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Tshiambara P, Hoffman M, Legodi H, Botha T, Mulol H, Pisa P, Feucht U. Comparison of Feeding Practices and Growth of Urbanized African Infants Aged 6-12 Months Old by Maternal HIV Status in Gauteng Province, South Africa. Nutrients 2023; 15:nu15061500. [PMID: 36986230 PMCID: PMC10053312 DOI: 10.3390/nu15061500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
Appropriate feeding practices are protective against malnutrition and poor growth. We compared feeding practices and growth in HIV-exposed-uninfected (HEU) and HIV-unexposed-uninfected (HUU) between 6-12 months of age in urbanized African infants in South Africa. A repeated cross-sectional analysis was used to determine differences in infant feeding practices and anthropometric measures by HIV exposure status at 6, 9, and 12 months in the Siyakhula study. The study included 181 infants (86 HEU; 95 HUU). Breastfeeding rates were lower in HEU vs. HUU infants at 9 (35.6% vs. 57.3%; p = 0.013) and 12 months (24.7% vs. 48.0%; p = 0.005). Introduction to early complementary foods was common (HEU = 16.2 ± 11.0 vs. HUU = 12.8 ± 9.3 weeks; p = 0.118). Lower weight-for-age Z-scores (WAZ) and head circumference-for-age Z-scores (HCZ) were found in HEU infants at birth. At 6 months, WAZ, length-for-age Z-scores (LAZ), HCZ, and mid-upper-arm circumference-for-age Z-scores (MUACAZ) were lower in HEU vs. HUU infants. At 9 months, lower WAZ, LAZ, and MUACAZ were found in HEU vs. HUU infants. At 12 months, lower WAZ, MUACAZ, and weight-for-length Z-scores (-0.2 ± 1.2 vs. 0.2 ± 1.2; p = 0.020) were observed. HEU infants had lower rates of breastfeeding and poorer growth compared to HUU infants. Maternal HIV exposure affects the feeding practices and growth of infants.
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Affiliation(s)
- Phumudzo Tshiambara
- Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria 0084, South Africa
- Department of Consumer and Food Sciences, Faculty of Natural and Agricultural Sciences, University of Pretoria, Hatfield Campus, Pretoria 0028, South Africa
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
| | - Marinel Hoffman
- Department of Consumer and Food Sciences, Faculty of Natural and Agricultural Sciences, University of Pretoria, Hatfield Campus, Pretoria 0028, South Africa
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
| | - Heather Legodi
- Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria 0084, South Africa
| | - Tanita Botha
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Hatfield Campus, Pretoria 0028, South Africa
| | - Helen Mulol
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Paediatrics, Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria 0084, South Africa
| | - Pedro Pisa
- Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria 0084, South Africa
| | - Ute Feucht
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Paediatrics, Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria 0084, South Africa
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Nsibande DF, Magasana V, Zembe W, Kindra G, Mogashoa M, Goga A, Ramokolo V. Health facility users' knowledge, perceptions, and practices about infant feeding in the context of option B+ in South Africa: a qualitative study. Int Breastfeed J 2022; 17:89. [PMID: 36539742 PMCID: PMC9764699 DOI: 10.1186/s13006-022-00526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND HIV and sub-optimal infant feeding practices remain important threats to child growth, development, and survival in low- and middle-income countries. To our knowledge, few studies have explored health service users' perspective of infant feeding in the context of WHO Option B+ policy to prevent vertical HIV transmission (PMTCT). This paper is a sub-analysis of qualitative data from a mixed-methods multi-level process evaluation of Option B+ implementation in South Africa (SA). In this study we explored health facility users' infant feeding knowledge, perceptions, and practices one year after SA adopted the 2016 updated World Health Organization prevention of mother-to-child transmission of HIV Option B+ infant feeding guidelines. METHODS Nineteen focus group discussions (FGDs) were held with six groups of men and women whose infants were aged < 6 months. Participants were attending randomly selected primary health care facilities within six purposively selected priority districts. The six groups included in the FGDs were: (i) adolescent girls and young women living with HIV (WHIV), (ii) adolescent girls and young women not living with HIV (WNHIV), (iii) older postnatal WHIV (iv) older postnatal WNHIV (v) pregnant women, and (vi) men. Data collection took place between April and December 2018. Data analysis involved coding and thematic framework analysis. RESULTS Women and men have suboptimal knowledge of the recommended breastfeeding duration and exclusive breastfeeding, especially for HIV-exposed infants. Most women received sub-optimal infant feeding counselling and mixed messages from health care workers. Fewer WHIV initiated breastfeeding at birth compared to WNHIV. Most parents believed that HIV-exposed infants should be breastfed for 6 months and many postnatal women on antiretroviral drugs and younger mothers lacked confidence to breastfeed beyond 6 months. Mixed feeding was predominant among all women due to individual, family, and socio-structural barriers. Many men were supportive on infant feeding; however, they lacked the appropriate information and skills to influence their partners' infant feeding decisions. CONCLUSIONS Differences in breastfeeding practices between WHIV and WNHIV are highly influenced by the lack of knowledge of infant feeding policy recommendations. Multiple-level factors deter many mothers from adhering to recommended guidelines. Appropriate ongoing infant feeding counselling and breastfeeding support are required for women and their partners.
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Affiliation(s)
- Duduzile Faith Nsibande
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024HIV and other Infectious Diseases Research Unit (HIDRU), SAMRC, Cape Town, South Africa
| | - Vuyolwethu Magasana
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024HIV and other Infectious Diseases Research Unit (HIDRU), SAMRC, Cape Town, South Africa
| | - Wanga Zembe
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa
| | - Gurpreet Kindra
- grid.513001.6United States Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Mary Mogashoa
- grid.513001.6United States Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Ameena Goga
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024HIV and other Infectious Diseases Research Unit (HIDRU), SAMRC, Cape Town, South Africa ,grid.49697.350000 0001 2107 2298Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Vundli Ramokolo
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024HIV and other Infectious Diseases Research Unit (HIDRU), SAMRC, Cape Town, South Africa
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Eccles R, du Toit M, de Jongh G, Krüger E. Breastfeeding Outcomes and Associated Risks in HIV-Infected and HIV-Exposed Infants: A Systematic Review. Breastfeed Med 2022; 17:112-130. [PMID: 34936484 DOI: 10.1089/bfm.2021.0107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose: To critically appraise recent literature regarding breastfeeding outcomes and associated risks in HIV-infected (HI) and HIV-exposed (HE) infants, using the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) statement guidelines. Materials and Methods: Five electronic databases were systematically searched to obtain English publications from the last 10 years (2010-2020), pertaining to breastfeeding outcomes and associated risks of HI and HE infants and children. Gray literature sources were also included. Data were extracted according to various data items and were synthesized using thematic synthesis. Results: Of the initial 7,151 sources identified, 42 articles were eligible for final inclusion. The final selection included 19 cohort studies and 2 expert committee reports, classified as gray literature. The remaining 21 studies comprised case-control, cross-sectional, and randomized controlled trial studies. The following themes were identified: breastfeeding outcomes in HI and HE infants, risks for suboptimal breastfeeding, HI and HE infant growth and developmental outcomes, and barriers and facilitators to feeding decisions. Most studies highlighted HE infants' growth and developmental outcomes and did not directly interrogate breastfeeding outcomes. The most prevalent risks for suboptimal breastfeeding were maternal factors affecting decision making for breastfeeding. Conclusions: This systematic review adds to the evidence of breastfeeding in HIV-affected mother-infant dyads. Findings reiterated that exclusive breastfeeding has a positive outcome on growth and development of all infants irrespective of HIV status. The review highlighted a dearth of research on breastfeeding outcomes of HI and HE infants. Large-scale prospective comparative studies should profile breastfeeding and developmental outcomes of infants with HIV infection or exposure and antiretroviral treatment exposure to enable early identification and intervention for this vulnerable population in low-income settings.
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Affiliation(s)
- Renata Eccles
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Maria du Toit
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Grethe de Jongh
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Esedra Krüger
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
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Chepuka L, Kwanjo-Banda C, Kafulafula U, Sefasi A, Chorwe-Sungani G. Prevalence and associated factors of intimate partner violence amongst women attending prevention of mother to child transmission services in Blantyre, Malawi. S Afr Fam Pract (2004) 2021; 63:e1-e7. [PMID: 34636592 PMCID: PMC8603061 DOI: 10.4102/safp.v63i1.5271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 12/02/2022] Open
Abstract
Background Intimate partner violence (IPV) during the perinatal period and when one is HIV-positive is a great concern because of the physical and mental impacts it has on health and on adherence to prevention of mother to child transmission (PMTCT) services. However, factors associated with IPV amongst perinatal women on PMTCT services are not adequately explored in Malawi. The aim of this study was to estimate the various types of IPV and the associated factors amongst HIV-positive pregnant and postnatal women in selected health centres in Blantyre district. Methods In this cross-sectional study, we recruited 200 HIV-positive women from antenatal, postnatal and antiretroviral therapy (ART) clinics from four selected primary care facilities of Blantyre district. Data were collected between March and May 2018. Results A total of 50% of the participants reported to have experienced either physical, psychological or sexual violence from their partner in the last 12 months. The multivariate logistic regression model showed that feelings about safety of the relationship and depression were the only factors that were consistently associated with IPV in the last 12 months (p = 0.001, Pseudo R2 = 0.20). Conclusion The presence of depression and safety concerns amongst our study participants calls for serious prioritisation of psychological interventions and risk assessment in the management of HIV-positive perinatal mothers who report IPV cases.
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Affiliation(s)
- Lignet Chepuka
- Department of Adult Health, Faculty of Nursing Health Studies, Kamuzu College of Nursing, University of Malawi, Blantyre.
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Hasan M, Hassan M, Khan MS, Tareq M, Afroj M. Prevalence, knowledge, attitudes and factors associated with exclusive breastfeeding among mothers in Dhaka, Bangladesh: A cross-sectional study. POPULATION MEDICINE 2021. [DOI: 10.18332/popmed/140132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Adam M, Johnston J, Job N, Dronavalli M, Le Roux I, Mbewu N, Mkunqwana N, Tomlinson M, McMahon SA, LeFevre AE, Vandormael A, Kuhnert KL, Suri P, Gates J, Mabaso B, Porwal A, Prober C, Bärnighausen T. Evaluation of a community-based mobile video breastfeeding intervention in Khayelitsha, South Africa: The Philani MOVIE cluster-randomized controlled trial. PLoS Med 2021; 18:e1003744. [PMID: 34582438 PMCID: PMC8478218 DOI: 10.1371/journal.pmed.1003744] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In South Africa, breastfeeding promotion is a national health priority. Regular perinatal home visits by community health workers (CHWs) have helped promote exclusive breastfeeding (EBF) in underresourced settings. Innovative, digital approaches including mobile video content have also shown promise, especially as access to mobile technology increases among CHWs. We measured the effects of an animated, mobile video series, the Philani MObile Video Intervention for Exclusive breastfeeding (MOVIE), delivered by a cadre of CHWs ("mentor mothers"). METHODS AND FINDINGS We conducted a stratified, cluster-randomized controlled trial from November 2018 to March 2020 in Khayelitsha, South Africa. The trial was conducted in collaboration with the Philani Maternal Child Health and Nutrition Trust, a nongovernmental community health organization. We quantified the effect of the MOVIE intervention on EBF at 1 and 5 months (primary outcomes), and on other infant feeding practices and maternal knowledge (secondary outcomes). We randomized 1,502 pregnant women in 84 clusters 1:1 to 2 study arms. Participants' median age was 26 years, 36.9% had completed secondary school, and 18.3% were employed. Mentor mothers in the video intervention arm provided standard-of-care counseling plus the MOVIE intervention; mentor mothers in the control arm provided standard of care only. Within the causal impact evaluation, we nested a mixed-methods performance evaluation measuring mentor mothers' time use and eliciting their subjective experiences through in-depth interviews. At both points of follow-up, we observed no statistically significant differences between the video intervention and the control arm with regard to EBF rates and other infant feeding practices [EBF in the last 24 hours at 1 month: RR 0.93 (95% CI 0.86 to 1.01, P = 0.091); EBF in the last 24 hours at 5 months: RR 0.90 (95% CI 0.77 to 1.04, P = 0.152)]. We observed a small, but significant improvement in maternal knowledge at the 1-month follow-up, but not at the 5-month follow-up. The interpretation of the results from this causal impact evaluation changes when we consider the results of the nested mixed-methods performance evaluation. The mean time spent per home visit was similar across study arms, but the intervention group spent approximately 40% of their visit time viewing videos. The absence of difference in effects on primary and secondary endpoints implies that, for the same time investment, the video intervention was as effective as face-to-face counseling with a mentor mother. The videos were also highly valued by mentor mothers and participants. Study limitations include a high loss to follow-up at 5 months after premature termination of the trial due to the COVID-19 pandemic and changes in mentor mother service demarcations. CONCLUSIONS This trial measured the effect of a video-based, mobile health (mHealth) intervention, delivered by CHWs during home visits in an underresourced setting. The videos replaced about two-fifths of CHWs' direct engagement time with participants in the intervention arm. The similar outcomes in the 2 study arms thus suggest that the videos were as effective as face-to-face counselling, when CHWs used them to replace a portion of that counselling. Where CHWs are scarce, mHealth video interventions could be a feasible and practical solution, supporting the delivery and scaling of community health promotion services. TRIAL REGISTRATION The study and its outcomes were registered at clinicaltrials.gov (#NCT03688217) on September 27, 2018.
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Affiliation(s)
- Maya Adam
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
- Heidelberg University Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- * E-mail:
| | - Jamie Johnston
- Stanford Center for Health Education, Stanford, California, United States of America
| | - Nophiwe Job
- Stanford Center for Health Education, Stanford, California, United States of America
- Digital Medic, Stanford Center for Health Education, Cape Town, South Africa
| | | | - Ingrid Le Roux
- The Philani Maternal Child Health and Nutrition Trust, Khayelitsha, South Africa
| | - Nokwanele Mbewu
- The Philani Maternal Child Health and Nutrition Trust, Khayelitsha, South Africa
| | - Neliswa Mkunqwana
- Digital Medic, Stanford Center for Health Education, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
| | - Shannon A. McMahon
- Heidelberg University Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Amnesty E. LeFevre
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- University of Cape Town, School of Public Health and Family Medicine, Cape Town, South Africa
| | - Alain Vandormael
- Heidelberg University Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Kira-Leigh Kuhnert
- Stanford Center for Health Education, Stanford, California, United States of America
- Digital Medic, Stanford Center for Health Education, Cape Town, South Africa
| | - Pooja Suri
- Stanford Center for Health Education, Stanford, California, United States of America
- Berkeley School of Public Health, Berkeley, California, United States of America
| | - Jennifer Gates
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Bongekile Mabaso
- School of Management Studies, University of Cape Town, Cape Town, South Africa
| | - Aarti Porwal
- Stanford Center for Health Education, Stanford, California, United States of America
- Digital Medic, Stanford Center for Health Education, Cape Town, South Africa
| | - Charles Prober
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
- Stanford Center for Health Education, Stanford, California, United States of America
- Digital Medic, Stanford Center for Health Education, Cape Town, South Africa
| | - Till Bärnighausen
- Heidelberg University Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, United States of America
- Wellcome Trust’s Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
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Iliyasu Z, Galadanci HS, Hassan-Hanga F, Abdulrahman Z, Tsiga FI, Marryshow SE, Aliyu MH. Healthcare Workers' Knowledge of HIV-Exposed Infant Feeding Options and Infant Feeding Counseling Practice in Northern Nigeria. Curr HIV Res 2021; 18:29-40. [PMID: 31870269 DOI: 10.2174/1570162x18666191223114657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/28/2019] [Accepted: 12/11/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite the existence of evidence-based HIV-exposed infant feeding guidelines, infants in Africa still acquire HIV through inappropriate feeding practices. OBJECTIVE To identify predictors of HIV-exposed infant feeding knowledge and counseling practice among health care workers (HCW) in Nigeria. METHODS Structured, pretested questionnaires were administered to HCW (n=262) in a tertiary health facility in Kano, Nigeria. Multivariate logistic regression was used to determine predictors of HIV-exposed infant feeding knowledge and counseling practice. RESULTS Of 262 respondents, (58.0%, n=152) had good knowledge of recommended feeding options. Respondents listed exclusive breastfeeding (57.6%, n=151), human milk substitutes (45.4%, n=119), HIV-negative wet-nursing (37.0%, n=97), heated expressed human milk (20.6%, n=54) and mixed feeding (13.4%, n=35) as appropriate feeding choices. Over half (57.3%, n=150) of the respondents have ever counseled a HIV-positive mother on infant feeding. Knowledge was predicted by female sex (Adjusted Odds Ratio (AOR)=2.47, 95% Confidence Interval (CI):1.35-4.52), profession (physician vs. laboratory scientist, AOR=4.00, 95%CI:1.25-12.87; nurse/midwife vs. laboratory scientist, AOR=2.75, 95%CI:1.17-9.28), infant feeding counseling training (AOR=3.27, 95%CI:1.87-5.71), and number of children (2-4 vs. 0, AOR=1.75, 95%CI:1.23-3.92). Infant feeding counseling was predicted by female sex (AOR=2.85, 95%CI:1.39-5.85), age (>40 vs. <30 years, AOR=3.87, 95%CI:1.27-15.65), knowledge of infant feeding options (good vs. fair/poor, AOR=3.96, 95%CI:2.07-7.59), training (AOR=2.60, 95%CI:1.42-5.32), and profession (physician vs. laboratory scientist, AOR=10.7, 95%CI:2.85-40.54; nurse/midwife vs. laboratory scientist, AOR=4.8, 95%CI:1.26-18.02). CONCLUSION The practice of infant feeding counseling among HCW in Nigeria is associated with sex, knowledge, and profession. Our findings may inform the development of targeted training programs for HCW in similar settings.
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Affiliation(s)
- Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Kano, Nigeria.,Centre for Infectious Diseases Research, Bayero University Kano, Nigeria
| | - Hadiza S Galadanci
- Department of Obstetrics and Gynecology, Bayero University, Kano, Nigeria
| | | | | | | | - Salisha E Marryshow
- Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Tennessee, United States
| | - Muktar H Aliyu
- Department of Health Policy and Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Tennessee, United States
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Napyo A, Tumwine JK, Mukunya D, Waako P, Tylleskär T, Ndeezi G. Exclusive breastfeeding among HIV exposed infants from birth to 14 weeks of life in Lira, Northern Uganda: a prospective cohort study. Glob Health Action 2021; 13:1833510. [PMID: 33121390 PMCID: PMC7599030 DOI: 10.1080/16549716.2020.1833510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Breastfeeding is important for growth, development and survival of HIV exposed infants. Exclusive breastfeeding reduces the risk of morbidity, mortality and increases HIV free survival of infants. Evidence on risk factors for inappropriate breastfeeding in Northern Uganda is limited. Objective This study determined the risk factors for non-exclusivity of breastfeeding in the first 14 weeks of life. Methods This prospective cohort study was conducted among 466 mother-infant pairs between August 2018 and February 2020 in Lira district, Northern Uganda. HIV infected pregnant women were enrolled and followed up at delivery, 6- and 14- weeks postpartum. We used a structured questionnaire to obtain data on socio-demographic, reproductive-related, HIV-related characteristics and exclusive breastfeeding. Data were analysed using Stata version 14.0 (StataCorp, College Station, Texas, USA.). We estimated adjusted risk ratios using modified Poisson regression models. Results The proportion of HIV exposed infants that were exclusively breastfed reduced with increasing age. Risk factors for non-exclusive breastfeeding included infants being born to HIV infected women who: were in the highest socioeconomic strata (adjusted risk ratio = 1.5, 95%CI: 1.01– 2.1), whose delivery was supervised by a non-health worker (adjusted risk ratio = 1.6, 95%CI: 1.01– 2.7) and who had not adhered to their ART during pregnancy (adjusted risk ratio = 1.3, 95%CI: 1.01– 1.7). Conclusions HIV infected women: with highest socioeconomic status, whose delivery was not supervised by a health worker and who did not adhere to ART were less likely to practice exclusive breastfeeding. We recommend ART adherence and infant feeding counselling to be emphasised among HIV infected women who are at risk of having a home delivery, those with poor ART adherence and those of higher socioeconomic status. We also recommend integration of these services into other settings like homes, community and work places instead of limiting them to hospital settings. Abbreviations HIV: Human Immunodeficiency Virus; ART: Antiretroviral therapy; HEI: HIV exposed infant; PMTCT: Prevention of mother-to-child transmission of HIV; MTCT: Mother-to-child transmission of HIV; AFASS: Acceptable, Feasible, Affordable, Sustainable and Safe; LRRH: Lira regional referral hospital; CI: confidence interval; ARR: Adjusted risk ratio; SD: Standard deviation; PCA: Principal component analysis
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Affiliation(s)
- Agnes Napyo
- Department of Public Health, Faculty of Health Sciences, Busitema University , Tororo, Uganda.,Centre for International Health, University of Bergen , Bergen, Norway.,Department of Pediatrics and Child Health, Makerere University , Kampala, Uganda
| | - James K Tumwine
- Department of Pediatrics and Child Health, Makerere University , Kampala, Uganda
| | - David Mukunya
- Centre for International Health, University of Bergen , Bergen, Norway
| | - Paul Waako
- Department of Pharmacology, Faculty of Health Sciences, Busitema University , Tororo, Uganda
| | | | - Grace Ndeezi
- Department of Pediatrics and Child Health, Makerere University , Kampala, Uganda
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Feeding Practices among Human Immunodeficiency Virus-Exposed Infants in Ethiopia: Systematic Review and Meta-Analysis. ADVANCES IN PUBLIC HEALTH 2021. [DOI: 10.1155/2021/9068074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Infant and young child feeding in the context of human immunodeficiency virus- (HIV-) infected mothers has significant challenges due to the risk of transmission of the virus via breastfeeding. In Ethiopia, a number of independent studies have been conducted to assess the feeding practice of HIV-exposed infants. But, there is no concrete evidence to show the national figure in Ethiopia. Hence, this review and meta-analysis aims to estimate the pooled prevalence of feeding practices among HIV exposed infants in Ethiopia. Methods. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. Articles were searched through search engines in PubMed, Cochrane Library, Google Scholar, and direct Google search. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument adapted for cross-sectional study design was used for quality assessment. The random effects model was used to estimate the pooled prevalence of infant feeding practices. Heterogeneity and publication bias were assessed. Trim and fill analysis was performed. Additionally, meta-regression was also performed. Results. In this review, a total of 26, 22, and 22 studies and 7413, 6224, and 6222 study participants for exclusive breastfeeding, replacement feeding, and mixed feelings were included, respectively. The overall pooled prevalence of exclusive breastfeeding, replacement feeding, and mixed feeding of HIV exposed infant was 63.99 % (95% Confidence Interval (CI): 52.32, 75.66), 16.13% (95% CI: 11.92, 20.32), and 20.95% (95% CI: 11.35, 30.58)) in Ethiopia, respectively. Conclusion and Recommendations. In Ethiopia, almost three in five HIV-exposed infants were exclusively breastfed. But still, mixed feeding during the period of first 6 months was practiced in almost one-fifth of the exposed infants in Ethiopia. Additionally, replacement feeding was also practiced even though not recommended for developing countries. Therefore, the government of Ethiopia should strengthen the health institutions to implement the existing infant feeding strategies and guidelines to increase exclusive breastfeeding for the first 6 months and to avoid mixed feeding during the periods of six months.
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Goon DT, Ajayi AI, Adeniyi OV. Sociodemographic and lifestyle correlates of exclusive breastfeeding practices among mothers on antiretroviral therapy in the Eastern Cape, South Africa. Int Breastfeed J 2021; 16:18. [PMID: 33593419 PMCID: PMC7885516 DOI: 10.1186/s13006-021-00366-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/08/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Exclusive breastfeeding (EBF) is associated with a reduction of postnatal HIV transmission and optimal infant growth. Given that the factors influencing exclusive breastfeeding are multi-factorial and context-specific, we examined the prevalence and factors associated with exclusive breastfeeding practice in the first 6 months among mothers on antiretroviral therapy in the Eastern Cape, South Africa. METHODS This was a cross-sectional study conducted between January to May 2018, on 469 parturient women enlisted in the prevention of mother-to-child HIV transmission cohort study in the Eastern Cape. Mothers were asked to recall whether they breastfed their infant exclusively with breast milk from birth and if so, to state how long they did. We collected relevant sociodemographic, lifestyle, and maternal information by interview. Bivariate and multivariable logistic regression analyses were fitted to determine the sociodemographic and lifestyle factors associated with exclusive breastfeeding practice. RESULTS The prevalence of six-month exclusive breastfeeding, measured since birth, was 32.0%. E Exclusive breastfeeding's prevalence was significantly higher among married women (36.8%), unemployed women (36.6%), non-smokers (32.7%), and those who never drank alcohol (37.0%). Unemployed women (adjusted odds ratio [AOR] 1.66, 95% Confidence Interval [CI] 1.08-2.56) and those with grade 12 or less level of education (AOR 2.76, 95% CI 1.02-7.49) had a higher likelihood of practising EBF for 6 months since birth while mothers who consumed alcohol (AOR 0.54, 95% CI 0.34-0.85) were less likely to practice EBF for 6 months. CONCLUSIONS The prevalence of six-month exclusive breastfeeding in the study, although comparable with sub-Saharan Africa and worldwide prevalence, remains suboptimal. Advocacy campaigns on EBF must target alcohol cessation and the creation of a favourable workplace environment for lactating mothers.
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Affiliation(s)
- Daniel Ter Goon
- Department of Public Health, University of Fort Hare, 5 Oxford Street, East London, 5201 South Africa
| | - Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Centre, APHRC Campus, Manga Close, Nairobi, Kenya
- Sociology Department, University of Fort Hare, East London, 5201 South Africa
| | - Oladele Vincent Adeniyi
- Department of Public Health, University of Fort Hare, 5 Oxford Street, East London, 5201 South Africa
- Department of Family Medicine, East London Hospital Complex, Cecilia Makiwane Hospital, East London, South Africa
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Goga A, Doherty T, Manda S, Nkwenika T, Haskins L, John V, Engebretsen IMS, Feucht U, Dhansay A, Rollins N, Kroon M, Sanders D, Kauchali S, Tylleskär T, Horwood C. Translating new evidence into clinical practice: a quasi-experimental controlled before-after study evaluating the effect of a novel outreach mentoring approach on knowledge, attitudes and confidence of health workers providing HIV and infant feeding counselling in South Africa. BMJ Open 2020; 10:e034770. [PMID: 33109638 PMCID: PMC7592306 DOI: 10.1136/bmjopen-2019-034770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We report the effectiveness of a mentoring approach to improve health workers' (HWs') knowledge, attitudes and confidence with counselling on HIV and infant feeding. DESIGN Quasi-experimental controlled before-after study. SETTING Randomly selected primary healthcare clinics (n=24 intervention, n=12 comparison); two districts, South Africa. PARTICIPANTS All HWs providing infant feeding counselling in selected facilities were invited. INTERVENTIONS Three 1-2 hours, on-site workshops over 3-6 weeks. PRIMARY OUTCOME MEASURES Knowledge (22 binary questions), attitude (21 questions-5-point Likert Scale) and confidence (19 questions-3-point Likert Scale). Individual item responses were added within each of the attitude and confidence domains. The respective sums were taken to be the domain composite index and used as a dependent variable to evaluate intervention effect. Linear regression models were used to estimate the mean score difference between intervention and comparison groups postintervention, adjusting for the mean score difference between them at baseline. Analyses were adjusted for participant baseline characteristics and clustering at health facility level. RESULTS In intervention and comparison sites, respectively: 289 and 131 baseline and 253 and 114 follow-up interviews were conducted (August-December 2017). At baseline there was no difference in mean number of correctly answered knowledge questions; this differed significantly at follow-up (15.2 in comparison; 17.2 in intervention sites (p<0.001)). At follow-up, the mean attitude and confidence scores towards breast feeding were better in intervention versus comparison sites (p<0.001 and p=0.05, respectively). Controlling for confounders, interactions between time and intervention group and preintervention values, the attitude score was 5.1 points significantly higher in intervention versus comparison groups. CONCLUSION A participatory, low-intensity on-site mentoring approach to disseminating updated infant feeding guidelines improved HWs' knowledge, attitudes and confidence more than standard dissemination via a circular. Further research is required to evaluate the effectiveness, feasibility and sustainability of this approach at scale.
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Affiliation(s)
- Ameena Goga
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, South Africa
- HIV Prevention Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Samuel Manda
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - Tshifhiwa Nkwenika
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Lyn Haskins
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Vaughn John
- School of Education, University of KwaZulu Natal, Pietermaritzburg, South Africa
| | | | - Ute Feucht
- Department of Paediatrics, University of Pretoria, Pretoria, South Africa
- Gauteng Department of Health, Tshwane District Health Services, Pretoria, South Africa
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Ali Dhansay
- Division of Human Nutrition and Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Switzerland
| | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Max Kroon
- Department of Neonatology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Mowbray Maternity Hospital, Cape Town, South Africa
| | - David Sanders
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | | | | | - Christiane Horwood
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
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12
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Yapa HM, Drayne R, Klein N, De Neve JW, Petoumenos K, Jiamsakul A, Herbst C, Pillay D, Post FA, Bärnighausen T. Infant feeding knowledge and practice vary by maternal HIV status: a nested cohort study in rural South Africa. Int Breastfeed J 2020; 15:77. [PMID: 32873311 PMCID: PMC7466779 DOI: 10.1186/s13006-020-00317-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 08/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background We investigate whether correct infant feeding knowledge and practice differ by maternal HIV status in an era of evolving clinical guidelines in rural South Africa. Methods This cohort study was nested within the MONARCH stepped-wedge cluster-randomised controlled trial (www.clinicaltrials.gov: NCT02626351) which tested the impact of continuous quality improvement on antenatal care quality at seven primary care clinics in KwaZulu-Natal, from July 2015 to January 2017. Women aged ≥18 years at delivery were followed up to 6 weeks postpartum. Clinical data were sourced from routine medical records at delivery. Structured interviews at early postnatal visits and the 6-week postnatal immunisation visit provided data on infant feeding knowledge and feeding practices respectively. We measured the relationship between maternal HIV status and (i) correct infant feeding knowledge at the early postnatal visit; and (ii) infant feeding practice at 6 weeks, using Poisson and multinomial regression models, respectively. Results We analysed data from 1693 women with early postnatal and 471 with 6-week postnatal interviews. HIV prevalence was 47% (95% confidence interval [CI] 42, 52%). Women living with HIV were more knowledgeable than women not living with HIV on correct infant feeding recommendations (adjusted risk ratio, aRR, 1.08, p < 0.001). More women living with HIV (33%; 95% CI 26, 41%) were not breastfeeding than women not living with HIV (15%; 95% CI 11, 21%). However, among women who were currently breastfeeding their infants, fewer women living with HIV (5%; 95% CI 2, 9%) mixed fed their babies than women not living with HIV (21%; 95% CI 14, 32%). In adjusted analyses, women living with HIV were more likely to avoid breastfeeding (adjusted relative risk ratio, aRRR, 2.78, p < 0.001) and less likely to mixed feed (aRRR 0.22, p < 0.001) than women not living with HIV. Conclusions Many mothers in rural South Africa still do not practice exclusive breastfeeding. Women living with HIV were more knowledgeable but had lower overall uptake of breastfeeding, compared with women not living with HIV. Women living with HIV were also more likely to practice exclusive breastfeeding over mixed feeding if currently breastfeeding. Improved approaches are needed to increase awareness of correct infant feeding and exclusive breastfeeding uptake.
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Affiliation(s)
- H Manisha Yapa
- The Kirby Institute, University of New South Wales Sydney, Sydney, Australia. .,Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa.
| | - Róisín Drayne
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Nigel Klein
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Kathy Petoumenos
- The Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Awachana Jiamsakul
- The Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Carina Herbst
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Deenan Pillay
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa.,Division of Infection & Immunity, University College London, London, UK
| | - Frank A Post
- King's College Hospital NHS Foundation Trust, London, UK
| | - Till Bärnighausen
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa.,Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.,Institute for Global Health, University College London, London, UK
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13
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Fuls N, Krüger E, van der Linde J. Feeding characteristics of infants in a lower-middle-income country. J Paediatr Child Health 2020; 56:1083-1089. [PMID: 32073196 DOI: 10.1111/jpc.14823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/27/2020] [Accepted: 02/02/2020] [Indexed: 12/01/2022]
Abstract
AIM To describe feeding characteristics (such as breast feeding and complementary feeding) and determine the nature of feeding difficulties of infants in a primary health-care clinic (PHC) in South Africa. METHODS A total of 200 infants aged 6-12 months (mean = 8.54, standard deviation = 2.18) received a feeding screening by a speech-language therapist at a PHC in a semi-urban area using the Montreal Children's Hospital-Feeding Scale (MCH-FS). Children who failed screening underwent further clinical feeding evaluation using the Schedule of Oral Motor Assessment. RESULTS The sample consisted of 200 participants, and most participants (n = 174; 87%) received breastfeeding, irrespective of their mothers' human immunodeficiency virus status. The longer the breastfeeding period, the less likely parents were to show concern about infants' feeding (P = 0.035). Complementary feeding was introduced between 6 and 8 months (n = 122; 82%). The MCH-FS identified 13 participants with feeding difficulties (6.5%), of which 11 were diagnosed with oral motor dysfunction (OMD) using the Schedule of Oral Motor Assessment. The 6.5% (n = 13) that failed had mild (n = 8; 61.5%), moderate (n = 2; 15.4%) and severe (n = 3; 23.1%) feeding difficulties, as reported by care givers using the MCH-FS. The MCH-FS showed that distraction during meals/following infants (n = 42; 21%); food refusal (n = 31; 15.5%); care giver unease about feeding (n = 29; 14.5%); and problems with vomiting, gagging or spitting (n = 28; 14%) were characteristics of feeding in this sample. Participants in the age groups 6 (n = 3; 27.3%) and 10 months (n = 3; 27.3%) were prone to OMD. CONCLUSIONS This study is the first of its kind to describe the feeding characteristics of a group of infants during the transitional feeding stage in late infancy in South Africa. Important findings were the existence of OMD in 11 infants and feeding difficulties during transitional feeding in 13 infants. The study's findings may be used as a starting point for larger-scale studies in a similar setting, investigating the development of future care giver education and health-care professional training programmes regarding transitional feeding. Research endeavours by speech-language therapists need to prioritise late infancy and transitional feeding in order to prevent possible difficulties arising from sub-optimal care giver feeding practices. The study may be valuable to all health-care providers in PHC.
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Affiliation(s)
- Nichole Fuls
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Esedra Krüger
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Jeannie van der Linde
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
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14
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Mixed Infant Feeding Practice and Associated Factors among HIV-Positive Women under Care in Gondar City's Public Health Facilities within Two Years Postpartum: A Cross-Sectional Study. Int J Pediatr 2020; 2020:4597962. [PMID: 32695187 PMCID: PMC7350176 DOI: 10.1155/2020/4597962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 05/14/2020] [Accepted: 06/02/2020] [Indexed: 11/18/2022] Open
Abstract
Background Mixed infant feeding practice remains a major setback for effective prevention of mother to child transmission of HIV program and updated evidences on this issue is essential for better interventions. Therefore, this study was aimed at assessing the proportion and associated factors of mixed infant feeding practice among HIV-positive women under care in public health institutions in Gondar city within two years postpartum, Ethiopia, 2017. Methods A cross-sectional study was conducted on 485 HIV-positive women under care in Gondar City's health facilities from May 1 to June 30/2017. Data were collected via interviewer administered questionnaire supplemented with chart review, entered into Epinfo version 7.0 and then exported to SPSS version 20.0. Both bivariable and multivariable analyses were done, and the statistical significance of each variable was claimed based on the adjusted odds ratio (AOR) with 95% confidence interval (CI) and its P value ≤0.05. Result The proportion of HIV-positive women practicing mixed infant feeding was 21.6%. Whereas, about 73.8% and 4.5% of the mothers demonstrated exclusive breastfeeding and exclusive replacement feeding, respectively. Mixed infant feeding practice was independently predicted by lack of antenatal care (AOR = 6.9; 95% CI: 3.4, 14.1) and home delivery (AOR = 2.8; 95% CI: 1.4, 5.4). Conclusion The magnitude of mixed infant feeding practice was higher than the reports of many other studies, and its predictors were connected to poor adherence to maternal health care service utilization. Hence, stakeholders need to work more on ANC and facility delivery service coverage.
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15
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Chakona G. Social circumstances and cultural beliefs influence maternal nutrition, breastfeeding and child feeding practices in South Africa. Nutr J 2020; 19:47. [PMID: 32434557 PMCID: PMC7240933 DOI: 10.1186/s12937-020-00566-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal and child undernutrition remain prevalent in developing countries with 45 and 11% of child deaths linked to poor nutrition and suboptimal breastfeeding, respectively. This also has adverse effects on child growth and development. The study determined maternal dietary diversity, breastfeeding and, infant and young child feeding (IYCF) practices and identified reasons for such behavior in five rural communities in South Africa, in the context of cultural beliefs and social aspects. METHODS The study used mixed methodology technique. Questionnaires were administered to 84 households, pairing mother/caregiver and a child (0-24 months old) to obtain information on maternal dietary diversity, IYCF and breastfeeding practices. Qualitative data on breastfeeding perceptions, IYCF practices, perceived eating habits for lactating mothers and cultural beliefs related to mothers' decision on IYCF and breastfeeding practices were obtained through focus group discussions. RESULTS Maternal dietary diversity was very low and exclusive breastfeeding for the first 6 months of life was rarely practiced, with young children exposed to poor-quality diets lacking essential nutrients for child growth and development. Social circumstances including lack of income, dependence on food purchasing, young mothers' feelings regarding breastfeeding and cultural beliefs were the major drivers of mothers' eating habits, breastfeeding behaviour and IYCF practices. Fathers were left out in breastfeeding and IYCF decision making and young mothers were unwilling to employ indigenous knowledge when preparing food (especially traditional foods) and feeding their children. CONCLUSION The study provides comprehensive information for South African context that can be used as an intervention measure to fight against malnutrition in young children. Finding a balance between mothers' income, dietary diversity, cultural beliefs, breastfeeding and considering life of lactating mothers so that they won't feel burdened and isolated when breastfeeding and taking care of their children is crucial. Paternal inclusion in breastfeeding decisions and safeguarding indigenous knowledge on IYCF practices is recommended.
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Affiliation(s)
- Gamuchirai Chakona
- Department of Environmental Science, Rhodes University, Grahamstown, 6140, South Africa.
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16
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Chakona G. Social circumstances and cultural beliefs influence maternal nutrition, breastfeeding and child feeding practices in South Africa. Nutr J 2020. [PMID: 32434557 DOI: 10.1186/512937-020-00566-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Maternal and child undernutrition remain prevalent in developing countries with 45 and 11% of child deaths linked to poor nutrition and suboptimal breastfeeding, respectively. This also has adverse effects on child growth and development. The study determined maternal dietary diversity, breastfeeding and, infant and young child feeding (IYCF) practices and identified reasons for such behavior in five rural communities in South Africa, in the context of cultural beliefs and social aspects. METHODS The study used mixed methodology technique. Questionnaires were administered to 84 households, pairing mother/caregiver and a child (0-24 months old) to obtain information on maternal dietary diversity, IYCF and breastfeeding practices. Qualitative data on breastfeeding perceptions, IYCF practices, perceived eating habits for lactating mothers and cultural beliefs related to mothers' decision on IYCF and breastfeeding practices were obtained through focus group discussions. RESULTS Maternal dietary diversity was very low and exclusive breastfeeding for the first 6 months of life was rarely practiced, with young children exposed to poor-quality diets lacking essential nutrients for child growth and development. Social circumstances including lack of income, dependence on food purchasing, young mothers' feelings regarding breastfeeding and cultural beliefs were the major drivers of mothers' eating habits, breastfeeding behaviour and IYCF practices. Fathers were left out in breastfeeding and IYCF decision making and young mothers were unwilling to employ indigenous knowledge when preparing food (especially traditional foods) and feeding their children. CONCLUSION The study provides comprehensive information for South African context that can be used as an intervention measure to fight against malnutrition in young children. Finding a balance between mothers' income, dietary diversity, cultural beliefs, breastfeeding and considering life of lactating mothers so that they won't feel burdened and isolated when breastfeeding and taking care of their children is crucial. Paternal inclusion in breastfeeding decisions and safeguarding indigenous knowledge on IYCF practices is recommended.
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Affiliation(s)
- Gamuchirai Chakona
- Department of Environmental Science, Rhodes University, Grahamstown, 6140, South Africa.
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17
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Jackson D, Swanevelder S, Doherty T, Lombard C, Bhardwaj S, Goga A. Changes in rates of early exclusive breast feeding in South Africa from 2010 to 2013: data from three national surveys before and during implementation of a change in national breastfeeding policy. BMJ Open 2019; 9:e028095. [PMID: 31740463 PMCID: PMC6886934 DOI: 10.1136/bmjopen-2018-028095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Between 1998 and 2009 reported exclusive breastfeeding (EBF) rates in South African infants, aged 0-6 months, ranged from 6.2% to 25.7%. In 2011, the National Minister of Health shifted policy to promote 'exclusive' breast feeding for all women in South Africa irrespective of HIV status (Tshwane Declaration of Support for Breastfeeding in South Africa). This analysis examines early EBF prior to and through implementation of the declaration. SETTING Data from the three South Africa national, cross-sectional, facility-based surveys, conducted in 2010, 2011-12 and 2012-13, were analysed. Primary health facilities (n=580) were randomly selected after a stratified multistage probability proportional-to-size sampling to provide valid national and provincial estimates. PARTICIPANTS A national sample of all infants attending their 6 weeks vaccination at selected facilities. The number of caregiver-infant pairs enrolled were 10 182, 10 106 and 9120 in 2010, 2011-12, and 2012-13, respectively. PRIMARY OUTCOME MEASURE Exclusive breast feeding as measured using structured 24 hours recall plus prior 7 days (8 days inclusive prior to day interview) and WHO definition. RESULTS The adjusted OR comparing EBF prevalence in 2011-12 and 2012-13 with 2010 were 2.08 and 5.51, respectively. Mothers with generally higher socioeconomic status, HIV-positive, unplanned pregnancy, primipara, postcaesarean delivery, resided in certain provinces and women who did not receive breastfeeding counselling had significantly lower odds of EBF. CONCLUSION With what seemed to be an intransigently low EBF rate since 1998, South Africa saw an increase in early EBF for infants aged 4-8 weeks from 2010 to 2013, coinciding with a major national breastfeeding policy change. These increases were seen across all provinces and subgroups, suggesting a population-wide effect, rather than an increase in certain subgroups or locations. While these increases in EBF were significant, the 59.1% prevalence is still below desired levels of early EBF. Further improvements in EBF programmes are needed.
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Affiliation(s)
- Debra Jackson
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- Health Section, United National Children's Fund, New York City, New York, USA
| | - Sonja Swanevelder
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Tanya Doherty
- Health Systems Research Unit, Medical Research Council, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South Africa Medical Research Council, Pretoria, South Africa
| | - Sanjana Bhardwaj
- Health Section, United Nations Children's Fund, Pretoria, South Africa
| | - Ameena Goga
- Health Systems Research Unit, Medical Research Council, Pretoria, South Africa
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18
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Nieuwoudt SJ, Ngandu CB, Manderson L, Norris SA. Exclusive breastfeeding policy, practice and influences in South Africa, 1980 to 2018: A mixed-methods systematic review. PLoS One 2019; 14:e0224029. [PMID: 31626658 PMCID: PMC6799928 DOI: 10.1371/journal.pone.0224029] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/03/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In 2011, South Africa committed to promoting exclusive breastfeeding (EBF) for six months for all mothers, regardless of HIV status, in line with World Health Organization recommendations. This was a marked shift from earlier policies, and with it, average EBF rates increased from less than 10% in 2011 to 32% by 2016. OBJECTIVES The aim of this mixed-methods systematic review was to describe EBF practices in South Africa and their multi-level influences over four policy periods. METHODS We applied PRISMA guidelines according to a published protocol (Prospero: CRD42014010512). We searched seven databases [Africa-Wide, PubMed, Popline, PsychINFO, CINAHL, Global Health, and The Cochrane Library] and conducted hand searches for eligible articles (all study designs, conducted in South Africa and published between 1980-2018). The quality of articles was assessed using published tools, as appropriate. Separate policy analysis was conducted to delineate four distinct policy periods. We compared EBF rates by these periods. Then, applying a three-level ecological framework, we analysed EBF influences concurrently by method. Finally, the findings were synthesized to compare breastfeeding influences by policy period, maintaining an ecological framework. RESULTS From an initial sample of 20,226 articles, 72 unique articles were reviewed, three of which contributed to both quantitative and qualitative analysis. Despite the large sample, several provinces were poorly represented (if at all) and many studies were assessed as low to moderate quality. Despite these limitations, our historical lens enabled us to explore why South African progress on increasing EBF practices has been slow. The review reflects a context that increasingly supports EBF, but falls short in accounting for family, community, and workplace influences. The findings also highlight the unintended damage caused by rapidly adopting and introducing global guidelines to an unsupported health workforce. CONCLUSIONS From a South African perspective, we identified geographic and methodological biases, as well as gaps in our understanding and potential explanations of inequities in EBF. Our recommendations relate to policy, programming, and research to inform changes that would be required to further improve EBF practice rates in South Africa. While our review is South Africa-specific, our findings have broader implications for investing in multi-level interventions and limiting how often infant feeding guidelines are changed.
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Affiliation(s)
- Sara Jewett Nieuwoudt
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa
- SAMRC Developmental Pathways Health and Research Unit, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa
| | - Christian B. Ngandu
- SAMRC Developmental Pathways Health and Research Unit, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa
| | - Lenore Manderson
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa
- Institute at Brown for Environment and Society, Brown University, Providence, RI, United States of America
- School of Social Sciences, Menzies Building, Clayton Campus, Monash University, Melbourne, Australia
| | - Shane A. Norris
- SAMRC Developmental Pathways Health and Research Unit, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa
- School of Human Development and Health, and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
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19
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Krüger EE, Kritzinger AA, Pottas LL. Breastfeeding skills of full-term newborns and associated factors in a low-and-middle-income setting. Afr Health Sci 2019; 19:2670-2678. [PMID: 32127840 PMCID: PMC7040260 DOI: 10.4314/ahs.v19i3.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Normative information on the breastfeeding of term newborns may guide clinicians in early identification of breastfeeding difficulties and oro-pharyngeal dysphagia (OPD), and may support optimal breastfeeding practices. OBJECTIVE To describe breastfeeding skills of term newborn infants in a South African hospital, a lower-middle-income setting, and investigate associations between infants' feeding and other factors. METHOD One breastfeeding session of each of the 71 healthy newborn full-term infants (mean chronological age=1.9 days; mean gestation=39.1 weeks) was evaluated using the Preterm Infant Breastfeeding Behavior Scale (PIBBS), suitable for use with term newborns. RESULTS All participants were exclusively breastfed. Thirteen participants (18%) were HIV-exposed. There was no significant difference in the findings of the PIBBS between HIV-exposed and unexposed participants. Most newborns had obvious rooting, latched deeply onto the nipple and some of the areola, had repeated long sucking bursts (mean length=16.82 sucks/burst), and swallowed repeatedly. Most participants were in either the drowsy or quiet-alert state, which are optimal behavioural states for breastfeeding. One to two-hourly on-demand feeds was significantly associated with mothers who had normal births and did not use galactogogues to promote lactation. CONCLUSION Results may be used for early identification of OPD in newborns. The findings may be useful to primary care clinicians.
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Affiliation(s)
- Esedra E Krüger
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Alta Am Kritzinger
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Lidia L Pottas
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
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Adam M, Tomlinson M, Le Roux I, LeFevre AE, McMahon SA, Johnston J, Kirton A, Mbewu N, Strydom SL, Prober C, Bärnighausen T. The Philani MOVIE study: a cluster-randomized controlled trial of a mobile video entertainment-education intervention to promote exclusive breastfeeding in South Africa. BMC Health Serv Res 2019; 19:211. [PMID: 30940132 PMCID: PMC6444854 DOI: 10.1186/s12913-019-4000-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/07/2019] [Indexed: 01/21/2023] Open
Abstract
Background In South Africa, rates of exclusive breastfeeding remain low and breastfeeding promotion is a national health priority. Mobile health and narrative entertainment-education are recognized strategies for health promotion. In-home counseling by community health workers (CHWs) is a proven breastfeeding promotion strategy. This protocol outlines a cluster-randomized controlled trial with a nested mixed-methods evaluation of the MObile Video Intervention for Exclusive breastfeeding (MOVIE) program. The evaluation will quantify the causal effect of the MOVIE program and generate a detailed understanding of the context in which the intervention took place and the mechanisms through which it enacted change. Findings from the study will inform the anticipated scale-up of mobile video health interventions in South Africa and the wider sub-Saharan region. Methods We will conduct a stratified cluster-randomized controlled trial in urban communities of the Western Cape, to measure the effect of the MOVIE intervention on exclusive breastfeeding and other infant feeding practices. Eighty-four mentor-mothers (CHWs employed by the Philani Maternal Child Health and Nutrition Trust) will be randomized 1:1 into intervention and control arms, stratified by neighborhood type. Mentor-mothers in the control arm will provide standard of care (SoC) perinatal in-home counseling. Mentor-mothers in the intervention arm will provide SoC plus the MOVIE intervention. At least 1008 pregnant participants will be enrolled in the study and mother-child pairs will be followed until 5 months post-delivery. The primary outcomes of the study are exclusive breastfeeding at 1 and 5 months of age. Secondary outcomes are other infant feeding practices and maternal knowledge. In order to capture human-centered underpinnings of the intervention, we will conduct interviews with stakeholders engaged in the intervention design. To contextualize quantitative findings and understand the mechanisms through which the intervention enacted change, end-line focus groups with mentor-mothers will be conducted. Discussion This trial will be among the first to explore a video-based, entertainment-education intervention delivered by CHWs and created using a community-based, human-centered design approach. As such, it could inform health policy, with regards to both the routine adoption of this intervention and, more broadly, the development of other entertainment-education interventions for health promotion in under-resourced settings. Trial Registration The study and its outcomes were registered at clinicaltrials.gov (#NCT03688217) on September 27th, 2018.
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Affiliation(s)
- Maya Adam
- The Department of Pediatrics, Stanford University, Stanford, CA, USA. .,Stanford University's Digital Medical Education International Collaborative (Digital MEdIC), Cape Town, South Africa. .,Stanford Center for Health Education, Stanford, CA, USA.
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Ingrid Le Roux
- Philani Maternal Child Health and Nutrition Trust, Cape Town, South Africa
| | - Amnesty E LeFevre
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Division of Epidemiology and Biostatistics, University of Cape Town School of Public Health, Cape Town, South Africa
| | - Shannon A McMahon
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | | | - Angela Kirton
- Stanford University's Digital Medical Education International Collaborative (Digital MEdIC), Cape Town, South Africa.,Stanford Center for Health Education, Stanford, CA, USA
| | - Nokwanele Mbewu
- Philani Maternal Child Health and Nutrition Trust, Cape Town, South Africa
| | | | - Charles Prober
- The Department of Pediatrics, Stanford University, Stanford, CA, USA.,Stanford University's Digital Medical Education International Collaborative (Digital MEdIC), Cape Town, South Africa.,Stanford Center for Health Education, Stanford, CA, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, USA.,Africa Health Research Institute (AHRI), Somkhele, KwaZulu-Natal, South Africa
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21
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Adeniyi OV, Ajayi AI, Issah M, Owolabi EO, Goon DT, Avramovic G, Lambert J. Beyond health care providers' recommendations: understanding influences on infant feeding choices of women with HIV in the Eastern Cape, South Africa. Int Breastfeed J 2019; 14:7. [PMID: 30733819 PMCID: PMC6357465 DOI: 10.1186/s13006-019-0201-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 01/23/2019] [Indexed: 12/31/2022] Open
Abstract
Background Despite the array of studies on infant feeding practices of HIV-infected women, gaps still exist in the understanding of the underlying reasons for their infant feeding choices. Potential for behavioural change exists, especially in the light of the 2016 updated World Health Organization guideline on HIV and infant feeding. The aim of this paper is to determine the rate of adoption of exclusive breastfeeding in this cohort, examine the determinants of infant feeding choices of HIV-infected women and assess the underlying reasons for these choices. Methods This was a mixed methods study conducted between September 2015 and May 2016. It analyses the quantitative and qualitative data of 1662 peripartum women enrolled in the East London Prospective Cohort Study across three large maternity services in the Eastern Cape. Women with HIV reported their preferred choices of infant feeding. In addition, participants explained the underlying reasons for their choices. Descriptive and inferential statistics summarised the quantitative data, while thematic content analysis was performed on qualitative data. Results Of the 1662 women with complete responses, 80.3% opted to exclusively breastfeed their babies. In the adjusted model, up to grade 12 education level (AOR: 1.81; 95% CI: 1.14, 2.86), rural/peri-urban residence (AOR:1.44; 95% CI: 1.05, 1.96), alcohol use (AOR: 1.65; 95% CI: 1.25, 2.18), negative or unknown HIV status at booking (AOR:1.85; 95% CI:1.27, 2.70), currently married (AOR:1.43; 95% CI:1.01, 2.02) and WHO Clinical Stage 2–4 (AOR:1.77; 95% CI: 1.15, 2.72) were significantly associated with the decision to exclusively breastfeed. Health care providers’ recommendations, perceived benefits of breastfeeding, unaffordability of formula feeding, and coercion were the underlying reasons for wanting to breastfeed; while work/school-related demands, breast-related issues, and fear of infecting the baby influenced their decision to formula feed. Conclusion The majority of HIV-infected women chose to breastfeed their babies in the Eastern Cape. Following up on these women to ensure they breastfeed exclusively, while also addressing their possible concerns, could be an important policy intervention. Future studies should focus on how early infant feeding decisions change over time, as well as the health outcomes for mother and child.
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Affiliation(s)
- Oladele Vincent Adeniyi
- 1Department of Family Medicine & Rural Health, Faculty of Health Science, Walter Sisulu University, Mthatha/East London Hospital Complex, Cecilia Makiwane Hospital, East London, South Africa
| | - Anthony Idowu Ajayi
- 2Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, East London, South Africa
| | - Moshood Issah
- 2Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, East London, South Africa
| | - Eyitayo Omolara Owolabi
- 3Department of Nursing Sciences, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Daniel Ter Goon
- 3Department of Nursing Sciences, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Gordana Avramovic
- 4Department of Infectious Diseases, Medicine and Sexual Health, Mater, Rotunda and University College, Dublin, Ireland
| | - John Lambert
- 4Department of Infectious Diseases, Medicine and Sexual Health, Mater, Rotunda and University College, Dublin, Ireland
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22
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Namale-Matovu J, Owora AH, Onyango-Makumbi C, Mubiru M, Namuli PE, Motevalli-Oliner M, Musoke P, Nolan M, Fowler MG. Comparative effects of three methods of promoting breastfeeding among human immunodeficiency virus-infected women in Uganda: a parallel randomized clinical trial. Int Health 2018; 10:430-441. [PMID: 30016450 PMCID: PMC6500425 DOI: 10.1093/inthealth/ihy041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/24/2018] [Accepted: 05/13/2018] [Indexed: 11/12/2022] Open
Abstract
Background The objective of this study was to evaluate the comparative effects of three breastfeeding promotion interventions on the duration of exclusive breastfeeding (EBF) and any breastfeeding (BF) among human immunodeficiency virus (HIV)-infected women in Uganda. Methods Between February 2012 and February 2013, 218 HIV-infected pregnant mothers were randomly assigned to (A) standard care (n=73), (B) enhanced family/peer support (n=72) or (C) enhanced nutrition education (n=73). Results The prevalence (%) of EBF/BF did not differ between intervention arms at the sixth (A, 85/92; B, 84/91; C, 87/89) and ninth (A, 17/91; B, 18/89; C, 16/87) postpartum month assessments (p>0.05). However, the risk of early BF cessation differed between intervention arms depending on the mother's level of formal education (p=0.04). Among women with no formal education, the risk of early BF cessation was 88% (adjusted hazard ratio [aHR] 0.12 [95% confidence interval {CI} 0.05-0.30]) and 93% (aHR 0.07 [95% CI 0.03-0.18]) lower in arms B and C, respectively, than in arm A (p<0.01). HIV status disclosure to a partner was associated with a higher risk of early EBF (p=0.03) and BF (p=0.04) cessation. Conclusions In resource-limited settings, enhanced (vs standard care) EBF promotion interventions may not differentially influence EBF but reduce the risk of early BF cessation among women with no formal education. Targeted enhanced interventions among women with no formal education and a mother's partner may be critical to reducing the risk of early EBF/BF cessation.
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Affiliation(s)
- Joyce Namale-Matovu
- Makerere University–Johns Hopkins University Research Collaboration, Upper Mulago Hill Road, Kampala, Uganda
| | - Arthur H Owora
- Makerere University–Johns Hopkins University Research Collaboration, Upper Mulago Hill Road, Kampala, Uganda
- Department of Public Health, Falk College, Syracuse University, Syracuse, NY, USA
| | - Carol Onyango-Makumbi
- Makerere University–Johns Hopkins University Research Collaboration, Upper Mulago Hill Road, Kampala, Uganda
| | - Mike Mubiru
- Makerere University–Johns Hopkins University Research Collaboration, Upper Mulago Hill Road, Kampala, Uganda
| | - Prossy E Namuli
- Makerere University–Johns Hopkins University Research Collaboration, Upper Mulago Hill Road, Kampala, Uganda
| | - Mahnaz Motevalli-Oliner
- Makerere University–Johns Hopkins University Research Collaboration, Upper Mulago Hill Road, Kampala, Uganda
| | - Philippa Musoke
- Makerere University–Johns Hopkins University Research Collaboration, Upper Mulago Hill Road, Kampala, Uganda
| | - Monica Nolan
- Makerere University–Johns Hopkins University Research Collaboration, Upper Mulago Hill Road, Kampala, Uganda
| | - Mary G Fowler
- Makerere University–Johns Hopkins University Research Collaboration, Upper Mulago Hill Road, Kampala, Uganda
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Breastfeeding mitigates the effects of maternal HIV on infant infectious morbidity in the Option B+ era. AIDS 2018; 32:2383-2391. [PMID: 30134300 DOI: 10.1097/qad.0000000000001974] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The effects of in-utero HIV-exposure on infectious morbidity and mortality in settings with universal maternal treatment and high breastfeeding rates are unclear. Further, the benefits of exclusive feeding options have not been assessed in the Option B+ era. We investigated these in two African settings with high breastfeeding uptake and good HIV treatment infrastructure during the first year of life. METHODS Cox regression with time-changing variables in a birth cohort of 749 HIV-exposed uninfected and HIV-unexposed uninfected infants from Cape Town, South Africa and Jos, Nigeria. RESULTS There was no difference in infectious morbidity incidence between HIV-exposed uninfected and HIV-unexposed uninfected infants (hazard ratio 1.01; 95% CI 0.78-1.32) after adjusting for confounding variables. Formula-fed infants had significantly higher infectious morbidity incidence when compared with exclusively breastfed infants (hazard ratio 1.64; 95% CI 1.03-2.63) and mixed-breastfed infants (hazard ratio 1.42; 95% CI 1.00-2.02) after adjusting for potential confounding variables. There was no significant difference in mortality among HIV-exposed infants and HIV-unexposed infants during the first year of life in this cohort (2.04 versus 0.94%, P = 0.38). Notably, exclusive breastfeeding for only 4 months had protective effects on morbidity up to 1 year. CONCLUSION In settings with universal antiretroviral coverage and high breastfeeding rates, breastfeeding mitigates the effects of in-utero HIV exposure among infants during the first year of life. These findings support previous recommendations for exclusive breastfeeding among HIV-infected women and highlight the role that breastfeeding plays on the health of infants in settings where exclusive breastfeeding is not always feasible or where replacement feeding is recommended.
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24
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Sayed N, Schönfeldt HC. A review of complementary feeding practices in South Africa. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2018. [DOI: 10.1080/16070658.2018.1510251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Nazeeia Sayed
- Department of Animal & Wildlife Sciences, University of Pretoria, Pretoria, South Africa
| | - Hettie C Schönfeldt
- Department of Animal & Wildlife Sciences, University of Pretoria, Pretoria, South Africa
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Larsen A, Cheyip M, Aynalem G, Dinh TH, Jackson D, Ngandu N, Chirinda W, Mogashoa M, Kindra G, Lombard C, Goga A. Uptake and predictors of early postnatal follow-up care amongst mother-baby pairs in South Africa: Results from three population-based surveys, 2010-2013. J Glob Health 2018; 7:021001. [PMID: 29302327 PMCID: PMC5735783 DOI: 10.7189/jogh.07.021001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Achieving World Health Organization (WHO) recommendations for postnatal care (PNC) within the first few weeks of life is vital to eliminating early mother–to–child transmission of HIV (MTCT) and improving infant health. Almost half of the annual global deaths among children under five occur during the first six weeks of life. This study aims to identify uptake of three PNC visits within the first six weeks of life as recommended by WHO among South African mother–infant pairs, and factors associated with uptake. Methods We analyzed data from three facility–based, nationally representative surveys (2010, 2011/12 and 2012/13) primarily designed to determine the effectiveness of the South African program to prevent MTCT. This analysis describes the proportion of infants achieving the WHO recommendation of at least 3 PNC visits. Interviews from 27 699 HIV–negative and HIV–positive mothers of infants aged 4–8 weeks receiving their six week immunization were included in analysis. Data were analyzed using STATA 13.0 and weighted for sample ascertainment and South African live births. We fitted a multivariable logistic regression model to estimate factors associated with early PNC uptake. Results Over half (59.6%, 95% confidence interval (CI) = 59.0–60.3) of mother–infant pairs received the recommended three PNC visits during the first 6 weeks; uptake was 63.1% (95% CI = 61.9–64.3) amongst HIV exposed infants and 58.1% (95% CI = 57.3–58.9) amongst HIV unexposed infants. Uptake of early PNC improved significantly with each survey, but varied significantly by province. Multivariable analysis of the pooled data, controlling for survey year, demonstrated that number of antenatal visits (4+ vs <4 Adjusted odds ratio (aOR) = 1.13, 95% CI = 1.04–1.23), timing of initial antenatal visits (≤12 weeks vs >12 weeks, aOR = 1.13, 95% CI = 1.04–1.23), place of delivery (clinic vs hospital aOR = 1.5, 1.3–1.6), and infant HIV exposure (exposed vs unexposed aOR = 1.2, 95% CI = 1.1–1.2) were the key factors associated with receiving recommended PNC visits. Conclusions Approximately 40% of neonates did not receive three or more postnatal care visits in the first 6 weeks of life from 2010–2013. To improve uptake of early PNC, early antenatal booking, more frequent antenatal care attendance, and attention to HIV negative women is needed.
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Affiliation(s)
- Anna Larsen
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Mireille Cheyip
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Getahun Aynalem
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Thu-Ha Dinh
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Debra Jackson
- School of Public Health, University of the Western Cape, Cape Town, South Africa.,United Nations Children's Fund (UNICEF), New York, New York, USA
| | - Nobubelo Ngandu
- Health Systems Research Unit, South African Medical Research Council (HSRU, SAMRC), Pretoria, South Africa
| | - Witness Chirinda
- Health Systems Research Unit, South African Medical Research Council (HSRU, SAMRC), Pretoria, South Africa
| | - Mary Mogashoa
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Gupreet Kindra
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Carl Lombard
- Health Systems Research Unit, South African Medical Research Council (HSRU, SAMRC), Pretoria, South Africa
| | - Ameena Goga
- Health Systems Research Unit, South African Medical Research Council (HSRU, SAMRC), Pretoria, South Africa.,Department of Paediatrics, University of Pretoria, Pretoria, South Africa
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Wood LF, Wood MP, Fisher BS, Jaspan HB, Sodora DL. T Cell Activation in South African HIV-Exposed Infants Correlates with Ochratoxin A Exposure. Front Immunol 2018; 8:1857. [PMID: 29312338 PMCID: PMC5743911 DOI: 10.3389/fimmu.2017.01857] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/07/2017] [Indexed: 01/23/2023] Open
Abstract
The introduction of non-breastmilk foods to HIV-infected infants is associated with increased levels of immune activation, which can impact the rate of HIV disease progression. This is particularly relevant in countries where mother-to-child transmission of HIV still occurs at unacceptable levels. The goal of this study was to evaluate the levels of the toxic food contaminant ochratoxin A (OTA) in HIV-exposed South African infants that are either breastfed or consuming non-breast milk foods. OTA is a common mycotoxin, found in grains and soil, which is toxic at high doses but has immunomodulatory properties at lower doses. Samples from HIV-exposed and HIV-unexposed infants enrolled in prospective observational cohort studies were collected and analyzed at birth through 14 weeks of age. We observed that infants consuming non-breast milk foods had significantly higher plasma levels of OTA at 6 weeks of age compared to breastfed infants, increasing until 8 weeks of age. The blood levels of OTA detected were comparable to levels observed in OTA-endemic communities. OTA plasma levels correlated with HIV target cell activation (CCR5 and HLADR expression on CD4+ T cells) and plasma levels of the inflammatory cytokine CXCL10. These findings provide evidence that elevated OTA levels in South African infants are associated with the consumption of non-breastmilk foods and activation of the immune system. Reducing infant OTA exposure has the potential to reduce immune activation and provide health benefits, particularly in those infants who are HIV-exposed or HIV-infected.
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Affiliation(s)
- Lianna Frances Wood
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, United States
| | - Matthew P Wood
- Center for Infectious Disease Research, Seattle, WA, United States
| | - Bridget S Fisher
- Center for Infectious Disease Research, Seattle, WA, United States
| | - Heather B Jaspan
- Divisions of Paediatrics, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Department of Infectious Disease, Seattle Children's Research Institute, Seattle, WA, United States
| | - Donald L Sodora
- Center for Infectious Disease Research, Seattle, WA, United States
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27
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Clouse K, Mongwenyana C, Musina M, Bokaba D, Long L, Maskew M, Ahonkhai A, Fox MP. Acceptability and feasibility of a financial incentive intervention to improve retention in HIV care among pregnant women in Johannesburg, South Africa. AIDS Care 2017; 30:453-460. [PMID: 29067861 DOI: 10.1080/09540121.2017.1394436] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Women initiating antiretroviral therapy during pregnancy are at high risk of dropping out of HIV care after delivery. We assessed the acceptability and feasibility of a financial incentive - a one-time R50 (∼USD4) supermarket voucher for completing one postpartum visit ≤10 weeks of delivery - to improve postpartum retention. We enrolled 100 pregnant, HIV-positive women at a primary health clinic in Johannesburg, South Africa. Participants were interviewed at enrollment and we reviewed files to assess retention ≥14 weeks postpartum. Median (IQR) respondent age was 28 years (24-31) and 31% were employed. Most (86%) said the incentive would motivate them to return and 76% supported clinics offering incentives. Among the 23% who found the intervention unacceptable, the most frequent reason was perceived personal responsibility for health. Feasibility was demonstrated, as 79.7% (51/64) of eligible participants received a voucher. When asked to rank preferred hypothetical incentive interventions, assistance with social services ranked first (29%), followed by infant formula (22%) and cash (21%); assistance with social services was the top-ranked choice by both those who found the voucher incentive intervention acceptable and unacceptable. To encourage HIV-positive women to remain in care, respondents most frequently suggested health education (34%), counseling (29%), financial incentives (25%), home visits (13%), and better service (6%). Our results suggest financial incentives are acceptable, but women frequently expressed preference for integrated services and improved education and counseling to improve retention. Interventions exploring the feasibility and efficacy of education and counseling interventions to improve postpartum HIV care are warranted.
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Affiliation(s)
- Kate Clouse
- a Vanderbilt Institute for Global Health , Vanderbilt University , Nashville , TN , USA.,b Department of Medicine, Division of Infectious Diseases , Vanderbilt University , Nashville , TN , USA.,c Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Constance Mongwenyana
- c Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Melda Musina
- c Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Dorah Bokaba
- d Hikhensile Clinic , City of Johannesburg , Johannesburg , South Africa
| | - Lawrence Long
- c Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Mhairi Maskew
- c Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Aima Ahonkhai
- a Vanderbilt Institute for Global Health , Vanderbilt University , Nashville , TN , USA.,b Department of Medicine, Division of Infectious Diseases , Vanderbilt University , Nashville , TN , USA
| | - Matthew P Fox
- c Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,e Department of Global Health , Boston University School of Public Health, Boston University , Boston , MA , USA.,f Department of Epidemiology , Boston University School of Public Health, Boston University , Boston , MA , USA
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Fox EL, Pelto GH, Rasmussen KM, Debrosse MG, Rouzier VA, Pape JW, Pelletier DL. Who knows what: An exploration of the infant feeding message environment and intracultural differences in Port-au-Prince, Haiti. MATERNAL AND CHILD NUTRITION 2017; 14:e12537. [PMID: 28976068 DOI: 10.1111/mcn.12537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/27/2017] [Accepted: 09/09/2017] [Indexed: 11/28/2022]
Abstract
Worldwide, mothers with young children receive many messages about infant feeding. Some messages are generated by health providers and others by the households, communities, and social contexts in which women live. We aimed to determine the scope of infant feeding messages in urban Haiti and to examine intracultural differences in salience of these messages and their alignment with international guidelines. We applied the method of free listing with 13 health workers and 15 human immunodeficiency virus (HIV)-infected and 15 HIV-uninfected mothers with infants 0-6 months old at Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes in Port-au-Prince, Haiti. Participants listed all messages women receive about infant feeding and specifically about HIV and infant feeding. Message salience was determined by frequency of mention and recall order; messages were coded for key themes. For all groups, the World Health Organization infant feeding recommendations were salient, especially those related to exclusive breastfeeding. Messages across all groups focused on infant health outcomes, with less emphasis on maternal outcomes. Cultural beliefs were also elicited and showed higher salience for mothers than health workers, particularly for consequences of poor maternal nutrition. Health workers' free lists were poorly correlated to those of mothers, whereas those of mothers were highly correlated, regardless of HIV status. Inasmuch as many salient messages were culturally generated, and differences existed between mothers and health workers, we conclude that it is important for health workers to acknowledge the broader infant feeding message environment, and discrepancies within that environment, to address successes and failures in the messages reaching mothers, given potential consequences for mothers' breastfeeding behaviours.
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Affiliation(s)
- Elizabeth L Fox
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.,Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gretel H Pelto
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | | | - Marie Guerda Debrosse
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haïti
| | - Vanessa A Rouzier
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haïti
| | - Jean William Pape
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haïti.,Center for Global Health, Weill Cornell Medical College, New York, New York, USA
| | - David L Pelletier
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
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Mnyani CN, Tait CL, Armstrong J, Blaauw D, Chersich MF, Buchmann EJ, Peters RPH, McIntyre JA. Infant feeding knowledge, perceptions and practices among women with and without HIV in Johannesburg, South Africa: a survey in healthcare facilities. Int Breastfeed J 2017; 12:17. [PMID: 28405213 PMCID: PMC5385001 DOI: 10.1186/s13006-017-0109-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Africa has a history of low breastfeeding rates among women with and without Human Immunodeficiency Virus (HIV). In this study, we assessed infant feeding knowledge, perceptions and practices among pregnant and postpartum women with and without HIV, in the context of changes in infant feeding and Prevention of Mother-to-Child Transmission of HIV (PMTCT) guidelines. METHODS This was a cross-sectional survey conducted from April 2014 to March 2015 in 10 healthcare facilities in Johannesburg, South Africa. A total of 190 pregnant and 180 postpartum women (74 and 67, respectively, were HIV positive) were interviewed using a semi-structured questionnaire. Multiple regression analyses assessed factors associated with an intention to exclusively breastfeed, and exclusive breastfeeding of infants less than six months of age. RESULTS Women with HIV had better overall knowledge on safe infant feeding practices, both in general and in the context of HIV infection. There were however gaps in knowledge among women with and without HIV. Information from healthcare facilities was the main source of information for all groups of women in the study. A greater percentage of women without HIV 80.9% (93/115), reported an intention to exclusively breastfeed, compared to 64.9% (48/74) of women with HIV, p = 0.014. Not having HIV was positively associated with a reported intention to breastfeed, Adjusted Odds Ratio (AOR) 3.60, 95% CI 1.50, 8.62. Other factors associated with a reported intention to exclusively breastfeed were prior breastfeeding experience and higher knowledge scores on safe infant feeding practices in the context of HIV infection. Among postpartum women, higher scores on general knowledge of safe infant feeding practices were positively associated with reported exclusive breastfeeding, AOR 2.18, 95% CI 1.52, 3.12. Most women perceived that it was difficult to exclusively breastfeed and that cultural factors were a barrier to exclusive breastfeeding. CONCLUSIONS While a greater proportion of women are electing to breastfeed, HIV infection and cultural factors remain an important influence on safe infant feeding practices. Healthcare workers are the main source of information, and highlight the need for accurate and consistent messaging for both women with and without HIV.
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Affiliation(s)
- Coceka N Mnyani
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,SACEMA (DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis), Stellenbosch University, Stellenbosch, South Africa
| | - Carol L Tait
- Anova Health Institute, Johannesburg, South Africa
| | | | - Duane Blaauw
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew F Chersich
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, University of Ghent, Ghent, Belgium
| | - Eckhart J Buchmann
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa
| | | | - James A McIntyre
- Anova Health Institute, Johannesburg, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Ogwu A, Moyo S, Powis K, Asmelash A, Lockman S, Moffat C, Leidner J, Makhema J, Essex M, Shapiro R. Predictors of early breastfeeding cessation among HIV-infected women in Botswana. Trop Med Int Health 2016; 21:1013-1018. [PMID: 27224454 DOI: 10.1111/tmi.12729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Infants born to HIV-infected women receiving antiretroviral treatment (ART) can be breastfed through at least 6 months with very low risk of HIV acquisition. We aimed to identify demographic and cultural factors that may influence mothers' willingness to breastfeed for the recommended duration. METHODS We evaluated factors associated with early cessation of breastfeeding (i.e. before 5 months post-partum) in a randomized clinical trial evaluating different ART regimens used for prevention of mother-to-child transmission during breastfeeding in Botswana. Univariate and multivariable Cox regressions were used to describe predictors of early exclusive BF cessation. RESULTS Among 677 women who started breastfeeding, the median time to breastfeeding cessation was 178 days (IQR 150-181) and 25.1% weaned early. In multivariable analysis, urban location (aHR = 1.86 95%CI 1.27-2.73; P = 0.002), salaried employment or being a student (aHR = 2.78 95% CI 1.63-4.75; P < 0.001) and infant hospitalisation before weaning (aHR = 2.04 95% CI 1.21-3.45; P = 0.008) were independently and significantly associated with early BF cessation. CONCLUSIONS Improved support for breastfeeding among employed mothers, especially in urban settings, may allow HIV-infected women who are receiving ART prophylaxis to breastfeed longer.
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Affiliation(s)
- Anthony Ogwu
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Trinity Medical Centre, Piccadilly, WA, Australia
| | - Sikhulile Moyo
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Kathleen Powis
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Aida Asmelash
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shahin Lockman
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Claire Moffat
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Greater Manchester West Mental Health NHS Foundation Trust, Prestwich, UK
| | | | - Joseph Makhema
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Max Essex
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Roger Shapiro
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Boston, MA, USA
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Odeny BM, Pfeiffer J, Farquhar C, Igonya EK, Gatuguta A, Kagwaini F, Nduati R, Kiarie J, Bosire R. The Stigma of Exclusive Breastfeeding Among Both HIV-Positive and HIV-Negative Women in Nairobi, Kenya. Breastfeed Med 2016; 11:252-8. [PMID: 27093583 PMCID: PMC4921896 DOI: 10.1089/bfm.2016.0014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Exclusive breastfeeding (EBF) means giving only breast milk to an infant. Although it is the optimal mode of feeding for infants younger than 6 months, its prevalence is low in HIV-endemic regions. Extensive promotion of EBF for 6 months in prevention of mother-to-child HIV transmission (PMTCT) programs could inadvertently result in stigma due to women's perceived association of EBF with HIV infection. In this qualitative study, we describe how stigma impacts the uptake of EBF among HIV-positive and -negative women. METHODS Pregnant and postpartum women and their male partners were recruited to participate in a total of 22 focus group discussions (FGDs). Transcripts were analyzed using ATLAS.ti. Codes were identified both a priori and inductively using the open coding approach. Major themes and subthemes were identified. RESULTS There was a broad and strong consensus among some FGD participants that HIV-related stigma was a barrier to EBF. EBF was perceived as a practice for HIV-positive women. Thus, fear of discrimination deterred both HIV-positive and -negative women from EBF. However, with health education, peer counselor, and male partner support, some women were able to breastfeed exclusively regardless of opposing social norms. CONCLUSION Stigma related to HIV poses a formidable barrier to EBF in HIV-endemic regions. There is an urgent need to widely target all women with EBF information and support EBF practices regardless of maternal HIV infection status. The lessons learned from this study indicate that vertical programs can hinder promotion of infant health interventions and therefore negatively affect child survival.
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Affiliation(s)
- Beryne Mikal Odeny
- 1 Department of Global Health, University of Washington , Seattle, Washington
| | - James Pfeiffer
- 1 Department of Global Health, University of Washington , Seattle, Washington.,2 Department of Anthropology, University of Washington , Seattle, Washington.,3 Department of Health Services, University of Washington , Seattle, Washington
| | - Carey Farquhar
- 1 Department of Global Health, University of Washington , Seattle, Washington.,4 Department of Epidemiology, University of Washington , Seattle, Washington.,5 Department of Medicine, University of Washington , Seattle, Washington
| | | | - Ann Gatuguta
- 7 School of Public Health, Kenyatta University , Nairobi, Kenya
| | | | - Ruth Nduati
- 9 Department of Pediatrics and Child Health, University of Nairobi , Nairobi, Kenya
| | - James Kiarie
- 10 Department of Obstetrics and Gynecology, University of Nairobi , Nairobi, Kenya
| | - Rose Bosire
- 11 Centre for Public Health Research , Kenya Medical Research Institute, Nairobi, Kenya
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Siziba L, Jerling J, Hanekom S, Wentzel-Viljoen E. Low rates of exclusive breastfeeding are still evident in four South African provinces. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2015.11734557] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Morden E, Technau KG, Giddy J, Maxwell N, Keiser O, Davies MA. Growth of HIV-Exposed Uninfected Infants in the First 6 Months of Life in South Africa: The IeDEA-SA Collaboration. PLoS One 2016; 11:e0151762. [PMID: 27049853 PMCID: PMC4822941 DOI: 10.1371/journal.pone.0151762] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/03/2016] [Indexed: 11/19/2022] Open
Abstract
Background HIV-exposed uninfected (HEU) infants are a growing population in sub-Saharan Africa especially with the increasing coverage of more effective prevention of mother-to-child transmission (PMTCT) antiretroviral therapy regimens. This study describes the characteristics of South African HEU infants, investigates factors impacting birth weight and assesses their growth within the first 28 weeks of life. Methods This is a retrospective cohort based on routine clinical data from two South African PMTCT programmes. Data were collected between 2007 and 2013. Linear regression assessed factors affecting birth weight-for-age z-scores (WAZ) while growth (longitudinal WAZ) was assessed using mixed effects models. Results We assessed the growth of 2621 HEU infants (median birth WAZ was -0.65 (IQR -1.46; 0.0) and 51% were male). The feeding modalities practised were as follows: 0.5% exclusive breastfeeding, 7.9% breastfeeding with unknown exclusivity, 0.08% mixed breastfeeding and 89.2% formula feeding. Mothers with CD4 <200 cells/μl delivered infants with a lower birth WAZ (adjusted ß -0.253 [95% CI -0.043; -0.072], p = 0.006) compared to mothers with aCD4 ≥500 cells/μl. Similarly, mothers who did not receive antiretroviral drugs delivered infants with a lower birth WAZ (adjusted ß -0.39 [95% CI -0.67; -0.11], p = 0.007) compared to mothers who received antenatal antiretrovirals. Infants with a birth weight <2 500g (ß 0.070 [95% CI 0.061; 0.078], p <0.0001) experienced faster growth within the first 28 weeks of life compared to infants with a birth weight ≥2 500g. Infants with any breastfeeding exposure experienced slower longitudinal growth compared to formula fed infants (adjusted ß -0.012 [95% CI 0.021; -0.003], p = 0.011). Conclusion Less severe maternal disease and the use of antiretrovirals positively impacts birth weight in this cohort of South African HEU infants. Formula feeding was common with breastfed infants experiencing marginally slower longitudinal growth.
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Affiliation(s)
- Erna Morden
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Karl-Günter Technau
- Rahima Moosa Mother and Child Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | | | - Nicola Maxwell
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Olivia Keiser
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Mary-Ann Davies
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Wojcicki JM, Nxumalo NC, Masuku S. Preventing mother-to-child transmission of the human immunodeficiency virus in Southern Africa. Acta Paediatr 2015; 104:1211-4. [PMID: 26080651 DOI: 10.1111/apa.13083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 06/04/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Janet M. Wojcicki
- Department of Pediatrics; University of California; San Francisco CA USA
- Department of Community Health Nursing; Faculty of Health Sciences; University of Swaziland; Mbabane Swaziland
| | - Nomathemba C. Nxumalo
- Department of Community Health Nursing; Faculty of Health Sciences; University of Swaziland; Mbabane Swaziland
| | - Sakile Masuku
- Department of Community Health Nursing; Faculty of Health Sciences; University of Swaziland; Mbabane Swaziland
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Jean J, Coll A, Monda M, Potter J, Jones D. Perspectives on safer conception practices and preconception counseling among women living with HIV. Health Care Women Int 2015; 37:1096-118. [PMID: 26492078 DOI: 10.1080/07399332.2015.1107068] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pregnancies are frequently unplanned, and higher rates of unplanned pregnancies occur among HIV-infected women. Reviewers examined reproductive decision making, conception practices, and patient-provider communication among women living with HIV. Qualitative interviews were conducted with 19 HIV-infected sexually active women aged 18-45 in southern Florida, USA. Using thematic analysis, we found decisions to conceive were influenced by women and partners; knowledge and use of safer conception practices were low. Discussion and support from partners, family, and providers was limited and diminished by stigma and nondisclosure. Preconception counseling discussions in HIV care should be comprehensive and initiated frequently by all health care providers.
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Affiliation(s)
- Jenny Jean
- a University of Rochester School of Medicine , Rochester , New York , USA
| | - Alison Coll
- b Department of Psychiatry & Behavioral Sciences, Miller School of Medicine , University of Miami , Miami , Florida , USA
| | - Mallory Monda
- c Department of Public Health Science, Miller School of Medicine , University of Miami , Miami , Florida , USA
| | - JoNell Potter
- d Department of Obstetrics & Gynecology , Miller School of Medicine, University of Miami , Florida , USA
| | - Deborah Jones
- b Department of Psychiatry & Behavioral Sciences, Miller School of Medicine , University of Miami , Miami , Florida , USA
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Thorne C, Idele P, Chamla D, Romano S, Luo C, Newell ML. Morbidity and mortality in HIV-exposed uninfected children. Future Virol 2015. [DOI: 10.2217/fvl.15.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Approximately 1.5 million HIV-positive women become pregnant annually. Antiretroviral therapy (ART) is central to prevention of mother-to-child transmission and maternal ART continued postpartum allows breastfeeding for at least 1 year of life, with important benefits for the child. In the pre-ART era, it was suggested that HIV-exposed uninfected (HEU) children may be at higher morbidity and mortality risk than children of HIV-negative mothers, associated with maternal illness and death and the lack, or limited duration, of breastfeeding as recommended for preventing mother-to-child transmission at that time. This review summarizes the evidence on morbidity and mortality risk in HEU children compared with HIV-unexposed children, and assesses the likely impact of roll-out of ART, which prolongs maternal survival and allows breastfeeding.
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Affiliation(s)
- Claire Thorne
- Population, Policy & Practice Programme, UCL Institute of Child Health, University College London, London, WC1E 6BT, UK
| | - Priscilla Idele
- Data & Analytics Section, UNICEF New York, New York, NY, USA
| | - Dick Chamla
- Health Section, UNICEF New York, New York, NY, USA
| | | | - Chewe Luo
- HIV/AIDS Section, UNICEF New York, New York, NY, USA
| | - Marie-Louise Newell
- Faculty of Medicine/Faculty of Social & Human Sciences, University of Southampton, Southampton, SO17 1BJ, UK
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Jones D, Peltzer K, Weiss SM, Sifunda S, Dwane N, Ramlagan S, Cook R, Matseke G, Maduna V, Spence A. Implementing comprehensive prevention of mother-to-child transmission and HIV prevention for South African couples: study protocol for a randomized controlled trial. Trials 2014; 15:417. [PMID: 25348459 PMCID: PMC4219009 DOI: 10.1186/1745-6215-15-417] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 10/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In rural South Africa, only two-thirds of HIV-positive pregnant women seeking antenatal care at community health centers took full advantage of 'prevention of mother-to-child transmission' (PMTCT) services in 2010. Studies generally support male involvement to promote PMTCT, but the nature and impact of that involvement is unclear and untested. Additionally, stigma, disclosure and intimate partner violence pose significant barriers to PMTCT uptake and retention in care, suggesting that male involvement may be 'necessary, but not sufficient' to reduce infant HIV incidence. This study expands on a successful United States President's Emergency Plan for AIDS Relief (PEPFAR)-supported PMTCT couples intervention pilot study conducted in the Mpumalanga province, targeting HIV-positive pregnant women and their partners, the primary objective being to determine whether male partner involvement plus a behavioral intervention will significantly reduce infant HIV incidence. METHODS/DESIGN The study follows a cluster randomized controlled design enrolling two cohorts of HIV-positive pregnant women recruited from 12 randomly assigned Community Health Centers (CHC) (six experimental, six control). The two cohorts will consist of women attending without their male partners (n = 720) and women attending with their male partners (n = 720 couples), in order to determine whether the influence of male participation itself, or combined with a behavioral PMTCT intervention, can significantly reduce infant HIV infection ante-, peri- and postnatally. DISCUSSION It is our intention to significantly increase PMTCT participation from current levels (69%) in the Mpumalanga province to between 90 and 95% through engaging women and couples in a controlled, six session ante- and postnatal risk-reducing and PMTCT promotion intervention addressing barriers to PMTCT (such as stigma, disclosure, intimate partner violence, communication, infant feeding practices and safer conception) that prevent women and men from utilizing treatment opportunities available to them and their infants. Based upon the encouraging preliminary results from our pilot study, successful CHC adoption of the program could have major public health policy implications for containing the epidemic among the most vulnerable populations in rural South Africa: HIV-positive pregnant women and their infants. TRIAL REGISTRATION ClinicalTrials.gov NCT02085356 (registration date: 10 March 2014).
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Affiliation(s)
| | - Karl Peltzer
- HIV/AIDS, STIs and TB (HAST) Research Programme, Human Sciences Research Council (HSRC), Private Bag X41, Pretoria 0001, South Africa.
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High-risk enteric pathogens associated with HIV infection and HIV exposure in Kenyan children with acute diarrhoea. AIDS 2014; 28:2287-96. [PMID: 25028987 DOI: 10.1097/qad.0000000000000396] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE HIV infection is an established risk for diarrhoeal severity, less is known about specific enteric pathogens associated with HIV status. We determined associations of selected enteric pathogens with HIV infection and HIV exposure among Kenyan children. DESIGN A cross-sectional study among 6 months to 15 year olds presenting to two Western Kenya District hospitals with acute diarrhoea between 2011 and 2013. METHODS Stool was tested using standard bacterial culture and microscopy for ova and parasites. HIV status was obtained from children and mothers. Enteric pathogen prevalence was compared between HIV-infected and HIV-uninfected children and between HIV-exposed uninfected (HEU) and HIV-unexposed. Unadjusted and adjusted prevalence ratios for selected pathogens by HIV status were estimated using relative risk (RR) regression. Age, site, income, household crowding, water source/treatment, anthropometrics, cotrimoxazole use and breastfeeding history were accounted for in multivariable models. RESULTS Among 1076 children, median age was 22 months (interquartile range: 11-42 months), 56 (5.2%) were HIV-infected and 105 (11.3%) of 926 HIV-uninfected children in whom maternal HIV status was obtained were HIV-exposed. The following organisms were most frequently isolated from stool: enteroaggregative Escherichia coli (13.3%), Giardia species (spp.) (11.1%), Campylobacter spp. (6.3%), enteropathogenic E. coli (EPEC) (6.1%) and Cryptosporidium spp. (3.7%). Accounting for age, HIV-infection was associated with typical EPEC infection (prevalence ratio 3.70, P = 0.002) while HIV-exposure was associated with Cryptosporidium among HIV-uninfected children (prevalence ratio 2.81, P = 0.005). CONCLUSION EPEC and Cryptosporidium infections were more common in HIV-infected and HIV-exposed children, respectively. This could explain the increased mortality attributed to these pathogens in other studies. Interventions targeting EPEC and Cryptosporidium may reduce morbidity and mortality in high HIV-prevalence settings.
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Tuthill EL, Butler LM, McGrath JM, Cusson RM, Makiwane GN, Gable RK, Fisher JD. Cross-cultural adaptation of instruments assessing breastfeeding determinants: a multi-step approach. Int Breastfeed J 2014; 9:16. [PMID: 25285151 PMCID: PMC4185181 DOI: 10.1186/1746-4358-9-16] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 09/06/2014] [Indexed: 12/01/2022] Open
Abstract
Background Cross-cultural adaptation is a necessary process to effectively use existing instruments in other cultural and language settings. The process of cross-culturally adapting, including translation, of existing instruments is considered a critical set to establishing a meaningful instrument for use in another setting. Using a multi-step approach is considered best practice in achieving cultural and semantic equivalence of the adapted version. We aimed to ensure the content validity of our instruments in the cultural context of KwaZulu-Natal, South Africa. Methods The Iowa Infant Feeding Attitudes Scale, Breastfeeding Self-Efficacy Scale-Short Form and additional items comprise our consolidated instrument, which was cross-culturally adapted utilizing a multi-step approach during August 2012. Cross-cultural adaptation was achieved through steps to maintain content validity and attain semantic equivalence in the target version. Specifically, Lynn’s recommendation to apply an item-level content validity index score was followed. The revised instrument was translated and back-translated. To ensure semantic equivalence, Brislin’s back-translation approach was utilized followed by the committee review to address any discrepancies that emerged from translation. Results Our consolidated instrument was adapted to be culturally relevant and translated to yield more reliable and valid results for use in our larger research study to measure infant feeding determinants effectively in our target cultural context. Conclusions Undertaking rigorous steps to effectively ensure cross-cultural adaptation increases our confidence that the conclusions we make based on our self-report instrument(s) will be stronger. In this way, our aim to achieve strong cross-cultural adaptation of our consolidated instruments was achieved while also providing a clear framework for other researchers choosing to utilize existing instruments for work in other cultural, geographic and population settings.
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Affiliation(s)
- Emily L Tuthill
- University of Connecticut School of Nursing, 231 Glenbrook Rd, Storrs, CT 06269, USA ; Center for Health Intervention and Prevention, University of Connecticut, 2006 Hillside Rd, Unit 1248, Storrs, CT 06269, USA
| | - Lisa M Butler
- Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Boston, MA 02215, USA ; Department of Pediatrics, Harvard Medical School, Boston, MA 02215, USA
| | - Jacqueline M McGrath
- University of Connecticut School of Nursing, 231 Glenbrook Rd, Storrs, CT 06269, USA ; Connecticut Children's Medical Center, Institute for Nursing Research and Evidence-Based Practice, 282 Washington St., Hartford, CT 06106, USA
| | - Regina M Cusson
- University of Connecticut School of Nursing, 231 Glenbrook Rd, Storrs, CT 06269, USA
| | - Gracia Nokhaya Makiwane
- University of KwaZulu-Natal, King Edward Avenue, Scottsville, Pietermaritzburg, South Africa
| | - Robert K Gable
- University of Connecticut School of Nursing, 231 Glenbrook Rd, Storrs, CT 06269, USA ; Johnson & Wales University, Center for Research and Evaluation, 8 Abbott Park Place, Providence, RI 02903, USA ; College of Arts & Sciences, Johnson & Wales University, 8 Abbott Park Place, Providence, RI 02903, USA
| | - Jeffrey D Fisher
- Center for Health Intervention and Prevention, University of Connecticut, 2006 Hillside Rd, Unit 1248, Storrs, CT 06269, USA
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Timing of maternal HIV testing and uptake of prevention of mother-to-child transmission interventions among women and their infected infants in Johannesburg, South Africa. J Acquir Immune Defic Syndr 2014; 65:e170-8. [PMID: 24759066 DOI: 10.1097/qai.0000000000000068] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND By 2011, South African prevention of mother-to-child transmission (PMTCT) of HIV programs had reduced perinatal HIV transmission at 6 weeks of age to 2.7%. We investigated the profile of newly diagnosed vertically infected children and their mothers to identify shortfalls in the PMTCT program. METHODS In this operational follow-up study, fieldworkers enrolled mothers of newly diagnosed HIV-infected children up to 2 years of age at 5 major health care facilities in Johannesburg. Structured questionnaires and clinical record reviews were conducted and analyzed to describe the population and assess factors associated with PMTCT uptake. RESULTS Two hundred eighty-nine mother-child pairs were enrolled. Timing of maternal HIV diagnosis influenced PMTCT access and feeding choices and was associated with infants' age at HIV diagnosis (7 vs. 11 vs. 31 weeks where mothers tested before, during, or after the pregnancy, respectively; P < 0.0001). Women diagnosed before pregnancy (12%) were older (median, 31 years) than those diagnosed during the index pregnancy (53%; median, 27 years). Women diagnosed after delivery (35%) were younger (median, 25 years, P < 0.0001), of lower parity, and less likely to be South African citizens. In 81 cases (29%), late maternal diagnosis precluded any PMTCT access. Where women were diagnosed during or before pregnancy, the recommended PMTCT guidelines for mother and infant were followed in 86 (61%) pairs. CONCLUSIONS Failure to diagnose maternal HIV infection before delivery was the main reason for missing PMTCT prophylaxis and early infant testing. Timely maternal diagnosis enables PMTCT uptake, but implementation and follow-up gaps require attention to improve infant outcomes.
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What does high and low have to do with it? Performance classification to identify health system factors associated with effective prevention of mother-to-child transmission of HIV delivery in Mozambique. J Int AIDS Soc 2014; 17:18828. [PMID: 24666594 PMCID: PMC3965711 DOI: 10.7448/ias.17.1.18828] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 01/24/2014] [Accepted: 02/10/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction Efforts to implement and take to scale highly efficacious, low-cost interventions to prevent mother-to-child HIV transmission (pMTCT) have been a cornerstone of reproductive health services in sub-Saharan Africa for over a decade. Yet efforts to increase access and utilization of these services remain far from optimal. This study developed and applied an approach to systematically classify pMTCT performance to identify modifiable health system factors associated with pMTCT performance which may be replicated in other pMTCT systems. Methods Facility-level performance measures were collected at 30 sites over a 12-month period and reviewed for consistency. Five combinations of three indicators (1. HIV testing; 2. CD4 testing; 3. antiretroviral prophylaxis and combined antiretroviral therapy initiation) were compared including a composite of all three, a combination of 1. and 3., and each individually. Approaches were visually assessed to describe facility performance, focusing on rank order consistency across high, medium and low categories. Modifiable and non-modifiable factors were ascertained at each site and ranking process was reviewed to estimate association with facility performance through unadjusted Chi-square tests and logistic regression. After describing factors associated with high versus low performing pMTCT clinics, the effect of inclusion of the 10 middle performers was assessed. Results The indicator most consistently associated with the reference composite indicator (HIV testing, antiretroviral prophylaxis and combined antiretroviral therapy) was the single measure of antiretroviral prophylaxis and combined antiretroviral therapy. Lower performing pMTCT clinics ranked consistently low across measurement strategies; high and middle performing clinics demonstrated more variability. Association between clinic characteristics and high pMTCT performance varied markedly across ranking strategies. Using the reference composite indicator, larger catchment area, higher number of institutional deliveries, onsite CD4 point-of-care capacity, and higher numbers of nurses and doctors were associated with high clinic performance while clinic location, NGO support, women's support group, community linkages patient-tracking systems and stock-outs were not associated with high performance. Conclusions Classifying high and low performance provided consistent results across ranking measures, though granularity was improved by aggregating middle performers with either high or low performers. Human resources, catchment size and utilization were positively associated with effective pMTCT service delivery.
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Ramokolo V, Lombard C, Fadnes LT, Doherty T, Jackson DJ, Goga AE, Chhagan M, Van den Broeck J. HIV infection, viral load, low birth weight, and nevirapine are independent influences on growth velocity in HIV-exposed South African infants. J Nutr 2014; 144:42-8. [PMID: 24198309 DOI: 10.3945/jn.113.178616] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Data from a prospective multisite cohort study were used to examine the effect of HIV exposure, untreated HIV infection, and single-dose nevirapine on infant growth velocity. The 2009 WHO growth velocity standards constitute a new tool for this type of investigation and are in need of functional validation. In period 1 (3-24 wk), 65 HIV-infected, 502 HIV-exposed uninfected (HEU), and 216 HIV-unexposed infants were included. In period 2 (25-36 wk), 31 infants moved from the HEU group to the HIV-infected group. We compared weight velocity Z-scores (WVZ) and length velocity Z-scores (LVZ) by HIV group and assessed their independent influences. In period 1, mean WVZ (95% CI) was significantly (P < 0.001) lower in infected [-0.87 (-1.77, 0.04)] than HEU [0.81 (0.67, 0.94)] and unexposed [0.55 (0.33, 0.78)] infants. LVZ showed similar associations. In both periods, sick infants and those exposed to higher maternal viral loads had lower WVZ. Higher mean LVZ was associated with low birth weight. Infants that had received nevirapine had higher LVZ. In conclusion, HIV infection and not exposure was associated with low WVZ and LVZ in period 1. Eliminating infant HIV infection is a critical component in averting HIV-related poor growth patterns in infants in the first 6 mo of life.
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Zulliger R, Abrams EJ, Myer L. Diversity of influences on infant feeding strategies in women living with HIV in Cape Town, South Africa: a mixed methods study. Trop Med Int Health 2013; 18:1547-54. [PMID: 24151822 DOI: 10.1111/tmi.12212] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore influences on infant feeding intentions and practices in women living with HIV in South Africa. METHODS Structured questionnaires were completed by 207 pregnant women and 203 post-partum women in Cape Town, South Africa. Concurrently, 34 semi-structured, qualitative interviews explored the influences on infant feeding strategies in women living with HIV. RESULTS Overall, 50% (104) of pregnant women intended to breastfeed and 22% (45) of post-partum women ever breastfed. Women who breastfed or intended to breastfeed were significantly more likely to have running water in their homes, to have formal housing and to receive advice in support of breastfeeding. Advice from clinic staff was the strongest predictor of breastfeeding [adjusted relative odds (ARO) in pregnant women: 6.87; 95% confidence interval (CI): 2.67, 17.66; ARO in post-partum women: 4.04; 95% CI: 1.60, 10.19]. Other important influences included previous infant feeding experiences, desires to protect the infant from HIV and involvement of other care providers. Many women also noted that breastfeeding was not feasible due to work commitments and highlighted concerns around the discontinuation of the free provision of infant formula. CONCLUSION These results suggest that women living with HIV balance complex influences in deciding on their preferred infant feeding strategies. This underscores the need for extensive provider, patient and community education to ensure consistent messaging, while allowing for adaptation to the circumstances of individual mothers.
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Affiliation(s)
- Rose Zulliger
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Infant feeding modes and determinants among HIV-1-infected African Women in the Kesho Bora Study. J Acquir Immune Defic Syndr 2013; 62:109-18. [PMID: 23075919 DOI: 10.1097/qai.0b013e318277005e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess breastfeeding modes and determinants in a prevention of mother-to-child transmission study. DESIGN HIV-1-infected pregnant women from 5 sites in Burkina Faso, Kenya, and South Africa were enrolled in the study that comprised 2 prospective cohorts and 1 randomized controlled trial. Women were counseled to either breastfeed exclusively up to 6 months or formula feed from birth. METHODS Determinants of breastfeeding initiation and continuation by 3 months postpartum were investigated using multiple logistic regression analysis. Neonatal morbidity was defined as mother-reported fever, diarrhea, or vomiting during the first month of life. RESULTS Among 1028, 781 women (76%) initiated breastfeeding and 565 of 995 (56%) were still breastfeeding at 3 months postpartum (30% exclusively, 18% predominantly, and 8% partially). Study site (Durban, Mombasa, and Nairobi compared with Bobo-Dioulasso), CD4 cell count (<200 cells/mm), secondary schooling (compared with none), and emergency cesarean delivery (compared with vaginal delivery) were independently associated with a lower probability of ever breastfeeding. The odds of still breastfeeding by 3 months postpartum (among those breastfeeding by 1 month) were lower in Mombasa, Nairobi, and Somkhele (compared with Bobo-Dioulasso) and among infants with neonatal morbidity [0.60 (0.37-0.976)]. The odds of exclusive breastfeeding (EBF) by 3 months (if EBF by 1 month) were lower in Mombasa and Nairobi, in ill neonates [0.54 (0.31-0.93)] and boys [0.51 (0.34-0.77)]. CONCLUSIONS EBF was of short duration, particularly for boys. The importance of neonatal morbidity for breastfeeding cessation requires further investigation. Infant feeding counseling might need adaptation to better support mothers of boys and ill neonates.
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Ijumba P, Doherty T, Jackson D, Tomlinson M, Sanders D, Persson LÅ. Social circumstances that drive early introduction of formula milk: an exploratory qualitative study in a peri-urban South African community. MATERNAL AND CHILD NUTRITION 2012; 10:102-11. [PMID: 23230962 DOI: 10.1111/mcn.12012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Breastfeeding is widely endorsed as the optimal strategy for feeding newborns and young infants, as well as improving child survival and achieving Millennium Development Goal 4. Exclusive breastfeeding (EBF) for the first 6 months of life is rarely practised in South Africa. Following the 2010 World Health Organization (WHO) infant feeding recommendations (EBF for HIV-positive mothers with maternal or infant antiretroviral treatment), South Africa adopted breastfeeding promotion as a National Infant Feeding Strategy and removed free formula milk from the Prevention of Mother-to-Child Transmission of HIV programme. This study aimed to explore the perceptions of mothers and household members at community level regarding the value they placed on formula feeding and circumstances that drive the practice in a peri-urban community. We conducted in-depth interviews with HIV-positive and HIV-negative mothers in a community-randomised trial (Good Start III). Focus group discussions were held with grandmothers, fathers and teenage mothers. Data were analysed using thematic analysis. The following themes were identified; inadequate involvement of teenage mothers; grandmothers who become replacement mothers; fear of failing to practise EBF for 6 months; partners as formula providers and costly formula milk leading to risky feeding practices. The new South African Infant Feeding Strategy needs to address the gaps in key health messages and develop community-orientated programmes with a focus on teenage mothers. These should encourage the involvement of grandmothers and fathers in decision-making about infant feeding so that they can support EBF for optimal child survival.
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Affiliation(s)
- Petrida Ijumba
- Health Systems Research Unit, Medical Research Council, Durban, South Africa; International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala, Sweden
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