (using the Household Food Insecurity Access Scale, range: 0-27) and WI (using a modified scale developed for this region, range: 0-51) in the prior month (n = 716). Outcomes included probable depression (using the Hopkins Symptom Checklist), fatigue and diarrhea in the prior month, and overall mental and physical health (using the Medical Outcomes Study HIV Health Survey, range: 0-100). We first assessed Pearson correlations between FI, WI, and sociodemographic characteristics. We then developed 3 regressions for each health outcome (control variables and FI; control variables and WI; control variables, FI, and WI) and compared model fit indexes. RESULTS: Correlations between household FI, WI, and wealth were low, meaning they measure distinct constructs. FI and WI were associated with numerous physical and mental health outcomes; accounting for both resource insecurities typically provided the best model fit. For instance, when controlling for FI, each 10-point higher WI score was associated with a 6.42-point lower physical health score (P < 0.001) and 2.92 times greater odds of probable depression (P < 0.001). CONCLUSIONS: Assessing both FI and WI is important for correctly estimating their relation with health outcomes. Interventions that address food- and water-related issues among persons living with HIV concurrently will likely be more effective at improving health than those addressing a single resource insecurity. This trial was registered at clinicaltrials.gov as NCT02815579.
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Agua Potable , Inseguridad Alimentaria , Infecciones por VIH , Estado de Salud , Salud Mental , Adulto , Abastecimiento de Alimentos , Infecciones por VIH/complicaciones , Humanos , KeniaRESUMEN
Food insecurity (FI) is an understudied risk factor for depression among perinatal women in sub-Saharan Africa. We therefore explored the longitudinal relationship between FI and depressive symptoms among a cohort of perinatal women of mixed HIV status (n = 371) in Kenya (NCT02974972, NCT02979418). Using longitudinal linear and logistic regressions with random effects, we assessed bivariate and adjusted associations between maternal FI and depressive symptoms. HIV status was also assessed as a potential effect modifier. At baseline, 58% of pregnant women had probable depression (CES-D score > 16) and 84% were severely food insecure. In adjusted analyses, severely food-insecure women had 5.90 greater odds (95% CI 2.32, 15.02, p < 0.001) of having probable depression and scored 4.58 points higher on the CES-D scale (SE: 1.04, p < 0.001) relative to food-secure women. HIV status did not modify the association between FI and depressive symptoms. Interventions to reduce FI may reduce perinatal depression, benefiting mothers and their infants.
RESUMEN: La inseguridad alimentaria es un factor de riesgo del estrés en el periodo de posparto entre mujeres en África Sub-sahariana que es poco estudiado. Por lo tanto exploramos la relación entre la seguridad alimentaria y los síntomas de depresión con un estudio longitudinal entre un cohorte de mujeres en diferentes etapas perinatal y con diferentes estatus de VIH (n=371) en Kenia (NCT02974972, NCT02979418). Se evaluaron asociaciones bi-variadas y asociaciones ajustadas entre la inseguridad alimentaria y las síntomas de depresión usando regresión lineal y logística con efectos aleatorios. El estatus de VIH también se evaluó como modificador de efecto. Al inicio del estudio el 58% de mujeres embarazadas tenían depresión probable (CES-D score >16) y el 84% tenían un nivel de inseguridad alimentaria severa. Mujeres con un nivel de inseguridad alimentaria severa tenían mayores posibilidades del 5.90 (95% IC: 2.32, 15.02, p < 0.001) de depresión probable y una puntuación mas alta del 4.58 en el CES-D (EE: 1.04, p < 0.001) en comparación a las mujeres con un nivel de inseguridad alimentaria seguro. El estatus de VIH no modifico la asociación entre la inseguridad alimentaria y los síntomas de depresión. Intervenciones destinadas para mitigar la inseguridad alimentaria podrían reducir la depresión en el periodo perinatal, proporcionando beneficios a las mamas y sus bebes.
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Depresión/epidemiología , Inseguridad Alimentaria , Abastecimiento de Alimentos/estadística & datos numéricos , Infecciones por VIH/complicaciones , Adulto , Depresión/psicología , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Humanos , Lactante , Recién Nacido , Kenia/epidemiología , Atención Posnatal , Embarazo , Atención Prenatal , Apoyo SocialRESUMEN
OBJECTIVES: This study compared the prevalence of concentrated urine (urine specific gravity ≥1.021), an indicator of hypohydration, across Tsimane' hunter-forager-horticulturalists living in hot-humid lowland Bolivia and Daasanach agropastoralists living in hot-arid Northern Kenya. It tested the hypotheses that household water and food insecurity would be associated with higher odds of hypohydration. METHODS: This study collected spot urine samples and corresponding weather data along with data on household water and food insecurity, demographics, and health characteristics among 266 Tsimane' households (N = 224 men, 235 women, 219 children) and 136 Daasanach households (N = 107 men, 120 women, 102 children). RESULTS: The prevalence of hypohydration among Tsimane' men (50.0%) and women (54.0%) was substantially higher (P < .001) than for Daasanach men (15.9%) and women (17.5%); the prevalence of hypohydration among Tsimane' (37.0%) and Daasanach (31.4%) children was not significantly different (P = .33). Multiple logistic regression models suggested positive but not statistically significant trends between household water insecurity and odds of hypohydration within populations, yet some significant joint effects of water and food insecurity were observed. Heat index (2°C) was associated with a 23% (95% confidence interval [CI]: 1.09-1.40, P = .001), 34% (95% CI: 1.18-1.53, P < .0005), and 23% (95% CI: 1.04-1.44, P = .01) higher odds of hypohydration among Tsimane' men, women, and children, respectively, and a 48% (95% CI: 1.02-2.15, P = .04) increase in the odds among Daasanach women. Lactation status was also associated with hypohydration among Tsimane' women (odds ratio = 3.35, 95% CI: 1.62-6.95, P = .001). CONCLUSION: These results suggest that heat stress and reproductive status may have a greater impact on hydration status than water insecurity across diverse ecological contexts.
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Deshidratación/epidemiología , Calor , Lactancia , Orina/química , Inseguridad Hídrica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bolivia/epidemiología , Niño , Deshidratación/etiología , Femenino , Humanos , Kenia/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Urinálisis , Adulto JovenRESUMEN
OBJECTIVE: To investigate if food security mediated the impact of a nutrition-sensitive agroecology intervention on women's depressive symptoms. DESIGN: We used annual longitudinal data (four time points) from a cluster-randomised effectiveness trial of a participatory nutrition-sensitive agroecology intervention, the Singida Nutrition and Agroecology Project. Structural equation modelling estimation of total, natural direct and natural indirect effects was used to investigate food security's role in the intervention's impact on women's risk of probable depression (Center for Epidemiologic Studies Depression Scale > 17) across 3 years. SETTING: Rural Singida, Tanzania. PARTICIPANTS: 548 food insecure, married, smallholder women farmers with children < 1 year old at baseline. RESULTS: At baseline, one-third of the women in each group had probable depression (Control: 32·0 %, Intervention: 31·9 %, P difference = 0·97). The intervention lowered the odds of probable depression by 43 % (OR = 0·57, 95 % CI: 0·43, 0·70). Differences in food insecurity explained approximately 10 percentage points of the effects of the intervention on odds of probable depression (OR = 0·90, 95 % CI: 0·83, 0·95). CONCLUSIONS: This is the first evidence of the strong, positive effect that lowering food insecurity has on reducing women's depressive symptoms. Nutrition-sensitive agricultural interventions can have broader impacts than previously demonstrated, i.e. improvements in mental health; changes in food security play an important causal role in this pathway. As such, these data suggest participatory nutrition-sensitive agroecology interventions have the potential to be an accessible method of improving women's well-being in farming communities.
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Depresión , Seguridad Alimentaria , Agricultura , Niño , Depresión/epidemiología , Depresión/prevención & control , Femenino , Abastecimiento de Alimentos , Humanos , Lactante , Estado Nutricional , Tanzanía/epidemiologíaRESUMEN
Stress and food insecurity (FI) are associated with poor perinatal and HIV outcomes. We hypothesized that FI would increase postpartum stress among women in Kenya, and that the impact would be greater in women with HIV. Among 371 pregnant women, we identified latent FI trajectories across the perinatal period, and estimated their association with postpartum stress. Stress metrics included the Perceived Stress Scale (PSS) and hair cortisol concentrations (HCC). We identified two FI trajectories: persistent moderate FI and persistent mild FI. Moderate FI (vs. mild) was associated with higher PSS; this association was stronger among HIV-negative women. We observed a trend towards higher HCC associated with moderate FI, which did not differ by HIV status. HCC and PSS were not correlated. In summary, moderate FI (vs. mild) was associated with increased stress. The lack of PSS-HCC correlation could reflect different physiological pathways. Interventions to mitigate FI could alleviate postpartum stress.
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Abastecimiento de Alimentos/estadística & datos numéricos , Madres/psicología , Atención Perinatal , Mujeres Embarazadas/psicología , Estrés Psicológico/epidemiología , Adulto , Femenino , Infecciones por VIH/psicología , Cabello/química , Humanos , Hidrocortisona/metabolismo , Kenia/epidemiología , Periodo Posparto , Embarazo , Escalas de Valoración Psiquiátrica , Adulto JovenRESUMEN
Food insecurity (FI), low social support, and low health-related quality of life (HRQoL) are associated with self-reported nonadherence to antiretroviral therapy (ART) among postpartum women, but these relationships have not been evaluated using objective adherence indicators. Hair samples were therefore analyzed among 83 postpartum Kenyan women living with HIV on efavirenz and nevirapine ART drug regimens in an observational cohort (NCT02974972). FI (0-27), social support (0-40), and HRQoL (8-40) in the prior month were also assessed. In multivariable models, each point increase in FI and decrease in HRQoL were associated with a 45.1% (95% CI: -64.3%, -15.6%) and 10.5% decrease (95% CI: 1.0%, 22.1%) in hair ART drug concentrations respectively, when social support was held constant. A significant interaction between social support and FI (ß = 0.02, p = 0.017) indicated that greater social support was predicted to mitigate the negative impacts of FI on ART adherence. Addressing these modifiable barriers could improve ART adherence during this critical period.
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Fármacos Anti-VIH/uso terapéutico , Abastecimiento de Alimentos/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación/psicología , Calidad de Vida/psicología , Apoyo Social , Adulto , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Humanos , Kenia/epidemiología , Periodo Posparto , Factores SocioeconómicosRESUMEN
Water problems due to scarcity, inaccessibility, or poor quality are a major barrier to household functioning, livelihood, and health globally. Household-to-household water borrowing has been posited as a strategy to alleviate unmet water needs. However, the prevalence and predictors of this practice have not been systematically examined. Therefore, we tested whether water borrowing occurs across diverse global contexts with varying water problems. Second, we tested if household water borrowing is associated with unmet water needs, perceived socio-economic status (SES), and/or water-related system failures, and if water access moderated (or changed) these relationships. Using survey data from the Household Water Insecurity Experiences (HWISE) study from 21 sites in 19 low- and middle-income countries (n = 5495 households), we found that household-to-household water borrowing was practiced in all 21 sites, with 44.7% (11.4-85.4%) of households borrowing water at least once the previous month. Multilevel mixed-effect logistic regression models demonstrate that high unmet water needs (odds ratio [OR] = 2.86], 95% confidence interval [CI] = 2.09-3.91), low perceived SES (OR = 1.09; 95% CI = 1.05-1.13), and water-related system failures (23-258%) were all significantly associated with higher odds of water borrowing. Significant interactions (all p < 0.01) between water access, unmet water needs, and water-related system failures on water borrowing indicate that water access moderates these relationships. These data are the first to demonstrate that borrowing water is commonly used by households around the world to cope with water insecurity. Due to how prevalent water borrowing is, its implications for social dynamics, resource allocation, and health and well-being are likely vast but severely under-recognized.
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[This corrects the article PMC7566692.].
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OBJECTIVES: Infant feeding plays a critical role in child health and development. Few studies to date have examined the link between household water insecurity and infant feeding, and none in a cross-cultural context. Therefore, we examined the perceived impact of household water insecurity in four domains: breastfeeding, non-breastmilk feeding, caregiver capabilities, and infant health. Our research was conducted as part of the Household Water Insecurity Experiences (HWISE) study. METHODS: We interviewed respondents from 19 sites in 16 low- and middle-income countries (N = 3303) about the link between water insecurity and infant feeding. We then thematically analyzed their open-ended textual responses. In each of the four domains (breastfeeding, non-breastmilk feeding, caregiver capabilities, infant health), we inductively identified cross-cultural metathemes. We analyzed the distribution of themes across sites quantitatively and qualitatively. RESULTS: Water was perceived to directly affect breastfeeding and non-breastmilk feeding via numerous pathways, including timing and frequency of feeding, unclean foods, and reduced dietary diversity. Water was perceived to indirectly affect infant feeding through caregiver capabilities by increasing time demands, exacerbating disease, undernutrition, and mortality, and requiring greater efficacy of caregivers. Respondents made connections between water challenges and infant health, for example, increased risk of infectious diseases, undernutrition, and mortality. CONCLUSIONS: These findings suggest that water presents many, and sometimes unexpected, challenges to infant feeding. By systematically investigating biocultural pathways by which water impacts infant and young child feeding, it will be possible to understand if, and how, water security can be leveraged to improve child nutrition and health.
Asunto(s)
Lactancia Materna/estadística & datos numéricos , Cuidadores/estadística & datos numéricos , Abastecimiento de Alimentos/estadística & datos numéricos , Salud del Lactante/estadística & datos numéricos , Agua , Países en Desarrollo , Conducta Alimentaria , Humanos , Lactante , Recién NacidoRESUMEN
OBJECTIVES: Geophagy, the intentional consumption of earth, is widely practiced among humans and other mammals, but its causes are not well understood. Given the growing number of reports of geophagy among nonhuman primates (NHP), we sought to (1) advance and codify our understanding of the patterns and functional and evolutionary significance of geophagy among NHP and (2) provide a research agenda for a more unified approach to its study. METHODS: We systematically reviewed all available literature on NHP geophagy, extracted available data on taxa, geography, climate, diet, sex, age-class, reproductive status, and the characteristics of the earth. We used these data to evaluate three major hypotheses about geophagy, that it is protective, provides mineral supplementation, and is nonadaptive. RESULTS: We identified 287 accounts of geophagy among 136 species, adding 79 new primate species to the list of those considered in prior reviews. Nineteen percent of species were in the suborder Strepsirrhini, while 81% were in the suborder Haplorrhini. There were reports of geophagy from 9 of the 17 families and 39 of the 76 genera currently recognized by the International Union for Conservation of Nature. DISCUSSION: The limited evidence suggests that geophagy is adaptive, and provides protection and mineral supplementation. We specify the behavioral, dietary, and soil data required to more rigorously investigate these hypotheses across representative species of all taxonomic groups, geographical regions, and dietary classification. Given the plausibility of geophagy for maintaining the health of both wild and captive populations, we urge further study and conservation of geophagy sites.
Asunto(s)
Pica , Primates/fisiología , Animales , Antropología Física , Femenino , MasculinoRESUMEN
BACKGROUND: Increasing the prevalence of optimal breastfeeding practices, including exclusive breastfeeding for 6 months, could prevent an estimated 823,000 child deaths annually. Self-efficacy is an important determinant of breastfeeding behaviors. However, existing measures do not specifically assess exclusive breastfeeding self-efficacy, but rather self-efficacy for any breastfeeding. Hence, we sought to adapt and validate an instrument to measure exclusive breastfeeding self-efficacy. METHODS: We modified and added items from Dennis' Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). It was then implemented in an observational cohort in Gulu, Uganda at 1 (n = 239) and 3 (n = 238) months postpartum ( clinicaltrials.gov NCT02925429). We performed inter-item and adjusted item-test correlations, as well as exploratory factor analysis and parallel analysis at 1 month postpartum to remove redundant items and determine their latent factor structure. We further applied confirmatory factor analysis to test dimensionality of the scale at 3 months postpartum. We then assessed the reliability of the scale and conducted tests of predictive and discriminant validity. Known group comparisons were made by primiparous status and correct breastfeeding knowledge. RESULTS: The modification of the original BSES-SF to target exclusive breastfeeding produced 19 items, which were reduced to 9 based on item correlations and factor loadings. Two dimensions of the adapted scale, the Breastfeeding Self-Efficacy Scale to Measure Exclusive Breastfeeding BSES-EBF emerged: Cognitive and Functional subscales, with alpha coefficients of 0.85 and 0.79 at 3 months postpartum. Predictive and discriminant validity and known group comparisons assessments supported its validity. CONCLUSIONS: This version of the Breastfeeding Self-Efficacy scale, the BSES-EBF Scale, is valid and reliable for measuring exclusive breastfeeding self-efficacy in northern Uganda, and ready for adaptation and validation for clinical and programmatic use elsewhere.