Food insecurity and self-reported cholera in Haitian households: An analysis of the 2012 Demographic and Health Survey

Abstract

BackgroundBoth cholera and food insecurity tend to occur in impoverished communities where poor access to food, inadequate sanitation, and an unsafe water supply often coexist. The relationship between the two, however, has not been well-characterized.MethodsWe performed a secondary analysis of household-level data from the 2012 Demographic and Health Survey in Haiti, a nationally and sub-nationally representative cross-sectional household survey conducted every five years. We used multivariable logistic regression to evaluate the relationship between household food security (as measured by the Household Hunger Scale) and (1) reported history of cholera since 2010 by any person in the household and (2) reported death by any person in the household from cholera (among households reporting at least one case). We performed a complete case analysis because there were <1% missing data for all variables.ResultsThere were 13,181 households in the survey, 2,104 of which reported at least one household member with history of cholera. After adjustment for potential confounders, both moderate hunger in the household [Adjusted Odds Ratio (AOR) 1.51, 95% Confidence Interval (CI) 1.30–1.76; p <.0001] and severe hunger in the household (AOR 1.73, 95% CI 1.45–2.08; p <.0001) were significantly associated with reported history of cholera in the household. Severe hunger in the household (AOR 1.85, 95% CI 1.05–3.26; p = 0.03), but not moderate hunger in the household, was independently associated with reported death from cholera in households with at least one case of cholera.ConclusionsIn this study we identified an independent relationship between household food insecurity and both reported history of cholera and death from cholera in a general population. The directionality of this relationship is uncertain and should be further explored in future prospective research.

The inverse relationship between national food security and annual cholera incidence: a 30-country analysis

“…In a multivariable analysis of 2320 people living in HIV-affected households, we found that severe household food insecurity was associated with a greater than threefold increase in an individual’s odds of reporting a history of cholera since the onset of the cholera epidemic in Haiti 10. In a subsequent study of the general population in Haiti using data from the 13 181 households in the 2012 Demographic and Health Survey, we similarly found that both moderate and severe household food insecurity were associated with a household reporting at least one member with history of cholera, independent of household wealth and other measured confounders 11. We also found that severe household food insecurity was associated with nearly double the odds of a household reporting that a member had died from cholera 11.…”

“…In two recent studies in Haiti, where cholera is now endemic after being introduced in 2010, we found an independent association between household food insecurity and both reported history of cholera and reported death from cholera 10 11. Food insecurity is defined as a lack of stable access to food in adequate quantity or quality 12.…”

“…Food insecurity is defined as a lack of stable access to food in adequate quantity or quality 12. Food insecurity is closely related to poverty,13 but has been linked to a variety of adverse health outcomes (including mortality) independent of wealth and other measured social determinants of health 10–12 14. The directionality of the relationship between food insecurity and cholera is unknown and may be bidirectional, as it is with other diseases 12 15.…”

“…The directionality of the relationship between food insecurity and cholera is unknown and may be bidirectional, as it is with other diseases 12 15. Plausible pathways from food insecurity to cholera-related risk include malnutrition, causing impaired immunity and gut barrier function; behavioural changes during periods of hunger or food scarcity leading to a higher likelihood of drinking unsafe water or eating unsafe food; and worse mental health, affecting an individual, household or community’s ability to respond to illness 11 15. To our knowledge, there have been no studies of cholera and food security outside of Haiti.…”

COVID-19: Global Health Equity in Pandemic Response

“…Food insecurity has a detrimental impact on health which is why, for example, in the midst of a major epidemic in Haiti in 2012, cholera was almost twice as deadly for families that were severely food insecure than for families with steady access to food. 8 Fourth, water insecurity and lack of access to safe sanitation and hygiene will undermine a basic pillar of COVID-19 prevention in many parts of the world. Twenty-nine percent of the global population lacks safely managed drinking water, and three billion people do not have access to soap or water for handwashing at home.…”