Abstract
BackgroundStunting results from decreased food intake, poor diet quality, and a high burden of early childhood infections, and contributes to significant morbidity and mortality worldwide. Although food insecurity is an important determinant of child nutrition, including stunting, development of universal measures has been challenging due to cumbersome nutritional questionnaires and concerns about lack of comparability across populations. We investigate the relationship between household food access, one component of food security, and indicators of nutritional status in early childhood across eight country sites.MethodsWe administered a socioeconomic survey to 800 households in research sites in eight countries, including a recently validated nine-item food access insecurity questionnaire, and obtained anthropometric measurements from children aged 24 to 60 months. We used multivariable regression models to assess the relationship between household food access insecurity and anthropometry in children, and we assessed the invariance of that relationship across country sites.ResultsAverage age of study children was 41 months. Mean food access insecurity score (range: 0–27) was 5.8, and varied from 2.4 in Nepal to 8.3 in Pakistan. Across sites, the prevalence of stunting (42%) was much higher than the prevalence of wasting (6%). In pooled regression analyses, a 10-point increase in food access insecurity score was associated with a 0.20 SD decrease in height-for-age Z score (95% CI 0.05 to 0.34 SD; p = 0.008). A likelihood ratio test for heterogeneity revealed that this relationship was consistent across countries (p = 0.17).ConclusionsOur study provides evidence of the validity of using a simple household food access insecurity score to investigate the etiology of childhood growth faltering across diverse geographic settings. Such a measure could be used to direct interventions by identifying children at risk of illness and death related to malnutrition.
Highlights
Stunting results from decreased food intake, poor diet quality, and a high burden of early childhood infections, and contributes to significant morbidity and mortality worldwide
We collected cross-sectional data on household food access insecurity and child nutritional status, as measured by anthropometry, in eight country sites to determine whether these variables were related, and whether this relationship was consistent across diverse populations
We report on pilot study activities that preceded enrollment for the cohort study, aimed at characterizing the relationship between food access and child nutritional status
Summary
Stunting results from decreased food intake, poor diet quality, and a high burden of early childhood infections, and contributes to significant morbidity and mortality worldwide. Low-cost and valid measures of household food insecurity are necessary to accurately predict the prevalence of food insecurity in response to changing conditions [15] Such measurements can inform targeted interventions to diminish childhood morbidity and mortality [10,12]. We sought to assess the acceptability, validity, and generalizability of the HFIAS, an existing nine-item measure of household food access, in the setting of a multi-country study. To achieve this aim, we collected cross-sectional data on household food access insecurity and child nutritional status, as measured by anthropometry, in eight country sites to determine whether these variables were related, and whether this relationship was consistent across diverse populations
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