Jacent Kamuntu Asiimwe

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 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.

Household food security plays a critical role in determining the nutritional status of children, which in turn impacts their growth and development. This study assessed factors influencing household food security and childhood nutritional status and explored the relationship between these variables in Namutumba District. A total of 299 child-caregiver pairs participated in the study. Data were collected through structured interviews and analyzed, with multi-level mixed effects generalized linear models to examine factors associated with severe household food insecurity and children’s nutritional status. Multilinear regressions were used to evaluate the relationship between severe household food insecurity and child nutritional status. The results revealed that most households (60.2%) were severely food insecure. A double burden of malnutrition was observed, with 28.0% of children stunted and 2.8% overweight or obese. Factors positively associated with improved household food security included secondary-level education ( p = 0.011), medium to high wealth percentile ( p < 0.001), and the presence of at least one income-earning household member ( p = 0.045). Conversely, lack of access to agricultural land, food stocks, and access to treated drinking water were significantly linked to severe food insecurity ( p < 0.001). Severe food insecurity was positively associated with wasting ( β = 0.81, p = 0.007) and negatively associated with stunting ( β = −0.37, p = 0.039). In conclusion, multiple factors influence household food security, and the nutritional status of children aged 24–59 months. A comprehensive, food systems-based approach may be key to addressing malnutrition in Namutumba District.