Infant feeding within the context of HIV

[摘要] English: The potential problems that HIV (human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome) cause are multifaceted and can have devastating effects on a community. These problems are closely related to issues such as unemployment, poverty and co-morbidities. Another dilemma that is created by HIV involves the feeding of infants born to HIV-infected women, and it is especially the poor who experience the burden of this predicament.In an ideal setting where resources are reliably available, it is recommended that HIV-infected mothers do not breastfeed as the risk of postnatal HIV transmission remains. The use of anti-retroviral medications can however, significantly decrease this risk. In resource-poor areas, such as in many South African communities, mothers are generally recommended to breastfeed. In these circumstances the safe and sustainable procurement and preparation of replacement feeds cannot be assured. It has been shown that the incorrect preparation of formula milk or the use of unsuitable breastmilk substitutes can notably increase infant mortality and morbidity, while breastfeeding has a major protective effect. Each HIV-infected pregnant woman must therefore weigh these options and attempt to make the best decision for her unique situation. Good quality counseling from health care workers is imperative to aid her in this process.The purpose of this cross-sectional descriptive study was to investigate the knowledge, attitudes and practices of health care workers (n = 64) in the maternity wards of Pelonomi Regional Hospital in the Free State regarding infant feeding in the context of HIV. This was also determined in HIV-infected mothers (n = 100) who had recently given birth at the same health care institution.The knowledge, attitudes and practices of health care workers were determined by means of self-administered questionnaires. The researcher completed the following questionnaires with the HIV-infected mothers during private structured interviews: socio-demography; household food security; anthropometry (infant / infants), reported health and medical histories (including infant / infants); knowledge, attitudes and practices regarding HIV and infant feeding; and, questions based on the 2010 WHO (World Health Organisation) Guidelines on HIV and Infant Feeding. Information that was obtained from patient files included in-hospital medication, CD4 cell counts and haemoglobin levels of mothers, as well as birth weight and birth length of infants.The over-all level of knowledge of the health care workers related to infant feeding in the context of HIV was not adequate, when it is considered that they interact with and counsel HIV-infected women on a daily basis and should be very well-informed regarding all of the related issues. Few of them could comprehensively explain what 'exclusive breastfeeding' entails (6.7%). Many felt that they lacked practical knowledge related to breastfeeding, as 25.6% felt that they only had low to moderate confidence in showing a mother how to breastfeed, and 35.9% felt that they only had low to moderate confidence in showing a mother how to express breastmilk. However, most of the health care workers (89.1%) had a positive attitude towards South Africa promoting breastfeeding for infants of HIV-infected mothers if they cannot safely and sustainably procure formula milk.Most of the mothers participating in this study were black, unmarried, unemployed and Sotho-speaking. Although most mothers lived in brick houses (84.0%) with access to electricity (83.0%) and tap water (96.0%), a large percentage of mothers indicated that food and money shortages do occur in their households (64.0%). However, very few mothers reported that they had a vegetable garden (23.0%) or owned livestock (4.0%).Some of the mothers experienced symptoms such as chest pain (16.0%), diarrhoea (18.0%), loss of appetite (36.0%) and involuntary weight loss (11.0%). Hypertension was common in both mothers (26.0%) and their family members (42.0%). A large percentage of mothers had a relatively low (< 350 cells/mm3) CD4 count (46.3%), and a low (< 11.0 g/dL) haemoglobin level (37.3%), indicators of HIV disease progression and anaemia respectively. Approximately 25.0% of infants were classified as premature according to the WHO definition, and most mothers planned to breastfeed their infant/s (70.9%). The median z-scores for the length-for-age parameter in the full-term group (n = 75) was in the normal category, while the weight-for-age and weight-for-length parameters in the full-term group were slightly below the WHO median reference values. Twenty-six breastfeedingproblems were reported in total, with low milk production (38.5%) and sore breasts andnipples (46.2%) the main breastfeeding problems that were experienced.Most mothers correctly planned to wean their infants at six months, with the median valuefor the introduction of both solids and liquids being six months. The majority lackedadequate knowledge regarding general correct formula feeding practices, and whenmothers decided on formula feeding it was mainly done in an attempt to prevent postnatalHIV transmission (76.7%).A large percentage of the mothers were not aware of the fact that HIV can be transmittedto an infant via breastfeeding (43.0%) even when anti-retroviral medications are used. Theyknew that HIV-infected breastfeeding mothers should not practice mixed feeding (80.0%),but they lacked knowledge related to the new WHO guidelines. As AFASS (affordable,feasible, acceptable, sustainable, safe) criteria for formula feeding were not met by mostmothers, a large percentage of mothers correctly opted to breastfeed their infants. Almostall of the mothers regarded animal milks such as cow's milk as the least preferable infantfeeding option (83.0%). In general, counseling that mothers had received was notadequate, or information was not retained by the mothers, since certain concepts relatedto HIV and infant feeding could mostly not be described sufficiently. Only 16.7% of motherswho chose to formula feed could comprehensively explain the correct procedure. Motherswere mostly either ignorant or skeptical regarding expressed heat-treated breastmilk as aninfant feeding option (78.0%).Nursing personnel were significantly more accepting of heat-treated expressed breastmilkas an infant feeding method than the doctors and dieticians group combined (53.2% and23.5% respectively), and they also felt a higher confidence in showing a mother how tobreastfeed (78.7 % and 58.8% respectively).The age of the mothers did not influence their knowledge related to HIV and infant feedingsignificantly. Mothers with higher educational levels were significantly more aware that HIVcan be transmitted via breastfeeding and they were also more concerned about transmitting HIV via breastfeeding than they were of the increased morbidity and mortality risks related to replacement feeding.The provision of high quality counselling related to infant feeding and follow-up visits can improve the knowledge of HIV-infected mothers and lead to better infant feeding decisions being made. These actions will ultimately benefit both the mother and her infant.

[发布机构] University of the Free State