Nieuwoudt S, Manderson L, Norris S A
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; South African Medical Research Council Developmental Pathways Health and Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2018 Aug 28;108(9):756-762. doi: 10.7196/SAMJ.2018.v108i9.13358.
The 2011 Tshwane Declaration for the Promotion of Breastfeeding in South Africa ended the country's longstanding support for promoting either exclusive breastfeeding (EBF) or exclusive formula feeding for HIV-positive mothers. However, South Africa's EBF rate is only 32%.
To describe multilevel factors associated with different infant feeding practices among HIV-positive and negative mothers of infants aged <6 months in an HIV-endemic community.
A cross-sectional survey was administered to 298 HIV-positive and negative mothers accessing care in one of five community health clinics in Soweto, Johannesburg, between September 2015 and May 2016. Infant feeding practices and associated factors were explored through descriptive and multivariate analysis.
Excluding HIV-positive mothers who chose formula feeding (n=97), breastfeeding initiation was almost universal (99.5%). Caesarean section (CS) was the most common reason mothers delayed breastfeeding. HIV-positive mothers were significantly more likely to report prolonged EBF (and formula feeding) practices than their HIV-negative counterparts. Breastfeeding mothers were significantly more likely to be unemployed than mothers who formula fed. Mixed feeding was common.
EBF remains strongly associated with HIV status as opposed to infant health and development. Breastfeeding support for working mothers is needed. While breastfeeding increased following the Declaration, more should be done in the health setting to communicate the risks of mixed feeding in the first 6 months. The high rate of CSs reported by mothers, linked to late initiation of breastfeeding, also needs the medical community's attention.
2011年《茨瓦内促进南非母乳喂养宣言》结束了该国长期以来对促进艾滋病毒呈阳性母亲进行纯母乳喂养（EBF）或纯配方奶喂养的支持。然而，南非的纯母乳喂养率仅为32%。
描述在一个艾滋病毒流行社区中，6个月以下婴儿的艾滋病毒呈阳性和阴性母亲中，与不同婴儿喂养方式相关的多层次因素。
2015年9月至2016年5月期间，对约翰内斯堡索韦托五家社区卫生诊所之一接受护理的298名艾滋病毒呈阳性和阴性母亲进行了横断面调查。通过描述性和多变量分析探讨婴儿喂养方式及相关因素。
排除选择配方奶喂养的艾滋病毒呈阳性母亲（n = 97）后，几乎所有母亲都开始母乳喂养（99.5%）。剖宫产是母亲推迟母乳喂养的最常见原因。与艾滋病毒呈阴性的母亲相比，艾滋病毒呈阳性的母亲报告纯母乳喂养时间延长（以及配方奶喂养）的可能性显著更高。母乳喂养的母亲比配方奶喂养的母亲失业的可能性显著更高。混合喂养很常见。
纯母乳喂养仍然与艾滋病毒感染状况密切相关，而非与婴儿健康和发育相关。需要为职业母亲提供母乳喂养支持。虽然宣言发布后母乳喂养有所增加，但在卫生环境中还应做更多工作，以传达头6个月混合喂养的风险。母亲报告的高剖宫产率与母乳喂养开始延迟有关，这也需要医学界予以关注。
