Food insecurity among Palestinian refugees living in Lebanon: a household survey

Abstract

Background Although the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has been providing food aid to the most vulnerable Palestinian families since 1978, Palestinian refugees in Lebanon are still prone to food insecurity because of their fragile livelihoods and high rates of poverty. For refugees living in Lebanon, food security has only been assessed in studies undertaken after the various conflicts, and the focus was on food availability in markets. Food insecurity within households has not been assessed directly. We aimed to estimate the prevalence of food insecurity and associated factors in the households of Palestinian refugees in Lebanon. Methods We undertook a socioeconomic survey of 2575 households of Palestinian refugees during July and August, 2010. A multistage cluster random sampling approach was used to select Palestinian households living in camps and gatherings in Lebanon. We adapted the survey module used to assess food security in the USA to the context of Palestinian refugees living in Lebanon; the module was validated with Rasch modelling. We constructed a four-item scale to classify households according to their severity of food insecurity. The questionnaire was also used to obtain information about socioeconomic, demographic, and health variables, and frequency of food consumption in households. Reported proportions and percentages are population estimates calculated with inverse probability weighting to take account of the differences in sampling proportions, selection probability, and response rates. We used Stata (version 12), with incorporation of stratification, sampling stages, and weighting information, for both bivariate (adjusted Wald to assess difference in means and χ 2 to test associations) and multivariate analyses (logistic regression models) of the survey data. This study was approved by the Institutional Review Board of the American University of Beirut, Beirut, Lebanon. Verbal informed consent was obtained from a household proxy respondent to whom the questionnaire was administered. Findings 2501 (97%) of 2575 eligible households of Palestinian refugees provided informed consent and completed the questionnaire. 63% (95% CI 60–65) of households reported some food insecurity and 13% (11–14) severe food insecurity. 59% (56–62) of households lived below the national poverty line—ie, on less than US$6 per person per day. The prevalence of severe food insecurity was 15% (14–18) in these households. 20% (15–27) of households with the head of the family in an elementary occupation (according to the International Standard Classification of Occupations, such as manual labourer, cleaner, and porter) reported severe food insecurity compared with 2% (2–7) in which the head of the household had a professional occupation (odds ratio 11·2, 95% CI 3·2–39·8; p=0·0001). 14% (13–16) of households in which the head had attended school for less than 10 years reported severe food insecurity compared with 8% (6–12) in which the head had attended school for 10 years or more (2·0, 1·3–2·5; p=0·004). 16% (13–21) of households with women as the head of the family had severe food insecurity compared with 11% (10–13) of those with men as the head (1·5, 1·1–2·1; p=0·0058). Households that were severely food insecure were more likely than those that were not to have at least one household member with a chronic disease (83% [78–87] vs 75% [70–79]; 1·6, 1·2–2·3; p=0·0033), disability (22% [17–30] vs 16% [14–19]; 1·5, 1·0–2·2; p=0·0439), and recent acute illness (66% [61–71] vs 57% [53–60]; 1·5, 1·1–2·0; p=0·0071). Respondents from households with severe food insecurity had lower scores on the five-item mental health inventory (p Interpretation Because food insecurity is common in households of Palestinian refugees in Lebanon and is related to low household income, female sex, and low socioeconomic group of the head of the family, food aid programmes need to be improved to reduce household food insecurity. The intake of fresh foods, particularly fruit and meat, needs to be increased to avoid micronutrient deficiencies. Special attention should be given to households of low socioeconomic status. Funding European Union.