Infant feeding in the time of HIV: Assessment of infant feeding policy and programmes in four African countries scaling up prevention of mother to child transmission programmes

Mickey Chopra ^1* and Nigel Rollins ²

¹ Medical Research Council, South Africa
² University of Kwa-Zulu/Natal, South Africa

^* To whom correspondence should be addressed. E-mail: mickey.chopra{at}mrc.ac.za.

Accepted 6 February 2007

Abstract

Objective: To assess the infant feeding components of prevention of mother to child HIV transmission (PMTCT) programmes.

Setting & Methods: Assessments were performed across four countries - Botswana, Kenya, Malawi and Uganda. Districts offering PMTCT were selected by stratified random sampling with rural and urban strata. All health facilities in the selected PMTCT district were assessed. The facility level manager and the senior nurse in charge of maternal care were interviewed. Three hundred and thirty four health workers involved in the PMTCT programme in 29 health districts across the four countries were randomly selected and completed self-administered questionnaires. A total of 640 PMTCT counselling observations were conducted. Finally, 34 focus groups were conducted amongst men and women in communities across the four countries.

Results: Most health workers (234/334, 70%) were unable to correctly estimate the transmission risks of breastfeeding. Exposure to PMTCT training made little difference to this. Infant feeding options were mentioned in 307 out of 640 (48%) observations of PMTCT counselling session and in only 35 (5.5%) were infant feeding issues discussed in any depth; of these 19 (54.3%) were rated as poor. A number of health workers also reported receiving free samples of infant formula in contravention of the International Code. National HIV managers stated that they were unsure about infant feeding policy in the context of HIV. Finally, there was an almost universal belief that a HIV positive mother who breastfeeds her child will always infect the child and intentional avoidance of breastfeeding by the mother indicates that she is HIV positive.

Conclusion: These findings underline the need to implement and support systematic infant feeding policies and programme responses in the context of HIV programmes

Keywords: Africa, HIV, breastfeeding, prevention of mother to child transmission, scaling up

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