A longitudinal survey on changes in employment and food consumption during the COVID-19 pandemic in rural Bihar, India.

BACKGROUND: There is a need for empirical evidence on changes in employment and food consumption during pandemic situations in households belonging to the informal economy. OBJECTIVE: To examine changes in food insecurity, household diet diversity, and employment in agriculture during the pre-COVID-19 (2019-early 2020) and COVID-19 pandemic (September 2021) periods. METHODS: A total of 1632 households from a face-to-face pre-COVID-19 survey and 621 of those followed up by a telephonic survey during COVID-19 in Bihar, India, were included in the analyses. Household food insecurity, household diet diversity score (HDDS), and employment change (agriculture or nonagriculture) were assessed during both periods. Food insecurity and diet diversity in the 2 periods were examined by logistic regression. A change in the odds of being food insecure or having low HDDS was examined as an interaction between time and employment status. RESULTS: Prevalence of food insecurity increased from 21% to 55%, and low diet diversity increased from 47% to 69% in households assessed in both surveys. Employment status was not associated with food insecurity or low HDDS during the baseline survey. However, during the pandemic, ∼30% of households changed their employment from agriculture to nonagriculture and were more likely to be food insecure (adjusted odds ratio [aOR]: 2.77; 95% confidence interval [CI] 1. 78-4.32) and have low HDDS (aOR: 1.66; 95%CI: 1.05-2.61), than those who remained in agriculture. Similarly, those who retained nonagricultural employment during the pandemic were more likely to be food insecure (aOR: 2.23; 95%CI: 1.45-3.43) and have low HDDS (aOR: 1.73; 95%CI: 1.11-2.70), compared to those who remained in agriculture. In propensity score-adjusted interaction analysis of time and employment, food insecurity and low HDDS remained significantly associated with nonagricultural employment during the pandemic. CONCLUSIONS: Enhanced support to rural households in agricultural occupations could buffer them from unexpected crises, which may also protect their nutritional intake.

Contextual Factors Influencing Production, Distribution, and Consumption of Nutrient-Rich Foods in Bihar, India: A Qualitative Study of Constraints and Facilitators.

BACKGROUND: Production-to-consumption linkages are important to improve consumption of nutrient-rich foods to tackle malnutrition. However, understanding specific contextual factors influencing production, distribution, and consumption in rural communities is necessary. OBJECTIVE: To explore household-, farm-, and market-level factors affecting consumption of nutrient-rich foods among producer and nonproducer households in Bihar, India. METHODS: We conducted focus group discussions (FGDs) and key informant interviews (KIIs) in producer and nonproducer households of Gaya and Nalanda districts in Bihar to examine factors affecting production and consumption of red lentils, green leafy vegetables (GLVs), milk, eggs, and chicken. Through the KIIs, we identified distribution chains and elicited market-level challenges faced by producers, sellers, and consumers. Data were translated, transcribed, and analyzed thematically using NVivo version 9. RESULTS: Findings from 27 FGDs indicate that consumers and producers were aware of the importance of nutrient-rich foods to health and the necessity of prioritizing their consumption in children. Food preferences, social factors, seasons, religions, and livestock epidemics influenced consumption. Among producers, consumption was mainly dependent on own production. Nonproducers perceived that production could help overcome the barrier of affordability and improve consumption. Data from 69 KIIs indicated that markets were unfavorable in terms of profitability for producers, spoilage and losses for market players, issues of accessibility, and availability for consumers. CONCLUSIONS: A local context-specific multipronged approach such as understanding sociocultural factors, own production, and local markets influencing consumption needs to be examined further to improve consumption of nutrient-rich foods among agricultural communities in India.

Impact of the COVID-19 lockdown on household diet diversity in rural Bihar, India: a longitudinal survey.

BACKGROUND: The COVID-19 pandemic disrupted livelihoods and diets across the world. This study aimed to assess changes in household diet diversity and food consumption between the pre-COVID-19 period (December 2019-January 2020) and during the lockdown (March-May 2020), and to identify the socio-economic characteristics that determine these changes in rural Bihar, India. METHODS: Households that had provided their phone numbers in the pre-COVID-19 household survey (n = 1797) were contacted for interviews during the lockdown telephonic survey in a longitudinal survey in two districts (Gaya and Nalanda) in Bihar. In total, 939 households were interviewed. Using data on food consumption from both surveys, 876 households were included in the analysis. Food and Agriculture Organization's household diet diversity score (HDDS) was used to compare diet diversity between the pre-COVID-19 period and during the lockdown. Logistic regression was used to identify factors affecting household diet diversity and food consumption in the study households. RESULTS: Low diet diversity increased from 51.6% (95% CI 48.3-54.9) to 75.8% (95% CI 73.0-78.6) from the pre-COVID-19 to the lockdown period. Reduced food consumption was reported across all foods with nearly a quarter of the households reporting reduced consumption of fruits (27%), pulses (25%) and cereals (21%). Nearly 60% and above reported stopping consumption of nutrient-rich foods such as chicken, fish and eggs although the population was predominantly non-vegetarian. Logistic regression analysis revealed that taking a loan from neighbours/relatives (OR = 1.8; 95% CI 1.3-2.5) and belonging to lower social groups (OR = 1.8; 95% CI 1.1-2.9) increased odds of low HDDS. While those possessing ration cards had lower odds of reduced consumption of all food items, it was not associated with stopping consumption of any food item. In an unadjusted analysis, receipt of cash transfer during lockdown was also not associated with diet diversity (OR = 1.2; 95% CI 0.9-1.7). CONCLUSIONS: COVID-19 has impacted the consumption of nutrient-rich foods among already low-income rural households in India. Maintaining diet diversity among socio-economically vulnerable households during periods when food consumption is most threatened by shocks such as COVID-19 would need sustained government support in terms of social protection coverage and benefit transfers in rural communities.

Role of cash transfers in mitigating food insecurity in India during the COVID-19 pandemic: a longitudinal study in the Bihar state.

OBJECTIVE: There are scant empirical data on the impacts of the COVID-19 pandemic on food security across the globe. India is no exception, with insights into the impacts of lockdown on food insecurity now emerging. We contribute to the empirical evidence on the prevalence of food insecurity in Bihar state before and after lockdown, and whether the government's policy of cash transfer moderated negative effects of food insecurity or not. DESIGN: This was a longitudinal study. SETTINGS: The study was conducted in Gaya and Nalanda district of Bihar state in India from December 2019 to September 2020. PARTICIPANTS: A total of 1797 households were surveyed in survey 1, and about 52% (n=939) were followed up in survey 2. Valid data for 859 households were considered for the analysis. MAIN OUTCOME MEASURES: Using the Food Insecurity Experience Scale, we found that household conditions were compared before and after lockdown. The effect of cash transfers was examined in a quasi-experimental method using a longitudinal study design. Logistic regression and propensity score adjusted analyses were used to identify factors associated with food insecurity. RESULTS: Household food insecurity worsened considerably during lockdown, rising from 20% (95% CI 17.4 to 22.8) to 47% (95% CI 43.8 to 50.4) at the sample mean. Households experiencing negative income shocks were more likely to have been food insecure before the lockdown (adjusted OR 6.4, 95% CI 4.9 to 8.3). However, households that received cash transfers had lower odds of being food insecure once the lockdown was lifted (adjusted OR 0.75, 95% CI 0.56 to 0.99). CONCLUSION: These findings provide evidence on how the swift economic response to the pandemic crises using targeted income transfers was relatively successful in mitigating potentially deep impacts of food insecurity.

Perceptions of stigma among medical and nursing students and tuberculosis and diabetes patients at a teaching hospital in southern India.

Stigma has a significant impact on the diagnosis of a variety of illnesses, patients' compliance with treatment and their recovery from these diseases. However, the Indian medical and nursing curriculum has given relatively little attention to recognising and addressing the issue of stigma. This study compared the perception of stigma with respect to tuberculosis (TB) and diabetes mellitus (DM) among medical and nursing students to that among patients with these diseases. The Explanatory Model Interview Catalogue (EMIC) questionnaire was used for all patients and student groups. Focus group discussions were held with only the students to understand their concept of stigma and the challenges they face while addressing stigma, and to explore their role in addressing stigma. The data showed that patients with TB prefer not to disclose their illness, while DM is not perceived of as stigmatising by patients. As a group, medical and nursing students attached excessive stigma to patients with both DM and TB, and this may mean that medical professionals subconsciously do harm through their interactions with patients and the attitudes they project to society. The perceptions of stigma were linked to the patient's socioeconomic background, apart from the medical condition itself. The students recognised that they lacked the skills to understand and address stigma. We recommend that the subject of stigma be integrated into the curriculum of medical and nursing students.

Report from a symposium on catalyzing primary and secondary prevention of cancer in India.

PURPOSE: Oral, breast, and cervical cancers are amenable to early detection and account for a third of India's cancer burden. We convened a symposium of diverse stakeholders to identify gaps in evidence, policy, and advocacy for the primary and secondary prevention of these cancers and recommendations to accelerate these efforts. METHODS: Indian and global experts from government, academia, private sector (health care, media), donor organizations, and civil society (including cancer survivors and patient advocates) presented and discussed challenges and solutions related to strategic communication and implementation of prevention, early detection, and treatment linkages. RESULTS: Innovative approaches to implementing and scaling up primary and secondary prevention were discussed using examples from India and elsewhere in the world. Participants also reflected on existing global guidelines and national cancer prevention policies and experiences. CONCLUSIONS: Symposium participants proposed implementation-focused research, advocacy, and policy/program priorities to strengthen primary and secondary prevention efforts in India to address the burden of oral, breast, and cervical cancers and improve survival.