Food security measurement and governance: Assessment of the usefulness of diverse food insecurity indicators for policy makers

Complex intertwined association between breastfeeding practices and household food insecurity: Systematic review and meta-analysis

Breastfeeding offers ideal food and nutrition for infants; however, structural barriers may amplify breastfeeding inequities. We aimed to identify whether household food insecurity (HFI) is associated with exclusive and continued breastfeeding (EBF and CBF) as recommended by the World Health Organization/United Nations Children's Fund (UNICEF) Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, literature searches using 'breastfeeding', 'food insecurity' and 'infant' terms were conducted in PubMed/MEDLINE, Embase, CINAHL, Global Health and LILACS from inception through November 2023, without language restrictions, yielding 1382 publications (PROSPERO:CRD42022329836). Predetermined eligibility criteria yielded the 12 included studies (nine cross-sectional and three cohorts). The risk of bias was assessed through the Effective Public Health Practice Project. Meta-analysis was performed for studies assessing EBF (n = 10), and metaregression was used to explore heterogeneity across studies. Prevalence of EBF ranged from 1.6% to 85.3%, with a lower prevalence among HFI. The pooled effect of the association between HFI and EBF presented an odds ratio (OR) of 0.61 (95% CI = 0.49-0.76) with consistent results across marginal (OR = 0.72, 95% CI = 0.55-0.94), moderate (OR = 0.59, 95% CI = 0.41-0.84) and severe HFI (OR = 0.49, 95% CI = 0.32-0.76). High heterogeneity was found only when HFI was dichotomized. The prevalence of CBF ranged from 35.4% to 78.0%, with inconsistent prevalence among HFI; a meta-analysis was not performed due to the low number of studies (n = 3). We concluded that HFI levels are associated with lower odds of EBF. Integrating service and policy-level strategies, such as screening, referrals, skilled breastfeeding counseling and access to comprehensive nutrition and social programs, could reduce structural inequities and promote adherence to the World Health Organization/UNICEF breastfeeding recommendations among food-insecure families.

Unveiling the nexus of climate change, adaptation strategies, and food security: Insights from small-scale farmers in zagros mountains in Iran

In today's world, climate change and its unprecedented impact on food and nutrition security have emerged as a significant and formidable global challenge. This study aimed to investigate the effect of adaptation strategies on the food security of small-scale farmers in Khorramabad city, Iran, using a survey-based analysis. To assess the food security level, the Household Food Security Survey Module (HFSSM) was employed. Additionally, Structural Equation Modeling was utilized to examine the relationship between adaptation dimensions and food security. The findings revealed that households without children exhibited a higher level of food security (48%) compared to households with children (6%). Moreover, the results demonstrated a positive and significant correlation between the food security of households, regardless of whether they had children, and the different adaptation components. Despite a satisfactory level of knowledge regarding climate change adaptation in the study area, the actual implementation of such measures remained low. While weed management, agricultural crop insurance, and access to meteorological information were identified as the top three strategies employed by farmers, the results suggested that sustainable-oriented operations and organic-oriented practices could serve as more effective strategies for both climate change resilience and enhancing food security status.

Food and nutrition security definitions, constructs, frameworks, measurements, and applications: global lessons

Food security (FS) is a powerful social determinant of health (SDOH) and is crucial for human and planetary health. The objectives of this article are to (i) provide clarity on the definitions of FS and nutrition security; (ii) provide a framework that clearly explains the links between the two constructs; (iii) summarize measurement approaches, and (iv) illustrate applications to monitoring and surveillance, policy and program design and evaluation, and research, mainly based on the ongoing rich experience with food insecurity (FI) scales. A clear and concise definition of FI and corresponding frameworks are available. There are different methods for directly or indirectly assessing FI. The best method(s) of choice need to be selected based on the questions asked, resources, and time frames available. Experience-based FI measures disseminated from the United States to the rest of the world in the early 2000s became a game changer for advancing FI research, policy, program evaluation, and governance. The success with experience FI scales is informing the dissemination, adaptation, and validation of water insecurity scales globally. The many lessons learned across countries on how to advance policy and program design and evaluation through improved FS conceptualization and measurement should be systematically shared through networks of researchers and practitioners.

Interventions to change antimicrobial use in livestock: A scoping review and an impact pathway analysis of what works, how, for whom and why

Antimicrobial resistance (AMR) is a public health threat responsible for 700,000 deaths per year worldwide. Antimicrobial use (AMU) in livestock contributes to AMR in animal and public health. Therefore, it is essential to implement effective interventions towards better AMU in livestock. However, there is a lack of evidence to inform decision-makers of what works, how, for whom and why and how effective interventions can be adapted to different contexts. We conducted a scoping review and an impact pathway analysis to systematically map the research done in this area and to inform evidence-based and context-appropriate policies. We followed the PRISMA-ScR requirements and searched Web of Science, PubMed and Scopus databases to identify studies in English or French languages, in open access and published between 2000 and 2022. We selected thirty references addressing twenty-eight different interventions that were successful in changing AMU in livestock. We used an impact pathway logic model as an analytic framework to guide the technical aspects of the scoping review process and to identify the complex relationships between outputs, outcomes, impacts and contextual factors. A majority of interventions managed to improve AMU by changing herd and health management practices (ni=18). We identified intermediate outcomes including change in the veterinarian-farmer relationship (ni=7), in knowledge and perception (ni=6), and in motivation and confidence (ni=1). Twenty-two studies recorded positive impacts on animal health and welfare (ni=11), technical performances (ni=9), economic performances (ni=4) and AMR reduction (ni=4). Interventions implemented different strategies including herd and health management support (ni=20), norms and standards (ni=11), informational and educational measures (ni=10), economic support (ni=5). Studies were mainly in European countries and in pig and large ruminants farming. Most interventions targeted farmers or veterinarians but we identified other major and influential actors including authority and governmental organizations, academics and research, organization of producers or veterinarians, herd advisors and technicians, laboratories, and public opinion. Key success factors were knowledge and perception (ni=14), social factors (ni=13), intervention characteristics (ni=11), trajectory and ecosystem of change (ni=11), economic factors (ni=9), herd and health status (ni=8), data access and monitoring (ni=4). This review describes a paucity of impact assessment of interventions towards better AMU in livestock. There is no one-size-fits-all transition pathway but we inform decision-makers about the most successful interventions that work, how, for whom and why. The impact pathway analysis provided a holistic view of the successful change processes and the complex relationships between outputs, outcomes, impacts and contexts.

A systematic literature review of indicators measuring food security

Measurement is critical for assessing and monitoring food security. Yet, it is difficult to comprehend which food security dimensions, components, and levels the numerous available indicators reflect. We thus conducted a systematic literature review to analyse the scientific evidence on these indicators to comprehend the food security dimensions and components covered, intended purpose, level of analysis, data requirements, and recent developments and concepts applied in food security measurement. Data analysis of 78 articles shows that the household-level calorie adequacy indicator is the most frequently used (22%) as a sole measure of food security. The dietary diversity-based (44%) and experience-based (40%) indicators also find frequent use. The food utilisation (13%) and stability (18%) dimensions were seldom captured when measuring food security, and only three of the retrieved publications measured food security by considering all the four food security dimensions. The majority of the studies that applied calorie adequacy and dietary diversity-based indicators employed secondary data whereas most of the studies that applied experience-based indicators employed primary data, suggesting the convenience of collecting data for experience-based indicators than dietary-based indicators. We confirm that the estimation of complementary food security indicators consistently over time can help capture the different food security dimensions and components, and experience-based indicators are more suitable for rapid food security assessments. We suggest practitioners to integrate food consumption and anthropometry data in regular household living standard surveys for more comprehensive food security analysis. The results of this study can be used by food security stakeholders such as governments, practitioners and academics for briefs, teaching, as well as policy-related interventions and evaluations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40066-023-00415-7.

Brazilian National Food and Nutritional Security System: what are the similarities in the decentralization process?

This study aimed to analyze the multiple characteristics of the decentralization of the Brazilian National Food and Nutritional Security System (SISAN) in a period before the institutional dismantling. Data from the 26 Brazilian states were collected in two public information systems, referring to the years 2017/2018. An exploratory and descriptive study was performed using a hierarchical cluster analysis, based on an analysis model with multiple characteristics of the system decentralization. The results indicated the formation of three clusters, showing the similarity among states with greater intersectoral and participatory character, better relationship with municipalities, and allocation of resources. On the other hand, states with less intersectoral and participatory character, linked to the low allocation of resources, execution of food security actions, and municipal support were clustered. These clusters composed mainly of North and Northeastern states, with a lower Gross Domestic Product, average Human Development Index, and a higher occurrence of food insecurity, expressed characteristics that may be related to greater obstacles in the system decentralization process. This information can help in the decision-making about the SISAN in a more equitable manner, supporting the actors involved in its maintenance and defense, at a time when the country presents an austere political and economic situation, marked by the progressive worsening of food insecurity.

Simulating Potential Associated Socio-Economic Determinants With Sustainable Food Security (A Macro-Micro Spatial Quantitative Model)

Improving sustainable food security status, nowadays, is an important challenge globally, especially in developing countries. The policy goal should be equity—everyone has the same opportunity to be food secure—rather than equality—everyone gets the same subsidy. Since the culture and socioeconomic status within a country vary from region to region, collapsing all areas into a unique region may introduce errors and inaccurate results, as most studies carried out. This study assesses the geographical pattern of association between food security and socioeconomic factors in urban areas in Iran using a nationally and regionally representative household consumption-expenditure survey from 2010 to 2018. The logistic regression model and big data are used to achieve this goal. The results show that a substantial number of households face food insecurity in urban areas in Iran. Also, different geographic regions have various salient factors that affect food insecurity. Aggregation tests confirmed that researchers should estimate separate models for different provinces, states, and districts to assess and monitor the food security status of a country instead of estimating a unique model for the whole of the country. Geographical disparities should be considered as an important issue before suggesting any catch-all policies for a country. The geo-locational factor of households is a key determinant of the association between socioeconomic factors and food security in urban areas in Iran. In sum, the practical suggestions for improving Iranian households' food security in urban areas are as follows: (1) Developing job opportunities for the head of household. (2) Enhancing the potential for self-employment. (3) Facilitating the study of children within households including providing inexpensive uniforms, books, and materials, especially for poor households. (4) Supporting young couples in terms of accessing to financial resources and providing inexpensive essential equipment of home for them; and (5) Introduction of the importance of dietary diversity and different foods which can be cooked by using these food ingredients within a household. Comparative case studies using similar methodologies can test if our results are generalizable.

Pathways to food insecurity in the context of conflict: the case of the occupied Palestinian territory

BACKGROUND

Conflict reduces availability of production input and income, increases the number of days households had to rely on less preferred foods, and limits the variety of foods eaten and the portion size of meals consumed. While existing studies examine the impact of conflict on different food security measures (e.g., Food Consumption Score, Food Insecurity Experience Scale), the relationship between these measures as well as their relationship with political, economic, and agricultural factors remain under explored. Food insecurity may not only be an externality of conflict but also food deprivation may be utilized as a weapon to discourage residency in contested territories or to incentivize rebellions.

METHODOLOGY

This paper examines the association between political factors (e.g., violence, policies that require permit for passage in one's own hometown), economic factors (e.g., loss of assets, unemployment), agricultural factors (e.g., shortage of water, poor weather conditions), and food insecurity experience and dietary diversity in a conflict setting-that of the occupied Palestinian territory (oPt). The study employs generalized structural equation models to analyze the 'Survey on socio-economic conditions for Palestinian households 2014' dataset compiled by the Palestinian Central Bureau of Statistics-which contains a representative sample of the population in the oPt at governorate and locality levels.

RESULTS

We find that in the West Bank, residence in Area C-administered by Israel in both civil and security issues and contains illegal Israeli settlements and outposts-is associated with a higher level of agricultural hardship (p < 0.01) but lower economic hardship (p < 0.01) and a higher dietary diversity (p < 0.001), as compared to those living outside of Area C. In the Gaza Strip, living within one kilometer to a buffer zone is associated with lower dietary diversity (p < 0.01), higher level of political hardship (p < 0.01), and higher level food insecurity experience (p < 0.01) compared to not living in close proximity to a buffer zone. Concomitantly, in the Gaza Strip, food insecurity experience is associated with approximately a one-point reduction in dietary diversity as measured by the food consumption score (p < 0.01).

CONCLUSIONS

The results suggest that broader socio-political conditions in the oPt impact different aspects of food security through augmenting the economic and agricultural hardships that are experienced by the residents. As such, it is important to address these broader political and economic structures in order to have more sustainable interventions in reducing food insecurity.

The Household Food Security Implications of Disrupted Access to Basic Services in Five Cities in the Global South

COVID-19 has caused significant disruptions regarding the extent to which households can access basic services and resources in cities around the world. Previous studies have indicated a predictive relationship between the consistency of resource access and food access among urban households. These investigations, however, have predominantly been isolated to Southern Africa and have not accounted for other dimensions of food security. To test whether these results are observable outside Southern Africa, and with a more multidimensional measure of food security, this investigation proposes a method for building an index of urban household food access, utilization and stability. The scores for the constructed index are then compared across household survey samples collected from five cities in the Global South. The investigation then assesses the predictive relationship between the consistency of household resource access and this more multidimensional index of food insecurity. While the general trend of inconsistent resource access predicting food insecurity is confirmed, there are geographic differences in the strength and quality of this relationship. These findings suggest that the resource access disruptions inflicted by COVID-19 will likely have a heterogeneous impact on urban food security dependent upon the affected resource and the city in which a given household resides.

National Trends and Disparities in Severe Food Insecurity in Brazil between 2004 and 2018

Background

The Brazilian Household Food Insecurity Measurement Scale (EBIA) is the main tool for assessing household food insecurity (FI) in Brazil and facilitates the monitoring and improvement of national public policies to promote food security. Since 2004, the Brazilian government has conducted National Household Sample Surveys, and in 2018, the government carried out the last national evaluation of FI.

Objectives

To describe trends in severe FI in Brazil from 2004 to 2018.

Methods

Data from 3 cross-sectional Brazilian National Household Sample Surveys (sample sizes: 2004 = 112,530; 2009 = 120,910; 2013 = 116,196) and from the last Household Budget Survey (sample size = 57,920) that assessed the status of FI using the EBIA were analyzed. Changes in severe FI during 2 periods (2004-2013; 2013-2018) were estimated while considering sociodemographic factors.

Results

The period between 2004 and 2013 was marked by a significant decrease in severe FI (-53.6%), but this trend reversed in 2013-2018 (+43.8%). The greatest decrease in severe FI occurred in the Northeast (-57.6%) among households where the reference person was a man (-57.6%) and self-identified as white (-58.1%) (2004-2013). In 2013-2018, households with children aged ≤4 y (+6.3%) and members aged ≥65 y (+12.5%) experienced the lowest increases in severe FI.

Conclusions

After a significant reduction from 2004 to 2013, severe FI increased sharply from 2013 to 2018, likely due to disruptions in public policies aimed at reducing hunger and unemployment rates.

Prevalence and Factors Associated with Food Insecurity among Older Adults in Sub-Saharan Africa: A Systematic Review

Food insecurity has been undermining the health and well-being of a growing number of older adults in Sub-Saharan Africa. This review aimed to examine the prevalence of food insecurity and the related contributing factors of food insecurity among older adults in Sub-Saharan Africa. We used PubMed, Scopus, ScienceDirect, and Web of Science Core Collection as our search engines and included 22 articles for data extraction. Prevalence of severe and moderate food insecurity in households with older adults ranged from 6.0 to 87.3% and from 8.3 to 48.5%, respectively. Various socio-economic (e.g., low education level, being widowed, low income, lower wealth position of households, living in a rental house, living in rural areas, lack of social grants or pensions), demographic (e.g., female, Black racial group, larger family size), and health and nutrition status-related (e.g., self-reported poor health status, having a functional and mobility-related disability, psychological disorders) factors influence food insecurity in older adults in Sub-Saharan Africa. The findings of this review can help stakeholders to prioritize the issue of food insecurity, design and implement policies and programs to improve food security among older adults in Sub-Saharan Africa.

The relationship between dietary intake and stunting among pre-school children in Upper Egypt

OBJECTIVE

Linear growth is controlled by several factors, malnutrition is one of the leading causes of stunted child growth. The objective of this study was to determine the dietary intakes associated with stunting among pre-school children in rural Upper Egypt.

DESIGN

Community-based cross-sectional study.

SETTING

Data were collected by interviewing the children's caregivers in the rural household setting.

PARTICIPANTS

The study included 497 pre-school children aged 2-5 years in rural Upper Egypt. Food intake data were estimated using 24-h recall method. Anthropometric measurements of children were taken and then converted to z-scores for weight-for-age Z-score, height-for-age Z-score and weight-for-height Z-score.

RESULTS

The study included 497 children of which 19·1 % were stunted, 76·3 % did not meet recommended energetic intake and 13·7 % did not meet recommended protein intake and this was significantly higher than non-stunted children. Children who were stunted significantly consumed poultry, eggs and fruits less often than non-stunted children, by regression; male sex (adjusted odds ratio (aOR) = 1·91), mother's age (0·93), lower socio-economic status (SES); and not meeting recommended protein intake (aOR = 2·26) were found to be associated with stunting.

CONCLUSION

Male sex, younger mothers, lower SES and not meeting recommended energy and protein were statistically associated with stunting. Nutrition education messages encouraging adequate and healthy eating are recommended.

Spatial analysis of food security in Iran: associated factors and governmental support policies

This study analyzes caloric intake in Iran as a proxy for food security to determine factors associated with caloric intake that could be impacted by policies. We modeled regional heterogeneity by analyzing a complete countrywide dataset disaggregated for rural intra-provincial areas using unique data from the Iranian Statistical Centre for 2007-2016. We applied logistic regression modeling and likelihood ratio tests to assess the association between socio-economic determinants and caloric intake among rural areas of all provinces. National policies (nation-wide food subsidies and a cash equivalent for food for each adult regardless of residence or income) had significant negative associations with caloric intake among all provinces. The detected spatial diversity suggests policies specific to each area could be more effective than a centralized national policy for food security. Rather than implementing one-size-fits-all policies, such as across-the-board cash food subsidies, the government should take a differential spatially targeted approach to directly support low-income households.

Validity of the Food Insecurity Experience Scale (FIES) for Use in League of Arab States (LAS) and Characteristics of Food Insecure Individuals by the Human Development Index (HDI)

BACKGROUND

The Food Insecurity Experience Scale (FIES) is a UN FAO Voices of the Hungry (FAO-VoH) experiential metric of food insecurity (FI). It was pilot tested in some countries but not in Arab speaking ones and validated using global data. Yet, its psychometric properties may vary in the League of Arab States (LAS) due to cultural and linguistic differences.

OBJECTIVES

1) assess the validity of FIES for use in the LAS region, 2) determine the prevalence of FI, by gender, age group, and the human development index (HDI), and 3) examine sociodemographic characteristics of severe FI individuals.

METHODS

To assess the psychometric properties of FIES, Rasch modeling was applied to the 2014-2015 Gallop World Poll (GWP) in the LAS. Prevalence and characteristics of severely FI individuals were assessed using the 2014-2017 GWP data of 62,261 respondents.

RESULTS

Overall, FIES met the Rasch model assumptions of equal discrimination and conditional independence. Infit statistics for FIES items, in most LAS countries, were <1.3, indicating good internal validity. In Syria and Sudan, the item "worried about not having enough food to eat" had infits >1.3. Outfit statistics >2.0, indicating erratic responses, were noted in 26% of the LAS countries. Significant correlations were found (≥0.4) between items in Algeria, Tunisia, and Lebanon. The overall prevalence of severe FI was 15.7%. At highest risk were those aged ≥50 y compared with younger adults (16.5% versus 15.5%, respectively, P <0.02), women compared with men (17.6% versus 14.1%, respectively, P <0.0001), and those in countries with low HDI compared with high HDI (24.9% versus 8.3%, respectively, P <0.0001).

CONCLUSIONS

Overall, FIES is valid for measuring FI in the LAS. Cognitive testing of items with high outfit statistics and omission of correlated ones may improve the scale. Populations vulnerable to severe FI include older adults and women. These populations should be examined further.

Cross-national analysis of food security drivers: comparing results based on the Food Insecurity Experience Scale and Global Food Security Index

The second UN Sustainable Development Goal establishes food security as a priority for governments, multilateral organizations, and NGOs. These institutions track national-level food security performance with an array of metrics and weigh intervention options considering the leverage of many possible drivers. We studied the relationships between several candidate drivers and two response variables based on prominent measures of national food security: the 2019 Global Food Security Index (GFSI) and the Food Insecurity Experience Scale’s (FIES) estimate of the percentage of a nation’s population experiencing food security or mild food insecurity (FI<mod). We compared the contributions of explanatory variables in regressions predicting both response variables, and we further tested the stability of our results to changes in explanatory variable selection and in the countries included in regression model training and testing. At the cross-national level, the quantity and quality of a nation’s agricultural land were not predictive of either food security metric. We found mixed evidence that per-capita cereal production, per-hectare cereal yield, an aggregate governance metric, logistics performance, and extent of paid employment work were predictive of national food security. Household spending as measured by per-capita final consumption expenditure (HFCE) was consistently the strongest driver among those studied, alone explaining a median of 92% and 70% of variation (based on out-of-sample R2) in GFSI and FI<mod, respectively. The relative strength of HFCE as a predictor was observed for both response variables and was independent of the countries used for model training, the transformations applied to the explanatory variables prior to model training, and the variable selection technique used to specify multivariate regressions. The results of this cross-national analysis reinforce previous research supportive of a causal mechanism where, in the absence of exceptional local factors, an increase in income drives increase in food security. However, the strength of this effect varies depending on the countries included in regression model fitting. We demonstrate that using multiple response metrics, repeated random sampling of input data, and iterative variable selection facilitates a convergence of evidence approach to analyzing food security drivers.

A self-applied valid scale for rapid tracking of household food insecurity among pregnant women in Sri Lanka

Rapid household food insecurity (HFI) tracking has been identified as a priority in the context of the COVID-19 pandemic and its aftermath. We report the validation of the Latin American and Caribbean Food Security Scale (Escala Latinoamericana y Caribena de Seguridad Alimentaria [ELCSA]) among pregnant women in Sri Lanka. The eight-item adult version of the ELCSA was translated from English to Sinhala and Tamil. Cognitive testing (on 10 pregnant women and five local experts) and psychometric validation of the self-administered HFI tool were conducted among pregnant women (n = 269) attending the special clinics of the Rajarata Pregnancy Cohort (RaPCo) in Anuradhapura in February 2020. We assessed the psychometric properties and fit using a one parameter logistic model (Rasch model analysis) using STATA Version 14 and WINSTEP software Version 4.3.4. Concurrent validity was tested using psychological distress. The scale was internally consistent (Cronbach's alpha = 0.79) and had a good model fit (Rasch items infit statistic range: 0.85 to 1.07). Item 8 ('did not eat for the whole day') was removed from the model fit analysis, as it was not affirmed by respondent. Item severity scores ranged from -2.15 for 'not eating a diverse diet' to 4.43 for 'not eating during the whole day'. Concurrent validity between HFI and psychological distress was confirmed (r = 0.15, p < 0.05). The self-applied version of ELCSA-pregnancy in Sri Lanka (ELCSA-P-SL) is a valid and feasible valid tool. We recommend it to track HFI among pregnant women in lower income countries during the COVID-19 pandemic.

Exploring the Drivers and the Interventions towards Sustainable Food Security in the Food Supply Chain

The sustainability of food security is a global concern, and one of the priorities related to it is the ability to identify effective efforts that can protect food security along the food supply chain (FSC). The present study demystifies the relation of sustainability and food security and structurally identifies the sustainable drivers, and the pragmatic interventions that can critically contribute to the sustainability of food security within each stage of the FSC. A systematic review of articles from six databases was implemented. Thematic analysis was engaged to detect the sustainable drivers and interventions practised at each stage in the FSC for food security purposes. Six main themes of the drivers and interventions were derived from the analysis: food security governance involvement, input resource management, output management, information sharing, income, and technology. The result identifies the potential that quality management has on the mediating effect towards sustainable food security, through which a conceptual model for sustainable food security in the FSC was thus developed. It is deduced that mapping and categorizing the drivers and intervention of sustainable food securities could help deepen the understanding of effective and innovative practices towards food security in the FSC.

Household food insecurity and early childhood development: Systematic review and meta-analysis

Household food insecurity (HFI) is a powerful stressor negatively associated with early childhood development (ECD). However, no comprehensive review has examined the association of HFI and ECD. Therefore, this systematic review and meta-analysis investigated the association between HFI and ECD domains and subdomains in children under 5 years old. Peer-reviewed and grey literature were systematically searched in electronic databases with no year or language restrictions. Studies were eligible if they assessed the association between HFI and one or more ECD domains. Data were extracted using a standard predefined protocol. Meta-analysis was performed, and the heterogeneity across studies was explored. Nineteen studies were included in the systematic review and 14 in the meta-analysis. Of the studies, 15 were from high income countries (HICs) and four from low-middle income countries (LMICs). For developmental risk and the cognitive/math and cognitive/school readiness and reading subdomains, the only studies available were conducted in HICs. The meta-analysis showed that HFI was associated with developmental risk (OR 1.28; 95% CI [1.14, 1.45]), cognitive/vocabulary (OR 0.94; 95% CI [0.90, 0.98]), and cognitive/math (OR 0.84; 95% CI [0.73, 0.96]). HFI was marginally associated with cognitive/school readiness and reading (OR 0.91; 95% CI [0.82, 1.00]) and motor development (OR; 0.91, 95% CI [0.80, 1.04]). HFI was associated with poor ECD in children under 5 years old. Specifically, HFI was associated with developmental risk and poor math skills in studies conducted in HICs and with poor vocabulary skills in studies conducted in both HICs and LMICs. Prospective studies examining HFI and ECD are needed in LMICs.

What is the food and nutrition security situation of Santa Catarina municipalities? Results of a multidimensional assessment

ABSTRACT Objective To describe the food and nutrition security situation of all municipalities of a Brazilian state. Methods The investigation was conducted using an assessment matrix developed through consensus workshops. The matrix is composed of 7 dimensions, 11 subdimensions, 27 indicators, and 59 items. Data were collected at the municipal level from different public databases using the state of Santa Catarina as the case study basis. Municipalities were classified according to their food and nutrition security situation as poor, fair, good, or excellent. Results Of the 295 Santa Catarina municipalities, 65.4% were rated as poor or fair in terms of food and nutrition security. The best-rated dimension was Continuing education, research, and training in food and nutrition security, followed by Agroecological production and sustainable food supply and Universal access to water and sanitation. The dimensions with the worst results were Food and nutrition at all levels of healthcare, Universal access to adequate food, and Assessment and monitoring. The dimension Traditional peoples and communities could not be evaluated because data were not available at the municipal level. Conclusion This study evidenced the need for a careful examination of the reality of Santa Catarina municipalities, as it made it possible to qualitatively characterize public policies within the context of food and nutrition security. The findings may contribute to the debate on evaluation and assist managers in strengthening food and nutrition security policies in Brazilian municipalities.

Intakes of energy, macronutrients and micronutrients of a population in severe food insecurity risk in Brazil

OBJECTIVE

To analyse usual intakes of energy, macronutrients and micronutrients, and their percentage of inadequacy, in a Brazilian population at severe food insecurity (SFI) risk, determined from a predictive model using two national databases.

DESIGN

Cross-sectional study. Our study used a statistical model to predict SFI using the 2009 National Sample Household Survey, where the Brazilian Food Insecurity Scale measured SFI.

SETTING

Brazil.

PARTICIPANTS

The model was applied in a probabilistic sample of 34 003 Brazilians aged 10 years or older that participated in a national dietary survey during 2008-2009. The application of the model generated the probability of each individual being in SFI. The probability of SFI was grouped into quartiles (first quartile with the lowest SFI risk, fourth quartile with highest probability of SFI risk).

RESULTS

The intakes of macro- and micronutrients were associated with SFI. The amount of energy and nutrients in the diet tended to be lower among individuals in the fourth quartile, with highest probability of SFI. The average intake of all studied minerals (Ca, Fe, Na, Mg) was less in individuals in the fourth quartile. Only Na presented a higher percentage of inadequacy in the first quartile, the one with a lower chance of SFI.

CONCLUSIONS

The food intake of the Brazilian population at higher SFI risk is characterized by energy reduction, reduced consumption of macronutrients and high prevalence of inadequate micronutrient intakes, as well as a lower mean intakes, when compared with the first quartile with the lowest SFI risk.

The Household Water InSecurity Experiences (HWISE) Scale: development and validation of a household water insecurity measure for low-income and middle-income countries

Objective

Progress towards equitable and sufficient water has primarily been measured by population-level data on water availability. However, higher-resolution measures of water accessibility, adequacy, reliability and safety (ie, water insecurity) are needed to understand how problems with water impact health and well-being. Therefore, we developed the Household Water InSecurity Experiences (HWISE) Scale to measure household water insecurity in an equivalent way across disparate cultural and ecological settings.

Methods

Cross-sectional surveys were implemented in 8127 households across 28 sites in 23 low-income and middle-income countries. Data collected included 34 items on water insecurity in the prior month; socio-demographics; water acquisition, use and storage; household food insecurity and perceived stress. We retained water insecurity items that were salient and applicable across all sites. We used classical test and item response theories to assess dimensionality, reliability and equivalence. Construct validity was assessed for both individual and pooled sites using random coefficient models.

Findings

Twelve items about experiences of household water insecurity were retained. Items showed unidimensionality in factor analyses and were reliable (Cronbach's alpha 0.84 to 0.93). The average non-invariance rate was 0.03% (threshold <25%), indicating equivalence of measurement and meaning across sites. Predictive, convergent and discriminant validity were also established.

Conclusions

The HWISE Scale measures universal experiences of household water insecurity across low-income and middle-income countries. Its development ushers in the ability to quantify the prevalence, causes and consequences of household water insecurity, and can contribute an evidence base for clinical, public health and policy recommendations regarding water.

Empirical Framework for a Relative Sustainability Evaluation of Urbanization on the Water⁻Energy⁻Food Nexus Using Simultaneous Equation Analysis

The water–energy–food (WEF) nexus attracts much attention due to the elevated public concern regarding environmental conservation and sustainability. As we head into a new era of civilization, population increase and modernized lifestyles have led to an increasing need for water, energy, and food. However, severe hydrological precipitation significantly impacts agricultural harvest, and such influence becomes more apparent under the influence of climate change. Meanwhile, the major method of electricity generation (i.e., fossil fuel burning) has a negative impact on the environment. These inevitable threats are crucial and have to be dealt with for a society on the road towards sustainability. In the present study, an integrated evaluation of the WEF nexus was conducted for two areas with different levels of urbanization using empirical multiple linear regression in a simultaneous equation model (SEM). By incorporating the collected data into the SEM, the weighting coefficient of each identified variable was obtained, and the nexus implication was assessed in model simulation at different scenarios considering the population growth, agro-technology advancement, energy structure improvement, and available water resources. In the simulated results, three observations were found: (1) the rural area is more sustainable than the urban one; (2) the sustainability for both the investigated areas is significantly subject to their water supply and demand; and (3) food production was found to have a less important effect on the sustainable development of the urban area. This study identified the key factors in the WEF nexus exploration, which are economically and environmentally important for resource allocation. An empirical model was developed to correlate sustainable achievement with WEF management, as well as strategic policies that should be implemented under the pressure of urbanization.

Food security and food self-sufficiency around the world: A typology of countries

The particularities of agriculture, as a sector which ensures food supply, result from many factors, including the multilateral interaction between the environment and human activity. The extent of human intervention in the food production process is usually measured with the amount of capital expenditure. Therefore, the food production potential and the resulting food security depend on both natural and economic factors. This paper identifies the current status of food security in different countries around the world, considering both aspects (physical and economic availability) combined together. The variables published by FAO were used together with a variable estimated based on the author’s own methodology to identify 8 groups of countries characterized by economic development level, net trade in agricultural products, and selected variables related to agriculture and food situation. As shown by this study, the degree to which food security is ensured with domestic supply varies strongly across the globe. Domestic production provides a foundation for food security in wealthy countries, usually located in areas with favorable conditions for agriculture (including North America, Australia, New Zealand, Kazakhstan) and in countries which, though characterized by a relatively small area of arable land per capita, demonstrate high production intensity (mainly European countries). International trade largely contributes to food security in Middle East and North African countries as well as in selected South American countries which are net importers of food products. The most problematic food situation continues to affect Sub-Saharan Africa and Central Asia.

Modelling the impacts of global multi-scale climatic drivers on hydro-climatic extremes (1901-2014) over the Congo basin

The knowledge of interactions between oceanic and atmospheric processes and associated influence on drought episodes is a key step toward designing robust measure that could support government and institutional measures for drought preparedness to promote region-specific drought risk-management policy solutions. This has become necessary for the Congo basin where the preponderance of evidence from few case studies shows long-term drying and hydro-climatic extremes attributed to perturbations of the nearby oceans. In this study, statistical relationships are developed between observed standardised precipitation index (SPI) and global sea surface temperature using principal component analysis as a regularization tool prior to the implementation of a canonical scheme. The connectivity between SPI patterns and global ocean-atmosphere phenomena was thereafter examined using the output from this scheme in a predictive framework based on non-linear autoregressive standard neural network. The Congo basin is shown to have been characterized by persistent and severe multi-year droughts during the earlier (1901-1930) and latter (1991-2014) decades of the last century. The impacts of these droughts were extensive affecting more than 50% of the basin between 1901 and 1930 and about 40% during the 1994-2006 period. Analysis of the latest decades (1994-2014) shows that relative to the two climatological periods between 1931 and 1990, the Congo basin has somewhat become drier. This likely contributed to the observed change in the hydrological regimes of the Congo river (after 1994) as indicated by the relationship between SPI and runoff index (r = 0.69 and 0.64 for 1931-1990 and 1961-1990 periods, respectively as opposed to r = 0.38 for 1991-2010 period). Pacific ENSO influences large departures in precipitation (r = 0.89) but prediction skill metrics demonstrate that multi-scale ocean-atmosphere phenomena (R² = 84%, 78%, and 77% for QBO, AMO, and ENSO, respectively) significantly impact on hydro-climatic extremes, especially droughts over the Congo basin.

Development and validation protocol for an instrument to measure household water insecurity across cultures and ecologies: the Household Water InSecurity Experiences (HWISE) Scale

INTRODUCTION

A wide range of water-related problems contribute to the global burden of disease. Despite the many plausible consequences for health and well-being, there is no validated tool to measure individual- or household-level water insecurity equivalently across varying cultural and ecological settings. Accordingly, we are developing the Household Water Insecurity Experiences (HWISE) Scale to measure household-level water insecurity in multiple contexts.

METHODS AND ANALYSIS

After domain specification and item development, items were assessed for both content and face validity. Retained items are being asked in surveys in 28 sites globally in which water-related problems have been reported (eg, shortages, excess water and issues with quality), with a target of at least 250 participants from each site. Scale development will draw on analytic methods from both classical test and item response theories and include item reduction and factor structure identification. Scale evaluation will entail assessments of reliability, and predictive, convergent, and discriminant validity, as well as the assessment of differentiation between known groups.

ETHICS AND DISSEMINATION

Study activities received necessary ethical approvals from institutional review bodies relevant to each site. We anticipate that the final HWISE Scale will be completed by late 2018 and made available through open-access publication. Associated findings will be disseminated to public health professionals, scientists, practitioners and policymakers through peer-reviewed journals, scientific presentations and meetings with various stakeholders. Measures to quantify household food insecurity have transformed policy, research and humanitarian aid efforts globally, and we expect that an analogous measure for household water insecurity will be similarly impactful.

Validity of the Food Insecurity Experience Scale for Use in Sub-Saharan Africa and Characteristics of Food-Insecure Individuals

BACKGROUND

The Food Insecurity Experience Scale (FIES) is a UN FAO-Voices of the Hungry project (FAO-VoH) metric of food insecurity (FI). The FAO-VoH tested the psychometric properties of FIES with the use of global 2014 Gallup World Poll (GWP) data. However, similarities in its psychometric structure in sub-Saharan Africa (SSA) to allow aggregation of SSA results were untested.

OBJECTIVES

We aimed to 1) assess the validity of FIES for use in SSA, 2) determine the prevalence of FI by country, age group, and gender, and 3) examine the sociodemographic and economic characteristics of individuals with FI.

METHODS

The Rasch modeling procedure was applied to data collected by GWP in 2014 and 2015 on 57,792 respondents aged ≥19 y in SSA.

RESULTS

FIES largely met the Rasch model assumptions of equal discrimination and conditional independence. However, 34.3% of countries had high outfits (≥2.0) for the item "went without eating for a whole day." Four countries had significant correlations for the items "were hungry but did not eat" and "ran out of food." The overall prevalence of severe FI (SFI) was 36.4%, ranging from 6.0% in Mauritius to 87.3% in South Sudan. Older adults were at significantly higher risk of SFI than younger adults (38.6% and 35.8%, respectively, P < 0.0001), and women more than men (37.3% and 35.4%, respectively, P < 0.0001). Higher proportions of individuals with SFI were rural residents, less educated, lower income, unemployed, and lived in households with many children under the age of 15 y.

CONCLUSIONS

FIES has acceptable levels of internal validity for use in SSA. However, the item "went without eating for a whole day" may need cognitive testing in a few SSA countries. For countries with correlated items, 1 of the items may be excluded.