Advertisement

AIDS and Behavior

, Volume 22, Issue 1, pp 212–223 | Cite as

A Cluster Randomised Trial to Determine the Efficacy of the “Feeding Buddies” Programme in Improving Exclusive Breastfeeding Rates Among HIV-Infected Women in Rural KwaZulu-Natal, South Africa

  • Penelope Reimers
  • Kiersten Israel-Ballard
  • Marlies Craig
  • Lenore Spies
  • Ibou Thior
  • Frank Tanser
  • Anna Coutsoudis
Original Paper

Abstract

This cluster randomised trial in KwaZulu-Natal South Africa, evaluated the implementation of a Feeding Buddies (FB) programme to improve exclusive breastfeeding (EBF) amongst human immunodeficiency virus infected mothers. Eight clinics were randomly allocated to intervention and control arms respectively. Pregnant women attending the prevention of mother-to-child transmission program and intending to EBF were enrolled: control (n = 326), intervention (n = 299). Intervention mothers selected FBs to support them and they were trained together (four sessions). Interviews of mothers occurred prenatally and at post-natal visits (day 3, weeks 6, 14 and 22). Breastfeeding results were analysed (Stata) as interval-censored time-to-event data, with up to four time intervals per mother. EBF rates at the final interview were similar for control and intervention groups: 44.68% (105/235) and 42.75% (109/255) respectively (p = 0.67). In Cox regression analysis better EBF rates were observed in mothers who received the appropriate training (p = 0.036), had a community care giver visit (p = 0.044), while controlling for other factors. Implementation realities reduced the potential effectiveness of the FBs.

Keywords

HIV/AIDS Prevention of mother -to- child transmission Exclusive breastfeeding Feeding buddy 

Resumen

Este ensayo aleatorio llevado a cabo en KwaZulu-Natal, Sudáfrica, evaluó la implementación del programa Feeding Buddies (FB) para mejorar la lactancia materna exclusiva (LME) entre las madres infectadas por el virus de inmunodeficiencia humana (VIH). Se seleccionaron grupos de intervención y de control en ocho clínicas diferentes de manera aleatoria. Se registraron mujeres embarazadas que asistían al programa de prevención de transmisión materno-infantil y que querían LME: control (n = 326), intervención (n = 299). Las madres del grupo de intervención seleccionaron el programa FB para que les diera apoyo y capacitación (cuatro sesiones). Las entrevistas con las madres ocurrieron en visitas pre y postparto (día 3, semanas 6, 14 y 22). Los resultados de la lactancia fueron analizados (Stata) como datos tiempo hasta que ocurre un evento censurados por intervalos, con una cantidad de hasta cuatro intervalos por madre. Las tasas de LME al final de la entrevista fueron similares para los grupos de control y de intervención: 44.68% (105/235) y 42.75% (109/255) respectivamente (p = 0.67). En el análisis de regresión de Cox, se observaron mejores tasas de LME en madres que recibieron una capacitación adecuada (p = 0.036), recibieron ayuda del/de la cuidador/a de la comunidad (p = 0.044), al tiempo que controlaban otros factores. Las realidades de implementación redujeron el potencial de efectividad del programa FB.

Palabras clave

VIH/SIDA Prevención de la transmisión materno-infantil Lactancia materna exclusiva Programa feeding buddy 

Notes

Funding

The study was funded by National Institute of Health, (NIH. 1759-05946-SUB) and the Window of Opportunity was supported by a grant from BPD Billiton Sustainable Community Program. We acknowledge with appreciation the participation of the mothers and the buddies. We thank the Department of Nutrition, KwaZulu-Natal, the District Health Office in Uthungulu and all the local clinics in the area for their cooperation and participation.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

Approval for the study was obtained by both the University of KwaZulu Natal’s Biomedical Research Ethics Committee (BE001/13) and the PATH Research Ethics Committee (HS721) and all procedures performed were in accordance with the ethical standards of the institution and with the 1964 Helsinki declaration and its later amendments. Approval was also obtained from local stakeholders, which included the Provincial Department of Health as well as the Manager of the Maternal and Child Health Program, KZN. Informed written consent was obtained from all participants.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    World Health Organization, United Nations Children’s Fund. Guideline: Updates on HIV and infant feeding: the duration of breastfeeding, and support from health services to improve feeding practices among mothers living with HIV (2016). http://apps.who.int/iris/bitstream/10665/246260/1/9789241549707-eng.pdf. Accessed 1 Aug 2016.
  2. 2.
    National Breastfeeding Consultative Meeting. The Tshwane declaration of support for breastfeeding in South Africa. National Breastfeeding Consultative Meeting (2011). http://www.sajcn.co.za/index.php/SAJCN/article/view/586/820. Accessed 6 Jan 2016.
  3. 3.
    South Africa National Department of Health. The National Antenatal Sentinel HIV & Herpes Simplex type-2 Prevalence Survey (2012). http://www.hst.org.za/publications/2012-national-antenatal-sentinel-hiv-herpes-simplex-type-2-prevalence-survey. Accessed 20 May 2015.
  4. 4.
    Shisana O, Labadarios D, Rehle T, et al & SANHANES-1 Team. The South African National Health and Nutrition Examination Survey (SANHANES-1) (2013). http://www.hsrc.ac.za/uploads/pageNews/72/SANHANES-launch%20edition%20(online%20version).pdf. Accessed 20 Jun 2016.
  5. 5.
    Coovadia HM, Rollins NC, Bland RM, et al. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet. 2007;369:1107–16.CrossRefPubMedGoogle Scholar
  6. 6.
    Iliff P, Piwoz E, Tavengwa NV, Zunguza CD, Marinda ET, Nathoo KJ, Humphrey JH. Early exlusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS. 2005;19:699–708. doi: 10.1097/01.aids.0000166093.16446.c9.CrossRefPubMedGoogle Scholar
  7. 7.
    Madiba SLJ. Cultural practices interfere with adherence to exclusive infant feeding. A qualitative study among HIV positive post- natal women in Hammanskraal, South Africa. Afr J Phys Health Ed Recreat Dance. 2014;1(1):264–78.Google Scholar
  8. 8.
    Tuthill E, Mc Grath J, Young S. Commonalities and differences in infant feeding attitudes and practices in the context of HIV in sub-Saharan Africa: a meta-synthesis. AIDS Care. 2014;26(2):214–25. doi: 10.1080/09540121.2013.813625.CrossRefPubMedGoogle Scholar
  9. 9.
    Odeny BM, Pfeiffer J, Farquhar C, et al. The stigma of exclusive breastfeeding among both HIV-positive and HIV-negative women in Nairobi, Kenya. Breastfeed Med. 2016;11(5):252–8. doi: 10.1089/bfm.2016.001.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    De Jager E, Skouteris H, Broadbent J, Amir L, Mellor K. Psychosocial correlates of exclusive breastfeeding: a systematic review. Midwifery. 2012;29(5):506–18. doi: 10.1016/j.midw.2012.04.009.CrossRefPubMedGoogle Scholar
  11. 11.
    O’Brien M, Buikstra E, Hegney D. The influence of psychological factors on breastfeeding duration. J Adv Nurs. 2008;63(4):397–408. doi: 10.1111/j.1365-2648.2008.04722.x.CrossRefPubMedGoogle Scholar
  12. 12.
    Meedya S, Fahy K, Kable A. Factors that positively influence breastfeeding duration to 6 months: a literature review. Women Birth. 2010;23(4):135–45. doi: 10.1016/j.wombi.2010.02.002.CrossRefPubMedGoogle Scholar
  13. 13.
    Lewin S, Munabi- Babigumira S, Glenton C, et al. Lay workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst. Rev. 2010;17(3):CD004015. doi: 10.1002/14651858.CD004015.pub3.Google Scholar
  14. 14.
    Gilmore B, Mc Auliffe E. Effectiveness of community health workers delivering preventative interventions for maternal and child health in low and middle- income countries: a systematic review. BMC Public Health. 2013;13:847. doi: 10.1186/1471-2458-13-847.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Mannan I, Rahamn SM, Sania A, Bangladesh Projahnmo Study Group, et al. Can early postpartum home visits by trained community health workers improve breastfeeding in newborns? J. Perinatal. 2008;28(9):632–40. doi: 10.1038/jp.2008.64.CrossRefGoogle Scholar
  16. 16.
    Nor B, Zembe Y, Daniels K, et al. “Peer but not peer”: considering the context of infant feeding peer counselling in a high HIV prevalence area. J Hum Lact. 2009;25(4):427–34. doi: 10.1177/0890334409341050.CrossRefPubMedGoogle Scholar
  17. 17.
    World Health Organisation. Final Report: The Nompilo Project. An evaluation of community case management of childhood illness training and quality improvement supervision of community caregivers to support maternal, neonatal, child and women’s health interventions in KwaZulu-Natal, South Africa (2015). Geneva: Switzerland. Department of Child and Adolescent Health and Development, World Health Organization.Google Scholar
  18. 18.
    Busza J, Walker D, Hairston A, et al. Community-based approaches for prevention of mother-to-child transmission in resource-poor settings: a social ecological review. J Int AIDS Soc. 2012;15(2):17373. doi: 10.7448/ias.15.4.17373.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Medley A, Garcia-Moreno C, McGill S, Maman S. Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries:implications for prevention of mother-to-child transmission programmes. Bull of the World Health Organ. 2004;82(4):299–307.Google Scholar
  20. 20.
    Mepham S, Zondi Z, Mbuyazi A, Mkhwanazi N, Newell ML. Challenges in PMTCT antiretroviral adherence in northern KwaZulu-Natal, South Africa. AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV. 2011;23(6):741–7.CrossRefGoogle Scholar
  21. 21.
    South Africa National Department of Health. National consolidated guidelines for PMTCT and the management of HIV in children and adolescents and adults. Pretoria: Department of Health; 2015.Google Scholar
  22. 22.
    Andersen J, Dana N, Hepfer B, et al. Feeding buddies. A strategy to support safe infant feeding for HIV-positive mothers. J Hum Lact. 2013;29(1):90–3. doi: 10.1177/0890334412469056.CrossRefGoogle Scholar
  23. 23.
    Windows of Opportunity Project: Review of analysis of maternal and child health development for four projects districts in South Africa: Health Systems Trust: 2012. http://www.hst.org.za/sites/default/files/Path_Report_19January2012.pdf Accessed 1 July 2016.
  24. 24.
    Reimers P, Israel Ballard K, Spies L, et al. A Protocol for a cluster randomized trial on the effect of a “feeding buddy” program on adherence to the prevention of mother-to-child-Transmission guidelines in a rural area of KwaZulu-Natal, South Africa. JAIDS. 2016;72(2):S130–6.PubMedPubMedCentralGoogle Scholar
  25. 25.
    StataCorp. 2013. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP.Google Scholar
  26. 26.
    Newson RB. Comparing the predictive powers of survival models using Harrell’s C or Somers’ D. The Stata Journal. 2010; 10(3): 339-358. http://www.stata-journal.com/article.html?article=st0198. Accessed 5 July 2016.
  27. 27.
    Grambsch PM, Therneau TM. Proportional hazards tests and diagnostics based on weighted residuals. Biometrika. 1994;81(3):515–26. doi: 10.1093/biomet/81.3.515.CrossRefGoogle Scholar
  28. 28.
    Britton C, McCormick FM, Renfrew MJ, Wade A, King SE. Support for breastfeeding mothers. Cochrane Database of Syst Rev. 2007;1(1):CD001141. doi: 10.1002/14651858.CD001141.pub3.Google Scholar
  29. 29.
    Chapman DJ, Morel K, Anderson AK, Damio G, Pérez-Escamilla R. Breastfeeding peer counselling: from efficacy through scale-up. J Hum Lact. 2010;26(3):314–26.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Hall J. Effective community-based intervention to improve exclusive breastfeeding at four to six months in low-and middle-income countries: a systematic review of randomised controlled trials. Midwifery. 2011;27(4):497–502. doi: 10.1016/j.midw.2010.03.011.CrossRefPubMedGoogle Scholar
  31. 31.
    Jolly K, Ingram L, Khan KS, Deeks JJ, Freemantle N, Mac Arthur C. Systematic review of peer support for breastfeeding continuation: meta-regressions analysis of the effect of setting, intensity and timing. BMJ. 2012;25(344):d8287. doi: 10.1136/bmj.d8287.CrossRefGoogle Scholar
  32. 32.
    Tylleskar T, Jackson D, Meda N, et al. Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial. Lancet. 2011;378(9789):420–7. doi: 10.1016/s0140-6736(11)60738-1.CrossRefPubMedGoogle Scholar
  33. 33.
    Tomlinson M, Doherty T, Ijumba P, et al. Goodstart: a cluster randomised effectiveness trial of an integrated, community-based package for maternal and newborn care, with prevention of mother-to-child transmission of HIV in a South African township. Trop Med and Int Health. 2014;19(3):256–66. doi: 10.1111/tmi.12257.CrossRefGoogle Scholar
  34. 34.
    Bosire R, Betz B, Aluisio A, et al. High rates of exclusive breastfeeding in both arms of a peer counselling study promoting EBF among HIV–infected women. Breastfeed Med. 2016;11:56–63. doi: 10.1089/bfm.2015.0071.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Buskens I, Jaffe A, Mkhatshwa H. Infant feeding practices: realities and mind sets of mothers in Southern Africa. AIDS Care. 2007;19:1101–9. doi: 10.1080/09540120701336400.CrossRefPubMedGoogle Scholar
  36. 36.
    Laar AS, Govender V. Individual and community perspectives, attitudes, and practices to mother-to-child-transmission and infant feeding among HIV-positive mothers in Sub-Saharan Africa: a systematic literature review. Int J of MCH AIDS. 2015;2(1):152–62. doi: 10.2457/ijma.v2i1.20.Google Scholar
  37. 37.
    Chinkonde JR, Sundby J, de Paoli M, Thorsen VC. The difficulty with responding to policy changes for HIV and infant feeding in Malawi. Int Breastfeed J. 2010;5(1):11. doi: 10.1186/1746-4358-5-11.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Dwadwa-Henda N, Mfecane S, Phalane T, Kelly K, Myers L, & Hajiyiannis H. Social mobilisation and communication to prevent mother-to-child transmission of HIV. Johannesburg, South Africa: CADRE/UNICEF (2015). http://www.unicef.org/southafrica/SAF_resources_pmtctsocmob.pdf Accessed 12 June 2016.
  39. 39.
    Bai DL, Fong DY, Tarrant M. Previous breastfeeding experience and duration of any and exclusive breastfeeding among multiparous mothers. Birth. 2015;42(1):70–7. doi: 10.1111/birt.12152.CrossRefPubMedGoogle Scholar
  40. 40.
    Hobbs AJ, Mannion CA, McDonald SW, Brockway M, Tough SC. The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy Childbirth. 2016;16:90. doi: 10.1186/s12884-016-0876-1.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Prior E, Santhakumaran S, Gale C, Philipps LH, Modi N. Hyde. M J. Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr. 2012;95:1113–35. doi: 10.3945/ajcn.111.030254.CrossRefPubMedGoogle Scholar
  42. 42.
    Sinha B, Chowdhury R, Sankar MJ, et al. Interventions to improve breastfeeding outcomes: a systematic review and meta-analysis. Acta Paediatr. 2015;10(4):114–34. doi: 10.1111/apa.13127.CrossRefGoogle Scholar
  43. 43.
    Zanardo V, Svegliado G, Cavallin F, et al. Elective caesarean delivery: does it have a negative effect on breastfeeding? Birth. 2010;37(4):275–9. doi: 10.1111/j.1523-536X.2010.00421.x.CrossRefPubMedGoogle Scholar
  44. 44.
    UNICEF. Infant and Young Child Feeding Programme Review Consolidated Report of Six-Country Review of Breastfeeding Programmes. 2010. http://www.univef.org/nutrition/files/IYCF_Booklet_April2010_Web.pdf. Accessed 10 July 2016.
  45. 45.
    World Health Organisation. Learning from large-scale community-based programmes to improve breastfeeding practices (2008). http://www.who.int/nutrition/publications/infantfeeding/9789241597371/en/. Accessed 10 July 2016.

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Penelope Reimers
    • 1
  • Kiersten Israel-Ballard
    • 2
  • Marlies Craig
    • 1
  • Lenore Spies
    • 3
  • Ibou Thior
    • 4
  • Frank Tanser
    • 5
    • 6
    • 7
  • Anna Coutsoudis
    • 1
  1. 1.Department of Paediatrics & Child HealthUniversity of KwaZulu-NatalDurbanSouth Africa
  2. 2.PATHSeattleUSA
  3. 3.Integrated Nutrition Programme at KwaZulu-Natal Department of HealthPietermaritzburgSouth Africa
  4. 4.PATHWashingtonUSA
  5. 5.Africa Health Research InstituteUniversity of KwaZulu-NatalSomkheleSouth Africa
  6. 6.School of Nursing and Public HealthUniversity of KwaZulu-NatalDurbanSouth Africa
  7. 7.Centre for the AIDS Programme of Research in South Africa –CAPRISAUniversity of KwaZulu-NatalDurbanSouth Africa

Personalised recommendations