Malawi's Nutrition Landscape and the Unfolding Challenges

Despite some significant progress over the past two decades, Malawi still has the highest level of chronic childhood undernutrition (stunting prevalence 37.1%) in the Southern Africa region and nearly two out of three children under five years old suffer from anaemia (Bernstein & Wiesmann, 2019; Clara Chikhungu, 2022; and NSO & ICF, 2017). In addition, one in every four cases of young child mortality in Malawi is linked to undernutrition (UNICEF, 2018). While there can be many reasons in a country for the high burden of malnutrition, widespread poverty, nutritionally poor diet, infectious diseases, and over-dependence on maize as a staple food are the predominant underlying causes of malnutrition in Malawi. To make matter worse, since early 2021, Malawi has been witnessing a sharp rise in food prices (Rana et al., 2023).

While the escalating costs of food are concerning in themselves, their implications extend beyond mere economic burdens. The fundamental question of affordability comes to the forefront. Is the nutritious diet, even at its lowest possible cost, accessible to the people of Malawi? In this blog post, we'll present the findings from our ongoing Cost of the Diet (CotD) analysis in Malawi, spotlighting the shifts in the cost and accessibility of a nutritious diet in the post-pandemic era.

Employing the Cost of the Diet (CotD) Approach and Software for In-Depth Analysis

We conducted a longitudinal examination of Malawi's food landscape using the Cost of the Diet (CotD) research method and software. The CotD software contains five databases: the energy and nutrient content of foods; the energy and nutrient specifications of individuals; predefined groups of individuals in typical households; the portion sizes of foods; and currency conversion factors (Deptford et al., 2017). During the analysis, primary data was presented to a linear programming solver within the software, which in combination with the internal databases, estimated the amount and combination of local foods that were needed to provide the target individuals and households with a diet that meets their average needs for energy and their recommended intakes of protein, fat and micronutrients. For this study, we examined the monthly prices of 29 essential food items across 77 markets in 25 districts from April 2021 to July 2023. We obtained this data from the Minimum Expenditure Basket provided by the World Food Programme.

Escalating Food Prices and the Soaring Cost of Nutritious Diets

As shown in Figure 1, during the study period, staple foods like maize witnessed an astronomical 357% increase, soaring from MWK 131 per kg in April 2021 to an astonishing MWK 601 per kg in July 2023. Rice and cassava prices rose by 150% and 137%, respectively, during the same period. Fish prices showed increments ranging from 80% to 139%, eggs doubled in price, and vegetables faced varying increases. While some leafy vegetables saw spikes of up to 200%, tomatoes' prices almost quadrupled with a staggering 273% increase. The cost of vegetable oil surged by 190% in 2022, culminating in a 161% increase by July 2023.

As expected, the escalating food prices directly impacted the cost of a nutritious diet, as depicted in Figure 2. Our study estimated the monthly expenses for a nutritious diet, catering to a standard family of five members at the lowest feasible cost. This diet fulfils the energy, protein, fat, nine vitamins, and four minerals requirements of all family members. Starting at MWK 72K in April 2021, the monthly cost surged to MWK 173K by July 2023, indicating a 141% increase.

Navigating Affordability Challenges

While the escalating costs of food are concerning in themselves, their implications extend beyond mere economic burdens. The fundamental question of affordability comes to the forefront. Is the nutritious diet, even at its lowest possible cost, accessible to the people of Malawi? To delve into this, the affordability of the diet was calculated by subtracting the cost of the nutritious diet along with non-food expenditures from the total income, thus shedding light on the financial gaps faced by different household types.

Results shown in Figure 3, clearly shows that, the cheapest possible nutritious diet was out of reach for an average Malawian household even at the beginning of the study and with time this situation worsened over the next 28 months of the study period. In April 2021, households faced a modest MWK 6K gap between income and combined expenses, accounting for a 6% affordability gap. However, by July 2023, this gap had surged to MWK 84K, marking a substantial 58% affordability gap relative to monthly household income.

So, what's next?

The widening affordability gap observed during the study not only continues but is expected to worsen post-study, as indicated by FEWSNET until March 2024. Malawi, already grappling with cyclones, economic challenges, and past food price hikes, now faces a critical juncture due to ongoing food price inflations and the expanding affordability gap. Urgent, coordinated efforts at the national level are essential to ensure access to healthy food, particularly for the most vulnerable populations. Prioritising pregnant women, young infants, and asset-poor households is crucial. Implementing cash and/or nutritious food transfers, along with effective communication and adjustments for inflation, can help prevent undernutrition. Investments in nutrition surveillance, early warning systems, and the monitoring and treatment of severe acute malnutrition are imperative in light of escalating food price volatility.

Ways to learn more

The results provided are from an ongoing study report currently in the finalization stage. Once complete, the full report will be accessible at the Save the Children Resource Centre. For a more detailed understanding of the Cost of the Diet (CotD) method and software, kindly refer to the CotD webpage.

Masud Rana will elaborate on the results described in this blog during the April Research Roundtable for the Research Community on Food Access. Join us on April 17 for a lively and informative discussion. 

References

Bernstein, J., & Wiesmann, D. (2019). Global Hunger Index (GHI): A closer look at hunger and undernutrition in Malawi. Concern Worldwide & Welthungerhilfe. https://www.globalhungerindex.org/pdf/en/2018/case-study-malawi.pdf

Clara Chikhungu, L. (2022). Trends and patterns of stunted only and stunted-underweight children in Malawi: A confirmation for child nutrition practitioners to continue focusing on stunting. Malawi Medical Journal, 34(2), 111–117. https://doi.org/10.4314/mmj.v34i2.6

Deptford, A., Allieri, T., Childs, R., Damu, C., Ferguson, E., Hilton, J., Parham, P., Perry, A., Rees, A., Seddon, J., & Hall, A. (2017). Cost of the Diet: A method and software to calculate the lowest cost of meeting recommended intakes of energy and nutrients from local foods. BMC Nutrition, 3(1), Article 1. https://doi.org/10.1186/s40795-017-0136-4

NSO & ICF. (2017). Malawi Demographic and Health Survey 2015-16. National Statistical Office (NSO) [Malawi], and ICF International. https://dhsprogram.com/pubs/pdf/FR319/FR319.pdf

Rana, M. M., Roschnik, N., Taiwo, O. C., Kulemba, A., Dambuleni, D., & Phiri, B. (2023). The trends and effects of food price inflation on the cost and affordability of nutritionally adequate diets in Malawi. World Nutrition, 14(3), 3–13. https://doi.org/10.26596/wn.20231433-13

UNICEF. (2018). Nutrition Statistics in Malawi: Updates from the national Integrated Nutrition and Food Security Surveillance (INFSS) System. Unicef Malawi. https://www.unicef.org/malawi/media/601/file/Nutrition%20Statistics%20Factsheet%202018.pd