Shapiro Roger L, Lockman Shahin, Thior Ibou, Stocking Lisa, Kebaabetswe Poloko, Wester Carolyn, Peter Trevor, Marlink Richard, Essex Max, Heymann S Jody
Botswana-Harvard AIDS Institute Partnership, Botswana.
AIDS Educ Prev. 2003 Jun;15(3):221-30. doi: 10.1521/aeap.15.4.221.23830.
Little is known about the ability of women to adhere to recommended feeding strategies to prevent mother-to-child HIV transmission (MTCT) from breast milk. We conducted a pilot study in rural Botswana to prevent MTCT from breast milk. Women were randomized to formula feed their infants or to exclusively breastfeed while providing prophylactic zidovudine. Women who chose to formula feed independently were also followed. Among those with > or = 3 postpartum visits, none of 31 women assigned to breastfeed did so exclusively for 5 months. Seven (22%) of 32 women in the formula arm definitely or probably breastfed by self-report or as witnessed in maternity, and evidence of breast milk on physical examination was present in 50% of women in > or = 2 visits beyond 1 month. Three (18%) of 17 women choosing formula definitely or probably breastfed, and breast milk was present on exam in 53%. We conclude that adherence to 5 months of exclusive breastfeeding did not occur, and that adherence to exclusive formula feeding was sub-optimal and potentially over reported. Breast examination may be a useful adjunct to self-report, but needs to be validated and standardized. Low adherence to infant feeding strategies that differ from local norms will reduce their effectiveness in preventing MTCT.
关于女性坚持采用推荐的喂养策略以预防母乳传播母婴艾滋病毒（MTCT）的能力，我们了解甚少。我们在博茨瓦纳农村地区开展了一项预防母乳传播MTCT的试点研究。将女性随机分为两组，一组用配方奶喂养婴儿，另一组在给予预防性齐多夫定的同时进行纯母乳喂养。对那些自主选择配方奶喂养的女性也进行了跟踪。在产后进行了≥3次访视的女性中，31名被分配进行母乳喂养的女性中，没有一人纯母乳喂养达到5个月。配方奶喂养组的32名女性中，有7名（22%）通过自我报告或在产科观察到肯定或可能进行了母乳喂养，在产后1个月后进行了≥2次访视的女性中，50%的女性经体格检查有母乳迹象。17名选择配方奶喂养的女性中，有3名（18%）肯定或可能进行了母乳喂养，53%的女性经检查有母乳。我们得出结论，没有出现坚持5个月纯母乳喂养的情况，坚持纯配方奶喂养的情况也不理想，而且可能存在报告过度的问题。乳房检查可能有助于补充自我报告，但需要进行验证和标准化。对不同于当地规范的婴儿喂养策略的低依从性会降低其预防MTCT的效果。
