Reasons for the Early Introduction of Complementary Feeding to HIV-Exposed Infants in the Eastern Cape, South Africa: An Exploratory Qualitative Study.

Daniel Ter Goon,Anthony Idowu Ajayi,Oladele Vincent Adeniyi

doi:10.3390/medicina56120703

Abstract

Exclusive breastfeeding has many health benefits for the baby and the mother. This study explored the reasons for the early introduction of supplementary feeding before six months, and the issues faced by parturient women in practicing exclusive breast feeding (EBF) for their HIV-exposed infants in the Eastern Cape, South Africa. Narratives from 319 parturient women with HIV (aged 18 years and above) were collected at three hospitals in the Eastern Cape through semi-structured interviews over a period of five months. Qualitative data were analysed using thematic content analysis. The maternal perception of HIV transmission from breast milk influenced the decision for the immediate introduction of formula feeding. Breast sores, lumps, surgery and perceived insufficiency of milk influenced the decision of mothers to initiate formula feeding within the first two months. However, mothers who initiated complementary feeding after two months were driven by factors common among newborns (refusal of breast milk, baby crying inconsolably and fear of losing weight) and social factors (economic or financial hardships and work-related challenges). Additionally, advice from family members weighed heavily in the decision to switch to complementary feeding, contrary to the healthcare providers’ recommendations. Early complementary feeding for HIV-exposed infants is influenced by maternal perceptions of breast milk transmission, breast and infant factors and socio-economic and cultural practices in the region. Thus, behavioural interventions tailored towards promoting exclusive breastfeeding practices in this population, starting from the pre-natal and continuing during the post-partum period, should also target the immediate family members. National policy should focus on creating an EBF-friendly environment at the workplace for women.

Highlights

The World Health Organization recommends the practice of exclusive breastfeeding for infants in the first six months of life in low- and middle-income countries [1]
Using an exploratory qualitative approach, this study explored the perspectives of mothers living with HIV on the reasons for the early introduction of complementary feeding to their HIV-exposed infants in the Eastern Cape, South Africa
I have to breastfeed the baby for the first six months, without giving any other food, or I could choose the option of formula feeding. She indicated that if I chose the first option, and I took my HIV medication regularly, the risk of my baby getting HIV from me would be low” (27-year-old; introduced formula at 3 months). This present study explored the reasons for the introduction of complementary feeding before six months among HIV-positive mothers in the Eastern Cape, South Africa

Summary

Introduction

The World Health Organization recommends the practice of exclusive breastfeeding (strictly breast milk with the exception of drugs) for infants in the first six months of life in low- and middle-income countries [1]. This is based on public health consensus that exclusive breastfeeding (EBF) in the first six months of life is the best for the optimal growth, development and survival of infants [2]. Breastfeeding should continue for the 24 months while carefully introducing safe, adequate and appropriate complementary foods from six months [1].

Methods

Results

Discussion

Conclusion