Journal of Health, Medicine and Nursing www.iiste.

org
ISSN 2422-8419 An International Peer-reviewed Journal
Vol.88, 2021

Food Insecurity and Associated Factors Among Households in

Areka Town, Southern Ethiopia
Habte Samuel1, Gudina Egata2, Wondimagegn Paulos3, TesfahunYonas Bogale4, Minyahil Tadesse4
1. Maternal and child health & nutrition service core process, Regional Health Bureau, Southern nations,
nationalities and people, Ethiopia
2. Public Health, College of Health and Medical Sciences, Haramaya University, Ethiopia
3. Academic Director, School of Public Health, Wolaita Sodo University, Ethiopia
4. Health Sciences and Medicine College, Wolaita Sodo University, Ethiopia
5. Health Sciences and Medicine College, Wolaita Sodo University, Ethiopia
6. Social Medicine and Global Health, Department of Clinical Sciences, Malmo, Lund University, Sweden

Abstract
Background: Food insecurity among poor urban households in low income settings is a major public health
concern. This study aimed to assess the magnitude of food insecurity and associated factors among households in
Areka town, Southern Ethiopia.Methods: A community based cross-sectional survey was conducted among a
total random sample of 309 urban households in Areka town, Southern Ethiopia, from March to April, 2015.
Data was gathered using an interviewer administered and pre-tested structured questionnaire. The data was
entered into Epi Info version 3.5.3 and exported to SPSS version 20.0 for analysis. Binary logistic regression
analysis was used to assess the association between independent and outcome variable. Multivariable analysis
was used to identify factors associated with household food insecurity after controlling possible confounders and
statistical significance set at p- value < 0.05.Result: The magnitude of household food insecurity was 69.6 %
(95% CI = 64.1, 75.2). Household food insecurity severity status was categorized as mild for34.3%, (95% CI =
(29.4, 39.8)], moderate for31.7%, (95% CI = (26.1, 37.0)], and severe for 3.6%, (95% CI = (1.9, 5.8)]
households respectively. Being a poor household [(AOR = 3.13, 95% CI = ( 1.42, 6.91)], lack of formal
education among household heads [(AOR = 4.70, 95% CI = (1.82, 12.12) ] , households whose monthly food
expenditure was <500 ETB [ (AOR =6.9 , 95% CI =1.45, 32.9)] and between 500- 1500 ETB [ (AOR = 2.70,
95% CI =1.48, 4.91)] , and household head’s age ≥ 50 years [(AOR = 2.11, 95% CI = (1.12, 3.95)] were
significantly associated with urban household food insecurity.Conclusion: The prevalence of urban household
food insecurity was high in the study setting. The older age group and lack of formal education by head of the
household, household poverty and less monthly household expenditure for food consumption was factors that
significantly contributed to urban food insecurity. Therefore, an integrated feasible urban food security
interventions should be emphasized at all levels by all relevant stakeholders targeting the urban poor households
to ensure urban household food security.
Keywords: Areka town, Southern Ethiopia, Household Food insecurity.
DOI: 10.7176/JHMN/88-02
Publication date: April 30th 2021

Background
Food security is a situation that exists when all people, at all times, have physical, social and economic access to
sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy
life [1]. Food security is complex and its drivers are interdependent, such that sufficiency of food alone cannot
be a guarantee to food security. Socio-economic, demographic and environmental factors can alter food
accessibility in varying degrees [2].Since most low-income groups in urban areas are net buyers of food, access
and affordability are central concerns for household food security [3].
Based on Food and Agricultural Organization (FAO) estimates, 842 million of the global population was
unable to meet their dietary energy requirements in 2011–2013. Majority of them (98%) live in developing
regions. Many parts of the developing world such as Southern Asia, Sub-Saharan Africa (SSA) and Eastern Asia
were food insecure [4]. Food insecurity remains a danger in parts of South and South-east Asia. Food insecurity
is a chronic problem and highly prevalent in SSA[2].
In Ethiopia, similar to other developing countries, food insecurity is a major public health agendum. An
interim report on poverty analysis survey in 2010/2011 indicated that more than one third of the population of
the country was food insufficient [5]. Moreover, FAO estimated that about 32.1 million people (37.1% of the
total population) in the country were undernourished in the years 2011-2013 [4].
Urban food security is gaining particular attention since achieving national food security is one of the keys
for sustainable economic development and poverty reduction in the country[5].Available evidence showed that
the prevalence of urban food insecurity ranged from 58.2 % to 75% [6-7]. Some studies also revealed that
dependency on markets for food availability with good supply, purchasing power (household income and market

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Vol.88, 2021

prices), access to safe drinking water, sanitation and health facilities were among some important factors
associated with urban food insecurity in Ethiopia [8]. In addition, educational status of head of the household
regardless of sex of the household head, number of earning members in the household, household size, farm size,
off farm income, credit access, and marital status also play a role in household food insecurity [9-10].
Although various studies have been conducted to assess the magnitude of rural food insecurity, literature is
limited on the urban household food insecurity in Ethiopia. Since urban food insecurity threatens sustainable
economic development and poverty reduction, its correlates should be explored further for policy directions.
There is also a need for more concern to urban food security due to alarming population growth in urban centers.
Furthermore, evidence on urban household food insecurity is essential to design effective food security
interventions .Thus, the study was aimed at assessing the prevalence of urban household food insecurity and
associated factors in the study setting.

Methods
Study area and setting
The study was conducted from March to April 2015in Areka town, Southern Ethiopia, which is located 299 KM
from Addis Ababa, the capital city of Ethiopia [11- 12].
All households found in the study area during the commencement of the study were eligible to be involved
in the study.

Sample size and sampling procedures

A sample size was obtained from a total random sample of309 household heads distributed in the four
administrative units of the town. Each administrative unit is further stratified into sub-administrative units.
There are 27sub-administrative units in the town of which a total of 9 were selected by simple random sampling
technique. A systematic sampling method was used to select the study participants who were eligible for the
study. The estimated sample size was proportionally allocated to the selected sub-administrative units based on
their population size.

Data collection
Data were collected using interviewer administered pretested structured questionnaires which was adapted from
Food and Agriculture Technical Assistance (FANTA) Version 3(2007) for collecting socio-demographic and
Economic details, and household food insecurity access scale (HFIAS) questions. Nine HFIAS questions were
used in estimating the prevalence of food insecurity [13]. The questionnaire was first drafted in English
language and then translated to Amharic language. Prior to data collection, the purpose of this study was
explained to the study participants, their consent to participate was sought and was also informed that their
participation in the study was totally voluntary. A total of nine diploma nurses who had prior experience in data
collection and proficient in the local language collected data.
The data collectors read out the questions loud and afterwards recorded the responses from the study
subjects.

Data collectors and Measurements

The questionnaires were administered by nine trained and experienced data collectors. Three qualified public
health officers supervised the process of data collection. Household food insecurity was measured on the
following question items: Presence of worry about food, inability to eat preferred foods, eating monotonous or
undesired foods, reduction in meal size and number, not having any foods and going hungry to bed at night or
the whole day directed to the households the last four weeks prior to the survey. It was measured by scoring
response of household heads to HFAIS questions. The questions were tested for their reliability in measuring
food insecurity using Cronbach's Alpha (α)and the value was found to 80% indicating their consistency .The
overall score of HFAIS was 27.
Socio-economic position (wealth index) which is an aggregate of thirteen variables such as presence of
livestock, television, refrigerator, motorbike, bicycle, private house, internet centers, stationeries’ shop, market
center, hotel ownership, land ownership, furniture center, and vehicle. These variables were reduced to a single
variable (wealth index) using principal component analysis (PCA) to produce a common factor score for each
household. Accordingly, six area specific factor scores were obtained, correlation matrix > 0.3, and total
variance of > 60% were assumed during analysis. Then, the cumulative score of common factor scores was
computed. Finally, wealth status of the households was divided as poor, medium, and rich for further analysis. In
this study, permanent residence was defined as living for more than 6 months in the study area to be eligible for
the study.

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Vol.88, 2021

Data quality control

The study tools were pretested on five percent of the estimated sample size on similar setting outside the study
area and all important corrections were made before the actual collection of the data. The data collectors and
supervisors were trained for two days on the process of data collection. The supervisors closely supervised the
data collection and the data were checked for completeness and consistency on the daily basis. The principal
investigator carefully monitored the data collection process. Multivariable logistic regression analysis was
carried out to control for all possible confounders.

Data Management
Three statistical software packages were used for data management. During the data collection, the data was
checked every day for uniformity and completeness before data entry. The data was first entered into EPi-Info
version 3.5.3 and the cleaned final data was then exported to SPSS version 20.0 for further analyses.

Statistical analyses
Simple and multiple logistic regressions were used to examine the association between food insecurity and the
explanatory variables. From the simple regression models, predictive variables which were associated with the
outcome at p-value less than 0.05 were selected for inclusion in the multiple logistic regression models.
Statistical significance was set at p<0.050 and 95% confidence interval.
Bivariate logistic regression model was used to assess the association between each independent variable
and the dependent variable. All variables which had a p- value of less than 0.2 during bivariate analyses were
included in multivariable logistic regression model to identify independent predictors of food insecurity.
Multicollinearity test was carried out to see the correlation between the independent variables using standard
error for categorical variables and variables with the stand error of greater than 2 were dropped from the analysis.
HosmerLemshow significance test was used to test model fit at a p-value greater than 0.05. Multivariable
analysis was used to control for all possible confounders and identify factors associated with household food
insecurity using multivariable logistic regression.

Operational definition:
Food insecurity: Households with a food insecurity access scale (HFIAS) score through 2 – 27 were considered
to be food insecure. Those households with a (HFIAS) score 2 – 7, 8 – 14, and 15 – 27 were categorized to be
mildly, moderately, and severely food insecure respectively.

Results
Socio-demographic and economic characteristics
Among the total 309 household heads that participated in the study, 101 (32.7%) were males. The mean age (SD)
of household head was 34.39 (±2.3) years. The average family size was 5.6. Most of the household heads were
Protestants (56.6%) followed by Orthodox Christian (34.3%). Majority of the respondents were Wolaita (88%)
in ethnicity. Ninety five percent of the study subjects were married Distribution of household heads by education
revealed that 32.7% had diploma or more. Participants ‘wealth status as determined by principal component
analysis were 32%, 33.7% and 34.3% for poor, medium and rich households respectively using the thirteen asset
ownership questions about their house hold wealth status. The average monthly household income was 2414.74
Ethiopian birr. Fifty two and thirteen percent of households reported trading and daily labor as their sources of
income respectively. The average monthly food expenditure of the household was 1344.34 Ethiopian birr (Table
1).

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Vol.88, 2021

Table 1: Socio -demographic characteristics of study participants, Areka Town, Southern Ethiopia,
March to April, 2015
Variables Categories Frequency Percent (%)
Male 101 32.7
Sex Female 208 67.3
Age 18-29 year 101 32.9
30-50 year 172 56
>50 year 34 11.1
Family size 1-3 51 16.5
4-6 177 57.3
7+ 81 26.2
Ethnicity Wolaita 272 88
Oromo 5 1.6
Amhara 13 4.2
Gurage 8 2.6
Others 11 3.6
Religion Orthodox 106 34.3
Muslim 8 2.6
Protestant 175 56.6
Others 20 6.5
Marital status Married 295 95.5
Single 4 1.3
Separated 4 1.3
Widowed/divorced 6 1.9
Sources of income Salary 132 42.1
Trading 161 52.1
Daily work 39 12.6
Agriculture 41 13.3
Others 23 7.4
Educational status Illiterate 72 23.3
Elementary 79 25.6
High school 57 18.4
Diploma and above 101 32.7
Monthly HH income <600 ETB 18 5.8
600-2000 ETB 122 39.5
>2000 ETB 269 54.7
Wealth index Poor 99 32
Medium 104 33.7
Rich 106 34.3
Monthly HH food <500 ETB 35 11.3
expenditure 500-1500 ETB 156 50.5
>1500 ETB 118 38.2

Prevalence of household food insecurity

Affirmative response to worrying about food inaccessibility was given by 124 households (40%). 189(61%)
households reported that they ate limited variety of food, 137 (44%) affirmed to eating smaller meal portions,
whereas 115 (37%) households gave affirmative responses to eating fewer meals. The proportion of affirmative
responses given for going to bed hungry and eating no food over the whole day were 4(1.3%) and 2(0.6%)
respectively (Table 2).

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Vol.88, 2021

Table 2: Percentage distribution of respondents’ responses to the HFIAS questionnaires, Areka Town,
Southern Ethiopia, March to April, 2015
Indicator No Total Rarely Some times Often
N (%) N (%) N (%) N (%) N (%)
Worry about food shortage 185(60) 124(40) 45(14.6) 65(210 14(4.5)
Not able to eat foods they preferred 125(41) 184(59) 52(16.8) 94(30.4) 38(12.3)
Eating just a few kinds of foods 120(39) 189(61) 66(21.4) 89(28.8) 34(11)
Eating foods that are not preferred 152(49) 157(51) 43(14) 82(26.5) 32(10.5)
Household members eat a smaller meal 172(56) 137(44) 51(16.5) 65(21) 21(6.8)
Household members ate fewer meals in 194(63) 115(37) 43(14) 56(18) 16(5)
a day
No food at all in the household 298(96.4) 11(3.6) 5(1.6) 5(1.6) 1(0.3)
Household members went to sleep 305(98.7) 4(1.3) (1.3) 0(0) 0(0)
hungry
Household members went a whole day 307(99.4) 2(0.6) 1(0.3) 1(0.3) 0(0)
& night without eating
The mean HFIAS score of the sample households was 5.5. A total of 215 [69.6 %, 95% CI = (64.1, 75.2)]
households had a score from 2 to 27, which indicates that they were food insecure. Household food insecurity
was further categorized based on its severity. Accordingly, 34.3%, 95% CI = (29.4, 39.8)], 31.7%, 95% CI =
(26.1, 37.0)], and 3.6%, 95% CI = (1.9, 5.8)] of the households were found to be mildly, moderately and
severely food insecure respectively (Figure 1).

Figure 1: Prevalence of household food insecurity, Areka Town, Southern Ethiopia, March to April, 2015
(N = 309)

Factors associated with household food insecurity

In the multivariable logistic regression model, household food insecurity was significantly associated with lack
of formal education by household head [(AOR = 4.70, 95% CI = (1.82, 12.12)], poor household wealth index
[(AOR = 3.13, 95% CI = (1.42, 6.91), households monthly food expenditure less than 500ETB [(AOR = 2.70,
95% CI =(1.49, 4.91)] , and household heads aged 50 years and above [(AOR = 2.11, 95% CI =(1.12, 3.95) ]
(Table 3).

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Table 3: Bivariate and Multivariable regression analysis for selected household characteristics, Areka
Town, Southern Ethiopia, March to April, 2015
Variables Categories Food security status COR (95% AOR (95%
Food insecure Food secure CI) CI)
Number (%) Number (%)
Age of 18-29 years 64(63%) 37(37%) 1.00
household head 30-49 years 123(71.5%) 49(28.5%) 1.45 1.57
(0.86,2.45) (0.53,4.67)
≥50 year s 26(76.5%) 8(23.5%) 1.88 2.11 (1.12,
(0.77,4.57) 3.95)*
Household’s Daily worker 33(84.6%) 6(15.4%) 2.66 0.59 (0.2,1.73)
daily source of (1.07,6.58)
income Not daily worker 182(67.4%) 88(32.6%) 1.00
Household Poor 84(85%) 15(15%) 4.80 3.13 (1.42,
Wealth index (2.45,9.40) 6.91)**
Medium 74(71%) 30(29%) 2.12 1.73
(1.20,3.75) (0.91,3.28)
Rich (ref.) 57(53.7%) 49(46.3%) 1.00 1.00
Household’s <200 ETB 78(88%) 11(12%) 6.84 1.60
non -food (3.28,14.24) (0.58,4.43)
expenditure 200-499 ETB 79(74%) 28(26%) 2.72 1.48
(1.54,4.81) (0.73,3.03)
≥500 ETB 56(51%) 54(49%) 1.00
Household head Have no formal 65(90.3%) 7 (9.7%) 9.10 4.70 (1.82,
‘s educational education (3.81,21.77) 2.12)**
status Elementary 60(76%) 19(24%) 3.10 1.82
(1.62,5.91) (0.91,3.82)
High school 39(68.5%) 18(31.5%) 2.12 1.48
(1.07,4.20) (0.70,3.17)
Diploma and above 51(50.5%) 50(49.5%) 1.00 1.00
Household Food <500 ETB 33(94.3%) 2(5.7%) 17.70 6.90
expenditure (3.92,74.40) (1.45,32.9)*
500-1500 ETB 124(79.5%) 32(20.5%) 4.10 2.70
(2.40,6.81) (1.48,4.91)**
>1500+ETB 58(49%) 60(51%) 1.00 1.00
Household <600 ETB 17(94.4%) 1(5.6%) 13.56 1.30
income (1.76,104.26) (0.51,3.26)
600-1999 ETB 104(85.3%) 18(14.7%) 4.61 1.2
(2.57,8.28) (0.05,27.04)
≥2000 ETB 94(55.6%) 75(44.4%) 1.00
* = p < 0.05 ,** = p < 0.01

Discussion
This study indicated the prevalence of household food insecurity to be 70%, of which 34.3% of the households
were mildly food insecure and 31.7% of households were moderately food insecure, while very few 3.6% of
them were severely food insecure. Household food insecurity was significantly associated with household heads
that did not have formal education, households with poor wealth index, households with monthly food
expenditure less ETB500, and household heads aged over 50 years.
This study reports higher prevalence of household food insecurity. The result was much higher than the
national food insecurity (37.1%) as estimated by world FAO in 2011-2013 [4].This higher level of food
insecurity could be attributed to seasonal variation in household food security status which is often higher in the
months from February to April in Ethiopian context. It might also be explained by eating fewer and smaller
meals among households due to monotonous diet and less diversified food items. However, the result was in
accordance with other similar studies conducted in different parts of Ethiopia including the study setting[6, 20
-21 ] and other urban communities of low income countries [10, 14 , 18].
Households headed by household heads who did not have formal education were more likely to be food
insecure compared with their counter parts. This might be due to the fact that uneducated household heads might
not able to satisfy the food needs of their families due to shortage in the food expenditure and lower awareness to

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Vol.88, 2021

dietary diversification as a result of lack of health education. This finding was consistent with other studies
conducted in Ethiopia, Addis Ababa [6-7, 21] and study conducted in India [10, 14].
According to this survey, poor households as explained by low wealth index were more likely to be food
insecure. This might be explained by the fact that poor urban households might have no /or single source of
income that might not enable them to purchase adequate foods that can satisfy the required needs of their
household members due to pronounced poverty. This finding was consistent with other previous findings in
SSA countries including Ethiopia [15,17,19,21- 22].
Household’s monthly expenditure on food was also found to be significantly associated with household
food insecurity. Those households which spend between ETB 500 to ETB 1500 on a monthly basis for their food
consumption were more likely to be food insecure as compared with their counter parts. This could be attributed
to low purchasing power of the households with low income to timely respond to the food needs of their families
on regular basis. This finding was in agreement with study conducted in South Africa [22].
This study revealed that the age of household head was significantly associated with household food
insecurity. Households headed by heads more than 50 years of age were more likely to be food insecure as
compared to their counter parts. This could be due to the fact that older household heads were not used to
actively engage in different activities to generate household income compared with their counterparts and they
might not have productive household members and often live on pension. This finding is in line with previous
studies done in Ethiopia and other countries [16, 20].

Conclusion
The prevalence of urban household food insecurity was found to be high in the study setting and associated with
being in the older age group of household heads and lack of formal education by the household head, household
poverty, and less monthly household expenditure for food consumption. Thus, it is essential that an integrated
feasible urban food security interventions should be emphasized at all levels by all relevant stakeholders
targeting the urban poor households to curb urban household food insecurity.

List of Abbreviations
AOR Adjusted Odd Ratio
COR Crude Odd Ratio
ETB Ethiopian Birr
HH House Hold
HH’ House Hold Head
OR Odds Ratio
SD Standard Deviation
SNNPR Southern Nation Nationalities and Peoples Region
SRS Simple Random Sampling
SSA Sub Saharan Africa
TEM Technical Error of Measurements
WHO World Health Organization

Declarations
Ethics approval and consent to participate
Ethical clearance was obtained from Research and Ethical Committee of Wolaita Sodo University, School of
Public Health. Informed written consent was obtained from each study subjects (household heads), and the
purpose of the study was explained to the respondents in advance. Confidentiality of the information and privacy
of the respondents was maintained. During the data collection, each study participant (household heads) was
informed that their participation was voluntary, and that they could quit from the study any time, even after the
interview has started.

Consent for publication

Not applicable

Availability of data and material

The datasets during and/or analyzed during the current study are available from the corresponding author on
reasonable request.
Competing interests
The authors declare that this study is free of any competing financial and non-financial interests.

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Vol.88, 2021

Funding
Not applicable

Authors’ contributions
HS: has taken a lead role from inception of the research idea up to its final stage including data analysis and
write up of the manuscript. GE: participated in the planning of the study by giving constructive comments
throughout the stages of the research work including the development of the manuscript. WP: participated in the
planning of the study by giving constructive comments and ideas and involved in data analysis and write up of
the manuscript. All authors read and approved the final manuscript. TY and MT were involved in the analysis
and interpretation of findings and participated in the analysis, interpretation and writing. All authors read and
approved the final version of the manuscript.

Acknowledgements
Areka town health office, the supervisors, data collectors, study participants, Wolaita Sodo University, College
of Health Sciences, and School of Public Health.

Authors’ information
Habte Samuel: Maternal and child health & nutrition service core process, Regional Health Bureau, Southern
nations, nationalities and people, Ethiopia.
Gudina Egata: Public Health, College of Health and Medical Sciences, Haramaya University, Ethiopia.
Wondimagegn Paulos: School of Public Health, Wolaita Sodo University, Ethiopia.
TesfahunYonas Bogale: College of Health Sciences and Medicine, School of Public Health, Wolaita Sodo
University, Ethiopia.
Minyahil Tadesse Boltena: College of Health Sciences and Medicine, School of Public Health, Wolaita Sodo
University, Ethiopia.

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