a1 School of Dietetics and Human Nutrition, McGill University, 21,111 Lakeshore Road, Ste. Anne de Bellevue, Quebec, Canada, H9X 3V9
a2 University of KwaZulu-Natal, Department of Paediatrics & Child Health, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, 710 Umbilo Road, Durban 4001, South Africa
Objective To better understand the enabling and challenging factors impacting on infant feeding practices in communities with a high HIV prevalence.
Design Qualitative study, with data collected through in-depth interviews and observations of mothers, in addition to discussions with health-service providers.
Setting Urban settlement in the province of KwaZulu-Natal, South Africa.
Subjects Mothers recruited from an HIV clinic and from within the community.
Results Emerging from discussions with mothers on the acceptability of alternative feeding methods were the challenges they encountered in feeding their infants. Mothers readily identified feeding in the context of HIV infection as an issue of great concern, encompassing three central themes: (i) stigma and disclosure of HIV; (ii) confusion and coercion; and (iii) diarrhoea, sickness and free formula. It became evident that mothers rarely received quality infant feeding counselling and consequently mixed feeding, a widespread practice but one that is highly risky for HIV transmission, remained a common feeding practice. Exclusive breast-feeding (EBF) was best practised with support, following disclosure of HIV status. Availability of free formula did not guarantee exclusive formula feeding but instead led to inappropriate feeding practices.
Conclusions In addition to providing accurate information, health-care workers must be empowered to counsel mothers effectively, addressing issues of disclosure and thereby facilitating mobilization of maternal support networks. These findings illustrate the challenges that exist in policy translation within the context of quality of training for health-care workers on optimizing maternal infant feeding practices, particularly in HIV-prevalent, resource-poor settings.
(Received November 14 2007)
(Accepted January 07 2009)
(Online publication March 27 2009)