title: Infant and Young Child Feeding Counseling, Decision-Making, and Practices Among HIV-Infected Women in Malawi's Option B+ Prevention of Mother-to-Child Transmission Program: A Mixed Methods Study.
abstract: This study examined infant and young child feeding (IYCF) counseling, decision-making, and practices among HIV-infected women with children 0-23 months participating in Malawi's Option B+ prevention of mother-to-child transmission (PMTCT) program. We conducted 160 survey interviews, 32 in-depth interviews, and 32 observations of PMTCT visits. Surveys indicated that exclusive breastfeeding was common (75 %) among children <6 months, while minimum dietary diversity (41 %) and minimum acceptable diet (40 %) for children 6-23 months occurred less often. In-depth interviews supported these findings. Most women felt comfortable with current breastfeeding recommendations, but chronic food insecurity made it difficult for them to follow complementary feeding guidelines. Women trusted IYCF advice from health workers, but mainly received it during pregnancy. During observations of postnatal PMTCT visits, health workers infrequently advised on breastfeeding (41 % of visits) or complementary feeding (29 % of visits). This represents a missed opportunity for health workers to support optimal IYCF practices within Option B+.
authors.affiliation: Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, 2200 McGavran-Greenberg Hall, CB#7461, Chapel Hill, NC, 27599-7461, USA. flax@unc.edu.|Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA. flax@unc.edu.
authors.forename: Valerie L
authors.initials: VL
authors.lastname: Flax
authors.affiliation: UNC Project - Malawi, Lilongwe, Malawi.
authors.forename: Gloria
authors.initials: G
authors.lastname: Hamela
authors.affiliation: UNC Project - Malawi, Lilongwe, Malawi.
authors.forename: Innocent
authors.initials: I
authors.lastname: Mofolo
authors.affiliation: UNC Project - Malawi, Lilongwe, Malawi.|Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.affiliation: UNC Project - Malawi, Lilongwe, Malawi.|Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Irving
authors.initials: I
authors.lastname: Hoffman
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Maman
mesh_terms: D001942:Breast Feeding / Q000706:statistics & numerical data; D003376:Counseling; D003657:Decision Making; D003906:Developing Countries; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000453:epidemiology* / Q000517:prevention & control*; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007406:Interview, Psychological; D008295:Malawi; D008297:Male; D011247:Pregnancy; D011795:Surveys and Questionnaires
keywords: Breast feeding; Complementary feeding; HIV; Option B+; Prevention of mother-to-child transmission