Persistent household food insecurity, HIV, and maternal stress in Peri-Urban Ghana

BACKGROUND: The mental health of caregivers has been shown to be important for improving HIV prevention and treatment. Household food insecurity affects hundreds of millions of individuals in Sub-Saharan Africa, a region that experiences a disproportionate burden of the HIV pandemic. Both maternal HIV diagnosis and household food insecurity may be linked with maternal stress. This in turn may lead to unhealthy coping behaviors. We examined the independent associations of HIV, persistent household food insecurity and the synergistic effect of both on maternal stress. METHODS: Ghanaian women recruited prenatally from hospitals offering voluntary counseling and testing (VCT) were followed for 12 months after childbirth (N = 232). A locally adapted 7-item version of the US Household Food Security Survey Module was applied at four time points postpartum. We dichotomized participant households as being persistently food insecure (i.e., food insecure at each time point) or not (i.e., food secure at any time point). We dichotomized participant women as not perceiving vs. perceiving stress at 12 months postpartum in reference to the median sample score on the 4-item Cohen’s stress scale. Binary multivariate logistic regression models were used to assess the independent and interactive effects of maternal HIV and persistent household food insecurity on maternal stress. RESULTS: The proportion of HIV-positive women that lived in severe food insecure households increased over time. By contrast, the HIV-negative group living in severely food insecure households experienced a steady decline across time. HIV-infection (AOR = 2.31, 95% CI 1.29-4.12) and persistent household food insecurity (AOR = 3.55, 95% CI 1.13-11.13) were independently associated with maternal stress in a multivariate model. Being both HIV-positive and persistently food insecure strongly and synergistically increased the risk for maternal perceived stress (AOR = 15.35, 95% CI 1.90-124.14). CONCLUSION: In agreement with syndemic theory there is a powerful synergism between maternal HIV diagnosis and household food insecurity on maternal stress. Comprehensive multi-dimensional intervention studies are needed to better understand how to reduce stress among HIV-positive women living in persistently food insecure households and how to reduce the likelihood of food insecurity in HIV-affected households in Sub-Saharan Africa

Risk factors for household food insecurity in the Eastern Caribbean Health Outcomes Research Network cohort study

BackgroundGlobally, 1.3 billion people were considered food insecure as of 2022. In the Caribbean region, the prevalence of moderate or severe food insecurity was 71.3% as of 2020, the highest of all subregions in Latin America. Experienced based measurement scales, like the Latin American and Caribbean Food Security Scale, are efficient measurement tools of food insecurity used globally. The Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study is a population-based longitudinal cohort study in the two Caribbean U.S. territories of Puerto Rico and the U.S. Virgin Islands, as well as in Barbados and Trinidad & Tobago. The purpose of this research was to examine the demographic, psychosocial, behavioral, and environmental risk factors associated with household food insecurity (HFI) among adults ≥40 years of age in the ECHORN cohort.MethodsA cross-sectional analysis of baseline ECHORN cohort study data was conducted. The primary outcome was household food insecurity (none, mild, moderate/severe). A total of 16 known and potential risk factors were examined for their association with HFI. The ANOVA and chi-square statistics were used in bivariate analysis. Ordinal logistic regression was used for the multivariable and sex stratified analyses.ResultsMore than one-quarter of the sample (27.3%) experienced HFI. In bivariate analyses, all risk factors examined except for sex, were significantly associated with HFI status. In the multivariable analysis, all variables except sex, education, marital status, smoking status, and residing in Puerto Rico were significant predictors of HFI in the adjusted model. In sex stratified analysis, depression, food availability, self-rated physical health, and island site were significantly associated with increased odds of worsening HFI for women, but not for men. Source of potable water was an important risk factor for both men and women.DiscussionThe prevalence of HFI in the ECHORN cohort study is comparable to other studies conducted in the region. While women did not have an increased risk of HFI compared to men, a different set of risk factors affected their vulnerability to HFI. More research is needed to understand how water and food security are interrelated in the ECHORN cohort

Nutrient intakes, food insecurity, pregnancy weight gain and birth outcomes among Connecticut Latinas

The primary objectives of this prospective study were to: (1) adapt and validate the U.S. Household Food Security Scale among pregnant Latinas; (2) describe nutrient intake patterns among Latina subgroups; and (3) document household food insecurity before as well as during pregnancy and examine it\u27s influence on pregnancy weight gain and infant birth weight among pregnant Latina women living in Hartford, Connecticut. Both qualitative and quantitative methods were used to fulfill these objectives. Focus groups were conducted among pregnant Latina women to adapt the U.S. Household Food Security Scale (FSS). Data from 241 participants who participated in the prenatal baseline survey for this study was used to assess the psychometric performance of the FSS. The final adapted version of the FSS was used to assess household food insecurity before and during pregnancy. Dietary intake and meal skipping patterns during pregnancy were assessed via a 24-hour recall and meal skipping questionnaire. Pregnancy and infant outcomes were obtained at a postpartum visit as well as through medical records. Univariate and bivariate analyses were used to evaluate the relationship between (1) nutrient intakes and ethnicity and (2) household food security (independent variables) and dependent variables (gestational weight gain and birthweight). Multivariate logistic regression analyses was used to assess the associations between (1) ethnicity, frequency of fast food restaurant use, and nutrient intakes, and (2) household food insecurity, gestational weight gain and infant birthweight. ^ The results from this study indicate that (1) the adapted household food security scale is valid for the target population, (2) nutrient intake patterns vary between Puerto Rican and non-Puerto Rican Latinas, and (3) household food security status is associated with gestational weight gain and low birth weight. Findings have important implications for food security policies and nutrition education, as well as monitoring risk of adverse pregnancy and birth outcomes among Latinas.

Acculturation Patterns and Depressive Symptoms among Low-income Pregnant Latina Women

Abstract This article examined the relationship between levels of acculturation and depression among pregnant Latina women. Among child bearing Latinas, higher acculturation has been found to be significantly associated with increased mental health problem

Persistent household food insecurity, HIV, and maternal stress in Peri-Urban Ghana

Abstract Background The mental health of caregivers has been shown to be important for improving HIV prevention and treatment. Household food insecurity affects hundreds of millions of individuals in Sub-Saharan Africa, a region that experiences a disproportionate burden of the HIV pandemic. Both maternal HIV diagnosis and household food insecurity may be linked with maternal stress. This in turn may lead to unhealthy coping behaviors. We examined the independent associations of HIV, persistent household food insecurity and the synergistic effect of both on maternal stress. Methods Ghanaian women recruited prenatally from hospitals offering voluntary counseling and testing (VCT) were followed for 12 months after childbirth (N = 232). A locally adapted 7-item version of the US Household Food Security Survey Module was applied at four time points postpartum. We dichotomized participant households as being persistently food insecure (i.e., food insecure at each time point) or not (i.e., food secure at any time point). We dichotomized participant women as not perceiving vs. perceiving stress at 12 months postpartum in reference to the median sample score on the 4-item Cohen’s stress scale. Binary multivariate logistic regression models were used to assess the independent and interactive effects of maternal HIV and persistent household food insecurity on maternal stress. Results The proportion of HIV-positive women that lived in severe food insecure households increased over time. By contrast, the HIV-negative group living in severely food insecure households experienced a steady decline across time. HIV-infection (AOR = 2.31, 95% CI 1.29-4.12) and persistent household food insecurity (AOR = 3.55, 95% CI 1.13-11.13) were independently associated with maternal stress in a multivariate model. Being both HIV-positive and persistently food insecure strongly and synergistically increased the risk for maternal perceived stress (AOR = 15.35, 95% CI 1.90-124.14). Conclusion In agreement with syndemic theory there is a powerful synergism between maternal HIV diagnosis and household food insecurity on maternal stress. Comprehensive multi-dimensional intervention studies are needed to better understand how to reduce stress among HIV-positive women living in persistently food insecure households and how to reduce the likelihood of food insecurity in HIV-affected households in Sub-Saharan Africa

Consensus-building during the Becoming Breastfeeding Friendly (BBF) initiative in Samoa: A qualitative content analysis.

The Becoming Breastfeeding Friendly (BBF) initiative provides countries with an evidence-based toolbox to improve the national breastfeeding environment by assessing and developing a plan to effectively scale up well-coordinated national policies and programs. BBF is carried out by a multi-institutional, intersectoral committee of experts, convening across five committee meetings designed to produce policy recommendations that can be implemented in the country's context. Samoa successfully completed the BBF initiative in 2018, resulting in the institution of breastfeeding policy in hospitals and the establishment of lactation rooms within government ministries. An important step in informing the success of future breastfeeding scale-up initiatives is understanding how consensus is built. This study aimed to investigate how the BBF Samoa committee built consensus. We conducted a content analysis of audio recordings of three BBF Samoa meetings (meetings 1, 2 and 4), meeting minutes, and meeting notes using an a priori operational consensus-building framework. We used a combination of deductive and inductive approaches to: a) evaluate the data against existing, a priori criteria for consensus-building and b) identify emergent ways in which the BBF Samoa committee may have achieved consensus. We identified 6 themes, 2 meta-subthemes, and 16 subthemes. The 6 themes, largely defined by the a priori framework, represented key components of successful consensus-building. The 2 meta-subthemes described two overarching methods of consensus-building: "process-led" (i.e., inherent to the BBF process itself) and "organic" (unique/specific to the committee). Lastly, the 16 subthemes described more specific ways that the committee reached consensus. The detailed manualization of the BBF process, its reliance on data, and its transparent and engaged committee process were key for reaching consensus on BBF scores and recommendations in Samoa. Our study contributes to the understanding of how effective breastfeeding policy recommendations are made, using a methodology that can be applied beyond the topic of breastfeeding

A self‐applied valid scale for rapid tracking of household food insecurity among pregnant women in Sri Lanka

Abstract Rapid household food insecurity (HFI) tracking has been identified as a priority in the context of the COVID‐19 pandemic and its aftermath. We report the validation of the Latin American and Caribbean Food Security Scale (Escala Latinoamericana y Caribena de Seguridad Alimentaria [ELCSA]) among pregnant women in Sri Lanka. The eight‐item adult version of the ELCSA was translated from English to Sinhala and Tamil. Cognitive testing (on 10 pregnant women and five local experts) and psychometric validation of the self‐administered HFI tool were conducted among pregnant women (n = 269) attending the special clinics of the Rajarata Pregnancy Cohort (RaPCo) in Anuradhapura in February 2020. We assessed the psychometric properties and fit using a one parameter logistic model (Rasch model analysis) using STATA Version 14 and WINSTEP software Version 4.3.4. Concurrent validity was tested using psychological distress. The scale was internally consistent (Cronbach's alpha = 0.79) and had a good model fit (Rasch items infit statistic range: 0.85 to 1.07). Item 8 (‘did not eat for the whole day’) was removed from the model fit analysis, as it was not affirmed by respondent. Item severity scores ranged from −2.15 for ‘not eating a diverse diet’ to 4.43 for ‘not eating during the whole day’. Concurrent validity between HFI and psychological distress was confirmed (r = 0.15, p < 0.05). The self‐applied version of ELCSA‐pregnancy in Sri Lanka (ELCSA‐P‐SL) is a valid and feasible valid tool. We recommend it to track HFI among pregnant women in lower income countries during the COVID‐19 pandemic