Household food insecurity, dietary intake and anaemia among pregnant women in Lilongwe, Malawi: a mixed-methods cross-sectional study with mediation analysis.

Anaemia during pregnancy is a public health concern, yet the relationship between household food insecurity, dietary intake and anaemia among pregnant women remains underexplored. This cross-sectional study investigated these associations in 612 second-trimester pregnant women attending antenatal care in Lilongwe, Malawi. Household food insecurity was assessed using the Household Food Insecurity Access Scale (HFIAS), dietary intake via the Semi-quantitative Food Frequency Questionnaire (SQ-FFQ) and anaemia defined as Hb <10·5 g/dL. Results showed that 21·24 % were anaemic, and 69·93 % resided in food-insecure households. Severe food insecurity (adjusted OR (a-OR): 2·58, 95 % CI 1·41-4·71), insufficient intake of energy (a-OR: 1·73, 95 % CI 1·13, 2·66), Fe (a-OR: 1·98, 95 % CI 1·21, 3·24) and vitamin C (a-OR: 1·71, 95 % CI 1·12, 2·59) were significantly associated with a higher likelihood of anaemia, whereas those with a Minimum Dietary Diversity for Women (MDD-W) had a substantially reduced risk compared with those with low dietary diversity (LDD) (a-OR: 0·19, 95 % CI 0·06, 0·61). Dietary diversity partially mediated the association between household food insecurity and anaemia among pregnant women. Findings underscore the need to promote food security, dietary diversity and nutrient intake through targeted health education and staff training. These strategies could reduce anaemia prevalence and improve maternal health outcomes.