Goga Ameena E, Van Wyk Brian, Doherty Tanya, Colvin Mark, Jackson Debra J, Chopra Mickey
Health Systems Research Unit, Medical Research Council, Pretoria, South Africa.
J Acquir Immune Defic Syndr. 2009 Apr 15;50(5):521-8. doi: 10.1097/qai.0b013e3181990620.
Until 2006, HIV-positive women who chose to exclusively breast-feed were advised to completely stop breast-feeding by 6 months. We investigated operational feasibility and predictors of complete breast-feeding cessation (CBC).
A prospective observational cohort study at 3 routine prevention of mother-to-child transmission sites, South Africa.
Data on "complete breast-feeding cessation at 24 weeks" and "not breast-feeding (NBF) for 4 days before the last follow-up visit at or before 24 weeks" were gathered during home visits (3, 5, 7, 9, 12, 16, 20, and 24 weeks). The main subgroup of interest for this analysis was women practicing exclusive breast-feeding/predominant breast-feeding at 3 weeks. Univariate analysis, logistic regression, Kaplan-Meier Survival analysis, and Cox regression were performed.
Eighty-eight women (43.6%) reported CBC. "Health staff suggesting formula use: [OR(a) 4.39 (1.76-10.97)] and "infant hospitalization" [OR(a) 3.27 (1.37-7.79)] were the only significant predictors of CBC. The probability of NBF at 5, 7, 9, 12, 16, 20, and 24 weeks was 2.8% [95% confidence interval (CI) 1.8% to 3.8%], 4.3% (3.0% to 5.6%), 5.9% (4.4% to 7.4%, 9.8% (7.9% to 11.7%), 16.1 (13.8% to 18.4%), 23.1% (20.5% to 25.7%), and 37.6% (34.6% to 40.6%), respectively. Infant HIV status [hazard ratio 5.5 95% CI 2.4 to 12.5] was the only predictor of infant death. NBF was not protective against 9-month infant HIV or death in univariate and multivariable analysis.
At programmatic level, CBC by 24 weeks is uncommon, and success seems unrelated to predetermined social, economic, and environmental (acceptable, feasible, affordable, sustainable, and safe AFASS) criteria. Thus at this level, activities that encourage CBC (amongst women meeting AFASS criteria) need to be identified and tested.
直到2006年，选择纯母乳喂养的HIV阳性女性被建议在6个月时完全停止母乳喂养。我们调查了完全停止母乳喂养（CBC）的操作可行性及预测因素。
在南非3个常规母婴传播预防地点进行的一项前瞻性观察队列研究。
在家庭访视（第3、5、7、9、12、16、20和24周）期间收集关于“24周时完全停止母乳喂养”以及“在24周或之前最后一次随访前4天未进行母乳喂养（NBF）”的数据。该分析的主要关注亚组是在3周时进行纯母乳喂养/主要母乳喂养的女性。进行了单因素分析、逻辑回归、Kaplan-Meier生存分析和Cox回归。
88名女性（43.6%）报告了完全停止母乳喂养。“医护人员建议使用配方奶：[优势比（a）4.39（1.76 - 10.97）]”和“婴儿住院”[优势比（a）3.27（1.37 - 7.79）]是完全停止母乳喂养的仅有的显著预测因素。在第5、7、9、12、16、20和24周时未进行母乳喂养的概率分别为2.8%[95%置信区间（CI）1.8%至3.8%]、4.3%（3.0%至5.6%）、5.9%（4.4%至7.4%）、9.8%（7.9%至11.7%）、16.1%（13.8%至18.4%）、23.1%（20.5%至25.7%）和37.6%（34.6%至40.6%）。婴儿HIV状态[风险比5.5，95%CI 2.4至12.5]是婴儿死亡的唯一预测因素。在单因素和多因素分析中，未进行母乳喂养对9个月大婴儿的HIV感染或死亡没有保护作用。
在项目层面，到24周时完全停止母乳喂养并不常见，且成功似乎与预先确定的社会、经济和环境（可接受、可行、可负担、可持续和安全，即AFASS）标准无关。因此，在这个层面，需要确定并测试鼓励完全停止母乳喂养（在符合AFASS标准的女性中）的活动。
