title: Breastfeeding and Complementary Feeding Practices among HIV-Exposed Infants in Coastal Tanzania.
abstract: BACKGROUND
  Appropriate infant feeding is a persistent challenge for human immunodeficiency virus (HIV)-infected mothers in sub-Saharan Africa.
  
  
  OBJECTIVE
  This study aimed to describe correlates of infant feeding among HIV-infected mothers in coastal Tanzania.
  
  
  METHODS
  HIV-infected women (n = 400) with infants younger than 18 months were enrolled from June to November 2011 from 3 public health facilities in Pwani, Tanzania: Tumbi Regional Hospital (TRH), Chalinze Health Center (CHC), and Bagamoyo District Hospital (BDH). Participants were surveyed about sociodemographics and infant feeding behavior at enrollment; infant feeding data were collected prospectively and retrospectively in the month of study follow-up.
  
  
  RESULTS
  Statistically significant correlates of exclusive breastfeeding (EBF) were infant age (months) (adjusted odds ratio [AOR] = 0.6; 95% confidence interval [CI], 0.5-0.9), enrollment facility (TRH: reference; CHC: AOR = 5.0, 95% CI, 1.2-20.8; BDH: AOR = 11.6, 95% CI, 2.3-59.9), and HIV disclosure to one's mother (AOR = 0.2; 95% CI, 0.1-0.6). Exclusive breastfeeding prevalence among infants younger than 6 months was 77%, but 50% of infants older than 6 months no longer receiving breast milk did not receive animal source foods (ASF) daily. Enrollment facility (TRH: reference; CHC: AOR = 0.2, 95% CI, 0.1-1.0; BDH: AOR = 0.1, 95% CI, 0.01-0.4) and HIV disclosure (to mother-in-law: AOR = 0.2, 95% CI, 0.1-0.8; to brother: AOR = 0.3, 95% CI, 0.1-0.8) were negatively associated with ASF provision.
  
  
  CONCLUSIONS
  High prevalence of EBF suggests that it is an attainable behavior, whereas low prevalence of daily ASF provision suggests that adequate diets are difficult to achieve after breastfeeding cessation. These findings support current recommendations for HIV-infected mothers in resource-poor regions to continue breastfeeding for at least 1 year and suggest the need for greater support with complementary feeding. Associations between HIV disclosure and infant feeding merit further exploration, and correlations between enrollment facility and infant feeding highlight the potential influence of clinics on achieving infant feeding recommendations.
authors.affiliation: Program in International and Community Nutrition, University of California, Davis, CA, USA amwilliams@ucdavis.edu.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Williams
authors.affiliation: Program in International and Community Nutrition, University of California, Davis, CA, USA Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Chantry
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Eveline L
authors.initials: EL
authors.lastname: Geubbels
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Astha K
authors.initials: AK
authors.lastname: Ramaiya
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Aloisia I
authors.initials: AI
authors.lastname: Shemdoe
authors.affiliation: Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tancredi
authors.affiliation: Department of Population Medicine & Diagnostic Sciences, Program in International Nutrition, Cornell University, Ithaca, NY, USA.
authors.forename: Sera L
authors.initials: SL
authors.lastname: Young
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D003906:Developing Countries; D005195:Family Relations; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data*; D007225:Infant Food / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D011446:Prospective Studies; D011897:Random Allocation; D012189:Retrospective Studies; D012944:Social Support; D013636:Tanzania; D014886:Weaning
keywords: Africa; Tanzania; animal source foods; breastfeeding; complementary feeding; disclosure; human immunodeficiency virus