Understanding the Drivers of Food Choice and Barriers to Diet Diversity in Madagascar

Effects of Risk and Time Preferences on Diet Quality: Empirical Evidence from Rural Madagascar

Malnutrition is a major concern in Madagascar. Eating a wide variety of nutritious food is necessary because Malagasy diets heavily rely on rice consumption. This study explored the barriers to dietary change towards diversification from the perspective of consumer behaviour. We analysed the impact of risk and time preferences on dietary diversity using economic experiments conducted with 539 rural lowland rice farmers in Central Highlands in Madagascar. The results showed that risk-averse or impatient individuals were more likely to have lower Household Dietary Diversity Score (HDDS), indicating poorer diet quality. Risk-averse people may not want to add different foods to meals as they perceive unfamiliar food as a 'risk'; people who prefer immediate gratification may fail to invest in nutritious diets now to achieve better health in the future. Additionally, higher HDDS was observed among households with a female head who earned off-farm income and who had frequent market visits. These findings contribute to explaining the limited shift in nutritional transition in Madagascar and provide useful insights into nutritional policies promoting healthier food choices. Depending on the preferences, more focused support such as nutritional education, financial support, market development, and pre-commitment mechanisms could be provided to reward long-term nutritional benefits.

Evaluation of nutritional status using the minimum dietary diversity for women of reproductive age (MDD-W) tool in breastfeeding mothers in Madagascar

OBJECTIVES

Women of reproductive age in low-income countries are especially nutritionally vulnerable given the strain that pregnancy and lactation places on the body. The aim of this study was to identify dietary diversity and its associated factors among mothers with young children.

METHODS

It is a cross-sectional study conducted in Ampefy, Madagascar from 1 November 2022 to 31 March 2023. Dietary diversity was determined using the minimum dietary diversity for women of reproductive age tool. Data were collected through face-to-face interviews using validated structured questionnaires, and anthropometric status was examined. Frequencies and percentages were calculated, and the comparison of variables was performed between mothers with acceptable and unacceptable dietary diversity using the chi-square test for qualitative variables. A logistic regression analysis was also conducted.

RESULTS

A total of 437 mothers with young children participated in the study, resulting in a response rate of 95.0%. The mean age of the participants was 25.84 years (SD = 6.30). The study revealed that 32.95% of participants had unacceptable dietary diversity scores and the associated profile included low education, no transport, homebirth not by personal choice, not breastfeeding within the first hour of birth, not breastfeed exclusively for 6 months, no dietary changes during pregnancy or lactation, and no use of folic acid supplements.

CONCLUSION

This study's findings underscore the importance of providing nutrition information to women, in order to improve dietary diversity and overall maternal and child health.

A Nuanced Examination of Primate Capture and Consumption and Human Socio-Economic Well-Being in Kirindy Mitea National Park, Madagascar

The futures of human and nonhuman primates are closely tied in protected areas. Understanding this interconnectedness is especially urgent in Madagascar, one of the world's most impoverished biodiversity hotspots. Yet, no study has evaluated the relationship between poverty and lemur hunting and consumption using a composite poverty metric that includes health, education, and living standards. To address this gap, and to inform primate conservation practice and policy, we administered annual surveys to 81 households over six consecutive months (September 2018 to March 2019) in a village on the border of Kirindy Mitea National Park, Madagascar. We observed extreme deprivation scores across multiple dimensions of poverty and identified ninety-five percent of households as 'impoverished'. Of these, three-quarters (77%) of households were identified as being in 'severe poverty'. One-fifth (19%) of all households hunted lemurs and half (49%) of households consumed lemurs. While poverty eradication is an urgent need in communities around Kirindy Mitea National Park, our findings show no relationship between poverty and lemur hunting and consumption, perhaps due to the lack of variance in poverty. Our results highlight the need to investigate other contributory factors to lemur hunting and consumption locally. Because food insecurity is a known driver of lemur hunting and consumption among the study community, and because domestic meats can be preferred over protected species, we recommend testing the efficacy of livestock interventions near Kirindy Mitea National Park.

Finding food in the hunger season: A mixed methods approach to understanding wild plant foods in relation to food security and dietary diversity in southeastern Madagascar

In many rural farming societies, wild plant foods (WPFs) continue to play an important role in everyday diets as well as in coping with hunger during food shortages. However, WPF collection and consumption may pose challenges to biodiversity conservation efforts (e.g., in protected areas), and some “famine foods,” foods not typically eaten under normal conditions, may have deleterious health impacts. Using data from a cross-sectional survey of 328 smallholder farmers and fisherfolk living in 15 villages surrounding Manombo Special Reserve on the southeastern coast of Madagascar, we examine the relationship between food security, dietary diversity, and consumption of WPFs, specifically giant aquatic arrowhead or via (Typhonodorum lindleyanum) and Polynesian arrowroot or tavolo (Tacca leontopetaloides), during the region's main lean season. We complement survey findings with focus group interviews to document traditional ecological knowledge and perceptions of these WPFs, including how tavolo and via are rendered edible, as well as human health effects from collecting, preparing, and eating them. Using multilevel logistic regression modeling, we found that consumption of these WPFs were significantly associated with inadequate nutrition among farmers. Wealthier households were less likely to consume these WPFs as a coping strategy during food insecure periods, while larger and more food insecure households were more likely to consume them. These findings reaffirm the importance of access to natural areas and support the design of protected area conservation strategies that honor local foodways and consider WPFs that serve as food safety nets for more vulnerable populations.

Food Insecurity and Health Outcomes Other than Malnutrition in Southern Africa: A Descriptive Systematic Review

Food insecurity (FI) is one of the major causes of malnutrition and is associated with a range of negative health outcomes in low and middle-income countries. The burden of FI in southern Africa is unknown, although FI continues to be a major public health problem across sub-Saharan Africa as a whole. Therefore, this review sought to identify empirical studies that related FI to health outcomes among adults in southern Africa. Altogether, 14 publications using diverse measures of FI were reviewed. The majority of the studies measured FI using modified versions of the United States Department of Agriculture Household Food Security Survey Module. A wide range in prevalence and severity of FI was reported (18-91%), depending on the measurement tool and population under investigation. Furthermore, FI was mostly associated with hypertension, diabetes, anxiety, depression and increased risk of human immunodeficiency virus (HIV) acquisition. Based on the findings, future research is needed, especially in countries with as yet no empirical studies on the subject, to identify and standardize measures of FI suitable for the southern African context and to inform public health policies and appropriate interventions aiming to alleviate FI and potentially improve health outcomes in the region.

Beyond price and income: Preferences and food values in peri-urban Viet Nam

Sub-optimal diets are one of the most important risk factors contributing to the global burden of disease. Developing a better understanding of the drivers of food choice, including the role of individual preferences, is important to address this issue. The objective of this mixed methods research was to identify the relative importance of preferences for different food quality attributes (e.g. nutrition, food safety, price and convenience) that might influence shopping habits and food choice in the context of a rapidly changing peri-urban food environment in Hanoi Province, Viet Nam. A total of 264 women were randomly selected and interviewed using Best-Worst Scaling to elicit preferences among food quality attributes for different food groups (leafy green vegetables, fruits, instant foods, snack foods). A subset of these respondents (n = 40) participated in focus group discussions in order to explore their preferences and food values in more detail. The food quality attributes considered to be most important varied by food group with nutrition and food safety (both immediate and future health) ranking highest for leafy green vegetables and fruits, convenience for instant foods, and taste for snack foods. Price was considered least important across all food groups. Focus group discussions reinforced these results with additional insights particularly regarding trade-offs between nutrition, food safety, convenience, and price. This research demonstrates the feasibility of identifying important drivers of consumption in a South East Asian context using Best-Worst Scaling. These results could help inform the design of behavior change interventions and guide food system policies that seek to shift consumer choices towards healthier diets.