title: Infant feeding counselling of HIV-infected women in two areas in Kenya in 2008.
abstract: While WHO no longer recommends individual infant feeding counselling to HIV-positive women, it may still be practised in some settings and for specific cases. In any case, lessons can be learned by examining how well front line health workers are able to take on counselling tasks. This qualitative study was designed to assess how counsellors deal with challenges they face in two Kenyan provinces. It consisted of brief post-counselling exit interviews with 80 mothers, observations of 21 counselling sessions and 11 key informant interviews. Much infant feeding counselling was of reasonable quality, better than often reported elsewhere. However, nutrition and infant feeding were given low priority, counsellors' training was inadequate, individual postnatal counselling as well as growth monitoring and promotion were rarely done and complementary feeding was inadequately covered. Acceptable, feasible, affordable, sustainable and safe (AFASS) assessments were not of satisfactory quality. Breast milk expression was mentioned only to a minority and the possibility of heat treatment during the transition to cessation was not mentioned. Counsellors were often biased in discussing risks of breastfeeding and replacement feeding. Implementing the new WHO guidance will reduce the need for AFASS assessments, greatly simplifying both the government's and counsellors' tasks.
authors.affiliation: Maternal and Child Health and Nutrition Global Program, PATH, Seattle, WA, USA tgreiner@hanyang.ac.kr tedgreiner@yahoo.com.
authors.forename: Kiersten
authors.initials: K
authors.lastname: Israel-Ballard
authors.affiliation: PATH, Nairobi, Kenya.
authors.forename: Margaret
authors.initials: M
authors.lastname: Waithaka
authors.affiliation: Department of Food and Nutrition, Hanyang University, Seoul, South Korea.
authors.forename: Ted
authors.initials: T
authors.lastname: Greiner
mesh_terms: D000328:Adult; D001942:Breast Feeding; D003376:Counseling; D004522:Educational Status; D005247:Feeding Behavior; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007407:Interviews as Topic; D007630:Kenya; D009035:Mothers; D015397:Program Evaluation / Q000379:methods; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: AFASS assessment; AIDS; Breastfeeding; HIV; Kenya; WHO guidance; counselling; prevention of mother-to-child transmission; women