Food insecurity is a barrier to prevention of mother-to-child HIV transmission services in Zimbabwe: a cross-sectional study
Identifieur interne : 003039 ( Ncbi/Merge ); précédent : 003038; suivant : 003040Food insecurity is a barrier to prevention of mother-to-child HIV transmission services in Zimbabwe: a cross-sectional study
Auteurs : Sandra I. Mccoy [États-Unis] ; Raluca Buzdugan [États-Unis] ; Angela Mushavi [Zimbabwe] ; Agnes Mahomva [Zimbabwe] ; Frances M. Cowan [Zimbabwe, Royaume-Uni] ; Nancy S. Padian [États-Unis]Source :
- BMC Public Health [ 1471-2458 ] ; 2015.
Abstract
Food insecurity (FI) is the lack of physical, social, and economic access to sufficient food for dietary needs and food preferences. We examined the association between FI and women’s uptake of services to prevent mother-to-child HIV transmission (MTCT) in Zimbabwe.
We analyzed cross-sectional data collected in 2012 from women living in five of ten provinces. Eligible women were ≥16 years old, biological mothers of infants born 9–18 months before the interview, and were randomly selected using multi-stage cluster sampling. Women and infants were tested for HIV and interviewed about health service utilization during pregnancy, delivery, and post-partum. We assessed FI in the past four weeks using a subset of questions from the Household Food Insecurity Access Scale and classified women as living in food secure, moderately food insecure, or severely food insecure households.
The weighted population included 8,790 women. Completion of all key steps in the PMTCT cascade was reported by 49%, 45%, and 38% of women in food secure, moderately food insecure, and severely food insecure households, respectively (adjusted prevalence ratio (PRa) = 0.95, 95% confidence interval (CI): 0.90, 1.00 (moderate FI vs. food secure), PRa = 0.86, 95% CI: 0.79, 0.94 (severe FI vs. food secure)). Food insecurity was not associated with maternal or infant receipt of ART/ARV prophylaxis. However, in the unadjusted analysis, among HIV-exposed infants, 13.3% of those born to women who reported severe household food insecurity were HIV-infected compared to 8.2% of infants whose mothers reported food secure households (PR = 1.62, 95% CI: 1.04, 2.52). After adjustment for covariates, this association was attenuated (PRa = 1.42, 95% CI: 0.89, 2.26). There was no association between moderate food insecurity and MTCT in unadjusted or adjusted analyses (PRa = 0.68, 95% CI: 0.43, 1.08).
Among women with a recent birth, food insecurity is inversely associated with service utilization in the PMTCT cascade and severe household food insecurity may be positively associated with MTCT. These preliminary findings support the assessment of FI in antenatal care and integrated food and nutrition programs for pregnant women to improve maternal and child health.
Url:
DOI: 10.1186/s12889-015-1764-8
PubMed: 25909583
PubMed Central: 4424582
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Food insecurity (FI) is the lack of physical, social, and economic access to sufficient food for dietary needs and food preferences. We examined the association between FI and women’s uptake of services to prevent mother-to-child HIV transmission (MTCT) in Zimbabwe.</p>
</sec>
<sec><title>Methods</title>
<p>We analyzed cross-sectional data collected in 2012 from women living in five of ten provinces. Eligible women were ≥16 years old, biological mothers of infants born 9–18 months before the interview, and were randomly selected using multi-stage cluster sampling. Women and infants were tested for HIV and interviewed about health service utilization during pregnancy, delivery, and post-partum. We assessed FI in the past four weeks using a subset of questions from the Household Food Insecurity Access Scale and classified women as living in food secure, moderately food insecure, or severely food insecure households.</p>
</sec>
<sec><title>Results</title>
<p>The weighted population included 8,790 women. Completion of all key steps in the PMTCT cascade was reported by 49%, 45%, and 38% of women in food secure, moderately food insecure, and severely food insecure households, respectively (adjusted prevalence ratio (PR<sub>a</sub>
) = 0.95, 95% confidence interval (CI): 0.90, 1.00 (moderate FI vs. food secure), PR<sub>a</sub>
= 0.86, 95% CI: 0.79, 0.94 (severe FI vs. food secure)). Food insecurity was not associated with maternal or infant receipt of ART/ARV prophylaxis. However, in the unadjusted analysis, among HIV-exposed infants, 13.3% of those born to women who reported severe household food insecurity were HIV-infected compared to 8.2% of infants whose mothers reported food secure households (PR = 1.62, 95% CI: 1.04, 2.52). After adjustment for covariates, this association was attenuated (PR<sub>a</sub>
= 1.42, 95% CI: 0.89, 2.26). There was no association between moderate food insecurity and MTCT in unadjusted or adjusted analyses (PR<sub>a</sub>
= 0.68, 95% CI: 0.43, 1.08).</p>
</sec>
<sec><title>Conclusions</title>
<p>Among women with a recent birth, food insecurity is inversely associated with service utilization in the PMTCT cascade and severe household food insecurity may be positively associated with MTCT. These preliminary findings support the assessment of FI in antenatal care and integrated food and nutrition programs for pregnant women to improve maternal and child health.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Public Health</journal-id>
<journal-id journal-id-type="iso-abbrev">BMC Public Health</journal-id>
<journal-title-group><journal-title>BMC Public Health</journal-title>
</journal-title-group>
<issn pub-type="epub">1471-2458</issn>
<publisher><publisher-name>BioMed Central</publisher-name>
<publisher-loc>London</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">25909583</article-id>
<article-id pub-id-type="pmc">4424582</article-id>
<article-id pub-id-type="publisher-id">1764</article-id>
<article-id pub-id-type="doi">10.1186/s12889-015-1764-8</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Food insecurity is a barrier to prevention of mother-to-child HIV transmission services in Zimbabwe: a cross-sectional study</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>McCoy</surname>
<given-names>Sandra I</given-names>
</name>
<address><email>smccoy@berkeley.edu</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Buzdugan</surname>
<given-names>Raluca</given-names>
</name>
<address><email>rbuzdugan@berkeley.edu</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mushavi</surname>
<given-names>Angela</given-names>
</name>
<address><email>mushavia@yahoo.co.uk</email>
</address>
<xref ref-type="aff" rid="Aff2"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mahomva</surname>
<given-names>Agnes</given-names>
</name>
<address><email>amahomva@pedaids.org</email>
</address>
<xref ref-type="aff" rid="Aff3"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cowan</surname>
<given-names>Frances M</given-names>
</name>
<address><email>f.cowan@ucl.ac.uk</email>
</address>
<xref ref-type="aff" rid="Aff4"></xref>
<xref ref-type="aff" rid="Aff5"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Padian</surname>
<given-names>Nancy S</given-names>
</name>
<address><email>nancy.padian@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
</contrib>
<aff id="Aff1"><label></label>
University of California, 1950 Addison Avenue, Suite 202-8, Berkeley, CA 94704 USA</aff>
<aff id="Aff2"><label></label>
Ministry of Health and Child Welfare, Mkwati Building Corner 5th Street and Livingstone Avenue, Harare, Zimbabwe</aff>
<aff id="Aff3"><label></label>
Elizabeth Glaser Pediatric AIDS Foundation, 107 King George Road, Avondale, Harare, Zimbabwe</aff>
<aff id="Aff4"><label></label>
Centre for Sexual Health and HIV Research, 9 Monmouth Rd, Avondale West, Harare, Zimbabwe</aff>
<aff id="Aff5"><label></label>
University College London, London, UK</aff>
</contrib-group>
<pub-date pub-type="epub"><day>25</day>
<month>4</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>25</day>
<month>4</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="collection"><year>2015</year>
</pub-date>
<volume>15</volume>
<elocation-id>420</elocation-id>
<history><date date-type="received"><day>28</day>
<month>10</month>
<year>2014</year>
</date>
<date date-type="accepted"><day>21</day>
<month>4</month>
<year>2015</year>
</date>
</history>
<permissions><copyright-statement>© McCoy et al.; licensee BioMed Central. 2015</copyright-statement>
<license license-type="open-access"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0">http://creativecommons.org/licenses/by/4.0</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>
) applies to the data made available in this article, unless otherwise stated.</license-p>
</license>
</permissions>
<abstract id="Abs1"><sec><title>Background</title>
<p>Food insecurity (FI) is the lack of physical, social, and economic access to sufficient food for dietary needs and food preferences. We examined the association between FI and women’s uptake of services to prevent mother-to-child HIV transmission (MTCT) in Zimbabwe.</p>
</sec>
<sec><title>Methods</title>
<p>We analyzed cross-sectional data collected in 2012 from women living in five of ten provinces. Eligible women were ≥16 years old, biological mothers of infants born 9–18 months before the interview, and were randomly selected using multi-stage cluster sampling. Women and infants were tested for HIV and interviewed about health service utilization during pregnancy, delivery, and post-partum. We assessed FI in the past four weeks using a subset of questions from the Household Food Insecurity Access Scale and classified women as living in food secure, moderately food insecure, or severely food insecure households.</p>
</sec>
<sec><title>Results</title>
<p>The weighted population included 8,790 women. Completion of all key steps in the PMTCT cascade was reported by 49%, 45%, and 38% of women in food secure, moderately food insecure, and severely food insecure households, respectively (adjusted prevalence ratio (PR<sub>a</sub>
) = 0.95, 95% confidence interval (CI): 0.90, 1.00 (moderate FI vs. food secure), PR<sub>a</sub>
= 0.86, 95% CI: 0.79, 0.94 (severe FI vs. food secure)). Food insecurity was not associated with maternal or infant receipt of ART/ARV prophylaxis. However, in the unadjusted analysis, among HIV-exposed infants, 13.3% of those born to women who reported severe household food insecurity were HIV-infected compared to 8.2% of infants whose mothers reported food secure households (PR = 1.62, 95% CI: 1.04, 2.52). After adjustment for covariates, this association was attenuated (PR<sub>a</sub>
= 1.42, 95% CI: 0.89, 2.26). There was no association between moderate food insecurity and MTCT in unadjusted or adjusted analyses (PR<sub>a</sub>
= 0.68, 95% CI: 0.43, 1.08).</p>
</sec>
<sec><title>Conclusions</title>
<p>Among women with a recent birth, food insecurity is inversely associated with service utilization in the PMTCT cascade and severe household food insecurity may be positively associated with MTCT. These preliminary findings support the assessment of FI in antenatal care and integrated food and nutrition programs for pregnant women to improve maternal and child health.</p>
</sec>
</abstract>
<kwd-group xml:lang="en"><title>Keywords</title>
<kwd>Food security</kwd>
<kwd>Prevention of mother-to-child transmission of HIV</kwd>
<kwd>PMTCT cascade</kwd>
<kwd>HIV infection</kwd>
<kwd>Zimbabwe</kwd>
<kwd>Maternal health</kwd>
</kwd-group>
<custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name>
<meta-value>© The Author(s) 2015</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Royaume-Uni</li>
<li>Zimbabwe</li>
<li>États-Unis</li>
</country>
<region><li>Angleterre</li>
<li>Californie</li>
<li>Grand Londres</li>
</region>
<settlement><li>Londres</li>
</settlement>
<orgName><li>University College de Londres</li>
</orgName>
</list>
<tree><country name="États-Unis"><region name="Californie"><name sortKey="Mccoy, Sandra I" sort="Mccoy, Sandra I" uniqKey="Mccoy S" first="Sandra I" last="Mccoy">Sandra I. Mccoy</name>
</region>
<name sortKey="Buzdugan, Raluca" sort="Buzdugan, Raluca" uniqKey="Buzdugan R" first="Raluca" last="Buzdugan">Raluca Buzdugan</name>
<name sortKey="Padian, Nancy S" sort="Padian, Nancy S" uniqKey="Padian N" first="Nancy S" last="Padian">Nancy S. Padian</name>
</country>
<country name="Zimbabwe"><noRegion><name sortKey="Mushavi, Angela" sort="Mushavi, Angela" uniqKey="Mushavi A" first="Angela" last="Mushavi">Angela Mushavi</name>
</noRegion>
<name sortKey="Cowan, Frances M" sort="Cowan, Frances M" uniqKey="Cowan F" first="Frances M" last="Cowan">Frances M. Cowan</name>
<name sortKey="Mahomva, Agnes" sort="Mahomva, Agnes" uniqKey="Mahomva A" first="Agnes" last="Mahomva">Agnes Mahomva</name>
</country>
<country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Cowan, Frances M" sort="Cowan, Frances M" uniqKey="Cowan F" first="Frances M" last="Cowan">Frances M. Cowan</name>
</region>
</country>
</tree>
</affiliations>
</record>
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