Rapid health impact assessment of COVID-19 on families with children with disabilities living in low-income communities in Lusaka, Zambia

Introduction Worldwide, children with disabilities are a vulnerable population and at high risk for COVID-19 morbidity and mortality. There is little information on the impact that COVID-19 had on children with disabilities and their families, particularly in low-income settings. This assessment describes the extent to which the pandemic impacted seven indicators of well-being in three low-income communities in Lusaka, Zambia. Methods Interviews were conducted with a random selection of families participating in an existing program (n = 39), community health workers (n = 6), healthcare workers (n = 7) and government officials (n = 2). Descriptive data was summarized and qualitative responses reviewed for themes. Results Most families reported a major loss of income resulting in food insecurity (79%), housing instability (67%), stress (36%), and increased risk of child separation and neglect (18%). Most families did not report receiving governmental financial assistance and reported loss of access to health services for their child such as physiotherapy (33%). Stakeholders interviewed reported that COVID-19 information was widely available although few specific interventions for children. Families were seen to have greater food insecurity, more poverty, more crowding, less healthcare services and children left alone or on the streets to beg. Discussion COVID-19 and related containment measures have impacted the lives of children with disabilities and their families to a great extent. There is an urgent need for disability-inclusive responses that deliberately address the needs of children with disabilities and their families, notably uninterrupted access to adequate food, inclusive education, rehabilitation therapy, and income-generating activities.

Download Full-text

THE IMPACT OF FOOD INSECURITY ON THE HEALTH AND WELL-BEING OF OLDER ADULTS: THE GROUPS MOST AT RISK

Innovation in Aging ◽

10.1093/geroni/igz038.2705 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S738-S738

Author(s):

Lauren E Popham ◽

Erin McGovern

Keyword(s):

Older Adults ◽

Food Insecurity ◽

Prescription Drugs ◽

Low Income ◽

Well Being ◽

National Council ◽

Assistance Program ◽

Increased Risk ◽

Nutrition Assistance ◽

The Impact

Abstract Older adults who experience food insecurity (4.6 million) often have worse health outcomes. Food insecure older adults consume less nutrients, which puts them at greater risk of developing chronic diseases. They are at increased risk of falls due the impact of poor nutrition on muscle mass, bone density, and balance. Low-income older adults are often forced to choose between buying groceries and paying other bills. The Supplemental Nutrition Assistance Program (SNAP) plays an important role in reducing food insecurity. SNAP enables older adults to buy the nutritious food they need, while freeing up resources to pay for everyday things to meet their health needs such as prescription drugs. Research shows that medication adherence increases when low-income older adults enroll in SNAP. Despite the beneficial impact of enrolling in SNAP, it’s estimated that 55% of eligible adults age 60 and older are not participating in this critical program. To understand which older adults are missing out on SNAP, the National Council on Aging engaged researchers at Leading Age LTSS Center at UMass Boston to analyze data from the 2014 Health and Retirement Study. The results show that some of the most vulnerable older adult populations are less likely to participate in SNAP even though they are eligible (i.e., Hispanic, age 75 and older, those who are not utilizing healthcare, etc.). The findings suggest that more targeted outreach to these groups is needed to ensure that the most vulnerable populations of older adults access this critical benefit.

Download Full-text

“You run out of hope:” An Exploration of Low-Income Parents’ Experiences with Food Insecurity using Photovoice

Public Health Nutrition ◽

10.1017/s1368980021002743 ◽

2021 ◽

pp. 1-21

Author(s):

Payge Lindow ◽

Irene H. Yen ◽

Mingyu Xiao ◽

Cindy W. Leung

Keyword(s):

Food Insecurity ◽

San Francisco ◽

Low Income ◽

Eating Behaviors ◽

Comparative Method ◽

Well Being ◽

Structured Interviews ◽

Unhealthy Eating ◽

Low Income Families ◽

The Impact

ABSTRACT Objective: Using an adaption of the Photovoice method, this study explored how food insecurity affected parents’ ability to provide food for their family, their strategies for managing household food insecurity, and the impact of food insecurity on their well-being. Design: Parents submitted photos around their families’ experiences with food insecurity. Afterwards, they completed in-depth, semi-structured interviews about their photos. The interviews were transcribed and analyzed for thematic content using the constant comparative method. Setting: San Francisco Bay Area, California, USA. Subjects: 17 parents (14 mothers and 3 fathers) were recruited from a broader qualitative study on understanding the experiences of food insecurity in low-income families. Results: Four themes were identified from the parents’ photos and interviews. First, parents described multiple aspects of their food environment that promoted unhealthy eating behaviors. Second, parents shared strategies they employed to acquire food with limited resources. Third, parents expressed feelings of shame, guilt, and distress resulting from their experience of food insecurity. And finally, parents described treating their children to special foods to cultivate a sense of normalcy. Conclusions: Parents highlighted the external contributors and internal struggles of their experiences of food insecurity. Additional research to understand the experiences of the food-insecure families may help to improve nutrition interventions targeting this structurally vulnerable population.

Download Full-text

Food Insecurity and Mental Health Outcomes among Low Income, Minority Cohorts during the COVID-19 Pandemic

Proceedings of IMPRS ◽

10.18060/25947 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Sai Kodukula ◽

Amy Han

Keyword(s):

Mental Health ◽

Food Security ◽

Health Outcomes ◽

Food Insecurity ◽

Low Income ◽

Mental Health Outcomes ◽

Anecdotal Evidence ◽

Increased Risk ◽

Anxiety Depression ◽

The Impact

Objective: To examine the impact of the COVID-19 shutdowns on food insecurity and mental health outcomes among low income, minority communities in Northwest Indiana. Methods: Surveys were distributed to 160 households during the Northwest Indiana food bank distribution hours to assess food security mental health status. The survey assessed participant food security through questions adapted from the USDA food security survey module. Participant anxiety, depression, and stress scores were aggregated from questions adapted from the PHQ-4. A multiple logit regression model was utilized to estimate the risk associated with food security status and the surveyed variables. Anecdotal evidence was also collected to understand pandemic specific factors impacting participant food security. Results: Food insecurity was linked to significantly increased risk of anxiety, depression and stress. Those who identify to be food insecure have an 811 % increased risk of anxiety, 411% increased risk of depression, and 535% increased risk of stress compared to those who are food secure. In addition, a significant correlation exists between median household income and poor mental health. Anecdotal evidence identifies poor job security, food distributions, and support networks as exacerbating factors towards participant’s declining mental health. Conclusions: Our findings highlights the exacerbated impact the pandemic has had on the food security and mental health of vulnerable populations. In the light of these results and anecdotal feedback, public health measures must focus on getting increased funding towards local food banks to increase the frequency of mobile distribution markets coupled with direct subsidies to allow for food purchases, especially for those households with children. Given its impact on mental health, food insecurity status should regularly be screened by physicians access to the right resources must be provided for those screening as high risk.

Download Full-text

The cost of school holidays for children from low income families

Childhood ◽

10.1177/0907568218779130 ◽

2018 ◽

Vol 25 (4) ◽

pp. 516-529 ◽

Cited By ~ 8

Author(s):

Hilary Stewart ◽

Nick Watson ◽

Mhairi Campbell

Keyword(s):

Food Insecurity ◽

Low Income ◽

Well Being ◽

Children's Health ◽

Children’S Health ◽

Limited Access ◽

Low Income Families ◽

The Cost ◽

The Impact ◽

Health And Well Being

School holidays can be stressful periods for children from low-income families. Poor provision of appropriate childcare, limited access to enrichment activities, and food insecurity mean that children’s health and well-being can suffer and their learning stagnate or decline. This article examines and documents the evidence that has emerged on this topic and aims to raise its profile and the impact on children’s lives. It makes the case for further academic scrutiny of this unexamined and neglected subject.

Download Full-text

Impact of lockdown and school closure on children’s health and well-being during the first wave of COVID-19: a narrative review

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001043 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001043

Author(s):

Luis Rajmil ◽

Anders Hjern ◽

Perran Boran ◽

Geir Gunnlaugsson ◽

Olaf Kraus de Camargo ◽

...

Keyword(s):

Child Abuse ◽

Low Income ◽

Well Being ◽

Risk Of Bias ◽

School Closure ◽

Low Income Countries ◽

School Closures ◽

Increased Risk ◽

The Impact ◽

Health And Well Being

BackgroundIn the context of containment measures against the COVID-19 pandemic, the aims were to examine the impact of lockdown and school closures on childs’ and adolescents’ health and well-being and social inequalities in health.MethodsLiterature review by searching five databases until November 2020. We included quantitative peer-reviewed studies reporting health and well-being outcomes in children (0–18 years) related to closure measures' impact due to COVID-19. A pair of authors assessed the risk of bias of included studies. A descriptive and narrative synthesis was carried out.FindingsTwenty-two studies, including high-income, middle-income and low-income countries, fulfilled our search criteria and were judged not to have an increased risk of bias. Studies from Australia, Spain and China showed an increase in depressive symptoms and decrease in life satisfaction. A decrease in physical activity and increase in unhealthy food consumption were shown in studies from two countries. There was a decrease in the number of visits to the emergency department in four countries, an increase in child mortality in Cameroon and a decrease by over 50% of immunisations administered in Pakistan. A significant drop of 39% in child protection medical examination referrals during 2020 compared with the previous years was found in the UK, a decrease in allegations of child abuse and neglect by almost one-third due to school closures in Florida, and an increase in the number of children with physical child abuse trauma was found in one centre in the USA.InterpretationFrom available reports, pandemic school closure and lockdown have adverse effects on child health and well-being in the short and probably long term. We urge governments to take the negative public health consequences into account before adopting restrictive measures in childhood.

Download Full-text

COVID-19, food security and maternal mental health in Ceará, Brazil: a repeated cross-sectional survey

Public Health Nutrition ◽

10.1017/s1368980021000628 ◽

2021 ◽

pp. 1-12

Author(s):

Hermano A. L. Rocha ◽

Christopher R. Sudfeld ◽

Álvaro J. M. Leite ◽

Sabrina Gabrielle Maia Oliveira Rocha ◽

Márcia M. T. Machado ◽

...

Keyword(s):

Food Security ◽

Food Insecurity ◽

Well Being ◽

P Value ◽

Paired Data ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Increased Risk ◽

Self Reporting Questionnaire ◽

The Impact

ABSTRACT Objective To quantify the change in the risk of food insecurity and maternal mental disorder (MMD) before and during the COVID-19 pandemic. Design Repeated cross-sectional survey. Between July 17 and September 10, 2020, mother-child pairs who were enrolled in a population-based survey in 2017 were re-contacted by telephone for consent and to complete a telephonic COVID-19 survey. We used the Brazilian Food Insecurity Scale to assess food security and the Self Reporting Questionnaire (SRQ-20) to assess maternal mental disorders. McNemar’s test for paired data that also accounted for clustering was used. Logistic regression was used to assess the relationship of unemployment and receipt of government assistance with food insecurity and MMD in 2020. Setting Ceará, Brazil. Participants 577 mother-child pairs who completed the 2017 and 2020 surveys. At the time of the 2020 interview, the child cohort was 36-108 months of age. Results The proportion of mothers reporting food insecurity was 15.5% higher (95% CI: (5.9 – 25.1), p-value < 0.001) during the pandemic in July-August 2020 as compared to November 2017, while the prevalence of MMD was 40.2% higher during the pandemic (95% CI: 32.6 – 47.8, p-value < 0.001). Loss of formal employment was associated with increased risk of food insecurity, but not with the risk of MMD. Conclusions The risk of food insecurity and MMD in Ceará increased during the COVID-19 pandemic. These findings highlight the need for policies and interventions to reduce the impact of the COVID-19 pandemic on maternal and child health, nutrition, and well-being in Brazil.

Download Full-text

Measuring the Impact of a Full Service Grocery Store in a Food Desert

The International Journal of Community and Social Development ◽

10.1177/25166026211015488 ◽

2021 ◽

Vol 3 (2) ◽

pp. 161-176

Author(s):

Kellie Schneider ◽

Diana Cuy Castellanos ◽

Felix Fernando ◽

Jeanne A. Holcomb

Keyword(s):

Systems Engineering ◽

Low Income ◽

Social Impact ◽

Food Deserts ◽

Well Being ◽

Environmental Indicators ◽

Grocery Store ◽

The Impact ◽

Health And Well Being

Food deserts, areas in which it is difficult to obtain affordable, nutritious food, are especially problematic in low-income neighbourhoods. One model for addressing food hardship and unemployment issues within low-income food deserts is a cooperative grocery store. Through the cooperative model, the grocery store can serve as a cornerstone to address socio-economic marginalisation of low-income neighbourhoods and improve the health and well-being of its residents. It is important for communities and policymakers to be able to assess the effectiveness of these types of endeavours beyond traditional economic factors such as profitability. This article uses a systems engineering approach to develop a framework for measuring the holistic impact of a cooperative grocery store on community health and well-being. This framework encompasses values that characterise the relationship between food retail, economic viability and social equality. We develop a dashboard to display the key metrics for measuring the economic, social and environmental indicators that reflect a grocery store’s social impact. We demonstrate the usefulness of the framework through a case study of a full-service cooperative grocery store that is planned within the city of Dayton, OH.

Download Full-text

Food Insecurity in the United States: Identification, Treatment, and Implications

Innovation in Aging ◽

10.1093/geroni/igaa057.2791 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 772-773

Author(s):

Rose Ann DiMaria-Ghalili ◽

Connie Bales ◽

Julie Locher

Keyword(s):

United States ◽

Older Adults ◽

At Risk ◽

Food Insecurity ◽

Well Being ◽

The United States ◽

Health Clinic ◽

High Risk Population ◽

Geriatric Syndrome ◽

The Impact

Abstract Food insecurity is an under-recognized geriatric syndrome that has extensive implications in the overall health and well-being of older adults. Understanding the impact of food insecurity in older adults is a first step in identifying at-risk populations and provides a framework for potential interventions in both hospital and community-based settings. This symposium will provide an overview of current prevalence rates of food insecurity using large population-based datasets. We will present a summary indicator that expands measurement to include the functional and social support limitations (e.g., community disability, social isolation, frailty, and being homebound), which disproportionately impact older adults, and in turn their rate and experience of food insecurity and inadequate food access. We will illustrate using an example of at-risk seniors the association between sarcopenia, the age-related loss of muscle mass and function, with rates of food security in the United States. The translational aspect of the symposium will then focus on identification of psychosocial and environmental risk factors including food insecurity in older veterans preparing for surgery within the Veterans Affairs Perioperative Optimization of Senior Health clinic. Gaining insights into the importance of food insecurity will lay the foundation for an intervention for food insecurity in the deep south. Our discussant will provide an overview of the implications of these results from a public health standpoint. By highlighting the importance of food insecurity, such data can potentially become a framework to allow policy makers to expand nutritional programs as a line of defense against hunger in this high-risk population.

Download Full-text

Psychological distress during COVID-19 pandemic in low-income and middle-income countries: a cross-sectional study of older persons in Thailand

BMJ Open ◽

10.1136/bmjopen-2020-047650 ◽

2021 ◽

Vol 11 (4) ◽

pp. e047650

Author(s):

Wiraporn Pothisiri ◽

Paolo Miguel Manalang Vicerra

Keyword(s):

Psychological Distress ◽

Low Income ◽

Older Persons ◽

Online Survey ◽

Well Being ◽

Secondary Outcome ◽

Ageing Society ◽

Psychological Well Being ◽

Middle Income ◽

The Impact

ObjectiveThe COVID-19 situation in Thailand was controlled with various social measures. Much of the information covered in the media and in studies focused on the public health and economic aspects of the pandemic. This study aimed to explore the psychological well-being of older people, which is important especially in an ageing society categorised as low income or middle income due to the limits of economic and healthcare resources.SettingThe impact of COVID-19 on older persons in Thailand, an online survey, taken across nine provinces within the five regions of the country.ParticipantsInformation was collected from 1230 adults aged at least 60 years old.If an older person was illiterate, unable to access the internet or had a disability preventing them from responding to the survey, an intermediary residing in the community conducted the survey interview.Primary and secondary outcome measuresThe analysis focused on the worries of older adults and the factors associated with psychological distress experienced during the pandemic using logistic regression analysis.ResultsThe majority of people aged at least 60 years old experienced psychological distress during COVID-19. Employment loss (OR 1.08, 95% CI 0.78 to 1.38), inadequate income (OR 1.77, 95% CI 1.28 to 2.44) and debt incursion (OR 2.74, 95% CI 1.57 to 4.80) were detrimental to psychological well-being. The negative changes in the perception of their health status (OR 1.92, 95% CI 1.23 to 2.99) and decreased life satisfaction (OR 1.49, 95% CI 0.45 to 1.87) also weighed on older Thais. The protective factors for psychological well-being were residing in rural areas (OR 0.46, 95% CI 0.35 to 0.61) and being married (OR 0.75, 95% CI 0.55 to 1.01).ConclusionObserving the concerns of the older population is important for introducing policies that can alleviate their precarious financial and health statuses.

Download Full-text

Impact of Medicaid expansion on two-year mortality among stage IV breast cancer (BC) patients according to race.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.6525 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 6525-6525

Author(s):

Catalina Malinowski ◽

Xiudong Lei ◽

Hui Zhao ◽

Sharon H. Giordano ◽

Mariana Chavez Mac Gregor

Keyword(s):

Breast Cancer ◽

Low Income ◽

Stage Iv ◽

Medicaid Expansion ◽

Risk Of Death ◽

Stage Iv Breast Cancer ◽

Increased Risk ◽

The Impact ◽

Expansion Period ◽

White Patients

6525 Background: Inadequate access to healthcare services is associated with worse outcomes. Disparities in access to cancer care are more frequently seen among racial/ethnic minorities, uninsured patients, and those with low socioeconomic status. A provision in the Affordable Care Act called for expansion of Medicaid eligibility in order to cover more low-income Americans. In this study, we evaluate the impact of Medicaid expansion in 2-year mortality among metastatic BC patients according to race. Methods: Women (aged 40-64) diagnosed with metastatic BC (stage IV de novo) between 01/01/2010 and 12/31/2015 and residing in states that underwent Medicaid expansion in 01/2014 were identified in the National Cancer Database. For comparison purposes, 2010-2013 was considered the pre-expansion period and 2014-2015 the post-expansion period. We calculated 2-year mortality difference-in-difference (DID) estimates between White and non-White patients using multivariable linear regression models. Results are presented as adjusted differences (in % points) between groups in the pre- and post-expansion periods and as adjusted DID with 95%CI. Covariates included age, comorbidity, BC subtype, insurance type, transfer of care, distance to hospital, region, residence area, education, income quartile, facility type and facility volume. In addition, overall survival (OS) was evaluated in pre- and post-expansion periods via Kaplan-Meier method and Cox proportional hazards models; results are presented as 2-year OS estimates, hazard ratios (HRs), and 95% CIs. Results: Among 7,675 patients included, 4,942 were diagnosed in the pre- and 2,733 in the post-expansion period. We observed a reduction in 2-year mortality rates in both groups according to Medicaid expansion. Among Whites 2-year mortality decreased from 42.5% to 38.7% and among non-Whites from 45.4% to 36.4%, resulting in an adjusted DID of -5.2% (95%CI -9.8 to -0.6, p = 0.027). A greater reduction in 2-year mortality was observed among non-Whites in a sub-analysis of patients who resided in the poorest quartile (n = 1372), with an adjusted DID of -14.6% (95%CI -24.8 to -4.4, p = 0.005). In the multivariable Cox model, during the pre-expansion period there was an increased risk of death for non-Whites compared to Whites (HR 1.14, 95% CI 1.03 to 1.26, P = 0.04), however no differences were seen in the post-expansion period between the two groups (HR 0.93, 95% CI 0.80 to 1.07, P = 0.31). Conclusions: Medicaid expansion reduced racial disparities by decreasing the 2-year mortality of non-White patients with metastatic breast cancer and reducing the gap when compared to Whites. These results highlight the positive impact of policies aimed at improving equity and increasing access to health care.

Download Full-text