ABSTRACT
One in every five children in the developing world is malnourished, and poor nutrition is associated with half of all child deaths worldwide [1, 2]. Malnutrition in early childhood can lead to cognitive and physical deficits, and may cause similar deficits in future generations as malnourished mothers give birth to low birth weight infants [3]. Malnutrition also increases susceptibility and incidence of infections and is associated with diminished response to vaccines [4]. The root of malnutrition in early childhood is complex with a variety of direct and underlying contributors related to lack of food, including insufficient breastfeeding and inadequate complementary foods; protein and nutrient loss from
respiratory and gastrointestinal infections; chronic immune stimulation due to persistent parasitic intestinal infections; and inadequate water and sanitation [5, 6]. Food insecurity is a key risk factor for child malnutrition [7, 8]. Based on the 1996 World Food Summit, food security occurs “when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life” [9]. Food security comprises three hierarchical components: availability, access and utilization [10]. Availability is often measured through proxies at the population level, such as national agricultural output, while access and utilization are more often measured at the household and individual levels respectively [11]. While direct measures of food utilization exist, such as food frequency questionnaires [12], household food access has often been measured indirectly, through child anthropometry [10] or agricultural productivity [12]. Measurement of all three aspects of food insecurity has posed persistent challenges, such as the difficulty in measuring the impact of short-term shocks on household food access [12]. Recent research, however, shows promise in the area of food access measurement, with the construction of simple household survey measures such as the Household Food Insecurity Access Scale (HFIAS) [11, 13, 14]. Low-cost and valid measures of household food insecurity are necessary to accurately predict the prevalence of food insecurity in response to changing conditions [15]. Such measurements can then inform targeted interventions to diminish childhood morbidity and mortality [10, 12]. However, global progress against food insecurity requires measures that are valid and comparable across countries. We sought to assess the acceptability, validity, and generalizability of the HFIAS, an existing nine-item measure of household food access, in the setting of a multi-country study. To achieve this aim, we collected cross-sectional data on household food access insecurity and child nutritional status, as measured by anthropometry, in eight country sites to determine whether these variables were related, and whether this relationship was consistent across diverse populations.
