Household Food Insecurity is Associated with Heterogeneous Patterns of Diet Quality Across Urban and Rural Regions of Malawi

Abstract

The nutritional consequences of food insecurity in rural as compared to urban regions of low‐ and middle‐income countries (LMICs) have not been well differentiated. We aimed to determine the region‐specific associations of food security with diet diversity, consumption of foods associated with the nutrition transition, and child stunting and overweight. We used data on 12,271 households from the 2010–2011 Malawi Third Integrated Household Survey (IHS3). We used multiple logistic regression analyses to assess the relation between household food security, measured using an adapted version of the Coping Strategies Index (CSI), and consumption of specific food groups and beverages as well as height‐for‐age Z‐score (HAZ) and weight‐for‐height Z‐score (WHZ) of preschool‐aged children. Analyses were stratified by urban and rural region. Food insecurity was associated with less diverse diets (p < 0.001), and among urban residents, higher odds of consumption of refined grains and processed vendor foods, and lower odds of consumption of millets (p < 0.05). In adjusted analyses, food security was not strongly associated with child anthropometry. Food insecure urban residents may be especially vulnerable to poor health outcomes associated with both poor access to nutrient‐dense foods and diets high in refined and processed foods.

Integrated agriculture programs to address malnutrition in northern Malawi

“…A number of studies in Malawi have also shown that young children’s complementary foods are inadequate in energy density, protein and micronutrients required for child nutrition [11]. As well, low dietary diversity, food insecurity, inadequate number of feedings in a day, low levels of exclusive breastfeeding and seasonal fluctuations in food prices are some of the persistent reasons for higher rates of child undernutrition in Malawi [12, 13]. The majority of Malawians are rural, smallholder farmers who rely on their own food production for their consumption, and experience ongoing challenges with low and declining soil fertility.…”

“…The majority of Malawians are rural, smallholder farmers who rely on their own food production for their consumption, and experience ongoing challenges with low and declining soil fertility. Malawi has high rates of rural poverty, and chronic seasonal food insecurity is commonly experienced [10, 12]. …”

Assessing food security using household consumption expenditure surveys (HCES): a scoping literature review

“…Authors of the reviewed articles attempted to deal with the limitations by using complex statistical methods to account for error and bias. Ordinary least-squares regression analysis was commonly used and compared with other types such as quantile regression (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) .…”

“…food secure or food insecure) (23,26,27,30,(33)(34)(35)(36)(37) , three studies used a ranking in the range of 1, 2 or 3 (i.e. food secure, moderately food insecure, severely food insecure) (22,28,38) and five studies assessed the variables as continuous measures (21,24,25,28,29) . Five studies also explored food security qualitatively, where coping strategies and participant experiences were assessed (21,24,25,30,41) .…”

“…Melgar-Quinonez et al (21) Dietary diversity 4 Dietary diversity as per Food Consumption Score (FCS) • FCS as per WFP, 2007. Weighted continuous measure Malawi Jones (24) Dietary diversity:…”