부산대학교 도서관

Background: 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. Methodology and principal findings: 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. Conclusion: 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. Author summary: Food insecurity has been found to be a risk factor for cholera at the household and national level, however the mechanism through which food insecurity may increase the risk of cholera remains unknown. In a large cross-sectional survey of 1072 households in rural Haiti, we observed a robust independent association between food insecurity—defined as a persistent lack of access to food in adequate quantity or quality and measured by the Household Hunger Scale—and reported history of severe, medically-attended cholera. The association was dose-dependent, with the odds of reported cholera increasing linearly with household food insecurity. Household food insecurity was associated with three high-risk behaviors: antacid use, consumption of leftover non-reheated food, and eating food and beverages prepared outside of the home. Two high-risk behaviors—including antacid use and consumption of food and beverages prepared outside of the home (i.e., at a restaurant or from a vendor)—were independent risk factors for cholera. High-risk food practices may be one causal pathway by which food insecurity increases risk of developing cholera. In this study, we provide a framework for future longitudinal and qualitative studies to investigate whether interventions that target food insecurity could also reduce cholera risk among populations who face a high burden of both conditions. [ABSTRACT FROM AUTHOR]