Ibrahim Kasujja

Food insecurity among children is typically assessed at the household level, overlooking experiences within school environments where food access, school feeding, and social comparison may shape how food insecurity is experienced. This represents an important measurement gap, particularly in settings where school attendance does not guarantee reliable access to food. Using rural Uganda as a country case study, this study developed and evaluated the psychometric properties of the School-based Food Insecurity Experience Scale (SFIES), a child-reported measure of multidimensional food insecurity during the school day.A mixed-methods design was employed with school-aged children (ages 7 to 13). Following cognitive pretesting and face validity assessment, exploratory factor analysis was used to refine items, and longitudinal confirmatory factor analysis was used to test unidimensional and multidimensional models at baseline and at the 14-day follow-up. Reliability, external validity, and discriminant validity were also evaluated. The SFIES demonstrated strong face validity (Face Validity Index = 0.94), yielding a four-item, multidimensional structure capturing emotional stress, material deprivation, social experiences, and functional impacts. The multidimensional model showed superior fit relative to a unidimensional model. Reliability was acceptable (composite reliability coefficient = 0.78; ordinal α = 0.84), with good scale-level stability (intraclass correlation coefficient = 0.78). SFIES scores were positively associated with household food insecurity and inversely associated with dietary diversity. Discriminant validity was supported. These findings provide initial evidence that school-based food insecurity can be measured as a distinct child-reported construct and demonstrate the potential utility of the SFIES as a brief measure in the Ugandan context. More broadly, the Uganda case highlights a measurement gap relevant to settings where children's food access during the school day is uncertain or dependent on variable school-feeding arrangements. Cross-context adaptation and validation are needed before the SFIES can be applied beyond Uganda.

Food insecurity and child mental health difficulties frequently intersect, yet the mechanisms and pathways connecting them remain underexplored in resource-limited settings. This study developed a contextually grounded explanatory model to examine these relationships within a single rural Ugandan setting. We conducted 12 focus group discussions with 36 teachers across four schools in Masaka district, drawing on their sustained observations of children’s food insecurity and mental health difficulties across a nine-month timeframe. Data were analysed using realist thematic analysis, supported by iterative coding, nine consensus meetings and member checking. Three interrelated pathways were identified. In the social causation pathway, food insecurity, manifested through hunger-related stress, food-related stigma and irregular or inadequate meals, preceded and contributed to mental health difficulties. In the social drift pathway, preexisting mental health difficulties among caregivers and/or children disrupted household functioning and food provision, increasing vulnerability to food insecurity. A bidirectional pathway captured recursive processes in which food insecurity and mental health difficulties co-evolved and reinforced one another over time. These pathways shaped children’s mental health and educational engagement within school environments. The findings offer context-specific insights that may inform research in similar settings. They also highlight the potential value of integrated, multi-level interventions, while underscoring the need for longitudinal and intervention research.

Food insecurity among children is typically assessed at the household level, overlooking experiences within school environments where food access and social comparison are highly salient. School-based food insecurity may represent a distinct form of hunger-related stress, yet it remains unmeasured. This study developed and evaluated the psychometric properties of the School-based Food Insecurity Experience Scale (SFIES), a child-reported measure of multidimensional food insecurity. A mixed-methods design was employed with school-aged children (ages 7 to 13) in rural Uganda. Following cognitive pretesting and face validity assessment, exploratory factor analysis was used to refine items, and longitudinal confirmatory factor analysis was used to test unidimensional and multidimensional models at baseline and at the 14-day follow-up. Reliability was assessed using composite reliability, ordinal alpha (α), and intraclass correlation coefficients. External validity was evaluated through associations with household food insecurity and dietary diversity. Discriminant validity was assessed using the Fornell–Larcker criterion. The SFIES demonstrated strong face validity (Face Validity Index = 0.94), yielding a four-item, multidimensional structure that captures emotional stress, material deprivation, social experiences, and functional impacts domains. The multidimensional model showed superior fit relative to a unidimensional model. Reliability was acceptable (composite reliability coefficient = 0.78; ordinal α = 0.84), with good scale level stability (intraclass correlation coefficient = 0.78). SFIES scores were positively associated with household food insecurity and inversely associated with dietary diversity. Discriminant validity was supported. These findings support school-based food insecurity as a mechanistically distinct, multidimensional construct and the SFIES as a parsimonious, four-item, reliable and valid measure.

Background: School feeding program evaluation requires the measurement of food insecurity, a more objective indicator, within schools in low-income countries. The Global Child Nutrition Foundation (GCNF) uses subjective indicators to report school feeding coverage rates across many countries that participate in the global survey of school meal programs all year round. Aim: To test the methodological feasibility of measuring a school food insecurity construct as a direct indicator of the effectiveness and efficiency of school feeding programs. Methods: Two-stage sampling was used during the selection of schools, and 128 schoolchildren with a mean (SD) age of 10.5(1.58) were recruited. Item Response Theory (IRT) and Classical Test Theory (CTT) approaches were utilized during the Day Scholars Food Insecurity Experience Scale Survey Module (DSFIES-SM) development. Psychometric analysis was utilized to assess the psychometric properties of the measure of school food insecurity and to establish the construct-level reliability, convergent and discriminant validity of the DSFIES-SM. Results: DSFIES-SM generated acceptable item-level reliabilities, ranging from .75 to .78. The construct-level reliability of the DSFIES-SM was indicated by Cronbach's a of .78. Composite reliability was at .77. Fit measures and tests of model fitness for confirmatory factor analysis (CFA) (RMSEA \ 0.0001; TLI = 1.06; SRMR = .043; CFI = 1.00, p = .85) confirmed that the data fitted the model perfectly. Conclusion: DSFIES-SM consists of twelve questions with dichotomous yes/no responses. DSFIES-SM has good convergent and discriminant validity. Findings suggest that the items compose a statistical scale designed to cover a range of severity of school food insecurity. Future replications to establish other forms of validity across different cultural contexts in low-income countries can be of benefit to the present research.

Background: Food insecurity and mental health conditions are considered public health problems in sub-Saharan Africa (SSA) among children and adolescents. Many potential biological, psychological and social mechanisms may explain the association between food insecurity and mental health among children and adolescents. Experiences of food insecurity are known to affect an individual’s psychological state resulting in anxiety, isolation, stress, and sadness. Aims: To examine the association between food insecurity and child and adolescent mental health (CAMH) and the impact of food insecurity reduction interventions on CAMH outcomes. Methods: A systematic search of eight databases (APA PsycINFO, CINAHL, EconLit, Embase, MEDLINE, Scopus, PubMed and Cochrane Library) was conducted to identify relevant studies. Included studies were assessed for quality and correlations between food insecurity and CAMH reported.Results: 9,547 published articles were retrieved during literature search. Seventeen observational studies met the inclusion criteria and were included in the review. No articles of intervention studies were identified. Positive significant associations were found between food insecurity and CAMH outcomes. Included articles of observational and intervention studies were of acceptable quality.Conclusions: Experiencing food insecurity is associated with both internalising and externalising problems among children and adolescents in SSA. While no interventions reducing food insecurity were found, there is a need to design and conduct intervention studies to assess the impact of such interventions on CAMH. Although cross-sectional evidence for the association between food insecurity and mental health conditions is well established, there is a need for longitudinal studies to assess the bi-directional, temporal associations, and unpack mechanisms through which food insecurity affects mental health (social causation) and through which mental health conditions affect food insecurity (social drift). Reducing food insecurity and improving CAMH is needed to break the cycle of food insecurity and to achieve the United Nations 2030 Sustainable Development Goals.Key wordsChildren and adolescents, food insecurity, hunger, mental health conditions, sub-Saharan Africa

Background: School feeding programs’ evaluation requires the measurement of food insecurity, a more objective indicator, within school in low-income countries. The Global Child Nutrition Foundation (GCNF) uses subjective indicators to report school feeding coverage rates across many countries that participate in the global survey of school meal programs all year round. Aim: To test the methodological feasibility of measuring a school food insecurity construct as a direct indicator of the effectiveness and efficiency of school feeding programs. Methods: Two-stage sampling was used during the selection of schools and 128 schoolchildren with a mean ( SD) age of 10.5(1.58) were recruited. Item Response Theory (IRT) and Classical Test Theory (CTT) approaches were utilized during DSFIES-SM development. Psychometric analysis was utilized to assess the psychometric properties of the measure of school food insecurity and to establish the construct-level reliability, convergent and discriminant validity of the DSFIES-SM. Results: DSFIES-SM generated acceptable item-level reliabilities, ranging from .75 to .78. The construct-level reliability of the DSFIES-SM was indicated by Cronbach’s α of .78. Composite reliability was at .77. Fit measures and tests of model fitness for confirmatory factor analysis (CFA) (RMSEA < 0.0001; TLI = 1.06; SRMR = 0.043; CFI = 1.00, p = .85) confirmed that the data fitted the model perfectly. Conclusion: DSFIES-SM consists of twelve questions with dichotomous yes/no responses. DSFIES-SM has good convergent and discriminant validity. Findings suggest that the items compose a statistical scale designed to cover a range of severity of school food insecurity. Future replications to establish other forms of validity across different cultural contexts in low-income countries can be of benefit to the present research.