Malawi is adapting an online dietary recall tool called Intake24 to capture what people actually eat, from cassava to fish, in a country where poor diet is the leading cause of non-communicable diseases. This matters because Malawi has no nationally representative, up-to-date data on what its population eats. National nutrition surveys rely on paper-based methods that are slow, expensive, and difficult to scale. Without reliable dietary data, the government and international funders cannot design targeted public health policies—such as fortifying staple foods or promoting healthier traditional dishes—to reduce the estimated 40% of deaths attributable to NCDs. If successful, the project will produce the first Malawian Nutrition Survey, using Intake24 on 1,500 people aged 1.5 and older, validated against weighed food records and biomarkers from blood and urine samples. The resulting nutrient databank and survey infrastructure will give the Malawi government quantitative evidence to set dietary guidelines, monitor policy impact, and direct resources to the populations with the poorest diets. International stakeholders will gain a tool to assess which nutrition interventions actually work in a low-income African setting.
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Poor diet poses the largest risk factor for non-communicable diseases (NCDs) compared with sedentary lifestyle, alcohol and tobacco combined. An estimated 40% of deaths in Malawi are attributable to NCDs and understanding Malawian dietary patterns could inform areas of the diet that require improvement for reduction of these preventable deaths. National nutrition surveys assess the dietary patterns of whole populations, provide data to monitor nutrient and food intake, identify dietary deficiencies and excesses, monitor dietary public health guidance, and evaluate policy impact in the population. Dietary assessment tools (DATs) such as 24-hour dietary recalls are used to collect data in individuals in these surveys. There has been an increase in use of web-based online DATs due to their ease of use, lower cost, and perceived efficiency due to real time access to nutrient databanks and automation over paper-based tools. Intake24 is a validated online multiple pass tool, initially developed for the UK and that has been adapted for use in other populations and settings, including South Asia, United Arab Emirates, several Europe countries, Australia, New Zealand, and Fiji. In 2019 Intake24 was updated and implemented in the UK National Diet and Nutrition Survey rolling programme, a continuous, cross-sectional survey designed to collect detailed, quantitative information on the food consumption, nutrient intake, and nutritional status of the general population. The tool is currently being adapted for France and New Zealand for their national survey programmes. The overarching aim of this project is to provide data to inform public health policies that are based on population specific evidence to improve the overall health of Malawians. Ensuring evidence-based, data-driven, and effective public health interventions requires nationally representative dietary intake data from all population groups, including individuals with the poorest diets, who stand to benefit the most from public health policies. This requires development of an easy to use, validated DAT that is appropriate for the Malawian diet. This project will adapt Intake24 to the Malawian diet and develop a national Malawian nutrition survey. This will be accomplished by pursuing the following specific objectives; Develop a nutrient databank of the commonly consumed foods in Malawi through food analysis and secondary published data compilation. Adapt Intake24 dietary assessment tool to the Malawian population through an iterative optimisation process. Validate Intake24_Malawi by comparing it against a covert weighed food record and biomarkers of nutrient intake in 164 Malawians aged 18-70 years old. Develop and pilot the first Malawian nutrition Survey in a nationally representative sample of 1500 people aged 1.5 and above using Intake24_Malawi and analysis of blood and urine samples to determine the health and nutritional status of Malawians. The project will produce population specific evidence which will have a broad range of benefits to different stakeholders; The Malawi government and its agencies will have quantitative evidence to use in development, implementation and monitoring of nutrition and health policies and dietary guidelines. International stakeholders and funders will be able to assess the impact nutrition sensitive interventions and identify areas that need intervention in order to make the largest impact in the population. Academics such as agriculturists, nutritionists, food scientists, econonomists and health specialists will have new resources and data to develop contextualised research goals and implement policies effectively. Disadvantaged populations will benefit from targeted solutions to health and nutrition challenges identified through the survey.
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