Knowledge of health workers about breast feeding in the intervention and comparison sites at baseline and follow-up
| Knowledge statements | Number (%) with correct answers at baseline | Number (%) with correct answers at follow-up | ||||
| Intervention (n=289) | Comparison (n=131) | P value* | Intervention (n=250) | Comparison (n=112) | P value* | |
| Knowledge relating to updates in the HIV and infant feeding guidelines | ||||||
| Significant improvements between intervention and comparison groups at follow-up | ||||||
| Continued breast feeding for 2 years is the recommended infant method in SA for all children, regardless of mother’s HIV status (true)† | 190 (65.7) | 91 (70.0) | 0.39 | 224 (89.6) | 88 (78.6) | <0.01 |
| An HIV-positive mother who is virally suppressed on antiretroviral treatment should breast feed her child rather than not breast feed to improve the child’s survival (true)† | 237 (82.0) | 108 (83.1) | 0.79 | 236 (94.4) | 96 (85.7) | <0.01 |
| A mother who has missed six tablets of fixed-dose combination antiretroviral therapy in 1 month is considered to be poorly adherent and should stop breast feeding immediately (false)†‡ | 181 (62.6) | 89 (68.5) | 0.25 | 201 (80.4) | 72 (64.3) | <0.01 |
| In South Africa, HIV-infected women who are breast feeding should be supported to adhere to antiretroviral treatment and should introduce complementary foods at 6 months and be supported to continue breast feeding for at least 2 years (true)† | 245 (84.8) | 116 (89.2) | 0.22 | 244 (97.6) | 91 (81.3) | <0.01 |
| When an HIV-infected mother is ready to add complementary feeds she should stop breast feeding rapidly over a 24-hour period (false)† | 214 (74.1) | 103 (79.2) | 0.25 | 217 (86.8) | 86 (76.8) | <0.05 |
| If a mother misses two doses of her antiretroviral therapy in 1 month, she should be classified as a treatment failure (false)†‡ | 185 (64.0) | 82 (63.1) | 0.85 | 191 (76.4) | 73 (65.2) | <0.05 |
| Low levels of knowledge (<80%) at baseline in both groups—no significant differences between intervention and comparison groups at follow-up (concept that this relates to) | ||||||
| If an HIV-exposed baby is receiving both breast milk and formula milk, the mother should choose either breast feeding or formula feeding if she is adherent to antiretroviral therapy (false)† (mixed feeding with formula and breast milk) | 69 (23.9) | 29 (22.3) | 0.71 | 75 (30.0) | 28 (25.0) | 0.33 |
| A mother living with HIV and adherent to antiretroviral treatment cannot exclusively breast feed her 4-month-old infant because she is working. It is better for this mother to give formula during the day and breast feed at night rather than giving no breast milk at all (true)† (mixed feeding with formula milk and breast milk) | 22 (7.6) | 14 (10.8) | 0.29 | 40 (16.0) | 14 (12.5) | 0.38 |
| High levels of knowledge (≥80%) at baseline in both groups—no significant differences between intervention and comparison groups at follow-up | ||||||
| In South Africa, HIV-infected women who are breast feeding should be supported to adhere to antiretroviral treatment and should be counselled and supported to exclusively breast feed their infants for the first 6 months of life while maintaining an undetectable viral load (true)† | 281 (97.2) | 123 (94.6) | 0.18 | 242 (96.8) | 109 (97.3) | 0.79 |
| Mothers living with HIV who are receiving antiretroviral treatment and are virally suppressed should be advised not to breast feed their infants (false)† | 252 (87.2) | 115 (88.5) | 0.85 | 230 (92.0) | 99 (88.4) | 0.27 |
| General breast feeding | ||||||
| Significant improvements between intervention and comparison groups at follow-up | ||||||
| In South Africa, the leading cause of death among children under 5 years is pneumonia (true) | 189 (65.4) | 82 (63.1) | 0.65 | 230 (92.0) | 75 (67.0) | <0.01 |
| Giving any formula milk during the first 6 months of life increases the risk of death from diarrhoea and/or pneumonia (true) | 246 (85.1) | 104 (80.0) | 0.17 | 232 (92.8) | 95 (84.8) | 0.02 |
| It is safe to give the baby expressed breast milk that has been kept outside the fridge for 8 hours (true) | 106 (36.7) | 43 (33.1) | 0.48 | 120 (48.0) | 38 (33.9) | <0.05 |
| A mother who is working and giving formula milk should mix the milk herself and leave for the carer to give during the day (false)‡ | 218 (75.4) | 94 (72.3) | 0.50 | 189 (75.6) | 68 (60.7) | <0.01 |
| Low levels of knowledge (<80%) at baseline in both groups—no significant differences between intervention and comparison groups at follow-up | ||||||
| When sterilising feeding bottles cover the bottles with water in a saucepan and place on the heat. As soon as the water boils remove from heat and do not leave the bottles in the water until completely cool (false)‡ | 64 (22.2) | 27 (20.8) | 0.75 | 53 (21.2) | 25 (22.3) | 0.81 |
| High levels of knowledge (≥80%) at baseline in both groups—no significant differences between intervention and comparison groups at follow-up | ||||||
| Exclusive breast feeding is the recommended infant feeding method for all infants aged 0–6 months in SA, regardless of mother’s HIV status (true) | 271 (93.8) | 118 (90.8) | 0.27 | 234 (93.6) | 102 (91.1) | 0.32 |
| A baby under 4 months should be given soft porridge once he/she seems hungry (false)‡ | 284 (98.3) | 124 (95.4) | 0.09 | 247 (98.8) | 108 (96.4) | 0.13 |
| Giving a baby expressed breast milk is not as good as breast feeding (false)‡ | 234 (81.0) | 106 (81.5) | 0.89 | 218 (87.2) | 96 (85.7) | 0.70 |
| There are long-term health benefits of breast feeding for mother and child that last beyond the breastfeeding period (true) | 264 (91.4) | 116 (89.2) | 0.49 | 232 (92.8) | 100 (89.3) | 0.26 |
| Breast feeding and HIV | ||||||
| Significant improvements between intervention and comparison groups at follow-up | ||||||
| An HIV-positive mother who has cracked nipples should continue to breast feed unless they are bleeding (true) | 143 (49.5) | 64 (49.2) | 0.96 | 187 (74.8) | 59 (52.7) | <0.01 |
| If a baby has a positive PCR (HIV test) at birth the mother should stop breast feeding if this is affordable and feasible in her situation (false)‡ | 224 (81.0) | 100 (76.9) | 0.90 | 214 (85.6) | 82 (73.2) | <0.01 |
| High levels of knowledge (<80%) at baseline in both groups—no significant differences between intervention and comparison groups at follow-up | ||||||
| An HIV-exposed baby who is exclusively breast feeding should be given some water when the weather is very hot (false)‡ | 270 (93.4) | 122 (93.9) | 0.87 | 239 (95.6) | 105 (93.8) | 0.45 |
| Mean Knowledge Score (SD) out of 22 | 15.2 (2.6) | 15.0 (3.1) | 0.61* | 17.2 (2.1) | 15.2 (2.8) | <0.01 |
The tables displays numbers with correct knowledge.
*Independent t-test comparing intervention and comparison sites at the relevant time point.
†These questions measure the change in knowledge relating to the South African Department of Health June 2017 circular and the WHO 2016 updated HIV and infant feeding guidelines.
‡The statement is false; thus, the scales were inverted during data analysis.