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A Longitudinal Qualitative Study of Infant-Feeding Decision Making and Practices among HIV-Positive Women in South Africa
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell barnhälsovård och nutrition/Persson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell barnhälsovård och nutrition/Persson)
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2006 (English)In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 136, no 9, 2421-2426 p.Article in journal (Refereed) Published
Abstract [en]

This study examined the challenges that HIV-positive women face at different stages of early infant feeding using a longitudinal, qualitative design. The study explored factors influencing infant-feeding decision-making and behavior of HIV positive mothers and identified characteristics of women and their environments that contributed to success in maintaining exclusivity of their infant feeding practices. The study was undertaken at 3 sites in South Africa. Participants consisted of a purposive sample of 27 women who had a positive HIV test result during antenatal care and were intending to either exclusively breast-feed or exclusively formula-feed their infants. Women were interviewed once antenatally and at 1, 4, 6, and 12 wk postpartum. Just under one-half of the women who initiated breast-feeding maintained exclusivity and over two-thirds of the women who initiated formula-feeding maintained exclusivity. Key characteristics of women who achieved success in exclusivity included the ability to resist pressure from the family to introduce other fluids and to recall key messages on mother-to-child transmission risks and mixed feeding. Among women who maintained exclusive breast-feeding, a strong belief in the benefits of breast-feeding and a supportive home environment was important. For women using formula milk, having resources such as electricity, a kettle, and flask made feeding at night easier. Support for infant feeding that extends beyond the antenatal period is important to enable mothers to cope with new challenges and pressures at critical times during the early postpartum period.

Place, publisher, year, edition, pages
2006. Vol. 136, no 9, 2421-2426 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-95144ISI: 000240058500024PubMedID: 16920864OAI: oai:DiVA.org:uu-95144DiVA: diva2:169243
Available from: 2006-11-21 Created: 2006-11-21 Last updated: 2017-12-14Bibliographically approved
In thesis
1. HIV and Infant Feeding: Operational Challenges of Achieving Safe Infant Feeding Practices
Open this publication in new window or tab >>HIV and Infant Feeding: Operational Challenges of Achieving Safe Infant Feeding Practices
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis assesses the uptake of the national Prevention of Mother to Child Transmission of HIV (PMTCT) programme in South Africa, and the challenges of achieving safe infant feeding practices in the context of HIV. The research studies contained in this thesis utilised a variety of quantitative and qualitative research methods in order to provide a full understanding of the challenges of moving from efficacy to effectiveness in PMTCT programmes. The first paper utilised a cross-sectional approach to a programme evaluation, papers two and three utilised qualitative methodologies, and paper four was based on a longitudinal cohort study design. The findings highlight the low uptake of PMTCT interventions and inappropriate infant feeding choices. The experiences of women with HIV provide an important insight into the difficulties of operationalising the WHO/UNICEF HIV and infant feeding recommendations in real life settings, where rates of HIV disclosure are low and mixed feeding is the norm. Several personal and environmental characteristics were identified that contributed to success in maintaining exclusive infant feeding practices. The research provides some guidance on the definition of appropriateness in infant feeding choices, and highlights the poor outcomes associated with formula feeding under unsafe conditions. Modifying infant feeding practices is essential in order to reduce postnatal HIV transmission and improve child survival. Interventions to improve infant feeding need to include improving the quality of counselling and support provided by health workers, with more structured assessments used to guide infant feeding choices. Efforts are also needed at the community level to increase rates of disclosure and to promote exclusive infant feeding as a norm.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2006. 83 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 200
Keyword
International health, HIV/AIDS, Prevention of Mother to Child Transmission of HIV, infant feeding, child health, qualitative research, cohort study, programme evaluation, nutrition, Internationell hälsa
Identifiers
urn:nbn:se:uu:diva-7291 (URN)91-554-6720-2 (ISBN)
Public defence
2006-12-13, Rosénsalen, Kvinnokliniken, Akademiska sjukhuset, Ing. 95/96, Uppsala, 09:15
Opponent
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Available from: 2006-11-21 Created: 2006-11-21Bibliographically approved

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Doherty, TanyaChopra, MickeyPersson, Lars-Åke

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