title: HIV serostatus and disclosure: implications for infant feeding practice in rural south Nyanza, Kenya.
abstract: BACKGROUND
  The World Health Organization (WHO) recommends that HIV-infected women practice exclusive breastfeeding (EBF) for the first 6 months postpartum to reduce HIV transmission. The aim of this study was to determine the effects of HIV/AIDS knowledge and other psychosocial factors on EBF practice among pregnant and postpartum women in rural Nyanza, Kenya, an area with a high prevalence of HIV.
  
  
  METHODS
  Data on baseline characteristics and knowledge during pregnancy, as well as infant feeding practices 4-8 weeks after the birth were obtained from 281 pregnant women recruited from nine antenatal clinics. Factors examined included: fear of HIV/AIDS stigma, male partner reactions, lack of disclosure to family members, knowledge of prevention of mother-to-child transmission (PMTCT) and mental health. In the analysis, comparisons were made using chi-squared and t-test methods as well as logistic multivariate regression models.
  
  
  RESULTS
  There were high levels of anticipated stigma 171(61.2%), intimate partner violence 57(20.4%) and postpartum depression 29(10.1%) and low levels of disclosure among HIV positive women 30(31.3%). The most significant factors determining EBF practice were hospital delivery (aOR = 2.1 95% CI 1.14-3.95) HIV positive serostatus (aOR 2.5 95% CI 1.23-5.27), and disclosure of HIV-positive serostatus (aOR 2.9 95% CI 1.31-6.79). Postpartum depression and PMTCT knowledge were not associated with EBF (aOR 1.1 95% CI 0.47-2.62 and aOR 1.2 95% CI 0.64-2.24) respectively.
  
  
  CONCLUSIONS
  Health care workers and counselors need to receive support in order to improve skills required for diagnosing, monitoring and managing psychosocial aspects of the care of pregnant and HIV positive women including facilitating disclosure to male partners in order to improve both maternal and child health outcomes.
authors.affiliation: Kenya Medical Research Institute (KEMRI), Kisumu, Kenya. maricianah@yahoo.com.
authors.forename: Maricianah A
authors.initials: MA
authors.lastname: Onono
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
authors.forename: Mable
authors.initials: M
authors.lastname: Jerop
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Janet M
authors.initials: JM
authors.lastname: Turan
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D019052:Depression, Postpartum / Q000453:epidemiology; D030881:Disclosure; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006679:HIV Seropositivity / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D007630:Kenya; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D012424:Rural Population; D057545:Social Stigma; D011795:Surveys and Questionnaires; D055815:Young Adult
references.citation: AIDS Behav. 2011 Aug;15(6):1111-20
references.pmid: 20827573
references.citation: Bull World Health Organ. 2006 Feb;84(2):90-6
references.pmid: 16501725
references.citation: J Int AIDS Soc. 2012 Feb 22;15(1):8
references.pmid: 22353553
references.citation: Hum Resour Health. 2007 Jul 24;5:18
references.pmid: 17650310
references.citation: N Engl J Med. 2008 Jul 10;359(2):189-91
references.pmid: 18525037
references.citation: AIDS Care. 2010;22 Suppl 1:6-13
references.pmid: 20680855
references.citation: BMC Health Serv Res. 2010 Sep 06;10:260
references.pmid: 20815932
references.citation: Pan Afr Med J. 2011;8:51
references.pmid: 22121458
references.citation: AIDS Care. 2012;24(9):1173-80
references.pmid: 22799618
references.citation: Dev World Bioeth. 2008 Apr;8(1):43-50
references.pmid: 18302543
references.citation: Am J Public Health. 2008 Oct;98(10):1865-71
references.pmid: 18703447
references.citation: Br J Psychiatry. 1987 Jun;150:782-6
references.pmid: 3651732
references.citation: Bull World Health Organ. 2004 Apr;82(4):299-307
references.pmid: 15259260
references.citation: BMC Psychiatry. 2007 Apr 04;7:11
references.pmid: 17408479
references.citation: PLoS Med. 2012;9(8):e1001295
references.pmid: 22927800
references.citation: Lancet. 2007 Mar 31;369(9567):1107-16
references.pmid: 17398310
references.citation: AIDS Care. 2007 May;19(5):674-6
references.pmid: 17505929
references.citation: Pediatrics. 2009 Apr;123(4):e736-51
references.pmid: 19336362
references.citation: Lancet. 2003 Jun 28;361(9376):2226-34
references.pmid: 12842379
references.citation: Med Anthropol. 1996 May;17(1):39-63
references.pmid: 8757712
references.citation: AIDS Care. 2002 Jun;14(3):431-3
references.pmid: 12042089
references.citation: AIDS. 2005 Oct 14;19(15):1719-20; author reply 1720-1
references.pmid: 16184057
references.citation: Afr Health Sci. 2011 Sep;11(3):464-73
references.pmid: 22275941
references.citation: Patient Educ Couns. 2014 Mar;94(3):438-41
references.pmid: 24316053
references.citation: AIDS Care. 2007 Oct;19(9):1101-9
references.pmid: 18058394
references.citation: Arch Womens Ment Health. 2006 Nov;9(6):309-15
references.pmid: 17013761
references.citation: SAHARA J. 2007 May;4(1):544-55
references.pmid: 18040533
references.citation: Int Breastfeed J. 2010 Oct 26;5:12
references.pmid: 20977711
references.citation: Soc Sci Med. 2009 Sep;69(6):821-9
references.pmid: 19559512
references.citation: AIDS Care. 2008 Mar;20(3):337-45
references.pmid: 18351482