Patterns and predictors of exclusive breastfeeding duration among women living with HIV in Cape Town, South Africa

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dc.contributor.advisorLe Roux, Stanzi Mariaen_ZA
dc.contributor.advisorMyer, Landonen_ZA
dc.contributor.authorNguyen, Kelly Khanhduongen_ZA
dc.date.accessioned2017-10-03T14:17:50Z
dc.date.available2017-10-03T14:17:50Z
dc.date.issued2017en_ZA
dc.description.abstractBackground: 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 NCT01933477en_ZA
dc.identifier.apacitationNguyen, K. K. (2017). <i>Patterns and predictors of exclusive breastfeeding duration among women living with HIV in Cape Town, South Africa</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/25506en_ZA
dc.identifier.chicagocitationNguyen, Kelly Khanhduong. <i>"Patterns and predictors of exclusive breastfeeding duration among women living with HIV in Cape Town, South Africa."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2017. http://hdl.handle.net/11427/25506en_ZA
dc.identifier.citationNguyen, K. 2017. Patterns and predictors of exclusive breastfeeding duration among women living with HIV in Cape Town, South Africa. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Nguyen, Kelly Khanhduong AB - 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 DA - 2017 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2017 T1 - Patterns and predictors of exclusive breastfeeding duration among women living with HIV in Cape Town, South Africa TI - Patterns and predictors of exclusive breastfeeding duration among women living with HIV in Cape Town, South Africa UR - http://hdl.handle.net/11427/25506 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/25506
dc.identifier.vancouvercitationNguyen KK. Patterns and predictors of exclusive breastfeeding duration among women living with HIV in Cape Town, South Africa. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2017 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/25506en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherPublic Healthen_ZA
dc.titlePatterns and predictors of exclusive breastfeeding duration among women living with HIV in Cape Town, South Africaen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMPHen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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