ABSTRACT
Background: Concurrent losses in biodiversity and human dietary diversity are evident in Madagascar and across many food systems globally. Wild food harvest can mitigate nutrition insecurities but may also pose species conservation concerns. Objectives: This study aimed to examine the association of wild plant and animal species consumption during hunger season with diet diversity and child growth near the Alandraza-Agnalavelo protected forest in Southwestern Madagascar. Second, we studied the conservation status of the consumed wild plants. Methods: Methods from public health nutrition (24-h recall dietary intake, anthropometry using World Health Organization [WHO] Growth Standards), ethnobotany, and forest ecology (ecologic studies of abundance, habitat preference, associated species, food chemistry assays, and species richness) were applied. Results: Malnutrition in children (n = 305) was highly prevalent: stunting (32.3%); wasting (18.8%); and low-dietary diversity (4% meeting WHO minimum dietary diversity threshold). Animal foods were consumed in small quantities, providing <10% of Dietary Reference Intakes for all limiting nutrients. Twenty-two wild plant species were consumed during hunger season, prominently tubers (Dioscoreaceae), and leafy greens (Asteraceae, Blechnaceae, Portulacaceae, and Solanaceae). Eight of the 9 target species were identified as abundant and "Least Concern," whereas Amorphophollus taurostigma was abundant and "Vulnerable." Regression modeling showed wild food consumption was associated with an increased household dietary diversity score [ß = 0.29 (0.06 standard error); P < 0.001], and total wild animal foods positively correlated with height-for-age Z score [ß = 0.14 (0.07 standard error); P = 0.04]. Conclusions: Wild plant and animal foods may be an important element of food systems to support human nutrition while maintaining ecosystem viability.
ABSTRACT
BACKGROUND: The incidence of sexually transmitted infections (STIs) has been increasing in the United States, and this trend has continued alongside expanding/changing human immunodeficiency virus (HIV) prevention strategies, moving from reliance solely on behavioral interventions like condoms to biomedical methods like oral and injectable antiretroviral preexposure prophylaxis (PrEP). In 2019, the Ending the HIV Epidemic (EHE) initiative was released to prioritize resource allocation to the 50 jurisdictions in the United States with the highest HIV incidence, providing an opportunity to monitor STI incidence in a national group of discrete, geographic units and identify trends and differences across jurisdictions. OBJECTIVES AND DESIGN: Using existing data from the US CDC and Census Bureau, a retrospective analysis was conducted to examine the incidence of STIs in 49 of the 50 EHE priority counties between 2005 and 2019. This timeframe was divided into 2 periods representing a before and after entry into the biomedical era of HIV prevention: P1 (2005-2011) and P2 (2012-2019). KEY RESULTS: A total of 49 EHE counties were included in this analysis, representing 27.4% of the total US population. Entry into the biomedical HIV prevention era was associated with an increase in STI incidence in 28 EHE counties and a decrease in 14 EHE counties. The greatest percent increase in total STI incidence was in the District of Columbia (+12.1%; incidence rate ratio = 1.121 [1.115, 1.127]; P < 0.001) and the greatest percent decrease was identified in Orleans Parish, LA (-8.7%; incidence rate ratio = 0.913 [0.908, 0.919]; P < 0.001). CONCLUSIONS: Rising STI rates in the biomedical era of HIV prevention represent missed opportunities for comprehensive sexual and preventive healthcare. County-level data provide actionable insight for reducing STI incidence. The EHE counties that have experienced decreases in STI incidence while being in the biomedical era may provide models of best practice, which may be scaled in other jurisdictions.
