The Republic of Malawi is a landlocked country situated in South-eastern Africa. The country has very large fresh-water resources and a high agricultural potential. The population, very young and predominantly rural, is growing rapidly.
The Malawian economy is largely based on agriculture. Most of the population is engaged in the agricultural sector, which accounts for more than one third of GDP. Smallholder rain-fed maize production is largely predominant and the livestock sub-sector remains underdeveloped. Economic growth, highly dependent on the agricultural sector, is constrained by a high vulnerability to climatic shocks which affect the country frequently. Poverty is widespread in the rural population. Moreover, the incidence of poverty is not declining. Nevertheless, during the last two years the country has experienced bumper crops for maize due to favourable climatic conditions and an input subsidy scheme that has reached a very large number of small farmers.
The HIV/AIDS epidemic, infectious diseases, malnutrition and limited access to basic health care are among the major factors contributing to high infant and underfive mortality rates. The maternal mortality ratio remains unacceptably high. In a context of high morbidity and the HIV/AIDS epidemic, access to health services is still limited and the lack of material and human resources further constrains the quality of services.
The Malawian diet is mainly composed of cereals, primarily maize, starchy roots (cassava and potatoes) and starchy fruit (plantain). Fruits and vegetables complement the diet. Many factors, including adverse climatic conditions, low agricultural productivity and poverty, contribute to widespread food insecurity among the population, leading to severe food crises when natural or man-made shocks occur. Twice in the 1990s and in 2001-2002, Malawi was affected by drought-induced famine. In 2005, the country faced another serious food crisis during which about a third of the population was in need of food assistance. Overall, dietary energy supply is barely sufficient to meet population energy requirements and more than a third of the population is undernourished (latest estimates 2001-2003). Moreover, the diet lacks diversity and is poor in micronutrient-rich foods.
Although breastfeeding is universal and prolonged, some infant and young child feeding practices remain unsatisfactory. Exclusive breastfeeding up to six months of age is not widespread and complementary foods are insufficiently diversified. These inappropriate feeding practices, along with high morbidity, low access to health care, poverty and food insecurity explain the very high prevalence of chronic malnutrition that plagues Malawi, almost half of the children under-five years being stunted. Since the early 1990s, the nutritional status of young Malawian children has not improved. Undernutrition also affects women.
Micronutrient deficiencies are widespread. During the 1990s iodine deficiency disorders were identified as a public health problem (Northern and Central regions). More recent data are urgently needed. Universal salt iodization is implemented in the country, but coverage is insufficient and needs to be re-evaluated. A national survey conducted in 2001 showed subclinical signs of vitamin A deficiency to be highly prevalent among young children. Routine supplementation with vitamin A is implemented but programmes for ensuring a more adequate intake of vitamin A rich foods for vulnerable groups, i.e. women and young children, are lacking. Anemia affects almost three-quarters of children under five years and more than two women out of five. A high proportion of pregnant women receive iron supplementation but few take supplements consistently during pregnancy. Food-based strategies are lacking to improve the micronutrient status of the population in a sustainable way. The current favourable agricultural context is a unique opportunity for introducing agricultural diversification for improving the nutritional quality of diets.
The nutritional status of the Malawian population remains critical. Although short-term interventions such as supplementation and fortification still need to be reinforced, investment in long-term food based strategies is urgently needed.