Food insecurity is a barrier to prevention of mother-to-child HIV transmission services in Zimbabwe: a cross-sectional study
Research article
1 University of California, 1950 Addison Avenue, Suite 202-8, Berkeley 94704, CA, USA
2 Ministry of Health and Child Welfare, Mkwati Building Corner 5th Street and Livingstone Avenue, Harare, Zimbabwe
3 Elizabeth Glaser Pediatric AIDS Foundation, 107 King George Road, Avondale, Harare, Zimbabwe
4 Centre for Sexual Health and HIV Research, 9 Monmouth Rd, Avondale West, Harare, Zimbabwe
5 University College London, London, UK
BMC Public Health 2015, 15:420Â
doi:10.1186/s12889-015-1764-8
Published: 25 April 2015
Abstract (provisional)
Background 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. Methods We analyzed cross-sectional data collected in 2012 from
women living in five of ten provinces. Eligible women were ?16Â 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. Results 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). Conclusions
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.