Exclusive breastfeeding and associated factors among HIV-infected mothers in sub-Saharan African countries: a systematic review and meta-analysis

INTRODUCTION: The World Health Organization recommends exclusive breastfeeding for the first six months, along with maternal antiretroviral treatment, to reduce the risk of HIV transmission to infants and promote their health and survival. However, globally, this practice is not as widespread as it should be, especially in sub-Saharan Africa, as shown by several studies among HIV-infected mothers. However, no comprehensive review has examined the overall prevalence and the factors influencing it. This systematic review and meta-analysis aimed to determine the overall prevalence of exclusive breastfeeding and associated factors among HIV-infected mothers in sub-Saharan Africa. METHODS: International electronic databases including PubMed, Embase, Scopus, Cochrane, and Web of Science were systematically searched for observational studies on exclusive breastfeeding among HIV-infected mothers in sub-Saharan Africa published after 2010. Citation tracking revealed additional references. Two authors extracted the necessary data independently in a standardized format, which was analyzed with STATA version 17. The Joanna Briggs Institute (JBI) critical appraisal tool was used to assess the study quality. Heterogeneity was evaluated using the Cochran Q test and quantified with the I(2) statistic. Publication bias was assessed using funnel plots and Egger’s test. Sensitivity analyses, subgroup analyses, and meta-regression were conducted to assess sources of heterogeneity. Finally, a random effects meta-analysis model was computed to estimate the pooled prevalence of exclusive breastfeeding. Associations between factors and exclusive breastfeeding were also examined via a random effects model. RESULT: After 5305 studies were reviewed, 32 studies involving 9319 study participants fulfilled the inclusion criteria and were included in this meta-analysis. The findings of these 32 studies revealed a pooled prevalence of 55.9% (95% CI: 45.93, 68.23%), with substantial heterogeneity (I(2)ƒ_%=ƒ_%99.68%). Breastfeeding counseling (AOR: 3.69, 95% CI: 2.41, 5.64), adequate antenatal care visits (AOR: 2, 95% CI: 1.49, 2.67), positive maternal attitudes toward infant feeding practices (AOR: 4.29, 95% CI: 2.32, 7.95) and good knowledge about infant feeding practices (AOR: 4.88, 95% CI: 3.3, 7.21) were associated with exclusive breastfeeding among HIV infected mothers. CONCLUSION: This study revealed that slightly over half of HIV-infected mothers in sub-Saharan Africa engage in exclusive breastfeeding. The findings highlight the need for support for HIV-infected mothers to enhance exclusive breastfeeding and minimize transmission risks, recommending better breastfeeding counseling, antenatal care, maternal education on feeding, and consideration of sociocultural factors for tailored strategies

• Epidemiology and Determinants of Health
  • Epidemiology
• Population(s)
  • Women
  • Children or Youth (less than 18 years old)
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Prevention
• Prevention
  • Biomedical interventions