| Summary: | 225 leaves printed on single pages, preliminary pages i- xxiii and numbered pages 1-203. Includes bibliography, list of abbreviations, list of definitions, list of tables and figures and list of appendices. === Digitized at 330 dpi color PDF format (OCR), using KODAK i 1220 PLUS scanner. === Thesis (MNutr (Interdisciplinary Health Sciences))--University of Stellenbosch, 2005. === ENGLISH ABSTRACT: "A comprehensive package of care for the Prevention of Mother- To-Child Transmission
(PMTCT) of HIV" states that all mothers participating in the PMTCT Programme should
receive education that will enable them to make informed decisions about infant feeding
options. Rapid, same-day HIV testing and results that are available immediately, enable
health care workers to be responsible for providing pre- and post-test counselling (which
includes infant feeding options) on the same day. This could place a tremendous
workload and time pressure on the health care workers.
The aim of this study was to determine how "informed" is the literate mother's decision
regarding infant feeding options, who participated in the PMTCT Programme, in the Gert
Sibande District, Mpumalanga, South Africa.
Method:
Data was collected from health care workers and mothers on the PMTCT Programme at
23 PMTCT sites in the Gert Sibande District, with the help of 6 field workers and the
PMTCT site manager at each PMTCT site, by means of once-off, self-administered
questionnaires, which had been previously tested and validated.
Results:
Health care workers' attitude towards the PMTCT Programme was positive, although
some (14%) indicated that what was expected of them was not achievable in their
working environment. The most prominent change relating to the personal preferences of
health care workers regarding infant feeding options for HIV-infected mothers, after
attending the 5-day PMTCT course, was from formula-feeding to breast-feeding. Most
(65%) indicated it was possible to stay neutral in a counselling session regardless of
personal preference for infant feeding and 60% of those who could not stay neutral, still
thought it was in the mother's best interest to be counselled by them. Most (98%) agreed
mothers had the right to make informed decisions and 80% agreed mothers were able to make such a decision. Most (67%) health care workers indicated that not enough staff
was stationed at PMTCT sites, only 53% used the feeding option cards when counselling
mothers and indicated that more educational material was needed. Sixty one percent of
the health care workers demonstrated the preparation of the formula to the mothers and
allowed the mothers to demonstrate back to them. Between 49-82% and 37-56% of the
health care workers knew the correct answers to knowledge questions relating to breastfeeding
and formula-feeding, respectively. Not one health care worker, nor mother, knew
all the steps in preparing a formula feed. Most (80%) mothers made decisions based on
information provided to them by health care workers and only a small (13%) percentage
were influenced by the community to practise a different feeding option than what they
had chosen. Conclusions: The attitude, personal preferences, knowledge of and resources available to health care
workers, influenced the decision made by mothers regarding infant feeding options and
seeing that most mothers made their decision, based on information provided by health
care workers, it is concluded that mothers can only make an informed decision about
infant feeding options if they are advised appropriately by well trained, equipped and
informed health care workers. === AFRIKAANSE OPSOMMING: "A comprehensive package of care for the Prevention of Mother-To-Child Transmission
of HIV", vermeld dat moeders, wat deelneem aan die Voorkoming van Moeder-Tot-Kind
Oordrag (VMTKO) progam, voorligting behoort te ontvang ten opsigte van
voedingsopsies vir hul babas, sodat hulle in staat sal wees om 'n ingeligte keuse te maak.
Gesondheidswerkers is verantwoordelik om voorligting voor en na die HIV toets te gee,
wat die voedingsopsies vir babas insluit, op dieselfde dag. Dit kan 'n ontsaglike
werkslading op die gesondheidswerkers plaas.
Die doel van die studie was om te bepaal hoe "ingelig" is die geletterde moeder se keuse
ten opsigte van voedingsopsies, wat deelneem aan die VMTKO program, in die Gert
Sibande distrik, Mpumalanga, Suid-Afrika.
Metode: Die data is ingesamel by 23 VMTKO-klinieke en -hospitale in die Gert Sibande distrik
onder gesondheidswerkers en moeders op die VMTKO-program, met behulp van 6
veldwerkers en VMTKO-bestuurders, deur middel van eenmalige, selfvoltooide
vraelyste, wat van tevore getoets en gevalideer was.
Resultate: Die gesondheidswerkers se houding teenoor die VMTKO-program was positief, alhoewel
14% aangedui het dat wat van hulle verwag word nie prakties of moontlik is in hul
werksomgewing nie. Die prominentste verandering rakende die persoonlike voorkeure
van die gesonheidswerkers teenoor voedingsopsies vir HIV -geinfekteerde moeders, na
die 5-dag VMTKO kursus, was van formulevoeding na borsvoeding. Meeste (65%) het
aangedui dit is moontlik om neutraal te bly gedurende 'n voorligtingssessie, ten spyte van
persoonlike voorkeure vir voedingsopsies en 60% van die wat nie neutraal kon bly nie,
het steeds gedink dit is in die beste belang van die moeder om deur hulle voorgelig te
word. Meeste (98%) het saamgestem dat dit die moeder se reg is om 'n ingeligte keuse te maak en 80% het saamgestem dat die moeder wel in staat is om so 'n besluit te neem.
Meeste (67%) gesondheidswerkers het aangedui dat personeel tekorte bestaan by die
VMTKO klinieke en hospitale. Slegs 53% gebruik die voedingsopsie kaarte gedurende 'n
voorligtingsessie met die moeder en het aangedui dat meer voorligtingsmateriaal benodig
word. Een en sestig persent van die gesondheidswerkers het die voorbereiding van die
formulevoeding aan die moeders gedemonstreer en het moeders toegelaat om ook die
demonstrasie te doen. Nege en veertig tot twee en tagtig persent en 37-56% van die
gesondheidswerkers kon die korrekte antwoorde verskaf vir vrae oor borsvoeding en
formulevoeding, afsonderlik. Nie een gesondheidswerker of moeder kon al die stappe vir
die voorbereiding van die formulevoeding noem nie. Meeste (80%) moeders maak keuses
gebaseer op inligting wat aan hulle verskaf word deur die gesondheidswerkers en slegs 'n
klein persentasie (13%) word beinvloed deur familielede om die teenoorgestelde
voedingsopsie te praktiseer as wat hulle gekies het.
Gevolgtrekking: Die houding, persoonlike voorkeure, kennis van en hulpbronne beskikbaar aan die
gesongheidswerkers, beinvloed die besluit wat moeders neem ten op sigte van
voedingsopsies en aangesien die moeders hulle besluit baseer op inligting wat deur die
gesondheidswerkers aan hulle gegee word, word die gevolgtrekking gemaak dat moeders
slegs 'n ingeligte keuse aangaande voedingsopsies kan maak indien hulle voorligting
ontvang deur goed opgeleide en ingeligte gesondheidswerkers.
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