FOOD INSECURITY AND COPING STRATEGIES AMONG LOW-INCOME HOUSEHOLDS: EVIDENCE FROM KUBWA GENERAL HOSPITAL

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Food insecurity is a pervasive public health and developmental challenge that disproportionately affects low-income households in sub-Saharan Africa, including Nigeria. According to the Food and Agriculture Organization (FAO), food security is achieved when all individuals consistently have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary requirements and food preferences, enabling them to lead active and healthy lives (Iheme et al., 2026). Globally, approximately 2.3 billion people experienced moderate or severe food insecurity in 2024, with a slight decline from 29.3% in 2021 to 28.0% in 2024 (FAO, IFAD, UNICEF, WFP & WHO, 2022). In Nigeria, the situation remains acute: the World Bank reported that 69.7% of the Nigerian population experienced moderate or severe food insecurity in 2021, with 21.3% experiencing severe food insecurity (Aborode et al., 2025).

For low-income households, food insecurity compels the adoption of diverse coping strategies, ranging from dietary modifications such as consuming cheaper, less preferred foods and reducing portion sizes, to non-food-based strategies such as selling household assets or borrowing money (Quinton et al., 2024). In conflict-affected areas of Nigeria such as Enugu State, households have been found to employ both food- and non-food-based coping strategies, with the majority of households headed by farmers reporting a mean monthly income of approximately $31.11, and a daily food expenditure of merely $2.69 (Olanrewaju et al., 2025). These precarious economic conditions create direct pathways to malnutrition, poor health outcomes, and increased healthcare utilisation.

Kubwa General Hospital in the Federal Capital Territory (FCT) serves a predominantly low-income, peri-urban population that reflects many of the food insecurity dynamics characteristic of urban Nigeria. The hospital thus provides a uniquely relevant setting for examining how food insecurity manifests and how low-income households cope, with direct implications for the design of healthcare interventions and social protection programmes.

1.2 Statement of the Problem

Despite the recognised association between food insecurity and poor health outcomes, there is a paucity of evidence specifically examining the food insecurity experiences and coping strategies of low-income households within the catchment area of Kubwa General Hospital. Coping strategies adopted in response to food insecurity are not merely indicators of vulnerability; they are also active health-relevant behaviours. The consumption of cheaper, nutritionally inferior foods, meal skipping, and engaging in exploitative economic transactions to access food all contribute to dietary inadequacy, micronutrient deficiencies, and increased susceptibility to disease (Iheme et al., 2026).

Nigeria experienced a significant food price shock between 2015 and 2018, and subsequent price volatility driven by the COVID-19 pandemic and post-pandemic economic disruptions has further eroded household food security (Quinton et al., 2024). A study in Ado-Ekiti showed that food insecurity indices declined with higher income and education but worsened with increased household size, and that female-headed households faced greater depth and severity of food insecurity (Babatunde et al., 2013). Similar dynamics are anticipated in the low-income catchment population of Kubwa General Hospital, yet this specific population remains understudied.

Furthermore, the escalating inflation in Nigeria, rising food prices, and diminishing purchasing power among low-income urban and peri-urban households have created an environment in which unsustainable coping strategies may entrench intergenerational food insecurity and health vulnerability. Evidence from the FCT context is therefore urgently needed.

1.3 Objectives of the Study

The main objective is to assess food insecurity and coping strategies among low-income households within the catchment area of Kubwa General Hospital, FCT, Abuja.

Specifically, the study aims to:

1. determine the prevalence and severity of food insecurity among low-income households in the Kubwa area;
2. identify the food-based and non-food-based coping strategies employed by food-insecure households;

iii. assess the sociodemographic determinants of food insecurity in the study population;

1. examine the relationship between food insecurity and selected health outcomes among household members; and
2. provide evidence-based recommendations for addressing food insecurity in the study area.

1.4 Research Questions

1. What is the prevalence and severity of food insecurity among low-income households in the Kubwa area?
2. What coping strategies do food-insecure households employ in the Kubwa area?

iii. What sociodemographic factors are associated with food insecurity in the study population?

1. What is the relationship between food insecurity and health outcomes in the study population?

1.5 Research Hypotheses

H01: There is no significant difference in the prevalence of food insecurity between male-headed and female-headed low-income households in the Kubwa area.

H02: Income level does not significantly predict the coping strategies adopted by food-insecure households in the Kubwa area.

H03: There is no significant association between food insecurity status and health-seeking behaviour among low-income households attending Kubwa General Hospital.

1.6 Significance of the Study

This study's findings will serve as an evidence base for Kubwa General Hospital management, FCT Health Secretariat, and nutrition programme planners seeking to integrate food security screening and referral pathways into primary healthcare services. The study also contributes to the evidence base on household food insecurity and coping strategies in peri-urban Nigeria, a context that has been less thoroughly examined compared to rural or highly urbanised settings.

1.7 Scope and Limitations of the Study

The study is limited to low-income households within the catchment area of Kubwa General Hospital, FCT Abuja. The study period covers household-level food security data collected over a defined cross-sectional window. Limitations include: the inherent difficulty of capturing seasonal variations in food security through a single data collection round; potential recall bias in food consumption and coping strategy reporting; and self-selection bias if only households that seek care at Kubwa General Hospital are recruited.

1.8 Definition of Terms

Food Security: A condition in which all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life.

Food Insecurity: The limited or uncertain availability of nutritionally adequate and safe foods, or the limited or uncertain ability to acquire acceptable foods in socially acceptable ways.

Coping Strategies: Specific behaviours and adaptations employed by households to maintain food access and manage dietary deficits during periods of food insecurity or shortage.

Low-Income Household: A household whose total monthly income falls below the national poverty line or a locally defined threshold, limiting the household's capacity to consistently meet its basic food and non-food needs.

Household Food Insecurity Access Scale (HFIAS): A validated measurement tool developed by the Food and Nutrition Technical Assistance (FANTA) Project to assess the degree of food insecurity (access) in a household over a four-week recall period.

Dietary Diversity Score (DDS): A measure of the number of food groups consumed by a household or individual over a 24-hour recall period, used as a proxy indicator of nutritional adequacy.

Peri-Urban: Areas situated at the interface of urban and rural environments, typically characterised by a mix of urban services and rural livelihoods, with populations that may face distinct vulnerability profiles compared to purely urban or rural communities.

Coping Strategies Index (CSI): A tool used to quantify the frequency and severity of food-based coping strategies employed by households in response to food shortages.

References

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FAO, IFAD, UNICEF, WFP & WHO. (2022). The state of food security and nutrition in the world 2022. FAO.

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Olanrewaju, O., & Balana, B. B. (2025). Conflict-induced shocks and household food security in Nigeria. International Food Policy Research Institute (IFPRI). Cited in Nigerian Health Journal.

Quinton, J., Ogundele, O., & Moyo, N. (2024). How do household coping strategies evolve with increased food insecurity? An examination of Nigeria's food price shock of 2015–2018. Food and Energy Security. https://doi.org/10.1002/fes3.70012