Triple Burden Research Articles

Level of Adequate Knowledge of Non-communicable Diseases and Associated Factors Among Adult Residents of North Shewa Zone, Oromia Region, Ethiopia: A Mixed-Method Approach.

BackgroundNon-communicable diseases (NCDs) are currently the leading cause of morbidity and mortality, posing significant challenges to global healthcare systems. Particularly, the prevalence of NCDs is rising in Ethiopia, resulting in a triple burden of diseases on the health system that disproportionately affects all age groups. Hence, this study aims to determine the level of adequate knowledge of NCDs and associated factors among adult residents of the North Shewa zone, Oromia region, Ethiopia.MethodsA community-based cross-sectional study with a concurrent mixed-method approach was conducted from April 1, 2021 to May 30, 2021 among 846 residents using the multistage sampling technique. Interviewer administered questionnaire was used to collect quantitative data and a guiding checklist was used to collect qualitative data. Bivariable and multivariable logistic regressions were fitted to compute the association between explanatory variables and knowledge of NCDs. Adjusted odds ratios at 95% confidence interval with a p-value < 0.05 were used to decree statistical significance in multivariable analysis. Also, a thematic framework analysis was used for qualitative data analysis.ResultsA total of 823 subjects have participated in this study making a response rate of 97.3%. The level of adequate knowledge was 33.9% (95%CI: 30.67, 37.13). Higher-income, receiving information from health professionals, owning a TV, having a family member with NCD(s), and marital status were factors significantly associated with adequate knowledge of NCDs.ConclusionThis study reveals a high level of inadequate knowledge of NCDs despite its foundational ability in tackling the burden of NCDs. As a result, broadening a wider and more comprehensive health promotion strategy for the prevention of triple burden of NCDs would benefit the population. Additionally, special efforts are needed both at the practice and policy levels targeting the disadvantaged groups, such as low-income people, those who do not receive information from health professionals, those who do not own a television, and those who are widowed/divorced, who were found to have less knowledge of NCDs.

Balancing work and family? Young mother’s coordination points in contemporary China

ABSTRACT China’s transition from a centrally planned to a market economy has substantially intensified the pressure on women in playing their dual roles as care givers and income earners. Drawing upon in-depth interviews with 34 young mothers in Jilin, China, this article employs the framework of ‘coordination point’ Skinner, C. [2003]. Running around in circles: Coordinating childcare education and work. Bristol: Policy Press). It looks at the daily journeys made in young women’s families and provides detailed information about the numbers of journeys take place and how these journeys are coordinated. The results show that Chinese young mothers retain the primary responsibility for childcare, not only transporting and caring for children, but taking the responsibility for organising the journeys to ensure the continuity of care. I argue that Chinese young mothers are not just taking on the ‘dual burden’ of work and care, but actually the ‘triple burden’ of worker, carer and manager as they deal with coordination points. Furthermore, grandparental support has been found to be particularly important in supporting working mothers by helping with coordination points and childcare activities. By contrast, long working hours and employed-favoured flexible arrangements, as well as the absence of childcare services for children under three, act as a hindrance to work–family balance.

A critical comparison of the Indian school food and nutrition guidelines with the WHO-nutrition friendly school initiative and the review of existing implementation scenario.

Background: The school-based food and nutrition guidelines approach has the potential to combat undernutrition, overnutrition and micronutrient deficiencies among children and adolescents and set the foundation for a healthy adult lifestyle. Aim: To critically compare the Nutrition Friendly School Initiative (NFSI) of the World Health Organization (WHO) with the Food Safety and Standards Authority of India (FSSAI) and the Indian Academy of Pediatrics (IAP) guidelines to gauge the strengths and limitations. Additionally, to summarize the existing studies on implementing school food and nutrition guidelines. Methods: Policy documents of the above guidelines were critically evaluated, and narrative analysis was conducted. An electronic search was conducted for full-text research articles published in the English language between January 2007 to September 2021 in Science Direct, PubMed, Web of Science, and SCOPUS databases. Results: Upon critical comparison of the three guidelines, it was found that the NFSI and FSSAI guidelines shared similarities in many components and the FSSAI guidelines, if implemented adequately, could improve the school food environment and combat the triple malnutrition burden in India. After screening the articles based on the eligibility criteria, 11 studies were included in the preparation of the review. Studies reported partial or inadequate implementation and poor compliance with the guidelines or approach. A few studies identified barriers to guideline implementation. Conclusion: Implementation of school food and nutrition guidelines could improve the nutritional outcomes in children and adolescents. To sustain the effective implementation, adequate resources and preparedness are essential in low-and middle-income countries, including India.

Nutrition in Indonesia toddlers and preschools: understanding challenges and strategies

There is surely rapid development of toddler and preschool age children, especially related to human brain development. Poor development among under-five children in Indonesia in 2010 is ranged 40–59%. Global data shows that there is triple burden of malnutrition, and amongst improper behavior, the two highest clinical symptoms are hyperactivity and showing anger when displeased. This shows that children need nurturing care in which has its contribution through the life course.

The Triple Burden of Tuberculosis, Helminthiasis, and HIV/AIDS: New Aspects of Old Diseases

The Triple Burden of Tuberculosis, Helminthiasis, and HIV/AIDS: New Aspects of Old Diseases

Assessing the Diets of Young Children and Adolescents in India: Challenges and Opportunities.

Sustainably addressing the crisis of undernutrition for children and adolescents in underserved and resource-limited communities will require, among other investments, interventions aimed at optimizing the diets of these vulnerable populations. However, to date, there are substantial global gaps in the collection of dietary data in children and adolescents. This review article summarizes the challenges and opportunities in assessing diet among children and adolescents in India. National surveys in India identify the scale of the triple burden of malnutrition (undernutrition, micronutrient deficiencies and overnutrition) in children and adolescents and assess key nutrition and food security indicators for making informed policy decisions. However, national surveys do not collect data on diet, instead relying on anthropometry, biomarkers of micronutrient deficiencies, and summary measures of diet, such as the WHO infant and young child feeding summary indicators. Sub-national surveys and the scientific literature thus fill important gaps in describing the nutrient intakes of children and adolescents in India; however large gaps remain. Future research can be improved by investments in infrastructure to streamline the assessment of diet in India. The current challenges confronting the collection and analysis of high-quality dietary data occur in both the data collection and data analysis phases. Common methods for assessing diets in low-resource settings—such as 24 h recalls and food frequency questionnaires are particularly challenging to implement well in young children and adolescents due to motivation and memory issues in young respondents. Additionally, there are challenges with parental recall including children having multiple caretakers and meals outside the home. Furthermore, analysis of dietary data is hindered by the lack of affordable, accessible software for dietary data analysis relevant to the diversity in Indian diets. New technologies can address some of the challenges in dietary data collection and analysis, but to date, there are no platforms designed for population-level dietary assessment in India. Public and private sector investment in dietary assessment, as well as collaboration of researchers and the creation of open-source platforms for the sharing of data inputs (local food lists, recipe databases, etc.) will be essential to build infrastructure to better understand the diets of children and adolescents in India and improve dietary interventions in these target groups.

Principles for Evidence-Based and Sustainable Food System Innovations for Healthier Diets.

Climate change, rapid urbanization, war, and economic recession are key drivers of the current food systems’ disruption, which has been exacerbated by the COVID pandemic. Local, regional, and global food systems are unable to provide consumers with nutritious and affordable diets. Suboptimal diets exacerbate the triple burden of malnutrition, with micronutrient deficiencies affecting more than two billion people, two billion people suffering from overweight, and more than 140 million children who are stunted. The unaffordability of nutritious diets represents an obstacle for many, especially in low- and middle-income countries where healthy diets are five times more expensive than starchy staple diets. Food system transformations are urgently required to provide consumers with more affordable and nutritious diets that are capable of meeting social and environmental challenges. In this review, we underline the critical role of innovation within the food system transformation discourse. We aim to define principles for implementing evidence-based and long-term food system innovations that are economically, socially, and environmentally sustainable and, above all, aimed at improving diets and public health. We begin by defining and describing the role of innovation in the transformation of food systems and uncover the major barriers to implementing these innovations. Lastly, we explore case studies that demonstrate successful innovations for healthier diets.

Total Usual Nutrient Intakes and Nutritional Status of United Arab Emirates Children (

ABSTRACTBackgroundThe transition from a predominantly milk-based diet to a diverse family diet is a window of opportunity for optimal child growth and development.ObjectivesThe study aims to examine the nutritional status and food-consumption patterns of children under 4 y of age in the United Arab Emirates (UAE) and their adherence to nutrient and dietary recommendations.MethodsA population-based cross-sectional survey of 525 children aged 0–47.9 mo was conducted in 3 major emirates: Abu Dhabi, Dubai, and Sharjah. Anthropometric measurements were obtained, and dietary assessment was conducted using the 24-h dietary recall approach. Usual intakes of energy, macronutrient, and micronutrients, including from supplements, were assessed using PC-SIDE software. Adherence to food-group recommendations was evaluated based on the American Heart Association/American Academy of Pediatrics dietary guidelines.ResultsAmong 0–4-y-old children, 10% were stunted, 6% were wasted, 17% were at risk of overweight, 5% were overweight, and 3% were obese. The contribution of sweets and sugar sweetened beverages to energy intake increased from 5% in 6–11.9-mo-old children to 17% in 36–47.9-mo-old children. Compared with dietary guidelines, the lowest adherence was for fruit (13–18%) and vegetables (7–12%), while protein was within the recommendations, and 92% and 89% of children (aged 24 to 35.9 mo and 36 to 47.9 mo, respectively) had high intakes of saturated fat. Almost all toddlers failed to meet the Adequate Intake for fiber. The proportions of children exceeding the free-sugar upper limit increased from 10.6% in infants (0–5.9 mo) to 56.7% in toddlers (12– 23.9 mo). Micronutrient inadequacies were observed, particularly for calcium, zinc, folate, and vitamins A and D.ConclusionsThis study suggests a triple burden of malnutrition among infants and young children in the UAE. Results call for national nutrition intervention strategies aimed at improving dietary quality in the pediatric population.

Triple Burden of Neurocognitive Impairment and Co-occurring Depression and Anxiety Among People Living With HIV in Bahir Dar, Ethiopia: A Multicenter Study.

BackgroundNeurocognitive impairment is associated with psychological morbidities, such as depression and anxiety, among people living with HIV. The presence of these comorbidities affects viral load suppression, treatment adherence, quality of life, treatment outcomes, and functionality. Despite this fact, there is a dearth of studies that examined the triple burden of neurocognitive impairment and co-occurring depression and anxiety among antiretroviral therapy attendees in Ethiopia. This study aimed to assess the magnitude of HIV-associated neurocognitive impairment and co-occurring depression and anxiety at the same time among people living with HIV/AIDS.MethodWe conducted an institution-based multicenter cross-sectional study in Bahir Dar, Northwest Ethiopia. A total of 410 study participants were selected using a systematic random sampling technique. Neurocognitive impairment was assessed using the International HIV Dementia Scale. Co-occurring depression and anxiety were assessed using the Hospital Anxiety and Depression Scale. A semi-structured questionnaire was applied to collect data on sociodemographic and clinical-related characteristics. Data were analyzed using descriptive statistics and univariate and multivariable logistic regression.ResultsTwo-thirds (66.8%) of the people living with HIV had neurocognitive impairment. The prevalence of co-occurring depression and anxiety was found in 39.8%. Women with HIV, people with comorbid chronic medical illness, and those under a second-line treatment regimen were factors associated with neurocognitive impairment. Furthermore, pill burden, second-line treatment regimen, HIV clinical stages, social support, HIV-perceived stigma, and neurocognitive impairment were associated factors with co-occurring depression and anxiety.ConclusionsWe found a high prevalence of neurocognitive impairment and co-occurring depression and anxiety among people living with HIV/AIDs. Further research is needed to assess the clinical course of neurocognitive impairment and co-occurring depression and anxiety.

Prevalence and associated factors of double and triple burden of malnutrition among child-mother pairs in Ethiopia: Spatial and survey regression analysis

BackgroundEvidence on double and triple burdens of malnutrition at household level among child-mother pairs is a key towards addressing the problem of malnutrition. In Ethiopia, studies on double and triple burdens of malnutrition are scarce. Even though there is a study on double burden of malnutrition at national level in Ethiopia, it doesn’t assess the triple burdens at all and a few forms of double burden of malnutrition. Therefore, this study aimed to determine the prevalence and associated factors of double and triple burdens of malnutrition among child-mother pairs in Ethiopia.MethodsA total sample of 7,624 child-mother pairs from Ethiopian Demographic and Health Survey (EDHS) 2016 were included in the study. All analysis were performed considering complex sampling design. Anthropometric measures and hemoglobin levels of children, as well as anthropometric measurements of their mothers, were used to calculate double burden of malnutrition (DBM) and triple burden of malnutrition (TBM). Spatial analysis was applied to detect geographic variation of prevalence of double and triple burdens of malnutrition among EDHS 2016 clusters. Bivariable and multivariable binary survey logistic regression models were used to assess the factors associated with DBM and TBM.ResultsThe overall weighted prevalence of DBM and TBM respectively were 1.8% (95%CI: 1.38–2.24) and 1.2% (95%CI: 0.83–1.57) among child-mother pairs in Ethiopia. Significant clusters of high prevalence of DBM and TBM were identified. In the adjusted multivariable binary survey logistic regression models, middle household economic status [AOR = 0.23, 95%CI: 0.06, 0.89] as compared to the poor, average birth weight [AOR = 0.26, 95%CI: 0.09, 0.80] as compared to large birth weight and children aged 24–35 months [AOR = 0.19, 95%CI: 0.04,0.95] as compared to 6–12 months were less likely to experience DBM. Average birth weight [AOR = 0.20, 95%CI: 0.05, 0.91] as compared to large birth weight and time to water source <=30 min [AOR = 0.41, 95%CI: 0.19,0.89] as compared to on premise were less likely to experience TBM.ConclusionThere is low prevalence of DBM and TBM among child-mother pairs in Ethiopia. Interventions tailored on geographic areas, wealth index, birth weight and child birth could help to control the emerging DBM and TBM at household level among child-mother pairs in Ethiopia.

Infant and Young Child Feeding Practice in Ethiopia and the Cost of Not Breastfeeding: Review

The cornerstone of baby and young child survival, healthy growth and development, healthy future generations, and national development is infancy and young child feeding (IYCF). Inappropriate feeding practices in infants and early children, as well as their repercussions, are substantial roadblocks to longterm socioeconomic development and poverty reduction, with acute and chronic health effects for individuals. Breastfeeding exclusively for the first six months of a baby’s life is the safest and healthiest method for feeding. Articles were searched and accessed using key terms, like “Infant feeding practice”, “Exclusive feeding”, “Non-exclusive feeding”, “Formula feeding Practice”, “Cost of not breast feeding”, “Economic benefit of breast feeding”. 38 published articles, 7 global standards and guidelines, 4 EDHS result reports and one website were included in this review. From 2000 to 2016, the percentage of mothers who started nursing within one hour climbed from 51% to 73 percent, while the number of mothers who exclusively breastfed increased from 2000 to 2016. Child malnutrition is caused by a lack of effective breast feeding and complementary feeding, and many nations throughout the world are seeing a dramatic increase in the prevalence of malnutrition, resulting in the triple burden of malnutrition. In Ethiopia, inadequate breastfeeding causes 14,000 unnecessary child deaths, 5 million instances of diarrhea and pneumonia, $190 million in household costs, and $2 million in health-care costs. Artificial feeding can cost up to $1,200 per year for powdered formula, which is four times the expense of breastfeeding, which costs about $300 per year for additional food for a lactating mom. Parental literacy, delivery in the health Institutions, spontaneous vaginal delivery, higher number of ANC visits, PNC attendance, maternal counseling during pregnancy and child sex being female are some factors among positively associated with exclusive breast feeding, whereas, full-time employment of mothers, urban residency, high weight of baby, caesarean-delivery, low wealth index, younger maternal age and child sex being male are few to mention among negatively associated factors with exclusive breast feeding.

General limitations of the current approach in developing sustainable food system frameworks

Current studies on sustainability transitions of the food system (FS) are limited. The tools for assessing FS sustainability and enhancing FS performance are still lacking, highlighting the critical role of developing an assessment indicator framework for assisting sustainable FS transitions. This study seeks opportunities for optimizing existing FS frameworks that address the triple burden of malnutrition and FS sustainability. It examines FS frameworks and other food system-related frameworks such as those linked to food security, food sovereignty, and so on, unveiling the general limitations of current approaches and methodologies in FS frameworks and other related frameworks. To our knowledge, it is the first study to discuss the gaps of FS frameworks regarding their coverage on the food lifecycle and their representation of FS's multidimensionality. The results indicate that most FS frameworks and related frameworks are conceptual. The most frequent limitations are no targeting audience, no coverage of the food disposal stage, and no institutional/political dimension/indicators. Some frameworks have no multi-stakeholder inputs, no coverage of food input and/or food storage stages, no economic or nutritional dimension/indicators, while only a few frameworks involve statistical/empirical methods or quantitative indicators. Other limitations regarding language, data, and time are also identified. Finally, this study suggests developing a comprehensive multi-dimensional urban food system framework considering the full life cycle of food and combining FS-related perspectives with the five dimensions of environmental, economic, institutional, socio-cultural, and nutritional sustainability to mitigate the lifecycle and sustainability dimension issues and gaps.

Insight on infant feeding among mothers of rural community: a cross sectional study

Background: India, a low-middle income and a developing country is combating with a triple burden of malnutrition with a very cost-effective measure, infant and young child feeding practices. But there are a lot of challenges in its implementation which need to be catered.Methods: A cross sectional study was aim to assess the knowledge and knowledge on practices of infant feeding among mothers of rural community. The mothers were included in the study were having children age between 0-1 year, who visits to primary health centers for availing health need services. Total 400 mothers were selected for the study by using purposive sampling method based on inclusive criteria.Results: The results shows that though it was encouraging to note that mothers were largely in favour of breast feeding, but majority 96.50% of mothers knowledge on infant feeding was inadequate, only 3.50% of mothers were found moderate level of knowledge on infant feeding, none of the mothers were found adequate level of knowledge on infant feeding.Conclusions: Regarding knowledge of infant feeding practices majority (94.25%) were identified in-adequate in their knowledge on practices of infant feeding, only (5.75%) having moderate level of knowledge on practices of infant feeding and none of the mothers found adequate knowledge of practices on infant feeding.

District-Level Analysis of Inequality in Malnutrition Among Children: Evidence from Maharashtra, India

Background and Objective: India currently faces the triple burden of malnutrition characterized by the coexistence of undernutrition and overnutrition along with micronutrient deficiencies. The unequal distribution of child health outcomes in the population may affect the goal of a ‘malnutrition free world’. The nutritional status and its inequalities among post under-five age have rarely been assessed in the country. This study examines the degree and extent of asset-based household wealth inequalities in malnutrition among preschool and school children in the Maharashtra state of India. Methods: The study utilizes the fourth round of the District Level Health Survey 2012-2013 to provide district-level estimates of the inequalities in five malnutrition indicators-stunting, wasting, underweight, overweight, and anemia among children. Concentration curves, normalized concentration index, geographical maps and correlation matrix are used to analyze the data by districts, rural-urban residence and gender. Results: Considerable proportion of children are malnourished in Maharashtra, even with its advanced economic status. Malnutrition levels among school going children are as high as those of children under six years of age. The findings indicate that malnutrition inequalities manifest primarily among the weaker sections of society. However, children from affluent households are more likely to suffer from overweight and obesity issues. The prevalence of malnutrition is higher in rural areas, but inequality is significantly higher in urban regions. The nutritionally backward areas are concentrated in the tribal districts of the Marathwada division and a few others from Vidarbha and Amravati. Many districts of Maharashtra have multiple burdens of malnutrition and have high inequalities on more than one indicator. A negative correlation is observed between the prevalence of malnutrition and human development indicators. Conclusion: There is a need to capture broader age groups in the nutrition monitoring frameworks. Recognizing the regional heterogeneity in the malnutrition prevalence and distribution calls for unique health intervention strategies to specific district targets.

Improving TB Surveillance and Patients' Quality of Care Through Improved Data Collection in Angola: Development of an Electronic Medical Record System in Two Health Facilities of Luanda.

TB Programs should promote the use of digital health platforms, like Electronic Medical Records (EMR) to collect patients' information, thus reducing data incompleteness and low accuracy and eventually improving patients' care. Nevertheless, the potential of digital health systems remains largely unexploited in low-resource settings. Angola is one of the 14 countries with a triple burden of TB, TB/HIV and MDR-TB (multidrug-resistant TB) and it is among the three countries, together with Congo and Liberia that have never completed a drug-resistance survey so far. The Sanatorium Hospital of Luanda and the Tuberculosis Dispensary of Luanda are the two reference health facilities in Luanda dealing with most of the TB cases, and they both rely entirely on paper-based data collection. The aim of this paper is to describe a three-stage process for the development of a TB EMR system in these two health facilities of Luanda and to share the lessons learned. The description is focused on the activities that took place from March 2019 to January 2020. Main lessons learned were identified in the importance of engaging all the stakeholders in the development process, in the mainstream of the “think digital” transition, in the promotion of a monitoring and evaluation (M&E) culture and in the planning of the system's sustainability. This approach may be replicated in similar contexts where the development of a TB EMR system is sought, and the lessons learned could assist and facilitate the programming of the interventions.

Realizing the Potential of Neglected and Underutilized Bananas in Improving Diets for Nutrition and Health Outcomes in the Pacific Islands

Pacific Island countries are undergoing rapid food system transformation. This has led to a deterioration in diet quality with decreased consumption of traditional, fresh foods, and increasing consumption of imported, ultra-processed foods. Consequently, the triple burden of malnutrition is a now a major issue in the region. It is estimated that Vitamin A deficiency (VAD) is widespread, particularly in Kiribati, Vanuatu, and Solomon Islands. Rates of overweight, obesity, and diet-related non-communicable disease (DR-NCD) are high. Increasing consumption of local, traditional fruits and vegetables, particularly those that have high nutritional value like Pacific Island bananas, could play an important role in improving diets and health outcomes of Pacific Islander populations. Many of the banana cultivars found in the Pacific Islands region are high in carotenoids, an important precursor to Vitamin A. Fe'i bananas, such as Utin Iap, have been shown to contain much higher amounts of carotenoids than that of the commonly consumed Cavendish banana. As a traditional, starchy staple food, bananas are a good source of carbohydrate, including resistant starch, with small amounts of protein and little fat. These characteristics also lend themselves to being part of a healthy diet. The promotion of neglected and underutilized banana cultivars in the Pacific region provides a food-based and low-cost solution that simultaneously supports healthy diets and good nutrition, local farming systems and livelihood opportunities. However, to realize this potential, more work is required to understand the availability of nutrient rich banana in the region, current consumption patterns and drivers of consumption.

Socioeconomic shocks, inequality and food systems in the Global South: an introduction

ABSTRACT Food and nutrition security is increasingly understood as the most vital component of human ecosystems for transforming raw materials into foods, nutrients, and health outcomes. In addition to the distortions in the global food and nutrition systems as reflected in the triple burden of undernutrition, micronutrient deficiency, and overnutrition, the COVID-19 pandemic has generated devastating socioeconomic crises in the Global South. Food supply chain fragilities have become more prominent due to inherent capacity shortages to mitigate the effects of the pandemic on food supply. From the global community’s perspective, scientific research innovations, disruptive technologies, and public health preparedness are some of the strategic pillars and critical drivers of post-pandemic socioeconomic recovery and resilience. As the COVID-19 pandemic signals a scientific paradigm shift towards accelerating food systems and public health innovation, a key takeaway for governments in the Global South, along with enterprises and communities, is scaling the implementation of selected social protection policy interventions towards rapidly absorbing future socioeconomic shocks while consolidating alternative pathways for a region-wide sustainable food system.

The status and future of emergency care in the Republic of Kenya.

Kenya is a rapidly developing country with a growing economy and evolving health care system. In the decade since the last publication on the state of emergency care in Kenya, significant developments have occurred in the country's approach to emergency care. Importantly, the country decentralized most health care functions to county governments in 2013. Despite the triple burden of traumatic, communicable, and non-communicable diseases, the structure of the health care system in the Republic of Kenya is evolving to adapt to the important role for the care of emergent medical conditions. This report provides a ten-year interval update on the current state of the development of emergency medical care and training in Kenya, and looks ahead towards areas for growth and development. Of particular focus is the role emergency care plays in Universal Health Coverage, and adapting to challenges from the devolution of health care.

The Influence of Social and Economic Factors of Entrepreneurs on SMEs in West Java

The population of entrepreneurs in Indonesia has increased from 1.6% to 3.47%. The number of women who work in the field of entrepreneurship is now 2.4 times more than men although the businesses for women tend to be smaller and grow more slowly than those for men. There are some constraints causing women to be reluctant to practice entrepreneurship, such as limited information, lack of profiles to imitate, limited access to business finance, lack of experience in doing business, and a low level of confidence to start and develop a business. Low level of education and ideological barriers of women related to the household, known as the "triple burden of women", are also among the constraints. The independent variables of this research were social condition variables (X1 ) and economic conditions (X2 ) while the dependent one was the number of Small and Medium Entrepreneurs (SMEs) (Y). The research population was the social and economic conditions and the number of SMEs from 27 districts of West Java. The samples were limited to only the data from 2016 – 2020 (5 years). The data analysis technique used for this research was panel data regression analysis. The results show that social and economic conditions have a positive and significant impact on the number of SMEs in 27 districts in West Java with an R 2 2 score of 99%. Keywords: SMEs, Social Factor, Economic, Panel Data, West Java

Cross-Sectional Association of Food Source with Food Insecurity, Dietary Diversity and Body Mass Index in Western Kenya.

The triple burden of malnutrition in many low- and middle-income countries (LMICs) is partly a result of changing food environments and a shift from traditional diets to high-calorie Western-style diets. Exploring the relationship between food sources and food- and nutrition-related outcomes is important to understanding how changes in food environments may affect nutrition in LMICs. This study examined associations of household food source with household food insecurity, individual dietary diversity and individual body mass index in Western Kenya. Interview-administered questionnaire and anthropometric data from 493 adults living in 376 randomly-selected households were collected in 2019. Adjusted regression analyses were used to assess the association of food source with measures of food insecurity, dietary diversity and body mass index. Notably, participants that reported rearing domesticated animals for consumption (‘own livestock’) had lower odds of moderate or severe household food insecurity (odds ratio (OR) = 0.29 (95% CI: 0.09, 0.96)) and those that reported buying food from supermarkets had lower odds of moderate or severe household food insecurity (borderline significant, OR = 0.37 (95% CI: 0.14, 1.00)), increased dietary diversity scores (Poisson coefficient = 0.17 (95% CI: 0.10, 0.24)) and higher odds of achieving minimum dietary diversity (OR = 2.84 (95% CI: 1.79, 4.49)). Our findings provide insight into the relationship between food environments, dietary patterns and nutrition in Kenya, and suggest that interventions that influence household food source may impact the malnutrition burden in this context.