title: Socio-economic determinants of household food security and women's dietary diversity in rural Bangladesh: a cross-sectional study.
abstract: BACKGROUND
  There has been limited decline in undernutrition rates in South Asia compared with the rest of Asia and one reason for this may be low levels of household food security. However, the evidence base on the determinants of household food security is limited. To develop policies intended to improve household food security, improved knowledge of the determinants of household food security is required.
  
  
  METHODS
  Household data were collected in 2011 from a randomly selected sample of 2,809 women of reproductive age. The sample was drawn from nine unions in three districts of rural Bangladesh. Multinomial logistic regression was conducted to measure the relationship between selected determinants of household food security and months of adequate household food provisioning, and a linear regression to measure the association between the same determinants and women's dietary diversity score.
  
  
  RESULTS
  The analyses found that land ownership, adjusted relative risk ratio (RRR) 0.28 (CI 0.18, 0.42); relative wealth (middle tertile 0.49 (0.29, 0.84) and top tertile 0.18 (0.10, 0.33)); women's literacy 0.64 (0.46, 0.90); access to media 0.49 (0.33, 0.72); and women's freedom to access the market 0.56 (0.36, 0.85) all significantly reduced the risk of food insecurity. Larger households increased the risk of food insecurity, adjusted RRR 1.46 (CI 1.02, 2.09). Households with vegetable gardens 0.20 (0.11, 0.31), rich households 0.46 (0.24, 0.68) and literate women 0.37 (0.20, 0.54) were significantly more likely to have better dietary diversity scores.
  
  
  CONCLUSIONS
  Household food insecurity remains a key public health problem in Bangladesh, with households suffering food shortages for an average of one quarter of the year. Simple survey and analytical methods are able to identify numerous interlinked factors associated with household food security, but wealth and literacy were the only two determinants associated with both improved food security and dietary diversity. We cannot conclude whether improvements in all determinants are necessarily needed to improve household food security, but new and existing policies that relate to these determinants should be designed and monitored with the knowledge that they could substantially influence the food security and nutritional status of the population.
authors.affiliation: UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK. h.fry.11@ucl.ac.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Harris-Fry
authors.affiliation: Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka, 1000, Bangladesh.
authors.forename: Kishwar
authors.initials: K
authors.lastname: Azad
authors.affiliation: Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka, 1000, Bangladesh.
authors.forename: Abdul
authors.initials: A
authors.lastname: Kuddus
authors.affiliation: Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka, 1000, Bangladesh.
authors.forename: Sanjit
authors.initials: S
authors.lastname: Shaha
authors.affiliation: Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka, 1000, Bangladesh.
authors.forename: Badrun
authors.initials: B
authors.lastname: Nahar
authors.affiliation: Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka, 1000, Bangladesh.
authors.forename: Munir
authors.initials: M
authors.lastname: Hossen
authors.affiliation: UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK.
authors.forename: Leila
authors.initials: L
authors.lastname: Younes
authors.affiliation: UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Costello
authors.affiliation: UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Fottrell
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D003430:Cross-Sectional Studies; D004032:Diet / Q000208:ethnology / Q000523:psychology; D000072001:Diet, Healthy / Q000191:economics / Q000208:ethnology / Q000523:psychology; D005191:Family Characteristics / Q000208:ethnology; D005260:Female; D005523:Food Supply / Q000191:economics; D051639:Gardening / Q000191:economics; D006801:Humans; D000067010:Literacy / Q000208:ethnology / Q000523:psychology; D008875:Middle Aged; D009749:Nutrition Surveys; D010349:Patient Compliance / Q000208:ethnology / Q000523:psychology; D011203:Poverty / Q000191:economics / Q000208:ethnology / Q000523:psychology; D011209:Power, Psychological; D012423:Rural Health / Q000191:economics / Q000208:ethnology; D012621:Seasons; D012959:Socioeconomic Factors; D016387:Women's Health / Q000191:economics / Q000208:ethnology; D055815:Young Adult
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