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Rapid assessment of infant feeding support to HIV-positive women accessing prevention of mother-to-child transmission services in Kenya, Malawi and Zambia

  • Mickey Chopra (a1) (a2), Tanya Doherty (a1) (a2), Saba Mehatru (a3) and Mark Tomlinson (a1) (a4)
Abstract
AbstractObjective

The possibility of mother-to-child transmission (MTCT) of HIV through breast-feeding has focused attention on how best to support optimal feeding practices especially in low-resource and high-HIV settings, which characterizes most of sub-Saharan Africa. To identify strategic opportunities to minimize late postnatal HIV transmission, we undertook a review of selected country experiences on HIV and infant feeding, with the aims of documenting progress over the last few years and determining the main challenges and constraints.

Design

Field teams conducted national-level interviews with key informants and visited a total of thirty-six facilities in twenty-one sites across the three countries – eighteen facilities in Malawi, eleven in Kenya and seven in Zambia. During these visits interviews were undertaken with key informants such as the district and facility management teams, programme coordinators and health workers.

Setting

A rapid assessment of HIV and infant feeding counselling in Kenya, Malawi and Zambia, undertaken from February to May 2007.

Results

Infant feeding counselling has, until now, been given low priority within programmes aimed at prevention of MTCT (PMTCT) of HIV. This is manifest in the lack of resources – human, financial and time – for infant feeding counselling, leading to widespread misunderstanding of the HIV transmission risks from breast-feeding. It has also resulted in lack of space and time for proper counselling, poor support and supervision, and very weak monitoring and evaluation of infant feeding. Finally, there are very few examples of linkages with community-based infant feeding interventions. However, all three countries have started to revise their feeding policies and strategies and there are signs of increased resources.

Conclusions

In order to sustain this momentum it will be necessary to continue the advocacy with the HIV community and stress the importance of child survival – not just minimization of HIV transmission – and hence the need for integrating MTCT prevention.

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Corresponding author
*Corresponding author: Email mickey.chopra@mrc.ac.za
Linked references
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2. HM Coovadia , NC Rollins , RM Bland , K Little , A Coutsoudis , ML Bennish & ML Newell (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.

3. PJ Iliff , EG Piwoz , NV Tavengwa , CD Zunguza , ET Marinda , KJ Nathoo , LH Moulton , BJ Ward & JH Humphrey ; ZVITAMBO study group (2005) Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS 19, 699708.

4. L Kuhn , M Sinkala , C Kankasa (2007) High uptake of exclusive breastfeeding and reduced early post-natal HIV transmission. PLoS ONE 2, e1363.

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7. DJ Jackson , M Chopra , TM Doherty , MS Colvin , JB Levin , JF Willumsen , AE Goga & P Moodley ; for the Good Start Study Group (2007) Operational effectiveness and 36 week HIV-free survival in the South African programme to prevent mother-to-child transmission of HIV-1. AIDS 21, 509516.

8. A Quaghebeur , L Mutunga , F Mwanyumba , K Mandaliya , C Verhofstede & M Temmerman (2004) Low efficacy of nevirapine (HIVNET) in preventing perinatal HIV-1 transmission in a real-life situation. AIDS 18, 18541856.

10. T Doherty , M Chopra , D Jackson , A Goga , M Colvin & LA Persson (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.

13. M Chopra & N Rollins (2008) Infant feeding in the time of HIV: assessment of infant feeding policy and programmes in four African countries scaling up prevention of mother to child transmission programmes. Arch Dis Child 93, 288291.

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Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
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