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Taha TE, Bandala-Jacques A, Yende-Zuma N, Violari A, Stranix-Chibanda L, Atuhaire P, Hanley S, Gadama L, Chinula L, Dadabhai S, Aizire J, Brummel SS, Fowler MG. Breastfeeding Among Women Living With HIV in the Era of Lifelong ART: An Observational Multicountry Study in Eastern and Southern Africa. J Acquir Immune Defic Syndr 2024; 95:10-17. [PMID: 37732877 PMCID: PMC10840656 DOI: 10.1097/qai.0000000000003306] [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: 03/17/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Lifelong antiretroviral treatment (ART) use is recommended for pregnant and breastfeeding (BF) women living with HIV (WLWH) to prevent perinatal HIV transmission and improve maternal health. We address 2 objectives in this analysis: (1) determine timing and factors associated with BF cessation and (2) assess the impact of BF on health of WLWH on ART. SETTING This multicountry study included 8 sites in Uganda, Malawi, Zimbabwe, and South Africa. METHODS This was a prospective study of WLWH on lifelong ART. These women initially participated from 2011 to 2016 in a randomized clinical trial (PROMISE) to prevent perinatal HIV transmission and subsequently reenrolled in an observational study (PROMOTE, 2016-2021) to assess ART adherence, safety, and impact. RESULTS The PROMOTE cohort included 1987 women on ART. Of them, 752 breastfed and were included in analyses of objective 1; all women were included in analyses of objective 2. The median time to BF cessation varied by country (11.2-19.7 months). Country of residence, age, and health status of women were significantly associated with time to BF cessation (compared with Zimbabwe: Malawi, adjusted hazard ratio [aHR] 0.50, 95% confidence interval [95% CI]: 0.40 to 0.62, P < 0.001; South Africa, aHR 1.49, 95% CI: 1.11 to 2.00, P = 0.008; and Uganda, aHR 1.77, 95% CI: 1.37 to 2.29, P < 0.001). Women who breastfed had lower risk of being "unwell" compared with women who never breastfed (adjusted rate ratio 0.87, 95% CI: 0.81 to 0.95 P = 0.030). CONCLUSION Women on lifelong ART should be encouraged to continue BF with no concern for their health. Time to BF cessation should be monitored for proper counseling in each country.
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Affiliation(s)
- Taha E. Taha
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Antonio Bandala-Jacques
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- SAMRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Avy Violari
- University of the Witwatersrand, Perinatal HIV Research Unit, Johannesburg, South Africa
| | | | - Patience Atuhaire
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Sherika Hanley
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Umlazi Clinical Research Site, University of Kwazulu-Natal, Durban, South Africa and University of Kwazulu-Natal, Department of Family Medicine, Durban, South Africa
| | - Luis Gadama
- Kamuzu University of Health Sciences - Johns Hopkins Research Project, Blantyre, Malawi
| | - Lameck Chinula
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- University of North Carolina, Department of Obstetrics and Gynecology, Chapel-Hill, NC, USA
| | - Sufia Dadabhai
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Jim Aizire
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Sean S. Brummel
- Harvard T.H. Chan School of Public Health, Center for Biostatistics in AIDS Research, Boston MA, USA
| | - Mary Glenn Fowler
- Johns Hopkins School of Medicine, Department of Pathology, Baltimore, MD, USA
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Kossakowska K, Bielawska-Batorowicz E. Postpartum Depressive Symptoms and Their Selected Psychological Predictors in Breast-, Mixed and Formula-Feeding Mothers. Front Psychiatry 2022; 13:813469. [PMID: 35185655 PMCID: PMC8847159 DOI: 10.3389/fpsyt.2022.813469] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/05/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Although breastfeeding is recommended by WHO and professionals as the most beneficial for newborn babies, many women find it challenging. Previous research yielded ambiguous results concerning the role of breastfeeding in the development of postpartum depression. The study aimed to identify the best predictors of depressive symptoms for each of these feeding method. METHODS The participants were 151 women (mean age 29.4 yrs; SD = 4.5) who gave birth within the last 6 months and included 82 women classified as breastfeeding, 38 classified as mixed-feeding (breast and bottle), and 31 as formula-feeding. The study had a cross-sectional design using a web-based survey for data collection. The following measures were administered: The Edinburgh Postnatal Depression Scale; Sense of Stress Questionnaire; The Postpartum Bonding Questionnaire; Parenting Sense of Competence Scale; Infant Feeding Questionnaire. RESULTS Women in study groups differed in stress, bonding difficulties, and beliefs related to feeding practices and infancy. There were no significant differences in the severity of depressive symptoms, but all mean EPDS scores were above 12. Maternal satisfaction, intrapsychic stress, and concerns about feeding on a schedule were the best predictors of EPDS scores for breastfeeding women. For mixed-feeding - emotional tension, concern about infant's hunger, overeating, and awareness of infant's hunger and satiety cues; while for the formula-feeding group, predictors included emotional tension, bonding difficulties, and such maternal feeding practices and beliefs as concern about undereating, awareness of infant's hunger and satiety cues, concerns about feeding on a schedule and social interaction with the infant during feeding. CONCLUSION Differences in predictors of postpartum depression for study groups suggest that breastfeeding itself may not be a risk for postpartum depression. However, the specificity of maternal experiences with the various types of feeding is related to difficulties promoting postpartum depression. Providing emotional and educational support appropriate for different types of feeding may be an essential protective factor for postnatal depression.
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Affiliation(s)
- Karolina Kossakowska
- Department of Clinical Psychology and Psychopathology, Faculty of Educational Sciences, Institute of Psychology, University of Lodz, Lodz, Poland
| | - Eleonora Bielawska-Batorowicz
- Department of Clinical Psychology and Psychopathology, Faculty of Educational Sciences, Institute of Psychology, University of Lodz, Lodz, Poland
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Tsaras K, Sorokina T, Papathanasiou IV, Fradelos EC, Papagiannis D, Koulierakis G. Breastfeeding Self-efficacy and Related Socio-demographic, Perinatal and Psychological Factors: a Cross-sectional Study Among Postpartum Greek Women. Mater Sociomed 2021; 33:206-212. [PMID: 34759779 PMCID: PMC8563051 DOI: 10.5455/msm.2021.33.206-212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Studies have shown that breastfeeding self-efficacy constitutes a determinant used to forecast breastfeeding behaviours. Objective: The aim of this study was to examine the factors associated to breastfeeding self-efficacy and identify its predictors among Greek women in their immediate postpartum period. Methods: A cross-sectional study was conducted at the General Hospital of Volos, Greece. A convenience sample of 120 postpartum women who gave birth at the hospital and met all the inclusion criteria were invited to participate; 100 responded. Questionnaires on socio-demographic, perinatal and breastfeeding-related characteristics, the Edinburgh Postnatal Depression Scale, and the Breastfeeding Self-Efficiency Scale were completed. Univariate and multivariate analyses were performed with the use of the linear regression model. Results: Women reported a rather good level of breastfeeding self-efficacy (mean = 3.65; SD = 0.85) in the early postpartum period. 52% of women carried out exclusive breastfeeding in the hospital. The prevalence of postnatal depression was 25%. The best-fit regression analysis revealed four predictors (timing of the mother’s decision to breastfeed, infant’s feeding pattern, previous breastfeeding experience, levels of postnatal depression) explaining 44.7% of the variance in breastfeeding self-efficacy. Conclusion: Acknowledging the determinants which affect breastfeeding self-efficacy of women in the immediate postpartum period is a necessary condition in designing targeted intervention services.
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Affiliation(s)
| | - Tatiana Sorokina
- Mental Health Center, Achillopouleio General Hospital of Volos, Volos, Greece
| | | | | | | | - George Koulierakis
- Department of Public Health Policy, University of West Attica, Athens, Greece
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Alyousefi NA. Determinants of Successful Exclusive Breastfeeding for Saudi Mothers: Social Acceptance Is a Unique Predictor. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105172. [PMID: 34068140 PMCID: PMC8152981 DOI: 10.3390/ijerph18105172] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/02/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022]
Abstract
Recent guidelines motivate health care professionals to promote exclusive breastfeeding (EBF). The reported rate of EBF is low in Saudi Arabia. This study aimed to explore the determinants of successful exclusive breastfeeding for Saudi mothers. A cross-sectional, survey-based study was conducted in family medicine clinics. The dependent variable was the actual practice of EBF. Independent variables were the mothers’ demographic information, comfortableness with breastfeeding in public, knowledge and attitudes about breastfeeding, previous experience of successful breastfeeding, and a previous feeding plan. Statistical analysis was carried out using bivariate analysis and multinomial logistic regression. Out of the 322 respondents, only 28% practiced exclusive breastfeeding for the first six months. Perceived insufficient milk (p = 0.011) was associated with a lower EBF rate. Mothers’ degrees of comfort with breastfeeding in front of their relatives (p = 0.024) and in front of friends (p = 0.028) were significantly associated with their infants’ actual feeding practices for the first six months of their infants’ lives. Mothers reported that the absence of a suitable place for breastfeeding caused them to stop breastfeeding (p = 0.043) and was associated with their infant’s actual feeding practices for the first six months of their infant’s lives. An antenatal breastfeeding intention was considered a significant predictor of EBF; OR: 7.31 (95% CI: 2.24—23.84). Mothers who do not stop breastfeeding when they get sick have a 5.054 times higher chance of continuing EBF (95% CI: 1.037—24.627) than the formula-only feeding group. Thus, social acceptance is a unique predictor for their success in exclusive breastfeeding. Mothers have good intentions and a desire to breastfeed. Therefore, they must be guided through their pregnancy and postpartum period to overcome breastfeeding issues.
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Affiliation(s)
- Nada A Alyousefi
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia; ; Tel.: +966-114670836
- King Saud University Medical City, King Saud University, Riyadh 12372, Saudi Arabia
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Minamida T, Iseki A, Sakai H, Imura M, Okano T, Tanii H. Do postpartum anxiety and breastfeeding self-efficacy and bonding at early postpartum predict postpartum depression and the breastfeeding method? Infant Ment Health J 2020; 41:662-676. [PMID: 32578270 DOI: 10.1002/imhj.21866] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We investigated whether postpartum anxiety (PPA) and breastfeeding self-efficacy and bonding at the early postpartum period can be used to predict postpartum depression and the breastfeeding method, and we sought to identify factors related to postpartum depression. Of the 510 eligible women, 185 (36%) returned the questionnaire on all three occasions (1 day, 3 days, and 1 month after childbirth). The mothers' progress on the State-Trait Anxiety Inventory (STAI), Breastfeeding Self-Efficacy Scale Short Form (BFSES-SF), and Postnatal Bonding Questionnaire (PBQ) was observed over three periods. A repeated-measures ANOVA revealed that the mothers at high risk of developing postpartum depression (PPD) were those who did not show an increase in BFSES-SF score at early postpartum, and mothers whose bonding disorders have deteriorated rapidly. The results of the logistic regression analysis revealed a significant difference in employment as a factor related to postpartum depression. Compared to Regular, Part-time status was 4.4 times more likely and Unemployed status was 2.3 times more likely to cause postpartum depression. For the early detection of PPD, it is necessary to identify (1) mothers who do not show an increase in the BFSES-SF score, (2) mothers whose bonding disorders have deteriorated rapidly, and (3) part-time or unemployed mothers as characteristic of postpartum depression.
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Affiliation(s)
- Tomoko Minamida
- Prenatal and Postpartum Care Center, Osaka Midwives' Association, Osaka, Osaka, Japan
| | - Atsuko Iseki
- Gifu University School of Medicine Nursing Course, Gifu, Gifu, Japan
| | - Hiroko Sakai
- Graduate School of Nursing, Faculty of Nursing, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masumi Imura
- Graduate School of Nursing, Department of Global Health Care and Midwifery, Japanese Red Cross College of Nursing, Shibuya, Tokyo, Japan
| | | | - Hisashi Tanii
- Center for Physical and Mental Health, Mie University, Graduate School of Medicine, Department of Health Promotion and Disease Prevention, Mie University, Tsu, Mie, Japan
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Karakoç H, Mucuk Ö, Özkan H. The Relationship of Emotional Intelligence and Breastfeeding Self-Efficacy in Mothers in the Early Postpartum Period. Breastfeed Med 2020; 15:103-108. [PMID: 31855462 DOI: 10.1089/bfm.2019.0234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction: Women have widespread breastfeeding problems in postpartum period. Emotional intelligence (EI) is thought to be important in problem-solving related to breastfeeding. Research Aims: The study was conducted to investigate the correlation between the EI and breastfeeding self-efficacy (BFSE) of women in the early postpartum period and the associated factors. Materials and Methods: A cross-sectional study was conducted in cesarean-postpartum service of a hospital in Erzurum between May 2015 and May 2016. The sample of the study consisted of 271 women. The dependent variables constituted the EI and BFSE mean scores. Descriptive statistics, independent samples t tests, one-way analysis of variance, Kruskal-Wallis test, Mann-Whitney U test, and Pearson correlation analysis were used. Results: The age, education level, perceived income status, and the status of planned pregnancy of the mothers affected their EI mean score, whereas their residence place, income status, the number of pregnancy and living children, and status of receiving prenatal care affected their BFSE levels. No significant correlation was found between the EI and BFSE mean scores in the early postpartum period (r = 0.77, p = 0.207). Conclusions: No significant correlation was determined between the EI and BFSE in the early postpartum period.
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Affiliation(s)
- Hediye Karakoç
- Department of Midwifery, College of Health Science, KTO Karatay University, Konya, Turkey
| | - Özlem Mucuk
- Department of Midwifery, Faculty of Health Sciences, Fırat University, Elazığ, Turkey
| | - Hava Özkan
- Department of Midwifery, Faculty of Health Sciences, Atatürk University, Erzurum, Turkey
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Relationship of Breastfeeding Self-Efficacy with Self-Esteem and General Health in Breastfeeding Mothers Referred to Health Centers of Falavarjan City-Iran, 2015. Community Ment Health J 2019; 55:1057-1063. [PMID: 31124007 DOI: 10.1007/s10597-019-00408-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
This study aimed to examine the relationship of breastfeeding self-efficacy with self-esteem and general health. This cross-sectional study was conducted on 547 breastfeeding mothers in Falavarjan-Iran. Participants were selected randomly, and questionnaires of socio-demographic characteristics, breastfeeding self-efficacy, self esteem, and the GHQ-28 were completed through interview. The mean score (SD) of breastfeeding self-efficacy was 134.5 (13.3) from the score range of 33-165. The mean score of self-esteem was 5.89 (4.0) from - 10 to + 10 score range, and the mean score of general health was 19.7 (9.13) from the 0-84 score range. Self-esteem, general health and its dimensions showed a significant relationship with breastfeeding self-efficacy. According to the multivariate linear regression, physical symptoms, social dysfunction, age, education, spouse's job, economic status, duration of previous breastfeeding, and receiving breastfeeding education were related to breastfeeding self-efficacy. The results indicated that with an improvement in self-esteem and general health, breastfeeding self-efficacy escalates significantly.
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An investigation of prepregnancy body mass index, ethnicity and health-related quality of life as predictors of breastfeeding exclusivity during early postpartum period: Cross sectional survey. Int J Nurs Stud 2019; 93:55-63. [PMID: 30861454 DOI: 10.1016/j.ijnurstu.2019.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Identifying and understanding the determinants of breastfeeding exclusivity during early postpartum period are crucial for sustainable breastfeeding. Few researchers have examined the association among prepregnancy body mass index, ethnicity and exclusive breastfeeding. As a result, whether or not these factors exhibit different relationship patterns across body mass index groups remains unclear. OBJECTIVES This study was performed to: (1) test the relationships among prepregnancy body mass index, ethnicity, health-related quality of life, maternal and obstetric characteristics and exclusive breastfeeding; and (2) compare the relationships among these study variables for two body mass index groups. DESIGN Exploratory cross-sectional research design. SETTING Two postnatal wards of a university-affiliated hospital. PARTICIPANTS A total of 715 postpartum multi-ethnic women in Singapore. METHODS We used structural equation modelling with multigroup analysis to examine our hypothetical model, which integrated the concepts of breastfeeding initiation and health-related quality of life conceptual models. A 12-item short form health survey was used to assess the health-related quality of life. RESULTS The structural equation modelling showed that women with following factors were significantly less likely to initiate exclusive breastfeeding: being Chinese (β = -0.10, p < 0.05), having high body mass index (β = -0.11, p < 0.01), living with low household income (β = -0.08, p < 0.05) and exhibiting poor health-related quality of life scores (β = 0.17, p < 0.001). Multigroup analysis showed no difference (critical ratio = 0.061) between the parameter estimates of health-related quality of life on exclusive breastfeeding in the two body mass index groups. Health-related quality of life (β = 0.17, p < 0.001) and monthly household incomes (β = -0.11, p < 0.05) were the only significant factors in the normal body mass index group. All structural equation modelling values satisfactorily fitted the data (Goodness of Fit Index = 0.937-0.954, Incremental Fit Index = 0.937-0.945, Tucker-Lewis Index = 0.906-0.917, Comparative Fit Index = 0.936-0.942 and Root Means Square Error of Approximation = 0.027-0.040). CONCLUSIONS Enhancing postpartum health-related quality of life and prepregnancy weight management are crucial to initiate exclusive breastfeeding. Our findings can guide the development of promising health promotion strategies among Chinese women with low household income.
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