Intro animation:
Session recording:
Speakers and presentations:
- Session chair: Nilofer Fatimi, Dow University of Health Sciences
@Dow_Uni - Deborah Aluh, University of Nigeria Nsukka
@debbilici0uss @unn_tweets
Evaluation of Health-related Quality of life of small-scale farmers in Enugu State, Nigeria
Presentation | Slides -
Afkera Daniel, Johns Hopkins University School of Medicine
@JohnsHopkins
Land Tenure, Empowerment, and Health Outcomes among Communities of the Shamba Maisha Intervention in Western Kenya
Presentation | Slides -
John Frederick Hoddinott, Cornell University
@CornellNutri @Cornell_PIN @CornellGlobal
Testing the effectiveness of combinations of trainings to improve agricultural production diversity, dietary diversity, and women’s empowerment in Bangladesh: The Agriculture, Nutrition, and Gender Linkages (ANGeL) Project
Presentation | Slides -
Nadine Bader, GIZ
@giz_gmbh
What enables and prevents women from following good nutrition practices in Madhya Pradesh, India? – Results from a multi-sectoral nutrition project
Presentation | Slides -
Victoria Chi, University of California, San Francisco
Effects of Shamba Maisha Multisectoral Food Security Intervention on Community Empowerment in Kenya: A Qualitative Study
Presentation | Slides
Abstracts:
Evaluation of Health-related Quality of life of small-scale farmers in Enugu State, Nigeria
Deborah Oyine Aluh1, Michael Ejime Ikehi2
1 Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka
2 Department of Agricultural Education, University of Nigeria Nsukka
Introduction
Agriculture has been acknowledged as one of the most hazardous occupations worldwide. Health Related Quality of life (HRQOL) is a multidimensional concept, which measures the patient’s health status in the domains related to physical, mental, emotional, and social functioning. Many studies have cited occupation as one of the demographic factors related to HRQOL. With agriculture being acclaimed as the largest employer of labour and a prominent workplace for a majority especially in Nigeria, evaluating the HRQOL of its employees becomes essential for policy advice. This will be the first attempt to assess the HRQOL of farmers in Nigeria.
Methods
The study employed a cross-sectional design. All Small-scale farmers from five communities in two local government areas in Enugu State who were willing to participate were included in the study. Both the EQ-5D-5L and EQ-VAS were used to evaluate the HRQOL of respondent farmers. English language, version 3.0 (Van Reenen et al., n.d.). Because there is no reference value set for Nigeria, the health state values of Zimbabwe was adopted (Jelsma, Hansen, de Weerdt, de Cock, & Kind, 2003). The Visual Analog Scale (EQ-VAS) is a vertical visual analog scale 20 cm in length, with a scale ranging from 0 (worst imaginable health state) to 100 (best imaginable health state. Each EQ-5D-5L health state were coded using a five-digit (1-5) numbering system to indicate the functional levels of the 5 dimensions of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression in the state. The scores were converted into an index using the shiny app (https://fragla.shinyapps.io/shiny-eq5d/). Pearson’s correlations were used to examine the nature of associations between socio-demographic factors and the EQ-5D index scores and the EQ-VAS scores. All statistical tests were considered significant at p<0.05. Data analyses were performed using SPSS version 24 (IBM Corporation, Armonk, NY, USA).
Conclusion
Of the 280 participants, 50% were female. Most of the respondents were between 41 and 45 years old (37.5%, n = 105) and had at least secondary school education (75%, n = 210). The mean EQ5D index score was 0.838±0.091. The mean EQVAS score was 81.88±27.38. The most prevalent problems reported were Pain/Discomfort and Anxiety/Depression. EQ5D scores were significantly strongly correlated with the Education level among the farmers surveyed (r=0.789, 0.020). EQ5D was also moderately negatively associated with the presence of an ailment (r=-0.550, p = 0.158). The most common ailment reported by the farmers was Malaria. The strong correlation between the EQ5D index score and education is consistent with previous studies (Adibe et al., 2014; Liu et al., 2017) and underscores the importance of education among the populace. The presence of an ailment was associated with a lower quality of life, thus farmers in malaria-endemic regions need to be educated on Malaria prevention and management. While Pain/Discomfort reflects problems with physiology, Anxiety/Depression reflects problems in the areas of psychology and social adaptation. Greater than one-third of the farmers reported having anxiety and depression pointing to the need to improve mental health awareness and help-seeking behaviors among this population.
Conclusion
Overall, the majority of the farmers and workers reported no health problems. Although some associations between specific sociodemographic factors and HRQOL were identified in this study, the cross-sectional nature of the study limits the validity of the findings. Further studies, preferably longitudinal, are needed to confirm these associations. Future studies should also focus on understanding the reasons behind the associations between specific sociodemographic factors and HRQOL. "Adibe, M. O., Ubaka, C. M., Udeogaranya, P. O., Igboeli, N. U., & Abraham-Igwe, K. A. 2014. Effect of Occupational Factors on the Quality of Life of Workers in Governmental and Non-Governmental Sectors in Southeastern Nigeria. Tropical Journal of Pharmaceutical Research, 13(2), 287–293. https://doi.org/10.4314/tjpr.v13i2.19
References
Gu, S., Hu, H., & Dong, H. 2016. Systematic Review of Health-Related Quality of Life in Patients with Pulmonary Arterial Hypertension. PharmacoEconomics. https://doi.org/10.1007/s40273-016-0395-y
Jelsma, J., Hansen, K. S., de Weerdt, W., de Cock, P., & Kind, P. 2003. How do Zimbabweans value health states? Population Health Metrics. https://doi.org/10.1186/1478-7954-1-11
Kim, B., Kim, W., Choi, H., Won, C., & Kim, Y. 2012. Health-related quality of life and related factors in full-time and part-time workers. Korean Journal of Family Medicine. https://doi.org/10.4082/kjfm.2012.33.4.197
Liu, X., Gu, S., Duan, S., Wu, Y., Ye, C., Wang, J., & Dong, H. 2017. Comparative Study on Health-Related Quality of Life of Farmers and Workers. Value in Health Regional Issues, 12, 123–129. https://doi.org/10.1016/j.vhri.2017.03.006
Olowogbon, T. S., Yoder, A. M., Fakayode, S. B., & Falola, A. O. 2019. Agricultural stressors: identification, causes and perceived effects among Nigerian crop farmers. Journal of Agromedicine. https://doi.org/10.1080/1059924X.2018.1538915
Omonona B.T., E. O. A. and O. M. A. (2012). Farmers’ Health and Labour Productivity in Osun State, Nigeria. Greener Journal of Agricultural Sciences, 2(4), 001–009. Retrieved from http://gjournals.org/GJAS/Publication/2012/August/HTML/07261204 Omonona et al.htm
Van Reenen, M., Janssen, B., Stolk, E., Boye, K. S., Herdman, M., Kennedy-Martin, M., … Slaap, B. (n.d.). CHANGES INCLUDED in this update of the EQ-5D-5L User Guide Table of contents. Retrieved from www.euroqol.org
Wu, S. F., Tong, H. Y., kan, Y. Y., Su, S. H., Lee, M. C., Kao, C. C., & Lin, Y. H. 2017. The Exploration of Health-Related Quality of Life: Factors Influencing Quality of Life in Gynecologic Cancer Patients. Clinical Nursing Research, 26(1), 114–131. https://doi.org/10.1177/1054773815600665"
Land Tenure, Empowerment, and Health Outcomes among Communities of the Shamba Maisha Intervention in Western Kenya
Afkera Daniel1, Annie McDonough2, Abagail Hatcher2, Rachel Burger2, Elly Weke3, Pauline Wekesa3, Monica Getahun2, Elizabeth A. Bukusi3, Sheri D Weiser2, Craig R. Cohen2
1Johns Hopkins University School of Medicine
2University of California San Francisco School of Medicine
3Kenya Medical Research Institute
Introduction
Women’s lack of land tenure (defined as the common law systems by which land is owned) has been linked to poor health, a higher probability of experiencing physical and sexual violence, and increased risk of HIV, poverty, and poor access to medical care. Few studies have explored the relationship between land access and women’s health and empowerment. This study sought to qualitatively explore how land access and property rights impact women’s empowerment in the context of the Shamba Maisha study -- a multisectoral agricultural and finance intervention – and whether land tenure affected how participants benefited from the intervention.
Methods
This qualitative study was embedded within the Shamba Maisha study (NCT02815579), a randomized controlled trial examining the impact of a multi-sectorial agricultural and finance intervention among HIV-infected farmers in western Kenya. The intervention consisted of a commodity loan and a human-powered water pump, agricultural commodities, and farming and financial management training. At enrollment, all participants were on ART, and had moderate to severe food insecurity and/or low body mass index. Thirty in-depth interviews (IDIs) were conducted within six months of intervention implementation with a purposively sampled cohort of male and female participants, balanced for age, gender, and region. We used a semi-structured interview guide to explore the effect of land tenure on experiences with the Shamba Maisha study. Interviews explored perceived and recent changes in self-confidence, empowerment, agricultural knowledge, household decision-making, and the role of women in the family/community. Interviews were conducted in the local language, audio recorded and transcribed in English. A collaboratively coded framework, developed deductively on the basis of theory, and inductively following the review of transcripts, was applied to segments of texts using Dedoose software. All interviews were double-coded by two investigators using the thematic framework. Codes were then queried and discussed by the study team.
Findings
Participants described several livelihood benefits resulting from their involvement in the Shamba Maisha study, including increased income and enhanced farming and cultivation practices. Through the sustenance provided from their Shamba Maisha farms, participants were able to reliably provide food for their families and reported feeling stronger and making fewer visits to the hospital due to opportunistic infections. Increased income, which helped to alleviate financial stress among families, was reported to increase self-confidence, ability to speak out in groups, and decision-making capacity – especially for women.
However, participants indicated that farming practices and participation in Shamba Maisha was heavily dependent on land tenure and the strength of their claim over their land. Findings revealed that land security (or lack thereof) dictated decision-making critical for intervention participation and success. Male and female participants who felt secure about their access to land reported increased investment in longer-term crops, farm equipment, and improvements to protect farm-land from domestic and wild animals. Women conveyed insecurity about their access to land and reported challenges with lack of legal documentation showing ownership or right to land. Land tenure security posed unique challenges for women, with important implications for their continued participation and success in the intervention.
Conclusion
Targeted livelihood interventions, like Shamba Maisha, have great potential for improving health among vulnerable populations. However, our data show that livelihood interventions may be more effective among those who have land tenure security and this should be a target for future interventions, especially among women.
References
Larson B, Fox M, Rosen S, Bii M, Sigei C, Shaffer D, Sawe F, Wasunna M, Simon J (2008) Early effects of antiretroviral therapy on work performance: preliminary results from a cohort study of Kenyan agricultural workers. AIDS 22(3):421
Morse, J. (1994). Designing funded qualitative research. In N. Denzin & Y. Lincoln (Eds.), Handbook of qualitative research (pp. 220-235). Thousand Oaks, CA: Sage
Nagata JM, Magerenge RO, Young SL, Oguta JO, Weiser SD, Cohen CR (2012) Social determinants, lived experiences, and consequences of household food insecurity among persons living with HIV/AIDS on the shore of Lake Victoria, Kenya. AIDS Care 24(6):728–736
National AIDS Control Council (NACC). (2016). Kenya HIV County Profiles 2016. Nairobi: Kenya Ministry of Health. Retrieved from https://nacc.or.ke/kenya-hiv-county-profiles/
Oluoko-Odingo, Alice Atieno (2011) Vulnerability and Adaptation to Food Insecurity and Poverty in Kenya, Annals of the Association of American Geographers, 101:1, 1-20, DOI: 10.1080/00045608.2010.532739
United States Agency for International Development (USAID). (2019). Kenya Agriculture and Food Security Fact Sheet 2019. Retrieved from https://www.usaid.gov/documents/1860/agriculture-and-food-security.
United States Agency for International Development (USAID). (2015). Kenya Food Insecurity Fact Sheet #1, Fiscal Year (FY) 2015. Retrieved from https://www.usaid.gov/sites/default/files/documents/1866/kenya_fi_fs01_0....
Weiser SD, Young SL, Cohen CR, Kushel MB, Tsai AC, Tien PC, Hatcher AM, Frongillo EA, Bangsberg DR (2011) Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. Am J Clin Nutr 94(6):1729S–1739S
Weiser SD, Tsai AC, Gupta R, Frongillo EA, Kawuma A, Senkungu J, Hunt PW, Emenyonu NI, Mattson JE, Martin JN, Bangsberg DR (2012) Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in a resource-poor setting. AIDS 26(1):67–75
What enables and prevents women from following good nutrition practices in Madhya Pradesh, India? – Results from a multi-sectoral nutrition project
Nadine Bader1 ,Archana Sarkar1,Neha Khara1,Gerrit Qualitz1 ,Petr Schmied2 ,Tina Koch3, Annette Roth3
1 Food and Nutrition Security, Enhanced Resilience project, GIZ India
2 Independent Consultant M&E and Behaviour Change
3 Sector Programme Agriculture Policy and Food Security, GIZ Germany
Introduction
India is affected by high stunting rates of children under 5 years, especially Madhya Pradesh (39.5%). The Food and Nutrition Security, Enhanced Resilience project, initiated by Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ) in 2015, aims to improve the food and nutrition situation of 30,000 children (6-23 months) and 144,000 women of reproductive age in Madhya Pradesh. The project´s focus is on improving dietary diversity through participatory nutrition trainings, facilitated by trained frontline workers, and support to homestead gardening. However, results of a midline survey showed a gap between women’s knowledge of promoted nutrition practices and the extent they follow them.
Methods
A qualitative research study was carried out to assess enablers and barriers to follow good nutrition and hygiene practices and providing implementation recommendations to overcome the main barriers and to take advantage of the enablers. Data collection was carried out in September 2019 in eight randomly selected villages in the project area using a combination of qualitative methods: Focus Group Discussions (n=15) with women, men, frontline workers and partner organisation´s field staff, semi-structured interviews (n=8) with relevant authorities and positive deviants, and observations (n=14) of child feeding practices, food preparation, homestead gardens and participatory nutrition sessions. Transcripts of audio-recorded interviews were coded and aggregated in themes before being validated. The main findings and recommendations were presented and validated in two workshops involving project and partner organisation staff.
Findings
The research has identified six main types of barriers that prevent women from practicing the desired nutrition practices: poor access to nutritious foods due to low income, limited land or seasonal migration; lack of time that is required to follow practices as complementary feeding; limited engagement of men in ensuring good nutrition; harmful beliefs/traditions such as avoid eating green leafy vegetables during lactation; unsupportive social norms such as women should work hard during pregnancy; and limited knowledge. Few women reported that migration hinders them from attending nutrition training sessions. Enabling factors include help provided by household members; know-how provided by frontline workers in participatory nutrition trainings through games, stories, cooking demonstrations and visual materials; women´s decision-making power within the households regarding food choices; and the presence of positive role models in the communities.
Conclusion
Besides further strengthening capacities of frontline workers, nutrition programmes benefit from assessing barriers and enablers towards good nutrition practices. Engaging men in nutrition-related activities, changing the focus of nutrition interventions from ‘women’ to ‘women and their husbands and mothers-in-law’, using the approach of positive deviants as motivators and dispelling harmful beliefs are key besides access to nutritious foods and further support to homestead gardening.
References
Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF and Population Council. 2019. Comprehensive National Nutrition Survey (CNNS) 2016-2018. National Report. New Delhi.