Motbainor et al. BMC Public Health (2016) 16:503 DOI 10.1186/s12889-016-3186-7 RESEARCH ARTICLE Open Access Level and determinants of food insecurity in East and West Gojjam zones of Amhara Region, Ethiopia: a community based comparative cross-sectional study Achenef Motbainor*, Alemayehu Worku and Abera Kumie Abstract Background: Food insecurity remains highly prevalent in developing countries and over the past two decades it has increasingly been recognized as a serious public health problem, including in Ethiopia. An emerging body of literature links food insecurity to a range of negative health outcomes and causes of a decline in productivity. The objectives of the present study were to determine the level of food insecurity in East Gojjam zone where the productive safety net program is available, and in West Gojjam zone where there is no program, and to identify the determinants of food insecurity in both East and West Gojjam zones of Amhara Region, Ethiopia. Methods: Community based comparative cross-sectional study design was used from 24 May 2013- 20 July 2013. Multistage sampling technique was implemented. A total of 4110 randomly selected households in two distinct populations were approached to be included in the study. Availability and absence of the productive safety net program between the two study areas was used to categorize them as comparative groups; otherwise the two communities are comparable in many socio-cultural characteristics. The household food security access scale questionnaire, developed by the Food and Nutrition Technical Assistant Project, was used to measure food security level. Socio-demographic and other household level information were collected by using a structured questionnaire. The binary logistic regression model was used to assess factors associated with food insecurity. Results: From the total 4110 households, 3964 (96.45 %) gave complete responses. The total prevalence of food insecurity was 55.3 % (95 % CI: 53.8, 56.8). To compare food insecurity levels between the two zones, nearly sixty percent, 59.2 % (95 % CI: 57 %, 61.4 %) of the East Gojjam and 51.3 % (95 % CI: 49.1 %, 53.5) of West Gojjam households were food insecure. Family size (2–4) (AOR = 0.641, 95 % CI: 0.513, 0.801), non-merchant women (AOR = 1.638, 95 % CI: 1.015, 2.643), household monthly income quartiles, 1st (AOR = 2.756, 95 % CI: 1.902, 3.993), and 2nd (AOR =1.897, 95 % CI: 1.299, 2. 775) were the significant socio-demographic determinants in east Gojjam zone. Illiterate mothers (AOR = 1.388, 95 % CI: 1.011, 1.905), household monthly income quartiles, 1st (AOR = 3.110232, 95 % CI: 2.366, 4.415), 2nd (AOR =2.618, 95 % CI: 1.892, 3.622) and 3rd (AOR = 2.177, 95 % CI: 1.6911, 2.803) were the significant socio-demographic predictors in west Gojjam zone. Rural residential area (AOR = 3.201, 95 % CI: 1.832, 5.594) and (AOR = 2.425, 95 % CI: 1.79, 3.272), highland agro-ecology (AOR = 2.193, 95 % CI: 1.348, 3.569 and AOR = 3.669, 95 % CI: 2.442, 5.513) and lack of livestock (AOR = 1.553, 95 % CI: 1. 160, 2.078 and AOR = 1.568 95 % CI: 1.183, 2.080) were significant environmental predictors in east and west Gojjam zones respectively. (Continued on next page) * Correspondence: [email protected] School of Public Health College of Health Science, Addis Ababa University, P. O. Box: 23676, Code: 1000 Addis Ababa, Ethiopia © 2016 Motbainor et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Motbainor et al. BMC Public Health (2016) 16:503 Page 2 of 13 (Continued from previous page) Conclusion: Food insecurity is highly prevalent in both study areas; however, there are different predictor factors. Intervention strategies should give emphasis to women’s education, diversified income generating opportunities, and for each agro-ecological zone, mixed agriculture strategy. Keywords: Food security, Food insecurity, Gojjam, Amhara, Ethiopia Background the proportion of its population suffering from hunger. The Food insecurity is a state or a condition in which people overall prevalence of hunger in the region declined by 30 % experience limited or uncertain physical and economic between 1990-92 and 2015 [13]. This progress has been access to safe, sufficient and nutritious food to meet made with significant differences between the four sub- their dietary needs or food preferences for a productive, regions of Sub-Saharan Africa, with 60 % reduction in healthy and active life [1–4]. Food security can be con- Western Africa and with no progress in the Middle Africa. sidered at national, household and individual levels. At Since 1990-92, other sub-regions experienced an increase national level, it is related to physical existence of food in the absolute number of undernourished people, approxi- stocks for consumption be it from own production or mately 20 % and 2 % respectively in Eastern and Southern from markets [5]. It is related to the availability dimen- Africa [5, 13]. Thus, the FAO estimated that about 805 mil- sion of food security and is a function of the combina- lion people are chronically undernourished in 2012-14, tions of domestic food stocks, commercial food imports, down more than 100 million over the last decade and 209 food aid and domestic food production including deter- million lower than in 1990-92. In the same period, the minants of each of these factors [5]. On the other hand prevalence of undernourishment has fallen from 18.7– household food security is related to the ability to obtain 11.3 % globally and from 23.4–13,5 % for developing sufficient food with sufficient quality to meet nutritional countries [5, 14]. requirements of all household members. Household level Drought and famine have become an everyday real- food security mainly relies on economic freedom and ity in Ethiopia. The country has faced three major purchasing power of household members which again famines and other similar situations in the past three related to income distribution in the household [5, 6]. decades [5]. The recurrence of famine in the 1970s, Although non-availability of food, lack of access, im- 1980s and 1990s has significantly affected the country’s proper utilization and instability over a certain period food production [5, 13]. However, during the past 20 years, time are the four main pillars that lead to a situation of the deficit in calorie intake in Ethiopia has been signifi- food insecurity, it exists in various ways in different parts cantly reduced from 623 to 314 Kcal/cap/day accompanied of the world [7]. Limited resource and increased food by a 33 % decline in poverty rate from 1999 to 2010 price problems affecting many households of the world [13, 15]. Although these results are recorded as good pro- including Ethiopia, are the common factors that affect gress in poverty reduction in Ethiopia, food insecurity is still food insecurity [8, 9]. In addition to the basic causes of a threat to the households of the country [15]. food insecurity, literature showed that the educational Studies conducted at small scale level in different parts status of the household, multiple income sources, num- of Ethiopia showed that almost 50 % of the study popu- ber of children, sole parenthood, marital status and em- lations were food insecure. According to the cross- ployment status of the households are perceived to be sectional study done in Farta district (Ethiopia) in 2012, determinants of food insecurity both in developed and from the total study participants about 70.70 % were developing countries [9–11]. food insecure [16]. Similarly, a study done in Addis Moreover, traditional farming practice, unstable wea- Ababa city showed 58.16 % of the total households were ther conditions, recurrent drought, pests and disease, below the food security cutoff point that classified food population pressure or growth, weak institutional cap- secure and insecure households and expressed this in acity, inadequate infrastructure and social services are terms of caloric requirements [12, 17]. Another study re- the other major reasons that determine food security in sult from Sidama, Southern Ethiopia, showed 54.10 % of Ethiopia [12]. the households were food insecure [18]. A longitudinal Food insecurity remains highly prevalent in developing study done in Ethiopia on adolescents’ food security sta- countries and over the past two decades, it has increasingly tus has shown that different or fluctuating levels of food been recognised as a serious public health problem in the insecurity were registered in different rounds of the developed world [11]. According to the latest estimates of study period. Overall, 20.50 % of adolescents were food the State of Food Insecurity in the World (2015 report), insecure in the first round survey, while the proportion Sub-Saharan Africa made some progress towards halving of adolescents with food insecurity increased to 48.40 % Motbainor et al. BMC Public Health (2016) 16:503 Page 3 of 13 one year later. During the one year follow up period, of the region ranges from 22-27OC in the lowlands and more than half (54.80 %) of the youth encountered tran- between 10 and 22OC in the highlands up to 3,000 sient food insecurity [8]. meter above sea level [25]. The long term mean annual Food insecurity has been linked in the literature to a rainfall of the region is 1165.2 mm [26].