Patterns and predictors of exclusive breastfeeding duration among women living with HIV in Cape Town, South Africa
Master Thesis
2017
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University of Cape Town
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Background: Exclusive breastfeeding (EBF) is the international gold standard for infant feeding in the first 4-6 months of life. In sub-Saharan Africa, breastfeeding has been adversely affected by the HIV epidemic, due to breastmilk-associated mother-to-child transmission (MTCT) risk in the absence of triple antiretroviral therapy (ART). However, with rapidly expanding global accessibility of ART, HIV treatment and infant feeding guidelines now recommend universal ART for all women ("Option B+") with breastfeeding as the optimal infant feeding choice in most settings. Data is scarce on breastfeeding practices in this context. This project seeks to describe early infant feeding practices among HIV-infected women initiating ART in an Option B+ PMTCT clinic in peri-urban Cape Town, South Africa. Methods: The Maternal-and-Child-Health-Antiretroviral (MCH-ART) study (2013-2016) enrolled HIV-infected women initiating ART in pregnancy; breastfeeding mother-infant pairs were followed until 18 months. Data were collected via interviews at scheduled study visits, including repeated measures of infant feeding practices (24-hour recall). EBF duration was defined from delivery date to date of last visit reporting EBF. A priori-defined maternal-infant characteristics potentially associated with early EBF cessation (< 4 months/never) were evaluated using exploratory data analysis and multivariable logistic regression. Results: Of 471 breastfeeding mother-infant pairs, 429 (91%) were ever EBF. Median duration of EBF was 1.5 months (interquartile range, IQR 0.3-5.4); only 115/471 (24%) were EBF for 4 months or longer. Median maternal age was 28 years (IQR 24-32); 41% were married/co-habiting; 58% delivered at primary care level. Women who reported any lactation concerns by 6 weeks postpartum (22%) were more likely to cease EBF prematurely (adjusted odds ratio, aOR 1.77; 95% CI 0.96-3.27). Adjusting for alcohol use, poverty, gravidity, delivery mode, maternal age and education, other factors associated with early EBF cessation included relationship status (married/co-habiting vs. single, aOR 0.50, 95%CI 0.31-0.81), place of delivery (secondary vs. primary, aOR 1.94, 95%CI 1.06-3.54), and antenatal maternal anxiety (aOR 4.02, 95%CI 0.91-17.72). Conclusions: Exclusive breastfeeding is sub-optimal in this setting. Lactation problems are common, and strongly associated with premature EBF cessation. Additional lactation support is urgently required in PMTCT settings promoting breastfeeding. Trial registration: ClinicalTrials.gov NCT01933477
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Nguyen, K. 2017. Patterns and predictors of exclusive breastfeeding duration among women living with HIV in Cape Town, South Africa. University of Cape Town.