Household Food Insecurity, Maternal Nutrition, Environmental Risks, and Infant Health Outcomes: Protocol from the IMPALA Birth Cohort Study in Uganda

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BMJ open. 2022 Mar 18;12(3):e050729. doi: 10.1136/bmjopen-2021-050729.


INTRODUCTION: In low- and middle-income countries (LMICs), food insecurity and undernutrition disproportionately affect women of reproductive age, infants and young children. The burden of disease due to undernutrition in these vulnerable segments of society remains a major concern in the LMICs. The use of biofuels for cooking is also common in LMICs. Empirical evidence from high-income countries indicates that nutritional and environmental exposures in early life and their effects on infant lung function are important; however, data from sub-Saharan Africa are scarce.

OBJECTIVE: To estimate the association between infant lung function and household food insecurity, energy poverty and maternal dietary diversity.

METHODS AND ANALYSIS: Pregnant women will be recruited from an existing health and demographic surveillance site in southwestern Uganda. Household food insecurity, energy sources and uses, economic measures and maternal dietary diversity will be collected during pregnancy and after birth. The primary health outcomes will be infant lung function determined by analysis of tidal flow and volume of breaths at 6-10 weeks of age. The infant’s weight and height will also be collected. A household food consumption score and a minimum dietary diversity indicator for women (MDD-W) will be constructed. The implied cost of dietary diversity will be estimated based on the MDD-W. The association between household level and maternal food access indicators and infant lung function will be assessed using regression models. The Multidimensional Energy Poverty Index (MEPI) will be estimated and used as an indicator of household environmental exposures. The association between household MEPI and infant lung function will be assessed using econometric models.

ETHICS AND DISSEMINATION: Ethical clearances were obtained from Liverpool School of Tropical Medicine (18-059), Uganda Virus Research Institute Ethics Committee (097/2018) and Uganda National Council for Science and technology (SS 4846). The results of the study will be shared with participants, policy makers, other stakeholders and published in peer-reviewed journals.

PMID:35304392 | DO I:10.1136/bmjopen-2021-050729