Adherence to Optimal Breastfeeding Practices Among HIV-Positive Mothers in Kilimanjaro, Tanzania

Rune Nathaniel Philemon; Blandina T Mmbaga; John Bartlett; Jenny Renju; Tara B Mtuy; Innocent B Mboya; Sia E Msuya

doi:10.2147/PPA.S343213

Adherence to Optimal Breastfeeding Practices Among HIV-Positive Mothers in Kilimanjaro, Tanzania

Patient Prefer Adherence. 2022 Mar 30:16:841-852. doi: 10.2147/PPA.S343213. eCollection 2022.

Authors

Rune Nathaniel Philemon¹, Blandina T Mmbaga^{1

2}, John Bartlett³, Jenny Renju^{4

5}, Tara B Mtuy^{4

6}, Innocent B Mboya^{4

7

8}, Sia E Msuya^{4

7

9}

Affiliations

¹ Department of Pediatrics and Child Health, Kilimanjaro Christian Medical University College (KCMUCo) & Kilimanjaro Christian Medical Centre (KCMC), Moshi, Kilimanjaro, Tanzania.
² Department of Research, Kilimanjaro Clinical Research Institute (KCRI), Moshi, Kilimanjaro, Tanzania.
³ Duke Global Health Institute, Duke University, Durham, NC, USA.
⁴ Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania.
⁵ Department of Population Studies, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK.
⁶ Faculty of Public Health and Policy and the Department of Global Health and Development, London School of Hygiene & Tropical Medicine (LSHTM), London, UK.
⁷ Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania.
⁸ School of Mathematics, Statistics & Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
⁹ Department of Community Health, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Kilimanjaro, Tanzania.

Abstract

Purpose: We sought to assess how HIV-positive mothers enrolled in the PMTCT program adhere to breastfeeding recommendations concerning early initiation of breastfeeding (EIBF), ie, within one hour of birth, pre-lacteal feeds, exclusive breastfeeding until six months (EBF), and continued breastfeeding to one year of age. This study was designed to assess the practices in response to changing recommendations for breastfeeding in HIV, which have differed drastically over the years.

Patients and methods: We recruited 524 mother-child pairs from 37 PMTCT clinics across Kilimanjaro, Tanzania. The 5 clinics with the highest patient load in each of the 7 districts of Kilimanjaro were chosen, plus the zonal and municipal referral hospitals. The children were below two years of age and currently in the PMTCT program. We administered a questionnaire to assess the mother's practices in feeding the child. We used multiple logistic regression models to determine factors associated with EIBF, EBF, and continued breastfeeding.

Results: EIBF was achieved for 73.1% of babies. Cesarean delivery, low birth weight, and partner disclosure of HIV status were significant risk factors for not achieving EIBF. About 19% of children did not breastfeed exclusively. Of the 247 children ≥12 months old, 43.3% had stopped breastfeeding before 12 months. Counseling on ARV, having had >2 pregnancies while HIV-positive and EBF were associated with breastfeeding until 12 months old. Using ART for more than two years decreased the odds of EBF and continued breastfeeding to 12 months of age.

Conclusion: Adherence to breastfeeding recommendations for HIV-positive women is suboptimal, particularly in aspects of recent changes in recommendations such as continuing breastfeeding for one year. There is a missed opportunity for interventions such as counseling, which has shown to favor adherence. Health education and counseling are needed for providers and mothers to keep them abreast with the frequently changing recommendations.

Keywords: continued breastfeeding; early initiation; exclusive breastfeeding; feeding recommendations.