[pronut-hiv] Preventing HIV transmission to children: Quality of counselling of mothers

["ProNut-HIV" <pronut-hiv@healthnet.org>]

Preventing HIV transmission to children: Quality of counselling
of mothers in South Africa

Mickey CHOPRA1, Tanya DOHERTY2, Debra JACKSON1 & Ann ASHWORTH3

1School of Public Health, University of the Western Cape, Bellville, South Africa, 2Health Systems Trust, Cape Town, South
Africa, and 3Public Health Nutrition Unit, London School of Hygiene and Tropical Medicine, London, UK

Abstract
Aim: To assess the quality of counselling provided to mothers through the programme to prevent mother-to-child transmission
(PMTCT) of HIV in South Africa. 

Methods: Structured observations of consultations and exit interviews with 60 mothers attending clinics at three purposively selected PMTCT sites across South Africa were conducted.

 Results: Twenty two counsellors were observed. The general quality of communication skills was very good, and 73% of HIV-negative mothers
were informed of the advantages of exclusive breastfeeding (EBF). However, only one of 34 HIV-positive mothers was
informed about the possible side effects of nevirapine, and none was told what to do when it occurred. Only two HIV-positive
mothers were asked about essential conditions for safe formula feeding before a decision about an infant feeding option was
made. None of the 12 mothers choosing to breastfeed was shown how to position the baby correctly on the breast or asked
whether they thought EBF was feasible. Fewer than a quarter of mothers expressed confidence in performing the actions
required, and 85% could not define the term EBF.

Conclusion: The poor quality of counselling in the PMTCT programme will reduce the effectiveness of these programmes.
As they are being scaled up, there needs to be far more attention paid towards the counselling of mothers, especially with
regards to optimal infant feeding.

Key Words: Counselling, exclusive breastfeeding, observation study, prevention of maternal- to-child transmission of HIV,
South Africa

Acta Pfdiatrica, 2005; 94: 357*363