Base de données d'évaluation

Evaluation report

2004 ZIM: Community Perspectives on Infant Feeding and HIV in the Context of PMTCT in Zimbabwe

Author: Sibanda, L. G.; Ncube, T.; Madzima, R.

Executive summary

Background:

HIV continues to be the major public health problem affecting Zimbabwe. In Zimbabwe, 9-10% of newborn babies are becoming infected with HIV through mother-to-child transmission yearly. Although the majority of transmissions are occurring before and during childbirth (70%), a significant proportion of HIV transmission to infants is as a result of breastfeeding (30%).

HIV-positive mothers-to-be are counseled on infant feeding options they can take so as to reduce the risk of HIV transmission through breastfeeding. The infant feeding options discussed during the PMTCT counseling sessions are exclusive and sustained breastfeeding, modified breastfeeding (which includes early cessation of breastfeeding, and expressing and heat-treating breast milk), and replacement feeding (which is the use of modified animal milk and infant formula feeding). Very little is known about the acceptability and feasibility of the infant feeding options that are being recommended through the PMTCT programme.

Zimbabwe is a breastfeeding nation, with 98% of the mothers breastfeeding their babies for up to one year. Many of these women, especially in rural and commercial farming settings, breastfeed for 24 months and beyond. Breastfeeding taboos and cultural issues surrounding infant feeding and care still influence infant feeding practices in the general population. The infant feeding options being discussed in the PMTCT programme are not familiar to both mothers and the general community.

Purpose/Objective:

Broad Objective: To explore the acceptability and feasibility of different infant feeding options offered in the PMTCT programme in urban and rural communities in Zimbabwe. Specific Objectives:

To determine the knowledge levels concerning PMTCT in the community
To determine infant feeding practices of women
To determine the acceptability of infant feeding options offered by PMTCT in the community
To assess the feasibility of using the different infant feeding options in the community
To determine the methods of infant feeding used in rural communities for an orphaned infant
To assess health workers' knowledge on infant feeding within the PMTCT context.

Methodology:

A cross-sectional survey in 2 purposively-selected districts with PMTCT programmes was conducted. In one district, the PMTCT programme had been running for at least 12 months and, in the second district, the programme had just started. The following study sites were chosen: Makoni and Tsholotsho districts. In each district, 7 health centre catchment areas implementing PMTCT were randomly selected and a random selection of 400 women was made from all women with children below 1 year. A questionnaire was administered and focus group discussions conducted.

Three groups of people: key informants, women above 45 yrs. and married men were purposively selected to participate in separate focus group discussions. The number of participants in each focus group discussion was between 8 and 10 individuals. Health workers from the two district hospitals and from selected health centres were also interviewed.

Findings and Conclusions:

This study supports that knowledge levels and enrollment of women into the PMTCT programme needs to be improved. Although levels of exclusive breastfeeding are increasing, more support is still required to make exclusive breastfeeding the community norm.

Knowledge that HIV is transmitted through sexual intercourse was high in both Makoni and Tsholotsho. Knowledge that HIV transmission is transmitted from mother to child was low: in Makoni 17% (34), and 12% (27) in Tsholotsho. However, when mothers were prompted in Makoni, 90% (181) mothers knew that HIV is transmitted from mother to child. Those who cited mother to unborn child were 46% (93), breastfeeding 74% (150), during delivery 46% (92). In Tsholotsho, 86% (190) mothers knew that HIV is transmitted from mother to child. Those who agreed for mother to child were 46% (102), breastfeeding 68% (150) and during delivery 25% (55).

The most acceptable infant feeding option in both districts was infant formula feeding: Makoni 86% and Tsholotsho 83%. The least acceptable infant feeding option was expressing and heat-treating in Makoni, and exclusive breastfeeding in Tsholotsho. Figure 3 shows that the women in the study perceived expressing and heat-treating as the least acceptable infant feeding option in the community in both Makoni (20%) and Tsholotsho (15%).

Recommendations:

1. Health Education
2. Training programme
3. Baby Friendly Hospital Initiative (BFHI)