Vol. 1 No. 1 (2024)
A Longitudinal Cohort Study of the HIV, Tuberculosis, and Food Insecurity Syndemic Among Pregnant Adolescents in Malawi
Abstract
This longitudinal cohort study investigates the syndemic interaction of HIV, tuberculosis (TB), and food insecurity among pregnant adolescents in Malawi, a critically under-researched group facing compounded vulnerabilities. We aimed to determine the prevalence, bidirectional relationships, and synergistic health impacts of these conditions throughout pregnancy and the early postpartum period. Between March 2023 and February 2025, we enrolled 512 pregnant adolescents aged 15–19 from four antenatal clinics in Central and Southern Malawi. Participants underwent baseline and trimonthly follow-up assessments for HIV and TB, alongside detailed household food insecurity evaluations using the validated Household Food Insecurity Access Scale. Longitudinal data were analysed using generalised estimating equations to model temporal associations. Findings revealed a high baseline co-prevalence, with 28.7% of participants experiencing severe food insecurity. This was significantly associated with a 1.8-fold increased odds of latent TB infection progression (95% CI: 1.2–2.7) and poorer antiretroviral therapy adherence among adolescents living with HIV. The syndemic demonstrated a cyclical nature: an incident HIV or TB diagnosis more than doubled the subsequent risk of severe food insecurity (adjusted odds ratio >2.0). This analysis provides novel longitudinal evidence that food insecurity is not merely a comorbidity but a critical driver and consequence of HIV/TB pathology in this group. The findings underscore the urgent need to integrate nutritional support and social protection into existing adolescent-focused antenatal and HIV/TB services to disrupt this detrimental cycle.
Read the Full Article
The HTML galley is loaded below for inline reading and better discovery.
How to Cite
Keywords
Research Snapshot
Desktop reading viewReferences
- Ammon, N., Limmer, M., & Kaley, A. (2025). “A creature inside me”: perceptions and representations of HIV among adolescents living with HIV in Malawi. AIDS Research and Therapy. https://doi.org/10.1186/s12981-025-00770-4
- Asim, S., & Casley Gera, R. (2024). What Matters for Learning in Malawi? Evidence from the Malawi Longitudinal School Survey. https://doi.org/10.1596/40948
- Banda, E., Martinez, S., Barooah, B., & Shah, R. (2025). Integrating Aquaculture-Agriculture to Combat Food Insecurity in Malawi. AEA Randomized Controlled Trials. https://doi.org/10.1257/rct.14852
- Banda, E., Martinez, S., Barooah, B., & Shah, R. (2025). Integrating Aquaculture-Agriculture to Combat Food Insecurity in Malawi. AEA Randomized Controlled Trials. https://doi.org/10.1257/rct.14852-1.0
- Chikalipo, M.C., Kaula, M.P., Mwapasa, V., & Nyondo-Mipando, A.L. (2026). Prevalence and factors associated with uptake of repeat HIV testing among pregnant women in Blantyre, Malawi. BMC Public Health. https://doi.org/10.1186/s12889-025-26176-5
- Chilala, K.R.S., & Kambewa, P. (2026). Gender Implications of the Malawi Social Cash Transfer Programme in Machinga District, Malawi. Open Research Africa. https://doi.org/10.12688/openresafrica.16315.1
- Chilanga, E., & Mbeya, R.A. (2024). Initiatives to promote uptake and adherence to Option B+ program among rural pregnant women living with HIV in Malawi. https://doi.org/10.21203/rs.3.rs-4340349/v1
- Dhakal, A. (2025). Food Insecurity and Labour Migration from Northern Malawi to South Africa. International Perspectives on Migration. https://doi.org/10.1007/978-981-97-9715-8_2
- Horesh, E. (2025). The Impact of Hunger Safety Net Programme on Food Insecurity in Malawi: Evidence from Graduated Beneficiaries. https://doi.org/10.20944/preprints202504.0692.v1
- Kasawala, T., Chikunkhuzeni, F., & Kadzakumanja, G. (2024). THE ROLE OF RADIO PROGRAMMES IN MITIGATING HIV AND AIDS AMONG FEMALE SEX WORKERS IN BLANTYRE. Proceedings of the International Conference on Public Health. https://doi.org/10.17501/24246735.2023.8207
- Kasujja, I., Lund, C., & salisbury, T. (2024). Food Insecurity and Mental Health among Children and Adolescents in Sub-Saharan Africa: Systematic Review. https://doi.org/10.31219/osf.io/bujak_v1
- Khubchandani, J., Banerjee, S., Kopera-Frye, K., Gonzales-Lagos, R., & Onukogu, C. (2024). Food insecurity and mortality risk among adults with Chronic Kidney Disease: A longitudinal cohort study of NHANES. Nutrire. https://doi.org/10.1186/s41110-024-00295-2
- Kiyingi, J., Ssewamala, F.M., Neilands, T.B., Tebbetts, S., Mulauzi, N., Mkandawire, J., & Conroy, A.A. (2025). The effect of an economic empowerment and relationship strengthening intervention on food insecurity among couples living with HIV in Malawi. BMC Public Health. https://doi.org/10.1186/s12889-025-23911-w
- Li, W., Kohler, I.V., & Kohler, H. (2024). Internal Migration and Weight Status in Sub-Saharan Africa: A Longitudinal Analysis of Malawi. https://doi.org/10.2139/ssrn.4976714
- Makonokaya, L., Ngwira, P., Kalitera, L.U., Singini, G.C., Khumbanyiwa, M., Maphosa, T., & Bhatt, N.B. (2025). Tuberculosis preventive treatment uptake among patients initiating antiretroviral therapy in Malawi: Children left behind. Southern African Journal of HIV Medicine. https://doi.org/10.4102/sajhivmed.v26i1.1760
- Mandiwa, C., Sanna, M., & Gao, W. (2025). Cervical cancer screening uptake among women living with HIV in the era of universal test and treat policy in Malawi: results from the 2020–2021 Malawi population-based HIV impact assessment. BMC Cancer. https://doi.org/10.1186/s12885-025-13436-1
- Mbakaya, B.C., Zgambo, M., Kaseka, P., Moyo, R., Nkhata, O., & Kalembo, F. (2025). Hand Hygiene Practices among Children and Adolescents living with HIV in the Northern City of Malawi. https://doi.org/10.21203/rs.3.rs-6397392/v1
- Mhango, W., Michelson, D., & Gaysina, D. (2024). Feasibility and acceptability of FOotpaths foR Adolescent MAternal Mental HeAlth (FOR MAMA): a co-designed intervention for pregnant adolescents in Malawi. https://doi.org/10.31234/osf.io/bkpc4
- Mhango, W., Michelson, D., & Gaysina, D. (2024). Co-design of FOotpaths foR Adolescent MAternal Mental HeAlth (FOR MAMA): a guided preventive mental health intervention for pregnant adolescents in Malawi. https://doi.org/10.31234/osf.io/sk46g
- Mhango, W. (2024). Author comment: Feasibility and acceptability of FOotpaths foR adolescent MAternal mental HeAlth (FOR MAMA): A co-designed intervention for pregnant adolescents in Malawi — R0/PR1. https://doi.org/10.1017/gmh.2024.76.pr1
- Mhango, W. (2024). Author comment: Feasibility and acceptability of FOotpaths foR adolescent MAternal mental HeAlth (FOR MAMA): A co-designed intervention for pregnant adolescents in Malawi — R1/PR4. https://doi.org/10.1017/gmh.2024.76.pr4
- Mhango-Chisiza, W. (2025). Using Participatory Strategies to Develop a Culturally Appropriate Mental Health Intervention for Pregnant Adolescents in Malawi. Theatre and Media for Social Change in Malawi. https://doi.org/10.4324/9781003648437-16
- Nagoli, J. (2024). Malawi in the Socio-Economic Development History of Southern Africa. The Oxford Handbook of the Malawi Economy. https://doi.org/10.1093/oxfordhb/9780198890164.013.3
- Phiri, U. (2024). Uptake of Cervical Cancer Screening Services and Associated Factors among HIV-Positive Women at Mzuzu Central Hospital, Malawi. Africa Journal of Nursing and Midwifery. https://doi.org/10.25159/2520-5293/16087
- Zhou, W., Pu, J., Zeng, W., Cho, Y., & Shang, S. (2025). Persistent Food Insecurity Among Older Adult Cancer Survivors: A National Cohort Study. Oncology Nursing Forum. https://doi.org/10.1188/25.onf.15-22