Food Insecurity & Intimate Partner Violence Against Women: Results from the California Women's Health Survey

OBJECTIVE:

To investigate the association between food insecurity and intimate partner violence in a population-based sample of heterosexual women.

DESIGN:

Logistic regression was used to evaluate the association between three levels of food insecurity and intimate partner violence.

SETTING:

Data from 6 years of the California Women's Health Survey.

SUBJECTS:

Randomly selected women (n 16 562) aged 18 years and older from the State of California, USA.

RESULTS:

We found: 

1. that African-American women had a higher prevalence of food insecurity and were more likely to report severe intimate partner violence; 
2. a strong positive association between food insecurity and intimate partner violence; 
3. evidence of effect modification of the association between food insecurity and intimate partner violence by marital status; and 
4. higher odds of intimate partner violence among those reporting more severe food insecurity.

CONCLUSIONS:

Food insecurity is an important risk indicator for intimate partner violence among women. Understanding the factors that put women, especially minority women, at greatest risk facilitates intervention development.

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By:  Ricks JL1, Cochran SD1, Arah OA1, Williams JK2, Seeman TE1.

• 1Department of Epidemiology, Fielding School of Public Health, University of California,Los Angeles, CA, USA.
• 2Department of Psychiatry & Biobehavioral Sciences,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA. 
• Public Health Nutr. 2016 Apr;19(5):914-23. doi: 10.1017/S1368980015001986. Epub 2015 Jun 22.

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Growth in HIV-Infected Children on Long-Term Antiretroviral Therapy

OBJECTIVES:

To describe growth in HIV-infected children on long-term antiretroviral therapy (ART) and to assess social, clinical, immunological and virological factors associated with suboptimal growth.

METHODS:

This observational cohort study included all HIV-infected children at an urban ART site in South Africa who were younger than 5 years at ART initiation and with more than 5 years of follow-up. Growth was assessed using weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and body mass index (BMI)-for-age Z-scores (BAZ). Children were stratified according to pre-treatment anthropometry and age. Univariate and mixed linear analysis were used to determine associations between independent variables and weight and height outcomes.

RESULTS:

The majority of the 159 children presented with advanced clinical disease (90%) and immunosuppression (89%). Before treatment underweight, stunting and wasting were common (WAZ<-2= 50%, HAZ<-2= 73%, BAZ<-2= 19%). Weight and BMI improved during the initial 12 months, while height improved over the entire 5-year period. Height at study exit was significantly worse for children with growth impairment at ART initiation (p<0.001), although infants (<1 year) demonstrated superior improvement in terms of BMI (p=0.04). Tuberculosis was an independent risk factor for suboptimal weight (p=0.01) and height (p=0.02) improvement. Weight gain was also hindered by lack of electricity (p=0.04). Immune reconstitution and virological suppression were not associated with being underweight or stunted at study end point.

CONCLUSIONS:

Malnutrition was a major clinical concern for this cohort of HIV-infected children. Early ART initiation, tuberculosis co-infection management and nutritional interventions are crucial to ensure optimal growth in HIV-infected children. This article is protected by copyright. All rights reserved.

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By:  Feucht UD¹, van Bruwaene L^1,2, Becker PJ³, Kruger M⁴.

¹Department of Paediatrics, Kalafong hospital, University of Pretoria, Pretoria, South Africa.

²University Hospital Gasthuisberg, Leuven, Belgium.

³Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.

⁴Department of Paediatrics and Child Health, University of Stellenbosch, Tygerberg, South Africa.

Trop Med Int Health. 2016 Feb 23. doi: 10.1111/tmi.12685.

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Integration of HIV Care into Community Management of Acute Childhood Malnutrition Permits Good Outcomes: Lusaka, Zambia

Background

While HIV has had a major impact on health care in southern Africa, there are few data on its impact on acute malnutrition in children in the community. We report an analysis of outcomes in a large programme of community management of acute malnutrition in the south of Lusaka.

Programme Activities and Analysis

Over 3 years, 68,707 assessments for undernutrition were conducted house-to-house, and children with severe acute malnutrition (SAM) or moderate acute malnutrition (MAM) were enrolled into either Outpatient Therapeutic Programme (OTP) or Supplementary Feeding Programme (SFP) respectively. Case records were analysed using tabulation and unconditional logistic regression.

Findings

1,859 children (889 boys, 970 girls; median age 16 months) with MAM (n = 664) or SAM (n = 1,195) were identified. Of 1,796 children whose parents consented to testing, 185 (10.3%) were HIV positive. Altogether 1,163 (62.6%) were discharged as recovered from acute malnutrition. Case fatality while in the programme was 4.2% in children with SAM and 0.5% in those with MAM, and higher in children with HIV infection. In multivariate analysis, HIV, MUAC <11.5cm and the first year of the program all increased mortality. Children with HIV infection who were able to initiate antiretroviral therapy had lower mortality.

Interpretation

Our programme suggests that a comprehensive community malnutrition programme, incorporating HIV care, can achieve low mortality even in a population heavily affected by HIV.

Below:  Flow of children with MAM through the program

Full article at:   http://goo.gl/N84AKd

By:  

Beatrice Amadi, Mercy Imikendu, Milika Sakala, Rosemary Banda 
Department of Paediatrics, University Teaching Hospital, Nationalist Road, Lusaka, Zambia

Beatrice Amadi, Paul Kelly 

Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia

Paul Kelly 

Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, 4 Newark Street, London, United Kingdom

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Predictors of Mortality and Mortality Rate in a Cohort of Children Living with HIV from India

OBJECTIVES:

To study the predictors of mortality and mortality rate in a clinical cohort of Children Living with Human Immunodeficiency Virus infection (CLHIV) from India.

METHODS:

This retrospective cohort analysis of CLHIV aged between 2 mo and 18 y registered during January 2004 through December 2014 at Pediatric Centre of Excellence (PCOE), Indira Gandhi Institute of Child Health (IGICH), was conducted using standard data collection sheet. Demographic and clinical characteristics of all eligible children were analyzed. The primary outcome measured was mortality. The authors also analyzed the cause of death and baseline parameters associated with death to study the predictors of mortality.

RESULTS:

Out of 1289 CLHIV registered in the PCOE during the study period, 834 (64.7 %) CLHIV, with or without antiretroviral therapy (ART) care, were included. The total time contributed by the study participants was 2872.8 child-years. The mortality rate in these children was 4.9/100 child-years. A significantly higher mortality rate of 28.2 % was found in children < 5 y, 38.6 % in children with advanced WHO clinical staging, 35.2 % among severely immunosuppressed children and 22.3 % in severely malnourished children. Tuberculosis accounted for 28 % of deaths. Univariate Cox regression analysis showed treatment status, age <5 y, baseline WHO clinical stage 3 and 4, severe immune suppression and severe malnutrition were strongly associated with mortality.

CONCLUSIONS:

The mortality rate in the index study cohort was 4.9/100 child-years and tuberculosis was the major cause of death. Younger age, baseline advanced clinical and immunological staging were predictors of mortality. Even though mortality was significantly higher in Pre-ART children, treatment status was not found to be an independent predictor of mortality.

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By:  Sanjeeva GN1,2, Gujjal Chebbi P3, Pavithra HB4, Sahana M4, Sunil Kumar DR5, Hande L6.

• 1Department of Pediatrics, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bangalore, 560 029, Karnataka, India. sanju_gn@rediffmail.com.
• 2Pediatric Center of Excellence, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bangalore, 560 029, Karnataka, India. sanju_gn@rediffmail.com.
• 3Department of Pediatrics, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bangalore, 560 029, Karnataka, India.
• 4Pediatric Center of Excellence, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bangalore, 560 029, Karnataka, India.
• 5CST, Ministry of Health and Family Welfare, National AIDS Control Organization, Bangalore, Karnataka, India.
• 6DD (ICTC/PPTCT), KSAPS, Bangalore, Karnataka, India. 
• Indian J Pediatr. 2016 Feb 26.

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Acceptability & Use of Ready-To-Use Supplementary Food Compared to Corn–Soy Blend as a Targeted Ration in an HIV Program in Rural Haiti

I am taking a medication that makes me want to eat more.I eat a lot because after I take the medication I am hungry.After you swallow the pill you have numbness and it does not feel good, and your chest is hurting. So you should have something to eat after that.

BACKGROUND:

Ready-to-use supplementary food (RUSF) is increasingly used as a component of food rations for adults with HIV.

METHODS:

We undertook a qualitative study to evaluate the acceptability and use of peanut-based RUSF compared to corn-soy blend (CSB) among adults living with HIV in rural Haiti who had been enrolled in a prospective, randomized trial comparing the impact of those rations. A total of 13 focus groups were conducted with 84 participants-42 selected from the RUSF arm of the study, and 42 from the CSB arm-using a guide with pre-designated core topics and open-ended questions.

RESULTS:

We found that RUSF was highly acceptable in terms of taste, preparation, and packaging. Both types of food ration were widely shared inside and outside households, especially with children. However, while CSB was without exception stored with the communal household foodsupply, RUSF was frequently separated from the household food supply and was more often reserved for consumption by individuals with HIV.

CONCLUSIONS:

RUSF was a highly acceptable food ration that, compared to CSB, was more often reserved for use by the individual with HIV.Qualitative examination of the perceptions, use, and sharing of food rations is critical to understanding and improving the efficacy of food assistance for food-insecure people living with HIV.

Full article at:   http://goo.gl/va96sr

By:  Beckett AG1, Humphries D2, Jerome JG3, Teng JE4, Ulysse P3, Ivers LC5.

• 1Internal Medicine Residency, Department of Medicine, Brigham & Women's Hospital, 75 Francis St., Boston, MA 02115 USA ; Department of Medicine, Boston Children's Hospital, Boston, MA USA ; Partners In Health, Boston, MA USA.
• 2Department of Epidemiology of Microbial Disease, Yale School of Public Health, 60 College Street, Ste 318, New Haven, CT 06510 USA.
• 3Zanmi Lasante, St. Marc, Haiti ; Zanmi Lasante, 18A, Santo 18, Croix-des-Bouquets, Haiti.
• 4Internal Medicine Residency, Department of Medicine, Brigham & Women's Hospital, 75 Francis St., Boston, MA 02115 USA ; Partners In Health, Boston, MA USA ; Division of Global Health Equity, Brigham & Women's Hospital, 641 Huntington Avenue, Boston, MA 02115 USA.
• 5Internal Medicine Residency, Department of Medicine, Brigham & Women's Hospital, 75 Francis St., Boston, MA 02115 USA ; Partners In Health, Boston, MA USA ; Division of Global Health Equity, Brigham & Women's Hospital, 641 Huntington Avenue, Boston, MA 02115 USA ; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA. 
• AIDS Res Ther. 2016 Feb 17;13:11. doi: 10.1186/s12981-016-0096-9. eCollection 2016.

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High Prevalence of Severe Food Insecurity and Malnutrition among HIV-Infected Adults in Senegal, West Africa

Malnutrition and food insecurity are associated with increased mortality and poor clinical outcomes among people living with HIV/AIDS; however, the prevalence of malnutrition and food insecurity among people living with HIV/AIDS in Senegal, West Africa is unknown. The objective of this study was to determine the prevalence and severity of food insecurity and malnutrition among HIV-infected adults in Senegal, and to identify associations between food insecurity, malnutrition, and HIV outcomes.

We conducted a cross-sectional study at outpatient clinics in Dakar and Ziguinchor, Senegal. Data were collected using participant interviews, anthropometry, the Household Food Insecurity Access Scale, the Individual Dietary Diversity Scale, and chart review.

One hundred and nine HIV-1 and/or HIV-2 participants were enrolled. The prevalence of food insecurity was 84.6% in Dakar and 89.5% in Ziguinchor. The prevalence of severe food insecurity was 59.6% in Dakar and 75.4% in Ziguinchor. The prevalence of malnutrition (BMI <18.5) was 19.2% in Dakar and 26.3% in Ziguinchor. Severe food insecurity was associated with missing clinic appointments (p = 0.01) and not taking antiretroviral therapy due to hunger (p = 0.02). Malnutrition was associated with lower CD4 cell counts (p = 0.01).

Severe food insecurity and malnutrition are highly prevalent among HIV-infected adults in both Dakar and Ziguinchor, and are associated with poor HIV outcomes. Our findings warrant further studies to determine the root causes of malnutrition and food insecurity in Senegal, and the short- and long-term impacts of malnutrition and food insecurity on HIV care. Urgent interventions are needed to address the unacceptably high rates of malnutrition and food insecurity in this population.

Full article at:  http://goo.gl/zWfrje

By: 

Noelle A. Benzekri, Geoffrey S. Gottlieb

Department of Medicine, University of Washington, Seattle, WA, United States of America

Jacques Sambou, El Hadji Ibrahima Sall, Alassane Niang

Centre de Santé de Ziguinchor, Ziguinchor, Sénégal

Binetou Diaw, Fatima Sall, Selly Ba, Ndèye Fatou Ngom Guèye, Mouhamadou Baïla Diallo, Moussa Seydi

Centre Hospitalier Universitaire de Fann, Dakar, Sénégal

Stephen E. Hawes, Geoffrey S. Gottlieb

Department of Global Health, University of Washington, Seattle, WA, United States of America

Stephen E. Hawes

Department of Epidemiology, University of Washington, Seattle, WA, United States of America

  

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Characteristics & Health of Homeless Families: The ENFAMS Survey in the Paris Region, France 2013

The objectives were to estimate the size of homeless family population in Paris region, to describe their living conditions and health and to analyse the impact of homelessness on children's growth and development, which was never investigated in France.

A cross-sectional survey was conducted on a random sample of homeless sheltered families in 2013. Families were interviewed in 17 languages and a nurse took anthropometric measures, blood samples and collected health data from child health reports.

The population size was estimated at 10 280 families. Half were single-parent female families and 94% were born outside France. Most families had experienced housing instability and 94% were living below the poverty line (828 euros/month). Malnutrition was a major problem: the prevalence of food insecurity was high (77% of parents and 69% of children), as well as anaemia (50% of mothers and 38% of children), overweight (38% of mothers and 22% of children) and obesity (32% of mothers and 4% of children). High rates of depressive disorders were found in 30% of homeless mothers and 20% of children had signs of possible mental health disorders.

These first results highlight the important number of families among the homeless population in Paris region. Families differed from other homeless people regarding social characteristics such as birthplace, single-parent status and residential instability that are likely to influence schooling, social ties, health and access to care. These results demonstrate the need for urgent actions targeting homeless families, in terms of reducing housing instability and providing adequate care, especially for children.

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By: Vandentorren S1, Le Méner E2, Oppenchaim N3, Arnaud A4, Jangal C5, Caum C2, Vuillermoz C6, Martin-Fernandez J6, Lioret S7, Roze M6, Le Strat Y8,Guyavarch E2.

• 1Observatoire du Samusocial de Paris, Paris, France Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France Institut de veille sanitaire, département des alertes et coordination des régions, Saint Maurice, France.
• 2Observatoire du Samusocial de Paris, Paris, France.
• 3Observatoire du Samusocial de Paris, Paris, France Université François Rabelais, Laboratoire Citeres, UMR CNS 7324, Tours, France.
• 4Observatoire du Samusocial de Paris, Paris, France Institut de veille sanitaire, département des maladies infectieuses, Saint Maurice, France.
• 5Observatoire du Samusocial de Paris, Paris, France Laboratoire Espace, Santé et Territoires, Université Paris Ouest Nanterre La Défense, Nanterre, France.
• 6Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.
• 7Early ORigin of the Child's Health and Development Team (ORCHAD), INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS). Paris Descartes University, France.
• 8Institut de veille sanitaire, département des maladies infectieuses, Saint Maurice, France.  

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