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

AuthorAndrew D. Jones
Published date01 September 2015
Date01 September 2015
Household Food Insecurity Is Associated With
Heterogeneous Patterns of Diet Quality Across Urban
and Rural Regions of Malawi
Andrew D. Jones
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.
KEY WORDS: food security, dietary diversity, nutrition transition
Global food security has become an increasingly dominant priority for policy-
makers throughout the international community in recent years, exemplif‌ied by
the convening of the World Food Summit in Rome in 1996; a second World Food
Summit in 2002; and in 2008, the formation of the High Level Task Force on the
Global Food Security Crisis by the UN Secretary General. Food security is
achieved “when all people, at all times, have physical and economic access to
suff‌icient, safe and nutritious food to meet their dietary needs and food
preferences for an active and healthy life” (FAO, 1996). Research examining the
determinants of food insecurity has largely focused on rural food insecurity and
has primarily framed solutions to the problem in terms of increasing smallholder
World Medical & Health Policy, Vol. 7, No. 3, 2015
1948-4682 #2015 Policy Studies Organization
Published by Wiley Periodicals, Inc., 350 Main Street, Malden, MA 02148, USA, and 9600 Garsington Road, Oxford, OX4 2DQ.
agricultural production and expanding social safety net programs (Crush &
Frayn, 2010). These approaches are certainly a component of the broader strategy
needed to ensure food security across its four components (i.e., availability,
access, utilization, and stability). However, the unprecedented global increase in
urbanization in recent decades, and the nutrition transition that has accompanied
this demographic transition, requires a renewed focus on the quality of diets
across differing strata of food availability and access, and new perspectives for
understanding the potential nutritional consequences of food insecurity across
both rural and urban environments.
The nutrition transition is characterized in most countries by shifts in diets
toward increased consumption of processed and ref‌ined foods, sugar-sweetened
beverages (SSBs), and vegetable oils, as well as changing livelihoods that are
accompanied by more sedentary lifestyles (Popkin, Adair, & Ng, 2012). This
transition, to the extent that it will impact the quality and diversity of diets, could
potentially provide both opportunities and challenges for improving food
security. Food security requires not only physical and economic access to
adequate dietary energy, but also access to diets that are safe and that provide for
the nutritional needs of individuals (Jones, Agudo, Galway, Bentley, & Pinstrup-
Andersen, 2013). Achieving diverse diets has consistently been shown to improve
the nutritional adequacy of diets (Kant, 1996; Steyn, Nel, Nantel, Kennedy, &
Labadarios, 2006). Therefore, diet diversity is commonly used not only as an
indicator of dietary adequacy, but also of food security (Ruel, 2002). Households
whose diets are converging toward an increased reliance on ref‌ined staple grains,
processed foods, and vegetable oils may increasingly have access to foods that
they had rarely consumed previously—for example, meat and dairy products that
could serve as a rich source of bioavailable micronutrients (Kennedy, Nantel, &
Shetty, 2004). Low-income households, especially rural migrants to urban or peri-
urban regions, may similarly be experiencing this dietary convergence and have
increased access to new foods and food brands. However, while the diets of these
households may in fact ref‌lect an increased diversity of foods, these households
may have little or no economic access to animal-source foods or other nutrient-
rich foods such as fruits and vegetables that may contribute to more nutritionally
meaningful dietary diversity.
Very little research has differentiated the nutritional consequences of food
insecurity in rural as compared to urban regions of low- and middle-income
countries (LMICs) despite the potential for households to respond differently to
food insecurity based on available and accessible foods across differing food
environments (Crush & Frayne, 2010). Research in the United States and other
high-income countries has predominantly focused on urban populations where
food insecurity has been shown to be associated with overweight status and
higher body mass index (BMI) among women (Olson, 1999; Townsend, Peerson,
Love, Achterberg, & Murphy, 2001). In LMICs, however, the preponderance of
research has emphasized rural food insecurity, demonstrating that food insecurity
is associated with poorer anthropometric indices (i.e., height-for-age Z-score
[HAZ] and weight-for-age Z-score [WAZ]) (Tiwari, Skouf‌ias, & Sherpa, 2013),
Jones: Food Insecurity and Diet Quality 235

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