Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status

Widen, Elizabeth M.; Collins, Steven M.; Khan, Hijab; Biribawa, Claire; Acidri, Daniel; Achoko, Winifred; Achola, Harriet; Ghosh, Shibani; Griffiths, Jeffrey K.; Young, Sera L.

doi:10.3945/ajcn.116.142513

Cited by 18 publications

(20 citation statements)

References 30 publications

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“…Studies indicate that food insecure women are more likely to suffer from poor nutritional, health and psychosocial consequences. The effects of food insecurity among women have been found to be a higher BMI and prevalence of obesity and overweight [12], maternal food insecurity has also been associated with loss of fat [13] leading to under nutrition and low BMI among women of reproductive age. The nutritional well being of women residing in slums is further compromised by the lack of access to safe water and sanitation, medical services and access to a diverse diet [14].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Factors Associated with Food Insecurity among Women Aged 18-49 Years in Kampala Slums Uganda; A Mixed Methods Study

Nantale¹,

Tumwesigye²,

Kiwanuka³

et al. 2017

JFS

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While much focus has been put on rural household food insecurity, with increasing urbanisation leading to urban slum formation, food insecurity is potentially on the rise particularly among women of reproductive age (WRA). We determined the prevalence and factors associated with food insecurity among women aged 18-49 years in Makindye slums of Kampala capital city, Uganda. In a community based cross-sectional study, we recruited a random sample of 573 women aged 18-49 years, resident in the slums for at least one year prior to the study. Quantitative data were collected using interviewer administered questionnaires while qualitative information was obtained through key informant interviews and focus group discussions. Multivariable logistic regression (using STATA® 13) and manifest content analysis methods were used to analyse quantitative and qualitative data respectively. Of the 573 participants, 60.7% were aged 20-34 years, 53.7% were married/cohabiting, 12.2% had no formal education and 82.5% lived in rented homes. Overall 88.5% of the women were food insecure of which 68.4% were severely food insecure. Factors that increased likeli hood of food insecurity were; socioeconomic factors such as absence of electricity in the household (AOR; 2.2, 95%CI: 1.05-4.86, p = 0.036) and having more than one school going child (AOR; 2.6, 95%CI: 1.42-4.89, p = 0.002). Qualitative findings indicate that food insecurity is indeed a problem among women in the slums with unemployment, high food prices, poverty and increasing number of household members reported as the major causes of food insecurity. The prevalence of food insecurity among women in Kampala slums is high. These findings suggest the need to invest in economic empowerment of women with emphasis on those living in deprived communities.

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Section: Introductionmentioning

confidence: 99%

Prevalence and Factors Associated with Food Insecurity among Women Aged 18-49 Years in Kampala Slums Uganda; A Mixed Methods Study

Nantale¹,

Tumwesigye²,

Kiwanuka³

et al. 2017

JFS

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“…In high‐resource settings, the rising prevalence of obesity throughout pregnancy and postpartum weight retention are well‐recognized risk factors for poor maternal and child health outcomes and increased healthcare service utilization (Chu et al, ; Mariona, ; Robbins et al, ). However, the prevalence and implications of postpartum weight retention in low‐ and middle‐income countries, particularly in the context of the HIV epidemic, has received less attention (Ramlal et al, ; Widen et al, ). In our analysis, we estimated that 51% of women were obese by 12 months postpartum, including 43% of HIV‐infected women.…”

Section: Discussionmentioning

confidence: 99%

Postpartum obesity and weight gain among human immunodeficiency virus‐infected and human immunodeficiency virus‐uninfected women in South Africa

Bengtson

Phillips

Roux

et al. 2020

Maternal & Child Nutrition

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In South Africa, up to 40% of pregnant women are living with human immunodeficiency virus (HIV), and 30–45% are obese. However, little is known about the dual burden of HIV and obesity in the postpartum period. In a cohort of HIV‐uninfected and HIV‐infected pregnant women initiating antiretroviral therapy in Cape Town, South Africa, we examined maternal anthropometry (weight and body mass index [BMI]) from 6 weeks through 12 months postpartum. Using multinomial logistic regression, we estimated associations between baseline sociodemographic, clinical, behavioural, and HIV factors and being overweight–obese I (BMI 25 to <35), or obese II‐III (BMI >35), compared with being underweight or normal weight (BMI <25), at 12 months postpartum. Among 877 women, we estimated that 43% of HIV‐infected women and 51% of HIV‐uninfected women were obese I‐III at enrollment into antenatal care, and 51% of women were obese I‐III by 12 months postpartum. On average, both HIV‐infected and HIV‐uninfected women gained, rather than lost, weight between 6 weeks and 12 months postpartum, but HIV‐uninfected women gained more weight (3.3 kg vs. 1.7 kg). Women who were obese I‐III pre‐pregnancy were more likely to gain weight postpartum. In multivariable analyses, HIV‐infection status, being married/cohabitating, higher gravidity, and high blood pressure were independently associated with being obese II‐III at 12 months postpartum. Obesity during pregnancy is a growing public health concern in low‐ and middle‐income countries, including South Africa. Additional research to understand how obesity and HIV infection affect maternal and child health outcomes is urgently needed.

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“…Study procedures have been described elsewhere (Natamba et al, , ; Widen et al, ). Briefly, 403 women who met the eligibility criteria: gestational age between 10 and 26 weeks, living <30 km from Gulu Regional Referral Hospital with known HIV status, were enrolled in the PreNAPS study and followed monthly during pregnancy.…”

Section: Methodsmentioning

confidence: 99%

“…The goal of the parent study was to examine the relationships between food security, psychosocial health and nutrition during pregnancy and post-partum. Study procedures have been described elsewhere (Natamba et al, 2014(Natamba et al, , 2015Widen et al, 2017). Briefly, 403 women who met the eligibility criteria: gestational age between 10 and 26 weeks, living <30 km from Gulu Regional Referral Hospital with known HIV status, were enrolled in the PreNAPS study and followed monthly during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Measuring exclusive breastfeeding social support: Scale development and validation in Uganda

Boateng

Collins

et al. 2018

Maternal & Child Nutrition

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The World Health Organization recommends exclusive breastfeeding (EBF) for 6 months and continued breastfeeding for at least 2 years. Social support has been widely recognized to influence breastfeeding practices. However, existing scales do not measure exclusive breastfeeding social support (EBFSS), rather they assess social support for any breastfeeding. Further, they are tailored towards high-income settings. Therefore, our objectives were to develop and validate a tool to measure EBFSS in low-income settings. To develop the scale, local and international breastfeeding experts were consulted on modifications to the Hughes' Breastfeeding Social Support Scale. It was then implemented in an observational cohort in Gulu, Uganda, at 1 (n = 238) and 3 (n = 237) months post-partum (NCT02925429). We performed polychoric and polyserial correlations to remove redundant items and exploratory factor analysis at 1 month post-partum to determine the latent factor structure of EBFSS. We further applied confirmatory factor analysis to assess dimensionality of the scale at 3 months post-partum. We then conducted tests of predictive, convergent, and discriminant validity against EBF, self-efficacy, general social support, and depression. The modification of the Hughes' scale resulted in 18 items, which were reduced to 16 after examining variances and factor loadings. Three dimensions of support emerged: Instrumental, Emotional, and Informational, with alpha coefficients of 0.79, 0.85, and 0.83, respectively. Predictive, convergent, and discriminant validity of the resultant EBFSS scale was supported. The EBFSS scale is valid and reliable for measuring EBFSS in northern Uganda and may be of use in other low-income settings to assess determinants of EBF.

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Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status

Cited by 18 publications

References 30 publications

Prevalence and Factors Associated with Food Insecurity among Women Aged 18-49 Years in Kampala Slums Uganda; A Mixed Methods Study

Prevalence and Factors Associated with Food Insecurity among Women Aged 18-49 Years in Kampala Slums Uganda; A Mixed Methods Study

Postpartum obesity and weight gain among human immunodeficiency virus‐infected and human immunodeficiency virus‐uninfected women in South Africa

Measuring exclusive breastfeeding social support: Scale development and validation in Uganda

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