title: Differences between international recommendations on breastfeeding in the presence of HIV and the attitudes and counselling messages of health workers in Lilongwe, Malawi.
abstract: BACKGROUND
  To prevent postnatal transmission of HIV in settings where safe alternatives to breastfeeding are unavailable, the World Health Organization (WHO) recommends exclusive breastfeeding followed by early, rapid cessation of breastfeeding. Only limited data are available on the attitudes of health workers toward this recommendation and the impact of these attitudes on infant feeding counselling messages given to mothers.
  
  
  METHODS
  As part of the Breastfeeding, Antiretroviral, and Nutrition (BAN) clinical trial, we carried out an in-depth qualitative study of the attitudes, beliefs, and counselling messages of 19 health workers in Lilongwe, Malawi.
  
  
  RESULTS
  Although none of the workers had received formal training, several reported having counseled HIV-positive mothers about infant feeding. Health workers with counselling experience believed that HIV-infected mothers should breastfeed exclusively, rather than infant formula feed, citing poverty as the primary reason. Because of high levels of malnutrition, all the workers had concerns about early cessation of breastfeeding.
  
  
  CONCLUSIONS
  Important differences were observed between the WHO recommendations and the attitudes and practices of the health workers. Understanding these differences is important for designing effective interventions.
authors.affiliation: Academy for Educational Development, 1875 Connecticut Ave, NW, Washington, DC, 20009, USA. epiwoz@aed.org.
authors.forename: Ellen G
authors.initials: EG
authors.lastname: Piwoz
authors.forename: Yvonne Owens
authors.initials: YO
authors.lastname: Ferguson
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Bentley
authors.forename: Amy L
authors.initials: AL
authors.lastname: Corneli
authors.forename: Agnes
authors.initials: A
authors.lastname: Moses
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Nkhoma
authors.forename: Beth Carlton
authors.initials: BC
authors.lastname: Tohill
authors.forename: Beatrice
authors.initials: B
authors.lastname: Mtimuni
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Ahmed
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.forename: Charles
authors.initials: C
authors.lastname: van der Horst
authors.forename: Peter
authors.initials: P
authors.lastname: Kazembe