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Infant feeding in the time of HIV: Rapid assessment of infant feeding policy and programmes in four African countries scaling up prevention of mother to child transmission programmes
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
2008 (English)In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 93, no 4, 288-91 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To assess the infant feeding components of prevention of mother to child HIV transmission (PMTCT) programmes. Methods: Assessments were performed across Botswana, Kenya, Malawi and Uganda. 29 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. 334 randomly selected health workers involved in the PMTCT programme completed self-administered questionnaires. 640 PMTCT counselling observations were carried out and 34 focus groups were conducted amongst men and women. Results: Most health workers (234/334, 70%) were unable to correctly estimate the transmission risks of breastfeeding irrespective of exposure to PMTCT training. Infant feeding options were mentioned in 307 of 640 (48%) observations of PMTCT counselling sessions, and in only 35 (5.5%) were infant feeding issues discussed in any depth; of these 19 (54.3%) were rated as poor. Several health workers also reported receiving free samples of infant formula in contravention of the International Code on Breastmilk Substitutes. National HIV managers stated they were unsure about infant feeding policy in the context of HIV. Finally, there was an almost universal belief that an 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.

Place, publisher, year, edition, pages
2008. Vol. 93, no 4, 288-91 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-97663DOI: 10.1136/adc.2006.096321ISI: 000254277700009OAI: oai:DiVA.org:uu-97663DiVA: diva2:172690
Available from: 2008-10-28 Created: 2008-10-28 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Prevention of Mother to Child Transmission of HIV in Africa: Operational Research to Reduce Post-natal Transmission and Infant Mortality
Open this publication in new window or tab >>Prevention of Mother to Child Transmission of HIV in Africa: Operational Research to Reduce Post-natal Transmission and Infant Mortality
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis assesses the effectiveness of the National Prevention of Mother to Child Transmission of HIV (PMTCT) programme in 3 sites in South Africa, and the quality of infant feeding counselling across four countries, Botswana, Kenya, Malawi and Uganda .

Implementation and outcome of PMTCT services were very different across the 3 sites. The Paarl site is achieving results comparable to clinical trial studies with a HIV-free survival rate of 85% at 36 weeks, while Umlazi is somewhat lower (74%) and Rietvlei, with HIV-free survival of 64%. Maternal viral load, prematurity and site were independent risk factors for infection and/or death. The regression analysis suggests that some of this difference is explained by the differences in quality of health systems across the sites. Traditional risk factors (e.g. viral load, prematurity) do not seem to explain the substantial differences in HIV-free survival between the Paarl and Rietvlei sites.

The overall mortality rate for HIV exposed infants in this cohort was 155 per 1000 live births at 36 weeks, a level higher than most other HIV exposed cohorts. The excess mortality is occurring almost completely amongst HIV infected infants who had a nine fold increased risk of mortality compared with HIV exposed but HIV negative infants. There was no significant difference in 36 week survival rates between those HIV exposed but uninfected infants and those who were not HIV exposed, Hazard ratio 0.7 (95% CI 0.3-1.5).

With respect to HIV and infant feeding most health workers across the four countries (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. South Africa was similar with only two out of thirty four HIV positive mothers being asked about essential conditions for safe formula feeding before a decision was made.

This body of work has demonstrated that the gap between efficacy and effectiveness can be significant.

Place, publisher, year, edition, pages
Uppsala: Universitetsbiblioteket, 2008. 47 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 389
Keyword
HIV/AIDS, Prevention of Mother to Child Transmission of HIV, infant feeding, child health, cohort study, health systems evaluation, effectiveness
Identifiers
urn:nbn:se:uu:diva-9331 (URN)978-91-554-7314-3 (ISBN)
Public defence
2008-11-20, Rosénsalen, Akademiska sjukhuset, Ing. 95/96 nb, Uppsala, 13:15
Opponent
Supervisors
Available from: 2008-10-28 Created: 2008-10-28Bibliographically approved

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