Counseling on Infant and Young Child Feeding Practices for HIV‐infected Women in Malawi's Option B+ Prevention of Mother‐to‐Child Transmission Program

Abstract

The World Health Organization recommends that HIV‐infected women on lifelong antiretrovirals (ARVs) for the prevention of mother‐to‐child transmission (PMTCT Option B+) exclusively breastfeed for 6 months and continue breastfeeding until 12 months. In Malawi, breastfeeding until 24 months is recommended for women on ARVs. Little is known about the extent, timing, content, or uptake of feeding counseling provided to women participating in Malawi's Option B+ program. To fill this gap, we conducted in‐depth interviews on feeding counseling and practices of 32 HIV‐infected women in PMTCT with children < 24 months and performed observations of postnatal PMTCT clinic visits with another 32 women with the same characteristics at 4 clinics in Lilongwe District. In‐depth interviews revealed that women trusted feeding advice from clinic staff compared to other sources. Counseling in clinics usually occurred during the first antenatal visit or at delivery and focused on exclusive breastfeeding for 6 months, which most women reportedly practiced. Postnatal counseling on feeding practices was infrequent. During clinic observations, about 40% of mothers were asked if they were breastfeeding, 12% were advised on feeding problems, <25% of women with children < 6 months were counseled on the introduction of fluids or foods, and <30% of women with children > 6 months were advised on complementary feeding. In conclusion, the low frequency of feeding counseling during postnatal PMTCT visits represents a missed opportunity for health workers to support optimal infant and young child feeding practices of HIV‐infected women. Funding: NIH BIRCWH K12 program, UNC CFAR developmental award