From Evidence to Action: Addressing Micronutrient Gaps among Women of Reproductive Age in Malawi Using the Comprehensive Nutrient Gap Assessment Framework

Abstract

Background

Despite limited and irregular micronutrient data collection in resource-poor countries like Malawi, existing evidence remains underutilized despite its potential to guide policies and programs addressing persistently high micronutrient deficiencies.

Objectives

This study applied the Comprehensive Nutrient Gap Assessment (CONGA) methodology to identify priority micronutrient gaps among Malawian women of reproductive age (WRA) and to determine locally available foods capable of substantially contributing to closing these gaps.

Methods

The assessment followed CONGA procedures and included the following: 1) a systematic review of existing micronutrient data; 2) weighted scoring of available evidence using criteria of recency, representativeness, relevance, and sample size; 3) quantitative and qualitative evaluation of nutrient burden; and 4) classification of each nutrient as having a clear (consistent evidence) or potential (inconclusive evidence) gap. To identify food-based solutions, household consumption data from the 2019‒2020 Malawi Fifth Integrated Household Survey (n = 9296 WRA households) were analyzed using the adult female equivalent metric to determine locally available foods with the potential to provide ≥50% of WRA micronutrient requirements per 100 g edible portion.

Results

Clear micronutrient gaps were identified for calcium, iron, selenium, and zinc, whereas potential gaps were found for vitamin B1, vitamin B12, vitamin C, and phosphorus. Small fish, gathered wild greens, and dairy emerged as nutrient-dense foods capable of addressing several of these gaps; however, their current consumption remains low. Cereals and vegetables constituted the most consumed foods among WRA households, yet they were insufficient to meet requirements.

Conclusions

Substantial micronutrient gaps persist among Malawian WRA, emphasizing the need for targeted interventions to improve access to and intake of nutrient-rich foods. Priority actions include strengthening nutrition education and dietary diversification, increasing the availability and affordability of nutrient-dense foods, and expanding fortification and biofortification initiatives. Further research is required to clarify the burden associated with micronutrients classified as having potential gaps.