scholarly journals Breastfeeding cessation in the era of Elimination of Mother to Child Transmission of HIV in Uganda: a retrospective cohort study

2020 ◽  
Author(s):  
Jackslina Gaaniri Ngbapai ◽  
Jonathan Izudi ◽  
Stephen Okoboi
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hiv Care ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Risk Of Death ◽  
One Year ◽  
Living With Hiv ◽  
Mother To Child

Abstract Background: Breastfeeding an infant exposed to HIV carries the risk of HIV acquisition whilst not breastfeeding poses higher risk of death from malnutrition, diarrhea, and pneumonia. In Uganda, mothers living with HIV are encouraged to discontinue breastfeeding at 12 months but data are limited. We examined the frequency and factors associated with cessation of breastfeeding at one year among mothers living with HIV at Ndejje Health Center IV, a large peri-urban health facility in Uganda.Methods: This retrospective cohort study involved all mothers living with HIV enrolled in HIV care for ≥12 months between June 2014 and June 2018. We abstracted data from registers, held focus group discussions with mothers living with HIV and key informant interviews with healthcare providers. Cessation of breastfeeding was defined as the proportion of mothers living with HIV who had discontinued breastfeeding at one year. We summarized quantitative data descriptively, tested differences in outcome using Chi-square and t-tests, and established independently associated factors using modified Poisson regression analysis at 5% statistical significance level. We thematically analyzed qualitative data to enrich and triangulate the quantitative results. Results: Of 235 participants, 150 (63.8%) had ceased breastfeeding at one year and this was independently associated with the infant being female (Adjusted risk ratio (aRR): 1.25, 95% confidence interval (CI), 1.04, 1.50), the mother being multiparous (aRR, 1.26; 95%CI, 1.04-1.53), and the initiation of breastfeeding being on the same-day as birth (aRR, 0.06; 95%CI, 0.01-0.41).The reasons for ceasing breastfeeding included male infants over breastfeed than females, maternal literacy and knowledge adequacy about breastfeeding, support and reminders from the partner, and boys can bite once they get teeth. Conversely, the reasons for not ceasing to breastfeed encompassed insufficient knowledge about breastfeeding and girls feed a bit less.Conclusion: Suboptimal proportion of infants were ceased from breastfeeding at one year and this might increase the risk of mother to child transmission of HIV. Cessation of breastfeeding was more likely among female infants and multiparous mothers but less likely when breastfeeding was initiated on same-day as birth. Interventions to enhance cessation of breastfeeding should target groups of mothers with lower rates.

scholarly journals Cessation of breastfeeding and associated factors in the era of elimination of mother to child transmission of HIV at Ndejje Health Center, Uganda: a retrospective cohort study

2020 ◽  
Author(s):  
Jackslina Gaaniri Ngbapai ◽  
Jonathan Izudi ◽  
Stephen Okoboi
Keyword(s):  
Cohort Study ◽  
Health Center ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Associated Factors ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
One Year ◽  
Living With Hiv ◽  
Mother To Child

Abstract BackgroundBreastfeeding an infant exposed to Human Immunodeficiency Virus (HIV) carries the risk of HIV acquisition whilst not breastfeeding poses a higher risk of death from malnutrition, diarrhea, and pneumonia. In Uganda, mothers living with HIV are encouraged to discontinue breastfeeding at 12 months but data are limited. We examined the frequency and factors associated with cessation of breastfeeding at one year among mothers living with HIV at Ndejje Health Center IV, a large peri-urban health facility in Uganda.MethodsThis retrospective cohort study involved all mothers living with HIV and enrolled in HIV care for ≥ 12 months between June 2014 and June 2018. We abstracted data from registers, held focus group discussions with mothers living with HIV and key informant interviews with healthcare providers. Cessation of breastfeeding was defined as the proportion of mothers living with HIV who had discontinued breastfeeding at one year. We summarized quantitative data descriptively, tested differences in outcome using Chi-square and t - tests, and established independently associated factors using modified Poisson regression analysis at 5 % statistical significance level. We thematically analyzed qualitative data to enrich and triangulate the quantitative results. ResultsOf 235 participants, 150 (63.8 %) had ceased breastfeeding at one year and this was independently associated with the infant being male (Adjusted Risk Ratio [aRR] 1.25, 95 % confidence interval [CI] 1.04, 1.50), the mother being multiparous (aRR 1.26, 95 % CI 1.04-1.53), and the initiation of breastfeeding being on the same-day as birth (aRR 0.06, 95 % CI 0.01-0.41). The reasons for ceasing breastfeeding included male infants over breastfeed than females, maternal literacy and knowledge adequacy about breastfeeding, support and reminders from the partner, and boys can bite once they get teeth. ConclusionSuboptimal proportion of infants were ceased from breastfeeding at one year and this might increase the risk of mother to child transmission of HIV. Cessation of breastfeeding was more likely among male infants and multiparous mothers but less likely when breastfeeding was initiated on the same-day as birth. Interventions to enhance cessation of breastfeeding should target none multiparous mothers and those with female infants.

scholarly journals Cessation of breastfeeding and associated factors in the era of elimination of mother to child transmission of HIV at Ndejje health center, Uganda: a retrospective cohort study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jackslina Gaaniri Ngbapai ◽  
Jonathan Izudi ◽  
Stephen Okoboi
Keyword(s):  
Cohort Study ◽  
Health Center ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Associated Factors ◽  
Hiv Care ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Living With Hiv ◽  
Mother To Child

Abstract Background Breastfeeding an infant exposed to Human Immunodeficiency Virus (HIV) carries the risk of HIV acquisition whilst not breastfeeding poses a higher risk of death from malnutrition, diarrhea, and pneumonia. In Uganda, mothers living with HIV are encouraged to discontinue breastfeeding at 12 months but data are limited. We examined the frequency and factors associated with cessation of breastfeeding at 1 year among mothers living with HIV at Ndejje Health Center IV, a large peri-urban health facility in Uganda. Methods This retrospective cohort study involved all mothers living with HIV and enrolled in HIV care for ≥12 months between June 2014 and June 2018. We abstracted data from registers, held focus group discussions with mothers living with HIV and key informant interviews with healthcare providers. Cessation of breastfeeding was defined as the proportion of mothers living with HIV who had discontinued breastfeeding at 1 year. We summarized quantitative data descriptively, tested differences in outcome using Chi-square and t - tests, and established independently associated factors using modified Poisson regression analysis at 5% statistical significance level. We thematically analyzed qualitative data to enrich and triangulate the quantitative results. Results Of 235 participants, 150 (63.8%) had ceased breastfeeding at 1 year and this was independently associated with the infant being male (Adjusted Risk Ratio [aRR] 1.25, 95% confidence interval [CI] 1.04, 1.50), the mother being multiparous (aRR 1.26, 95% CI 1.04–1.53), and the initiation of breastfeeding being on the same-day as birth (aRR 0.06, 95% CI 0.01–0.41). The reasons for ceasing breastfeeding included male infants over breastfeed than females, maternal literacy and knowledge adequacy about breastfeeding, support and reminders from the partner, and boys can bite once they get teeth. Conclusion Suboptimal proportion of infants were ceased from breastfeeding at 1 year and this might increase the risk of mother to child transmission of HIV. Cessation of breastfeeding was more likely among male infants and multiparous mothers but less likely when breastfeeding was initiated on the same-day as birth. Interventions to enhance cessation of breastfeeding should target none multiparous mothers and those with female infants.

scholarly journals Breastfeeding cessation in the era of Elimination of Mother to Child Transmission of HIV in Uganda: a retrospective cohort study

2020 ◽  
Author(s):  
Jackslina Gaaniri Ngbapai ◽  
Jonathan Izudi ◽  
Stephen Okoboi
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
World Health ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Breastfeeding Cessation ◽  
One Year ◽  
Postpartum Mothers ◽  
Mother To Child

Abstract Background To eliminate mother to child transmission of HIV (EMTCT), the World Health Organization (WHO) recommends that breastfeeding should cease at one year for infants born to HIV infected mothers but data are limited. We examined the magnitude and factors associated with breastfeeding cessation at one year among HIV infected postpartum mothers at Ndejje Health Center IV, a large peri-urban health facility in Uganda. Methods We conducted a retrospective cohort study involving all HIV infected postpartum mothers enrolled on EMTCT program for at least 12 months, between June 2014 and June 2018, abstracted data from EMTCT registers, held four focused group discussions with HIV infected postpartum mothers and four key informant interviews with healthcare providers. Breastfeeding cessation was defined as the proportion of HIV infected postpartum mothers who stopped breastfeeding an HIV exposed infant (HEI) at one year. We summarized quantitative data descriptively, tested differences in outcome with the Chi-square and t-tests, and established factors independently associated with breastfeeding cessation using modified Poisson regression analysis at 5% statistical significance level, and thematically analyzed qualitative data to enrich and triangulate the quantitative results. Results Of 235 HIV infected postpartum mothers, 150 (63.8%) ceased breastfeeding at one year and this was independently associated with the HEI being female than male (Adjusted risk ratio (aRR): 1.25, 95% confidence interval (CI), 1.04, 1.50), the mother being multiparous than primparous (aRR, 1.26; 95% CI, 1.04-1.53), and breastfeeding initiation on same day as birth (aRR, 0.06; 95% CI, 0.01-0.41). Qualitative results showed that maternal demands of work, high demand for breastfeeding among male HEIs, and low breastfeeding interest among primarous mothers were reasons for cessation of breastfeeding before one year. Conclusion Breastfeeding cessation at one year among HIV infected postpartum mothers was suboptimal. This might increase the risk of mother to child transmissions of HIV. Breastfeeding cessation at one year was more likely when the HEI was female than male and when the HIV infected postpartum mother was multiparous than primparous, but less likely when breastfeeding was initiated on same-day as birth. Interventions to enhance breastfeeding cessation at one year should target these areas.

scholarly journals Breastfeeding cessation in the era of Elimination of Mother to Child Transmission of HIV in Uganda: a retrospective cohort study

2020 ◽  
Author(s):  
Jackslina Gaaniri Ngbapai ◽  
Jonathan Izudi ◽  
Stephen Okoboi
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Statistical Significance ◽  
World Health ◽  
Hiv Care ◽  
Breastfeeding Initiation ◽  
One Year ◽  
Postpartum Mothers ◽  
Mother To Child

Abstract Background: Among human immunodeficiency (HIV) infected mothers, the World Health Organization (WHO) recommends cessation of breastfeeding at one year to prevent HIV transmission but data are limited. We examined the frequency and factors associated with cessation of breastfeeding at one year among HIV infected postpartum mothers at Ndejje Health Center IV, a large peri-urban health facility in Uganda. Methods: This retrospective cohort study involved all HIV infected postpartum mothers enrolled in HIV care for at least 12 months between June 2014 and June 2018. We abstracted data from registers, held focused group discussions with HIV infected postpartum mothers, and key informant interviews with healthcare providers. Cessation of breastfeeding was defined as the proportion of HIV infected postpartum mothers who had stopped breastfeeding at one year. We summarized quantitative data descriptively, tested differences in outcome with the Chi-square and t-tests, and established independently associated factors using the modified Poisson regression analysis at 5% statistical significance level. We thematically analyzed qualitative data to enrich and triangulate the quantitative results. Results: Of 235 HIV infected postpartum mothers, 150 (63.8%) ceased breastfeeding at one year and this was independently associated with the HIV exposed infant (HEI) being female than male (Adjusted risk ratio (aRR): 1.25, 95% confidence interval (CI), 1.04, 1.50), the mother being multiparous than primparous (aRR, 1.26; 95% CI, 1.04-1.53), and breastfeeding initiation on same-day as birth (aRR, 0.06; 95% CI, 0.01-0.41). Qualitative results showed that partner reminders about breastfeeding adequacy of BF knowledge and maternal literacy facilitated continued breastfeeding until one year. Inadequate breastfeeding knowledge, casual and formal work demands, in addition to increased breastfeeding demand among boys led to cessation of breastfeeding before one year.Conclusion. Cessation of breastfeeding at one year among HIV infected postpartum mothers was suboptimal and this might increase risk of mother to child transmissions of HIV. Cessation of breastfeeding was more likely among female HEIs and multiparous mothers, and less likely when breastfeeding is initiated on same-day as birth. Interventions to enhance cessation of breastfeeding at one year should target groups of women with lower rates.

scholarly journals Uptake of prevention of mother-to-child-transmission using Option B+ in northern rural Malawi: a retrospective cohort study

2014 ◽  
Vol 90 (4) ◽  
pp. 309-314 ◽  
Author(s):  
Alison J Price ◽  
Michael Kayange ◽  
Basia Zaba ◽  
Frank M Chimbwandira ◽  
Andreas Jahn ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Mother To Child

scholarly journals Evaluation of routine Isoniazid Preventive Therapy among People Living with HIV for reducing Tuberculosis; a retrospective cohort study in Tanzania (2012-2016)

2020 ◽  
Author(s):  
Werner Maokola ◽  
Bernard Ngowi ◽  
Lovett Lawson ◽  
Michael Mahande ◽  
Jim Todd ◽  
...  
Keyword(s):  
Cohort Study ◽  
Functional Status ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Scale Up ◽  
Preventive Therapy ◽  
Isoniazid Preventive Therapy ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Living With Hiv

Abstract Background: Isoniazid Preventive Therapy (IPT) reduced Tuberculosis (TB) among People Living with HIV (PLHIV). Despite this, uptake has been reported to be sub-optimal . We describe characteristics of visits in which PLHIV were screened TB negative (as the main source for IPT initiation), determine characteristics of visits in which PLHIV were initiated on IPT as well as determined factors associated with IPT initiation to inform program scale up and improve quality of service.Methods : Retrospective cohort study design which involved PLHIV enrolled into care and treatment clinics in Dar es Salaam, Iringa and Njombe regions from January 2012 to December 2016. The study aimed at evaluating implementation of IPT among PLHIV. Data analysis was conducted using STATA.Results: A total 173,746 were enrolled in CTC in the 3 regions during the period of follow up and made a total of 2,638,876 visits. Of the eligible visits, only 24,429 (1.26%) were initiated on IPT. In multivariate analysis, 50 years and more (aOR=3.42, 95% CI: 3.07-3.82, P<0.01), bedridden functional status individuals with bedridden functional status (aOR=4.56, 95% CI:2.45-8.49, P<0.01) and WHO clinical stage II had higher odds of IPT initiation (aOR=1.18, 95% CI:1.13-1.23, P<0.01). Furthermore, enrolment in 2016 (aOR=2.92, 95% CI:2.79-3.06, P<0.01), enrolment in hospitals (aOR=1.84, 95% CI:1.77-1.90, P<0.01), enrolment in public health facilities (aOR=1.82, 95% CI: 1.75-1.90, P<0.01) and been on care for more than one year (aOR=6.77, 95% CI: 5.25-8.73, P<0.000) were also more likely to be initiated on IPT. Enrollment in Iringa (aOR=0.44, 95% CI: 0.41-0.47, P<0.01) and good adherence (aOR=0.56, 95% CI 0.47-0.67, P<0.01) was less likely to be initiated on IPT.Conclusions: Our study documented low IPT initiation proportion among those who were enrolled in HIV care and eligible in the 3 regions during the study period. Variations in IPT initiation among regions signals different dynamics affecting IPT uptake in different regions and hence customized approaches in quality improvement. Implementation research is needed to understand health system as well as cultural barriers in the uptake of IPT intervention.

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