Infant Feeding and Counselling Within Kenyan and Zambian PMTCT Services: How Well Does It Promote Good Feeding Practices?

The document examines the implementation of infant feeding counselling as part of a comprehensive study in each country to document the acceptability, operational barriers, cost, and impact of pilot prevention of mother-to-child transmission (PMTCT) of HIV services.

The Horizons Programme collaborated with NARESA in Kenya, the MTCT Working Group in Zambia, and UNICEF to examine the implementation of infant feeding counselling as part of the study in each country to document the acceptability, operational barriers and impact of pilot PMTCT services.

The research activities included tracking the utilisation of various services; following a cohort of clinic users for 12 to 18 months to determine outcomes of service utilisation on knowledge, practices, and rates of mother-to-child HIV transmission; observation of the quality of care delivered by providers and an economic analysis of the PMTCT programme.

Researchers looked at the infant feeding practices of mother and infant pairs who received newly introduced PMTCT services at Chipata Clinic in Lusaka, Zambia, and Karatina and Homa Bay district hospitals in Kenya.

When speaking to an HIV-positive woman about infant feeding, PMTCT providers in Zambia reported their role as one of giving information, encouragement, and support, and helping women make a decision about an infant feeding option. This was observed to be the case in most counselling sessions. In slightly over half (26/42) of sessions observed, the providers adequately explored (and in 12 observations “somewhat” explored) the feasibility and acceptability of various feeding options. With one exception, every provider made suggestions rather than commands about infant feeding options. Most (87 percent) clients were married or living with a partner, and providers directly addressed partner involvement in infant feeding decisions in threequarters of the sessions.

Local guidelines developed for PMTCT in Kenya and Zambia recommend that pregnant mothers be informed about the risks of mother-to-child transmission during infant feeding and that infant feeding options be discussed.

In Kenya, women who receive a negative HIV test result and women of unknown status are recommended to breastfeed their infant exclusively. Women who receive an HIV-positive test result are counseled about the risks of breast milk transmission of HIV and informed of three optimal choices: exclusive breastfeeding, replacement feeding with formula, and replacement feeding with modified cow’s milk. HIV-positive women who choose to breastfeed are supported with appropriate information and skills counseling on good breastfeeding techniques to enable exclusive breastfeeding and to shorten the duration of breastfeeding. HIV-positive mothers who choose not to breastfeed receive education and support on how to prepare and give their infant the replacement feed, as well as six months supply of infant formula.

In the Zambian PMTCT programme, HIV-negative women and those of unknown status are also encouraged to exclusively breastfeed for six months and continue breastfeeding up to 24 months. The programme recommends three infant feeding options to HIV-positive women:

1. exclusive breastfeeding for six months with abrupt cessation,
2. exclusive breastfeeding for three to four months with abrupt cessation, and
3. exclusive formula feeding, with infant formula supplies and education in its preparation provided by the programme to the mother.