Exploring Food Fortification and An Analysis of the Sociodemographic Impact on Basic WASH Practices: Evidence from the 2018 Pakistan Household Integrated Economic Survey Pubblico
Shirajan, Sheerin Roxana (Spring 2022)
Abstract
Objective: Micronutrient deficiencies, food insecurity, and water, sanitation, and hygiene (WASH) practices are complex and common issues in public health, especially in low-and-middle-income countries (LMIC). Yet, the three are rarely studied together and research is lacking on the combined occurrences in public health. The aim of this study is to (1) explore the current fortification mandates and prepare data for fortification analysis in Pakistan, (2) investigate the association between sociodemographic variables and basic WASH practices in Pakistan, and (3) map the significant results of aim two by province.
Methods: Data were obtained from the 2018 Pakistan Household Integrated Household Survey (HIES) for all three aims. Energy and nutrients associated with the synthesis of hemoglobin were chosen as nutrients of interest for aim one (iron, folic acid, copper, vitamin B12, vitamin B6, vitamin C, zinc, riboflavin, vitamin A, thiamine, and vitamin E). Descriptive analyses for aim two on provincial and national levels were performed. Multiple logistic regressions were used to test the association of covariates (food insecurity experience scale, food decisions, homeownership status, literacy, number of rooms in the house, province, and region) with household WASH practices (basic drinking water, basic hygiene, and basic sanitation).
Results: Basic WASH practices were significantly associated with all covariates of interest but one. Punjab was strongly associated with basic drinking water [OR = 23.147 (22.998, 23.297)], urban areas were strongly associated with basic sanitation practices [OR = 30.852 (30.816, 30.888)], and the food insecurity experience scale (FIES) at mild, moderate, and severe levels were negatively associated with basic drinking water, basic hygiene, and basic sanitation when compared to food-secure households. The number of rooms in the household was associated with basic hygiene and sanitation, where the association grew stronger as the rooms in the household increased when compared to homes with 12-15 rooms.
Conclusion: Our findings were, all but one, statistically significant for associations of sociodemographic and WASH. Effective WASH practices, micronutrient supplementation, and food security are necessary to ensure the health of the public in Pakistan, and more research is needed on their intersections.
Table of Contents
Table of Contents
1. INTRODUCTION 1
MICRONUTRIENT DEFICIENCIES 2
FOOD FORTIFICATION 2
FOOD INSECURITY 3
WASH AND WASH EDUCATION 4
2. STUDY PURPOSE 5
3. METHODS 6
IRB CONSIDERATIONS 6
DATABASE SELECTION 6
OBJECTIVE 1 7
OBJECTIVE 2 11
OBJECTIVE 3 20
4. RESULTS 21
OBJECTIVE 1 21
OBJECTIVE 2 22
OBJECTIVE 3 28
5. DISCUSSION 30
OBJECTIVE 1 30
OBJECTIVES 2 & 3 32
STRENGTHS 36
LIMITATIONS 37
6. CONCLUSION AND RECOMMENDATIONS 38
7. APPENDICES 40
8. REFERENCES 227
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