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Are infant feeding options that are recommended for mothers with HIV acceptable, feasible, affordable, sustainable and safe? Pregnant women's perspectives

Published online by Cambridge University Press:  02 January 2007

Marina Manuela de Paoli ,
Rachel Manongi  and
Knut-Inge Klepp
Marina Manuela de Paoli*
Affiliation:
Institute for Nutrition Research, University of Oslo, PO Box 1046 Blindern, 0316 Oslo, Norway.
Rachel Manongi
Affiliation:
Kilimanjaro Christian Medical College, Community Health Department, PO Box 3010, Moshi, Tanzania.
Knut-Inge Klepp
Affiliation:
Institute for Nutrition Research, University of Oslo, PO Box 1046 Blindern, 0316 Oslo, Norway.
*
*Corresponding author: Email [email protected]
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Abstract

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Objective:

To investigate pregnant women's views on infant feeding options recommended for HIV-infected women.

Design:

A structured interview survey complemented with focus group discussions.

Setting:

Antenatal clinics in Moshi urban and rural districts of Tanzania.

Subjects:

Five hundred pregnant women participated in the interview survey and 46 pregnant women participated in six focus group discussions.

Results:

Participating women reported that they would change to an alternative infant feeding method if they were found to be HIV-infected and were advised to do so. Cow's milk was regarded as the most feasible infant feeding method for local HIV-infected mothers. Infant feeding formula was regarded as too costly, but if recommended by health workers and distributed free of charge, the majority of the women (82%) were confident that they would then choose this option. In the focus group discussions, women were less optimistic and expressed great concern for the social consequences of not breast-feeding. The safety of exclusive breast-feeding was questioned. Less common infant feeding methods, such as expressed heat-treated breast milk and wet-nursing, were not regarded as viable options. Several social barriers to replacement feeding were identified in the focus group discussions, including possible lack of support from partner and potential negative reactions from the community.

Conclusion:

Future research on infant feeding options should include the broader cultural context and the psychological stress that HIV-infected women face when choosing infant feeding methods.

Keywords

HIVInfant feeding optionsMother-to-child transmissionPregnant womenTanzania
Type
Research Article
Information
Public Health Nutrition , Volume 7 , Issue 5 , August 2004 , pp. 611 - 619
Copyright
Copyright © The Authors 2004

References

1Kuhn, L, Stein, S. Infant survival, HIV infection, and feeding alternatives in less developed countries. American Journal of Public Health 1997; 87(6): 926–31.CrossRefGoogle ScholarPubMed
2Humphrey, J, Iliff, P. Is breast not best? Bringing balance to a complex issue. SAfAiDS News 2001; 9(3): 18–20.Google Scholar
3Coutsoudis, A, Rollins, NC. Breastfeeding and HIV transmission: the jury is still out. Journal of Pediatric Gastoenterology and Nutrition 2003; 36: 434–42.Google ScholarPubMed
4World Health Organization (WHO). New Data on the Prevention of Mother-to-child Transmission of HIV and Their Policy Implications. Conclusions and Recommendations. Technical Consultation of the United Nations Population Fund (UNFPA)/United Nations Children's Fund (UNICEF)/ WHO/Joint United Nations Programme on HIV/AIDS (UNAIDS) Inter-Agency Task Team on Mother-to-Child Transmission of HIV. Geneva: WHO, 2000.Google Scholar
5Joint United Nations Programme on HIV/AIDS (UNAIDS)/ World Health Organization (WHO)/United Nations Children's Fund (UNICEF). HIV and Infant Feeding. A Guide for Health Care Managers and Supervisors. Geneva: WHO, 1998.Google Scholar
6Piwoz, EG, Ross, J, Humphrey, J. Human immunodeficiency virus-transmission during breastfeeding: knowledge, gaps and challenges for the future. In: Pickering, LK, Morrow, AL, Ruiz-Palacios, GM, Schanler, RJ, eds. Protecting Infants through Human Milk: Advancing the Scientific Evidence Base. New York: Kluwer Academic/Plenum Publishers, 2004.Google Scholar
7WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality. Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet 2000; 355: 451–5.CrossRefGoogle Scholar
8Nicoll, A, Newell, M-L, Peckham, C, Luo, C, Savage, F. Infant feeding and HIV-1 infection. AIDS 2000; 14(Suppl. 3): S57–74.Google ScholarPubMed
9Haider, R, Ashworth, A, Kabir, I, Huttly, SRA. Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial. Lancet 2000; 356: 1643–7.CrossRefGoogle ScholarPubMed
10Morrow, AL, Guerrero, ML, Shults, J, Calva, JC, Lutter, C, Bravo, J. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet 1999; 353: 1226–31.CrossRefGoogle ScholarPubMed
11Kramer, MS, Chalmers, B, Hodnet, ED, Sevkovskaya, Z, Dzikovich, I, Shapiro, S, et al. Promotion of breastfeeding intervention trial (PROBIT) – a randomized trial in the Republic of Belarus. Journal of the American Medical Association 2001; 285(4): 413–20.CrossRefGoogle ScholarPubMed
12De Paoli, M, Manongi, R, Helsing, E, Klepp, K-I. Exclusive breastfeeding in the era of AIDS. Journal of Human Lactation 2001; 17(4): 313–20.CrossRefGoogle ScholarPubMed
13Bland, RM, Rollins, NC, Coutsoudis, A, Coovadia, HM. Breastfeeding practices in an area of high HIV prevalence in rural South Africa. Acta Paediatrica 2002; 91(6): 704–11.CrossRefGoogle Scholar
14Coutsoudis, A, Pillay, K, Spooner, E, Kuhn, L, Coovadia, HM. Influence of infant feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. Lancet 1999; 354: 471–6.CrossRefGoogle ScholarPubMed
15Joint United Nations Programme on HIV/AIDS (UNAIDS)/ World Health Organization (WHO)/United Nations Children's Fund (UNICEF). HIV and Infant Feeding. Guidelines for Decision-makers. Geneva: WHO, 1998.Google Scholar
16De Paoli, MM, Manongi, R, Klepp, K-I. Factors influencing acceptability of voluntary counselling and HIV-testing among pregnant women in northern Tanzania. AIDS Care 2004; in press.CrossRefGoogle ScholarPubMed
17Baranowski, T, Perry, CL, Parcel, GS. How individuals, environments, and health behaviour interact. Social Cognitive Theory. In: Glanz, K, Lewis, FM, Rimer, BK, eds. Health Behavior and Health Education. Theory, Research, and Practice, 3rd ed. San Francisco, CA: Jossey-Bass, 2002; 165–74.Google Scholar
18Bandura, A. Self-efficacy – The Exercise of Control. New York: WH Freeman, 1997.Google Scholar
19Dennis, C-L. Theoretical underpinnings of breastfeeding confidence: a self-efficacy framework. Journal of Human Lactation 1999; 15(3): 195–201.CrossRefGoogle ScholarPubMed
20Torres, MM, Torres, D, Parilla Rodriguez, AM, Dennis, C-L. Translation and validation of the breastfeeding self-efficacy scale into Spanish: data from a Puerto Rican population. Journal of Human Lactation 2003; 19(1): 35–42.CrossRefGoogle Scholar
21Jonsson, U. Nutrition and the Convention on the Rights of the Child. Food Policy 1996; 21(1): 41–57.CrossRefGoogle Scholar
22Oshaug, A, Eide, WB, Eide, A. Human rights: a normative basis for food and nutrition relevant policies. Food Policy 1994; 19: 491–516.CrossRefGoogle Scholar
23Winkvist, A, Dahlgren, L, Emmelin, MOpen Code Qualitative Program [online], 2003. Available from: http://www.umu. se/phmed/epidemi/forskning/open_code.htmlGoogle Scholar
24Bureau of Statistics (Tanzania)/Macro International Inc. Tanzania Demographic and Health Survey 1996. Calverton, MD: Bureau of Statistics and Macro International, 1997.Google Scholar
25Agnarsson, I, Mpello, A, Gunnlaugsson, G, Hofvander, Y, Greiner, T. Infant feeding practices during the first six months of life in a rural area in Tanzania. East African Medical Journal 2001; 78(1): 6–10.CrossRefGoogle Scholar
26De Paoli, MM, Manongi, R, Klepp, K-I. Counsellors' perspectives on antenatal HIV testing and infant feeding dilemmas facing women with HIV in northern Tanzania. Reproductive Health Matters 2002; 10(20): 144–56.CrossRefGoogle ScholarPubMed
27Kuhn, L, Mathews, C, Fransman, D, Dikweni, L, Hussey, G. Child feeding practices of HIV-positive mothers in Cape Town, South Africa. AIDS 1999; 13(1): 144–6.Google ScholarPubMed
28Omari, AA, Luo, C, Kankasa, C, Bhat, GJ, Bunn, J. Infant-feeding practices of mothers of known HIV-status in Lusaka, Zambia. Health Policy and Planning 2002; 18(2): 156–62.CrossRefGoogle Scholar
29Muryn, C. Perceptions of Food, Health and Body Ideal in the context of Urbanisation and Western Influence. A Study focussing on Young Women in Arusha, Tanzania. Oslo: Institute for Nutrition Research, University of Oslo, 2001.Google Scholar
30Shirima, R, Greiner, T, Kylberg, E, Gebre-Medhin, M. Exclusive breast-feeding is rarely practised in rural and urban Morogoro, Tanzania. Public Health Nutrition 2001; 4(2): 147–54.CrossRefGoogle Scholar
31Seidel, G, Sewpaul, V, Dano, B. Experiences of breastfeeding and vulnerability among a group of HIV-positive women in Durban, South Africa. Health Policy and Planning 2000; 15(1): 24–33.CrossRefGoogle ScholarPubMed
32Seidel, G. Reconceptualising issues around HIV and breastfeeding advice: finding from KwaZulu-Natal, South Africa. Review of African Political Economy 2000; 27(86): 501–18.CrossRefGoogle Scholar
33Chopra, M, Sengwana, J, Schaay, N, Sanders, D. Effect of a mother-to-child HIV prevention programme on infant feeding and caring practices in South Africa. South African Medical Journal 2002; 92(4): 298–302.Google ScholarPubMed
34Programme Review Team PMTCT Advisory Group and Infant Study Group. Evaluation of a pilot programme and a follow-up study of infant feeding practices during the scaled-up programme in Botswana. Evaluation and Programme Planning 2002; 25: 421–31.CrossRefGoogle Scholar
35Ministry of Health. The Reproductive and Child Health Report [Taarifa ya huduma ya afya ya uzazi na mtoto]. Kilimanjaro, Tanzania: Ministry of Health, 2002 [in Kiswahili].Google Scholar
36Bureau of Statistics (Tanzania)/Macro International Inc. Tanzania Demographic Health Survey. Calverton, MD: Bureau of Statistics and Macro International, 1999.Google Scholar