{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T19:10:01Z","timestamp":1760814601878,"version":"build-2065373602"},"reference-count":34,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2012,3,6]]},"published-print":{"date-parts":[[2012]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>In Sub-Saharan Africa, the overlapping epidemics of undernutrition and HIV infection affect over 200 and 23 million people, respectively, and little is known about the combined prevalence and nutritional effects. The authors sought to determine which structural factors are associated with food insufficiency, low dietary diversity and low body mass index (BMI) in HIV-negative and HIV-infected Sub-Saharan women.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Study design<\/jats:title>\n                  <jats:p>Cross-sectional analysis of a longitudinal cohort.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Community-based women's organisations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>161 HIV-negative and 514 HIV-infected Rwandan women.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Primary and secondary outcome measures<\/jats:title>\n                  <jats:p>Primary outcomes included food insufficiency (reporting \u2018usually not\u2019 or \u2018never\u2019 to \u2018Do you have enough food?\u2019), low household dietary diversity (Household Dietary Diversity Score \u22643) and BMI &lt;18.5 (kg\/m<jats:sup>2<\/jats:sup>). The authors also measured structural and behavioural factors including: income, household size, literacy and alcohol use.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Food insufficiency was prevalent (46%) as was low dietary diversity (43%) and low BMI (15%). Food insufficiency and dietary diversity were associated with low income (adjusted odds ratio (aOR)=2.14 (95% CI 1.30 to 3.52) p&lt;0.01), (aOR=6.51 (95% CI 3.66 to 11.57) p&lt;0.001), respectfully and illiteracy (aOR=2.00 (95% CI 1.31 to 3.04) p&lt;0.01), (aOR=2.10 (95% CI 1.37 to 3.23) p&lt;0.001), respectfully and were not associated with HIV infection. Alcohol use was strongly associated with food insufficiency (aOR=3.23 (95% CI 1.99 to 5.24) p&lt;0.001). Low BMI was inversely associated with HIV infection (aOR\u22480.5) and was not correlated with food insufficiency or dietary diversity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Rwandan women experienced high rates of food insufficiency and low dietary diversity. Extreme poverty, illiteracy and alcohol use, not HIV infection alone, may contribute to food insufficiency in Rwandan women. Food insufficiency, dietary diversity and low BMI do not correlate with one another; therefore, low BMI may not be an adequate screening tool for food insufficiency. Further studies are needed to understand the health effects of not having enough food, low food diversity and low weight in both HIV-negative and HIV-infected women.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2011-000714","type":"journal-article","created":{"date-parts":[[2012,4,14]],"date-time":"2012-04-14T20:24:14Z","timestamp":1334435054000},"page":"e000714","source":"Crossref","is-referenced-by-count":23,"title":["Structural determinants of food insufficiency, low dietary diversity and BMI: a cross-sectional study of HIV-infected and HIV-negative Rwandan women"],"prefix":"10.1136","volume":"2","author":[{"given":"Nicole","family":"Sirotin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald","family":"Hoover","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C J","family":"Segal-Isaacson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiuhu","family":"Shi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adebola","family":"Adedimeji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugene","family":"Mutimura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mardge","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn","family":"Anastos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2012,4,13]]},"reference":[{"key":"2025101811425468000_2.2.e000714.1","unstructured":"Reaching sustainable food security for all by 2020: getting the priorities and responsibilities right. Washington, DC: International Food Policy Research Institute, 2002."},{"key":"2025101811425468000_2.2.e000714.2","unstructured":"Bickel G Nord M Price C . Guide to Measuring Household Food Security. Alexandria VA: U.S. Department of Agriculture, Food and Nutrition Service, 2000."},{"key":"2025101811425468000_2.2.e000714.3","unstructured":"Women in Agriculture: Closing the Gender Gap For Development. Rome: Food and Agriculture Organization, 2011."},{"key":"2025101811425468000_2.2.e000714.4","unstructured":"Shapouri SRS Peters M Tandon S . International Food Security Assessment 2011-21. Washington, DC: Economic Research Service\/US Department of Agriculture, 2011."},{"key":"2025101811425468000_2.2.e000714.5","unstructured":"UNAIDS. Global Report Fact Sheet. Sub Saharan Africa Geneva: Joint United Nations Programme on HIV\/AIDS, 2011."},{"key":"2025101811425468000_2.2.e000714.6","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-008-0824-5"},{"key":"2025101811425468000_2.2.e000714.7","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1093\/jn\/138.9.1705","article-title":"HIV infection is associated with Decreased dietary diversity in South African children","volume":"138","author":"Mpontshane","year":"2008","journal-title":"J Nutr"},{"key":"2025101811425468000_2.2.e000714.8","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3181b627c2"},{"key":"2025101811425468000_2.2.e000714.9","unstructured":"Closing the gap in a generation: Health Equity through Action on the Social Determinants of Health in Final Report of the Commission on Social Determinants of Health. Geneva: World Health Organization, 2008."},{"key":"2025101811425468000_2.2.e000714.10","unstructured":"Millennium Development Goals. Towards Sustainable Social and Economic Growth. First Edition. Country Report 2007. Kigali: The national Institute of statistics of Rwanda (NISR), 2007."},{"key":"2025101811425468000_2.2.e000714.11","unstructured":"Abbott P Rwirahira J . Millennium Development Goals Rwanda Country Report 2010. 2010 Kigali: UNDP, 2010."},{"key":"2025101811425468000_2.2.e000714.12","doi-asserted-by":"publisher","DOI":"10.1186\/1475-9276-4-10"},{"key":"2025101811425468000_2.2.e000714.13","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa054017"},{"key":"2025101811425468000_2.2.e000714.14","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ejcn.1602135"},{"key":"2025101811425468000_2.2.e000714.15","doi-asserted-by":"publisher","DOI":"10.3945\/jn.110.123356"},{"key":"2025101811425468000_2.2.e000714.16","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2009.1367"},{"key":"2025101811425468000_2.2.e000714.17","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1371\/journal.pmed.0040260","article-title":"Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland","volume":"4","author":"Weiser","year":"2007","journal-title":"PLoS Med"},{"key":"2025101811425468000_2.2.e000714.18","doi-asserted-by":"crossref","unstructured":"Coates J Swindale A Bilinsky P . Household Food Insecurity Access Scale (HFIAS) for Measurement of Household Food Access: Indicator Guide in Food and Nutrition Technical Assistance Project. Washington, DC: Academy for Educational Development, 2007.","DOI":"10.1037\/e576842013-001"},{"key":"2025101811425468000_2.2.e000714.19","unstructured":"Swindale A Bilinsky P . Household Dietary Diversity Score (HDDS) for Measurement of Household Food Access: Indicator Guide in Food and Nutrition Technical Assistance Project (FANTA). Washington, DC: Academy for Educational Development, 2006."},{"key":"2025101811425468000_2.2.e000714.20","doi-asserted-by":"publisher","DOI":"10.3945\/jn.110.125716"},{"key":"2025101811425468000_2.2.e000714.21","unstructured":"The World Bank. Poverty. The World Bank, 2010. http:\/\/data.worldbank.org\/topic\/poverty (accessed 31 Mar 2012)."},{"key":"2025101811425468000_2.2.e000714.22","unstructured":"The Millennium Development Goals Report. New York: Department of Economic and Social Affairs, 2009."},{"key":"2025101811425468000_2.2.e000714.23","first-page":"592","article-title":"Reaching Mexico's poorest","volume":"84","author":"Braine","year":"2006","journal-title":"Bull World Health Organ"},{"key":"2025101811425468000_2.2.e000714.24","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czg018"},{"key":"2025101811425468000_2.2.e000714.25","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czp064"},{"key":"2025101811425468000_2.2.e000714.26","unstructured":"Dodd R Hinshelwood E Harvey C . Poverty Reduction Strategy Papers: Their Significance for health in Second Synthesis report. Geneva: World Health Organization, 2004."},{"key":"2025101811425468000_2.2.e000714.27","unstructured":"Citro CF Michael RT , eds. Measuring Poverty: A New Approach. Washington, DC: National Academy Press, 1995."},{"key":"2025101811425468000_2.2.e000714.28","unstructured":"UBOS & ORC Macro. Uganda Demographic and Health Survey 2000-2001. Calverton, Maryland, USA: Uganda Bureau of Statistics and ORC Macro, 2001."},{"key":"2025101811425468000_2.2.e000714.29","unstructured":"http:\/\/www.who.int\/substance_abuse\/publications\/alcohol_gender_drinking _problem.pdf#page=200 (assessed 2 Apr 2012)."},{"key":"2025101811425468000_2.2.e000714.30","unstructured":"http:\/\/www.who.int\/substance_abuse\/publications\/en\/rwanda.pdf (accessed 20 Nov 2011)."},{"key":"2025101811425468000_2.2.e000714.31","doi-asserted-by":"crossref","unstructured":"World Bank. Education in Rwanda: Rebalancing Resources To Accelerate Post-Conflict Development And Poverty Reduction, in AWorld Bank Country Study. The International Bank for Reconstruction and Development. Washington DC: The World Bank, 2004.","DOI":"10.1596\/0-8213-5610-0"},{"key":"2025101811425468000_2.2.e000714.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.foodpol.2005.10.006"},{"key":"2025101811425468000_2.2.e000714.33","unstructured":"World Bank. World Development Report 2008: Agriculture for Development. The international Bank for Reconstruction and Development\/The World Bank, 2008."},{"key":"2025101811425468000_2.2.e000714.34","doi-asserted-by":"crossref","first-page":"1669","DOI":"10.1016\/0305-750X(95)00073-L","article-title":"Alternative food security strategy: a household analysis of urban agriculture in Kampala","volume":"23","author":"Maxwell","year":"1995","journal-title":"World Dev"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2011-000714","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T18:43:06Z","timestamp":1760812986000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2011-000714"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012]]},"references-count":34,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2012,4,13]]},"published-print":{"date-parts":[[2012]]}},"alternative-id":["10.1136\/bmjopen-2011-000714"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2011-000714","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2012]]}}}