A demographic-sensitive model for estimating micronutrient inadequacy risk among nutritionally vulnerable households using household food consumption data

Abstract Household Consumption and Expenditure Surveys often estimate nutrient adequacy using a single reference individual – typically a non-pregnant, non-lactating (NPNL) woman of reproductive age, known as the Adult Female Equivalent (AFE). However, due to the diversity in nutrient requirements across demographic groups, the AFE approach may underestimate the proportion of households where at least one member has increased risk of inadequate intake. We developed a novel modeling approach – the Vulnerable Household Equivalent (VHE), which identifies the household member with the highest nutrient density requirement as the reference individual. Using data from Malawi’s 2019/20 Fifth Integrated Household Survey and local food composition tables, we estimated micronutrient inadequacy for vitamin A and zinc using AFE and VHE metrics. Prevalence of apparent micronutrient inadequacy was consistently higher using the VHE approach compared to the AFE across national, rural/urban, and socioeconomic strata. The most common reference groups for VHE were NPNL women aged 18–29 years (25.0%) and lactating women (20.5%) for vitamin A, and adult men aged 30–59 years (25.7%) and 18–29 years (21.5%) for zinc. The VHE metric offers a more inclusive and equitable approach for estimating household-level micronutrient inadequacy, though its complexity may require computational support for broader applications.