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

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 (Cronbach’s 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.