Education Improves Breastfeeeding Practices in Zambia. (HIV Prevention)

Article excerpt

Last year, 800,000 children became infected with HIV, most of them during their mother's pregnancy, childbirth, or through breastfeeding. The Population Council's Horizons program has tested the introduction of infant feeding counseling to inform women about ways to reduce the risk of HIV transmission during breastfeeding and to support them in their infant feeding choices. The program is being tested at antenatal care clinics in Ndola, Zambia, a low-income setting where antiretroviral drugs are unavailable. The intervention is a collaboration with three nongovernmental organizations, Hope Humana, the LINKAGES project, and the Zambia Integrated Health Project, and two government agencies, the Zambian National Food and Nutrition Commission and the Ndola District Health Management Team.

The research shows that women receiving infant feeding counseling maintain healthier breastfeeding practices in the first six months of their infants' lives. But more work is needed to increase community use of voluntary HIV counseling and testing services and to promote behavior change for preventing HIV transmission and seeking care and support for HIV infection.

The Horizons program of operations research is implemented by the Population Council with the International Center for Research on Women, the International HIV/AIDS Alliance, the Program for Appropriate Technology in Health, Tulane University, Family Health International, and Johns Hopkins University.

Horizons is funded by the U.S. Agency for International Development; its findings allow the agency and its cooperating partners to allocate limited funds most effectively on the basis of empirical information.

Breastfeeding conundrum

In richer countries, mothers with HIV are advised to feed their babies exclusively with formula to avoid transmitting the infection. In poorer countries, however, this strategy can be problematic. In addition to the high cost of formula, a stigma is often attached to formula feeding babies because it suggests the mother may have HIV. Thus, formula feeding may lead to discrimination against the mother. Moreover, if clean water is unavailable, as it often is in poor countries, formula can do more harm than good by exposing babies to waterborne microorganisms that cause diarrhea and respiratory infections. These conditions, combined with malnutrition, are the leading causes of death among children under five years of age worldwide.

Feeding babies with a combination of formula or other feeds and breast milk can result in a higher rate of HIV transmission than breastfeeding alone. UNAIDS, UNICEE and the World Health Organization advise that health-care managers conduct a thorough investigation into local infant feeding options and that health workers help individual HIV-positive mothers weigh the relative risks specific to each locality. Such an assessment conducted in Zambia's Ndola district found that for most mothers breastfeeding is the safest option, even when the mother knows she is HIV-positive.

Working with the study partners, six maternal and child health clinics in Sdola added services aimed at preventing the transmission of HIV from mother to child. The services included counseling on infant feeding and voluntary HIV counseling and testing. The Sisters of the Sacred Heart, part of the Catholic Diocese in Ndola, participated by referring pregnant women to voluntary HIV counseling and testing services at the Ndola clinics. For social support the clinics referred HIV-positive mothers and their families to the Sisters of the Sacred Heart Home Based Care program and Hope Humana, a nongovernmental organization focused on HIV/AIDS.

Researchers assessed knowledge, attitudes, and practices regarding these added services and HIV in general through questionnaires administered to community members and mothers attending clinics. Baseline interviews among 1,430 people were conducted in 2000. …