Quality of infant feeding counselling for HIV+ mothers in Brazil: challenges and achievements

Intervening factors in the feeding of infants vertically-exposed to HIV: an integrative review

Objective

To evaluate the available scientific literature on factors that may intervene in the adequate feeding of infants vertically-exposed to HIV.

Methods

This was an integrative review of the literature, performed on the LILACS, PubMed and Scopus databases in February 2017. The search was guided by the question "What are the factors involved in feeding infants vertically-exposed to HIV." Selected studies met the inclusion criteria of being research articles published in English, Portuguese, or Spanish. Articles excluded were those on exclusive breastfeeding. There was no need to perform a temporal cut off of the studies.

Results

In all, the 32 primary studies selected showed that intervening factors were of three types: individual, such as maternal feelings and desires, beliefs, and practical difficulties; social, such as socioeconomic conditions, social support, and stigma; and political, such as health services structure and organization, supplies, health care guidance, and the knowledge and attitudes of health care professionals.

Conclusions

The factors that interfere with feeding infants vertically-exposed to HIV may be independent or associated with each other. To reduce the risk of inadequate nutrition and its associated diseases, actions must be taken to identify and minimize these factors, guaranteeing a better quality of life and reduction of infant morbidity and mortality.

Effect of using HIV and infant feeding counselling cards on the quality of counselling provided to HIV positive mothers: a cluster randomized controlled trial

Background

Counselling human immunodeficiency virus (HIV) positive mothers on safer infant and young child feeding (IYCF) options is an important component of programmes to prevent mother to child transmission of HIV, but the quality of counselling is often inadequate. The aim of this study was to determine the effect the World Health Organization HIV and infant feeding cards on the quality of counselling provided to HIV positive mothers by health workers about safer infant feeding options.

Method

This was a un-blinded cluster-randomized controlled field trial in which 36 primary health facilities in Kafue and Lusaka districts in Zambia were randomized to intervention (IYCF counselling with counselling cards) or non- intervention arm (IYCF counselling without counselling cards). Counselling sessions with 10 HIV positive women attending each facility were observed and exit interviews were conducted by research assistants.

Results

Totals of 180 women in the intervention group and 180 women in the control group were attended to by health care providers and interviewed upon exiting the health facility. The health care providers in the intervention facilities more often discussed the advantages of disclosing their HIV status to a household member (RR = 1.46, 95% CI [1.11, 1.92]); used visual aids in explaining the risk of HIV transmission through breast milk (RR = 4.65, 95% CI [2.28, 9.46]); and discussed the advantages and disadvantages of infant feeding options for HIV positive mothers (all p values < 0.05). The differences also included exploration of the home situation (p < 0.05); involving the partner in the process of choosing a feeding option (RR = 1.38, 95% CI [1.09, 1.75]); and exploring how the mother will manage to feed the baby when she is at work (RR = 2.82, 95% CI [1.70, 4.67]). The clients in the intervention group felt that the provider was more caring and understanding (RR = 1.81, 95% CI [1.19, 2.75]).

Conclusion

The addition of counselling cards to the IYCF counselling session for HIV positive mothers were a valuable aid to counselling and significantly improved the quality of the counselling session.

Antenatal counseling in maternal and newborn care: use of job aids to improve health worker performance and maternal understanding in Benin

Background

Antenatal care provides an important opportunity to improve maternal understanding of care during and after pregnancy. Yet, studies suggest that communication is often insufficient. This research examined the effect of a job aids-focused intervention on quality of counseling and maternal understanding of care for mothers and newborns.

Methods

Counseling job aids were developed to support provider communication to pregnant women. Fourteen health facilities were randomized to control or intervention, where providers were trained to use job aids and provided implementation support. Direct observation of antenatal counseling sessions and patient exit interviews were undertaken to assess quality of counseling and maternal knowledge. Providers were also interviewed regarding their perceptions of the tools. Data were collected before and after the job aids intervention and analyzed using a difference-in-differences analysis to quantify relative changes over time.

Results

Mean percent of recommended messages provided to pregnant women significantly improved in the intervention arm as compared to the control arm in birth preparedness (difference-in-differences [Δ_I-C] = +17.9, 95%CI: 6.7,29.1), danger sign recognition (Δ_I-C = +26.0, 95%CI: 14.6,37.4), clean delivery (Δ_I-C = +21.7, 95%CI: 10.9,32.6), and newborn care (Δ_I-C = +26.2, 95%CI: 13.5,38.9). Significant gains were also observed in the mean percent of communication techniques applied (Δ_I-C = +28.8, 95%CI: 22.5,35.2) and duration (minutes) of antenatal consultations (Δ_I-C = +5.9, 95%CI: 3.0,8.8). No relative increase was found for messages relating to general prenatal care (Δ_I-C = +8.2, 95%CI: -2.6,19.1). The proportion of pregnant women with correct knowledge also significantly improved for birth preparedness (Δ_I-C = +23.6, 95%CI: 9.8,37.4), danger sign recognition (Δ_I-C = +28.7, 95%CI: 14.2,43.2), and clean delivery (Δ_I-C = +31.1, 95%CI: 19.4,42.9). There were no significant changes in maternal knowledge of general prenatal (Δ_I-C = -6.4, 95%CI: -21.3,8.5) or newborn care (Δ_I-C = +12.7, 95%CI: -6.1,31.5). Job aids were positively perceived by providers and pregnant women, although time constraints remained for health workers with other clinical responsibilities.

Conclusions

This study demonstrates that a job aids-focused intervention can be integrated into routine antenatal care with positive outcomes on provider communication and maternal knowledge. Efforts are needed to address time constraints and other communication barriers, including introduction of on-going quality assessment for long-term sustainability.

Condições sociodemográficas de crianças de zero a dois anos filhas de mães com HIV/Aids, Fortaleza, CE, Brasil

OBJETIVOS: identificar as condições sociodemográficas das crianças de 0 a 2 anos de idade nascidas de mães HIV + / AIDS em Fortaleza, Ceará, Nordeste do Brasil. MÉTODOS: estudo transversal utilizando um questionário semiestruturado com cuidadores (63 mães e 5 avós) de crianças no ambulatório de um hospital estadual, entre Dezembro de 2005 e Abril de 2006. RESULTADOS: a idade média das mães foi de 26 anos de idade. Aproximadamente 16% eram analfabetas, 57,3% eram casadas e 5,9% viúvas. Mais de dois terços (79,4%) das mulheres participantes do estudo tornou-se ciente de seu status de HIV + no último parto e 51,5% relataram não receber qualquer tipo de assistência social do governo. A idade média das crianças foi de 15,6 meses e 13% não tiveram um teste de HIV. A maioria delas era proveniente de áreas rurais (60,3%), com renda familiar média mensal de R$ 446,32. Verificou-se que 57,9% das crianças viviam em uma casa com cinco ou mais pessoas, e 31% relataram ter quatro ou mais crianças morando na mesma casa. CONCLUSÕES: há necessidade de estratégias de prevenção e promoção à saúde, levando em consideração o contexto social das famílias que vivem com HIV/AIDS.