Effect of using HIV and infant feeding counselling cards on the quality of counselling provided to HIV positive mothers: a cluster randomized controlled trial

Katepa-Bwalya Mary, Kankasa Chipepo, Babaniyi Olusegun, Siziya, Siziya Seter

Description

Counselling human immunodeficiency virus (HIV) positive mothers on safer infant and young child feeding (IYCF) options is an important component of programmes to prevent mother to child transmission of HIV, but the quality of counselling is often inadequate. The aim of this study was to determine the effect the World Health Organization HIV and infant feeding cards on the quality of counselling provided to HIV positive mothers by health workers about safer infant feeding options. Method This was a un-blinded cluster-randomized controlled field trial in which 36 primary health facilities in Kafue and Lusaka districts in Zambia were randomized to intervention (IYCF counselling with counselling cards) or non- intervention arm (IYCF counselling without counselling cards). Counselling sessions with 10 HIV positive women attending each facility were observed and exit interviews were conducted by research assistants. Results Totals of 180 women in the intervention group and 180 women in the control group were attended to by health care providers and interviewed upon exiting the health facility. The health care providers in the intervention facilities more often discussed the advantages of disclosing their HIV status to a household member (RR = 1.46, 95% CI [1.11, 1.92]); used visual aids in explaining the risk of HIV transmission through breast milk (RR = 4.65, 95% CI [2.28, 9.46]); and discussed the advantages and disadvantages of infant feeding options for HIV positive mothers (all p values < 0.05). The differences also included exploration of the home situation (p < 0.05); involving the partner in the process of choosing a feeding option (RR = 1.38, 95% CI [1.09, 1.75]); and exploring how the mother will manage to feed the baby when she is at work (RR = 2.82, 95% CI [1.70, 4.67]). The clients in the intervention group felt that the provider was more caring and understanding (RR = 1.81, 95% CI [1.19, 2.75]). Conclusion The addition of counselling cards to the IYCF counselling session for HIV positive mothers were a valuable aid to counselling and significantly improved the quality of the counselling session.

Sujets

• Breastfeeding
• HIV

Informations

• Publié par: biomed
• Publié le: 01 janvier 2011
• Nombre de lectures: 7
• Langue: English

Extrait

Katepa-Bwalya et al. International Breastfeeding Journal 2011, 6:13
http://www.internationalbreastfeedingjournal.com/content/6/1/13
RESEARCH Open Access
Effect of using HIV and infant feeding counselling
cards on the quality of counselling provided to
HIV positive mothers: a cluster randomized
controlled trial
1* 2 1 3Mary Katepa-Bwalya , Chipepo Kankasa , Olusegun Babaniyi and Seter Siziya
Abstract
Background: Counselling human immunodeficiency virus (HIV) positive mothers on safer infant and young child
feeding (IYCF) options is an important component of programmes to prevent mother to child transmission of HIV,
but the quality of counselling is often inadequate. The aim of this study was to determine the effect the World
Health Organization HIV and infant feeding cards on the quality of counselling provided to HIV positive mothers by
health workers about safer infant feeding options.
Method: This was a un-blinded cluster-randomized controlled field trial in which 36 primary health facilities in
Kafue and Lusaka districts in Zambia were randomized to intervention (IYCF counselling with counselling cards) or
non- intervention arm (IYCF counselling without counselling cards). Counselling sessions with 10 HIV positive
women attending each facility were observed and exit interviews were conducted by research assistants.
Results: Totals of 180 women in the intervention group and 180 women in the control group were attended to
by health care providers and interviewed upon exiting the health facility. The health care providers in the
intervention facilities more often discussed the advantages of disclosing their HIV status to a household member
(RR = 1.46, 95% CI [1.11, 1.92]); used visual aids in explaining the risk of HIV transmission through breast milk (RR =
4.65, 95% CI [2.28, 9.46]); and discussed the advantages and disadvantages of infant feeding options for HIV
positive mothers (all p values < 0.05). The differences also included exploration of the home situation (p < 0.05);
involving the partner in the process of choosing a feeding option (RR = 1.38, 95% CI [1.09, 1.75]); and exploring
how the mother will manage to feed the baby when she is at work (RR = 2.82, 95% CI [1.70, 4.67]). The clients in
the intervention group felt that the provider was more caring and understanding (RR = 1.81, 95% CI [1.19, 2.75]).
Conclusion: The addition of counselling cards to the IYCF counselling session for HIV positive mothers were a
valuable aid to counselling and significantly improved the quality of the counselling session.
Keywords: infant feeding, breastfeeding, young children feeding, HIV, counselling cards
Background [1]. With a high antenatal HIV prevalence, estimated at
Strategies that aim at reducing Mother to Child Trans- 16.4% in 2008, approximately 80,000 infants born
annually in Zambia are at risk of acquiring HIV frommission (MTCT) of the Human Immunodeficiency
Virus (HIV) are the cornerstone in reducing the preva- their mothers. For the majority of mothers in
sublence of HIV in children. Antenatal care (ANC) atten- Saharan Africa, where both HIV prevalence and infant
dance in Zambia is high (94%) with more than 90% of mortality are high, breastfeeding an infant is particularly
women attending ANC services being tested for HIV important for child survival [2-4]. Exclusive
breastfeeding has been shown to have a lower risk of HIV
transmission as compared to mixed feeding [5-7]. According* Correspondence: [e-mail]
1World Health Organization, Lusaka, Zambia to the Zambia Demographic Health Surveys (ZDHS) of
Full list of author information is available at the end of the article
© 2011 Katepa-Bwalya et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.Katepa-Bwalya et al. International Breastfeeding Journal 2011, 6:13 Page 2 of 10
http://www.internationalbreastfeedingjournal.com/content/6/1/13
2002 and 2007, the six months exclusive breastfeeding each health facility, giving 180 women in the
intervenrates increased from 41 to 60% respectively [8]. Replace- tion group and another 180 in the control
ment feeding remains elusive for the majority who do group.
not fulfil the AFASS (affordable, feasible, acceptable,
2 2 2 2 2c=1+{(z +z ) [2p(1−p)/n+k (p +p )] }/(p −p )1 2 1 2 2 1sustainable and safe) criteria [9]. Given the risk of
transmission of HIV through breast milk, efforts to make Where
breastmilk as safe as possible remains an important c = number of clusters required per group
aspect in the prevention of MTCT (PMTCT) in Zambia. p = proportion in intervention group1
Counselling HIV positive mothers so that they may p = in control group2
make informed choices on safer infant feeding options p=(p +p )/21 2
is an important component of national programmes to z = percentage point for error1
prevent MTCT. Zambia adopted and adapted the 2003 z = point for error2
World Health Organization (WHO) recommendations n = number of individuals in each cluster
[9] on infant feeding and these were part of the PMTCT k = coefficient of variation of proportions (risks)
guidelines until November 2010 when Zambia adopted among clusters in each group (which is estimated from
the new recommendations [10]. Research in South the range of outcomes across clusters)
Africa and Brazil showed that the quality of counselling
provided to HIV positive mothers on safer infant feeding
Sampling
options was inadequate [11-14]. This was despite the
The health workers in the Maternal and Child Health
fact that health providers had good general counselling
(MCH) unit who normally offer FANC and infant
feedskills and received training on HIV and infant feeding
ing counselling services at the selected health facilities
counselling. In an effort to improve the counselling of
were recruited to participate in the study. The health
HIV positive mothers, WHO has developed counselling
workers from the randomly selected intervention sites
cardstobeusedasjobaids,tocomplementtheHIV
were trained to use the counselling cards. The mothers
and infant feeding counselling training. Job aids are
who were known to be HIV positive were sequentially
visual images with messages which give step by step
guienrolled so long as they agreed to participate in the
dance to the provider and have been shown to improve
study.
client understanding [15,16]. The study aimed to
determine the effect of using HIV and infant feeding
counselStudy designling cards on the quality of counselling provided to HIV
positive mothers about safer feeding options. We report Figure 1 (Evaluation of HIV and Infant Feeding
Councomparisons of processes and outcomes of counselling selling Cards: Synopsis of the Study) shows the flow of
participants in the study. Thirty-six (36) health facilitiesbetween health workers in the intervention (with infant
in Kafue and Lusaka districts were randomized intofeeding counselling cards) and non-intervention
(withintervention and non-intervention sites. The groupingout infant feeding counselling cards) arms.
and randomisation of health facilities was done in WHO
headquarters, Geneva and provided to the PrincipalMethods
Investigator (PI) two weeks prior to the orientation ofStudy area
health workers from the intervention sites. The rando-The study took place in primary health facilities in
mization took into consideration the health facility’sLusaka and Kafue districts of Lusaka Province between
catchment population and the distance from the districtApril and June 2007. The health facilities in the two
dishealth management offices. Half the health facilitiestricts all offer prevention of MTCT and infant feeding
were randomized to intervention sites and their healthcounselling to mothers who are HIV positive as part of
workers were oriented in the use of the HIV and infantthe focused antenatal care (FANC) services.
feeding counselling cards, and the other half were
randomized to non-intervention sites.Sample size
Twenty-seven health workers from the interventionIt was hypothesized that the use of HIV and infant
feedsites were oriented through a three day workshop beforeing counselling cards as job aids by health workers
the implementation of the intervention. They had pre-offering infant feeding options to HIV positive mothers
viously been trained in HIV and infant feeding counsel-would result in a 40% increase in the mothers who
ling as part of the training in prevention of MTCT. The receive appropriate infant feeding counselling.
counselling cards were used as job aids to complementWe obtained 18 health facilities (clusters) in the
interthis training. They were then followed and given super-vention group and another 18 health facilities in the
visorysupportoveraperiodof6to12weeksbythreecontrol group. A total of 10 women were recruited fromKatepa-Bwalya et al. International Breastfeeding Journal 2011, 6:13 Page 3 of 10
http://www.internationalbreastfeedingjournal.com/content/6/1/13
Select health facilities for
inclusion in the study
18 Health facilities-non- 18 health facilities intervention sites
intervention sites (Provide HIV and infant feeding counselling
(Provide HIV and infant feeding with