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Intervention to promote exclusive breast-feeding for the first 6 months of life in a high HIV prevalence area

Bland, Ruth Ma,b; Little, Kirsty Ec; Coovadia, Hoosen Md; Coutsoudis, Annae; Rollins, Nigel Ce; Newell, Marie-Louisea,c

doi: 10.1097/QAD.0b013e3282f768de
Epidemiology and Social

Objectives: We report on a nonrandomized intervention cohort study to increase exclusive breast-feeding rates for 6 months after delivery in HIV-positive and HIV-negative women in KwaZulu-Natal, South Africa.

Methods: Lay counselors visited women to support exclusive breast-feeding: four times antenatally, four times in the first 2 weeks postpartum and then fortnightly to 6 months. Daily feeding practices were collected at weekly intervals by separate field workers. Cumulative exclusive breast-feeding rates from birth were assessed by Kaplan–Meier analysis and association with maternal and infant variables was quantified in a Cox regression analysis.

Findings: One thousand, two hundred and nineteen infants of HIV-negative and 1217 infants of HIV-positive women were followed postnatally. Median duration of exclusive breast-feeding was 177 (R = 1–180; interquartile range: 150–180) and 175 days (R = 1–180; interquartile range: 137–180) in HIV-negative and HIV-positive women, respectively. Using 24-h recall, exclusive breast-feeding rates at 3 and 5 months were 83.1 and 76.5%, respectively, in HIV-negative women and 72.5 and 66.7%, respectively, in HIV-positive women. Using the most stringent cumulative data, 45% of HIV-negative and 40% of HIV-positive women adhered to exclusive breast-feeding for 6 months. Counseling visits were strongly associated with adherence to cumulative exclusive breast-feeding at 4 months, those who had received the scheduled number of visits were more than twice as likely to still be exclusively breast-feeding than those who had not (HIV-negative women: adjusted odds ratio: 2.07, 95% confidence interval: 1.56–2.74, P < 0.0001; HIV-positive women: adjusted odds ratio: 2.86, 95% CI 2.13–3.83, P < 0.0001).

Conclusion: It is feasible to promote and sustain exclusive breast-feeding for 6 months in both HIV-positive and HIV-negative women, with home support from well trained lay counselors.

From the aAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, KwaZulu-Natal, South Africa

bDivision of Developmental Medicine, University of Glasgow, Glasgow, UK

cCentre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College, London, UK

dCentre for HIV/AIDS Networking, South Africa

eDepartment of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa.

Received 16 October, 2007

Revised 14 December, 2007

Accepted 9 January, 2008

Correspondence to Dr Ruth Bland, Africa Centre for Health and Population Studies, P.O. Box 198, Mtubatuba, KwaZulu-Natal 3935, South Africa. Tel: +27 35 550 7500; fax: +27 35 550 7565; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.