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We tested the validity of ELCSA in a convenience sample of 153 women with children under five in South Haiti. ELCSA was applied to the women in Creole, contained 16 items and used a reference period of 3 months. Cronbach’s alpha was 0.92. Based on affirmative response prevalence, the items referring to child hunger tended to be the most severe. However, social unacceptability of procuring food was the most severe item. This question asked ‘Was there any time during the past 3 months when you had to do something that you would have preferred not to do (such as begging or sending the children to work) to be able to get food?’. There were no food secure households in the sample, 44% were food insecure (FI), 49% were very FI, and 7% were extremely FI. Criterion validity was strong. Those reporting having good/very good health ranged from 38.8% among those FI to 9.1% among those extremely FI (p=0.02). Households with children who had recently had malaria were more likely to be very/extremely FI than households where the index child had been free of malaria (82.0% vs. 37.1%, p<0.001). Additional factors associated with very/extreme FI (p<0.05) were: female-headed household, lack of electricity at home, no land ownership, and poorer dietary quality. Results suggest that ELCSA is a valid tool for assessing household FI in rural Haiti. Funded by CIDA (7034161)
through a grant to the Centro Internacional de Agricultura
Tropical (CIAT).
Validity of the Latin American and Caribbean Household Food Security Scale (ELCSA) in South Haiti
At a recent FAO-sponsored Regional meeting in Antioquia, Colombia, consensus was reached on the importance of testing a single experience-based household food security measurement scale in different Latin American and Caribbean countries. The ‘EscalaLatinoamericana y Caribeña de Seguridad Alimentaria’ (ELCSA) was developed mostly based on the national household food insecuritymeasurement experiences in Brazil, Colombia and the USA*. The data reported herein represents the first application of ELCSA in the field.
* Pérez-Escamilla R, Melgar-Quiñonez H, Nord M, Alvarez Uribe MC, Segall-Correa AM.Escala
Latinoamericana y Caribeña de Seguridad Alimentaria (ELCSA) [Latinamerican andCaribbean Food
Security Scale]. Perspectivas en Nutrición Humana (Colombia) 2007 (supplement):117-134.
Rafael Pérez-Escamilla, PhD1, Michael Dessalines BS1, Mousson Finnigan, MD2, Amber Hromi-Fiedler, MPH PhD1, Helena Pachón, PhD3
7.030.7Mother’s age (y)
43.462Child stunting (height-age Z <-2)
34.0
50.3
12.4
3.3
52
77
19
5
Maternal BMI
Underweight (<18.0 kg/m2)
Adequate weight (18.0 - <25.0 kg/m2)
Overweight (25.0 - <30.0 kg/m2)
Obese (≥ 30.0 kg/m2)
12.6
SD
33.3
25.5
28.1
26.1
65.4
9.2
2.6
%
39Child diarrhea (past 2 wks)
100Income < $30 per month
4Sewage at home
51Child malaria (past 2 mo)
n
32.9Study child’s age (mo)
Mean
43Good/very good health (self-reported)
40Married
14Electricity at home
a Participant responses for each item were yes, no, don’t know or refused.
• ELCSA is a valid tool for assessing household food insecurity (FI) in rural Haiti
• Content validity (expert review)• Face validity (preliminary review by local community
members)• Convergence validity (FI & meal skipping)• Criterion validity (FI & SES/health outcomes)• Psychometric behavior (Cronbach’s alpha and Rasch
modeling)• “Worried’ had inadequate fit, perhaps as a result of translation
(term translated as ‘fear’ instead of ‘worry’). Further research needed to verify psychometric behavior of this scale item in Haiti.
1University of Connecticut, Storrs, CT, USA, 2Organization for the Rehabilitation of the Environment (ORE), Camp Camperrin, Haiti, 3Centro Internacional de Agricultura Tropical, Cali, Colombia
STUDY DESIGN
ABSTRACT
BACKGROUND
RESULTS: PSYCHOMETRIC PROPERTIESa,b,c
CONCLUSIONS
RESULTS: CONVERGENCE AND CRITERION VALIDITYa,bELCSA ITEMS
• Location: Camp Camperrin, South Haiti
• Cross-sectional, convenience sample
• N=153 mothers with children < 5 y
• Household food security measured with the ‘Escala Latinoamericana y Caribeña de Seguridad Alimentaria’ (ELCSA)
• ELCSA translated from Spanish to French and then to local Creolebefore application
• ELCSA validated in the context of a larger study whose objectivewas to evaluate the potential for biofortified sweet potato to improve vitamin A intake among pre-school children and their mothers
SURVEY INSTRUMENT
• Socio-economic and demographic information
• Infant-feeding practices
• Maternal dietary intake: 24-hour recall (twice on non-consecutive days) and food frequency questionnaire
• Family sweet potato consumption: habits and preferences
• Maternal and child self-reported health indicators
• Maternal and child anthropometry
PARTICIPANT CHARACTERISTICS (N=153)
12) During the last 3 months did any child in your home eat less food than what s/he needed because there wasn’t enough food?
13) During the last 3 months did you have to serve less food to any child because there wasn’t enough food?
14) During the last 3 months was there any day when any child in your home felt hungry but could not be fed because there wasn’t enough food?
15) Did any child in your home go to bed hungry in any day during the past 3 months because of lack of food?
11) Did any children in your home usually have to eat the same foods almost every day during the last 3 months?
8) Was there any day when you or any other adult in your home didn’t eat for a whole day or just ate once during the day because there wasn’t enough food during the last 3 months?
9) During the last 3 months, did you do things that you would have preferred not to do, such as begging or sending children to work, to get food?
6) During the last 3 months did any adult in your home eat less food than what they needed because there wasn’t enough food?
3) Was your home unable to eat the kinds of foods that make you healthy at any time during the last 3 months?
1) During the last 3 months, were you worried about running out of food?
7) During the last 3 months was there any day when you or any other adult in your home felt hungry but did not eat because there wasn’t enough food?
Questions referring to respondent and/or other adults in the householda
Questions referring to children under 5 years old in the householda
16) Was there any day when any child in your home didn’t eat for a whole day or just ate once during the day because there wasn’t enough food during the last 3 months?
10) During the last 3 months were you unable to provide the children in your home with the kinds of foods they need to be healthy?
5) Was there any day during the last 3 months that you or any other adult in your home skipped a meal because of lack of food?
4) Did you or anybody in your home usually have to eat the same foods almost every day during the last 3 months?
2) Did your home run out of food at any time during the last 3 months?
ELCSA Item Prevalence
0
2
4
6
8
10
12
ran ou
t (2)
less
food
-child (1
2)
less
food
per
mea
l-child (1
3)wor
ried (1)
health
y an
d va
ried (3)
less
food
(6)
low variety (4
)
no fo
od all da
y (8)
low variety-child (1
1)
skippe
d mea
ls (5
)hu
ngry (7
)
health
y & varied-
child
(10)
hung
ry-child (1
4)
no fo
od all da
y-ch
ild (1
6)
bed hu
ngry-child (1
5)
socially una
ccep
table (9)
01020
3040506070
8090
100
ran ou
t (2)
less
food
-child (1
2)
less
food
per
mea
l-child (1
3)
wor
ried (1)
healthy & varied (3)
less
food
(6)
low var
iety (4
)
no fo
od all da
y (8)
low var
iety-child (1
1)
skippe
d mea
ls (5
)hu
ngry (7
)
health
y & var
ied-
child
(10)
hung
ry-child (1
4)
no fo
od all da
y-ch
ild (1
6)
bed hu
ngry
-child (1
5)
socially una
ccep
table (9)
% a
ffirm
ativ
e r
esponses
ELCSA Item Severity Values
38.8
21.3
9.1
0
5
10
15
20
25
30
35
40
45
FI very FI extremely FI
%
60
30
10
39.2
54.6
6.2
18.2
9.1
72.7
0
10
20
30
40
50
60
70
80
FI very FI extremely FI
%
married common law single
71.4
14.3 14.3
43.8
52.5
6.5
0
10
20
30
40
50
60
70
80
FI very FI extremely FI
%
electricity other&
Good/Very Good Maternal Healthby FI Level*
a p values base on chi-squared analysesb N=153
Marital Status by FI Level
Energy/Fuel Source by FI Level
54.7
39.6
5.7
19.1
70.2
10.6
0
10
20
30
40
50
60
70
80
FI very FI extremely FI
%
yes no
17.6
70.6
11.8
56.9
38.2
4.9
0
10
20
30
40
50
60
70
80
FI very FI extremely FI
%
malaria healthy
05.3
9.13
8
36
11.916
9.1
85.1
70.7
45.5
0
10
20
30
40
50
60
70
80
90
100
FI very FI extremely FI
%
didn't eat 1- < 3 times 3-6 times every day
Maternal Breakfast Weekly Consumption by FI Level
1.5
8 9.14.5
17.3
9.13
14.7
54.5
91
60
27.3
0
10
20
30
40
50
60
70
80
90
100
FI very FI extremely FI
%
didn't eat 1- < 3 times 3-6 times every day
Maternal Lunch Weekly Consumption by FI Level
Maternal Dinner Weekly Consumption by FI Level
3
29.3
54.5
4.5 5.39.1
14.917.3
48
77.6
48
27.3
0
10
20
30
40
50
60
70
80
90
100
FI very FI extremely FI
%
didn't eat 1- < 3 times 3-6 times every day
Land Ownership by FI LevelMalaria in Children Under 5 by FI Level
* Self-reported
p<0.001
p=0.024p=0.041
p=0.023 p<0.001
p=0.002 p=<0.001p=<0.001
a ELCSA item # shown within parenthesis in x-axisb N=153CRasch model analyses used to produce results
RaschItem
Severity Value
00.20.40.60.81
1.21.41.61.82
2.2
ran ou
t (2)
less
food
-child (1
2)
less
food
per m
eal-c
hi..
wor
ried
(1)
healthy & varied (3)
less
food
(6)
low variety (4
)
no foo
d all d
ay (8
)
low var
iety
-child (1
1)
skippe
d mea
ls (5)
hungr
y (7)
hungr
y-ch
ild (1
4)
health
y & varied-ch
ild...
no foo
dall d
ay-child
(16)
bed hu
ngry
-child (1
5)
socially unac
cept
able (9
)
RaschItem Infit
Value
ELCSA Item Infit Values