Food insecurity is defined as a lack of consistent access to food in adequate quantity or quality. Both cholera and food insecurity tend to occur in impoverished communities where poor access to food, inadequate sanitation, and an unsafe water supply often coexist. The relationship between the two, however, has not been previously studied.
We performed a secondary analysis of household-level data from the 2012 Demographic and Health Survey in Haiti, a nationally and sub-nationally representative cross-sectional household survey conducted every five years. We used multivariable logistic regression to evaluate the relationship between household food insecurity (as measured by the Household Hunger Scale) and (1) reported history of cholera since 2010 by any person in the household and (2) reported death by any person in the household from cholera. We used survey commands to apply sampling probability weights and account for clustering and stratification in sample design. We performed a complete case analysis because there were no missing data on household food insecurity or cholera and <1% for the other covariates of interest.
There were 13,181 households in the survey, 2,104 of which reported at least one household member with history of cholera. Both moderate hunger in the household [Adjusted Odds Ratio (AOR) 1.47, 95% Confidence Interval (CI) 1.27-1.71; p<.0001] and severe hunger in the household (AOR 1.71, 95% CI 1.42-2.05; p<.0001) were significantly associated with reported history of cholera in the household after controlling for urban setting, household size, wealth index, water source, time to water source, latrine, and housing materials. Severe hunger in the household (AOR 2.81, 95% CI 1.58-5.00; p=0.0005), but not moderate hunger in the household, was independently associated with reported death from cholera in the household.
This is the first study to identify an independent relationship between household food insecurity and reported history of cholera and death from cholera. The directionality of this relationship is uncertain and should be further explored in future prospective research.
L. C. Ivers, None