Infant feeding knowledge, perceptions and practices among women with and without HIV in Johannesburg, South Africa: a survey in healthcare facilities

Abstract

BackgroundSouth Africa has a history of low breastfeeding rates among women with and without Human Immunodeficiency Virus (HIV). In this study, we assessed infant feeding knowledge, perceptions and practices among pregnant and postpartum women with and without HIV, in the context of changes in infant feeding and Prevention of Mother-to-Child Transmission of HIV (PMTCT) guidelines.MethodsThis was a cross-sectional survey conducted from April 2014 to March 2015 in 10 healthcare facilities in Johannesburg, South Africa. A total of 190 pregnant and 180 postpartum women (74 and 67, respectively, were HIV positive) were interviewed using a semi-structured questionnaire. Multiple regression analyses assessed factors associated with an intention to exclusively breastfeed, and exclusive breastfeeding of infants less than six months of age.ResultsWomen with HIV had better overall knowledge on safe infant feeding practices, both in general and in the context of HIV infection. There were however gaps in knowledge among women with and without HIV. Information from healthcare facilities was the main source of information for all groups of women in the study. A greater percentage of women without HIV 80.9% (93/115), reported an intention to exclusively breastfeed, compared to 64.9% (48/74) of women with HIV, p = 0.014. Not having HIV was positively associated with a reported intention to breastfeed, Adjusted Odds Ratio (AOR) 3.60, 95% CI 1.50, 8.62. Other factors associated with a reported intention to exclusively breastfeed were prior breastfeeding experience and higher knowledge scores on safe infant feeding practices in the context of HIV infection. Among postpartum women, higher scores on general knowledge of safe infant feeding practices were positively associated with reported exclusive breastfeeding, AOR 2.18, 95% CI 1.52, 3.12. Most women perceived that it was difficult to exclusively breastfeed and that cultural factors were a barrier to exclusive breastfeeding.ConclusionsWhile a greater proportion of women are electing to breastfeed, HIV infection and cultural factors remain an important influence on safe infant feeding practices. Healthcare workers are the main source of information, and highlight the need for accurate and consistent messaging for both women with and without HIV.

Vulnerabilidade programática para insegurança alimentar de crianças expostas ao HIV: revisão integrativa.

“…Na escolha entre as opções de alimentação, os fatores que aumentam a vulnerabilidade para a insegurança alimentar foram: o fornecimento instável de FL gratuita [16][17][26][27][28][29] e a falha no compromisso com orientações para boas práticas de alimentação quando os profissionais de saúde ofereciam poucas orientações acerca do custo de compra [15][16]34 , da necessidade de usar suprimento adequado de água 34 e de manter o leite preparado refrigerado 19 . A confiança e o aconselhamento dos profissionais de saúde foram fundamentais para manutenção do aleitamento materno exclusivo (AME) 15,36 ; o baixo nível socioeconômico inviabilizou a alimentação com fórmula láctea (FL) 22,25,33,36 e favoreceu o AME 23 ; o suprimento gratuito e ininterrupto de fórmula, água potável encanada e energia elétrica no domicílio favoreceram a alimentação com FL 16,[24][25] .…”

“…Os conhecimentos, atitudes e práticas dos profissionais de saúde aumentaram a vulnerabilidade quando houve preconceito e estigma, com revelação do diagnóstico a pessoas da comunidade 18,23,30 ; imposição de não amamentação, sem considerar as condições das famílias 16,19,21,23,27,28,32,33,36 ; falta de orientações de introdução de alimentação complementar 32 .…”

“…A falha no compromisso com orientações para boas práticas de alimentação infantil 32 gera dúvida e medo de adoecimento dos filhos para aquelas famílias que optaram pela alimentação de substituição, em razão das dificuldades de preparo da fórmula 23,24,27 ou alergias à fórmula láctea infantil 28 . Em um serviço de saúde, o critério adotado para a recomendação da prática alimentar para cada criança exposta era determinado pelo nível de carga viral materna.…”

Factors associated with the practice of exclusive breastfeeding for six months among mothers on antiretroviral therapy in the Eastern Cape, South Africa

“…Mothers are counselled to observe the six-month EBF, continue to breastfeed beyond six months, having introduced complementary feeding. Also, the new policy recommended the adoption of Option B + as a lifelong ART strategy for all HIV-infected pregnant and postpartum women, irrespective of their immune suppression status or infant feeding mode [1,5,6].…”

Mental health predictors of breastfeeding initiation and continuation among HIV infected and uninfected women in a South African birth cohort study

“…Pregnancy and gestational factors such as unplanned pregnancy, nulliparity, caesarean section, infant male gender and low birth weight to be negatively associated with breastfeeding behaviour 14,21,22 . Among HIV-infected mothers HIV-infection and a low CD4 + T-cell count during pregnancy to be associated with non-initiation 23–25 , whilst low socioeconomic status and large family size have been associated with early breastfeeding cessation 26 . Notably absent are studies in generalized HIV epidemic that examine factors that disproportionately affect LMIC mothers such as mental health disorders.…”