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Infant feeding practices in the context of HIV: A qualitative exploration of the barriers and facilitators to exclusive breastfeeding in one rural and one peri-urban community in South Africa

Marlow, Marguerite Barbara (2017-12)

Thesis (MA)--Stellenbosch University, 2017.

Thesis

ENGLISH SUMMARY: Appropriate early feeding practices are crucial for the survival and health of young children. No breastfeeding or non-exclusive breastfeeding leads to high morbidity and mortality amongst infants. The World Health Organisation recommends that mothers exclusively breastfeed their infants for six months and continue breastfeeding for two years. This includes infants born to HIV-positive mothers, since mixed feeding (combining breast milk substitutes with breastfeeding) significantly increases vertical transmission of HIV. Despite various strategies to improve optimum breastfeeding, most infants receive a combination of breast milk, formula milk and other foods in the first months of life. This is problematic since mixed feeding carries the highest risk of HIVtransmission, diarrhoea and other health problems for infants. The study used a qualitative design to explore factors that enable or prevent mothers from adhering to exclusive breastfeeding (EBF) in one rural and one peri-urban community in South Africa. Mothers with infants between three and four months of age participated in individual interviews or focus group discussions conducted by trained data collectors in isiXhosa. All interviews were audio-recorded, transcribed and translated into English. Transcripts were coded with ATLAS.ti software and analysed using thematic analysis to identify barriers and facilitators to EBF. Several barriers were identified that prohibited mothers from practicing EBF. Feeding success, concerns about breast milk sufficiency and infant weight gain played an important role in determining feeding practices. Involvement of other Caregivers, time demands of infant care and competing bio-medical and socio-cultural concerns negatively affected EBF adherence. Interventions need to address several enabling factors, including structural and social support and changing attitudes and subjective norms to provide the conditions conducive to EBF adherence.

AFRIKAANS OPSOMMING: Toepaslike vroëe voedingspraktyke is noodsaaklik vir jong kinders se oorlewing en gesondheid. Geen borsvoeding of nie-eksklusiewe borsvoeding lei tot hoë sterfte- en siekte-syfers in kinders jonger as ses maande. Die Wêreld Gesondheidsorganisasie beveel aan dat moeders hul babas uitsluitlik vir ses maande moet borsvoed en dat borsvoeding vir twee jaar volgehou moet word. Dit is ook van toepassing op jong kinders van moeders met MIV, omdat gemengde voeding (‘n kombinasie van formulemelk en borsvoeding) die risiko van MIV-infeksie drasties verhoog. Ten spyte van verskeie pogings om optimale borsvoeding te bevorder, word meeste jong kinders in Suid-Afrika ‘n kombinasie van borsmelk, formulemelk en ander kossoorte gevoer tydens die eerste paar maande na geboorte. Dit is kommerwekkend omdat gemengde voeding die voedingspraktyk is wat die hoogste risisko vir MIV-infeksie, gastroenteritis en ander gesondheidskwale vir jong kinders tot gevolg kan hê. Hierdie studie het ‘n kwalitatiewe navorsingsontwerp gebruik om die faktore wat eksklusiewe borsvoeding (EBV) belemmer of bevorder te ondersoek in een plaaslike en een semi-stedelike gemeenskap in Suid-Afrika. Moeders met babas tussen drie en vier maande oud het aan individuele onderhoude of fokusgroupbesprekings deelgeneem wat deur opgeleide dataversamelaars in isiXhosa uitgevoer is. Alle onderhoude is digitaal opgeneem, getranskribeer en na Engels vertaal. Transkripsies is met ATLAS.ti sagteware gekodeer en geanaliseer deur middel van tematiese analise om die hindernisse en hulpmiddels met betrekking to EBV te identifiseer. Heelparty hindernisse is geïdentifiseer wat moeders verhoed om EBV te beoefen. Die behoefte om babas suksesvol te voed, bekommernisse oor voldoende borsmelk en gewigstoename het ‘n belangrike rol gespeel in die bepaling van voedingspraktyke. Die betrokkenheid van ander versorgers, tyd eise ten opsigte van versorging van babas en meedingende bio-mediese en sosio-kulturele oorwegings het die nakoming van EBV negatief beïnvloed. Intervensies moet verskeie magtigingsfaktore soos die beskikbaarheid van strukturele en sosiale ondersteuning, benewens die veranderende gesindhede en subjektiewe norme wat gunstige omstandighede vir eksklusiewe borsvoeding daarstel, aanspreek.

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