母乳喂养知识和实践因产妇 HIV 状况而异：南非农村的嵌套队列研究。

Infant feeding knowledge and practice vary by maternal HIV status: a nested cohort study in rural South Africa.

机构信息

The Kirby Institute, University of New South Wales Sydney, Sydney, Australia.

Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa.

出版信息

Int Breastfeed J. 2020 Sep 1;15(1):77. doi: 10.1186/s13006-020-00317-5.

DOI:10.1186/s13006-020-00317-5

PMID:32873311

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7466779/

Abstract

BACKGROUND

We investigate whether correct infant feeding knowledge and practice differ by maternal HIV status in an era of evolving clinical guidelines in rural South Africa.

METHODS

This cohort study was nested within the MONARCH stepped-wedge cluster-randomised controlled trial ( www.clinicaltrials.gov : NCT02626351 ) which tested the impact of continuous quality improvement on antenatal care quality at seven primary care clinics in KwaZulu-Natal, from July 2015 to January 2017. Women aged ≥18 years at delivery were followed up to 6 weeks postpartum. Clinical data were sourced from routine medical records at delivery. Structured interviews at early postnatal visits and the 6-week postnatal immunisation visit provided data on infant feeding knowledge and feeding practices respectively. We measured the relationship between maternal HIV status and (i) correct infant feeding knowledge at the early postnatal visit; and (ii) infant feeding practice at 6 weeks, using Poisson and multinomial regression models, respectively.

RESULTS

We analysed data from 1693 women with early postnatal and 471 with 6-week postnatal interviews. HIV prevalence was 47% (95% confidence interval [CI] 42, 52%). Women living with HIV were more knowledgeable than women not living with HIV on correct infant feeding recommendations (adjusted risk ratio, aRR, 1.08, p < 0.001). More women living with HIV (33%; 95% CI 26, 41%) were not breastfeeding than women not living with HIV (15%; 95% CI 11, 21%). However, among women who were currently breastfeeding their infants, fewer women living with HIV (5%; 95% CI 2, 9%) mixed fed their babies than women not living with HIV (21%; 95% CI 14, 32%). In adjusted analyses, women living with HIV were more likely to avoid breastfeeding (adjusted relative risk ratio, aRRR, 2.78, p < 0.001) and less likely to mixed feed (aRRR 0.22, p < 0.001) than women not living with HIV.

CONCLUSIONS

Many mothers in rural South Africa still do not practice exclusive breastfeeding. Women living with HIV were more knowledgeable but had lower overall uptake of breastfeeding, compared with women not living with HIV. Women living with HIV were also more likely to practice exclusive breastfeeding over mixed feeding if currently breastfeeding. Improved approaches are needed to increase awareness of correct infant feeding and exclusive breastfeeding uptake.

摘要

背景

我们研究了在南非农村，随着临床指南的不断发展，婴儿喂养知识和实践是否因产妇 HIV 状况而异。

方法

这项队列研究嵌套在 MONARCH 阶梯式随机对照试验中（www.clinicaltrials.gov：NCT02626351），该试验测试了在夸祖鲁-纳塔尔省的 7 个初级保健诊所中通过持续质量改进对产前保健质量的影响，试验从 2015 年 7 月到 2017 年 1 月进行。分娩时年龄≥18 岁的妇女在产后 6 周内进行随访。临床数据来源于分娩时的常规病历。在产后早期访问和 6 周产后免疫接种访问中进行的结构化访谈分别提供了婴儿喂养知识和喂养实践的数据。我们使用泊松和多项回归模型分别测量了产妇 HIV 状况与（i）产后早期访视时正确的婴儿喂养知识；以及（ii）6 周时婴儿喂养实践之间的关系。

结果

我们分析了 1693 名有早期产后访谈和 471 名有 6 周产后访谈的妇女的数据。HIV 流行率为 47%（95%置信区间 [CI] 42, 52%）。与未感染 HIV 的妇女相比，感染 HIV 的妇女对正确的婴儿喂养建议更有知识（调整后的风险比，aRR，1.08，p<0.001）。更多感染 HIV 的妇女（33%；95%CI 26, 41%）没有母乳喂养，而未感染 HIV 的妇女有 15%（95%CI 11, 21%）。然而，在目前正在母乳喂养婴儿的妇女中，感染 HIV 的妇女（5%；95%CI 2, 9%）混合喂养婴儿的比例低于未感染 HIV 的妇女（21%；95%CI 14, 32%）。在调整后的分析中，与未感染 HIV 的妇女相比，感染 HIV 的妇女更有可能避免母乳喂养（调整后的相对风险比，aRRR，2.78，p<0.001）和不太可能混合喂养（aRRR 0.22，p<0.001）。