Households' Food Insecurity and Their Association With Dietary Intakes, Nutrition-Related Knowledge, Attitudes and Practices Among Under-five Children in Gaza Strip, Palestine

Shifts in food consumption patterns in the Levant: a systematic review of the last six decades

BACKGROUND

Food consumption patterns have changed tremendously since the mid-twentieth century, with a rapid global nutritional shift raising concerns, particularly in disadvantaged regions such as the Eastern Mediterranean region (EMR). Given that food intake is very context-specific, this research examines food consumption patterns in Jordan, Lebanon, Palestine, and Syria, representing the contemporary Levant region.

METHODS

A systematic review was conducted by searching PubMed, EMBASE, Web of Science, and CINAHL. The eligibility criteria were to include only original peer-reviewed observational studies reporting individual-level food consumption among local Jordanians, Lebanese, Palestinians, and Syrians. Extracted data were synthesized through descriptive statistics and presented in tables and charts. The risk of bias was assessed using the tool developed by Hoy et al. for prevalence studies.

RESULTS

A total of 43 articles that measured and reported food consumption at the individual level for the populations in these countries were included. Findings reveal that in the 1960s, diets in the region were primarily local, seasonal, and plant-based, with moderate to low animal product intake. By the 1990s, a noticeable shift occurred, marked by increased consumption of processed foods, refined carbohydrates, and animal products, with minimal increase in fruit and vegetable intake. Most studies were conducted in Lebanon, limiting the generalizability of findings across the Levant countries.

CONCLUSION

This review presents an understanding of food consumption changes on the level of food items, food groups, and dietary patterns specific to the Levant. Future studies on food consumption patterns should prioritize national surveys using valid, reliable, and cultural-specific measurement tools and provide detailed, age-disaggregated dietary data. Public health interventions are needed to address the ongoing dietary shift, which is unfolding amid political instability, economic crises, and food insecurity.

Household food insecurity and nutritional status of pre-school children following relaxation of corona virus disease-2019 (COVID-19) restrictions

BACKGROUND & AIMS

Studies found a high prevalence of household food insecurity (HFI) and malnutrition and an association between them during the movement restriction period of the corona virus disease-2019 (COVID-19) pandemic. This nutritional status should have improved by now as movement restrictions, including quarantine, have been lifted. Therefore, the goal of this cross-sectional study was to determine the current prevalence of HFI and malnutrition and their associations and contributing factors among pre-school children (i.e., children under the age of 5 years) following relaxation of the COVID-19 restrictions in Jordan.

METHODS

A sample of 386 children (197 boys and 189 girls) in Irbid, Jordan, were recruited in this study following the simple random sampling method. The levels of HFI and malnutrition were assessed using the Food Insecurity Experience Scale (FIES) and the World Health Organization (WHO) growth reference values, respectively. Relevant information were managed and measurements made and employed to calculate four major anthropometric indicators for the sample children (weight for height (WHZ), height for age z-score (HAZ), weight for age z-score (WAZ) and body mass index (BMI)-for-age z-score.

RESULTS

The results of analysis pointed out that prevalence of food security among the sample children was 58.2 %, where 19.9 % of the kids were experiencing moderate food insecurity and 38.3 % were suffering from severe food insecurity. On the other hand, prevalence of malnutrition among those children was 1.81 %, where 1.55 % of the kids were emaciated and 1.26 % were severely emaciated. The results also indicated that mother's age, number of children in the family, income of the family, monthly expenses on food and beverages and the energy expenses contributed significantly (p < 0.05) to food insecurity. Moreover, the study found that HFI had negative correlations with WHZ (r = -0.272, p = 0.000), WAZ (r = -0.193, p = 0.000) and BMI-for-age z-score (r = -0.263, p = 0.000) and a positive correlation with HAZ (r = 0.041, p = 0.00).

CONCLUSIONS

The study reports high prevalence of HFI among children under the age of 5 years in Jordan, even after relaxation of the COVID-19 restrictions on mobility. However, prevalence of malnutrition among this group of the population is low. These results spotlight the continued impact of the COVID-19 crisis on the financial statuses of households.

Current trends in household food insecurity, dietary diversity, and stunting among children under five in Asia: a systematic review

Background

Household food insecurity (HFI) and poor dietary diversity (DD) are major public health challenges in Asia, greatly contributing to stunting among children under five. While previous research has focussed primarily on African regions, this systematic review provides novel insights into the association between HFI, DD, and stunting within the Asian context.

Methods

We searched across six major databases for studies published between 2019 and 2023 exploring the association between HFI, DD, and stunting in children under five across Asia. We then extracted their characteristics, evaluation methods, and outcomes related to stunting for analysis.

Results

From 3215 records, 37 met the inclusion criteria. Most studies were from South Asia (n = 22), followed by Southeast Asia (n = 8), with fewer from West (n = 4), East (n = 2), and Central Asia (n = 1), highlighting geographical research gaps. We found high stunting rates among children under five, especially in South and Southeast Asia. Stunting was strongly linked to HFI and poor DD, suggesting that these factors are critical in addressing malnutrition. Socioeconomic factors, maternal education, and access to clean water also influence stunting outcomes.

Conclusions

Current research on HFI, DD, and stunting in Asia shows substantial variation, with the highest stunting rates in South and Southeast Asia. Limited data from Central and East Asia highlights the need for more comprehensive research in these regions. Addressing HFI and improving DD is critical for reducing stunting and achieving global nutrition targets by 2030.

Determinants and consequences of food insecurity in families having children under the age of 2 years

Background: Today, food insecurity is recognized as an important public health problem that can have detrimental effects on families. Aim: The aim of this study was to assess the determinants and consequences of food insecurity in families having children under the age of 2 years. Method: In this cross-sectional study, 307 mothers and their children under the age of 2 years were selected by stratified random sampling. Demographic and socioeconomic data were collected by completing questionnaires through face-to-face interview. Household food insecurity (HFI) status was determined using the United States Department of Agriculture (USDA) household food security questionnaire. Results: Based on the results, 67.4% of families were high food secure. Low and very low food security was 25.7% and 6.9%, respectively. House size (Beta = -0.019, 95% CI: -0.029, -0.009), father's job (Beta = -4.758, 95% CI:-6.777, -2.738), father education (Beta = -0.370, 95% CI: -0.717, -0.023), and economic status (Beta = -0.628, 95% CI: -0.809, -0.448) were significantly related to the USDA total food insecurity score (p < 0.05). Regression analysis showed that children birth weight, father's body mass index (BMI), and mother's waist circumference had a significant positive correlation with weight for age (Z-score) of children. Children's birth weight, father's BMI, and HFI status had significant and positive correlation with weight for length (Z-score). Moreover, the significant association between children's birth height, mother's BMI, and mother's waist circumference with length for age (Z-score) were observed (p < 0.05). Conclusion: We found the father's job was the most effective factor in food insecurity and economic status of the family was in the second place. Also, HFI had a relationship with weight status of children under the age of 2 years.

The burden of acute malnutrition among children under five in conflict-afflicted Gaza strip: prevalence and associated factors

Background

This study aims to assess the prevalence and associated factors of Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) among children in this region during a period of conflict.

Methods

A cross-sectional study was conducted with a sample of 1,200 children under 5 years old, selected through stratified random sampling from three governorates in the Gaza Strip. Data were collected using structured interviews and physical examinations, including Mid-Upper Arm Circumference (MUAC) measurements to determine nutritional status based on established cut-off points. Statistical analyses were performed using IBM-SPSS, version 26.

Results

Among the 1,200 children screened, 605 (50.8%) were males and 595 (49.2%) were females. The age distribution of the children screened showed that 48.4% (n = 581) fall within the range of 6 months to <24 months category and 51.6% (n = 619) fall within the range of 24-60 months. Overall, 58.3% of children live in schools, 26.6% live in houses, and 15.1% reside in tents. The overall prevalence of malnutrition across all regions was 16.6%, including 6.7% with SAM and 9.7% with MAM. The prevalence of SAM is highest in North Gaza and South Gaza (both at 6.8%) and slightly lower in the Middle Zone (6.5%). For MAM, the highest prevalence is in South Gaza (11.5%), with Middle Zone showing the lowest rate (7.3%). Logistic regression analysis indicated that children living in houses had a higher likelihood of SAM (OR = 2.36; 95% CI = 1.39-3.99) and MAM (OR = 1.44; 95% CI = 1.13-1.84), and children living in schools had a higher likelihood of SAM (OR = 2.79; 95% CI = 1.35-5.74) and MAM (OR = 2.08; 95% CI = 1.14-3.80) compared to those in tents. Notably, children residing in North Gaza were significantly more likely to experience SAM (OR = 13.2; 95% CI = 6.23-27.95) and MAM (OR = 10.51; 95% CI = 5.74-19.3) compared to those in South Gaza.

Conclusion

The study highlights a high prevalence of malnutrition among children under five in the Gaza Strip, particularly among those living in houses, shelters and in the North Gaza governorate. These findings underscore the urgent need for targeted nutritional interventions and support for affected families in conflict zones.

Maternal and household factors affecting the dietary diversity of preschool children in eastern Ethiopia: a cross-sectional study

OBJECTIVE

Investigate the association between the dietary diversity of preschool children and proximate factors including household food insecurity, maternal food choice, preferences, khat use, and levels of depressive symptoms.

DESIGN

Cross-sectional survey of randomly selected households.

SETTING

Haramaya Health and Demographic Surveillance site in Eastern Ethiopia, predominantly smallholder farming households.

PARTICIPANTS

678 preschool children (24-59 months) and their mothers.

METHODS

The key outcome, the adequacy of dietary diversity of preschool children, was calculated using a 24-hour parental dietary recall. Binary logistic regression was then used to identify maternal and household factors associated with dietary adequacy versus inadequacy.

RESULTS

The majority (80.53%) of surveyed children had low dietary diversity (mean Dietary Diversity (MDD)) score of 3.06±1.70 on a 7-point scale). Approximately 80% of households exhibited food insecurity. Households with greater food security (adjusted OR (AOR)=1.96, 95% CI 1.19 to 3.23), healthier maternal food choice (AOR=2.19, 95% CI 1.12 to 4.31) and broader maternal food preferences (AOR=4.95, 95% CI 1.11 to 21.95) were all associated with higher dietary diversity of their preschool children (p≤0.05). Other covariates associated with adequate child dietary diversity included improved household drinking water sources (AOR=1.84, 95% CI 1.16 to 2.92) and family planning use (AOR=1.69, 95% CI 1.00 to 2.86). Despite predictions, however, maternal depression and khat consumption were not identified as factors.

CONCLUSIONS

The dietary diversity of preschool children is extremely low-a pattern observed in both food-secure and food-insecure households. Key factors include maternal selection of food for convenience and ease, preferences that do not include animal protein or healthier food choices, and lack of access to improved drinking water sources. Interventions around maternal food choice and preferences could improve preschool children's nutritional health.

Analysis of the nutritional status in the Palestinian territory: a review study

Background

Food insecurity, occupation, and poverty contribute to the poor nutritional status of Palestine. This review study aimed to analyze the nutritional status in the Palestinian Territory by analyzing published data from 2011 to 2023.

Method

Searching for relevant publications yielded 67 studies. Based on reviewing these studies, five major themes were identified: low birth weight, breastfeeding, obesity and overweight, protein-energy malnutrition, and micronutrient deficiency.

Results

Based on the review of these studies, five major themes were identified, namely, low birth weight, breastfeeding, obesity and overweight, protein-energy malnutrition, and micronutrient deficiency. Based on the literature, the prevalence rate of exclusive breastfeeding was 24.4% in the Gaza Strip, compared to a national rate of 39.9% in 2020. Smoking, anemia in mothers, diet during pregnancy, and indoor pollution were associated with low birth weight. One-fifth of the boys and girls were stunted by 2 years of age in the Gaza Strip, and girls were more stunted than boys. The prevalence rates of underweight, overweight, and obesity among school children in the West Bank were 7.3%, 14.5%, and 15.7%, respectively. Age, gender, and living area were significant predictors of being overweight among school children. The prevalence rates of overweight and obesity among adults in Palestine were 57.8% and 26.8%, respectively. Obesity is associated with a family history, chronic diseases, and low physical activity among adults. Exclusive breastfeeding was below the WHO recommendations, while significant rates of obesity and overweight were found among children and adults. Iron-deficiency anemia (IDA) among pregnant women and children remains a challenging public health issue, while other micronutrient deficiencies are high among children.

Conclusion

This review emphasizes the need for multi-sectoral interventions to address malnutrition and nutritional shifts. It identifies gaps and addresses nutrition-related issues in the Palestinian Territory, which can serve as a basis for guiding United Nations agencies and governments in formulating evidence-based policies and strategies for prioritizing nutritional interventions to meet sustainable development goals.

Association of Household Food Insecurity With Dietary Intakes and Nutrition-Related Knowledge, Attitudes, and Practices Among School-Aged Children in Gaza Strip, Palestine

Background

The present study aimed to determine the association of household food insecurity with dietary intakes and nutrition-related knowledge, attitudes, and practices (KAP) among school-aged children.

Methods

This cross-sectional study was conducted among a representative sample of school-aged children. A total of 380 children and their parents were selected from all Gaza strip governorates, using a random sampling method. The demographic and socioeconomic characteristics; the Radimer/Cornell food security scale; two non-consecutive days of 24-h dietary recall; anthropometric measurements; and the Food and Agriculture Organization KAP-questionnaire (Module 3) were employed. Statistical analysis was performed using SPSS version 25.

Results

About 71.6% of school-aged children were household food-insecure, while 28.4% were household food-secure. Significant associations were found between living area, educational level, household monthly income, weight for age and BMI for age z-scores, underweight, malnutrition status, intakes of protein, iron, vitamin D, and zinc among household food-secure, and household food-insecure. After adjustment for confounding variables, having nutrition-related adequate KAP were associated with lower odds of being food-insecure household [OR = 0.519, 95% (CI = 0.320–0.841)], [OR = 0.510, 95% CI = (0.315–0.827)], and [OR = 0.466, 95% CI = (0.285–0.763), P < 0.05 for all], respectively.

Conclusions

Low socioeconomic status, low anthropometric indices, poor dietary intakes may be associated with a high level of food-insecurity; while having nutrition-related adequate KAP may be protective against food-insecurity among school-aged children.