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Vitamin A deficiency is a global health challenge, particularly in the developing world. Diet based approaches, using locally available foods, are recommended for providing long term, sustainable solutions. The ProFarmer project, initiated in Malawi, encouraged local farmers to re-adopt landrace crop varieties. Orange maize was used as a case study. Over time, reintroducing this carotenoid-rich crop is predicted to increase provitamin A content in the Malawian diet. Furthermore, it is considered a relatively simple, cost-effective approach that has the potential to reduce dependence on food fortification. This study was aimed at evaluating the impact of the reintroduction of landrace orange maize on nutrition knowledge, attitudes and behaviours (KAB) in women of farming families that currently cultivate the crop. Women were selected, as they are largely responsible for food preparation and providing healthy foods for their families. Additionally, the overall diet adequacy in women living in rural Malawi was assessed. A total of 336 females took part in the cross-sectional study. Before the study, the participating farming families underwent a training program run by local Agriculture Extension workers prior to receiving seeds for cultivation. The training included an explanation of the rationale behind reintroducing landrace maize and nutrition education regarding the health aspects of providing provitamin A through locally grown foods. Families that had recently joined the project and families that had already harvested the crop in previous years were included in the study sample. A semi-structured questionnaire was used to determine KAB regarding orange maize. Diet quality was also assessed using the FAO Minimum Dietary Diversity questionnaire (MDD-W) designed for women. Independent t-tests and Chi-square tests were performed where appropriate. Positive attitudes towards growing and consuming landrace orange maize were recorded. However, only 32% of the women understood the nutritional benefits. Dietary Diversity scores, a proxy for nutrient adequacy, were low with only 34% of women consuming a sufficiently diverse diet. Despite low levels of nutritional knowledge, landrace orange maize was well accepted by families in rural Malawi and presents an affordable, sustainable option for increasing dietary sources of provitamin A. Nutrition education emphasizing the advantages of eating orange maize and expanding diet diversity is recommended in Malawi. [ABSTRACT FROM AUTHOR]

Background: Low food security is common among people with HIV (PWH) and is associated with poorer health outcomes. Frailty, an aging-related outcome that is increasingly prevalent among PWH, may be stimulated by low food security. We assessed associations between food security and frailty among PWH., Methods: The Impact of Physical Activity Routines and Dietary Intake on the Longitudinal Symptom Experience of People Living with HIV (PROSPER-HIV) study follows PWH to evaluate how diet and physical activity impact symptoms. We utilized food security and frailty data from PROSPER-HIV Year 1 visits (January 2019 to July 2022) to estimate associations. Food security was measured via the validated two-item Food Security Questionnaire and categorized as Food Secure, Low Food Security, or Very Low Food Security. Frailty was measured with the Fried frailty phenotype, and categorized as robust, prefrail, and frail. We used relative risk regression to estimate associations between food security and frailty status, adjusted for demographic characteristics., Results: Among 574 PWH, nearly one-quarter were women (22%), mean age was 52 years old, 8% were frail, and 46% prefrail. Low food security was reported among nearly one-third of PWH: 13% Low Food Security and 18% Very Low Food Security. Compared with being Food Secure, we found Low Food Security was associated with frailty [prevalence ratio: 4.06 (95% confidence interval (CI) 2.16-7.62] and Very Low Food Security was associated with both prefrailty [1.48 (1.23-1.78)] and frailty [5.61 (3.14-10.0)], as compared with robust status., Conclusion: Low food security was associated with increased frailty among PWH in this study, suggesting a potential intervention point to promote healthy aging., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

This study examined modifiable caregiver factors influencing child development in Malawi using baseline data from 1,021 mothers and their children <2 years of age participating in a cluster-randomized controlled trial implemented in rural Malawi (2022-2025). We fit an evidence-based theoretical model using structural equation modelling examining four caregiver factors: (1) diet diversity (sum of food groups consumed in the past 24 h), (2) empowerment (assessed using the project-level Women's Empowerment in Agriculture Index), (3) mental health (assessed using the Self-Reported Questionnaire, SRQ-20), and (4) stimulation (number of stimulation activities the mother engaged in the past 3 days). Child development was assessed using the Malawi Development Assessment Tool (norm-referenced aggregate Z-score). The model controlled for child, caregiver, and household socioeconomic characteristics. Results showed that caregiver dietary diversity was directly associated with higher child development scores (standardized coefficient 0.091 [95% CI 0.027, 0.153]) and lower SRQ-20 scores -0.058 (-0.111, -0.006). Empowerment was directly associated with higher child development scores (0.071 [0.007, 0.133]), higher stimulation score (0.074 [0.013, 0.140]), higher dietary diversity (0.085 [0.016, 0.145]), and lower SRQ-20 scores (-0.068 [-0.137, -0.002]). Further, higher empowerment was indirectly associated with improved child development through enhancement of caregiver dietary diversity, with an indirect effect of 0.008 (0.002, 0.018). These findings highlight the important role that caregiver diet and empowerment play in directly influencing child development and other aspects of caregiver well-being. Interventions aimed at enhancing child development should consider these factors as potential targets to improve outcomes for children and caregivers., (© 2024 The Author(s). Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

We analyse household resilience capacities during the COVID-19 pandemic in the fishing communities along Lake Malawi by using FAO's resilience index measurement assessment (RIMA) methodology. The study is based on a sample of 400 households, and we employ the multiple indicators multiple causes (MIMIC) model to estimate resilience capacities. The model uses household food security indicators as development outcomes. Our findings show that the COVID-19 pandemic significantly reduces household food security and resilience capacity. COVID-19 shocks that significantly reduce household resilience capacities are death and illness of a household member. Important pillars for resilience building are assets, access to basic services and adaptive capacity. These findings point to the need to build assets of the households, build their adaptive capacity, and identify innovative ways of improving access to basic services to build household resilience capacities in the fishing communities. We recommend providing external support to households that have been directly affected by the pandemic through the death or illness of a member because their capacities to bounce back on their own significantly declines., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Elsevier Ltd. All rights reserved.)

Background: Young children in Malawi consume low-quality diets lacking micronutrients critical for their development., Objective: To evaluate the impact of an agriculture and nutrition behavior change communication (BCC) intervention implemented through community-based childcare centers on the nutrient adequacy of diets of children living in food-insecure settings in Malawi., Methods: A cluster randomized trial was undertaken in 60 community-based childcare centers, including 1248 children aged 3-6 y. Nutrient intakes were estimated using interactive, multipass 24-h recall. Dietary adequacy was estimated through the probability of adequacy (PA) and mean probability of adequacy (MPA) of 11 micronutrients. Impacts were assessed by difference-in-difference (DID) estimates, adjusted for geographic clustering and child age and sex., Results: Intervention groups were similar for most baseline characteristics. Loss to follow-up was low (7% over a 12-mo period) and participation in the intervention was high (>90% enrollment and 80% attendance during the 5 d before the survey). Positive impacts were found for the PA of several individual micronutrient intakes: vitamin A [DID: 9 percentage points (pp), SE 3 pp], vitamin C (14 pp, SE 3 pp), riboflavin (11 pp, SE 3 pp), zinc (8 pp, SE 3 pp), and for the MPA for the 11 nutrients considered (5 pp, SE 1 pp). These impacts were driven by effects on younger children (aged 3-4 y)., Conclusions: Using a preschool platform to implement a nutrition-sensitive BCC intervention is an effective strategy to improve the adequacy of micronutrient intake of preschool children in food-insecure settings. The trial was registered at ISCRCTN as ISCRCTN96497560., (Copyright © American Society for Nutrition 2019.)

Microbiological quality of smoked catfish ( Clarias gariepinus ) locally known as Mlamba was assessed in this study where traditional and improved smoking kilns were used to smoke fish. Catfish is common fish caught in abundance in the Lake Chilwa basin, and the fish is usually smoked to reduce postharvest losses and increase shelf life. Samples were collected in sterile polythene bags, well labeled, and collected in cooler boxes transported ready for laboratory analysis. One gram representative sample was obtained aseptically from the muscle of the fresh and smoked catfish (Mlamba) samples. The samples were grounded, and fourfold serial dilutions (10 -1 -10 -4 ) of the homogenized samples were made using sterile distilled water. Fish samples were analyzed for total plate count (TPC), Escherichia coli counts, and pathogenic organisms ( Salmonella ) following the methods prescribed by AOAC (Official methods of analysis, Association of Official Analytical Chemistry, Arlington, VA, 2000). Each analysis was carried out in triplicates. There were significant differences ( p  = 0.05), with respect to total viable bacterial counts between traditional kiln smoked and improved kiln smoked catfish (5.6 × 10 6  cfu/g, 1.9 × 10 6  cfu/g, respectively). Traditional kiln smoked catfish harbored significantly higher total viable counts as well as a higher population of E. coli compared to improved kiln smoked catfish. However, for both types of smoking kilns there were detected levels of pathogenic bacteria Salmonella with traditional kiln smoked catfish containing 2.1 × 10 4  cfu/g which were significantly higher than amount found in improved kiln smoked catfish (1.5 × 10 4  cfu/g; p  = 0.05). Salmonella is a microbe of public health importance and has implications on the handling and source of the fish.

Background: Children in Malawi face nutritional risks related to low-quality diets and chronic malnutrition., Objective: This study evaluated the impact of a 1-y early childhood development (ECD) center-based agriculture and nutrition intervention aimed at improving household production diversity, maternal knowledge on child nutrition and feeding practices, and children's diets and anthropometric measures., Methods: A longitudinal cluster-randomized controlled trial was implemented in 60 community-based childcare centers (CBCCs), covering 1248 preschool children (aged 36-72 mo) and 304 younger siblings (aged 6-24 mo). CBCCs were randomly assigned to 1) a control group providing the Save the Children's ECD program or 2) a treatment group providing a standard ECD program with additional activities to improve nutritious food production and behavior change communication to improve diets and care practices for young children. Primary outcomes were household production and production diversity, preschooler enrollment and attendance, and dietary intake measured by quantitative 24-h recall and minimum diet diversity for younger siblings. Secondary outcomes included anthropometric measures for preschoolers and younger siblings, child development scores for preschoolers, and women's asset ownership and time use (the latter 2 are not discussed in this article). We used difference-in-difference (DID) estimates to assess impacts., Results: Compared with the control group, preschool children in the intervention group had greater increases in nutrient intakes and in dietary diversity. No impacts on anthropometric measures were seen in preschoolers. Younger siblings in the intervention group had greater increases in height-for-age z scores than did children in the control group (DID: 0.44; P < 0.05) and greater reductions in the prevalence of stunting (DID: -17 percentage points; P < 0.05). The plausibility of the impact on growth in younger siblings was supported by effects along program impact pathways, including production of nutritious foods, caregiver knowledge, and dietary diversity., Conclusion: Implementing an integrated agriculture and nutrition intervention through an ECD platform benefited children's diets and reduced stunting among younger siblings of targeted preschoolers. This trial was registered on the ISRCTN registry as ISCRCTN96497560.

This paper assesses the relationship between agroecology, food security, and human health. Specifically, we ask if agroecology can lead to improved food security and human health among vulnerable smallholder farmers in semi-humid tropical Africa. The empirical evidence comes from a cross-sectional household survey (n=1000) in two districts in Malawi, a small country in semi-humid, tropical Africa. The survey consisted of 571 agroecology-adoption and 429 non-agroecology-adoption households. Ordered logistics regression and average treatment effects models were used to determine the effect of agroecology adoption on self-reported health. Our results show that agroecology-adoption households (OR=1.37, p=0.05) were more likely to report optimal health status, and the average treatment effect shows that adopters were 12% more likely to be in optimal health. Furthermore, being moderately food insecure (OR=0.59, p=0.05) and severely food insecure (OR=0.89, p=0.10) were associated with less likelihood of reporting optimal health status. The paper concludes that with the adoption of agroecology in the semi-humid tropics, it is possible for households to diversify their crops and diets, a condition that has strong implications for improved food security, good nutrition and human health., (Copyright © 2016 Elsevier B.V. All rights reserved.)

The aims of the current work were: (1) to study the influence of variety and geographical production area on the total phenolic content, total anthocyanin content, total flavonoid content, total carotenoid content and antioxidant activity in bean varieties (Dimeta, Napirira and Nanyati) from different growing areas in central Malawi, and (2) to evaluate the possibility of establishing a classification based on the geographical areas of the growing regions. A total of 47 bean samples were collected from Makowe, Mphathi, Chuma-Chitsala and Khulungira Zone. These four locations were segregated based on altitude, latitude and longitude. Principal component and hierarchical cluster analysis were used to distinguish and classify among these samples. Significant differences (P < 0.05) in total phenolic content (2.92-4.97 mg/g), total anthocyanin content (14.52-152.31 μg/g), total flavonoid content (2.01-6.38 mg/g) and oxygen radical absorbance capacity (16.75-24.51 μmol/g) were found among the different sampled villages, showing a significant effect of the producing region on these parameters. The beans in Makowe had lower polyphenols than in other locations. Results of principal component analysis indicate that phytochemicals and antioxidant capacity could serve as parameters to establish a bean classification according to the geographical area of production.

The provitamin A potential of landrace orange maize from different locations (A, B, C and D) of central Malawi has been evaluated. Physicochemical compositions, color, total carotenoid content (TCC), carotenoid profiles, and oxygen radical absorbance capacity (ORAC) and 2,2-diphenyl-1-picryhydrazyl (DPPH) free radical scavenging activity as antioxidant capacities of maize were determined. Color values of orange maize had correlations with β-cryptoxanthin (r>0.36). TCC of white and orange maize averaged 2.12 and 59.5 mg/kg, respectively. Lutein was the most abundant carotenoid (47.8%) in orange maize, followed by zeaxanthin (24.2%), β-carotene (16.4%) and β-cryptoxanthin (11.6%). Location D showed the highest levels of lutein, zeaxanthin and antioxidant capacity. Provitamin A content of orange maize met the target level (15 μg/g) of biofortification. Retinol activity equivalent (RAE) from β-cryptoxanthin and β-carotene in orange maize averaged 81.73 μg/100g. In conclusion, orange maize has the potential to be a natural source of provitamin A., (Copyright © 2015 Elsevier Ltd. All rights reserved.)