The intersection of food insecurity and health for rural Malawian women at the end of life

Abstract

Background One of the poorest countries in the world, Malawi's palliative care system is under-resourced, and one-third of the population is food-insecure. Aims This study describes the lived experience of female palliative care patients, and their caregivers, and aimed to: (1) analyse their physical, spiritual and mental health needs; and (2) analyse best palliative nursing practice for patients at the end of life. An unexpected finding was the impact of food insecurity on the women and their caregivers. Methods We conducted interviews with 26 women who at the end of life and 14 of their caregivers. All were participating in a community palliative care programme offered by an AIDS support organisation in Kasungu, Malawi. We used deductive qualitative analysis to organise identified themes using the four pillars of food security: availability, access, utilisation and stability. Findings All study participants experienced challenges with food security. Conclusions We offer policy recommendations for palliative care nurses, and other allied health professionals.

A black dog enters the home: hunger and malnutrition in Malawi

“…While women were aware of the health impacts of the lack of dietary diversity, women and men both shared that it was the woman’s responsibility to prepare food. In Malawi, and in many other parts of the world, women have the primary responsibility for preparing household food (Dressel et al 2020, 373). Women’s productive roles mentioned during this study depict the gender imbalance in the distribution of household chores, including food preparation, which can impact household nutrition security.…”

“…Family physicians are also trained to work with nurses and other allied health professionals such as health surveillance assistants (HSAs) (Makwero, Lutala, and McDonald 2017, 315). HSAs provide nutrition education in rural areas, and support nurses in health promotion efforts (Dressel et al 2020, 372). Increasing the number of physicians practising family medicine in Malawi and strengthening interprofessional collaborations among physicians, nurses, HSAs and nutritionists, could help to address hunger and malnutrition among rural communities in Malawi.…”

“…Finally, Malawi has been experiencing alternating periods of drought and flooding in recent years, which destroy crops, and has been identified as one of the countries most vulnerable to the impacts of climate change (Warnatzsch and Reay 2019, 379). Climate change impacts food security, which encompasses food availability, economic and physical access to food, utilisation of food including nutrient uptake, and sustainability of the food supply (Dressel et al 2020, 375).…”