The Prevalence and Covariates of Food Insecurity Across Gestation and Postpartum Among Women of Mixed HIV Status in Nyanza Region, Kenya

Abstract

Abstract Objectives Food insecurity (FI) is recognized as an important predictor of a range of health outcomes, including HIV acquisition and progression. Less is understood about the drivers of FI during the first 1000 days. Therefore we assessed the prevalence and covariates of FI among women of mixed HIV status in southwestern Kenya from pregnancy to 21 months postpartum. Methods The prevalence of FI was measured amongst all pregnant women attending 7 antenatal clinics in the Nyanza region, Kenya (n = 954) between 2015 and 2017 using the Individually Focused Food Insecurity Access Scale (IFIAS, range: 0–27). Subsequently, equal proportions of HIV-infected and -uninfected pregnant women (n = 363) were enrolled into an observational study and surveyed at 9 timepoints. Results In the population-based sample, 81% were severely food insecure. In the study cohort, the mean (SD) IFIAS score was 15.4 (6.1); 88% were considered severely food insecure. In longitudinal logistic regression models of FI (severe vs. not severe) from pregnancy to 21 m postpartum, greater depression scores, lower social support, greater stress, rural residence, and having dependents under 15-years were associated with greater IFIAS scores. Surprisingly, HIV infection, gestation age, education, and maternal age did not predict IFIAS scores. Conclusions These findings suggest programs in severely food insecure communities should also address psychosocial well-being of women to improve health outcomes. Funding Sources National Institute of Mental Health (K01 MH098902 and R21MH108444).