The infant feeding practices of Human Immunodeficiency Virus positive women within the Prevention of Mother to Child Transmission program in Soweto, Johannesburg

Abstract

Introduction: In South Africa, over 25% of all babies born each year are exposed to HIV. The high antenatal HIV sero-prevalence rates coupled with high levels of maternal morbidity and mortality advocate for high quality maternal and child health care, which should include resilient PMTCT programs. This study aimed to explore infant feeding practices selected by HIV-positive women enrolled on a PMTCT program and describe some of the reasons for their choices, within the first 6 months postpartum. The study also reports on infant feeding practice and HIV status of the infant. Methodology: The study was a cross-sectional study which was carried out within the Perinatal Research Unit at Chris Hani Baragwanath hospital in Soweto. A sample of 200 women enrolled in the PMTCT program was interviewed, using a semi-structured questionnaire, during April 2007 – June 2007. Results: The study revealed that 84.5% of the study population had received infant feeding counseling. There was a high rate of exclusive formula feeding (EFF=84.5%), with lower exclusive breastfeeding (EBF=14%) and mixed feeding (MF=1.5%) rates. The corresponding HIV transmission rates were EFF – 26% (n=44/169); EBF – 75% (n=21/28); MF – 100% (n=3/3). The study demonstrated that babies born to mothers who did not receive information on infant feeding were twice as likely to be HIV positive (OR=2.43), which was statistically significant. The study also showed that the timing of the counseling was critical – all mothers who received counseling 6 weeks or more after delivery had HIV-positive babies. The overwhelming majority of women (78%) indicated that they would breast feed their babies if they were HIV-negative. Conclusion: The study demonstrated the vital role of infant feeding counseling in antenatal care and PMTCT programs. It illustrated that it was critically important that all HIV-infected women receive infant feeding counseling as soon as possible after the HIV diagnosis is made, prior to delivery and highlighted the importance of reinforcement of infant feeding choice at every antenatal care visit, for every woman. 5 The key recommendations focus on the need for: • Improved Antenatal care for all pregnant women • Improved care for HIV-positive pregnant women • Improvements in infant feeding counseling for HIV positive women • Integration of Maternal, Child health and PMTCT programs • Intensification of ongoing prevention efforts • The need for further research to: o identify some of the reasons HIV positive women choose certain infant feeding modalities throughout the country, and the challenges associated with these; and o critically evaluate the training that health care workers and counselors receive, regarding infant feeding counseling.