Date of Award

9-30-2010

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Andrea Asnes

Second Advisor

Urania Magriples

Abstract

Child malnutrition remains a significant problem worldwide with children under two years of age at particular risk. Even mild to moderate child undernutrition in food insecure households has been associated with poor growth, increased rates of infection and poor development. Rural Honduras undergoes a rainy and a dry season each year. Households rely on subsistence agriculture and as the dry season progresses, they have fewer food reserves and limited cash resources. It is anticipated that this will lead not only to decreased measures of food security, but also that children in food secure households will have higher rates of growth and lower rates of disease than children from food insecure households. This study aims to determine predictors of household food security, the impact of seasonality on food security and the utility of food security at predicting rates of growth and disease in children under two in rural Honduras. One hundred and forty-one mother-infant pairs participated in this longitudinal, observational study. Food security was assessed at baseline and at the close of the study period utilizing a 14 question Food Insecurity Questionnaire. Additional measures included: a baseline demographic assessment and monthly child health questionnaire. Analyses of food security were completed using both a paired sample t-test and a repeated measures ANOVA to determine the impact of season (dry versus rainy) on food security. A multivariate regression model using backwards selection determined the best fit model for predicting total food security in both dry and rainy seasons. Multivariate regression modeling identified the food security questions that were the best predictors of growth and illness during dry season controlling for age cohort and gender. Food security was significantly lower during the dry season (mean 32.98±4.35) compared to the rainy season (mean=36.44±5.23) (p<0.001). Bivariate analyses showed decreased rates of food security in households with female children (N=65; mean 32.5±4.98) compared to households with male children (N=74; mean 34.0 ±5.3; p=0.099) during the dry season. In addition, rates of food security in households with younger children (ages 6-12 months of age) were lower than households with older children (ages 12-19 months of age) in both dry and rainy season (p=0.110; p=0.038). Multivariate regression modeling identified the food security measures and maternal and child characteristics that predicted total food security during rainy (p=0.002) and dry season (p<0.001). Multivariate regression models used questions from the food security questionnaire to predict parent-reported days of illness controlling for age and gender. Different groupings of food security questions were significant predictors for parent-reported days of diarrhea, fever, shortness of breath, and vomiting, but not days of cough. Our findings confirm higher rates of food insecurity during the dry season than during the rainy season in rural Honduras. They identify maternal and child characteristics that increase the risk and severity of food insecurity in children and also illustrate the link between different indicators of household food security and rates of child growth and morbidity.

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This is an Open Access Thesis.

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