Household food insecurity and associated factors in South Ari district, Southern Ethiopia: A community-based cross-sectional study

{"Background": "Food insecurity is a major public health problem worldwide, particularly in developing countries. According to the FAO, 2.37 billion people lacked access to enough food in 2020, with Asia and Africa being the most affected continents. In Ethiopia, food insecurity is widespread and severe, with the 2019 Comprehensive Food Security and Vulnerability Analysis estimating that nearly 20.5% of households were food insecure in 2016. The Amhara region had the highest percentage (36.1%), followed by Afar (26.1%) and Tigray (24.7%). Ethiopia loses 16.5% of its GDP annually due to long-term effects of hunger on the labor force. Despite various government interventions, there is a dearth of evidence on food insecurity and its responsible factors in the South Ari district, an area known for high agricultural productivity yet also a high burden of child undernutrition. This study aimed to assess household food insecurity and associated factors in South Ari district, Southern Ethiopia.", "Methods": "A community-based cross-sectional study was conducted from March 11 to April 11, 2021, in selected kebeles of the South Ari district, South Omo Zone, Southern Ethiopia. The district is located 767 km from Addis Ababa and has a projected 2021 population of 160,896. A multi-stage sampling technique was used: first, 31 kebeles were stratified into Dega (n=6), Woina Dega (n=23), and Kolla (n=2) agro-ecological zones; then 10 kebeles (2 from Dega, 7 from Woina Dega, 1 from Kolla) were selected by lottery. Sample size was calculated based on 75.8% prevalence from a prior study, yielding 727 households after accounting for a design effect of 1.5 and 10% non-response rate. A total of 717 households were successfully interviewed (98.6% response rate). Data were collected using a structured questionnaire translated into Amharic. Household food insecurity was measured using the Household Food Insecurity Access Scale (HFIAS) standardized tool (FANTA version 3), with nine questions covering three domains: anxiety about food access, insufficient food quality, and insufficient food intake. Wealth index was computed using principal components analysis (PCA) based on 26 asset types. Data were entered into Epi-Data V3.2 and analyzed using SPSS V25.0. Bivariable logistic regression identified candidate variables (p<0.25) for multivariable logistic regression. Adjusted odds ratio (AOR) with 95% CI was used, and statistical significance was declared at p<0.05. Multicollinearity was checked (highest VIF=3.09) and model fitness was assessed using the Hosmer\u2013Lemeshow test (p\u22650.05).", "Key Results": "The prevalence of household food insecurity was 44.8% (95% CI: 41.1%, 48.5%). By severity: 8.7% (95% CI: 6.8%, 10.9%) were severely food insecure, 16.3% (95% CI: 13.8%, 19.2%) moderately, and 19.8% (95% CI: 17.0%, 22.9%) mildly food insecure. Among respondents, 56.6% of household heads were male, 40.4% were aged \u226535 years, 22.9% had no formal education, 87.0% were married, and 90.7% were Ari ethnicity. Family size of 8 or more was reported by 12.6% of households, 36.0% had a high dependency ratio, and 33.3% were from poor households. Regarding agricultural characteristics: 58.3% owned farmland, 45.5% used agricultural inputs, 43.4% used agricultural extension services, 17.2% were beneficiaries of the productive safety net program, and 24.8% owned livestock equivalent to \u22652.5 tropical livestock units. In multivariable logistic regression, five factors were significantly associated with household food insecurity: larger family size (\u22658) (AOR=1.91, 95% CI: 1.10, 3.30; p=0.021), high dependency ratio (AOR=2.71, 95% CI: 1.67, 4.40; p<0.001), medium dependency ratio (AOR=1.72, 95% CI: 1.13, 2.62; p=0.011), poor wealth index (AOR=2.30, 95% CI: 1.53, 3.46; p<0.001), not using agricultural extension service (AOR=2.25, 95% CI: 1.57, 3.23; p<0.001), and non-beneficiary of productive safety net program (AOR=1.71, 95% CI: 1.01, 2.87; p=0.045).", "Clinical Implications": "The finding that 44.8% of households in South Ari district are food insecure\u2014despite the area being known for high agricultural productivity\u2014indicates that food insecurity persists even in agrarian regions of Ethiopia. The significant associations with larger family size and high dependency ratio suggest that population pressure and household composition are critical drivers. Clinically, food insecurity is linked to malnutrition, impaired child development, and poor health outcomes. The study recommends that primary health care services should promote family planning to limit population pressure, expand and integrate the productive safety net program with basic health care services, and enhance income-generating activities. Households experiencing severe food insecurity (8.7%) need immediate intervention to reduce mortality and morbidity. The findings also underscore the importance of agricultural extension services as a modifiable factor\u2014households not using these services had more than double the odds of food insecurity. Strengthening agricultural productivity through extension services and safety net programs could improve food security and, consequently, nutritional and health outcomes in the district."}