Predictors and outcomes associated with household hunger in Lusaka, Zambia: secondary analysis of a citywide survey

Abstract

Background: Food insecurity has important social and health consequences for affected individuals and households. We sought to measure one aspect of food insecurity—household hunger—and evaluated its possible association with household morbidity and mortality.

Methods: We analyzed data from the final two rounds of a repeat cross-sectional, population-based survey conducted in Lusaka Zambia (May and August 2011). Using the Household Hunger Scale, we categorized participating households into three groups using established convention in the public health literature: little to no hunger, moderate hunger, and severe hunger. We used multilevel logistic regression to investigate associations between household hunger and the following morbidities, adjusting for individual, household, and cluster characteristics: malaria, persistent cough, tuberculosis, diarrhea, hospitalization, and death.

Results: Overall, 90.0%, (95%CI: 88.1–91.7%) participating households were considered to have little to no household hunger; 9.8% (95%CI:  8.2–11.6%) reported moderate household hunger; and 0.2% (95%CI: 0.1–0.4%) reported severe household hunger. Marital status, functional status, education, employment, household member requiring nursing care, and household wealth index were associated with all levels of hunger. Adjusted for individual and household characteristics and sampling cluster, hunger was associated with malaria (OR:1.29, 95%CI:1.03–1.63 [mild] and OR:3.68, 95% CI:1.76 –13.74 [severe]), persistent cough (OR:1.64, 95%CI:1.13–2.38 [mild]), tuberculosis (OR:2.24, 95%CI:1.45–3.46 [mild], OR:6.06; 95%CI:1.56–23.57 [severe]), and hospitalization (OR:1.95; 95%CI:1.38–2.76 [mild]; OR:5.52; 95%CI:1.78-17.16 [severe]). Household hunger was not associated with death (p>0.05).

Conclusions: Household hunger was associated with a number of adverse health outcomes. Although further studies are needed, our findings suggest that programs to alleviate household hunger—an important aspect of food insecurity—could lead to measurable public health impacts.

Keywords: Household hunger scale, HHS, health outcomes, Zambia, sub-Saharan Africa, food insecurity