Changing precipitation patterns resulting from climate change are likely to have deleterious effects on health. We examined historical relationships between precipitation and diarrhea, cough, and fever among children aged 0-24 months in Uganda, a drought-prone region. Using data from the Uganda National Panel Survey from 2009 to 2012 (2,324 observations), we specified logistic regression models evaluating the relationships between deviations from annual and 30-day precipitation and caregiver-reported diarrhea, cough, and fever, adjusting for sociodemographic characteristics and including enumeration of area-fixed effects. Nonlinearities were assessed using restricted cubic splines. We observed nonlinear (J-shaped) relationships between deviations from annual precipitation and the three child illness outcomes. These J-shaped relationships represented steep reductions in illness with increasing precipitation at lower levels of rainfall and a leveling off at higher levels, with a small increase at higher levels. We did not find evidence for a relationship between 30-day precipitation and childhood illness. Trends of reduced rainfall in Uganda are likely having negative effects on child health.

Food insecurity has recently emerged as an important risk factor for HIV acquisition among women worldwide. No previous studies have used linked data that would permit investigation of the extent to which food insecurity may have differential associations with HIV transmission risk behaviors or symptoms of sexually transmitted infections (STIs) among men and women in the same households. We used nationally representative data on linked couples from the Nepal 2011 Demographic and Health Survey. The primary explanatory variable of interest was food insecurity, measured with a modified version of the Household Food Insecurity Access Scale. In multivariable logistic regression models, women in food insecure households were less likely to report recent condom use and more likely to report symptoms consistent with STIs. These patterns were absent among men. Interventions targeting food insecurity may have beneficial implications for both HIV prevention and gender equity in Nepal.

Community efforts and peer support programs are needed in addition to provider-initiated and opt-out HIV testing in adolescents, Sheri Weiser and colleagues discuss.

BACKGROUND: Women in Nepal have low status, especially younger women in co-resident households. Nepal also faces high levels of household food insecurity and malnutrition, and stagnation in uptake of modern family planning methods. OBJECTIVE: This study aims to understand if household structure and food insecurity interact to influence family planning use in Nepal. METHODS: Using data on married, non-pregnant women aged 15-49 with at least one child from the Nepal 2011 Demographic and Health Survey (N = 7,460), we explore the relationship between womens position in the household, food insecurity as a moderator, and family planning use, using multi-variable logistic regressions. We adjust for household and individual factors, including other status-related variables. RESULTS: In adjusted models, living in a food insecure household and co-residing with in-laws either with no other daughter-in-laws or as the eldest or youngest daughter-in-law (compared to not-co-residing with in-laws) are all associated with lower odds of family planning use. In the interaction model, younger-sisters-in-law and women co-residing with no sisters-in-law in food insecure households have the lowest odds of family planning use. CONCLUSION: This study shows that household position is associated with family planning use in Nepal, and that food insecurity modifies these associations-highlighting the importance of considering both factors in understanding reproductive health care use in Nepal. Policies and programs should focus on the multiple pathways through which food insecurity impacts womens reproductive health, including focusing on women with the lowest status in households.

Objective

Women in South Asia, including Nepal, have some of the poorest nutritional indicators globally, leading to poor maternal and child health outcomes. Nepal also suffers from high levels of household food insecurity, and newly married women are at high risk. Intra-household relationships may mediate the relationship between food insecurity and women's nutrition in Nepal for newly married women. Our aim is to understand how newly married, preconception, women's food consumption changes when she enters her husband's home, compared with her natal home. We also explore whether relationship quality with husbands and mothers-in-law mediates the association between food insecurity and eating less high-quality food, using structural equation modelling.

Design

Cross-sectional survey data.

Setting

Rural Nepal in 2018.

Participants

Data were collected from 200 newly married, preconception women.

Results

Women had poor diet quality, and most ate fewer high-quality foods important for pregnancy in their marital, compared with natal, home. Higher quality relationships with mothers-in-laws mediated the association between food insecurity and a woman eating fewer high-quality foods in her marital, compared with natal, home. Relationship quality with husbands was not associated with changes in food consumption.

Conclusions

Preconception, newly married women in Nepal are eating less high-quality foods important for women's health during the preconception period - a key period for avoiding adverse maternal and infant health outcomes. Relationships with mothers-in-law are key to women's access to high-quality food, suggesting that interventions aiming to improve maternal and child nutrition should target all household members.

Food insecurity, a well-established determinant of chronic disease morbidity and mortality, is rapidly increasing due to the coronavirus disease 2019 (COVID-19) pandemic. We present a conceptual model to understand the multiple mechanisms through which the economic and public health crises sparked by COVID-19 might increase food insecurity and contribute to poor health outcomes in the short- and long-term. We hypothesize that, in the short-term, increased food insecurity, household economic disruption, household stress, and interruptions in healthcare will contribute to acute chronic disease complications. However, the impact of the pandemic on food security will linger after social-distancing policies are lifted and the health system stabilizes, resulting in increased risk for chronic disease development, morbidity, and mortality among food-insecure households in the long-term. Research is needed to examine the impact of the pandemic-related increase in food insecurity on short- and long-term chronic health outcomes, and to delineate the underlying causal mechanisms. Such research is critical to inform the development of effective programs and policies to address food insecurity and its downstream health impacts during COVID-19 and future pandemics.

BACKGROUND: Food insecurity is associated with poor nutritional and clinical outcomes among people living with HIV/AIDS. Few studies investigate the link between food insecurity, dietary diversity and health-related quality of life among people living with

A growing body of research has identified food insecurity as a barrier to antiretroviral therapy (ART) adherence. We systematically reviewed and summarized the quantitative literature on food insecurity or food assistance and ART adherence. We identified nineteen analyses from eighteen distinct studies examining food insecurity and ART adherence. Of the thirteen studies that presented an adjusted effect estimate for the relationship between food insecurity and ART adherence, nine found a statistically significant association between food insecurity and sub-optimal ART adherence. Four studies examined the association between food assistance and ART adherence, and three found that ART adherence was significantly better among food assistance recipients than non-recipients. Across diverse populations, food insecurity is an important barrier to ART adherence, and food assistance appears to be a promising intervention strategy to improve ART adherence among persons living with HIV. Additional research is needed to determine the effectiveness and cost-effectiveness of food assistance in improving ART adherence and other clinical outcomes among people living with HIV in the era of widespread and long-term treatment.

During the coronavirus disease 2019 (COVID-19) pandemic, food insecurity has doubled overall and tripled among households with children in the United States. Food insecurity and COVID-19 may exacerbate one another through bidirectional links, leading to a syndemic, or sequential disease clusters, which exacerbate one another. Experiencing food insecurity may be associated with macronutrient and micronutrient deficiencies, which can weaken host defenses, thus increasing susceptibility to COVID-19. Food insecurity is associated with chronic medical conditions, which may afford a higher risk of severe COVID-19 illness. People experiencing food insecurity may have increased exposure to COVID-19 while procuring food. People with COVID-19 may be unable to work, generate income, and procure food while quarantined, which may exacerbate food insecurity. Clinicians should screen for food insecurity during the COVID-19 pandemic and provide referrals to food-assistance programs when appropriate. Policymakers should expand benefits for the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to address increases in the depth and breadth of food insecurity during the COVID-19 pandemic.