title: Predictors of breastfeeding cessation among HIV-infected women in Dar es Salaam, Tanzania.
abstract: This paper examines predictors of breastfeeding cessation among a cohort of human immunodeficiency virus (HIV)-infected women. This was a prospective follow-up study of HIV-infected women who participated in a randomized micronutrient supplementation trial conducted in Dar es Salaam, Tanzania. 795 HIV-infected Tanzanian women with singleton newborns were utilized from the cohort for this analysis. The proportion of women breastfeeding declined from 95% at 12 months to 11% at 24 months. The multivariate analysis showed breastfeeding cessation was significantly associated with increasing calendar year of delivery from 1995 to 1997 [risk ratio (RR), 1.36; 95% confidence interval (CI) 1.13-1.63], having a new pregnancy (RR 1.33; 95% CI 1.10-1.61), overweight [body mass index (BMI) ≥25 kg m(-2) ; RR 1.37; 95% CI 1.07-1.75], underweight (BMI <18.5kg m(-2) ; RR 1.29; 95% CI 1.00-1.65), introduction of cow's milk at infant's age of 4 months (RR 1.30; 95% CI 1.04-1.63). Material and social support was associated with decreased likelihood of cessation (RR 0.83; 95% CI 0.68-1.02). Demographic, health and nutritional factors among women and infants are associated with decisions by HIV-infected women to cease breastfeeding. The impact of breastfeeding counselling programs for HIV-infected African women should consider individual maternal, social and health contexts.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA. ppetraro@hsph.harvard.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Petraro
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.forename: Gernard
authors.initials: G
authors.lastname: Msamanga
authors.forename: Karen E
authors.initials: KE
authors.lastname: Peterson
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.forename: Wafaie
authors.initials: W
authors.lastname: Fawzi
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001903:Bottle Feeding / Q000706:statistics & numerical data; D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000523:psychology*; D015438:Health Behavior; D006801:Humans; D008429:Maternal Welfare / Q000523:psychology; D050177:Overweight / Q000150:complications; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000523:psychology; D011446:Prospective Studies; D012944:Social Support; D013223:Statistics as Topic; D013636:Tanzania; D013997:Time Factors; D055815:Young Adult