Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS Negl Trop Dis. 2023 Feb 6;17(2):e0010574. doi: 10.1371/journal.pntd.0010574. eCollection 2023 Feb.
Food insecurity has been independently associated with developing cholera and there is an inverse relationship between national food security and annual cholera incidence. However, the factors that mediate the risk of cholera among food insecure households remain largely unexplored.
In a cross-sectional survey of rural households in Haiti, we explored the role of food behaviors (i.e., dietary choices and food-handling practices) as mediators of cholera risk among food-insecure families. We generated a series of multivariable regression models to test hypothesized associations between the severity of food insecurity (measured by the Household Hunger Scale), hygiene and food behaviors, and history of severe, medically-attended cholera. Moderate household hunger (Adjusted Odds Ratio [AOR] 1.47, 95% Confidence Interval (CI) 1.05-2.04; p = 0.021) and severe hunger (AOR 2.45, 95% CI 1.45-4.15; p = 0.001) were positively associated with a history of severe, medically-attended cholera compared with little to no household hunger. Household hunger was positively associated with three behaviors: antacid use, consumption of leftover non-reheated food, and eating food and beverages prepared outside of the home (i.e., at a restaurant or from a vendor). Consumption of outside food items and antacid use were positively associated with a history of cholera.
Our findings suggest that food behaviors may mediate the association between food insecurity and cholera and contribute to an understanding of how interventions could be designed to target food insecurity as part of cholera prevention and control.
食物不安全与霍乱的发生独立相关，国家粮食安全与霍乱年发病率呈反比。然而，在粮食不安全家庭中，导致霍乱风险的因素在很大程度上仍未得到探索。
在海地农村家庭的横断面调查中，我们探讨了食物行为（即饮食选择和食物处理实践）作为粮食不安全家庭中霍乱风险的中介因素的作用。我们生成了一系列多变量回归模型，以检验粮食不安全严重程度（通过家庭饥饿量表测量）、卫生和食物行为与严重、需要医疗的霍乱史之间的假设关联。中度家庭饥饿（调整后的优势比 [AOR] 1.47，95%置信区间 [CI] 1.05-2.04；p = 0.021）和严重饥饿（AOR 2.45，95% CI 1.45-4.15；p = 0.001）与严重、需要医疗的霍乱史呈正相关，而轻度至无家庭饥饿则无此关联。家庭饥饿与三种行为呈正相关：使用抗酸剂、食用未重新加热的剩余食物以及在家庭以外的地方（即在餐馆或从摊贩处）进食食物和饮料。食用外部食物和使用抗酸剂与霍乱史呈正相关。
我们的研究结果表明，食物行为可能在粮食不安全与霍乱之间的关联中起中介作用，并有助于了解如何设计干预措施，将粮食不安全作为霍乱预防和控制的一部分。
