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A qualitative study exploring infant feeding decision-making between birth and 6 months among HIV-positive mothers.
Matern Child Nutr. 2019 04; 15(2):e12726.MC

Abstract

Despite efforts to support breastfeeding for HIV-positive mothers in South Africa, being HIV-positive remains a barrier to initiating and sustaining breastfeeding. The aim was to explore decision-making about infant feeding practices among HIV-positive mothers in a rural and urban settings in KwaZulu-Natal, South Africa. HIV-positive pregnant women were purposively sampled from one antenatal clinic in each setting. A qualitative longitudinal cohort design was employed, with monthly in-depth interviews conducted over 6 months postdelivery. Data were analysed using framework analysis. We report findings from 11 HIV-positive women within a larger cohort. Participants were aged between 15 and 41 years and were all on antiretroviral therapy. Before delivery, nine mothers intended to exclusively breastfeed (EBF) for 6 months, and two intended to exclusively formula feed (EFF). Three mothers successfully EBF for 6 months, whereas four had stopped breastfeeding, and two were mixed breastfeeding by 6 months. Mothers reported receiving strong advice from health workers (HWs) to EBF and made decisions based primarily on HWs advice, resisting contrary pressure from family or friends. The main motivation for EBF was to protect the child from HIV acquisition, but sometimes fear of mixed feeding led to mothers stopping breastfeeding entirely. Infant feeding messages from HWs advice were frequently inadequate and out of date, and failed to address mothers' challenges. Minimal support was provided for EFF. In conclusion, HWs play a pivotal role in providing infant feeding support to HIV infected mothers, but need regular updates to ensure if advice is correct and appropriate.

Authors+Show Affiliations

Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.Department of Paediatrics and Child Health School of Clinical Medicine Nelson R Mandela School of Medicine, University of KwaZulu-Natal Durban, Durban, South Africa.Department of Health, Nutrition Directorate, Pietermaritzburg, South Africa.

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30338632

Citation

Horwood, Christiane, et al. "A Qualitative Study Exploring Infant Feeding Decision-making Between Birth and 6 Months Among HIV-positive Mothers." Maternal & Child Nutrition, vol. 15, no. 2, 2019, pp. e12726.
Horwood C, Jama NA, Haskins L, et al. A qualitative study exploring infant feeding decision-making between birth and 6 months among HIV-positive mothers. Matern Child Nutr. 2019;15(2):e12726.
Horwood, C., Jama, N. A., Haskins, L., Coutsoudis, A., & Spies, L. (2019). A qualitative study exploring infant feeding decision-making between birth and 6 months among HIV-positive mothers. Maternal & Child Nutrition, 15(2), e12726. https://doi.org/10.1111/mcn.12726
Horwood C, et al. A Qualitative Study Exploring Infant Feeding Decision-making Between Birth and 6 Months Among HIV-positive Mothers. Matern Child Nutr. 2019;15(2):e12726. PubMed PMID: 30338632.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A qualitative study exploring infant feeding decision-making between birth and 6 months among HIV-positive mothers. AU - Horwood,Christiane, AU - Jama,Ngcwalisa Amanda, AU - Haskins,Lyn, AU - Coutsoudis,Anna, AU - Spies,Lenore, Y1 - 2018/11/22/ PY - 2018/04/23/received PY - 2018/09/28/revised PY - 2018/10/02/accepted PY - 2018/10/20/pubmed PY - 2020/1/7/medline PY - 2018/10/20/entrez KW - HIV infection KW - South Africa KW - breast feeding KW - health workers KW - prevention of mother-to-child transmission SP - e12726 EP - e12726 JF - Maternal & child nutrition JO - Matern Child Nutr VL - 15 IS - 2 N2 - Despite efforts to support breastfeeding for HIV-positive mothers in South Africa, being HIV-positive remains a barrier to initiating and sustaining breastfeeding. The aim was to explore decision-making about infant feeding practices among HIV-positive mothers in a rural and urban settings in KwaZulu-Natal, South Africa. HIV-positive pregnant women were purposively sampled from one antenatal clinic in each setting. A qualitative longitudinal cohort design was employed, with monthly in-depth interviews conducted over 6 months postdelivery. Data were analysed using framework analysis. We report findings from 11 HIV-positive women within a larger cohort. Participants were aged between 15 and 41 years and were all on antiretroviral therapy. Before delivery, nine mothers intended to exclusively breastfeed (EBF) for 6 months, and two intended to exclusively formula feed (EFF). Three mothers successfully EBF for 6 months, whereas four had stopped breastfeeding, and two were mixed breastfeeding by 6 months. Mothers reported receiving strong advice from health workers (HWs) to EBF and made decisions based primarily on HWs advice, resisting contrary pressure from family or friends. The main motivation for EBF was to protect the child from HIV acquisition, but sometimes fear of mixed feeding led to mothers stopping breastfeeding entirely. Infant feeding messages from HWs advice were frequently inadequate and out of date, and failed to address mothers' challenges. Minimal support was provided for EFF. In conclusion, HWs play a pivotal role in providing infant feeding support to HIV infected mothers, but need regular updates to ensure if advice is correct and appropriate. SN - 1740-8709 UR - https://www.unboundmedicine.com/medline/citation/30338632/A_qualitative_study_exploring_infant_feeding_decision_making_between_birth_and_6_months_among_HIV_positive_mothers_ L2 - https://doi.org/10.1111/mcn.12726 DB - PRIME DP - Unbound Medicine ER -