Belachew et al.

Nutrition Journal 2011, 10:29

http://www.nutritionj.com/content/10/1/29

RESEARCH Open Access

Food insecurity, school absenteeism and

educational attainment of adolescents in Jimma
Zone Southwest Ethiopia: a longitudinal study
Tefera Belachew1,2*, Craig Hadley3, David Lindstrom4, Abebe Gebremariam1, Carl Lachat2,5 and Patrick Kolsteren2,5

Abstract
Background: Food insecurity not only affects physical growth and health of children but also their intellectual
development, school attendance and academic performance. However, most evidences are based on studies in
high income countries. Although food insecurity is common in Ethiopia, to what extent it affects school
attendance and educational attainment of adolescents is not explored. We hypothesized that food insecure
adolescents would be more likely to be absent from school and have lower grades attained after 1 year compared
to their food secure peers.
Methods: We used data from 2009 adolescents in the age group of 13-17 years from two consecutive surveys of a
five year longitudinal family study in Southwest Ethiopia. A stratified random sampling was used to select
participants. Regression analyses were used to compare school absenteeism and the highest grade attained after 1
year of follow-up in food secure and insecure adolescents. The analysis was adjusted for demographic factors,
reported illness and workload.
Results: Significantly more (33.0%) food insecure adolescents were absent from school compared with their food
secure peers (17.8%, P < 0.001). Multivariable logistic regression analyses showed that after adjusting for gender,
place of residence and gender of the household head, adolescent food insecurity [OR 1.77 (1.34-2.33)], severe
household food insecurity [OR 1.62 (1.27-2.06)], illness during the past one month before the survey [OR 2.26 (1.68-
3.06)], the highest grade aspired to be completed by the adolescent [OR 0.92 (0.88-0.96)], and the number of days
that the adolescent had to work per week [OR 1.16 (1.07-1.26)] were independent predictors of school
absenteeism. Similarly after controlling for household income and gender of the household head, adolescent food
insecurity(P < 0.001), severe household food insecurity(P < 0.001), illness during the last month(P < 0.001) and rural
residence(P < 0.001) were inversely associated with highest grade attained, while age of the adolescent(P < 0.001),
the highest grade intended to be completed(P < 0.001) and residence in semi urban area(P < 0.001) were
positively associated with the highest grade attained.
Conclusions: Adolescent and household food insecurity are positively associated with school absenteeism and a
lower educational attainment. Programs aiming to achieve universal access to primary education in food insecure
environments should integrate interventions to ensure food security of adolescents.

* Correspondence: tefera_belachew@yahoo.com
1
Department of Population and Family Health, College of Public Health and
Medical Sciences, Jimma University, PO.Box:1104, Jimma, Ethiopia
Full list of author information is available at the end of the article

2011 Belachew et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
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Background Subjects and methods

Optimal cognitive and emotional development and phy- Study sample
siological function in children and adolescents requires This study is based on data from 2009 adolescents
access to food of adequate quantity and quality at all enrolled in the first two consecutive rounds of the five
stages in life. Recurrent food insecurity as experienced year longitudinal study of adolescents in Jimma zone
in Ethiopia [1] may result in malnutrition with resulting in Southwest Ethiopia. The study area was stratified
developmental impairments such as poor learning capa- into urban (Jimma city), semi urban (small towns) and
city in children [2-4]. Food insecurity adversely affects six rural communities kebeles adjacent to the towns,
intellectual development [2,3,5-7], school attendance [8], representing a range of ecological and developmental
growth [7], health [9] academic performance and social contexts. A census generated a list of all 5795 house-
skills [2,5,7] of children and adolescents. holds in the study sites. A two-stage sampling plan
There are different mechanisms through which food was used to select a representative sample of 2100
insecurity could negatively affect educational attainment. adolescents from this list. First, 3700 households were
A frequently mentioned pathway is through high rates selected from this list based on a probability propor-
of school absenteeism, with children living in food inse- tional to size of the household. Next, one adolescent (a
cure households being pulled form school to engage in boy or a girl) was selected from each household using
productive activities. It has been hypothesized that this a Kish table [20].
might be particularly true for girls. Another of the
mechanisms is through decreased intake of nutrients Measurements
during periods of reduced food supply. Although various Structured questionnaires for the households and ado-
studies have shown that adult household members buf- lescents were used to collect data. The interviewers
fer children from food insecurity [10-13]; alterations in received one week of intensive training prior to the pre-
the eating behaviour of food insecure adolescents in a test and an additional week of training was given with
way that affects their nutritional status [8,14] have been the final version of the questionnaire before the start of
reported. Children who experience food insecurity the actual interviews. Supervisors checked the data col-
might also suffer from a significant amount of psycholo- lection process and filled questionnaires daily to ensure
gical and emotional stress at home around the concerns accuracy of the data. The research team supervised the
of the caregivers to provide adequate food. This may data collection team every week through meetings and
affect the emotional well-being of the adolescent to an checking of the filled questionnaires. The first round of
extent that interferes with cognitive [15-17] and beha- data collection was carried out from mid - 2005 to
vioral performance [18]. Food-insufficient teenagers 2006, while the second round was finalized around same
were reported to have behavioral problems that are time in 2006-2007. The timing of both rounds corre-
incompatible with their school attendance [5]. sponds to the rainy season (hunger season) and spring
Several longitudinal [2,3,19] and cross-sectional season which is relatively better in terms of food
[5,6,18] studies in high income countries have shown a security.
relationship between household food insecurity as Food insecurity is a situation that exists when all peo-
reported by the head of the household and adverse edu- ple, at all times, do not have physical, social and eco-
cational outcomes in younger children. This relation- nomic access to sufficient, safe and nutritious food that
ship, however, has not been explored in low income meets their dietary needs and food preferences for an
countries. To our knowledge there are no studies on the active and healthy life [21]. Both adolescent and house-
effect of adolescents personal experience of food inse- hold food insecurity were measured in the first round of
curity on school absenteeism and educational attain- the survey using items from previously adapted and vali-
ment from both high or from low income countries dated household food insecurity scales for use in the
where food insecurity is prevalent. Assessing the link developing countries [22-24]. Adolescent food insecurity
between adolescent food insecurity and school absentee- was measured with a modified version of the household
ism and educational attainment is critical to design and food security scales by selecting the items in the scales
integrate multi-sectoral strategies aiming to achieve the that apply to their personal experiences. Adolescents
Millennium Development Goal 2, Universal Access to were asked to think of their own experience and not
Primary Education, in Ethiopia. We hypothesized that that of the household and then asked whether in the
the proportion of school absentees would be higher in last three months they had (1) ever worried about hav-
the food insecure adolescents compared to their food ing enough food (2) ever had to reduce food intake
secure peers and that the food insecure adolescents because of shortage of food or lack of money to buy
would have a lower educational attainment as well. food (3) ever had to go without eating because of
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shortage of food or money to buy food (4) ever had to (Ethiopia). Informed verbal consent was obtained both
ask outside the home for food. All Yes responses were from the parents and each adolescent before the
coded as one and No responses were coded as zero, interview.
and the responses were summed to produce an index of
adolescent food insecurity. The index had an adequate Data analysis
internal consistency (Cronbachs alpha = 0.81) and was The data were entered in double, checked for missing
further dichotomized as food secure for a score equal values and outliers and analyzed using SPSS for win-
to zero food insecure for a score is greater than zero. dows version 16.0 (SPSS Inc. version 16.1, Chicago, Illi-
To assess household food insecurity, a series of six nois). First, bivariate analyses were carried out. Means
questions were presented to the household head. The and proportions were compared by school absenteeism
questions asked whether during the past three months using t-test and Chi-square tests, respectively. To iden-
(1) the respondent worried about running out of food tify the predictors of school absenteeism, a multivariable
(2) the household ran out of food (3) the variety of food logistic regression model with school absenteeism as
for children was reduced (4) the children did not have dependent variable was constructed. Variables that
enough to eat (5), the respondent or another adult did showed a significant association with school absenteeism
not have enough to eat (6) and the respondent ever felt in the bivariate analyses were entered in a multivariable
hungry but did not eat. The Yes responses were coded logistic model. Interaction between variables was
one and the No responses were coded zero, and the checked at the level of significance of P < 0.05. A sec-
responses were summed to produce an index of house- ond multivariable linear regression model was fitted to
hold food insecurity. The index had a high internal con- assess factors predicting educational attainment. All
sistency (Cronbachs alpha = 0.92). The distribution of variables that were significantly associated (P < 0.05)
the food insecurity index was divided into tertiles and with the highest grade completed in the bivariate mod-
the highest tertile was labeled as severely food insecure els were entered into the adjusted linear model to assess
in contrast to the two lower tertiles combined which their independent effects. Normality of the data was
were coded zero. Severe household food insecurity was assessed visually using a P-P plot for all numerical pre-
used in subsequent analyses as we previously documen- dictor variables and for the dependent variable (highest
ted that adolescents in the region suffer more from food grade completed) in the regression model. All variables
insecurity when household food insecurity is severe [13]. were normally distributed and there was no need of
The questionnaires were translated to the local lan- transformation. Co-linearity between household food
guages (Amharic and Oromifa) and the administered by insecurity and adolescent food insecurity were checked
an interviewer. The consistency of the forms was using correlation coefficients and variance inflation fac-
checked by a researcher other than the interviewers. tor test. All tests were two-sided and a P < 0.05 was
During the first round of the survey, school absentee- considered statistically significant. We present the
ism and other socio-demographic variables were results as means SD, output of the logistic regression
recorded. School absenteeism was defined as any illegi- as odds ratios (OR) with 95% confidence intervals and
timate absence from school for at least a day [25,26]. the results from the linear regression model as b-coeffi-
An illegitimate absence was defined as any absence from cients and P values.
school due to reasons others than the formal school clo-
sure days (due to either national holidays or religious Results
days for which the school is closed). Adolescents were Out of the 2100 adolescents intended, 2084 completed
asked: Thinking back to the full semester you were in the questionnaires. For further analysis of absenteeism
school, how often did you miss school? The possible we excluded 75 adolescents who were not enrolled in
responses were: several days a week, several days a the school. Bivariate analyses showed that a significantly
month, several days in the semester and never. We higher proportion (33.0%) of food insecure adolescents
coded the responses several days a week, several days was identified as absentees compared with food secure
a month and several days in the semester as absentees youth (17.8%), P < 0.001. School absenteeism was posi-
and never as non-absentees. tively associated with household food insecurity (P <
The educational attainment was assessed one year 0.001) and number of hours per week that the adoles-
later by asking the adolescents, What is the highest cents had to work for the household (P < 0.001). Simi-
grade you have completed? The questionnaire was larly, 51.0% adolescents from households with severe
tested on 200 adolescents (not included in the sample) food insecurity reported absenteeism compared to 36.3%
selected from a community in Jimma city. of adolescents who were not part of severely food inse-
The study was cleared by the Ethical Review Boards of cure households (P < 0.001). A larger proportion
both Brown University (USA) and Jimma University (24.9%) of adolescents who reported an illness during
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Table 1 Characteristics of adolescents in Southwest Ethiopia by school absenteeism

Characteristics Non-absentees [n 1660] Absentees [n 349] P
Gender
Male 51.8% 46.4% 0.067
Female 48.2% 53.6%
Age (Years) 14.8 (1.3) 14.7 (1.3) 0.277
Residence*
Urban 36.9% 36.7% 0.216
Semi-urban 28.5% 32.7%
Rural 34.6% 30.7%
Adolescent food insecurity
Food secure 82.1% 67.0% < 0.001
Food insecure 17.8% 33.0%
Severe household food insecurity
No 63.7% 49.0% < 0.001
Yes 36.3% 51.0%
Illness during the last one month before the survey
Yes 88.9% 75.1% < 0.001
No 11.1% 24.9%
Being part of female headed household
No 82.4% 80.5% 0.402
Yes 17.6% 19.5%
Number of days in a week the adolescent has to work for at least 1 hour 1.9(1.6) 2.3(1.3) < 0.001
The highest grade the adolescent aspires to complete 13.7(6.9) 13.3(4.9) 0.006
The highest grade attained at round 2 of the survey 6.2(2.5) 5.9(2.3) 0.047
*"Semi-urban refers to small towns including Yebbu, Serbo and Dedo and urban refers to Jimma City.
Means and proportions were compared using t-test and Chi-square tests, respectively.

Means with standard deviations in brackets are shown, unless otherwise indicated.
Percentages are computed out of row totals.

one month prior to the survey also reported absentee- completed 5.5( 2.7) compared to those from household
ism compared to those who did not report an illness that did not have severe food insecurity (6.2 2.7, P <
(11.1%, P < 0.001). The mean educational level attained 0.001). The proportion adolescents who completed pri-
(Table 1), expressed as the highest grade completed at mary education (grade 8) was higher (31.5%) for food
the second survey was 6.2 2.5 for non-absentees and secure adolescents compared to food insecure adoles-
5.9 2.3, for absentees (P = 0.047). cents (24.1%, P < 0.01).
Figure 1 shows the frequency of school absenteeism Multivariable logistic regression model (Table 2)
by food security status of adolescents. The frequency of showed that food insecure adolescents were nearly
school absenteeism was significantly higher among food twice as likely to be absent from school [OR 1.77 (1.34-
insecure adolescents (P < 0.001). While the majority 2.33)] compared to their food secure peers after adjust-
(67.8%) of food secure adolescents was never absent, the ing for age, gender, place of residence and gender of
frequency of school absenteeism among food insecure household head. Similarly, severe household food inse-
youth ranged from several days per week (29.2%) to sev- curity [OR 1.6 (1.27-2.06)], illness reported during the
eral days per semester (15.7%). After stratification by last month [OR 2.26 (1.68-3.06)] and the number of
gender, a significantly (P < 0.001) higher proportion days the adolescents had to work for at least one hour
(34.5%) of food insecure girls were absent compared to per week [OR 1.16 (1.07-1.26)] were positively asso-
boys (15.0%). This gender difference in absenteeism was ciated with school absenteeism. Adolescents who
not significant(P > 0.05) in the food secure adolescents aspired to higher grades were less likely to be absent
(Figure 2). from school compared to their peers who aspired to a
The mean ( SD) highest grade completed after 1 lower grade [OR 0.92 (0.88-0.96)].
year was 6.0( 2.7) for food secure adolescents and 5.5 In bivariate linear regression models, adolescent food
( 2.7) for food insecure adolescents (P = 0.003). Simi- insecurity (P < 0.001), severe household food insecurity
larly, adolescents from households with severe food (P < 0.001), residence in rural area (P < 0.001) and
insecurity had lower mean grades mean ( SD) female gender (P = 0.043) were negatively associated
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80

70 67.8

60
Food secure
50
42.5 Food insecure
Percent

40
29.2
30

20 17.7 15.7
12.5
9.5
10 5

0
Never absent Several days a Several days a Several days a
semester month week
P<0.001
Figure 1 Frequency of school absenteeism by food security status of adolescents in Jimma Zone Southwest Ethiopia.

with educational attainment, while age of the adolescent After adjusting for all other variables in the multivari-
(P < 0.001), highest grade aspired to be attained by the able linear regression model (Table 3), food insecure ado-
adolescent(P < 0.001), residence in urban area (P < lescents attained a lower grade after 1 year of follow-up
0.001), residence in semi urban area (P < 0.001) and compared to food secure adolescents (b = -0.44, P <
household income (P < 0.001) were positively associated 0.001). Female gender (b = -0.18, P = 0.039), being a
with educational attainment. member of a severely food insecure household (b = -0.41,

40
36.1
35
Female
30 Male
25
Percent

20 16.5
15.9
15 13.1

10
5
0
Food secure(P=0.120) Food insecure(P<0.001)
Figure 2 School absenteeism by food security status and gender of adolescents in Southwest Ethiopia.
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Table 2 Predictors of school absenteeism in adolescents in Southwest Ethiopia

Predictors of school absenteeism b AORa [95% CIb] P
Adolescent food insecurity
Food insecure 0.57 1.77[1.34-2.33] < 0.001
Food secure [reference] 1.00
Illness within the last one month before the survey
Yes 0.82 2.26[1.68-3.06] < 0.001
No [reference] 1.00
Severe household food insecurity
Yes 0.48 1.62[1.27-2.06] < 0.001
No [reference] 1.00
The highest grade the adolescent aspires to complete -0.08 0.92[0.88-0.96] < 0.001
Number days in a week the adolescent has to work for least 1 hour 0.15 1.16[1.07-1.26] < 0.001

Semi-urban refers to small towns including Yebbu, Serbo and Dedo and urban refers to Jimma city.
Parameter estimates are adjusted for place of residence, gender of the adolescent, gender of the household head and the tabulated variables.
a
Adjusted odds ratios as obtained from a multivariable logistic regression model.
b
Confidence intervals, as obtained from a multivariable logistic regression model.

P < 0.001) and residing in a rural area (b = -2.70, P < Ethiopia. Food insecure adolescents had on average a
0.001) or semi-urban area (b = -0.92, P < 0.001) were lower grade completed (5.5) compared to food secure ado-
negatively associated with educational attainment. How- lescents (6.0). The proportion of food insecure adolescents
ever, age (b = 0.66, P < 0.001) and the highest grade who completed primary education (24.1%) was also signifi-
aspired to be completed by the adolescent (b = 0.17, P < cantly lower than that of food secure adolescents (31.5%),
0.001) were positively associated with educational attain- although both proportions were lower than the national
ment. The effect of household income and gender of the completion rate of primary schools in 2005-2006 [28].
household head disappeared in the adjusted model. Food insecure adolescents are likely to have a lower educa-
tional attainment due to several reasons including high
Discussion absenteeism, illness, poor academic performance, aca-
Food insecurity is a common problem among adolescents demic delays, poor social functioning and behavioral pro-
and households in Southwest Ethiopia [13,27]. The present blems [2,3,6]. According to Food and Agricultural
study shows that food insecure adolescents and adoles- Organization of the United Nations, hungry children start
cents who were members of severely food insecure house- school later, drop out sooner and are also more likely to
holds were more likely to be absent from school and have be absent and learn less while they do attend [29].
a lower educational attainment in terms of the highest The effect of food insecurity on physical health and
grade completed after 1 year of follow-up in Southwest wellbeing is one of the ways through which food

Table 3 Predictors of highest grade completed by adolescents in Southwest Ethiopia

Predictors Bivariate Multivariable
b P b P
Female gender -0.21 0.083 - -
Age in completed years 0.76 < 0.001 0.66 < 0.001
Adolescent food insecurity -0.45 0.003 -0.44 < 0.001
Severe household food insecurity -0.63 < 0.001 -0.41 < 0.001
The highest grade the adolescent aspires to complete 0.30 < 0.001 0.17 < 0.001
Residence in semi urban area*,f 0.70 < 0.001 -0.92 < 0.001
Residence in rural areaf -3.04 < 0.001 -2.70 < 0.001
Gender of the head of the household 0.77 < 0.001 -0.10 0.402
Household income 0.01 < 0.001 0.00 0.235

The highest grade completed in school refers to the grade attained 1 year after the collection of data on predictors.

Coefficients as obtained from a multivariable linear regression model [adjusted R = 0.48].

Multivariable models with the highest grade completed by the adolescents as dependent variable and predictors with P < 0.05 of the bivariate model.
*Yebbu, Serbo & Dedo Towns.
Parameters estimates adjusted for gender, household income, gender of the household head and the tabulated variables.
f
Urban was used as a reference category in the multivariable model.
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insecurity can erode educational attainment. As adoles- in constrained situations [35]. Children living in con-
cence is a critical period of human growth and develop- strained environments were reported to have signifi-
ment, it can be affected by nutritional constraints cantly higher cortisol levels due to stress [15]. Prolonged
resulting from food insecurity. There is an increasing elevated cortisol level in humans have been associated
recognition that ill health and malnutrition among with depression, cognitive deficits, and atrophy of brain
school aged children have a major impact of on their structures involved in learning and memory [16,17]
cognitive development, learning and educational which may also lead to lower educational attainment. As
achievement. Improved health and nutrition are posi- a result of stress, anxiety and disrupted household
tively associated with enrolment at younger age, reduced dynamics [18], food-insufficient teenagers are more
absenteeism, less grade repetition and higher perfor- likely to have behavioral problems which makes them
mance on test scores [30,31] due better cognitive devel- incompatible with school norms [5] negatively impacting
opment [32]. Cross-sectional studies from high income on their educational attainment. Any of these mechan-
countries show that when food supplies are constrained isms, alone or combined, could explain how food secur-
at the household level, both adults and children use ity affects the educational attainment of adolescents in
coping strategies such as reduction of meal size and the study area. Interventions focusing on improving the
meal frequency and eating lower quality foods [14], food insecurity situation such as conditional cash and/or
which in turn might induce malnutrition [8]. Similarly, food transfer programmes [36] need to consider these
cross-sectional [5] and longitudinal studies from high consequences on adolescents in identifying target
income countries [3,7] and a cross sectional study from groups.
a low income country [33] also showed that malnutri- After stratifying for gender, the bivariate analysis
tion is associated with poor cognitive development and showed that in food insecure situations a higher propor-
decreased school performance in children. Malnourished tion of girls are more likely to be absent from school
children are less able to concentrate in school [3,18,29], compared to boys. This might be related to the social
which could lead to lower educational attainment. norms in the community that give low value female to
In this study, adolescents who reported an illness dur- education [37] that are potentially exacerbated when
ing the last month were twice as likely to be absent resources are constrained. A significantly larger propor-
from school. A report from the study area showed that tion of girls was from food insecure households, food
food insecure adolescents had a higher frequency of ill- insecure themselves and reported an illness during the
ness than food secures ones [9,13]. Food insecurity not past one month compared to boys. This may be due to
only jeopardizes the right to health but also has serious the selective buffering of boys from food insecurity by
implications on education and schooling of adolescents. adult household members that is common in the study
Secure access to food may enhance school attendance area [13]. The higher rates of food insecurity in girls
and overall health and well-being through decreasing could result in their school absenteeism through
use of negative coping strategies [30,31]. mechanisms discussed above. When entering gender as
Food insecurity can also act as a psychological or a variable in the multivariable model for school absen-
emotional stress factor [15,34,35], affecting adolescent teeism however, no significant association was observed
behavior and aspiration for further education. Our find- (results not shown), which indicates that the effect of
ings show that adolescents who aspire to complete gender is mediated by the other variables in the model.
higher grades were 18% less likely to be absent from School absenteeism in this study was also determined
school. The effect of food insecurity on childrens well- by a high frequency of work at the household level that
being is related to its effect on the physical and socio- the adolescent was engaged in. Adolescents who had to
emotional aspects [3,4] that are linked to developmental work longer hours per week were 1.4 times more likely
consequences through nutritional and non-nutritional to be absent from school. Children become absentees or
mechanisms [3]. While the nutritional effects might dropout of school to help household labor as one of the
explain the negative consequences of inadequate nutri- coping strategies of food insecurity [38].
ent intake on physical health and cognitive development, Our results imply that secure access of adolescents to
non-nutritional aspects of food insecurity relate to psy- food supply needs to be given attention to achieve the
chological effects including worry, anxiety or sadness targets of the Millennium Development Goal. The find-
about the familys food supply, feelings of having no ings provide arguments to incorporate food security in
choice in the foods eaten, shame/fear of being labeled as interventions that aim to address school attendance.
poor which are beyond the nutritional effects of food Interventions including food stamp programs [2] and
insecurity on adolescents [18]. Cook and Frank reported school breakfast programs [39] were reported to have
that food insecurity is a common risk to the growth, beneficial effects for children on academic learning
health, cognitive, and behavioural potential of children through improving dietary intake and/or reduction of
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stress. School supplementation program were also Acknowledgements

The Jimma Longitudinal Family Survey of Youth was funded by the Packard
shown to have beneficial effects in reducing scholastic
Foundation, Campton Foundation, National Institute of Health and National
difficulties of adolescents [40]. In Ethiopia although Science Foundation. We are extremely grateful to adolescents involved in
such programs are being implemented by relief actors as the study, data collectors and the research team members, Prof. Dennis
Hogan, Dr. Kifle Woldemichael, Prof. Challi Jira and Mr. Fasil Tesema.
part of an emergency response [41] there is no school
feeding programme in non-emergency scenarios. There Author details
1
is a need to consider such interventions in potentially Department of Population and Family Health, College of Public Health and
Medical Sciences, Jimma University, PO.Box:1104, Jimma, Ethiopia.
food constrained areas to prevent attrition of food inse- 2
Department of Food Safety and Food Quality, Faculty of Bioscience
cure adolescents from school. Engineering, Ghent University, Coupure links 653, 9000 Gent, Belgium.
3
We acknowledge a number of limitations in our study. Department of Anthropology, Emory University, 207 Anthropology Building
1557 Dickey Drive, USA. 4Department of Sociology, Brown University, Box
Although the adolescent and household food security
1916, Providence, RI 02912, USA. 5Nutrition and Child Health Unit,
scales were adapted from household food security scales Department of Public Health, Institute of Tropical Medicine, Nationalestraat
after thorough discussion with the interview team who 155, 2000 Antwerpen, Belgium.
are residents of the study area, we might not rule out
Authors contributions
the possibility of some misclassification. The scales used The authors responsibilities were as follows: DL, CH, TB & AG: Designed and
assessed acute food insecurity as they covered only the supervised the study and ensured quality of the data and made a
substantial contribution to the local implementation of the study and PK, CL,
last three months prior to the interview. The total sur-
CH & DL assisted in the analysis and interpretation of the data. All authors
vey period involved two seasons (rainy/peak hunger sea- critically reviewed the manuscript. TB, the corresponding author did the
son) and spring season [42] which is better off in terms analysis & drafted the manuscript and had the responsibility to submit the
manuscript for publication.
of food security and this matches a follow up period of
one year. The proportion of food insecure households Competing interests
was 39.4% which was similar to estimations for urban The authors declare that they have no competing interests.
areas of the region [38]. When interpreting the results
Received: 16 November 2010 Accepted: 10 April 2011
of the study, it is important to note that our findings Published: 10 April 2011
regarding food insecurity relate mainly to the study sea-
son and might not reflect the total year, but this is not a References
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