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Global Health Econ Sustain Household food insecurity and Under-five Mortality

Sub-Saharan Africa has by far the fastest growing to safe and nutritious food increases the risk of under-
population of any major region in the world, with a five mortality, highlighting the necessity for stakeholder
population of 1.3 billion (17% of the world population) intervention (Belachew et al., 2012). As a result, the
(United Nations, 2022). Sub-Saharan Africa has the highest purpose of this study is to examine the prevalence and
mortality rate for children under five, at 73/1,000 live effect of household food insecurity on under-five mortality
births. In 2021, one in 14 children in Sub-Saharan Africa in the sub-city.
died before reaching the age of five. This rate aligns closely
with the global average from 20 years ago, when the under- 1.1. Theoretical framework and empirical literature
five mortality rate was also one in 14 in 2001. However, it This study is grounded in two theoretical frameworks:
remains markedly higher than the risk for children born in Schultz (1984) and Mosley & Chen (1984), which were
high-income countries, surpassing it by 15 times. In 2020, developed to investigate the relationships between
the under-five mortality rate in the poorest households was food insecurity and child survival, alongside other
estimated to be 151/1,000 live births, while in the richest factors influencing under-five mortality. Schultz (1984)
households, it was approximately 96/1000 live births is recognized as one of the pioneering researchers in
(Sharrow et al., 2021). developing a theoretical framework for child survival. In
Ethiopia remains one of the world’s most impoverished addition to observed socioeconomic (social, economic,
and food-insecure nations, with 30.8% of its population community, and religious) and biomedical (breastfeeding
living below the poverty line for sustenance (Odekon, habits and hygiene) factors, Schultz’s theoretical framework
2022). The majority of urban households in Ethiopia, concentrated on the structural relationship between child
comprising approximately 80%, experience food survival and individual behavioral variables. According
insufficiency, and heavily rely on market mechanisms to to Schultz’s framework, socioeconomic factors have an
indirect impact on child survival through their interaction
procure their food requirements (WFP/UNICEF, 2019). with biomedical factors, which are modeled as having a
The under-five mortality rate in Ethiopia remains high,
estimated at 59/1000 live births (CSA, 2016; 2019). direct effect on child mortality (Schultz, 1984). Similarly,
Mosley & Chen (1984) divided child survival determinants
The relationship between food insecurity and under- into socioeconomic and biomedical (maternal, nutrition,
five mortality is found not only at the national level but environmental, injuries, and personal disease) factors.
also at the regional level. According to the Interim Report Proximate determinants were classified by Mosley and Chen
on Poverty Analysis Study in Ethiopia (FDRE, 2017), an as maternal factors (age, birth order, and birth intervals),
estimated 19.1% of individuals in Addis Ababa experience nutrient deficiency (calories, protein, and micronutrient
food insecurity (defined as being unable to purchase deficiency), environmental hygiene factors such as the
consumption items providing a minimum of 2,200 kcal) source of water and type of sanitation, injury (related to
(PDC, 2019). Despite this, the under-five mortality rate in physical, burn, and poisoning injuries), and personal illness.
Addis Ababa is relatively lower, estimated at 26/1000 live The foundation for this research is the framework
births (CSA, 2016; 2019). However, in the Lideta Sub-City, developed by Mosley & Chen (1984), which connects
considered one of the most deprived sub-cities in Addis under-five mortality to nutrient deficiencies, as well as
Ababa, around 29.3% of the population suffers from food other maternal and environmental factors. However, while
insecurity. This data suggests that approximately one-third many studies have focused on the association of food
of the population falls below the threshold of adequate food insecurity with stunting, wasting, and being underweight, it
intake (MOFED, 2018), which could exacerbate under-five is worth noting that more than 50% of under-five mortality
mortality in the sub-city.
is attributable to food insecurity and malnutrition. Among
The previous studies have focused on examining the the principal causes of death in young children, diarrhea,
relationship between food insecurity and under-five pneumonia, measles, and malaria are attributable to
mortality at national and regional levels, often overlooking malnutrition (Caulfield et al., 2018). Both past and recent
disparities within localities and sub-cities. The empirical studies have consistently demonstrated that malnutrition
data provided in these studies may not definitively significantly contributes to morbidity and under-five
authenticate circumstances that transpire at a fundamental mortality (Girma et al., 2022; Pelletier et al., 1995; Puffer
level, potentially underestimating the magnitude of under- & Serrano, 1973). A study conducted across 53 developing
five mortality within sub-regional domains. Chronic food countries revealed that malnutrition’s potentiating effects
insecurity in households can result in persistent malnutrition account for 56% of child deaths, with 83% attributed to
as a consequence of the inability to secure adequate and mild-to-moderate malnutrition. In individual countries,
sustained access to food. Conversely, the lack of access malnutrition’s total potentiating effects on mortality

Volume 2 Issue 1 (2024) 2 https://doi.org/10.36922/ghes.1682