title: Need to optimise infant feeding counselling: a cross-sectional survey among HIV-positive mothers in Eastern Uganda.
abstract: BACKGROUND
  The choice of infant feeding method is important for HIV-positive mothers in order to optimise the chance of survival of their infants and to minimise the risk of HIV transmission. The aim of this study was to investigate feeding practices, including breastfeeding, in the context of PMTCT for infants and children under two years of age born to HIV-positive mothers in Uganda.
  
  
  METHODS
  In collaboration with The Aids Support Organisation Mbale, we conducted a cross-sectional survey involving 235 HIV-positive mothers in Uganda. Infant feeding practices, reasons for stopping breastfeeding, and breast health problems were studied. Breastfeeding duration was analysed using the Kaplan-Meier method based on retrospective recall.
  
  
  RESULTS
  Breastfeeding was initiated by most of the mothers, but 20 of them (8.5%) opted exclusively for replacement feeding. Pre-lacteal feeding was given to 150 (64%) infants and 65 (28%) practised exclusive breastfeeding during the first three days. One-fifth of the infants less than 6 months old were exclusively breastfed, the majority being complementary fed including breast milk. The median duration of breastfeeding was 12 months (95% confidence interval [CI] 11.5 to 12.5). Adjusted Cox regression analysis indicated that a mother's education, socio-economic status, participation in the PMTCT-program and her positive attitude to breastfeeding exclusively, were all associated with a reduction in breastfeeding duration. Median duration was 3 months (95% CI 0-10.2) among the most educated mothers, and 18 months (95% CI 15.0-21.0) among uneducated mothers. Participation in the PMTCT program and being socio-economically better-off were also associated with earlier cessation of breastfeeding (9 months [95% CI 7.2-10.8] vs. 14 months [95% CI 10.8-17.2] and 8 months [95% CI 5.9-10.1] vs. 17 months [95% CI 15.2-18.8], respectively). The main reasons for stopping breastfeeding were reported as: advice from health workers, maternal illness, and the HIV-positive status of the mother.
  
  
  CONCLUSIONS
  Exclusive breastfeeding was uncommon. Exclusive replacement feeding was practised by few HIV-positive mothers. Well-educated mothers, mothers who were socio-economically better-off and PMTCT-attendees had the shortest durations of breastfeeding. Further efforts are needed to optimise infant feeding counselling and to increase the feasibility of the recommendations.
authors.affiliation: Centre for International Health, University of Bergen, Bergen, Norway. infantfeeding@fadnes.net
authors.forename: Lars T
authors.initials: LT
authors.lastname: Fadnes
authors.forename: Ingunn M S
authors.initials: IM
authors.lastname: Engebretsen
authors.forename: Henry
authors.initials: H
authors.lastname: Wamani
authors.forename: Jonathan
authors.initials: J
authors.lastname: Wangisi
authors.forename: James K
authors.initials: JK
authors.lastname: Tumwine
authors.forename: Thorkild
authors.initials: T
authors.lastname: Tylleskär
mesh_terms: D001942:Breast Feeding / Q000706:statistics & numerical data; D002675:Child, Preschool; D003376:Counseling / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000009:adverse effects*; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D008297:Male; D011247:Pregnancy; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D014454:Uganda