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

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. Electronic supplementary material The online version of this article (10.1186/s12889-019-6949-0) contains supplementary material, which is available to authorized users.

Mixed Infant Feeding Practice and Associated Factors among HIV-Positive Women under Care in Gondar City’s Public Health Facilities within Two Years Postpartum: A Cross-Sectional Study

“…This significant association conversely entails that infant feeding counseling (i.e., counseling on PMTCT) during ANC visit has a positive role on the appropriate infant feeding practice as it is observed in the current study that almost all (98.7%) of ANC attendees had received PMTCT counseling. This implication is further supported by existing evidences which show a positive correlation between infant feeding counseling during antenatal care and exclusive infant feeding practice [13,25,40].…”

Social Determinants of Breastfeeding Preferences among Black Mothers Living with HIV in Two North American Cities

“…Healthcare workers’ opinion has significant statistical association with breastfeeding attitudes. 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 impact of opposing feeding-related cultural belief, and the support from others to be assertive about their feeding choices when faced with pressure to mix feed [ 42 ]. Thus, mothers had so much faith in healthcare facilities and believed the advice of healthcare workers to be trustworthy as they are professionals.…”

Qualitative evidence synthesis of values and preferences to inform infant feeding in the context of non-HIV transmission risk

“…It is therefore important to understand factors that influence decision-making in the context of transmissible illness, and to explore stakeholders' values and preferences, that is, their beliefs, fears, perceptions and experiences around infant feeding. A substantial body of qualitative research, including multiple published systematic reviews and qualitative evidence syntheses (QES), has explored the values and preferences of stakeholders concerning infant feeding within the specific context of the risk of transmission of HIV/AIDS [4][5][6][7][8][9][10][11][12][13][14][15] and updated WHO guidance has recently been published for this group [16]. However, no systematic review or QES has been performed to date to understand the values and preferences of relevant stakeholders concerning infant feeding when there is the risk of transmission of diseases other than HIV/AIDS.…”