Knowledge and counselling practices of healthcare workers related to HIV and infant feeding in Ethekwini.

Abstract

Introduction: Breastfeeding is recognised globally as the single most effective child survival strategy for children under the age of five years. It is associated with much health, cognitive and economic benefits. Thus, the World Health Organization (WHO) recommends exclusive breastfeeding for infants for the first six months of life, followed by the introduction of appropriate complementary foods with continued breastfeeding until two years of age. This recommendation has been adopted and included in the South Africa Infant and Young Child Feeding (IYCF) policy for all mothers, including those living with human immunodeficiency virus (HIV). Although breastfeeding does carry a small risk of HIV transmission, the benefits of breastfeeding far outweigh this risk. With the South African Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme now including the use of maternal antiretroviral therapy (ART), mother-to-child transmission rates have been successfully reduced. However, what has not improved successfully is the rate of breastfeeding in the country, despite recommendations in the IYCF policy. Poor IYCF counselling is a problem in South Africa and is thought to be one of the reasons for the country‟s poor breastfeeding rates. Healthcare workers are responsible for counselling mothers on IYCF practices. While it is very important to update HIV and IYCF guidelines based on new evidence, on-going changes to these guidelines can be confusing and overwhelming for healthcare workers. It can result in inappropriate IYCF counselling and in turn inappropriate IYCF practices by mothers. Mothers living with HIV require accurate and consistent information to make informed feeding decisions. Whether healthcare workers in eThekwini, KwaZulu-Natal (KZN) are knowledgeable and up-to-date with IYCF recommendations in the context of HIV is not known. Aim: To assess the knowledge and counselling practices of healthcare workers, primarily doctors and nurses, employed at eThekwini, KZN regional state hospital antiretroviral (ARV), paediatric and antenatal departments, regarding IYCF in the context of HIV. Objectives: (i) To determine the knowledge of healthcare workers on IYCF in the context of HIV in eThekwini, KZN. (ii) To determine if healthcare workers have attended formal training on IYCF in the context of HIV in eThekwini, KZN. (iii) To determine if healthcare workers feel they require training on IYCF in the context of HIV in eThekwini, KZN. (iv) To determine if antiretroviral (ARV) clinics, antenatal departments and paediatric departments all have a role in IYCF counselling of mothers living with HIV in eThekwini, KZN. (v) To determine the level of confidence that healthcare workers have regarding counselling mothers on IYCF in the context of HIV in eThekwini, KZN. Method: A self-administered questionnaire was developed for this study based on IYCF recommendations included in the National Department of Health South Africa (NDoH) 2013 IYCF policy, the 2017 amendment of the IYCF policy and the 2015 National Consolidated Guidelines for the PMTCT and the Management of HIV in Children, Adolescents and Adults. The questionnaire was administered to 188 healthcare workers, primarily doctors and nurses, working in ARV, antenatal and paediatric departments from three regional hospitals (Addington Hospital, Prince Mshiyeni Memorial Hospital and RK Khan Hospital) in eThekwini, South Africa. Results: The participants in all three departments were not knowledgeable on IYCF in the context of HIV with a mean knowledge score of 51.7% (SD±14.1) for the overall group. The knowledge scores did not differ significantly across departments. Only 47.3% (n=89) of the participants had attended formal training on IYCF in the context of HIV. The vast majority of participants (n=171; 91.4%) felt they required more training. All three departments were found to have a role in IYCF counselling of mothers living with HIV, with antenatal departments counselling pregnant women living with HIV more frequently than ARV and paediatric departments. Overall, the group indicated an above average confidence score regarding the IYCF counselling of mothers living with HIV. Attendance of the training did not equate to improved knowledge scores. Conclusion: This study aimed to assess the knowledge and counselling practices of healthcare workers regarding IYCF in the context of HIV. It was found that healthcare workers across all three departments were not knowledgeable on IYCF in the context of HIV. Less than half of the healthcare workers in the study had attended formal training on IYCF in the context of HIV. The majority of healthcare workers felt they required more training on the topic. The ARV, paediatric and antenatal departments at the three hospitals were all found to be involved in IYCF counselling of mothers living with HIV. Overall, the healthcare workers were confident about counselling mothers living with HIV on IYCF. The findings from this study highlight an urgent need for effective and on-going training of healthcare workers on IYCF in the context of HIV, in order to improve knowledge and to ensure that counselling practices of healthcare workers are in line with the national policies and guidelines that exist.