Influences on Exclusive Breastfeeding Among Rural HIV-Infected South African Women: A Cluster Randomized Control Trial

Abstract

South African guidelines for prevention-of-mother-to-child-transmission (PMTCT) of HIV emphasize exclusive breastfeeding (EBF). This study examined the impact of a PMTCT intervention and male involvement on EBF. In a two-phase cluster-randomized trial, rural South African community health centers were randomized to offer HIV-infected pregnant women PMTCT standard of care plus either: a behavioral PMTCT intervention, or a time-equivalent attention-control condition. Phase 1 women had non-participating male partners; Phase 2 women had participating partners. Pregnant women (n = 1398) were assessed on HIV stigma, disclosure of HIV status to partner, male involvement, and family planning knowledge. Feeding practices were assessed 6 weeks postpartum (56% retained). Reduced depressive symptomatology predicted EBF 6 weeks postpartum, adjusting for attrition (AOR = 0.954, p = 0.001). Neither male involvement in antenatal care, phase, HIV stigma, disclosure, nor family planning knowledge predicted EBF. Future studies and perinatal care should address depression, which has important implications for infant health.

Sociodemographic and lifestyle correlates of exclusive breastfeeding practices among mothers on antiretroviral therapy in the Eastern Cape, South Africa

“…Considering the high HIV epidemic in South Africa, with approximately 7.7 million people with HIV [24], understanding the factors associated with EBF is essential in crafting strategies to support and sustain appropriate breastfeeding practices to increase the prevalence of exclusive breastfeeding. Even though previous studies have examined the prevalence of EBF among lactating mothers living with HIV in South Africa [10,15,17,20,[25][26][27][28], scanty information exists in the Eastern Cape, a province with a twin burden of HIV epidemic and poverty. Given that factors affecting EBF practices vary among countries and even within the sub-groups of populations [29], contextual information on the prevalence and determinants of EBF is vital to inform contextspecific interventions.…”

Engaging family members in maternal, infant and young child nutrition activities in low‐ and middle‐income countries: A systematic scoping review

“…Interventions were largely nutrition specific and implemented as part of nutrition or broader maternal and child health (Tall et al, 2018 ) activities. There are examples of nutrition‐sensitive interventions for early child development (Betancourt et al, 2020 ; Singla et al, 2015 ), agriculture (Bezner Kerr et al, 2011 ; Kumar et al, 2018 ), and prevention of mother‐to‐child transmission of HIV (Jones et al, 2018 ; Krakowiak et al, 2016 ).…”

“…Eight studies included health facility‐based interventions that reached individual mothers and family members during antenatal care or at delivery, and to a lesser extent, during child health services. These typically focused on counselling about exclusive breastfeeding and how fathers, grandmothers, or other family members could support maternal and child nutrition (Andreson et al, 2013 ; Bich et al, 2014 , 2019 ; DeOliveira et al, 2012 ; Jones et al, 2018 ; Özlüses & Çelebioglu, 2014 ).…”

“…These typically focused on counselling about exclusive breastfeeding and how fathers, grandmothers, or other family members could support maternal and child nutrition (Andreson et al, 2013;Bich et al, 2014Bich et al, , 2019DeOliveira et al, 2012;Jones et al, 2018;Özlüses & Çelebioglu, 2014).…”

Sociodemographic and lifestyle correlates of exclusive breastfeeding practices among mothers on antiretroviral therapy in the Eastern Cape, South Africa

“…Considering the high HIV epidemic in South Africa, with approximately 7.7 million people with HIV [24), understanding the factors associated with EBF is essential in crafting strategies to support and sustain appropriate breastfeeding practices to increase the prevalence of EBF. Even though previous studies have examined the prevalence of EBF among lactating mothers living with HIV in South Africa [10,15,17,20,[25][26][27][28], scanty information exists in the Eastern Cape, a province with a twin burden of HIV epidemic and poverty. Given that factors affecting EBF practices vary among countries and even within the sub-groups of populations [29], contextual information on the prevalence and determinants of EBF is vital to inform context-speci c interventions.…”