Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 6;17(2):e0010574.
doi: 10.1371/journal.pntd.0010574. eCollection 2023 Feb.

Food insecurity and risk of cholera: A cross-sectional study and exploratory analysis of potential mediators

Ahmed D Elnaiem  1 , Molly F Franke  2 , Aaron Richterman  3 , Yodeline Guillaume  4 , Kenia Vissieres  5 , Gertrude Cene Augustin  5 , Ralph Ternier  5 , Louise C Ivers  2   4
Affiliations

Food insecurity and risk of cholera: A cross-sectional study and exploratory analysis of potential mediators

Ahmed D Elnaiem et al. PLoS Negl Trop Dis. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Directed acyclic graph illustrating hypothesized relationship pathways.
Exposure is shown in green, mediating food behaviors in light blue, confounders in grey, and outcome in yellow. The indirect effect of food insecurity occurring through mediating household food behaviors is shown in green (dashed line). The direct effect of food insecurity on cholera is shown in black, and that of confounders in red.
Fig 2
Fig 2. Adjusted associations of high-risk behaviors and history of severe medically-attended cholera in a cross-sectional study in Mirebalais, Haiti 2019 (N = 1072).
See this image and copyright information in PMC

References

    1. About Cholera–Global Task Force on Cholera Control [Internet]. [cited 2022 Nov 14]. Available from: https://www.gtfcc.org/about-cholera/.
    1. 9th-annual-meeting-gtfcc-2022-report.pdf [Internet]. [cited 2022 Nov 14]. Available from: https://www.gtfcc.org/wp-content/uploads/2022/09/9th-annual-meeting-gtfc....
    1. Food and Agriculture Organization of the United Nations/World Food Program. Monitoring food security in countries with conflict situations. United Nations Security Council; 2020. Jan. Report No.: Issue No.7.
    1. Weiser SD, Palar K, Hatcher AM, Young SL, Frongillo EA, Laraia BA . Food Insecurity and Health: A Conceptual Framework. In: Ivers LC, editor. Food insecurity and public health. Boca Raton: CRC Press, Taylor & Francis Group; 2015. p. 23–50.
    1. Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr. 2010. Feb;140(2):304–10. doi: 10.3945/jn.109.112573 - DOI - PMC - PubMed

Publication types