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Diakhate MM, Unger JA, Langat A, Singa B, Kinuthia J, Itindi J, Nyaboe E, John-Stewart GC, McGrath CJ. Factors associated with exclusive breastfeeding by maternal HIV status: a population-based survey in Kenya. Int Breastfeed J 2024; 19:44. [PMID: 38926772 PMCID: PMC11210159 DOI: 10.1186/s13006-024-00651-y] [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: 09/01/2023] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Exclusive breastfeeding (EBF) in the first six months remains low globally, despite known benefits of lower morbidity and mortality among breastfed infants. It is important to understand factors associated with breastfeeding to support optimal breastfeeding practices, particularly in settings with a high burden of HIV. METHODS We analyzed data from a population-level survey of mother-infant pairs attending 6-week or 9-month immunizations at 141 clinics across Kenya. Primary outcomes included maternal report of (1) EBF at 6-week visit, defined as currently feeding the infant breast milk only, (2) EBF for the first 6-months of life, defined as breastfeeding or feeding the infant breast milk only with no introduction of other liquids or solid foods until 6 months, and (3) continued breastfeeding with complementary feeding at 9-months. Correlates of breastfeeding practices were assessed using generalized Poisson regression models accounting for facility-level clustering. RESULTS Among 1662 mothers at 6-weeks, nearly all self-reported breastfeeding of whom 93% were EBF. Among 1180 mothers at 9-months, 99% had ever breastfed, 94% were currently breastfeeding and 73% reported 6-month EBF. At 6-weeks, younger age (< 25 years) (adjusted Prevalence Ratio (aPR) 0.96; 95% CI 0.93, 0.99), lower education (aPR 0.96; 95% CI 0.93, 0.99) and recent infant illness (aPR 0.97; 95% CI 0.94, 1.00) were associated with lower EBF prevalence while women living with HIV (WLWH) had higher EBF prevalence (aPR 1.06; 95% CI 1.02, 1.10) than women without HIV. 6-month EBF prevalence was 26% higher in WLWH (aPR 1.26; 95% CI 1.15, 1.35) than women without HIV, 14% lower in women reporting mild or above depressive symptoms (aPR 0.86; 95% CI 0.76, 0.99) than those with none or minimal depressive symptoms, and 15% lower in women with versus without history of intimate partner violence (aPR 0.85; 95% CI 0.74, 0.98). At 9-months, WLWH had a lower prevalence of continued breastfeeding with complementary feeding (aPR 0.73; 95% CI 0.64, 0.84) than women without HIV. CONCLUSION WLWH had higher EBF prevalence in the first 6-months, but lower prevalence of continued breastfeeding at 9-months. Strategies to support EBF and continued breastfeeding beyond 6-months postpartum, particularly among WLWH, are needed.
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Affiliation(s)
- Mame M Diakhate
- Department of Global Health, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA.
| | - Jennifer A Unger
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Brown University, Providence, RI, USA
| | - Agnes Langat
- Centers for Disease Control and Prevention Kenya, Nairobi, Kenya
| | - Benson Singa
- Kenya Medical Research Institute, Nairobi, Kenya
| | - John Kinuthia
- Departments of Obstetrics and Gynaecology, Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Janet Itindi
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Grace C John-Stewart
- Department of Global Health, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Christine J McGrath
- Department of Global Health, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA
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Tuthill EL, Maltby AE, Odhiambo BC, Akama E, Dawson-Rose C, Weiser SD. Resilient Mothering: An Application of Transitions Theory From Pregnancy to Motherhood Among Women Living With HIV in Western Kenya. ANS Adv Nurs Sci 2024; 47:E20-E39. [PMID: 36656116 PMCID: PMC10354209 DOI: 10.1097/ans.0000000000000478] [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] [Indexed: 01/20/2023]
Abstract
Efficacious strategies can now prevent the transmission of HIV from mother to child. However, transmission rates remain unacceptably high, especially in sub-Saharan Africa. Understanding women's perinatal transitions can inform interventions to support adherence to preventive strategies. Therefore, we applied Transitions Theory in a longitudinal qualitative study to explore perinatal transitions among women living with HIV in western Kenya. We conducted in-depth interviews with 30 women living with HIV at 3 key time points and, using our findings, described the theory's concepts in terms of participants' experiences. We then proposed theory-based interventions that could support smooth transition processes and positive outcomes.
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Affiliation(s)
- Emily L. Tuthill
- Department of Community Health Systems, School of Nursing University of California, San Francisco, CA, USA
| | - Ann E. Maltby
- Department of Community Health Systems, School of Nursing University of California, San Francisco, CA, USA
| | | | - Eliud Akama
- Kenya Medical Research Institute- Center for Microbiology Research, Nairobi Kenya
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing University of California, San Francisco, CA, USA
| | - Sheri D. Weiser
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California San Francisco
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Tuthill EL, Maltby AE, Odhiambo BC, Akama E, Dawson-Rose C, Cohen CR, Weiser SD. Financial and Food Insecurity are Primary Challenges to Breastfeeding for Women Living with HIV in Western Kenya: A Longitudinal Qualitative Investigation. AIDS Behav 2023; 27:3258-3271. [PMID: 37043052 PMCID: PMC10577374 DOI: 10.1007/s10461-023-04046-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/13/2023]
Abstract
Exclusive breastfeeding for the first 6 months and continued breastfeeding for 24 months or longer is recommended for all mothers world-wide, including women living with HIV (WLWH). Given evidence of suboptimal infant feeding and the need to understand context specific barriers, we explored experiences of perinatal WLWH in Kisumu, Kenya. We applied a longitudinal qualitative approach (4 in-depth interviews) with 30 women from pregnancy to 14-18 months postpartum. Cross-sectional profiling led to a narrative description of infant feeding across time. The majority of women breastfed exclusively for 6 months and weaned by 18 months. Severe financial and food insecurity were primary challenges as women worked through when/how to breastfeed or stop breastfeeding in the setting of multiple competing priorities/pressures across time. Financial and food support and increased support for breastfeeding beyond 18 months have the potential to reduce women's stress and uncertainty associated with infant feeding as well as optimize infant health and nutrition in this setting.
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Affiliation(s)
- Emily L Tuthill
- Department of Community Health Systems, School of Nursing, University of California, 2 Koret Way, San Francisco, CA, 94143, USA.
| | - Ann E Maltby
- Department of Community Health Systems, School of Nursing, University of California, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Belinda C Odhiambo
- Global Programs for Research and Training - Kenya, University of California, San Francisco, CA, USA
| | - Eliud Akama
- Kenya Medical Research Institute- Center for Microbiology Research, Nairobi, Kenya
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Sokou R, Parastatidou S, Iliodromiti Z, Lampropoulou K, Vrachnis D, Boutsikou T, Konstantinidi A, Iacovidou N. Knowledge Gaps and Current Evidence Regarding Breastfeeding Issues in Mothers with Chronic Diseases. Nutrients 2023; 15:2822. [PMID: 37447149 DOI: 10.3390/nu15132822] [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: 05/24/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The prevalence of chronic maternal disease is rising in the last decades in the developed world. Recent evidence indicated that the incidence of chronic maternal disease ranges from 10 to 30% of pregnancies worldwide. Several epidemiological studies in mothers with chronic diseases have mainly focused on the risk for adverse obstetric outcomes. Evidence from these studies supports a correlation between maternal chronic conditions and adverse perinatal outcomes, including increased risk for preeclampsia, cesarean section, preterm birth, and admission in the Neonatal Intensive Care Unit (NICU). However, there is a knowledge gap pertaining to the management of these women during lactation. This review aimed at summarizing the available research literature regarding breastfeeding in mothers with chronic diseases. Adjusted and evidence-based support may be required to promote breastfeeding in women with chronic diseases; however, our comprehension of breastfeeding in this subpopulation is still unclear. The literature related to breastfeeding extends in various scientific areas and multidisciplinary effort is necessary to compile an overview of current evidence and knowledge regarding breastfeeding issues in mothers with chronic diseases.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, 3 D.Mantouvalou Str., Nikea, 18454 Piraeus, Greece
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, "Elena Venizelou" Maternity Hospital, 11521 Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Katerina Lampropoulou
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Dionysios Vrachnis
- Endocrinology Unit, 2nd Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, 3 D.Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
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Miller JD, Collins SM, Boateng GO, Widen E, Natamba B, Achoko W, Achidri D, Young SL, Martin SL. Pathways linking social support, self-efficacy, and exclusive breastfeeding among women in northern Uganda. Glob Public Health 2022; 17:3506-3518. [PMID: 35960598 PMCID: PMC9898077 DOI: 10.1080/17441692.2022.2110918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
Despite improvements in infant feeding practices over the past two decades, the prevalence of exclusive breastfeeding (EBF) is below global targets. Social support can create an enabling environment for recommended infant feeding practices such as EBF, but the types of social support most important for sustained EBF and their potential mechanisms of action have not been thoroughly characterized. We therefore aimed to assess the relationship between EBF-specific social support, EBF self-efficacy, and EBF at 1 and 3 months among postpartum women in northern Uganda. Women (n = 238, 36.2% living with HIV) were recruited during pregnancy. EBF, social support, and EBF self-efficacy were assessed at 1 and 3 months postpartum. Path analysis was used to assess relationships between these factors. Most mothers exclusively breastfed to 1 (80.8%) and 3 months postpartum (62.9%). EBF-specific, but not general, social support differed by EBF status. EBF-specific social support was associated with higher odds of EBF, which was almost fully mediated by EBF self-efficacy. That is, there was evidence that social support primarily influences EBF through its association with self-efficacy. In sum, EBF-specific social support and self-efficacy likely promote EBF and are modifiable factors that can be intervened upon.
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Affiliation(s)
- Joshua D. Miller
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, US
| | - Shalean M. Collins
- Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Lousiana, US
| | - Godfred O. Boateng
- School of Global Health, York University, Toronto, Canada
- Dahdaleh Institute for Global Health Research, York University, Toronto, Canada
| | - Elizabeth Widen
- Department of Nutritional Sciences & Population Research Center, University of Texas at Austin, Austin, Texas, US
| | - Barnabas Natamba
- Non-Communicable Diseases Theme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Entebbe, Uganda
| | | | | | - Sera L. Young
- Department of Anthropology, Northwestern University, Evanston, Illinois, US
- Institute for Policy Research, Northwestern University, Evanston, Illinois, US
| | - Stephanie L. Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, US
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, US
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Sandhi A, Dennis CL, Kuo SY. Psychometric Assessment of the Breastfeeding Self-Efficacy Scale-Short Form: A Confirmatory Factor Analysis of Indonesian Mothers. Clin Nurs Res 2022; 31:1520-1528. [PMID: 35904160 DOI: 10.1177/10547738221112756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study aimed to evaluate the psychometric properties of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) in Indonesian postpartum women. We conducted a cross-sectional study including 237 postpartum women in Yogyakarta City, Indonesia. Participants completed the BSES-SF, Edinburgh Postnatal Depression Scale (EPDS), and Hospital Anxiety and Depression Scale (HADS). Construct validity, internal reliability, and divergent validity were examined using confirmatory factor analysis, Cronbach's alpha, and Pearson's correlations. We identified a unidimensional structure through confirmatory factor analysis with an excellent internal consistency by Cronbach's alpha of .90. Divergent validity was evidenced by low correlation of the BSES-SF with the depressive symptoms (EPDS, r = -.21; HADS-D, r = -.17, p < .05) and anxiety symptoms (HADS-A, r = -.15, p = .02). It is concluded that the Indonesian version of BSES-SF is a valid and reliable measurement tool to assess breastfeeding self-efficacy among postpartum women.
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Affiliation(s)
- Ayyu Sandhi
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Pediatric and Maternity Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Shu-Yu Kuo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Mhungu A, Sixsmith J, Burnett E. Adolescent Girls and Young Women's Experiences of Living with HIV in the Context of Patriarchal Culture in Sub-Saharan Africa: A Scoping Review. AIDS Behav 2022; 27:1365-1379. [PMID: 36318422 PMCID: PMC10129999 DOI: 10.1007/s10461-022-03872-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 04/28/2023]
Abstract
Adolescent girls and young women (AGYW) in sub-Saharan Africa are disproportionately affected by the human immunodeficiency virus (HIV) due to socio-cultural gender, power, and economic disparities. This scoping review examined the literature to explore what is known about AGYW's everyday personal, relational, and social experiences of HIV to help shape future protective HIV policy and practice. Six databases were searched: Medline, CINAHL, Scopus, ASSIA, Google Scholar, and ProQuest, resulting in a total of 12,581 articles. Of these, 40 articles were included in the review. Key themes generated from the thematic analysis were relational and psychosocial challenges, inhibiting sexual expression, poverty, stigma, and discrimination; managing health in everyday life; agency and resilience; and personal space and social support. In conclusion, the review found a lack of understanding of AGYW's everyday experiences of living with HIV from their own perspectives. There was also little consideration of the role of patriarchal culture and how this constrains AGYW's ability to negotiate their relationships. Further research is needed to reveal AGYW's perspectives on living with HIV in sub-Saharan Africa.
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Affiliation(s)
- Alington Mhungu
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland.
| | - Judith Sixsmith
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland
| | - Emma Burnett
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland
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Mildon A, Decelles S, Salameh B, Sebai I, Batal M. Protecting both infant and mother: perceptions of infant feeding practices in rural Haiti. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.38736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Global recommendations for optimal breastfeeding include early initiation, exclusivity for six months, and continued breastfeeding for two years and beyond. Although breastfeeding is near universal in Haiti, gaps in optimal practices persist. Determinants of breastfeeding practices are complex, and a contextualized understanding is needed to strengthen breastfeeding support interventions. We conducted a qualitative study to explore mothers’ perceptions of factors influencing breastfeeding practices in rural Haiti. Methods Focus group discussions were held in eight rural communes participating in a nutrition project. Study participants (n=86) were recruited from mothers’ support groups. A moderator facilitated the focus groups in Haitian Creole using a question guide to elicit observations about community breastfeeding practices related to early initiation, colostrum feeding, complementary foods and beverages, and breastfeeding cessation. Focus groups were recorded, and three observers took notes which were compiled into a single report of key points and validated by participants following each session. Quotes representing the key points were selected from the audio recordings, translated into English and analyzed to identify explanatory themes. Results Participants described breastfeeding for 12-18 months as the norm in study areas, with early and frequent use of additional foods and beverages. Three explanatory themes were identified, related to concerns for (i) infant well-being, including digestive health, nutritional needs and contentment; (ii) transmission of negative maternal emotional and physical states through breast milk; and (iii) maternal well-being, including effects on breastfeeding practices of maternal illness, hunger, stress, and competing time pressures. Underlying all these concerns is the context of rural poverty and the cultural meanings of breastfeeding. Conclusions Findings suggest that practices which compromise global breastfeeding recommendations may persist because of their perceived value in addressing concerns for infant and maternal well-being in the challenging context of rural poverty, food insecurity and poor health. Multi-sectoral interventions are needed to mitigate these underlying contributors and create an enabling environment for early, exclusive and continued breastfeeding.
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Jiang Q, Zhang E, Cohen N, Ohtori M, Zhu S, Guo Y, Johnstone HF, Dill SE, Zhou H, Rozelle SD. Postnatal mental health, breastfeeding beliefs, and breastfeeding practices in rural China. Int Breastfeed J 2022; 17:60. [PMID: 35987837 PMCID: PMC9392351 DOI: 10.1186/s13006-022-00504-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 08/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background The importance of breastfeeding in low- and middle- income countries is well recognized, yet the importance of postnatal mental health on breastfeeding practices and beliefs in these settings has been understudied. This study investigates the associations between maternal mental health problems, breastfeeding beliefs and breastfeeding practices in rural China. Methods Cross-sectional data were collected in November and December 2019 from 742 mothers of infants under 6 months old in rural Sichuan Province, China. Maternal mental health (depression, anxiety, and stress symptoms) was assessed using the Depression, Anxiety, and Stress Scale (short form). Breastfeeding beliefs were assessed using the Iowa Infant Feeding Attitude Scale and Breastfeeding Self-Efficacy Scale (short form). Breastfeeding practices were assessed through a 24-h dietary recall questionnaire. Ordinary least squares regression, multiple logistic regression and heterogeneous effects analyses were used to identify associations between symptoms of mental health problems and breastfeeding outcomes. Results The average age of sample infants was 2.7 months. Among mothers, 13% showed symptoms of depression, 16% anxiety, and 9% stress. The prevalence of exclusive breastfeeding in the previous 24 h was 38.0%. Depression symptoms were significantly associated with breastfeeding attitude (𝛽= − 1.11, 95% CI: − 2.07, − 0.14) and breastfeeding self-efficacy (𝛽= − 3.19, 95% CI: − 4.93, − 1.45). Anxiety and stress symptoms were significantly associated with breastfeeding self-efficacy (𝛽= − 1.81, 95% CI: − 3.43, − 0.18 and 𝛽 = − 2.88, 95% CI: − 4.98, − 0.78, respectively). There were no significant associations between symptoms of mental health problems and exclusive breastfeeding. The heterogeneous effects analyses revealed that less educated mothers with symptoms of stress had lower odds of exclusive breastfeeding than educated mothers without symptoms of stress (OR: 0.53, 95% CI: 0.25,1.10). Mothers of younger infants had higher odds of exclusive breastfeeding than the mother of older infants, regardless of depression, anxiety, or stress symptoms. Conclusion Symptoms of maternal mental health problems are significantly associated with breastfeeding attitude and self-efficacy; however, these symptoms are not associated with breastfeeding practices. Maternal educational level and infant age may play a role in mothers’ breastfeeding practices. To improve breastfeeding practices, interventions should employ a multi-dimensional approach that focuses on improving maternal mental well-being and considers demographic characteristics.
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Faustine R, Moshi FV. Exclusive breastfeeding practice among HIV infected mothers in the southern highlands of Tanzania; assessing the prevalence and factors associated with the practice, an analytical cross-sectional survey. AIDS Res Ther 2022; 19:29. [PMID: 35761241 PMCID: PMC9235179 DOI: 10.1186/s12981-022-00451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background There is no other better way to safeguard an infant’s health in the first 6 months of life than exclusive breastfeeding (EBF). Breast milk is valuable in all aspects of an infant’s physical and mental growth as well as immune development. The study aimed to assess the prevalence and factors associated with EBF practice among HIV-infected mothers in the Southern Highlands of Tanzania. Method A hospital-based analytical cross-sectional study was conducted among lactating HIV-infected mothers. A random sampling procedure was used to obtain 372 HIV-infected mothers of infants from 6 to 12 months of age who were still breastfeeding at the time of data collection. An interviewer-administered structured questionnaire was used for data collection. Bivariate and multivariable logistic regression was used to assess factors associated with EBF practice. Statistical package for social science (SPSS volume 20) software was used for data entry and analysis. Results The prevalence of EBF practice was 58.1% at 95% Confidence Interval of 52.9% to 63.1%. More than half of the respondents 199 (53.5%) had adequate knowledge while 173(46.5%) had inadequate knowledge about EBF. After adjusting for confounders, factors associated with EBF practice were knowledge about EBF [Adequate knowledge (AOR = 5.11 at 95% CI 3.2–8.17, p < 0.001)], ANC visits [Adequate (AOR = 1.76 at 95% CI 1.09–2.82, p = 0.002)], Income per day [1 0r more USD (AOR = 1.83 at 95% CI 1.14–2.94, p = 0.013)], positive perception of EBF [ positive perception (AOR = 3.51 at 95% CI 2.25–5.47, p < 0.001) and having ever experienced a breast problem AOR = 3.91 at 95% CI 1.89–8.08, p < 0.001. Conclusion More than half of interviewed mothers with HIV practiced EBF. The EBF practice among HIV lactating mothers was significantly influenced by adequate knowledge of EBF, positive perception toward EBF, adequate ANC visits, and having never experienced breast problems. Strengthening adherence to ANC routine visits, counseling on breastfeeding, and improving mothers’ knowledge about exclusive breastfeeding would contribute to the enhancement of EBF practice in this region. An innovative interventional study is recommended to develop more effective strategies to improve EBF knowledge and practice among HIV-infected mothers.
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Lockdown-Associated Hunger May Be Affecting Breastfeeding: Findings from a Large SMS Survey in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010351. [PMID: 35010611 PMCID: PMC8744606 DOI: 10.3390/ijerph19010351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 12/19/2022]
Abstract
The impact that the COVID-19 pandemic has had, and will continue to have, on food security and child health is especially concerning. A rapid, Short Message Service (SMS) Maternal and Child Health survey was conducted in South Africa in June 2020 (n = 3140), with a follow-up in July 2020 (n = 2287). This was a national cross-sectional survey conducted among pregnant women and mothers registered with the MomConnect mhealth platform. Logistic regression was conducted to explore the associations between breastfeeding, maternal depressive symptoms, and hunger in the household. High breastfeeding initiation rates and the early introduction of other foods or mixed milk feeding were found. The prevalence of depressive symptoms in this survey sample was 26.95%, but there was no association between breastfeeding behaviour and depressive symptom scores (OR = 0.89; 95% CI: 0.63, 1.27). A positive correlation was found between not breastfeeding and not going to the health clinic. The odds of hungry mothers breastfeeding were significantly lower (OR = 0.66; p = 0.045). This result also holds in a multivariate framework, including covariates such as depressive symptoms, attendance of a PHC facility, and whether the infant was older than 3 months. Support for breastfeeding must include support, such as economic support, for breastfeeding mothers, to enable them to access nutritious diets. Mothers also need reassurance on the quality of their breastmilk and their ability to breastfeed and should be encouraged to continue to attend the health clinic regularly.
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Tuthill EL, Maltby AE, Odhiambo BC, Akama E, Pellowski JA, Cohen CR, Weiser SD, Conroy AA. "I Found Out I was Pregnant, and I Started Feeling Stressed": A Longitudinal Qualitative Perspective of Mental Health Experiences Among Perinatal Women Living with HIV. AIDS Behav 2021; 25:4154-4168. [PMID: 33997940 PMCID: PMC8126180 DOI: 10.1007/s10461-021-03283-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/03/2022]
Abstract
Globally, depressive symptoms among pregnant and postpartum (i.e., perinatal) women living with HIV (WLWH) are alarmingly high and associated with poor outcomes such as suboptimal adherence to antiretroviral therapy (ART), and early cessation of exclusive breastfeeding (EBF). Few qualitative studies have described the experience of perinatal depression among WLWH to identify the underlying social-structural determinants of poor mental health and potential strategies to intervene. We conducted a longitudinal qualitative study applying semi-structured interviews with 30 WLWH at three timepoints (28-38 weeks pregnant, 6-weeks postpartum and 5-7 months postpartum) to understand mental health experiences of perinatal WLWH in western Kenya. Financial insecurity emerged as the central theme impacting the mental health of women across time. Financial insecurity was often attributed to the loss of employment, related to pregnancy and the demands of breastfeeding and caring for an infant, as well as a lack of support from male partners. The loss of income and subsequent financial strain contributed to worsening levels of food insecurity and relationship stress and challenged engagement in HIV care. In this way, increased financial strain during the perinatal period negatively impacted the mental health of perinatal WLWH. Our findings suggest support to meet basic needs and remain engaged in HIV care during pregnancy and postpartum could improve perinatal mental health for WLWH in this setting.
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Affiliation(s)
- Emily L Tuthill
- Department of Community Health Systems, School of Nursing, University of California, 2 Koret Way, San Francisco, CA, 94143, USA.
| | - Ann E Maltby
- Department of Community Health Systems, School of Nursing, University of California, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Belinda C Odhiambo
- Department of Community Health Systems, School of Nursing, University of California, 2 Koret Way, San Francisco, CA, 94143, USA
- Global Programs, University of California, San Francisco, CA, USA
| | - Eliud Akama
- Kenya Medical Research Institute- Center for Microbiology Research, Nairobi, Kenya
| | - Jennifer A Pellowski
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- International Health Institute, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Amy A Conroy
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
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13
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Alvarez GG, Miller JD, Santoso MV, Wekesa P, Owuor PM, Onono M, Young SL. Prevalence and Covariates of Food Insecurity Across the First 1000 Days Among Women of Mixed HIV Status in Western Kenya: A Longitudinal Perspective. Food Nutr Bull 2021; 42:319-333. [PMID: 34011176 DOI: 10.1177/0379572121999024] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Food insecurity (FI) is common globally and can have lifelong consequences. However, few studies have longitudinally examined how FI varies across gestation and the postpartum period ("the first 1000 days"); none have explored this in sub-Saharan Africa or in the context of HIV. OBJECTIVE To assess the prevalence and covariates of FI in the first 1000 days among Kenyan women. METHODS All pregnant women attending 7 clinics in western Kenya (n = 1247) were screened for HIV and FI (Individual Food Insecurity Access Scale) between September 2014 and June 2015. A subset of women (n = 371) was recruited into an observational cohort study and surveyed 11 times through 2 years postpartum (NCT02974972, NCT02979418). Data on FI, sociodemographics, and health were repeatedly collected. Severe FI was modeled using multilevel, mixed-effects logistic regressions (n = 346). RESULTS Of the 1247 pregnant women screened, 76.5% were severely food insecure in the prior month. Further, the prevalence of severe FI was higher among women living with HIV than those without (82.6% vs 74.6%, P < .05). In the cohort, the odds of being severely food insecure decreased monotonically after delivery. Each point higher on the Center for Epidemiologic Studies-Depression scale was associated with 1.08 times greater odds of being severely food insecure (95% CI: 1.05-1.10); each point higher on the Duke/UNC Functional Social Support Scale was associated with 0.97 lower odds of severe FI (95% CI: 0.94-0.99). CONCLUSIONS Severe FI is prevalent during the first 1000 days in western Kenya. Services to mitigate the far-reaching consequences of this modifiable risk should be considered.
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Affiliation(s)
- Gloria G Alvarez
- Gerald J. And Dorothy R. Friedman School of Nutrition Science and Policy, 1810Tufts University, Boston, MA, USA.,* Gloria G. Alvarez and Joshua D. Miller contributed equally to the manuscript
| | - Joshua D Miller
- Department of Anthropology, 3270Northwestern University, Evanston, IL, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, NC, USA.,* Gloria G. Alvarez and Joshua D. Miller contributed equally to the manuscript
| | - Marianne V Santoso
- Department of Anthropology, 3270Northwestern University, Evanston, IL, USA
| | | | | | | | - Sera L Young
- Department of Anthropology, 3270Northwestern University, Evanston, IL, USA.,Institute for Policy Research, 3270Northwestern University
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14
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Tuthill EL, Maltby A, Conteh J, Sheira LA, Miller JD, Onono M, Weiser SD, Young SL. Persistent Food Insecurity, but not HIV, is Associated with Depressive Symptoms Among Perinatal Women in Kenya: A Longitudinal Perspective. AIDS Behav 2021; 25:847-855. [PMID: 32989575 PMCID: PMC7886965 DOI: 10.1007/s10461-020-03047-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 02/06/2023]
Abstract
Food insecurity (FI) is an understudied risk factor for depression among perinatal women in sub-Saharan Africa. We therefore explored the longitudinal relationship between FI and depressive symptoms among a cohort of perinatal women of mixed HIV status (n = 371) in Kenya (NCT02974972, NCT02979418). Using longitudinal linear and logistic regressions with random effects, we assessed bivariate and adjusted associations between maternal FI and depressive symptoms. HIV status was also assessed as a potential effect modifier. At baseline, 58% of pregnant women had probable depression (CES-D score > 16) and 84% were severely food insecure. In adjusted analyses, severely food-insecure women had 5.90 greater odds (95% CI 2.32, 15.02, p < 0.001) of having probable depression and scored 4.58 points higher on the CES-D scale (SE: 1.04, p < 0.001) relative to food-secure women. HIV status did not modify the association between FI and depressive symptoms. Interventions to reduce FI may reduce perinatal depression, benefiting mothers and their infants.
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Affiliation(s)
- Emily L Tuthill
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Ann Maltby
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Jalang Conteh
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lila A Sheira
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Joshua D Miller
- Department of Anthropology, Northwestern University, 1819 Hinman Ave., Evanston, IL, 60208, USA
| | - Maricianah Onono
- Kenya Medical Research Institute- Center for Microbiology Research, Nairobi, Kenya
| | - Sheri D Weiser
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, 1819 Hinman Ave., Evanston, IL, 60208, USA.
- Institute for Policy Research, Northwestern University, 2040 Sheridan Road, Evanston, IL, 60208-4100, USA.
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15
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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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16
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Duran MC, Bosire R, Beima-Sofie KM, Igonya EK, Aluisio AR, Gatuguta A, Mbori-Ngacha D, Farquhar C, Stewart GJ, Roxby AC. Women's Autonomy in Infant Feeding Decision-Making: A Qualitative Study in Nairobi, Kenya. Matern Child Health J 2021; 25:724-730. [PMID: 33544286 DOI: 10.1007/s10995-021-03119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Exclusive breastfeeding (EBF) is the optimal way to feed young infants. Guidelines recommend that women living with HIV on antiretroviral therapy should EBF for 6 months and continue breastfeeding for up to 24 months or longer. Parents may face social or logistical barriers creating challenges to EBF. OBJECTIVES To explore barriers, facilitators and community norms influencing EBF practices in Kenya. METHODS This qualitative research was nested within a longitudinal study of intensive maternal counseling to increase EBF among HIV-positive mothers. HIV-negative and HIV-positive mothers were recruited from four public clinics in Nairobi. Women participated in focus group discussions (FGDs) that explored beliefs about and experiences with infant feeding. Conventional content analysis was used to describe and compare barriers and facilitators influencing HIV-positive and HIV-negative women's EBF experiences. RESULTS We conducted 17 FGDs with 80 HIV-positive and 53 HIV-negative women between 2009 and 2012. Overall, women agreed that breastmilk is good for infants. However, early mixed feeding was a common cultural practice. HIV-positive women perceived that infant feeding methods and durations were their decision. In contrast, HIV-negative women reported less autonomy and more mixed feeding, citing peer pressure and lack of HIV transmission concerns. Autonomy in decision-making was facilitated by receiving EBF counseling and family support, especially from male partners. Low milk production was a barrier to EBF, regardless of HIV status, and perceived to represent poor maternal nutrition. CONCLUSIONS Despite challenges, counseling empowered women living with HIV to advocate for EBF with spouses and family.
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Affiliation(s)
- Miriana C Duran
- Department of Global Health, University of Washington, 1510 San Juan Rd, Seattle, WA, 98195, USA.
| | - Rose Bosire
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kristin M Beima-Sofie
- Department of Global Health, University of Washington, 1510 San Juan Rd, Seattle, WA, 98195, USA
| | - Emmy Kageha Igonya
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands.,African Population and Health Research Center, Nairobi, Kenya
| | - Adam R Aluisio
- Division of Global Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - Anne Gatuguta
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, UK
| | | | - Carey Farquhar
- Department of Global Health, University of Washington, 1510 San Juan Rd, Seattle, WA, 98195, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Grace John Stewart
- Department of Global Health, University of Washington, 1510 San Juan Rd, Seattle, WA, 98195, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Alison C Roxby
- Department of Global Health, University of Washington, 1510 San Juan Rd, Seattle, WA, 98195, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
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