Qualitative research approaches for studying local food environment and drivers of food purchase in South Asia

The High Level Panel of Experts on Food Security and Nutrition (2017)’s definition of the food environment has been expanded to include the significant issue of sustainability and the different types of food environment relevant to low- to middle-income countries (Downs et al., 2020), while Turner et al. (2018) builds on food environment research into the socio- ecological theory that posits that inter- related personal and environmental factors determine health-related behaviors

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Protocol for evidence synthesis of market intelligence : application to rice in the global South

Demand-oriented crop breeding relies on market intelligence to support market segmentation, target product profile (TPP) design, alignment of breeding pipelines, and prioritization and allocation of investments. Synthesis of existing evidence such as stakeholder preferences (e.g., consumers, farmers) is needed to inform discussions on the expectations and requirements of actors along rice value chains and the implications for current and future rice markets segments and product design. We designed a protocol carrying out a systematic literature review (SLR) as a tool for evidence synthesis. We used this protocol to review and synthesize current stakeholder requirements for rice seed products in the global South. The protocol can be used by researchers to synthesize market intelligence for specific market segments and/or other crops. At the global level, our findings suggest that the traits preferred by stakeholders are generally considered in the current portfolio of rice market segments and TPPs. This analysis can be scaled down to the market-segment level to verify whether the traits proposed in the TPPs are in line with stakeholder requirements in each market segment. Broadly, maturity, texture, and grain color are considered important in the reviewed farmer and consumer studies, and these are among the basic criteria for market segmentation. Specifically, farmer requirements for agronomic traits focus on yield, maturity, plant height, lodging tolerance, and tillering ability. These are generally included as essential traits in the rice TPPs. Through the systematic approach, potential areas for future research have been identified. In terms of geographical regions, we found that peer-reviewed publications on farmer evaluation of seed products and consumer preferences for rice are underrepresented in South Asia and in Africa. In terms of value chain stakeholders, we found limited evaluation by midstream stakeholders (i.e., processors). In terms of attributes, evidence on evaluation of chalkiness was missing in the reviewed studies. Limited evaluation of nutrition-related attributes was also found, which suggests that more research to identify future market segments for nutrition attributes

Rice Quality Defined by Urban Consumers and Value Chain Actors in South and Southeast Asia

Quality is a powerful engine in food value chain (VC) upgrading in developing countries. However, the concept is abstract. In the rice sector, for instance, there is currently no uniformly applicable definition of “rice quality” and there is even less unanimity on how it should be measured. Understanding how the market and industry perceives and differentiates rice quality could contribute to more efficient, demand-driven, and sustainable rice VCs. To assess how rice quality is perceived and defined by consumers and the industry, we review evidences from multi-country urban consumer surveys and key informant interviews with industry stakeholders conducted in selected countries in Southeast Asia (SEA) and South Asia (SA) in 2013–2014. We conclude that the specificity and heterogeneity of consumer perception of rice quality can guide rice breeders in incorporating grain quality improvements in varietal development programs relevant to target markets. And that rice quality is further reinforced through labeling, branding, and packaging. These results provide valuable insights that can be used by the rice industry stakeholders and policymakers in formulating value chain upgrading initiatives in Asia

Rice Quality Defined by Urban Consumers and Value Chain Actors in South and Southeast Asia

Quality is a powerful engine in food value chain (VC) upgrading in developing countries. However, the concept is abstract. In the rice sector, for instance, there is currently no uniformly applicable definition of “rice quality” and there is even less unanimity on how it should be measured. Understanding how the market and industry perceives and differentiates rice quality could contribute to more efficient, demand-driven, and sustainable rice VCs. To assess how rice quality is perceived and defined by consumers and the industry, we review evidences from multi-country urban consumer surveys and key informant interviews with industry stakeholders conducted in selected countries in Southeast Asia (SEA) and South Asia (SA) in 2013–2014. We conclude that the specificity and heterogeneity of consumer perception of rice quality can guide rice breeders in incorporating grain quality improvements in varietal development programs relevant to target markets. And that rice quality is further reinforced through labeling, branding, and packaging. These results provide valuable insights that can be used by the rice industry stakeholders and policymakers in formulating value chain upgrading initiatives in Asia

Survey data on heterogeneity in consumers’ food choice in eastern India

A consumer survey was conducted in eastern India in 2017 to understand the heterogeneity of consumers’ food choice. Face-to-face interviews were conducted among urban and rural consumers from low- and middle-income households in Odisha and West Bengal, eastern India, using a structured questionnaire. A multi-stage sampling procedure was implemented with stratified random sampling as the first stage and systematic sampling as the second stage. The survey data comprise responses from 501 respondents who have active involvement in grocery purchase decision-making and/or in meal planning or cooking for the household. The survey generated a dataset that was used to unravel five sources of heterogeneity (5Ws) in gastronomic systems that affect consumers' diets: (i) socioeconomic characteristics of the target population (who); (ii) food environments (where); (iii) eating occasions (when); (iv) consumed dishes (what); and (v) ingredient attributes and consumer attitudes towards food (why). The approach and analyses are elaborated in the article “Unraveling heterogeneity of consumers’ food choice: Implications for nutrition interventions in eastern India”. Data from the survey can be further used to design behavioral experiments and interactive food choice tablet applications to elicit behavioral intentions in food choice

Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity

Background The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries.Methods The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria.Results A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)).Conclusion Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable