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.

/pdf/exclusive-breastfeeding-policy-practice-and-influences-in-4p1w7rhnur.pdf

Exclusive breastfeeding policy, practice and influences in South Africa, 1980 to 2018: A mixed-methods systematic review.

The prevalence of HIV infection in Swaziland (26%) is among the highest in the world. We investigated nutritional knowledge, attitude, and practices (KAP) and the influence of sociodemographic factors on KAP among pregnant and lactating women living with HIV in the Manzini region of Swaziland. Interviews were conducted using a structured questionnaire to collect data from 324 subjects seeking healthcare from selected regional hospitals, health centres, and clinics in Manzini region. The results showed mean percentage scores of nutritional knowledge (67%), attitude (67%), and practices (51%) whereby educational level (p = 0.002), employment status (p = 0.009), income (p = 0.008), religion (p = 0.007), type of accommodation (p = 0.006), type of transport used when going for shopping (p = 0.001), and BMI (p = 0.015) were significantly associated with nutritional practices. Significant positive correlations between nutritional KAP were observed: nutritional K and A (r = 0.155, p = 0.005), nutritional K and P (r = 0.456, p = 0.001), and nutritional A and P (r = 0.230, p = 0.001). Multiple linear regression analysis indicated that type of transport used when going for shopping (p = 0.002), educational level (p = 0.001), income (p = 0.001), employment (p = 0.038), knowledge of food proportion in a plate (p = 0.000), a positive attitude towards high-fibre diet (p = 0.004), and eating a variety of foods (p = 0.006) were predictors of nutritional practices. Educational level was identified as a common predictor of nutritional knowledge, attitude, and practices, suggesting that both formal and informal education systems are potential factors influencing dietary practices among pregnant and lactating women living with HIV in Swaziland.

Nutritional Knowledge, Attitude, and Practices among Pregnant and Lactating Women Living with HIV in the Manzini Region of Swaziland

Introduction: The controversy between the risk of HIV transmission through breast milk and the life saving benefits of breastfeeding remains to be a dilemma faced by HIV positive mothers. Cognizant of this, World Health Organization recommends avoidance of all breastfeeding by HIV positive mothers when replacement feeding is acceptable, feasible, affordable, sustainable and safe. Otherwise, exclusive breast feeding is recommended during the first 6 months of life. Despite this effort, exclusive breast feeding is uncommon practice among HIV infected women. The aim of this study was to assess attitude and practice towards exclusive breast feeding and its associated factors among HIV positive mothers attending public hospitals of southern Ethiopia, 2013. Methods: Institution based cross-sectional study was conducted from August 1 to September 15, 2013. A total of 436 HIV positive mothers were recruited in the study. Pretested and structured interviewer administered questionnaires were used for data collection. Data were entered to EpiInfo and exported to SPSS for further analysis. Logistic regression analyses were used to see the association of different variables. Odds ratios and 95% confidence interval were computed to determine the presence and strength of association. Results: More than half (56.7%) of mothers had favorable attitude towards exclusive breast feeding and nearly half (48.2%) mothers exclusively breast feed their infants. Mother’s education, occupation, house hold income, antenatal care attendance, counseling and HIV disclosure to spouse/family members were found to be associated with attitude and practice towards exclusive breast feeding. Conclusion: The attitude and prevalence of exclusive breast feeding practice were found to be very low. Therefore, HIV positive women opting to breastfeed should be encouraged to exclusively breast feed their infants and need to be promoted by policy makers and implementers.

/pdf/attitude-and-practice-towards-exclusive-breast-feeding-and-29iywu4gj7.pdf

Attitude and Practice Towards Exclusive Breast Feeding and Its Associated Factors Among HIV Positive Mothers in Southern Ethiopia

Exclusive breast feeding practices to infants from birth to six months of age are declining as their age increases despite the associated benefits. Knowledge on the factors influencing exclusive breastfeeding among HIV positive mothers will create awareness on feeding practices that are risk to the infant’s health. To determine factors that influence exclusive breastfeeding among HIV positive mothers of infants aged 6-12 months old attending Reproductive and child Health clinic and care and treatment clinic at Ilala Municipality. Materials and Methods: A cross-sectional survey was conducted among HIV positive mothers with infants aged 6-12 months at three health facilities of Ilala Municipality namely: Amana hospital, Mnazi Mmoja and Buguruni Health Centres. Both quantitative and qualitative data collection methods were used. A questionnaire was administered to 200 HIV positive mothers to collect information and to characterize infants feeding practices. In depth Interview guide was used to explore infant feeding practices to five mothers of the same group. Exclusive breastfeeding was reported to be 46%. The other feeding practices reported were: mixed feeding 14% and exclusive replacement feeding 6%. Prelacteal and early complementary feeding was reported to be 34%. Exclusive breastfeeding practice was influenced mainly by health workers and mother’s perception that breast milk is sufficient for infant’s body requirements for the first six months of life. Early cessation of breastfeeding was reported to be result of mother’s fear of infecting the child and also infant’s HIV test results being negative after DNA-PCR test. However, lack of HIV status disclosure, breast problem, family and social pressures were found to be barriers in practicing exclusive breastfeeding. HIV positive mothers are faced with multiple challenges as they strive to practice exclusive breastfeeding. Despite nearly half of the mothers reporting practicing exclusive breastfeeding, the rates are still not satisfactory. More extensive and comprehensive approach of infant feeding counseling that embrace all stakeholders, with emphasis to significant others should be put in place in order to increase exclusive breastfeeding rates.

Factors Influencing Exclusive Breastfeeding Among HIV Positive Mothers at Ilala Municipality Dar es Salaam

Background: Worldwide, an estimated 2.3 million children under the age of 15 are HIV positive. The main source of HIV infection in children is vertical transmission of HIV from mother-to-child during pregnancy, labor and delivery, or breastfeeding. Prevention of Mother-to-Child Transmission of HIV has been expanded in accelerated fashion throughout Ethiopia with all public hospitals and health centers providing the services. However, published studies on the services’ provision in the country are generally limited. If at all, they did not comprehensively examine quality of the services. Objective: The study aimed to assess the quality of Prevention of Mother-to-Child Transmission of HIV services in Gebretsadiq Shawo Memorial Hospital in Kafa Zone, Southwest Ethiopia. Methods: Facility based cross-sectional study involving both quantitative and qualitative methods was conducted in September 2012. A total of 311 pregnant mothers were interviewed and a one year (2011) record of PMTCT clients was reviewed and service provision processes were observed for 10 counseling sessions. Donabedian’s Structure-Process-Outcome model was used to conceptualize the study. Data were analyzed using SPSS for windows version 17 software. Descriptive statistics were computed to summarize the findings. Results: Almost all of the minimum required resources such as test kits, prophylactic drugs and other supplies were available in the hospital; counselors followed the national guideline in providing HIV counseling and testing services; and most (90%) of clients were satisfied or very satisfied by the PMTCT services they received. However, from 858 pregnant mothers who visited the ANC clinic in 2011, only 330(38.5%) were offered HIV pretest counseling, while 281 (33%) were tested. Conclusion: Although clients’ satisfaction by PMTCT service is very high, considerable proportion of pregnant mothers who utilize ANC services are not offered HIV counseling and testing services. Therefore, appropriate quality improvement interventions against the missed opportunities are highly recommended.

/pdf/quality-of-pmtct-services-in-gebretsadiq-shawo-memorial-clns0rw80u.pdf

Quality of PMTCT Services in Gebretsadiq Shawo Memorial Hospital, Kafa Zone, South West Ethiopia: A Descriptive Study

Objective: The aim of the study was to determine the knowledge, attitudes and practices of women regarding the prevention of mother-to-child transmission (PMTCT) programme at a community health centre (CHC).

/pdf/knowledge-attitudes-and-practices-of-women-regarding-the-30o9x3myou.pdf

Knowledge, attitudes and practices of women regarding the prevention of mother-to-child transmission (PMTCT) programme at the Vanguard Community Health Centre, Western Cape – a pilot Study

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Knowledge, attitudes and practices of women regarding the prevention of mother-to-child transmission (PMTCT) programme at the Vanguard Community Health Centre, Western Cape – a pilot Study