Infant feeding modes and determinants among HIV-1-infected African Women in the Kesho Bora Study.
OBJECTIVE
To assess breastfeeding modes and determinants in a prevention of mother-to-child transmission study.


METHODS
HIV-1-infected pregnant women from 5 sites in Burkina Faso, Kenya, and South Africa were enrolled in the study that comprised 2 prospective cohorts and 1 randomized controlled trial. Women were counseled to either breastfeed exclusively up to 6 months or formula feed from birth.


METHODS
Determinants of breastfeeding initiation and continuation by 3 months postpartum were investigated using multiple logistic regression analysis. Neonatal morbidity was defined as mother-reported fever, diarrhea, or vomiting during the first month of life.


RESULTS
Among 1028, 781 women (76%) initiated breastfeeding and 565 of 995 (56%) were still breastfeeding at 3 months postpartum (30% exclusively, 18% predominantly, and 8% partially). Study site (Durban, Mombasa, and Nairobi compared with Bobo-Dioulasso), CD4 cell count (<200 cells/mm), secondary schooling (compared with none), and emergency cesarean delivery (compared with vaginal delivery) were independently associated with a lower probability of ever breastfeeding. The odds of still breastfeeding by 3 months postpartum (among those breastfeeding by 1 month) were lower in Mombasa, Nairobi, and Somkhele (compared with Bobo-Dioulasso) and among infants with neonatal morbidity [0.60 (0.37-0.976)]. The odds of exclusive breastfeeding (EBF) by 3 months (if EBF by 1 month) were lower in Mombasa and Nairobi, in ill neonates [0.54 (0.31-0.93)] and boys [0.51 (0.34-0.77)].


CONCLUSIONS
EBF was of short duration, particularly for boys. The importance of neonatal morbidity for breastfeeding cessation requires further investigation. Infant feeding counseling might need adaptation to better support mothers of boys and ill neonates.
Institut de Recherche pour le Développement (IRD), UMI233 IRD/UM1, Montpellier, France. kirsten.bork@ird.fr
Kirsten
K
Bork
Cécile
C
Cames
Amandine
A
Cournil
Faith
F
Musyoka
Kossiwavi
K
Ayassou
Kevindra
K
Naidu
Stephen
S
Mepham
Christine
C
Gichuhi
Jennifer S
JS
Read
Philippe
P
Gaillard
Isabelle
I
de Vincenzi
D001942:Breast Feeding / Q000706:statistics & numerical data*; D002050:Burkina Faso / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya / Q000453:epidemiology; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology