Household food insecurity is associated with low dietary diversity among pregnant and lactating women in rural Malawi

Abstract

ObjectiveTo examine the association between household food insecurity and dietary diversity in the past 24h (dietary diversity score (DDS, range: 0–9); minimum dietary diversity (MDD, consumption of three or more food groups); consumption of nine separate food groups) among pregnant and lactating women in rural Malawi.DesignCross-sectional study.SettingTwo rural districts in Central Malawi.SubjectsPregnant (n 589) and lactating (n 641) women.ResultsOf surveyed pregnant and lactating women, 66·7 and 68·6 %, respectively, experienced moderate or severe food insecurity and only 32·4 and 28·1 %, respectively, met MDD. Compared with food-secure pregnant women, those who reported severe food insecurity had a 0·36 lower DDS (P<0·05) and more than threefold higher risk (OR; 95 % CI) of not consuming meat/fish (3·19; CI 1·68, 6·03). The risk of not consuming eggs (3·77; 1·04, 13·7) was higher among moderately food-insecure pregnant women. Compared with food-secure lactating women, those who reported mild, moderate and severe food insecurity showed a 0·36, 0·44 and 0·62 lower DDS, respectively (all P<0·05). The risk of not achieving MDD was higher among moderately (1·95; 1·06, 3·59) and severely (2·82; 1·53, 5·22) food-insecure lactating women. The risk of not consuming meat/fish and eggs increased in a dose–response manner among lactating women experiencing mild (1·75; 1·01, 3·03 and 2·81; 1·09, 7·25), moderate (2·66; 1·47, 4·82 and 3·75; 1·40, 10·0) and severe (5·33; 2·63, 10·8 and 3·47; 1·19, 10·1) food insecurity.ConclusionsAddressing food insecurity during and after pregnancy needs to be considered when designing nutrition programmes aiming to increase dietary diversity in rural Malawi.

Food Security and Dietary Quality in African Slums

“…HFIAS, energy consumption, and HDDS are all positively and significantly correlated with CDD and MDD-W, which even holds after controlling for socioeconomic characteristics. Similar findings were also reported in other recent studies [24,26,27,29], but these other studies did not analyze the situation in urban slums. Most of the correlation coefficients between our household-level and individual-level measures were in a magnitude of 0.3, meaning that the associations are not very strong.…”

“…However, most of these studies have either compared different household-level indicators [12,16,21] or different individual-level indicators [14,15,22,23]. Only a few studies have compared household-level food security and dietary indicators with individual-level dietary and nutrition indicators [24][25][26][27][28][29], and those that did either focused on rural areas or used national data without much regional disaggregation. The situation in rural areas may differ from that in urban areas.…”

Only one in four lactating mothers met the minimum dietary diversity score in the pastoral community, Afar region, Ethiopia: a community-based cross-sectional study

“…The MDDS in the present study is lower than as compared with studies done in other parts of Ethiopia such as Angecha district 47⋅8 % (14) , Dedo and Seqa-Chekorsa district 32⋅8 % (15) , Ataye district 48⋅8 % (16) , Lay Gayt district 34⋅3 % (17) , Dessie town 45⋅5 % (18) , Aksum town 43⋅6 % (9) and Debretabor 75 % (19) showed that lactating mothers met the minimum diet diversity. This finding is also lower than findings from other low-to middle-income countries such as Nepal 53 % (20) and Malawi 28⋅1 % (21) . In a case-control study in Dhaka, Bangladesh 42 % (22) also has higher findings than the present study.…”

“…Additionally, a little proportion of lactating mothers consumed dark green leafy vegetables and other vitamin A-rich foods. This kind of feeding practice will expose mothers to different forms of malnutrition as evidenced from different studies ( 14 , 21 , 22 , 24 ) .…”

Household food insecurity associated with gestacional and neonatal outcomes: a systematic review

“…Outcomes related to consumption and dietary quality were the most investigated after stress and depressionrelated events [10,14,31,34,41,45,54,63], showing the authors' concern with verifying dietary adequacy among pregnant women and whether dietary adequacy is truly associated with FI. Since most of the instruments that were used to assess FI in the studies included in this review relied on psychometric methodologies to measure access to food in sufficient quantity and quality, pregnant women's perceptions of access to adequate food did not necessarily correspond to the actual quality or fitness of the diet they consumed.…”