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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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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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Acknowledgments

We gratefully acknowledge the women and infants who participated in this study as well as the dedicated PROMOTE study staff and midwives at the Tororo District Hospital. The primary sponsor of the PROMOTE-Pregnant Women and Infants trial is the National Institute for Child Health and Human Development (P01 HD059454 Havlir). The nutritional sub-study was supported by the President’s Emergency Plan For AIDS Relief, the Office of the Global AIDS Coordinator, and the Office of AIDS Research. Abbvie Laboratories provided Lopinavir/ritonavir for the parent trial. We thank Françoise Vermeylen for advice on statistical analysis. SLY was supported by NIH K01 MH098902. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA

    Sera L. Young & Barnabas K. Natamba

  2. Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA

    Albert H. J. Plenty & Edwin D. Charlebois

  3. Makerere University-University of California, San Francisco (MU-UCSF) Research Collaboration, Tororo, Uganda

    Flavia A. Luwedde, Paul Natureeba & Julia Mwesigwa

  4. Department of Medicine, Makerere University Medical School, Kampala, Uganda

    Jane Achan & Moses Kamya

  5. Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA

    Theodore D. Ruel

  6. Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, NY, USA

    Veronica Ades

  7. Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Beth Osterbauer, Tamara D. Clark, Grant Dorsey & Diane V. Havlir

  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

    Deborah L. Cohan

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  1. Sera L. Young
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Young, S.L., Plenty, A.H.J., Luwedde, F.A. et al. Household Food Insecurity, Maternal Nutritional Status, and Infant Feeding Practices Among HIV-infected Ugandan Women Receiving Combination Antiretroviral Therapy. Matern Child Health J 18, 2044–2053 (2014). https://doi.org/10.1007/s10995-014-1450-y

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