Mental health predictors of breastfeeding initiation and continuation among HIV infected and uninfected women in a South African birth cohort study.

Journal: Preventive medicine

Volume: 102

Issue: 

Year of Publication: 2018

Affiliated Institutions:  Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town , South Africa. Electronic address: eileenthomas@sun.ac.za. Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town , South Africa; Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, South Main Street, Box G-S-th Floor, Room , Providence, RI , USA. Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa. Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town , South Africa. Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town , South Africa; Medical Research Council Unit on Anxiety and Stress Disorders, South Africa. Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Medical Research Council Unit on Child and Adolescent Health, South Africa.

Abstract summary 

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.

Authors & Co-authors:  Thomas Eileen E Kuo Caroline C Cohen Sophie S Hoare Jacqueline J Koen Natassja N Barnett Whitney W Zar Heather J HJ Stein Dan J DJ

Study Outcome 

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Citations :  Doherty T, Sanders D, Goga A, Jackson D. Implications of the new WHO guidelines on HIV and infant feeding for child survival in South Africa. Bull World Health Organ. 2011;89(1):62–67. doi: 10.2471/BLT.10.079798.
Authors :  8
Identifiers
Doi : 10.1016/j.ypmed.2017.07.004
SSN : 1096-0260
Study Population
Women,Mothers
Mesh Terms
Adult
Other Terms
Breastfeeding;Exclusive breastfeeding;HIV;Psychosocial;South Africa
Study Design
Cohort Study,Cross Sectional Study
Study Approach
Country of Study
South Africa
Publication Country
United States