Maternal and health care workers' perceptions of the effects of exclusive breastfeeding by HIV positive mothers on maternal and infant health in Blantyre, Malawi.

BACKGROUND: HIV-positive mothers are likely to exclusively breastfeed if they perceive exclusive breastfeeding (EBF) beneficial to them and their infants. Nevertheless, very little is known in Malawi about HIV-positive mothers' perceptions regarding EBF. In order to effectively promote EBF among these mothers, it is important to first understand their perceptions on benefits of exclusive breastfeeding. This study therefore, explored maternal and health care workers' perceptions of the effects of exclusive breastfeeding on HIV-positive mothers' health and that of their infants. METHODS: This was a qualitative study within a larger project. Face-to-face in-depth interviews and focus group discussions using a semi- structured interview and focus group guide were conducted. Sixteen HIV-positive breastfeeding mothers, between 18 and 35 years old, were interviewed and data saturation was achieved. Two focus group discussions (FGDs) comprising of five and six adult women of unknown HIV status who were personal assistants to maternity patients, and one FGD with five nurse-midwives working in the maternity wards of Queen Elizabeth Central Hospital in Blantyre, Malawi, were also conducted. Thematic content data analysis was utilized. RESULTS: The study revealed more positive than negative perceived effects of exclusive breastfeeding. However, the fear of transmitting HIV to infants through breast milk featured strongly in the study participants' reports including those of the nurse-midwives. Only one nurse-midwife and a few HIV-positive mothers believed that EBF prevents mother-to-child transmission of HIV. Furthermore, participants, especially the HIV-positive mothers felt that exclusive breastfeeding leads to maternal ill- health and would accelerate their progression to full blown AIDS. CONCLUSION: While most participants considered exclusive breastfeeding as an important component of the wellbeing of their infants' health, they did not share the worldwide acknowledged benefits of exclusive breastfeeding in the prevention of mother-to-child transmission (PMTCT) of HIV. These results suggest a need for more breastfeeding education for all mothers, communities and nurse-midwives involved in breastfeeding counseling in the context of HIV infection. Maternal wellbeing promotion activities such as nutrition supplementation need to be included in all PMTCT of HIV programs.

Decrease in use of manual vacuum aspiration in postabortion care in Malawi: a cross-sectional study from three public hospitals, 2008-2012.

OBJECTIVES: To investigate the use of manual vacuum aspiration in postabortion care in Malawi between 2008-2012. METHODS: A retrospective cross-sectional study was done at the referral hospital Queen Elisabeth Central Hospital, and the two district hospitals of Chiradzulu and Mangochi. The data were collected simultaneously at the three sites from Feb-March 2013. All records available for women admitted to the gynaecological ward from 2008-2012 were reviewed. Women who had undergone surgical uterine evacuation after incomplete abortion were included and the use of manual vacuum aspiration versus sharp curettage was analysed. RESULTS: Altogether, 5121 women were included. One third (34.2%) of first trimester abortions were treated with manual vacuum aspiration, while all others were treated with sharp curettage. There were significant differences between the hospitals and between years. Overall there was an increase in the use of manual vacuum aspiration from 2008 (19.7%) to 2009 (31.0%), with a rapid decline after 2010 (28.5%) ending at only 4.9% in 2012. Conversely there was an increase in use of sharp curettage in all hospitals from 2010 to 2012. CONCLUSION: Use of manual vacuum aspiration as part of the postabortion care in Malawi is rather low, and decreased from 2010 to 2012, while the use of sharp curettage became more frequent. This is in contrast with current international guidelines.

Exclusive breastfeeding prenatal intentions among HIV-positive mothers in Blantyre, Malawi: a correlation study.

BACKGROUND: Exclusive breastfeeding is an important component of child survival and prevention of mother-to-child transmission of HIV in resource-poor settings like Malawi. In Malawi, children under the age of six months are exclusively breastfed for an average duration of 3.7 months. This falls short of the recommendations by the World Health Organization as well as the Malawi Ministry of Health that mothers exclusively breastfeed for the first six months of the child's life. Understanding factors that influence exclusive breastfeeding duration among HIV-positive mothers is important in promoting exclusive breastfeeding among these mothers. An exploratory study was therefore conducted to determine factors that influence HIV-positive mothers' prenatal intended duration of exclusive breastfeeding and their likelihood to exclusively breastfeed for six months. METHODS: This paper is based on data from a longitudinal, descriptive and correlation study that was conducted at Queen Elizabeth Central Hospital in Blantyre, Malawi between May 12, 2009 and March 22, 2010. Theory of Planned Behavior guided the study. A face-to-face survey was utilized to collect data from a convenience sample of 110 HIV-positive mothers who were at least 36 weeks pregnant at baseline. A modified and pre-tested breastfeeding attrition prediction tool was used to measure exclusive breastfeeding beliefs, intentions and external influences at baseline. Data were analyzed using descriptive and association statistics. Additionally, multiple regressions were run to determine significant predictors of HIV-positive mothers' prenatal intended duration of exclusive breastfeeding and their likelihood to exclusively breastfeed for six months. RESULTS: Results revealed high exclusive breastfeeding prenatal intentions among HIV-positive mothers. Prenatal intended duration of exclusive breastfeeding was positively associated with normative, control beliefs and negatively associated with positive beliefs, maternal education and disclosure of HIV status. CONCLUSIONS: Current results suggest that assessment of mothers' level of education and their positive beliefs towards exclusive breastfeeding may help to identify mothers who are at risk of discontinuing exclusive breastfeeding. Interventions to promote exclusive breastfeeding could include provision of appropriate skills, support and information to help HIV-positive mothers gain control over exclusive breastfeeding.

Process evaluation of HIV prevention peer groups in Malawi: a look inside the black box.

This paper reports the process evaluation of a peer group intervention for human immunodeficiency virus (HIV) prevention which had positive outcomes for three target groups in Malawi: rural adults, adolescents and urban hospital workers. The six-session intervention was delivered to small groups of 10-12 participants by 85 trained volunteer peer leaders working in pairs. A descriptive, observational mixed methods design was used with a convenience sample of 294 intervention sessions. Using project records and a conceptually based observation guide, we examined five aspects of the implementation process. The context was favorable, but privacy to discuss sensitive issues was a concern for some groups. In study communities, program reach was 58% of rural adults, 70% of adolescents and nearly all hospital workers. Session records confirmed that all peer groups received the intended six sessions (dose delivered). The dose received was high, as evidenced by high participant engagement in peer group activities. Peer leaders were rated above the median for three indicators of peer group content and process fidelity: session management skills, interpersonal facilitation skills and whether more like a peer group than classroom. Documenting that this HIV prevention peer group intervention was delivered as intended by trained peer volunteers supports widespread dissemination of the intervention.