Social and contextual factors affecting HIV-infected women's feeding practices for their infants in normal practice settings : effects on growth and morbidity

[摘要] ENGLISH ABSTRACT: the significant reduction in HIV transmission through breastfeeding by antiretroviral treatmentguided the current recommendations favouring breastfeeding which has to be continued until12 months of age. Infant feeding guidelines for HIV-infected women in low-resourcedsettings are primarily informed by studies that spend much effort in controlling guidelineadherence by investigators and participants. These studies however may not reflect the realworld effects of the feeding options on important outcomes because such efforts are lessenforced or rear in primary care settings. Reliable studies are lacking for predicting the realworld effects of the feeding options on infant growth and morbidity to guide healthcareauthorities in decision making. Social and contextual factors affecting HIV-infected women'sinfant feeding practices are major barriers to uptake of infant feeding recommendations tolevels that would result in a significant impact. Yet less attention is paid to these duringguideline development and implementation. Methods: To address this knowledge gap weperformed a longitudinal cohort study in primary healthcare settings, over a 12 monthsperiod. The objectives were to a) describe HIV-infected women's infant feeding practices b)compare infant feeding practices of HIV-infected and HIV-uninfected breastfeeding womenc) assess growth and infection-related hospitalizations among predominantly breastfed andpredominantly formula-fed HIV-exposed uninfected infants. We explored infant feedingexperiences of a sub-set of HIV-infected women who were followed-up for at least 6 monthspost-delivery in the longitudinal cohort. Results: We found that few HIV-infected womenchose breastfeeding, and among those who did, many switched to formula feeding early.The proportion of women who continued predominantly breastfeeding was only slightly loweramong HIV-infected compared to HIV-uninfected women (p = 0.0005). These differenceswere seen from about two weeks, and persisted throughout follow-up. By about four months,half of the HIV-infected women had switched to predominant formula feeding. However, theproportion of HIV-uninfected women who switched to formula feeding was also relativelyhigh. The dual infant feeding option employed by the Western Cape PMTCT program whiletransitioning from formula feeding policy confused HIV-infected women who were worriedthat their child may contract HIV through breastmilk because of conflicting messages theyreceived from healthcare providers, possibly explaining why some women stoppedbreastfeeding. Women's interpretation of information about risks and benefits of infantfeeding options, formula feeding stigma and the quality of infant feeding counselling affectedwomen's infant feeding practices. Mean weight velocity Z-scores (95% CI) of predominantlybreastfed infants was -0.70 (-1.31 to -0.09; p = 0.024) lower than that of predominantlyformula fed infants in the two to four months age interval. Protection against infections bybreastfeeding was minimal and insignificant, odds ratio (OR) 0.95 (95% CI 0.33 to 2.74). Inconclusion, it is important that all women, whether HIV-infected or not, be educated thatbreastfeeding is the feeding of choice in this setting. The potential of breastfeeding to reducerisks of infections to levels similar to those observed under highly controlled settings,involves changing women's infant feeding practices. Strategies to promote and sustaincontinued breastfeeding by women, to levels that would result in a significant impact on thegrowth and protection against infections of their children are urgently needed. The strategiesshould be guided by social and contextual factors affecting women's feeding practices

[发布机构] Stellenbosch University