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A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts.
BMC Public Health 2019; 19(1):570BP

Abstract

BACKGROUND

The most recent World Health Organization (WHO) guidelines on Human Immunodeficiency Virus (HIV) and infant feeding promotes exclusive breastfeeding (EBF) in resource limited settings for the prevention of mother to child transmission (PMTCT) of HIV. Literature reveals poor uptake of WHO feeding guidelines, with mixed feeding being a regular practice. In light of the limited success in EBF promotion, a realist review was conducted, analysing the use of feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa, where the majority of HIV childhood infections occur. We considered what mechanisms were at play, for whom and in what circumstances they led to exclusive breastfeeding.

METHODS

Because infant feeding counselling is a complex social intervention with a non-linear causal pathway for preventing mother to child HIV transmission, a realist methodology was chosen for this study. Using Pawson's five stage sequence for conducting realist reviews, the results are presented as a set of identified and refined context-mechanism-outcome (CMO) configurations. These CMO configurations were used to show how particular outcomes occurred in specific contexts due to a generative mechanism and were developed through identifying a review question and program theory, searching for primary studies, quality appraisal, data extraction and data synthesis.

RESULTS

From an initial 1010 papers, 27 papers met the inclusion criteria and were used to refine the program theory. Exclusive breastfeeding occurred when a woman was motivated regarding motherhood, had correct learning and understanding about infant feeding practices through counselling, no fear of breastfeeding or the impact of opposing feeding related cultural beliefs, and the support from others to be assertive about their feeding choices when faced with pressure to mix-feed. An additional CMO configuration was added during the refinement of the program theory identifying that mothers needed to not just understand but also prioritize EBF advice over cultural beliefs and stigma.

CONCLUSION

The intended audience for this review are researchers and health care workers in PMTCT, particularly sub-Saharan Africa, who may benefit from the work that has been done to identify contexts for the success and failures of EBF.

Authors+Show Affiliations

College of Medicine and Public Health, Flinders University, Adelaide, Australia.College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, 5001, Australia. Linda.sweet@flinders.edu.au.College of Medicine and Public Health, Flinders University, Adelaide, Australia.College of Medicine and Public Health, Flinders University, Adelaide, Australia.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31088541

Citation

Nyoni, Simangaliso, et al. "A Realist Review of Infant Feeding Counselling to Increase Exclusive Breastfeeding By HIV-positive Women in Sub Saharan-Africa: what Works for Whom and in what Contexts." BMC Public Health, vol. 19, no. 1, 2019, p. 570.
Nyoni S, Sweet L, Clark J, et al. A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts. BMC Public Health. 2019;19(1):570.
Nyoni, S., Sweet, L., Clark, J., & Ward, P. (2019). A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts. BMC Public Health, 19(1), p. 570. doi:10.1186/s12889-019-6949-0.
Nyoni S, et al. A Realist Review of Infant Feeding Counselling to Increase Exclusive Breastfeeding By HIV-positive Women in Sub Saharan-Africa: what Works for Whom and in what Contexts. BMC Public Health. 2019 May 14;19(1):570. PubMed PMID: 31088541.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts. AU - Nyoni,Simangaliso, AU - Sweet,Linda, AU - Clark,Jacinta, AU - Ward,Paul, Y1 - 2019/05/14/ PY - 2019/02/05/received PY - 2019/05/07/accepted PY - 2019/5/16/entrez PY - 2019/5/16/pubmed PY - 2019/7/31/medline KW - Exclusive breastfeeding (EBF) KW - HIV KW - Health care provider (HCP) KW - Infant feeding counselling KW - Mixed feeding KW - Preventing mother to child transmission (PMTCT) SP - 570 EP - 570 JF - BMC public health JO - BMC Public Health VL - 19 IS - 1 N2 - BACKGROUND: The most recent World Health Organization (WHO) guidelines on Human Immunodeficiency Virus (HIV) and infant feeding promotes exclusive breastfeeding (EBF) in resource limited settings for the prevention of mother to child transmission (PMTCT) of HIV. Literature reveals poor uptake of WHO feeding guidelines, with mixed feeding being a regular practice. In light of the limited success in EBF promotion, a realist review was conducted, analysing the use of feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa, where the majority of HIV childhood infections occur. We considered what mechanisms were at play, for whom and in what circumstances they led to exclusive breastfeeding. METHODS: Because infant feeding counselling is a complex social intervention with a non-linear causal pathway for preventing mother to child HIV transmission, a realist methodology was chosen for this study. Using Pawson's five stage sequence for conducting realist reviews, the results are presented as a set of identified and refined context-mechanism-outcome (CMO) configurations. These CMO configurations were used to show how particular outcomes occurred in specific contexts due to a generative mechanism and were developed through identifying a review question and program theory, searching for primary studies, quality appraisal, data extraction and data synthesis. RESULTS: From an initial 1010 papers, 27 papers met the inclusion criteria and were used to refine the program theory. Exclusive breastfeeding occurred when a woman was motivated regarding motherhood, had correct learning and understanding about infant feeding practices through counselling, no fear of breastfeeding or the impact of opposing feeding related cultural beliefs, and the support from others to be assertive about their feeding choices when faced with pressure to mix-feed. An additional CMO configuration was added during the refinement of the program theory identifying that mothers needed to not just understand but also prioritize EBF advice over cultural beliefs and stigma. CONCLUSION: The intended audience for this review are researchers and health care workers in PMTCT, particularly sub-Saharan Africa, who may benefit from the work that has been done to identify contexts for the success and failures of EBF. SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/31088541/A_realist_review_of_infant_feeding_counselling_to_increase_exclusive_breastfeeding_by_HIV_positive_women_in_sub_Saharan_Africa:_what_works_for_whom_and_in_what_contexts_ L2 - https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6949-0 DB - PRIME DP - Unbound Medicine ER -