[pronut-hiv] Counseling and Support for Breast-Feeding in South Africa

["ProNut-HIV" <pronut-hiv@healthnet.org>]

Cross-posted from [PMTCTforum]
Breast Health Problems Are Rare in Both HIV-Infected and HIV-Uninfected
Women Who Receive Counseling and Support for Breast-Feeding in South
Africa

Background. Breast problems, including mastitis, can interfere with the
duration and exclusivity of breast-feeding. However, there are no large prospective studies documenting the prevalence, duration, and timing of such problems in breast-feeding women, particularly those who are infected with human immunodeficiency virus (HIV).

Methods. Women enrolled prenatally underwent a breast-feeding counseling
intervention until 6 months after delivery. Breast health problems were documented per breast for 180 days after delivery, with
14-day recall histories.
Results. Breast health problems were rare, and there were no significant
differences between HIV-infected and HIV-uninfected
women for any of the following conditions: engorgement, 39 HIV-infected
women (3.5%) versus 33 HIV-uninfected women (2.7%; Pp.30) breast thrush, 17 (1.5%) versus 12 (1.0%; Pp.25); 
bleeding nipple, 6 (0.5%) versus 4 (0.3%; Pp.45); and
mastitis/abscess, 11 (1.0%) versus 6 (0.5%; Pp.17).

 Most problems occurred during the first month after birth, with few additional mothers experiencing problems after this point: at 1 and 6 months, 13% and 17% of all mothers, respectively, had experienced
a minor or major breast health problem, including sore nipples. Women
who had not exclusively breast-fed their infants were
more likely to experience any of the breast health problems than were
women who had exclusively breast-fed their infants (time dependent
variable; adjusted odds ratio, 1.46; 95% confidence interval,
1.13-1.87;Pp.003). HIV-infected women who experienced
any serious breast health problem (i.e., bleeding nipple, pus oozing
from a nipple or breast, or mastitis/abscess) were 3.55 times
(95% confidence interval, 0.86-14.78 times; Pp.08) more likely to
transmit HIV postnatally to their infant.

Conclusions. With encouragement to exclusively breast-feed, women
experienced few breast health problems. When those
problems did occur, HIV-infected women with bleeding nipple, pus oozing
from a nipple or breast, or mastitis/abscess were more
likely to transmit HIV to their infants.