Spatial Distribution of Inadequate Apparent Intake of Protein, Lysine, and Tryptophan among Malawi's Households with Children Aged <5 y: Evidence from the 2019-2020 Integrated Household Survey.

Background: Understanding the spatial distribution of nutrient inadequacy is critical for designing context-specific interventions to improve human health. Objectives: The objective of our study was to determine the spatial distribution of inadequate apparent protein, lysine, and tryptophan intake among Malawi's households with children aged <5 y. Methods: We retrieved household consumption and expenditure data for 5952 children aged 6 to 59 mo from Malawi's 2019-2020 Integrated Household Survey under formal consent from the National Statistical Office. Relevant food composition tables and databases were used to estimate protein, lysine, and tryptophan intake based on food items. Using the adult female equivalent matrix, we applied Food and Agriculture Organization thresholds (0.66 g/kg/d protein, 35 mg/kg/d lysine, and 4.8 mg/kg/d tryptophan) to assess adequacy. Household consumption data were processed in R Studio. Median values were used to replace outliers and conversion factors utilized to compute edible portions. The processed data were merged with district shapefiles and subsequently analyzed to generate the spatial distribution of nutrient inadequacy (total and available protein, lysine, and tryptophan). Results: Regional disparities in nutrient inadequacy for total and available protein, lysine, and tryptophan were evident across Malawi, with inadequate available lysine intake being highly prevalent (>40%) in all districts in the Central Region, followed by the Southern Region, where 7 of 13 districts experienced lysine deprivation of >40%. Similarly, inadequate available protein intake was evident in the Central Region, followed by the Southern Region. The Northern Region exhibited the lowest inadequacy for total and available protein, lysine, and tryptophan intake among children. Conclusions: Regional variations in nutrient inadequacy were evident across Malawi, with the Central Region most affected by protein, lysine, and tryptophan inadequacy, followed by the Southern Region, although the Northern Region showed the lowest inadequacy. This highlights the need for region-specific interventions to address protein, lysine, and tryptophan inadequacy among children aged <5 y.