Objective: To investigate if food security mediated the impact of a nutrition-sensitive agroecology intervention on women’s depressive symptoms. Design: We used annual longitudinal data (4 time points) from a cluster-randomized effectiveness trial of a participatory nutrition-sensitive agroecology intervention, the Singida Nutrition and Agroecology Project (SNAP-Tz). Structural equation modelling estimation of total, natural direct, and natural indirect effects was used to investigate food security’s role in the intervention’s impact on women’s risk of probable depression (CES-D > 17) across three years. Setting: Rural Singida, Tanzania. Participants: 548 food insecure, married, smallholder women farmers with children < 1-year-old at baseline. Results: At baseline, one third of the women in each group had probable depression (Control: 32.0%, Intervention: 31.9%, p difference=0.97). The intervention lowered odds of probable depression by 43% (OR=0.57, 95% CI: 0.43-0.70). Differences in food insecurity explained approximately 10 percentage points of the effects of the intervention on odds of probable depression (OR = 0.90, 95% CI: 0.83-0.95). Conclusions: This is the first evidence of the strong, positive effect that lowering food insecurity has on reducing women’s depressive symptoms. Nutrition-sensitive agricultural interventions can have broader impacts than previously demonstrated, i.e., improvements in mental health, and changes in food security play an important causal role in this pathway. As such, these data suggest participatory nutrition-sensitive agroecology interventions have the potential to be an accessible method of improving women’s wellbeing in farming communities.
Objectives In 2015, depressive disorders led to over 50 million disability-adjusted life years lost globally, with more than 80% occurring in low- and middle-income countries. Depressive disorders are also risk factors of a number of adverse maternal and child health outcomes. To our knowledge, the Singida Nutrition and Agroecology Project (SNAP-Tz), is the first nutrition-sensitive agriculture (NSA) intervention identified to improve women's probable depression (2020). Food security has been posited to play an important role in the relationship between NSA interventions and depression, yet causal factors have not yet been analyzed quantitatively. Therefore, we investigated food security's mediating role on this impact. Methods SNAP-Tz is a 30-month participatory agroecological intervention aimed to improve sustainable agriculture, nutrition and gender equity in Singida, Tanzania. Food insecure, married, smallholder female farmers with children < 1-year-old at baseline (n = 548) were interviewed annually in Feb 2016–2019. We used multiple logistic regression models to estimate the total effect (TE) of the SNAP-Tz intervention on women's Center for Epidemiological Studies-Depression scores (CESD). We further estimated natural direct effects (NDE) to evaluate mediation through household food insecurity access score (HFIAS); these represent estimates of the effect of SNAP-Tz on CESD if everyone were to receive SNAP-Tz, thereby changing food insecurity (HFIAS). Results SNAP-Tz had a large impact on reducing CESD scores: odds of probable depression were 32% lower in SNAP-Tz women compared to the delayed intervention group after adjusting for gender equity measures and religion (TE OR = 0.68, 95% CI: 0.58–0.80). Mediation by HFIAS explained about one quarter of the intervention's impact (NIE OR = 0.90, 95% CI: 0.84–0.94). Conclusions Improvements in household food security seems to play a substantial mediating role in the strong and unexpected impact of NSA interventions on women's mental health. Other possible pathways include improvements in peer mentoring and farmer experimentation. Future agricultural and nutrition projects should include mental health evaluations to see if this impact can be generalized. Funding Sources This study was funded by the McKnight Foundation, Mabie Global Health Fellowship at Northwestern University; NIH (K01MH098902).
Objectives Childhood vaccines and biannual vitamin A delivery by health systems are key to child health; suboptimal administration may be a result of inadequate coverage or access to health systems. There have been national programs set in Ethiopia, such as the health sector development program, to improve child health. Therefore, we sought to describe trends in infant vaccines and vitamin A in urban and rural settings in Ethiopia. We hypothesized there would be an increase over time in infants (1) receiving all basic vaccines and (2) vitamin A in the past 6 months. We also hypothesized (3) coverage would be higher in urban settings. Methods We used four nationally representative Demographic and Health Surveys (DHS) from Ethiopia between 2000 and 2016. The analysis comprised 11,621 infants 6–23 months old. Logistic regression models using a forward-stepwise approach were created to test these 3 hypotheses, controlling for wealth, age, sex of infant, and mother's highest education level. Interaction terms were fitted between survey year and education level, setting and education level, and setting and wealth index quintile, and tested using the Wald test. Results (1) The percentage of infants having received all basic vaccines increased from 11.1% in 2000 to 31.0% in 2016; the odds of having received these vaccines increased over time also. (2) This is not true for vitamin A, where there was no pattern in the odds of having received vitamin A between survey years. (3) Rural infants were 40% less likely to have received all basic vaccines, compared to urban infants (adjusted odds ratio (AOR): 0.60; 95% CI: 0.43, 0.83), and there was no evidence of an association between setting and receiving vitamin A (AOR: 0.81; 95% CI: 0.61, 1.09). There was strong evidence for interaction between setting and mother's highest education level, setting and wealth index quintile, and survey year and education level (all P < 0.01). Conclusions These results suggest that (1) while there has been improvement in infants receiving basic vaccines, (2) progress may be slowing slightly in vitamin A coverage and (3)there is a need to improve coverage of basic vaccines for infants in rural areas. Strengthening of and improved access to health services should remain a priority to ensure proper distribution of vaccines and vitamin A in Ethiopia. Funding Sources N/A. Supporting Tables, Images and/or Graphs
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