Mental health predictors of breastfeeding initiation and continuation among HIV infected and uninfected women in a South African birth cohort study

Abstract

Breastfeeding is a cost-effective, yet underutilized strategy to promote maternal and infant health in low and middle income countries (LMICs). Breastfeeding remains challenging for mothers living with HIV in LMICs, yet few studies have examined mental health predictors of breastfeeding initiation and continuation. We investigated breastfeeding among mothers by HIV status in South Africa, evaluating predictors of breastfeeding initiation and continuation to identify intervention-targets. Breastfeeding patterns were investigated in a subsample of 899 breastfeeding mothers from the Drakenstein Child Health Study; a prospective birth cohort of 1,225 pregnant women, between March 2012 and March 2015 in a peri-urban area. Breastfeeding was assessed at 5 time-points between 6 weeks and 24 months’ infant age. Cox proportional hazard models evaluated breastfeeding initiation and duration. Logistic regression models with breastfeeding non-initiation as the outcome parameter were performed to determine associations with maternal sociodemographic, psychosocial factors and gestational outcomes. More HIV-uninfected mothers initiated breastfeeding (n=685, 97%) than HIV-infected mothers (n=87, 45%). Median duration of exclusive breastfeeding was short (2 months), but HIV-infected mothers engaged in exclusive breastfeeding for longer duration than uninfected mothers (3 vs 2 months). Despite concerning high rates, mental disorders were not significant predictors of breastfeeding behaviour. Employment and HIV diagnosis during pregnancy predicted a lower likelihood of breastfeeding initiation among HIV-infected mothers, while employment was associated with earlier breastfeeding-discontinuation in HIV-uninfected mothers. Findings indicate that future interventions should target sub-populations such as HIV-infected women because of distinct needs. Workplace interventions appear particularly key for mothers in our study.

Assessment of initiation of breastfeeding practice in Kassala, Eastern Sudan: a community-based study

“…Inconsistent with the current results, delayed initiation of breastfeeding was observed among mothers with medical disorders such as diabetes and hypertension [ 18 , 42 ]. In an African context, among maternal medical disorders, maternal human immunodeficiency virus (HIV) was found as a key barrier to early initiation of breastfeeding [ 43 – 45 ]. In Mauritius, despite the fact that 60.6% of mothers initiate breastfeeding, low rate of exclusive breastfeeding in the first six months were documented (17.9%) [ 46 ].…”

HIV Infections and Food Insecurity Among Pregnant Women from Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

“…In a meta-analysis that evaluated the association between HIV and FI using five articles [ 9 , 13 , 14 , 17 , 28 ], PrWLWHA had a higher prevalence of FI (PR = 1.23, 95% CI 1.16–1.38) than those without HIV (Fig. 4 ).…”

“…The following information was collected from the eligible studies: author, year of publication, period, location, study design, sample, number of PrWLWHA, and diagnostic methods used for FI and FI prevalence. For clinical trials and cohort studies, the data were strained from the pregnancy baseline [9,[12][13][14][15][16][17].…”

Exclusive breastfeeding policy, practice and influences in South Africa, 1980 to 2018: A mixed-methods systematic review

“…Geographic biases were also clear in terms of where EBF was studied, clustering in Kwa-Zulu Natal (KZN; 17) [11, 18, 56–70], the Western Cape (WC; 13) [11, 53–55, 65, 71–78], and Gauteng provinces (GP; 10) [79–88]. Five studies reported data from the Eastern Cape (EC) [11, 65, 87, 89, 90].…”