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

Household food security and dietary diversity in south-eastern Nigeria

The aim of this study was to investigate household food security (access) level and the dietary diversity of households in the Nsukka Local Government Area in South-eastern Nigeria. From 20 local communities of Nsukka, 390 women were randomly sampled from the women's group and asked to complete a survey that determined the Household Food Insecurity Access Scale scores and the Household Dietary Diversity Scores (HDDS). The descriptive results indicated a high level of food insecurity with 82.6% households reporting various degrees of food insecurity. Over half of the sampled population experienced insufficient food quality. They either ate unwanted food (65.9%), limited variety (63.1%), or unpreferred food (64.6%). Some households experienced insufficient food intake by going a whole day without food (38.2%), go to sleep hungry (45.1%), or have no food of any kind (49%). The analysis of variance showed no significant difference (p = 0.428) in the food security level of households headed by males as compared with those headed by females. Approximately 53.6% of households fell at or below the average HDDS; males headed 48% of these households, while females headed 64%. The chi-square test indicated factors associated with household food security including age, education, work status and income, whereas the gender of the household head, household size and marital status were not significantly associated. Public-private partnerships, nutrition orientation and food intervention programs could improve food security in this area.

Food insecurity is associated with low diet quality and unhealthy cooking and eating habits in Iranian women

BACKGROUND

Food insecurity affects diet and nutrition intakes. We explored the relationship between food insecurity and dietary intakes in a group of Iranian women.

METHODS

The cross-sectional study was performed on 190 healthy females aged 20-55 years attending primary healthcare centers in Shiraz. Food insecurity was evaluated by Household Food Insecurity Access Scale, which is a validated tool for assessing food insecurity in developing countries. Diet was assessed using a food frequency questionnaire. The association of dietary patterns and food insecurity was assessed by linear regression.

RESULTS

Assessment of dietary intakes revealed that consumption of red meat, poultry, fish, dairy, fruits, non-starchy vegetables, and nuts decreased whereas that of grains, processed meats, potato, and sugary foods increased with increasing food insecurity. Among nutrients, carbohydrates, fiber, vitamin A, vitamin C, folic acid, potassium, calcium, and magnesium decreased while fat and sodium increased as food insecurity increased. Three major dietary patterns were detected. Healthy dietary patterns showed inverse associations with food insecurity in the crude (β = -0.422 and - 0.435, P < 0.001) and adjusted (adjusted for age, marital status, and educational level) (β = -0.475 and - 0.341, P < 0.001) models of regression analysis but unhealthy pattern did not show an association with food insecurity. Compared to food secure participants, a higher percentage of food insecure individuals indicated unhealthy eating habits, such as skipping breakfast, lower snack ingestion, more fast and fried food consumption, and using unhealthy cooking methods.

CONCLUSION

Overall, this study showed that food insecurity was associated with less healthy diet and unhealthy cooking and eating habits.

Outcomes of a homestead food production program on nutritional knowledge, dietary diversity, food security and empowerment of rural women in Tehran province, Iran

BACKGROUND

Food and nutrition insecurity is a major health issue in developing countries. Homestead food production (HFP) programs are strategies for improving food and nutrition security of a country. Iran implemented a HFP program entitled "Nutrition Improvement of Rural and Nomadic Women" in its villages for a five-year period from 2017. The current study assessed the outcomes of this mentioned program and its determinants among rural women in Tehran province.

METHODS

The population of this cross-sectional study comprised a group covered by the program (n = 143) and a non-covered group (n = 160). The participants were selected randomly from 32 villages of five counties in Tehran province. Data was collected using five questionnaires: (1) General information, (2) Women's empowerment, (3) Nutritional knowledge, (4) Dietary diversity, and (5) Household Food Insecurity Access Scale (HFIAS). Data was analyzed using the IBM SPSS version 21 and the IBM Amos SPSS version 22 software.

RESULTS

The results of the study showed no significant improvement in the expected indicators, such as frequency of home gardening, nutritional knowledge, dietary diversity, women's empowerment, and household food insecurity status among women covered by the program (p > 0.05). The structural equation modelling (SEM) results indicated that women's empowerment from the dimension of decision-making power (r = 0.151) and nutritional knowledge (r = 0.135) were the significant positive predictors of dietary diversity (p < 0.05), while household food insecurity predicted it negatively (r=-0.138) (p < 0.05).

CONCLUSION

Because the current evaluated program has not been able to improve the expected indicators, modification of the program implementation may be needed, such as: addressing the probable barriers and challenges and strengthening the facilities in the covered villages. The current study presents a model of the dietary diversity predictors for consideration in redesigning or enhancing the program.

Is household food insecurity related to mothers' stress, anxiety and depression in Iran?

Food insecurity is a public health concern with pervasive effects on numerous human biological factors. In addition to physical problems, food insecurity may have adverse social and psychological impacts. The present study aimed to determine the correlations between household food insecurity and stress, anxiety, and depression in mothers living in Mashhad, Iran. In this cross-sectional study we recruited 312 mothers. We collected data on the food insecurity status of households using the Household Food Insecurity Access Scale (HFIAS) and used the Depression Anxiety Stress Scale (DASS) to assess the levels of stress, anxiety, and depression in the subjects. The prevalence rate of food insecurity was 51.9%, and the prevalence rate of stress, anxiety, and depression was 70.2%, 70.2%, and 55.1%, respectively. In the food-insecure group, 94.3% of the mothers had stress, 91.4% had anxiety, and 87.1% had depression. While in the food-secure group, 60.7%, 61.3%, and 37.3% of the mothers had stressed, anxiety, and depression, respectively. In all the analytical models, food insecurity was significantly and positively associated with stress, anxiety, and depression (P < 0.001). Our results suggested that a higher level of food insecurity correlates with extreme degrees of stress, anxiety, and depression. Therefore, the improvement of mothers' mental health in terms of stress, anxiety, and depression depends on the improvement of household food insecurity.

Food insecurity status and its contributing factors in slums' dwellers of southwest Iran, 2021: a cross-sectional study

BACKGROUND

One major factor causing food insecurity is believed to be poverty. Approximately 20 million Iranians live in slums with a vulnerable socioeconomic context. The outbreak of COVID-19, on top of the economic sanctions against Iran, has increased this vulnerability and made its inhabitants prone to food insecurity. The current study investigates food insecurity and its associated socioeconomic factors among slum residents of Shiraz, southwest Iran.

METHODS

Random cluster sampling was used to select the participants in this cross-sectional study. The heads of the households completed the validated Household Food Insecurity Access Scale questionnaire to assess food insecurity. Univariate analysis was utilized to calculate the unadjusted associations between the study variables. Moreover, a multiple logistic regression model was employed to determine the adjusted association of each independent variable with the food insecurity risk.

RESULTS

Among the 1227 households, the prevalence of food insecurity was 87.20%, with 53.87% experiencing moderate and 33.33% experiencing severe food insecurity. A significant relationship was observed between socioeconomic status and food insecurity, indicating that people with low socioeconomic status are more prone to food insecurity (P < 0.001).

CONCLUSIONS

The current study revealed that food insecurity is highly prevalent in slum areas of southwest Iran. The socioeconomic status of households was the most important determinant of food insecurity among them. Noticeably, the coincidence of the COVID-19 pandemic with the economic crisis in Iran has amplified the poverty and food insecurity cycle. Hence, the government should consider equity-based interventions to reduce poverty and its related outcomes on food security. Furthermore, NGOs, charities, and governmental organizations should focus on local community-oriented programs to make basic food baskets available for the most vulnerable households.

Prevalence of depression, anxiety, and suicidal ideation during the Shanghai 2022 Lockdown: A cross-sectional study

BACKGROUND

Common mental disorders and suicidal ideation are associated with exposures to COVID-19 pandemic stressors, including lockdown. Limited data is available on the effect of city-wide lockdowns on population mental health. In April 2022, Shanghai entered a city-wide lockdown that sealed 24 million residents in their homes or residential compounds. The rapid initiation of the lockdown disrupted food systems, spurred economic losses, and widespread fear. The associated mental health effects of a lockdown of this magnitude are largely unknown. The purpose of this study is to estimate the prevalence of depression, anxiety, and suicidal ideation during this unprecedented lockdown.

METHODS

In this cross-sectional study, data were obtained via purposive sampling across 16 districts in Shanghai. Online surveys were distributed between April 29 and June 1, 2022. All participants were physically present and residents of Shanghai during the lockdown. Logistic regression was used to estimate the associations between lockdown-related stressors and study outcomes, adjusting for covariates.

FINDINGS

A total of 3230 Shanghai residents who personally experienced the lockdown participated the survey, with 1657 (55.5 %) men, 1563 (44.3 %) women, and 10 (0.02 %) other, and a median age of 32 (IQR 26-39), who were predominately 3242 (96.9 %) Han Chinese. The overall prevalence of depression based on PHQ-9 was 26.1 % (95 % CI, 24.8 %-27.4 %), 20.1 % (18.3 %-22.0 %) for anxiety based on GAD-7, and 3.8 % (2.9 %-4.8 %) for suicidal ideation based on ASQ. The prevalence of all outcomes was higher among younger adults, single people, lower income earners, migrants, those in poor health, and with a previous psychiatric diagnosis or suicide attempt. The odds of depression and anxiety were associated with job loss, income loss, and lockdown-related fear. Higher odds of anxiety and suicidal ideation were associated with being in close contact with a COVID-19 case. Moderate food insecurity was reported by 1731 (51.8 %), and 498 (14.6 %) reported severe food insecurity. Moderate food insecurity was associated with a >3-fold increase in the odds of screening for depression and anxiety and reporting suicidal ideation (aOR from 3.15 to 3.84); severe food insecurity was associated with >5-fold increased odds for depression, anxiety, and suicidal ideation (aOR from 5.21 to 10.87), compared to being food secure.

INTERPRETATION

Lockdown stressors, including food insecurity, job and income loss, and lockdown-related fears, were associated with increased odds of mental health outcomes. COVID-19 elimination strategies including lockdowns should be balanced against the effects on population wellbeing. Strategies to avoid unneeded lockdown, and policies that can strengthen food systems and protect against economic shocks are needed.

FUNDING

Funding was provided by the NYU Shanghai Center for Global Health Equity.

Anemia Among Women Using Family Planning at Public Health Facilities in Ambo Town, Central Ethiopia: Multi-Center Cross-Sectional Study

Background

Anemia affects more than a quarter of non-pregnant women over the globe, with Sub-Saharan Africa bearing a disproportionate share. Although the use of family planning is beneficial in reducing anemia, lack of scientific study on anemia among family planning users of reproductive-age women is notable, particularly in the study setting. The purpose of this study was to determine the extent of anemia and associated factors in women who used family planning.

Methods

A cross-sectional multi-centered study was conducted from March 3 to 29, 2019, among 443 non-pregnant reproductive age (15 to 49 years) women receiving family planning services in Ambo town. Sample size was calculated using Epi-info version 7 software. Participants were selected by systematic random sampling technique. Trained data collectors collected data using a structured pretested questionnaire, as well as venous blood and stool samples. Epi-Data and SPSS were used to enter and analyze data. The effect of independent variables on the outcome variable was determined by binary logistic regression analysis with adjusted odds ratio at 95% confidence interval and 5% margin of error. P-value <0.05 was used to declare statistical significance.

Results

This study revealed 28% (95% CI:23.9%, 32.3%) magnitude of anemia. Age of 25-35 years [AOR:2.84, 95% CI:1.74, 4.64], implantable family planning method [AOR: 0.34, 95% CI: 0.12, 0.96], no previous use of family planning [AOR:2.62, 95% CI: 1.62, 4.24], household food insecurity [AOR: 2.04, 95% CI: 1.06, 3.93], parasite infestations [AOR:2.01, 95% CI: 1.12, 3.63], and regular intake of coffee/tea within 30 minutes post meal [AOR:3.85, 95% CI:1.24, 11.92] were independently associated with anemia.

Conclusion

Anemia is a moderate public health concern among reproductive-age women receiving family planning services in the study area. There are missed opportunities to address the anemia burden during family planning services. This study emphasizes the importance of nutritional screening for early detection and targeted interventions for healthcare workers in reducing missed opportunities to prevent and control anemia in vulnerable populations.

Household food insecurity and associated factors in the Northeast of Iran: a cross-sectional study : Household food security in Northern Iran

BACKGROUND

Food Insecurity (FI) is a global health concern. For the first time, this study evaluated households' food insecurity and factors related to it in Golestan province, North of Iran.

METHODS

This cross-sectional study was conducted on 5129 randomly selected households in the Golestan Province in 2016. Sociodemographic characteristics, including age, ethnicity, household size, education level, and occupation status, were collected via interview. The prevalence and severity of food insecurity were identified by the Household Food Insecurity Access Scale (HFIAS), whose scores are between 0 and 27, with larger values indicating more severe food insecurity. The prevalence of food insecurity based on the geographical area was presented using GIS.

RESULTS

Out of 5129 households, 2216 (43.21%) had food security, and 2913 (56.79%) households had food insecurity, with a Mean ± SD HFIAS score of 4.86 ± 5.95. Out of 2913 households with FI, 1526 (52.39%), 956 (32.82%), and 431 (14.79%) had mild, moderate, and severe food insecurity, respectively. Among 14 regions of the province, three regions had the most cases of food insecurity. Food insecurity (moderate or severe) was significantly associated with mothers as the household head (adjusted OR = 1.67, 95% CI: 1.03-2.70) and lower education level of the household head.

CONCLUSION

The prevalence of household food insecurity in the Golestan Province is higher than the national average. Factors such as literacy, employment status, and gender of the household head can be significantly associated with food insecurity.

Impacts of urban safety net on income, food expenditure and intake capacity of poor households in Addis Ababa city, Ethiopia, 2021

Although measures taken to address food insecurity and income inequality showed notable outcomes, they have continued to be major global issues mainly in urban areas of developing countries. To relieve these problems, Ethiopia started an urban safety net program in Addis Ababa city in 2017. The purpose of this study was to investigate the impacts and progress of the urban safety net program, mainly its cash transfers (CTs) on income, consumption, and food security of poor households using indicators based on elements of a theory of change and Engel's coefficient. It assessed whether the program was significant (or not) to program beneficiaries compared to situations before the start of the program, non-beneficiaries, and beneficiaries' sex. A total of 560 sample households were selected through a multi-stage sampling for household surveys. Comparative approaches, paired and independent t-tests, and linear regression were used to analyze the data. Results revealed that the CTs had a satisfactory targeting accuracy of the poor and produced positive effects on monthly income, savings, food expenditures and intake, and seed money for a business start. Since financial transfers account for a larger proportion of the income of households, current income becomes significantly bigger compared to income during the pre-program periods and non-beneficiary households. Food access, expenditure, and savings capacities of beneficiaries in post-CT became better than in pre-CT along with better food access and diet intake two to three a day than non-beneficiaries. Besides, coverage and benefits were statistically significant for women compared to men. The implementation of the urban safety net program is good in its positive impacts and progress toward nutrition and food security of poor households as a result of an increase in their income, food expenditure, intake, and access. This implies policymakers could potentially expect to see improvements in nutrition and food security, especially when targeting urban poor and female-headed households. However, delays in payments and work equipment, declining size and value of payments, and weak supplementary services are the program's shortcomings. Policy implications to improve the size of transfers, emergency aids, timely payments and equipment provisions, and interventions like regular business training, supervision, and guidance are recommended.

Determinants and consequences of food insecurity in families having children under the age of 2 years

Background: Today, food insecurity is recognized as an important public health problem that can have detrimental effects on families. Aim: The aim of this study was to assess the determinants and consequences of food insecurity in families having children under the age of 2 years. Method: In this cross-sectional study, 307 mothers and their children under the age of 2 years were selected by stratified random sampling. Demographic and socioeconomic data were collected by completing questionnaires through face-to-face interview. Household food insecurity (HFI) status was determined using the United States Department of Agriculture (USDA) household food security questionnaire. Results: Based on the results, 67.4% of families were high food secure. Low and very low food security was 25.7% and 6.9%, respectively. House size (Beta = -0.019, 95% CI: -0.029, -0.009), father's job (Beta = -4.758, 95% CI:-6.777, -2.738), father education (Beta = -0.370, 95% CI: -0.717, -0.023), and economic status (Beta = -0.628, 95% CI: -0.809, -0.448) were significantly related to the USDA total food insecurity score (p < 0.05). Regression analysis showed that children birth weight, father's body mass index (BMI), and mother's waist circumference had a significant positive correlation with weight for age (Z-score) of children. Children's birth weight, father's BMI, and HFI status had significant and positive correlation with weight for length (Z-score). Moreover, the significant association between children's birth height, mother's BMI, and mother's waist circumference with length for age (Z-score) were observed (p < 0.05). Conclusion: We found the father's job was the most effective factor in food insecurity and economic status of the family was in the second place. Also, HFI had a relationship with weight status of children under the age of 2 years.

The association of food insecurity and cardiometabolic risk factors was independent of body mass index in Iranian women

Background

Investigations on food insecurity have shown that food insecurity is inversely associated with health. We examined the association of food insecurity and cardiometabolic risk factors in women living in Shiraz, Iran.

Methods

The cross-sectional study was performed on 190 females. Food insecurity was assessed by Household Food Insecurity Access Scale. Cardiometabolic risk factors including anthropometric characteristics, blood pressure, and serum glucose and lipids were measured. Metabolic syndrome score was calculated according to the criteria described for Iranian adults. The association of food insecurity and cardiometabolic risk factors was assessed by linear regression.

Results

The prevalence of food security, and mild, moderate, and severe food insecurity was 42.6%, 40.5%, 15.8%, and 1.1%, respectively. Cardiometabolic risk factors worsened with increasing severity of food insecurity. Among the risk factors, body mass index (BMI) had the strongest association with food insecurity. After controlling demographic factors and BMI, fasting blood glucose, triglycerides, total, LDL, and HDL cholesterols, and metabolic syndrome score still showed significant associations with food insecurity (P < 0.01) but systolic and diastolic blood pressure were no longer associated with food insecurity after adjustment for BMI.

Conclusion

Overall, although BMI was strongly associated with food insecurity, cardiometabolic risk factors including blood glucose, triglycerides, total, HDL, and LDL cholesterols, and metabolic syndrome score were associated with food insecurity independent of BMI, suggesting that other factors such as lifestyle and diet may have contributed to the exacerbated cardiometabolic risk in food insecure participants of this study. Future studies need to clarify underlying factors in the association of food insecurity and cardiometabolic risk factors.

Is nutritional functional diversity in the rural food and nutrition system associated with food security and nutrient adequacy? A case study of rural areas of Zahedan district, Iran

BACKGROUND

An overlooked problem in food and nutrition system analysis is assuring adequate diversity for a healthy diet. Little is known about nutrient diversity in food and nutrition systems and how it transmits to dietary diversity. Nutritional functional diversity (NFD) is a metric that describes diversity in providing nutrients from farm to market and the consumption level. The objective of this study is to determine the NFD score at different stages of the rural food and nutrition system, including household's agricultural and home production, domestic food processing, purchased food, and diet. It also aims to explore the association between NFD and nutrient adequacy, food security, and anthropometric indicators.

METHODS

A cross-sectional study was conducted on 321 households in 6 villages of Zahedan district. The NFD score was measured at three subsystems (production, processing, and consumption) of the food and nutrition system. Household food security, mean adequacy ratio (MAR), and anthropometrics of the household's head were measured to assess the association between NFD and food and nutrition indicators. Linear and bivariate statistical techniques were applied to study the associations between variables.

RESULTS

In the rural food and nutrition system, the food purchased from the city plays the main role in the households NFD score. Their contribution to total NFD was twice that of the food items purchased from the village. The NFD score of homestead production and households food processing was found to be five times less than those of food purchased from cities. The food insecure households had significantly lower NFD scores for food purchased from the city and higher NFD scores for purchased food items from the rural market and native wild vegetable consumption. A strong and positive relationship was observed between NFD of food items purchased from the city and households'MAR. No significant association was found between the NFD score of homestead production, processing, and dependent variables, i.e. food insecurity, MAR, and household head anthropometrics.

CONCLUSION

NFD score, as a relatively new metric, could help in determining diversity from farm to diet and identifying the gaps to plan appropriate interventions for improving diversity in the local food system.

Food insecurity among Finnish private service sector workers: validity, prevalence and determinants

OBJECTIVE

To examine the prevalence and determinants of food insecurity among private sector service workers in Finland and assess validity of the Household Food Insecurity Access Scale (HFIAS) tool.

DESIGN

In this cross-sectional study, food insecurity and background characteristics were collected from Finnish private service workers via electronic questionnaires (2019) and national register data (2018-2019). We conducted univariate and multivariate logistic regression analyses to determine the variables explaining food insecurity. Validity of HFIAS was assessed with rotated principal component analysis and Cronbach's α.

SETTING

Members of the trade union for private sector service workers, Service Union United (PAM), from all municipalities in Finland participated in the study in 2019.

PARTICIPANTS

The subjects were 6435 private sector workers that were members of the Service Union United (PAM) in Finland. Mean age of participants was 44 years (sd 12·7 years).

RESULTS

Two-thirds of the participants (65 %) were food insecure with over a third (36 %) reporting severe food insecurity. Reporting great difficulties in covering household expenses and young age markedly increased the risk of severe food insecurity (OR 15·05; 95 % CI 10·60, 21·38 and OR 5·07; 95 % CI 3·94, 6·52, respectively). Not being married, low education, working in the hospitality industry, being male and living in rented housing also increased the probability of severe food insecurity. The HFIAS tool demonstrated acceptable construct and criterion validity.

CONCLUSIONS

Severe food insecurity was widespread and associated with low socio-economic status, young age and being male among Finnish private sector service workers, emphasising the need for regular monitoring of food insecurity in Finland.

The prevalence of overweight/obesity and its association with household food insecurity among women living with HIV in rural Eswatini

BACKGROUND

Eswatini is currently afflicted by an extremely high prevalence of HIV (27%) and malnutrition (both under-and over-nutrition). While rates of overweight/obesity in the general adult population have been documented, data on overweight/obesity and associated risk factors among women living with HIV (WLHIV) in Eswatini is limited. This study examines the prevalence of overweight/obesity and associated risk factors, with an emphasis on clarifying the association between household food insecurity and overweight/obesity for WLHIV in rural Eswatini.

METHODS

This cross-sectional study was conducted among WLHIV (n = 166) in rural communities of Eswatini. Data were collected using an interviewer-administered survey questionnaire between October and November, 2017. Body Mass Index (BMI) was calculated to determine overweight and obesity among study participants. Women with BMI values of 25 kg/m² or greater were classified as being overweight/obese. Multivariable log-binomial regression models were used to examine associations between household food insecurity and overweight/obesity in our study.

RESULTS

Nearly a third (32.5%) of the women in our study were overweight and almost a quarter were obese (22.9%). We found significant associations between household food insecurity and overweight/obesity, with women who experienced household food insecurity the most being 0.38 times less likely to be overweight/obese compared to those who experienced household food insecurity the least (ARR: 0.38, 95% CI: 0.2-0.71). In our study sample, women who perceived themselves as being in poor health were less likely to be overweight/obese compared to those who perceived themselves as being in good health (ARR: 0.58, 95% CI: 0.39-0.86). We found significant associations between overweight/obesity and alcohol use, with the risk of overweight/obesity nearly 1.5 times higher among women who consumed alcohol compared to those who did not (ARR: 1.49, 95% CI: 1.07-2.05).

CONCLUSIONS

The high prevalence of overweight/obesity among food insecure women in poverty stricken communities may pose significant challenges for nutritional health and HIV management. With an increasing prevalence of overweight/obesity in food insecure households, there is a need to re-evaluate current strategies and develop multi-level targeted interventions that include prevention of excessive weight gain among women, particularly those living with HIV in rural Eswatini. HIV programs could include screening to identify individuals at risk for overweight/obesity in this population, and provide nutrition education for weight management for those individuals.

Exploring the Food (In)Security Status of Suburban Households and Its Determinants during COVID-19

Household food insecurity in South African suburban low-income households is a major challenge. Research outcomes that will inform decisions on effective solutions towards reducing household food insecurity in South Africa are essential. The purpose of this study was firstly to determine the food security status of households and the skills of household members in Ward 60 of the Nelson Mandela Bay Municipality in the Eastern Cape Province in South Africa. Secondly, it was also to determine the association between the socioeconomic and demographic variables of the households and their level of food (in-)security. The study employed a mixed method of both qualitative and quantitative methodologies, comprising a qualitative Community-Based Participatory Action Research (CBPAR) methodology and a quantitative household food security survey methodology. A household food security survey was employed using a questionnaire that was based on the Household Food Insecurity Access Scale (HFIAS). The questionnaire was used to collect data from 170 randomly selected households. The data analysis used the HFIAS score and logistic regression analysis. The results show 6.1% of households as food secure, 3.05% as mildly food insecure, 13.4% as moderately food insecure, and 77.4% as severely food insecure. The results also show that a significant unemployment rate, a reliance on social grants, and absence of income seriously impact the extent of household food insecurity. The results show a significant association between the household food security and the variables of unemployment, income, and gender. The regression analysis results suggest that gender, household size, age, employment, and household income influence household food security. The results of the household skills show that the households had a variety of skills. These results can help to inform decisions by the government, local municipalities, NGOs, and other stakeholders towards designing effective solutions for enhancing household food security.

Dietary diversity, nutritional status and associated factors among lactating mothers visiting government health facilities at Dessie town, Amhara region, Ethiopia

Background

Maternal undernutrition is one of the most common causes of maternal morbidity and mortality in developing countries. Severe undernutrition among mothers leads to reduced lactation performance which further contributes to an increased risk of infant mortality. However, data regarding nutritional status of lactating mothers at Dessie town and its surrounding areas is lacking. This study assessed dietary diversity, nutritional status and associated factors of lactating mothers visiting health facilities at Dessie town, Amhara region, Ethiopia.

Methods

Institutional based cross-sectional study was conducted from March to April, 2017 among 408 lactating mothers. Systematic random sampling technique was employed to select the study participants. Data on socio-demographic and economic characteristics, health related characteristics, dietary diversity and food security status of participants were collected using interviewer administered questionnaire. Data were entered into EPI-INFO and analyzed using SPSS Version 22. Bivariate and multivariate analyses were performed to identify factors associated with dietary diversity and nutritional status of lactating mothers.

Results

More than half (55.6%) of lactating mothers had inadequate dietary diversity (DDS<5.3) and about 21% were undernourished (BMI<18.5 kg/m²). Household monthly income [AOR = 2.0, 95% CI (1.15, 3.65)], type of house [AOR = 1.8, 95% CI (1.15, 2.94)], nutrition information [AOR = 1.6, 95% CI (1.05, 2.61)] and household food insecurity [AOR = 1.8, 95% CI (1.05, 3.06)] were factors associated with dietary diversity of lactating mothers. Being young in age 15–19 years [AOR = 10.3, 95% CI (2.89, 36.39)] & 20–29 years [AOR = 3.4, 95% CI (1.57, 7.36)], being divorced/separated [AOR = 10.1, 95% CI (1.42, 72.06)], inadequate dietary diversity [AOR = 3.8, 95% CI (2.08, 7.03)] and household food insecurity [AOR = 3.1, 95% CI (1.81, 5.32)] were factors associated with maternal undernutrition.

Conclusion

The dietary diversity of lactating mothers in the study area was sub optimal and the prevalence of undernutrition was relatively high. Public health nutrition interventions such as improving accessibility of affordable and diversified nutrient rich foods are important to improve the nutritional status of mothers and their children in the study area.

Association of Diet Quality and Food Insecurity with Metabolic Syndrome in Obese Adults

Background:

The link between diet quality, food insecurity (FI), and metabolic syndrome (MetS) remains unclear in obese adults. The aim of this study was to examine the association of diet quality and FI with MetS in obese Iranian adults.

Methods:

This cross-sectional study was conducted on 300 obese adults. Dietary intake was assessed using a validated 168-item food frequency questionnaire. Diet quality and FI were measured using the Diet Quality Index-International (DQI-I) and an adapted USDA2000 household food security status questionnaire, respectively. MetS was defined according to the International Diabetes Federation diagnostic criteria. Association was determined using logistic regression analysis adjusting for potential confounders.

Results:

MetS subjects had lower DQI-I score than subjects without MetS (67.5 ± 8.7 vs 71.5 ± 7.4, P = 0.05). The prevalence of food insecurity was 48.6% (95% confidence interval (CI): 41.2, 56.1) in MetS subjects and 39.4% (95% CI: 29.4, 49.9) in subjects without MetS. After adjustment, participants in the fourth quartile of DQI-I score had 70% lower odds of MetS (Adjusted odds ratio [AOR], 0.3; 95% CI: 0.1–0.7), 70% lower odds of hypertriglyceridemia (AOR, 0.3; 95% CI: 0.2–0.7) and 60% lower risk of reduced high-density lipoprotein [HDL] (AOR, 0.4; 95% CI: 0.2–0.9) compared with the first quartile. Obese food insecure adults had 60% higher odds of high blood pressure (AOR, 1.6; 95% CI: 1.0–2.6) and 70% higher odds of hypertriglyceridemia (AOR, 1.7; 95% CI: 1.0–2.8) compared with food-secure obese adults. There was no statistically significant interaction observed between DQI-I and food insecurity on MetS.

Conclusions:

Lower DQI-I score and food insecurity were associated with an increased risk of MetS and some features such as hypertriglyceridemia, reduced HDL, and high blood pressure in obese Iranian adults.

Invariance of the Household Food Insecurity Access Scale Across Different Groups of Adolescents and Young Adults

BACKGROUND

Cross-group comparisons of household food insecurity and its associations using multiple-item scales assume that scale scores can be interpreted as identical across groups. However, scores should not be interpreted as identical across groups without evidence of measurement invariance. Noninvariant measures indicate that the underlying construct may be different across groups.

OBJECTIVE

To determine whether the Household Food Insecurity Access Scale (HFIAS) is invariant across different groups of Ghanaian and South African youth aged 15 to 24.

METHODS

We analyzed cross-sectional quantitative data from 1437 and 4165 young South Africans and Ghanaians, respectively. Multi-group confirmatory factor analysis was used to examine whether the HFIAS was invariant across different groups of youth, including sex (male or female), age group (middle adolescence, late adolescence, or emerging adulthood), and receipt of child support grant (yes or no). We assessed 3 levels of invariance: configural, metric, and scalar. The model fit between nested models was compared using χ2 difference testing.

RESULTS

Invariance tests indicated that the HFIAS had configural, metric, and scalar invariance across different groups of Ghanaian and South African youth. Model fit statistics across all invariance levels indicated good fit of our hypothesized model with the observed data. χ2 difference testing results were not statistically significant across all nested models.

CONCLUSIONS

Food insecurity, as measured by the HFIAS, meant the same thing for different groups of Ghanaian and South African youth. Evidence of invariance means that the HFIAS scores could be interpreted as identical across youth groups in our study.

Dietary diversity and food security status among heart failure patients in the north of Iran

Background

Dietary diversity score (DDS) is an indicator for assessing nutritional adequacy. Food security is another important measure in nutrition field which can be associated with several cardiovascular risk factors. Considering the importance of nutrition in heart failure (HF) patients, this study was designed to evaluate the DDS and food security of patients with HF.

Methods

A total of 200 HF patients were enrolled. DDS was evaluated using valid and reliable food frequency questionnaire and was calculated by scoring food intakes as 5 main groups. Household food insecurity access scale was applied to assess food security status. Data were analyzed using descriptive statistics, Chi-square and Kruskal-Wallis tests and multiple logistic regression models.

Results

The mean age of patients was 65 (standard deviation: 12) years and 59% of patients were male. Median of DDS was 1.96 (range: 0.29 to 6.12). Adjusted odds of greater DDS (> = median of 2) was 2.58 times higher for patients without hypertension than for patients with hypertension (95%CI: 1.31–5.08, P = 0.006). Also, odds of greater DDS were more in ex-smokers’ patients when compared to non-smokers (adjusted odds ratio (AOR): 2.70, 95%CI: 1.27–5.75, P = 0.010), patients with supplement use (AOR: 2.42, 95%CI: 1.16–5.05, P = 0.019), patients with lower total cholesterol level (AOR: 1.01, 95%CI: 1.00–1.02, P = 0.051), and patients with higher ejection fraction (AOR: 1.03, 95%CI: 1.00–1.05, with borderline.

P = 0.073). About 57% of patients had experienced degrees of food insecurity as mild (26%), moderate (16%) and severe (15%). On the other hand, women (AOR: 1.90, 95%CI: 0.90–3.71, with borderline P = 0.061) and patients with middle (AOR: 3.48, 95%CI: 1.79–6.76, P < 0.001) or high (AOR: 20.32, 95%CI: 2.56–161.19, P = 0.004) socio-economic status were more likely to be food secure or mild insecure. Also, no relation between DDS and food security was found (r = − 0.08, P = 0.262).

Conclusion

This study found that HF patients had a low DDS and more than half of the patients were food insecure to some extents.

Food insecurity status and associated factors among rural households in the north of Iran

BACKGROUND

Iran has been experiencing an accelerated change in the nutrition and health of its people, which has led to considerable variations in the country's nutritional status. Little is known about the food insecurity status in the north of Iran.

AIM

The present study aimed to investigate the food insecurity status and factors associated with it in a rural area in the north of Iran.

METHODS

This cross-sectional study was conducted among 573 rural households in Guilan Province in the north of Iran. The food insecurity status of the households was measured using the Household Food Insecurity Access Scale. Data on the demographic characteristics of the households and their depression status were collected by interviewing the heads of the households. The socioeconomic status index of the households was constructed using factor analysis, and a multivariate ordinal logistic regression model was used to estimate the adjusted odds ratio of the independent predictors of food insecurity.

RESULTS

The results indicated that approximately half of the households (50.8%) had experienced mild (43.2%), moderate (6.5%) or severe (1.1%) food insecurity. The multivariate model showed that sex, age, depression status of the head of the household and having a patient with a chronic condition in the household were independently associated with food security status.

CONCLUSIONS

This study showed that food insecurity was highly prevalent among rural households in the north of Iran. The study concludes that interventions with the aim of reducing the prevalence of food insecurity, depression and chronic diseases in the area can be effective in improving the nutritional status of the households.

Factors determining household-level food insecurity during COVID-19 epidemic: a case of Wuhan, China

Background

In coping with the coronavirus disease 2019 (COVID-19) epidemic, cities adopted social isolation and lockdown measures; however, little is known about the impacts of these restrictions on household food security.

Objective

This study provides a timely assessment of household food insecurity (HFI) in the Chinese city of Wuhan during the COVID-19 epidemic period and also investigates its determinant factors.

Design

We collected valid data on food insecurity from 653 households in Wuhan via an online questionnaire in March 2020. The Household Food Insecurity Access Scale Score (HFIASS) was used to measure HFI, and a multiple linear regression model was used to determine the HFIASS.

Results

The mean HFIASS in Wuhan was 9.42 (standard deviation: 5.82), with more than 50% of the households had an HFIASS < 9. Compared with normal conditions, lockdown measures had a huge negative impact on household food security. The results revealed that socio-demographic characteristics remained the underlying determinants of HFIASS during the epidemic. Households in Wuhan with local Hukou (city household registration) and self-owned property had a lower risk of food insecurity.

Discussion and conclusion

After the restriction of conventional food access channels, intermediary food purchase methods such as group purchasing, shopping with the help of neighborhood committees, property management agents, and volunteers became the most important or the only channel for residents to access food. There were similarities in the use of these intermediary channels. Based on the probability that the epidemic will continue and the probability of similar public health-related outbreaks in the future, the study calls for a more resilient and responsive sustainable food supply system by harnessing the capacity of communities, e-commerce and rapid logistics.

Food Insecurity and Cardiovascular Risk Factors among Iranian Women

We evaluated whether food insecurity is associated with clinical evidence of diet-sensitive cardiovascular diseases (CVD) risk factors, including obesity, hypertension, dyslipidemia, and diabetes. In this population-based cross-sectional study, 630 women aged 18-50 years under cover of health centers in Iran randomly selected and interviewed face-to-face. Food insecurity was evaluated using a household food insecurity access scale (HFIAS) questionnaire, which its validity and reliability was determined in the Iranian population. Logistic regression was used to assess the associations between food insecurity and having CVD risk factors including general and abdominal obesity, hypertension, hypercholesterolemia, high low-density lipoprotein cholesterol (LDL), low high-density lipoprotein cholesterol (HDL), hypertriglyceridemia, and diabetes. The probability of having hypertriglyceridemia (Adjusted OR = 2.04, P = .031), general obesity (Adjusted OR = 2.43, P = .029), abdominal obesity (Adjusted OR = 2.09, P = .024), and hypertension (Adjusted OR = 2.04, P = .038) increased with exacerbation of women's food insecurity condition. The odds ratio of having CVD risk factors became stronger after adjusting for confounders. Food insecurity was associated with increased risk of CVD risk factors among Iranian reproductive-age women. Efforts to improve food security conditions among women might be associated with reductions in the incidence of CVD-related metabolic risks.

Weight gain during pregnancy and its associated factors: A Path analysis

Aim

Weight gain during pregnancy is an important indicator in the prediction of morbidity and mortality in infants and mothers. This study aimed to determine the association factors for weight gain during pregnancy.

Design

A longitudinal study.

Methods

A total of 734 women were selected using multistage cluster sampling. Data were collected using demographic and midwifery questionnaires, economic and social status, psychological factors, domestic violence, perceived social support and food insecurity.

Results

Of participants 28.7%, 49.6% and 21.7%, respectively, received insufficient, adequate and excessive weight gain in pregnancy respectively. Among health determinants entered in the model, mother's age, prepartum body mass index and direct and indirect prenatal care, size of households, food insecurity, stress, anxiety, stress and pregnancy-specific stress as well as violence had a positive and increasing effect on weight gain during pregnancy.

Conclusion

Considering the effect of inappropriate weight gain during pregnancy on undesirable pregnancy outcomes, related factors such as nutritional status, stress and depression in prenatal care should be assessed. Healthcare providers should consult, educate pregnant women.

Is the modified household food security survey (HFSS) questionnaire a practical tool for screening food insecurity? Evidence from northwest of Iran

BACKGROUND

Adequate supplies of food and food security (FS) are the fundamental aspects of human societies, and considered one of the pivotal factors of individual and social health. The aim of the present study was to assess the applicability of the short questionnaire for screening food insecurity (FI) and to evaluate the prevalence of FI in northwest of Iran.

METHODS

In this study, 550 subjects aged ≥16 years were studied. Three-day dietary records and a short questionnaire were applied to estimate the prevalence of FI in terms of hunger and hidden hunger. The sensitivity, specificity and accuracy of the short questionnaire were assessed. Moreover, the association between the results of the short questionnaire and the criteria that were theoretically related to FI were examined. Data were presented as mean (SD), median (min-max) for the numeric normal and non-normal variables, respectively, and frequency (percent) for categorical variables. The between-group comparisons of variables were done using independent samples t test. P values less than 0.05 were considered statistically significant.

RESULTS

The prevalence of hunger and hidden hunger was 30.8 and 46.0%, respectively. Overall, 23.2% of the subjects were classified as "food secure". The sensitivity, specificity and accuracy of the short questionnaire in determining hunger were 92.8% (95% CI: 87.3-95.9), 84.2% (95% CI: 79.3-89.3), and 87% (95% CI: 84-90.2), respectively. These values for hidden hunger were 21.6% (95% CI: 15.7-29.9), 92.3% (95% CI: 88.7-99.4), and 53.4% (95% CI: 47.9-59.8), respectively. Our study showed a statistically significant association between FI and socio-economic status. FI significantly enhanced the risk of underweight, while it markedly reduced the risk of overweight and obesity. The average frequency of monthly consumption of meat, dairy products, fruits, vegetables, and rice was significantly lower in food insecure group, while the median frequency of bread consumption was markedly higher in food insecure group. The participants of insecure group were less likely to consume fruits, vegetables, dairy products, rice and meat.

CONCLUSIONS

FI was frequent in North-west of Iran. The findings indicated that the short questionnaire was a simple, low-cost and practical tool for screening FI in terms of hunger.

TRIAL REGISTRATION

IR.TBZMED.REC.1397.400.

Food insecurity and substance use in people with HIV infection and substance use disorder

BACKGROUND

Food insecurity and substance use are common among people living with HIV (PLWH). Substance use may help people cope with hunger and thus be associated with food insecurity, but the association is uncertain. This study assessed whether, in PLWH and substance dependence, if there was an association between food insecurity and substance use.

Methods: We studied adults with HIV and current substance dependence or ever injection drug use interviewed at 12 and 24 months after enrollment in a prospective cohort study. The presence of food insecurity (insufficient food quantity or quality, or anxiety about its availability) was assessed using the Household Food Insecurity Assessment Scale questionnaire (HFIAS). Unhealthy alcohol use was assessed with the Alcohol Use Disorder Identification Test - Consumption (AUDIT-C) and past 30-day other drug use with the Addiction Severity Index. Associations using repeat cross-sectional data from each of two time-points, 12 months apart, from the same participants were tested using generalized estimating equations logistic regressions.

Results: The 233 participants had a mean age of 50 years and 65% were male. At the first interview, 44% reported food insecurity, 40% unhealthy alcohol use, 25% past 30-day cocaine use, and 17% past 30-day illicit opioid use. In analyses adjusted for demographics, social factors, physical and mental health function, and substance use related variables, there was no significant association between food insecurity and unhealthy alcohol use (adjusted odds ratio (aOR) = 1.06 (95% CI: 0.59, 1.87)). Those with food insecurity had higher odds of illicit opioid use (aOR = 2.5 (95% CI: 1.12, 5.58)) and cocaine use (aOR = 1.95 (CI 95%: 1.00, 3.81)).

Conclusion: Food insecurity was not associated with unhealthy alcohol use but was associated with cocaine and illicit opioid use. Given the prevalence and impact substance use has on PLWH, food insecurity should be identified and addressed.

The association of maternal plant-based diets and the growth of breastfed infants

Background: Studies are needed to further understand how different plant-based dietary patterns of mothers relate to infant growth. Thus, we investigated the association between maternal plant-based diets and infant growth in breastfed infants during the first 4 months of life.

Methods: This cross-sectional study included 290 Iranian mothers and infants. Maternal dietary intake was assessed using a 168-question validated semi-quantitative food frequency questionnaire (FFQ). Three plant-based diet indices (PDIs) were then created to evaluate dietary intakes. Eighteen food groups were classified in three main categories by scoring method: wholeplant diet, healthy plant diet, and animal and unhealthy plant diet.

Results: Participants in the top tertile of unhealthy PDI (uPDI) had a lower intake of potassium,phosphorus, zinc, magnesium, calcium, folate and vitamin C, B1, B2, and B3. The upper tertileof uPDI was associated with stunting at 4-month in infants (uPDI: odds ratio [OR] = 3.27, 95%CI= 1.32, 8.10). There were no significant associations between plant-based diet scores and anthropometric indices, including weight, weight status and head circumference (P > 0.05).

Conclusion: In conclusion, higher adherence to uPDI may be associated with stuntingamong Iranian infants. Other PDIs were not associated with anthropometric measures. Future studies are needed to further understand the association between plant-based diets and infant growth.

Food insecurity among women of reproductive age in Nepal: prevalence and correlates

BACKGROUND

Food insecurity is widely prevalent in certain sections of society in low and middle-income countries. The United Nations has challenged all member countries to eliminate hunger for all people by 2030. This study examines the prevalence and correlates of household food insecurity among women, especially Dalit women of reproductive age in Nepal.

METHODS

Data came from 2016 Nepal Demographic Health Survey, a cross-sectional, nationally representative survey that included 12,862 women between 15 and 49 years of age of which 12% were Dalit. Descriptive analysis was used to assess the prevalence of household food insecurity while logistic regression examined the relationship between women's ethnicity and the risk of food insecurity after accounting for demographic, economic, cultural, and geo-ecological characteristics.

RESULTS

About 56% of all women and 76% of Dalit women had experienced food insecurity. Ethnicity is strongly related to food insecurity. Dalit women were most likely to be food insecure, even after accounting for factors such as education and wealth. They were 82, 85, 89 and 92% more vulnerable to food insecurity than Muslims, Brahmin/Chhetri, Terai Indigenous, and Hill Indigenous populations, respectively. Education was a protective factor-women with secondary education (6th to 10th grade) were 39% less likely to be food insecure compared to their counterparts without education. With a more than 10th grade education, women were 2.27 times more likely to be food secure compared to their counterparts without education. Marriage was also protective. Economically, household wealth is inversely correlated with food insecurity. Finally, residence in the Mid-Western, Far-Western and Central Development regions was correlated with food insecurity.

CONCLUSION

To reduce food insecurity in Nepal, interventions should focus on improving women's education and wealth, especially among Dalit and those residing in the Far- and Mid-Western regions.

Performance of an adapted household food insecurity access scale in measuring seasonality in household food insecurity in rural Ethiopia: a cohort analysis

Background

Seasonality poses a considerable food security challenge in Ethiopia. Yet, measuring seasonal variations in food insecurity, particularly the dimension of food access, lacks an adequately validated tool. We therefore evaluated the performance of an adapted Household Food Insecurity Access Scale (HFIAS) to estimate seasonal variations in food insecurity (FI) among subsistence villagers in Ethiopia.

Methods

We employed a cohort study design using a panel of four repeated measurements taken in June, September, and December in the year 2017, and in March 2018. The study recruited 473 villagers from the drought-affected Wolaita area in southwest Ethiopia. The performance of the HFIAS was evaluated via internal consistency (Chronbach's alpha values) and criterion validation techniques. The set of criteria include: parallelism between affirmative responses to FI questions and wealth strata; dose-response relationship between FI and dietary intake; and also FI severity and household wealth status.

Results

This study revealed that the HFIAS had satisfactory performance in four repeated measurements. The likelihood of affirmative responses to questions about FI decreased with ascending wealth quintiles. We observed an inverse dose-response relationship between FI and wealth status, and between FI and household dietary diversity.

Conclusions

The HFIAS showed an acceptable potential for measuring seasonal variations in FI in the study area. Our findings complement efforts to evaluate the scale's applicability in various settings, in order to promote cross-culture monitoring and comparisons. However, it required a careful adaption for contextual and cultural sensitivities.

Association of Socioeconomic Status and Food Security with Anthropometric Indices Among 2-5-year-old Urban Children in Eight Different cities in Iran

Introduction:

Child nutrition status is very important in all societies, which is influenced by the interaction of multiple factors including food security and socioeconomic status in both genders. The aim of this study was to examine the relationship between food security and socioeconomic status with anthropometric indices among 2–5-year-old urban children in eight different cities in Iran.

Materials and Methods:

In this cross-sectional study, anthropometric Z scores of 7028 children of urban area were measured by using World Health Organization (WHO) Anthro software based on WHO 2007 standards. Family food security was assessed by using HFIAS 9-item questionnaire. Socioeconomic status as well as health factors were analyzed using the SPSS.

Results:

Based on the present study, significant correlation was observed between sleep time, birth weight, and food security (P < 0.05) with body mass index (BMI), while the rest of the variables including age, family size, number of children, parents’ education, breastfeeding duration, watching TV, playing computer games, playing outdoors, number of main eating, and number of snacks showed no significant relation (P > 0.05).

Conclusion:

It was shown that 2–5 years old children's life are the most vital and vulnerable to the hazards of undernutrition or overweight and obesity, which could affect the whole health of the person. As food security affects BMI, it is important to focus more on this issue in order to improve child's health status.

Effects of multiannual, seasonal unconditional cash transfers on food security and dietary diversity in rural Burkina Faso: the Moderate Acute Malnutrition Out (MAM'Out) cluster-randomized controlled trial

OBJECTIVE

To evaluate the impact of multiannual, seasonal unconditional cash transfers (UCT) provided within the Moderate Acute Malnutrition Out (MAM'Out) research project on households' food security and children's and caregivers' dietary diversity.

DESIGN

A two-arm cluster-randomized controlled trial with sixteen villages in the intervention group and sixteen others in the control group. A monthly allowance of 10 000 XOF was transferred to caregivers of eligible children via a personal mobile phone account from July to November 2013 and 2014.

SETTING

Tapoa province in the eastern region of Burkina Faso.

PARTICIPANTS

Data on household food access (monthly adequate household food provisioning (MAHFP); household food insecurity access scale (HFIAS)) and maternal and child dietary diversity were analysed for 1143 households, 1219 caregivers of reproductive age (15-49 years) and 1247 under-5 children from both intervention and control groups.

RESULTS

The mean women dietary diversity score in intervention caregivers and the mean dietary diversity score (DDS) in intervention children with inadequate minimum DDS at baseline were respectively 7 % (95 % CI 2, 11 %; P = 0·002) and 17 % (95 % CI 11, 23 %; P <0·001) higher compared with the control group. However, no difference was found in the intervention effect on household food security measured with HFIAS (relative risk = 1·03; 95 % CI 0·92, 1·15; P = 0·565) and MAHFP (relative risk = 0·98; 95 % CI 0·96, 1·01; P = 0·426).

CONCLUSIONS

Multiannual, seasonalUCT increased dietary diversity in children and their caregivers. They can be recommended in actions aiming to improve maternal and child diet diversity.

Household food insecurity is associated with a higher burden of obesity and risk of dietary inadequacies among mothers in Beirut, Lebanon

BACKGROUND

Mixed evidence exists with respect to the association between household food insecurity (HFIS) and obesity in low-to-middle income countries (LMICs), particularly among women. This study aimed to measure socioeconomic correlates of HFIS and explores its association with dietary intake and odds of obesity among mothers in Lebanon, a middle-income country undergoing nutrition transition.

METHODS

A cross-sectional study was conducted among a representative sample of households (n = 378) in Beirut, Lebanon. Surveys were completed with mothers of children <18 years. HFIS was measured using a locally-validated, Arabic-translated Household Food Insecurity Access Scale (HFIAS). Dietary intake was assessed using the multiple pass 24-h recall method. Associations between HFIS (food vs food insecure) and socio-demographic characteristics were reported using crude and adjusted odds ratios. The odds of consuming <2/3rd Dietary Reference Intakes (DRIs) for nutrients among mothers from food secure and food insecure households were explored. In addition, logistic regression analyses were conducted to explore the association of HFIS with obesity (BMI ≥ 30 kg/m2) and at-risk waist circumference (WC ≥ 80 cm) among mothers.

RESULTS

HFIS was found among 50% of study sample and was inversely associated with household income and mother's educational level, even after adjusting for other socioeconomic variables (p < 0.01). Mothers in food insecure households reported consuming significantly less dairy products, fruits, and nuts yet more breads and sweets; and they had higher odds of consuming <2/3rd the DRI's for key micronutrients (potassium, folate, and vitamin C) compared to secure ones. Adjusting for socioeconomic correlates, food insecure mothers had 1.73 odds of obesity (95% CI: 1.02-2.92) compared to food secure mothers.

CONCLUSIONS

High HFIS prevalence was reported among urban Lebanese households. Mothers from food insecure households had a high risk of dietary inadequacy and obesity. Adequate evidence-based public health strategies are needed to reduce the vulnerability of mothers to food insecurity in LMIC settings and alleviate their risk of a high burden of nutrient insecurity and obesity.

Development of a Home Food Safety Questionnaire Based on the PRECEDE Model: Targeting Iranian Women

Food safety is an essential public health issue for all countries. This study was the first attempt to design and develop a home food safety questionnaire (HFSQ), in the conceptual framework of the PRECEDE (predisposing, reinforcing, and enabling constructs in educational diagnosis and evaluation) model, and to assess its validity and reliability. The HFSQ was developed by reviewing electronic databases and 12 focus group discussions with 96 women volunteers. Ten panel members reviewed the questionnaire, and the content validity ratio and content validity index were computed. Twenty women completed the HFSQ, and face validity was assessed. Women who were responsible for food handling in their households (n =320) were selected randomly from 10 health centers and completed the HFSQ based on the PRECEDE model. To examine the construct validity, a principal components factor analysis with varimax rotation was used. Internal consistency was determined with Cronbach's α. Reproducibility was checked by Kendall's τ after 4 weeks with 30 women. The developed HSFQ was considered acceptable with a content validity index of 0.88. Face validity revealed that 95% of the participants understood the questions and found them easy to answer, and 90% confirmed the appearance of the HFSQ and declared the layout acceptable. Principal component factor analysis revealed that the HFSQ could explain 33.7, 55.3, 34.8, and 60.0% of the total variance of the predisposing, reinforcing, practice, and enabling components, respectively. Cronbach's α was acceptable at 0.73. For Kendall's τ_c, r = 0.89, with a 95% confidence interval of 0.85 to 0.93. The HFSQ developed based on the PRECEDE model met the standards of acceptable reliability and validity, which can be generalized to a wider population. These results can provide information for the development of effective communication strategies to promote home food safety.

Impact of the National Food Supplementary Program for Children on Household Food Security and Maternal Weight Status in Iran

Background:

Food aid programs are strategies that aim to improve nutritional status and to tackle food insecurity. This study aimed to evaluate the effect of a National Food Supplementary Program for Children on households’ food security.

Methods:

The study sample included 359 mothers of children aged 6–72 months under the coverage of the program in two provinces of Iran. Demographic and socioeconomic characteristics of the households and percentage of supplementary food items consumed by target child were assessed by a questionnaire and checklist. Data on household food security were collected by locally adapted Household Food Insecurity Access Scale at the baseline of the study and 6 months thereafter.

Results:

At the baseline, only 4.7% of families were food secure, while 43.5% were severely food insecure, and these proportions were changed to 7.9% and 38%, respectively (P < 0.001), at the end of the study. Odds of having worse food insecurity in households with medium and high wealth index was 65% and 87% lower than those with low wealth index, respectively (odds ratio [OR] = 0.35, 95% confidence interval [CI]: 0.2–0.61, and OR = 0.23, 95% CI: 0.12–0.43). Food sharing was common among more than 95% of the studied households. Mean maternal body mass index (BMI) increased significantly after 6 months (P < 0.001). However, there was no significant association between mother's BMI and household food security in the baseline and at the end of the study (P > 0.05).

Conclusions:

Findings show that the food supplementary program for children can also improve the household food security status. Further research is needed to assess other factors that affect the effectiveness of this kind of programs.

Major dietary patterns in relation to demographic and socio-economic status and food insecurity in two Iranian ethnic groups living in Urmia, Iran

Objective

To identify major dietary patterns and their association with socio-economic status (SES) and food insecurity in two major ethnic groups living in Urmia, north-west Iran.

Design

A cross-sectional study.

Setting

All four geographical zones of Urmia city.

Subjects

Participants (n 723; 427 women and 296 men), aged 20–64 years, from two ethnic groups (445 Azeri Turks and 278 Kurds).

Results

Three major dietary patterns were extracted: ‘Traditional High SES’ (THS), ‘Traditional Low SES’ (TLS) and ‘Transitional’. After adjusting for confounders, the THS pattern was positively associated with education level and negatively associated with moderate or severe food insecurity in Azeri Turks; whereas, among Kurds, it was more common in women and positively associated with age. The TLS pattern was more common among men and negatively associated with educational level and all levels of food insecurity in Azeris; while, among Kurds, it was more common among men, positively associated with being married and negatively associated with household income/capita. The ‘Transitional’ pattern was positively associated with being employed and negatively associated with age and all levels of food insecurity in Azeris; while, among Kurds, it was more common among men and negatively associated with age, being married and physical activity level.

Conclusions

Findings suggest that household SES and food insecurity are associated with detrimental dietary patterns and that this effect may be stronger than cultural and ethnic background. These patterns differ by age and gender. Therefore, such characteristics should be considered in planning and formulating diet-related policies and programmes.

Household Food Insecurity, Mother's Feeding Practices, and the Early Childhood's Iron Status

BACKGROUND

Health consequences of food insecurity among infants and toddlers have not been fully examined. The purpose of this study was to assess the relationship between household food insecurity, mother's infant feeding practices and iron status of 6-24 months children.

METHODS

In this cross-sectional study, 423 mother-child pairs were randomly selected by multistage sampling method. Children blood samples were analyzed for hemoglobin and serum ferritin concentrations. Household food security was evaluated using a validated Household Food Insecurity Access Scale. The mother's feeding practices were evaluated using Infant and Young Child Feeding practice variables including: The duration of breastfeeding and the time of introducing of complementary feeding.

RESULTS

Based on the results, of the studied households only 47.7% were food secure. Mild and moderate-severe household food insecurity was 39.5% and 12.8%, respectively. Anemia, iron deficiency (ID), and iron deficiency anemia were seen in 29.1%, 12.2%, and 4.8% of children, respectively. There was no significant association between household food insecurity; mother's feeding practices and child ID with or without anemia.

CONCLUSIONS

We found no association between household food insecurity and the occurrence of anemia in the 6-24 months children. However, these findings do not rule out the possibility of other micronutrient deficiencies among the food-insecure household children.

Reliability and validity of an individually focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

OBJECTIVE

To determine the reliability, validity and correlates of measures of food insecurity (FI) obtained using an individually focused food insecurity access scale (IFIAS) among pregnant women of mixed HIV status in northern Uganda.

DESIGN

A mixed-methods study involving cognitive interviews nested within a cross-sectional survey.

SETTING

The antenatal care clinic of Gulu Regional Referral Hospital.

SUBJECTS

Survey respondents included 403 pregnant women, recruited in a ratio of one HIV-infected to two HIV-uninfected respondents, twenty-six (nine of them HIV-infected) of whom were asked to participate in the cognitive interviews.

RESULTS

Over 80% of cognitive interview participants reported understanding the respective meanings of six of the nine items (i.e. items 4 to 9) on the IFIAS. Two main factors emerged from rotated exploratory factor analysis of the IFIAS: mild to moderate FI (IFIAS items 1-6) and severe FI (items 7-9). Together, they explained 90·4% of the FI measure's variance. The full IFIAS and the two subscales had moderate to high internal consistency (Cronbach's α ranged from 0.75 to 0.87). Dose-response associations between IFIAS scores, and measures of socio-economic status and women's diet quality, were observed. Multivariate linear regression revealed significant positive associations between IFIAS scores and HIV infection, maternal age, number of children and a history of internal displacement. IFIAS scores were negatively associated with women's diet diversity score, asset index and being employed.

CONCLUSIONS

The IFIAS showed strong reliability, validity and contextual relevance among women attending antenatal care in northern Uganda.

Validity and reliability of the Arabic version of the Household Food Insecurity Access Scale in rural Lebanon

OBJECTIVE

To assess the validity and reliability of the Arabic version of the Household Food Insecurity Access Scale (HFIAS) in rural Lebanon.

DESIGN

A cross-sectional study on a sample of households with at least one child aged 0-2 years. In a one-to-one interview, participants completed an adapted Arabic version of the HFIAS. In order to evaluate the validity of the HFIAS, basic sociodemographic information, anthropometric measurements of the mother and child, and dietary intake data of the child were obtained. In order to examine reproducibility, the HFIAS was re-administered after 3 months.

SETTING

Rural Lebanon.

SUBJECTS

Mother and child pairs (n 150).

RESULTS

Factor analysis of HFIAS items revealed two factors: 'insufficient food quality' and 'insufficient food quantity'. Using Pearson's correlation, food insecurity was inversely associated with mother's and father's education levels, number of cars and electrical appliances in the household, income, weight-for-age and length-for-age of the child and the child's dietary adequacy. In contrast, mother's BMI and crowding index were positively associated with food insecurity scores (P < 0·05 for all correlations). Cronbach's α of the scale was 0·91. A moderate correlation was observed between the two administrations of the questionnaire (intra-class correlation = 0·58; P < 0·05).

CONCLUSIONS

Our findings indicated that the adapted Arabic version of the HFIAS is a valid and reliable tool to assess food insecurity in rural Lebanon, lending further evidence to the utility of the HFIAS in assessing food insecurity in culturally diverse populations.

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.

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.