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International Breastfeeding Journal
Published in: International Breastfeeding Journal 1/2006

Open Access 01-12-2006 | Research

Differences between international recommendations on breastfeeding in the presence of HIV and the attitudes and counselling messages of health workers in Lilongwe, Malawi

Authors: Ellen G Piwoz, Yvonne Owens Ferguson, Margaret E Bentley, Amy L Corneli, Agnes Moses, Jacqueline Nkhoma, Beth Carlton Tohill, Beatrice Mtimuni, Yusuf Ahmed, Denise J Jamieson, Charles van der Horst, Peter Kazembe

Published in: International Breastfeeding Journal | Issue 1/2006

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Abstract

Background

To prevent postnatal transmission of HIV in settings where safe alternatives to breastfeeding are unavailable, the World Health Organization (WHO) recommends exclusive breastfeeding followed by early, rapid cessation of breastfeeding. Only limited data are available on the attitudes of health workers toward this recommendation and the impact of these attitudes on infant feeding counselling messages given to mothers.

Methods

As part of the Breastfeeding, Antiretroviral, and Nutrition (BAN) clinical trial, we carried out an in-depth qualitative study of the attitudes, beliefs, and counselling messages of 19 health workers in Lilongwe, Malawi.

Results

Although none of the workers had received formal training, several reported having counseled HIV-positive mothers about infant feeding. Health workers with counselling experience believed that HIV-infected mothers should breastfeed exclusively, rather than infant formula feed, citing poverty as the primary reason. Because of high levels of malnutrition, all the workers had concerns about early cessation of breastfeeding.

Conclusion

Important differences were observed between the WHO recommendations and the attitudes and practices of the health workers. Understanding these differences is important for designing effective interventions.
Literature
1.
UNAIDS/WHO: AIDS epidemic update: 2004UNAIDS/WHOAIDS epidemic update: 2004. 2004, Geneva: UNAIDS, Report No.: UNAIDS/04.45E
2.
WHO: New data on the prevention of mother-to-child transmission of HIV and their policy implications: Conclusions and recommendations. WHO Technical Consultation on Behalf of the UNFPA/UNICEF/WHO/UNAIDS Inter-Agency Task Team on mother-to-child transmission of HIV. Geneva, 11–13 October 2000. 2001, Geneva: World Health Organization
3.
WHO/UNICEF: Global strategy for infant and young child feedingWHO/UNICEFGlobal strategy for infant and young child feeding. 2003, Geneva: World Health Organization
4.
Malawi Ministry of Health and Population: Infant and Young Child Nutrition Policy and Guidelines. 2003, Malawi Ministry of Health and Population. Lilongwe
5.
Ahmed F, Clemens JD, Rao MR, Sack DA, Khan MR, Haque E: Community-based evaluation of the effect of breast-feeding on the risk of microbiologically confirmed or clinically presumptive shigellosis in Bangladeshi children. Pediatrics. 1992, 90: 406-411.PubMed
6.
Brown KH, Black RE, Lopez de Romana G, Creed de Kanashiro H: Infant-feeding practices and their relationship with diarrheal and other diseases in Huascar (Lima), Peru. Pediatrics. 1989, 83: 31-40.PubMed
7.
Victora CG, Smith PG, Vaughan JP, Nobre LC, Lombardi C, Teixeira AM, Fuchs SM, Moreira LB, Gigante LP, Barros FC: Evidence for protection by breast-feeding against infant deaths from infectious diseases in Brazil. Lancet. 1987, 2: 319-322. 10.1016/S0140-6736(87)90902-0.CrossRefPubMed
8.
Coutsoudis A, Pillay K, Spooner E, Kuhn L, Coovadia HM: Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. South African Vitamin A Study Group. Lancet. 1999, 354: 471-476. 10.1016/S0140-6736(99)01101-0.CrossRefPubMed
9.
Iliff PJ, Piwoz EG, Tavengwa NV, Zunguza CD, Marinda ET, Nathoo KJ, Moulton LH, Ward BJ, Humphrey JH: Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS. 2005, 19: 699-708. 10.1097/01.aids.0000166093.16446.c9.CrossRefPubMed
10.
Kourtis AP, Butera S, Ibegbu C, Beled L, Duerr A: Breast milk and HIV-1: vector of transmission or vehicle of protection?. Lancet Infect Dis. 2003, 12: 786-793. 10.1016/S1473-3099(03)00832-6.CrossRef
11.
UNAIDS/WHO: UNAIDS/WHO epidemiological fact sheets on HIV/AIDS and sexually transmitted infections, 2004 Update-Malawi. 2004, Geneva: UNAIDS
12.
National Statistical Office [Malawi] & ORC Macro: Malawi demographic and health survey 2000, Zomba, Malawi and Calverton, Maryland, USA, Author: 2001.
13.
de Paoli MM, Manongi R, Klepp KI: Counsellors' perspectives on antenatal HIV testing and infant feeding dilemmas facing women with HIV in northern Tanzania. Reprod Health Matters. 2002, 10: 144-156. 10.1016/S0968-8080(02)00088-5.CrossRefPubMed
14.
Seidel G, Sewpaul V, Dano B: Experiences of breastfeeding and vulnerability among a group of HIV-positive women in Durban, South Africa. Health Policy Plan. 2000, 15: 24-33. 10.1093/heapol/15.1.24.CrossRefPubMed
15.
Akuse RM, Obinya EA: Why healthcare workers give prelacteal feeds. Eur J Clin Nutr. 2002, 56: 729-734. 10.1038/sj.ejcn.1601385.CrossRefPubMed
16.
Ojofeitimi EO, Olaogun AA, Osokoya AA, Owolabi SP: Infant feeding practices in a deprived environment: a concern for early introduction of water and glucose D water to neonates. Nutr Health. 1999, 13: 11-21.CrossRefPubMed
17.
Owoaje ET, Oyemade A, Kolude OO: Previous BFHI training and nurses' knowledge, attitudes and practices regarding exclusive breastfeeding. Afr J Med Med Sci. 2002, 31: 137-140.PubMed
18.
Davies-Adetugbo AA, Adebawa HA: The Ife South Breastfeeding Project: training community health extension workers to promote and manage breastfeeding in rural communities. Bull World Health Organ. 1997, 75: 323-332.PubMedCentralPubMed
19.
Davies-Adetugbo AA, Fabiyi AK, Ojoofeitimi EO, Adetugbo K: Breastfeeding training improves health worker performance in rural Nigeria. East Afr Med J. 1997, 74: 510-513.PubMed
20.
Haider R, Ashworth A, Kabir I, Huttly SR: Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial. Lancet. 2000, 356: 1643-1647. 10.1016/S0140-6736(00)03159-7.CrossRefPubMed
21.
Morrow AL, Guerrero ML, Shults J, Calva JJ, Lutter C, Bravo J, Ruiz-Palacios G, Morrow RC, Butterfoss FD: Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet. 1999, 353: 1226-1231. 10.1016/S0140-6736(98)08037-4.CrossRefPubMed
22.
Piwoz EG, Iliff PJ, Tavengwa N, Gavin L, Marinda E, Lunney K, Zunguza C, Nathoo KJ, Humphrey JH: An education and counselling program for preventing breast-feeding-associated HIV transmission in Zimbabwe: design and impact on maternal knowledge and behaviour. J Nutr. 2005, 135: 950-955.PubMed
23.
Semega-Janneh IJ, Bohler E, Holm H, Matheson I, Holmboe-Ottesen G: Promoting breastfeeding in rural Gambia: combining traditional and modern knowledge. Health Policy Plan. 2001, 16: 199-205. 10.1093/heapol/16.2.199.CrossRefPubMed
24.
Chopra M, Piwoz E, Sengwana J, Schaay N, Dunnett L, Saders D: Effect of a mother-to-child HIV prevention programme on infant feeding and caring practices in South Africa. S Afr Med J. 2002, 92: 298-302.PubMed
25.
Coutsoudis A, Goga AE, Rollins N, Coovadia HM: Free formula milk for infants of HIV-infected women: blessing or curse?. Health Policy Plan. 2002, 17: 154-160. 10.1093/heapol/17.2.154.CrossRefPubMed
26.
Bentley ME, Corneli AL, Piwoz E, Moses A, Nkhoma J, Tohill BC, Ahmed Y, Adair L, Jamieson DJ, van der Horst C: Perceptions of the role of maternal nutrition in HIV-positive breast-feeding women in Malawi. J Nutr. 2005, 135: 945-949.PubMed
27.
Gaillard P, Fowler MG, Dabis F, Coovadia H, Van Der Horst C, Van Rompay K, Ruff A, Taha T, Thomas T, De Vincenzi I: Use of antiretroviral drugs to prevent HIV-1 transmission through breast-feeding: from animal studies to randomized clinical trials. J Acquir Immune Defic Syndr. 2004, 35: 178-187.CrossRefPubMed
28.
van der Horst C, Fiscus S, Piwoz E, Corneli A, Moses A, Jones D, Adair L, Bentley M, Hoffman I, Kashuba A: Prevention of mother to infant transmission of HIV through breastfeeding and reduction of morbidity and mortality of the breastfeeding mothers: A study in Malawi.[abstract]. Antiviral Therapy. 2003, S477-Suppl 1
29.
Corneli A, Piwoz E, Bentley ME, Moses A, Ahmed Y, Duerr A, van der Horst C: Trust me, I'm a Doctor: Issues related to study participants, adherence, and informed consent in a clinical trial to prevent mother-to-child transmission of HIV through breastfeeding. Poster session presented at the 10th Conference on Retroviruses and Opportunisitic Infections; Boston, MA.
30.
Patton MQ: Qualitative evaluation and research methods. 1990, Newbury Park: Sage Publications, Second
31.
Bentley ME, Pelto GH, Straus WL, Schumann DA, Adegbola C, de la Pena E, Oni GA, Brown KH, Huffman SL: Rapid ethnographic assessment: applications in a diarrhea management program. Soc Sci Med. 1988, 27: 107-116. 10.1016/0277-9536(88)90168-2.CrossRefPubMed
32.
Miles M, Huberman AM: An Expanded Sourcebook: Qualitative Data Analysis, Thousand Oaks, CA: Sage Publications, Inc, 1994.
33.
Sandelowski M: Whatever happened to qualitative description?. Res Nurs Health. 2000, 23: 334-340. 10.1002/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G.CrossRefPubMed
34.
Rodgers BL, Cowles KV: The qualitative research audit trail: a complex collection of documentation. Res Nurs Health. 1993, 16: 219-226.CrossRefPubMed
35.
LINKAGES: Integrated prevention of mother-to-child transmission of HIV and support for infant feeding: Health providers course. 2004, Washington, DC: Academy for Educational Development
36.
WHO/UNAIDS/UNICEF: HIV and infant feeding counselling: A training course. 2000, Geneva: World Health Organization, Report No.: WHO/FCH/CAH/00.3.
37.
WHO/UNICEF: Breastfeeding counselling: A training course. 1993, Geneva: World Health Organization, Report No.: WHO/CDR/93.4.
38.
Sandige H, Ndekha MJ, Briend A, Ashorn P, Manary MJ: Home-based treatment of malnourished Malawian children with locally produced or imported ready-to-use food. J Pediatr Gastroenterol Nutr. 2004, 39: 141-146.CrossRefPubMed
Metadata
Title
Differences between international recommendations on breastfeeding in the presence of HIV and the attitudes and counselling messages of health workers in Lilongwe, Malawi
Authors
Ellen G Piwoz
Yvonne Owens Ferguson
Margaret E Bentley
Amy L Corneli
Agnes Moses
Jacqueline Nkhoma
Beth Carlton Tohill
Beatrice Mtimuni
Yusuf Ahmed
Denise J Jamieson
Charles van der Horst
Peter Kazembe
Publication date
01-12-2006
Publisher
BioMed Central
Published in
International Breastfeeding Journal / Issue 1/2006
Electronic ISSN: 1746-4358
DOI
https://doi.org/10.1186/1746-4358-1-2

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