Household Food Insecurity, Maternal Nutritional Status, and Infant Feeding Practices Among HIV-infected Ugandan Women Receiving Combination Antiretroviral Therapy

Abstract

Objectives Household food insecurity 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 explored if greater household food insecurity was associated with poorer maternal nutritional status, shorter duration of exclusive breastfeeding (EBF) and fewer animal-source complementary foods. Methods We assessed these outcomes among 180 HIV-infected pregnant and breastfeeding (BF) women receiving combination antiretroviral therapy in the PROMOTE trial (NCT00993031), a prospective, longitudinal cohort study in Tororo, Uganda. Results Household food insecurity was common; the prevalence of severe, moderate, and little to no household hunger was 7.3%, 40.5%, and 52.2%, respectively. Poor maternal nutritional status was common and women in households experiencing moderate to severe household hunger (MSHH) had statistically significantly lower BMIs at enrollment (21.3 vs 22.5, p<0.01) and prior to delivery (22.6 vs. 23.8, p<0.01). However, MSHH was not associated with maternal BMI or gestational weight gain in multivariate models. The prevalence (95% CI) of EBF at 6 months was 66.4% (59.0%-72.8%), and the proportion of women breastfeeding at 12 months was 80.0% (73.0%-85.3%).MSHH was not associated with EBF at 6 months or breastfeeding at 12 months. However, among those women still EBF at 4 months (81.0% of population), those experiencing MSHH were significantly more likely to cease EBF between 4 and 6 months (aHR: 2.52, 95% CI 1.03-6.19). Conclusions Interventions addressing household food insecurity, maternal malnutrition and suboptimal breastfeeding practices are urgently needed.

Breastfeeding and Complementary Feeding Practices among HIV-Exposed Infants in Coastal Tanzania

“…41 Our findings, however, did not show clear associations between food security and infant feeding, although unadjusted analyses are suggestive that food secure mothers have higher prevalence of EBF than food insecure mothers (Tables 2 and 3). 41 Our findings, however, did not show clear associations between food security and infant feeding, although unadjusted analyses are suggestive that food secure mothers have higher prevalence of EBF than food insecure mothers (Tables 2 and 3).…”

“I Have Remained Strong Because of That Food”: Acceptability and Use of Lipid-Based Nutrient Supplements Among Pregnant HIV-Infected Ugandan Women Receiving Combination Antiretroviral Therapy

“…For example, 59% (33/56) of participants reported difficulties in accessing sufficient food, and 45% typically ate only 1 or 2 meals per day. This was triangulated by later findings among participants in the parent study that the prevalence of moderate to severe household hunger and moderate to severe household food insecurity access were 47.8% and 76.7%, respectively [39]. …”

Greater household food insecurity is associated with lower breast milk intake among infants in western Kenya

“…Household food insecurity has been proposed as a determinant of EBF (Webb‐Girard et al, ; Young et al, ). Studies in Uganda (Young, Plenty, et al, ) and Canada (Orr, Dachner, Frank, & Tarasuk, ) found that moderate to severe household food insecurity was associated with earlier cessation of EBF.…”