Household Hunger Research Articles

Understanding the impact of pandemics on long-term medication adherence: directly observed therapy in a tuberculosis treatment cohort pre- and post-COVID-19 lockdowns

BackgroundThe COVID-19 pandemic negatively impacted tuberculosis (TB) treatment services, including directly observed therapy (DOT) programs used to promote medication adherence. We compared DOT adherence embedded in a research study before and after COVID-19 lockdowns in South Africa.MethodsWe analyzed data from 263 observational study participants undergoing drug susceptible (DS)-TB DOT between May 2017 to March 2022. Participants enrolled before October 2019 were considered ‘pre-COVID-19’ and those enrolled after September 2020 were considered ‘post-COVID-19 lockdown groups. Negative binomial regression models were used to compare DOT non-adherence rates between the two lockdown groups. We then conducted a sensitivity analysis which only included participants enrolled in the immediate period following the first COVID-19 lockdown.ResultsDOT non-adherence rate was higher in the post-COVID-19 lockdown group (aIRR = 1.42, 95% CI = 1.04–1.96; p = 0.028) compared to pre-COVID-19 lockdown period, adjusting for age, sex, employment status, household hunger, depression risk, and smoked substance use. DOT non-adherence was highest immediately following the initial lockdown (aIRR = 1.74, 95% CI = 1.17–2.67; p = 0.006).ConclusionThe COVID-19 lockdowns adversely effected adherence to TB DOT in the period after lockdowns were lifted. The change in DOT adherence persisted even after adjusting for socioeconomic and behavioral variables. We need a better understanding of what treatment adherence barriers were exacerbated by COVID-19 lockdowns to improve outcomes in post-pandemic times.Trial registrationClinicalTrials.gov Registration Number: NCT02840877. Registered on 19 July 2016.

Food Insecurity at Tuberculosis Treatment Initiation Is Associated With Clinical Outcomes in Rural Haiti: A Prospective Cohort Study.

Tuberculosis is a leading cause of death worldwide, and food insecurity is known to negatively influence health outcomes through multiple pathways. Few studies have interrogated the relationship between food insecurity and tuberculosis outcomes, particularly independent of nutrition. We conducted a prospective cohort study of adults initiating first-line treatment for clinically suspected or microbiologically confirmed drug-sensitive tuberculosis at a rural referral center in Haiti. We administered a baseline questionnaire, collected clinical data, and analyzed laboratory samples. We used logistic regression models to estimate the relationship between household food insecurity (Household Hunger Scale) and treatment failure or death. We accounted for exclusion of patients lost to follow-up using inverse probability of censoring weighting and adjusted for measured confounders and nutritional status using inverse probability of treatment weighting. We enrolled 257 participants (37% female) between May 2020 and March 2023 with a median age (interquartile range) of 35 (25-45) years. Of these, 105 (41%) had no hunger in the household, 104 (40%) had moderate hunger in the household, and 48 (19%) had severe hunger in the household. Eleven participants (4%) died, and 6 (3%) had treatment failure. After adjustment, food insecurity was significantly associated with subsequent treatment failure or death (odds ratio 5.78 [95% confidence interval, 1.20-27.8]; P = .03). Household food insecurity at tuberculosis treatment initiation was significantly associated with death or treatment failure after accounting for loss to follow-up, measured confounders, and nutritional status. In addition to the known importance of undernutrition, our findings indicate that food insecurity independently affects tuberculosis treatment outcomes in Haiti.

Impact of floods on food security in rural Afghanistan

Floods, affecting roughly one million Afghans annually and causing substantial economic losses, is one of the most frequent disasters. This study examines the impacts of floods on household food security in rural Afghanistan, where 80 % of the population relies on subsistence farming and consists of 80 % of the food-insecure population. Based on the 2022 Data in Emergency Monitoring Round 5 dataset, a two-stage least squares with an instrumental variable is applied to analyze the relationship, considering district altitude and unconditional aid. Our findings reveal the negative impacts of floods, i.e., flood exposure decreases the Food Consumption Score (FCS) by 7.1 points and the Household Dietary Diversity Score (HDDS) by 0.14 points. Additionally, flood exposure increases the Household Hunger Scale (HHS) by 0.77 points and significantly raises the probability of moderate and severe food insecurity by 11 % and 20 %, respectively. Food aid offers a lifeline, boosting FCS by 1.54 points and reducing HHS by 0.42 points while mitigating food insecurity risks. High-altitude areas experience greater vulnerability, with higher hunger levels and lower dietary diversity compared to lowlands. Our research suggests prioritizing preventative strategies like area-based policies and flood preparedness plans over solely relying on post-disaster relief initiatives. Additionally, accounting for topographical variations, at least at the district level, is crucial for future food security studies in Afghanistan and similar contexts. These findings hold significant implications for achieving UN Sustainable Development Goals 2 (Zero Hunger) and 13 (Climate Action).

Mobile money, food security and coping strategies in a post-conflict and fragile context: evidence from Burundi

PurposeAttaining the Sustainable Development Goal 2 (SDG2) of zero hunger continues to be a challenge in most parts of Sub-Saharan Africa. However, financial inclusion is seen as a potential pathway for reducing food insecurity among poor households. Mobile money is a financial inclusion instrument that is easily accessible to poor households and has the potential to increase the level of financial inclusion. This paper contributes to the literature by examining the determinants of mobile money adoption, its effects on household food security and the choice of coping strategies in Burundi, a post-conflict and fragile country.Design/methodology/approachUsing survey data that involved 860 households in Burundi, we adopted the Household Hunger Scale (HHS) developed under the Food and Nutrition Technical Assistance Project to measure household food security. We further employ the endogenous switching regression treatment effects model for ordered outcomes and the multivariate probit model to achieve our aims.FindingsThe results of our study reveal that the adoption of mobile money is influenced by factors such as gender, marital status, age, formal education, membership in a social network, area of residence and access to a tarred road network. Additionally, the food security status of a household was determined by marital status, formal education, social network membership, access to tarred roads, off-farm income, access to credit and land tenure security. We confirm that mobile money adoption has a significantly positive effect on the food security status of households with heterogeneity in gender and area of residence. We also find that mobile money adoption reduces the likelihood of households adopting consumption-related coping strategies.Practical implicationsThe promotion of mobile money should, therefore, be included in Burundi’s national food security policies.Originality/valueThis study contributes to the literature by providing empirical evidence on the effect of mobile money adoption on household food security and the choice of coping strategies in a post-conflict context.

High manifestations of food insecurity and hunger among pregnant and lactating women during post-conflict in Tigray, Ethiopia: a community-based study

BackgroundFood insecurity is a state or condition in which people have limited or uncertain physical, social, and economic access to safe, sufficient, and nutritious food to meet their dietary needs. Since no thorough evaluation was carried out to determine the degree of household food insecurity in Tigrayan communities in the aftermath of the conflict. This study aims to describe household-level food insecurity status among pregnant and lactating women during the post-armed conflict in Tigray, Ethiopia.MethodDescriptive research was designed to assess household food insecurity. A multi-stage sampling technique was used for this study. One thousand two hundred forty-nine households were selected systematically following a list of food insecure households. Descriptive statistical values, including frequency counts, percentages, minimum values, maximum values, and averages, were calculated to quantify the indicators under study. Household food insecurity and hunger Scale measurement using the standardized Food and Agriculture Organization standard.ResultsThe mean age (± SD) of the mothers was 28.35 ± 5.91 years. More than three fourth of the participants 1010(80.93%) were rural residents. The survey result showed that 88.8% of the pregnant and lactating were food insecure. Half (50.1%) of the households were hungry,one month before the study, 78.5% of the families expressed concern about running out of food and 6.4% had severe hunger.ConclusionsThe food insecurity levels and hunger prestige of the study communities were excessively high. This is in the context of a region affected by intense armed conflict. It is commended that the study communities need to be safeguarded from the direct and long-term consequences of armed conflict-caused household food insecurity.

Multivariate mixed-effects ordinal logistic regression models with difference-in-differences estimator of the impact of WORTH Yetu on household hunger and socioeconomic status among OVC caregivers in Tanzania.

Although most of the livelihood programmes target women, those that involve women and men have been evaluated as though men and women were a single homogenous population, with a mere inclusion of gender as an explanatory variable. This study evaluated the impact of WORTH Yetu (an economic empowerment intervention to improve livelihood outcomes) on household hunger, and household socioeconomic status (SES) among caregivers (both women and men) of orphaned and vulnerable children (OVC) in Tanzania. The study hypothesized that women and men respond to livelihood interventions differently, hence a need for gender-disaggregated impact evaluation of such interventions. This is a secondary analysis of longitudinal data, involving caregivers' baseline (2016-2019) and follow-up (2019-2020) data from the USAID Kizazi Kipya project in 25 regions of Tanzania. Two dependent variables (ie, outcomes) were assessed; household hunger which was measured using the Household Hunger Scale (HHS), and Socioeconomic Status (SES) using the Principal Component Analysis (PCA). WORTH Yetu, a livelihood intervention implemented by the USAID Kizazi Kipya project was the main independent variable whose impact on the two outcomes was evaluated using multivariate analysis with a multilevel mixed-effects, ordinal logistic regression model with difference-in-differences (DiD) estimator for impact estimation. The analysis was based on 497,293 observations from 249,655 caregivers of OVC at baseline, and 247,638 of them at the follow-up survey. In both surveys, 70% were women and 30% were men. Their mean age was 49.3 (±14.5) years at baseline and 52.7 (±14.8) years at the follow-up survey. Caregivers' membership in WORTH Yetu was 10.1% at the follow-up. After adjusting for important confounders there was a significant decline in the severity of household hunger by 46.4% among WORTH Yetu members at the follow-up compared to the situation at the baseline (adjusted Odds Ratio (aOR) = 0.536, 95% Confidence Interval (CI) [0.521, 0.553]). The decline was 45.7% among women (aOR = 0.543 [0.524, 0.563]) and 47.5% among men (aOR = 0.525 [0.497, 0.556]). Regarding SES, WORTH Yetu members were 15.9% more likely to be in higher wealth quintiles at the follow-up compared to the situation at the baseline (aOR = 1.159 [1.128, 1.190]). This impact was 20.8% among women (aOR = 1.208 [1.170, 1.247]) and 4.6% among men (aOR = 1.046 [0.995, 1.101]). WORTH Yetu was associated with a significant reduction in household hunger, and a significant increase in household SES among OVC caregivers in Tanzania within an average follow-up period of 1.6 years. The estimated impacts differed significantly by gender, suggesting that women and men responded to the WORTH Yetu intervention differently. This implied that the design, delivery, and evaluation of such programmes should happen in a gender responsive manner, recognising that women and men are not the same with respect to the programmes.

Addressing hunger among households with children utilizing food assistance resources: an analysis of food pantry users

Abstract Aim Households with children have higher rates of food insecurity compared to households without children. Financial instabilities, including job loss, decreased income, and family structure changes are food insecurity risk factors. During the COVID-19 pandemic, programs were implemented to alleviate the impacts on food insecurity, but those expanded benefits were decreased in March 2023, leaving many families with economic burden. Subject and methods This study used a cross-sectional survey administered to food pantry users across ten food pantries in Eastern Massachusetts from June to August 2018, with 279 users reporting at least one child in the household. The outcome, hunger, was assessed using a modified version of the Household Hunger Scale. Households were categorized (one child, two children, or three or more children). Mixed-effects logistic regression models assessed the relationship between hunger categories and number of children in the household. Results This study found that having more children in the household increases the severity of hunger. Households with at least three children had 1.46 times the odds (95% CI: 1.08, 1.97) of moderate hunger and 1.85 times the odds (95% CI: 1.11, 3.07) of severe hunger compared to one-child households. Severe hunger was associated with monthly household income, with higher incomes having a protective effect for severe hunger. Conclusion Programs and policies addressing food insecurity are critical for supporting households with children already accessing supports, so removal of benefits may impact food insecurity. A multi-pronged approach including government-funded benefits and food pantry services is most effective in alleviating food insecurity. Significance Previous studies show that food insecurity increases with more children in the household compared to households without children, but focus less on populations already utilizing food assistance programs such as food pantries. This study examines hunger in households with children who are already at risk for food insecurity and receive food pantry services. Studying this population is essential given the recent decision by the US government to remove expanded COVID-19 benefits addressing food insecurity. Households with children experiencing food insecurity now depend upon those benefits and will be affected by their removal. These study findings can inform future resource allocation.

Psychosocial factors associated with intention to pursue tertiary education among Malawian students: the moderating effect of mental health

BackgroundIn Sub Saharan Africa (SSA), approximately 9 million students are enrolled in tertiary education (TE), which is 4% of the total TE enrolment globally. Barriers to higher education in SSA are numerous: poverty, food insecurity, gender, and disability, while the COVID-19 pandemic has worsened the situation. Little is known about the psychosocial factors and underlying mechanisms associated with students’ intention to apply for TE. Using a psychological theory of behaviour change, our study investigated the psychosocial and context factors associated with the application to TE.MethodsIn a cross-sectional research study 821 interviews using researcher-administered questionnaires were conducted with secondary school students in rural and urban Blantyre, Malawi. A quantitative questionnaire based on the risks, attitudes, norms, abilities, and self-regulation (RANAS) model was used to assess psychosocial factors underlying application for TE. The Centre for Epidemiological Studies Depression Scale for Children (CES-DC) and household hunger scale were used to assess mental health and hunger respectively.ResultsMore than half of the youth were at risk to develop depression (66.5%). Girls reported experiencing more depression symptoms than boys. Around 1 in every 5 interviewed youth lived in a home experiencing moderate or severe hunger. A higher intention to apply for TE was related to perceived vulnerability, affective beliefs (joy, happiness, excitement), injunctive (approval of others) and personal norms, self-efficacy, and commitment to apply. Factual knowledge about TE application was very limited. An intention to apply for TE and self-efficacy was positively associated with regular physical exercise, but negatively associated with mental health and hunger. However, mental health moderated the effects of physical exercise on the intention to apply for TE. We found significant differences between poor and good mental health groups on intention to apply for TE in perceived vulnerability, descriptive (behaviour of others) and personal norms, self-efficacy, maintenance self-efficacy and commitment factors. The results informed a behaviour change intervention strategy to increase students’ intention to apply for TE.ConclusionsOur research findings are an important contribution to the long-term strategy of achieving the Sustainable Development Goals (SDGs) and contribute to the inclusion of vulnerable students with impaired mental health in higher education in Malawi and beyond.

Assessing the effect of adverse economic events on severity of hunger among food pantry clients.

This study assessed relationship between adverse economic events (AEE) and hunger level (i.e., little to no, moderate, severe). A cross-sectional survey was conducted from June to August 2018 in 10 food pantries with 616 food pantry users. Hunger level was assessed by the Household Hunger Scale. AEE were evaluated over the past 3 months. Participants (60.55%) experienced unexpected or increased medical expenses (17.69%), job loss (13.64%), pay reduction (11.85%), and death of a family member (9.09%). Pay reduction (OR = 1.87, 95% CI: 1.12, 3.14) and increased debt (OR = 2.71, 95% CI: 1.92, 3.84) were associated with moderate hunger; death of a family member (OR = 2.43, 95% CI: 1.21, 4.90), pay reduction (OR = 2.95, 95% CI: 1.24, 7.04), and increased debt (OR = 3.46, 95% CI: 1.98, 6.04) were associated with severe hunger. Awareness of AEE can inform public health programs and policies for people in need of additional resources, which is essential in times of increased economic instability.

Effect of an action-research nutrition intervention on the Global Diet Quality Score of Colombian adolescents.

Strategies to address the nutritional needs of adolescent girls and young women often focus on supplementation. In this study, an action-research approach involving a nutrition education and entrepreneurship intervention was carried out among adolescent girls and young women in poor neighborhoods of Medellín, Colombia. The intervention group significantly increased its intake of several nutrients, including energy, protein, total fat, saturated fat, monounsaturated fat, polyunsaturated fat, cholesterol, dietary fiber, calcium, zinc, and vitamins A, B2, B3, B9, and C. A significant increase was observed in the intake of the Global Diet Quality Score (GDQS) healthy food groups (other fruits, other vegetables, legumes, high-fat dairy products), accompanied by a decrease in the consumption of some unhealthy food groups (sweets and ice creams). A multivariate regression controlling for age, socioeconomic status, occupation, Household Hunger Scale, mean probability of adequacy, physical activity, and body self-perception showed that the nutrition intervention improved the total GDQS by 33% in the intervention group-a substantial improvement notwithstanding the study group's precarious social and economic conditions. We conclude that nutrition education and entrepreneurship models based on this approach may improve the dietary profile of this population and reduce future pressures from nutrition-related chronic diseases.

Cash for assets during acute food insecurity: an observational study in South Sudan

BackgroundCash-based assistance in humanitarian contexts has grown substantially in recent years, yet little is empirically known about differential impacts of cash for diverse beneficiaries, which could better inform assistance targeting. In the context of increasing food insecurity and extreme levels of famine in South Sudan despite significant scale-up of humanitarian assistance, this analysis examined food security and household economy outcomes to better understand the impact of cash assistance and characteristics associated with worsened household food security and coping strategies.MethodsIn 2019–2021, a prospective cohort study was conducted leveraging a program providing cash for work in community gardens. 1213 households receiving cash prior to the start of the study (Cohort A/B), 582 non-intervention households (Control), and 300 households that received cash after the start of the study (Cohort C) completed 2 interviews spaced one year apart to measure household food insecurity and coping mechanism adoption.ResultsThere were no significant differences in change over time in household hunger score (p = 0.074), livelihoods coping strategy index score (p = 0.104), or meal frequency (p = 0.113) between program participants and the comparison group. The comparison group had a significantly larger increase in dietary diversity over time (0.6 vs. 0.2 in Cohort A/B, p = 0.005); however, at endline there were no significant differences in dietary diversity between program participants and the non-intervention group (4.3 in both groups). There were few factors associated with increased likelihood of worsened food security and coping outcomes, the most noticeable being recent investment livestock, which was associated with 1.5 times greater odds of worsened hunger and 1.63 times greater odds of worsened coping strategy adoption.ConclusionCash transfers did not appear to have lasting benefits on food security and livelihoods coping strategy use. Larger transfer sizes may need to be considered in future programming to achieve more substantial improvements in household food security; however, maintaining rather than improving household food security may be sufficient in worsening food crises contexts.

Pest risk information, agricultural outcomes and food security: evidence from Ghana

This article investigates the short-term effects of an information intervention that provided early warning pest alerts and integrated pest management (IPM)-based advice to smallholder farmers. Specifically, this study focuses on fall armyworm (Spodoptera frugiperda) of maize in Ghana. We particularly examine the relationships between access to pest risk information and a number of outcomes, ranging from farmer’s knowledge to household food security. This study is based on survey data collected between December 2021 and January 2022 from 888 farm households operating 1305 maize fields. Results from doubly robust and switching regression models indicated that exposure to the pest risk information campaign was significantly (ρ < 0.05) associated with increases in the likelihood of optimal timing of fall armyworm control action and the adoption of multiple IPM practices, but it had no significant effect on pesticide use. Households who received the pest risk information obtained an average of 4% or 54 kg/ha (ρ < 0.01) gain in maize yield and were about 38% less likely (ρ < 0.01) than their non-recipient counterparts to report experiencing hunger, as measured by the household hunger scale. However, the pest risk information campaign was not associated with greater household dietary diversity. Further results indicated that households where the pest risk information was received by women, alone or together with their spouses, were more likely (ρ < 0.05) to achieve positive outcomes than if the recipient of information were male member of households. Overall, our findings imply that the dissemination of early warning pest alerts in combination with actionable IPM information to smallholder farmers can contribute to the adoption of sustainable crop protection technologies, and ultimately improve the standard of living of farm households.

Evidences of Widespread Hunger in Gbeo Community, North East Region, Ghana; the Determinants of Malnutrition and Susceptibility to Extreme Hunger

Background: The global community aspires towards zero hunger and minimized prevalence of various metrics of malnutrition by 2030 and beyond. Despite mainstream routine nutrition/food surveillance interventions carried out by provincial, national and civil society bodies, the markers of global hunger are rife. This study sought to investigate with the aid of household food insecurity experience scale (HFIES) and nutrition indices, the evidence of hunger, child malnutrition and other forms of extreme household deprivation in Gbeo; a rural hard-to-reach community in the Mamprugu East Municipality, North East Region. Methods: This study was a case analysis of Gbeo community using cross-sectional modalities. Mother – child dyads from 235 systematically selected households were recruited for one-on-one interviews including anthropometric/dietary assessments. Data were obtained on household hunger (using HFIES as proxy), child (6 – 59 months) malnutrition and their potential predictors (SE characteristics, IYCF, WASH, etc.). Child anthropometric growth indices were computed in accordance with WHO (2017) revised standard protocols. Findings: Out of 235 children 34.4% were stunted, 18.8% underweight and 37.9% wasted; these are elevated above Ghana Demographic and Health Survey (GDHS) data for Northern Region, Ghana as a whole and WHO/UNICEF/World Bank (2021) latest global estimates. Four (1.8%) children had all growth failure and in 5.6% of cases, underweight co-occur with stunting and wasting. The proportion of HHs in the 3rd tertile [T3], 2nd tertile [T2] and 1st tertile [T1] of food insecurity were 33%, 29% and 38% respectively. Multiple logistic regression models showed that mean HFIES scores were higher among households that; has a female food-based decision maker [t (degrees of freedom=1, n=235) = 1.93, significance level p =.000], have not received any form of remittances within the past 12 months [t (1, 235) = 2.65, p = .016], source their food stuffs from predominantly purchasing [t (1, 235) = 2.65, p = .009] and has a caregiver or household head that is an alcoholic [t (1, 235) = 4.01, p = .000]. Conclusion: Food insecurity predicts acute child malnutrition. Social protection and economic empowerment interventions should be integrated with nutrition-based initiatives for holistic household improvement.

Increasing Household Diet Diversity and Food Security in Rural Rwanda Using Small-Scale Nutrition-Sensitive Agriculture: A Community-Engaged Proof-of-Concept Study.

Malnutrition and food insecurity remain high in rural Rwanda, where residents consume a low-diversity diet provided through subsistence farming. Agricultural interventions using kitchen gardens may improve diet diversity in some populations. However, little is known about their efficacy when developed using community-based participatory research in combination with nutrition education focused on the empowerment of women. The objective of this study was to develop and implement a kitchen garden and nutrition education intervention using a community-engaged model and examine its impact on household diet diversity and food security. Using a mixed methods community-level design, we assessed a 16-week intervention implemented in Cyanika, Rwanda. Stratified purposeful sampling was used to select women participants representing 42 households. Household diet diversity scores (HHDS) and hunger scores were calculated at the baseline, post-intervention and one-year follow-up. HDDS increased after intervention from a pre-intervention intake of 2.59 [1.3] food groups/day, to 4.85 [1.6] at four months post-intervention and at one year post-intervention, reaching 5.55 [1.3]. There were no significant changes in household hunger scores. Our results indicate that collaborative community-engaged nutrition-sensitive agricultural interventions can increase household diet diversity; however, future work should explore whether this type of intervention strategy can lead to sustained changes and impact nutritional adequacy in this population.

Urbanization and food security: evidence from Mali

Income poverty remains the main root of urban food insecurity as purchased food represents a major component of the spending of urban residents. The rapid and increasing urbanization and urban sprawl are major concerns for food security in Mali. In Mali, 3.6% of households, are severely food insecure and the food insecurity prevalence rate for urban households is 7.5%. The effect of urbanization on households’ food security was assessed in the literature using only a single measure of food security. In this regard, this study analyzed the effect of urbanization on both objective and subjective measures of food security in Mali, using data from the national survey on food security and nutrition (ENSAN). The data collection was conducted by the Early Warning System against Famine (SAP) on 9,782 households in February 2018. For the objective measure of food security, the study used an OLS model to estimate the effect of urbanization on household food expenditure per capita. Using the household hunger scale (HHS) score, the study estimated two models (logit and ordered probit) to capture the effect of urbanization on subjective measures of food security. The results of the OLS and logit models showed that households living in urban areas are less food secure compared to their counterparts living in rural areas. The results from the ordered probit also confirmed that urban households are more food insecure (mildly and moderately) compared to their counterparts living in rural areas. Based on these results, the study recommends to decision-makers to take into account urban poor households when setting up food safety net programmes.

Using the household hunger scale to improve analysis and classification of severe food insecurity in famine-risk conditions: Evidence from three countries

The currently accepted means of categorizing household food insecurity and identifying famine or famine risk is through Integrated Food Security Phase Classification (IPC) analysis. IPC guidelines set criteria for the measurement and determination of famine, but recent analyses in famine-risk countries have faced several challenges. Commonly used indicators capture different aspects of food security and often produce very divergent estimates of the prevalence of food insecurity. This led to the usage of the Household Hunger Scale (HHS) as the presumed “anchor” indicator for IPC acute food insecurity analysis, with all other indicators of food consumption calibrated to the HHS. But because there was no gold standard, only an “anchor,” this presumption had never been tested. Further, given that HHS was the only indicator that could specify the difference between the two most severe categories of IPC Phase Classification (Phase 4 “Emergency” and Phase 5 “Famine”), analysis of food insecurity at the extreme end of the IPC scale relies heavily on HHS, rather than the standard panoply of indicators used for acute food insecurity analysis at lesser levels of severity. This study sought to test how well HHS differentiates between IPC Phase 4 and Phase 5 and to investigate the validity of the usage of HHS as the “anchor” indicator across the spectrum of IPC analysis. Data was collected in seven different severely food-insecure areas of South Sudan, Kenya, and Somalia. The findings show that, overall, the HHS performs reasonably well as an “anchor indicator” across the IPC scale and is able to differentiate the majority of cases in Phases 4 and 5 but tends to over-classify (over-estimate the severity of food insecurity at the household level)—especially at the lower end of the IPC scale. At the high end of the scale, these results indicate that HHS is good at flagging highly food-insecure households but may require additional information to rigorously differentiate households in Phase 4 from those in Phase 5. The study identified ways to improve classification by HHS by some simple additional questions or observations to differentiate between Phase 4 and Phase 5. In an era of extreme scarcity of humanitarian funding, this has substantial implications for resource allocation and humanitarian prioritization.

Validity of Food insecurity experience scale (FIES) for use in rural Bangladesh and prevalence and determinants of household food insecurity: An analysis of data from Bangladesh integrated household survey (BIHS) 2018-2019

“Access” dimension of Food insecurity (FI) is directly measured by the Food Insecurity Experience Scale (FIES). The current study assessed the appropriateness of the FIES for measuring FI in rural Bangladesh, followed by an assessment of FI prevalence and its correlates utilizing Bangladesh Integrated Household Survey (BIHS) data. The internal validity of the FIES and the prevalence of FI were investigated using the Rasch modeling approach. We utilized equating procedure to calibrate the study’s result to the global FIES reference scale and determined FI prevalence rates that were comparable across countries. The external validity of the FIES was evaluated by examining its association with other FI measures using Spearman’s rho correlation analysis. With an overall Rasch reliability of 0.84, the FIES met the Rasch model assumptions of conditional independence and equal discrimination, and as well as the fit statistics standards for all eight items. Infit statistics were within the allowed limit for all FIES items indicating good internal validity. However, we noted a high outfit (>2) for the “unable to eat healthy and nutritious food” item indicating the presence of some unusual response patterns. Our analysis found no significant (>0.4) correlation between FIES items. We also found a significant correlation between FIES and other FI proxies, e.g., the Household hunger scale (HHS), Food consumption score (FCS), and Household dietary diversity score (HDDS). Overall, the prevalence of moderate or severe FI was 18.92% in rural Bangladesh. Geographic areas, access to electricity, household ownership, access to sanitation, livestock ownership, family size, education level, and monthly per capita food expenditure significantly explained the variation in FI. Our analyses suggest that the FIES is internally and externally valid for FI measurement in rural Bangladesh. However, FIES questions may need to be reordered to more accurately evaluate lower levels of FI, and the item “unable to eat healthy and nutritious food” may need cognitive testing.

Prevalence of Poverty and Hunger at Cancer Diagnosis and Its Association with Malnutrition and Overall Survival in South Africa

Many South African children live in poverty and food insecurity; therefore, malnutrition within the context of childhood cancer should be examined. Parents/caregivers completed the Poverty-Assessment Tool (divided into poverty risk groups) and the Household Hunger Scale questionnaire in five pediatric oncology units. Height, weight, and mid-upper arm circumference assessments classified malnutrition. Regression analysis evaluated the association of poverty and food insecurity with nutritional status, abandonment of treatment, and one-year overall survival (OS). Nearly a third (27.8%) of 320 patients had a high poverty risk, associated significantly with stunting (p = 0.009), food insecurity (p < 0.001) and residential province (p < 0.001) (multinomial regression). Stunting was independently and significantly associated with one-year OS on univariate analysis. The hunger scale was significant predictor of OS, as patients living with hunger at home had an increased odds ratio for treatment abandonment (OR 4.5; 95% CI 1.0; 19.4; p = 0.045) and hazard for death (HR 3.2; 95% CI 1.02, 9.9; p = 0.046) compared to those with food security. Evaluating sociodemographic factors such as poverty and food insecurity at diagnosis is essential among South African children to identify at-risk children and implement adequate nutritional support during cancer treatment.

An evaluation of nutrition, culinary, and production interventions using African indigenous vegetables on nutrition security among smallholder farmers in Western Kenya.

Nutrition security continues to worsen in sub-Saharan Africa. Current research is limited on how seasonality may influence the impact of nutrition, culinary, and production interventions on food security, diet quality, and consumption of African Indigenous Vegetables (AIV); a culturally accepted source of micro-and-macronutrients that are easily produced due to their adaptation to the local environment. The objective of this study was to evaluate the programmatic impact of AIV interventions on nutrition security among smallholder farmers. In a randomized control trial, five target counties in Western Kenya were randomly assigned to one of four treatments: (1) control; (2) production intervention (PI); (3) nutrition and culinary intervention (NCI); and (4) NCI and PI (NCI/PI). After the counties were randomly assigned to a treatment, 503 smallholder farmers (18-65 years) were selected from participatory farmer groups. The PI consisted of five agricultural production modules delivered between 2016 and 2019. The NCI was delivered twice: (1) household nutrition education (2017) and (2) community culinary training (2019). The NCI/PI included communities receiving both interventions at these time periods. Baseline and endline surveys were administered to all participants once in October 2016 (harvest season) and to all available participants (n = 250) once in June to July 2019 (dry season), respectively. The impact evaluation was analyzed by Household Hunger Scale (HHS), Women's Dietary Diversity Score (WDDS), AIV consumption frequency, and AIV market availability. Statistical tests included descriptive statistics (means and frequencies), paired t-test, McNemar's test, Wilcoxon Signed-Rank test, ANOVA test with Tukey post hoc, and χ2 test. Open-ended questions were aggregated, and responses were selected based on relevancy and thoroughness of the response to provide context to the quantitative data. A value of p < 0.05 was used to denote statistical significance. There was an overall decrease in WDDS, HHS, and consumption frequency between baseline and endline attributed to seasonal differences. Despite this, post-intervention, households that received NCI/PI had a higher WDDS relative to the control: WDDS 5.1 ± 1.8 vs. 4.2 ± 1.5, p = 0.035. In addition, between baseline and endline, there was an overall increase in the percentage of respondents that reported an adequate supply of key AIVs, particularly for households that received PI. Furthermore, seasonal effects caused a reported shift in the primary location for purchasing AIVs from the village to the town market. There was no reported difference in HHS. While "diet awareness" significantly influenced diet quality among the NCI treatment group, "production" was reported to have the greatest influence on diet quality among all intervention groups. The findings revealed that coupled nutrition, culinary, and production interventions could create a protective effect against seasonal fluctuations in the availability and affordability of AIV as evidenced by a higher WDDs. These findings suggest that future programming and policy should focus on promoting the availability, accessibility, acceptability, and affordability of improved agronomic practices and germplasm for both smallholder farmers with particular emphasis on AIV varieties that contain high levels of micro-and macronutrients, improved agronomic characteristics (e.g., delayed flowering, multiple harvests, higher yields, and disease resistance), and are aligned with the communities' cultural preferences. In addition, agricultural training and extension services should incorporate nutrition and culinary interventions that emphasize the importance of farmers prioritizing harvests for their household consumption.

Armed conflict and household food insecurity: evidence from war-torn Tigray, Ethiopia

BackgroundExposure to armed conflicts result in strongly adverse and often irreversible short- and long-term effects which may transmit across generations. Armed conflicts directly cause food insecurity and starvation by disruption and destruction of food systems, reduce farming populations, destroying infrastructure, reducing resilience, and increasing vulnerabilities, disruptions in access to market, increasing food price or making goods and services unavailable altogether. The objective of the present study was to determine the status of household food insecurity in the armed conflict affected communities of Tigray in terms of Access, Experience and Hunger scale.MethodCommunity-based cross-sectional study was conducted to assess impact of armed conflict on household food insecurity among households with children with under one year. FHI 360 and FAO guidelines were used to quantify household food insecurity and Household hunger status.ResultsThree-fourth of the households had anxiety about food supply and eat undesired monotonous diet due to lack of resources. Households were obliged to eat few kinds of foods, eat smaller meals, eat foods they do not want to eat, or went a whole day without eating any food. Household food insecurity access, food insecurity experience, and hunger scales significantly increased by 43.3 (95% CI: 41.9–44.7), 41.9 (95% CI: 40.5–43.3) and 32.5 (95% CI: 31.0-33.9) percentage points from the prewar period.ConclusionsHousehold food insecurity levels and household hunger status of the study communities was unacceptably high. The armed conflict has significant negative effect on food security in Tigray. It is recommended that the study communities need to be protected from the immediate and long-term consequences of conflict-induced household food insecurity.