Self-applied ELCSA is valid for rapid tracking of household food insecurity among pregnant women during the COVID-19 pandemic

Agampodi, Thilini Chanchala; Hromi-Fiedler, Amber; Agampodi, Suneth Buddhika; Amarasinghe, Gayani Shashikala; Wickramasinghe, Nuwan Darshana; Jayasinghe, Imasha U; Hettiarachchi, Ayesh Umasena; Perez-Escamilla, Rafael

Abstract Background Rapid household food insecurity (HFI) tracking has been identified as a priority in the context of the COVID-19 pandemic and its aftermath. We report the validation of the Latin American and Caribbean Food Security Scale (Escala Latinoamericana y Caribena de Seguridad Alimentaria -ELCSA) among pregnant women in Sri Lanka. Methods The adult eight-items of the English version of ELCSA was translated into Sinhala and Tamil. Cognitive testing (on ten pregnant women and five local experts) and psychometric validation of the self-administered HFI tool was conducted among pregnant women (n=269) attending the Rajarata Pregnancy Cohort (RaPCo) special clinics in Anuradhapura in February 2020. We assessed psychometric properties and fit using a one parameter logistic model (Rasch analysis) using STATA version 14 and WINSTEP software version 4.3.4. Concurrent validity was tested using psychological distress. Results The scale was internally consistent (Cronbachs alpha = 0.79), had a good model fit (Rasch infit statistic range: 0.85 to 1.07). Item 8 (did not eat for the whole day) was removed from the model fit analysis as it was not affirmed by anyone. Item severity scores ranged from -2.15 for not eating a diverse diet to 4.43 for not eating during the whole day. Concurrent validity between HFI and psychological distress was confirmed (r=0.15, p<0.05). Conclusions The self-applied version of ELCSA- pregnancy in Sri Lanka (ELCSA-P-SL) is a valid and feasible tool to track HFI among pregnant women in similar contexts during the COVID-19 pandemic, where social distancing is a major concern and its aftermath.