title: Commonalities and differences in infant feeding attitudes and practices in the context of HIV in sub-Saharan Africa: a metasynthesis.
abstract: Exclusive breastfeeding (EBF) has been identified as a key intervention to promote infant health and to reduce the vertical transmission of HIV. Despite this knowledge and increased resources to promote EBF, the practice in sub-Saharan Africa (SSA) remains low among HIV+ women. Although a number of qualitative studies have been conducted throughout SSA, the influences on and consequences of infant feeding choices of HIV+ mothers' findings have not been regarded systematically. Therefore, our objective was to identify overarching themes, commonalities, and differences in infant feeding choices among qualitative studies with HIV+ mothers in SSA. Sixteen qualitative studies of infant feeding practices in the context of HIV were identified. Noblit and Hare's seven-step metasynthesis methodology was used to analyze the experiences of HIV+ women and those who provide infant feeding services/counseling. Data were available from approximately 920 participants (i.e., 750 HIV+ mothers, 109 health-care providers, and 62 family members) across 13 SSA countries from 2000 to 2011. From these data, five themes emerged within which 3-4 overarching key metaphors were identified. The consistency of key metaphors across a variety of geographic, economic, and cultural settings suggest the importance of approaching infant feeding holistically, within the context of maternal knowledge, health-care support, family resources, and cultural expectations. EBF campaigns in SSA are more likely to successfully support optimal health for infants and a safe supportive environment for their mothers when the impact of infant feeding decisions are evaluated across these themes.
authors.affiliation: a School of Nursing , University of Connecticut , Storrs , CT , USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Tuthill
authors.forename: Jacqueline
authors.initials: J
authors.lastname: McGrath
authors.forename: Sera
authors.initials: S
authors.lastname: Young
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D001903:Bottle Feeding; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D003376:Counseling; D005260:Female; D006679:HIV Seropositivity / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D007223:Infant; D041943:Infant Formula; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D008895:Milk, Human; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data; D010379:Peer Group; D011247:Pregnancy; D036301:Qualitative Research; D012938:Social Perception