Background: Food insecurity remains highly prevalent in developing countries and over the past two decades it has increasingly been recognized as a serious public health problem, including in Ethiopia. An emerging body of literature links food insecurity to a range of negative health outcomes and causes of a decline in productivity. The objectives of the present study were to determine the level of food insecurity in East Gojjam zone where the productive safety net program is available, and in West Gojjam zone where there is no program, and to identify the determinants of food insecurity in both East and West Gojjam zones of Amhara Region, Ethiopia. Methods: Community based comparative cross-sectional study design was used from 24 May 2013- 20 July 2013. Multistage sampling technique was implemented. A total of 4110 randomly selected households in two distinct populations were approached to be included in the study. Availability and absence of the productive safety net program between the two study areas was used to categorize them as comparative groups; otherwise the two communities are comparable in many socio-cultural characteristics. The household food security access scale questionnaire, developed by the Food and Nutrition Technical Assistant Project, was used to measure food security level. Socio-demographic and other household level information were collected by using a structured questionnaire. The binary logistic regression model was used to assess factors associated with food insecurity. Results: From the total 4110 households, 3964 (96.45 %) gave complete responses. The total prevalence of food insecurity was 55.3 % (95 % CI: 53.8, 56.8). To compare food insecurity levels between the two zones, nearly sixty percent, 59.2 % (95 % CI: 57 %, 61.4 %) of the East Gojjam and 51.3 % (95 % CI: 49.1 %, 53.5) of West Gojjam households were food insecure. Family size (2-4) (AOR = 0.641, 95 % CI: 0.513, 0.801), non-merchant women (AOR = 1.638, 95 % CI: 1.015, 2.643), household monthly income quartiles, 1st (AOR = 2.756, 95 % CI: 1.902, 3.993), and 2nd (AOR =1.897, 95 % CI: 1.299, 2.775) were the significant socio-demographic determinants in east Gojjam zone. Illiterate mothers (AOR = 1.388, 95 % CI: 1.011, 1.905), household monthly income quartiles, 1st (AOR = 3.110232, 95 % CI: 2.366, 4.415), 2nd (AOR =2.618, 95 % CI: 1.892, 3.622) and 3rd (AOR = 2.177, 95 % CI: 1.6911, 2.803) were the significant socio-demographic predictors in west Gojjam zone. Rural residential area (AOR = 3.201, 95 % CI: 1.832, 5.594) and (AOR = 2.425, 95 % CI: 1.79, 3.272), highland agro-ecology (AOR = 2.193, 95 % CI: 1.348, 3.569 and AOR = 3.669, 95 % CI: 2.442, 5.513) and lack of livestock (AOR = 1.553, 95 % CI: 1.160, 2.078 and AOR = 1.568 95 % CI: 1.183, 2.080) were significant environmental predictors in east and west Gojjam zones respectively. Conclusion: Food insecurity is highly prevalent in both study areas; however, there are different predictor factors. Intervention strategies should give emphasis to women's education, diversified income generating opportunities, and for each agro-ecological zone, mixed agriculture strategy.
