title: Household food insecurity and mental distress among pregnant women in Southwestern Ethiopia: a cross sectional study design.
abstract: BACKGROUND
  There are compelling theoretical and empirical reasons that link household food insecurity to mental distress in the setting where both problems are common. However, little is known about their association during pregnancy in Ethiopia.
  
  
  METHODS
  A cross-sectional study was conducted to examine the association of household food insecurity with mental distress during pregnancy. Six hundred and forty-two pregnant women were recruited from 11 health centers and one hospital. Probability proportional to size (PPS) and consecutive sampling techniques were employed to recruit study subjects until the desired sample size was obtained. The Self Reporting Questionnaire (SRQ-20) was used to measure mental distress and a 9-item Household Food Insecurity Access Scale was used to measure food security status. Descriptive and inferential statistics were computed accordingly. Multivariate logistic regression was used to estimate the effect of food insecurity on mental distress.
  
  
  RESULTS
  Fifty eight of the respondents (9%) were moderately food insecure and 144 of the respondents (22.4%) had mental distress. Food insecurity was also associated with mental distress. Pregnant women living in food insecure households were 4 times more likely to have mental distress than their counterparts (COR = 3.77, 95% CI: 2.17, 6.55). After controlling for confounders, a multivariate logistic regression model supported a link between food insecurity and mental distress (AOR = 4.15, 95% CI: 1.67, 10.32).
  
  
  CONCLUSIONS
  The study found a significant association between food insecurity and mental distress. However, the mechanism by which food insecurity is associated with mental distress is not clear. Further investigation is therefore needed to understand either how food insecurity during pregnancy leads to mental distress or weather mental distress is a contributing factor in the development of food insecurity.
authors.affiliation: Population and Family Health, Jimma University, Jimma, Ethiopia. mulusew.gerbaba@gmail.com.|Department of Food Safety and Food Quality, Ghent University, CoupureLinks, Ghent, Belgium. mulusew.gerbaba@gmail.com.
authors.forename: Mulusew G
authors.initials: MG
authors.lastname: Jebena
authors.affiliation: Department of Epidemiology, Jimma University, Jimma, Ethiopia. tahamohammed2009@gmail.com.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Taha
authors.affiliation: Duluth Medical Research Institute, Department of Bio behavioral Health and Population Sciences, University of Minnesota Medical School, Duluth, MN, USA. mnakajim@d.umn.edu.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Nakajima
authors.affiliation: Duluth Medical Research Institute, Department of Bio behavioral Health and Population Sciences, University of Minnesota Medical School, Duluth, MN, USA. lemie008@d.umn.edu.
authors.forename: Andrine
authors.initials: A
authors.lastname: Lemieux
authors.affiliation: Department of Horticulture and Plant Sciences, Jimma University, Jimma, Ethiopia. fikre.lemessa@ju.edu.et.
authors.forename: Fikre
authors.initials: F
authors.lastname: Lemessa
authors.affiliation: Duluth Medical Research Institute, Department of Bio behavioral Health and Population Sciences, University of Minnesota Medical School, Duluth, MN, USA. rhoffman@d.umn.edu.
authors.forename: Richard
authors.initials: R
authors.lastname: Hoffman
authors.affiliation: Department of Psychiatry, Jimma University, Jimma, Ethiopia. tesmarkos@yahoo.com.
authors.forename: Markos
authors.initials: M
authors.lastname: Tesfaye
authors.affiliation: Population and Family Health, Jimma University, Jimma, Ethiopia. teferabelachew@gmail.com.
authors.forename: Tefera
authors.initials: T
authors.lastname: Belachew
authors.affiliation: Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia. konetsanet@gmail.com.
authors.forename: Netsanet
authors.initials: N
authors.lastname: Workineh
authors.affiliation: Department of Internal Medicine, Jimma University, Jimma, Ethiopia. esakgd@gmail.com.
authors.forename: Esayas
authors.initials: E
authors.lastname: Kebede
authors.affiliation: Department of Psychology, Jimma University, Jimma, Ethiopia. teklu.gem@yahoo.com.
authors.forename: Teklu
authors.initials: T
authors.lastname: Gemechu
authors.affiliation: Department of Chemistry, Jimma University, Jimma, Ethiopia. yinebeb_tariku@yahoo.com.
authors.forename: Yinebeb
authors.initials: Y
authors.lastname: Tariku
authors.affiliation: Department of Obstetrics and Gynecology, Jimma University, Jimma, Ethiopia. hmullu@yahoo.com.
authors.forename: Hailemariam
authors.initials: H
authors.lastname: Segni
authors.affiliation: Department of Food Safety and Food Quality, Ghent University, CoupureLinks, Ghent, Belgium. pkolsteren@itg.be.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kolsteren
authors.affiliation: Duluth Medical Research Institute, Department of Bio behavioral Health and Population Sciences, University of Minnesota Medical School, Duluth, MN, USA. malabsi@umn.edu.
authors.forename: Mustafa
authors.initials: M
authors.lastname: al'Absi
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D005523:Food Supply; D006801:Humans; D007182:Income; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology; D011569:Psychiatric Status Rating Scales; D012424:Rural Population / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000453:epidemiology* / Q000209:etiology; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult