Abstract
Household food insecurity (HFI) is a major global public health and pediatric concern due to its reported association with adverse child nutrition, growth, and health outcomes. Psychosocial dysfunction is a major cause of childhood disability. US and Canadian studies have linked HFI to poorer overall psychosocial dysfunction and specific dysfunction types in school-aged children, i.e., internalizing, externalizing, and attention behaviors. However, it is uncertain whether prior findings are generalizable to low- and middle-income country (LMIC) settings. We conducted a cross-sectional study to explore the association of HFI with psychosocial dysfunction in 6-12-year-old public elementary schoolchildren (n=279) residing in low-income neighborhoods in Quito, Ecuador. Maternal caregivers were interviewed to obtain data on child psychosocial dysfunction (Pediatric Symptom Checklist, PSC), food security (Household Food Security Survey Module), and maternal mental health (SF-36 Mental Composite Summary). Capillary blood samples were obtained from child participants to measure hemoglobin levels. The data were analyzed using general linear models with adjustment for covariates. The results revealed that HFI was associated with significantly higher overall average PSC scores (p=0.002) and with internalizing (p=0.001) and externalizing (p=0.03) but not attention subscale scores. However, anemia was independently associated with PSC attention subscale scores (p=0.015). This is the first study to report on the relationship between HFI and psychosocial dysfunction in school-aged children in a LMIC setting. It highlights the importance of improving policies and programs protecting vulnerable households from HFI. In addition to improving health and nutrition, such improvements could potentially reduce the burden of child psychosocial dysfunction.
Highlights
Household food insecurity (HFI) constitutes a major global public health and pediatric concern due to its high prevalence and association with adverse health and nutrition outcomes
To the best of our knowledge, the present study is the first to report on the relationship of household food insecurity (HFI) with child psychosocial dysfunction in a Latin American or other low- and middle-income countries (LMIC) population context
The study data support our hypothesis that compared to school-age children living in food secure homes, those from food insecure households suffer from greater psychosocial dysfunction as reflected by their higher average scores on the Pediatric Symptom Checklist (PSC) and PSC internalizing and externalizing subscales
Summary
Household food insecurity (HFI) constitutes a major global public health and pediatric concern due to its high prevalence and association with adverse health and nutrition outcomes. The findings from a number of prior studies conducted in the US and Canada suggest that school-age children exposed to HFI have greater psychosocial dysfunction [9,10,11,12,13,14,15,16]. This is important since psychosocial dysfunction is a major cause of childhood disability that can adversely affect normal child development, social relations, academic performance, and quality of life. If not identified and treated early, it can persist into adolescence and later life to interfere with daily functioning and cause long-term work disability [17, 18]
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