Psychometric properties of the household food insecurity assess scale among households with tuberculosis patients in South India

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Yuvaraj Krishnamoorthy
Sathish Rajaa
Komala Ezhumalai
Selby Knudsen
Robert Horsburgh Jr
Natasha Hochberg
Padmini Salgame
Jerrold Ellner
Senbagavalli Prakash Babu
Sonali Sarkar


Food security, Tuberculosis, Validation Studies, Household Food Insecurity Access Scale



We conducted this study to assess the psychometric properties (construct validity and internal consistency) of the Household Food Insecurity Access Scale (HFIAS) in measuring household food insecurity among households with tuberculosis (TB) patients in South India


Cross-sectional analysis of data from large-scale cohort study under RePORT-India consortium, conducted between 2014 and 2019 amongst three districts of South India (Pondicherry district in Puducherry, Villupuram and Cuddalore in Tamil Nadu. Households with newly diagnosed smear positive TB patients aged ≥6 years were selected as study participants. Construct validity of HFIAS was assessed through exploratory and confirmatory factor analysis. Reliability assessment was done through Cronbach’s alpha.


We found that 33.4% of the households with TB patients had food insecurity. The principal component analysis in this study found two-factor model for HFIAS, representing insufficient food quality and quantity. Both these factors explained 88% of the total variance. Confirmatory factor analysis also revealed acceptable goodness-of-fit indices for the two-factor model. The scale had very good internal consistency (Cronbach’s α=0.92).


The HFIAS tool has showed good validity and reliability to measure household food insecurity among TB households in South India.


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1. World Health Organization. Malnutrition. WHO. [Internet] [cited 7 Dec 2020]. Available from:
2. Gil JD, Reidsma P, Giller K, Todman L, Whitmore A, van Ittersum M. Sustainable development goal 2: Improved targets and indicators for agriculture and food security. Ambio. 2019; 48(7):685-98.
3. Jennifer CJ, Swindale A, Bilinsky P: Household Food Insecurity Access Scale (HFIAS) for Measurement of Household Food Access: Indicator Guide (v. 3). Washington, D.C: Food and Nutrition Technical Assistance Project, Academy for Educational Development; 2007
4. Barrett CB: Measuring food insecurity. Science. 2010; 327:825–828.
5. Sen AK: Poverty and famines: An easy on entitlement and deprivation. 2014.
6. Swindale A, Bilinsky P: Development of a universally applicable household food insecurity measurement tool: process, current status, and outstanding issues. J Nutr 2006, 136:1449S–1452S
7. Mohammadi F, Omidvar N, Houshiar-Rad A, Khoshfetrat MR, Abdollahi M, Mehrabi Y: Validity of an adapted Household Food Insecurity Access Scale in urban households in Iran. Public Health Nutr 2012, 15:149–157
8. Maes KC, Hadley C, Tesfaye F, Shifferaw S, Tesfaye YA: Food insecurity among volunteer AIDS caregivers in Addis Ababa, Ethiopia was highly prevalent but buffered from the 2008 food crisis. J Nutr 2009, 139:1758–1764.
9. Knueppel D, Demment M, Kaiser L: Validation of the Household Food Insecurity Access Scale in rural Tanzania. Public Health Nutr 2010; 13:360–367.
10. Becquey E, Martin-Prevel Y, Traissac P, Dembele B, Bambara A, Delpeuch F: The household food insecurity access scale and an index-member dietary diversity score contribute valid and complementary information on household food insecurity in an urban West-African setting. J Nutr 2010; 140:2233–2240.
11. Medecins Sans Frontieres (MSF). Food security assessment report, Chittagong Hill Tracks Sajek Union. Banglasdesh: MSF; 2008.
12. Pasricha SR, Vikaykumar V, Prashant NS, et al. A community based field research project investigating anaemia amongst young children living in rural Karnataka, India: a cross sectional study. BMC Public Health. 2009;. doi:10.1186/1471-2458-9-59.
13. International Food Policy Research Institute. Delivering for nutrition in Odisha: insights from a study on the state of essential nutrition interventions. Report. New Delhi: IFPRI. 2015.
14. Chinnakali P, Upadhyay RP, Shokeen D, et al. Prevalence of household-level food insecurity and its determinants in an urban resettlement colony in North India. J Health Popul Nutr. 2014;32(2):227–36.
15. Chatterjee N, Fernandes G, Hernandez M. Food insecurity in urban poor households in Mumbai, India. Food Secur. 2012;4(4):619–32.
16. Central TB Division. Guidance document: nutritional care and support for patients with tuberculosis in India, 2017. Available: Document - Nutritional Care %26 Support for TB patients in India.pdf
17. Sinha P, Davis J, Saag L, Wanke C, Salgame P, Mesick J, Horsburgh Jr CR, Hochberg NS. Undernutrition and tuberculosis: public health implications. J Infect Dis. 2019; 219(9):1356-63.
18. Leong S, Zhao Y, Joseph NM, et al. Existing blood transcriptional classifiers accurately discriminate active tuberculosis from latent infection in individuals from South India. Tuberculosis. 2017;2018:41–51.
19. Hochberg NS, Sarkar S, Horsburgh CR, et al. . Comorbidities in pulmonary tuberculosis cases in Puducherry and Tamil Nadu, India: opportunities for intervention. PLoS One. 2017;12:e0183195
20. Van Ness SE, Chandra A, Sarkar S, et al. Predictors of delayed care seeking for tuberculosis in southern India: an observational study. BMC Infect Dis. 2017;17:1–9
21. Hoyt KJ, Sarkar S, White L, et al. Effect of malnutrition on radiographic findings and mycobacterial burden in pulmonary tuberculosis. PLoS One. 2019;14:e0214011–11
22. Schermelleh-Engel K, Moosbrugger H, Muller H. Evaluating the fit of structural equation models: tests of significance and descriptive goodness of fit measures. MPR Online. 2003; 8(2):23–74.
23. Gebreyesus SH, Lunde T, Mariam DH, Woldehanna T, Lindtjørn B. Is the adapted Household Food Insecurity Access Scale (HFIAS) developed internationally to measure food insecurity valid in urban and rural households of Ethiopia?. BMC Nutr. 2015; 1(1):2.
24. Coates J, Frongillo EA, Rogers BL, Webb P, Wilde PE, Houser R: Commonalities in the experience of household food insecurity across cultures: what are the measures missing? J Nutr 2006, 136:1438S–1448S.
25. Gulliford MC, Mahabir D, Rocke B: Reliability and validity of a short form household food security scale in a Caribbean community. BMC Public Health 2004, 4:22.
26. Kendall A, Olson CM, Frongillo EA Jr: Validation of the Radimer/Cornell measures of hunger and food insecurity. J Nutr 1995, 125:2793–2801