An Adaptation of the Food Insecurity Experience Scale (FIES) for Measuring Food Insecurity Among Women in Socially- Backward Communities

Recent reviews on the use of experience-based food insecurity scales in the Indian context suggested the addition of "how often" related items to food insecurity modules to avoid overestimation of food insecurity, especially in underprivileged communities. Following this recommendation, we adapted the 8-item Food Insecurity Experience Scale (FIES), an official tool for measuring access to food within the Sustainable Development Goals (target 2.1), and assessed its validity and reliability in socially-backward communities in the Indian context. The polytomous Rasch model was successfully applied and soundly integrated within the probabilistic methodology already in use for the FIES, allowing the computation of comparable prevalence of food insecurity at different levels of severity and related measures of uncertainty. Data from the SWABHIMAAN programme survey, which collected information on food insecurity from mothers of children under two years of age in three Indian states (Bihar, Odisha, and Chhattisgarh), was used for analysis. Results suggest that the proposed adapted version of the FIES can be considered as a proper tool for measuring food insecurity in underprivileged communities, since it satisfies requirements of internal and external validity and reliability. Individual determinants and protective factors of food insecurity were also investigated within this methodological framework and results suggest that education, economic wealth, and homestead kitchen garden can act as a buffer against food insecurity, while the number of pregnancies seems to exacerbate a situation of food insecurity

Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE):an international observational study

Background: Stroke disproportionately affects people in low-income and middle-income countries. Although improvements in stroke care and outcomes have been reported in high-income countries, little is known about practice and outcomes in low and middle-income countries. We aimed to compare patterns of care available and their association with patient outcomes across countries at different economic levels. Methods: We studied the patterns and effect of practice variations (ie, treatments used and access to services) among participants in the INTERSTROKE study, an international observational study that enrolled 13 447 stroke patients from 142 clinical sites in 32 countries between Jan 11, 2007, and Aug 8, 2015. We supplemented patient data with a questionnaire about health-care and stroke service facilities at all participating hospitals. Using univariate and multivariate regression analyses to account for patient casemix and service clustering, we estimated the association between services available, treatments given, and patient outcomes (death or dependency) at 1 month. Findings: We obtained full information for 12 342 (92%) of 13 447 INTERSTROKE patients, from 108 hospitals in 28 countries; 2576 from 38 hospitals in ten high-income countries and 9766 from 70 hospitals in 18 low and middle-income countries. Patients in low-income and middle-income countries more often had severe strokes, intracerebral haemorrhage, poorer access to services, and used fewer investigations and treatments (p<0·0001) than those in high-income countries, although only differences in patient characteristics explained the poorer clinical outcomes in low and middle-income countries. However across all countries, irrespective of economic level, access to a stroke unit was associated with improved use of investigations and treatments, access to other rehabilitation services, and improved survival without severe dependency (odds ratio [OR] 1·29; 95% CI 1·14–1·44; all p<0·0001), which was independent of patient casemix characteristics and other measures of care. Use of acute antiplatelet treatment was associated with improved survival (1·39; 1·12–1·72) irrespective of other patient and service characteristics. Interpretation: Evidence-based treatments, diagnostics, and stroke units were less commonly available or used in low and middle-income countries. Access to stroke units and appropriate use of antiplatelet treatment were associated with improved recovery. Improved care and facilities in low-income and middle-income countries are essential to improve outcomes