Integrated assessment and prioritization framework for the sustainability of food security among women of reproductive age in Masindray, Madagascar

National responses to food insecurity require comparable diagnostic tools, yet classifications vary across indicators and comparisons under shock conditions remain difficult. This study addresses the need for an evaluation and intervention framework to support the sustainability of food security among women of reproductive age. It examines two research questions: which score can operationalize the sustainability of food security among women of reproductive age, and which sets of leverage points can structure a multisectoral framework for food security intervention? In the rural commune of Masindray, Madagascar, a cross-sectional survey was used to construct a continuous composite score structured around five dimensions and then classified into four levels, S1 to S4. Internal validation relied on Principal Component Analysis and Spearman correlation with the F1 axis, while external validation used Body Mass Index and Mid-Upper Arm Circumference. The strategic rectangle identified a core set of priority modalities. The score ranged from 0.05 to 0.97, with a mean of 0.58. S1 accounted for 4% of the sample, whereas S2 to S4 each represented nearly one third. Internal consistency was high, and external association reached 0.18 with Body Mass Index and 0.28 with Mid-Upper Arm Circumference. The core set highlighted domestic constraints, intra-household decision-making, and access security. These findings support the use of a continuous reading complemented by component-based analysis and multisectoral prioritization. Future work should include multi-season validation, territorial replication, and causal assessment of intervention portfolios.