Determinants of infant feeding choices by Zambian mothers: a mixed quantitative and qualitative study
Determinants of infant feeding choices by Zambian mothers: a mixed quantitative and qualitative study
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DOI：
10.1111/j.1740-8709.2010.00264.x
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发表时间：
2011-04-01
影响因子：
3.4
通讯作者：
Filteau, Suzanne
中科院分区：
文献类型：
--
作者：
Chisenga, Molly;Siame, Joshua;Filteau, Suzanne
对于感染人类免疫缺陷病毒（HIV）的非洲女性来说，选择婴儿喂养方式是复杂的。我们记录了811名年龄小于18个月婴儿的母亲在奇伦杰婴儿生长、营养和强化补充或替代食品感染研究中的婴儿喂养选择。我们还在女性和护士中进行了20次访谈和4次焦点小组讨论，以深入探讨相关问题。大多数感染HIV的女性的做法没有严格遵循国家或国际指南：26%的女性从未开始母乳喂养，55%的女性在产后6个月时已停止母乳喂养。社会经济地位较低的女性以及那些不符合安全替代喂养标准的女性更有可能开始母乳喂养，持续时间更长，并且在试验中获得免费食物的情况下在6个月时停止母乳喂养。大多数HIV阴性女性和HIV感染状况不明的女性在婴儿第二年时仍继续母乳喂养，这表明为感染HIV的女性设计的婴儿喂养信息对未感染人群的“溢出效应”有限。定性研究表明，影响感染HIV的女性婴儿喂养决策的主要因素是配方奶粉的成本、卫生工作者的建议、亲属的影响、耻辱感以及采用单一喂养方式的困难。快速变化的国际建议让母亲和护士都感到困惑。许多感染HIV的女性在不符合安全标准的情况下选择了替代喂养。女性受到卫生工作者的影响，但由于多种原因，很难遵循他们的建议。最近修订的国际HIV和婴儿喂养建议可能会使卫生工作者的咨询过程更简单，也使感染HIV的女性更容易遵循他们的建议。
Choosing an infant feeding mode is complex for human immunodeficiency virus (HIV)-infected African women. We documented infant feeding choices by 811 mothers of infants aged less than 18 months enrolled in the Chilenje Infant Growth, Nutrition and Infection Study of fortified complementary or replacement foods. We also conducted 20 interviews and 4 focus group discussions among women and nurses to explore the issues in depth. Practices of most HIV-infected women did not closely follow national or international guidelines: 26% never initiated breastfeeding, and 55% were not breastfeeding by 6 months post partum. Women of lower socio-economic status and those not meeting criteria for safe replacement feeding were more likely to initiate breastfeeding, to continue longer and to stop at 6 months when provided with free food within the trial. Most HIV-negative women and women of unknown HIV status continued breastfeeding into the infant's second year, indicating limited 'spillover' of infant feeding messages designed for HIV-infected women into the uninfected population. Qualitative work indicated that the main factors affecting HIV-infected women's infant feeding decisions were the cost of formula, the advice of health workers, influence of relatives, stigma and difficulties with using an exclusive feeding mode. Rapidly changing international recommendations confused both mothers and nurses. Many HIV-infected women chose replacement feeding without meeting criteria to do this safely. Women were influenced by health workers but, for several reasons, found it difficult to follow their advice. The recently revised international HIV and infant feeding recommendations may make the counselling process simpler for health workers and makes following their advice easier for HIV-infected women.