Prevalence, safety evidence, and determinants of medicine use during breastfeeding among women in Kampala, Uganda.

Abstract

Background: Breastfeeding is essential for child health and survival, yet breastfeeding mothers often require medications to manage postpartum and chronic conditions, raising concerns about potential infant safety. Limited research has been undertaken on medication practices during lactation, especially in low-resource settings like Uganda. The study aimed to investigate the prevalence of medicine use, evidence about safety, and factors that influence medicine use among breastfeeding women in Kampala, Uganda.

Methods: We conducted a cross-sectional study among 294 breastfeeding women aged 18 years and older with infants aged 12 months and below, attending six healthcare clinics in Kampala between September 2023 and January 2024. Using a structured questionnaire, we collected data on medicine use and breastfeeding practices. Modified Poisson regression was used to identify factors associated with medicine use. Medication safety during breastfeeding was evaluated using Hale's Lactation Risk Category, the LactMed database, the WHO Anatomic Therapeutic Chemical (ATC) classification system, and Relative Infant Dose (RID), with RID > 10% considered high infant exposure.

Results: Among 294 participants, the majority of infants were aged ≤ 6 months (202/294, 68.7%), while 92 (31.3%) were older than 6 months. A total of 168 women (57.1%) practiced exclusive breastfeeding. Medicine use in the past six months was reported by 232 women (78.9%), of whom 170 (64.4%) obtained medicines without prescriptions. Medicine use was more common among women with younger infants (adjusted prevalence ratio [aPR] = 1.4; 95% CI: 1.1-1.6), higher educational attainment (aPR = 1.3; 95% CI: 1.1-1.4), and absence of chronic illness (aPR = 1.1; 95% CI: 1.1-1.3). The most commonly used antibiotic was metronidazole, taken by 137 (46.6%) participants, with a high relative infant dose (RID) of 11-24%. This was followed by amoxicillin and ampicillin/cloxacillin, used by 112 (38.1%). Paracetamol was the most frequently used drug (74.5%). Overall, 61.0% of medicines were classified as compatible with breastfeeding, 35.4% as probably compatible, and 2.6% as possibly hazardous. Drugs requiring cautious use included frusemide, cyproheptadine, phenylpropanolamine, metronidazole, acetaminophen with caffeine, and griseofulvin due to risks such as significant infant exposure, interference with lactation, or limited safety data. By contrast, frequently used medicines such as dihydroartemisinin/piperaquine phosphate, artemether/lumefantrine, cefixime, pyrazinamide, and ethambutol were considered acceptable during breastfeeding, although formal lactation safety studies are lacking.

Conclusion: The overall prevalence of medicine use among breastfeeding women was high, with frequent self-medication using over-the-counter drugs. There is urgent need for strengthened regulatory frameworks, enhanced healthcare provider training, with community based education to promote rational medicine use and improve public health literacy. Further pharmacokinetic research is critical to generate safety data on commonly used medications, hence informing clinical guidelines and supporting evidence-based decision-making among breastfeeding women.