为感染和未感染艾滋病毒的妇女提供婴儿喂养咨询：选择的适宜性与实践
Infant feeding counselling for HIV-infected and uninfected women: appropriateness of choice and practice.
作者信息
Bland R M, Rollins N C, Coovadia H M, Coutsoudis A, Newell M L
机构信息
Africa Centre for Health and Population Studies, University of KwaZulu Natal, South Africa.
出版信息
Bull World Health Organ. 2007 Apr;85(4):289-96. doi: 10.2471/blt.06.032441.
OBJECTIVE
To examine infant feeding intentions of HIV-infected and uninfected women and the appropriateness of their choices according to their home resources; and to determine their adherence to their intentions in the first postnatal week.
METHODS
Feeding intentions of pregnant women were compared against four resources that facilitate replacement feeding: clean water, adequate fuel, access to a refrigerator and regular maternal income. First-week feeding practices were documented.
FINDINGS
The antenatal feeding intentions of 1253 HIV-infected women were: exclusive breastfeeding 73%; replacement feeding 9%; undecided 18%. Three percent had access to all four resources, of whom 23% chose replacement feeding. Of those choosing replacement feeding, 8% had access to all four resources. A clean water supply and regular maternal income were independently associated with intention to replacement feed (adjusted odds ratio (AOR) 1.94, 95% confidence interval (CI) 1.2-3.2; AOR 2.1, 95% CI: 1.2-3.5, respectively). Significantly more HIV-infected women intending to exclusively breastfeed, rather than replacement feed, adhered to their intention in week one (exclusive breastfeeding 78%; replacement feeding 42%; P<0.001). Of 1238 HIV-uninfected women, 82% intended to exclusively breastfeed; 2% to replacement feed; and 16% were undecided. Seventy-five percent who intended to exclusively breastfeed adhered to this intention postnatally, and only 11 infants (<1%) received no breast milk. The number of antenatal home visits significantly influenced adherence to feeding intention.
CONCLUSION
Most HIV-infected women did not have the resources for safe replacement feeding, instead choosing appropriately to exclusively breastfeed. Adherence to feeding intention among HIV-infected women was higher in those who chose to exclusively breastfeed than to replacement feed. With appropriate counselling and support, spillover of suboptimal feeding practices to HIV-negative women is minimal.
目的
调查感染和未感染艾滋病毒的妇女的婴儿喂养意向，以及根据其家庭资源判断她们选择的合理性；并确定她们在产后第一周是否坚持其喂养意向。
方法
将孕妇的喂养意向与有助于替代喂养的四项资源进行比较：清洁水、充足的燃料、有冰箱可用以及母亲有固定收入。记录第一周的喂养方式。
结果
1253名感染艾滋病毒的妇女产前喂养意向为：纯母乳喂养73%；替代喂养9%；未决定18%。3%的妇女具备全部四项资源，其中23%选择替代喂养。在选择替代喂养的妇女中，8%具备全部四项资源。清洁水供应和母亲有固定收入与选择替代喂养的意向独立相关（调整优势比[AOR]分别为1.94，95%置信区间[CI]1.2 - 3.2；AOR 2.1，95% CI：1.2 - 3.5）。在第一周，打算纯母乳喂养而非替代喂养的感染艾滋病毒的妇女中，坚持其意向的比例明显更高（纯母乳喂养78%；替代喂养42%；P<0.001）。在1238名未感染艾滋病毒的妇女中，82%打算纯母乳喂养；2%打算替代喂养；16%未决定。打算纯母乳喂养的妇女中有75%在产后坚持了这一意向，只有11名婴儿（<1%）未接受母乳。产前家访次数对喂养意向的坚持有显著影响。
结论
大多数感染艾滋病毒的妇女没有进行安全替代喂养的资源，而是选择了合适的纯母乳喂养方式。选择纯母乳喂养的感染艾滋病毒的妇女比选择替代喂养的妇女对喂养意向的坚持程度更高。通过适当的咨询和支持，次优喂养方式对艾滋病毒阴性妇女的影响极小。
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