Household food insecurity and food expenditure in Bolivia, Burkina Faso, And the Philippines

Validation of the food access survey tool to assess household food insecurity in rural Bangladesh

Background

Perception-based Likert scale are commonly used to assess household food insecurity. The aim of this study was to evaluate the psychometric properties and external construct validity of the 9-item Food Access Survey Tool (FAST) in a population-based randomized controlled trial.

Methods

Participating women (n = 11,992) were asked to recall the frequencies of nine food insecurity experiences over the past 6 months on a 5-point Likert scale. The Rasch partial credit model was used to study the item category severity and differential item functioning (DIF) by literacy status, respondents’ age, land ownership and household sizes. Principal component analysis (PCA), non-parametric methods, and cumulative ordinal logistic regression models were applied to examine the Rasch model assumptions, namely unidimensionality, monotonicity and measurement invariance (non-DIF).

Results

All items demonstrated good model fit with acceptable values of fit statistics (infit). PCA as well as other indices (Cronbach’s alpha = 0.85, scalability coefficient = 0.48) indicated that all items fit in a single statistical dimension. The ordered responses of nine items displayed monotonic increasing item category severity as expected theoretically. All nine items were flagged with statistically significant DIF between key demographic—and socioeconomic subgroups (p < 0.001); however, none of the detected DIF was considered practically significant given small effect sizes (variance explained by group membership and interaction term < 1 %). The total summed score over the polytomous FAST was inversely associated with household wealth, dietary diversity score and maternal body mass index, demonstrating external construct validity.

Conclusion

The polytomous FAST is internally and externally valid tool to measure household food insecurity in rural Bangladesh. Validation of this type of studies are recommended for similar Likert food insecurity scales.

Household Food Insecurity is Associated with Respiratory Infections Among 6-11-Month Old Infants in Rural Ghana

BACKGROUND

To determine the relationship between household food insecurity (HHFI) and symptoms of respiratory infections among infants in rural Ghana.

METHODS

The study was cross-sectional. The outcome variables were symptoms of respiratory infections (cough and nasal discharge) in infants. HHFI was measured using a 15-item modified U.S. Department of Agriculture (USDA) household food security module. Households were classified as food insecure if they had an affirmative answer for at least 1 item. Associations were examined using multiple logistic regression analysis. Data were collected in 32 communities located in 3 rural subdistricts in the Upper Manya Krobo district of the Eastern region of Ghana. The sample included 367 infants aged 6-11 months who attended a community-based growth monitoring session.

RESULTS

Overall, 20.5% of households reported experiencing food insecurity in the last month. Compared with infants in food secure households, infants living in food insecure households were about twice as likely to experience cough (adjusted odds ratio: 2.25, 95% confidence intervals: 1.25, 4.04) and nasal discharge (adjusted odds ratio: 1.87, 95% confidence intervals: 1.05, 3.36).

CONCLUSION

Infants living in food insecure households are at an increased risk of respiratory tract morbidity. Interventions that address HHFI might be important to improve infant health in rural Ghana.

Household food insecurity, diet, and weight status in a disadvantaged district of Ho Chi Minh City, Vietnam: a cross-sectional study

Background

Food security exists when all people, at all times, have physical, economic and socially acceptable access to safe, sufficient, and adequately nutritious food in order to meet their dietary needs for an active and healthy life. For high income countries and those experiencing the nutrition transition, food security is not only about the quantity of available food but also the nutritional quality as related to over- and under-nutrition. Vietnam is currently undergoing this nutrition transition, and as a result the relationship between food insecurity, socio-demographic factors and weight status is complex. The primary objective of this study was to therefore measure the prevalence of household food insecurity in a disadvantaged urban district in Ho Chi Minh City (HCMC) in Vietnam using a more comprehensive tool. This study also aims to examine the relationships between food insecurity and socio-demographic factors, weight status, and food intakes.

Methods

A cross-sectional study was conducted using multi-stage sampling. Adults who were mainly responsible for cooking were interviewed in 250 households. Data was collected on socioeconomic and demographic factors using previously validated tools. Food security was assessed using the Latin American and Caribbean Household Food Security Scale (ELCSA) tool and households were categorized as food secure or mildly, moderately or severely food insecure. Questions regarding food intake were based on routinely used and validated questions in HCMC, weight status was self-reported.

Results

Cronbach’s alpha coefficient was 0.87, showing the ELCSA had a good internal reliability. Approximately 34.4% of households were food insecure. Food insecurity was inversely related to total household income (OR = 0.09, 95% CI = 0.04 - 0.22) and fruit intakes (OR = 2.2, 95% CI 1.31 - 4.22). There was no association between weight and food security status.

Conclusions

Despite rapid industrialization and modernization, food insecurity remains an important public health issue in large urban areas of HCMC, suggesting that strategies to address food insecurity should be implemented in urban settings, and not just rural locations. Fruit consumption among food insecure households may be compromised because of financial difficulties, which may lead to poorer health outcomes particularly related to non-communicable disease prevention and management.

Validity and reliability of food security measures

This paper reviews some of the existing food security indicators, discussing the validity of the underlying concept and the expected reliability of measures under reasonably feasible conditions. The main objective of the paper is to raise awareness on existing trade-offs between different qualities of possible food security measurement tools that must be taken into account when such tools are proposed for practical application, especially for use within an international monitoring framework. The hope is to provide a timely, useful contribution to the process leading to the definition of a food security goal and the associated monitoring framework within the post-2015 Development Agenda.

Features of child food insecurity after the 2010 Haiti earthquake: results from longitudinal random survey of households

BACKGROUND

Recent commentary on the health consequences of natural disasters has suggested a dearth of research on understanding the antecedents prior to the disaster that are associated with health consequences after the disaster. Utilizing data from a two-wave panel survey of Port-au-Prince, Haiti, conducted just prior to and six weeks after the January 2010 earthquake, we test factors prior to the quake hypothesized to be associated with food insecurity after the quake.

METHODS

Using random Global Positioning System (GPS) sampling, we re-interviewed 93.1% (N = 1732) of the original 1,800 households interviewed in 2009. Respondents were queried with regard to mortalities, injuries, food security, housing, and other factors after the quake.

FINDINGS

Child food insecurity was found to be common on all three indices of food security (17.2%-22.6%). Additionally, only 36.5% of school-aged children were attending school prior to the quake. Findings suggest that prior schooling was associated with a substantial reduction on food insecurity indices (OR 0.62-0.75). Findings further suggest that several household characteristics were associated with food insecurity for children. Prior chronic/acute illnesses, poor living conditions, remittances from abroad, primary respondent mental health, and histories of criminal and other human rights violations committed against family members prior to the quake were associated with food insecurity after the earthquake. Earned household income after the quake was only associated with one of the measures of food insecurity.

INTERPRETATION

Food insecurity for children was common after the quake. Those households vulnerable on multiple dimensions prior to the quake were also vulnerable to food insecurity after the quake. Remittances from abroad were leading protective factors for food security. Because Haiti is well known for the potentiality of both hurricanes and earthquakes, reconstruction and redevelopment should focus on ameliorating potential vulnerabilities to poor outcomes in these natural disasters.

Household food insecurity: a systematic review of the measuring instruments used in epidemiological studies

OBJECTIVE

To conduct a systematic review aimed at identifying and characterizing the experience-based household food security scales and to synthesize their psychometric properties.

DESIGN

Search in the MEDLINE, LILACS and SciELO databases, using the descriptors ('food insecurity' OR 'food security') AND ('questionnaires' OR 'scales' OR 'validity' OR 'reliability'). There was no limitation on the period of publication. All articles had their titles and abstracts analysed by two reviewers. The studies of interest were read in their entirety and the relevant information extracted using a standard form.

RESULTS

The initial bibliographic search identified 299 articles. Of these, the 159 that seemed to meet the criteria for inclusion were read fully. After consultation of the bibliographic references of these articles, twenty articles and five documents were added, as they satisfied the previously determined criteria for inclusion. Twenty-four different instruments were identified; all were brief and of easy application. The majority were devised in the USA. Forty-seven references reported results of psychometric studies. The instruments that presented the highest number of psychometric studies were the Core Food Security Measurement/Household Food Security Survey Module (CFSM/HFSSM) and the Self-Perceived Household Food Security Scale.

CONCLUSIONS

There are a number of structured scales available in the literature for characterization of household food insecurity. However, despite some psychometric studies already existing about the majority of the instruments, it is observed that, except for the studies of the CFSM/HFSSM, these are still restricted to appraisal of a few aspects of reliability and validity.

The economic burden of pediatric gastroenteritis to Bolivian families: a cross-sectional study of correlates of catastrophic cost and overall cost burden

BACKGROUND

Worldwide, acute gastroenteritis causes substantial morbidity and mortality in children less than five years of age. In Bolivia, which has one of the lower GDPs in South America, 16% of child deaths can be attributed to diarrhea, and the costs associated with diarrhea can weigh heavily on patient families. To address this need, the study goal was to identify predictors of cost burden (diarrhea-related costs incurred as a percentage of annual income) and catastrophic cost (cost burden ≥ 1% of annual household income).

METHODS

From 2007 to 2009, researchers interviewed caregivers (n = 1,107) of pediatric patients (<5 years old) seeking treatment for diarrhea in six Bolivian hospitals. Caregivers were surveyed on demographics, clinical symptoms, direct (e.g. medication, consult fees), and indirect (e.g. lost wages) costs. Multivariate regression models (n = 551) were used to assess relationships of covariates to the outcomes of cost burden (linear model) and catastrophic cost (logistic model).

RESULTS

We determined that cost burden and catastrophic cost shared the same significant (p < 0.05) predictors. In the logistic model that also controlled for child sex, child age, household size, rural residence, transportations taken to the current visit, whether the child presented with complications, and whether this was the child's first episode of diarrhea, significant predictors of catastrophic cost included outpatient status (OR 0.16, 95% CI [0.07, 0.37]); seeking care at a private hospital (OR 4.12, 95% CI [2.30, 7.41]); having previously sought treatment for this diarrheal episode (OR 3.92, 95% CI [1.64, 9.35]); and the number of days the child had diarrhea prior to the current visit (OR 1.14, 95% CI [1.05, 1.24]).

CONCLUSIONS

Our analysis highlights the economic impact of pediatric diarrhea from the familial perspective and provides insight into potential areas of intervention to reduce associated economic burden.

The association of family food security and depression in mothers having primary school children in Ray-Iran

Background

As a major public health problem, food insecurity has adverse social and psychological effects, in addition to the impact on public health. This study aimed to determine the association of household food security and depression in mothers with primary school children in Ray County.

Methods

This descriptive, analytical cross-sectional study was conducted on 430 mothers with primary school children in the spring 2010. During a two-stage cluster sampling, an 18-items food security questionnaire (USDA) and the Beck depression inventory were completed via interviewing mothers. Chi-squared test, one-way analysis of variance, simple regression and stepwise multiple regression were used to describe and analyze data, and to identify related factors using SPSS-16 software.

Results

The prevalence of food insecurity and depression in mothers were 50.2% and 51.4% respectively. Also 34.6% of mothers in the "food secure" group were depressed and 77.8% in "food insecure with hunger" group were depressed and this difference was statistically significant. Twelve out of the 20 examined variables (age, family size, number of children, economic status, home ownership, employment households, educational level of the mother and also the head of household, height, energy intake, and carbohydrate and protein intakes) were significantly associated with food security and depression. Food insecurity and depression in mothers with primary school children in Ray County showed a significant positive correlation (P < 0.001).

Conclusion

The prevalence of household food insecurity and depression in the studied population were high. Since there is a significant relationship between food insecurity and depression, more attention must be paid to this group.

Development and validation of an Arab family food security scale

The objective of this article was to describe 1) the validation of 2 similar but not identical food security modules used to collect data from 2 vulnerable populations, southern Lebanon residents (n = 815) and Palestinian refugees in Lebanon (n = 2501), and 2) the development and validation of an Arab Family Food Security Scale (AFFSS). The surveys used a cluster-randomized sampling design. The 2 food security subscales underwent face and construct validity. In addition, both of these tools and the AFFSS underwent psychometric assessment for internal validity by using statistical methods based on Item Response Theory. The food security questions tested by focus groups were understood and accepted in all regions of Lebanon. The food security subscales and the AFFSS had acceptable levels of internal consistency. The psychometric assessment confirmed that the 7 items of the AFFSS had good internal validity and reasonable reliability with item in-fits from 0.73 to 1.16. Food insecurity was identified among 42% of southern Lebanese and 62% of Palestinian refugee households. The determinants and consequences of food security measured in this study provide additional support for the validity of the modules. Using multivariate logistic regression, the higher the mean monthly income per household member and the higher the educational attainment of the head of household, the lower the risk of food insecurity [ORs (95% CIs): 0.99 (0.98, 0.99) and 0.66 (0.54, 0.80), respectively]. There was a strong significant association between food insecurity and lower food expenditure and lower intake of all food categories except for legumes, which was significantly associated in the opposite direction (P < 0.001). The odds of borrowing money and accepting gifts/donations were significantly higher among moderately and severely food-insecure households (P < 0.000). The AFFSS has been validated within Lebanon and can potentially be extended to other Arab-speaking populations.

Seguridad alimentaria, crecimiento y niveles de vitamina A, hemoglobina y zinc en niños preescolares del nordeste de Brasil

El presente estudio buscó analizar la asociación entre la (in)seguridad alimentaria y el estado nutricional de niños preescolares asistidos en jardines infantiles. La seguridad alimentaria fue evaluada a través de la Escala Brasileña de Inseguridad Alimentaria (EBIA). El estado nutricional se evaluó a través del peso/edad, talla/edad, hemoglobina, retinol sérico y zinc sérico. Fueron encontradas prevalencias de déficit de estatura (6,2%), déficit de peso/edad (2,1%), deficiencia de vitamina A (24,4%), anemia (15,5%) y deficiencia de zinc (15,0%). La inseguridad alimentaria familiar fue caracterizada en 64,2% de las familias predominando la forma leve (32,6%). El estudio concluye que la inseguridad alimentaria estimada por la EBIA no se asoció a los Escore-z de crecimiento ni a las concentraciones de retinol sérico, hemoglobina y zinc sérico.

Insegurança alimentar no Nordeste e Sul do Brasil: magnitude, fatores associados e padrões de renda per capita para redução das iniquidades

O artigo analisa a insegurança alimentar em domicílios urbanos com crianças menores de sete anos de idade. Por meio de estudo transversal localizou-se, nas áreas de abrangência de unidades básicas de saúde, 5.419 domicílios na Região Nordeste e 5.081 na Região Sul do Brasil. A insegurança alimentar foi avaliada usando-se a Escala Brasileira de Insegurança Alimentar. A prevalência de insegurança alimentar moderada ou grave foi 22,9% no Nordeste e 7,5% no Sul. Em ambas as regiões, na análise ajustada, a maior probabilidade de insegurança alimentar moderada e grave foi identificada em domicílios chefiados por mulheres, com cor da pele materna preta e parda/mestiça, com menor escolaridade materna, menor renda familiar per capita e beneficiários do Bolsa Família. A insegurança alimentar moderada ou grave seria reduzida em 59,5% no Nordeste e em 45,4% no Sul, com uma renda familiar per capita mínima de R$ 175,00 ao mês. O aumento da renda familiar dos mais pobres e a melhor focalização do Bolsa Família são essenciais para a diminuição da insegurança alimentar no país.

What are we assessing when we measure food security? A compendium and review of current metrics

The appropriate measurement of food security is critical for targeting food and economic aid; supporting early famine warning and global monitoring systems; evaluating nutrition, health, and development programs; and informing government policy across many sectors. This important work is complicated by the multiple approaches and tools for assessing food security. In response, we have prepared a compendium and review of food security assessment tools in which we review issues of terminology, measurement, and validation. We begin by describing the evolving definition of food security and use this discussion to frame a review of the current landscape of measurement tools available for assessing food security. We critically assess the purpose/s of these tools, the domains of food security assessed by each, the conceptualizations of food security that underpin each metric, as well as the approaches that have been used to validate these metrics. Specifically, we describe measurement tools that 1) provide national-level estimates of food security, 2) inform global monitoring and early warning systems, 3) assess household food access and acquisition, and 4) measure food consumption and utilization. After describing a number of outstanding measurement challenges that might be addressed in future research, we conclude by offering suggestions to guide the selection of appropriate food security metrics.

The burden of pediatric diarrhea: a cross-sectional study of incurred costs and perceptions of cost among Bolivian families

Background

Worldwide, acute gastroenteritis represents an enormous public health threat to children under five years of age, causing one billion episodes and 1.9 to 3.2 million deaths per year. In Bolivia, which has one of the lower GDPs in South America, an estimated 15% of under-five deaths are caused by diarrhea. Bolivian caregiver expenses related to diarrhea are believed to be minimal, as citizens benefit from universal health insurance for children under five. The goals of this report were to describe total incurred costs and cost burden associated with caregivers seeking treatment for pediatric gastroenteritis, and to quantify relationships among costs, cost burden, treatment setting, and perceptions of costs.

Methods

From 2007 to 2009, researchers interviewed caregivers (n=1,107) of pediatric patients (<5 years of age) seeking treatment for diarrhea in sentinel hospitals participating in Bolivia’s diarrheal surveillance program across three main geographic regions. Data collected included demographics, clinical symptoms, direct costs (e.g. medication, consult fees) and indirect costs (e.g. lost wages).

Results

Patient populations were similar across cities in terms of gender, duration of illness, and age, but familial income varied significantly (p<0.05) when stratified on appointment type. Direct, indirect, and total costs to families were significantly higher for inpatients as compared to outpatients of urban (p<0.001) and rural (p<0.05) residence. Consult fees and indirect costs made up a large proportion of total costs. Forty-five percent of patients’ families paid ≥1% of their annual household income for this single diarrheal episode. The perception that cost was affecting family finances was more frequent among those with higher actual cost burden.

Conclusions

This study demonstrated that indirect costs due to acute pediatric diarrhea were a large component of total incurred familial costs. Additionally, familial costs associated with a single diarrheal episode affected the actual and perceived financial situation of a large number of caregivers. These data serve as a baseline for societal diarrheal costs before and immediately following the implementation of the rotavirus vaccine and highlight the serious economic importance of a diarrheal episode to Bolivian caregivers.

Determinants of better health: a cross-sectional assessment of positive deviants among women in West Bengal

Background

Rural women in West Bengal have been found to have low rates of formal education, poor health knowledge, high rates of malnutrition and anemia, and low levels of empowerment. Despite these difficult circumstances, some women have positive health outcomes compared to women with similarly disadvantaged backgrounds. The purpose of this study is to identify factors associated with positive health outcomes among women with primary education or less.

Methods

Multivariable regression models were built for outcomes of positive deviance to better characterize the factors in a woman’s life that most impact her ability to deviate from the status quo.

Results

Positive deviants in this context are shown to be women who are able to earn an income, who have access to information through media sources, and who, despite little schooling, have marginally higher levels of formal education that lead to improved health outcomes.

Conclusions

Study findings indicate that positive deviant women in disadvantaged circumstances can achieve positive outcomes amidst a host of contextual barriers that would predict poor health outcomes. Focusing on areas such as enhancing access to media sources, facilitating self-help groups for married women, and promoting prolonged education and delayed marriage for girls may improve health knowledge and behavior among married women with low levels of education.

Food insecurity, food based coping strategies and suboptimal dietary practices of adolescents in Jimma zone Southwest Ethiopia

Despite the high prevalence of adolescent food insecurity in Ethiopia, there is no study which documented its association with suboptimal dietary practices. The objective of this study is to determine the association between adolescent food insecurity and dietary practices. We used data on 2084 adolescents in the age group of 13-17 years involved in the first round survey of the five year longitudinal family study in Southwest Ethiopia. Adolescents were selected using residence stratified random sampling methods. Food insecurity was measured using scales validated in developing countries. Dietary practices were measured using dietary diversity score, food variety score and frequency of consuming animal source food. Multivariable regression models were used to compare dietary behaviors by food security status after controlling for socio-demographic and economic covariates. Food insecure adolescents had low dietary diversity score (P<0.001), low mean food variety score (P<0.001) and low frequency of consuming animal source foods (P<0.001). After adjusting for other variables in a multivariable logistic regression model, adolescent food insecurity (P<0.001) and rural residence (P<0.001) were negatively associated with the likelihood of having a diversified diet (P<0.001) and frequency of consuming animal source foods, while a high household income tertile was positively associated. Similarly, multivariable linear regression model showed that adolescent food insecurity was negatively associated with food variety score, while residence in semi-urban areas (P<0.001), in urban areas (P<0.001) and high household income tertile (P = 0.013) were positively associated. Girls were less likely to have diversified diet (P = 0.001) compared with boys. Our findings suggest that food insecurity has negative consequence on optimal dietary intake of adolescents. Food security interventions should look into ways of targeting adolescents to mitigate these dietary consequences and provide alternative strategies to improve dietary quality of adolescents in Southwest Ethiopia.

Insegurança alimentar em domicílios com adolescentes da Amazônia Legal Brasileira: prevalência e fatores associados

Estudo transversal de base populacional, realizado em 2007, para investigar a prevalência de insegurança alimentar e fatores associados em domicílios com adolescentes da área urbana de quatro municípios da Amazônia Legal Brasileira, abrangência da rodovia BR-163, que liga Cuiabá, Mato Grosso, a Santarém, Pará. Aplicou-se a Escala Brasileira de Insegurança Alimentar a uma amostra de 363 domicílios e se realizou avaliação antropométrica de 534 adolescentes com idade entre 10 e 19 anos. Na análise múltipla, utilizou-se o modelo de regressão de Poisson. Os resultados apresentaram uma prevalência de 23,1% de insegurança alimentar moderada e grave, indicando associação com as seguintes categorias: baixa renda familiar, condições de saneamento precárias, naturalidade do Estado de Mato Grosso e raça/cor (preta) do adolescente. Os resultados apontam a necessidade de ações para a melhoria do acesso ao saneamento básico, a qualificação de recursos humanos visando à geração de emprego e renda e a ações educativas que ampliem a compreensão sobre insegurança alimentar e seus determinantes nos municípios.

Spending on vegetable and fruit consumption could reduce all-cause mortality among older adults

BACKGROUND

Few studies have evaluated the linkage between food cost and mortality among older adults. This study considers the hypothesis that greater food expenditure in general, and particularly on more nutritious plant and animal-derived foods, decreases mortality in older adults.

METHODS

This study uses the 1999-2000 Elderly Nutrition and Health Survey in Taiwan and follows the cohort until 2008, collecting 24-hr dietary recall data for 1781 participants (874 men and 907 women) aged 65 y or older. Using monthly mean national food prices and 24-hr recall, this study presents an estimate of daily expenditures for vegetable, fruit, animal-derived, and grain food categories. Participants were linked to the national death registry.

RESULTS

Of the 1781 original participants, 625 died during the 10-y follow-up period. Among the 4 food categories, the fourth and fifth expenditure quintiles for vegetables and for fruits had the highest survival rates. After adjusting for co-variates, higher (Q4) vegetable and higher fruit (Q4) food expenditures referent to Q1 were significantly predictive of reduced mortality (HR = 0.55, 95% CI: 0.39-0.78 and HR = 0.64, 95% CI: 0.42-0.99, respectively) and the risk decreased by 12% and 10% for every NT$15 (US$0.50) increase in their daily expenditures. Animal-derived and grain food spending was not predictive of mortality.

CONCLUSION

Greater and more achievable vegetable and fruit affordability may improve food security and longevity for older adults.

Household food access and child malnutrition: results from the eight-country MAL-ED study

Background

Stunting results from decreased food intake, poor diet quality, and a high burden of early childhood infections, and contributes to significant morbidity and mortality worldwide. Although food insecurity is an important determinant of child nutrition, including stunting, development of universal measures has been challenging due to cumbersome nutritional questionnaires and concerns about lack of comparability across populations. We investigate the relationship between household food access, one component of food security, and indicators of nutritional status in early childhood across eight country sites.

Methods

We administered a socioeconomic survey to 800 households in research sites in eight countries, including a recently validated nine-item food access insecurity questionnaire, and obtained anthropometric measurements from children aged 24 to 60 months. We used multivariable regression models to assess the relationship between household food access insecurity and anthropometry in children, and we assessed the invariance of that relationship across country sites.

Results

Average age of study children was 41 months. Mean food access insecurity score (range: 0–27) was 5.8, and varied from 2.4 in Nepal to 8.3 in Pakistan. Across sites, the prevalence of stunting (42%) was much higher than the prevalence of wasting (6%). In pooled regression analyses, a 10-point increase in food access insecurity score was associated with a 0.20 SD decrease in height-for-age Z score (95% CI 0.05 to 0.34 SD; p = 0.008). A likelihood ratio test for heterogeneity revealed that this relationship was consistent across countries (p = 0.17).

Conclusions

Our study provides evidence of the validity of using a simple household food access insecurity score to investigate the etiology of childhood growth faltering across diverse geographic settings. Such a measure could be used to direct interventions by identifying children at risk of illness and death related to malnutrition.

Can experience-based household food security scales help improve food security governance?

Experience-based food security scales (EBFSSs) have been shown to be valid across world regions. EBFSSs are increasingly been included in national food and nutrition assessments and food hardship items have been added to regional and global public opinion polls. EBFSSs meet the SMART criteria for identifying useful indicators. And have the potential to help improve accountability, transparency, intersectoral coordination and a more effective and equitable distribution of resources. EBFSSs have increased awareness about food and nutrition insecurity in the court of public opinion. Thus, it's important to understand the potential that EBFSSs have for improving food and nutrition security governance within and across countries. The case of Brazil illustrates the strong likelihood that EBFSSs do have a strong potential to influence food and governance from the national to the municipal level. A recent Gallup World Poll data analysis on the influence of the '2008 food crisis' on food hardship illustrates how even a single item from EBFSSs can help examine if food security governance in different world regions modifies the impact of crises on household food insecurity. Systematic research that bridges across economics, political science, ethics, public health and program evaluation is needed to better understand if and how measurement in general and EBFSSs in particular affect food security governance.

Ready to Use Therapeutic Foods (RUTF) improves undernutrition among ART-treated, HIV-positive children in Dar es Salaam, Tanzania

Background

HIV/AIDS is associated with an increased burden of undernutrition among children even under antiretroviral therapy (ART). To treat undernutrition, WHO endorsed the use of Ready to Use Therapeutic Foods (RUTF) that can reduce case fatality and undernutrition among ART-naïve HIV-positive children. However, its effects are not studied among ART-treated, HIV-positive children. Therefore, we examined the association between RUTF use with underweight, wasting, and stunting statuses among ART-treated HIV-positive children in Dar es Salaam, Tanzania.

Methods

This cross-sectional study was conducted from September-October 2010. The target population was 219 ART-treated, HIV-positive children and the same number of their caregivers. We used questionnaires to measure socio-economic factors, food security, RUTF-use, and ART-duration. Our outcome variables were underweight, wasting, and stunting statuses.

Results

Of 219 ART-treated, HIV-positive children, 140 (63.9%) had received RUTF intervention prior to the interview. The percentages of underweight and wasting among non-RUTF-receivers were 12.4% and 16.5%; whereas those of RUTF-receivers were 3.0% (P = 0.006) and 2.8% (P = 0.001), respectively. RUTF-receivers were less likely to have underweight (Adjusted Odd Ratio (AOR) =0.19, CI: 0.04, 0.78), and wasting (AOR = 0.24, CI: 0.07, 0.81), compared to non RUTF-receivers. Among RUTF receivers, children treated for at least four months (n = 84) were less likely to have underweight (P = 0.049), wasting (P = 0.049) and stunting (P < 0.001).

Conclusions

Among HIV-positive children under ART, the provision of RUTF for at least four months was associated with low proportions of undernutrition status. RUTF has a potential to improve undernutrition among HIV-positive children under ART in the clinical settings in Dar es Salaam, Tanzania.

Food insecurity and associated factors among HIV-infected individuals receiving highly active antiretroviral therapy in Jimma zone Southwest Ethiopia

Background

In resource limited settings, many People Living with HIV/AIDS (PLWHA) lack access to sufficient quantities of nutritious foods, which poses additional challenges to the success of antiretroviral therapy (ART). Maintaining adequate food consumption and nutrient intake levels and meeting the special nutritional needs to cope up with the disease and the ART are critical for PLWHA to achieve the full benefit of such a treatment.

Objective

To determine the prevalence and correlates of food insecurity among HIV-infected individuals receiving highly active antiretroviral therapy in resource-limited settings.

Methods

A cross sectional study was carried out from January 1, 2009 to March 3, 2009 at ART clinic at Jimma University specialized hospital (JUSH) in Ethiopia. We used multivariable logistic regression model to compare independent risk factors by food insecurity status among 319 adult PLWHA (≥18 years) attending ART Clinic.

Results

A total of 319 adult PLWHA participated in the study giving a response rate of 100%. Out of 319 PLWHA the largest numbers of participants, 46.4% were in the age group of 25-34 years. The overall 201(63.0%) PLWHA were food insecure. Educational status of elementary or lower [OR = 3.10 (95%CI; (1.68-5.71)], average family monthly income <100 USD [OR = 13.1 (95% CI; (4.29-40.0)] and lower food diversity [OR = 2.18 (95%CI; (1.21-3.99)] were significantly and independently associated with food insecurity.

Conclusion

Food insecurity is a significant problem among PLWHA on HAART. Lower educational status and low family income were the predictors of food insecurity. Food security interventions should be an integral component of HIV/AIDS care and support programs. Special attention need to be given to patients who have lower educational status and are members of households with low income.

Insegurança alimentar entre beneficiários de programas de transferência de renda

OBJETIVO: Analisar a proporção de insegurança alimentar domiciliar entre a população beneficiária de programas de transferência de renda e os fatores relacionados a essa condição. MÉTODOS: Estudo de delineamento transversal, cuja amostra foi constituída por 421 famílias beneficiárias, residentes no município de Toledo, Paraná. Os dados foram coletados entre setembro de 2006 e fevereiro de 2007, em entrevistas domiciliares, por meio da Escala Brasileira de Insegurança Alimentar e do Questionário de Classificação Econômica, ambos incluídos em questionário sociodemográfico. Para análise das variáveis, foram aplicados os testes de Qui-quadrado, razão de chances, regressão logística multivariada. RESULTADOS: A insegurança alimentar esteve presente em 74,6% dos domicílios, 5,9% na forma grave e 23,8% moderada. Segundo o teste de Qui-quadrado, as variáveis independentes que mostraram associação com a insegurança foram renda per capita, classe econômica D ou E, presença de menores de 18 anos, 7 ou mais membros no domicílio, baixa escolaridade e desemprego ou trabalho informal do chefe. Na regressão logística multivariada, considerando a variável dependente a condição de segurança alimentar/insegurança leve, mantiveram-se associadas à insegurança moderada/grave a classe econômica D/E (OR=2,88), presença 5/6 moradores (OR=2,90) e 7 ou mais (OR=3,05), trabalho informal ou desemprego do responsável pelo domicílio (OR=1,87). CONCLUSÃO: O fato de a transferência de renda ainda deixar em situação de insegurança alimentar um contingente grande de beneficiários (74,6%) é explicado pela extrema condição de vulnerabilidade social a que essa população está submetida. Os resultados deste estudo sugerem a necessidade de políticas públicas multissetoriais, com enfoque prioritário para geração de emprego e de renda.

Relationship of household food insecurity to anaemia in children aged 6-59 months among families in rural Indonesia

BACKGROUND

Anaemia is a significant global public health problem in developing countries with adverse health effects on young children. Household food insecurity, which reflects a household's access, availability and utilisation of food, has not been well characterised in relation to anaemia in children.

OBJECTIVE

To examine the relationship of household food insecurity with anaemia (Hb <11 g/dl) in children.

METHODS

In a cross-sectional study of 4940 rural households participating in the Indonesian Nutrition Surveillance System, household food insecurity was measured using a modified 9-item food security questionnaire and related to anaemia in children aged 6-59 months.

RESULTS

The proportion of households with an anaemic child was 56·6%. In households with and without anaemic children, the mean (SD) food insecurity score was 1·82 (1·72) vs 1·55 (1·54) (p<0·0001), respectively. In a multivariate logistic regression model, food insecurity score was related to anaemia in children (odds ratio 0·77, 95% confidence interval 0·63-0·95, p=0·01) when the highest quintile of food insecurity score was compared with the lowest quintile, adjusting for potential confounders.

CONCLUSION

A higher household food insecurity score is associated with greater prevalence of anaemia in children in rural families in Indonesia.

Altered social cohesion and adverse psychological experiences with chronic food insecurity in the non-market economy and complex households of Burkina Faso

Food insecurity negatively impacts outcomes in adults and children including parenting practices, child development, educational achievement, school performance, diet, and nutritional status. Ethnographic and quantitative research suggests that food insecurity affects well-being not only through the lack food, poor diet, and hunger, but also through social and psychological consequences that are closely linked to it. These studies are limited in number, and have mostly been carried out in contexts with market economies where household access to food depends almost solely on income. This study considers the social and psychological experiences closely linked to food insecurity in northern Burkina Faso, a context marked by subsistence farming, chronic food insecurity with a strong seasonal pattern, and a complex social structure. A total of 33 men and women from ten households were interviewed in February 2001 using semi-structured interview guides. Data were analyzed following the principles of thematic analysis. Food insecurity is closely linked with consequences such as concern, worries, and anxiety that ultimately lead to weight and sleep loss. Food insecurity results in feelings of alienation (e.g., shame) and deprivation (e.g., guilt), and alters household cohesion leading to disputes and difficulties keeping children at home. Decisions made by household members to manage and cope with food insecurity are shaped by their fear of alienation and other cultural and social norms. These findings, although derived from data collected 10 years ago before the 2008 food and fuel crises, remain valid in the study context, and emphasize the importance of social and psychological consequences closely linked to food insecurity and their negative impact on the well-being at both individual and household levels in contexts of non-market economy and chronic food insecurity. Attention to these non-nutritional consequences will improve the design, implementation, and evaluation of food insecurity programs in this and similar contexts.

Social determinants, lived experiences, and consequences of household food insecurity among persons living with HIV/AIDS on the shore of Lake Victoria, Kenya

Food insecurity is a considerable challenge in sub-Saharan Africa, disproportionately affecting persons living with HIV/AIDS. This study investigates the lived experience, determinants, and consequences of food insecurity and hunger among individuals living with HIV/AIDS on the shore of Lake Victoria in Suba District, Kenya. Parallel mixed methods included semi-structured interviews and administration of the Household Food Insecurity Access Scale among a systematic sample of 67 persons living with HIV/AIDS (49 of whom were receiving antiretroviral therapy [ART]). All respondents were either severely (79.1%) or moderately (20.9%) food insecure; no respondents were mildly food insecure or food secure. Qualitative data and simple and multiple linear regression models indicated that significant determinants of food insecurity include increased age, a greater number of children, and not being married. A number of themes related to food insecurity and ART emerged, including: (1) an increase in hunger or appetite since initiating ART; (2) exacerbation of ART-related side effects; and (3) non-adherence to ART due to hunger, food insecurity, or agricultural work responsibilities. HIV interventions should address food insecurity and hunger, particularly among at-risk populations, to promote ART adherence and better health outcomes.

Validation of the Malaysian Coping Strategy Instrument to Measure Household Food Insecurity in Kelantan, Malaysia

Background

Food insecurity occurs whenever people are not able to access enough food at all times for an active and healthy life or when adequate and safe food acquired by socially acceptable ways is not available.

Objective

To validate the Malaysian Coping Strategy Instrument (MCSI) to measure household food insecurity in Kelantan, Malaysia.

Methods

A cross-sectional study was conducted on 301 nonpregnant, nonlactating Malay women, aged between 19 and 49 years, living in rural and urban areas. The respondents were interviewed with the use of a structured questionnaire to obtain information on their demographic and socioeconomic characteristics, household food security, and dietary intake.

Results

Demographic and socioeconomic characteristics (household size, number of children, number of children attending school, household income, and per capita income) were significantly associated with household food-security status in rural and urban areas. Energy intake, fat intake, percentage of energy from fat, and number of servings of meat, fish, or poultry and legumes were significantly associated with household food-security status in rural areas. The dietary diversity score was significantly associated with household food-security status in rural and urban areas.

Conclusions

Validating the MCSI in other areas of Malaysia as well as in similar settings elsewhere in the world before it is used to measure household food insecurity in the population is strongly recommended. In this study, the MCSI was found to be a reliable and valid measure of household food insecurity based on criterion-related validity, particularly in terms of demographic and socioeconomic characteristics and dietary diversity.

Undernutrition among HIV-positive children in Dar es Salaam, Tanzania: antiretroviral therapy alone is not enough

Background

The prevalence of HIV/AIDS has exacerbated the impact of childhood undernutrition in many developing countries, including Tanzania. Even with the provision of antiretroviral therapy, undernutrition among HIV-positive children remains a serious problem. Most studies to examine risk factors for undernutrition have been limited to the general population and ART-naive HIV-positive children, making it difficult to generalize findings to ART-treated HIV-positive children. The objectives of this study were thus to compare the proportions of undernutrition among ART-treated HIV-positive and HIV-negative children and to examine factors associated with undernutrition among ART-treated HIV-positive children in Dar es Salaam, Tanzania.

Methods

From September to October 2010, we conducted a cross-sectional survey among 213 ART-treated HIV-positive and 202 HIV-negative children in Dar es Salaam, Tanzania. We measured the children's anthropometrics, socio-demographic factors, food security, dietary habits, diarrhea episodes, economic status, and HIV clinical stage. Data were analyzed using both univariate and multivariate methods.

Results

ART-treated HIV-positive children had higher rates of undernutrition than their HIV-negative counterparts. Among the ART-treated HIV-positive children, 78 (36.6%) were stunted, 47 (22.1%) were underweight, and 29 (13.6%) were wasted. Households of ART-treated HIV-positive children exhibited lower economic status, lower levels of education, and higher percentages of unmarried caregivers with higher unemployment rates. Food insecurity was prevalent in over half of ART-treated HIV-positive children's households. Furthermore, ART-treated HIV-positive children were more likely to be orphaned, to be fed less frequently, and to have lower body weight at birth compared to HIV-negative children.

In the multivariate analysis, child's HIV-positive status was associated with being underweight (AOR = 4.61, 95% CI 1.38-15.36 P = 0.013) and wasting (AOR = 9.62, 95% CI 1.72-54.02, P = 0.010) but not with stunting (AOR = 0.68, 95% CI 0.26-1.77, P = 0.428). Important factors associated with underweight status among ART-treated HIV-positive children included hunger (AOR = 9.90, P = 0.022), feeding frequency (AOR = 0.02, p < 0.001), and low birth weight (AOR = 5.13, P = 0.039). Factors associated with wasting among ART-treated HIV-positive children were diarrhea (AOR = 22.49, P = 0.001) and feeding frequency (AOR = 0.03, p < 0.001).

Conclusion

HIV/AIDS is associated with an increased burden of child underweight status and wasting, even among ART-treated children, in Dar es Salaam, Tanzania. In addition to increasing coverage of ART among HIV-positive children, interventions to ameliorate poor nutrition status may be necessary in this and similar settings. Such interventions should aim at promoting adequate feeding patterns, as well as preventing and treating diarrhea.

Food insecurity and age at menarche among adolescent girls in Jimma Zone Southwest Ethiopia: a longitudinal study

BACKGROUND

Age at menarche is the reflection of cumulative pre-adolescent exposure of girls to either adverse environment such as food insecurity or affluent living conditions. Food insecurity could result in inadequate nutrient intake and stress, both of which are hypothesized to have opposing effects on the timing of menarche through divergent pathways. It is not known whether food insecure girls have delayed menarche or early menarche compared with their food secure peers. In this study we test the competing hypothesis of the relationship between food insecurity and age at menarche among adolescent girls in the Southwest Ethiopia.

METHODS

We report on 900 girls who were investigated in the first two rounds of the five year longitudinal survey. The semi-parametric frailty model was fitted to determine the effect of adolescent food insecurity on time to menarche after adjusting for socio-demographic and economic variables.

RESULTS

Food insecure girls have menarche one year later than their food secure peer (median age of 15 years vs 14 years). The hazard of menarche showed a significant decline (P = 0.019) as severity of food insecurity level increased, the hazard ratio (HR) for mild food insecurity and moderate/severe food insecurity were 0.936 and 0.496, respectively compared to food secure girls. Stunted girls had menarche nearly one year later than their non-stunted peers (HR = 0.551, P < 0.001).

CONCLUSION

Food insecurity is associated with delay of age at menarche by one year among girls in the study area. Stunted girls had menarche one year later than their non-stunted peers. Age at menarche reflects the development of girls including the timing of sexual maturation, nutritional status and trajectory of growth during the pre-pubertal periods. The findings reflect the consequence of chronic food insecurity on the development and well-being of girls in the study area.

Validity of an adapted Household Food Insecurity Access Scale in urban households in Iran

OBJECTIVE

To assess the validity of a locally adapted Household Food Insecurity Access Scale (HFIAS) in the measurement of household food insecurity (FI) in the city of Tehran.

DESIGN

A cross-sectional study.

SETTING

Urban households were selected through a systematic cluster sampling method from six different districts of Tehran. The socio-economic status of households was evaluated using a questionnaire by means of interviews. An adapted HFIAS was used to measure FI. Content validity was assessed by an expert panel, and the questionnaire was then tested among ten households for clarity. Criterion validity was assessed by comparing the measure with a number of determinants and consequences of FI. Internal consistency was evaluated by Cronbach's α and exploratory factor analysis. For repeatability, the questionnaire was administered twice to twenty-five households at an interval of 20 d and Pearson's correlation coefficient was calculated.

SUBJECTS

A total of 416 households.

RESULTS

In all, 11·8 %, 14·4 % and 17·5 % of the households were severely, moderately and mildly food insecure, respectively. Cronbach's α was 0·855. A significant correlation was observed between the two administrations of the questionnaire (r = 0·895, P < 0·001). Factor analysis of HFIAS items revealed two factors: the first five items as factor 1 (mild-to-moderate FI) and the last four as factor 2 (severe FI). Heads of food-secure households had higher education and higher job position compared with heads of food-insecure households (P < 0·001). Income and expenditure were lower in food-insecure households compared with food-secure households.

CONCLUSIONS

Adapted HFIAS showed acceptable levels of internal consistency, criterion validity and reliability in assessing household FI among Tehranians.

Food insecurity, childhood illness and maternal emotional distress in Ethiopia

OBJECTIVE

The relationship between food insecurity, maternal emotional distress and childhood morbidity in resource-poor settings is not well clarified. The present study aimed to assess independent associations between household food insecurity and childhood morbidity and potential modifications by maternal emotional distress.

DESIGN

A cross-sectional survey. A food security scale was used to assess household food insecurity; maternal reports were used to assess recent childhood illness; and the Hopkins Symptom Checklist was used to assess symptoms of emotional distress among mothers.

SETTING

The Oromia Region, Ethiopia (rural area).

SUBJECTS

A total of 936 mother-child pairs.

RESULTS

Of 936 children assessed, 22·4% had experienced diarrhoea, 20·7% had cough and 21·5% had fever in the 2 weeks preceding the interview. Household food insecurity was reported by 39% of mothers. Greater food insecurity and greater maternal emotional distress were each independently associated with higher prevalence of cough and fever. Among mothers with low emotional distress, food insecurity was associated with a 2·3 times greater odds of diarrhoea in their children.

CONCLUSIONS

Household food insecurity may increase the risk of childhood illness in rural Ethiopia, and children having mothers with greater emotional distress may be at highest risk. These findings highlight the importance of strengthening policy initiatives aimed at reducing the high prevalence of food insecurity and emotional distress in Ethiopia.

[Conceptualizing and measuring food and nutrition security]

An interdisciplinary conceptual framework of food security is presented that identifies determinants at the macro-socioeconomic, regional-local, and household levels. Food insecurity is described as having consequences for health and well-being that may or may not be expressed in the form of physical-biological consequences such as underweight or nutritional deficiencies. The implications of this perspective for measurement of food security are addressed. A comparative review of indicators commonly used to assess food security is presented, with special focus on the Brazilian Food Insecurity Scale, which was included in the 2004 National Household Survey (PNAD). The history of the development of the scale in the U.S. and its validation in Brazil are described. Characterized as a direct measure of household food insecurity, this psychometric scale can be used together with indicators and measurement instruments from diverse fields to broaden understanding of this complex phenomenon.

Household food insecurity and childhood overweight in Jamaica and Québec: a gender-based analysis

Background

Childhood overweight is not restricted to developed countries: a number of lower- and middle-income countries are struggling with the double burden of underweight and overweight. Another public health problem that concerns both developing and, to a lesser extent, developed countries is food insecurity. This study presents a comparative gender-based analysis of the association between household food insecurity and overweight among 10-to-11-year-old children living in the Canadian province of Québec and in the country of Jamaica.

Methods

Analyses were performed using data from the 2008 round of the Québec Longitudinal Study of Child Development and the Jamaica Youth Risk and Resiliency Behaviour Survey of 2007. Cross-sectional data were obtained from 1190 10-year old children in Québec and 1674 10-11-year-old children in Jamaica. Body mass index was derived using anthropometric measurements and overweight was defined using Cole's age- and sex-specific criteria. Questionnaires were used to collect data on food insecurity. The associations were examined using chi-square tests and multivariate regression models were used to estimate odds ratios (OR) and 95% confidence intervals.

Results

The prevalence of overweight was 26% and 11% (p < 0.001) in the Québec and Jamaican samples, respectively. In Québec, the adjusted odds ratio for being overweight was 3.03 (95% CI: 1.8-5.0) among children living in food-insecure households, in comparison to children living in food-secure households. Furthermore, girls who lived in food-insecure households had odds of 4.99 (95% CI: 2.4-10.5) for being overweight in comparison to girls who lived in food-secure households; no such differences were observed among boys. In Jamaica, children who lived in food-insecure households had significantly lower odds (OR 0.65, 95% CI: 0.4-0.9) for being overweight in comparison to children living in food-secure households. No gender differences were observed in the relationship between food-insecurity and overweight/obesity among Jamaican children.

Conclusions

Public health interventions which aim to stem the epidemic of overweight/obesity should consider gender differences and other family factors associated with overweight/obesity in both developed and developing countries.

Household food insecurity and symptoms of neurologic disorder in Ethiopia: an observational analysis

BACKGROUND

Food insecurity (FI) has been shown to be associated with poor health both in developing and developed countries. Little is known about the relation between FI and neurological disorder. We assessed the relation between FI and risk for neurologic symptoms in southwest Ethiopia.

METHODS

Data about food security, gender, age, household assets, and self-reported neurologic symptoms were collected from a representative, community-based sample of adults (N = 900) in Jimma Zone, Ethiopia. We calculated univariate statistics and used bivariate chi-square tests and multivariate logistic regression models to assess the relation between FI and risk of neurologic symptoms including seizures, extremity weakness, extremity numbness, tremors/ataxia, aphasia, carpal tunnel syndrome, vision dysfunction, and spinal pain.

RESULTS

In separate multivariate models by outcome and gender, adjusting for age and household socioeconomic status, severe FI was associated with higher odds of seizures, movement abnormalities, carpal tunnel, vision dysfunction, spinal pain, and comorbid disorders among women. Severe FI was associated with higher odds of seizures, extremity numbness, movement abnormalities, difficulty speaking, carpal tunnel, vision dysfunction, and comorbid disorders among men.

CONCLUSION

We found that FI was associated with symptoms of neurologic disorder. Given the cross-sectional nature of our study, the directionality of these associations is unclear. Future research should assess causal mechanisms relating FI to neurologic symptoms in sub-Saharan Africa.

The household food insecurity access scale and an index-member dietary diversity score contribute valid and complementary information on household food insecurity in an urban West-African setting

The number of urban poor is increasing quickly in West Africa, yet food security early warning systems still do not include urban areas. One reason is the lack of appropriate and internationally agreed-upon indicators to measure urban household food insecurity. Our objective was to assess the performance of the household food insecurity access scale (HFIAS) and an index-member's dietary diversity score (IDDS) to approximate the adequacy of urban households' diets. A survey was performed on a random cluster sample of 1056 households in Ouagadougou, Burkina Faso. Data on HFIAS and IDDS and 2 nonconsecutive household quantitative 24-h recalls were collected twice, in June-July and in November-December 2007. Diet adequacy was assessed through the household's mean adequacy ratio (MAR) using energy and 11 micronutrients. Structural equation modeling was used to quantify the association of each candidate indicator with the MAR and receiver-operating characteristic (ROC) analyses were performed to assess their targeting performance in predicting low or high MAR. HFIAS was negatively associated with the MAR [path coefficient (P) = -7.95 × 10(-3) ± 1.45 × 10(-3); P < 0.001], whereas IDDS was positively associated with it (P = 5.19 × 10(-2) ± 1.27 × 10(-2); P < 0.001). Areas under the ROC curves ranged from 0.585 to 0.661 for HFIAS and from 0.536 to 0.629 for IDDS. In conclusion, HFIAS and IDDS performed well in approximating adequacy of urban households' diets. They are informative indicators about urban food insecurity, promising for evaluation and monitoring but not for household targeting given their insufficient predictive power.

The impact of orphanhood on food security in the high-HIV context of Blantyre, Malawi

BACKGROUND

A 2004 UNICEF/UNAIDS/USAID survey in Blantyre, Malawi, examined methods to improve monitoring and evaluation of interventions aimed at orphans and vulnerable children.

OBJECTIVE

A derivative of this larger study, the present study utilized the household data collected to assess differences in food security status among orphan households with the aim of helping food security programmers focus resources on the households most affected.

METHODS

Orphan households were classified by number and type of orphans supported. Descriptive analyses and logistic regressions were performed to assess differential vulnerability to food insecurity according to these classifications.

RESULTS

Multiple-orphan households and multiple-orphan households that cared for at least one foster child were 2.42 and 6.87 times more likely to be food insecure, respectively, than nonorphan households. No other category of orphan household was at elevated risk.

CONCLUSIONS

The food security impact of caring for orphans varied significantly among orphan households, requiring food security planners to focus resources on the households most heavily impacted by HIV/AIDS, including multiple-orphan households, rather than focusing on conventional designations of vulnerability, such as orphans and vulnerable children.

Access to healthy food: a key focus for research on domestic food insecurity

Geographic access to food is an important dimension of food insecurity in the US, because it affects the cost of food that low-income consumers face and the decisions they make about which foods to purchase. This symposium highlighted several recent studies that developed new techniques for characterizing the food environment, analyzed its influence on consumption and weight status, and explored alternative policy options for interventions.

Household food security status and associated factors among high-school students in Esfahan, Iran

Objective

The present study was designed to determine household food security status and factors associated with food insecurity among high-school students in Esfahan, Iran.

Design

Cross-sectional surveys.

Setting

The present study was conducted in autumn 2008 in Esfahan, Iran. The samples were selected using systematic cluster sampling. Socio-economic questionnaires, food security questionnaires and FFQ were filled out during face-to-face interviews. In addition, data on participants’ weights and heights were collected.

Subjects

A total of 580 students (261 boys and 319 girls) aged 14–17 years from forty high schools in Esfahan, Iran, were selected.

Results

The prevalence of household food insecurity according to the US Department of Agriculture food security questionnaire was 36·6 % (95 % CI 0·33, 0·40). Food insecurity was positively associated with number of members in the household (P < 0·05) and negatively associated with parental education level and job status and household economic status (P < 0·05). Moreover, students living in food-insecure households more frequently consumed bread, macaroni, potato and egg (P < 0·05), while they less frequently consumed rice, red meat, sausage and hamburger, poultry, fish, green vegetables, root and bulb (coloured) vegetables, melons, apples and oranges, milk and yoghurt (P < 0·05).

Conclusions

Food insecurity was prevalent among households in Esfahan, Iran, and food security status was associated with socio-economic factors. Students who belonged to food-secure households more frequently consumed healthy foods (except sausage and hamburger), whereas those living in food-insecure households more frequently consumed cheap foods containing high energy per kilogram. The present study suggests that intervention programmes be designed and carried out.

Household dietary diversity and food expenditures are closely linked in rural Bangladesh, increasing the risk of malnutrition due to the financial crisis

In Bangladesh, rice prices are known to be positively associated with the prevalence of child underweight and inversely associated with household nongrain food expenditures, an indicator of dietary quality. The collection of reliable data on household expenditures is relatively time consuming and requires extensive training. Simple dietary diversity scores are increasingly used as measures of food security and as proxies for nutrient adequacy. This study examines associations between a simple dietary diversity score and commonly used indicators of socioeconomic status in Bangladesh. Data representative of rural Bangladesh was collected from 188,835 households over 18 rounds of bi-monthly data collection from 2003-2005. A simple household dietary diversity score was developed by summing the number of days each household consumed an item from each of 7 food groups over a 7-d period. The dietary diversity score was associated with per capita nongrain food expenditures (r = 0.415), total food expenditures (r = 0.327), and total household expenditures (r = 0.332) using Spearman correlations (all P < 0.0001). The frequency of meat and egg consumption showed greater variation across quintiles of total monthly expenditure than other items contributing to the dietary diversity score. After controlling for other measures of socioeconomic status in multiple linear regression models, the dietary diversity score was significantly associated with monthly per capita food and total expenditures. Low dietary diversity during the period prior to major food price increases indicates potential risk for worsening of micronutrient deficiencies and child malnutrition in Bangladesh.

Relationship of household food insecurity to neonatal, infant, and under-five child mortality among families in rural Indonesia

BACKGROUND

Food insecurity is common in developing countries and is related to the physical well-being of families. Household food insecurity is intended to reflect a household's access, availability, and utilization of food, but its relationship with child mortality has not been well characterized.

OBJECTIVE

To examine the relationship of a modified household food insecurity score with a history of neonatal, infant, and under-five child mortality.

METHODS

In a cross-sectional study of 26,339 rural households in the Indonesian Nutrition Surveillance System, 2000-03, household food insecurity was measured with the use of a modified nine-item food security questionnaire. A simple food insecurity score of O to 9 was calculated based on responses and related to mortality history in the family.

RESULTS

The proportion of households with neonatal, infant, and under-five child mortality was 4.6%, 8.8%, and 10.6%, respectively. In households with and without neonatal, infant, and under-five child mortality, the mean (+/- SD) food insecurity scores were 2.19 +/- 1.89 vs. 1.72 +/- 1.65, 2.29 +/- 1.94 vs. 1.69 +/- 1.63, and 2.29 +/- 1.93 vs. 1.68 +/- 1.62 (all p < .0001), respectively. The food insecurity score was related to mortality among neonates (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02 to 1.09; p = .003), infants (OR, 1.06; 95% CI, 1.03 to 1.09; p < .0001), and children under five (OR, 1.07; 95% CI, 1.04 to 1.10; p < .0001) after adjustment for potential confounders.

CONCLUSIONS

Higher household food insecurity score is associated with greater neonatal, infant, and under-five child mortality among rural families in Indonesia. Greater household food insecurity may signify a higher risk of infant and young child mortality.

Assessing the internal validity of a household survey-based food security measure adapted for use in Iran

Background

The prevalence of food insecurity is an indicator of material well-being in an area of basic need. The U.S. Food Security Module has been adapted for use in a wide variety of cultural and linguistic settings around the world. We assessed the internal validity of the adapted U.S. Household Food Security Survey Module to measure adult and child food insecurity in Isfahan, Iran, using statistical methods based on the Rasch measurement model.

Methods

The U.S. Household Food Security Survey Module was translated into Farsi and after adaptation, administered to a representative sample. Data were provided by 2,004 randomly selected households from all sectors of the population of Isfahan, Iran, during 2005.

Results

53.1 percent reported that their food had run out at some time during the previous 12 months and they did not have money to buy more, while 26.7 percent reported that an adult had cut the size of a meal or skipped a meal because there was not enough money for food, and 7.2 percent reported that an adult did not eat for a whole day because there was not enough money for food. The severity of the items in the adult scale, estimated under Rasch-model assumptions, covered a range of 6.65 logistic units, and those in the child scale 11.68 logistic units. Most Item-infit statistics were near unity, and none exceeded 1.20.

Conclusion

The range of severity of items provides measurement coverage across a wide range of severity of food insecurity for both adults and children. Both scales demonstrated acceptable levels of internal validity, although several items should be improved. The similarity of the response patterns in the Isfahan and the U.S. suggests that food insecurity is experienced, managed, and described similarly in the two countries.