Prevalence and determinants of food insecurity among households headed by mothers who are female sex workers in three African Countries: Validation and application of food insecurity experience scale

Reduction in prevalence of food insecurity, a key factor in reaching the United Nations Sustainable Development Goal 2.2, was challenged by COVID-19 lockdowns in low- and middle-income countries, which impacted the affordability and accessibility of food. Prevalence and determinants of food insecurity among female sex workers who are mothers (FSWM) and heads of households (FSWM-HH) in the African region have not been previously assessed. This study validated the food insecurity experience scale (FIES) using data collected from 852 FSWM-HH living in the Democratic Republic of the Congo (DRC), Kenya, or Nigeria. Results were calibrated on the global metric to compare with the country-level prevalence of household severe food insecurity (HSFI). Associated individual and household determinants and their intersections were examined to identify vulnerable sub-groups. The FIES reliably assessed (fit index=0.75) household food insecurity among FSWM-HH using a 7-item scale, omitting the item of being worried about not having enough food to eat. The prevalence of HSFI was 59.6% in the DRC, 77.8% in Kenya, and 89.0% in Nigeria and compared to FAO 2016-2018 country levels, 1.5, 3.0, and 4.5 times higher, respectively, than previous estimates. Determinants of HSFI among FSWM-HH were similar to the African region, except FSWM-HH composition of children, but the magnitudes of odds were higher. Multiple logistic regression revealed important ecological relationships. FSWM-HH with 0-3 children living with them (AOR=1.63,95% CI:1.13-2.37, reference >4 children) and mothers having no schooling or primary education (AOR=1.92,95% CI:1.33-2.78, reference with higher education) significantly determined HSFI. Prevalence of HSFI was highest among two subgroups of FSWM-HH: those > 30 years of age, without partners (93.7%, p=0.002) and those with low levels of education with 0-3 children living with them (85%, p=0.03). Food programs and welfare policies may be effective strategies to reduce HSFI among this high-risk group of mothers with children.