Association between household food insecurity and dietary diversity among pregnant and lactating women in rural Malawi
Authors: Kang Yunhee , Hurley Kristen , Monclus Assumpta Bou , Ruel‐Bergeron Julie , Oemcke Rachel , Wu Lee Shu Fune , Mitra Maithilee , Phuka John , Klemm Rolf , West Keith , Christian Parul 
Published: November 2023

Pregnant and lactating women (PLW) in resource‐poor settings have low quality diets likely due to limited food access and availability. However, few studies have explored the associations between dietary diversity and food insecurity in such settings. Using data from an impact evaluation study of a large nutrition program being conducted in a rural district in Malawi, this cross‐sectional analysis examined the association between the Household Food Insecurity Access Scale (HFIAS, range: 0–27; high score represents higher food insecurity), dietary diversity scores (DDS, range: 0–9), low dietary diversity (DDS≤3; the median of DDS or below) and consumption of 9 food groups among pregnant (n=589) and lactating women (n=641). The 9 food groups, referenced by FAO, included grains, dark green leafy vegetables, vitamin A‐rich fruits and vegetables, other fruits and vegetables, organ meat, meat/fish, eggs, legumes, and dairy foods. Multivariate linear or logistic regression was applied adjusting for potential confounding factors including household size, household wealth status, types of drinking water sources, women's age, education, occupation, and marriage status, and geographical clustering. The mean (±SD) of HFIAS was 9.3 (± 6.7) in the pregnant and 9.7 (± 6.8) in the lactating women. Dietary diversity score (DDS) was low at 2.9 (± 1.1) and 2.8 (± 1.0) out of 9 points in pregnant and lactating mothers, respectively. 74.5% of the pregnant and 77.5% of the lactating women consumed 3 or less food groups in the past 24 hours. Among pregnant women, an increase of one point in the HFIAS was related to a decrease of 0.02 in the DDS (p=0.004). An increase of one point in HFIAS was associated with 6% higher odds of consuming 3 or less food groups (OR=1.06; p=0.004) and 8% higher odds of not consuming both meat (OR=1.08; p=0.05) and eggs (OR=1.08; p=0.06). However, the HFIAS was not associated with the likelihood of not consuming the remaining six food groups (all p>0.10). Among lactating women, an increase of one point in the HFIAS was associated with a decrease of 0.03 in the DDS (p<0.001) and 8% higher odds of consuming 3 or less food groups (OR=1.08; p=0.004). An increase of one point in the HFIAS was related to 5%, 9%, 12%, 3%, and 20% higher odds of not consuming other fruits and vegetables (OR=1.05), meat/fish (OR=1.09), eggs (OR=1.12), legumes (OR=0.03), and dairy (OR=1.20), respectively [all p<0.05; except for legumes (p=0.08)], but not significantly associated with the likelihood of not consuming grains, dark green leafy vegetables, vitamin A‐rich fruits and vegetables, and organ meat (all p>0.10). Food insecurity was associated with low dietary diversity among PLW in rural Malawi. Efforts to improve household food security may complement nutrition education activities targeting PLW in rural Malawi.Support or Funding InformationThis study was supported by Children's Investment Fund Foundation, UK.