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Augustino G, Anaeli A, Sunguya BF. Infant and Young Child Feeding in the Context of HIV: An Exploration of Barriers in Exclusive Breastfeeding Practice in Dar Es Salaam, Tanzania.. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.21.23300402. [PMID: 38234791 PMCID: PMC10793536 DOI: 10.1101/2023.12.21.23300402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Background Ensuring optimal nutrition through early breastfeeding is vital for infant mental development and overall health. HIV infections complicate decisions regarding exclusive breastfeeding, jeopardizing effective infant and young child feeding, which affects nutrition and health outcomes. Recognizing the lack of evidence on barriers to infant feeding in the context of HIV in Tanzania, this study was conducted to explore individual, household, and community obstacles in the Ilala district, Dar es Salaam. Methods The study used a hospital-based qualitative approach, focusing on HIV-positive mothers with infants aged 3-6 months in Dar es Salaam city. This involved reviewing mothers' files, conducting interviews with them, and interviewing Reproductive and Child Health clinics (RCH) and community healthcare providers. In total, 27 In-depth interviews were conducted until data saturation was reached, and thematic analysis was used to analyze collected data. Findings The study identified various barriers to exclusive breastfeeding, encompassing individual factors like work schedules, postpartum depression, and breast conditions. On the household level, barriers included limited access to resources, family influence, and HIV status disclosure reluctance due to stigma. In the community, low retention in the Prevention of Mother-to-Child Transmission (PMTCT) programs plays a pivotal role in hindering exclusive breastfeeding support for HIV-positive mothers. Conclusion and Recommendations HIV-positive mothers face diverse barriers ranging from individual, household, and community-based barriers. Policies supporting breastfeeding, early detection of postnatal depression and breast problems, and peer support for young mothers are of paramount importance. Food insecurity and HIV stigma should be tackled through income-generating activities, family involvement in PMTCT programs, and awareness campaigns. Community-based counselors play a crucial role in supporting HIV-positive mothers in their exclusive breastfeeding journey to improve PMTCT care retention.
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Affiliation(s)
- Goodluck Augustino
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West 11103 Dar Es Salaam, Tanzania
| | - Amani Anaeli
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West 11103 Dar Es Salaam, Tanzania
| | - Bruno F. Sunguya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West 11103 Dar Es Salaam, Tanzania
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Kimuli D, Nakaggwa F, Namuwenge N, Nsubuga RN, Isabirye P, Kasule K, Katwesige JF, Nyakwezi S, Sevume S, Mubiru N, Amuron B, Bukenya D. Sociodemographic and health-related factors associated with exclusive breastfeeding in 77 districts of Uganda. Int Breastfeed J 2023; 18:66. [PMID: 38053098 DOI: 10.1186/s13006-023-00604-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Uganda surpasses many African nations and the global average in exclusive breastfeeding (EBF) rates. Yet, malnutrition is a critical issue, with stunting impacting roughly 29% of children under 5 years. Enhancing EBF could mitigate such nutritional challenges. This study focused on determining the current EBF prevalence and identifying associated factors across 77 surveyed districts. METHODS Pooled data from the Lot Quality Assurance Sampling (LQAS) surveys conducted in 77 districts in Uganda during 2021 and 2022 were analyzed. The analysis involved 7,210 mothers of children under 6 months, EBF was considered as the proportion of infants who received breast milk only in the 24 hours before the survey. A mother practicing EBF was (1) currently breastfeeding (2) had not started giving foods other than breastmilk (3) had not given any other probed liquids or (4) semi-solid foods the previous day or night. Multivariable logistic regression was used to identify factors associated with EBF, presenting adjusted odds ratios (aOR) with corresponding 95% confidence intervals at a 5% significance level. RESULTS The prevalence of EBF was 62.3%. In the adjusted analysis, EBF was more common among older mothers 20-24 years, 25-29 years and 30 + years (aOR 1.4; 95% CI 1.2,1.6), (aOR 1.4; 95% CI 1.1, 1.6) and (aOR 1.3; 95% CI 1.1, 1.5) respectively compared to teenage mothers. Also, EBF was more likely among mothers who lived in rural areas compared to urban areas (aOR 1.1; 95% CI 1.0, 1.3) and those who attended antenatal care (ANC) (aOR 2.2; 95% CI 1.5, 3.1). On the contrary, EBF was less common for children aged 3-5 months compared to younger (aOR 0.5; 95% CI 0.5, 0.6) and children who had received Vitamin A supplementation (aOR 0.7; 95% 0.6, 0.8). CONCLUSION The study suggests that most districts in Uganda might not have made significant strides in improving EBF rates over the last twenty years, pointing to possible ongoing hurdles that need urgent attention. Particularly, there's a pressing need to focus on teenage mothers. Maintaining and strengthening programs that advocate EBF, such as ANC, is crucial to bridge the gaps and bring about more equitable rates among different groups.
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Affiliation(s)
- Derrick Kimuli
- Social & Scientific Systems, Inc., a DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda.
| | - Florence Nakaggwa
- Social & Scientific Systems, Inc., a DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
| | - Norah Namuwenge
- Social & Scientific Systems, Inc., a DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
| | - Rebecca N Nsubuga
- Social & Scientific Systems, Inc., a DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
| | - Paul Isabirye
- Social & Scientific Systems, Inc., a DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
| | - Kenneth Kasule
- Social & Scientific Systems, Inc., a DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
| | - Justine Fay Katwesige
- Social & Scientific Systems, Inc., a DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
| | - Sheila Nyakwezi
- The United States Agency for International Development Uganda, US Mission Compound - South Wing, Kampala, Uganda
| | - Solome Sevume
- The United States Agency for International Development Uganda, US Mission Compound - South Wing, Kampala, Uganda
| | - Norbert Mubiru
- The United States Agency for International Development Uganda, US Mission Compound - South Wing, Kampala, Uganda
| | - Barbara Amuron
- Social & Scientific Systems, Inc., a DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
| | - Daraus Bukenya
- Social & Scientific Systems, Inc., a DLH Holdings company / United States Agency for International Development Strategic Information Technical Support Activity, Kampala, Uganda
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Leandro DB, Celerino da Silva R, Rodrigues JKF, Leite MCG, Arraes LC, Coelho AVC, Crovella S, Zupin L, Guimarães RL. Clinical-Epidemiological Characteristics and IFITM-3 (rs12252) Variant Involvement in HIV-1 Mother-to-Children Transmission Susceptibility in a Brazilian Population. Life (Basel) 2023; 13:life13020397. [PMID: 36836754 PMCID: PMC9959554 DOI: 10.3390/life13020397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
Mother-to-children transmission (MTCT) is the main infection route for HIV-1 in children, and may occur during pregnancy, delivery, and/or postpartum. It is a multifactorial phenomenon, where genetic variants play an important role. This study aims at analyzing the influence of clinical epidemiological characteristics and a variant (rs12252) in interferon-induced transmembrane protein 3 (IFITM-3), a gene encoding an important viral restriction factor, on the susceptibility to HIV-1 mother-to-children transmission (MTCT). A case-control study was performed on 209 HIV-1-infected mothers and their exposed infected (87) and uninfected (122) children from Pernambuco, Brazil. Clinical-epidemiological characteristics are significantly associated with MTCT susceptibility. Transmitter mothers have a significantly lower age at delivery, late diagnosis, deficiency in ART use (pregnancy and delivery), and detectable viral load in the third trimester of pregnancy compared with non-transmitter mothers. Infected children show late diagnosis, vaginal delivery frequency, and tend to breastfeed, differing significantly from uninfected children. The IFITM-3 rs12252-C allele and TC/CC genotypes (dominant model) are significantly more frequent among infected than uninfected children, but the statistical significance does not remain when adjusted for clinical factors. No significant differences are observed between transmitter and non-transmitter mothers in relation to the IFITM-3 variant.
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Affiliation(s)
- Dalila Bernardes Leandro
- Department of Genetics, Federal University of Pernambuco (UFPE), Avenida da Engenharia, S/N, Cidade Universitária, Recife 50670-901, PE, Brazil
- Keizo Asami Institute (iLIKA), Federal University of Pernambuco (UFPE), Avenida Prof. Moraes Rego, S/N, Cidade Universitária, Recife 50670-901, PE, Brazil
| | - Ronaldo Celerino da Silva
- Departament of Virology and Experimental Therapy (LAVITE), Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), Avenida Prof. Moraes Rego, S/N, Cidade Universitária, Recife 50670-901, PE, Brazil
| | - Jessyca Kalynne Farias Rodrigues
- Department of Genetics, Federal University of Pernambuco (UFPE), Avenida da Engenharia, S/N, Cidade Universitária, Recife 50670-901, PE, Brazil
- Keizo Asami Institute (iLIKA), Federal University of Pernambuco (UFPE), Avenida Prof. Moraes Rego, S/N, Cidade Universitária, Recife 50670-901, PE, Brazil
| | - Maria Carollayne Gonçalves Leite
- Keizo Asami Institute (iLIKA), Federal University of Pernambuco (UFPE), Avenida Prof. Moraes Rego, S/N, Cidade Universitária, Recife 50670-901, PE, Brazil
| | - Luiz Claudio Arraes
- Institute of Medicine Integral of Pernambuco Professor Fernando Figueira (IMIP-PE), Rua dos Coelhos, 300, Boa Vista, Recife 50070-902, PE, Brazil
| | | | - Sergio Crovella
- Biological Science Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha 2713, Qatar
| | - Luisa Zupin
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
- Correspondence:
| | - Rafael Lima Guimarães
- Department of Genetics, Federal University of Pernambuco (UFPE), Avenida da Engenharia, S/N, Cidade Universitária, Recife 50670-901, PE, Brazil
- Keizo Asami Institute (iLIKA), Federal University of Pernambuco (UFPE), Avenida Prof. Moraes Rego, S/N, Cidade Universitária, Recife 50670-901, PE, Brazil
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