The comparison of antenatal education, breastfeeding knowledge and neonatal positioning and attachment of HIV reactive and HIV non-reactive primigravidae

Abstract

Background: The millennium development goals (MDGs) of 2000 aimed at a reduction of infant mortality (IM) by two thirds by 2015. This goal has not been met, despite the implementation of various strategies and policies. Exclusive breastfeeding (EBF) and continued breastfeeding (BF) has been reported to be one of the most effective strategies in reducing IM; EBF and BF rates, however, remain low. Enhanced BF promotion, protection and support are therefore crucial in achieving a reduction in IM rate. Problem statement: Considering the triple burden South Africa (SA) is faced with, namely overnutrition, undernutrition and high prevalence of human immunodeficiency virus (HIV), enhanced support is often given to HIV reactive (HIVR) mothers, who make up approximately 29.5% of the population of pregnant women. Where HIVR mothers have BF education provided at ANC as well as elimination of mother-to-child transmission (EMTCT) program visits; HIV non-reactive (HIVNR) mothers (who make up the majority of the population) only have the opportunity for BF education at scheduled ANC visits. If an increased EBF rate and subsequent decrease in IM rate is desired, it is vital to ensure increased coverage of BF education support to all pregnant mothers, irrespective of their HIV status. Aim: To compare antenatal BF education, knowledge, attitudes, neonatal positioning and attachment of infants of HIVR and HIVNR primigravidae. Methods: The study was cross-sectional in design. The first 60 HIVR and first 60 HIVNR primigravid mothers to give birth at Leratong Hospital who met inclusion criteria and consented to study participation were included. BF knowledge and antenatal BF education were assessed using a standardised questionnaire. Positioning and BF attachment were assessed using the LATCH scoring system. Results: HIVR mothers had significantly greater (p=0.003) BF knowledge than HIVNR mothers. Nearly 54% of HIVR mothers had good BF knowledge compared with 26.7% of HIVNR mothers. HIVNR mothers attended significantly more (p=0.030) ANC visits than reactive mothers; however, a tendency (p=0.086) existed where HIVR mothers received more BF education at ANC visits attended. LATCH scores between the two groups were comparable. EBF attitudes of HIVR mothers were more indicative of SA policy than those of HIVNR mothers, where significantly more HIVNR mothers expressed the view that mixed feeding is easier than EBF (p=0.004), that EBF makes it harder to go back to work (p=0.023), that they get less rest (p=0.001) and that they don’t know how adequate BM is (p=0.001). Conclusion: HIVR mothers benefited from increased BF education support as they have increased BF knowledge but attended fewer ANC visits than mothers who are HIVNR. As HIVR mothers make up the minority of those pregnant in SA, the results suggest that only a few benefit from the effect that BF knowledge has on EBF and BF duration. If an increase in EBF and enhanced BF duration is desired to reduce IM rates, more emphasis must be placed on using every opportunity to educate mothers on proper BF practice