Development and Validation of a Direct Food Insecurity Measurement Instrument: A Study Protocol (Preprint).. [DOI: 10.2196/preprints.40945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

BACKGROUND

The Sustainable Development Goals (SDGs) aim to achieve sustainable food security with a focus on eradicating hunger and poverty. Although some progress has been made, conflicts and food insecurity issues are still inevitable worldwide. In Malaysia, food insecurity is still evident in 2021 as food-insecure groups were present in the surveyed population. The problem leads to negative impacts on the health and development of individuals. To tackle this problem, an appropriate measurement tool is needed to assess the experience of food insecurity among Malaysians. A valid, reliable and culturally specific food insecurity measurement tool is needed for further planning and implementation.

OBJECTIVE

Our objective is to develop a direct food insecurity measurement instrument that will assist practitioners in assessing food security status in communities.

METHODS

This paper describes a mixed-methods sequential study to develop and validate a direct food insecurity measurement tool that is culturally specific for use in Malaysia. It begins with a qualitative study to understand the experience of food insecurity among food bank beneficiaries through interpretive phenomenological analysis (IPA). Validation procedures will then be conducted to validate the instrument under study, assessing content validity, construct validity and reliability. Finally, a pilot study will be conducted to evaluate the instrument in order to increase the credibility of this measurement tool in directly assessing the experience of food insecurity.

RESULTS

In-depth interviews for qualitative data will be carried out after ethics approval and expected to be completed by 2022 November 30. For validation procedures, it is estimated to be completed by 2023 June 31.

CONCLUSIONS

This study will enable the development and validation of a direct food insecurity measurement tool to be used nationwide in Malaysia, and will go part of the way in assessing the relationship between the determinants and consequences of food insecurity status.

Implication of food insecurity on the gut microbiota and its potential relevance to a multi‐ethnic population in Malaysia

Food insecurity (FI) has an impact on food intake, and it can make it difficult for people to eat enough nutritious food at all times to sustain an active and healthy lifestyle. The COVID‐19 outbreak has hampered people's capacity to obtain nutritious and affordable food. Although FI has been studied in Malaysia, the extent to which it is linked to gut microbiota has yet to be discovered. This review aimed to compile evidence of the relationship between FI and gut microbial changes and their potential relevance to a multi‐ethnic population in Malaysia. FI is typically associated with cheaper and calorie‐dense foods because of the high cost of quality food and financial constraints that hinder food‐insecure people from adopting healthier dietary choices. As a result, they have started eating low‐quality food such as simple carbohydrates, fats, and processed foods. These poor eating habits can reduce microbial diversity and influence changes in the composition and function of the gut microbiota. This review also explores the impact of ethnicity on the variation in composition of gut microbiota. In conclusion, the findings of this review may be utilized to develop and implement diet‐related intervention programs to ensure that Malaysians get enough nutritious food to maintain a healthy gut microbiota and improve overall health.

Association between Household Food Security and Anemia among Pregnant Women in Rural Area in Indonesia

BACKGROUND: The increase of high anemia prevalence among pregnant women in Indonesia can reflect the raise of anemia potential in pregnancy. Food insecurity might influence the ability of households to meet the nutritional needs of pregnant women. AIM: This research aimed to find out the relationship between household food security status and anemia in pregnant women in Bektiharjo Village, Semanding District, Tuban Regency. METHODS: This was a cross-sectional study involving 50 pregnant women who lived in a typical rural area in Indonesia, namely Bektiharjo Village Semanding Sub-District Tuban District. The United States Household Food Security Survey Module questionnaire was used as the instrument for household food security status, while the level of hemoglobin was measured by the Easy Touch GCHb digital device. The Pearson Correlation test was used as a statistical test for this study. RESULTS: most respondents were of healthy reproductive age (76%). The prevalence of anemia was 32% affecting mostly women aged 20–35. Forty-six percent of households were experiencing food insecurity. There was a significant relationship between household food security status with anemia among pregnant women (p = 0.019; OR = −0.331). CONCLUSIONS: Pregnant women with food-insecure household status are more at risk of experiencing anemia, especially iron-deficiency anemia. Increasing consumption of affordable foods that contain non-heme iron and iron enhancers is recommended for pregnant women living in food-insecure households.

A Food Insecurity Systematic Review: Experience from Malaysia

Living free from hunger is a basic human right. However, some communities still experience household food insecurity. This systematic literature review explored different aspects of household food insecurity in Malaysia including vulnerable groups, prevalence, risk factors, coping strategies, and the consequences of food insecurity. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Thirty-three relevant articles were selected from scientific databases such as CINAHL, Pubmed and Google Scholar, scrutiny of reference lists, and personal communication with experts in the field. The prevalence of household food insecurity in Malaysia was unexpectedly reported as high, with affected groups including Orang Asli, low-income household/welfare-recipient households, university students, and the elderly. Demographic risk factors and socioeconomic characteristics included larger household, living in poverty, and low education. Coping strategies were practices to increase the accessibility of food in their households. Consequences of household food insecurity included psychological, dietary (macro- and micronutrient intakes), nutritional status, and health impacts. In conclusion, this review confirmed that household food insecurity in Malaysia continues to exist. Nevertheless, extensive and active investigations are encouraged to obtain a more holistic and comprehensive picture pertaining to household food security in Malaysia.

Adherence of Malaysian Adults' Energy and Macronutrient Intakes to National Recommendations: A Review and Meta-Analysis

The present study examined the best available evidence regarding energy and macronutrient intake during adulthood (age 19 to 59 years) in Malaysia and assessed whether intakes adhere to national recommendations, in order to develop recommendations for dietary improvement based on population consumption patterns. A literature review and meta-analysis evaluated intake based on the following characteristics, using information from food balance sheets, national surveys, and individual studies: (1) levels of intake, (2) proportion of the population whose diets adhere to/exceed/fail to meet Malaysian Recommended Nutrient Intake (RNI) levels, and (3) sources of macronutrients observed in these studies. Food balance data suggested high levels of available energy, animal source protein, vegetable fat, and refined carbohydrates. Twenty studies (five nationwide, 15 individual) indicated that Malaysian adults generally met or exceeded recommendations for fat and protein, but were inconsistent with respect to energy and carbohydrates. Information on dietary sources was limited. Due to methodological limitations, insufficient evidence exists regarding energy and macronutrient intakes of Malaysian adults. Improved dietary assessment methods (including use of biomarkers), better data analysis, and updated food composition data, will provide more reliable information on which to base policy decisions and recommendations for improvement.

Qualitative study on identification of common coping strategies practised by Indigenous Peoples (Orang Asli) in Peninsular Malaysia during periods of food insecurity

OBJECTIVE

To examine the types of coping strategies practised by Indigenous women or Orang Asli (OA) in Peninsular Malaysia during times of food shortage and to determine the level of severity for food insecurity that will trigger each specific coping strategy.

DESIGN

A qualitative case study was conducted. Pertinent information about each type of coping strategy was gathered by in-depth interviews. To gauge the level of severity for each of the coping strategies, focus group discussions (FGD) were held. Thematic analysis was used for data analysis.

SETTING

OA villages in the states of Kelantan, Pahang, Perak and Selangor, Malaysia.

SUBJECTS

Sixty-one OA women from three ethnic groups (Senoi, Proto-Malay and Negrito) for in-depth interviews and nineteen OA women from the Proto-Malay ethnic group for three FGD.

RESULTS

The findings identified twenty-nine different coping strategies and these were divided into two main themes: food consumption (sub-themes of food consumption included dietary changes, diversification of food sources, decreasing the number of people and rationing) and financial management (sub-themes of financial management included increasing household income, reducing expenses for schooling children and reducing expenses on daily necessities). Three levels of severity were derived: less severe, severe and very severe.

CONCLUSIONS

This information would enable local authorities or non-governmental organisations to more precisely target and plan interventions to better aid the OA communities needing assistance in the areas of food sources and financial management.

Household food insecurity, diet quality, and weight status among indigenous women (Mah Meri) in Peninsular Malaysia

BACKGROUND/OBJECTIVES

This cross-sectional study assessed household food security status and determined its association with diet quality and weight status among indigenous women from the Mah Meri tribe in Peninsular Malaysia.

SUBJECTS/METHODS

The Radimer/Cornell Hunger and Food Insecurity Instrument and the Malaysian Healthy Eating Index (HEI) were used to assess household food security status and diet quality, respectively. Information on socio-demographic characteristics and 24-hour dietary recall data were collected through face-to-face interview, and anthropometric measurements including weight, height, and body mass index (BMI) were obtained from 222 women.

RESULTS

Majority of households (82.9%) experienced different levels of food insecurity: 29.3% household food insecurity, 23.4% individual food insecurity, and 30.2% fell into the child hunger group. The food-secure group had significantly fewer children and smaller household sizes than the food-insecure groups (P < 0.05). The mean household income, income per capita, and food expenditure significantly decreased as food insecurity worsened (P < 0.001). The food-secure group had significantly higher Malaysian HEI scores for grains and cereals (P < 0.01), as well as for meat, poultry, and eggs (P < 0.001), than the food-insecure groups. The child-hunger group had significantly higher fat (P < 0.05) and sodium (P < 0.001) scores than the food-secure and household food-insecure groups. Compared to the individual food-insecure and child-hunger groups, multivariate analysis of covariance showed that the food-secure group was significantly associated with a higher Malaysian HEI score while the household food-insecure group was significantly associated with a higher BMI after controlling for age (P < 0.025).

CONCLUSIONS

The majority of indigenous households faced food insecurity. Food insecurity at the individual and child levels was associated with lower quality of diet, while food insecurity at the household level was associated with higher body weight. Therefore, a substantial effort by all stakeholders is warranted to improve food insecurity among poorer households. The results suggest a pressing need for nutritional interventions to improve dietary intake among low income households.

Maternal Dietary Diversity Decreases with Household Food Insecurity in Rural Bangladesh: A Longitudinal Analysis

BACKGROUND

Household food insecurity (HFI) can lead to a poor diet and malnutrition. Yet, little is known about the extent to which maternal diet covaries with food insecurity during pregnancy and lactation.

OBJECTIVE

Longitudinal associations between HFI and maternal dietary diversity from early pregnancy to 3 mo postpartum were examined in rural Bangladesh.

METHODS

We repeatedly assessed dietary intake by using a 7-d food-frequency questionnaire in the first and third trimesters of pregnancy and at 3 mo postpartum among 14,600 women enrolled into an antenatal micronutrient supplementation trial. Maternal dietary diversity score (DDS) was constructed as the sum of 10 food groups reportedly consumed at each assessment. Households were classified at 6 mo postpartum as being food secure or having mild, moderate, or severe HFI on the basis of a 9-item standard scale. Generalized estimating equations were used to estimate the longitudinal relation between HFI status and DDS and the likelihood of individual food-group consumption, adjusting for confounders at the maternal and household levels.

RESULTS

The DDS decreased with progressively worse HFI, an association best explained by a derived household wealth index. Compared with women from food-secure households, women of mild, moderate, and severe HFI were less likely, in a dose-response fashion, to have consumed dairy products [adjusted ORs (95% CIs): 0.73 (0.69, 0.78), 0.62 (0.58, 0.66), and 0.52 (0.48, 0.55), respectively], eggs [0.81 (0.76, 0.85), 0.73 (0.68, 0.77), and 0.61 (0.57, 0.65)], meat [0.83 (0.79, 0.88), 0.73 (0.69, 0.78), and 0.60 (0.56, 0.64)], fish [0.87 (0.80, 0.94), 0.76 (0.70, 0.83), and 0.59 (0.54, 0.65)], legumes and nuts [0.88 (0.83, 0.93), 0.81 (0.76, 0.87), and 0.79 (0.74, 0.85)], and yellow and orange fruit and vegetables [0.85 (0.80, 0.91), 0.78 (0.73, 0.84), and 0.72 (0.67, 0.78)]. Neither intakes of dark-green leafy vegetables nor of vegetable oil were associated with HFI status.

CONCLUSION

Antenatal and postnatal maternal dietary diversity, especially intakes of animal-source foods, fruit, and vegetables, declined with worsening food insecurity in rural Bangladesh.

Food insecurity reported by children, but not by mothers, is associated with lower quality of diet and shifts in foods consumed

Household food security shows little indication of nutrient inadequacy among children, according to reports made by parents. We examined the associations of food insecurity as reported by children and mothers with children's consumption of energy, macronutrients such as vitamin A, calcium, iron and zinc, and selected foods, and whether these associations differed by child's gender. This cross-sectional study had non-probabilistic 128 Venezuelan mother-child pairs. We assessed food insecurity and management strategies in children using 10- and nine-item instruments, respectively. Mothers' report of food insecurity came from a previously validated 12-item instrument. Nutrient intake of children was assessed with a 67-item food frequency questionnaire. Comparisons were made using chi-square test for contingency tables and t-tests for trends (P < 0.05). Linear regression models were used for intakes of nutrients and selected foods. We tested for interactions with gender. Prevalence of child- and mother-reported food insecurity was 83.6 and 61.7%, respectively (P < 0.01). Greater food insecurity or management strategies reported by boys was associated with lower calcium, iron and zinc intake (P < 0.05), but reported intakes were low in girls who are even food secure. Rice and corn flour consumption was higher with higher food insecurity in children. Papaya and banana were less consumed by food-insecure children. We found shifts in 13 of 67 foods consumed, with less quality in those food insecure, as reported by children. Mother-reported food insecurity was associated only with rice intake of children. In contrast to mothers' reports, food insecurity reported by children was associated with children's lower quality of diet and shifts in foods consumed.

Evaluating household food insecurity: applications and insights from rural Malaysia

Hunger is complex, encompassing experiences ranging from a family's forced acceptance of a monotonous diet to individual physiological pain. I evaluate the Household Food Insecurity Access Scale (HFIAS) as a means of capturing the universal elements of hunger without doing violence to its culturally-specific expressions within two Malay communities. The HFIAS is assessed conceptually by comparing its assumptions and concept-to-measurement gap with competing indicators and practically with respect to village conditions and practices. This case study recommends the HFIAS for this site and for communities that similarly lack maternal buffering, while highlighting the unique features of the local hunger experience.