Search

Armed conflict throughout the world's biodiversity hotspots poses a critical threat to conservation efforts. To date, research and policy have focused more on the ultimate outcomes of conflict for wildlife rather than on the ecological, social, and economic processes that create those outcomes. Yet the militarization that accompanies armed conflict, as well as consequent changes in governance, economies, and human settlement, has diverse influences on wildlife populations and habitats. To better understand these complex dynamics, we summarized 144 case studies from around the world and identified 24 distinct pathways linking armed conflict to wildlife outcomes. The most commonly cited pathways reflect changes to institutional and socioeconomic factors, rather than tactical aspects of conflict. Marked differences in the most salient pathways emerge across geographic regions and wildlife taxa. Our review demonstrates that mitigating the negative effects of conflict on biodiversity conservation requires a nuanced understanding of the ways in which conflict affects wildlife populations and communities.

Women's access to natural resources for food and livelihoods is shaped by resource availability, income, and the gender dynamics that mediate access. In fisheries, where men often fish but women comprise 90% of traders, transactional sex is among the strategies women use to access resources. Using the case of Lake Victoria, we employed mixed methods (in-depth interviews, n = 30; cross-sectional survey, n = 303) to analyze the influence of fish declines on fish-for-sex relationships. We found that fish declines affect relationship duration and women's bargaining power. Our results have broad implications for the dynamics of economies dependent on increasingly scarce resources throughout the world.

The global biodiversity that underpins wild food systems-including fisheries-is rapidly declining. Yet, we often have only a limited understanding of how households use and benefit from biodiversity in the ecosystems surrounding them. Explicating these relationships is critical to forestall and mitigate the effects of biodiversity declines on food and nutrition security. Here, we quantify how biodiversity filters from ecosystems to household harvest, consumption, and sale, and how ecological traits and household characteristics shape these relationships. We used a unique, integrated ecological (40 sites, quarterly data collection) and household survey (n = 414, every 2 mo data collection) dataset collected over 3 y in rice field fisheries surrounding Cambodia's Tonlé Sap, one of Earth's most productive and diverse freshwater systems. While ecosystem biodiversity was positively associated with household catch, consumption, and sold biodiversity, households consumed an average of 43% of the species present in the ecosystem and sold only 9%. Larger, less nutritious, and more common species were disproportionally represented in portfolios of commercially traded species, while consumed species mirrored catches. The relationship between ecosystem and consumed biodiversity was remarkably consistent across variation in household fishing effort, demographics, and distance to nearest markets. Poorer households also consumed more species, underscoring how wild food systems may most benefit the vulnerable. Our findings amplify concerns about the impacts of biodiversity loss on our global food systems and highlight that utilization of biodiversity for consumption may far exceed what is commercially traded., Competing Interests: Competing interests statement:The authors declare no competing interest.

Drowning is an overlooked public health concern and drowning risk is dependent on environmental risk factors. The preponderance of drowning deaths occurs in low- and middle-income countries. Small-scale fishers face high occupational risk of drowning. Climate change increases the frequency and intensity of storms, thereby exacerbating fishers' risks and creating a need to examine the contribution of storms to fisher drowning deaths for the development of mitigation strategies. We examined this relationship between weather and fisher drowning deaths in Lake Victoria, which is Africa's largest lake, a site of high fishing pressure, and where climate change is predicted to increase thunderstorms. We conducted a verbal autopsy with people knowledgeable about recent fatal fisher drowning incidents to collect information about the deceased fishers and circumstances surrounding the incidents across 43 landing sites in the Kenyan shore of Lake Victoria. Semi-structured interviews with stakeholders also elucidated community perspectives on drowning risks. Fatal drownings were often attributed to bad weather (41.8%). Other risk factors, such as non-use of life jacket and navigation equipment, co-occurred with bad weather at high rates (69.5% and 67.8%, respectively) to jointly contribute to fatal drowning incidents. Such co-occurrence of risk factors indicates that actions across multiple risk factors can help mitigate the issue. Stakeholder analysis revealed a range of opportunities for improved communication of risks and action to mitigate risks across boat operators and manufacturers, as well as multiple levels of management. Across global small-scale fisheries, limited use of safety equipment and intensive fishing pressure may coincide with increases in extreme weather events, necessitating action to address current and mitigate future drowning risks to small-scale fishers., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Rasolofoson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: The contamination of fresh surface waters poses a significant burden on human health and prosperity, especially in marginalized communities with limited resources and inadequate infrastructure. Here, we performed in-depth genomic analyses of multidrug-resistant bacteria (MDR-B) isolated from Al-Oueik river water that is used for irrigation of agricultural fields in a disenfranchised area that also hosts a makeshift Syrian refugee camp., Methods: A composite freshwater sample was filtered. Faecal coliforms were counted and extended spectrum cephalosporins and/or ertapenem resistant bacteria were screened. Isolates were identified using MALDI-TOF-MS and analysed using whole-genome sequencing (WGS) to identify the resistome, sequence types, plasmid types, and virulence genes., Results: Approximately 10 6 CFU/100 mL of faecal coliforms were detected in the water. Four drug-resistant Gram-negative bacteria were identified, namely Escherichia coli, Klebsiella pneumoniae, Enterobacter hormaechei, and Pseudomonas otitidis. Notably, the E. coli isolate harboured bla NDM-5 and a YRIN-inserted PBP3, representing an emerging public health challenge. The K. pneumoniae isolate carried bla SHV-187 as well as mutations in the gene encoding the OmpK37 porin. Enterobacter hormaechei and P. otitidis harboured bla ACT-16 and bla POM-1 , respectively., Conclusion: This report provides comprehensive genomic analyses of MDR-B in irrigation water in Lebanon. Our results further support that irrigation water contaminated with faecal material can be a reservoir of important MDR-B, which can spread to adjacent agricultural fields and other water bodies, posing both public health and food safety issues. Therefore, there is an urgent need to implement effective water quality monitoring and management programs to control the proliferation of antibiotic-resistant pathogens in irrigation water in Lebanon., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: We declare no competing interests. This paper was supported by the Natural Sciences and Engineering Research Council of Canada and Carleton University. Any use of trade, firm, or product names is for descriptive purposes only and does not imply endorsement by the US Government. SJC is supported by the Natural Sciences and Engineering Research Council of Canada (319774) and Carleton University.

Background: Economic reforms and trade liberalisation in Vietnam have transformed the food environment, influencing dietary patterns and malnutrition status. The present study focuses on the relationship between food environments (proximity and density of food outlets) and malnutrition (underweight, overweight, obesity) through diet quality in adult populations across urban, periurban and rural areas of Vietnam., Methods: We evaluated food environment by geospatial mapping of food outlets through a transect walk across the "food ecosystem" from rural to urban areas. Diet quality was assessed using the Diet Quality Index - Vietnamese (DQI-V) comprising Variety, Adequacy, Moderation and Balance components. Malnutrition status was determined using body mass index. We performed a mediation analysis utilising mixed effect models to control for neighbourhood clustering effects. Confounders included age, education, income and nutrition knowledge score., Results: Analysis of data from 595 adult participants (mean ± SD age: 31.2 ± 6.4 years; 50% female) found that longer distance to the nearest food outlet was associated with higher overall DQI-V (β = 2.0; 95% confidence interval = 0.2-3.8; p = 0.036) and the Moderation component (β = 2.6; 95% confidence interval = 1.2-4.0; p = 0.001). Outlet density shows a negative association with the odds of underweight among women (odds ratio = 0.62; 95% confidence interval = 0.37-0.96). However, we did not observe statistically significant relationships between diet quality and malnutrition. Education and nutrition knowledge scores were positively associated with diet diversity, while income was negatively associated with diet moderation., Conclusions: The findings of the present study have important implications for nutrition and dietetics practice in Vietnam and globally. It emphasises the need to consider various dimensions of sustainable diets, including economic, health and socio-cultural/political factors. Longer distances to food outlets are associated with higher diet quality, whereas lower food outlet density increases the odds of underweight among women. This poses challenges in balancing modernisation and its adverse effects on sustainable food systems. Socio-economic status consistently correlated with diet quality and malnutrition, necessitating further research to promote healthy diets across socio-economic strata., (© 2023 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

Species, through their traits, influence how ecosystems simultaneously sustain multiple functions. However, it is unclear how trait diversity sustains the multiple contributions biodiversity makes to people. Freshwater fisheries nourish hundreds of millions of people globally, but overharvesting and river fragmentation are increasingly affecting catches. We analyse how loss of nutritional trait diversity in consumed fish portfolios affects the simultaneous provisioning of six essential dietary nutrients using household data from the Amazon and Tonlé Sap, two of Earth's most productive and diverse freshwater fisheries. We find that fish portfolios with high trait diversity meet higher thresholds of required daily intakes for a greater variety of nutrients with less fish biomass. This beneficial biodiversity effect is driven by low redundancy in species nutrient content profiles. Our findings imply that sustaining the dietary contributions fish make to people given declining biodiversity could require more biomass and ultimately exacerbate fishing pressure in already-stressed ecosystems., (© 2023 John Wiley & Sons Ltd.)

Introduction: COVID-19 acutely shocked both socio-economic and food systems in 2020. We investigated the impact of COVID-19 on production and consumption of gardened produce, backyard poultry, wild game and fish, and foraged mushrooms, berries, and other plants in New York State, aiming to understand crisis influenced food choice and motivations, including food security., Methods: We conducted an online, cross-sectional survey in October-December 2020 with a convenience sample of participants ( n = 505) with an interest in gardening, poultry rearing, foraging, hunting, and/or fishing from six counties in upstate New York. We recruited through the New York Department of Environmental Conservation, Cornell Cooperative Extension, and other relevant email and social media pages., Results: Across the wild and backyard food production strategies, 4.0-14.3% of respondents reported engaging for the first time and 39.6-45.7% reported increased production (a little or a lot more), and 31.6-42.7% of respondents' production was the same as the previous year. Consumption of foods produced was widespread, including fruit and vegetables (97.6% of producers also consumed), backyard eggs (92.7%), and foraged foods (93.8%). For meats, a majority consumed backyard poultry meat (51.2%), wild-caught fish (69.7%), and wild game they hunted (80.1%). The frequency of consumption of fruit and vegetables (average of 13.5 times/month) and eggs (16.4 times/month) was very high, while average consumption of poultry meat, foraged foods, fish, and wild game ranged from 3.1 to 5.8 times/month. The number of respondents who reported "have more control over food availability" as motivation to produce all wild and backyard foods increased from 2019 to 2020 ( p < 0.05 - p < 0.001). There was also a significant relationship between experiences of COVID-19 related hardship (i.e., food insecurity, income loss) with gardening and poultry-rearing ( p ≤ 0.05), but not with other production methods or with consumption of wild and backyard foods., Discussion: Our findings help to locate wild and backyard foods within COVID-19 impacted food environments, and describe food security as a particularly relevant motivation, among others, reported by respondents in 2020. Given this, New York State service providers can use these findings to tailor current future support for households exerting control over their own food environments with wild and backyard foods, allowing the state to be better prepared for future crises., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Coffin-Schmitt, Clements, Marshall, Liu, Trombitas, Wang, Yuan, Safi, Hanson and Fiorella.)

Wild-caught fish provide an irreplaceable source of essential nutrients in food-insecure places. Fishers catch thousands of species, yet the diversity of aquatic foods is often categorized homogeneously as 'fish', obscuring an understanding of which species supply affordable, nutritious and abundant food. Here, we use catch, economic and nutrient data on 2,348 species to identify the most affordable and nutritious fish in 39 low- and middle-income countries. We find that a 100 g portion of fish cost between 10 and 30% of the cheapest daily diet, with small pelagic fish (herring, sardine, anchovy) being the cheapest nutritious fish in 72% of countries. In sub-Saharan Africa, where nutrient deficiencies are rising, <20% of small pelagic catch would meet recommended dietary fish intakes for all children (6 months to 4 years old) living near to water bodies. Nutrition-sensitive policies that ensure local supplies and promote consumption of wild-caught fish could help address nutrient deficiencies in vulnerable populations., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

As sustainable development practitioners have worked to "ensure healthy lives and promote well-being for all" and "conserve life on land and below water", what progress has been made with win-win interventions that reduce human infectious disease burdens while advancing conservation goals? Using a systematic literature review, we identified 46 proposed solutions, which we then investigated individually using targeted literature reviews. The proposed solutions addressed diverse conservation threats and human infectious diseases, and thus, the proposed interventions varied in scale, costs, and impacts. Some potential solutions had medium-quality to high-quality evidence for previous success in achieving proposed impacts in one or both sectors. However, there were notable evidence gaps within and among solutions, highlighting opportunities for further research and adaptive implementation. Stakeholders seeking win-win interventions can explore this Review and an online database to find and tailor a relevant solution or brainstorm new solutions., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: The coronavirus disease 2019 (COVID-19) pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support and identify long-term impacts and needs., Objective: The National Food Access and COVID research Team (NFACT) was formed to assess food security over different US study sites throughout the pandemic, using common instruments and measurements. This study presents results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic., Methods: A validated survey instrument was developed and implemented in whole or part through an online survey of adults across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA 6-item module. Food security prevalence was analyzed using ANOVA by sampling method to assess statistically significant differences., Results: Respondents ( n  = 27,168) indicate higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, compared with before the pandemic. In nearly all study sites, there is a higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. The findings demonstrate lingering food insecurity, with high prevalence over time in sites with repeat cross-sectional surveys. There are no statistically significant differences between convenience and representative surveys, but a statistically higher prevalence of food insecurity among high-risk compared with convenience surveys., Conclusions: This comprehensive study demonstrates a higher prevalence of food insecurity in the first year of the COVID-19 pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations. Results especially document the continued high levels of food insecurity, as well as the variability in estimates due to the survey implementation method., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Despite contributing to healthy diets for billions of people, aquatic foods are often undervalued as a nutritional solution because their diversity is often reduced to the protein and energy value of a single food type ('seafood' or 'fish') 1-4 . Here we create a cohesive model that unites terrestrial foods with nearly 3,000 taxa of aquatic foods to understand the future impact of aquatic foods on human nutrition. We project two plausible futures to 2030: a baseline scenario with moderate growth in aquatic animal-source food (AASF) production, and a high-production scenario with a 15-million-tonne increased supply of AASFs over the business-as-usual scenario in 2030, driven largely by investment and innovation in aquaculture production. By comparing changes in AASF consumption between the scenarios, we elucidate geographic and demographic vulnerabilities and estimate health impacts from diet-related causes. Globally, we find that a high-production scenario will decrease AASF prices by 26% and increase their consumption, thereby reducing the consumption of red and processed meats that can lead to diet-related non-communicable diseases 5,6 while also preventing approximately 166 million cases of inadequate micronutrient intake. This finding provides a broad evidentiary basis for policy makers and development stakeholders to capitalize on the potential of aquatic foods to reduce food and nutrition insecurity and tackle malnutrition in all its forms., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Existing social relationships are a potential source of "social capital" that can enhance support for sustained retention in HIV care. A previous pilot study of a social network-based 'microclinic' intervention, including group health education and facilitated HIV status disclosure, reduced disengagement from HIV care. We conducted a pragmatic randomized trial to evaluate microclinic effectiveness., Methods: In nine rural health facilities in western Kenya, we randomized HIV-positive adults with a recent missed clinic visit to either participation in a microclinic or usual care (NCT02474992). We collected visit data at all clinics where participants accessed care and evaluated intervention effect on disengagement from care (≥90-day absence from care after a missed visit) and the proportion of time patients were adherent to clinic visits ('time-in-care'). We also evaluated changes in social support, HIV status disclosure, and HIV-associated stigma., Results: Of 350 eligible patients, 304 (87%) enrolled, with 154 randomized to intervention and 150 to control. Over one year of follow-up, disengagement from care was similar in intervention and control (18% vs 17%, hazard ratio 1.03, 95% CI 0.61-1.75), as was time-in-care (risk difference -2.8%, 95% CI -10.0% to +4.5%). The intervention improved social support for attending clinic appointments (+0.4 units on 5-point scale, 95% CI 0.08-0.63), HIV status disclosure to close social supports (+0.3 persons, 95% CI 0.2-0.5), and reduced stigma (-0.3 units on 5-point scale, 95% CI -0.40 to -0.17)., Conclusions: The data from our pragmatic randomized trial in rural western Kenya are compatible with the null hypothesis of no difference in HIV care engagement between those who participated in a microclinic intervention and those who did not, despite improvements in proposed intervention mechanisms of action. However, some benefit or harm cannot be ruled out because the confidence intervals were wide. Results differ from a prior quasi-experimental pilot study, highlighting important implementation considerations when evaluating complex social interventions for HIV care., Trial Registration: Clinical trial number: NCT02474992., Competing Interests: G Ouma, B Mattah, P Mohamed, J Obanda, and A Odhiambo are employed by the Ekialo Kiona Centre, a Community Based Organization in Kenya and the local implementing organization for the microclinic/kanyakla intervention. M Hickey, B Pedersen, N DesLauriers, K Fiorella, and C Salmen are unpaid members of the Board of Directors of Organic Health Response (organichealthresponse.org), a US-based 501c3 nonprofit organization that supports the Ekialo Kiona Centre. D Zoughbie is employed by, and E Ding provides consultation for Microclinic International (microclinics.org), a US-based 501c3 nonprofit that provided technical support for intervention design and implementation. Microclinic International also received an unrestricted grant from a commercial source to support this work: Google Inc (administered via the Tides Foundation). These disclosures do not alter our adherence to PLOS ONE policies on sharing data and materials.

Aquaculture is increasing the global supply of foods, and holds tremendous potential to address malnutrition and diet-related diseases. The species selected and feeds used affects the nutrients available from aquaculture. Progress in the development of novel and sustainable aquaculture feeds to reduce reliance on wild fisheries, feed fortification to increase nutrient content, and expansion of the diversity of aquatic species produced are key areas for continued research and development. Ultimately, the degree to which aquaculture will contribute to nutrition depends largely on who can access the fish produced, which will be shaped by production technology as well as trade and price dynamics. Finally, the contribution of aquaculture expansion to improving nutrition will be bounded by aquaculture's environmental sustainability., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Small-scale fisheries underpin the aquatic food supply, and are facing acute challenges in the wake of the COVID-19 pandemic. The study aimed to examine how small-scale fishing households, including fishers and fish traders, are responding to COVID-19 and associated movement restrictions around Lake Victoria, Kenya. We conducted phone interviews with 88 households in three riparian communities around Lake Victoria to examine shifts in fish consumption, fishing activities, price changes, and coping strategies. We found that households are consuming less fish, perceiving high fish prices, and coping by more often selling than eating fish. Most fishers and traders reported spending less time fishing and trading, and concern about being infected with COVID-19 was high. Our findings suggest movement restrictions and COVID-19 concern, along with high lake levels in the region, may limit fishing activities and fish access. Controlling COVID-19 and supporting opportunities for fishers and traders to safely return to their livelihood activities will be paramount to the recovery of small-scale fishing communities today. Our findings can also support planning to mitigate the impacts of future crises on small-scale fishing communities., Competing Interests: The authors report no declarations of interest., (© 2020 Elsevier B.V. All rights reserved.)

Climate change will reshape ecological dynamics. Yet, how temperature increases alter the behavior and resource use of people reliant on natural resources remains underexplored. Consequent behavior shifts have the potential to mitigate or accelerate climate impacts on livelihoods and food security. Particularly within the small-scale inland fisheries that support approximately 10% of the global population, temperature changes likely affect both fish and fishers. To analyze how changing temperatures alter households' fishing behavior, we examined fishing effort and fish catch in a major inland fishery. We used longitudinal observational data from households in Cambodia, which has the highest per-capita consumption of inland fish in the world. Higher temperatures caused households to reduce their participation in fishing but had limited net effects on fish catch. Incorporating human behavioral responses to changing environmental conditions will be fundamental to determining how climate change affects rural livelihoods, food production, and food access., (Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).)

Objective: Our understanding of the nutrient contribution of fish and other aquatic species to human diets relies on nutrient composition data for a limited number of species. Yet particularly for nutritionally vulnerable aquatic food consumers, consumption includes a wide diversity of species whose nutrient composition data are disparate, poorly compiled or unknown., Design: To address the gap in understanding fish and other aquatic species' nutrient composition data, we reviewed the literature with an emphasis on species of fish that are under-represented in global databases. We reviewed 164 articles containing 1370 entries of all available nutrient composition data (e.g. macronutrients, micronutrients and fatty acids) and heavy metals (e.g. Pb and Hg) for 515 species, including both inland and marine species of fish, as well as other aquatic species (e.g. crustaceans, molluscs, etc.) when those species were returned by our searches., Results: We highlight aquatic species that are particularly high in nutrients of global importance, including Fe, Zn, Ca, vitamin A and docosahexaenoic acid (DHA), and demonstrate that, in many cases, a serving can fill critical nutrient needs for pregnant and lactating women and young children., Conclusions: By collating the available nutrient composition data on species of fish and other aquatic species, we provide a resource for fisheries and nutrition researchers, experts and practitioners to better understand these critical species and include them in fishery management as well as food-based programmes and policies.

Environmental change is projected to decrease the availability of key natural resources. Decreasing availability of resources that support food security and livelihoods for vulnerable populations is hypothesised to increase engagement in transactional sex. Therefore, we systematically examined the peer-reviewed literature to characterise what is known about transactional sex for natural resources, document the natural resources that are exchanged for sex, and identify qualitative trends. Of the 1063 articles, 33 were retained for full abstraction. A majority of articles were published after 2005 (93%) and focused on Africa (90%). Two-thirds of articles focused on sex-for-fish exchanges. Reports of transactional sex were also found for other resources, including agricultural land (12%) as well as food, water, and fuel in emergency contexts (12%). Migration and altered resource availability were described as underlying causes of transactional sex. Some studies described an increased risk of sexually transmitted infection, including HIV, as a health consequence of transactional sex. We offer three possible explanations for why the preponderance of previous studies have focused on sex-for-fish rather than other natural resources, and suggest directions for future research.

Background : Pica, the craving and purposeful consumption of nonfoods, is poorly understood. We described the prevalence of pica among women on Mfangano Island, Kenya, and examined sociodemographic and health correlates. Methods : Our cross-sectional study included 299 pregnant or postpartum women in 2012. We used a 24-h recall to assess pica, defined as consumption of earth (geophagy), charcoal/ash, or raw starches (amylophagy) and built multivariable logistic regression models to examine sociodemographic and health correlates of pica. Results : Eighty-one women (27.1%) engaged in pica in the previous 24 h, with 59.3% reporting amylophagy and 56.8% reporting geophagy, charcoal, and/or ash consumption. The most common substances consumed were raw cassava ( n = 30, 36.6%), odowa, a chalky, soft rock-like earth ( n = 21, 25.6%), and soil ( n = 17, 20.7%). Geophagy, charcoal, and/or ash consumption was negatively associated with breastfeeding (OR = 0.38, 95% CI: 0.18-0.81), and amylophagy was associated with pregnancy (OR = 4.31, 95% CI: 1.24-14.96). Pica was more common within one of six study regions (OR = 3.64, 95% CI: 1.39-9.51). We found no evidence of an association between food insecurity and pica. Conclusion : Pica was a common behavior among women, and the prevalence underscores the need to uncover its dietary, environmental, and cultural etiologies.

Food insecurity and poor infant and young child feeding (IYCF) practices contribute to undernutrition. The Kanyakla Nutrition Program was developed in rural Kenya to provide knowledge alongside social support for recommended IYCF practices. Utilizing a social network approach, the Kanyakla Nutrition Program trained community health workers (CHWs) to engage mothers, fathers, and grandparents in nutrition education and discussions about strategies to provide instrumental, emotional, and information support within their community. The 12-week programme included six sessions and was implemented on Mfangano Island, Kenya, in 2014-2015. We analysed intervention effects on (a) nutrition knowledge among community members or CHWs and (2) IYCF practices among children 1-3 years. Nutrition knowledge was assessed using a postintervention comparison among intervention (community, n = 43; CHW, n = 22) and comparison groups (community, n = 149; CHW, n = 64). We used a quasi-experimental design and difference-in-difference to assess IYCF indicators using dietary recall data from an ongoing cohort study among intervention participants (n = 48) with individuals living on Mfangano Island where the intervention was not implemented (n = 178) before the intervention, within 1 month postintervention, and 6 months postintervention. Findings showed no effect of the intervention on IYCF indicators (e.g., dietary diversity and meal frequency), and less than 15% of children met minimum acceptable diet criteria at any time point. However, knowledge and confidence among community members and CHWs were significantly higher 2 years postintervention. Thus, a social network approach had an enduring effect on nutrition knowledge, but no effects on improved IYCF practices., (© 2019 John Wiley & Sons Ltd.)

This study examines the association between 3 dimensions of food insecurity (timing, intensity, and duration) and 3 domains of child development (gross motor, communication, and personal social). Longitudinal data from 303 households (n = 309 children) visited 9 times over 2 years were collected. Children in households experiencing severe food insecurity 3 months prior (timing) had significantly lower gross motor (β -0.14; 95% CI [0.27, -0.0033]; p = .045), communication (β -0.16; 95% CI [-0.30, -0.023]; p = .023), and personal social (β -0.20; 95% CI [-0.33, -0.073]; p = .002) Z-scores, using lagged longitudinal linear models controlling for current food insecurity; these results were attenuated in full models, which included maternal education, household asset index, and child anthropometry. Children in households that experienced greater aggregate food insecurity over the past 2 years (intensity) had significantly lower gross motor (β -0.047; 95% CI [-0.077, -0.018]; p = .002), communication (β -0.042; 95% CI [-0.076, -0.0073]; p = .018), and personal social (β -0.042; 95% CI [-0.074, -0.010]; p = .010) Z-scores; these results were also attenuated in full models. Children with more time exposed to food insecurity (duration) had significantly lower gross motor (β -0.050; 95% CI [-0.087, -0.012]; p = .010), communication (β -0.042; 95% CI [-0.086, 0.0013]; p = .057), and personal social (β -0.037; 95% CI [-0.077, 0.0039]; p = .076) Z-scores; these results were no longer significant in full models. Our findings suggest that acute and chronic food insecurity and child development are related, but that many associations are attenuated with the inclusion of relevant covariates., (© 2017 John Wiley & Sons Ltd.)

Background: In rural sub-Saharan Africa (SSA), the human immunodeficiency virus (HIV)/AIDS pandemic has exerted effects on nearly every aspect of life. Yet despite the pandemic's near ubiquitous impacts, major barriers to HIV care, treatment, and support persist. Compounding the barriers to care is the incredible complexity and diversity of experience across different sociocultural contexts., Objectives: This exploratory community-based participatory study aimed to generate an explanatory model about how geographic and socioeconomic marginalization shape community perception of HIV care, treatment, and support among rural communities of Mfangano Island, Kenya., Methods: Twelve focus groups with a total of 105 participants were conducted as a part of a mixed-methods cross-sectional health study., Results: Study findings are organized within an ecological framework with the following themes: readiness at the individual level, social capital at the household level, and collective efficacy at the community level. Potential solutions were also described within this framework; enabling encouragement at the individual level, enhancing productivity at the household level, and addressing underlying socioeconomic inequities at the community level., Conclusions: HIV-related consequences at the individual, household, and community levels have adversely affected how Mfangano communities respond to the HIV/AIDS epidemic. Community-based strategies are needed to address interrelated inequities at multiple levels. Changing community perception may overcome HIV stigma to enable individual readiness to seek care. Access to care and treatment enhances productivity and hence social capital in HIV-affected households. Addressing socioeconomic inequities at the community level increases access to social and instrumental support and, thus, may decrease risk and vulnerability for HIV/AIDS.

Rationale: A growing body of research emphasizes the need to engage social networks in maternal and child nutrition interventions. However, an understanding of how interventions functionally engage not only mothers but fathers, grandparents, friends, and other social network members remains limited., Objective: This study uses an adaptation of a social-ecological model to analyze the multiple levels at which the Kanyakla Nutrition Program operates to change behavior., Methods: This study analyzes focus group data (four groups; n = 35, 7 men and 28 women) following the implementation of the Kanyakla Nutrition Program, a novel nutrition intervention engaging social networks to increase nutrition knowledge, shift perceptions, and promote positive practices for infant and young child feeding and community nutrition in general., Results: Participant perspectives indicate that the Kanyakla Nutrition Program contributed to nutrition knowledge and confidence, changed perceptions, and supported infant and child feeding practices at the individual, interpersonal, and institutional levels. However, many respondents report challenges in transcending barriers at the broader community and systems levels of influence, where environmental and economic constraints continue to affect food access., Conclusion: Analysis of the Kanyakla Nutrition Program suggests that for interventions addressing household level determinants of nutrition, simultaneously engaging the household's network of interpersonal and community relationships can play a role in building momentum and consensus to address persistent structural barriers to improved nutrition., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Understanding feedbacks between human and environmental health is critical for the millions who cope with recurrent illness and rely directly on natural resources for sustenance. Although studies have examined how environmental degradation exacerbates infectious disease, the effects of human health on our use of the environment remains unexplored. Human illness is often tacitly assumed to reduce human impacts on the environment. By this logic, ill people reduce the time and effort that they put into extractive livelihoods and, thereby, their impact on natural resources. We followed 303 households living on Lake Victoria, Kenya over four time points to examine how illness influenced fishing. Using fixed effect conditional logit models to control for individual-level and time-invariant factors, we analyzed the effect of illness on fishing effort and methods. Illness among individuals who listed fishing as their primary occupation affected their participation in fishing. However, among active fishers, we found limited evidence that illness reduced fishing effort. Instead, ill fishers shifted their fishing methods. When ill, fishers were more likely to use methods that were illegal, destructive, and concentrated in inshore areas but required less travel and energy. Ill fishers were also less likely to fish using legal methods that are physically demanding, require travel to deep waters, and are considered more sustainable. By altering the physical capacity and outlook of fishers, human illness shifted their effort, their engagement with natural resources, and the sustainability of their actions. These findings show a previously unexplored pathway through which poor human health may negatively impact the environment., Competing Interests: The authors declare no conflict of interest.

HIV treatment is life-long, yet many patients travel or migrate for their livelihoods, risking treatment interruption. We examine timely reengagement in care among patients who transferred-out or were lost-to-follow-up (LTFU) from a rural HIV facility. We conducted a cohort study among 369 adult patients on antiretroviral therapy between November 2011 and November 2013 on Mfangano Island, Kenya. Patients who transferred or were LTFU (i.e., missed a scheduled appointment by ≥90 days) were traced to determine if they reengaged or accessed care at another clinic. We report cumulative incidence and time to reengagement using Cox proportional hazards models adjusted for patient demographic and clinical characteristics. Among 369 patients at the clinic, 23(6%) requested an official transfer and 78(21%) were LTFU. Among official transfers, cumulative incidence of linkage to their destination facility was 91% at three months (95%CI (confidence intervals) 69-98%). Among LTFU, cumulative incidence of reengagement in care at the original or a new clinic was 14% at three months (95%CI 7-23%) and 60% at six months (95%CI 48-69%). In the adjusted Cox model, patients who left with an official transfer reengaged in care six times faster than those who did not (adjusted hazard ratio 6.2, 95%CI 3.4-11.0). Patients who left an island-based HIV clinic in Kenya with an official transfer letter reengaged in care faster than those who were LTFU, although many in both groups had treatment gaps long enough to risk viral rebound. Better coordination of transfers between clinics, such as assisting patients with navigating the process or improving inter-clinic communication surrounding transfers, may reduce delays in treatment during transfer and improve overall clinical outcomes.

Background: In sub-Saharan Africa, failure to initiate and sustain HIV treatment contributes to significant health, psychosocial, and economic impacts that burden not only infected individuals but diverse members of their social networks. Yet, due to intense stigma, the responsibility for managing lifelong HIV treatment rests solely, and often secretly, with infected individuals. We introduce the concept of "HIV risk induction" to suggest that social networks of infected individuals share a vested interest in improving long-term engagement with HIV care, and may represent an underutilized resource for improving HIV/AIDS outcomes within high prevalence populations., Methods: In 2012, we implemented a 'microclinic' intervention to promote social network engagement in HIV/AIDS care and treatment. A microclinic is a therapy management collective comprised of a small group of neighbors, relatives, and friends who are trained as a team to provide psychosocial and adherence support for HIV-infected members. Our study population included 369 patients on ART and members of their social networks on Mfangano Island, Kenya, where HIV prevalence approaches 30%. Here we report qualitative data from 18 focus group discussions conducted with microclinic participants (n = 82), community health workers (n = 40), and local program staff (n = 39)., Results: Participants reported widespread acceptability and enthusiasm for the microclinic intervention. Responses highlight four overlapping community transformations regarding HIV care and treatment, namely (1) enhanced HIV treatment literacy (2) reduction in HIV stigma, (3) improved atmosphere for HIV status disclosure and (4) improved material and psychosocial support for HIV-infected patients. Despite challenges, participants describe an emerging sense of "collective responsibility" for treatment among HIV-infected and HIV-uninfected members of social networks., Discussion: The lived experiences and community transformations highlighted by participants enrolled in this social network intervention in Western Kenya suggest opportunities to reframe the continuum of HIV care from a secretive individual journey into a network-oriented cycle of engagement., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Despite progress in the global scale-up of antiretroviral therapy, sustained engagement in HIV care remains challenging. Social capital is an important factor for sustained engagement, but interventions designed to harness this powerful social force are uncommon., Methods: We conducted a quasiexperimental study evaluating the impact of the Microclinic Social Network intervention on engagement in HIV care and medication adherence on Mfangano Island, Kenya. The intervention was introduced into 1 of 4 similar communities served by this clinic; comparisons were made between communities using an intention-to-treat analysis. Microclinics, composed of patient-defined support networks, participated in 10 biweekly discussion sessions covering topics ranging from HIV biology to group support and group HIV status disclosure. Nevirapine concentrations in hair were measured before and after study., Results: One hundred thirteen (74%) intervention community participants joined a microclinic group, 86% of whom participated in group HIV status disclosure. Over 22-month follow-up, intervention community participants experienced one-half the rate of ≥ 90-day clinic absence as those in control communities (adjusted hazard ratio: 0.48; 95% confidence interval: 0.25 to 0.92). Nevirapine hair levels declined in both study arms; in adjusted linear regression analysis, the decline was 6.7 ng/mg less severe in the intervention arm than control arm (95% confidence interval: -2.7 to 16.1)., Conclusions: The microclinic intervention is a promising and feasible community-based strategy to improve long-term engagement in HIV care and possibly medication adherence. Reducing treatment interruptions using a social network approach has important implications for individual patient virologic suppression, morbidity, and mortality and for broader community empowerment and engagement in healthcare.

The objective of this study was to investigate the relationship among socioeconomic status, social support, and food insecurity in a rural Kenyan island community. A cross-sectional random sample of 111 female heads of households representing 583 household members were surveyed in Mfangano Island, Kenya from August to October 2010 using adaptations of the Household Food Insecurity Access Scale and the Medical Outcomes Study Social Support Survey. In multiple linear regression models, less instrumental social support, defined as concrete direct ways people help others (B = -0.81; 95% confidence interval [CI] -1.45 to -0.17), and decreased ownership scale based on owning material assets (B = -2.93; 95% CI -4.99 to -0.86) were significantly associated with increased food insecurity, controlling for age, education, marital status, and household size. Social support interventions geared at group capacity and resilience may be crucial adjuncts to improve and maintain the long term food security and health of persons living in low-resource regions.

Food-producing livelihoods have the potential to improve food security and nutrition through direct consumption or indirectly through income. To better understand these pathways, we examined if fishing households ate more fish and had higher food security than non-fishing households around Lake Victoria, Kenya. In 2010, we randomly sampled 111 households containing 583 individuals for a cross-sectional household survey in a rural fishing community. We modeled the associations between fish consumption and food security and fishing household status, as well as socio-economic variables (asset index, monthly income, household size) for all households and also for a subset of households with adult male household members (76% of households). Participating in fishing as a livelihood was not associated with household fish consumption or food security. Higher household fish consumption was associated with higher household income and food security, and was weakly associated with lower household morbidity. Household food security was associated with higher incomes and asset index scores. Our results suggest socioeconomic factors may be more important than participation in food-producing livelihoods for predicting household consumption of high quality foods., Competing Interests: Conflict of Interest Statement The authors declare that they have no conflicts of interest.

Antiretroviral hair levels objectively quantify drug exposure over time and predict virologic responses. We assessed the acceptability and feasibility of collecting small hair samples in a rural Kenyan cohort. Ninety-five percentage of participants (354/373) donated hair. Although median self-reported adherence was 100% (interquartile range, 96%-100%), a wide range of hair concentrations likely indicates overestimation of self-reported adherence and the advantages of a pharmacologic adherence measure. Higher nevirapine hair concentrations observed in women and older adults require further study to unravel behavioral versus pharmacokinetic contributors. In resource-limited settings, hair antiretroviral levels may serve as a low-cost quantitative biomarker of adherence.

Background: The proportion of heterosexual HIV transmission in sub-Saharan Africa that occurs within cohabiting partnerships, compared with that in single people or extra-couple relationships, is widely debated. We estimated the proportional contribution of different routes of transmission to new HIV infections. As plans to use antiretroviral drugs as a strategy for population-level prevention progress, understanding the importance of different transmission routes is crucial to target intervention efforts., Methods: We built a mechanistic model of HIV transmission with data from Demographic and Health Surveys (DHS) for 2003-2011, of 27,201 cohabiting couples (men aged 15-59 years and women aged 15-49 years) from 18 sub-Saharan African countries with information about relationship duration, age at sexual debut, and HIV serostatus. We combined this model with estimates of HIV survival times and country-specific estimates of HIV prevalence and coverage of antiretroviral therapy (ART). We then estimated the proportion of recorded infections in surveyed cohabiting couples that occurred before couple formation, between couple members, and because of extra-couple intercourse., Findings: In surveyed couples, we estimated that extra-couple transmission accounted for 27-61% of all HIV infections in men and 21-51% of all those in women, with ranges showing intercountry variation. We estimated that in 2011, extra-couple transmission accounted for 32-65% of new incident HIV infections in men in cohabiting couples, and 10-47% of new infections in women in such couples. Our findings suggest that transmission within couples occurs largely from men to women; however, the latter sex have a very high-risk period before couple formation., Interpretation: Because of the large contribution of extra-couple transmission to new HIV infections, interventions for HIV prevention should target the general sexually active population and not only serodiscordant couples., Funding: US National Institutes of Health, US National Science Foundation, and J S McDonnell Foundation., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Low body mass index (BMI) at the time of enrollment into HIV care has been shown to be a strong predictor of mortality independent of CD4 count. This study investigated socio-demographic associations with underweight (BMI < 18.5) among adults in Nyanza Province, Kenya, upon enrollment into HIV care. BMI, socio-demographic, and health data from a cross-sectional sample of 8254 women and 3533 men were gathered upon enrollment in the Family AIDS Care and Education Services (FACES) program in Nyanza Province, Kenya, between January 2005 and March 2010. Overall, 27.4% of adults were underweight upon enrollment in HIV care. Among each women [W] and men [M], being underweight was associated with younger age (W: adjusted odds ratio [AOR], 2.90; 95% confidence interval [CI], 1.85-4.55; M: AOR, 5.87; 95% CI, 2.80-12.32 for those aged 15-19 compared to ≥50 years old), less education (W: AOR, 2.92; 95% CI, 1.83-4.65; M: AOR, 1.55; 95% CI, 1.04-2.31 for primary education compared to some college/university), low CD4 count (W: AOR, 2.13; 95% CI, 1.50-3.03; M: AOR, 1.43; 95% CI, 0.76-2.70 for 0-250 compared to ≥750 cells/mm(3)), and poor self-reported health status (W: AOR, 1.72; 95% CI, 0.89-3.33; M: AOR, 9.78; 95% CI, 1.26-75.73 for poor compared to excellent). Among all enrollees to HIV care, low BMI was associated with male gender, lower educational attainment, younger age, and poor self-reported health. HIV care and treatment programs should consider using socio-demographic and health risk factors associated with low BMI to target and recruit patients with the goal of preventing late enrollment into care.