Malnourished but not destitute: the spatial interplay between nutrition and poverty in Madagascar

Hidden hunger, or micronutrient deficiencies, is a serious public health issue affecting approximately 2 billion people worldwide. Identifying areas with high prevalence of hidden hunger is crucial for targeted interventions and effective resource allocation. However, conventional methods such as nutritional assessments and dietary surveys are expensive and time-consuming, rendering them unsustainable for developing countries. This study proposes an alternative approach to estimating the prevalence of hidden hunger at the commune level in Madagascar by combining data from the household budget survey and the Demographic and Health Survey. The study employs small area estimation techniques to borrow strength from the recent census and produce precise and accurate estimates at the lowest administrative level. The findings reveal that 17.9 percent of stunted children reside in non-poor households, highlighting the ineffectiveness of using poverty levels as a targeting tool for identifying stunted children. The findings also show that 21.3 percent of non-stunted children live in impoverished households, reinforcing Sen's argument that malnutrition is not solely a product of destitution. These findings emphasize the need for tailored food security interventions designed for specific geographical areas with clustered needs rather than employing uniform nutrition policies. The study concludes by outlining policies that are appropriate for addressing various categories of hidden hunger.