Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
Carter Center, Atlanta, GA, USA.
Matern Child Health J. 2019 Oct;23(10):1308-1316. doi: 10.1007/s10995-019-02760-1.
Objective HIV-exposed uninfected infants are almost twice as likely to die compared to infants born to HIV-uninfected women. HIV-exposed uninfected children whose mothers are on ART and who are breastfed have the lowest risk of dying by 24 months of age. Interventions to improve breastfeeding among HIV-infected mothers are needed. We aimed to assess the association between support/counseling provided by healthcare workers following delivery and the rate of exclusive breastfeeding (EBF) at 6-week postpartum. Methods This is a secondary analysis of data collected as part of a trial to evaluate the effect of conditional cash transfers on retention in and uptake of PMTCT services. Between April 2013 and August 2014, newly diagnosed HIV-infected women, ≤ 32 weeks pregnant, registering for antenatal care (ANC), in 89 clinics in Kinshasa, Democratic Republic of Congo, were recruited and followed through 6 weeks postpartum. At 6-week, participants were asked if they had given anything other than breastmilk to their infant in the 24 h preceding the interview (No = EBF) and whether a nurse or a doctor talked to them about breastfeeding after they gave birth (YES = received breastfeeding support/counseling). Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) measuring the strength of the association between EBF and receiving breastfeeding support/counseling by a healthcare provider following delivery. Results Of 433 women enrolled, 328 attended a 6-week postpartum visit including 320 (97%) with complete information on EBF. Of those 320, 202 (63%) reported giving nothing other than breastmilk to their infant in the previous 24 h; 252 (79%) reported that a healthcare provider came to talk to them about breastfeeding following delivery. Mothers who reported receiveing breastfeeding support/counseling from a healthcare provider were more likely to exclusively breastfeed compared to those who did not (69% vs. 38%, OR 3.74; 95% CI 2.14-6.54). Adjustment for baseline sociodemographic characteristics did not change the association substantially, (adjusted OR 3.72; 95% CI 2.06-6.71). Conclusion for Practice Receipt of breastfeeding support/counseling from a healthcare provider after delivery among HIV-infected mothers in care at 6-weeks postpartum in Kinshasa almost quadrupled the odds of EBF.
与未感染 HIV 的母亲所生婴儿相比,HIV 暴露但未感染的婴儿死亡的可能性几乎高出一倍。接受抗逆转录病毒治疗且母乳喂养的 HIV 暴露但未感染的儿童在 24 个月龄时的死亡风险最低。需要采取措施来提高 HIV 感染母亲的母乳喂养率。我们旨在评估分娩后医护人员提供的支持/咨询与产后 6 周内纯母乳喂养(EBF)率之间的关联。
这是一项对刚果民主共和国金沙萨 89 个诊所内于 2013 年 4 月至 2014 年 8 月期间参与评估有条件现金转移对维持和接受预防母婴传播服务影响的一项试验中收集的数据进行的二次分析。新诊断为 HIV 感染、妊娠不足 32 周、登记参加产前保健(ANC)的孕妇,以及在 6 周时通过访谈进行了评估。在 6 周时,参与者被问到在访谈前 24 小时内是否给婴儿喂过除母乳以外的其他东西(否=纯母乳喂养),以及分娩后护士或医生是否与他们谈过母乳喂养(是=接受母乳喂养支持/咨询)。使用逻辑回归来估计 EBF 和分娩后接受医护人员母乳喂养支持/咨询之间的比值比(OR)和 95%置信区间(CI),以衡量两者之间的关联强度。
在 433 名入组的女性中,有 328 人参加了产后 6 周的随访,其中 320 人(97%)提供了完整的 EBF 信息。在这 320 名女性中,202 人(63%)报告在过去 24 小时内仅给婴儿喂母乳;252 人(79%)报告说分娩后有医护人员来与他们谈论母乳喂养。与未接受医护人员母乳喂养支持/咨询的母亲相比,报告接受过该支持/咨询的母亲更有可能进行纯母乳喂养(69%对 38%,OR 3.74;95%CI 2.14-6.54)。调整基线社会人口学特征后,该关联并未发生实质性变化(调整后的 OR 3.72;95%CI 2.06-6.71)。
在金沙萨,接受抗逆转录病毒治疗的 HIV 感染母亲在产后 6 周内接受医护人员的母乳喂养支持/咨询,可使 EBF 的可能性增加近四倍。