Use and Utilization in Food and Nutrition Security, With Particular Emphasis on School Children in Kuyu Woreda, North Shewa, Ethiopia
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Date
2026
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Addis Abeba University
Abstract
Background: Global food insecurity continues to pose a major public health and development challenge that disproportionately affect Sub-Saharan Africa. Due to their reliance on the availability of home resources and caregiving methods, schoolchildren in Ethiopia are especially susceptible to nutritional shocks. The intricate relationship between household (HH) resource limitations and caregivers' behavioral "gatekeeping"— including their knowledge, attitudes, and practices (KAP) about food safety, child feeding and care—remains understudied despite increased focus on isolated approaches. Since caregivers are crucial in converting available resources into actual dietary consumption and nutritional outcomes, it is imperative to comprehend this link. Objective: To examine household food insecurity and undernutrition among schoolchildren and to assess the impact of a tailored nutrition and water, sanitation, and hygiene intervention on schoolchildren and caregiver KAP in Kuyu Woreda, North Shewa Zone, Ethiopia 2023/4. Methods: A mixed-methods longitudinal study was conducted with 610 caregiver-child pairs. Baseline data were collected using the Household Food Insecurity Access Scale (HFIAS) and the Household Dietary Diversity Score (HDDS). Anthropometric measurements (HAZ, BAZ, WAZ, and MUAC) were obtained following standard WHO protocols. A school-home intervention, including nutrition education and WASH infrastructure support, was implemented. Data were analyzed using logistic regression, Chi square test, and t-test for baseline predictors and mixed-effects models to evaluate the intervention’s impact. Statistical significance was set at p < 0.05, and all ssociations
were presented with 95% confidence intervals (CIs) for the adjusted odds ratios (AOR). Results: Majority (80%) of HHs reliance on subsistence farming. HH food insecurity was (83.1%) and over 90% of the HHs consumed less than four food groups. Malnutrition was very prevalent, with 64.3% exhibiting single, double, or triple growth failures; 27.5% stunted and 7% overweight. Baseline data showed overcrowded classrooms (>70), poor school sanitation, and an inconsistent water supply with student-to-water point ratio was 776:1. All schools used unsafe pit latrines, and only 9% of HHs had basic sanitation. A
school-based intervention significantly improved KAP, reducing inadequate food safety and nutrition knowledge from 73.3% to 17.2% (p < 0.0001). A regression analyses identified significant associations between HHs food access, caregiver hygiene practices, and child growth. The longitudinal phase tracked improvements in caregiver nutritional literacy and hygiene behaviors following the school-home and peer-led intervention activities. Conclusion: Findings suggest that food availability alone is insufficient to ensure nutritional health; rather, caregiver KAP and the environmental WASH context are critical mediators of nutrient utilization. The integrated school-home approach proved to be a viable model for improving dietary habits and health practices, providing an evidence-based framework for policymakers to address "hidden hunger" and stunting in similar low-resource settings.
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Keywords
Food Security, Nutrition, KAP, WASH, Schoolchildren, Ethiopia, HFIAS.