|DR. P.C. SEN MEMORIAL AWARD PAPER ON RURAL HEALTH PRACTICE
|Year : 2010 | Volume
| Issue : 2 | Page : 92-97
Enduring starvation in silent Population: A study on prevalence and factors contributing to household food security in the tribal population in Bankura, West Bengal
Dipta Kanti Mukhopadhyay1, Sujishnu Mukhopadhyay2, Akhil Bandhu Biswas3
1 Asst. Prof., Department of Community Medicine, B. S. Medical College, Bankura, West Bengal, India
2 Asst. Prof.,Department of Community Medicine, Burdwan Medical College, Burdwan, West Bengal, India
3 Professor, Department of Community Medicine, B. S. Medical College, Bankura, West Bengal, India
|Date of Web Publication||27-Nov-2010|
Dipta Kanti Mukhopadhyay
Department of Community Medicine, B. S. Medical College, Bankura, West Bengal
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background : Strengthening food security enhancement intervention should be based on the assessment of household food security and its correlates. Objectives: The objective was to find out the prevalence and factors contributing to household food security in a tribal population in Bankura. Methods: A cross-sectional study was conducted among 267 tribal households in Bankura-I CD Block selected through cluster random sampling. Household food security was assessed using a validated Bengali version of Household Food Security Scale-Short Form along with the collection of information regarding the monthly per capita expenditure (MPCE), total to earning member ratio, BPL card holding, utilization of the public distribution system (PDS) and receipt of any social assistance through a house-to-house survey. Result and Conclusion: Overall, 47.2% of study households were food secure whereas 29.6% and 23.2% were low and very low food secure, respectively. MPCE ≥ Rs. 356, total to earning member ratio ≤ 4:1, regular utilization of PDS, and nonholding of the BPL card were significantly related with household food security.
Keywords: Household food security, Prevalence, Factors, Tribal population
|How to cite this article:|
Mukhopadhyay DK, Mukhopadhyay S, Biswas AB. Enduring starvation in silent Population: A study on prevalence and factors contributing to household food security in the tribal population in Bankura, West Bengal. Indian J Public Health 2010;54:92-7
|How to cite this URL:|
Mukhopadhyay DK, Mukhopadhyay S, Biswas AB. Enduring starvation in silent Population: A study on prevalence and factors contributing to household food security in the tribal population in Bankura, West Bengal. Indian J Public Health [serial online] 2010 [cited 2019 Dec 5];54:92-7. Available from: http://www.ijph.in/text.asp?2010/54/2/92/73277
| Introduction|| |
Food security - access by all people at all times to enough food for an active and a healthy life - is an important objective of every nation, which was formalized in the "Rome Declaration," adopted at the World Food Summit in 1996,  and further reiterated in Millennium Development Goals.  Reliable and adequately detailed information about the country's population is essential for the development of policies and programs to reduce food insecurity and hunger.
Almost 8% of the Indian population belongs to scheduled tribe.  Half of the tribal population in rural areas is below poverty line (BPL) compared to one-third of their urban counterpart.  Almost half of their work force is agricultural laborers. The literacy rate of the tribal population is far below the literacy rate of the general population.  Undernutrition is more prevalent among tribal children as per the National Family Health Survey-3 based on any of the three indicators: stunting, wasting, and underweight. The chronic energy deficiency is more among adult tribal males and females as compared to the general population as a whole or to other backward classes  and the scheduled class population in particular.
Numerous nutrition and social assistance programs, operating at national, state, and local levels, serve to ameliorate food insecurity and hunger in India, especially for vulnerable groups like scheduled castes and scheduled tribes. The deprivation of basic needs represented by food insecurity is not desirable in their own right and is also a possible precursor to nutritional, health and developmental problems. Food security is not a monolithic condition easily measured in monetary and energy availability terms. Instead of using proxy, indirect, quantitative indicators to measure food insecurity like resource availability (in terms of income) or prevalence of undernutrition, use of direct, qualitative measures, which are valid, reliable, and also rapid and easy to apply, are being preferred by the researchers in the recent past. The qualitative measures based on Household Food Security Scale (HFSS) , are rapid, cheap, and not labor intensive which can assess the perception of the people regarding household food insecurity. It is effective to monitor different interventions to ensure food security and ameliorate poverty, unexplored in this part of the country especially among tribal population.
The objectives of the study were to assess the prevalence of household food security of tribal population of the study area and to find out the socioeconomic factors related to household food security.
| Materials and Methods|| |
A community-based, cross-sectional study was undertaken among the tribal population of Bankura-I CD Block during July-August 2009.
Considering the prevalence of food insecurity as 44%,  a confidence level of 95%, 20% relative precision, design effect 2, and 10% nonresponse rate, the sample size became 268. Villages eligible to be included in the study had at least 25% tribal population. From such 25 villages, 50%, i.e., 13 were selected randomly for the study. In each village, 21 consecutive tribal households were selected with a random start from the center of the village to achieve the requisite sample size. In the case of nonavailability of the required number of households in a village, households from the nearest tribal village were selected.
After taking the informed consent, the head of the household or any responsible adult family member, preferably a woman, was interviewed by the investigators with a predesigned, pretested, semistructured questionnaire to collect information regarding the socioeconomic characteristics of the household. A validated Bengali version of the six-item HFSS-Short  Form was used to assess the household food security status. The households responding affirmatively to four or more questions of the scale were designated as households with very low food security, whereas the households giving two to four affirmative answers were considered as low food secure households. Households which responded negatively to all six questions and those which gave only one affirmative answer were coded as households with high food security and marginal food security, respectively.  High as well as marginal food secure households and low as well as very low food secure households were grouped under two broad categories: food secure and food insecure households in the same order. The monthly per capita expenditure (MPCE) was calculated as per guidelines of the National Sample Survey Organization.  The total to earning member ratio was computed as the number of family members per earning member. The respondents were enquired about BPL card holding and receiving any benefits under social assistance programs like Antyodaya Anna Yojona, Annapurna scheme, old age pension, widow pension, disability pension, etc. The utilization of the public distribution system (PDS) through fair price shops was dichotomized as regular (on an average ≥ 3 weeks/month) and irregular as per the statement of the respondent.
The HFSS was developed by the US Department of Agriculture and extensively studied in United States , as well as few other countries,  and found effective in measuring food insecurity. For using it in Bengali vernacular, at first, two forward and two backward translations were done parallel by two medical and two language experts, so that the meaning and contents of the items remained unaltered as well as sentences were grammatically correct. Good translations were reflected by the fact that two English back translations were almost similar to the original English version. A harmonized Bengali version of the questionnaire was pretested in a sample of the tribal population to restructure the items for better comprehension and understanding. The test-retest reliability was tested in a sample of the bilingual tribal population, and kappa as well as adjusted kappa for all items was over 0.84. The internal consistency of the scale was assessed with Cronbach's alpha, which was 0.82 for the scale. Principal component analysis with varimax rotation yielded only one principal component (eigenvalue > 1) and all the items had substantial loading (>0.4) on that component.
Simple proportion was calculated to determine the prevalence of different grades of household food security. Binary logistic regression was done to find out the relation of study variables with outcome variables using SPSS version 13.
The study followed the ethical standards for an observational study and obtained clearance from Institutional Ethics Committee, B. S. Medical College, Bankura.
| Results|| |
Among 273 households surveyed, six questionnaires were found to be inconsistent and therefore rejected from analysis giving a final sample size of 267 households. Out of them, 6.2% households have pucca houses, 14.7% have mixed kutchcha-pucca houses, and the rest lived in kutchcha houses. The average family size was 6.0 (±0.15) and almost three-fourth households (75.7%) had under-5 children. Only 27.3% households had nuclear families. A total of 12.6% households had any member with 10 years or more years of formal education. The MPCE was 342.3 (±10.3) and the average total to earning member ratio was 4.3 (±0.1). BPL card holding was reported by 69.3% households and 18% received benefits from any of the social assistance programs.
As evident from [Table 1], 47.2% households had high or marginal food security whereas 29.6% and 23.2%, respectively, had low and very low food security. The prevalence of low and very low food security was higher among households having under-5 children (31.2% and 24.3%) compared to households without under-5 children (24.6% and 20.0%).
The proportion of households which utilized PDS regularly was 56.9% (152 out of 267) and food security was found to be higher among households regularly utilizing the facility of PDS (59.2% vs. 31.3%) as well as among those who were the beneficiaries of any social assistance program (56.3% vs. 45.2%). Low food security was higher among BPL card holders (31.9%) compared to the households who did not have a BPL card (24.4%) but the very low food security was similar (23.2% in both cases) in households with BPL cards [Table 1].
|Table 1 :Status of household food security according to socioeconomic variables|
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On further analysis, it was evident that the regular utilization of PDS among BPL card holders (62.7%) was better compared to the study population as a whole (56.9%) but the difference was substantial between households with (62.7%) and without a BPL card (43.9%). The regular utilization of PDS (60.3% vs. 18.8%) and social assistance (56.5% vs. 44.9%) improved the food security among BPL card holders (not shown in the table).
[Table 2] revealed that food secure households had the highest MPCE and the lowest total to earning member ratio. The MPCE (Kruskal-Wallis H = 115.171, df = 2, P < 0.0001) and total to earning member ratio (Kruskal-Wallis H = 50.785, df = 2, P < 0.0001) were significantly associated with household food security (not shown in the table). On classification tree analysis, it was found that 90.8% households having an MPCE Rs. 356 or more were food secure whereas only 10.8% households were food secure if the MPCE was less than Rs. 356.
|Table 2 :Average monthly per capita expenditure and total to earning member ratio according to status of food security|
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On binary logistic regression, it was found that factors like nonholding of the BPL card, a regular utilization of PDS, an MPCE of ≥ Rs. 356, and a total to earning member ratio of ≤ 4 were significantly associated with household food security. The Hosmer and Lameshow test (χ2 = 8.343, df = 8, and P-value = 0.401) confirmed that the regression model fitted the data well. The model can correctly predict 94.6% households with low and very low food security and 85.9% of households with high and marginal food security. The overall predictability of the model was 90.5% [Table 3].
| Discussion|| |
Identifying at-risk households for food security and targeting interventions to reduce the risk of their condition worsening further is increasingly being recognized as critical to prevent the physical and economic consequences that accompany a plunge into hunger.  A household food security survey can provide information about behaviors and experiences that are known to characterize households having difficulties in meeting their requirement of food. It can also provide a direct measure of household food stress or food deprivation in a resource-constraint situation. The HFSS was effectively used in some cultural and linguistic settings.  A single principal component with substantial loading of all six items and stability after varimax rotation confirmed the single underlying factor of the Bengali version of the scale under study. A strong test-retest reliability as evident by a higher value of kappa (>0.84) ensured the quality of Bengali translation. The internal consistency of the scale was also found to be high (Cronbach's alpha = 0.82). All these features of the Bengali version of the HFSS-Short Form made it suitable for use in a field situation.
In the present study, 47.2% households were found to be food secure whereas 29.6% were low food secure and 23.2% were very low food secure. A similar picture was depicted by Agarwal et al.  in their study in an urban slum where the proportion of households having food security was 49%. In an earlier study using the caloric adequacy method in a tribal population of West Bengal, Ray et al.  reported that the prevalence of food insecurity was 48.0%. In another study in an urban slum and a riverine rural area in West Bengal,  the prevalence of food insecurity was found to be 43.7% and 52.0%, respectively.
The present study also revealed that low and very low food security was more prevalent among households with under-5 children compared to where there were none of them. Similar findings were reported from a study in Coimbatore  as well as among the aboriginal population of Canada. 
Poverty is intricately correlated with household food security as evident from different studies across the globe. ,, In India, criticism is an inextricable issue related with the delineation of the poverty line. In 2004-2005, the national poverty line was taken at an MPCE of Rs. 356 for the rural population and Rs. 539 for the urban population. The benchmark corresponded to the provision of 1820 kcal per day which was far less than the recommended norm  and identified the severe form of caloric deficiency. The new score-based poverty line also faced valid opposition. In spite of the widespread dissatisfaction with it, the BPL list mainly included the poor, at least in the study area, as evident by the higher proportion of food insecurity among households with BPL cards.
Inclusion (inclusion of nonpoor) and exclusion (exclusion of poor) errors could be innate in PDS. Ray et al. , reported a low coverage of PDS as well as low utilization of it among card holders. In contrast, in the present study, almost 57% households utilized PDS regularly. Nearly 70% of the households had BPL cards and three-fifths of them were using PDS regularly. As per critique's version, in a country like India, where the target group is very large and focus should be on ensuring that the malnourished are reached, a universal scheme is better than a narrowly targeted scheme.  However, the enormous network of fair price shops targeting 160 million families could still play a meaningful role in ensuring household food security. In concordance with the latter finding, the present study reported a significant association of food security with regular utilization of PDS, particularly in BPL households.
To ensure food security among poor, different social assistance programs were introduced. Ray et al. , reported low awareness and low access of social assistance programs. The present study revealed that they had percolated to the poor and to a certain extent were successful in achieving their target of ensuring food security. Both, in general and in BPL households, social assistance was associated with the low prevalence of food insecurity especially of the severe grade.
An MPCE of Rs. 356 or more was significantly associated with food security. It was also noted that about 11% households with an MPCE less than Rs. 356 were food secure. A cut-off value of Rs. 580 for urban slum dwellers was generated by Gupta et al.  and 9.4% households with an MPCE below that cut-off were reported to be food secure in their study. The food secure households with an MPCE below the cut-off might be assumed as the "positive deviants" and their practices as well as coping strategies in a food-stressed situation should be replicated.
A low total to earning member ratio was found to be a protective factor for household food security as shown earlier in a study in a Delhi slum. 
The questionnaire-based study of household food security with a short form of the HFSS did not measure the most severe form of food insecurity which affects children. A further study with refined instruments with a better adaptation to our culture and language is needed to be undertaken to gather more reliable information on food security status and its predictors in our nation, especially for the marginalized and vulnerable population in order to fine tune the programs and policies toward achieving our commitment in World Food Summit  and Millennium Development Goals. 
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[Table 1], [Table 2], [Table 3]
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