Outcomes of a homestead food production program on nutritional knowledge, dietary diversity, food security and empowerment of rural women in Tehran province, Iran.

BACKGROUND: Food and nutrition insecurity is a major health issue in developing countries. Homestead food production (HFP) programs are strategies for improving food and nutrition security of a country. Iran implemented a HFP program entitled "Nutrition Improvement of Rural and Nomadic Women" in its villages for a five-year period from 2017. The current study assessed the outcomes of this mentioned program and its determinants among rural women in Tehran province. METHODS: The population of this cross-sectional study comprised a group covered by the program (n = 143) and a non-covered group (n = 160). The participants were selected randomly from 32 villages of five counties in Tehran province. Data was collected using five questionnaires: (1) General information, (2) Women's empowerment, (3) Nutritional knowledge, (4) Dietary diversity, and (5) Household Food Insecurity Access Scale (HFIAS). Data was analyzed using the IBM SPSS version 21 and the IBM Amos SPSS version 22 software. RESULTS: The results of the study showed no significant improvement in the expected indicators, such as frequency of home gardening, nutritional knowledge, dietary diversity, women's empowerment, and household food insecurity status among women covered by the program (p > 0.05). The structural equation modelling (SEM) results indicated that women's empowerment from the dimension of decision-making power (r = 0.151) and nutritional knowledge (r = 0.135) were the significant positive predictors of dietary diversity (p < 0.05), while household food insecurity predicted it negatively (r=-0.138) (p < 0.05). CONCLUSION: Because the current evaluated program has not been able to improve the expected indicators, modification of the program implementation may be needed, such as: addressing the probable barriers and challenges and strengthening the facilities in the covered villages. The current study presents a model of the dietary diversity predictors for consideration in redesigning or enhancing the program.

Fear of COVID-19 Higher among Food-Insecure Households: A Model-Based Study, Mediated by Perceived Stress among Iranian Populations.

Objective: The COVID-19 pandemic is a crisis accompanied by multiple psychological consequences (including fear of COVID-19) and threatens the food security status of millions of people. This study aimed to examine the association between fear of COVID-19 and food insecurity, mediated by perceived stress. Method : This cross-sectional study was conducted among 2871 Iranian participants (18-80 years), recruited through the Social Media during the COVID-19 epidemic. The demographic and socio-economic information questionnaire, Household Food Insecurity Access Scale (HFIAS), COVID-19 fear scale (FCV-19S), Cohen's Perceived Stress Scale (PSS-14) and Perceived Social Support Questionnaire (MSPSS) were used in data gathering. Descriptive and analytical analyses were done using SPSS 22.0 and Amos 22.0 was used for structural equation modeling (SES). Results: Food insecurity has significant positive direct and indirect (mediated by perceived stress) correlations with fear of COVID-19 (P < 0.05). It was also shown that perceived social support could negatively relate to fear of COVID-19 through the pathways of food security status or perceived stress (P < 0.05). Among women, the presence of a child under 5 had a significant direct association with fear of COVID-19 (P < 0.05). Conclusion: Food insecurity was associated with more perceived fear of COVID-19 among the studied population. The crisis caused by COVID-19 highlights the need to increase social resilience through developing and implementing appropriate strategies to prevent and mitigate social costs (whether physical, psychological, or nutritional).

Household food insecurity associations with pregnancy hypertension, diabetes mellitus and infant birth anthropometric measures: a cross-sectional study of Iranian mothers.

Objective: The purpose of this study was to determine the associations between food insecurity on pregnancy and its outcomes.Materials and methods: This cross-sectional study was carried out on 700 Iranian mothers. Household socioeconomic status, prenatal information and household food security status were assessed using questionnaires. Data analysis was applied by SPSS version 22.Results: The results of the study showed a significant association between food insecurity with gestational diabetes mellitus. The results also showed a significant association between birth weight, and height with pregnancy-induced hypertension.Conclusion: food insecure women should be recognized, and receive appropriate training and assistance.

Relationship Between Household Food Insecurity and Growth Disorders in Children Aged 3 to 6 in Qazvin City, Iran.

PURPOSE: Food insecurity, which is the inability to obtain food or inadequate food consumption in terms of quality and quantity, has physical and psychological consequences on children's health. This study aimed to investigate the relationship between children's growth disorders and food insecurity in Qazvin city, Iran. METHODS: A case-control study was conducted on 177 cases and 355 controls of children aged 3 to 6 years, who were referred to health centers in Qazvin city. The case group consisted of children with growth disorders. Data were obtained with the 18-item US Department of Agriculture questionnaire, a household socioeconomic questionnaire, a and growth monitoring card. The data were analyzed with using IBM SPSS Version 22.0, by independent sample t-test, chi-square test, and logistic regression. RESULTS: A significant relationship was found between children's growth disorders and household food insecurity with (p<0.05, odds ratio [OR]=17.0, confidence interval [CI]=5.9, 48.8) and without hunger (p<0.05, OR=2.69, CI=1.4, 4.9). There were also significant relationships between children's growth disorders and socioeconomic status (p<0.05, OR=3.4, CI=1.4, 8.5), the duration of breastfeeding (p<0.05, OR=0.94, CI=0.9, 0.98), and children's ages (p<0.05, OR=0.94, CI=0.92, 0.96). Sex and birth order, and the age of the parents was not found to be significantly related with growth disorders. CONCLUSION: Lower socioeconomic status and household food insecurity were the important predictors of children's growth disorders. Policymakers should focus more on promoting steady employment and income among family members. Nutritional education for mothers is also recommended, in order to better meet the nutritional needs of the children.

WHO Ending Childhood Obesity and Iran-Ending Childhood Obesity Programs Based on Urban Health Equity Indicators: A Qualitative Content Analysis.

BACKGROUND: The childhood obesity epidemic is one of the most serious global health challenges, and many relevant policies have been designed and implemented. Regarding health equity policy-making, it is important to adopt proper interventional strategies, including childhood obesity policies. The purpose of this study is to assess compliance with the WHO Ending Childhood Obesity (ECHO), and the Iran-Ending Childhood Obesity (IRAN-ECHO) program draft in terms of Urban Health Equity Indicators (UHEIs) in Iran. METHODS: This is a descriptive study, using a directed quantitative content analysis approach to analyze the ECHO report and IRAN-ECHO program draft, based on Iranian UHEI. The UHEI consist of 52 indicators in 5 domains. The frequency of each code in the ECHO report and IRAN-ECHO draft was calculated and analyzed. RESULTS: In total, 148 and 84 phrases or words in ECHO and IRAN-ECHO were encoded with UHEI concepts. The results showed that the physical activity indicator was the most frequent among indicators in both ECHO (n = 48, 32.43%) and IRAN-ECHO (n = 41, 48.80%). Indicators 28 (prevalence of underweight in children under 5, n = 14, 9.45%) and 19 (use of primary care services, n = 21, 25%) were the next most frequent in ECHO and IRAN-ECHO, respectively. CONCLUSION: In this study, ECHO and IRAN-ECHO had high compliance with some UHEI, especially indicators placed in domain 3 (social and human development). It indicates that social and human development plays an important role in preventing and controlling childhood obesity.

Association of Infant Exclusive Breast Feeding with Household Food Security and Maternal Mental Health.

BACKGROUND: Exclusive breastfeeding (EBF) is emphasized by the World Health Organization (WHO) as the most desirable way of infant feeding in the first 6 months. EBF has beneficial health effects on mothers and infants. The aim of this study was to examine factors influencing EBF, with emphasis on household food security status and maternal mental health. METHODS: This cross-sectional study was carried out on 325 women referring to community health centers in west Tehran. Data were collected using questionnaires, including Edinburgh Postnatal Depression Scale (EPDS) and the USDA (US Department of Agriculture) 18-item questionnaire. The data was analyzed using both descriptive and analytical methods such as the chi-squared test, t test and logistic regression with SPSS 22. RESULTS: The prevalence of EBF was 82.5% (CI = 0.70, 0.94), 63.9% (CI = 0.57, 0.70) and 72.3% (CI = 0.62, 0.82) in 3-month, 3-6-month and 6-8-month-old infants, respectively. The results of this study showed a significant association between EBF and infant gender satisfaction (P < 0.001, OR = 4.85, CI = 2.12, 11.12), economic satisfaction score (P = 0.028, OR = 0.82, CI = 0.69, 0.98), infant birth weight (P = 0.013, OR = 0.99, CI = 0.99, 1.00) and unwanted pregnancy (P = 0.098, OR = 1.82, CI = 0.89, 3.70). However, we did not find any significant association between EBF and other variables such as household food security status, mother's postpartum depression, parents' education and age, type of delivery and pregnancy numbers. CONCLUSION: Infant gender satisfaction, economic satisfaction, unwanted pregnancy and infant birth weight were the significant factors for predicting EBF in this study. Since EBF is important for infants and mothers' health, policy-makers should devise strategies to promote and encourage EBF in the society.

Prevalence of folic acid supplement consumption before and during pregnancy, and its determinants among community health center referrals.

OBJECTIVE: The aim of this study is to assess the prevalence and determinants of folic acid supplementation among women referred to community health centers. METHODS: This was a cross-sectional study conducted in 325 women referred to community health centers. The subjects were selected from 8 community health centers, using a stratified sampling technique. Data regarding demographics, socioeconomic status, obstetrics, folic acid supplementation status, and household food security status were obtained via questionnaires. The data was analyzed in SPSS v22. RESULTS: The prevalence of folic acid supplementation both before and during pregnancy was 54.5%. The results of the study showed that folic acid supplementation had a significant positive association with education level (odds ratio [OR],0 .441; 95% confidence interval [CI], 0.199-0.977; P<0.05), being employed (OR, 0.353; 95% CI, 0.148-0.840; P<0.05), and planned pregnancy (OR, 18.113; 95% CI, 7.371-44.51; P<0.001). However, other variables, including age, husband's age, husband's education and employment status, the number of prior pregnancies, economic satisfaction, and household food security, were nonsignificant factors affecting folic acid supplementation. CONCLUSION: Women with lower socioeconomic status are less likely to take folic acid supplements, and more effort should be made to increase their awareness of the importance of supplementation. Unplanned pregnancy is another strong risk factor for not supplementing with folic acid, and thus should be avoided.

The Prevalence of Postpartum Depression and Its Association with Food Insecurity among Mothers Referring to Community Health Centers.

Objective: Postpartum depression (PPD) is a condition which may compromise both maternal and neonatal health. The present study was conducted to determine the prevalence of PPD and its association with demographic, socioeconomic, obstetric, and household food security status. Method : This cross sectional study was conducted in community health centers in west of Tehran. A total of 325 women were selected by stratified sampling method from community health centers. A sociodemographic questionnaire, USDA 18-item questionnaire, and Edinburgh Postnatal Depression Scale (EPDS) questionnaire were used for data collection. Data were analyzed using both descriptive and analytic analyses, such as chi-squared test and logistic regression in SPSS 22. Results: The prevalence of PPD and food insecurity among the studied population was 35.4% and 34.2%, respectively. The results of this study revealed a significant association among PPD and food insecurity (OR = 6.690, CI = 3.118-14.353, p<0.001), the levels of economic satisfaction (OR = 3.419, CI = 1.241-9.420, P = 0.017), pregnancy loss (OR = 1.899, CI = 1.006-3.582, p = 0.048), and pregnancy complications (OR = 1.853, CI = 1.083-3.170, P = 0.024). Conclusion: Based on the results of this study, household food insecurity may predispose mothers to PPD. Moreover, it was observed that mothers with poor economic satisfaction were more likely to be depressed. Histories of pregnancy loss and pregnancy complications were other risk factors for PPD.

The Association Between Postpartum Depression and Pica During Pregnancy.

INTRODUCTION & OBJECTIVES: Postpartum depression (PPD) is a common disorder and social debilitating that has adverse effects on the mother, child and family. Pica is an eating disorder characterized by persistent ingestion of substances that the consumer does not define as food. The aim of this study was to investigate the association of postpartum depression with pica during pregnancy. METHOD: This is case-control study was carried out in health centers in west Tehran. 152 depressed women (case group) and 148 non-depressed women (control group) were selected randomly from these health care centers. In addition to collecting demographic and pica data, the Edinburgh Depression Scale was used. The data was analyzed by both descriptive and analytic analyses such as chi-squared and logistic regression in SPSS version 16. RESULT: In this study, there wasn't a significant association between PPD and pica during pregnancy (P=0.153, OR=2.043, CI=0.767, 5.438), but, postpartum depression has a significant association with type (clay) (P= 0.024) and duration (more than 2 months) (P= 0.023) of pica practice. CONCLUSIONS: In the present study, pregnancy pica was not important risk factor for PPD but there were similar risk factors such as iron supplementation during and postpartum pregnancy with pica and PPD.

Prevalence and risk factors for pica during pregnancy in Tehran, Iran.

INTRODUCTION AND OBJECTIVES: Pica is an eating disorder characterized by the persistent ingestion of substances that the consumer does not define as food. The exact cause of pica is often unknown. The purpose of this study was to determine the prevalence of pica during pregnancy and its related risk factors. METHOD: This cross-sectional study was carried out in health care centers in west of Tehran. Three hundred women were selected by stratified sampling method from the population. Demographic information and characteristics of pica during pregnancy, such as the kind, the onset, duration, frequency and the reasons, and also iron supplementation status before and during pregnancy and kind of infant feeding were collected via interview and questionnaire. The data were analyzed by chi square test and logistic regression in SPSS 16. RESULTS: The prevalence of pica among the studied population was 8.33%, and pagophagia (ice and freezer frost) was the most common form of pica which is characterized by the ingestion of non-food substance (76%). Sixty-four percent of women reported practicing pica regularly on a daily basis. In this study, there was significant association between pica practice and education, unwanted pregnancy, pregnancy complications, the levels of economic satisfaction, iron supplementation during pregnancy, kind of infant feeding, and type of delivery. However, there was no significant association between pica and age, employment, pregnancy ranks, the history of abortions or stillbirths, infant sex, and iron supplementation before pregnancy. CONCLUSIONS: Iron supplementation during pregnancy should be more considered. Also women with low education should be asked concerning pregnancy pica.