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Abstract：
BACKGROUND: Exclusive breastfeeding (EBF) in the first six months remains low globally, despite known benefits of lower morbidity and mortality among breastfed infants. It is important to understand factors associated with breastfeeding to support optimal breastfeeding practices, particularly in settings with a high burden of HIV.
METHODS: We analyzed data from a population-level survey of mother-infant pairs attending 6-week or 9-month immunizations at 141 clinics across Kenya. Primary outcomes included maternal report of (1) EBF at 6-week visit, defined as currently feeding the infant breast milk only, (2) EBF for the first 6-months of life, defined as breastfeeding or feeding the infant breast milk only with no introduction of other liquids or solid foods until 6 months, and (3) continued breastfeeding with complementary feeding at 9-months. Correlates of breastfeeding practices were assessed using generalized Poisson regression models accounting for facility-level clustering.
RESULTS: Among 1662 mothers at 6-weeks, nearly all self-reported breastfeeding of whom 93% were EBF. Among 1180 mothers at 9-months, 99% had ever breastfed, 94% were currently breastfeeding and 73% reported 6-month EBF. At 6-weeks, younger age (< 25 years) (adjusted Prevalence Ratio (aPR) 0.96; 95% CI 0.93, 0.99), lower education (aPR 0.96; 95% CI 0.93, 0.99) and recent infant illness (aPR 0.97; 95% CI 0.94, 1.00) were associated with lower EBF prevalence while women living with HIV (WLWH) had higher EBF prevalence (aPR 1.06; 95% CI 1.02, 1.10) than women without HIV. 6-month EBF prevalence was 26% higher in WLWH (aPR 1.26; 95% CI 1.15, 1.35) than women without HIV, 14% lower in women reporting mild or above depressive symptoms (aPR 0.86; 95% CI 0.76, 0.99) than those with none or minimal depressive symptoms, and 15% lower in women with versus without history of intimate partner violence (aPR 0.85; 95% CI 0.74, 0.98). At 9-months, WLWH had a lower prevalence of continued breastfeeding with complementary feeding (aPR 0.73; 95% CI 0.64, 0.84) than women without HIV.
CONCLUSIONS: WLWH had higher EBF prevalence in the first 6-months, but lower prevalence of continued breastfeeding at 9-months. Strategies to support EBF and continued breastfeeding beyond 6-months postpartum, particularly among WLWH, are needed.
METHODS: We analyzed data from a population-level survey of mother-infant pairs attending 6-week or 9-month immunizations at 141 clinics across Kenya. Primary outcomes included maternal report of (1) EBF at 6-week visit, defined as currently feeding the infant breast milk only, (2) EBF for the first 6-months of life, defined as breastfeeding or feeding the infant breast milk only with no introduction of other liquids or solid foods until 6 months, and (3) continued breastfeeding with complementary feeding at 9-months. Correlates of breastfeeding practices were assessed using generalized Poisson regression models accounting for facility-level clustering.
RESULTS: Among 1662 mothers at 6-weeks, nearly all self-reported breastfeeding of whom 93% were EBF. Among 1180 mothers at 9-months, 99% had ever breastfed, 94% were currently breastfeeding and 73% reported 6-month EBF. At 6-weeks, younger age (< 25 years) (adjusted Prevalence Ratio (aPR) 0.96; 95% CI 0.93, 0.99), lower education (aPR 0.96; 95% CI 0.93, 0.99) and recent infant illness (aPR 0.97; 95% CI 0.94, 1.00) were associated with lower EBF prevalence while women living with HIV (WLWH) had higher EBF prevalence (aPR 1.06; 95% CI 1.02, 1.10) than women without HIV. 6-month EBF prevalence was 26% higher in WLWH (aPR 1.26; 95% CI 1.15, 1.35) than women without HIV, 14% lower in women reporting mild or above depressive symptoms (aPR 0.86; 95% CI 0.76, 0.99) than those with none or minimal depressive symptoms, and 15% lower in women with versus without history of intimate partner violence (aPR 0.85; 95% CI 0.74, 0.98). At 9-months, WLWH had a lower prevalence of continued breastfeeding with complementary feeding (aPR 0.73; 95% CI 0.64, 0.84) than women without HIV.
CONCLUSIONS: WLWH had higher EBF prevalence in the first 6-months, but lower prevalence of continued breastfeeding at 9-months. Strategies to support EBF and continued breastfeeding beyond 6-months postpartum, particularly among WLWH, are needed.
摘要：
背景：全球前六个月的纯母乳喂养（EBF）仍然很低，尽管已知母乳喂养婴儿发病率和死亡率较低的益处。重要的是要了解与母乳喂养相关的因素，以支持最佳的母乳喂养做法，特别是在艾滋病毒负担较高的环境中。
方法：我们分析了来自肯尼亚141个诊所进行6周或9个月免疫的母婴对人群水平调查的数据。主要结局包括产妇报告（1）6周访视时的EBF，定义为目前仅喂养婴儿母乳，(2)生命最初6个月的EBF，定义为母乳喂养或喂养婴儿母乳，仅在6个月前不引入其他液体或固体食物，（3）在9个月时继续母乳喂养并补充喂养。使用广义Poisson回归模型评估了母乳喂养实践的相关性，该模型考虑了设施级别的聚类。
结果：在6周的1662名母亲中，几乎所有自我报告的母乳喂养，其中93%为EBF。在9个月的1180名母亲中，99%的人曾经母乳喂养过，94%的人目前是母乳喂养，73%的人报告了6个月的EBF。6周时,年龄较小（<25岁）（调整后的患病率（APR）0.96；95%CI0.93，0.99），较低的受教育程度(aPR0.96;95%CI0.93,0.99)和近期婴儿疾病(aPR0.97;95%CI0.94,1.00)与较低的EBF患病率相关,而感染HIV的女性(WLWH)的EBF患病率高于未感染HIV的女性(aPR1.06;95%CI1.02,1.10).WLWH的6个月EBF患病率比没有艾滋病毒的女性高26％（aPR1.26;95％CI1.15，1.35），报告轻度或以上抑郁症状的女性（aPR0.86;95％CI0.76,0.99）比无抑郁症状或轻度抑郁症状的女性低14％，与没有亲密伴侣暴力史的女性相比，低15%(aPR0.85;95%CI0.74,0.98)。9个月时,WLWH的持续母乳喂养与补充喂养的患病率较低（aPR0.73;95％CI0.64，0.84）。
结论：WLWH在前6个月有较高的EBF患病率，但9个月时持续母乳喂养的患病率较低。支持EBF和持续母乳喂养超过产后6个月的策略，特别是在WLWH中，是需要的。
方法：我们分析了来自肯尼亚141个诊所进行6周或9个月免疫的母婴对人群水平调查的数据。主要结局包括产妇报告（1）6周访视时的EBF，定义为目前仅喂养婴儿母乳，(2)生命最初6个月的EBF，定义为母乳喂养或喂养婴儿母乳，仅在6个月前不引入其他液体或固体食物，（3）在9个月时继续母乳喂养并补充喂养。使用广义Poisson回归模型评估了母乳喂养实践的相关性，该模型考虑了设施级别的聚类。
结果：在6周的1662名母亲中，几乎所有自我报告的母乳喂养，其中93%为EBF。在9个月的1180名母亲中，99%的人曾经母乳喂养过，94%的人目前是母乳喂养，73%的人报告了6个月的EBF。6周时,年龄较小（<25岁）（调整后的患病率（APR）0.96；95%CI0.93，0.99），较低的受教育程度(aPR0.96;95%CI0.93,0.99)和近期婴儿疾病(aPR0.97;95%CI0.94,1.00)与较低的EBF患病率相关,而感染HIV的女性(WLWH)的EBF患病率高于未感染HIV的女性(aPR1.06;95%CI1.02,1.10).WLWH的6个月EBF患病率比没有艾滋病毒的女性高26％（aPR1.26;95％CI1.15，1.35），报告轻度或以上抑郁症状的女性（aPR0.86;95％CI0.76,0.99）比无抑郁症状或轻度抑郁症状的女性低14％，与没有亲密伴侣暴力史的女性相比，低15%(aPR0.85;95%CI0.74,0.98)。9个月时,WLWH的持续母乳喂养与补充喂养的患病率较低（aPR0.73;95％CI0.64，0.84）。
结论：WLWH在前6个月有较高的EBF患病率，但9个月时持续母乳喂养的患病率较低。支持EBF和持续母乳喂养超过产后6个月的策略，特别是在WLWH中，是需要的。
