title: Household food insecurity, maternal nutritional status, and infant feeding practices among HIV-infected Ugandan women receiving combination antiretroviral therapy.
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.
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA, sera.young@cornell.edu.
authors.forename: Sera L
authors.initials: SL
authors.lastname: Young
authors.forename: Albert H J
authors.initials: AH
authors.lastname: Plenty
authors.forename: Flavia A
authors.initials: FA
authors.lastname: Luwedde
authors.forename: Barnabas K
authors.initials: BK
authors.lastname: Natamba
authors.forename: Paul
authors.initials: P
authors.lastname: Natureeba
authors.forename: Jane
authors.initials: J
authors.lastname: Achan
authors.forename: Julia
authors.initials: J
authors.lastname: Mwesigwa
authors.forename: Theodore D
authors.initials: TD
authors.lastname: Ruel
authors.forename: Veronica
authors.initials: V
authors.lastname: Ades
authors.forename: Beth
authors.initials: B
authors.lastname: Osterbauer
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Clark
authors.forename: Grant
authors.initials: G
authors.lastname: Dorsey
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Charlebois
authors.forename: Moses
authors.initials: M
authors.lastname: Kamya
authors.forename: Diane V
authors.initials: DV
authors.lastname: Havlir
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Cohan
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015992:Body Mass Index; D001942:Breast Feeding / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D003863:Depression / Q000209:etiology; D004359:Drug Therapy, Combination; D005191:Family Characteristics; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D039382:Maternal Nutritional Physiological Phenomena; D009752:Nutritional Status; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012923:Social Class; D013315:Stress, Psychological / Q000209:etiology; D013997:Time Factors; D014454:Uganda / Q000453:epidemiology; D015430:Weight Gain
chemical_list: D019380:Anti-HIV Agents