Household Food Insecurity Access Scale (HFIAS) and Household Food Insecurity Access Prevalence (HFIAP) as Predictor of Stunted Child and Overweight/Obese Mother (SCOWT) in Urban Indonesia

Abstract

BACKGROUND AND PURPOSEFood insecurity exists whenever the availability of nutritionally adequate, safe foods or access to attain basic foods in socially acceptable ways is deteriorated. The purpose of this study was to determine the relationship between the household food insecurity and double burden of malnutrition as indicated by household stunted child and overweight/obese mother (SCOWT).METHODThe household food insecurity access scale (HFIAS) is a continuous measure of the degree of food insecurity in the household in the past 30 days. While the household food insecurity access prevalence (HFIAP) is a categorical indicator of food insecurity status. Stunting was defined as <−2.0 height‐for‐age Z‐score (HAZ) by WHO‐Anthro 2005. Maternal overweight was defined as BMI >25.0 to 30.0 and obesity defined as BMI>30.0. Trained interviewers administered the HFIAS questionnaire to 685 urban households with children aged 2 to <5 years in Surabaya, Indonesia. Logistic regression models were constructed to test the association between SCOWT and HFIAS or HFIAP.RESULTS/FINDINGSResults showed that the prevalence of child stunting was 36.5%, maternal overweight and obesity was 58.8% and SCOWT prevalence was 21.2%. Based on the HFIAP, 42% of households were food secure, 22.9% were mildly food insecure, 15.3% were moderately food insecure, and 19.7% were severely food insecure. After adjustment for family size, maternal education, maternal occupation, food expenditure and maternal height, the models revealed that higher HFIAS scores were associated with higher likelihood of SCOWT (OR=1.044; 95%CI=1.003–1.087; p‐value=0.036), but not with child stunting (OR=1.022; 95%CI=0.985–1.060; p‐value=0.251), or maternal overweight/obesity (OR=1.031; 95%CI=0.995–1.068; p‐value=0.095). Similar pattern shown in logistic regression models for HFIAP. The adjusted models showed significant association between HFIAP and SCOWT (OR=1.254; 95%CI=1.024–1.535; p‐value=0.028), but not with child stunting (OR=1.167; 95%CI=0.976–1.395; p‐value=0.090), or maternal overweight/obesity (OR=1.127; 95%CI=0.949–1.338; p‐value=0.173). Subsequent logistic regression analysis for HFIAP and SCOWT using food secure households as reference group revealed that all food insecure households have higher risk of SCOWT. Moderately food insecure households have greatest odds (OR=3.665; 95%CI=1.782–7.538; p‐value<0.001) followed by the mildly food insecure (OR=2.964; 95%CI=1.544–5.693; p‐value=0.001) and severely food insecure households (OR=2.016; 95%CI=1.011–4.021; p‐value=0.047).CONCLUSIONThese results support the hypothesis that double burden of malnutrition is robustly related to food insecurity and HFIAS and HFIAP is a good predictor of SCOWT.Support or Funding InformationThis study is part of a self‐funded dissertation project by Trias Mahmudiono under supervision of Dr. Richard Rosenkranz at Kansas State University.