Food (in)security in families of preschool children in a rural zone of Ceará

Abstracts

OBJECTIVES: To determine the prevalence of food (in)security among housteholds in a rural zone of Maranguape, and to verify the association between socioeconomic variables and the degree of food (in)security. METHODS: A descriptive study with a quantitative approach, conducted in the Centro de Saúde da Família (CSF) , Center of Family Health, in a rural zone in Maranguape - Ceará in September of 2009. The sample consisted of 200 families with preschool children who are seen in the CSF, applying the Escala Brasileira de Insegurança Alimentar (EBIA), Brasilian Food Insecurity Scale. RESULTS: Of the families, 12% presented with food security and 88% with food insecurity. A statistically significant association was noted between the prevalence of food (in)security and education of the head of household (p<0.0001), number of household members (p = 0.018), and family income (p < 0.0001). CONCLUSION: With the application of the EBIA, we could diagnose food (in)security, which enables nurses to offer health education interventions aimed at improving care related to alimentation.

Food security; Prevalence; Child, preschool; Food consumption; Socioeconomic factors

OBJETIVOS: Detectar a prevalência da (in) segurança alimentar entre as famílias residentes na zona rural de Maranguape e verificar a associação entre as variáveis socioeconômicas e o grau de (in) segurança alimentar. MÉTODOS: Estudo descritivo, com abordagem quantitativa, realizado no Centro de Saúde da Família (CSF) na zona rural de Maranguape-Ceará em setembro de 2009. A amostra constituiu-se de 200 famílias com crianças pré-escolares atendidas no CSF, sendo aplicada a Escala Brasileira de Insegurança Alimentar (EBIA). RESULTADOS: Das famílias, 12% apresentaram segurança alimentar e 88% insegurança alimentar. Constatou-se associação estatisticamente significante entre a prevalência da (in) segurança alimentar e a escolaridade do responsável (p<0,0001), número de moradores no domicílio (p=0,018) e renda familiar (p<0,0001). CONCLUSÃO: Com a aplicação da EBIA, pôde-se diagnosticar a (in) segurança alimentar, o que possibilita ao enfermeiro propor ações de educação em saúde, visando a melhorar os cuidados relativos à alimentação.

Segurança alimentar e nutricional; Prevalência; Pré-escolar; Consumo de alimentos; Fatores socioeconômicos

OBJETIVOS: Detectar la prevalencia de la (in) seguridad alimenticia entre las familias residentes en la zona rural de Maranguape y verificar la asociación entre las variables socioeconómicas y el grado de (in) seguridad alimenticia. MÉTODOS: Estudio descriptivo, con abordaje cuantitativo, realizado en el Centro de Salud de la Familia (CSF) en la zona rural de Maranguape-Ceará en setiembre del 2009. La muestra se constituyó de 200 familias con niños preescolares atendidos en el CSF, siendo aplicada la Escala Brasileña de Inseguridad Alimenticia (EBIA). RESULTADOS: De las familias, el 12% presentaron seguridad alimenticia y el 88% inseguridad alimenticia. Se constató asociación estadísticamente significativa entre la prevalencia de la (in) seguridad alimenticia y la escolaridad del responsable (p<0,0001), número de moradores en el domicilio (p=0,018) e ingreso familiar (p<0,0001). CONCLUSIÓN: Con la aplicación de la EBIA, se puede diagnosticar la (in) seguridad alimenticia, lo que posibilita al enfermero proponer acciones de educación en salud, visando mejorar los cuidados relativos a la alimentación.

Seguridad alimentaria; Prevalencia; Preescolar; Consumo de Alimentos; Factores socioeconômicos

ORIGINAL ARTICLE

Food (in)security in families of preschool children in a rural zone of Ceara^*

Julliana dos Santos Aires^I; Mariana Cavalcante Martins^II; Emanuella Silva Joventino^III; Lorena Barbosa Ximenes^IV

^IMNSc Student, Federal University of Ceará - UFC - Fortaleza, Ceará, Brazil

^IIPhD, Professor at Nursing Department, Federal University of Ceará - UFC - Fortaleza, Ceará, Brazil

^IIIPhD Student, Graduate Program in Nursing, Federal University of Ceará - UFC - Fortaleza (CE), Brazil

^IVPhD, Professor at Nursing Department, Federal University of Ceará - UFC - Fortaleza, Ceará, Brazil. Coordinator of Graduate Program in Nursing. CNPq Researcher

Corresponding Author

ABSTRACT

OBJECTIVES: To determine the prevalence of food (in)security among housteholds in a rural zone of Maranguape, and to verify the association between socioeconomic variables and the degree of food (in)security.

METHODS: A descriptive study with a quantitative approach, conducted in the Centro de Saúde da Família (CSF), Center of Family Health, in a rural zone in Maranguape - Ceará in September of 2009. The sample consisted of 200 families with preschool children who are seen in the CSF, applying the Escala Brasileira de Insegurança Alimentar (EBIA), Brasilian Food Insecurity Scale.

RESULTS: Of the families, 12% presented with food security and 88% with food insecurity. A statistically significant association was noted between the prevalence of food (in)security and education of the head of household (p<0.0001), number of household members (p = 0.018), and family income (p < 0.0001).

CONCLUSION: With the application of the EBIA, we could diagnose food (in)secunty, which enables nurses to offer health education interventions aimed at improving care related to alimentation.

Keywords: Food security; Prevalence; Child, preschool; Food consumption; Socioeconomic factors.

INTRODUCTION

Food and nutrition are the basic constituents necessary for promoting and protecting health and also promote healthy growth and development. In human societies, access to adequate food and nutrition also increase an individual's likelihood of achieving an adequate standard of living ⁽¹⁾

A recent evaluation by the Food and Agriculture Organization of the United States found that 1.02 billion people worldwide were undernourished in 2009, an increase from the 915 million individuals estimated in 2008 ⁽²⁾. Undernourished individuals are people who suffer from nutritional deficiencies, either because of a lack of food or a poor food quality or because of inadequate living and health conditions that prevent proper utilization of the available food ⁽³⁾.

In Brazil, the development of public policies to fight hunger and poverty based on the concept of food and nutritional security has enabled a new understanding of nutrition beyond the act of eating ⁽⁴⁾. The adverse effects of food insecurity are particularly severe in women, elderly adults and children ⁽⁵⁾, causing impaired cognitive function and development problems ⁽⁶⁾.

In this context, the concept of food security is particularly relevant. Food security refers to the regular and permanent access to quality food in sufficient quantity without having to compromise meeting other basic needs. This is based on promoting healthy food practices that respect cultural diversity and are socially, economically and environmentally sustainable ⁽⁷⁾.

Food safety concerns consistent access to food that is rich in vitamins and minerals, and it is not limited simply to the act of consuming these nutrients ⁽⁸⁾. To this end, the identification of living conditions and food availability in the everyday lives of families is an essential requirement for assessing food (in) security ⁽⁹⁾.

Facing this reality, the following questions emerge: Do families of preschool children residing in rural areas experience food insecurity? Are the socioeconomic and demographic conditions of households correlated with the levels of food (in) security?

To answer these questions, we applied the Brazilian Food Insecurity Scale (EBIA) in a rural municipality located in the metropolitan region of Fortaleza in the State of Ceara. Using the scale, we aimed to provide a plausible diagnosis that is consistent with the reality of the families' living conditions.

The choice of the municipality was based on the results from a previous study ⁽¹⁰⁾ conducted in the same rural area, which showed that children at the complementary feeding stage consumed foods with a low energy content and poor nutritional quality that were also relatively costly (yogurt, instant noodles and soft drinks). However, the study also found that these families continued to experience precarious living conditions, which are likely to affect their food security situation.

The relevance of the present study is indicated by understanding food security issues may enable health professionals, especially nurses, to act consistently according to their target population's socioeconomic situation. This consistent action aims to educate the population about the importance of maintaining healthy eating habits while offering alternatives that fit the target population's reality and meet their families' nutritional needs.

Thus, we aimed to detect the prevalence of food (in) security among households in rural Maranguape and the association between socioeconomic variables and the degree of food (in) security.

METHODS

We conducted a descriptive study with a quantitative approach in a Family Health Center (CSF) situated in the district of Sapupara in the rural area of the municipality of Maranguape, located in the metropolitan region of Fortaleza, State of Ceará (Brazil).

The sample consisted of 200 families with preschool children aged three to six years who attended the CSF. The inclusion criteria were families of preschool children who were enrolled in the CSF and resided in the selected district of Sapupara. We did not include families whose members presented mental health or cognitive problems.

Data collection occurred in September 2009. Individual interviews with the children's families took place at the CSF. We used a socioeconomic questionnaire and the Brazilian Food Insecurity Scale (EBIA) ⁽¹¹⁾, which included 15 items related to the diet of the families and the children/adolescents. This questionnaire allowed us to evaluate the family's perception of food security ⁽¹²⁾. The scale is scored as follows: one point for each "yes" answer and zero points for "no" or "do not know" answers. The sum of these points allowed us to classify the families' situations as food secure (0 points), mild food insecure (1-5 points), moderate food insecure (6-10 points) and severe food insecure (11-15 points) ⁽¹¹⁾

We analyzed only the positive (yes) and negative (no) answers because "do not know" responses were rare. As in previous studies ^(13-17), alternatives for positive responses (e.g., nearly every day, every few days, only in one or two days, and does not know or refusal to reply) were not evaluated.

It should also be noted that the selection of a positive alternative on the scale indicates that the family experiences food insecurity in their daily situations; i.e., the more "yes" responses, the greater the severity of the family's food insecurity.

Data were tabulated and processed using the Predictive Analytics Software (PASW), version 18. For the analysis, we applied descriptive statistics (absolute and relative frequencies) and tested for statistical significance using a linear by linear test, as described in the literature.

The research project was approved by the Ethics Committee of the Federal University of Ceará under Opinion No. 98/09. The research was conducted in compliance with ethical requirements for research involving humans, as described in Resolution 196/96 ⁽¹⁸⁾. The purpose of the research was explained to all respondents, and they all signed a consent form prior to participating.

RESULTS

The distribution of responses to the EBIA questionnaire can be evaluated based on the data presented in Table 1. Item 3 had the highest proportion (72%) of positive responses, whereas item 15 received the most negative responses (95%).

The prevalence of negative responses (ranging from 53.5% to 77%) to items 7, 8, 9, 10 and 11, which related to adult feeding in the household, demonstrated that food restriction situations, hunger and weight loss were minimized in the families. However, it is noteworthy that items 7 and 8 received a considerable number of positive responses, 46.5% and 46%, respectively.

Although variable, a relatively high proportion of negative responses (ranging from 35% to 95%) to items 5, 6, 12, 13, 14 and 15 was observed. These responses concerned the daily meals of the families' children. There were a significant number of positive responses (42.5%) to item 6.

Of the 200 families interviewed, 24 (12%) were in a food secure situation, but most families experienced some form of food insecurity (176; 88%). Of these, 70 (35%) were classified as mild insecure, 57 (28.5%) as moderate insecure and 49 (24.5%) and severe insecure (Figure 1).

We detected significant associations between the degree of food (in) security and socioeconomic variables (Table 2). There was a statistically significant association between the prevalence of food (in) security and parents'

education levels (p < 0.0001), the number of household members (p = 0.018) and monthly household income (p < 0.0001). No statistically significant association between food (in) security and marital status (p = 0.790), work outside the home (p = 0.625) and the number of preschool-age children (p = 0.662) was observed.

DISCUSSION

In Brazil, the issue of food (in) security has been the focus of government attention. This issue has receives attention from a number of different approaches and has increasingly occupied the public policy stage ⁽¹⁹⁾.

Concern about the lack of food at home (item 1) was indicated by 132 (66%) of respondents, which is similar to the proportion found in studies conducted in Quebec, Canada, where psychological insecurity was reported by 34 (62%) of the families interviewed⁽²⁰⁾.

Regarding questions that addressed children's meals, item 5 received a high number of positive responses (65%), and the others (6, 12, 13, 14 and 15) had a higher percentage of negative responses. This response pattern may be associated with the severity of the items as the number of positive responses declined as the seriousness of the questions increased.

Research conducted with 213 women in Costa Rica found that the response to the "adults who went the whole day without eating some food" item of the version of the scale validated in that country was approximately 6.1%. The response to the "children who went a whole day without eating" item was positive in 2.8% of families ⁽²¹⁾. These results differ from the present study, which showed 22.5% of positive responses regarding adults and 5% regarding children. However, the families' protection of the children's daily diet proved to be common to all of the studies cited.

Research conducted with indigenous families of preschool children in Canada confirms these findings. The rate of food insecurity among the adults in a household was higher than that of the children because the adults reduced their food intake and gave the child's diet priority ⁽²²⁾.

We found that 176 (88%) of interviewed families were food insecure. Similar levels were reported in a previous study that found 87% of rural families in the northeastern forest area reported food insecurityand ⁽¹³⁾ and a study that examined the status of food (in) security in the semi-arid northeast, which found 87% food insecurity ⁽¹⁴⁾.

However, these results differ from those obtained from the National Household Sample Survey 2004. This study reported that throughout the country, only 34.8% of households were food insecure; of these, 16% were mild insecure, 12.3% were moderate insecure, and 6.5% were severe insecure. In the northeast region, the food insecurity level was 53.5%; 19.5% were mild insecure, 21.6% were moderate insecure, and 12.4% were severe insecure, with higher insecurity levels in rural (49.9%) than in urban (37.7%) areas ⁽²³⁾.

Additionally, we found that a statistically significant association such variables as parents' education levels, monthly household income and number of household members. Our results revealed that high levels of food insecurity were associated with reduced educational levels of the head of the family (p < 0.0001), a greater number of household members (p = 0.018) or lower monthly family income (p < 0.0001). An ecological study of 19,037 people in South Australia supports the finding that such variables were risk factors associated with food insecurity ⁽²⁴⁾.

Research conducted in the municipality of Duque de Caxias (RJ) in 1,085 households also found that the proportion of families with moderate and severe food insecurity declined as the head of the family's education level increased. However, mild food insecurity did not increase with the family head's education level ⁽¹⁵⁾. Furthermore, a study conducted in 1,045 households in the city of Pelotas (RS) also noted that the prevalence of food insecurity was higher among families with five or more household members ⁽²⁵⁾.

Nevertheless, an analysis of food insecurity determinants in Brazil demonstrated that the variable with the greatest relevance to food insecurity was low household income⁽²⁶⁾. This finding corroborates a study conducted in a rural municipality of Minas Gerais, which identified that, among families with incomes of less than the minimum wage, the food insecurity prevalence was 68.7%, and in families that earned salaries greater than or equal to the minimum wage, the food insecurity prevalence was 16.6% ⁽¹⁶⁾. In the state of Paraíba, families with monthly incomes greater than the minimum wage rarely experienced severe food insecurity (0.9%) and had lower rates of moderate (3.5%) and mild (10.4%) insecurity ⁽¹⁷⁾.

Dietary habits are known to be associated with economic and cultural factors that influence the availability of and access to food. Thus, the foods consumed by a family also tend to be accepted by the child ⁽²⁷⁾.

We found that marital status and working outside the home were not significantly associated with food (in) security. However, research conducted nationwide found that for families in which mothers were married, the prevalence of food security (18%) and mild food insecurity (29.6%) were higher, while in families with an unmarried mother, the moderate (36.31%) and severe (24.37%) food insecurity were higher ⁽²⁸⁾.

Although we did not find a statistically significant association between the number of preschool children and the prevalence of food (in)security in the families, we found that food security prevalence were higher in families with only one child compared with families with more than one child. This result supports the fact that the family's attention to the child plays a key role in the child's development by providing adequate food and strengthening the emotional bond, thus promoting healthier eating habits ⁽²⁹⁾. Thus, the presence of fewer children may facilitate such actions and enable greater security.

In view of the financial constraints that some families experience, regional foods (including cashews, bananas, siriguelas, pumpkins and sweet potatoes) may provide a healthy, nutritious diet. These are generally inexpensive, readily available and of high nutritional value ⁽¹⁰⁾. However, most individuals limit their use of local crops to the preparation of juices, ignoring their additional dietary benefits for their children ⁽³⁰⁾.

Although national and international studies (13,14, 20) have found similar results regarding food (in)security, the priority each country or region gives this issue is determined by political, economic and cultural influences on individual lifestyles and food choices. Nevertheless, it is believed that ensuring adequate nutrition for individuals should be a priority in political discussions in all countries and states, as this issue can influence education, housing and occupational opportunities and is critical to the survival of humanity.

CONCLUSION

The EBIA proved to be an important tool for identifying the food situations of families living in rural areas. However, a limitation of the study was that we did not consider in detail the frequencies of affirmative responses to the EBIA (almost all days, some days, only one or two days, do not know or unwilling to answer). Further analysis could improve our understanding of the research findings and allow us to reach new conclusions.

The context of this study provides an expanded examination of the social, economic and demographic associations with food (in) security. It provides a foundation for health professionals, especially nurses, to act as health educators and plan and implement interventions that include food items that are available in the Brazilian regions. The inclusion of regional foods could improve the quality of infant feeding and promote proper child development.

Although our study was performed in rural areas of the metropolitan region of a state capital, the rate of food insecurity we identified was alarming. It is reasonable to assume that the nutritional reality for poorer populations in other Brazilian regions, including the rural northeast, is likely to be even more insecure.

The academic and government participation is imperative for establishing policies and development programs to combat food insecurity. Furthermore, we emphasize that few municipalities have conducted surveys to assess food and nutritional security using the EBIA. The use of such scales must be encouraged, as they could be used to inform the development of effective policies to combat food insecurity and hunger both regionally and nationally.

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*

Trabalho realizado no município de Maranguape, localizado na região metropolitana de Fortaleza no Estado do Ceará, Brasil.

Publication Dates

• Publication in this collection
  11 May 2012
• Date of issue
  2012

History

• Received
  05 Jan 2011
• Accepted
  04 Aug 2011