Infant feeding knowledge and practice vary by maternal HIV status: a nested cohort study in rural South Africa

H Manisha Yapa, Róisín Drayne, Nigel Klein, Jan-Walter De Neve, Kathy Petoumenos, Awachana Jiamsakul, Carina Herbst, Deenan Pillay, Frank A Post, Till Bärnighausen, H Manisha Yapa, Róisín Drayne, Nigel Klein, Jan-Walter De Neve, Kathy Petoumenos, Awachana Jiamsakul, Carina Herbst, Deenan Pillay, Frank A Post, Till Bärnighausen

Abstract

Background: We investigate whether correct infant feeding knowledge and practice differ by maternal HIV status in an era of evolving clinical guidelines in rural South Africa.

Methods: This cohort study was nested within the MONARCH stepped-wedge cluster-randomised controlled trial ( www.clinicaltrials.gov : NCT02626351 ) which tested the impact of continuous quality improvement on antenatal care quality at seven primary care clinics in KwaZulu-Natal, from July 2015 to January 2017. Women aged ≥18 years at delivery were followed up to 6 weeks postpartum. Clinical data were sourced from routine medical records at delivery. Structured interviews at early postnatal visits and the 6-week postnatal immunisation visit provided data on infant feeding knowledge and feeding practices respectively. We measured the relationship between maternal HIV status and (i) correct infant feeding knowledge at the early postnatal visit; and (ii) infant feeding practice at 6 weeks, using Poisson and multinomial regression models, respectively.

Results: We analysed data from 1693 women with early postnatal and 471 with 6-week postnatal interviews. HIV prevalence was 47% (95% confidence interval [CI] 42, 52%). Women living with HIV were more knowledgeable than women not living with HIV on correct infant feeding recommendations (adjusted risk ratio, aRR, 1.08, p < 0.001). More women living with HIV (33%; 95% CI 26, 41%) were not breastfeeding than women not living with HIV (15%; 95% CI 11, 21%). However, among women who were currently breastfeeding their infants, fewer women living with HIV (5%; 95% CI 2, 9%) mixed fed their babies than women not living with HIV (21%; 95% CI 14, 32%). In adjusted analyses, women living with HIV were more likely to avoid breastfeeding (adjusted relative risk ratio, aRRR, 2.78, p < 0.001) and less likely to mixed feed (aRRR 0.22, p < 0.001) than women not living with HIV.

Conclusions: Many mothers in rural South Africa still do not practice exclusive breastfeeding. Women living with HIV were more knowledgeable but had lower overall uptake of breastfeeding, compared with women not living with HIV. Women living with HIV were also more likely to practice exclusive breastfeeding over mixed feeding if currently breastfeeding. Improved approaches are needed to increase awareness of correct infant feeding and exclusive breastfeeding uptake.

Keywords: Clinical guidelines; Exclusive breastfeeding; HIV/AIDS; Healthcare quality; Primary care; Resource poor.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Association between maternal HIV status and infant feeding practices. Graphs depict outputs from unadjusted and adjusted multinomial regression models comparing (i) not breastfeeding vs exclusive breastfeeding, and (ii) mixed feeding vs exclusive breastfeeding. The unadjusted (basic) model contains a priori covariates for maternal age, education and knowledge. The adjusted model contains additional covariates for parity, employment, relationship status, household assets, CQI exposure, and time. Both unadjusted and adjusted models account for clinic-level clustering of outcomes. CQI, continuous quality improvement; WLHIV, women living with HIV; WNLHIV, women not living with HIV
Fig. 2
Fig. 2
Proportion of women not living with HIV and women living with HIV with a correct response to each of eight questions on HIV treatment and transmission. ART, antiretroviral therapy; VL, HIV viral load; HIV status: at delivery

References

    1. Kramer MS, Kakuma R. The optimal duration of exclusive breastfeeding: a systematic review. Adv Exp Med Biol. 2004;554:63–77. doi: 10.1007/978-1-4757-4242-8_7.
    1. Bar S, Milanaik R, Adesman A. Long-term neurodevelopmental benefits of breastfeeding. Curr Opin Pediatr. 2016;28:559–566. doi: 10.1097/MOP.0000000000000389.
    1. Victora CG, Vaughan JP, Lombardi C, Fuchs SMC, Gigante LP, Smith PG, et al. Evidence for protection by breast-feeding against infant deaths from infectious diseases in Brazil. Lancet. 1987;2:319–322. doi: 10.1016/S0140-6736(87)90902-0.
    1. Coovadia HM, Rollins NC, Bland RM, Little K, Coutsoudis A, Bennish ML, et al. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet. 2007;369:1107–1116. doi: 10.1016/S0140-6736(07)60283-9.
    1. United Nations . Sustainable development goals: breastfeeding is ‘smartest investment’ families, communities and countries can make – UN. 2017.
    1. Warszawski J, Tubiana R, Le Chenadec J, Blanche S, Teglas JP, Dollfus C, et al. Mother-to-child HIV transmission despite antiretroviral therapy in the ANRS French perinatal cohort. AIDS. 2008;22:289–299. doi: 10.1097/QAD.0b013e3282f3d63c.
    1. WHO . Mother-to-child transmission of HIV. 2015.
    1. Iliff PJ, Piwoz EG, Tavengwa NV, Zunguza CD, Marinda ET, Nathoo KJ, et al. Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS. 2005;19:699–708. doi: 10.1097/01.aids.0000166093.16446.c9.
    1. Van De Perre P, Rubbo P-A, Viljoen J, Nagot N, Tylleskar T, Lepage P, et al. HIV-1 Reservoirs in Breast Milk and Challenges to Elimination of Breast-Feeding Transmission of HIV-1. Sci Transl Med. 2012;4:143sr143.
    1. Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev. 2012;8:CD003517.
    1. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. Bellagio child survival study group: how many child deaths can we prevent this year? Lancet. 2003;362:65–71. doi: 10.1016/S0140-6736(03)13811-1.
    1. Tchakoute CT, Sainani KL, Osawe S, Datong P, Kiravu A, Rosenthal KL, et al. Breastfeeding mitigates the effects of maternal HIV on infant infectious morbidity in the Option B+ era. AIDS. 2018;32:2383–91.
    1. National Department of Health South Africa The Tshwane declaration of support for breastfeeding in South Africa. South Afr J Clin Nutr. 2011;24:214.
    1. du Plessis L, Peer N, Honikman S, English R. Breastfeeding in South Africa: are we making progress? In: Padarath A, King J, Mackie E, Casciola J, editors. South African Health Review. Durban: Health Systems Trust; 2016. p. 109-24.
    1. National Department of Health South Africa . Infant and young child feeding policy. Pretoria: National Department of Health; 2013.
    1. WHO . Updates on HIV and infant feeding. 2016.
    1. National Department of Health South Africa . National Consolidated Guidelines for the Prevention of Mother-to-Child Transmission of HIV (PMTCT) and the Management of HIV in Children, Adolescents and Adults. Pretoria: National Department of Health; 2015.
    1. National Department of Health South Africa . Implementation of the Universal Test and Treat strategy for HIV positive patients and differentiated care for stable patients. Pretoria: National Department of Health South Africa; 2016.
    1. Mnyani CN, Tait CL, Armstrong J, Blaauw D, Chersich MF, Buchmann EJ, et al. Infant feeding knowledge, perceptions and practices among women with and without HIV in Johannesburg, South Africa: a survey in healthcare facilities. Int Breastfeed J. 2017;12:17. doi: 10.1186/s13006-017-0109-x.
    1. Horwood C, Haskins L, Engebretsen IM, Phakathi S, Connolly C, Coutsoudis A, et al. Improved rates of exclusive breastfeeding at 14 weeks of age in KwaZulu Natal, South Africa: what are the challenges now? BMC Public Health. 2018;18:757. doi: 10.1186/s12889-018-5657-5.
    1. Bork K, Cames C, Cournil A, Musyoka F, Ayassou K, Naidu K, et al. Infant feeding modes and determinants among HIV-1– infected African women in the Kesho Bora study. J Acquir Immune Defic Syndr. 2013;62:109–18.
    1. Somé EN, Engebretsen IMS, Nagot N, Meda N, Lombard C, Vallo R, et al. Breastfeeding patterns and its determinants among mothers living with Human Immuno-deficiency Virus −1 in four African countries participating in the ANRS 12174 trial. Int Breastfeed J. 2017;12:22.
    1. Goga AE, Doherty T, Jackson DJ, Sanders D, Colvin M, Chopra M, et al. Infant feeding practices at routine PMTCT sites, South Africa: results of a prospective observational study amongst HIV exposed and unexposed infants - birth to 9 months. Int Breastfeed J. 2012;7:4. doi: 10.1186/1746-4358-7-4.
    1. Patil CL, Turab A, Ambikapathi R, Nesamvuni C, Chandyo RK, Bose A, et al. Early interruption of exclusive breastfeeding: results from the eight-country MAL-ED study. J Health Popul Nutr. 2015;34:10. doi: 10.1186/s41043-015-0004-2.
    1. West NS, Schwartz SR, Yende N, Schwartz SJ, Parmley L, Gadarowski MB, et al. Infant feeding by South African mothers living with HIV: implications for future training of health care workers and the need for consistent counseling. Int Breastfeed J. 2019;14:11.
    1. Chetty T, Yapa HMN, Herbst C, Geldsetzer P, Naidu KK, De Neve J-W, et al. The MONARCH intervention to enhance the quality of antenatal and postnatal primary health services in rural South Africa: protocol for a stepped-wedge cluster-randomised controlled trial. BMC Health Serv Res. 2018;18:625. doi: 10.1186/s12913-018-3404-3.
    1. Yapa HMN, De Neve J-W, Chetty T, Herbst C, Post F, Cooper DA, et al. Does QI improve PMTCT processes in rural South Africa? A stepped-wedge cluster RCT. Conference on Retroviruses and Opportunistic Infections. Boston; 2018: Abstract #819.
    1. Hoffman SD, Duncan GJ. Multinomial and conditional logit discrete-choice models in demography. Demography. 1988;25:413–427.
    1. Onono MA, Cohen CR, Jerop M, Bukusi EA, J.M. T: HIV serostatus and disclosure: implications for infant feeding practice in rural South Nyanza, Kenya. BMC Public Health 2014; 14:390.
    1. Jama NA, Wilford A, Masango Z, Haskins L, Coutsoudis A, Spies L, et al. Enablers and barriers to success among mothers planning to exclusively breastfeed for six months: a qualitative prospective cohort study in KwaZulu-Natal, South Africa. Int Breastfeed J. 2017;12:43. doi: 10.1186/s13006-017-0135-8.
    1. Nieuwoudt S, Manderson L. Frontline health workers and exclusive breastfeeding guidelines in an HIV endemic south African community: a qualitative exploration of policy translation. Int Breastfeed J. 2018;13:20. doi: 10.1186/s13006-018-0164-y.
    1. Doherty T, Horwood C, Haskins L, Magasana V, Goga A, Feucht U, et al. Breastfeeding advice for reality: women’s perspectives on infant feeding support received in primary health care settings in South Africa. Matern Child Nutr. 2020;16:e12877. doi: 10.1111/mcn.12877.
    1. Vandormael A, Newell M-L, Bärnighausen T, Tanser F. Use of antiretroviral therapy in households and risk of HIV acquisition in rural KwaZulu-Natal, South Africa, 2004–12: a prospective cohort study. Lancet Glob Health. 2014;2:e209–e215. doi: 10.1016/S2214-109X(14)70018-X.
    1. Dinh TH, Delaney KP, Goga A, Jackson D, Lombard C, Woldesenbet S, et al. Impact of maternal HIV seroconversion during pregnancy on early mother to child transmission of HIV (MTCT) measured at 4-8 weeks postpartum in South Africa 2011-2012: a national population-based evaluation. PLoS One. 2015;10:e0125525. doi: 10.1371/journal.pone.0125525.
    1. Ndubuka J, Ndubuka N, Li Y, Marshall CM, Ehiri J. Knowledge, attitudes and practices regarding infant feeding among HIV-infected pregnant women in Gaborone, Botswana: a cross-sectional survey. BMJ Open. 2013;3:e003749. doi: 10.1136/bmjopen-2013-003749.
    1. Gewa CA, Chepkemboi J. Maternal knowledge, outcome expectancies and normative beliefs as determinants of cessation of exclusive breastfeeding: a cross-sectional study in rural Kenya. BMC Public Health. 2016;16:243. doi: 10.1186/s12889-016-2907-2.
    1. Cresswell JA, Ganaba R, Sarrassat S, Cousens S, Some H, Diallo AH, et al. Predictors of exclusive breastfeeding and consumption of soft, semi-solid or solid food among infants in Boucle du Mouhoun, Burkina Faso: A cross-sectional survey. PLoS One. 2017;12:e0179593.
    1. Adeniyi OV, Ajayi AI, Issah M, Owolabi EO, Goon DT, Avramovic G, et al. Beyond health care providers’ recommendations: understanding influences on infant feeding choices of women with HIV in the Eastern Cape, South Africa. Int Breastfeed J. 2019;14:7.
    1. Mensah KA, Acheampong E, Anokye FO, Okyere P, Appiah-Brempong E, Adjei RO. Factors influencing the practice of exclusive breastfeeding among nursing mothers in a peri-urban district of Ghana. BMC Res Notes. 2017;10:466. doi: 10.1186/s13104-017-2774-7.
    1. Department of Labour SA . Basic Guide to Maternity Leave. 2014.
    1. Rudwick S, Posel D. Contemporary functions of ilobolo (bridewealth) in urban South African Zulu society. J Contemp Afr Stud. 2014;32:118–36.
    1. National Department of Health South Africa . The South African Antiretroviral Treatment Guidelines. 2010.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj