COVID-19 pandemic has multifaceted impact on health, nutrition and wellbeing of families, specially those who are already living with poverty. In 2020, World Food Programme’s Nutrition-Sensitive Food Assistance for Assets Program in Sri Lanka has conducted a baseline survey among 1300 farming households to assess food insecurity during the COVID-19 pandemic. Food insecurity was assessed using the 8-item Food Insecurity Experience Scale and the results reported an alarmingly high rate of food insecurity with 36% moderately and 14% severely food insecure households. This survey further shows that the proportion of households experiencing food insecurity is varied by wealth quintile and the geographical location.
The national child health care programme in Sri Lanka has food insecurity assessment in-built to the field care services. Public health midwives assess individual families for social risk factors and has a system of identifying them as “at risk” families. After the huge wave of pandemic in July-September 2021, Family health Bureau, the apex body in maternal and child health care programmes in Sri Lanka is currently in the process of revisiting post COVID-19 recovery programmes. At this juncture, including a systematic assessment will enhance the assessment as well as interventions for individual families.
In February 2020, the RaPCo research team has validated the Latin American and Caribbean Food Security Scale (Escala Latinoamericana y Caribena de Seguridad Alimentaria [ELCSA]) among households with pregnant women in Sri Lanka. This tool is widely used for food insecurity assessment by many UN agencies and has been used in national surveys, but without a proper validation.
We translated the ELCSA scale from English to Sinhala and Tamil and cognitive testing (on 10 pregnant women and five local experts) and psychometric validation was done among pregnant women (n = 269) attending the special clinics of the Rajarata Pregnancy Cohort (RaPCo) in Anuradhapura. The psychometric properties were assessed using a one-parameter logistic model (Rasch model analysis) with STATA Version 14 and WINSTEP software Version 4.3.4. We assessed the concurrent validity using psychological distress using GHQ 12. The ELCSA-SL tool was internally consistent (Cronbach’s alpha = 0.79) and had a good model fit (Rasch items infit statistic range: 0.85 to 1.07). Concurrent validity between HFI and psychological distress was confirmed (r = 0.15, p < 0.05). After this assessment of households with pregnant women, it was proposed as a valid and reliable tool to track household food insecurity in Sri Lankan households during the COVID-19 pandemic.
Implications and Recommendations
As the ELCSA-SL is a simple tool recommended by all UN agencies and now validated in Sri Lanka, this tool could be incorporated into national programmes to track household food insecurity.
- Use the ELCSA-SL for the risk assessment of families under-care of public health midwives
- Plan appropriate interventions based on the ELCSA-SL tool. For mild food insecurity, PHM can offer help. For moderate to severe food insecurity, collaborative efforts need to be carried out with other sectors and MOH.
 Singh, N., Scott, S., Olney, D., Kumar, N., Ramani, G., Jayatissa, R., Sinclair, K. and Marshall, Q., 2021. Food Insecurity Among Farmers in Rural Sri Lanka and the Perceived Impacts of COVID-19. Current Developments in Nutrition, 5(Supplement_2), pp.248-248.
 Agampodi, T.C., Hromi‐Fiedler, A., Agampodi, S.B., Amarasinghe, G.S., Wickramasinghe, N.D., Jayasinghe, I.U., Hettiarachchi, A.U. and Perez‐Escamilla, R., 2021. A self‐applied valid scale for rapid tracking of household food insecurity among pregnant women in Sri Lanka. Maternal & child nutrition, 17(3), p.e13165.