Differences between international recommendations on breastfeeding in the presence of HIV and the attitudes and counselling messages of health workers in Lilongwe, Malawi

Ellen G. Piwoz*, Yvonne Owens Ferguson, Margaret E. Bentley, Amy L. Corneli, Agnes Moses, Jacqueline Nkhoma, Beth Carlton Tohill, Beatrice Mtimuni, Yusuf Ahmed, Denise J. Jamieson, Charles van der Horst, Peter Kazembe, Linda Adair, Sandra Albrecth, Mounir Alt-Khaled, Kant Bangdiwala, Ronald Bayer, Sal Butera, Joseph Chigwenembe, David ChilongoziGrace Chiudzu, Ann Cole, Amanda Corbett, Ann Duerr, Henry Eliya, Susan Fiscuss, Shannon Galvin, Chad Heilig, Irving Hoffman, Elizabeth Hooten, Tien Hsiao, Stacey Hurst, George Joaki, David Jones, Gift Kamanga, Portia Kamthunzi, Cecilia Kanyama, Angela Kashuba, Dansom Kathyola, Rod Knight, Robert Krysiak, Edde Loeliger, Misheck Luhanga, Alice Maida, Francis Martinson, Douglas Mayers, Isabel Mayuni, Marita McDonough, Ceppei Merry, Wezi Msungama, Jane Multa, Charles Mwansambo, Gerald Mwapasa, Richard Pendame, Byron Raines, Mairin Ryan, Diane Shugars, Dorothy Sichali, Jean Marc Steens, Gerald Tegha, Martin Tembo, Roshan Thomas, Esther Waalberg, Chifundo Zimba

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Background: To prevent postnatal transmission of HIV in settings where safe alternatives to breastfeeding are unavailable, the World Health Organization (WHO) recommends exclusive breastfeeding followed by early, rapid cessation of breastfeeding. Only limited data are available on the attitudes of health workers toward this recommendation and the impact of these attitudes on infant feeding counselling messages given to mothers. Methods: As part of the Breastfeeding, Antiretroviral, and Nutrition (BAN) clinical trial, we carried out an in-depth qualitative study of the attitudes, beliefs, and counselling messages of 19 health workers in Lilongwe, Malawi. Results: Although none of the workers had received formal training, several reported having counseled HIV-positive mothers about infant feeding. Health workers with counselling experience believed that HIV-infected mothers should breastfeed exclusively, rather than infant formula feed, citing poverty as the primary reason. Because of high levels of malnutrition, all the workers had concerns about early cessation of breastfeeding. Conclusion: Important differences were observed between the WHO recommendations and the attitudes and practices of the health workers. Understanding these differences is important for designing effective interventions.

Original languageEnglish (US)
Article number2
JournalInternational breastfeeding journal
StatePublished - Mar 9 2006

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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