Weight gain, physical activity and dietary changes during the seven months of first-year university life in Malawi

Objective: The objective of the study was to assess weight gain, physical activity and dietary changes during the first year of university lifein Malawi.Setting: The setting was Bunda College of Agriculture, University of Malawi.Subjects: The subjects were first-year students (n = 47) enrolled for the 2008/2009 academic year.Method: A prospective cohort study was carried out, with repeated measures (November 2008 and June 2009). It included residentialand nonresidential students. Data were collected using self-administered structured questionnaires. Weight, height and mid-upper-armcircumference were measured.Results: There was a significant difference in mean weight gain between female (7.1 ± 3.2 kg, n = 26) and male students (9.6 ± 3.5 kg,n = 21) (p-value = 0.013). Overall, within the first year of university life, the students gained 8.5 ± 3.6 kg (p-value < 0.001), and a modestbut significant height of 0.2 cm (p-value = 0.04). Body mass index (kg/m2) increased from 20.7 ± 3.2 to 23.9 ± 3.2 (p-value < 0.001). Atthe baseline, in general, the students lived sedentary lives, with 6.6 hours spent resting, 2.1 hours engaged in light activities, and 0.9 hoursengaged in heavy activities. No significant changes were observed at the end of the study. Daily consumption of wheat products, meat andmeat products, sugar, milk and milk products and margarine increased, while that of other foods such as fish, and fruits and vegetablesdeclined.Conclusion: Unprecedented freshman weight gain was observed in this study. Transition to university life in Malawi might be the beginningof poor dietary and lifestyle changes. If not restrained, these could elevate the risk of lifestyle diseases in people who have attained tertiaryeducation and who are important to national development

Consumption and wastage of home-fortified maize flour products in northern Malawi

Objective: The objective of the study was to determine the amount of home fortified maize flour products consumed and wasted by women aged 15-49 years, and children aged ≤ 5 years.Design: This was a descriptive cross-sectional study.Setting: The study took place in Ekwendeni, a home fortification project area in Mzimba District, Northern Region, Malawi.Subjects: The study subjects were members of a random sample of 205 households practising home fortification.Outcome measures: The study’s outcome measures included weighing fortified nsima, a thick maize flour-based porridge which was consumed, and its leftovers, using a kitchen scale. Using systematic random sampling, fortified maize flour and nsima samples were collected from households for energy, iron, zinc and vitamin A analysis. The data were analysed using descriptive statistics.Results: The food intake and plate waste of fortified food products pertaining to 94 children (49% male and 51% female) and 173 women was analysed. Predominantly, nsima (55%) was the main food product made from fortified maize flour. Other foods were porridge and chigumu, whole maize flour-based bread. Overall, the daily average consumption of fortified foods (nsima, porridge and chigumu) was 332 g/day for children, and 1011 g/day for women. Plate waste accounted for 25% of the food served to the children, and 12% served to the women. Discarding fortified nsima resulted in a 23% loss of energy and micronutrients in the children, and a 11.2% loss in the women.Conclusion: Commonly consumed home-fortified maize flour products were nsima, porridge and chigumu. The plate waste of the fortified foods, primarily nsima, resulted in considerable loss of energy and micronutrients, especially in the children. Home-fortification interventions should include nutrition messages on food budgeting to minimise food and nutrient losses in women and children in northern Malawi.Keywords: home fortification, Malawi, micronutrients, plate waste, nsim

Dietary mineral supplies in Malawi: spatial and socioeconomic assessment

Background Dietary mineral deficiencies are widespread globally causing a large disease burden. However, estimates of deficiency prevalence are often only available at national scales or for small population sub-groups with limited relevance for policy makers. Methods This study combines food supply data from the Third Integrated Household Survey of Malawi with locally-generated food crop composition data to derive estimates of dietary mineral supplies and prevalence of inadequate intakes in Malawi. Results We estimate that >50 % of households in Malawi are at risk of energy, calcium (Ca), selenium (Se) and/or zinc (Zn) deficiencies due to inadequate dietary supplies, but supplies of iron (Fe), copper (Cu) and magnesium (Mg) are adequate for >80 % of households. Adequacy of iodine (I) is contingent on the use of iodised salt with 80 % of rural households living on low-pH soils had inadequate dietary Se supplies compared to 55 % on calcareous soils; concurrent inadequate supplies of Ca, Se and Zn were observed in >80 % of the poorest rural households living in areas with non-calcareous soils. Prevalence of inadequate dietary supplies was greater in rural than urban households for all nutrients except Fe. Interventions to address dietary mineral deficiencies were assessed. For example, an agronomic biofortification strategy could reduce the prevalence of inadequate dietary Se supplies from 82 to 14 % of households living in areas with low-pH soils, including from 95 to 21 % for the poorest subset of those households. If currently-used fertiliser alone were enriched with Se then the prevalence of inadequate supplies would fall from 82 to 57 % with a cost per alleviated case of dietary Se deficiency of ~ US$ 0.36 year−1. Conclusions Household surveys can provide useful insights into the prevalence and underlying causes of dietary mineral deficiencies, allowing disaggregation by spatial and socioeconomic criteria. Furthermore, impacts of potential interventions can be modelled

MATERNAL KNOWLEDGE AND PRACTICES RELATED TO ANAEMIA AND IRON SUPPLEMENTATION IN RURAL MALAWI: A CROSS- SECTIONAL STUDY

ABSTRACT Anaemia is a leading cause of maternal morbidity, mortality and poor birth outcomes in developing countries. In Malawi, education on anaemia and provision of prophylaxis iron supplements during pregnancy are key strategies that are used to reduce the high prevalence of anaemia in this population. Therefore, as part of Surveillance of Micronutrient Programmes in Malawi, a cross-sectional study was done to assess maternal knowledge and practices related to anaemia and iron supplementation in rural areas. A total of 629 (mean age 27.9 years) randomly selected women were interviewed in the Northern, Central and Southern regions using a pre-tested questionnaire. The data were entered in EpiInfo 6.04d and analyzed in SPSS 9.0 for Windows. The results showed that 96.6% of the women were aware of anaemia, with at least two thirds knowing its causes, ways of prevention, and treatment. As expected, health facilities are the primary source of iron supplements (97.1%). On whether or not pregnant women actually take the supplements, the study found that 22.5%, 29% and 33.8% of women from the Central, Northern and Southern regions, respectively reported taking the supplements for one month only during their most recent pregnancy (χ 2 =6.79, p=0.009). Overall, about 9% reported taking the supplements throughout pregnancy, but the proportion was higher (22.5%) in the Central than the Southern (2.5%) and Northern (0.5%) regions. The single most important reason for non-compliance was nausea (43.6%), with 34.9% of those reporting nausea resorting to withdrawal. On a positive note, 47.4% of women from the Southern region reported taking the supplements with nsima (stiff maize gruel) to overcome nausea. Therefore, this study shows that Malawi's efforts to increase awareness on anaemia in women of reproductive age in rural areas are largely effective. However, non-compliance with iron supplementation is a big challenge which requires strategic planning and implementation of ways to ensure that pregnant women consistently take iron supplements throughout pregnancy

Soil-type influences human selenium status and underlies widespread selenium deficiency risks in Malawi

Selenium (Se) is an essential human micronutrient with critical roles in immune functioning and antioxidant defence. Estimates of dietary Se intakes and status are scarce for Africa although crop surveys indicate deficiency is probably widespread in Malawi. Here we show that Se deficiency is likely endemic in Malawi based on the Se status of adults consuming food from contrasting soil types. These data are consistent with food balance sheets and composition tables revealing that >80% of the Malawi population is at risk of dietary Se inadequacy. Risk of dietary Se inadequacy is >60% in seven other countries in Southern Africa, and 22% across Africa as a whole. Given that most Malawi soils cannot supply sufficient Se to crops for adequate human nutrition, the cost and benefits of interventions to alleviate Se deficiency should be determined; for example, Se-enriched nitrogen fertilisers could be adopted as in Finland