Between the city and the farm: food environments in artisanal mining communities in Upper Guinea.

OBJECTIVE: Artisanal and small-scale mining (ASM) is a widespread livelihood in low- and middle-income countries; however, many in ASM communities face high levels of poverty and malnutrition. The food environments in ASM communities have non-agricultural rural characteristics that differ from those in urban and agricultural rural areas examined in much existing food environment literature. DESIGN: We examine these complex external and personal food environments in ASM communities via a study using qualitative and quantitative methods. Market surveys and a cross-sectional household survey, plus qualitative mining site non-participant observations and in-depth structured interviews, were conducted in three waves. SETTING: Eighteen study sites in ASM communities in northern Guinea. PARTICIPANTS: Surveys covered mothers in mining households with young children (n 613); in-depth interviews engaged caregivers of young children (n 45), food vendors (n 40) and young single miners (n 15); observations focused on mothers of young children (n 25). RESULTS: The external food environment in these ASM communities combines widespread availability of commercially processed and staple-heavy foods with lower availability and higher prices for more nutritious, non-staple foods. Within the personal food environment, miners are constrained in their food choices by considerable variability in daily cash income and limited time for acquisition and preparation. CONCLUSIONS: We demonstrate that ASM communities have characteristics of both urban and rural populations and argue for greater nuance and appreciation of complexity in food environment research and resultant policy and programming.

A Pilot Study of Patient Photographs and Handoff Communication.

BACKGROUND AND OBJECTIVES: Safe and effective handoffs have become a national priority. Given that patient photographs have been associated with safety benefits in other settings, we hypothesize they could improve handoff communication. Our objective was to determine whether patient photographs used during simulated handoffs improves information retention, response to clinical scenarios, and familiarity with patients, compared with simulated handoffs without photographs. METHODS: We conducted a pilot mixed-methods study using simulated handoff sessions with pediatric residents. One investigator simulated 2 verbal handoff sessions with participants randomized to receive stock patient photographs in either the first or second session. Participants answered an online questionnaire after each session to assess information recall and familiarity with patients. Primary outcomes included percent correct responses and response time. Participants were interviewed to assess the benefits and challenges of using photographs in handoffs. RESULTS: Forty pediatric residents participated. Correct responses and response time did not differ significantly between sessions. Participants indicated less confusion and more comfort caring for patients after photograph handoff sessions. All participants identified benefits to using patient photographs and 75% identified challenges. Benefits included assisting memory, enhancing connection with patients, and improving patient safety. Challenges included visual distraction, bias concerns, and patient privacy. CONCLUSIONS: In this pilot study, patient photographs did not result in improved information retention or efficiency of response to clinical scenarios but were associated with perceptions of reduced confusion and enhanced comfort. Participants identified benefits and challenges of incorporating photographs in handoffs that could inform use in real-world settings.

"If you don't find anything, you can't eat" - Mining livelihoods and income, gender roles, and food choices in northern Guinea.

Artisanal and small-scale mining (ASM) continues to grow as a viable economic activity in sub-Saharan Africa. The health and environmental impacts of the industry, notably linked to the use of potentially toxic chemicals, has been well documented. What has not been explored to the same extent is how pressures associated with ASM affect food choices of individuals and families living in mining camps. This paper presents research conducted in 18 mining sites in northern Guinea exploring food choices and the various factors affecting food decision-making practices. Two of the most influential factors to emerge from this study are income variability and gender roles. Results from this study suggest that through artisanal mining, women have the opportunity to earn a larger income that would otherwise be unavailable through agriculture. However, this benefit of potentially earning a larger income is often reduced or constrained by existing gender roles both at the mines and in the home, such as disparity in pay between men and women and increased pressures on women's time. This limits the potential benefit to household food decision-making that could have been gained from higher income. These results do not seek to establish one livelihood as superior; rather, they demonstrate that even when presented with opportunities to earn higher incomes, women still face many of the same barriers and challenges that they would in other economic activities. Additionally, while work and time demands on women change upon arrival in the mining camps, existing gender roles and expectations do not, further restricting women's decision-making capacity.

Food Security in Artisanal Mining Communities: An Exploration of Rural Markets in Northern Guinea.

The number of people engaged in artisanal and small-scale mining (ASM) has grown rapidly in the past twenty years, but they continue to be an understudied population experiencing high rates of malnutrition, poverty, and food insecurity. This paper explores how characteristics of markets that serve ASM populations facilitate and pose challenges to acquiring a nutritious and sustainable diet. The study sites included eight markets across four mining districts in the Kankan Region in the Republic of Guinea. Market descriptions to capture the structure of village markets, as well as twenty in-depth structured interviews with food vendors at mining site markets were conducted. We identified three forms of market organization based on location and distance from mining sites. Markets located close to mining sites offered fewer fruit and vegetable options, as well as a higher ratio of prepared food options as compared with markets located close to village centers. Vendors were highly responsive to customer needs. Food accessibility and utilization, rather than availability, are critical for food security in non-agricultural rural areas such as mining sites. Future market-based nutrition interventions need to consider the diverse market settings serving ASM communities and leverage the high vendor responsiveness to customer needs.