Introduction: In southern Malawi, El Niño–driven floods and drought, together with cyclones, have deepened food insecurity. Yet, despite growing attention to the vulnerabilities of rural communities, little focus has been directed toward the nutritional challenges faced by healthcare providers themselves.
Objectives: This study explored food security and diversity patterns among healthcare providers in two climate-affected rural districts of Malawi to identify factors contributing to food insecurity.
Methods: We conducted a mixed methods study that included cross-sectional surveys and semi-structured interviews in March-April and August-September 2024 in Neno and Chikwawa Districts. The survey population included 146 healthcare workers, and the interview population included 33 health workers of all ranks in the local health system. Food security was measured using the Household Food Insecurity Access Scale and food diversity using 24-hour dietary recall. Survey data were analyzed in R using descriptive statistics and parametric/non-parametric tests (p<0.05), followed by univariate screening and ordinal logistic regression. The interviews were coded and analyzed using a thematic analysis with Atlas.ti software.
Results: Health workers suffered from varied degrees of food insecurity and reported being impacted by severe climate events, with 28.1% reporting severe food insecurity. Health workers interviewed, discussed the impact of the cyclones on their housholds and their understandings of the meaning of food insecurity. Professional hierarchy significantly predicted food insecurity: Health Surveillance Assistants and Hospital Support Staff had 2.9 points higher odds compared to Clinical Staff (p<0.01). Male healthcare workers had 2.6 points higher odds than females (p<0.01). Poor self-rated health increased food insecurity risk in a dose-response pattern. Notably, food diversity was not predicted by professional status, demographics, season, or income, suggesting barriers beyond socioeconomic disparities within the healthcare workforce.
Conclusions: Climate-related shocks affect not only members of rural communities but also the healthcare workforce assigned to their care. In settings where most households experience severe food insecurity, integrated support strategies must extend to health providers themselves. This study highlights the importance of addressing professional hierarchies, gender, and individual health status as key determinants shaping vulnerability within the workforce. Targeted interventions—such as workplace nutrition programs for lower-cadre staff—offer immediate support, while further research is required to identify sustainable strategies for improving dietary diversity across all health worker groups.
