Poverty and health

Associations between child marriage and food insecurity in Zimbabwe: a participatory mixed methods study
Gambir K, Matsika A, Panagiotou A, et al: BMC Public Health 24:13, 1-14, 2024

This study explored how food insecurity influences child marriage practices in Chiredzi, Zimbabwe. It used mixed methods, including participant-led storytelling and key informant interviews. A total of 1,668 community members participated in the story-telling, while 22 staff participated in interviews. The authors found that food insecurity was a primary concern among community members and was among the contextual factors of deprivation that influenced parents’ and adolescent girls’ decisions around child marriage. Parents often forced their daughters into marriage to relieve the household economic burden. At the same time, adolescents were found to be initiating their own marriages due to limited alternative survival opportunities and within the restraints imposed by food insecurity, poverty, abuse in the home, and parental migration. COVID-19 and climate hazards exacerbated food insecurity and child marriage, while education was assessed to be a modifier that reduces girls’ risk of marriage. The authors suggest that child marriage programming in humanitarian settings should be community-led and address the gender inequality that underpins child marriage. They argues that programming must be responsive to the diverse risks and realities that adolescents face to address intersecting levels of deprivation.

Perceived barriers of access to health and nutrition services under drought and food insecurity emergency in north-east Uganda: a qualitative study
Njuguna C, Tola H, Maina B N, et al: BMC Public Health 24:390, 1-9, 2024

This study explored barriers to access health and nutrition services in drought and food insecurity emergency affected districts in north-east Uganda. The authors interviewed 30 patients and 20 Village Health Teams from 15 districts and used thematic data analysis on the findings. The majority of respondents reported that difficulties in access to health and nutrition services, with various sociocultural, economic, environmental, health system, and individual barriers. The study identified several modifiable barriers that are addressed in proposals for comprehensive interventions in the paper.

COVID-19 crisis interlinkage with past pandemics and their effects on food security
Roubík H, Lošťák M, Ketuama C, et al: Globalisation and Health 19:52; 1-16, 2023

This paper explores the impacts of COVID-19 and past pandemics on food security and key strategies that could be put in place to manage these impacts on security. The coronavirus pandemic deepened disruptions in the flow of farm workers and farm operations leading to post-harvest food losses, and diets were affected. The authors recommend future responses to prevent and mitigate the effects of pandemics on food security consider inter-connected pro-active policy, program, and institutional actions.

What SA’s dirty water does to your health
Malan M, Mdzeke Y, Moloi M: Health Beat #10,|Bhekisisa, South Africa, 2023

A broken sewerage system in Bophelong near the Vaal River in Gauteng, forces people to live “like pigs”, says environmental activist Lawrence Majoro. The department of water and sanitation acknowledges the Vaal is “one of the worst polluted rivers in South Africa”, leaving residents exposed to diseases like cholera. In this episode of Bhekisisa’s monthly television show, Health Beat, viewers are taken to see the Emfuleni municipality in Vanderbijlpark’s rundown sewers, with input from an infectious diseases expert and a water scientist on the implications if water treatment services don’t improve.

Concurrence of water and food insecurities, 25 low- and middle-income countries
Young SL, Bethancourt HJ, Frongillo EA et al: Bulletin of the World Health Organisation 101:2;90–101, 2023

This study investigated how water and food insecurity were associated in nationally representative samples of individuals from 25 low- and middle-income countries, using data from the Individual Water Insecurity Experiences Scale and the Food Insecurity Experience Scale administered to 31 755 respondents, measuring insecurity in the previous 12 months. The likelihood of experiencing moderate-to-severe food insecurity was higher among respondents also experiencing water insecurity, including in sub-Saharan Africa. The results suggest that water insecurity should be considered when developing food and nutrition policies and interventions and the authors propose research to understand the paths between these insecurities.

Drivers of child marriage in specific settings of Ethiopia, Indonesia, Kenya, Malawi, Mozambique and Zambia – findings from the Yes I Do baseline study
Kok M C, Kakal T, Kassegne AB, et al: BMC Public Health 23:794; 1-16, 2023

This study explored the drivers of child marriage in specific contexts in Ethiopia, Indonesia, Kenya, Malawi, Mozambique and Zambia, combining a household survey among youth with focus group discussions and interviews conducted with youth, parents and community stakeholders. A lack of education was associated with the occurrence of child marriage in Ethiopia, Kenya and Zambia. In all countries, teenage pregnancy was associated with child marriage. In Ethiopia, Kenya and Mozambique, fathers’ education seemed a protective factor for child marriage. In all countries, child marriage was driven by difficult economic circumstances, which were often intertwined with disapproved social circumstances, in particular teenage pregnancy, in case of Kenya, Malawi, Mozambique and Zambia. These circumstances made child marriage an ‘acceptable practice’. The authors found that child marriage is a manifestation of social norms, particularly related to girls’ sexuality, which are intersecting with other factors at individual, social, material, and institutional level – most prominently poverty or economic constraints. The authors argue that efforts to prevent child marriage need to take these realities of girls and their families into account.

Limited handwashing facility and associated factors in sub-Saharan Africa: pooled prevalence and multilevel analysis of 29 sub-Saharan Africa countries from demographic health survey data
Endalew M; Belay D G; Tsega N T; et al: BMC Public Health 22(1969), 1-12, 2022

This study determined the prevalence of limited handwashing facility and its associated factors in sub-Saharan Africa. Data was obtained from the Demographic and Health Surveys in 29 sub-Saharan African countries since January 1, 2010. The pooled prevalence of limited handwashing facilities was found to be 66%. Having a limited handwashing facility was associated with having a household head aged between 35 and 60, having a mobile type of hand washing facility, unimproved sanitation facility, water access requiring more than a 30 min round trip, living in an urban residential area, having low media exposure, low educational level, low income level and being in a lower middle-income level and having more than three children.

A qualitative assessment of gender roles in child nutrition in Central Malawi
Mkandawire E; Bisai C; Dyke E; Dressel A; et al: BMC Public Health 22(1392), 1-13, doi: https://doi.org/10.1186/s12889-022-13749-x, 2022

This study was implemented in central Malawi in 2017 to understand the different roles that Malawian men and women play in child nutrition. It involved interviews (76), focus group discussions and in-depth interviews. The authors found that women carried a disproportionate workload in supporting child nutrition compared to men, and that their heavier workloads in other areas often prevented them from being able to meet children’s food needs. There were some shifts in gender roles with men taking up responsibilities typically associated with women, but this did not necessarily increase women’s power within the household. Women continued to be primarily responsible for the food, care, and health of the household. The authors suggest that improving gender equality and child nutrition will require efforts to redistribute gendered work and encourage men to move towards shared power with women over household decision-making and control over income.

COVID-19 Crisis and the Informal Economy
WIEGO: Study Report, 2022

Women in Informal Employment: Globalizing and Organizing (WIEGO) is a global network focused on empowering the working poor, especially women, in the informal economy to secure their livelihoods. WIEGO implemented this study in two rounds to capture changes across the different stages of the crisis during the second and third quarters of 2020, and how workers adapted by the first quarter of 2021. The study was implemented in 12 cities, including Dar es Salaam in Tanzania and Durban in South Africa. The work provides a platform to give visibility to the experience and voices of informal workers in policy. The organizations of informal workers involved in the study called for continuing relief, inclusive recovery and longer-term reforms for informal workers going forward. These demands, with concrete examples, were categorized into a common framework. a “Summary of Demands” to support these and other organizations of informal workers in their on-going advocacy and negotiations for a full and just recovery and for a “better deal” in the future for informal workers.

Application of community dialogue approach to prevent adolescent pregnancy, early marriage and school dropout in Zambia: a case study
Zulu I; Zulu J; Svanemyr J; Michelo C; et al: Reproductive Health 19(30), 1-9, 2022

This paper presents parents’ perspectives on the application of the community dialogue approach in addressing adolescents’ early pregnancy and school dropout in a 2018 cluster randomized controlled trial in rural Zambia. The guardians/parents perceived the community dialogue to be a relevant approach for addressing social and cultural norms regarding early pregnancy, marriage and school dropout. It was embraced for its value in initiating individual and collective change. The facilitators’ interactive approach and dialogue in the community meetings coupled with the use of films and role plays with the parents, lead to active participation and open discussions about sexual and reproductive health topics during the community dialogue meetings. Group interactions and sharing of experiences helped parents clarify their sexual and reproductive health values and subsequently made them feel able to communicate about sexual and reproductive health issues with their children. However, cultural and religious beliefs among the parents regarding some topics, like the use of condoms and contraceptives, complicated the delivery of reproductive health messages from the parents to their children.