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Exclusive breast-feeding promotion among HIV-infected women in South Africa: an Information-Motivation-Behavioural Skills model-based pilot intervention.

Exclusive breast-feeding promotion among HIV-infected women in South Africa: an Information-Motivation-Behavioural Skills model-based pilot intervention.
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Tuthill EL, Butler LM, Pellowski JA, McGrath JM, Cusson RM, Gable RK, Fisher JD,


Tuthill EL, Butler LM, Pellowski JA, McGrath JM, Cusson RM, Gable RK, Fisher JD, (click to view)

Tuthill EL, Butler LM, Pellowski JA, McGrath JM, Cusson RM, Gable RK, Fisher JD,

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Public health nutrition 2017 02 08() 1-10 doi 10.1017/S1368980016003657

Abstract
OBJECTIVE
Exclusive breast-feeding (EBF) provides optimal nutrition for infants and mothers. The practice of EBF while adhering to antiretroviral medication decreases the risk of mother-to-child transmission of HIV from approximately 25 % to less than 5 %. Thus the WHO recommends EBF for the first 6 months among HIV-infected women living in resource-limited settings; however, EBF rates remain low. In the present study our aim was to design and implement a pilot intervention promoting EBF among HIV-infected women.

DESIGN
The Information-Motivation-Behavioural Skills (IMB) model was applied in a brief motivational interviewing counselling session that was tested in a small randomized controlled trial.

SETTING
Pietermaritzburg, South Africa, at two comparable rural public health service clinics.

SUBJECTS
Sixty-eight HIV-infected women in their third trimester were enrolled and completed baseline interviews between June and August 2014. Those randomized to the intervention arm received the IMB-based pilot intervention directly following baseline interviews. Follow-up interviews occurred at 6 weeks postpartum.

RESULTS
While not significantly different between trial arms, high rates of intention and practice of EBF at 6-week follow-up were reported. Findings showed high levels of self-efficacy being significantly predictive of breast-feeding initiation and duration regardless of intervention arm.

CONCLUSIONS
Future research must account for breast-feeding self-efficacy on sustaining breast-feeding behaviour and leverage strategies to enhance self-efficacy in supportive interventions. Supporting breast-feeding behaviour through programmes that include both individual-level and multi-systems components targeting the role of health-care providers, family and community may create environments that value and support EBF behaviour.

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