Early cessation of breastfeeding amongst women in South Africa: an area needing urgent attention to improve child health
Doherty, T.; Sanders, D.; Jackson, D.; Swanevelder, S.; Lombard, C.; Zembe, W.; Chopra, M.; Goga, A.; Colvin, M.; Fadnes, L.T.; Engebretsen, I.M.S.; Ekström, E-Charlotte.; Tylleskär, T.; Tylleskär, T.; Van de Perre, P.; Ekström, E-Charlotte.; Meda, N.; Tumwine, J.K.; Kankasa, C.; Jackson, D.; Engebretsen, I.M.S.; Fadnes, L.T.; Falnes, E.Fjeld.; Fylkesnes, K.; Klungsøyr, Jørn.; Nordrehaug-Åstrøm, A.; Olsen, Øystein.Evjen.; Robberstad, B.; Sommerfelt, H.; Nor, B.; Diallo, A.Hama.; Ouedrag
Bmc Pediatrics 12: 105
2012
ISSN/ISBN: 1471-2431 PMID: 22827969 DOI: 10.1186/1471-2431-12-105Document Number: 565354
Breastfeeding is a critical component of interventions to reduce child mortality. Exclusivebreastfeeding practice is extremely low in South Africa and there has been no improvementin this over the past ten years largely due to fears of HIV transmission. Early cessation ofbreastfeeding has been found to have negative effects on child morbidity and survival inseveral studies in Africa. This paper reports on determinants of early breastfeeding cessationamong women in South Africa. This is a sub group analysis of a community-based cluster-randomized trial (PROMISE EBF)promoting exclusive breastfeeding in three South African sites (Paarl in the Western CapeProvince, and Umlazi and Rietvlei in KwaZulu-Natal) between 26 and 28(ClinicalTrials.gov no: NCT39715). Infant feeding recall of 22 food and fluid items wascollected at 3, 6, 12 and 24 weeks postpartum. Women's experiences of breast healthproblems were also collected at the same time points. 999 women who ever breastfed wereincluded in the analysis. Univariable and multivariable logistic regression analysis adjustingfor site, arm and cluster, was performed to determine predictors of stopping breastfeeding by12 weeks postpartum. By 12 weeks postpartum, 2% of HIV-negative women and 4% of HIV-positive women hadstopped all breastfeeding. About a third of women introduced other fluids, most commonlyformula milk, within the first 3 days after birth. Antenatal intention not to breastfeed andbeing undecided about how to feed were most strongly associated with stoppingbreastfeeding by 12 weeks (Adjusted odds ratio, AOR 5.6, 95% CI 3.4 - 9.5 and AOR 4.1,95% CI 1.6 - 1.8, respectively). Also important was self-reported breast health problemsassociated with a 3-fold risk of stopping breastfeeding (AOR 3.1, 95%CI 1.7 - 5.7) and themother having her own income doubled the risk of stopping breastfeeding (AOR 1.9, 95% CI1.3 - 2.8 ). Early cessation of breastfeeding is common amongst both HIV-negative and positive womenin South Africa. There is an urgent need to improve antenatal breastfeeding counsellingtaking into account the challenges faced by working women as well as early postnatallactation support to prevent breast health problems.