title: Intervention to promote exclusive breast-feeding for the first 6 months of life in a high HIV prevalence area.
abstract: OBJECTIVE
  We report on a nonrandomized intervention cohort study to increase exclusive breast-feeding rates for 6 months after delivery in HIV-positive and HIV-negative women in KwaZulu-Natal, South Africa.
  
  
  METHODS
  Lay counselors visited women to support exclusive breast-feeding: four times antenatally, four times in the first 2 weeks postpartum and then fortnightly to 6 months. Daily feeding practices were collected at weekly intervals by separate field workers. Cumulative exclusive breast-feeding rates from birth were assessed by Kaplan-Meier analysis and association with maternal and infant variables was quantified in a Cox regression analysis.
  
  
  RESULTS
  One thousand, two hundred and nineteen infants of HIV-negative and 1217 infants of HIV-positive women were followed postnatally. Median duration of exclusive breast-feeding was 177 (R = 1-180; interquartile range: 150-180) and 175 days (R = 1-180; interquartile range: 137-180) in HIV-negative and HIV-positive women, respectively. Using 24-h recall, exclusive breast-feeding rates at 3 and 5 months were 83.1 and 76.5%, respectively, in HIV-negative women and 72.5 and 66.7%, respectively, in HIV-positive women. Using the most stringent cumulative data, 45% of HIV-negative and 40% of HIV-positive women adhered to exclusive breast-feeding for 6 months. Counseling visits were strongly associated with adherence to cumulative exclusive breast-feeding at 4 months, those who had received the scheduled number of visits were more than twice as likely to still be exclusively breast-feeding than those who had not (HIV-negative women: adjusted odds ratio: 2.07, 95% confidence interval: 1.56-2.74, P < 0.0001; HIV-positive women: adjusted odds ratio: 2.86, 95% CI 2.13-3.83, P < 0.0001).
  
  
  CONCLUSIONS
  It is feasible to promote and sustain exclusive breast-feeding for 6 months in both HIV-positive and HIV-negative women, with home support from well trained lay counselors.
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, KwaZulu-Natal, South Africa. rbland@africacentre.ac.za
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Bland
authors.forename: Kirsty E
authors.initials: KE
authors.lastname: Little
authors.forename: Hoosen M
authors.initials: HM
authors.lastname: Coovadia
authors.forename: Anna
authors.initials: A
authors.lastname: Coutsoudis
authors.forename: Nigel C
authors.initials: NC
authors.lastname: Rollins
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
mesh_terms: D000328:Adult; D001942:Breast Feeding; D016022:Case-Control Studies; D003376:Counseling / Q000379:methods*; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000523:psychology / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D016015:Logistic Models; D015995:Prevalence; D013019:South Africa