PMID- 31088541
OWN - NLM
STAT- MEDLINE
DCOM- 20190730
LR  - 20200225
IS  - 1471-2458 (Electronic)
IS  - 1471-2458 (Linking)
VI  - 19
IP  - 1
DP  - 2019 May 14
TI  - 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.
PG  - 570
LID - 10.1186/s12889-019-6949-0 [doi]
LID - 570
AB  - 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.
FAU - Nyoni, Simangaliso
AU  - Nyoni S
AD  - College of Medicine and Public Health, Flinders University, Adelaide, Australia.
FAU - Sweet, Linda
AU  - Sweet L
AUID- ORCID: 0000-0003-0605-1186
AD  - College of Nursing and Health Sciences, Flinders University, GPO Box 2100, 
      Adelaide, 5001, Australia. Linda.sweet@flinders.edu.au.
FAU - Clark, Jacinta
AU  - Clark J
AD  - College of Medicine and Public Health, Flinders University, Adelaide, Australia.
FAU - Ward, Paul
AU  - Ward P
AD  - College of Medicine and Public Health, Flinders University, Adelaide, Australia.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20190514
PL  - England
TA  - BMC Public Health
JT  - BMC public health
JID - 100968562
MH  - Adult
MH  - Africa South of the Sahara
MH  - Breast Feeding/*psychology
MH  - Counseling/*methods
MH  - Feeding Behavior/psychology
MH  - Female
MH  - HIV Infections/prevention & control/*psychology/transmission
MH  - HIV Seropositivity/psychology/transmission
MH  - Health Personnel/*psychology
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Infectious Disease Transmission, Vertical/prevention & control
MH  - Mothers/*psychology
MH  - Motivation
PMC - PMC6518720
OTO - NOTNLM
OT  - Exclusive breastfeeding (EBF)
OT  - HIV
OT  - Health care provider (HCP)
OT  - Infant feeding counselling
OT  - Mixed feeding
OT  - Preventing mother to child transmission (PMTCT)
COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: Not Applicable. CONSENT FOR 
      PUBLICATION: Not Applicable. COMPETING INTERESTS: The authors declare that they 
      have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral 
      with regard to jurisdictional claims in published maps and institutional 
      affiliations.
EDAT- 2019/05/16 06:00
MHDA- 2019/07/31 06:00
PMCR- 2019/05/14
CRDT- 2019/05/16 06:00
PHST- 2019/02/05 00:00 [received]
PHST- 2019/05/07 00:00 [accepted]
PHST- 2019/05/16 06:00 [entrez]
PHST- 2019/05/16 06:00 [pubmed]
PHST- 2019/07/31 06:00 [medline]
PHST- 2019/05/14 00:00 [pmc-release]
AID - 10.1186/s12889-019-6949-0 [pii]
AID - 6949 [pii]
AID - 10.1186/s12889-019-6949-0 [doi]
PST - epublish
SO  - BMC Public Health. 2019 May 14;19(1):570. doi: 10.1186/s12889-019-6949-0.