Cargando…

A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts

BACKGROUND: The most recent World Health Organization (WHO) guidelines on Human Immunodeficiency Virus (HIV) and infant feeding promotes exclusive breastfeeding (EBF) in resource limited settings for the prevention of mother to child transmission (PMTCT) of HIV. Literature reveals poor uptake of WHO...

Descripción completa

Detalles Bibliográficos
Autores principales: Nyoni, Simangaliso, Sweet, Linda, Clark, Jacinta, Ward, Paul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518720/
https://www.ncbi.nlm.nih.gov/pubmed/31088541
http://dx.doi.org/10.1186/s12889-019-6949-0
_version_ 1783418513470259200
author Nyoni, Simangaliso
Sweet, Linda
Clark, Jacinta
Ward, Paul
author_facet Nyoni, Simangaliso
Sweet, Linda
Clark, Jacinta
Ward, Paul
author_sort Nyoni, Simangaliso
collection PubMed
description BACKGROUND: The most recent World Health Organization (WHO) guidelines on Human Immunodeficiency Virus (HIV) and infant feeding promotes exclusive breastfeeding (EBF) in resource limited settings for the prevention of mother to child transmission (PMTCT) of HIV. Literature reveals poor uptake of WHO feeding guidelines, with mixed feeding being a regular practice. In light of the limited success in EBF promotion, a realist review was conducted, analysing the use of feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa, where the majority of HIV childhood infections occur. We considered what mechanisms were at play, for whom and in what circumstances they led to exclusive breastfeeding. METHODS: Because infant feeding counselling is a complex social intervention with a non-linear causal pathway for preventing mother to child HIV transmission, a realist methodology was chosen for this study. Using Pawson’s five stage sequence for conducting realist reviews, the results are presented as a set of identified and refined context-mechanism-outcome (CMO) configurations. These CMO configurations were used to show how particular outcomes occurred in specific contexts due to a generative mechanism and were developed through identifying a review question and program theory, searching for primary studies, quality appraisal, data extraction and data synthesis. RESULTS: From an initial 1010 papers, 27 papers met the inclusion criteria and were used to refine the program theory. Exclusive breastfeeding occurred when a woman was motivated regarding motherhood, had correct learning and understanding about infant feeding practices through counselling, no fear of breastfeeding or the impact of opposing feeding related cultural beliefs, and the support from others to be assertive about their feeding choices when faced with pressure to mix-feed. An additional CMO configuration was added during the refinement of the program theory identifying that mothers needed to not just understand but also prioritize EBF advice over cultural beliefs and stigma. CONCLUSION: The intended audience for this review are researchers and health care workers in PMTCT, particularly sub-Saharan Africa, who may benefit from the work that has been done to identify contexts for the success and failures of EBF. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12889-019-6949-0) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-6518720
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-65187202019-05-21 A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts Nyoni, Simangaliso Sweet, Linda Clark, Jacinta Ward, Paul BMC Public Health Research Article BACKGROUND: The most recent World Health Organization (WHO) guidelines on Human Immunodeficiency Virus (HIV) and infant feeding promotes exclusive breastfeeding (EBF) in resource limited settings for the prevention of mother to child transmission (PMTCT) of HIV. Literature reveals poor uptake of WHO feeding guidelines, with mixed feeding being a regular practice. In light of the limited success in EBF promotion, a realist review was conducted, analysing the use of feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa, where the majority of HIV childhood infections occur. We considered what mechanisms were at play, for whom and in what circumstances they led to exclusive breastfeeding. METHODS: Because infant feeding counselling is a complex social intervention with a non-linear causal pathway for preventing mother to child HIV transmission, a realist methodology was chosen for this study. Using Pawson’s five stage sequence for conducting realist reviews, the results are presented as a set of identified and refined context-mechanism-outcome (CMO) configurations. These CMO configurations were used to show how particular outcomes occurred in specific contexts due to a generative mechanism and were developed through identifying a review question and program theory, searching for primary studies, quality appraisal, data extraction and data synthesis. RESULTS: From an initial 1010 papers, 27 papers met the inclusion criteria and were used to refine the program theory. Exclusive breastfeeding occurred when a woman was motivated regarding motherhood, had correct learning and understanding about infant feeding practices through counselling, no fear of breastfeeding or the impact of opposing feeding related cultural beliefs, and the support from others to be assertive about their feeding choices when faced with pressure to mix-feed. An additional CMO configuration was added during the refinement of the program theory identifying that mothers needed to not just understand but also prioritize EBF advice over cultural beliefs and stigma. CONCLUSION: The intended audience for this review are researchers and health care workers in PMTCT, particularly sub-Saharan Africa, who may benefit from the work that has been done to identify contexts for the success and failures of EBF. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12889-019-6949-0) contains supplementary material, which is available to authorized users. BioMed Central 2019-05-14 /pmc/articles/PMC6518720/ /pubmed/31088541 http://dx.doi.org/10.1186/s12889-019-6949-0 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Nyoni, Simangaliso
Sweet, Linda
Clark, Jacinta
Ward, Paul
A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts
title A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts
title_full A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts
title_fullStr A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts
title_full_unstemmed A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts
title_short A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts
title_sort realist review of infant feeding counselling to increase exclusive breastfeeding by hiv-positive women in sub saharan-africa: what works for whom and in what contexts
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518720/
https://www.ncbi.nlm.nih.gov/pubmed/31088541
http://dx.doi.org/10.1186/s12889-019-6949-0
work_keys_str_mv AT nyonisimangaliso arealistreviewofinfantfeedingcounsellingtoincreaseexclusivebreastfeedingbyhivpositivewomeninsubsaharanafricawhatworksforwhomandinwhatcontexts
AT sweetlinda arealistreviewofinfantfeedingcounsellingtoincreaseexclusivebreastfeedingbyhivpositivewomeninsubsaharanafricawhatworksforwhomandinwhatcontexts
AT clarkjacinta arealistreviewofinfantfeedingcounsellingtoincreaseexclusivebreastfeedingbyhivpositivewomeninsubsaharanafricawhatworksforwhomandinwhatcontexts
AT wardpaul arealistreviewofinfantfeedingcounsellingtoincreaseexclusivebreastfeedingbyhivpositivewomeninsubsaharanafricawhatworksforwhomandinwhatcontexts
AT nyonisimangaliso realistreviewofinfantfeedingcounsellingtoincreaseexclusivebreastfeedingbyhivpositivewomeninsubsaharanafricawhatworksforwhomandinwhatcontexts
AT sweetlinda realistreviewofinfantfeedingcounsellingtoincreaseexclusivebreastfeedingbyhivpositivewomeninsubsaharanafricawhatworksforwhomandinwhatcontexts
AT clarkjacinta realistreviewofinfantfeedingcounsellingtoincreaseexclusivebreastfeedingbyhivpositivewomeninsubsaharanafricawhatworksforwhomandinwhatcontexts
AT wardpaul realistreviewofinfantfeedingcounsellingtoincreaseexclusivebreastfeedingbyhivpositivewomeninsubsaharanafricawhatworksforwhomandinwhatcontexts