Counseling and choosing between infant-feeding options: Overall limits and local interpretations by health care providers and women living with HIV in resource-poor countries (Burkina Faso, Cambodia, Cameroon)
Counseling and choosing between infant-feeding options: Overall limits and local interpretations by health care providers and women living with HIV in resource-poor countries (Burkina Faso, Cambodia, Cameroon)
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DOI：
10.1016/j.socscimed.2009.06.007
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发表时间：
2009-09-01
影响因子：
5.4
通讯作者：
Alfieri, Chiara
中科院分区：
文献类型：
--
作者：
Desclaux, Alice;Alfieri, Chiara
作为预防艾滋病毒母子传播（PMTCT）策略的一部分，要求艾滋病毒阳性妇女在两个有关婴儿喂养的选择之间选择：替代喂养或与早期断奶的独家母乳喂养。卫生服务必须为妇女提供咨询，指导和支持，以使她们做出明智的选择。本文旨在阐明咨询的内容及其对当地情况的适应，包括妇女的看法，在三个贫困的贫困国家（Burkina Faso，Cambodia和Cameroon）都有不同的贫困国家。定性研究包括对卫生设施的观察以及对艾滋病毒阳性母亲和卫生工作者的访谈。结果表明，咨询实践各不相同，包括仅向所有妇女提出一种选择，根据卫生保健提供者评估的母亲经济水平的选择以及选择之间的选择。尽管卫生工作者首先考虑经济方面，但妇女主要考虑与被污名化为“坏母亲”或艾滋病毒阳性的风险有关的社会方面。总体趋势在考虑妇女的看法和需求时确定了咨询效率的一定限制，例如：卫生保健提供者提供的信息内容，咨询的持续时间和时间，咨询期间提供的信息之间的差异以及卫生系统中提供的信息以及卫生工作者对预防选择的排名。妇女喂养选择的机构与地方惯例和地方当局的能力有关，根据健康和援助系统的组织提供或多或少的全面咨询。当地的做法还取决于机构对国际建议的解释，该建议基于公共卫生的考虑，以及卫生系统各自的责任。除了阻碍预防婴儿喂养模式的结构限制外，解决这些问题还可以帮助改善咨询实践。 （c）2009 Elsevier Ltd.保留所有权利。
As part of prevention of HIV mother-to-child transmission (PMTCT) strategies, HIV-positive women are asked to choose between two options regarding infant feeding: replacement feeding or exclusive breastfeeding with early weaning. Health services must offer women counseling, guidance, and support to enable them to make an informed choice. This article aims to shed light on the content of counseling and its adaptation to local situations, including women's perceptions, in three resource-poor countries with different infant feeding patterns (Burkina Faso, Cambodia, and Cameroon). The qualitative study included observations in health facilities and interviews with HIV-positive mothers and health workers. The results show that counseling practices vary, including prescriptive counseling proposing only one option to all women, an option based on the mother's economic level assessed by health care providers, and the choice between options. While health workers consider economic aspects first, women mostly consider social aspects related to the risk of being stigmatized as a "bad mother"' or as HIV-positive. Overall trends identify some limits to counseling effectiveness when considering women's perceptions and needs, such as: the content of information provided by health care providers, duration and timing of counseling, discrepancies between information provided during counseling and from the health system, and ranking of preventive options by health workers. Women's agency for feeding choices is related to local practices and local authorities' abilities to provide more or less comprehensive counseling based on the organization of the health and aid system. Local practices also depend on institutions' interpretations of international recommendations based on public health considerations regarding standard of care and women's and the health system's respective responsibilities. Beyond structural constraints that hinder the adoption of preventive infant feeding patterns, addressing these issues may help improve counseling practices. (C) 2009 Elsevier Ltd. All rights reserved.