Hunger and Risk for Emotional and Behavioral Problems: A Comparison between Students in Botswana, Kenya, Uganda and Zambia

Objective: To examine the prevalence and correlates (i.e., bullying victimization, physical fighting, having no friends, sadness, suicidal ideation, alcohol use, drug use and missed school) of hunger among students in Botswana, Kenya, Uganda and Zambia.

Method: Data from students in Botswana (N=2,197;2005), Kenya (N=3,691;2003), Uganda (N=1,878;2003) and Zambia (N=2,257;2004) were obtained from the Global School-Based Student Health Survey. Cross-sectional logistic regression analyses were conducted to determine the prevalence and correlates of hunger in each country. The risk factors examined were bullying victimization, involvement in physical fighting, social isolation, sadness, suicidal ideation, alcohol use, drug use, and missed school.

Results: The prevalence of hunger was highest in Zambia (28.7%) followed by Kenya (14.7%), Botswana (13.9%) and Uganda (9.3%). No differences were found for hunger based on sex or age across any of the four countries. Of the eight variables examined in multivariate logistic regression analyses, each were statistically significantly associated with hunger in at least one country. Suicidal ideation was associated with hunger in Botswana (Adj.OR=1.76; 95%CI:1.32-2.36), Kenya (Adj.OR=1.60; 95%CI:1.11-2.30), and Uganda (Adj.OR=1.34; 95%CI:1.03-1.74) but not in Zambia. Other factors varied across countries in their associations with hunger.

Conclusions: While the associations between hunger and the selected outcomes varied across countries, students in each country who reported hunger were at increased risk for at least two or more emotional or behavioral adverse outcomes. These findings underscore the urgent need to focus additional efforts on reducing and eliminating food insecurity among adolescents in developing areas. Evidence based strategies for improving access and the distribution of food are already available and, if implemented fully, would likely significantly improve the emotional and physical health of these young students.