BACKGROUND Exclusive breastfeeding for the first six months of life is recommended for all infants. However, breastfeeding rates remain suboptimal; around 37% of infants are exclusively breastfed for the first six months globally. In Nyanza region, western Kenya, numerous challenges to breastfeeding have been identified, including food insecurity, hunger, depressive symptoms, and HIV infection. Yet, evidence to inform our understanding of how these problems influence women's breastfeeding behaviors across time is lacking. We therefore sought to examine these factors and how they interact to affect the initiation and duration of exclusive breastfeeding in this region. We hypothesized that women experiencing greater food insecurity, hunger, and/or depressive symptoms would be less likely to maintain exclusive breastfeeding for six months than women who were food secure or not depressed. We also hypothesized that women living with HIV would be more likely to maintain exclusive breastfeeding to six months compared to HIV-uninfected women. METHODS Women in Pith Moromo, a longitudinal cohort study in western Kenya, were surveyed at two antenatal and three postpartum timepoints (n = 275). Data were collected on breastfeeding behavior and self-efficacy, maternal food insecurity and hunger, maternal psychosocial health, and HIV status. Cox proportional hazards models were used to identify predictors of early exclusive breastfeeding cessation. RESULTS The majority of women (52.3%) exclusively breastfed for the first six months. In the final multivariable Cox proportional hazards model, living with HIV was associated with a 64% decrease in the rate of early exclusive breastfeeding cessation. Additionally, the rate of early exclusive breastfeeding cessation increased by 100 and 98% for those experiencing probable depression or hunger, respectively. Although there was no main effect of breastfeeding self-efficacy, the interaction between breastfeeding self-efficacy and hunger was significant, such that the rate of early exclusive breastfeeding cessation was predicted to decrease by 2% for every point increase in breastfeeding self-efficacy score (range: 0-56). CONCLUSIONS This study contributes to previous work demonstrating that women living with HIV more consistently exclusively breastfeed and suggests that rates of exclusive breastfeeding could be increased through targeted support that promotes maternal mental health and breastfeeding self-efficacy, while reducing maternal hunger. TRIAL REGISTRATION Study registration NCT02974972.

中文翻译：

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HIV 感染、饥饿、母乳喂养自我效能和抑郁症状与肯尼亚西部妇女六个月纯母乳喂养有关：一项纵向观察研究。


背景 建议所有婴儿在生命的前六个月进行纯母乳喂养。然而，母乳喂养率仍然不理想；全球约 37% 的婴儿在头六个月内接受纯母乳喂养。在肯尼亚西部的尼安萨地区，母乳喂养面临诸多挑战，包括粮食不安全、饥饿、抑郁症状和艾滋病毒感染。然而，缺乏证据来帮助我们了解这些问题如何影响女性的母乳喂养行为。因此，我们试图研究这些因素以及它们如何相互作用以影响该地区纯母乳喂养的开始和持续时间。我们假设，与粮食安全或不抑郁的女性相比，经历更严重粮食不安全、饥饿和/或抑郁症状的女性维持纯母乳喂养六个月的可能性较小。我们还假设，与未感染艾滋病毒的女性相比，感染艾滋病毒的女性更有可能维持纯母乳喂养至六个月。方法 Pith Moromo（肯尼亚西部的一项纵向队列研究）中的妇女在两个产前时间点和三个产后时间点进行了调查（n = 275）。收集了有关母乳喂养行为和自我效能、孕产妇粮食不安全和饥饿、孕产妇心理社会健康和艾滋病毒状况的数据。 Cox 比例风险模型用于确定早期纯母乳喂养停止的预测因素。结果 大多数女性 (52.3%) 在前六个月进行纯母乳喂养。在最终的多变量 Cox 比例风险模型中，感染 HIV 与早期纯母乳喂养停止率下降 64% 相关。 此外，对于那些可能患有抑郁症或饥饿的人来说，早期停止纯母乳喂养的比率分别增加了 100% 和 98%。尽管母乳喂养自我效能感没有主效应，但母乳喂养自我效能感与饥饿之间的交互作用显着，因此母乳喂养自我效能感得分每增加一点，早期纯母乳喂养停止率预计会下降 2% （范围：0-56）。结论 这项研究对之前的工作做出了贡献，证明感染艾滋病毒的妇女更一致地进行纯母乳喂养，并表明可以通过有针对性的支持来提高纯母乳喂养率，以促进孕产妇心理健康和母乳喂养自我效能，同时减少孕产妇饥饿。试用注册 研究注册 NCT02974972。