Household food insecurity and caregiver distress: equal threats to child nutritional status?

Objectives: There is considerable interest in the link between household food insecurity and child wellbeing, and the extent to which caregiver wellbeing mediates the relationship between food insecurity and child wellbeing. The aim of this was to assess these relationships among a rural population in Ethiopia.

Methods: We used existing survey data from a maximum of 1,006 children under 5 years of age with matched data on household-level data on food insecurity, caregiver distress, and asset ownership, along with other sociodemographic information. All respondents lived in a predominately rural, primarily subsistence-based area in southwest Ethiopia. Multivariable regression models were used to test hypothesized associations.

Results: Household food insecurity, distress, and socioeconomic status predicted children's weight for age and undernutrition, defined as weight for age Z (WAZ) less than -2SD from the reference median. A small portion of the household food insecurity effect was mediated by caregiver distress but these were largely independent effects. Maternal distress was associated with greater odds of a child having any illness, and any illness was associated with lower WAZ and higher odds of being undernourished. The effect of maternal distress on undernutrition was mediated by diarrhea.

Conclusions: This study suggests that household food insecurity, maternal distress, and household SES are independent contributors to children's undernutrition. Our results are consistent with others but are not generally consistent with the hypothesis that maternal distress is a primary pathway through which food insecurity impacts on child nutritional wellbeing.