This section presents three subsections of the findings: 1) sociodemographic characteristics of the study population; 2) determinants of EFF relative to MF; and 3) determinants of EBF relative to MF
Sociodemographic characteristics of the study population
A preliminary description of sociodemographic variables was necessary because their distribution is a well-known potential source of variability among many outcome variables, including variations in infant feeding practices in mothers living with HIV [
36‐
38]. Hence, Table
1 summarizes the key demographic characteristics of the ACB mothers living with HIV.
Table 1
Socioeconomic characteristics of the mothers
Mothers’ age (categories) |
18–24 years | 2 (2.9) | 18 (4.5) | 15 (8.3) | 35 (5.4)) |
25–34 years | 20 (29.4) | 180 (45.0) | 91 (50.3) | 291 (44.8) |
35–44 years | 37 (54.4) | 184 (46.0) | 74 (40.9) | 295 (45.5) |
45–49 years | 9 (13.2) | 18 (4.5) | 1 (0.5) | 28 (4.3) |
Total valid responses | 68 (100) | 400 (100) | 181 (100) | 649 (100) |
Relationship status: |
Single/separated/divorced/widowed | 57 (66.3) | 57 (14.4) | 61 (33.5) | 175 (26.3) |
Married | 29 (33.7) | 340 (85.6) | 121 (66.5) | 490 (73.7) |
Total valid responses | 86 (100) | 397 (100) | 182 (100) | 665 (100) |
Number of persons in household |
< 5 persons | 56 (66.7) | 222 (56.1) | 125 (77.2) | 403 (62.8) |
≥ 5 persons | 28 (33.3) | 174 (43.9) | 37 (22.8) | 239 (37.2) |
Total valid responses | 84 (100) | 396 (100) | 162 (100) | 642 (100) |
Number of children born after HIV+ |
< 3 children | 43 (87.8) | 372 (93.0) | 193 (96.0) | 608 (93.5) |
≥ 3 children | 6 (12.2) | 28 (7.0) | 8 (4.0) | 42 (6.5) |
Total valid responses | 49 (100) | 400 (100) | 201 (100) | 650 (100) |
Number of years since HIV+ |
1–5 years | 9 (12.2) | 178 (45.2) | 29 (24.4) | 216 (36.8)) |
6–10 years | 24 (32.4) | 166 (42.1) | 28 (23.5) | 218 (37.1) |
> 10 years | 41 (55.4) | 50 (12.7) | 62 (52.1) | 153 (26.1) |
Total valid responses | 74 (100) | 394 (100) | 119 (100) | 587 (100) |
On HIV treatment (ART)? |
Yes | 50 (96.2) | 399 (99.8) | 187 (97.4) | 636 (98.8) |
No | 0 (0.0) | 1 (0.2) | 0 (0.0) | 1 (0.1) |
I choose not to answer | 2 (3.8) | 0 (0.0) | 5 (2.6) | 7 (1.1) |
Total valid responses | 52 (100) | 400 (100) | 192 (100) | 644 (100) |
Education: |
Primary school | 1 (1.2) | 42 (10.7) | 0 (0.0) | 43 (6.4) |
High school, technical or vocational school | 34 (40.0) | 250 (63.4) | 131 (66.5) | 415 (61.4) |
College or university | 50 (58.8) | 102 (25.9) | 66 (33.5) | 218 (32.2) |
Total valid responses | 85 (100) | 394 (100) | 187 (100) | 676 (100) |
Employment status: |
Employed (full time or part time) | 51 (57.3) | 320 (87.9) | 65 (32.7) | 436 (66.9) |
Unemployed | 38 (42.7) | 44 (12.1) | 134 (67.3) | 216 (33.1) |
Total valid responses | 89 (100) | 364 (100) | 189 (100) | 652 (100) |
Main source of income: |
Wages or salaries | 40 (48.8) | 66 (20.1) | 64 (40.3) | 170 (29.9) |
Self employment income | 5 (6.1) | 260 (79.3) | 8 (5.0) | 273 (48.0) |
Social assistance | 20 (24.4) | 0 (0.0) | 77 (48.4) | 97 (17.0) |
Other income sources | 17 (20.7) | 2 (0.6) | 10 (6.3) | 29 (5.1) |
Total valid responses | 82 (100) | 328 (100) | 159 (100) | 569 (100) |
Average age of the mothers was 34 years, however, the largest percentage of them were aged 35–44 years in Ottawa (n = 37, 54.4%). In Port Harcourt, almost equal majority of the women were aged 25–34 years (n = 180, 45.0%) and 3–44 years (n = 184, 46.0%). The largest percentage of the women were aged 25 to 34 years in Miami (n = 91, 50.3%). Most mothers were either single, separated, divorced or widowed in Ottawa (n = 57, 66.3%) and the greater percentage were married in Port Harcourt (n = 340, 85.6%) and in Miami (n = 121, 66.5%). Household sizes were mostly small (less than 5 persons) in Ottawa (n = 55, 66.7%), Port Harcourt (n = 222, 56.1%) and Miami (n = 125, 77.2%). All mothers had at least a baby after being diagnosed of HIV, and almost all gave birth to only one or two children since living with HIV in Ottawa (n = 43, 87.8%), Port Harcourt (n = 372, 93.0%), and Miami (n = 193, 96.0%). The average number of years since HIV diagnosis was 8.1 years with the majority diagnosed for HIV since more than 10 years ago in Ottawa (n = 41, 55.4%), and Miami (n = 62, 52.1%). Most mothers in Port Harcourt were either diagnosed in the past 5 years (n = 178, 45.2%) or 6 to 10 years (n = 166, 42.1%) prior to the survey. Almost all mothers were on ART in Ottawa (n = 50, 96.2%), Port Harcourt (n = 399, 99.8%) and Miami (n = 187, 97.4%). Most of the mothers in Port Harcourt had completed high school, technical or vocational education (n = 415, 61.4%), or completed a college or a university education (n = 218, 32.2%). Miami had largest percentage (n = 131, 66.5%) of mothers who completed high school, technical or vocational education while 33.5% (n = 66) or completed a college or a university education (n = 66, 33.5%). In Port Harcourt, 63.4% (n = 210) completed high school, technical or vocational education while 25.9% (n = 103) finished a college or a university education. Mothers reported a wide range of employment (full- or part-time), with the highest rate in Port Harcourt (n = 320, 87.9%) and the lowest in Miami (n = 65, 32.7%).
Table
2 provides descriptive statistics for the mothers’ infant feeding practices. It also describes each mother’s perception of her social network’s opinions about appropriate infant feeding methods. Most Black mothers living with HIV practiced EFF in Ottawa (
n = 79, 90.8%) and Miami (
n = 146, 75.7%). In contrast, only 57 (18.1%) mothers in Port Harcourt practiced EFF; most of them (
n = 210, 66.7%) practiced EBF by following their national guidelines.
Table 2
Sociocultural variables related to infant feeding practices of the Black mothers living with HIV
When it comes to feeding your baby, do you practice exclusive formula feeding? |
Yes, exclusive formula feeding | 79 (90.8) | 57 (18.1) | 146 (75.6) | 282 (47.4) |
No, mixed feeding | 3 (3.4) | 48 (15.2) | 14 (7.3) | 65 (10.9) |
No, exclusive breastfeeding | 5 (5.8) | 210 (66.7) | 10 (5.2) | 225 (37.8) |
I choose not to answer | 0 (0.0) | 0 (0.0) | 23 (11.9) | 23 (3.9) |
Total valid responses | 87 (100) | 315 (100) | 193 (100) | 595 (100) |
Your spouse/partner/baby’s father thinks you should practice? |
Exclusive formula feeding | 56 (65.1) | 57 (17.9) | 106 (53.0) | 219 (36.2) |
Mix feed | 4 (4.7) | 49 (15.3) | 10 (5.0) | 63 (10.4) |
Exclusive breastfeeding | 10 (11.6) | 213 (66.8) | 20 (10.0) | 243 (40.2) |
I choose not to answer | 16 (18.6) | 0 (0.0) | 64 (32.0) | 80 (13.2) |
Total valid responses | 86 (100) | 319 (100) | 200 (100) | 605 (100) |
Your other family members or close relatives thinks you should practice? |
Exclusive formula feeding | 13 (15.3) | 35 (12.0) | 114 (56.7) | 162 (28.1) |
Mix feed | 7 (8.2) | 86 (29.7) | 14 (7.0) | 107 (18.6) |
Exclusive breastfeeding | 57 (67.1) | 114 (39.3) | 25 (12.4) | 196 (34.0) |
I choose not to answer | 8 (9.4) | 55 (19.0) | 48 (23.9) | 111 (19.3) |
Total valid responses | 85 (100) | 290 (100) | 201 (100) | 576 (100) |
What type infant feeding do your healthcare provider think you should practice? |
Exclusive formula feeding | 78 (89.7) | 37 (11.9) | 162 (80.6) | 277 (46.3) |
Mix feed | 4 (4.6 | 2 (0.6) | 6 (3.0) | 12 (2.0) |
Exclusive breastfeeding | 4 (4.6) | 269 (86.7) | 14 (7.0) | 287 (48.0) |
I choose not to answer | 1 (1.1) | 2 (0.6) | 19 (9.4) | 22 (3.7) |
Total valid responses | 87 (100) | 310 (100) | 201 (100) | 598 (100) |
Are there cultural beliefs and practices in your place of origin about methods of feeding your baby? |
Yes | 59 (67.8) | 26 (6.6) | 62 (30.8) | 147 (21.5) |
No | 17 (19.6) | 367 (92.9) | 88 (43.8) | 472 (69.1) |
I choose not to answer | 11 (12.6) | 2 (0.5) | 51 (25.4) | 64 (9.4) |
Total valid responses | 87 (100) | 395 (100) | 201 (100) | 683 (100) |
Does the cultural beliefs oppose any of the infant feeding methods? |
Yes, exclusive breast feeding | 18 (22.5) | 8 (12.7) | 27 (14.0) | 53 (15.8) |
Yes, mix feeding | 7 (8.8) | 4 (6.4) | 13 (6.7) | 24 (7.1) |
Yes, exclusive formula feeding | 29 (36.2) | 12 (19.0) | 59 (30.6) | 100 (29.8) |
I choose not to answer | 26 (32.5) | 39 (61.9) | 94 (48.7) | 159 (47.3) |
Total valid responses | 80 (100) | 63 (100) | 193 (100) | 336 (100) |
Most of the mothers in Ottawa (n = 56, 65.1%) and Miami (n = 106, 53.0%) perceived that their spouses, partners or baby’s fathers supported EFF. In Ottawa, most (n = 57, 67.1%) other family members (grandparents, siblings, in-laws, etc.) supported EBF, while the majority (n = 114, 56.7%) supported EFF in Miami. In Port Harcourt, most (n = 213, 66.8%) of the women reported that their spouses, partners or baby’s fathers supported EBF. Proportions of the mothers in Port Harcourt who reported other relatives’ opinions about infant feeding practices included EFF (n = 35, 12.1%); MF (n = 86, 29.7%) and EBF (n = 114, 39.3%). In Port Harcourt, 55 mothers (19.0%) chose not to answer to the question of other relatives’ opinion on their infant feeding practices. Most mothers in Ottawa (n = 78, 89.7%) and Miami (n = 162, 80.6%) perceived that their health providers supported EFF, and, in Port Harcourt (n = 269, 84.3%), most of them believed their health providers promoted EBF. Mothers had divergent views about whether their cultural beliefs or practices inhibited infant feeding practices. In Ottawa, 18 mothers (22.5%) reported that their culture of origin prohibited EFF; seven (8.8%) believed their culture disallowed MF; 29 (36.3%) explained that their culture forbade EBF; and 26 (32.5%) chose not to answer. Similarly, in Miami, 27 mothers (14.0%) reported that their culture of origin culture prohibited EFF; 13 (6.7%) believed their culture disallowed MF; 59 (30.6%) stated that their culture forbade EBF; and 94 (48.7%) chose not to answer. In Port Harcourt, responses to this question about the influence of culture were sparse, with only 63 valid responses out of 400 respondents. The greater percent of the mothers did not answer this question. Based on the valid responses, eight mothers (12.7%) reported that their culture of origin prohibited EFF, four (6.3%) viewed their culture as disallowing MF, 12 (19.0%) believed their culture forbade EBF; and 39 (61.9%) chose not to answer.
Table
3 describes statistics of other sociocultural variables, some of which were included in the analysis model. These variables included healthcare information during pregnancy while living with HIV, mothers’ ratings of their spouses, and other family members’ opinions about infant feeding practices, mothers’ ratings of health providers’ views about infant feeding options, and mothers’ ratings of how cultural beliefs and practices influence their methods of feeding their babies. Concerning healthcare information, the mothers were asked if they received health care during pregnancy while living with HIV, they were also asked to name the category of health care staff that rendered the health care services. Almost all mothers from all sites (
n = 659, 96.6%) received health care during their pregnancy while living with HIV. In Ottawa (
n = 85, 96.6%), Miami (
n = 179, 91.3%) and Port Harcourt (
n = 395, 99.2%) – received healthcare from healthcare personnel when they were pregnant while living with HIV. A larger percentage of the mothers received the health care from medical doctor or a clinical officer in Ottawa (
n = 47, 55.3%) and in Miami (
n = 151, 84.4). In contrast, most of the mothers in in Port Harcourt (
n = 305, 77.2%) received health care from a nurse.
Table 3
Other sociocultural factors that potentially influence infant feeding practices
Did you receive health care during pregnancy? |
Yes | 85 (96.6) | 395 (99.2) | 179 (91.3) | 659 (96.6) |
No | 3 (3.4) | 3 (0.8) | 17 (8.7) | 23 (3.4) |
Total valid responses | 88 (100) | 398 (100) | 196 (100) | 684 (100) |
From whom did you receive health care during pregnancy? |
Medical doctor, clinical officer | 47 (55.3) | 88 (22.3) | 151 (84.4) | 286 (43.4) |
Nurse, Midwife | 6 (7.1) | 305 (77.2) | 7 (3.9) | 318 (48.2) |
Other sources | 32 (37.6) | 2 (0.5) | 21 (11.7) | 55 (9.4) |
Total valid responses | 85 (100) | 395 (100) | 179 (100) | 659 (100) |
How important is your spouse/partner/baby’s father’s opinion to you about how to feed your baby? |
Very unimportant, unimportant, unsure | 20 (23.0) | 72 (18.8) | 65 (32.3) | 157 (23.0) |
Important, very important | 62 (71.3) | 310 (78.3) | 108 (53.7) | 480 (70.2) |
I choose not to answer | 5 (5.7) | 14 (3.5) | 28 (14.0) | 47 (6.8) |
Total valid responses | 87 (100) | 396 (100) | 201 (100) | 684 (100) |
How much do you care about family members opinion about feeding your baby? |
Do not care at all, do not care, unsure | 20 (22.5) | 194 (52.4) | 77 (38.3) | 291 (44.1) |
Care, care very much | 66 (74.1) | 168 (45.4) | 97 (48.3) | 331 (50.1) |
I choose not to answer | 3 (3.4) | 8 (2.2) | 27 (13.4) | 38 (5.8) |
Total valid responses | 89 (100) | 370 (100) | 201 (100) | 660 (100) |
How much do you care about your healthcare provider’s opinion about feeding your baby? |
Do not care at all, do not care or unsure | 0 (0.0) | 4 (1.0) | 12 (6.0) | 16 (2.3) |
Care or care very much | 89 (100) | 393 (98.5) | 170 (84.6) | 652 (94.6) |
I choose not to answer | 0 (0.0) | 2 (0.5) | 19 (9.4) | 21 (3.1) |
Total valid responses | 89 (100) | 399 (100) | 201 (100) | 689 (100) |
How much do your cultural beliefs/practices influence your infant feeding choices? |
Not at all, Not much, unsure | 44 (49.4) | 383 (96.2) | 70 (47.9) | 497 (78.5) |
Much or very much | 43 (48.3) | 13 (3.3.) | 60 (41.1) | 116 (18.3) |
I choose not to answer | 2 (2.3) | 2 (0.5) | 16 (11.0) | 20 (3.2) |
Total valid responses | 89 (100) | 398 (100) | 146 (100) | 633 (100) |
Most mothers in all sites (n = 480, 70.2%) rated the opinions of their spouses/partners/babies’ fathers about infant feeding as being “important” or “very important.” At individual site levels, this rating was broken down into Ottawa (n = 62, 71.3%), Miami (n = 108, 53.7%) and Port Harcourt (n = 310, 78.3%). Most mothers reported that they either “cared” or “cared very much” about other family members’ (grandmothers, mothers-in-law, siblings, etc.) opinions about infant feeding practices in Ottawa (n = 66, 74.1%) and Miami (n = 97, 48.3%). In Port Harcourt, however, the majority (n = 194, 53.6%) did not care at all, did not care or were unsure about their other family members’ opinions on infant feeding methods. Mothers rated healthcare providers exceptionally highly, as all women in Ottawa (n = 89, 100%) either “cared” or “cared very much” about their healthcare providers’ recommendations. Also, almost all mothers in Port Harcourt (n = 393, 98.5%) and Miami (n = 170, 84.6%) either “cared” or “cared very much” about their healthcare providers’ infant feeding recommendations. When asked how their cultural beliefs and practices influenced their infant feeding practices, most mothers in all three sites (n = 497, 78.5%) reported either “not at all,” “not much” or “unsure.” Site specific breakdown show that about half of the mothers who provided valid responses in Ottawa (n = 43, 49.4%) and Miami (n = 60, 46.1%) rated the influence of cultural beliefs and practices on their infant feeding practices as “not at all,” “not much,” or “unsure.” In Port Harcourt, the vast majority (n = 393, 96.2%) felt that the reported the influence of cultural beliefs and practices on their infant feeding practices as “not at all,” “not much” or “unsure.”
Table
4 provides mean scale scores for the three psychosocial parameters included in the multinomial logistic regression. Mean scores on the Iowa infant feeding attitudes scale were Ottawa (59.1 ± 7.0), Miami (52.6 ± 7.0) and Port Harcourt (55.7 ± 6.9) out of a total of 85. Mean functional social support scores were Ottawa (24.8 ± 6.6), Miami (21.9 ± 8.1) and Port Harcourt (20.7 ± 6.2) out of a total of 35. Mean scores on Cohen’s perceived stress scale were Ottawa (15.2 ± 6.5), Miami (21.1 ± 6.9) and Port Harcourt (22.1 ± 4.2) out of a total of 40.
Table 4
Psychosocial variables of the Black mothers included in the multinomial logistic model
Iowa infant feeding attitude score | 59.1 ± 7.0 | 55.72 ± 6.1 | 52.6 ± 6.9 | 55.2 ± 6.9 | 85 |
Functional social support score | 24.8 ± 6.6 | 20.7 ± 6.2 | 21.9 ± 8.1 | 21.6 ± 7.0 | 35 |
Cohen’s perceived stress score | 15.2 ± 6.5 | 21.1 ± 4.7 | 21.1 ± 6.9 | 20.7 ± 5.9 | 40 |
The result of the multinomial logistic analysis is split in Tables
5 and
6 to show parameter estimates of EFF versus MF and EBF versus MF, respectively. Model in each of the tables is the final step of analysis, containing comprehensive entries of predictor variables, which yielded a statistically significant fitted model (
X2 = 243.3,
p < 0.05) with a relatively reduced error estimate (− 2 log-likelihood = 485.2) and an accuracy of 75.1%. Based on their significant (
X2) estimates, each of the consecutive models (1 to 4) in Tables
5 and
6 show that each step in the analysis had a significant (
p < 0.05) contribution to Model 5.
Table 5
Results of multinomial logistic regression to determine factors of infant feeding practices (EFF versus MF)
National Guideline (EFF = 1, EBF + ART =0) | 13.6* (0.3) | 18.3* (0.4) | 35.4* (0.6) | 76.7* (0.8) | 218.2* (0.9) |
Age (Years) | | 1.1*(< 0.1) | 1.4 (< 0.1) | 1.1 (< 0.1) | 1.1 (< 0.1) |
Marital Status (Married =1, Otherwise = 0) | | 0.7 (0.4) | 0.6 (0.5) | 0.7 (0.5) | 0.8 (0.5) |
Children born after diagnosed HIV Positive (headcount) | | 0.9 (0.2) | 1.0 (0.3) | 0.9 (0.3) | 0.8 (0.3) |
Formal education (Years) | | 0.9 (0.1) | 0.9 (0.1) | 0.8* (0.1) | 0.9 (0.1) |
Employment (Salaried/waged =1, otherwise =0) | | 1.2 (0.4) | 1.0 (0.5) | 0.9 (0.5) | 0.8 (0.6) |
Rating of Baby’s father’s opinion about infant feeding (Important =1, Otherwise =0) | | | 0.8 (0.5) | 0.6 (0.5) | 0.7 (0.5) |
Concerns about family members’ opinion on infant feeding (cared =1, otherwise =0) | | | 0.9 (0.4) | 0.7 (0.4) | 0.8 (0.4) |
Are there cultural beliefs/ traditions in your place of origin about methods of feeding your baby? (Yes = 1, No = 0) | | | 0.2* (0.6) | 0.2* (0.6) | 0.2* (0.7) |
Received health care during pregnancy? (yes = 1, No =0) | | | | 14.8* (0.9) | 21.2* (1.1) |
Received healthcare from? (Nurse =1, Medical doctor/clinical officer =0) | | | | 2.6 (1.0) | 3.1* (0.5) |
Infant feeding attitude (score on Iowa scale) | | | | | 1.1 (< 0.1) |
Functional Social Support (score on scale) | | | | | 1.04 (< 0.1) |
Perceived Stress (score on Cohen’s scale) | | | | | 0.9* (0.1) |
Model summary |
(−2 Log Likelihood) | 20.2 | 543.0 | 532.5 | 490.5 | 485.2 |
Chi-square statistics (X2) | 339.4* | 312.3* | 231.6* | 229.2* | 243.3* |
Observations analysed, n (%) | 373 (54.1) | | | | |
Accuracy (%) | 76.8 | 75.3 | 73.1 | 74.6 | 75.1 |
Table 6
Results of multinomial logistic regression to determine factors of infant feeding practices (EBF versus MF)
National guideline (EFF =1, EBF + ART =0) | 0.2* (0.4) | 0.2* (0.5) | 0.3 (0.6) | 0.5 (0.7) | 0.7 (0.9) |
Age (Years) | | 1.1*(< 0.1) | 1.04 (< 0.1) | 1.1 (< 0.1) | 1.0 (< 0.1) |
Marital Status (Married =1, Otherwise = 0) | | 1.2 (0.4) | 1.1 (0.5) | 1.2 (0.5) | 1.4 (0.5) |
Children born after diagnosed HIV Positive (headcount) | | 0.6 (0.2) | 0.7 (0.2) | 0.7 (0.2) | 0.7 (0.3) |
Formal education (Years) | | 1.0 (0.1) | 1.0 (0.1) | 1.0 (0.1) | 1.0 (< 0.1) |
Employment (Salaried/waged =1, otherwise =0) | | 2.2 (0.4) | 1.7 (0.4) | 1.9 (0.5) | 2.3 (0.5) |
Rating of Baby’s father’s opinion about infant feeding (Important =1, Otherwise =0) | | | 0.7 (0.4) | 0.6 (0.5) | 0.6 (0.5) |
Concerns about family members’ opinion on infant feeding (cared =1, otherwise =0) | | | 1.4 (0.3) | 1.2 (0.4) | 1.2 (0.4) |
Are there cultural beliefs/ traditions in your place of origin about methods of feeding your baby? (Yes = 1, No = 0) | | | 0.5 (0.5) | 0.5 (0.6) | 0.5 (0.6) |
Received health care during pregnancy? (yes = 1, No =0) | | | | 13.9* (1.2) | 20.2* (1.3) |
Received healthcare from? (Nurse =1, Medical doctor/clinical officer =0) | | | | 1.9 (1.2) | 2.3* (0.4) |
Infant feeding attitude (score on Iowa scale) | | | | | 1.1* (< 0.1) |
Functional Social Support (score on scale) | | | | | 1.1* (< 0.1) |
Perceived Stress (score on Cohen’s scale) | | | | | 0.9* (< 0.1) |
Model summary |
(−2 Log Likelihood) | 20.2 | 543.0 | 532.5 | 490.5 | 485.2 |
Chi-square statistics (X2) | 339.4* | 312.3* | 231.6* | 229.2* | 243.3* |
Observations analysed, n (%) | 373 (54.1) | | | | |
Accuracy (%) | 76.8 | 75.3 | 73.1 | 74.6 | 75.1 |
Determinants of EFF relative to MF
Five variables in Model 5 were statistically significant determinants of EFF relative to MF at
p < 0.05 (Table
5): the national guideline of EFF, the existence of cultural beliefs/traditions about infant feeding in the woman’s place of origin, pregnancy related healthcare received while living with HIV, received pregnancy healthcare from a nurse or midwife, and perceived stress.
Firstly, for a Black mother whose national guideline is EFF (1), compared to those whose guideline is EBF while on ART (0), had greater relative risk of choosing EFF over MF, holding all other variables in the model constant. Black mothers living with HIV and residing in Ottawa or Miami (relative to Port Harcourt) were several times more likely to practice EFF than MF.
Secondly, among mothers who said “yes” to the existence of cultural beliefs and traditions about infant feeding methods in their place of origin versus those who said “no,” the relative risk of practicing EFF relative to MF declined by a factor of 0.2, holding all other variables in the model constant. That is, mothers were less likely to practice EFF and more likely to practice MF if they reported cultural beliefs and practices about methods of feeding their babies in their places of origin. Thirdly, for mothers who received pregnancy related healthcare while living with HIV compared to those who did not, the relative risk of practicing EFF relative to MF increased by a factor of 21.2, holding all other factors in the model constant. Mothers who received healthcare during pregnancy were 21.2 times more likely to practice EFF instead of MF. Furthermore, among Black mothers living with HIV who received healthcare from a nurse or midwife instead of a medical doctor or clinical officer, the relative risk of EFF relative to MF increased by a factor of 3.1. Mothers who received pregnancy healthcare via a nurse or midwife were more likely to practice EFF instead of MF than those who received healthcare from a medical doctor or clinical officer. Finally, for a unit increase in a mother’s perceived stress score, the relative risk of EFF relative to MF was reduced by a factor of 0.9. Mothers with increased perceived stress were less likely to practice EFF and more likely to practice MF.