We tested the validity of ELCSA in a convenience sample of 153 women with children under five in South Haiti. ELCSA was applied to the women in Creole, contained 16 items and used a reference period of 3 months. Cronbach’s alpha was 0.92. Based on affirmative response prevalence, the items referring to child hunger tended to be the most severe. However, social unacceptability of procuring food was the most severe item. This question asked ‘Was there any time during the past 3 months when you had to do something that you would have preferred not to do (such as begging or sending the children to work) to be able to get food?’. There were no food secure households in the sample, 44% were food insecure (FI), 49% were very FI, and 7% were extremely FI. Criterion validity was strong. Those reporting having good/very good health ranged from 38.8% among those FI to 9.1% among those extremely FI (p=0.02). Households with children who had recently had malaria were more likely to be very/extremely FI than households where the index child had been free of malaria (82.0% vs. 37.1%, p<0.001). Additional factors associated with very/extreme FI (p<0.05) were: female-headed household, lack of electricity at home, no land ownership, and poorer dietary quality. Results suggest that ELCSA is a valid tool for assessing household FI in rural Haiti. Funded by CIDA (7034161)

through a grant to the Centro Internacional de Agricultura

Tropical (CIAT).

Validity of the Latin American and Caribbean Household Food Security Scale (ELCSA) in South Haiti

At a recent FAO-sponsored Regional meeting in Antioquia, Colombia, consensus was reached on the importance of testing a single experience-based household food security measurement scale in different Latin American and Caribbean countries. The ‘EscalaLatinoamericana y Caribeña de Seguridad Alimentaria’ (ELCSA) was developed mostly based on the national household food insecuritymeasurement experiences in Brazil, Colombia and the USA*. The data reported herein represents the first application of ELCSA in the field.

* Pérez-Escamilla R, Melgar-Quiñonez H, Nord M, Alvarez Uribe MC, Segall-Correa AM.Escala

Latinoamericana y Caribeña de Seguridad Alimentaria (ELCSA) [Latinamerican andCaribbean Food

Security Scale]. Perspectivas en Nutrición Humana (Colombia) 2007 (supplement):117-134.

Rafael Pérez-Escamilla, PhD1, Michael Dessalines BS1, Mousson Finnigan, MD2, Amber Hromi-Fiedler, MPH PhD1, Helena Pachón, PhD3

7.030.7Mother’s age (y)

43.462Child stunting (height-age Z <-2)

34.0

50.3

12.4

3.3

52

77

19

5

Maternal BMI

Underweight (<18.0 kg/m2)

Adequate weight (18.0 - <25.0 kg/m2)

Overweight (25.0 - <30.0 kg/m2)

Obese (≥ 30.0 kg/m2)

12.6

SD

33.3

25.5

28.1

26.1

65.4

9.2

2.6

%

39Child diarrhea (past 2 wks)

100Income < $30 per month

4Sewage at home

51Child malaria (past 2 mo)

n

32.9Study child’s age (mo)

Mean

43Good/very good health (self-reported)

40Married

14Electricity at home

a Participant responses for each item were yes, no, don’t know or refused.

• ELCSA is a valid tool for assessing household food insecurity (FI) in rural Haiti

• Content validity (expert review)• Face validity (preliminary review by local community

members)• Convergence validity (FI & meal skipping)• Criterion validity (FI & SES/health outcomes)• Psychometric behavior (Cronbach’s alpha and Rasch

modeling)• “Worried’ had inadequate fit, perhaps as a result of translation

(term translated as ‘fear’ instead of ‘worry’). Further research needed to verify psychometric behavior of this scale item in Haiti.

1University of Connecticut, Storrs, CT, USA, 2Organization for the Rehabilitation of the Environment (ORE), Camp Camperrin, Haiti, 3Centro Internacional de Agricultura Tropical, Cali, Colombia

STUDY DESIGN

ABSTRACT

BACKGROUND

RESULTS: PSYCHOMETRIC PROPERTIESa,b,c

CONCLUSIONS

RESULTS: CONVERGENCE AND CRITERION VALIDITYa,bELCSA ITEMS

• Location: Camp Camperrin, South Haiti

• Cross-sectional, convenience sample

• N=153 mothers with children < 5 y

• Household food security measured with the ‘Escala Latinoamericana y Caribeña de Seguridad Alimentaria’ (ELCSA)

• ELCSA translated from Spanish to French and then to local Creolebefore application

• ELCSA validated in the context of a larger study whose objectivewas to evaluate the potential for biofortified sweet potato to improve vitamin A intake among pre-school children and their mothers

SURVEY INSTRUMENT

• Socio-economic and demographic information

• Infant-feeding practices

• Maternal dietary intake: 24-hour recall (twice on non-consecutive days) and food frequency questionnaire

• Family sweet potato consumption: habits and preferences

• Maternal and child self-reported health indicators

• Maternal and child anthropometry

PARTICIPANT CHARACTERISTICS (N=153)

12) During the last 3 months did any child in your home eat less food than what s/he needed because there wasn’t enough food?

13) During the last 3 months did you have to serve less food to any child because there wasn’t enough food?

14) During the last 3 months was there any day when any child in your home felt hungry but could not be fed because there wasn’t enough food?

15) Did any child in your home go to bed hungry in any day during the past 3 months because of lack of food?

11) Did any children in your home usually have to eat the same foods almost every day during the last 3 months?

8) Was there any day when you or any other adult in your home didn’t eat for a whole day or just ate once during the day because there wasn’t enough food during the last 3 months?

9) During the last 3 months, did you do things that you would have preferred not to do, such as begging or sending children to work, to get food?

6) During the last 3 months did any adult in your home eat less food than what they needed because there wasn’t enough food?

3) Was your home unable to eat the kinds of foods that make you healthy at any time during the last 3 months?

1) During the last 3 months, were you worried about running out of food?

7) During the last 3 months was there any day when you or any other adult in your home felt hungry but did not eat because there wasn’t enough food?

Questions referring to respondent and/or other adults in the householda

Questions referring to children under 5 years old in the householda

16) Was there any day when any child in your home didn’t eat for a whole day or just ate once during the day because there wasn’t enough food during the last 3 months?

10) During the last 3 months were you unable to provide the children in your home with the kinds of foods they need to be healthy?

5) Was there any day during the last 3 months that you or any other adult in your home skipped a meal because of lack of food?

4) Did you or anybody in your home usually have to eat the same foods almost every day during the last 3 months?

2) Did your home run out of food at any time during the last 3 months?

ELCSA Item Prevalence

0

2

4

6

8

10

12

ran ou

t (2)

less

food

-child (1

2)

less

food

per

mea

l-child (1

3)wor

ried (1)

health

y an

d va

ried (3)

less

food

(6)

low variety (4

)

no fo

od all da

y (8)

low variety-child (1

1)

skippe

d mea

ls (5

)hu

ngry (7

)

health

y & varied-

child

(10)

hung

ry-child (1

4)

no fo

od all da

y-ch

ild (1

6)

bed hu

ngry-child (1

5)

socially una

ccep

table (9)

01020

3040506070

8090

100

ran ou

t (2)

less

food

-child (1

2)

less

food

per

mea

l-child (1

3)

wor

ried (1)

healthy & varied (3)

less

food

(6)

low var

iety (4

)

no fo

od all da

y (8)

low var

iety-child (1

1)

skippe

d mea

ls (5

)hu

ngry (7

)

health

y & var

ied-

child

(10)

hung

ry-child (1

4)

no fo

od all da

y-ch

ild (1

6)

bed hu

ngry

-child (1

5)

socially una

ccep

table (9)

% a

ffirm

ativ

e r

esponses

ELCSA Item Severity Values

38.8

21.3

9.1

0

5

10

15

20

25

30

35

40

45

FI very FI extremely FI

%

60

30

10

39.2

54.6

6.2

18.2

9.1

72.7

0

10

20

30

40

50

60

70

80

FI very FI extremely FI

%

married common law single

71.4

14.3 14.3

43.8

52.5

6.5

0

10

20

30

40

50

60

70

80

FI very FI extremely FI

%

electricity other&

Good/Very Good Maternal Healthby FI Level*

a p values base on chi-squared analysesb N=153

Marital Status by FI Level

Energy/Fuel Source by FI Level

54.7

39.6

5.7

19.1

70.2

10.6

0

10

20

30

40

50

60

70

80

FI very FI extremely FI

%

yes no

17.6

70.6

11.8

56.9

38.2

4.9

0

10

20

30

40

50

60

70

80

FI very FI extremely FI

%

malaria healthy

05.3

9.13

8

36

11.916

9.1

85.1

70.7

45.5

0

10

20

30

40

50

60

70

80

90

100

FI very FI extremely FI

%

didn't eat 1- < 3 times 3-6 times every day

Maternal Breakfast Weekly Consumption by FI Level

1.5

8 9.14.5

17.3

9.13

14.7

54.5

91

60

27.3

0

10

20

30

40

50

60

70

80

90

100

FI very FI extremely FI

%

didn't eat 1- < 3 times 3-6 times every day

Maternal Lunch Weekly Consumption by FI Level

Maternal Dinner Weekly Consumption by FI Level

3

29.3

54.5

4.5 5.39.1

14.917.3

48

77.6

48

27.3

0

10

20

30

40

50

60

70

80

90

100

FI very FI extremely FI

%

didn't eat 1- < 3 times 3-6 times every day

Land Ownership by FI LevelMalaria in Children Under 5 by FI Level

* Self-reported

p<0.001

p=0.024p=0.041

p=0.023 p<0.001

p=0.002 p=<0.001p=<0.001

a ELCSA item # shown within parenthesis in x-axisb N=153CRasch model analyses used to produce results

RaschItem

Severity Value

00.20.40.60.81

1.21.41.61.82

2.2

ran ou

t (2)

less

food

-child (1

2)

less

food

per m

eal-c

hi..

wor

ried

(1)

healthy & varied (3)

less

food

(6)

low variety (4

)

no foo

d all d

ay (8

)

low var

iety

-child (1

1)

skippe

d mea

ls (5)

hungr

y (7)

hungr

y-ch

ild (1

4)

health

y & varied-ch

ild...

no foo

dall d

ay-child

(16)

bed hu

ngry

-child (1

5)

socially unac

cept

able (9

)

RaschItem Infit

Value

ELCSA Item Infit Values