HIV and infant feeding : choices and decision-outcomes in the context of prevention of mother-to-child transmission among HIV-positive mothers in Zambia.

Abstract

Mother-to-child transmission of HIV is one of the key drivers of the HIV pandemic in Zambia and impacts infant feeding for HIV-exposed infants. The aim of infant feeding counselling is to facilitate informed decision on method of feeding in relation to prevention of mother-to-child transmission of HIV. However, HIV-positive mothers are faced with uncertainty on how best to feed their infants. While exclusive breastfeeding has potential to contribute to a reduction in infant and under-five mortality, the practice is not widespread in resource-poor settings of sub-Saharan Africa. The overall aim of this study was to analyse choices and decision-outcomes on infant feeding in the context of prevention of mother-to-child transmission of HIV to enhance safer feeding practices during the first six months of the infant’s life. The study was conducted using qualitative triangulation through participant observations, focus group discussions and individual interviews. The study included HIV infected mothers (n=30), health care workers (n=6), HIV infected men (n=7) and community based volunteers (n=20). The field work was conducted from January to September 2014. Data were managed in QRS NVivo 10 and analysed using framework analysis. While recognising promotion of exclusive breastfeeding as a public health approach in Zambia, the results showed that implementation was influenced by factors beyond the health care system. The findings highlight five thematic areas that explained and gave meaning to behavioural processes that determine decision-outcome on infant feeding in relation to prevention of mother-to-child transmission. Participants described breastfeeding as a cultural norm based on practices passed from generation to generation that impacted the understanding and behaviour change to practice exclusive breastfeeding for HIV-exposed infants. Therefore, choosing to exclusively breastfeed depended on how well mothers were counselled on infant feeding and prepared to practice exclusive breastfeeding in the first six months of the baby’s life. Although, health care workers reported that they supported mothers to choose and practice exclusive breastfeeding, mothers in this study lacked the necessary skills needed to successfully feed their HIV-exposed infants. Drawing on theories of behaviour change, the findings accordingly informed the development of a model that provides nurses, midwives and other front-line health care workers with simplified steps for consideration during infant feeding counselling of HIV-positive mothers.