Poverty and health

Factors associated with household food insecurity and depression in pregnant South African women from a low socio-economic setting: a cross-sectional study
Abrahams Z; Lund C; Field S; et al: Social Psychiatry and Psychiatric Epidemiology, doi: https://doi.org/10.1007/s00127-018-1497-y, 2018

This study aimed to assess factors associated with food insecurity and depression in a sample of pregnant South African women in a low-income suburb in Cape Town. Pregnant women attending a local clinic for their first antenatal visit were invited to participate. The shortened form of the US Household Food Security Survey Module was used to measure food insecurity. The Expanded Mini-International Neuropsychiatric Interview was used to diagnose depression, anxiety, alcohol and drug dependence, and assess for suicidal ideation and behaviour. Logistic regression modelling was conducted to explore factors associated with food insecurity and depression in separate models. The authors found that 42% of households were food insecure and that 21% of participants were depressed. The odds of being food insecure were increased in women with suicidal behaviour, with depression and in those with three or more children. The odds of depression was greater in women who were food insecure, substance dependent or diagnosed with an anxiety disorder. Food insecurity and depression are strongly associated in pregnant women. The relationship between food insecurity and depression is complex and requires further investigation. Interventions that improve both food security and mental health during the perinatal period are likely to benefit the physical and mental well-being of mothers and children.

Psychosocial support for adolescent girls in post-conflict settings: beyond a health systems approach
Samuels F; Jones N; Hamad B: Health Policy and Planning 32(Suppl 5) v40–v51 2017

This paper focuses on the importance of psychosocial support services for adolescent girls in fragile contexts. Its starting point is that adolescence is a pivotal time in the life course but given the physical, cognitive and emotional changes triggered by the onset of puberty, it can also be a period of heightened sensitivity and vulnerability to trauma, social isolation, bullying by peers, a lack of supportive adults and gender-based and sexual violence. The authors’ findings highlighted why humanitarian and biomedical approaches in their current form are inadequate to address these complexities. Drawing on qualitative fieldwork, the authors argued that going beyond biomedical approaches and considering the social determinants of health, including approaches to tackle discriminatory gendered norms and barriers to service access, are critical for achieving broader health and wellbeing. While all three case study countries are classified as post-conflict, the political economy dynamics vary with associated implications for experiences of psychosocial vulnerabilities and the service environment. The study concludes by reflecting on actions to address psychosocial vulnerabilities facing adolescent girls through tailoring services to ensure gender and age-sensitivity, investing in capacity building of service providers to promote service uptake and enhancing strategies to regulate and coordinate actors providing mental health and psychosocial support services.

World's poor to suffer most unless developed countries act fast on climate change
Khan A: Pambuzuka News, December 2017

Storms and hurricanes are becoming more severe due to warmer sea temperatures. Low lying island nations, like the Maldives, now experience annual flooding with the seawater contaminating groundwater supplies. Whether flooding, drought or other climate-related catastrophic events, the author observes that low income countries nations and their populations suffer most, given their lack of resources, infrastructure, emergency services and preparedness. They also point to a further consequence relating to the quality of food. Rising CO2 levels speed up plant growth increasing carbohydrates through plant sugars and diluting nutrition due to reduced minerals and protein. The nutrient quality of our food is expected to fall as CO2 levels rise this century. The effect will be worst felt by the world's poorer populations relying on a plant diet. Extreme weather events affect production, distribution, spoilage and contamination. The author notes that those most affected will be people in Africa, Asia and the Americas.

“If it's issues to do with nutrition…I can decide…”: gendered decision-making in joining community-based child nutrition interventions within rural coastal Kenya
Muraya K; Jones C; Berkley ; et al.: Health Policy and Planning 32 (Suppl 5) ppv31–v39 2017

This qualitative study undertaken in rural Coastal Kenya aimed to explore the interaction between household gender relations and a community-based child nutrition programme. It focused on household decision-making dynamics related to joining the intervention. Fifteen households whose children were enrolled in the programme were followed up over a period of 12 months. Over 60 household visits, group and individual in-depth interviews were conducted with a range of respondents, supplemented by non-participant observations. Data were analysed using a framework analysis approach. Engagement with the intervention was highly gendered with women being the primary decision-makers and engagers. Women were responsible for managing child feeding and minor child illnesses in households. As such, involvement in community-based nutrition interventions and particularly one that targeted a condition perceived as non-serious, fell within women’s domain. Despite this, the nutrition programme of interest could be categorized as gender-blind. Gender was not explicitly considered in the design and implementation of the intervention, and the gender roles and norms in the community with regards to child nutrition were not critically examined or challenged. In fact, the authors argue that the intervention might have inadvertently reinforced existing gender divisions and practices in relation to child nutrition, by excluding men from the nutrition discussions and activities and thereby supporting the notion of child feeding and nutrition as “women’s business”. To improve outcomes, community based nutrition interventions are argued to need to understand and take into account gendered household dynamics, and incorporate strategies that promote behaviour change and attitude shifts in relation to gendered norms and child nutrition.

The Power of 'Know-Who': Adaptation to Climate Change in a Changing Humanitarian Landscape in Isiolo, Kenya
Mosberg M; Nyukuri E; Naess L: IDS Bulletin 48(4), doi: 10.19088/1968-2017.154, 2016

This article examines adaptation to climate change in view of changing humanitarian approaches in Isiolo County, Kenya. While humanitarian actors are increasingly integrating climate change in their international and national-level strategies, less is known about how this plays out at sub-national levels, which is key to tracking whether and how short-term assistance can support long-term adaptation. The article suggests that increasing attention to resilience and adaptation among humanitarian actors may not lead to reduced vulnerability because resources tend to be captured through existing power structures, directed by who you know and your place in the social hierarchy. In turn, this sustains rather than challenges the marginalisation processes that cause vulnerability to climate shocks and stressors. The article highlights the important role of power and politics both in channelling resources and determining outcomes.

Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services
Mutebi A; Kananura R; Ekirapa-Kiracho; et al.: Global Health Action 10(S4)82-91, 2017

Data on the characteristics of community-based savings groups were collected from 247 community-based savings group leaders in the districts of Kamuli, Kibukuand Pallisa using a self-administered open-ended questionnaire, and in-depth interviews with seven community-based savings group leaders. Ninety-three percent of the community-based savings groups said they elected their management committees democratically to select the group leaders and held meetings at least once a week. Eighty-nine percent used metallic boxes to keep their money, while 10% kept their money in mobile money and banks. The community-based savings groups were formed mainly to increase household income, to develop the community and to save for emergencies. The community-based savings groups faced challenges of high illiteracy among the leaders, irregular attendance of meetings, and lack of training on management and leadership. Saving groups in Uganda are reported to have the basic required structures, but with challenges in relation to training and management of the groups and their assets, calling for technical support in these areas.

If you miss them, then you’re missing out
Riria J: Daily Nation, 7 November 2017

The author reports an estimated 65 per cent of women-led small and medium-sized enterprises (SMEs) in the developing economies that are either unserved or underserved financially. SMEs provide 80 per cent of Kenya’s employment and contribute 20 per cent of our GDP, according to latest reports from African Economic Outlook. Data on registered firms shows that women hold ownership roles in 48 per cent of Kenyan SMEs. The World Bank says that only 51 per cent of Kenyan women have access to a simple bank account, much less a business loan or insurance to protect them financially. The author notes that microfinance can address this deficit through loans designed specifically for women-led SMEs that need access to working capital to expand their businesses, that have flexible monthly repayment amounts, security and collateral requirements, and longer repayment periods.

Tuberculosis, human rights and ethics considerations along the route of a highly vulnerable migrant from sub-Saharan Africa to Europe
Wild V; Jaff D; Shah NS; et al.: International Union Against Tuberculosis and Lung Disease 21(10)1075-1085, 2017

Migrant health is a critical public health issue, and in many countries attention to this topic has focused on the link between migration and communicable diseases, including tuberculosis (TB). This paper traces a commonly used migration route from sub-Saharan Africa to Europe, identifying situations at each stage in which human rights and ethical values might be affected in relation to TB care. The authors highlight three strands of discussion in the ethics and justice literature in an effort to develop more comprehensive ethics of migrant health. These strands include theories of global justice and global health ethics, the creation of ‘firewalls' to separate enforcement of immigration law from protection of human rights, and the importance of non-stigmatization to health justice.

Effectiveness of a brief behavioural intervention on psychological distress among women with a history of gender-based violence in urban Kenya: A randomised clinical trial
Bryant R; Schafer A; Dawson K; et al.: Public Library of Science Medicine( PLOS Med) 14(8) https://doi.org/10.1371/journal.pmed.1002371, 2017

Gender-based violence (GBV) represents a major cause of psychological morbidity worldwide, and particularly in low- and middle-income countries). Although there are effective treatments for common mental disorders associated with GBV, they typically require lengthy treatment programs that may limit scaling up in low- and middle-income countries. This study tested the effectiveness of a new 5-session behavioural treatment called Problem Management Plus (PM+) that lay community workers can be taught to deliver. In this single-blind, parallel, randomised controlled trial, adult women who had experienced GBV were identified through community screening for psychological distress and impaired functioning in Nairobi, Kenya. Participants were randomly allocated in a 1:1 ratio either to PM+ delivered in the community by lay community health workers provided with 8 days of training or to facility-based enhanced usual care (EUC) provided by community nurses. Participants were aware of treatment allocation, but research assessors were blinded. The primary outcome was psychological distress as measured by the total score on the 12-item General Health Questionnaire (GHQ-12) assessed at 3 months after treatment. Between 15 April 2015 and 20 August 2015, 1,393 women were screened for eligibility on the basis of psychological distress and impaired functioning. Of these, 37% screened positive, of whom 81% were women who had experienced GBV. Of these women, 209 were assigned to PM+ and 212 to EUC. Follow-up assessments were implemented. The study found that among a community sample of women in urban Kenya with a history of GBV, a brief, lay-administered behavioural intervention, compared with EUC, resulted in moderate reductions in psychological distress at 3-month follow-up.

World poverty could be cut in half if all adults completed secondary education
United Nations Educational, Scientific and Cultural Organisation: UNESCO Policy Paper 32, Fact sheet 44, New York, 2017

This UNESCO policy paper reports that the global poverty rate could be more than halved if all adults completed secondary school. Yet, new data from the UNESCO Institute for Statistics (UIS) show persistently high out-of-school rates in many countries, making it likely that completion levels in education will remain well below that target for generations to come. The paper demonstrates the importance of recognising education as a core lever for ending poverty in all its forms, everywhere. The analysis of education’s impact on poverty shows that nearly 60 million people could escape poverty if all adults had just two more years of schooling. Despite education’s potential, new UIS data show that there has been virtually no progress in reducing out-of-school rates in recent years. Globally, 9% of all children of primary school age are still denied their right to education, with rates reaching 16% and 37% for youth of lower and upper secondary ages, respectively. In total, 264 million children, adolescents and youth were out of school in 2015. UNESCO argues that education must reach the poorest households to maximise its benefits and reduce income inequality.