Page 171 - GHES-2-1

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

to be closed, the household with the next number on the compositions. Therefore, if this adult-equivalent estimate
list was selected, and this process continued until the was taken, 31.46 birr/2,200 kcal would serve as a standard
required number of sampled women was acquired. threshold for distinguishing food-insecure households
from food-secure ones. However, such an approach risks
2.3. Study variables misclassifying households as food insecure when they may
The outcome variable in this study is under-five mortality, not be, as it overlooks the presence of household members
which encompasses neonatal mortality, infant mortality, with distinct energy needs. Consequently, in this study, an
and child mortality. This variable can be measured by adult-equivalent estimate of the calorie availability scale
categorizing a child’s survival status or event as a dummy that has an adult-equivalent conversion factor was used
outcome variable (dead or alive). Predictor variables (Appendix). The application of an adult-equivalent scale
and covariates include household food insecurity status, effectively narrows the variance between estimated and
categorized as either food insecure or food secure, as actual food intake, thereby enabling the discernment of the
well as demographic and socio-economic factors such as relative contributions of distinct household members to
maternal education, age at first birth, availability of toilet the overall dietary pattern of the household. This nuanced
facilities, antenatal care service, initiation of breastfeeding, understanding is unattainable when using on per capita
age and sex of the child, type of birth, preceding birth metrics. The household income and expenditure survey are
interval, birth order, and the number of children ever born. a standardized and widely applicable method for measuring
household food insecurity and poverty at the household
2.4. Measurement of household food insecurity level (Bellú & Liberati, 2005; Ruggeri Laderchi et al.,
The caloric value of foods that meet the recommended 2003). Organizations such as the World Bank, the United
threshold of 2,200 kcal, as outlined by the Food and States Agency for International Development (USAID),
Agriculture Organization (FAO, 2004), for supporting the International Development Association (IDA), and
healthy and moderately active adult living, is determined the Ethiopian government have applied this monetary
by their corresponding national average prices to establish approach to measure household food insecurity/poverty
the food poverty line. Although the 2016 Interim Poverty within the urban productive safety net program in urban
Analysis Report estimated the cost at 3,772 birr/year/adult Ethiopia (UPSNP, 2021). Moreover, the governments of
person in Ethiopia (FDRE, 2017; MOFED, 2018), this price Ethiopia and other developing countries have applied this
was not feasible and had to be adjusted based on current monetary approach to analyze food poverty and insecurity,
food prices in this study. Over the period from June 2016 identifying the prevalence, gap (shortfall), and severity of
to January 2023, the overall inflation had reached 122.2%. household food insecurity (FDRE, 2017; PDC, 2019).
Computing the yearly food inflation rate brings the
estimated cost to 11,524.52 birr/year/adult (CSA, 2022a; 2.5. Statistical analysis
NBE, 2022). Accordingly, the cost of one kilocalorie is The data were collected using KoboCollect 3.5 and
estimated to be 0.0143 birr. subsequently entered into the SPSS 24 software with caution.

This study utilizes the national food poverty line as a The data cleansing method was employed to assess the
metric to gauge food insecurity status. The food poverty correctness and inconsistencies, ensuring the completeness
line determines whether a household possesses adequate and accuracy of the dataset. The data were then categorized
daily food expenditure (total household income spent and sorted to facilitate their analysis. The Chi-square test
2
on food) to meet the minimum daily calorie needs of its (χ ) was employed to identify variables that exhibited
members. Therefore, households unable to afford the a statistically significant association with under-five
requisite funds or procure consumer goods to meet these mortality. In this study, the variables that exhibited a p-value
daily calorie needs are considered food insecure, while of less than 0.25 were subjected to a thorough examination
those able to do so are classified as food secure. However, for multicollinearity issues utilizing the variance inflation
individual access to food depends on household food factor (VIF). Following this preliminary assessment, the
distribution and gender parity, which in practice means that identified variables were included in a logistic regression
consumption patterns are not uniform (Battersby, 2011). model to determine their effect on the outcome variable
Often, children, women, and elderly household members (under-five mortality). The adjusted odds ratios, along with
consume less food compared to male adults (Claro et al., their respective 95% CI, were computed. A significance
2010). A per capita adult-equivalent estimate is obtained level of 0.05 was deemed statistically significant in the
by dividing the total daily food expenditure or calorie present study. To identify the best independent predictors
intake by all household members, assuming a uniform of under-five mortality, logistic regression with a stepwise
food consumption pattern across families with different selection (LR) method was used.

Volume 2 Issue 1 (2024) 4 https://doi.org/10.36922/ghes.1682