title: Infant feeding counselling for HIV-infected and uninfected women: appropriateness of choice and practice.
abstract: OBJECTIVE
  To examine infant feeding intentions of HIV-infected and uninfected women and the appropriateness of their choices according to their home resources; and to determine their adherence to their intentions in the first postnatal week.
  
  
  METHODS
  Feeding intentions of pregnant women were compared against four resources that facilitate replacement feeding: clean water, adequate fuel, access to a refrigerator and regular maternal income. First-week feeding practices were documented.
  
  
  RESULTS
  The antenatal feeding intentions of 1253 HIV-infected women were: exclusive breastfeeding 73%; replacement feeding 9%; undecided 18%. Three percent had access to all four resources, of whom 23% chose replacement feeding. Of those choosing replacement feeding, 8% had access to all four resources. A clean water supply and regular maternal income were independently associated with intention to replacement feed (adjusted odds ratio (AOR) 1.94, 95% confidence interval (CI) 1.2-3.2; AOR 2.1, 95% CI: 1.2-3.5, respectively). Significantly more HIV-infected women intending to exclusively breastfeed, rather than replacement feed, adhered to their intention in week one (exclusive breastfeeding 78%; replacement feeding 42%; P<0.001). Of 1238 HIV-uninfected women, 82% intended to exclusively breastfeed; 2% to replacement feed; and 16% were undecided. Seventy-five percent who intended to exclusively breastfeed adhered to this intention postnatally, and only 11 infants (<1%) received no breast milk. The number of antenatal home visits significantly influenced adherence to feeding intention.
  
  
  CONCLUSIONS
  Most HIV-infected women did not have the resources for safe replacement feeding, instead choosing appropriately to exclusively breastfeed. Adherence to feeding intention among HIV-infected women was higher in those who chose to exclusively breastfeed than to replacement feed. With appropriate counselling and support, spillover of suboptimal feeding practices to HIV-negative women is minimal.
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu Natal, South Africa. rbland@africacentre.ac.za
authors.forename: R M
authors.initials: RM
authors.lastname: Bland
authors.forename: N C
authors.initials: NC
authors.lastname: Rollins
authors.forename: H M
authors.initials: HM
authors.lastname: Coovadia
authors.forename: A
authors.initials: A
authors.lastname: Coutsoudis
authors.forename: M L
authors.initials: ML
authors.lastname: Newell
mesh_terms: D000293:Adolescent; D000328:Adult; D001903:Bottle Feeding / Q000523:psychology*; D001942:Breast Feeding / Q000523:psychology*; D002755:Choice Behavior; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008427:Maternal Health Services / Q000458:organization & administration*; D008875:Middle Aged; D010353:Patient Education as Topic / Q000458:organization & administration*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology