Reliability and validity of an individually focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

Abstract

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...

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

“…Study procedures have been previously described (26,28,29). Briefly, women (n = 403) were invited to participate in PreNAPS if they met the following eligibility criteria: gestational age between 10 and 26 wk (assessed according to the last menstrual period), living #30 km of GRRH, and having a known HIV status.…”

“…Bioelectrical impedance analysis testing was completed after subjects drank w8 ounces (250 mL) H 2 O. Other measures included an interviewer-administered, 10-item, individually focused food-insecurity access scale (26), the Center for Epidemiologic Studies Depression Scale (CES-D) (28), and the assessment of maternal dietary diversity from the previous day (31). At the enrollment visit during pregnancy, education, marital status, urban or rural residence, age, and report of previous displacement and living in an internally displaced person camp during the conflict in Gulu (ending in 2006) were obtained.…”

“…In addition, in Uganda, as in many other countries, an annual hunger season of food scarcity can adversely affect nutritional status. During pregnancy and lactation, women may be vulnerable to adverse effects of food insecurity on health and nutritional status because of shifts in household resources, the ability to work, the ability to prepare food (24), and heightened energy and nutritional demands (24)(25)(26). However, we know of only one study that has examined the role of food insecurity on weight changes during pregnancy in HIV+ women (25), and to our knowledge, no study has examined this role during lactation.…”

The association between food insecurity and depressive symptoms severity among pregnant women differs by social support category: a cross‐sectional study

“…Data were collected as part of the (Prenatal Nutrition and Psychosocial Health Outcomes) study PreNAPs, a longitudinal observational study designed to document the interrelationships between FI, nutritional, and psychosocial exposures and outcomes among HIV‐infected and HIV‐uninfected pregnant women in post‐conflict northern Uganda. The recruitment process, inclusion and exclusion criteria, response rates, and reasons for refusal to participate have been reported elsewhere (Natamba, Achan, et al 2014; Natamba, Kilama, et al 2015). Briefly, between October 2012 and August 2013, we approached 415 pregnant women, and 405 of them accepted to participate.…”

Food insecurity: a critical public health nutrition concern

“…The study included pregnant women (HIV-infected and uninfected), who tend to be at higher risk of undernutrition. The questionnaire was assessed as a good instrument to measure FI at the individual level based on agreement with other measures of socio-economic status and women's diet quality, and allowed discrimination of mild/ moderate from severe FI (9) . In Nepal, a nationwide representative survey carried out in 2011 ascertained the association between household FI and anthropometric indicators among children under 5 years old.…”