Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA.
Global Programs for Research and Training, University of California San Francisco, Kisumu, Kenya.
Int Breastfeed J. 2023 Nov 27;18(1):64. doi: 10.1186/s13006-023-00600-1.
The syndemic effects of poverty, food insecurity and living with HIV are recognized as global health priorities, including through the United Nations Sustainability Goals 1, 2 and 3. Today, women and girls account for 63% of all new HIV infections in eastern and southern Africa, including Kenya. Pregnant and postpartum women living with HIV in this setting face unique challenges including increased financial insecurity as women leave the work force to care for their newborn infants. This contributes to poverty, food scarcity and stress.
To address financial insecurity, improve infant feeding and reduce stress among mothers living with HIV in this setting, we developed a multilevel intervention, Supporting Healthy Mothers, consisting of 10 monthly unconditional cash transfers (10,000 KES, ~$75 USD/month) and personalized infant feeding support from pregnancy to 7 months postpartum. We conducted a non-randomized feasibility trial of this intervention among women engaged in HIV care in Kisumu, Kenya. From February 23, 2022 to March 23, 2022, we enrolled a total of 40 women who were 20-35 weeks pregnant-20 women to the intervention group at a public clinic, and 20 women to the control group at a similar clinic. Our aim was to assess feasibility, acceptability, and the potential impact of the intervention on food security, infant feeding and maternal mental health.
Analyzing data from all 40 participants, we found a significant reduction in food insecurity scores from baseline for the intervention group when compared to the control group at 6 weeks and 6 months postpartum (p = 0.0008 and p < 0.0001, respectively). Qualitative exit interviews with intervention group participants confirmed women felt more financially secure and had newly acquired practical knowledge and skills related to infant feeding. Women found the two intervention components highly acceptable and described an overall positive impact on wellbeing.
The Supporting Healthy Mothers intervention has potential to positively impact women across the perinatal period and beyond by increasing financial security and supporting women to overcome infant feeding challenges and should be assessed in larger trials.
Supporting Healthy Mothers was registered with ClinicalTrials.gov Protocol Registration and Results System, initially published on February 1, 2022.
gov ID: NCT05219552 Protocol ID: K23MH116807.
贫困、粮食不安全和感染艾滋病毒的综合影响被认为是全球卫生重点，包括通过联合国可持续发展目标 1、2 和 3。如今，在东非和南非，女性和女孩占所有新艾滋病毒感染人数的 63%，肯尼亚也不例外。在这种情况下，感染艾滋病毒的孕妇和产后妇女面临着独特的挑战，包括由于妇女离开工作岗位照顾新生儿而导致的财务不安全感增加。这导致了贫困、粮食短缺和压力。
为了解决该环境中感染艾滋病毒的母亲的财务不安全感、改善婴儿喂养和减轻压力问题，我们开发了一项多层次干预措施，即支持健康母亲，包括 10 个月的无条件现金转移（每月 10,000 肯尼亚先令，约 75 美元）和从怀孕到产后 7 个月的个性化婴儿喂养支持。我们在肯尼亚基苏木的艾滋病毒护理中心进行了这项干预措施的非随机可行性试验。从 2022 年 2 月 23 日至 2022 年 3 月 23 日，我们共招募了 40 名 20-35 周妊娠的孕妇，其中 20 名在一家公立诊所入组干预组，20 名在类似诊所入组对照组。我们的目的是评估该干预措施的可行性、可接受性以及对粮食安全、婴儿喂养和产妇心理健康的潜在影响。
对所有 40 名参与者的数据进行分析后，我们发现干预组在产后 6 周和 6 个月时的粮食不安全评分与对照组相比显著降低（p=0.0008 和 p<0.0001）。对干预组参与者的定性退出访谈证实，女性感到更有财务安全感，并获得了与婴儿喂养相关的新实践知识和技能。女性认为这两个干预措施非常容易接受，并描述了对幸福感的整体积极影响。
支持健康母亲的干预措施具有通过增加财务安全性和支持妇女克服婴儿喂养挑战来积极影响整个围产期及以后的妇女的潜力，应该在更大的试验中进行评估。
supporting Healthy Mothers 在 ClinicalTrials.gov 注册并在结果系统中发布，最初于 2022 年 2 月 1 日发布。
gov ID：NCT05219552 协议 ID：K23MH116807。
