Determinants of Food Insecurity in the League of Arab States

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Background Food insecurity (FI) is widespread in the League of Arab States (LAS) due to factors including gender inequality, conflict, and political turmoil. However, limited data are available on its prevalence and determinants in that region. This dissertation aims to 1) validate the Food Insecurity Experience Scale (FIES), developed by the UN Food and Agriculture Organization, and assess the prevalence of FI in that region; 2) examine the association between FI, physical health, and mental well-being by sex and whether social support modifies this association in women; 3) examine the relationship between Palestinian live-in grandparents (GP) and the health and well-being of their grandchildren.Methods Rasch modeling was applied to the Gallup World Poll data to validate FIES in 19 countries of the region. Descriptive and logistic regression analyses were applied to data from 62,261 respondents aged 19 and over to examine determinants of FI. Logistic regression was also used to analyze the data of 2707 households and 8,034 children ages 0-17 from two surveys of Palestinian refugees. Results FIES met the Rasch assumptions indicating good internal validity. The prevalence of severe FI was 15.7% and women were at highest risk compared to men (17.6% vs. 14.1%, respectively, p<0.0001). Older age, living in rural areas, and high dependency ratio were associated with severe FI in women. High negative experience and low income were associated with severe FI, but good physical health and high positive experience with lower prevalence of severe FI. Having a live-in GP in the household was associated with grandchildren’s lower odds of experiencing an acute disease and higher odds of attending school. Conclusion FIES is a valid tool; however, cognitive testing of some items and omission of correlated ones may improve the scale. FI is highly prevalent and should be monitored to develop multi-sectoral intervention strategies. Mixed method studies are needed to better understand the relationship between grandparents and their grandchildren.