Maternal and health care workers' perspectives on exclusive breastfeeding in the context of maternal HIV infection, in Busia county, western Kenya: a mixed methods cross-sectional survey.

World Health Organization recommends exclusive breastfeeding (EBF) for 6 months with maternal active antiretroviral therapy (ART) to prevent mother-to-child transmission (PMTCT) of HIV. However, EBF in low resource settings remains low. We explored perspectives of EBF by HIV-infected mothers and health care workers in Busia County with a high prevalence of HIV to understand factors influencing the practice. A mixed methods cross-sectional survey using concurrent quantitative and qualitative data collection methods was conducted at PMTCT clinics. Data on socio-demography, young infant feeding practices, maternal and infant health was collected between February 2013 and August 2015 from 371 purposively sampled HIV-infected mother-infant dyads using a semi-structured questionnaire. Focus group discussions with mothers, in-depth interviews and passive observation of health care workers during interaction with mothers were conducted. Significance of difference between mothers practicing EBF or not was tested by Chi-square and Fisher's exact tests setting significance level at 5%. Qualitative data was coded and content analyzed to generate themes. Three hundred and forty-nine (94%) mothers practiced EBF. Maternal comprehension of EBF to PMTCT of HIV influenced choice and practice of EBF (P value = 0.019 and < 0.001 respectively). Health care workers emphasized adherence to ART and offered nutritional supplementation during EBF. Health care workers' nutritional counseling in the context of maternal HIV was poor. Mentor mothers shared their experiences with mothers and offered live case demonstrations of their successfully EBF, healthy and HIV-uninfected children. The main threats to EBF were teenage motherhood, low maternal education and working during EBF. EBF among HIV-infected mothers in Busia County, Kenya was high. Health education and counselling by health care workers, maternal comprehension of ART adherence to PMTCT of HIV, nutritional supplementation and mentor mothers' peer counseling using live case demonstrations of HIV-uninfected EBF children promoted and sustained practice of EBF for 6 months. Teenage motherhood, low maternal education and having to work threatened EBF.

Nabakwe EC ，Egesah O ，Kiverenge-Ettyang GA 《International Breastfeeding Journal》

Maternal and health care workers' perceptions of the effects of exclusive breastfeeding by HIV positive mothers on maternal and infant health in Blantyre, Malawi.

Kafulafula UK ，Hutchinson MK ，Gennaro S ，Guttmacher S ... -  《BMC Pregnancy and Childbirth》

Exclusive breastfeeding among women taking HAART for PMTCT of HIV-1 in the Kisumu Breastfeeding Study.

Okanda JO ，Borkowf CB ，Girde S ，Thomas TK ，Lecher SL ... -  《BMC Pediatrics》

Realities and challenges of breastfeeding policy in the context of HIV: a qualitative study on community perspectives on facilitators and barriers related to breastfeeding among HIV positive mothers in Baringo County, Kenya.

Samburu BM ，Kimiywe J ，Young SL ，Wekesah FM ，Wanjohi MN ，Muriuki P ，Madise NJ ，Griffiths PL ，Kimani-Murage EW ... -  《International Breastfeeding Journal》

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 S ，Sweet L ，Clark J ，Ward P ... -  《BMC PUBLIC HEALTH》