Breastfeeding and Complementary Feeding Practices among HIV-Exposed Infants in Coastal Tanzania.

Abstract

Appropriate infant feeding is a persistent challenge for human immunodeficiency virus (HIV)-infected mothers in sub-Saharan Africa. This study aimed to describe correlates of infant feeding among HIV-infected mothers in coastal Tanzania. 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. 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. 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.