Infant feeding practices in rural South Africa and recommendations to prevent postnatal transmission of HIV

BACKGROUND: Breastfeeding makes a major contribution to child health and is also recognised as a significant factor in child survival. Exclusive breastfeeding (EBF) from 0 to 6 months of age is recommended by the World Health Organization (WHO) as the optimal feeding method for infants, including infants of HIV-infected women from developing countries who, after appropriate counselling, choose to breastfeed. Whilst there is evidence that EBF may be associated with less risk of postnatal HIV transmission than mixed feeding, it is still uncommonly practised for reasons that are poorly understood. Both the patterns and duration of breastfeeding are important determinants of health outcomes. In vertical HIV transmission research, reliable documentation of early breastfeeding practices is important in order to correctly attribute postnatal transmission to feeding patterns. AIMS: The work of this thesis formed the preparatory phase of work for the Wellcome-funded Vertical Transmission Study (VTS) in rural KwaZulu Natal, South Africa. The aim of the VTS was to examine the postnatal transmission risks associated with infant feeding, specifically exclusive breastfeeding. The aim of this thesis was to undertake three specific areas of work to inform the design of the VTS: 1. Breastfeeding practices in the study area. To assess exclusive breastfeeding rates, other infant feeding practices, and impediments to exclusive breastfeeding in a cohort of infants. 2. Use of non-prescribed medications. To describe the variety, and frequency of administration, of non-prescribed medications given to infants in the first three months of life in the study area. 3. Methodology of collection of breastfeeding data. To validate methods of collecting data on the duration of exclusive breastfeeding in the study area. CONCLUSIONS Exclusive breastfeeding is uncommon despite a Baby-friendly Hospital Initiative in the district. Any strategy to promote exclusive breastfeeding should target women antenatally, involve other influential members of the family, provide relevant information about the physiology of breastfeeding and breastmilk production, and support mothers in the important first two weeks post delivery. Non-prescribed medications are given almost universally to young infants, irrespective of socio-economic class. These medications interfere with exclusive breastfeeding, and their effect on postnatal mother-to-child transmission of HIV is not known. Health professionals need to be aware of the extent of, and reasons for, administration of non-prescribed medications to young infants, so that effective health messages can be targeted at mothers and caregivers. The study compared different methods for measuring the recollection of duration of exclusive breastfeeding in the same cohort of women, in which the WHO definitions of early infant feeding were consistently applied. If an infant ever received a fluid or feed other than breastmilk s/he was removed from the EBF category, and was classified as a mixed feeder from that time. This is crucial when documenting breastfeeding patterns in relation to mother-to-child transmission of HIV. In this study, 48 hour exclusive breastfeeding status did not accurately reflect feeding practices since birth. Long term recall data on exclusive breastfeeding were even more inaccurate. Studies examining duration of exclusive breastfeeding, particularly in HIV transmission research, should be collected prospectively at intervals of no longer than a week. (Abstract shortened by ProQuest.