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Infant and Young Child Feeding Counseling, Decision-Making, and Practices Among HIV-Infected Women in Malawi’s Option B+ Prevention of Mother-to-Child Transmission Program: A Mixed Methods Study

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Abstract

This study examined infant and young child feeding (IYCF) counseling, decision-making, and practices among HIV-infected women with children 0–23 months participating in Malawi’s Option B+ prevention of mother-to-child transmission (PMTCT) program. We conducted 160 survey interviews, 32 in-depth interviews, and 32 observations of PMTCT visits. Surveys indicated that exclusive breastfeeding was common (75 %) among children <6 months, while minimum dietary diversity (41 %) and minimum acceptable diet (40 %) for children 6–23 months occurred less often. In-depth interviews supported these findings. Most women felt comfortable with current breastfeeding recommendations, but chronic food insecurity made it difficult for them to follow complementary feeding guidelines. Women trusted IYCF advice from health workers, but mainly received it during pregnancy. During observations of postnatal PMTCT visits, health workers infrequently advised on breastfeeding (41 % of visits) or complementary feeding (29 % of visits). This represents a missed opportunity for health workers to support optimal IYCF practices within Option B+.

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Acknowledgments

The authors would like to thank Francis Chapasuka, John Chapola, Madalo Kamanga, Rumbidzai Mlewah, Angela Nyirenda, Odala Sande, Shadreck Ulaya, and Aubrey Zoya for their help collecting the data and Ellie Carter, Nainisha Chintalapudi, and Samantha Croffut for their assistance coding the data. This study was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development grant 5KHD001441-15 BIRCWH Career Development Program (Flax – Scholar); a development grant from the University of North Carolina Center for AIDS Research (P30 AI50410); a University of North Carolina University Research Council small grant; and the Carolina Population Center (R24 HD050924).

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Correspondence to Valerie L. Flax.

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Flax, V.L., Hamela, G., Mofolo, I. et al. Infant and Young Child Feeding Counseling, Decision-Making, and Practices Among HIV-Infected Women in Malawi’s Option B+ Prevention of Mother-to-Child Transmission Program: A Mixed Methods Study. AIDS Behav 20, 2612–2623 (2016). https://doi.org/10.1007/s10461-016-1378-x

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