Alcohol Use Among Pregnant Ugandan Women of Mixed HIV Status is Associated with Social Environment and Food Insecurity

Abstract

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 >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) <0.001 0.16 ref 3.59 (1.84‐7.00) 1.78 (0.60‐5.26) <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 >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]