Promotion of exclusive breastfeeding among HIV-positive mothers: an exploratory qualitative study

Ngoma-Hazemba, Alice; Ncama, Busisiwe Purity; Sithole, Sello Levy

doi:10.1186/s13006-016-0068-7

Cited by 27 publications

(29 citation statements)

References 36 publications

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“…This could be a reflection of the misconception that only women with HIV need to practice exclusive breastfeeding, to prevent HIV transmission, and is optional for women without HIV [26]. In most sub-Saharan countries, including South Africa, mixed feeding is the norm and adherence to exclusive breastfeeding raises suspicions of HIV infection, and to avoid the stigma, women with and without HIV may elect to ‘mix feed’ [26–28]. This is somewhat a contradiction given that, as discussed earlier, there is a perception that formula feeding is also associated with having HIV [22, 23].…”

Section: Discussionmentioning

confidence: 99%

“…It would have been more desirable to do a longitudinal study to compare intentions and actual postpartum practices in the same group of women, to determine how intentions translate to practice. The study design used was the most efficient use of available resources, and there are several challenges with mobility and loss to follow-up among postpartum women [28]. There could also have been a social desirability bias in reporting of infant feeding intentions and practices, and because the study was quantitative, we did not explore in detail the motivation behind the intentions and practices.…”

Section: Discussionmentioning

confidence: 99%

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

Mnyani

Tait

Armstrong³

et al. 2016

Int Breastfeed J

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Mnyani

Tait

Armstrong³

et al. 2016

Int Breastfeed J

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“…Some participants perceived breast milk as safe while others viewed it as a risk for transmitting HIV to the baby. This conflict of belief had already been documented in earlier studies conducted in Zambia [47]. This is generally linked to inadequate health education about the benefits of exclusive breastfeeding in the presence of HIV.…”

Section: Discussionmentioning

confidence: 88%

Exploring Perceptions and Practices of Biomedical Norms during Exclusive Breastfeeding among HIV-Positive Lactating Mothers in Mozambique

Cuinhane

Coene²,

Roelens

et al. 2017

J AIDS Clin Res

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Introduction: To prevent passing infection to their infants, Mozambican mothers with HIV are advised to follow biomedical norms during breastfeeding. However, little is yet known about how HIV-positive mothers perceive biomedical norms during the breastfeeding period.Objective: To analyse lactating mothers' perceptions and compliance with biomedical norms recommended for reducing the risk of mother-to-child transmission of HIV via breastfeeding. Method:A qualitative study was carried out consisting of in-depth interviews with 59 HIV-positive lactating mothers. This involved 5 focus group discussions, direct observation and 6 semi-structured interviews with nurses. We used Bourdieu's theory of practice as a guiding framework for data analysis.Results: Findings revealed participants had mixed perceptions and inadequate knowledge about breast milk and exclusive breastfeeding. As well, participants struggled to comply with some biomedical norms. Approximately half of the participants breastfed immediately after childbirth. Most participants do breastfeed on demand and all participants complied with prescription regarding antiretroviral therapy for their infants. Of the 59 participants, 53 complied with prescription of antiretroviral therapy for themselves.A total of 56 participants did not comply with exclusive breastfeeding to the sixth month. This was due to a lack of knowledge about exclusive breastfeeding, the perception that both breast milk and formula were not enough to feed the baby up to the age of six months. Other factors included returning to school or work, illness of the mother and child, lack of disclosure of HIV status of the mother as well as social norms. Conclusion:The study results suggest participants' perceptions, incorporated learned experiences and the social environment they inhabit seem to influence compliance to biomedical norms. These norms seem new, and participants are still processing its incorporation. Health education on exclusive breastfeeding and prevention of mother-to-child HIV transmission should take into account the participant's perceptions and their social environment.

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“…This could be as a result of the impact of interventions that have raised awareness on the importance of EBF and hence mothers practice it regardless of their HIV status. Hazemba et al, [62] in their exploratory qualitative study on the promotion of exclusive breastfeeding among HIV-infected mothers in Zambia, found that gaps in understanding benefits of exclusive breastfeeding and potential for behaviour change were a challenge. They attribute lower practice of EBF among HIV-infected mothers to lack of understanding of instructions provided by health workers.…”

Section: Discussionmentioning

confidence: 99%

Assessing the Effects of Maternal HIV Infection on Child Birth Weight and Knowledge of HIV status on Breastfeeding using Observational Data in Malawi

Twabi

Manda

Small

2020

Preprint

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Background : Evidence has shown that maternal HIV infection has adverse effect on pregnancy outcomes including childbirth weight and that knowledge of mothers HIV status affects practice of exclusive breastfeeding for the first six month. Using methods for matching possible confounders, the purpose of this study were twofold: a) to assess whether or not the association of maternal HIV on childbirth weight was moderated by use of ART drugs and b) to determine if indeed knowledge of HIV status among mothers was associated with exclusive breastfeeding. Methods: Data on over 18,000 and 16,000 children still alive and born within five years of the 2010 and 2015-16 Malawi Demographic and Health Surveys (MDHS) were analysed. A set of methods for confounder balance namely, the 1:1 nearest neighbour (NN) matching, matching on the propensity score (PS) and inverse weighting the propensity score (PS) were used. Results: Using the 2010 data, maternal HIV infection had a negative effect on infant birth weight -149.0 (-324.2, -26.2) and -154.3 (-295.4, -13.3), under PS matching and PS inverse weighting respectively. Infant birth weights from HIV-infected mothers on ART and uninfected mothers were the same (mean: 3121.3, 95% CI: 3021.9, 3220.7) and (3273.7, 95% CI: 3259.1, 3288.3), respectively) and differed significantly from those HIV-infected mothers (3193.9, 95% CI: 3122.2, 3265.6). For the 2015-16 data, mothers who were HIV-infected gave birth to infants who significantly weighted more than infants from HIV-uninfected mothers 144.7 (40.4, 249.1) and 115.4 (11.6, 219.2), under PS matching and PS inverse weighting respectively. Knowledge of HIV status among mothers was not associated with their behaviour concerning exclusive breastfeeding for the 2010 and 2015-16 data. Conclusion: The association between maternal HIV infection and birth weight depended on the data used, with the 2010 data showing adverse effect. The higher birth weight among infants born to HIV infected mothers in 2015-16 maybe indicative of successes of policies and interventions within the PMTCT program in Malawi. The observed mitigating effect of ART usage by HIV infected mothers on child birth weight further confirms that PMTCT interventions should continue to be supported among antenatal clinics in Malawi.

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Promotion of exclusive breastfeeding among HIV-positive mothers: an exploratory qualitative study

Cited by 27 publications

References 36 publications

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

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

Exploring Perceptions and Practices of Biomedical Norms during Exclusive Breastfeeding among HIV-Positive Lactating Mothers in Mozambique

Assessing the Effects of Maternal HIV Infection on Child Birth Weight and Knowledge of HIV status on Breastfeeding using Observational Data in Malawi

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