Household Food Insecurity and Complementary Feeding in Malawi

Objective The World Health Organization (WHO) recognizes inadequate complementary feeding (CF) practices, including infrequent feeding, lack of dietary diversity, thin food consistency, and insufficient volume, as a cause of stunted growth and development. The purpose of this study is to identify associations between household food security and CF practices in Malawi, and to identify associations between CF practices and length‐for‐age z‐scores (LAZ). Methods Households in the Mchinji District, Malawi with at least one child aged 6 to 17 months were considered eligible for participation in a child feeding survey, which assessed household sociodemographic information, food security status, infant and young child feeding practices, and anthropometric measurements. To estimate volume, caregivers used rice and their child's feeding dish to demonstrate food volume at a typical meal; rice was then transferred to a measurement cylinder. To estimate food consistency, caregivers were shown five photographs of local porridge of varying consistency and were asked to identify which most closely matched food typically given to their child. Logistic regression models were used to identify associations between household food security and meeting WHO CF recommendations, while controlling for covariates. Linear regression models were used to identify associations of household food security and feeding volume, as well as for CF practices and LAZ, controlling for covariates. Results Moderate or severe household food insecurity was associated with failure to meet WHO recommendations for meal frequency (OR=1.65, 95% CI 1.20, 2.26) and dietary diversity (OR=2.57, 95% CI 1.84, 3.60), but not with food consistency (OR= 1.18, 95% CI 0.88, 1.57). There was no observed association between household food insecurity and volume. An analysis of variance was used to explore food consistency, meal frequency and volume. Among 6 to 8 month old infants, both thin food consistency and inadequate meal frequency corresponded to lower food volume (p=0.005 and 0.01, respectively), but no significant relationships were observed for other ages. In a multivariable linear regression model controlling for covariates, increasing food volume was significantly associated with greater LAZ (p=0.0002). No other CF practices were significantly associated with LAZ. Conclusion These results highlight the need for providing timely and age‐specific education and effective interventions related to CF recommendations, but also suggest that household food insecurity may contribute to caregivers’ inability to follow some CF recommendations. The practices of providing too thin or too few meals per day are not compensated with increased volume per meal, and in the youngest age category, are associated with lowest food volume. There is evidence that food volume is positively associated with LAZ, but the effect of other CF practices is unclear. Results of this baseline survey warrant further exploration of determinants and outcomes of CF practices in low income countries. Support or Funding Information Financial support for this research was provided by the Support for Nutrition Improvement Component A of the Republic of Malawi Nutrition, HIV, and AIDS Project, funded by The World Bank.