title: Infant feeding knowledge, perceptions and practices among women with and without HIV in Johannesburg, South Africa: a survey in healthcare facilities.
abstract: BACKGROUND
  South Africa has a history of low breastfeeding rates among women with and without Human Immunodeficiency Virus (HIV). In this study, we assessed infant feeding knowledge, perceptions and practices among pregnant and postpartum women with and without HIV, in the context of changes in infant feeding and Prevention of Mother-to-Child Transmission of HIV (PMTCT) guidelines.
  
  
  METHODS
  This was a cross-sectional survey conducted from April 2014 to March 2015 in 10 healthcare facilities in Johannesburg, South Africa. A total of 190 pregnant and 180 postpartum women (74 and 67, respectively, were HIV positive) were interviewed using a semi-structured questionnaire. Multiple regression analyses assessed factors associated with an intention to exclusively breastfeed, and exclusive breastfeeding of infants less than six months of age.
  
  
  RESULTS
  Women with HIV had better overall knowledge on safe infant feeding practices, both in general and in the context of HIV infection. There were however gaps in knowledge among women with and without HIV. Information from healthcare facilities was the main source of information for all groups of women in the study. A greater percentage of women without HIV 80.9% (93/115), reported an intention to exclusively breastfeed, compared to 64.9% (48/74) of women with HIV,p= 0.014. Not having HIV was positively associated with a reported intention to breastfeed, Adjusted Odds Ratio (AOR) 3.60, 95% CI 1.50, 8.62. Other factors associated with a reported intention to exclusively breastfeed were prior breastfeeding experience and higher knowledge scores on safe infant feeding practices in the context of HIV infection. Among postpartum women, higher scores on general knowledge of safe infant feeding practices were positively associated with reported exclusive breastfeeding, AOR 2.18, 95% CI 1.52, 3.12. Most women perceived that it was difficult to exclusively breastfeed and that cultural factors were a barrier to exclusive breastfeeding.
  
  
  CONCLUSIONS
  While a greater proportion of women are electing to breastfeed, HIV infection and cultural factors remain an important influence on safe infant feeding practices. Healthcare workers are the main source of information, and highlight the need for accurate and consistent messaging for both women with and without HIV.
authors.affiliation: Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa.|School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.|SACEMA (DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis), Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Coceka N
authors.initials: CN
authors.lastname: Mnyani
authors.affiliation: Anova Health Institute, Johannesburg, South Africa.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Tait
authors.affiliation: HIVSA, Johannesburg, South Africa.
authors.forename: Jean
authors.initials: J
authors.lastname: Armstrong
authors.affiliation: School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Duane
authors.initials: D
authors.lastname: Blaauw
authors.affiliation: Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, University of Ghent, Ghent, Belgium.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Chersich
authors.affiliation: Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa.
authors.forename: Eckhart J
authors.initials: EJ
authors.lastname: Buchmann
authors.affiliation: Anova Health Institute, Johannesburg, South Africa.
authors.forename: Remco P H
authors.initials: RPH
authors.lastname: Peters
authors.affiliation: Anova Health Institute, Johannesburg, South Africa.|School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: James A
authors.initials: JA
authors.lastname: McIntyre
keywords: Breastfeeding; HIV; Infant feeding; PMTCT; South Africa