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Household Food Insecurity,Maternal Nutritional Status,and Infant Feeding Practices Among HIV-infected Ugandan Women Receiving Combination Antiretroviral Therapy |
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| Authors: | Sera L. Young Albert H. J. Plenty Flavia A. Luwedde Barnabas K. Natamba Paul Natureeba Jane Achan Julia Mwesigwa Theodore D. Ruel Veronica Ades Beth Osterbauer Tamara D. Clark Grant Dorsey Edwin D. Charlebois Moses Kamya Diane V. Havlir Deborah L. Cohan |
| Affiliation: | 1. Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA 2. Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA 3. Makerere University-University of California, San Francisco (MU-UCSF) Research Collaboration, Tororo, Uganda 4. Department of Medicine, Makerere University Medical School, Kampala, Uganda 5. Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA 6. Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, NY, USA 7. Department of Medicine, University of California, San Francisco, San Francisco, CA, USA 8. Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco General Hospital, 1001 Potrero Ave, 6D-22, San Francisco, CA, 94110, USA |
| Abstract: | Household food insecurity (HHFI) may be a barrier to both optimal maternal nutritional status and infant feeding practices, but few studies have tested this relationship quantitatively, and never among HIV-infected individuals. We therefore described the prevalence of HHFI and explored if it was associated with poorer maternal nutritional status, shorter duration of exclusive breastfeeding (EBF) and fewer animal-source complementary foods. We assessed these outcomes using bivariate and multivariate analyses among 178 HIV-infected pregnant and breastfeeding (BF) women receiving combination antiretroviral therapy in the PROMOTE trial (NCT00993031), a prospective, longitudinal cohort study in Tororo, Uganda. HHFI was common; the prevalence of severe, moderate, and little to no household hunger was 7.3, 39.9, and 52.8 %, respectively. Poor maternal nutritional status was common and women in households experiencing moderate to severe household hunger (MSHH) had statistically significantly lower body mass index (BMIs) at enrollment (21.3 vs. 22.5, p < 0.01) and prior to delivery (22.6 vs. 23.8, p < 0.01). BMI across time during pregnancy, but not gestational weight gain, was significantly lower for MSHH [adjusted beta (95 % CI) ?0.79 (?1.56, ?0.02), p = 0.04; ?2.06 (?4.31, 0.19), p = 0.07], respectively. The prevalence (95 % CI) of EBF at 6 months was 67.2 % (59.7–73.5 %), and the proportion of women BF at 12 months was 80.4 % (73.3–85.7 %). MSHH was not associated with prevalence of EBF at 6 months or BF at 12 months. However, among those women still EBF at 4 months (81.4 % of population), those experiencing MSHH were significantly more likely to cease EBF between 4 and 6 months (aHR 2.38, 95 % CI 1.02–5.58). The prevalence of HHFI, maternal malnutrition, and suboptimal infant feeding practices are high and the causal relationships among these phenomena must be further explored. |
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