Quality of infant feeding counselling for HIV+ mothers in Brazil: challenges and achievements

Abstract

This project aimed to assess the information and counselling on infant feeding in HIV+ mothers. A cross-sectional study, based on 118 structured observations of mothers' visits to health professionals (5-8/professional)-in 15 purposively selected HIV/Aids healthcare units in Sao Paulo. The general quality of communication and counselling skills was good: for example, professionals responded to all mothers' questions (98%); kept eye-to-eye contact (82%); encouraged the mother to talk (77.1%). However, the information provided to mothers aimed to help their choices concerning infant feeding was of very poor quality. No mother, for example, was informed about alternatives to formula feeding and the danger of mixed feeding. None was offered the option of using banked breast milk. Only around 20% of mothers were informed about the safe preparation of formula feeding. When counselled by a nutritionist (compared with a paediatrician) more mothers were informed about the correct way to prepare bottle-feeds. No mention was made of cup feeding. Although health workers have good communication skills, the information provided to HIV+ mothers is insufficient. Recommending against breast-feeding and providing infant formula may not be enough to achieve safer infant-feeding practices.