Barriers and Promoters of Home-Based Pasteurization of Breastmilk Among HIV-Infected Mothers in Greater Dar es Salaam, Tanzania

Abstract

Background: For the past decade, heat-treating breastmilk has been an infant feeding option recommended by the World Health Organization as a strategy to reduce vertical transmission. However, little is known about field experiences with it. Our primary objective was to explore the barriers and promoters of the implementation of breastmilk pasteurization, ''flash-heating'' (FH), in the real-world setting of Dar es Salaam, Tanzania. Subjects and Methods: Nineteen in-depth interviews were conducted with participants in a home-based infant feeding counseling intervention in which FH was promoted after 6 months of exclusive breastfeeding. Additionally, three focus group discussions were conducted with peer counselors. Interviews were transcribed, translated, and coded independently using NVivo 8 software (QSR International). Data were analyzed using the socioecological framework. Results: Information and support provided by peer counselors were the most important promoters of initiation and continuation of FH; this impacted individual-, interpersonal-, and institutional-level promoters of success. Other promoters included perceived successful breastmilk expression, infant health after initiation of FH, and the inability to pay for replacement milks. Stigma was the most important barrier and cut across all levels of the framework. Other barriers included doubt about the safety or importance of pasteurized breastmilk, difficulties with expressing milk (often attributed to poor diet), and competing responsibilities. The most common suggestion for improving the uptake and duration of FH was community education. Conclusions: Given the acknowledged role of breastmilk pasteurization in the prevention of vertical transmission, further implementation research is needed. A multilevel intervention addressing barriers to FH would likely improve uptake.

Knowledge of, and attitudes to giving expressed breastmilk to infants in rural coastal Kenya; focus group discussions of first time mothers and their advisers

“…Research on home heat treated breastmilk in Tanzania showed that some mothers did not continue the procedure for long as it was considered too much work and it was easier to give alternative fluids [ 13 ]. The same barriers might be encountered in Kilifi when cooking is done on firewood or charcoal and cow’s milk or maize porridge is easily available to the household.…”

Breastfeeding and Complementary Feeding Practices among HIV-Exposed Infants in Coastal Tanzania

“…25 Complementary feeding, recommended to begin at 6 months of age, is expected to take place alongside continued breastfeeding. They may cease breastfeeding earlier than recommended to reduce the risk of HIV transmission 23,30 or because of perceived milk insufficiency, which is often exacerbated by food insecurity. [27][28][29] HIV-infected mothers face unique challenges to feed their infants in accordance with evidence-based recommendations.…”

Suporte social de gestantes com HIV: revisão narrativa

“…Participação em programas de prevenção 13,16,[18][19][20][23][24][25][26][27][28] Acolhimento da equipe de saúde 11,16,21,24 Educação em saúde 20 Conforto das condições de saúde 24 Divulgação do estado sorológico [16][17][18][19] Aderir às medidas de profilaxia da TV 11,[16][17][18][19] Repercussões na saúde sexual 13 Deus e a fé 15,24,27 Divulgação do estado sorológico 29 Motivação para aceitar o diagnóstico e o tratamento 24 repercussões na saúde sexual: consideraram-se com maior capacidade para negociar o planejamento familiar, além do uso de preservativo, e solicitar ao companheiro que realizasse o teste de anticorpos do HIV.…”

“…As organizações comunitárias com patrocínio externo fornecem maior apoio a discussões sobre profilaxia da transmissão HIV do que outros grupos, entretanto a pequena participação masculina pode ser um fator que contribui para baixa adesão dessas medidas. 18 Em outros países, a utilização de algumas estratégias de educação em saúde, 20 desenvolvidas por educadores pares foi destacada. Estes são trabalhadores de saúde que devem ser membros das comunidades, responsáveis pelas atividades de aconselhamento sobre os cuidados de saúde.…”

“…Esta é uma estratégia para reduzir a taxa de TV recomendada pela OMS, sendo uma opção de alimentação infantil nos locais onde é restrita a distribuição de fórmula láctea infantil. 20 O Fundo das Nações Unidas para a Infância (UNICEF) e a OMS recomendam que as mulheres soropositivas devam evitar a amamentação, quando conseguem substituir alimentação de forma acessível e segura. Se os métodos não atendem a esses critérios, o aleitamento materno exclusivo é recomendado.…”