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

Abstract

IntroductionIndividual and household-level evidence suggests a relationship between food insecurity and cholera risk. The relationship between national food security and the size of cholera outbreaks is unknown.MethodsWe analysed the relationship between national food security and annual cholera incidence rate from 2012 to 2015 across 30 countries. We used components of the Global Food Security Index (GFSI) as measures of food security. We included countries with available GFSI reporting cases of cholera during the study period, excluding high-income countries. We developed multivariable zero-inflated negative binomial models with annual cholera incidence rate as the outcome, GFSI components as the exposure of interest, fixed effects for country and year, and time-varying effects related to water, sanitation, and hygiene, oral cholera vaccine deployment, healthcare expenditure, conflict and extreme weather.ResultsThe 30 countries reported 550 106 total cases of cholera from 2012 to 2015, with a median annual incidence rate of 3.1 cases per 100 000 people (IQR 0.3–9.9). We found independent inverse relationships between cholera and Overall GFSI (incidence rate ratio (IRR) 0.57, 95% CI 0.43 to 0.78), GFSI-Availability (IRR 0.81, 95% CI 0.70 to 0.95) and GFSI-Affordability (IRR 0.76, 95% CI 0.62 to 0.92).ConclusionsWe identified a strong inverse relationship between national food security and annual incidence rate of cholera. In the context of prior evidence at the individual and household levels, this suggests that there is a linkage between food insecurity and cholera at the national level that should be further considered in assessing cholera risk in vulnerable regions and in designing cholera control interventions.

Food insecurity and cholera risk: An Exploratory Analysis of Potential Mediators

“…Food insecurity has been found to be a risk factor for cholera at the household and national level;[1–3] however the mechanism through which food insecurity may increase the risk of cholera remains unknown.…”

“…[2,3] An analysis of 30 countries demonstrated a strong inverse relationship between national food security and the annual incidence of cholera. [1] Food insecurity may affect cholera outcomes through several hypothesized pathways: impaired immune and gut barrier function from malnutrition; suboptimal food hygiene practices resulting from altered risk-calculation because of increased attention to immediate food needs; and poor mental health undermining resilience to the economic losses and emotional stress imparted by cholera infection. [6,11,18,19] Yet, no studies to date have sought to elucidate which of these pathways in fact operates to increase cholera risk.…”

Country Income Is Only One of the Tiles: The Global Journey of Antimicrobial Resistance among Humans, Animals, and Environment

“…The first one is the potential unsafety of food linked to contaminated water, preparation, or poor hygiene [ 35 , 36 , 37 , 38 ]. Vegetables and mussels contaminated with Gram-negative carriers of ESBL or KPC-3 carbapenemase in retail markets in North Africa, or imported seafood and raw dog food with the presence of mcr-1 positive E. coli isolates in Norway, have been recently reported, thus highlighting new potential pathways to transfer AMR genes to “low prevalence” countries [ 39 , 40 , 41 , 42 , 43 ].…”

An Overview of Cholera Epidemiology: A Focus on Africa; with a Keen Interest on Nigeria

“…Cholera (a "disease of the poor") [17,9], was reported by Richterman et al [10], to have affected 550,106 people from thirty low or middle-income countries with available Global Food Security Index [GFSI] from 2012 to 2015. The median yearly incidence rate recorded during this period was 3.1 cases per 100 000 people for a total of 120 country-years.…”

“…This estimate is contrasted by Chioma et al [9], who stated that in 2019, the globally estimated number of cholera cases range from 3 to 5 million with 28,000 to 150,000 deaths yearly. This increased in death rates (70%) due to cholera disease is promoted by the late administration of fluid therapy to cholera patients Thandavarayan et al [10]. There has been no substantive decrease in the annual number of cholera cases reported over the last three decades.…”