Dataset Information

Food-insecure pregnant women in South Africa: a cross-sectional exploration of maternal depression as a mediator of violence and trauma risk factors.

ABSTRACT: OBJECTIVES:Better understanding of psychosocial risk factors for food insecurity (FI) during pregnancy and how they interact is crucial, given long-term health implications for maternal and child health. We investigated the association between maternal childhood trauma as well as intimate partner violence (IPV) and FI among pregnant women in South Africa, in the Drakenstein Child Health Study, and whether maternal depression mediates these relationships. SETTING:Two primary care clinics in Paarl, South Africa. PARTICIPANTS:992 pregnant women; inclusion criteria were clinic attendance and remaining in area for at least 1?year; women were excluded if a minor. METHODS:We examined psychosocial predictors of FI using multivariate regression. Mediation analyses investigated whether depression mediated the relationship between IPV and FI as well as between childhood trauma and FI, including disaggregation by two study communities. FI was assessed using an adapted US Department of Agriculture food security scale; households were coded as food insecure where 2 of 5 affirmative responses were recorded. RESULTS:Among 992 pregnant women, there were high rates of IPV (7%-27%), depression (24%) and childhood trauma (34%). In multivariate cross-sectional analysis, emotional IPV (adjusted OR [aOR] 1.60; 95%?CI 1.04 to 2.46), depression (aOR 1.05; 95%?CI 1.01 to 1.08) and childhood trauma (aOR 1.52; 95%?CI 1.08 to 2.15) predicted FI. In mediation models, depression partially mediated the relationship between emotional IPV and FI as well as physical IPV and FI; depression partially mediated the relationship between childhood trauma and FI. Differing degrees of mediation were found when applied to communities. CONCLUSIONS:Antenatal maternal depression, IPV and childhood trauma were highly prevalent and associated with FI. Depression, IPV and trauma screening services should be considered within routine antenatal care and may offer an opportunity to identify and intervene. Community-level differences in risk and in mediation analyses indicate that contextual tailoring of interventions may be important.

SUBMITTER: Barnett W

PROVIDER: S-EPMC6429723 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Food-insecure pregnant women in South Africa: a cross-sectional exploration of maternal depression as a mediator of violence and trauma risk factors.

Barnett Whitney W Pellowski Jennifer J Kuo Caroline C Koen Nastassja N Donald Kirsten A KA Zar Heather J HJ Stein Dan J DJ

BMJ open 20190313 3

<h4>Objectives</h4>Better understanding of psychosocial risk factors for food insecurity (FI) during pregnancy and how they interact is crucial, given long-term health implications for maternal and child health. We investigated the association between maternal childhood trauma as well as intimate partner violence (IPV) and FI among pregnant women in South Africa, in the Drakenstein Child Health Study, and whether maternal depression mediates these relationships.<h4>Setting</h4>Two primary care c ...[more]

PMID: 30867198

Similar Datasets

Project description:Since 2015, Sub-Saharan Africa (SSA) has experienced an unprecedented rise in acute food insecurity (AFI), and current projections for the year 2020 indicate that more than 100 million Africans are estimated to receive emergency food assistance. Climate-driven drought is one of the main contributing factors to AFI, and timely and appropriate actions can be taken to mitigate impacts of AFI on lives and livelihoods through early warning systems. To support this goal, we use observations of peak Normalized Difference Vegetation Index (NDVI) as an indicator of seasonal drought conditions following a rainy season to show that delays in the onset of the rainy season (onset date) can be an effective early indicator of seasonal drought conditions. The core of this study is an evaluation of the relationship of the onset dates and peak NDVI, stratified by AFI risks, calculated using AFI reports by the United States Agency of International Development (USAID)-funded Famine Early Warning Systems Network (FEWS NET). Several parts of SSA, mostly located in East Africa (EA), reported the "Crisis" phase of AFI-requiring emergency food assistance-at least one-third of the time between April 2011 to present. The results show that the onset date can effectively explain much of the interannual variability in peak NDVI in the regions with the highest AFI risk level, particularly in EA where the median of correlation (across all the Administrative Unit 2) varies between -0.42 to -0.68. In general, an onset date delay of at least 1 dekad (10 days) increases the likelihood of seasonal drought conditions. In the regions with highest risks of AFI, an onset delay of just 1 dekad doubles the chance of the standardized anomaly of peak NDVI being below -1, making a -1 anomaly the most probable outcome. In those regions, a 2-dekads delay in the onset date is associated with a very high probability (50%) of seasonal drought conditions (-1 standardized anomaly of NDVI). Finally, a multivariate regression analysis between standardized anomaly and onset date anomaly further substantiates the negative impacts of delay in onset date on NDVI anomaly. This relationship is statistically significant over the SSA as a whole, particularly in the EA region. These results imply that the onset date can be used as an additional critical tool to provide alerts of seasonal drought development in the most food-insecure regions of SSA. Early warning systems using onset date as a tool can help trigger effective mid-season responses to save human lives, livestock, and livelihoods, and, therefore, mitigate the adverse impacts of drought hazards.

Project description:Food insecurity has emerged as an important, and potentially modifiable, risk factor for depression. Few studies have brought longitudinal data to bear on investigating this association in sub-Saharan Africa.To estimate the association between food insufficiency and depression symptom severity, and to determine the extent to which any observed associations were modified by social support.We conducted a secondary analysis of population-based, longitudinal data collected from 1238 pregnant women during a three-year cluster-randomized trial of a home visiting intervention in Cape Town, South Africa. Surveys were conducted at baseline, 6 months, 18 months, and 36 months (85% retention). A validated, single-item food insufficiency measure inquired about the number of days of hunger in the past week. Depression symptom severity was measured using the Xhosa version of the 10-item Edinburgh Postnatal Depression Scale. In multivariable regression models with cluster-correlated robust estimates of variance, lagged food insufficiency had a strong and statistically significant association with depression symptom severity (? = 0.70; 95% CI, 0.46-0.94), suggesting a 6.5% relative difference in depression symptom severity per day of hunger. In stratified analyses, food insufficiency had a statistically significant association with depression only among women with low levels of instrumental support. Using quantile regression, we found that the adverse impacts of food insufficiency were experienced to a greater degree by women in the upper end of the conditional distribution of depression symptom severity. Estimates from fixed-effects regression models and fixed-effects quantile regression models, accounting for unobserved confounding by time-invariant characteristics, were similar.Food insufficiency was associated with depression symptom severity, particularly for women in the upper end of the conditional depression distribution. Instrumental social support buffered women against the adverse impacts of food insufficiency.

Dataset Information

Food-insecure pregnant women in South Africa: a cross-sectional exploration of maternal depression as a mediator of violence and trauma risk factors.

Publications

Food-insecure pregnant women in South Africa: a cross-sectional exploration of maternal depression as a mediator of violence and trauma risk factors.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets