Effect of using HIV and infant feeding counselling cards on the quality of counselling provided to HIV positive mothers: a cluster randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Counselling human immunodeficiency virus (HIV) positive mothers on safer infant and young child feeding (IYCF) options is an important component of programmes to prevent mother to child transmission of HIV, but the quality of counselling is often inadequate. The aim of this study was to determine the effect the World Health Organization HIV and infant feeding cards on the quality of counselling provided to HIV positive mothers by health workers about safer infant feeding options.</p> <p>Method</p> <p>This was a un-blinded cluster-randomized controlled field trial in which 36 primary health facilities in Kafue and Lusaka districts in Zambia were randomized to intervention (IYCF counselling with counselling cards) or non- intervention arm (IYCF counselling without counselling cards). Counselling sessions with 10 HIV positive women attending each facility were observed and exit interviews were conducted by research assistants.</p> <p>Results</p> <p>Totals of 180 women in the intervention group and 180 women in the control group were attended to by health care providers and interviewed upon exiting the health facility. The health care providers in the intervention facilities more often discussed the advantages of disclosing their HIV status to a household member (RR = 1.46, 95% CI [1.11, 1.92]); used visual aids in explaining the risk of HIV transmission through breast milk (RR = 4.65, 95% CI [2.28, 9.46]); and discussed the advantages and disadvantages of infant feeding options for HIV positive mothers (all p values < 0.05). The differences also included exploration of the home situation (p < 0.05); involving the partner in the process of choosing a feeding option (RR = 1.38, 95% CI [1.09, 1.75]); and exploring how the mother will manage to feed the baby when she is at work (RR = 2.82, 95% CI [1.70, 4.67]). The clients in the intervention group felt that the provider was more caring and understanding (RR = 1.81, 95% CI [1.19, 2.75]).</p> <p>Conclusion</p> <p>The addition of counselling cards to the IYCF counselling session for HIV positive mothers were a valuable aid to counselling and significantly improved the quality of the counselling session.</p

'No sister, the breast alone is not enough for my baby' a qualitative assessment of potentials and barriers in the promotion of exclusive breastfeeding in southern Zambia

<p>Abstract</p> <p>Background</p> <p>Appropriate feeding practices are of fundamental importance for the survival, growth, development and health of infants and young children. The aim of the present study was to collect baseline information on current infant and young child feeding practices, attitudes and knowledge in Mazabuka, Zambia, using a qualitative approach.</p> <p>Methods</p> <p>The study was conducted in Mazabuka, 130 km south of Lusaka in Zambia in January and February in 2005. Nine focus group discussions with mothers and a total of 18 in-depth interviews with fathers, grandmothers, health staff and traditional birth attendants were performed in both rural and urban areas.</p> <p>Results</p> <p>Breastfeeding was reported to be universal, the use of pre-lacteal feeds appeared to be low, colostrum was rarely discarded, and attitudes to and knowledge about exclusive breastfeeding were generally good. However, few practised exclusive breastfeeding. The barriers revealed were: (1) the perception of insufficient milk, (2) the fear of dying or becoming too sick to be able to breastfeed, (3) convention, (4) the perception of 'bad milk' and (5) lack of knowledge on the subject. The health staff and traditional birth attendants were the most important actors in transmitting knowledge about infant feeding to the mothers. Both categories appeared to have updated knowledge on child health and were well respected in the society. Fathers and grandmothers tended to be less knowledgeable on novel subjects such as exclusive breastfeeding and often showed a negative attitude towards it. At the same time they had considerable authority over mothers and children and infant feeding decisions. The rural population was in general less educated and more prone to conventional non-exclusive feeding practices.</p> <p>Conclusion</p> <p>The message that exclusive breastfeeding (EBF) is beneficial for child health had reached the health workers and was taught to mothers. However, conventions and expectations from family members in this Zambian community were important barriers in preventing the message of EBF from being translated into practice. The deep-rooted beliefs that prohibit EBF need to be addressed in projects and campaigns promoting EBF.</p

Increased uptake of intermittent preventive treatment for malaria in pregnant women in Zambia (2006–2012): Potential determinants and highlight of lessons learnt

Objective: To assess potential determinants of uptake and highlight lessons learnt from the implementation of intermittent preventive treatment (IPTp), given to pregnant women as early as possible during the second trimester in Zambia. Methods: Data from four national malaria surveys (2006, 2008, 2010, 2012) were reviewed, and proportions of pregnant women attending antenatal clinics (ANCs) who received two or more doses of sulfadoxine–pyrimethamine (IPTp2) were compared by place of residence, education level, and wealth status. Malaria cases and deaths in pregnant women, from Health Information Management System 2011–2013, were analyzed to determine malaria burden in pregnancy in Zambia. A multiple logistic regression model was applied to identify potential determinants of IPTp uptake. Results: The proportion of pregnant women who took IPTp at ANCs increased from near zero at inception in 2001 to 61.9% in 2006; and to 72% by 2012 (P < 0.001), and overall the uptake was 1.41 times higher in 2012 compared to 2006. From 2006 to 2012, IPTp2 uptake among women with no formal education increased from 51% to 68% (P < 0.1). Likewise, uptake among pregnant women with the lowest wealth index increased from 58.2% to 61.2%. By 2012, IPTp uptake among pregnant women within the lowest wealth index increased to a similar level as the women with high wealth index (P = 0.05). Incidence of malaria cases, hospital admissions and mortality during pregnancy decreased between 2011 and 2013. Overall, increased IPTp uptake was associated with being in urban areas (OR = 1.56, 95% CI: 1.39–1.74), having college (OR = 1.83, 95% CI: 1.25–2.75) or secondary education (OR = 1.68, 95% CI: 1.44–1.96) or of being of higher wealth status (OR = 1.86, 95% CI: 1.60–2.17). Conclusions: Zambia has increased IPTp uptake through ANC for all women. The malaria control program has contributed to increasing access to health services and reducing demographic and socioeconomic disparities