Infant feeding in the time of HIV: rapid assessment of infant feeding policy and programmes in four African countries scaling up prevention of mother to child transmission programmes.
OBJECTIVE
To assess the infant feeding components of prevention of mother to child HIV transmission (PMTCT) programmes.


METHODS
Assessments were performed across Botswana, Kenya, Malawi and Uganda. 29 districts offering PMTCT were selected by stratified random sampling with rural and urban strata. All health facilities in the selected PMTCT district were assessed. The facility level manager and the senior nurse in charge of maternal care were interviewed. 334 randomly selected health workers involved in the PMTCT programme completed self-administered questionnaires. 640 PMTCT counselling observations were carried out and 34 focus groups were conducted amongst men and women.


RESULTS
Most health workers (234/334, 70%) were unable to correctly estimate the transmission risks of breastfeeding irrespective of exposure to PMTCT training. Infant feeding options were mentioned in 307 of 640 (48%) observations of PMTCT counselling sessions, and in only 35 (5.5%) were infant feeding issues discussed in any depth; of these 19 (54.3%) were rated as poor. Several health workers also reported receiving free samples of infant formula in contravention of the International Code on Breastmilk Substitutes. National HIV managers stated they were unsure about infant feeding policy in the context of HIV. Finally, there was an almost universal belief that an HIV positive mother who breastfeeds her child will always infect the child and intentional avoidance of breastfeeding by the mother indicates that she is HIV positive.


CONCLUSIONS
These findings underline the need to implement and support systematic infant feeding policies and programme responses in the context of HIV programmes.
Chopra
M
M
Health Systems Research Unit, Medical Research Council, Tygerberg, 7535, Western Cape, South Africa. mickey.chopra@mrc.ac.za
Rollins
N
N
D001902:Botswana; D001942:Breast Feeding / Q000009:adverse effects; D002983:Clinical Competence; D003376:Counseling / Q000592:standards; D003430:Cross-Sectional Studies; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D015497:HIV-1; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya; D008295:Malawi; D008297:Male; D015397:Program Evaluation; D014454:Uganda