Vulnerability to Food Insecurity in Urban Slums: Experiences from Nairobi,Kenya

Food and nutrition security is critical for economic development due to the role of nutrition in healthy growth and human capital development. Slum residents, already grossly affected by chronic poverty, are highly vulnerable to different forms of shocks, including those arising from political instability. This study describes the food security situation among slum residents in Nairobi, with specific focus on vulnerability associated with the 2007/2008 postelection crisis in Kenya. The study from which the data is drawn was nested within the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), which follows about 70,000 individuals from close to 30,000 households in two slums in Nairobi, Kenya. The study triangulates data from qualitative and quantitative sources. It uses qualitative data from 10 focus group discussions with community members and 12 key-informant interviews with community opinion leaders conducted in November 2010, and quantitative data involving about 3,000 households randomly sampled from the NUHDSS database in three rounds of data collection between March 2011 and January 2012. Food security was defined using the Household Food Insecurity Access Scale (HFIAS) criteria. The study found high prevalence of food insecurity; 85 % of the households were food insecure, with 50 % being severely food insecure. Factors associated with food security include level of income, source of livelihood, household size, dependence ratio; illness, perceived insecurity and slum of residence. The qualitative narratives highlighted household vulnerability to food insecurity as commonplace but critical during times of crisis. Respondents indicated that residents in the slums generally eat for bare survival, with little concern for quality. The narratives described heightened vulnerability during the 2007/2008 postelection violence in Kenya in the perception of slum residents. Prices of staple foods like maize flour doubled and simultaneously household purchasing power was eroded due to worsened unemployment situation. The use of negative coping strategies to address food insecurity such as reducing the number of meals, reducing food variety and quality, scavenging, and eating street foods was prevalent. In conclusion, this study describes the deeply intertwined nature of chronic poverty and acute crisis, and the subsequent high levels of food insecurity in urban slum settings. Households are extremely vulnerable to food insecurity; the situation worsening during periods of crisis in the perception of slum residents, engendering frequent use of negative coping strategies. Effective response to addressing vulnerability to household food insecurity among the urban poor should focus on both the underlying vulnerabilities of households due to chronic poverty and added impacts of acute crises.     

Development and validation of an experience-based measure of household food insecurity within and across seasons in northern Burkina Faso

Organizations measure household food insecurity for program design, planning, targeting, implementation, monitoring, and evaluation, but existing measures often are inadequate. Qualitative and quantitative methods were used to develop and validate an experienced-based measure of the access component of food insecurity in northern Burkina Faso. In-depth interviews on food insecurity were done with 10 household heads and 26 women using interview guides. We identified themes, classified households, created a table of food insecurity categories, identified items to add to or delete from an initial questionnaire, and developed and revised answer choices. A longitudinal study provided quantitative data on changes over time in household food insecurity, economic situation, and related factors. Data were collected on 126 simple and complex households from 9 villages each July and January from 2001 to 2003 (5 waves). These data allowed examination of changes in household food insecurity twice annually across the best and worst seasons for food, and evaluation of the ability of the experience-based measure to differentiate changes in household food insecurity. Validity was assessed by examining reliability and by comparing the experienced-based food insecurity measure with economic status, dietary, and anthropometric measures and with a measure created by an observer who rated the households' food insecurity. The results provide strong evidence that the food insecurity score, calculated from experience-based questionnaire items, was valid for determining seasonal differences in household food insecurity, differences among households in food insecurity at a given time, and changes in household food insecurity over time in northern rural Burkina Faso.     

Paternal smoking is associated with greater food insecurity among poor families in rural Indonesia

Food insecurity is common in developing countries and related to the physical well being of families. Household food insecurity is intended to reflect a household's access, availability, and utilization of food. The relationship between paternal smoking and household food insecurity has not been well characterized. The objective of this study was to examine the relationship of paternal smoking with household food insecurity among poor families in rural Indonesia. In a cross-sectional study of 26,380 rural households in the Indonesian Nutrition Surveillance System in 2003, we examined the relationship between paternal smoking and household food insecurity score, as measured using a 9-item food security questionnaire. The prevalence of paternal smoking was 72.9%. In families with and without a father who smoked, the mean (standard error) household food insecurity score was 1.83 (0.01) and 1.48 (0.02), respectively (p<0.0001). Paternal smoking was associated with greater household food insecurity score (p<0.0001) in a multivariable linear regression model, adjusting for maternal age, maternal education, weekly household expenditure per capita, and province. Among poor families in rural Indonesia, households with a father who smokes are at greater risk of household food insecurity.     

LESS MONEY LESS FOOD: VOICES FROM WOMEN IN URBAN POOR FAMILIES IN THAILAND

Food insecurity is a public health problem. Information on how cultures perceive the experience of a financial crisis and resultant food insecurity is limited. Our purpose in this study was to understand how poor families residing in urban slums in Thailand perceive their food situation. Interviews were conducted with 30 women aged 20–65 years who were household food providers. Content analysis revealed three themes: experiencing changes, being vulnerable to not having enough food, and getting support. Policy changes to address access to social and health services and development of additional welfare programs must be made to achieve food security.     

Less money less food: voices from women in urban poor families in Thailand

Food insecurity is a public health problem. Information on how cultures perceive the experience of a financial crisis and resultant food insecurity is limited. Our purpose in this study was to understand how poor families residing in urban slums in Thailand perceive their food situation. Interviews were conducted with 30 women aged 20-65 years who were household food providers. Content analysis revealed three themes: experiencing changes, being vulnerable to not having enough food, and getting support. Policy changes to address access to social and health services and development of additional welfare programs must be made to achieve food security.     

Household capacities, vulnerabilities and food insecurity: shifts in food insecurity in urban and rural Ethiopia during the 2008 food crisis

The global food crisis of 2008 led to renewed interest in global food insecurity and how macro-level food prices impact household and individual level wellbeing. There is debate over the extent to which food price increases in 2008 eroded food security, the extent to which this effect was distributed across rural and urban locales, and the extent to which rural farmers might have benefited. Ethiopia's food prices increased particularly dramatically between 2005 and 2008 and here we ask whether there was a concomitant increase in household food insecurity, whether this decline was distributed equally across rural, urban, and semi-urban locales, and to what extent pre-crisis household capacities and vulnerabilities impacted 2008 household food insecurity levels. Data are drawn from a random sample of 2610 households in Southwest Ethiopia surveyed 2005/6 and again in mid to late 2008. Results show broad deterioration of household food insecurity relative to baseline but declines were most pronounced in the rural areas. Wealthier households and those that were relatively more food secure in 2005/6 tended to be more food secure in 2008, net of other factors, and these effects were most pronounced in urban areas. External shocks, such as a job loss or loss of crops, experienced by households were also associated with worse food insecurity in 2008 but few other household variables were associated with 2008 food insecurity. Our results also showed that rural farmers tended to produce small amounts for sale on markets, and thus were not able to enjoy the potential benefits that come from greater crop prices. We conclude that poverty, and not urban/rural difference, is the important variable for understanding the risk of food insecurity during a food crisis and that many rural farmers are too poor to take advantage of rapid rises in food prices.     

Quantitative indicators from a food expenditure survey can be used to target the food insecure in South Africa

Recent work on assessing household food insecurity has focused mainly on experiential-based measures using qualitative survey questions. In this paper, we employed two quantitative measures to estimate prevalence rates for household food insecurity in South Africa. One measure, termed food poverty, assessed whether the amount spent by a household on food was inadequate to purchase a low cost food plan. Low energy availability assessed whether the food energy available to a household, through its purchases and home production, was less than the sum of its members' recommended energy intakes. The 1995 Income and Expenditure Survey, a large representative survey of South African households (n = 28,704), was used for this secondary data analysis. Results showed that 43% of households were in food poverty in October 1995, and 55% had a low energy availability. These indicators allowed classification of households into four groups: food poverty only; low energy availability only; food insecure on both measures; and food secure. These groups differed on various aspects of household food consumption, suggesting that these indicators can be used to target different types of interventions to meet specific needs. Both bivariate and multivariate analyses showed that households that were food insecure on both measures were more likely to be in rural areas, have low incomes or large household sizes, and be headed by Africans or individuals of mixed ancestry. These patterns of food insecurity were corroborated by previous research on income poverty and nutritional status, suggesting that food poverty and low energy availability are useful, quantitative indicators for assessing food insecurity in South Africa.     

Household Food Insecurity Shows Associations with Food Intake,Social Support Utilization and Dietary Change among Refugee Adult Caregivers Resettled in the United States

Forced migration puts families at risk of household food insecurity and economic hardship. We administered a questionnaire to examine household food insecurity in a sample of 49 recently legally resettled Sudanese refugees with at least one child under age 3 years. Of households polled, 37% had experienced household food insecurity and 12% reported child hunger within the previous month. Increasing severity of household food insecurity was associated with decreased consumption of high-cost, high-nutrient-density food items and increased consumption of some low-cost traditional Sudanese foods by adult caregivers of young children. Furthermore, household food insecurity was associated with decreased household and per capita food expenditure, indicators of more limited dietary change with migration, and indicators of increased social support.     

Food insecurity: a nutritional outcome or a predictor variable?

The phenomenon loosely labeled hunger in the 1980s is now being discussed as food security or insecurity. Food security is defined as access by all people at all times to enough food for an active, healthy life, and at a minimum includes the following: 1) the ready availability of nutritionally adequate and safe foods and 2) the assured ability to acquire personally acceptable foods in a socially acceptable way. Food insecurity exists whenever food security is limited or uncertain. The measurement of food insecurity at the household or individual level involves the measurement of those quantitative, qualitative, psychological and social or normative constructs that are central to the experience of food insecurity, qualified by their involuntariness and periodicity. Risk factors for food insecurity include any factors that affect household resources and the proportion of those resources available for food acquisition. Potential consequences of food insecurity include hunger, malnutrition and (either directly or indirectly) negative effects on health and quality of life. The precise relationships between food insecurity and its risk factors and potential consequences need much more research now that there is an emerging consensus on the definition and measurement of food insecurity. Indicators of food security or insecurity are proposed as a necessary component of the core measures of the nutritional state of individuals, communities or nations.     

The 2008 food price crisis negatively affected household food security and dietary diversity in urban burkina faso

Although the 2008 food price crisis presumably plunged millions of households into poverty and food insecurity, the real impact of the crisis has rarely been documented using field data. Our objective was to assess the consequences of this crisis for household food insecurity and dietary diversity in urban Burkina Faso. Two cross-sectional surveys were conducted among randomly selected households in Ouagadougou in July 2007 (n = 3017) and July 2008 (n = 3002). At each round, food insecurity assessed by the Household Food Insecurity Access Scale (HFIAS), the Dietary Diversity Score of an index-member of the household (IDDS = number of food groups consumed in the last 24 h), and food expenditure were collected. Food prices of the 17 most frequently consumed food items were recorded throughout the study area. Food prices at local markets increased considerably between 2007 and 2008, especially those of fish (113%), cereals (53%), and vegetable oil (44%), increasing the household monthly food expenditure by 18%. Thirty-three percent of households were food secure in 2007 and 22% in 2008 (P = 0.02). Individuals consumed fewer fruits and vegetables, dairy products, and meat/poultry in 2008 than in 2007 (mean IDDS = 5.7 ± 1.7 food groups in 2007 vs. 5.2 ± 1.5 in 2008; P < 0.0001). Differences in IDDS and HFIAS between the 2 y were even more marked after adjustment for confounding factors and food expenditure. Food security and dietary diversity significantly decreased between 2007 and 2008, whereas food prices increased. Households increased their food expenditure, but this was not sufficient to compensate the effects of the crisis.     

Predictors and outcomes of household food insecurity among inner city families with preschool children in Vancouver

OBJECTIVES: The purposes of this study were to measure household food security and to determine its association with potential predictor variables related to household and community environments, as well as the relationship between household food insecurity and preschool children's nutritional status. METHODS: In this cross-sectional study, household food security was measured in a convenience sample of households (n=142) with children aged 2-5 years in Vancouver in March 2004. We assessed the association between environmental predictors and household food security status, adjusted for household income. Indicators of children's nutrition were compared between categories of household food security. RESULTS: Household food insecurity was associated with indicators of suboptimal health status in preschoolers. After controlling for household income, parents with less access to food of reasonable quality, fewer kitchen appliances and a lower rating of their cooking skills had greater odds of experiencing household food insecurity. IMPLICATIONS: Our study results support the need to test interventions involving collaborative efforts among government, social planners and public health practitioners to remove barriers to food security for families. Multiple measures, including opportunities to gain practical food skills and household resources that enable convenient preparation of nutrient-dense foods, could be examined. Our findings suggest the need for improved selection and quality at existing small stores and an increase in the number of food outlets in low-income neighbourhoods.     

Hunger and Food Insecurity in Nairobi’s Slums: An Assessment Using IRT Models

Although linked to poverty as conditions reflecting inadequate access to resources to obtain food, issues such as hunger and food insecurity have seldom been recognized as important in urban settings. Overall, little is known about the prevalence and magnitude of hunger and food insecurity in most cities. Yet, in sub-Saharan Africa where the majority of urban dwellers live on less than one dollar a day, it is obvious that a large proportion of the urban population must be satisfied with just one meal a day. This paper suggests using the one- and two-parameter item response theory models to infer a reliable and valid measure of hunger and food insecurity relevant to low-income urban settings, drawing evidence from the Nairobi Urban Health and Demographic Surveillance System. The reliability and accuracy of the items are tested using both the Mokken scale analysis and the Cronbach test. The validity of the inferred household food insecurity measure is assessed by examining how it is associated with households’ economic status. Results show that food insecurity is pervasive amongst slum dwellers in Nairobi. Only one household in five is food-secure, and nearly half of all households are categorized as “food-insecure with both adult and child hunger.” Moreover, in line with what is known about household allocation of resources, evidence indicates that parents often forego food in order to prioritize their children.     

Prevalence and Predictors of Food Insecurity among People Living with HIV Enrolled in Antiretroviral Therapy and Livelihood Programs in Two Rural Zambian Hospitals

The objective of this study was to examine the prevalence and predictors of food insecurity among people living with HIV (PLHIV) in two rural communities in Zambia. A cross-sectional sample of 101 PLHIV was surveyed using the Household Food Insecurity Access Scale. In multivariable linear regression models, income, household possessions, and perceived coping strategies were significantly associated with decreased food insecurity. Debt and perceived mental distress were significantly associated with increased food insecurity. Programs that tackle economic disadvantage and its adverse effect on stress may be an appropriate strategy to improve food security of PLHIV in low-resource communities.     

Frequency and duration of food insecurity and hunger in US households

OBJECTIVE: This study examines the extent to which food insecurity and hunger in US households are occasional, recurring, or frequent/chronic. Design/Variables: The federal food security scale measures the severity of food insecurity in surveyed households and classifies households as to their food security status during the previous year. The Current Population Survey Food Security Supplement (CPS-FSS) collects the data elements used to calculate the food security scale. Supplementary data on the frequency of occurrence of the behaviors and experiences comprising the food security scale are also collected by the CPS-FSS, but most of this information is not included in the food security scale. This study analyzes these supplementary data along with the food security scale and its constituent items using data from the Food Security Supplement of the nationally representative CPS conducted in August 1998. RESULTS: About two thirds of households classified as food insecure by the federal food security scale experience the condition as recurring, and around one fifth experience these conditions as frequent or chronic. The monthly prevalence of hunger is about 60% of the annual prevalence, and the daily prevalence is about 13% to 18% of the annual prevalence. CONCLUSIONS AND IMPLICATIONS: Nutritionists can use these findings to enhance the informative value of food insecurity and hunger statistics from national, state, and local surveys when interpreting them to policy makers and to the general public.     

Food insecurity and mental health: Surprising trends among community health volunteers in Addis Ababa,Ethiopia during the 2008 food crisis

The 2008 food crisis may have increased household food insecurity and caused distress among impoverished populations in low-income countries. Policy researchers have attempted to quantify the impact that a sharp rise in food prices might have on population wellbeing by asking what proportion of households would drop below conventional poverty lines given a set increase in prices. Our understanding of the impact of food crises can be extended by conducting micro-level ethnographic studies. This study examined self-reported household food insecurity (FI) and common mental disorders (CMD) among 110 community health AIDS care volunteers living in Addis Ababa, Ethiopia during the height of the 2008 food crisis. We used generalized estimating equations that account for associations between responses given by the same participants over 3 survey rounds during 2008, to model the longitudinal response profiles of FI, CMD symptoms, and socio-behavioral and micro-economic covariates. To help explain the patterns observed in the response profiles and regression results, we examine qualitative data that contextualize the cognition and reporting behavior of AIDS care volunteers, as well as potential observation biases inherent in longitudinal, community-based research. Our data show that food insecurity is highly prevalent, that is it associated with household economic factors, and that it is linked to mental health. Surprisingly, the volunteers in this urban sample did not report increasingly severe FI or CMD during the peak of the 2008 food crisis. This is a counter-intuitive result that would not be predicted in analyses of population-level data such as those used in econometrics simulations. But when these results are linked to real people in specific urban ecologies, they can improve our understanding of the psychosocial consequences of food price shocks.     

Assessment of food insecurity among low income households in kuala lumpur using the radimer/cornell food insecurity instrument - a validation study

Food insecurity exists whenever people are not able to access sufficient food at all times for an active and healthy life. This study used the Radimer/Cornell hunger and food insecurity instrument to assess food insecurity and to determine the risk factors and consequences of food insecurity among low-income households in Kuala Lumpur. One hundred and thirty-seven Malay pre-school children (4-6 years old) from Taman Sang Kancil were measured for their weights and heights. Questionnaires were used to collect food security and socioeconomic information on the households. The findings indicated that 34.3% of the households were food secure, while 65.7% experienced some kind of food insecurity, (27.7% households were food insecure, 10.9% individuals were food insecure and 27.0% fell into the child hunger category). The prevalence of underweight, stunting and wasting were 44.5%, 36.5% and 30.7% respectively. The prevalence of high weight-for-height (overweight) was 13.1%. Based on multinomial logistic regression, larger household size (OR=1.418; p<0.01) and lower educational level of mothers (OR=0.749; p<0.01) and fathers (OR=0.802; p<0.05) were found to be significant risk factors for food insecurity. The study, however, did not find any significant difference in children's nutritional status according to household food security levels. It is recommended that for the Malaysian population, the Radimer/Cornell hunger and food insecurity instrument should be modified and further validated with various ethnic groups in a variety of settings. The validation should include the appropriateness of the statements to the target grounds and their different risk factors and outcomes of food insecurity.     

Do People Agree on What Foods are Prestigious? Evidence of a Single,Shared Cultural Model of Food in Urban Ethiopia and Rural Brazil

To what extent do people agree on the meaning of foods, and does this vary by socioeconomic status, demographics, or household type? Addressing this question is critical for testing hypotheses about the relationship between food insecurity, food meaning, and mental well-being because it speaks directly to the social implications of food behaviors. In this study, we test for a shared cultural model of food meaning in two diverse settings: urban Ethiopia and rural Brazil. Using freelist and pile sort data from 63 respondents in Ethiopia and 62 from Brazil, we show strong consensus on the prestige value of various key food items in each context. Further, consensus varies little across household composition, food security status, and age and gender. This suggests that, in these two settings, consumption of widely available foods is an act that has both biological and social consequences.     

Food Insecurity and Age at Menarche in Tampa Bay,Florida

ABSTRACT

The aim of this study was to assess whether household food insecurity is associated with delayed or early menarche among girls in the United States. Thirty-six dyadic household interviews were conducted with mothers and adolescent girls. The interviews included a socio-demographic survey, the USDA Six-Item Short Form Household Food Security Survey Module, anthropometric measurements, and the self-administered Youth-Adolescent Food Frequency Questionnaire. Using non-parametric quantitative analyses, we examined the associations among food insecurity, anthropometrics, diet, and age at menarche. Cox Proportional Hazards Models were used to evaluate the odds of menarche based on household food insecurity. Food insecurity significantly predicted earlier time to menarche. Food insecure girls were 4.38 times more likely to experience menarche at earlier ages when compared to food secure girls (HR = 4.38, p = .04). Furthermore, the hazard of menarche increased by 25% for each unit increase in food insecurity (OR = 1.253, p = .027). The findings suggest that household food insecurity is associated with earlier ages of menarche among girls in this sample. Early menarche has been associated with adult chronic disease risk. Thus, these findings propose that food security initiatives may be used to reduce the prevalence and health consequences of early-onset puberty.     

Food insecurity in Canada: considerations for monitoring

Food insecurity, which has been recognized as an important determinant of health, is estimated to have affected almost one in ten Canadian households in 2004. Analyses of indicators of household food insecurity on several recent population health surveys have shed light on markers of vulnerability and the public health implications of this problem. However, the lack of detailed information on the economic circumstances of households and inconsistent measurement across surveys thwart attempts to develop a deeper understanding of problems of food insecurity. To better inform the development and evaluation of policies to address food insecurity among Canadian households, more effective monitoring is needed. This requires the consistent administration of a well-validated measure of food security on a population survey that routinely collects detailed information on the economic circumstances of households. Health professionals can contribute to the amelioration of problems of food insecurity in Canada by advocating for improved monitoring of the problem at a population level.     

Food Insecurity in Urban and Rural Areas in Central Brazil: Transition from Locally Produced Foods to Processed Items

Aiming to investigate the effect of diet and food consumption with regard to health, environment, and economy in light of nutrition ecology, we studied the dimensions of nutrition and food security in urban and rural settings in the region of Chapada dos Veadeiros, Central Brazil. We tracked diet and food consumption through carbon and nitrogen stable isotope ratios in fingernails of these inhabitants together with food intake data as a proxy for their diet patterns. We estimated household food insecurity by using the Brazilian Food Insecurity Scale. Nutrition and food insecurity was observed in both urban and rural areas, but was accentuated in rural settings. The diet pattern had high δ¹³C values in fingernails and low δ¹⁵N. Both urban and rural areas have diets with low diversity and relying on low-quality processed food staples at the same time that nutrition and food insecurity is quite high in the region.