Beyond Purchasing Power: The Association Between Sense of Community Belongingness and Food Insecurity Among Older Adults in Canada.

Food is a basic human need, yet a significant proportion of older Canadian adults are vulnerable to food insecurity. The health risks associated with aging make food insecurity among this subgroup a critical policy issue. In Canada, policy solutions to food insecurity are however skewed toward the provision of income support to vulnerable groups. While these income support programs are timely, little emphasis is placed on social factors such as sense of community belongingness. This is despite evidence that food insecurity is a socially mediated experience that goes beyond the ability to purchase food. Drawing data from the Canadian Community Health Survey (n = 24,546) and using negative log-log regression, we examined the association between sense of community belongingness and food insecurity among older adults. Findings show that older adults with a "very weak" (odds ratio [OR] = 1.40, p < .001) and "somewhat weak" (OR = 1.23, p < .01) sense of community belongingness were significantly more likely to be food insecure compared to those with a "very strong" sense of belongingness. This study contributes to a growing body of the literature that demonstrates the need for an integrated approach to addressing food insecurity - one that goes beyond income support to include consideration of social factors like sense of community belonging.

Alcohol misuse as a social determinant of food insecurity among smallholder farmers.

The availability and affordability of alcohol in smallholder communities have surged the misuse of alcohol. Misusing alcohol has dire health and nutrition consequences in smallholder communities. Alcohol misuse can divert household resources from essential household needs such as food and also hinder local food production. In the context of multiple stressors on smallholder farmers' livelihoods, it is crucial to assess the relationship between alcohol consumption and smallholder farmers' experience of hunger. Therefore, we used data from a cross-sectional survey involving 1100 smallholder farmers in the Upper West region of Ghana to examine the association between alcohol consumption and household food insecurity. Results showed that daily (OR = 3.81; p ≤ 0.001) and weekly/frequent (OR = 2.32; p ≤ 0.001) consumption of alcohol was significantly associated with higher odds of household food insecurity compared to no consumption. The relationship between alcohol and food insecurity was bidirectional. The experience of food insecurity was also significantly associated with higher odds of occasional or frequent alcohol consumption. While alcohol misuse can transition smallholder households into food insecurity, the household heads of food insecure households may resort to alcohol to cope with underlying stressors such as climate change and food insecurity. This calls for policy interventions to mitigate alcohol misuse through regulations, surveillance, economic disincentives and improving the social mechanisms of resilience to climate change and food insecurity in smallholder communities. However, policy approaches must be cautious not to disrupt the livelihoods of vulnerable smallholder farmers.

Knowledge of pregnancy complications and utilization of antenatal care services in Rwanda.

BACKGROUND: While Rwanda's progress towards achieving the maternal health care targets of the Sustainable Development Goals is impressive, evidence of women's limited utilization of antenatal care (ANC) services in the context of an improved health care system provides an opportunity for exploring other essential but less highlighted factors that may shape ANC service utilization. In this study, we examined the association between women's knowledge of pregnancy complications and the utilization of maternal health services. METHODS: We employed logistic regression analysis using the 2015 Rwanda Demographic and Health Survey data. Our analytical sample consisted of women (n = 5883) in their reproductive ages (15-49 years). Three maternal health care indicators, namely, timing of first ANC visit, number of ANC visits, and place of delivery, were explored. We controlled for the effects of socioeconomic and demographic characteristics, including marital status, place of residence and age. RESULTS: The results show that women with no knowledge of pregnancy complications were less likely to utilize ANC services within the first trimester (odds ratio [OR] = 0.76, p < 0.01), achieve the WHO recommended minimum of eight visits (OR = 0.66, p < 0.01), and deliver at a health facility (OR = 0.77, p < 0.10). CONCLUSION: Given these findings, we recommend restructuring existing maternal health care programs to include rigorous maternal health education.

Agroecology and household production diversity and dietary diversity: Evidence from a five-year agroecological intervention in rural Malawi.

Following a decade of declining food insecurity, the global undernourished population has increased successively in the last three years. This increasing trend highlights the challenge of meeting the zero hunger and nutrition targets of Sustainable Development Goal (SDG) 2. Malawi is one of the most food insecure countries in Africa, with a significant proportion of its population being undernourished. Amid evidence of the counter-productive effects of input-intensive agriculture in this context, including the narrowing of the food basket and unequal access to subsidized inputs, some scholars have argued that alternative diversified agricultural approaches, combined with attention to underlying inequalities, maybe more promising in addressing undernutrition. Agroecology is one such approach which promotes biodiversity and pays attention to socio-political inequalities. That notwithstanding, there is limited research on the potential role of agroecology in improving household food outcomes. Drawing theoretical insights from political ecology and using Difference-in-Difference and mediation techniques, we examine the impact of agroecology on household production diversity and dietary diversity using data from a five-year agroecological intervention in Malawi (n = 514 agroecology-practicing farming households and 400 non-agroecology households). Findings from the Difference-in-Difference analysis show a positive treatment effect of agroecology on both production diversity (ß = 0.289, p < 0.01) and dietary diversity (ß = 0.390, p < 0.01). Results from the mediation analysis indicate that generally, production diversity is directly associated with dietary diversity (ß = 0.18, p < 0.01), although the relationship is stronger for households practicing agroecology (ß = 0.19, p < 0.01) compared to non-agroecology households (ß = 0.14, p < 0.01). These findings provide evidence of the potential for agroecology to improve nutrition in smallholder farming contexts and contribute to achieving SDGs 2. Malawi is currently grappling with widespread micronutrient deficiencies. Given that smallholder farmers typically draw a significant proportion of their diet from what they produce, farming approaches like agroecology, which emphasizes the cultivation of diverse crops, may be promising for improving household nutrition.

Examining the unresolved conundrum of Traditional Birth Attendants' involvement in maternal and child health care delivery in Ghana.

Traditional Birth Attendants (TBAs) have been a critical human resource in maternal health care delivery in Ghana. However, following the World Health Organization's directive for countries to discontinue using TBAs, the government of Ghana has since emphasized the use of skilled birth attendants. This policy shift created tensions between TBAs and Community Health Nurses. We examine this conundrum in this paper. We find that despite the ban, TBAs still attend a significant number of births - a situation which has produced intense contestations and continuous jostling for "functioning space" and clients between TBAs and nurses. We recommend a consensus-based partnership approach that promotes cultural competence and is sensitive to contextual cultural practices that underpin pregnancy and childbirth.

Examining the association between exposure to mass media and health insurance enrolment in Ghana.

Although previous studies have explored the National Health Insurance Scheme (NHIS) in Ghana, very little attention is paid to the influence of mass media exposure on NHIS enrolment. Yet, understanding this linkage is important, particularly due to the critical role of mass media in disseminating health information and shaping people's health perceptions and choices. Using data from the 2014 Ghana Demographic and Health Survey, we employed logistic regression analysis to understand the relationship between NHIS enrolment and exposure to print media, radio, and television. Our findings indicate that women with more exposure to radio (OR = 1.23, P < 0.01) and television (OR = 1.24, P < 0.01) were more likely to enroll in the NHIS than those with no exposure. For men, more exposure to print media was associated with higher odds of enrolling in the NHIS (OR = 1.41, P < 0.01). In conclusion, all 3 types of media may be helpful in promoting NHIS enrolment in Ghana. However, given that the relationship between media exposure and enrolment in the NHIS was gendered, we recommend that policymakers should pay attention to these dynamics to ensure effective targeting in NHIS media campaigns for increased enrolment into the scheme.