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Mothers’ infant feeding experiences: constraints and supports for optimal feeding in an HIV-impacted urban community in South Africa

  • Lindiwe Sibeko (a1), Anna Coutsoudis (a2), S’phindile Nzuza (a2) and Katherine Gray-Donald (a1)

Abstract

Objective

To better understand the enabling and challenging factors impacting on infant feeding practices in communities with a high HIV prevalence.

Design

Qualitative study, with data collected through in-depth interviews and observations of mothers, in addition to discussions with health-service providers.

Setting

Urban settlement in the province of KwaZulu-Natal, South Africa.

Subjects

Mothers recruited from an HIV clinic and from within the community.

Results

Emerging from discussions with mothers on the acceptability of alternative feeding methods were the challenges they encountered in feeding their infants. Mothers readily identified feeding in the context of HIV infection as an issue of great concern, encompassing three central themes: (i) stigma and disclosure of HIV; (ii) confusion and coercion; and (iii) diarrhoea, sickness and free formula. It became evident that mothers rarely received quality infant feeding counselling and consequently mixed feeding, a widespread practice but one that is highly risky for HIV transmission, remained a common feeding practice. Exclusive breast-feeding (EBF) was best practised with support, following disclosure of HIV status. Availability of free formula did not guarantee exclusive formula feeding but instead led to inappropriate feeding practices.

Conclusions

In addition to providing accurate information, health-care workers must be empowered to counsel mothers effectively, addressing issues of disclosure and thereby facilitating mobilization of maternal support networks. These findings illustrate the challenges that exist in policy translation within the context of quality of training for health-care workers on optimizing maternal infant feeding practices, particularly in HIV-prevalent, resource-poor settings.

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Copyright

Corresponding author

*Corresponding author: Email katherine.gray-donald@mcgill.ca

References

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1.Joint United Nations Programme on HIV/AIDS (2008) Report on the Global AIDS Epidemic. Geneva: WHO/UNAIDS.
2.Joint United Nations Programme on HIV/AIDS (2006) Report on the Global AIDS Epidemic. Geneva: WHO/UNAIDS.
3.De Cock, KM, Fowler, MG, Mercier, E, de Vincenzi, I, Saba, J, Hoff, E, Alnwick, DJ, Rogers, M & Shaffer, N (2000) Prevention of mother-to-child HIV transmission in resource-poor countries: translating research into policy and practice. JAMA 283, 11751182.
4.Jones, G, Steketee, RW, Black, RE, Bhutta, ZA & Morris, SS (2003) How many child deaths can we prevent this year? Lancet 362, 6571.
5.Coutsoudis, A, Pillay, K, Kuhn, L, Spooner, E, Tsai, WY & Coovadia, HM (2001) Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: prospective cohort study from Durban, South Africa. AIDS 15, 379387.
6.Iliff, PJ, Piwoz, EG, Tavengwa, NV, Zunguza, CD, Marinda, ET, Nathoo, KJ, Moulton, LH, Ward, BJ & Humphrey, JH; ZVITAMBO Study Group (2005) Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS 19, 699708.
7.Newell, M (2006) Current issues in the prevention of mother-to-child transmission of HIV-1 infection. Trans R Soc Trop Med Hyg 100, 15.
8.Coovadia, H, Rollins, N, Bland, R, Little, K, Coutsoudis, A, Bennish, M & Newell, ML (2007) Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet 369, 11071116.
9.World Health Organization/Joint United Nations Programme on HIV and AIDS/UNICEF (1998) Technical Consultation on HIV and Infant Feeding. Geneva: WHO.
10.World Health Organization (2006) WHO HIV and Infant Feeding Technical Consultation Held on behalf of the Inter-agency Task Team (IATT) on Prevention of HIV Infections in Pregnant Women, Mothers and their Infants, Geneva, October 25–27, 2006. Consensus Statement. http://who.int/reproductive-health/stis/mtct/infantfeedingconsensusstatement.pdf (accessed January 2009).
11.Rutenberg, N (2003) HIV testing and disclosure: experiences from prevention of mother- to- child transmission programs in Kenya and Zambia. In Women’s Experiences with HIV Serodisclosure in Africa: Implementation for VCT and PMTCT. Report of a USAID Technical Meeting, pp. 711. Washington, DC: USAID Office of HIV/AIDS.
12.Varga, CA, Sherman, GG & Jones, SA (2006) HIV-disclosure in the context of vertical transmission: HIV-positive mothers in Johannesburg, South Africa. AIDS Care 18, 952960.
13.Department of Health (2007) National HIV and syphilis antenatal sero-pravlence survey in South Africa, 2006. http://www.doh.gov.za/docs/hivaids (accessed January 2007).
14.Patton, MQ (2002) Qualitative Research and Evaluation Methods. Thousand Oaks, CA: Sage.
15.Cavanagh, S (1997) Content analysis: concepts, methods and applications. Nurse Res 4, issue 3, 516.
16.Lincoln, Y & Guba, E (1985) Naturalistic Inquiry. New York: Sage.
17.Medley, A, Garcia-Moreno, C, McGill, S & Maman, S (2004) Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child-transmission programmes. Bull World Health Organ 82, 299307.
18.Matthews, C, Kuhn, L, Fransman, D, Hussey, G & Dikweni, L (1999) Disclosure of HIV status and its consequences. S Afr Med J 89, 1238.
19.Chopra, M, Doherty, T, Jackson, D & Ashworth, A (2005) Preventing HIV transmission to children: quality of counseling of mothers in South Africa. Acta Paediatr 94, 357363.
20.Doherty, T, Chopra, M, Jackson, D, Colvin, M & Persson, LA (2007) Effectiveness of the WHO/UNICEF guidelines on infant feeding for HIV-positive women: results from a prospective cohort study in South Africa. AIDS 21, 17911797.
21.Coutsoudis, A, Pillay, K, Spooner, E, Kuhn, L & Coovadia, HM (1999) Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. Lancet 354, 471476.
22.di Paoli, M, Manongi, R & Klepp, KI (2002) Counsellors’ perspectives on antenatal HIV testing and infant feeding dilemmas facing women with HIV in northern Tanzania. Reprod Health Matters 10, 144156.
23.Piwoz, E, Ross, J & Humphrey, J (2004) Human immunodeficiency virus transmission during breastfeeding: knowledge, gaps, and challenges for the future. Adv Exp Med Biol 554, 195210.
24.Leshabari, SC, Blystad, A, de Paoli, M & Moland, KM (2007) HIV and infant feeding counselling: challenges faced by nurse-counsellors in northern Tanzania. Hum Resour Health 5, 18; available at http://www.human-resources-health.com/content/5/1/18
25.Buskens, I & Jaffe, A (2008) Demotivating infant feeding counselling encounters in southern Africa: do counsellors need more or different training? AIDS Care 20, 337345.
26.Bourne, LT, Hendricks, MK, Marais, D & Eley, B (2007) Addressing malnutrition in young children in South Africa. Setting the national context for paediatric food-based dietary guidelines. Matern Child Nutr 3, 230238.
27.Walker, AR & Adam, FI (2000) Breastfeeding in sub-Saharan Africa: outlook for 2000. Public Health Nutr 3, 285292.
28.Coutsoudis, A, Goga, AE, Rollins, N & Coovadia, HM (2002) Free formula milk for infants of HIV-infected women: blessing or curse? Health Policy Plan 17, 154160.
29.Creek, T, Luo, C & Quick, T (2006) HIV-exposed children highly affected by deadly outbreak of diarrhea and severe acute malnutrition – Botswana, 2006. Presented at The 2006 HIV/AIDS Implementers Meeting of the President’s Emergency Plan for AIDS Relief, Durban, South Africa, 12–15 June 2006.
30.Creek, T, Arvelo, W, Kim, A, Lu, L, Bowen, A, Mach, O, Finkbeiner, T, Zaks, L, Masunge, J & Davis, M (2007) A large outbreak of diarrhea among non-breastfed children in Botswana 2006 – implications for HIV prevention strategies and child health. Presented at XIV Conference on Retroviruses and Opportunistic Infections, Los Angeles, CA, USA, 25–28 February 2007.

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