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

• Author: Andrew D. Jones
• DOI: http://doi.org/10.1002/wmh3.152
• Published date: 01 September 2015
• Date: 01 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

Introduction

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

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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