Yara H. Shahin*, Maha A. Shaaban, Mahmoud M. Sokkar

Ainshams University: Abbasia, Cairo, Egypt.

1. Abstract

Access to quality, safe, and nutritious food by achieving food security is fundamental to human existence and for establishing global health care and sustainability. Although awareness of the cruciality of food security has expanded greatly, it is important to impose attention to identify areas with deceased nutritional access in the context of their local financial circumstances and pollution. The purpose of this paper is to assess the food security situation among a sample of households in Egyptian rural villages and to determine the effect of coping strategies and supply card use by the inhabitants on the dietary diversity of the studied households. A cross-sectional study, using cluster sampling, was conducted in two rural villages in El Fayoum and Beni-sueif. An interview questionnaire was used to collect data about the socio-demographic background of the participants, their nutritional status, and the strategies they followed to cope with food shortage. Analyzing data using SPSS 16, we reported that most participants used one or more coping strategies to keep food resources, which were not sufficient for most supply card holders. Moreover, there was a significant correlation between not owning a supply card, using coping strategies, and having a low Household dietary diversity score (HDDS), as inhabitants who had supply cards were more likely to use coping strategies and the participants who followed one or more coping strategy were more likely to have low and moderate HDDS in Beni-sueif and El-Fayoum governorates. We conclude that a notable percentage of rural villages’ residents suffer from food insecurity, represented by having low dietary diversity scores and caused by financial hardship reflected in using economic coping strategies such as borrowing money or decreasing meals. 

*Correspondences

[email protected]

2. Introduction

Developed concepts of food security in the recent decades represent changes in official policy thinking ⁽¹⁾. Lately, the moral and human rights measurement of food security has come into focus. According to the World Food Summit, “Food security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food that meet their dietary needs and food preferences for an active and healthy life ⁽²⁾.” On the opposite side, food insecurity indicates nutritional deficiency because of the insufficient availability of food resources and/or decreased food quality. In its early stages, household resistance to food insecurity is characterized by several behavioral reflections adopted to cope with the limitation or absence of food resources ⁽³⁾; these coping strategies can be separated into food and non-food-based methods. Although coping strategies vary in order, technique, and effectiveness according to cultural and geographical differences ⁽⁴⁾, almost all coping strategies are applied because of financial hardship and/or natural disasters. 

Globally, food insecurity is a major health challenge that should be looked at in different areas frequently. Ensuring the food security of households is crucial for accurate sustainability measurements. Several works of literature have identified food insecurity, its factors and implications in different parts of the world. However, many fail to address the specifics of the limitations in a rural community in a developing African country like Egypt that is rich in various food sources. The purpose of this paper is to examine food security by assessing the household dietary diversity score and its correlation with several factors including applying coping strategies and obtaining a supply card at villages in Beni-sueif and El-Fayoum governorates.

Household Dietary Diversity Score (HDDS) is taken as the main indicator reflecting food security because obtaining detailed data on individual nutritional intake can be time-consuming and expensive ⁽⁵⁾. Dietary diversity is a qualitative risk factor of food consumption that reflects household access to a diverse range of food and is also a scale for nutrient adequacy of the diet of individuals ⁽⁵⁾. As poverty is widespread through the affected cities, a supply card is treated as a financial factor by the inhabitants. A supply card is a form of government financial assistance that aids its holders of Egyptians under a certain income threshold with a particular amount of food supplies of their choice. Other factors to assess HDDS include the education level of the head of the family, which is assumed by convention as the father, or if absent, other legal guardians. We claim in this paper that El-Fayoum and Beni-sueif residents’ financial hardship, represented by having a supply card, lowers their HDDS and forces them to apply one or more coping strategies.

3. Materials and methods

Our study population are the residents of two different villages: El-Khamaseen and El-Kom El-Ahmar in El-Fayoum and Beni-sueif governorates, respectively, in Egypt. The study design is a cross-sectional study, which is an observational study design on a clinic-based sample that is representative of a population. Our sample was chosen objectively, using random sample cluster types in which an assembly of people, like a household, was chosen randomly to be participants in the research. One member from the household was asked for the whole house. 369 persons were asked from El-Fayoum while 328 were from Beni-sueif.

Data was collected through a structured interview facilitated by using the “Guidelines for measuring household and individual dietary diversity” FAO questionnaire ⁽⁵⁾ because it is standardized and accurate and yet simple to use, inexpensive, and applicable in Egypt’s conditions. The questionnaire is divided into 3 sections:

1. The first section includes socio-demography data such as name, age, gender, education, number of family members, marital status, head of the family education and having a supply card. Education is measured by either completion of Egyptian school stages or absence of school education entirely. The graduated ascending order of education levels used in the questionnaire is: illiterate, read and write, primary school, middle school, high school, university, and post-university studies. Head of the family, as previously defined, is the legal guardian with the highest legitimacy. 
2. The coping strategies section, consisting of 6 questions about techniques used for stabilizing the household food resources used in the previous 30 days: whether or not you borrowed money to get food, sold things to get food, got help from charities, asked for more help to get food, decreased your meals and/or did extra work to get food.
3. Household Dietary Diversity Score section which consists of questions about the intake in the previous 24 hours of 12 specific food groups: seeds and bread, roots, vegetable elements, fruit elements, beans, meat elements, eggs, fish, milk, desserts, oil & butter, and species. According to their answer, a score called Household Dietary Diversity Score (HDDS) is calculated. The food diversity of their household is then classified into three levels: lowest dietary diversity (≤3 food group), medium dietary diversity (4 and 5 food groups) and highest dietary diversity (≥6 food groups). 

In concern for the data analysis, SPSS (version 16) was used for conducting the analysis. The analysis primarily involved descriptive statistics using appropriate cut-off values for particular variables, such as excluding responses in which the member filling the questionnaire (i.e. the wife) is below 20 years. Multinomial logistic regression, which is a predictive analysis applied when the dependent variable is of more than two levels (more than 2 responses are available), was used to establish an adjusted relationship between HDDS levels and head of family education, number of family members, and age of marriage. Binary logistic regression was used as a relationship estimator between the explanatory variable, which are the coping strategies, followed by an output binary variable, which is having a supply card or not. In both types of regression, a 95% confidence interval, which is a range of probability values that one can be 95% certain contains the true mean of the population, was noticed. Relationships between variables were considered as significant predictors if the p-value was less than 0.05; low p-value means a higher probability of the hypothesis to be true. We also compare the two villages in the type of food group that is most consumed. In regard of the ethical considerations, verbal consent was taken instead of a written one due to the cultural stigma towards signing paper documents, especially in rural areas ⁽⁶⁾. At the beginning of each interview, the data collection officers informed the respondent about the purpose of our study and the measures taken to honor their privacy, such as not specifying their names concerning any recorded data and not using their answer for anything other than research purposes. They were informed about their right to not complete the questionnaire or cancel their contribution at any time.

4. Results

4.1 Representation of sample data within the governorates of Egypt

As shown in table 1, the number of females was higher than the number of males, about 62.7% in Fayoum and 69.8% in Beni-sueif were females. Approximately 80% and 86% in Fayoum and Beni-sueif respectively had access to a supply card from the government. Also, nearly 81% of subjects in both governorates were married and 61% were married to a member in the same family, this indicates that most of the married people in rural Egyptian governorates are married to their relatives. On average, the services and themes of life between the two governorates were similar. These similarities include the level of education, marital status, and employment status (Table 1).

4.2 Prevalence of coping strategies and food diversity among the sample

Figure 2 shows that about half of the sample surrendered to use more than one way of coping strategies and only 30% had enough resources to fully depend on themselves to get food. Sold possessions, meal decrease, and dangerous jobs were some of the ways that people used to lower the effect of food absence. Figure 3 shows that the most followed strategy to cope with food deficiency was borrowing money, 48.8% in Fayoum and 43.6% in Beni-sueif. The second was decreasing meals with about 48.5% in Fayoum and 42.4% in Beni-sueif. On the other side, only 25.2% in Fayoum and 20.7% in Beni-sueif were working dangerous and

	Fayoum		Beni-sueif
	%	(n= 369)	%	(n= 328)
Gender Male Female	37.3 62.7	137 230	30.2 69.8	99 299
Marital Status Married Consanguinity Single divorced widowed	81.1 63.9 10.0 1.1 7.8	291 198 36 4 28	81.4 61.7 6.5 2.8 9.3	263 180 21 9 30
Easy to reach nearest health facility	49.0	165	34.8	102
Employed	44.5	134	45.1	146
Level of education No formal education Joined education	33.5 66.5	121 240	36.4 63.6	118 206
Head of family education No formal education Joined education	61.7 38.3	171 106	80.3 19.7	223 57
Having a supply card The food was sufficient.	80.2 67	296 22.6	86.3 46	283 16.3

extra jobs to make up the shortage of food supplies. Between the two governorates, the circumstances were nearly the same, apart from very few differences. One of which was the rise in percentage (20.7%) in asking charities for help in Beni-sueif than in Fayoum. Also, on average, people that used coping strategies in Beni-sueif were less than in Fayoum. The last two phenomena may be connected. Because of the great help Beni-sueif charities provide, the number of people using the other coping strategies was lower than in Fayoum, where only a small portion found assistance from charities.

Generally, the two governorates differ in the number of people but not the order of the most used coping strategies.

As shown in table 2, the significance in the p-value in the binary logistic regression test shows the association between people who had a supply card and how many coping strategies followed. The significance in the p-value shows that there is an explanatory relationship between the two parameters: using coping strategies can explain why users have a supply card (because a supply card is meant for low-income families, so they are likely to use coping strategies as well.)

The Spearman\’s correlation for the coping strategy and socioeconomic variables of the households was calculated to explain the strength and direction of their association. This correlation was specifically used because the Spearman correlation coefficient is based on the ranked values for each variable rather than the raw data. The data in the table (3) shows that in El-Fayoum, the head of family education has a negative and significant correlation with selling things to get food and decreasing their meals, while the number of family members has a positive and significant correlation with asking for help to get food. In Beni-sueif governorate, the head of family education didn\’t correlate with any of the coping strategies while the number of family members had a positive and significant correlation with asking for help to get food, so these coping strategies are somehow correlated with socioeconomic characteristics of the sample households.

Beni-sueif		El Fayoum		Coping strategies
No. of members	Head of family education	No. of members	Head of family education
-0.042	-0.009	0.084	0.047	Borrow money to get food
0.089	-0.106	0.090	-0.133	Sell things to get food
-0.009	-0.052	-0.086	-0.105	Get help from charities
0.161	-0.078	0.118	-0.058	Ask for help to get food
0.015	-0.041	0.087	-0.118	Decreased your meals
0.057	0.051	-0.008	0.045	Do extra work to get food

3.3 food groups and household dietary diversity score

Household dietary diversity score includes many food groups. As shown in figure (4), about 54.9% of the sample had high food diversity scores, so they ate many different food types, and only 16.6% ate limited types of food and thus had low HDDS. As shown in figure 5, the most popular food group is spices (87.8%) in Fayoum and (83.2%) in Beni-sueif. As table 4 shows, the food groups that were consumed most for low HDDS score level were seeds, spices, oil, and butter for both Fayoum and Beni-sueif, with an addition of milk, beans, and vegetables for high HDDS. On the other side, there were differences between the extra consumed food groups by medium food diversity scores between the governorates. In Fayoum, the medium HDDS level population had beans and vegetables while they preferred beans and milk in Beni-sueif. It can also be reasonably inferred from the highlighted areas in table (4) that beans, milk, and vegetables are the food types common among medium and high rather than low HDDS.

Table (4): food groups consumed by households in Fayoum

High diversity (≥6 food groups)	Medium diversity (4 and 5 food groups)	Lowest diversity (≤3 food groups)
Spices	Spices	Spices
Seeds	Seeds	Seeds
Oil and Butter	Oil and Butter	Oil and Butter
Vegetables	Vegetables
Beans	Beans
Milk

Food groups consumed by households in Beni -sueif

High diversity (≥6 food groups)	Medium diversity (4 & 5 food groups)	Lowest diversity (≤3 food groups)
Seeds	Seeds	Seeds
Oil and Butter	Oil and Butter	Oil and Butter
Spices	Spices	Spices
Milk	Milk
Beans	Beans
Vegetables

Many characteristics factors were to affect the nutritional diet of a rural household. As shown in table (5), a multinomial logistic Regression of HDDS levels and the number of family members, head of family education and age of marriage as indicators. In Fayoum, there was a strong association between household food diversity score and head of family education, the age of marriage and number of family members. When assessing head of family education as a predictor for HDDS and taking postgraduate as a reference, we find that when the head of family education decreases, it\’s more expected that he has low or medium HDDS. A significance in the p-value occurred (p value= 0.034 for low HDDS and p-value for medium HDDS = 0.002). In Beni-sueif, a similar significance pattern between HDDS and level of education of the head of the family (postgraduate as reference) occurs. Another indicator about HDDS is the age of marriage to low HDDS in Fayoum, the odds ratio was 0.91 and confidence intervals between (0.85-0.97) (1 isn\’t included, thus significant). There is also a significance between the age of marriage and medium HDDS, meaning that people who married younger are more likely to have low and medium HDDS.

Since coping strategies indicate economic status and food availability, there was a significant association between the number of coping strategies followed and HDDS level. As shown in table 3, the binary logistic regression of coping strategies and medium HDDS level indicates (taking high HDDS as reference) that the p-value is less than 0.05 and 1 is not included in the confidence interval. Thus, it means that individuals who use multiple coping strategies are more likely to have a medium HDDS level rather than high HDDS.

5. Discussion

5.1 Basic Representation of samples characteristics

Within the sample data taken from Fayoum and Beni-sueif, there was a variance in the gender, marital status, and other traits that are important to consider in respect to the basic qualities of life. Unexpectedly, the number of females was dramatically higher than the number of males. The increase may have occurred because of two main reasons:

1. Females are more appropriate members to ask about food distribution and quality within a family.
2. The percentage of employed males was significantly larger than females, so women were likely to be asked as housewives.

The high percentage of consanguinity noted in the results indicates that couples were more likely to be family related. The obvious rise in the percentage of consanguinity might be caused by the old traditions that are still followed in some of Egypt governorates. Health facilities in El-Fayoum were probably more spread out than in Beni-sueif, so they were easier to reach in El Fayoum by the population.

5.2 Prevalence of coping strategies among the sample

Coping strategies followed by a governorate’s population is a strong indicator for the economic and social resources. Shariff and Khor found, in a Malaysian rural area, that using coping strategies seemed to slightly prevent the food insecure households from experiencing food insufficiency ⁽⁷⁾. About half of the sample surrendered to using more than one way of coping strategies and only 30% had enough resource to fully depend on themselves to obtain nutrition. In terms of frequency, coping strategies can be categorized into 3 distinct stages. Each stage represents the level of despair that the individual reached regarding the absence of nutritional supplies. The first stage’s strategies are skipping meals, decreasing their amounts, lowering food quality, and/or buying only necessities. The second category includes selling family members‏‏’ possessions and doing extra and/or dangerous jobs to get the money required for food. The final category shows that eventually, people surrender to borrowing money from family and friends, getting help from charities, and asking for more help to get food. As shown in figure 3, a possible chronological order for the followed coping strategies:

1. Decreasing meals quantity and/or quality and borrowing (48.5%).
2. Selling possessions and doing extra and/or dangerous jobs (20.7%).
3. Getting help from charities (7.2%).

Many studies have shown, to a far extent, a similar order of coping strategies in Egypt ^(8)(9)(10). Moreover, Shisanya and Hendriks found in Maphephetheni Uplands, South Africa, that the most used coping strategies by households were eating smaller meals than they needed (83% of the households) and eating fewer meals in a day (91% of the households) ⁽¹¹⁾. On the other side, there were slight differences between our findings and another study. It was in the economically vulnerable zone of Bangladesh which showed that nearly 80% of the households primarily preferred borrowing money to circumvent poverty and food insecurity, while half of the population also implemented food decreasing strategies ⁽⁶⁾.

Another interesting difference is that compared to Fayoum, the rise in percentage (20.7%) to ask charities for help in Beni-sueif indicates that the social services and financial aids are bigger and/or easier to give in Beni-sueif than in Fayoum. The previous result explains the decrease in all the other coping strategies in Beni-sueif than in Fayoum. Charities and other social facilities help people in Beni-sueif, so they wouldn\’t refuge to many coping strategies.

As shown in table 2, there was a cause-result relationship between the number of coping strategies followed and having a supply card, meaning that using coping strategies justifies owning supply cards. This is logical on one side because as coping strategies’ usage indicates poor financial situation, supply cards are also granted for low-income citizens only. On the other side, this result rejects the null hypothesis that states that governmental support makes people more independent. We can conclude that although most Beni-sueif and Fayoum residents receive government help, this aid has little to no contribution towards levitating the financial capacity of citizens in nutrition. Similarly, a study in Bangladesh found that as an assisted coping strategy, over two-thirds of the population opted for food relief provided through different safety net programs by the government, non-governmental organizations (NGOs), or other organizations ⁽⁶⁾.

Head of family education and the number of family members play a vital role in adopting coping strategies. Our study shows a relationship between coping and head of family education. Another study supports our idea regarding Household size. It has a negative correlation with selling assets. Head of family education has a positive and significant correlation with the coping mechanism of borrowing from friends ⁽¹²⁾.

5.3 Household dietary diversity score (HDDS)

The household dietary diversity score (HDDS) is meant to reflect, in a snapshot form, the economic ability of a household to access a variety of food elements. HDDS level in the Fayoum and Beni-sueif governorates is mainly high (54.9%). It means that meals in rural areas have many food varieties. Generally, seeds, oil, butter, and species are the most consumed elements. That is most likely due to their price and availability. It is easy for anyone from any economic level to have access to seeds and other elements that are considered necessary for life. The consumed food groups started to decrease in deserts and the animal protein section such as meat, eggs, and fish. People in rural areas consider spices, seeds, oil, and butter essential food elements, so these food groups are the most consumed by low, moderate and high HDDS levels in both El-Fayoum and Beni-sueif. People with a higher diversity level preferred vegetables, beans, and milk in addition. In contrast to our findings, there were other research papers that show other nutritional priorities for some other people. These priorities aren\’t connected to the ideal healthy diet as much as they are connected to the traditions of a specific area. A study constructed in central Mozambique showed that what people with low dietary diversity score preferred to eat were cereals, green leafy vegetables, and vitamin A rich fruit. Other food groups like seeds and fish showed neither in the low nor in the medium HDDS levels ⁽¹³⁾.

The most important factor regarding HDDS was coping strategies. The significance in the binary logistic regression, between low and moderate HDDS (high is the reference) and coping strategies, illustrates that an increase in the number of coping strategies predicts a decrease in the score of dietary diversity. In the Fayoum and Beni-sueif governorates, a person who uses many coping strategies is more likely to score medium and low respectively rather than high in the HDDS, which is furthermore evident because the frequency of different food groups in Beni-sueif was notably lower than it was in El-Fayoum. A possible explanation for these phenomena is that people who use few coping strategies are more likely to have good financial resources, thus have the capacity to buy different food groups.

Child marriage is considered one of the most fatal challenges in the world that should be tackled to erase its several negative consequences. One of which is the food insecurity that would affect the whole household due to the child’s incompetent strategic planning in terms of finances and nutrition. As shown in table 5, there was a significant association of age of marriage as a predictor to low and medium HDDS in Fayoum. This implies that decreasing the age of marriage is an indicative risk factor of having low and medium dietary diversity scores. People with a lower age of marriage are more likely to have diet disorders caused by low food diversity. A possible explanation is that when they were married at a young age, they would have the responsibility of having a family while they are not qualified enough to pursue a healthy diet.

Head of family education also is an important indicator of the diversity score. A significance occurred in the multinomial logistic regression analysis for the head of family education (reference: post-graduate) for low HDDS in Beni-sueif and for low and medium HDDS in Fayoum indicates that it is more expected for an individual to have a low or medium HDDS when they have a lower education level. This association might have occurred because an educated head of a family is more likely to be aware of the right nutritional diet.

6. Limitations

Even though the information drawn to form a conclusion is sufficient, a fraction of the data collected may not be reliable because of the stressful conditions the participants are in whilst attending the questionnaire, as some of them are being interviewed in the field hospital. A few misassumptions about the purpose of asking about coping strategies may have played a factor in signifying the impacts of participants’ financial hardship.

It is recommended that certain information would be taken from participants regarding the weight, height, and food groups consumed in the previous week of individuals to calculate BMI and to measure the individual dietary diversity score. Family income will also be helpful in indicating the level of dependency on coping strategies.

7. Conclusion

Food security is achieved for a given household by ensuring healthy nutrition and a stable financial situation that ensures a healthy, sustainable life. The first can be measured by HDDS and the latter by coping strategies.

HDDS in the Fayoum and Beni-sueif governorates is mainly high, however, food species consumed by all diversity level consumers are mainly raw, low-quality supplies such as spices, oil, seeds, and butter. Food elements’ intake is prioritized differently in other parts of the world merely according to culture and preferences. Risk factors that predict a low and medium diversity level include a low age of marriage and a low education level, which can be justified in the inability of these individuals to constitute a healthy lifestyle for various reasons.

Usage of more coping strategies indicates poor financial situation and has serious implications on the level of disparity an individual can opt to obtain necessary nutritional resources that can reach to the extent of pursuing dangerous jobs. At the first stages of food shortage, they tend to decrease food quality and quantity and sell possessions. Upholding coping strategies indeed has an effect on HDDS. Increasing the number of coping strategies followed is found to be connected to low HDDS because of the financial hardship high coping strategies users are characterized by and so their inability to obtain various elements or nourishment. There is also a relationship between having a supply card and using more coping techniques; although both are a measure undertaken in poor financial circumstances, it implies that federal nutritional aid isn’t granted effectively enough to erase the recession.

We conclude that a notable percentage of rural village residents in El-Fayoum and Beni-sueif governorates suffer from food insecurity, represented by having a low dietary diversity score and caused by financial hardship, reflected in using economic coping strategies, especially for the participants who already own a supply card. 

8. Acknowledgements

The authors would like to thank Bedaya Medical Caravan, its members and community department for their effort in the study. We are also ultimately grateful to the effort of the participants of the data collection team.

9. References

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4. Maxwell, Daniel, Richard Caldwell, and Mark Langworthy. \”Measuring food insecurity: Can an indicator based on localized coping behaviors be used to compare across contexts?\” Food Policy 33, no. 6 (2008): 533-540.
5. Kennedy, Gina, Terri Ballard, and M. C. Dop. Guidelines for Measuring Household and Individual Dietary Diversity. Rome: Food and Agriculture Organization of the United Nations, 2011.
6. Farzana FD, Rahman ASAS., Sultana S, Raihan MJ. Haque MA. MA, Waid JLJL., et al. Coping strategies related to food insecurity at the household level in Bangladesh. PLoS One [Internet]. 2017;12(4): e0171411. Available at: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85017565781&doi=10.1371%2Fjournal.pone.0171411&partnerID=40&md5=94fd21f2f230aae9cfbdbd73297d5e8d
7. Shariff, Zalilah Mohd., and Geok Lin Khor. “Household Food Insecurity and Coping Strategies in a Poor Rural Community in Malaysia.” Nutrition Research and Practice 2, no. 1 (2008): 26. https://doi.org/10.4162/nrp.2008.2.1.26.
8. Ngidi, M.S.C.; Hendriks, S.L. Coping with Food Insecurity in Rural South Africa: The Case of Jozini, KwaZulu-Natal. Mediterr. J. Soc. Sci. 2014, 5, 278.
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Beni-sueif				Fayoum
Coping or not
CI (95%)		OR	P value	CI (95%)		OR	P value
4.14	1.15	2.19	0.016	3.84	1.32	2.25	0.003	supply card (Ref: No)? Yes
4.78 2.02	1.15 0.73	2.35 1.21	0.018 0.452	2.84 3.38	0.75 1.04	1.46 1.88	0.261 0.035	HDDS levels (Ref: High) Low Medium

Beni-sueif				Fayoum				HDDS level (Ref: high)
CI (95%)		OR	P value	CI (95%)		OR	P value
8.05	1.09	2.96	0.033	4.82	1.06	2.26	0.034	Head of family Education (Ref: joined education)	Low dietary level
1.09	0.98	1.03	0.230	0.97	0.85	0.91	0.006	Age of marriage
1.01	0.79	0.90	0.087	1.15	0.90	1.02	0.748	No. of family members
2.39	0.67	1.27	0.467	5.08	1.42	2.68	0.002	Head of family Education (Ref: joined education)	Medium dietary level
1.05	0.96	1.00	0.850	0.95	0.84	0.89	0.001	Age of marriage
1.03	0.85	0.94	0.171	1.06	0.86	0.96	0.407	No. of family members

Beni-sueif				Fayoum
Having supply card (ref: No)
CI (95%)		OR	P value	CI (95%)		OR	P value
1.676 1.262	0.494 0.460	1.146 1.238	0.657 0.407	2.087 2.050	0.629 0.748	0.910 0.762	0.762 0.291	HDDS levels (Ref: High) Low Medium

 

 

About the author

Yara is an innovative STEM senior, finding solace in physics and technology. She is also a graphic designer and a software developer.
Trying to make a practical combination between technology and sustainability, she participated with her group in Technovation challenge reaching global semifinals.
She learned a lot from reading in mythology, living by Greek wisdom.