[64] INFANT FEEDING COUNSELLING IN THE REDUCTION OF MOTHER TO CHILD TRANSMISSION OF HIV IN MATERNAL AND CHILD HEALTH SETTINGS, NDOLA, ZAMBIA

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] INFANT FEEDING COUNSELLING IN THE REDUCTION OF MOTHER TO CHILD TRANSMISSION OF HIV IN MATERNAL AND CHILD HEALTH SETTINGS, NDOLA, ZAMBIA

[AUTHOR(S):] E Muyunda², N Ntombela², J Tshiula², F Munkonze², N Dondi², T Nyirenda², M Mzumara², M Barrett², N Franklin², C Kruger², H Chiyota², W Siasulwe³, M Lembalemba¹, E Sakala¹, A Banda¹, S Kalibala³, N Rutenberg³ and S Geibel³
¹Ndola District Health Management Team; ²Linkages; ³ National Food and Nutrition Commission (NFNC); and ⁴ Population Council/Horizons, Zambia

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 64
Antiviral Therapy 2003; 8(Suppl. 1):S200

[ABSTRACT:] Issues: Optimal infant feeding is an important aspect in the reduction of mother-to-child transmission of HIV in high HIV prevalence settings. The choices made by women, irrespective of their status, will determine their child’s survival.

Description: Below are findings related to infant feeding choices within a public health intervention (Ndola Demonstration Project) to reduce MTCT in an urban setting in the Copperbelt province of Zambia. The intervention strengthened MCH services and integrated HIV/AIDS counseling plus infant feeding counseling into the service. Infant feeding issues were studied as part of a broader operations research to examine how the integration of services for the prevention of mother-to-child transmission of HIV into low-resource maternal child health services (MCH) and antenatal care (ANC) settings influences a woman’s ability to make and implement informed decisions about HIV and infant feeding. This was done alongside NDP interventions in a peri-urban, middle income community of about 170,000 people in six primary health care clinics and seven communities which included two communitybased organizations and two referral hospitals. The interventions included the training of providers in HIV counseling, VCT, infant feeding counseling, provision of basic supplies, the development of a referral directory and referral slips plus the improvement of clinic infrastructure. Qualitative measures included baseline, midterm and end line surveys of KAP related to VCT, infant feeding and MCH services while small cohorts of women of different status served for qualitative enquiry.

Lessons learned: Exclusive breastfeeding rates among community mothers of children aged 0–<6 months remained high at 56% at baseline to 70% at endline. EBR did not differ significantly between women who knew their HIV status and those who did not. Breastfeeding intention remained high at 76% at baseline to 97% at endline. Increasingly more women received assistance to initiate breastfeeding from health care providers. Immediate mother to baby contact remained high at 89% at baseline to 91% at endline. Initiation of breastfeeding within an hour of birth did not change significantly being 85% at baseline and 87% at endline. Increasingly more mothers took to breastfeeding on demand. Mothers with children over 6 months increasingly used groundnuts as a complementary food while milk, sugar, salt and oil were also used to enrich babies’ porridge.

Recommendation: There is need to seriously consider realistic ways of incorporating replacement feeding in this community. If replacement feeding is unrealistic even in an urban area, it may not be different in the rural areas.

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