Household Food Insecurity Is Associated with Higher Child Undernutrition in Bangladesh, Ethiopia, and Vietnam, but the Effect Is Not Mediated by Child Dietary Diversity

Abstract

Household food insecurity (HFI) is a recognized underlying determinant of child undernutrition, but evidence of associations between HFI and child undernutrition is mixed. The purpose of this study was to investigate if HFI is associated with undernutrition in children aged 6-59.9 mo in Bangladesh (n = 2356), Ethiopia (n = 3422), and Vietnam (n = 3075) and if child dietary diversity (DD) mediated this effect. We used baseline survey data from the Alive & Thrive project. Logistic regression, adjusting for potential confounding factors, was used to determine the magnitude and significance of the association of HFI with stunting, underweight, and wasting. The mediating effect of child DD was tested by using a Sobel-Goodman mediation test. The prevalences of HFI were 66%, 40%, and 32% in Ethiopia, Vietnam, and Bangladesh, respectively. The prevalences of stunting, underweight, and wasting were higher in Bangladesh (47.1%, 43.7%, and 19.1%, respectively) and Ethiopia (50.7%, 27.5%, and 5.9%, respectively) than in Vietnam (20.7%, 15.8%, and 5%, respectively). In the adjusted models, the odds of being stunted or underweight were significantly higher for children in severely food-insecure households in Bangladesh (stunting OR: 1.36; 95% CI: 1.05, 1.76; underweight OR: 1.28; 95% CI: 0.99, 1.65) and Ethiopia (stunting OR: 1.48; 95% CI: 1.09, 2.00; underweight OR: 1.68; 95% CI: 1.22, 2.30) and in moderately food-insecure households in Vietnam (stunting OR: 1.39; 95% CI: 1.16, 1.65; underweight OR: 1.69; 95% CI: 1.28, 2.23). HFI was significantly associated with wasting in Bangladesh where close to 1 in 5 children demonstrated wasting. Child DD did not mediate the relation between HFI and undernutrition in any of the countries. Further research is recommended to investigate potential mediators in this pathway.

The nutrition transition and indicators of child malnutrition

“…This method does not refer to children in particular, but uses country level average numbers of calorie supply and minimum consumption requirements in the population (de Haen, Klasen, & Qaim, 2011). Calorie availability and access are important determinants of child nutritional status (Psaki et al, 2012;Ali et al, 2013). Furthermore, we control for sanitation conditions, which are also important for explaining child nutrition (Fink, Günther, & Hill, 2011;Smith & Haddad, 2014).…”

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

“…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.…”

Does household food insecurity influence nutritional practice of children age 6 to 23 months in Bangladesh?

“…The prevalence of under-five year old children HHFI was also significantly higher in some developing countries, such as, Brazil (51.7%), Ghana (69.9%), Ethiopia (66.4%), Vietnam (40.3%) and Nepal (69.0%). 6,16,18,28 Our study showed that food insecurity was more prevalent among the children of illiterate parents, socio-economically poor families and rural dwelling. The findings were consistent with a study in Nepal that suggested that parent's educational status and socio-economic status were significantly associated with HHFI.…”

“…Despite impressive progress in agriculture since independence in 1971, food prices have rapidly increased in the last decade which has resulted in poverty and hunger in Bangladesh. 28 In addition, natural hazards, such as, environmental pollution, floods, global worming etc, sometimes hamper agricultural production which may cause HHFI. 34 Bivariate analysis also showed the significant relationship between HHFI and breastfeeding status.…”