Abstract
BackgroundFood 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.MethodsWe 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.ResultsThe 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).ConclusionsAmong 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.
Highlights
Food insecurity (FI) is the lack of physical, social, and economic access to sufficient food for dietary needs and food preferences
Because the analyses presented in this paper use data from the 2012 survey, which were the baseline data for the parent impact evaluation, we describe the association between food security and engagement in prevention of mother-to-child HIV transmission (PMTCT) services before the Ministry of Health and Child Care’s (MoHCC) implementation of PMTCT strategy ‘Option A’
Food insecurity and receipt of maternal health services Food insecurity was inversely associated with use of antenatal care (ANC) services, with 95%, 94%, and 92% of women from food secure, moderately food insecure, and severely food insecure households reporting attendance at ≥1 ANC visit, respectively (p < 0.01, Table 2), food insecurity was not associated with ≥4 ANC visits nor the timing of the first ANC visit
Summary
Food insecurity (FI) is the lack of physical, social, and economic access to sufficient food for dietary needs and food preferences. The PMTCT cascade is a series of services that HIV-positive pregnant women and their infants need to receive in order to prevent HIV transmission, including antenatal care (ANC), HIV testing, and antiretroviral therapy (ART) or antiretroviral (ARV) prophylaxis [5]. Economic factors are cited as barriers to ANC and PMTCT services, [9,10] including facilitybased delivery, [11] initiation of ART and ARV prophylaxis, and retention in HIV care [12]. People are considered food secure when they have adequate 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 [13]. Few studies have examined the relationship between food insecurity and utilization of PMTCT services and MTCT [19,20]
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