The current infant feeding practices and related factors of Zulu mothers with 0-6 month old infants attending PMTCT and non-PMTCT clinics in central Durban, KwaZulu-Natal : an exploratory study.
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Date
2005
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Abstract
Abstract: Introduction:
Exclusive breastfeeding for the first six months of an infant's life is
recommended worldwide. In 1998 the South African Demographic and
Health Survey (SADHS) showed that only 10% of mothers exclusively
breastfeed at three months. As the HIV virus is transmissible via breast milk,
UNAIDS (2002) recommends that women in developing countries should be
given a choice of feeding method after being counselled on the risks and
benefits of breast feeding versus formula feeding. As a result, the Prevention
of Mother-to-Child Transmission (PMTCT) programme was launched in
KwaZulu-Natal with the aim of providing interventions to prevent Mother-to-Child
Transmission of the HIV virus. However, research has shown that infant
feeding practices are influenced by numerous factors. Ultimately mothers will
feed their infants in a manner they feel comfortable with, even if it is not
always the most appropriate choice.
Aim:
The aim of this study was to determine and compare current infant feeding
practices and some of the factors that influenced these practices among Zulu
mothers with 0 - 6 month old infants attending PMTCT and non-PMTCT
clinics in Central Durban, KwaZulu-Natal.
Methodology:
A cross-sectional, descriptive survey was conducted amongst 150 mothers
sampled from three non-PMTCT clinics and 150 mothers sampled from three
PMTCT clinics. Systematic random sampling of mothers attending the two
types of clinics was used to ensure an equal number of mothersĀ· with infants
aged 0 - < 6 weeks, 6 - < 14 weeks and 14 weeks to 6 months. The number
of mothers interviewed per clinic was determined proportionate to clinic size.
Interviews were conducted in Zulu by trained fieldworkers according to a
structured interview schedule consisting of 87 open- and closed-ended
questions.
Summary of most important findings and conclusion:
Overall, one quarter of the mothers attending non-PMTCT and one third of
mothers at PMTCT clinics were practising exclusive breastfeeding at the time
of the survey. The general trend was that mothers attending PMTCT clinics
were more inclined than those attending non-PMTCT clinics to breastfeed
their infants exclusively (34% versus 24% respectively) or to formula feed
(16,7% versus 12,7% respectively). Furthermore, there was a significant
decline in exclusive breastfeeding and predominant breastfeeding with
increasing infant age in both clinic groups. The opposite held true for mixed
feeding and formula feeding in that infants were more inclined to mixed
feeding or formula feeding with increasing infant age. In both clinic groups,
exclusive breastfeeding was the method of choice in the 0 - < 6 week age
category, while a preference for mixed feeding was shown in the 6 - < 14
week category. This trend persisted in the 14 week - < 6 month age
category, especially in the non-PMTCT clinics, while there was a small but
pronounced increase in formula feeding amongst PMTCT mothers. Although
these findings can be explained as a result of implementing the PMTCT
programme, the positive trends observed in non-PMTCT clinics serve as an
indicator that the Integrated Nutrition Programme (INP) and Baby Friendly
Hospital initiative have also had an impact on the feeding choices mothers
make.
Despite the limited duration of the PMTCT programme at the time of the
study, indicators of the impact of the intervention include that a lower
percentage of PMTCT mothers introduced foods and/or liquids in addition to
breast milk to their infants before six months of age compared to non-PMTCT
mothers. Furthermore, more mothers attending PMTCT clinics were
shown how to breastfeed and were more likely to have received information
about formula feeding. Despite these indicators of a positive impact of the
PMTCT programme, the mean age for introducing liquids and/or solids in
addition to breast milk was about six weeks and the incidence of this practice
was very high for both groups. The similar incidence of formula feeding
observed between the two clinic groups suggests the presence of constraints
to safe infant feeding choices among mothers attending PMTCT clinics.
As observed, infant feeding practices were still not ideal in either of the two
clinic groups. However, the high level of antenatal clinic attendance
documented for both groups serves as evidence that, if opportunities for
providing mothers with appropriate infant feeding advice are utilized
optimally, the antenatal clinic could serve as an ideal medium through which
infant feeding education can take place, especially as the clinic-based nursing
staff were cited as the most important source of infant feeding information by
both groups of mothers in the antenatal and postnatal phases. The
documented infant feeding practices should be interpreted against the
backdrop of factors such as socio-demographic characteristics of the
mothers, availability of resources such as social support from peers and
significant others and reigning infant feeding beliefs that could influence
infant feeding decisions.
Predictors of exclusive breastfeeding in PMTCT and non-PMTCT clinics were
determined by means of multivariate logistic regression analysis. Significant
values were obtained for both clinic groups in terms of the infant not having
received liquids in addition to breast milk. No additional predictors were
found amongst mothers attending non-PMTCT clinics, however predictors
amongst mothers attending PMTCT clinics included whether the mother had
not visited the clinic since the infant's birth, whether she practiced demand
feeding and whether she was experiencing stress at the time of the study.
The limited number of predictors of exclusive breastfeeding documented in
this study, especially among non-PMTCT mothers may be explained by the
fact that infant feeding behaviour is multifactorial by nature and the
interaction between factors that influence feeding choice is strong.
Description
Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2005.
Keywords
Infants--Nutrition--South Africa., Infants--Nutrition--KwaZulu-Natal--Durban., Children--Nutrition--South Africa., Breastfeeding., Breastfeeding--KwaZulu-Natal--Durban., Breastfeeding--Social aspects., Infant formulas., Baby foods., AIDS (Disease)--Transmission., Theses--Dietetics and human nutrition.