南非出生队列研究中 HIV 感染和未感染妇女母乳喂养起始和持续的心理健康预测因素。
Mental health predictors of breastfeeding initiation and continuation among HIV infected and uninfected women in a South African birth cohort study.
机构信息
Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa.
Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa; Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, 121 South Main Street, Box G-S121-4th Floor, Room 406, Providence, RI 02912, USA.
出版信息
Prev Med. 2017 Sep;102:100-111. doi: 10.1016/j.ypmed.2017.07.004. Epub 2017 Jul 8.
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 1225 pregnant women, between March 2012 and March 2015 in a peri-urban area. Breastfeeding was assessed at 5 time-points between 6weeks and 24months' 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 (2months), but HIV-infected mothers engaged in exclusive breastfeeding for longer duration than uninfected mothers (3 vs 2months). 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.
母乳喂养是一种具有成本效益的策略，但在中低收入国家（LMICs）尚未得到充分利用，可用于促进母婴健康。在 LMICs 中，HIV 阳性母亲母乳喂养仍然具有挑战性，但很少有研究调查母乳喂养的开始和持续的精神健康预测因素。我们调查了南非 HIV 阳性母亲的母乳喂养情况，评估了母乳喂养开始和持续的预测因素，以确定干预目标。在 Drakenstein 儿童健康研究的 899 名母乳喂养母亲的亚样本中调查了母乳喂养模式；这是一个前瞻性的出生队列，由 1225 名孕妇组成，于 2012 年 3 月至 2015 年 3 月在城乡结合部。在 6 周至 24 个月的婴儿年龄之间的 5 个时间点评估母乳喂养情况。Cox 比例风险模型评估母乳喂养的开始和持续时间。对母乳喂养非起始作为结果参数的逻辑回归模型进行了分析，以确定与产妇社会人口统计学，心理社会因素和妊娠结局的关联。更多的 HIV 未感染母亲开始母乳喂养（n = 685，97％），而 HIV 感染母亲（n = 87，45％）。纯母乳喂养的中位数持续时间较短（2 个月），但 HIV 感染母亲的纯母乳喂养持续时间长于未感染母亲（3 个月对 2 个月）。尽管令人担忧的是高比例，精神障碍不是母乳喂养行为的重要预测因素。怀孕期间的就业和 HIV 诊断预测 HIV 感染母亲母乳喂养开始的可能性降低，而就业与 HIV 未感染母亲的母乳喂养提前中断有关。研究结果表明，未来的干预措施应该针对特定的亚人群，如 HIV 感染的妇女，因为他们有特殊的需求。工作场所干预措施对我们研究中的母亲来说似乎特别关键。
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