HIV and infant feeding – one step forward, two steps back

Saloojee, Haroon; Gray, Glenda; McIntyre, James

doi:10.4102/sajhivmed.v12i4.164

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…Our inclusion of other types of HWs introduced different perspectives. The WBOTs worried that formula removal was increasing mixed feeding among HIV positive mothers, a fear expressed by researchers when the Declaration was passed [ 26 ]. These contradictory opinions suggest that the context of care provision (facility versus community) may influence HW policy perspectives.…”

Section: Discussionmentioning

confidence: 99%

“…During this period, there was clear documentation that HW counseling was not meeting mothers’ needs [ 23 ] and mothers were often confused with mixed messages [ 8 , 24 , 25 ]. Many researchers advocated promoting a single feeding option [ 21 ], although some feared that this might unintentionally increase mixed feeding among HIV positive mothers [ 19 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

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Frontline health workers and exclusive breastfeeding guidelines in an HIV endemic South African community: a qualitative exploration of policy translation

Jewett

Manderson

2018

Int Breastfeed J

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BackgroundMothers rely heavily on health worker advice to make infant feeding decisions. Confusing or misleading advice can lead to suboptimal feeding practices. From 2001, HIV positive mothers in South Africa were counseled to choose either exclusive breastfeeding or exclusive formula feeding to minimize vertical HIV transmission. On the basis of revised World Health Organization guidelines, the government amended this policy in 2011, by promoting exclusive breastfeeding and discontinuing the provision of free formula. We explored how health workers experienced this new policy in an HIV endemic community in 2015–16, with attention to their knowledge of the policy, counselling practices, and observations of any changes.MethodsWe interviewed eleven health workers, from four community health clinics, who had counseled mothers before and after the policy change. The transcribed interviews were analyzed thematically, using a hybrid coding approach.ResultsThe scientific rationale of the policy was not explained to most health workers, who mostly thought that the discontinuation of the formula program was cost-related. The content of their counseling reflected knowledge about promoting breastfeeding for all women, and accordingly they mentioned the nutritional and developmental benefits of breastfeeding. The importance of exclusive breastfeeding for all infants was not emphasized, instead counseling focused on HIV prevention, even for uninfected mothers. The health workers noted an increased incidence of breastfeeding, but some worried that to avoid HIV disclosure, HIV positive mothers were mixed feeding rather than exclusively breastfeeding.ConclusionsCausal links between the policy, counseling content and feeding practices were unclear. Some participants believed that breastfeeding practices were driven by finance or family pressures rather than the health information they provided. Health workers generally lacked training on the policy’s evidence base, particularly the health benefits of exclusive breastfeeding for non-exposed infants. They wanted clarity on their counseling role, based on individual risk or to promote exclusive breastfeeding as a single option. If the latter, they needed training on how to assist mothers with community-based barriers. Infant feeding messages from health workers are likely to remain confusing until their uncertainties are addressed. Their insights should inform future guideline development as key actors.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Frontline health workers and exclusive breastfeeding guidelines in an HIV endemic South African community: a qualitative exploration of policy translation

Jewett

Manderson

2018

Int Breastfeed J

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“…This work seeks to confirm whether infants born to mothers with dysbiosis have altered early gut microbiomes, which suggests that manipulation of the gut microbiome could assist with improving infant immunity. The infant gut is already a site of intervention in South African perinatal policy, which focuses on exclusive breastfeeding for six months to mitigate the risk of HIV transmission associated with mixed feeding and the increased risk of diarrhoea that accompanies formula feeding (Doherty and Sanders ; Saloojee et al ; Zunza et al ). Further, childhood diarrhoea claims several hundred lives in Cape Town every year, with the “diarrhoea season” peaking between November and May.…”

Section: Governing Microbes Governing the Gutmentioning

confidence: 99%

Strata of the Political: Epigenetic and Microbial Imaginaries in Post‐Apartheid Cape Town

Pentecost

Cousins

2017

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The epigenetic and microbiomic imaginaries that animate public health discourse on perinatal nutrition and the infant gut in South Africa offer a case study through which to reconsider the ontological presuppositions of “space” that frame epigenetic biopolitics. We suggest that the mutual constitution of the relations at stake in and around questions of nutrition, mothers and infants, the gut and sanitation in Khayelitsha, can be understood through a Deleuzian geomorphological image of “strata of the political”. Strata are conjunctural entanglements that temporarily stabilise when distinctions hold briefly, and that bring into alignment particular relations and forces that distribute life and non‐life. This analytic makes visible and available to political life the spatio‐temporal, socio‐natural blurring of categories that epigenetic and microbiomic discourses could afford. Grounded ethnographic descriptions of these processes of “mattering” can challenge political epistemologies and take further critical perspectives on space to open up possibilities for a robust postgenomic politics.

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