Infant formula preparation by rural and semi-rural women in South Africa

Abstract

This paper describes an exploratory study conducted in a rural district of KwaZulu-Natal Province, South Africa. This study investigated the feasibility of preparing safe and hygienic commercial infant formula in this area according to UNAIDS guidelines. The HIV prevalence among women of child-bearing age in this region is greater than 30%; thus, the risk of mother-to-child-transmission (MTCT) of the human immunodeficiency virus through breastfeeding has been of concern to the healthcare community. There were both observational and analytical components to this study. The observational aspect included interviewing, observing, and recording practices of formula milk preparation by mothers and other caregivers, in comparison to safe preparation per UNAIDS guidelines. The analytical aspect included sampling of formula and expressed breast milk to look for the presence and growth of bacterial colonies. Various sources of water and fuel were used in the preparation of commercial infant formula. All the women in this study boiled the water used in preparing infant formula. Large amounts of bacteria colonized all of the formula milk as well as manually expressed breast milk samples immediately after formula preparation and breast milk collection. While the analytical results have limited use in this study, we recommend it be repeated with systematic dilution of samples in order to correctly quantify colony counts for all infant formula sampled. The results from observation and interviews suggest that, among HIV-positive women who choose to formula feed in this region, education efforts be aimed primarily at the cleaning of teats and bottles, discarding or safe storage of leftover formula, and cleanliness of food preparation areas. In addition, further emphasis on hand-washing practices should be a priority for healthcare researchers involved in hazard analysis of infant formula contamination. While all these women tried their best to prepare hygienic infant formula by boiling the water, it may be difficult for these women to follow all of the UNAIDS guidelines which are necessary for the preparation of safe infant food.