Food insecurity, food coping strategies, and child health among Ghanaians and long term Liberian refugees living in Ghana
Authors: Hromi‐Fiedler Amber , Lartey Anna , Gallego‐Perez Daniel , Sandow Adam , Perez‐Escamilla Rafael 
Published: November 2023

We examined household food insecurity (HFI), food coping strategies, and child health among Ghanaians and Liberian refugees living in Ghana. A cross sectional survey was administered between June and August 2008 to 480 female Liberian refugees and Ghanaians living in Buduburam Refugee Settlement and in Awutu village (~5 km away). Liberian and Ghanaian women were included if they were: a) ≥ 16 years old, b) had a biological child 6 to 59 months old, c) not currently pregnant, d) did not have health problems or conditions that would change their diet. HFI was assessed over 6 months prior to the survey using a modified version of the Latin American and Caribbean Household Food Security Scale (ELCSA). Fifteen of the 16 items were included in the final scoring due to poor psychometric properties of one adult item. An additive score was used to classify households as: food secure (0), mildly food insecure (1 – 5), moderately food insecure (6 – 10), severely food insecure (11 – 15). Results showed that Liberians were significantly more food insecure compared to Ghanaians. Only 1.3% of Liberians were food secure compared to 19.5% of Ghanaians. Over 56% of Liberians experienced severe food insecurity compared to 22.2% of Ghanaians. Compared to Ghanaians, Liberians were significantly more likely to use different food coping strategies. Almost 67% of Liberians borrowed food or relied on help from family/friends compared to 30% of Ghanaians. Half of Liberians purchased food on credit (vs. to 30.3% of Ghanaians), 8.4% sent household members to live elsewhere (vs. 1.7% of Ghanaians), 23.5% sold other assets to purchase food (vs. 6.6% of Ghanaians), 15% sent children to other household members or neighbors to eat (vs. 3.1% of Ghanaians), and 36.5% begged for food (vs. 1.4% of Ghanaians). Ghanaians were more likely to sell livestock to obtain money for food compared to Liberians (9.5% vs. 2.5%, respectively). To access food, both Liberians and Ghanaians typically purchased food. However, Liberians were significantly more likely than Ghanaians to also access food by: receiving food aid (23.8% vs. 0.4%, respectively), getting food as a gift/asking someone for food (49% vs. 18.3%, respectively), and borrowing food from someone (18% vs. 5%, respectively). Ghanaians were more likely to grow their food compared to Liberians (39% vs. 2.9%, respectively). Child health was examined via maternal self‐reported child health status and malaria diagnosis confirmation by a doctor. Liberians were more likely to report their child's health as poor/very poor compared to Ghanaians (33.9% vs. 19.1%, p<0.05). Almost 58% of Liberian children had malaria 6 months prior to the interview compared to 39.2% of Ghanaian children (p<0.05). Findings suggest that refugees living in protracted situations would greatly benefit from sustainability projects fostering food security, sanitation and preventive health care to improve food insecurity and child health.Support or Funding InformationFunded by the West African Research Association.