Association Between Household Food Security, Dietary Diversity, Feeding Practices, and Malnutrition Among Under Five Children in Lebanon: A Cross-Sectional Study

Abstract

Background and Objectives: Food security and malnutrition are major public health concerns in Lebanon, exacerbated by economic crises and political instability. Young children are amongst the most vulnerable to food insecurity and its nutritional impact given the high rate of growth and development that occurs in early childhood. This study aims to assess the association between household food security, dietary diversity, feeding practices, and malnutrition among under-five children in four Lebanese governorates. Methods: A cross-sectional study was conducted among 176 mothers and their under-five children in North Lebanon, Akkar, Baalbek-Hermel, and South Lebanon during the year 2023. Household food security was assessed using the Arab Family Food Security Scale (AFFSS), and dietary diversity and feeding practices were evaluated through validated questionnaires. Anthropometric measurements, including weight and height, were taken to assess the nutritional status of children. Data analysis was performed to examine the relationships between food security, feeding practices, and malnutrition indicators such as stunting, wasting, and underweight. Results: The study found that 64.2% of households were food insecure, with significant associations observed between food security status and various sociodemographic factors, including child age, residency governorate, total number of children in the household, maternal and paternal education level, maternal employment, crowding index, and maternal illness. Food-insecure households had lower food consumption score and lower maternal and child dietary diversity scores. In the study sample, 9.1% of the children were stunted, 4.5% were wasted, 2.3% were underweight, 7.4% were overweight, and 4% were obese with food-insecure households having a significantly higher prevalence of child overweight. The assessment of feeding practices showed that 86.9% of the participating children were ever breastfed, 22.6% were exclusively breastfed, 27.7% were breastfed until the age of 2 years, and 65.9% received appropriate complementary feeding. Multiple logistic regression analyses showed that food security status was significantly associated with maternal dietary diversity, child dietary diversity, continued breastfeeding, and BMI for age status. More specifically, food insecurity was associated with lower odds of having an acceptable maternal dietary diversity (OR= 0.13; 95%CI 0.04-0.38) and an acceptable child dietary diversity (OR= 0.008; 95%CI 0-0.24). In contrast, food insecure households had higher odds of adhering to continued breastfeeding guidelines compared to food secure households (OR 4.74; 95%CI 1.52-14.75), and higher odds of having an overweight child compared to food secure households (OR 1.02; 95%CI 0.01-0.78) Conclusion: The findings highlight the substantial burden of food insecurity among Lebanese households and its detrimental impact on dietary diversity and nutritional status amongst young children. Addressing food security challenges through targeted interventions and policy initiatives is crucial to improving dietary diversity and reducing malnutrition rates among vulnerable populations.