Severe Household Food Insecurity is Associated with Childhood
Malaria in Rural South Haiti
1 1 2 3 1 1
Rafael Pérez-Escamilla , Michael Dessalines , Mousson Finnigan , Helena Pachón , Amber Hromi-Fiedler , Nishang Gupta
1
University of Connecticut, Storrs, CT, USA, 2Organization for the Rehabilitation of the Environment, Camp Perrin, Haiti, 3Centro Internacional de Agricultura Tropical (CIAT), Cali, Colombia
Abstract Results
Haiti is the poorest country in the Western Table 1. Latin American and Caribbean Household Table 2. Household socio-economic and Table 3. Maternal and child demographic and Table 4. Factors associated with perceived malaria risk
Hemisphere and is heavily affected by food Food Security Scale (ELCSA) demographic characteristics. biomedical characteristics. among children 1–5 years of age.
insecurity (FI) and malaria. To find out if these (N=153) Camp Perrin, South Haiti (N=153) Camp Perrin, South Haiti (N=153) Camp Perrin, South Haiti (N=149)
two conditions are associated with each other Item % Yes N % N % or mean ± SD Variable N Odds Ratio 95% CI
we studied a convenience sample of 153 women Questions referring to Respondent and/or Other Adults in the Monthly household income: Mother’s age (y) 153 30.8 ±7.1 Food Insecurity1
with children 1–5 y in Camp Perrin, South Haiti. Household During the last 3 months… US$1 to US$30 100 65.3 Marital status Severely Food Insecure (FI) 85 4.92 1.45-16.66
Household food insecurity was assessed with US$31 to US$60 33 21.6 Common law 97 63.4 FI/Very FI 64 1.00
Were you worried about running out of food? 72.5
the 16-item ELCSA scale previously validated US$61 to US$120 20 13.1 Married 40 26.1 Child fed colostrum
in the target communities. ELCSA’s reference Savings in bank 23 15.0 Single/never married 11 7.2 Yes 121 0.19 0.05-0.75
Did your home run out of food at any time? 88.9
time period was the 3 months preceding the Employment status of head of the household Separated/divorced/widowed 5 3.3 No 28 1.00
survey and it was answered by the mother. Were people in your home unable to eat, at any time, the
71.9 Working full-time 66 43.1 Mother’s parity Maternal-reported child health
Households were categorized as either food kind of foods that make you healthy?
Working part-time 58 37.9 1 to 3 children 75 49.0 Poor/Average 106 5.74 1.44-22.9
secure (2%, ELCSA score=0), FI/very FI (42%, Did you or anybody in your home usually have to eat the 4 to 6 children 56 36.6 Good/Very good 43 1.00
64.7 Unemployed 29 19.0
same foods almost every day?
ELCSA score range:1–10) or severely FI (56%, Occupation of head of household 7 to 13 children 22 14.3 Child’s BMI (kg/m2) tertile
ELCSA score range:11–16). 34.0% of women reported that their children had malaria during the 2 Was there any day that you or any other adult in your home
60.1 Farming 91 59.5 Respondent’s educational status <15.22 49 21.01 3.74-118.0
skipped a meal because of lack of food?
months preceding the survey. Multivariate analyses showed that severe FI was a risk factor for malaria Trading 30 19.6 No formal schooling 41 26.8 15.22-16.88 50 33.83 6.09-188.01
Did any adult in your home eat less food than what they
(OR: 4.92; 95% CI: 1.45–16.66). Children who were fed colostrum at birth were at lower risk for malaria needed because there wasn’t enough food?
70.6 Other1 32 20.9 Elementary not completed 68 44.4 ≥16.88 50 1.00
(0.19; 0.05–0.75). Additional risk factors for malaria were: Poor child health (via maternal self-report), Was there any day when you or any other adult in your Métayage (sharecropping system) 58 37.9 Elementary completed 18 11.8 Mother’s Age (y)
a child BMI < 17 kg/m2, and child vitamin A supplementation multiple times. Findings suggest that home felt hungry but did not eat because there wasn’t 58.8 Land ownership 106 69.3 High school not completed 1 0.7 18-26 48 0.56 0.14-2.26
policies and programs that address food insecurity are also likely to reduce the risk of malaria in Haiti. enough food? High school completed 25 16.3 27-34 52 0.18 0.04-0.77
Land size (hectare (ha)) (n=106)
Was there any day when you or any other adult in your home Maternal BMI (kg/m2) 35-45 49 1.00
didn’t eat for a whole day or just ate once during the day 63.4 None to < 1/4 ha 92 86.8
because there wasn’t enough food? 1/4 to < 1/2 ha 6 5.6 Underweight (< 20) 44 28.8 Mother’s education
Introduction Did you do things that you would have preferred not to do, 1/2 to < 1 ha 3 2.8 Normal weight (20-< 25) 85 55.6 No formal schooling 41 0.17 0.02-1.16
13.1
such as begging or sending children to work, to get food? > 1 ha 5 4.6 Overweight (25-< 30) 20 13.1 Elementary school incomplete 66 1.49 0.32-6.92
Malaria is responsible for one million annual deaths worldwide (1). It has been estimated that half a
Questions referring to Children in the Household Household size Obese (>= 30) 4 2.6 Elementary school completed 17 0.28 0.04-2.16
billion attacks of clinical malaria occur every year. Malaria is a major cause of death among children
During the last 3 months… 2 to 4 people 29 19.0 Household Food Insecurity Any high School 25 1.00
under five years of age in developing countries (1). Even though 80% of the global burden of malaria
Were you unable to provide the children in your home with 5 to 7 people 86 56.2 Food Secure 3 2.0 Study child age (months)
falls in Africa (2), there are countries in other regions of the world where it is a major public health the kinds of foods they need to be healthy?
56.2
8 to 14 people 38 24.9 Food Insecure 26 17.0 12-<24 45 1.52 0.29-8.04
problem. One such country is Haiti, where malaria is endemic. The 2006 Demographic and Health
Did any children in your home usually have to eat the same # of bedrooms Very Food Insecure 38 25.0 24-<36 37 0.83 0.15-4.70
Survey from Haiti found that 28% of children under five had malaria within the two weeks preceding 61.4
foods almost every day?
1 bedroom 45 29.4 Severely Food Insecure 86 56.0 36-<48 44 0.42 0.08-2.29
the survey (proxied by maternal report of fever in the child) (3). The same survey showed that the Did any child in your home eat less food than what s/he
77.8 2 bedrooms 72 47.1 Child age (y) 153 2.3±1.1 48-59 23 1.00
population of Haiti as a whole has little, if any, access to malaria prevention (insecticide treated nets, needed because there wasn’t enough food?
>2 bedrooms 36 23.5 Study child gender Study child sex
intermittent preventive treatment among pregnant women), proactive screening, and treatment Did you have to serve less food to any child because there
77.8 Sewage at home 4 2.6 Male 82 53.6 Boy 81 0.53 0.18-1.55
options (antimalarial combined therapy). wasn’t enough food?
Head of household Female 71 46.4 Girl 68 1.00
Was there any day when any child in your home felt hungry
56.2 Mother 36 23.5 Child health rating (maternal report) Head of Household
but could not be fed because there wasn’t enough food?
Objective Did any child in your home go to bed hungry on any day
because of lack of food?
49.0
Grandmother 27 17.6 Good/Very Good
Average
45
99
29.4
64.7
Mother
Grandmother
36
26
0.26
0.66
0.03-1.93
0.16-2.72
Father 72 47.1
The objective of this study is to examine the association between household food insecurity and Was there any day when any child in your home didn’t eat Other 18 11.8 Poor/Very Poor 9 5.9 Other 17 0.29 0.04-2.23
the likelihood of malaria among children 1–5 years living in rural south Haiti. for a whole day or just ate once during the day because 54.9 1
daily worker, wood charcoal maker, tailor, custodian Child diarrhea in previous 2 weeks 45 29.4 Father 70 1.00
there wasn’t enough food?
Child malaria in previous 2 months 51 33.3 Occupation of Household Head
Child fed colostrum 124 81.0 Trading 28 4.39 0.47-40.92
Methods Summary of Findings
Child stunting (<-2 height-for-age Z-
score)
61 42.7
Farming 89 3.25 0.85-12.44
Daily Worker 32 1.00
• Convenience sample of 153 mothers were recruited in the three districts of Camp Perrin in Child underweight (<-2 weight-for-
28 18.3 Household land ownership?
• Severe household food insecurity is an independent risk age Z-score)
approximately equal numbers (district 1 (n=53), district 2 (n=57), and district 3 (n=43)) Yes 104 0.40 0.12-1.33
factor for malaria among children 1–5 years in rural Haiti, Child wasted (<-2 weight-for-height
• Convenience sampling snowball approach 7 4.8 No 45 1.00
and the effect size is strong Z-score)
• Women were interviewed in Haitian Creole by three fieldworkers Electricity at home?
• A child BMI < 17 kg/m2 was associated with higher malaria risk Child BMI (kg/m2)
• Household food insecurity was assessed, using the 3 months preceding the survey as the reference Yes 53 1.86 0.52-6.65
• Severe household food insecurity was associated with <15.22 50 32.7
time period, with the previously validated ELCSA scale (Table 1) No 96 1.00
malaria risk even after controlling for child BMI 15.22-16.88 51 33.3
• Women were asked if the index child had Times child had vitamin A capsules
• Colostrum feeding is protective against the risk of >16.88 52 34.0
malaria with the question ‘Has your [name since birth
childhood malaria even after controlling for household Place of delivery of study child
of index child] ever had malaria in the past ≤1 69 0.29 0.09-0.99
food insecurity and potential confounders Home 131 85.6
2 months?’ >1 80 1.00
• Poor child health status was strongly associated with Hospital 22 14.4 1
Very food insecure was defined as having an ELCSA score of 11 or more (out of 16).
malaria risk Food insecure was defined as an ELCSA score between 1 and 10. The 3 food secure
• Maternal age and multiple child vitamin A supplementation
Inclusion Criteria since birth were also associated with malaria risk
households were dropped from analyses. Hosmer–Lemeshow fitness p value=0.93
(chi-square=3.0, df=8)
Women were included in the study if they were:
• Healthy, non-pregnant mothers between the ages
of 17 and 45 years Acknowledgement
• Living in the target community for at least the Funded by the AgroSalud Project (CIDA # 7034161)
past 12 months
Conclusion
References
• The biological mother of at least one healthy child Policies and programs that address food insecurity are also likely to reduce the risk of malaria in Haiti 1. Greenwood BM, Bojang K, Whitty CJ, Targett GA. Malaria. Lancet. 2005 Apr 23-29;365(9469):1487-98.
between the ages of 1 and 5 years 2.
3.
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Cayemittes M, Placide MF, Mariko S, Barrère B, Sévère B, Alexandre C. Enquête Mortalité, Morbidité et Utilisation des Services, Haïti, 2005-2006. Calverton, Maryland, USA: Ministère de la Santé Publique et de la Population,
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