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Exclusive breastfeeding among women taking HAART for PMTCT of HIV-1 in the Kisumu Breastfeeding Study.
BMC Pediatr 2014; 14:280BPed

Abstract

BACKGROUND

One of the most effective ways to promote the prevention of mother-to-child transmission (PMTCT) of HIV-1 in resource-limited settings is to encourage HIV-positive mothers to practice exclusive breastfeeding (EBF) for the first 6 months post-partum while they receive antiretroviral therapy (ARV). Although EBF reduces mortality in this context, its practice has been low. We studied the rate of adherence to EBF and assessed associated maternal and infant characteristics using data from a phase II PMTCT clinical trial conducted in Western Kenya which included a counseling intervention to encourage EBF by all participants.

METHODS

We analyzed data from the Kisumu Breastfeeding Study (KiBS), conducted between July 2003 and February 2009. This study enrolled a total of 522 HIV-1 infected pregnant women. Data on breastfeeding were available for 480 mother-infant pairs. Infant feeding and general nutrition counseling began at 35 weeks gestation and continued throughout the 6 month post-partum intervention period, following World Health Organization (WHO) infant feeding guidelines. Data on infant feeding were collected during routine clinic visits and home visits using food frequency questionnaires and dietary recall methods. Participants were instructed to exclusively breastfeed until initiation of weaning at 5.5 months post-partum. We used Kaplan-Meier methods to estimate the rates of EBF at 5.25 months post-partum, stratified by maternal and infant characteristics measured at enrollment, delivery, and 2 weeks post-partum.

RESULTS

The estimated EBF rate at 5.25 months post-partum was 80.4%. Only 3% of women introduced other foods (most commonly water with or without glucose, cow's milk, formula, and fruit) by 2 months; this percentage increased to 5% of women by 4 months. Women who had ≥3 previous births (p < 0.01) and who were not living with the infant's father (p = 0.04) were more likely to exclusively breastfeed. Mixed feeding was more common for male infants than for female infants (p = 0.04).

CONCLUSION

Exclusive breastfeeding was common in this clinical trial, which emphasized EBF as a best practice until infants reached 5.5 months of age. Counseling initiated prior to delivery and continued during the post-partum period provided a consistent message reinforcing the benefits of EBF. The findings from this study suggest high adherence to EBF in resource limited settings can be achieved by a comprehensive counseling intervention that encourages EBF.

Authors+Show Affiliations

Kenya Medical Research Institute/U,S, Centers for Disease Control and Prevention (KEMRI/CDC), Research and Public Health Collaboration, P,O, Box 1578, 40100 Kisumu, Kenya. JOkanda@kemricdc.org.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial, Phase II
Journal Article

Language

eng

PubMed ID

25380718

Citation

Okanda, John O., et al. "Exclusive Breastfeeding Among Women Taking HAART for PMTCT of HIV-1 in the Kisumu Breastfeeding Study." BMC Pediatrics, vol. 14, 2014, p. 280.
Okanda JO, Borkowf CB, Girde S, et al. Exclusive breastfeeding among women taking HAART for PMTCT of HIV-1 in the Kisumu Breastfeeding Study. BMC Pediatr. 2014;14:280.
Okanda, J. O., Borkowf, C. B., Girde, S., Thomas, T. K., & Lecher, S. L. (2014). Exclusive breastfeeding among women taking HAART for PMTCT of HIV-1 in the Kisumu Breastfeeding Study. BMC Pediatrics, 14, p. 280. doi:10.1186/1471-2431-14-280.
Okanda JO, et al. Exclusive Breastfeeding Among Women Taking HAART for PMTCT of HIV-1 in the Kisumu Breastfeeding Study. BMC Pediatr. 2014 Nov 7;14:280. PubMed PMID: 25380718.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Exclusive breastfeeding among women taking HAART for PMTCT of HIV-1 in the Kisumu Breastfeeding Study. AU - Okanda,John O, AU - Borkowf,Craig B, AU - Girde,Sonali, AU - Thomas,Timothy K, AU - Lecher,Shirley Lee, Y1 - 2014/11/07/ PY - 2013/11/06/received PY - 2014/10/16/accepted PY - 2014/11/9/entrez PY - 2014/11/9/pubmed PY - 2015/7/8/medline SP - 280 EP - 280 JF - BMC pediatrics JO - BMC Pediatr VL - 14 N2 - BACKGROUND: One of the most effective ways to promote the prevention of mother-to-child transmission (PMTCT) of HIV-1 in resource-limited settings is to encourage HIV-positive mothers to practice exclusive breastfeeding (EBF) for the first 6 months post-partum while they receive antiretroviral therapy (ARV). Although EBF reduces mortality in this context, its practice has been low. We studied the rate of adherence to EBF and assessed associated maternal and infant characteristics using data from a phase II PMTCT clinical trial conducted in Western Kenya which included a counseling intervention to encourage EBF by all participants. METHODS: We analyzed data from the Kisumu Breastfeeding Study (KiBS), conducted between July 2003 and February 2009. This study enrolled a total of 522 HIV-1 infected pregnant women. Data on breastfeeding were available for 480 mother-infant pairs. Infant feeding and general nutrition counseling began at 35 weeks gestation and continued throughout the 6 month post-partum intervention period, following World Health Organization (WHO) infant feeding guidelines. Data on infant feeding were collected during routine clinic visits and home visits using food frequency questionnaires and dietary recall methods. Participants were instructed to exclusively breastfeed until initiation of weaning at 5.5 months post-partum. We used Kaplan-Meier methods to estimate the rates of EBF at 5.25 months post-partum, stratified by maternal and infant characteristics measured at enrollment, delivery, and 2 weeks post-partum. RESULTS: The estimated EBF rate at 5.25 months post-partum was 80.4%. Only 3% of women introduced other foods (most commonly water with or without glucose, cow's milk, formula, and fruit) by 2 months; this percentage increased to 5% of women by 4 months. Women who had ≥3 previous births (p < 0.01) and who were not living with the infant's father (p = 0.04) were more likely to exclusively breastfeed. Mixed feeding was more common for male infants than for female infants (p = 0.04). CONCLUSION: Exclusive breastfeeding was common in this clinical trial, which emphasized EBF as a best practice until infants reached 5.5 months of age. Counseling initiated prior to delivery and continued during the post-partum period provided a consistent message reinforcing the benefits of EBF. The findings from this study suggest high adherence to EBF in resource limited settings can be achieved by a comprehensive counseling intervention that encourages EBF. SN - 1471-2431 UR - https://www.unboundmedicine.com/medline/citation/25380718/Exclusive_breastfeeding_among_women_taking_HAART_for_PMTCT_of_HIV_1_in_the_Kisumu_Breastfeeding_Study_ L2 - https://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-14-280 DB - PRIME DP - Unbound Medicine ER -