BackgroundThere are limited data on the prevalence and approaches to screening for depression among pregnant women living in resource poor settings with high HIV burden.MethodsWe studied the reliability and accuracy of the Center for Epidemiologic Studies Depression (CES-D) scale in 123 (36 HIV-infected and 87 -uninfected) pregnant women receiving antenatal care at Gulu Regional Referral Hospital, Uganda. CES-D scores were compared to results from the psychiatrist-administered Mini-International Neuropsychiatric Interview (MINI) for current major depressive disorder (MDD), a “gold standard” for assessing depression. We employed measures of internal consistency (Cronbach’s alpha), and criterion validity [Area Under the Receiver Operating Characteristic Curve (AUROC), sensitivity (Se), specificity (Sp), and positive predictive value (PPV)] to evaluate the reliability and validity of the CES-D scale.Results35.8% of respondents were currently experiencing an MDD, as defined from outputs of the MINI-depression module. The CES-D had high internal consistency (Cronbach’s alpha = 0.92) and good discriminatory ability in detecting MINI-defined current MDDs (AUROC = 0.82). The optimum CES-D cutoff score for the identification of probable MDD was between 16 and 17. A CES-D cutoff score of 17, corresponding to Se, Sp, and PPV values of 72.7%, 78.5%, and 76.5%, is proposed for adoption in this population and performs well for HIV-infected and -uninfected women. After adjusting for baseline differences between the HIV subgroups (maternal age and marital status), HIV-infected pregnant women scored 6.2 points higher on the CES-D than HIV-uninfected women (p = 0.032).ConclusionsThe CES-D is a suitable instrument for screening for probable major depression among pregnant women of mixed HIV status attending antenatal services in northern Uganda.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0303-y) contains supplementary material, which is available to authorized users.

Objective: To determine the reliability, validity and correlates of measures of food insecurity (FI) obtained using an individually focused food insecurity access scale (IFIAS) among pregnant women of mixed HIV status in northern Uganda. Design: A mixed-methods study involving cognitive interviews nested within a cross-sectional survey. Setting: The antenatal care clinic of Gulu Regional Referral Hospital. Subjects: Survey respondents included 403 pregnant women, recruited in a ratio of one HIV-infected to two HIV-uninfected respondents, twenty-six (nine of them HIV-infected) of whom were asked to participate in the cognitive interviews. Results: Over 80 % of cognitive interview participants reported understanding the respective meanings of six of the nine items (i.e. items 4 to 9) on the IFIAS. Two main factors emerged from rotated exploratory factor analysis of the IFIAS: mild to moderate FI (IFIAS items 1-6) and severe FI (items 7-9). Together, they explained 90·4 % of the FI measure's variance. The full IFIAS and the two subscales had moderate to high internal consistency (Cronbach's α ranged from 0.75 to 0.87). Dose-response associations between IFIAS scores, and measures of socioeconomic status and women's diet quality, were observed. Multivariate linear regression revealed significant positive associations between IFIAS scores and HIV infection, maternal age, number of children and a history of internal displacement. IFIAS scores were negatively associated with women's diet diversity score, asset index and being employed. Conclusions: The IFIAS showed strong reliability, validity and contextual relevance among women attending antenatal care in northern Uganda. Keywords Food accessPregnancy HIV Food security Uganda AfricaFood security occurs 'when all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life' (1) . Food insecurity (FI) exists when these conditions are not met and is a major underlying cause of undernutrition enshrined in the UNICEF conceptual framework (1,2) . FI is a major risk factor for adverse health outcomes among specific vulnerable populations including persons infected with HIV (3,4) , women (5) and children (5,6) . Women's responsibilities in managing family feeding (7) , gender bias in the experience of FI (8) and unequal control over household resources make them particularly vulnerable to FI and its consequences (3) . Data from the USA indicate that, when faced with FI, women suffer a range of negative nutritional (9) and psychosocial consequences (10,11) .Pregnant women are more likely to experience greater FI than non-pregnant women because they have higher nutrient demands, less physical ability to obtain and prepare food (especially later in pregnancy and early postpartum) and less ability to engage in income-generating labour (10) . The three studies to date about FI among pregnant women have shown that FI has serious negative nutrition...

However, the Paule-Mandel estimator of tau 2 and Hartung-Knapp-Sidik-Jonkman adjustment that we used account for it. In addition, all the included studies in our study were unblinded and this make them subject to detection, performance, and reporting biases.In patients with ASCVD, using polypill strategy as a substitute to using separate key cardiovascular medications was associated with lower risk for MACE and MI. The use of polypill could be an important strategy to increase the adherence rates in the secondary prevention of ASCVD and improve outcomes.

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Antenatal alcohol use (AAU) is associated with poor health outcomes in maternal‐infant dyads. However, AAU prevalence and risk factors are poorly understood, particularly in low‐income settings. Therefore we studied correlates of any AAU among pregnant women receiving antenatal care in Gulu, Uganda.Characteristics of pregnant women enrolled in a cohort study (n=403, 33% HIV+) were assessed at multiple levels of the social‐ecological model (SEM).AAU was reported by 20.1% of participants. Beer (10.1%) and kweete (sorgum‐millet brew) (9.2%) were the most frequently consumed alcohols (Figure 1). Excessive drinking was rare; mean alcohol units consumed/month was 4.4 in those who drank.In multivariate logistic models, social environment, (partner drinking 蠅30 days/month, [Odds Ratio (OR) 2.17, p=0.03] or friends drinking 1‐29 days/month [OR 3.59, p<0.001]), maternal age [OR 1.06, p value=0.01], and greater food security [OR 0.93, p=0.02} were associated with AAU (Table 1). Many covariates of AAU seen elsewhere in sub‐Saharan Africa, including HIV, maternal depression, and domestic violence were not significant.Future research may focus on peer and partner‐based interventions and behavior change at multiple levels of SEM to reduce AAU.Funding: USAID Feed the Future Innovation Laboratory for Collaborative Research in Nutrition for Africa (AID‐OAA‐L‐10‐00006 to Tufts University). SLY was supported by NIH (K01 MH098902). Table 1. Bivariate and multivariate logistic models of any alcohol use during pregnancy among 403 pregnant Ugandans of mixed HIV status Characteristic Unadjusted OR p‐value Adjusted OR p‐value Maternal Characteristics Maternal Age (y) 1.05 (1.00‐1.10) 0.01 1.06 (1.01‐1.12) 0.01 HIV‐positive 0.68 (0.39‐1.18) 0.17 0.60 (0.32‐1.12) 0.11 Depression score1 1.00 (0.98‐1.02) 0.70 Maternal education level ≥Primary Secondary &gt;Secondary ref 1.04 (0.61‐1.78) 2.26 (1.01‐5.03) 0.17 0.04 ref 1.05 (0.58‐1.90) 1.03 (0.39‐2.68) 0.86 0.94 Maternal Nutrition Food insecurity score2 0.95(0.91‐1.00) 0.05 0.93 (0.88‐0.99) 0.02 Dietary diversity score3 1.17 (1.02‐1.35) 0.02 Household and Interpersonal Characteristics Partner drinks (days/month) Never 1‐29 ≥30 ref 1.43 (0.79‐2.56) 1.87 (1.00‐3.50) 0.04 0.22 ref 1.05(0.55‐1.99) 2.17(1.06‐4.44) 0.86 0.03 Friends drink (days/month) Never 1‐29 ≥30 ref 2.99 (1.65‐5.42) 2.00 (0.74‐5.36) &lt;0.001 0.16 ref 3.59 (1.84‐7.00) 1.78 (0.60‐5.26) &lt;0.001 0.29 Domestic violence4 1.53 (0.90‐2.59) 0.11 1.63 (0.91‐2.90) 0.09 Asset score5 1.13 (1.01‐1.27) 0.02 1.06 (0.93‐1.22) 0.34 Community and Environmental Characteristics Urban residence 0.88 (0.48‐1.60) 0.67 Displaced during civil war 1.36 (0.76‐2.43) 0.29 Lived in an internally displaced persons camp 0.95(0.58‐1.55) 0.84 Years displaced to IDP camp None 1‐4 5‐10 &gt;10 ref 0.90 (0.18‐4.57) 1.00 (0.18‐5.28) 1.00 (0.20‐4.91) 0.90 1.00 0.99 1Depression score (0‐56) Center for Epidemiologic Studies Depression Scale (CES‐D) 2Individually‐Focused Food Insecurity Access Scale (IFIAS); Natamba et al., 2014 3Dietary diversity (0‐26), FAO HDDS Scale; FAO 2011 4Domestic violence: sexual and physical violence within the past year 5Asset score (0‐12) based on possession of 12 household items of value [figure1]