The risk of dietary multiple micronutrient inadequacies is widespread and geographically varied in Malawi.

Abstract

Background: In resource-constrained settings, routine assessment of micronutrient deficiencies is often limited to a small set of priority nutrients due to the high cost and complexity of biomarker-based surveys. The objective of this study was to estimate the risk of inadequate apparent intake for 15 micronutrients in Malawi, disaggregated by wealth group and geographic location, using Household Consumption and Expenditure Survey (HCES) data.

Methods: We used food consumption data from Malawi's Fifth Integrated Household Survey (2019/20), matched with relevant food composition tables, to estimate apparent daily intake per adult female equivalent (AFE) - the reference individual used to apply micronutrient requirement cut-offs for 15 micronutrients: vitamins A, C, E, B1, B2, B3, B6, B9, B12, and minerals Ca, Cu, Fe, Mg, Se, and Zn. Intake estimates were compared against Harmonized Average Requirement values using a fixed cut-point method for all micronutrients except Fe, for which the full probability approach was applied.

Results: Nationally, inadequacy was widespread, with 12 of the 15 assessed micronutrients showing prevalence above 20%. These included vitamins A, B2, B3, B6, B9, B12, C, and E, and minerals Ca, Fe, Se, and Zn. Vitamin B2 and Ca had the highest inadequacy rates, both exceeding 87%. Inadequacies were most pronounced in central region districts and among poorer, rural households. Diets dominated by cereals and limited food diversity contributed to these patterns. Geographic disparities were evident, with some districts facing substantially higher risks than others.

Conclusions: The risk of dietary micronutrient inadequacies is widespread and geographically varied in Malawi. Expanding routine public health surveillance to include a wider range of micronutrients is essential for guiding targeted interventions and improving public health outcomes.