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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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Etowa J, Hannan J, Etowa EB, Babatunde S, Phillips JC. Determinants of infant feeding practices among Black mothers living with HIV: a multinomial logistic regression analysis. BMC Public Health 2021; 21:663. [PMID: 33827510 PMCID: PMC8025335 DOI: 10.1186/s12889-021-10675-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infant feeding practices are imperative for babies' and mothers' health and emotional wellbeing. Although infant feeding may seem simple, the decisions surrounding it are complex and have far-reaching implications for women globally. This is an especially difficult concern among mothers living with HIV because breastfeeding can transmit HIV from mother to child. This is further complicated by cultural expectations in case of Black mothers living with HIV. This paper discusses determinants of infant feeding practices among Black mothers living with HIV who were on anti-retroviral therapy (ART) in two North American cites and one African city. METHODS A cross-sectional, multi-country survey using venue-based convenience sampling of Black mothers living with HIV was employed. The effective response rates were 89% (n = 89) in Ottawa, Canada; 67% (n = 201) in Miami, Florida, US; and 100% (n = 400) in Port Harcourt, Nigeria, equaling a total sample size of 690. Data were collected in Qualtrics and managed in Excel and SPSS. Multinomial logistic regression analyses were used to determine the factors influencing the mothers' infant feeding practices (Exclusive Formula Feeding [EFF] = 1; Mixed Feeding [MF] = 2; and Exclusive Breastfeeding [EBF while on ART] =3). RESULTS The results highlight socio-demographics, EFF determinants, and EBF determinants. The statistically significant determinants of infant feeding practices included national guideline on infant feeding, cultural beliefs and practices, healthcare systems, healthcare personnel, infant feeding attitudes, social support, and perceived stress. Mothers' mean ages were Ottawa (36.6 ± 6.4), Miami (32.4 ± 5.8), and Port Harcourt (34.7 ± 5.7). All sampled women gave birth to least one infant after their HIV diagnoses. Statistically significant (p < .05) determinants of EFF relative to MF were the national guideline of EFF (relative risk [RR] = 218.19), cultural beliefs (RR = .15), received healthcare (RR = 21.17), received healthcare through a nurse/midwife (RR = 3.1), and perceived stress (RR = .9). Statistically significant determinants of EBF relative to MF were received healthcare (RR = 20.26), received healthcare through a nurse/midwife (RR = 2.31), functional social support (RR = 1.07), and perceived stress (RR = .9). CONCLUSION While cultural beliefs and perceived stress favoured MF over EFF, advice of healthcare workers, and the care received from a nurse/midwife improved EFF over MF. Also while the mothers' perceived stress favoured MF over EBF, advice of their nurses or midwife and the social support improved EBF over MF. The providers advice was congruent with WHO and national guidelines for infant feeding among mothers living with HIV. These results have implications for nursing, healthcare practice, and policies on infant feeding practices for mothers living with HIV.
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Affiliation(s)
- Josephine Etowa
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Jean Hannan
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, 11200 Southwest 8th Street, Miami, FL, 33199, USA
| | - Egbe B Etowa
- Department of Sociology, Anthropology & Criminology; Faculty of Arts, Humanities & Social Sciences, 401 Sunset Avenue, Windsor, Ontario, N9B 3P4, Canada.
| | - Seye Babatunde
- Centre for Health and Development, University of Port Harcourt, Port Harcourt, Nigeria
| | - J Craig Phillips
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
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Rasheed MH, Philemon R, Kinabo GD, Maxym M, Shayo AM, Mmbaga BT. Adherence to Exclusive Breastfeeding and Associated Factors in Mothers of HIV-Exposed Infants Receiving Care at Kilimanjaro Christian Medical Centre, Tanzania. East Afr Health Res J 2018; 2:33-42. [PMID: 34308173 PMCID: PMC8279206 DOI: 10.24248/eahrj-d-16-00365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 10/26/2017] [Indexed: 11/20/2022] Open
Abstract
Background: More than 90% of HIV in children occurs through mother-to-child transmission. Breastfeeding is one of several factors associated with transmission of HIV, and, because of this, infant feeding practice is one of the cornerstones in the effort to reduce HIV transmission in children. World Health Organization guidelines from 2012 recommend exclusive breastfeeding to all infants for first 6 months of life. However, many factors contribute to the adherence of mothers to exclusive breastfeeding (EBF) recommendations. The aim of this study was to determine what factors likely influence adherence to exclusive breastfeeding in mothers of HIV-exposed infants receiving care at Kilimanjaro Christian Medical Centre. Methods: A cross-sectional hospital-based study was conducted from September 2012 to March 2013 at Kilimanjaro Christian Medical Centre in Moshi. All mothers of HIV-exposed infants aged 6 to 12 months receiving care at child-centred family care clinic who consented to participate in the study were included. Data were collected using a pretested structured questionnaire and analysed using SPSS version 16.0 statistical package. Results: Of the 128 mothers of HIV-exposed infants enrolled in the study, 71 (55.5%) adhered to EBF for 6 months. No statistical significance was seen between adherence status and maternal characteristics in bivariate analysis (P>.05). The mean age and standard deviation of initiating other foods by mothers who did not adhere was 3.32 months ± 1.24. Of 57 (44.5%) non-adherent mothers, one-tenth of them practised mixed breastfeeding and the rest stopped breastfeeding completely. Fear of postnatal transmission of HIV through breastfeeding and inadequate breast milk production were the most common reasons for non-adherence to EBF. Conclusion: Adherence to the recommended duration for EBF by mothers to their HIV-exposed infants is still a challenge. Ongoing intensive feeding counselling and education on EBF may increase the number of mother who can adhere to EBF in our society.
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Affiliation(s)
- Murtaza Husain Rasheed
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Rune Philemon
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Grace Damas Kinabo
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Maya Maxym
- Kapi'olani Medical Center for Women and Children, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Aisa Mamuu Shayo
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Blandina Theophil Mmbaga
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania
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Nielsen KK, Rheinländer T, Kapur A, Damm P, Seshiah V, Bygbjerg IC. Factors influencing timely initiation and completion of gestational diabetes mellitus screening and diagnosis - a qualitative study from Tamil Nadu, India. BMC Pregnancy Childbirth 2017; 17:255. [PMID: 28764665 PMCID: PMC5539632 DOI: 10.1186/s12884-017-1429-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/18/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2007, universal screening for gestational diabetes mellitus (GDM) was introduced in Tamil Nadu, India. To identify factors hindering or facilitating timely initiation and completion of the GDM screening and diagnosis process, our study investigated how pregnant women in rural and urban Tamil Nadu access and navigate different GDM related health services. METHODS The study was carried out in two settings: an urban private diabetes centre and a rural government primary health centre. Observations of the process of screening and diagnosis at the health centres as well as semi-structured interviews with 30 pregnant women and nine health care providers were conducted. Data was analysed using qualitative content analysis. RESULTS There were significant differences in the process of GDM screening and diagnosis in the urban and rural settings. Several factors hindering or facilitating timely initiation and completion of the process were identified. Timely attendance required awareness, motivation and opportunity to attend. Women had to attend the health centre at the right time and sometimes at the right gestational age to initiate the test, wait to complete the test and obtain the test report in time to initiate further action. All these steps and requirements were influenced by factors within and outside the health system such as getting right information from health care providers, clinic timings, characteristics of the test, availability of transport, social network and support, and social norms and cultural practices. CONCLUSIONS Minimising and aligning complex stepwise processes of prenatal care and GDM screening delivery and attention to the factors influencing it are important for further improving and expanding GDM screening and related services, not only in Tamil Nadu but in other similar low and middle income settings. This study stresses the importance of guidelines and diagnostic criteria which are simple and feasible on the ground.
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Affiliation(s)
- Karoline Kragelund Nielsen
- Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820 Gentofte, Denmark
| | - Thilde Rheinländer
- Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen, Denmark
| | - Anil Kapur
- World Diabetes Foundation, Brogaardsvej 70, 2820 Gentofte, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Veerasamy Seshiah
- Dr. Seshiah Diabetes Research Institute and Dr. Balaji Diabetes Care Centre, 729 Poonamallee High Road, Aminjikarai, Chennai, Tamil Nadu 600029 India
| | - Ib C. Bygbjerg
- Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen, Denmark
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Haile D, Belachew T, Birhanu G, Setegn T, Biadgilign S. Predictors of breastfeeding cessation among HIV infected mothers in Southern Ethiopia: a survival analysis. PLoS One 2014; 9:e90067. [PMID: 24608772 PMCID: PMC3946480 DOI: 10.1371/journal.pone.0090067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 01/29/2014] [Indexed: 11/30/2022] Open
Abstract
Background Mother-to-child transmission (MTCT) of Human immunodeficiency virus (HIV) through breastfeeding remains the most significant route infection among children. Although the current guideline is recommending continued breastfeeding for HIV exposed infants, significant proportion of infants have been subjected to early weaning to prevent HIV transmission. However the predictors of breastfeeding cessation among HIV positive mothers were not documented in Ethiopia. Therefore the objective of this study was to determine the predictors of breastfeeding cessation among HIV-infected women in Southern Ethiopia. Methods A facility based cross sectional study was conducted in Southern Ethiopia. The samples were selected by cluster sampling technique. The Kaplan-Meier curve was used to describe the survival time of breastfeeding and a step-wise multivariable Cox-proportional hazards regression model were used to identify the predictors of breastfeeding cessation. Both crude and adjusted hazard ratio were determined and p<0.05 was considered as statistically significant. Result The mean duration of breastfeeding among HIV positive mothers was 13.79 [95% CI: (12.97–14.59)] months. The Kaplan-Meier estimate showed that proportions of women who were breastfeeding at 6, 9, 12 and 17 months were 89.3%, 75.3%, 66% and 17%, respectively. Those mothers having a monthly income of ≤500 ETB [AHR = 0.16, 95% CI :(0.03–0.76)], having a family size of three and below [AHR = 0.12, 95%CI: (0.02–0.68), four and above [AHR = 0.07, 95%CI: (0.01–0.35)] and bottle feeding [AHR = 3.95, 95%CI: (1.64–9.51)] were also independent factors associated with breastfeeding cessation. Conclusion Above one third of HIV positive mothers stopped breastfeeding before 12 months. Monthly income, bottle feeding and family size were the independent predictors of breastfeeding cessations. Strengthening the current counseling and promotion modality on avoidance of bottle feeding and continued breastfeeding is recommended for improved HIV free survival.
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Affiliation(s)
- Demewoz Haile
- Department of Public Health, College of Medicine and Health Sciences Madawalabu University, Bale Goba, Ethiopia
- * E-mail:
| | - Tefera Belachew
- Department of Population and Family Health, College of Public Health and Medical Sciences Jimma University, Jimma, Ethiopia
| | - Getenesh Birhanu
- Department of applied human nutrition, School of food sciences and Nutrition, Hawassa University, Ethiopia
| | - Tesfaye Setegn
- Department of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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