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Rosen F, Settel L, Irvine F, Koselka EPD, Miller JD, Young SL. Associations between food insecurity and child and parental physical, nutritional, psychosocial and economic well-being globally during the first 1000 days: A scoping review. MATERNAL & CHILD NUTRITION 2024; 20:e13574. [PMID: 37828823 PMCID: PMC10750018 DOI: 10.1111/mcn.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
Food insecurity affects billions of individuals annually and contributes to myriad poor health outcomes. Experiences of food insecurity may be particularly harmful during the first 1000 days, but literature on the topic has not been synthesized. We therefore aimed to characterize all available studies examining associations between food insecurity and nutritional, psychosocial, physical and economic well-being among parents and children during this period. We implemented a standardized search strategy across 11 databases. Four researchers screened 10,257 articles, 120 of which met the inclusion criteria. Most studies were conducted in Sub-Saharan Africa (43.3%), followed by North America (20.8%). Studies were primarily quantitative (95.8%), cross-sectional (70.0%) and focused on women (pregnant or post-partum, 48.3%) or women and children (15.8%). Physical health outcomes were the most investigated (n = 87 studies), followed by nutritional (n = 69), psychosocial (n = 35) and economic well-being (n = 2). The most studied associations were between food insecurity and stunting (n = 15), maternal depression (n = 12), child dietary diversity (n = 7) and maternal body mass index (n = 6). The strength of evidence for the observed associations varied across populations as well as within and between examined outcomes. We recommend that future studies recruit more diverse study populations, consider temporality of relationships, use instruments that facilitate cross-site comparisons, measure individual-level food insecurity and outcomes most likely to be impacted by food insecurity, evaluate contextual factors that may modify the effects of food insecurity and employ analytic techniques that permit assessment of causal pathways.
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Affiliation(s)
- Francesca Rosen
- Department of Global Health StudiesNorthwestern UniversityEvanstonIllinoisUSA
| | - Lily Settel
- Department of Global Health StudiesNorthwestern UniversityEvanstonIllinoisUSA
- Department of AnthropologyNorthwestern UniversityEvanstonIllinoisUSA
| | - Faith Irvine
- Department of Global Health StudiesNorthwestern UniversityEvanstonIllinoisUSA
| | | | - Joshua D. Miller
- Department of AnthropologyNorthwestern UniversityEvanstonIllinoisUSA
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Sera L. Young
- Department of AnthropologyNorthwestern UniversityEvanstonIllinoisUSA
- Institute for Policy ResearchNorthwestern UniversityEvanstonIllinoisUSA
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Glaubius R, Stover J, Johnson LF, Mahiane SG, Mahy MI, Eaton JW. Differences in Breastfeeding Duration by Maternal HIV Status: A Pooled Analysis of Nationally Representative Surveys in Sub-Saharan Africa. J Acquir Immune Defic Syndr 2024; 95:e81-e88. [PMID: 38180741 PMCID: PMC10769179 DOI: 10.1097/qai.0000000000003317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Breastfeeding improves child survival but is a source of mother-to-child HIV transmission among women with unsuppressed HIV infection. Estimated HIV incidence in children is sensitive to breastfeeding duration among mothers living with HIV (MLHIV). Breastfeeding duration may vary according to maternal HIV status. SETTING Sub-Saharan Africa. METHODS We analyzed pooled data from nationally representative household surveys conducted during 2003-2019 that included HIV testing and elicited breastfeeding practices. We fitted survival models of breastfeeding duration by country, year, and maternal HIV status for 4 sub-Saharan African regions (Eastern, Central, Southern, and Western). RESULTS Data were obtained from 65 surveys in 31 countries. In 2010, breastfeeding in the first month of life ("initial breastfeeding") among MLHIV ranged from 69.1% (95% credible interval: 68-79.9) in Southern Africa to 93.4% (92.7-98.0) in Western Africa. Median breastfeeding duration among MLHIV was the shortest in Southern Africa at 15.6 (14.2-16.3) months and the longest in Eastern Africa at 22.0 (21.7-22.5) months. By comparison, HIV-negative mothers were more likely to breastfeed initially (91.0%-98.7% across regions) and for longer duration (median 18.3-24.6 months across regions). Initial breastfeeding and median breastfeeding duration decreased during 2005-2015 in most regions and did not increase in any region regardless of maternal HIV status. CONCLUSIONS MLHIV in sub-Saharan Africa are less likely to breastfeed initially and stop breastfeeding sooner than HIV-negative mothers. Since 2020, UNAIDS-supported HIV estimates have accounted for this shorter breastfeeding exposure among HIV-exposed children. MLHIV need support to enable optimal breastfeeding practices and to adhere to antiretroviral therapy for HIV treatment and prevention of postnatal mother-to-child transmission.
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Affiliation(s)
- Robert Glaubius
- Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, CT
| | - John Stover
- Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, CT
| | - Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Severin G. Mahiane
- Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, CT
| | | | - Jeffrey W. Eaton
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA; and
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
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Mohammed S, Yakubu I, Fuseini AG, Abdulai AM, Yakubu YH. Systematic review and meta-analysis of the prevalence and determinants of exclusive breastfeeding in the first six months of life in Ghana. BMC Public Health 2023; 23:920. [PMID: 37208682 PMCID: PMC10199593 DOI: 10.1186/s12889-023-15758-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 04/26/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Exclusive breastfeeding is a public health priority in sub-Saharan Africa. However, systematic reviews on its determinants in Ghana remain scarce. Therefore, we systematically reviewed the prevalence and determinants of exclusive breastfeeding in children 0-6 months in Ghana. METHODS We conducted systematic searches in Embase, Medline, and Africa-Wide Information from the databases' inception until February 2021 for studies that assessed the prevalence and determinants of exclusive breastfeeding in children 0-6 months in Ghana. Random-effects meta-analysis was used to estimate the pooled prevalence of exclusive breastfeeding and narrative synthesis to summarise the determinants. We calculated the proportion of total variability that was due to between study heterogeneity using I² statistics, and Egger's test assessed publication bias. The review is registered with PROSPERO, CRD42021278019. RESULTS Out of the 258 articles identified, 24 met the inclusion criteria. Most of the included studies were cross-sectional and were published between 2005 and 2021. The pooled prevalence of exclusive breastfeeding (EBF) among children 0-6 months in Ghana was 50% (95%CI 41.0-60.0%). The prevalence was higher in rural areas (54%) than in urban areas (44%). Several factors were identified as facilitators of EBF, including older maternal age, self-employment, unemployment, living in a large house, being a house owner, giving birth in a health facility, non-caesarean delivery, adequate antenatal attendance, counselling services, participation in support groups, adequate knowledge about EBF, positive attitude towards EBF, and higher maternal education among rural dwellers. Additionally, having an average birthweight facilitated EBF. Barriers to EBF were also identified, including higher maternal education among urban dwellers, less than three months of maternity leave, maternal HIV-positive status, the experience of partner violence, lack of access to radio, inadequate breastmilk production, lack of family support, having a partner who wants more children, counselling on complementary feeding, healthcare worker recommendation of complementary feed, single marital status, and infant admission to neonatal intensive care units. CONCLUSION In Ghana, EBF rates are low, with only about half of all children aged 0-6 months breastfed exclusively. A multi-dimensional approach is required to tackle the diverse sociodemographic, obstetric, and infant-related issues that hinder EBF practice in Ghana.
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Affiliation(s)
- Shamsudeen Mohammed
- MedicineDepartment of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ibrahim Yakubu
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.
- Department of Nursing, Nursing and Midwifery Training College, Gushegu, Ghana.
| | | | - Abdul-Malik Abdulai
- Department of Nursing, Nurses' and Midwives' Training College, Tamale, Ghana
| | - Yakubu H Yakubu
- School of Clinical Sciences, Department of Nursing, Auckland University of Technology, Auckland, New Zealand
- Department of Intensive Care Unit, Tamale Teaching Hospital, Tamale, Ghana
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Gyamfi A, Jefferson UT, O'Neill B, Lucas R, Spatz DL, Henderson WA. Disparities in 6 Month Exclusive Breastfeeding in Ghana, Africa: A Scoping Review. J Hum Lact 2022:8903344221130988. [PMID: 36305494 DOI: 10.1177/08903344221130988] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Exclusive breastfeeding practice for 6 months is a critical global public health goal. In 2020, only 44% of infants globally, 31% in Central and West Africa, and 43% in Ghana, were exclusively breastfed for the first 6 months of life. RESEARCH AIM To critically evaluate disparities in exclusive breastfeeding practice for 6 months in Ghana. METHODS The scoping review was guided by Arksey and O'Malley's (2005) six-stage scoping review process. The online databases of American Psychological Association PsychInfo (APA PsychInfo), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Scopus were searched with keywords inclusive of Ghana, exclusive breastfeeding, breastfeeding, infant feeding, lactation, lactating, and exclusive. Eligibility criteria included full-text, peer-reviewed research articles written in the English language without limitation to specific years. Data were analyzed thematically. RESULTS Initially, 317 records were identified, and 15 full-text articles were eligible for the scoping review. Four main themes emerged as disparities in exclusive breastfeeding practice in Ghana. The themes were healthcare (prenatal clinic visits, delivery place, exclusive breastfeeding knowledge), personal (maternal age, Human Immunodeficiency Virus status, parity, type of delivery, breast problem), employment (unemployed, formal, or informal sector worker), and sociocultural (ethnicity/region, family support, religious beliefs, cultural practices). CONCLUSION Disparities in exclusive breastfeeding in Ghana warrant the collaborative efforts of stakeholders for successful mitigation. Future researchers should explore the role of religion and sociocultural practices to protect, promote, and support 6 months of exclusive breastfeeding in Ghana.
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Affiliation(s)
- Adwoa Gyamfi
- St Michael's Midwifery Training School, Ashanti Region, Ghana.,School of Nursing, University of Connecticut, Storrs, CT, USA
| | | | - Barbara O'Neill
- School of Nursing, University of Connecticut, Storrs, CT, USA
| | - Ruth Lucas
- School of Nursing, University of Connecticut, Storrs, CT, USA.,School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Diane Lynn Spatz
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Wendy A Henderson
- School of Nursing, University of Connecticut, Storrs, CT, USA.,School of Medicine, University of Connecticut, Farmington, CT, USA
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Agyekum MW, Codjoe SNA, Dake FAA, Abu M. Is Infant birth weight and mothers perceived birth size associated with the practice of exclusive breastfeeding in Ghana? PLoS One 2022; 17:e0267179. [PMID: 35511936 PMCID: PMC9070922 DOI: 10.1371/journal.pone.0267179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/05/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Despite widespread advocacy for exclusive breastfeeding, and the associated benefits of exclusive breastfeeding for both infants and mothers, there is low prevalence in both developed and developing countries. Additionally, although several studies have been conducted on exclusive breastfeeding, very few of such studies have linked birth weight and birth size to exclusive breastfeeding. This study seeks to examine the influence of birth weight and birth size on exclusive breastfeeding. Methodology This study adopted a sequential explanatory mixed method approach using both quantitative and qualitative methods. The quantitative approach used cross-sectional data from the 2014 Ghana Demographic and Health Survey (GDHS) and the qualitative data from interviews with exclusive breastfeeding mothers from two health facilities in La Nkwantanang Municipal Assembly in Accra, Ghana. Logistic regression analysis was used to examine whether infants birth weight and mothers perceived birth size are associated with the practice of exclusive breastfeeding while the qualitative data provided further insights into the findings from the quantitative analysis. Results Majority (85%) of the infants in the study were of normal birth weight while 52% of the infants were perceived by their mothers to be of small birth size. The prevalence of exclusive breastfeeding was found to be 54.8%. The birth weight of infants and mothers’ perceived birth size were found to be significant predictors of exclusive breastfeeding. Infants of normal birth weight (OR = 7.532; 95% CI: 2.171–26.132) and high birth weight (OR = 6.654; 95% CI: 1.477–29.978) were more likely to be exclusively breastfed compared to low-birth-weight infants. Similarly, infants perceived to be of normal birth size were more likely (OR = 1.908; 95% CI: 1.058–3.441) to be exclusively breastfed compared to infants perceived to be of small birth size. The findings from the qualitative analysis show that birth weight rather than birth size influence mothers’ decision to practice exclusive breastfeeding. Conclusion The findings of the study underscore the relevance of infant birth weight and perceived birth size in the practice of exclusive breastfeeding and highlights the need to incorporate both actual measurement of birth weight, and perception of infant’s birth size into policies targeted at exclusive breastfeeding. There is the need for deliberate targeted efforts at women who deliver infants of low birth weight and women who perceive their children to be of small birth size to practice exclusive breastfeeding.
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Affiliation(s)
- Martin Wiredu Agyekum
- Institute for Educational Research and Innovation Studies, University of Education, Winneba, Ghana
- Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
- * E-mail:
| | - Samuel N. A. Codjoe
- Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
| | - Fidelia A. A. Dake
- Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
| | - Mumuni Abu
- Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
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Agbozo F, Ocansey D, Atitto P, Jahn A. Compliance of a Baby-Friendly Designated Hospital in Ghana With the WHO/UNICEF Baby and Mother-Friendly Care Practices. J Hum Lact 2020; 36:175-186. [PMID: 31112053 DOI: 10.1177/0890334419848728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the Baby-Friendly Hospital Initiative has improved breastfeeding rates globally, weak monitoring still affects hospital-level implementation. RESEARCH AIM To reassess compliance of a Baby-Friendly Hospital with the Ten Steps to Successful Breastfeeding, International Code of Marketing of Breast-milk Substitutes, HIV and Infant Feeding, and Mother-Friendly Care following the WHO/UNICEF global criteria. METHODS In this cross-sectional, prospective, mixed-methods study (N = 180), clinical staff (n = 60), pregnant women (n = 40), postpartum mothers (n = 60), and mothers of babies in intensive care (n = 20) were randomly selected from one urban secondary-level public hospital in Ghana designated as Baby-Friendly in 2004 but never reassessed. Data were collected through interviews, document reviews, and observations using the revised WHO/UNICEF external reassessment tool and analyzed quantitatively using the Baby-Friendly Hospital Initiative computer tool. Scores higher than 80% signified a pass (high compliance). Scores rated as low (< 50%) and moderate (50-80%) signified noncompliance. RESULTS The facility passed the criteria for full compliance with the International Code (86%) but failed other components. Compliance with the Ten Steps was moderate (55%). Step 7 about rooming-in (84%) and Step 9 about human milk substitutes (100%) were passed, whereas Step 1 about written breastfeeding policies (0%), Step 2 about staff training (7%), and Step 4 about early breastfeeding initiation (31%) were met the least. Compliance with Mother-Friendly Care (34%) and HIV and Infant Feeding (47%) were low. Main implementation gaps were unavailability of policies and staff's inadequate knowledge about Baby-Friendly practices. CONCLUSIONS Improving staff training and maternal counseling, routinely reassessing designated facilities, and providing technical support in problematic areas might sustain implementation.
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Affiliation(s)
- Faith Agbozo
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana.,Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Germany
| | - Doris Ocansey
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Prosper Atitto
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Germany
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Hanselman B, Ambikapathi R, Mduma E, Svensen E, Caulfield LE, Patil CL. Associations of land, cattle and food security with infant feeding practices among a rural population living in Manyara, Tanzania. BMC Public Health 2018; 18:159. [PMID: 29351750 PMCID: PMC5775554 DOI: 10.1186/s12889-018-5074-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 01/11/2018] [Indexed: 11/29/2022] Open
Abstract
Background Livelihoods strategies and food security experiences can positively and negatively affect infant and young child feeding (IYCF) practices. This study contributes to this literature by exploring how variation in household economics among rural farmers in Tanzania relates to IYCF patterns over the first 8 months of an infant’s life. Methods These data were produced from a longitudinal study in which a cohort of mother-infant dyads was followed from birth to 24 months. In addition to baseline maternal, infant, and household characteristics, mothers were queried twice weekly and monthly about infant feeding practices and diet. Weekly and monthly datasets were merged and analyzed to assess infant feeding patterns through the first 8 months. Standard statistical methods including survival and logistic regression analyses were used. Results Aside from breastfeeding initiation, all other IYCF practices were suboptimal in this cohort. Land and cattle ownership were associated with the early introduction of non-breastmilk food items. Food insecurity also played a role in patterning and inadequate complementary feeding was commonplace. Conclusions Health promotion programs are needed to delay the introduction of animal milks and grain-based porridge, and to achieve a minimum acceptable diet after 6 months of age among smallholder farmers in rural Tanzania. Results highlight that livelihoods-based health promotion interventions, built from a flexible and integrated design, may be an important strategy to address community-level variation in infant feeding practices and promote optimal IYCF practices.
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Affiliation(s)
- Bailey Hanselman
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
| | - Ramya Ambikapathi
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Estomih Mduma
- Haydom Global Health Research Centre, Haydom, Tanzania
| | | | - Laura E Caulfield
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health & Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Crystal L Patil
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA.
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Thomas E, Kuo C, Cohen S, Hoare J, Koen N, Barnett W, Zar HJ, Stein DJ. Mental health predictors of breastfeeding initiation and continuation among HIV infected and uninfected women in a South African birth cohort study. Prev Med 2017; 102:100-111. [PMID: 28694059 PMCID: PMC5802398 DOI: 10.1016/j.ypmed.2017.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 06/26/2017] [Accepted: 07/05/2017] [Indexed: 12/19/2022]
Abstract
Breastfeeding is a cost-effective, yet underutilized strategy to promote maternal and infant health in low and middle income countries (LMICs). Breastfeeding remains challenging for mothers living with HIV in LMICs, yet few studies have examined mental health predictors of breastfeeding initiation and continuation. We investigated breastfeeding among mothers by HIV status in South Africa, evaluating predictors of breastfeeding initiation and continuation to identify intervention-targets. Breastfeeding patterns were investigated in a subsample of 899 breastfeeding mothers from the Drakenstein Child Health Study; a prospective birth cohort of 1225 pregnant women, between March 2012 and March 2015 in a peri-urban area. Breastfeeding was assessed at 5 time-points between 6weeks and 24months' infant age. Cox proportional hazard models evaluated breastfeeding initiation and duration. Logistic regression models with breastfeeding non-initiation as the outcome parameter were performed to determine associations with maternal sociodemographic, psychosocial factors and gestational outcomes. More HIV-uninfected mothers initiated breastfeeding (n=685, 97%) than HIV-infected mothers (n=87, 45%). Median duration of exclusive breastfeeding was short (2months), but HIV-infected mothers engaged in exclusive breastfeeding for longer duration than uninfected mothers (3 vs 2months). Despite concerning high rates, mental disorders were not significant predictors of breastfeeding behaviour. Employment and HIV diagnosis during pregnancy predicted a lower likelihood of breastfeeding initiation among HIV-infected mothers, while employment was associated with earlier breastfeeding-discontinuation in HIV-uninfected mothers. Findings indicate that future interventions should target sub-populations such as HIV-infected women because of distinct needs. Workplace interventions appear particularly key for mothers in our study.
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Affiliation(s)
- Eileen Thomas
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa.
| | - Caroline Kuo
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa; Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, 121 South Main Street, Box G-S121-4th Floor, Room 406, Providence, RI 02912, USA
| | - Sophie Cohen
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa
| | - Natassja Koen
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa; Medical Research Council Unit on Anxiety and Stress Disorders, South Africa
| | - Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Medical Research Council Unit on Child and Adolescent Health, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa; Medical Research Council Unit on Anxiety and Stress Disorders, South Africa
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Nabwera HM, Jepkosgei J, Muraya KW, Hassan AS, Molyneux CS, Ali R, Prentice AM, Berkley JA, Mwangome MK. What influences feeding decisions for HIV-exposed infants in rural Kenya? Int Breastfeed J 2017; 12:31. [PMID: 28717383 PMCID: PMC5508793 DOI: 10.1186/s13006-017-0125-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/05/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Infant feeding in the context of human immunodeficiency virus (HIV) poses unique challenges to mothers and healthcare workers in balancing the perceived risks of HIV transmission and nutritional requirements. We aimed to describe the decision-making processes around infant feeding at a rural HIV clinic in Kenya. METHODS We used a qualitative study design. Between March and August 2011, we conducted in-depth interviews (n = 9) and focus group discussions (n = 10) with purposively selected hospital and community respondents at Kilifi County Hospital, Kenya. These respondents had all experienced of infant feeding in the context of HIV. These interviews were informed by prior structured observations of health care worker interactions with carers during infant feeding counselling sessions. RESULTS Overall, women living with HIV found it difficult to adhere to the HIV infant feeding guidance. There were three dominant factors that influenced decision making processes: 1) Exclusive breastfeeding was not the cultural norm, therefore practising it raised questions within the family and community about a mother's parenting capabilities and HIV status. 2) Women living with HIV lacked autonomy in decision-making on infant feeding due to socio-cultural factors. 3) Non-disclosure of HIV status to close members due to the stigma. CONCLUSION Infant feeding decision-making by women living with HIV in rural Kenya is constrained by a lack of autonomy, stigma and poverty. There is an urgent need to address these challenges through scaling up psycho-social and gender empowerment strategies for women, and introducing initiatives that promote the integration of HIV infant feeding strategies into other child health services.
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Affiliation(s)
- Helen M. Nabwera
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
| | - Joyline Jepkosgei
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
| | - Kelly W. Muraya
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
- The Childhood Acute Illness & Nutrition (CHAIN) Network, PO Box 43640-00100, Nairobi, Kenya
| | - Amin S. Hassan
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
| | - Catherine S. Molyneux
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
- The Childhood Acute Illness & Nutrition (CHAIN) Network, PO Box 43640-00100, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Rehema Ali
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
| | - Andrew M. Prentice
- MRC Unit, The Gambia, PO Box 273, Banjul, The Gambia
- MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - James A. Berkley
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
- The Childhood Acute Illness & Nutrition (CHAIN) Network, PO Box 43640-00100, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Martha K. Mwangome
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
- The Childhood Acute Illness & Nutrition (CHAIN) Network, PO Box 43640-00100, Nairobi, Kenya
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