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Schneider L, Korhonen K, Ollila S, Mutanen M. Social realities in remote villages: Infant and young child feeding in Kirewa, Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003016. [PMID: 39255291 PMCID: PMC11386423 DOI: 10.1371/journal.pgph.0003016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 08/09/2024] [Indexed: 09/12/2024]
Abstract
Understanding infant and young child feeding (IYCF) practices in Africa requires an examination of the social context. Social relationships influence people through mechanisms such as social support, social influence, social engagement, access to resources and negative social interactions. This study explores how these mechanisms manifest in IYCF in remote villages in Uganda. In 2018, we conducted two focus group discussions each with mothers, fathers and grandparents, ande interviews with two clan leaders, six village health teamers (VHT) and four healthcare workers (HCW). We deductively searched the data for any indications of elements that could influence child feeding and health using the psychosocial mechanisms of social support, social influence, social engagement, access to resources and negative social interactions as the broader themes. The manifestation of social support involved practical help from mothers-in-law (MIL), financial contributions from fathers, and informational, instrumental, emotional and appraisal support from VHTs. Social influence by MILs mainly concerned the transmission of food-related beliefs and pressure to have many children. The social engagement of young mothers was restricted. Access to resources was stratified and affected by poverty, patriarchy, and knowledge of HCWs and VHTs. Negative social interactions included physical abuse, alcoholism, and fear-based relationships. We found the different psychosocial mechanisms to construct a useful framework for describing the social reality surrounding IYCF. Changing attitudes towards family planning, involving fathers in IYCF, and strengthening the position of VHTs as family advisers can potentially improve IYCF in rural Uganda.
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Affiliation(s)
- Lauriina Schneider
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Katja Korhonen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Sari Ollila
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Marja Mutanen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
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Trafford Z, Jewett S, Swartz A, LeFevre AE, Winch PJ, Colvin CJ, Barron P, Bamford L. Reported infant feeding practices and contextual influences on breastfeeding: qualitative interviews with women registered to MomConnect in three South African provinces. Int Breastfeed J 2020; 15:81. [PMID: 32928259 PMCID: PMC7489212 DOI: 10.1186/s13006-020-00315-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/04/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Global guidelines recommend exclusive breastfeeding (EBF) for the first 6 months of life. South African EBF rates have steadily increased but still only average 32% for infants below 6 months of age. Malnutrition and developmental delays continue to contribute substantially to the morbidity and mortality of South African children. MomConnect, a national mHealth messaging system used to send infant and maternal health messages during and after pregnancy, has a specific focus on improving rates of breastfeeding and has achieved high rates of population coverage. METHODS For this qualitative study, we interviewed women who were registered to MomConnect to investigate their breastfeeding and other infant feeding practices, decision-making pre- and post-delivery, and the role of the health system, family members and the wider community in supporting or detracting from breastfeeding intentions. Data were collected from February-March 2018 in South Africa's KwaZulu-Natal, Free State and Gauteng provinces. Framework analysis was conducted to identify common themes. RESULTS Most women interviewed had breastfed, including HIV-positive women. Even when women had delivered by caesarean section, they had usually been able to initiate breastfeeding a few hours after birth. Understandings of EBF varied in thoroughness and there was some confusion about the best way to cease breastfeeding. Most women felt well-equipped to make infant feeding decisions and to stick to their intentions, but returning to work or school sometimes prevented 6 months of EBF. Advice from the health system (both via clinics and MomConnect) was considered helpful and supportive in encouraging EBF to 6 months, although family influences could thwart these intentions, especially for younger women. Mothers reported a range of breastfeeding information sources that influenced their choices, including social media. CONCLUSIONS Efforts to improve EBF rates must include consideration of the social and economic environment surrounding women. Interventions that focus only on improving women's knowledge are valuable but insufficient on their own. Attention should also be paid to infant behaviors, and how these affect women's breastfeeding choices. Finally, although there is strong local policy support for EBF, more rigorous implementation of these and other broader changes to create a more enabling structural environment ought to be prioritized.
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Affiliation(s)
- Zara Trafford
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Sara Jewett
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Alison Swartz
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Amnesty E. LeFevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Peter J. Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Christopher J. Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Public Health Sciences, University of Virginia, Charlottesville, USA
- Department of Epidemiology, School of Public Health, Brown University, Providence, USA
| | - Peter Barron
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Jackson D, Swanevelder S, Doherty T, Lombard C, Bhardwaj S, Goga A. Changes in rates of early exclusive breast feeding in South Africa from 2010 to 2013: data from three national surveys before and during implementation of a change in national breastfeeding policy. BMJ Open 2019; 9:e028095. [PMID: 31740463 PMCID: PMC6886934 DOI: 10.1136/bmjopen-2018-028095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Between 1998 and 2009 reported exclusive breastfeeding (EBF) rates in South African infants, aged 0-6 months, ranged from 6.2% to 25.7%. In 2011, the National Minister of Health shifted policy to promote 'exclusive' breast feeding for all women in South Africa irrespective of HIV status (Tshwane Declaration of Support for Breastfeeding in South Africa). This analysis examines early EBF prior to and through implementation of the declaration. SETTING Data from the three South Africa national, cross-sectional, facility-based surveys, conducted in 2010, 2011-12 and 2012-13, were analysed. Primary health facilities (n=580) were randomly selected after a stratified multistage probability proportional-to-size sampling to provide valid national and provincial estimates. PARTICIPANTS A national sample of all infants attending their 6 weeks vaccination at selected facilities. The number of caregiver-infant pairs enrolled were 10 182, 10 106 and 9120 in 2010, 2011-12, and 2012-13, respectively. PRIMARY OUTCOME MEASURE Exclusive breast feeding as measured using structured 24 hours recall plus prior 7 days (8 days inclusive prior to day interview) and WHO definition. RESULTS The adjusted OR comparing EBF prevalence in 2011-12 and 2012-13 with 2010 were 2.08 and 5.51, respectively. Mothers with generally higher socioeconomic status, HIV-positive, unplanned pregnancy, primipara, postcaesarean delivery, resided in certain provinces and women who did not receive breastfeeding counselling had significantly lower odds of EBF. CONCLUSION With what seemed to be an intransigently low EBF rate since 1998, South Africa saw an increase in early EBF for infants aged 4-8 weeks from 2010 to 2013, coinciding with a major national breastfeeding policy change. These increases were seen across all provinces and subgroups, suggesting a population-wide effect, rather than an increase in certain subgroups or locations. While these increases in EBF were significant, the 59.1% prevalence is still below desired levels of early EBF. Further improvements in EBF programmes are needed.
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Affiliation(s)
- Debra Jackson
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- Health Section, United National Children's Fund, New York City, New York, USA
| | - Sonja Swanevelder
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Tanya Doherty
- Health Systems Research Unit, Medical Research Council, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South Africa Medical Research Council, Pretoria, South Africa
| | - Sanjana Bhardwaj
- Health Section, United Nations Children's Fund, Pretoria, South Africa
| | - Ameena Goga
- Health Systems Research Unit, Medical Research Council, Pretoria, South Africa
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Nieuwoudt SJ, Ngandu CB, Manderson L, Norris SA. Exclusive breastfeeding policy, practice and influences in South Africa, 1980 to 2018: A mixed-methods systematic review. PLoS One 2019; 14:e0224029. [PMID: 31626658 PMCID: PMC6799928 DOI: 10.1371/journal.pone.0224029] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/03/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In 2011, South Africa committed to promoting exclusive breastfeeding (EBF) for six months for all mothers, regardless of HIV status, in line with World Health Organization recommendations. This was a marked shift from earlier policies, and with it, average EBF rates increased from less than 10% in 2011 to 32% by 2016. OBJECTIVES The aim of this mixed-methods systematic review was to describe EBF practices in South Africa and their multi-level influences over four policy periods. METHODS We applied PRISMA guidelines according to a published protocol (Prospero: CRD42014010512). We searched seven databases [Africa-Wide, PubMed, Popline, PsychINFO, CINAHL, Global Health, and The Cochrane Library] and conducted hand searches for eligible articles (all study designs, conducted in South Africa and published between 1980-2018). The quality of articles was assessed using published tools, as appropriate. Separate policy analysis was conducted to delineate four distinct policy periods. We compared EBF rates by these periods. Then, applying a three-level ecological framework, we analysed EBF influences concurrently by method. Finally, the findings were synthesized to compare breastfeeding influences by policy period, maintaining an ecological framework. RESULTS From an initial sample of 20,226 articles, 72 unique articles were reviewed, three of which contributed to both quantitative and qualitative analysis. Despite the large sample, several provinces were poorly represented (if at all) and many studies were assessed as low to moderate quality. Despite these limitations, our historical lens enabled us to explore why South African progress on increasing EBF practices has been slow. The review reflects a context that increasingly supports EBF, but falls short in accounting for family, community, and workplace influences. The findings also highlight the unintended damage caused by rapidly adopting and introducing global guidelines to an unsupported health workforce. CONCLUSIONS From a South African perspective, we identified geographic and methodological biases, as well as gaps in our understanding and potential explanations of inequities in EBF. Our recommendations relate to policy, programming, and research to inform changes that would be required to further improve EBF practice rates in South Africa. While our review is South Africa-specific, our findings have broader implications for investing in multi-level interventions and limiting how often infant feeding guidelines are changed.
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Affiliation(s)
- Sara Jewett Nieuwoudt
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa
- SAMRC Developmental Pathways Health and Research Unit, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa
| | - Christian B. Ngandu
- SAMRC Developmental Pathways Health and Research Unit, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa
| | - Lenore Manderson
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa
- Institute at Brown for Environment and Society, Brown University, Providence, RI, United States of America
- School of Social Sciences, Menzies Building, Clayton Campus, Monash University, Melbourne, Australia
| | - Shane A. Norris
- SAMRC Developmental Pathways Health and Research Unit, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa
- School of Human Development and Health, and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
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Takah NF, Atem JA, Aminde LN, Malisheni M, Murewenhema G. The impact of approaches in improving male partner involvement in the prevention of mother-to-child transmission of HIV on the uptake of safe infant feeding practices by HIV positive women in sub-Saharan Africa. A systematic review and meta-analysis. PLoS One 2018; 13:e0207060. [PMID: 30507942 PMCID: PMC6277072 DOI: 10.1371/journal.pone.0207060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/24/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The low level of male partner involvement in Prevention of Mother to Child Transmission of HIV services such as safe infant feeding practices poses a serious challenge to the implementation of guidelines on safe infant feeding and may undermine efforts towards elimination of mother to child transmission of HIV in sub Saharan Africa(SSA). We conducted a systematic review and meta-analysis to identify the approaches that have been utilized to improve male partner involvement in PMTCT services as well as their impact on the uptake of safe infant feeding practices by HIV positive mothers in SSA. METHODS In this systematic review and meta-analysis, Ovid Medline, Embase, PsycINFO, Cochrane library, ClinicalTrials.gov, Web of Science and Current Controlled Trials were searched. Only studies performed in SSA that reported an approach that specifically involved male partners and its impact on the uptake of safe infant feeding practices (irrespective of the language and date of publication) were included. Odds ratios were extracted or calculated from studies and combined in a meta-analysis using the statistical package Stata version 11.0. Forest plots were generated using the random effect model. RESULTS From an initial 2416 non-duplicate articles, 06 articles were included in the systematic review and meta-analysis. The overall pooled unadjusted OR was 3.08[95%CI: 2.58-3.68], while the effect sizes for interventions aimed at promoting male partner involvement such as verbal encouragement, complex community intervention and enhanced psychosocial interventions were 1.93[95%CI: 1.34-2.79], 3.45[95%CI: 2.79-4.25] and 5.14[95%CI: 2.42-10.90] respectively. Using only adjusted odd ratios, the pooled adjusted OR = 1.78[95%CI: 1.35-2.34]. The I2 = 60.1% p = 0.057 using adjusted ORs. CONCLUSION Interventions aimed at promoting male partner involvement such as enhanced psychosocial interventions, verbal encouragement and complex community interventions increase the uptake of safe infant feeding options. The heterogeneity was moderate among studies. More studies including randomised trials that will recruit larger, representative samples of patients are needed in the future. Prospero registration number: 42016032673.
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Affiliation(s)
- Noah F. Takah
- Department of Health Policy, International Diagnostics Centre Africa, Addis Ababa, Ethiopia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jeannine A. Atem
- Department of Health Policy, International Diagnostics Centre Africa, Addis Ababa, Ethiopia
| | - Leopold N. Aminde
- Department of Health Policy, International Diagnostics Centre Africa, Addis Ababa, Ethiopia
- Department of Clinical Epidemiology, School of Public Health, University of Queensland, Brisbane, Australia
| | - Moffat Malisheni
- Department of Maternal and Child Health, Ministry of Health, Lusaka, Zambia
| | - Grant Murewenhema
- Department of Maternal and Child Health, Ministry of Health, Harare, Zimbabwe
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Yah CS, Tambo E. Why is mother to child transmission (MTCT) of HIV a continual threat to new-borns in sub-Saharan Africa (SSA). J Infect Public Health 2018; 12:213-223. [PMID: 30415979 DOI: 10.1016/j.jiph.2018.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/30/2018] [Accepted: 10/14/2018] [Indexed: 11/15/2022] Open
Abstract
Sub-Saharan Africa (SSA) accounts for more than two thirds of the world's HIV infection. Despite scaled-up prevention of mother-to-child transmission of HIV (PMTCT) programmes, mother to child transmission of HIV (MTCT) continues to escalate. We describe the challenges faced by PMTCT in MTCT in SSA. The study reviewed articles and reports published online. The most common barriers and challenges were non-disclosure of HIV status, late initiation of ARVs treatment/adherence, STIs screening, long clinics waiting time, non-involvement of men in ANC/PMTCT, infant feeding methods and sensitization of community members on ANC/PMTCT programmes. The study highlights the need to expand PMTCT coverage and the implementation of the 90-90-90 programme toward MTCT elimination in SSA. That is " ≥90% of pregnant and breast-feeding mothers must know their HIV status; ≥90% of those that are positive are enrolled on ARVs treatment and care; ≥90% of those on ARVs treatment and care are virally suppressed.
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Affiliation(s)
- Clarence S Yah
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Science, University of the Witwatersrand, Johannesburg, P/Bag 3, Wits 2050, South Africa.
| | - Ernest Tambo
- Higher Institute of Health Sciences, Université des Montagnes, Bangangte, Cameroon; Africa Intelligence and Surveillance, Communication and Response (Africa DISCoR) Institute, Yaoundé, Cameroon.
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Influences on Exclusive Breastfeeding Among Rural HIV-Infected South African Women: A Cluster Randomized Control Trial. AIDS Behav 2018; 22:2966-2977. [PMID: 29926300 DOI: 10.1007/s10461-018-2197-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
South African guidelines for prevention-of-mother-to-child-transmission (PMTCT) of HIV emphasize exclusive breastfeeding (EBF). This study examined the impact of a PMTCT intervention and male involvement on EBF. In a two-phase cluster-randomized trial, rural South African community health centers were randomized to offer HIV-infected pregnant women PMTCT standard of care plus either: a behavioral PMTCT intervention, or a time-equivalent attention-control condition. Phase 1 women had non-participating male partners; Phase 2 women had participating partners. Pregnant women (n = 1398) were assessed on HIV stigma, disclosure of HIV status to partner, male involvement, and family planning knowledge. Feeding practices were assessed 6 weeks postpartum (56% retained). Reduced depressive symptomatology predicted EBF 6 weeks postpartum, adjusting for attrition (AOR = 0.954, p = 0.001). Neither male involvement in antenatal care, phase, HIV stigma, disclosure, nor family planning knowledge predicted EBF. Future studies and perinatal care should address depression, which has important implications for infant health.
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Ngoma-Hazemba A, Ncama BP. The role of community volunteers in PMTCT programme: Lessons from selected sites in Zambia to strengthen health education on infant feeding and follow-up of HIV-positive mother-infant pair. Afr J Prim Health Care Fam Med 2018; 10:e1-e8. [PMID: 29943606 PMCID: PMC6018380 DOI: 10.4102/phcfm.v10i1.1665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/14/2018] [Accepted: 03/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background A global debate surrounding health care delivery at the lowest level of the community has aroused interest among researchers. In settings where skilled health workforce is scarce, the community relies on volunteers to provide care. Aim To explore the role of community-based volunteers (CBVs) and their perspectives on human immunodeficiency virus (HIV) and infant feeding to gain insights into the implementation of prevention of mother-to-child transmission (PMTCT) interventions at community level. Setting The study was conducted in Lusaka using Ngombe and Chelstone health facilities to recruit participants. Fieldwork took place from January 2014 to September 2014. Methods An exploratory descriptive qualitative study employing focus group discussions was conducted with CBVs. Convenient sampling was used to recruit 10 participants from each site. All transcribed interviews were imported into the Nvivo 10 for open coding and analysis. Results Although the role of community volunteers was to support and teach mothers on infant feeding in relation to HIV, the known cultural norms and practices had a bearing on how they tailored their information on breastfeeding to mothers. However, their link of the community to the health facilities cannot be overemphasised in these settings. Conclusion The role of community volunteers in PMTCT interventions can be strengthened by improving their training through use of appropriate educational materials and support of required resources. Lessons from these sites can inform future research to design community-based interventions and develop health education materials that are sensitive to cultural norms and practices in this and similar settings.
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Nieuwoudt S, Manderson L. Frontline health workers and exclusive breastfeeding guidelines in an HIV endemic South African community: a qualitative exploration of policy translation. Int Breastfeed J 2018; 13:20. [PMID: 29930693 PMCID: PMC5992713 DOI: 10.1186/s13006-018-0164-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/14/2018] [Indexed: 12/27/2022] Open
Abstract
Background Mothers rely heavily on health worker advice to make infant feeding decisions. Confusing or misleading advice can lead to suboptimal feeding practices. From 2001, HIV positive mothers in South Africa were counseled to choose either exclusive breastfeeding or exclusive formula feeding to minimize vertical HIV transmission. On the basis of revised World Health Organization guidelines, the government amended this policy in 2011, by promoting exclusive breastfeeding and discontinuing the provision of free formula. We explored how health workers experienced this new policy in an HIV endemic community in 2015–16, with attention to their knowledge of the policy, counselling practices, and observations of any changes. Methods We interviewed eleven health workers, from four community health clinics, who had counseled mothers before and after the policy change. The transcribed interviews were analyzed thematically, using a hybrid coding approach. Results The scientific rationale of the policy was not explained to most health workers, who mostly thought that the discontinuation of the formula program was cost-related. The content of their counseling reflected knowledge about promoting breastfeeding for all women, and accordingly they mentioned the nutritional and developmental benefits of breastfeeding. The importance of exclusive breastfeeding for all infants was not emphasized, instead counseling focused on HIV prevention, even for uninfected mothers. The health workers noted an increased incidence of breastfeeding, but some worried that to avoid HIV disclosure, HIV positive mothers were mixed feeding rather than exclusively breastfeeding. Conclusions Causal links between the policy, counseling content and feeding practices were unclear. Some participants believed that breastfeeding practices were driven by finance or family pressures rather than the health information they provided. Health workers generally lacked training on the policy’s evidence base, particularly the health benefits of exclusive breastfeeding for non-exposed infants. They wanted clarity on their counseling role, based on individual risk or to promote exclusive breastfeeding as a single option. If the latter, they needed training on how to assist mothers with community-based barriers. Infant feeding messages from health workers are likely to remain confusing until their uncertainties are addressed. Their insights should inform future guideline development as key actors.
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Affiliation(s)
- Sara Nieuwoudt
- 1School of Public Health, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000 South Africa.,2Developmental Pathways Health and Research Unit, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000 South Africa
| | - Lenore Manderson
- 1School of Public Health, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000 South Africa.,3Institute at Brown for Environment and Society, Brown University, 85 Waterman St, Providence, RI 02912 USA
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Fox EL, Pelto GH, Bar H, Rasmussen KM, Young SL, Debrosse MG, Rouzier VA, Pape JW, Pelletier DL. Capturing Changes in HIV-Infected Breastfeeding Mothers' Cognitive Processes from Before Delivery to 5 Months Postpartum: An Application of the Pile-Sorting Technique in Haiti. Curr Dev Nutr 2018; 2:nzy017. [PMID: 29955729 PMCID: PMC6007337 DOI: 10.1093/cdn/nzy017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/16/2018] [Accepted: 03/20/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The cognitive processes involved in individuals' perceptions and prioritization of information, and how these change with experience or exposure to interventions, are rarely examined in the evaluation of nutrition interventions. Exclusive breastfeeding counseling is a common infant and young-child feeding intervention and is used to promote HIV-free survival in the prevention of mother-to-child transmission programs. However, it is often designed without adequate attention to the changes in mothers' perceptions over the course of their early breastfeeding experiences. OBJECTIVE The aim of this study was to identify HIV-infected breastfeeding mothers' cognitive structure (their organization of messages and ideas) of infant feeding messages and to characterize whether their cognitive organization of infant feeding messages changed from pregnancy through the first 5 mo postpartum. METHODS With the use of semistructured interviews and the cognitive mapping technique of pile sorting, we interviewed 30 HIV-infected breastfeeding mothers in Port-au-Prince, Haiti. We asked them to sort and rate 18 infant feeding messages 3 times (during pregnancy, 0- to 1-mo postpartum, and 3- to 5-mo postpartum). We analyzed their responses by using multidimensional scaling, property fitting, and partition analyses. RESULTS At all 3 visits, we found consistency in women's cognitive mapping of messages. For example, mothers consistently differentiated messages pertinent for exclusive breastfeeding compared with those that pertained to other practices. However, subtle variations in mothers' cognition over time were also evident, particularly at 0- to 1-mo postpartum, when message proximity was tightly clustered compared with the earlier and later periods. CONCLUSIONS We conclude that mothers share a common cognitive organization of infant feeding messages and that this organization changes over time. Attention to variations in cognition can support context-sensitive, patient-centered counseling by practitioners and improve the effectiveness of nutrition interventions. Pile sorting is an efficient, systematic technique to examine cognitive processes related to health and nutrition.
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Affiliation(s)
- Elizabeth L Fox
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
| | - Gretel H Pelto
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Haim Bar
- Department of Statistics, University of Connecticut, Storrs, CT
| | | | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL
| | - Marie Guerda Debrosse
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa A Rouzier
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Jean William Pape
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
- Center for Global Health, Weill Cornell Medical College, New York, NY
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Fox EL, Pelto GH, Rasmussen KM, Debrosse MG, Rouzier VA, Pape JW, Pelletier DL. Who knows what: An exploration of the infant feeding message environment and intracultural differences in Port-au-Prince, Haiti. MATERNAL AND CHILD NUTRITION 2017; 14:e12537. [PMID: 28976068 DOI: 10.1111/mcn.12537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/27/2017] [Accepted: 09/09/2017] [Indexed: 11/28/2022]
Abstract
Worldwide, mothers with young children receive many messages about infant feeding. Some messages are generated by health providers and others by the households, communities, and social contexts in which women live. We aimed to determine the scope of infant feeding messages in urban Haiti and to examine intracultural differences in salience of these messages and their alignment with international guidelines. We applied the method of free listing with 13 health workers and 15 human immunodeficiency virus (HIV)-infected and 15 HIV-uninfected mothers with infants 0-6 months old at Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes in Port-au-Prince, Haiti. Participants listed all messages women receive about infant feeding and specifically about HIV and infant feeding. Message salience was determined by frequency of mention and recall order; messages were coded for key themes. For all groups, the World Health Organization infant feeding recommendations were salient, especially those related to exclusive breastfeeding. Messages across all groups focused on infant health outcomes, with less emphasis on maternal outcomes. Cultural beliefs were also elicited and showed higher salience for mothers than health workers, particularly for consequences of poor maternal nutrition. Health workers' free lists were poorly correlated to those of mothers, whereas those of mothers were highly correlated, regardless of HIV status. Inasmuch as many salient messages were culturally generated, and differences existed between mothers and health workers, we conclude that it is important for health workers to acknowledge the broader infant feeding message environment, and discrepancies within that environment, to address successes and failures in the messages reaching mothers, given potential consequences for mothers' breastfeeding behaviours.
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Affiliation(s)
- Elizabeth L Fox
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.,Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gretel H Pelto
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | | | - Marie Guerda Debrosse
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haïti
| | - Vanessa A Rouzier
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haïti
| | - Jean William Pape
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haïti.,Center for Global Health, Weill Cornell Medical College, New York, New York, USA
| | - David L Pelletier
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
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Mnyani CN, Tait CL, Armstrong J, Blaauw D, Chersich MF, Buchmann EJ, Peters RPH, McIntyre JA. Infant feeding knowledge, perceptions and practices among women with and without HIV in Johannesburg, South Africa: a survey in healthcare facilities. Int Breastfeed J 2017; 12:17. [PMID: 28405213 PMCID: PMC5385001 DOI: 10.1186/s13006-017-0109-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South 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. METHODS This 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. RESULTS Women 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. CONCLUSIONS While 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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Affiliation(s)
- Coceka N Mnyani
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,SACEMA (DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis), Stellenbosch University, Stellenbosch, South Africa
| | - Carol L Tait
- Anova Health Institute, Johannesburg, South Africa
| | | | - Duane Blaauw
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew F Chersich
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, University of Ghent, Ghent, Belgium
| | - Eckhart J Buchmann
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa
| | | | - James A McIntyre
- Anova Health Institute, Johannesburg, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Infant and Young Child Feeding Counseling, Decision-Making, and Practices Among HIV-Infected Women in Malawi's Option B+ Prevention of Mother-to-Child Transmission Program: A Mixed Methods Study. AIDS Behav 2016; 20:2612-2623. [PMID: 27022939 DOI: 10.1007/s10461-016-1378-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examined infant and young child feeding (IYCF) counseling, decision-making, and practices among HIV-infected women with children 0-23 months participating in Malawi's Option B+ prevention of mother-to-child transmission (PMTCT) program. We conducted 160 survey interviews, 32 in-depth interviews, and 32 observations of PMTCT visits. Surveys indicated that exclusive breastfeeding was common (75 %) among children <6 months, while minimum dietary diversity (41 %) and minimum acceptable diet (40 %) for children 6-23 months occurred less often. In-depth interviews supported these findings. Most women felt comfortable with current breastfeeding recommendations, but chronic food insecurity made it difficult for them to follow complementary feeding guidelines. Women trusted IYCF advice from health workers, but mainly received it during pregnancy. During observations of postnatal PMTCT visits, health workers infrequently advised on breastfeeding (41 % of visits) or complementary feeding (29 % of visits). This represents a missed opportunity for health workers to support optimal IYCF practices within Option B+.
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Maryam ALM, Nadia SA, Rosemary K. Barriers to the practice of exclusive breastfeeding among HIV-positive mothers in sub-Saharan Africa: A Scoping Review of counselling, socioeconomic and cultural factors. ACTA ACUST UNITED AC 2016. [DOI: 10.5897/jahr2015.0353] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Hazemba AN, Ncama BP, Sithole SL. Promotion of exclusive breastfeeding among HIV-positive mothers: an exploratory qualitative study. Int Breastfeed J 2016; 11:9. [PMID: 27103938 PMCID: PMC4839145 DOI: 10.1186/s13006-016-0068-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/09/2016] [Indexed: 11/21/2022] Open
Abstract
Background Exclusive breastfeeding has the potential to reduce infant and under-five mortality, but research shows the practice is not widespread in resource-poor settings of sub-Saharan Africa. We explored factors influencing the decision to exclusively breastfeed among HIV-positive mothers accessing interventions for prevention of mother-to-child transmission of HIV in selected sites of Zambia. Methods This exploratory qualitative study was embedded in research conducted on: HIV and infant feeding; choices and decision-outcomes in the context of prevention of mother-to-child transmission among HIV-positive mothers in Zambia. Thirty HIV-positive mothers and six key informants were recruited from two health facilities providing mother-to-child HIV transmission prevention services. A semi-structured guide was used to conduct interviews, which were digitally recorded and simultaneously transcribed. Data coding and analysis was done with the support of QRS Nvivo 10 version software. Results Despite the known benefits of exclusive breastfeeding, gaps in understanding and potential for behaviour change remained. We found that information promoting exclusive breastfeeding may have been understood by mothers as instructions from the health care workers indicating how to feed their HIV-exposed babies rather than as an option for the mothers’ own informed-decision. This understanding influenced a mother’s perceptions of breast milk safety while on antiretroviral medicine, of the formula feeding option, and of the baby crying after breastfeeding. The meanings mothers attached to exclusive breastfeeding thus influenced their understanding of breast milk insufficiency, abrupt weaning and mixed feeding in the context of preventing mother-to-child transmission of HIV. Conclusion In order to enhance feeding practices for HIV-exposed infants, our study suggests a broader health campaign supporting all mothers to exclusively breastfeed.
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Affiliation(s)
- Alice N Hazemba
- Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Busisiwe P Ncama
- School of Nursing and Public Health, Howard College Campus, University of KwaZulu Natal, Durban, South Africa
| | - Sello L Sithole
- Department of Social Work, School of Social Sciences, University of Limpopo, Sovenga, South Africa
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Effect of an integrated community-based package for maternal and newborn care on feeding patterns during the first 12 weeks of life: a cluster-randomized trial in a South African township. Public Health Nutr 2015; 18:2660-8. [PMID: 25660465 DOI: 10.1017/s1368980015000099] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To analyse the effect of community-based counselling on feeding patterns during the first 12 weeks after birth, and to study whether the effect differs by maternal HIV status, educational level or household wealth. DESIGN Cluster-randomized trial with fifteen clusters in each arm to evaluate an integrated package providing two pregnancy and five postnatal home visits delivered by community health workers. Infant feeding data were collected using 24 h recall of nineteen food and fluid items. SETTING A township near Durban, South Africa. SUBJECTS Pregnant women (1894 intervention and 2243 control) aged 17 years or more. RESULTS Twelve weeks after birth, 1629 (intervention) and 1865 (control) mother-infant pairs were available for analysis. Socio-economic conditions differed slightly across intervention groups, which were considered in the analyses. There was no effect on early initiation of breast-feeding. At 12 weeks of age the intervention doubled exclusive breast-feeding (OR=2·29; 95 % CI 1·80, 2·92), increased exclusive formula-feeding (OR=1·70; 95 % CI 1·28, 2·27), increased predominant breast-feeding (OR=1·71; 95 % CI 1·34, 2·19), decreased mixed formula-feeding (OR=0·68; 95 % CI 0·55, 0·83) and decreased mixed breast-feeding (OR=0·54; 95 % CI 0·44, 0·67). The effect on exclusive breast-feeding at 12 weeks was stronger among HIV-negative mothers than HIV-positive mothers (P=0·01), while the effect on mixed formula-feeding was significant only among HIV-positive mothers (P=0·03). The effect on exclusive feeding was not different by household wealth or maternal education levels. CONCLUSIONS A perinatal intervention package delivered by community health workers was effective in increasing exclusive breast-feeding, exclusive formula-feeding and decreasing mixed feeding.
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Zulliger R, Abrams EJ, Myer L. Diversity of influences on infant feeding strategies in women living with HIV in Cape Town, South Africa: a mixed methods study. Trop Med Int Health 2013; 18:1547-54. [PMID: 24151822 DOI: 10.1111/tmi.12212] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore influences on infant feeding intentions and practices in women living with HIV in South Africa. METHODS Structured questionnaires were completed by 207 pregnant women and 203 post-partum women in Cape Town, South Africa. Concurrently, 34 semi-structured, qualitative interviews explored the influences on infant feeding strategies in women living with HIV. RESULTS Overall, 50% (104) of pregnant women intended to breastfeed and 22% (45) of post-partum women ever breastfed. Women who breastfed or intended to breastfeed were significantly more likely to have running water in their homes, to have formal housing and to receive advice in support of breastfeeding. Advice from clinic staff was the strongest predictor of breastfeeding [adjusted relative odds (ARO) in pregnant women: 6.87; 95% confidence interval (CI): 2.67, 17.66; ARO in post-partum women: 4.04; 95% CI: 1.60, 10.19]. Other important influences included previous infant feeding experiences, desires to protect the infant from HIV and involvement of other care providers. Many women also noted that breastfeeding was not feasible due to work commitments and highlighted concerns around the discontinuation of the free provision of infant formula. CONCLUSION These results suggest that women living with HIV balance complex influences in deciding on their preferred infant feeding strategies. This underscores the need for extensive provider, patient and community education to ensure consistent messaging, while allowing for adaptation to the circumstances of individual mothers.
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Affiliation(s)
- Rose Zulliger
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Haschke F, Haiden N, Detzel P, Yarnoff B, Allaire B, Haschke-Becher E. Feeding Patterns during the First 2 Years and Health Outcome. ANNALS OF NUTRITION AND METABOLISM 2013; 62 Suppl 3:16-25. [DOI: 10.1159/000351575] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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