Differences between international recommendations on breastfeeding in the presence of HIV and the attitudes and counselling messages of health workers in Lilongwe, Malawi.
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.
Piwoz
Ellen G
EG
Academy for Educational Development, 1875 Connecticut Ave, NW, Washington, DC, 20009, USA. epiwoz@aed.org.
Ferguson
Yvonne Owens
YO
Bentley
Margaret E
ME
Corneli
Amy L
AL
Moses
Agnes
A
Nkhoma
Jacqueline
J
Tohill
Beth Carlton
BC
Mtimuni
Beatrice
B
Ahmed
Yusuf
Y
Jamieson
Denise J
DJ
van der Horst
Charles
C
Kazembe
Peter
P