Abstract
BackgroundInfant feeding is a subject of worry in prevention of mother to child transmission (pMTCT) programmes in settings where breastfeeding is normative. Nurse-counsellors, expected to counsel HIV-positive women on safer infant feeding methods as defined in national/international guidelines, are faced with a number of challenges. This study aims to explore the experiences and situated concerns of nurses working as infant feeding counsellors to HIV-positive mothers enrolled in pMTCT programmes in the Kilimanjaro region, northern Tanzania.MethodsA qualitative study was conducted using in-depth interviews and focus group discussions (FGDs) with 25 nurse-counsellors at four pMTCT sites. Interviews were handwritten and FGDs were tape-recorded and transcribed, and the programme Open Code assisted in sorting and structuring the data. Analysis was performed using 'content analysis.'ResultsThe findings revealed a high level of stress and frustration among the nurse-counsellors. They found themselves unable to give qualified and relevant advice to HIV-positive women on how best to feed their infants. They were confused regarding the appropriateness of the feeding options they were expected to advise HIV-positive women to employ, and perceived both exclusive breastfeeding and exclusive replacement feeding as culturally and socially unsuitable. However, most counsellors believed that formula feeding was the right way for an HIV-positive woman to feed her infant. They expressed a lack of confidence in their own knowledge of HIV and infant feeding, as well as in their own skills in assessing a woman's possibilities of adhering to a particular method of feeding. Moreover, the nurses were in general not comfortable in their newly gained role as counsellors and felt that it undermined the authority and trust traditionally vested in nursing as a knowledgeable and caring profession.ConclusionThe findings illuminate the immense burden placed on nurses in their role as infant feeding counsellors in pMTCT programmes and the urgent need to provide the training and support structure necessary to promote professional confidence and skills. The organisation of counselling services must to a larger extent take into account the local realities in which nurses construct their role as counsellors to HIV-positive childbearing women.
Highlights
Infant feeding is a subject of worry in prevention of mother to child transmission programmes in settings where breastfeeding is normative
With the aim of increasing our knowledge of the problems associated with the provision of infant feeding counselling, this study sets out to explore the experiences and situated concerns of nurses working as infant feeding counsellors to HIV-positive mothers enrolled in prevention of mother to child transmission (pMTCT) programmes in the Kilimanjaro region, northern Tanzania
Almost all counsellors stated that from their point of view infant formula was the preferred infant feeding method for HIV-positive women. When they were asked "What are your opinions about HIV-positive women who breastfeed?" only the two counsellors who had participated in the national HIV and infant feeding training said that the women were doing the right thing to breastfeed, while 19 said that the women were doing the wrong thing to breastfeed
Summary
Infant feeding is a subject of worry in prevention of mother to child transmission (pMTCT) programmes in settings where breastfeeding is normative. Exposed to pressures from family and friends, many end up feeding their infants in ways that may increase the risk of HIV transmission. In this context, the quality of the infant feeding counselling and the knowledge and practices of nurses providing the services have been called into question. In response to the risk of HIV transmission through breastfeeding, the current international guidelines for HIV and infant feeding state that "when replacement feeding is acceptable, feasible, affordable, sustainable, and safe (AFASS), avoidance of all breastfeeding by HIV-positive mothers is recommended. The guidelines state that HIV-positive mothers should receive individual counselling on the risks and benefits of the different infant feeding options including exclusive breastfeeding or exclusive replacement feeding with either animal modified milk or industrial infant formula. Based on the principle of informed choice, women should be given the necessary guidance and support to enable them to choose the most appropriate option for their particular life situation while taking the AFASS criteria into account [12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
