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      Food Insecurity as a Risk Factor for Outcomes Related to Ebola Virus Disease in Kono District, Sierra Leone: A Cross-Sectional Study

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          Abstract

          <p id="d3408086e351">Studies have shown that people suffering from food insecurity are at higher risk for infectious and noncommunicable diseases and have poorer health outcomes. No study, however, has examined the association between food insecurity and outcomes related to Ebola virus disease (EVD). We conducted a cross-sectional study in two Ebola-affected communities in Kono district, Sierra Leone, from November 2015 to September 2016. We enrolled persons who were determined to have been exposed to Ebola virus. We assessed the association of food insecurity, using an adapted version of the Household Food Insecurity Access Scale, a nine-item scale well validated across Africa, with having been diagnosed with EVD and having died of EVD, using logistic regression models with cluster-adjusted standard errors. We interviewed 326 persons who were exposed to Ebola virus; 61 (19%) were diagnosed with EVD and 45/61 (74%) died. We found high levels (87%) of food insecurity, but there was no association between food insecurity and having been diagnosed with EVD. Among EVD cases, those who were food insecure had 18.3 times the adjusted odds of death than those who were food secure ( <i>P</i> = 0.03). This is the first study to demonstrate a potential relationship between food insecurity and having died of EVD, although larger prospective studies are needed to confirm these findings. </p>

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          Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS.

          Sheri D Weiser, Sera Young, Craig R Cohen … (2011)
          Food insecurity, which affects >1 billion people worldwide, is inextricably linked to the HIV epidemic. We present a conceptual framework of the multiple pathways through which food insecurity and HIV/AIDS may be linked at the community, household, and individual levels. Whereas the mechanisms through which HIV/AIDS can cause food insecurity have been fairly well elucidated, the ways in which food insecurity can lead to HIV are less well understood. We argue that there are nutritional, mental health, and behavioral pathways through which food insecurity leads to HIV acquisition and disease progression. Specifically, food insecurity can lead to macronutrient and micronutrient deficiencies, which can affect both vertical and horizontal transmission of HIV, and can also contribute to immunologic decline and increased morbidity and mortality among those already infected. Food insecurity can have mental health consequences, such as depression and increased drug abuse, which, in turn, contribute to HIV transmission risk and incomplete HIV viral load suppression, increased probability of AIDS-defining illness, and AIDS-related mortality among HIV-infected individuals. As a result of the inability to procure food in socially or personally acceptable ways, food insecurity also contributes to risky sexual practices and enhanced HIV transmission, as well as to antiretroviral therapy nonadherence, treatment interruptions, and missed clinic visits, which are strong determinants of worse HIV health outcomes. More research on the relative importance of each of these pathways is warranted because effective interventions to reduce food insecurity and HIV depend on a rigorous understanding of these multifaceted relationships.
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            Inflammatory responses in Ebola virus-infected patients.

            M. Courbot, I Bedjabaga, Bruce E. LeRoy … (2002)
            Ebola virus subtype Zaire (Ebo-Z) induces acute haemorrhagic fever and a 60-80% mortality rate in humans. Inflammatory responses were monitored in victims and survivors of Ebo-Z haemorrhagic fever during two recent outbreaks in Gabon. Survivors were characterized by a transient release in plasma of interleukin-1beta (IL-1beta), IL-6, tumour necrosis factor-alpha (TNFalpha), macrophage inflammatory protein-1alpha (MIP-1alpha) and MIP-1beta early in the disease, followed by circulation of IL-1 receptor antagonist (IL-1RA) and soluble receptors for TNFalpha (sTNF-R) and IL-6 (sIL-6R) towards the end of the symptomatic phase and after recovery. Fatal infection was associated with moderate levels of TNFalpha and IL-6, and high levels of IL-10, IL-1RA and sTNF-R, in the days before death, while IL-1beta was not detected and MIP-1alpha and MIP-1beta concentrations were similar to those of endemic controls. Simultaneous massive activation of monocytes/macrophages, the main target of Ebo-Z, was suggested in fatal infection by elevated neopterin levels. Thus, presence of IL-1beta and of elevated concentrations of IL-6 in plasma during the symptomatic phase can be used as markers of non-fatal infection, while release of IL-10 and of high levels of neopterin and IL-1RA in plasma as soon as a few days after the disease onset is indicative of a fatal outcome. In conclusion, recovery from Ebo-Z infection is associated with early and well-regulated inflammatory responses, which may be crucial in controlling viral replication and inducing specific immunity. In contrast, defective inflammatory responses and massive monocyte/macrophage activation were associated with fatal outcome.
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              Development of indicators to assess hunger.

              T Olson, C Ryan Campbell, K L Radimer (1990)
              Despite widespread concern about hunger in America, efforts to monitor and assess the extent of hunger have been hampered by lack of consensus on an appropriate meaning for the term hunger and by the lack of valid indicators to assess it. The first phase of the research used qualitative methods to derive a socially-appropriate definition of hunger. Thirty-two women in Upstate New York were interviewed regarding their experience with food problems and hunger. The interviews were analyzed using the constant comparative method. Results indicated that women had a narrow and a broad concept of hunger. The narrow concept focused on going without food for a specified period of time and the physical sensation of hunger. The broad one included two dimensions: household and individual hunger. Each had quantitative, qualitative, psychological, and social components. The second phase of the research used survey methodology to examine the validity and reliability of items designed to measure the conceptual definition of hunger. The survey was administered to 189 women in Upstate New York who participated in programs designed for low-income households or households in need of food. The second phase confirmed the conceptualization of hunger developed in the first phase. A subset of valid and reliable items that represented each of the major dimensions and components of hunger was identified as being useful for monitoring and assessing hunger.
              Article 0 comments Cited 107 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: The American Journal of Tropical Medicine and Hygiene
                Publisher: American Society of Tropical Medicine and Hygiene
                ISSN (Print): 0002-9637
                ISSN (Electronic): 1476-1645
                Publication date Created: May 09 2018
                Publication date (Print): May 09 2018
                Volume: 98
                Issue: 5
                Pages: 1484-1488
                Affiliations
                [1 ] Department of Medicine, University of California, San Francisco, San Francisco, California;
                [2 ] Institute for Global Health Sciences, University of California, San Francisco, California
                [3 ] Division of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California;
                [4 ] Partners In Health, Freetown, Sierra Leone;
                [5 ] Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;
                [6 ] Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts;
                Article
                DOI: 10.4269/ajtmh.17-0820
                PMC ID: 5953383
                PubMed ID: 29557329
                SO-VID: f8dce518-6724-4aec-b45c-7b76da7481e3
                Copyright © © 2018
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