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Social circumstances that drive early introduction of formula milk: an exploratory qualitative study in a peri-urban South African community
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). School of Public health , University of Western Cape . (CHILD HEALTH)
Medical Research Council/ university of . (child health)
UNICEF NY. USA.. (child health)
Stellenbosch University . (Child psychology)
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2014 (English)In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 10, no 1, 102-111 p.Article in journal (Refereed) Published
Abstract [en]

Breastfeeding is widely endorsed as the optimal strategy for feeding newborns and young infants, as well as improving child survival and achieving Millennium Development Goal 4. Exclusive breastfeeding (EBF) for the first 6 months of life is rarely practised in South Africa. Following the 2010 World Health Organization (WHO) infant feeding recommendations (EBF for HIV-positive mothers with maternal or infant antiretroviral treatment), South Africa adopted breastfeeding promotion as a National Infant Feeding Strategy and removed free formula milk from the Prevention of Mother-to-Child Transmission of HIV programme. This study aimed to explore the perceptions of mothers and household members at community level regarding the value they placed on formula feeding and circumstances that drive the practice in a peri-urban community. We conducted in-depth interviews with HIV-positive and HIV-negative mothers in a community-randomised trial (Good Start III). Focus group discussions were held with grandmothers, fathers and teenage mothers. Data were analysed using thematic analysis. The following themes were identified; inadequate involvement of teenage mothers; grandmothers who become replacement mothers; fear of failing to practise EBF for 6 months; partners as formula providers and costly formula milk leading to risky feeding practices. The new South African Infant Feeding Strategy needs to address the gaps in key health messages and develop community-orientated programmes with a focus on teenage mothers. These should encourage the involvement of grandmothers and fathers in decision-making about infant feeding so that they can support EBF for optimal child survival.

Place, publisher, year, edition, pages
2014. Vol. 10, no 1, 102-111 p.
Keyword [en]
formula feeding, community perception, HIV, qualitative research focus group discussion, social circumstances
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-232039DOI: 10.1111/mcn.12012OAI: oai:DiVA.org:uu-232039DiVA: diva2:746448
Available from: 2014-09-12 Created: 2014-09-12 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Intervention for improved newborn feeding and survival where HIV is common: Perceptions and effects of a community-based package for maternal and newborn care in a South African township
Open this publication in new window or tab >>Intervention for improved newborn feeding and survival where HIV is common: Perceptions and effects of a community-based package for maternal and newborn care in a South African township
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

South Africa recently changed infant feeding policy within Prevention of Mother to Child Transmission (PMTCT) of HIV from free formula to recommendation of breastfeeding for all. The country is evaluating the role of Community Health Workers (CHWs) in supporting mothers and newborns.

The aim of this thesis is to explore perceptions of household members on the value given to and the social forces behind formula feeding in light of the recent policy change, and to assess the effect of a community-based package of maternal and newborn care delivered by CHWs on HIV-free survival and exclusive and appropriate infant feeding up to 12 weeks of age.

Studies were conducted in a high HIV prevalence township. Focus group discussions were performed (grandmothers, fathers and teenage mothers) and in-depth interviews with HIV-positive and HIV-negative mothers. Perceptions of household members on the formula policy change were explored and the value household members place on formula feeding and circumstances that drive it. In a cluster-randomized trial (15 intervention, 15 control clusters) CHWs provided two antenatal and five post-natal home visits to support and promote PMTCT activities.

There were misunderstandings by community members on the free formula policy change. Mothers transferred the motherhood role to their mothers while partners provided inadequate financial support, leading to risky mixed feeding. Teenage mothers rarely breastfed their infants due to perceived constraints including embarrassment, sagging breasts and loss of freedom and boyfriends.

At 12 weeks of age the intervention had doubled exclusive breastfeeding (EBF) (28% vs. 14%) and slightly increased infant weight and length. No difference was seen between study arms in HIV-free survival. The effect on EBF at12 weeks did not differ with maternal education or wealth levels, but was higher among HIV-negative mothers.

 Focusing on teenage mothers breastfeeding challenges, involvement of grandmothers and fathers in infant feeding decision-making, improving communication strategies on policy change and breastfeeding to the community and health workers and CHWs home visits supporting PMTCT activities are important for infant feeding and child health.

Place, publisher, year, edition, pages
UPPSALA: Acta Universitatis Upsaliensis, 2014. 89 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1027
Keyword
Prevention of Mother to Child Transmission of HIV, Community Health Workers, Exclusive breastfeeding, Formula feeding, South Africa
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-232110 (URN)978-91-554-9035-5 (ISBN)
Public defence
2014-10-29, Rosensalen, Barnsjukhuset Akademiska sjukhuset, Entrance 95/96, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2014-10-02 Created: 2014-09-12 Last updated: 2015-01-23Bibliographically approved

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Publisher's full texthttp://www.ncbi.nlm.nih.gov/pubmed/23230962

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Ijumba, PetridaPersson, Lars-Åke

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