Household food access and child malnutrition: results from the eight-country MAL-ED study

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.

Association between household food access insecurity and nutritional status indicators among children aged <5 years in Nepal: results from a national, cross-sectional household survey

“…As nearly 80 % of the Nepalese population depends on subsistence farming, they usually face inadequate food supplies during the dry period between October and May. Therefore, a recall period of 12 months may have adjusted for the seasonal variations in the food supply while measuring HFI, as reported in previous studies (9,14) . Reporting bias due to cultural stigma against food insecurity and use of a non-validated modified sevenitem version of HFIAS in NDHS 2011 may have resulted in lower estimates of HFI.…”

“…availability, access and utilization (25) . HFIAS has been shown to be a low-cost, valid tool that can be applied to estimate the prevalence of household food insecurity (26) and be used in different settings (14) . To suit the Nepalese context, NDHS 2011 used a modified HFIAS that included seven of the nine generic questions with a recall period of 12 months instead of 30 d in the original HFIAS.…”

“…According to the World Food Summit 1996, food security occurs 'when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life' (8) . Studies from a few developing countries have reported that HFI is associated with childhood undernutrition indicators such as stunting and underweight (9)(10)(11)(12)(13)(14)(15) , but a study from Brazil has reported that HFI was not associated with Z-score for BMI-for-age or weight-for-height (16) . These studies were done among schoolchildren and pre-school children in Columbia (11,12) , tribal children aged 6-59 months in West Bengal, India (13) , children aged 6-18 months living in urban squatter settlements of Karachi, Pakistan (10) and a nationally representative sample of children aged 0-60 months in Brazil (16) .…”

“…These studies were done among schoolchildren and pre-school children in Columbia (11,12) , tribal children aged 6-59 months in West Bengal, India (13) , children aged 6-18 months living in urban squatter settlements of Karachi, Pakistan (10) and a nationally representative sample of children aged 0-60 months in Brazil (16) . A multinational study from eight countries was done on a sample of 100 children aged 24-60 months in each country (14) and another study included samples ranging from 2356 to 3422 children aged 6-60 months in three countries (9) , but none covered a nationally representative sample of children aged <5 years. In most of the studies, the association of HFI with stunting and underweight was consistent despite different instruments being applied to measure HFI (9)(10)(11)(12)(13)(14)(15) .…”

“…A multinational study from eight countries was done on a sample of 100 children aged 24-60 months in each country (14) and another study included samples ranging from 2356 to 3422 children aged 6-60 months in three countries (9) , but none covered a nationally representative sample of children aged <5 years. In most of the studies, the association of HFI with stunting and underweight was consistent despite different instruments being applied to measure HFI (9)(10)(11)(12)(13)(14)(15) . However, using level of HFI and/or stunting, wasting, etc.…”