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Assessing Household Food security in a conflict-affected urban setting: A cross-sectional study of food consumption scores among households with children aged 6-59 months in Bukavu, Eastern Democratic Republic of the Congo

This cross-sectional study of 390 households in conflict-affected Bukavu, DRC, reveals that 80% of families with young children face unacceptable food consumption scores, driven primarily by socioeconomic factors such as employment status, home ownership, and access to credit, thereby highlighting the urgent need for integrated interventions targeting livelihoods and dietary diversity.

Original authors: Jean-Paul Ntakobajira Karani, Basimine Lulemire Bienfait, Tristan Asifiwe Mulumeorhwa, Jean-Claude Nkurunziza, Justin Ombeni Birhashwirwa

Published 2026-07-07

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Jean-Paul Ntakobajira Karani, Basimine Lulemire Bienfait, Tristan Asifiwe Mulumeorhwa, Jean-Claude Nkurunziza, Justin Ombeni Birhashwirwa

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine a city called Bukavu, located in the eastern part of the Democratic Republic of Congo. Think of this city as a bustling marketplace that has been caught in the middle of a long, violent storm. Because of the fighting, the roads are blocked, the markets are shaky, and people are scared to leave their homes.

This study is like a "health check-up" for the stomachs of families in this stormy city. The researchers wanted to know: Are these families getting enough to eat, and are they eating the right kinds of food? They focused specifically on families with young children (toddlers to preschoolers), because these little ones are the most fragile when food runs low.

Here is the story of what they found, broken down into simple parts:

1. The Big Picture: A City Hungry for Stability

The researchers visited 390 families. They used two different "rulers" to measure hunger:

The "Weekly Menu" Ruler (HFCS): This checks what a family ate over the last 7 days. It counts how often they ate different types of food (like beans, meat, or vegetables) and gives them a score.
The "Daily Variety" Ruler (HDDS): This checks what a family ate in just the last 24 hours. It asks, "Did you eat from many different food groups today?"

The Shocking Result:
Imagine a classroom where 8 out of 10 students are failing a test. That is what the study found. 80% of the families had an "unacceptable" score on their weekly menu.

About half were "borderline" (like walking a tightrope; they are hungry but trying to hold on).
About a quarter were "poor" (severely hungry).
Only 20% of families were actually eating well enough to be considered "safe."

2. The "Diversity Trap": Eating a Little Bit of Everything, But Not Enough

Here is a confusing part the study uncovered.

When they looked at the Daily Variety (what people ate yesterday), many families actually looked good. They had eaten a mix of foods.
But when they looked at the Weekly Menu (what they ate over the whole week), those same families were starving.

The Analogy:
Think of it like a party. Imagine a family goes to a party where there is a huge buffet with 12 different dishes (high variety). They eat a little bit of everything and feel full for that one day. But, the next six days, they only have bread and water.

The "Daily Variety" ruler says: "Great job! You ate many foods!"
The "Weekly Menu" ruler says: "Wait, you only had that feast once. For the rest of the week, you are starving."

The study found that these two rulers often disagreed. A family could have a "good" daily variety score but still be "poor" on their weekly score. This happens because in a war zone, you might get lucky and find diverse food one day, but you can't count on it happening again tomorrow. You need both rulers to see the full picture.

3. Who is Doing Better? (The "Winners" of the Food Game)

The researchers asked: "What makes a family able to eat well while everyone else is struggling?" They found that it wasn't about how many children you have or whether you are a man or a woman. Instead, it was about economic stability.

Think of these four factors as "shields" that protect a family from hunger:

The Right Age: Families led by someone between 30 and 44 years old were much more likely to eat well. This is like having a captain who is in their prime—strong, experienced, and energetic enough to navigate the storm.
Having a Job: If the head of the household had a professional job, they were much safer. It's like having a steady engine in a car; even if the road is bumpy, the car keeps moving.
Owning a Home: Families who owned their houses were doing better than those renting. Renting is like paying a toll every month just to stay in the car. If you own the car, you can use that money to buy gas (food) instead.
Access to Credit: This is the most surprising shield. Families who could borrow money (from a bank or a loan group) were significantly better off. In a war zone, when your income stops, having a "safety net" of credit allows you to buy food until you get back on your feet.

4. What the Researchers Say We Should Do

The paper concludes that simply handing out food bags isn't enough. Because the problem is rooted in the economy (no jobs, no money, high rent), the solution must be too.

Build Shields, Not Just Meals: We need to help families get jobs, help them own homes, and make sure they can access loans.
Teach Smart Eating: Since people are eating a "little bit of everything" but not enough, we need to teach them how to get the most nutrition from the cheap, local foods they can actually find.
Use Two Rulers: When checking on hunger in war zones, don't just ask "What did you eat today?" Ask "What did you eat this week?" and "What did you eat yesterday?" You need both answers to understand the real danger.

The Bottom Line

In the stormy city of Bukavu, most families with young children are struggling to eat enough. They are surviving on the edge. The study shows that the key to getting them off that edge isn't just charity; it's giving them the economic tools (jobs, homes, loans) to build their own safety nets so they can feed their children consistently, even when the world around them is falling apart.

Technical Summary: Assessing Household Food Security in Conflict-Affected Bukavu

Problem Statement
Urban household food security in the eastern Democratic Republic of the Congo (DRC) is critically compromised by prolonged armed conflict, which disrupts agricultural systems, supply chains, and livelihoods. While global and regional data indicate high rates of food insecurity, rigorous quantitative assessments using validated indicators in conflict-affected urban settings like Bukavu remain scarce. Specifically, there is a lack of peer-reviewed studies analyzing the Household Food Consumption Score (HFCS) and Household Dietary Diversity Score (HDDS) among households with young children (6–59 months) in this context. Furthermore, the concordance between these two widely used indicators in protracted conflict zones is underexplored, and the structural socioeconomic determinants driving food consumption quality in this specific urban environment have not been fully disentangled using multivariate econometric methods.

Methodology
The study employed a cross-sectional analytical design conducted in November 2025 in Bukavu, South Kivu Province, during an active escalation of the AFC/M23 armed conflict.

Sampling: A two-stage stratified random sampling procedure was used to select 390 households with at least one child aged 6–59 months across three health zones: Ibanda, Kadutu, and Bagira.
Data Collection: Structured questionnaires were administered via KoboCollect. Data included sociodemographic characteristics, socioeconomic variables, and food security metrics.
Indicators:
- HFCS: Calculated based on a 7-day recall of nine food groups, weighted by nutritional importance. Scores were categorized as Poor (0–21), Borderline (21.5–35), or Acceptable (>35).
- HDDS: Calculated based on a 24-hour recall of 12 food groups, categorized as Low (≤3), Medium (4–5), or High (≥6).
Statistical Analysis: Data were analyzed using SPSS and R. Methods included descriptive statistics, Spearman correlation, Cohen's weighted kappa for categorical concordance, K-means clustering for vulnerability profiling, and binary logistic regression (full and stepwise models) to identify determinants of acceptable HFCS.

Key Results

Prevalence of Insecurity: 80% of surveyed households had an unacceptable HFCS. Specifically, 53.8% were classified as "borderline" and 25.9% as "poor." Only 20.3% achieved acceptable food consumption.
Dietary Diversity vs. Consumption: While 43.6% of households had a "High" HDDS, this did not translate to acceptable consumption levels. There was a moderate-to-strong positive correlation between continuous HFCS and HDDS scores ( $\rho = 0.683$ ), but very low categorical agreement ( $\kappa = 0.048$ ). This indicates that households may access diverse food groups episodically (high HDDS) without maintaining consistent consumption patterns (low HFCS).
Vulnerability Profiles: K-means clustering identified three distinct household profiles:
1. Most Vulnerable (n=157): Small, young-headed households with the lowest HFCS (21.41) and HDDS (4.13), averaging 1.64 meals/day.
2. Intermediate (n=133): Larger, older-headed households with moderate HFCS (26.24).
3. Least Vulnerable (n=100): Households with the highest HFCS (35.46) and HDDS (7.72).
Determinants of Acceptable HFCS: Binary logistic regression identified four significant structural socioeconomic predictors of acceptable HFCS:
- Household Head Age: Heads aged 30–44 years were significantly more likely to have acceptable HFCS compared to those aged 60+ (aOR = 7.01).
- Employment: Professional employment increased the odds of acceptable HFCS by 4.55 times (aOR = 4.55).
- Home Ownership: Owning a home increased the odds by 3.21 times (aOR = 3.21) compared to renting.
- Access to Credit: Access to credit increased the odds by 5.12 times (aOR = 5.12).
- Note: Variables such as sex of the head, education level, and residential status were significant in bivariate analysis but lost significance in the multivariate model, suggesting their effects are mediated by economic factors.

Key Contributions

Empirical Evidence in Conflict Zones: The study provides robust quantitative evidence that 80% of urban households with young children in Bukavu face unacceptable food consumption levels during active conflict, a rate higher than many comparable sub-Saharan African urban settings.
Indicator Concordance Analysis: The paper demonstrates that HFCS and HDDS, while correlated, are not interchangeable. The low kappa statistic highlights that relying on a single indicator may misclassify household food security status in conflict settings where food access is volatile ("diversity without consistency").
Shift in Determinant Analysis: The research shifts the focus from immutable demographic characteristics to modifiable structural economic factors. It identifies employment, credit access, and housing ownership as the primary drivers of food security resilience, rather than household composition or education alone.
Vulnerability Profiling: The identification of distinct household clusters provides a nuanced view of vulnerability, distinguishing between those with chronic low consumption and those with intermediate or stable profiles.

Significance and Claims
The authors claim that household food security in conflict-affected Bukavu is "critically compromised," driven primarily by structural socioeconomic fragility rather than just demographic factors. The study argues that the "diversity without consistency" phenomenon observed necessitates the joint use of HFCS and HDDS in monitoring systems to fully capture the complexity of food insecurity in urban conflict zones.

The paper concludes that integrated interventions are essential. Specifically, it posits that livelihood support, access to credit, and housing stability should complement or precede purely food-based transfers, as economic resilience is the primary driver of acceptable food consumption. Furthermore, dietary diversification interventions must address the gap between episodic access and consistent consumption, particularly for households with young children. The authors emphasize that these findings underscore the need for multi-indicator measurement frameworks and integrated responses that address both economic resilience and dietary quality.