Market food environments and child nutrition

Child malnutrition remains a widespread public health problem in sub-Saharan Africa. Providing access to nutritious foods for all is key, but it is not clear how this can be achieved in various local contexts. Here, we analyze the role of markets and food environments for child diets and nutrition in Malawi along a rural-urban continuum. We develop a new methodology to characterize food environments in terms of the variety of fresh and processed foods available in local market settings. Geocoded data of market food variety are combined with individual-level child diet and anthropometric data collected through a household survey. We find large differences in food environments, diets, and nutrition outcomes between urban, rural, and remote locations. The spatially-explicit analysis shows that market food variety is positively associated with dietary diversity and negatively associated with stunting, also after controlling for confounding factors. Strikingly, processed food variety has more favorable associations with child nutrition than fresh food variety, suggesting that lightly and moderately processed foods are important sources of nutrients in the local settings. Our findings stress the importance of improving the functioning of markets for nutritious foods, especially in rural areas. Conceptually, we add to the literature on measuring food environments.