Login Register Cart 0
Generic placeholder image

Current HIV Research

Editor-in-Chief

ISSN (Print): 1570-162X
ISSN (Online): 1873-4251

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Healthcare Workers’ Knowledge of HIV-Exposed Infant Feeding Options and Infant Feeding Counseling Practice in Northern Nigeria

Author(s): Zubairu Iliyasu*, Hadiza S. Galadanci, Fatima Hassan-Hanga, Zainab Abdulrahman, Fatima Ismail Tsiga, Salisha E. Marryshow and Muktar H. Aliyu

Volume 18, Issue 1, 2020

Page: [29 - 40] Pages: 12

DOI: 10.2174/1570162X18666191223114657

Price: $65

Abstract

Background: Despite the existence of evidence-based HIV-exposed infant feeding guidelines, infants in Africa still acquire HIV through inappropriate feeding practices.

Objective: To identify predictors of HIV-exposed infant feeding knowledge and counseling practice among health care workers (HCW) in Nigeria.

Methods: Structured, pretested questionnaires were administered to HCW (n=262) in a tertiary health facility in Kano, Nigeria. Multivariate logistic regression was used to determine predictors of HIV-exposed infant feeding knowledge and counseling practice.

Results: Of 262 respondents, (58.0%, n=152) had good knowledge of recommended feeding options. Respondents listed exclusive breastfeeding (57.6%, n=151), human milk substitutes (45.4%, n=119), HIV-negative wet-nursing (37.0%, n=97), heated expressed human milk (20.6%, n=54) and mixed feeding (13.4%, n=35) as appropriate feeding choices. Over half (57.3%, n=150) of the respondents have ever counseled a HIV-positive mother on infant feeding. Knowledge was predicted by female sex (Adjusted Odds Ratio (AOR)=2.47, 95% Confidence Interval (CI):1.35-4.52), profession (physician vs. laboratory scientist, AOR=4.00, 95%CI:1.25-12.87; nurse/midwife vs. laboratory scientist, AOR=2.75, 95%CI:1.17-9.28), infant feeding counseling training (AOR=3.27, 95%CI:1.87-5.71), and number of children (2-4 vs. 0, AOR=1.75, 95%CI:1.23-3.92). Infant feeding counseling was predicted by female sex (AOR=2.85, 95%CI:1.39-5.85), age (>40 vs. <30 years, AOR=3.87, 95%CI:1.27-15.65), knowledge of infant feeding options (good vs. fair/poor, AOR=3.96, 95%CI:2.07-7.59), training (AOR=2.60, 95%CI:1.42-5.32), and profession (physician vs. laboratory scientist, AOR=10.7, 95%CI:2.85-40.54; nurse/midwife vs. laboratory scientist, AOR=4.8, 95%CI:1.26-18.02).

Conclusion: The practice of infant feeding counseling among HCW in Nigeria is associated with sex, knowledge, and profession. Our findings may inform the development of targeted training programs for HCW in similar settings.

Keywords: Health care workers, HIV, Infant feeding, human milk, cross-sectional study, counseling.

« Previous Next »
Graphical Abstract

[1]
UNAIDS. Joint United Nations Programme on HIV/AIDS. 1998. A review of HIV transmission through breastfeeding. https://www.unaids.org/sites/default/files/media_asset/jc180-hiv-infantfeeding-3_en_0.pdf
[2]
Black RF. Transmission of HIV-1 in the breast-feeding process. J Am Diet Assoc 1996; 96(3): 267-74.
[http://dx.doi.org/10.1016/S0002-8223(96)00079-X] [PMID: 8613662]
[3]
Nicoll A, Killewo JZ, Mgone C. HIV and infant feeding practices: epidemiological implications for sub-Saharan African countries. AIDS 1990; 4(7): 661-5.
[http://dx.doi.org/10.1097/00002030-199007000-00009] [PMID: 2397059]
[4]
John GC, Kreiss J. Mother-to-child transmission of human immunodeficiency virus type 1. Epidemiol Rev 1996; 18(2): 149-57.
[http://dx.doi.org/10.1093/oxfordjournals.epirev.a017922] [PMID: 9021309]
[5]
The United Nations Joint Programme on HIV/AIDS and the World Health Organization. A Review of HIV transmission through Breastfeeding. Geneva, Switzerland: UNAIDS and WHO 1998.
[6]
De Cock KM, Fowler MG, Mercier E, et al. Prevention of mother-to-child HIV transmission in resource-poor countries: translating research into policy and practice. JAMA 2000; 283(9): 1175-82.
[http://dx.doi.org/10.1001/jama.283.9.1175] [PMID: 10703780]
[7]
Mofenson LM, Lambert JS, Stiehm ER, et al. Risk factors for perinatal transmission of human immunodeficiency virus type 1 in women treated with zidovudine. Pediatric AIDS Clinical Trials Group Study 185 Team. N Engl J Med 1999; 341(6): 385-93.
[http://dx.doi.org/10.1056/NEJM199908053410601] [PMID: 10432323]
[8]
Kourtis AP, Jamieson DJ, de Vincenzi I, et al. Prevention of human immunodeficiency virus-1 transmission to the infant through breastfeeding: new developments. Am J Obstet Gynecol 2007; 197(3)(Suppl.): S113-22.
[http://dx.doi.org/10.1016/j.ajog.2007.03.003] [PMID: 17825642]
[9]
Coutsoudis A. Breastfeeding and HIV. Best Pract Res Clin Obstet Gynaecol 2005; 19(2): 185-96.
[http://dx.doi.org/10.1016/j.bpobgyn.2004.10.006] [PMID: 15778109]
[10]
Mallampati D, MacLean RL, Shapiro R, et al. Optimal breastfeeding durations for HIV-exposed infants: The impact of maternal ART use, infant mortality and replacement feeding risk. J Int AIDS Soc 2018; 21(4)e25107
[http://dx.doi.org/10.1002/jia2.25107] [PMID: 29667336]
[11]
Flynn PM, Taha TE, Cababasay M, et al. PROMISE Study Team. Prevention of HIV-1 Transmission Through Breastfeeding: Efficacy and Safety of Maternal Antiretroviral Therapy Versus Infant Nevirapine Prophylaxis for Duration of Breastfeeding in HIV-1-Infected Women With High CD4 Cell Count (IMPAACT PROMISE): A Randomized, Open-Label, Clinical Trial. J Acquir Immune Defic Syndr 2018; 77(4): 383-92.
[http://dx.doi.org/10.1097/QAI.0000000000001612] [PMID: 29239901]
[12]
World Health Organization, United Nations Children’s Fund. Guideline: Updates on HIV and infant feeding: The duration of breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva: World Health Organization 2016.
[13]
Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States 2010.http://aidsinfo.nih.gov/contentfiles/PerinatalGL.pdf
[14]
Leshabari SC, Blystad A, Moland KM. Difficult choices: Infant feeding experiences of HIV-positive mothers in northern Tanzania. SAHARA J 2007; 4(1): 544-55.
[http://dx.doi.org/10.1080/17290376.2007.9724816] [PMID: 18040533]
[15]
van Lettow M, Bedell R, Landes M, et al. Uptake and outcomes of a prevention-of mother-to-child transmission (PMTCT) program in Zomba district, Malawi. BMC Public Health 2011; 11: 426.
[http://dx.doi.org/10.1186/1471-2458-11-426] [PMID: 21639873]
[16]
Siegfried N, van der Merwe L, Brocklehurst P, Sint TT. Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection. Cochrane Database Syst Rev 2011; 7(7)CD003510
[http://dx.doi.org/10.1002/14651858.CD003510.pub3] [PMID: 21735394]
[17]
Rujumba J, Tumwine JK, Tylleskär T, Neema S, Heggenhougen HK. Listening to health workers: Lessons from Eastern Uganda for strengthening the programme for the prevention of mother-to-child transmission of HIV. BMC Health Serv Res 2012; 12: 3.
[http://dx.doi.org/10.1186/1472-6963-12-3] [PMID: 22222064]
[18]
Fadnes LT, Engebretsen IM, Moland KM, Nankunda J, Tumwine JK, Tylleskär T. Infant feeding counselling in Uganda in a changing environment with focus on the general population and HIV-positive mothers - a mixed method approach. BMC Health Serv Res 2010; 10: 260.
[http://dx.doi.org/10.1186/1472-6963-10-260] [PMID: 20815932]
[19]
Sprague C, Chersich MF, Black V. Health system weaknesses constrain access to PMTCT and maternal HIV services in South Africa: a qualitative enquiry. AIDS Res Ther 2011; 8: 10.
[http://dx.doi.org/10.1186/1742-6405-8-10] [PMID: 21371301]
[20]
Tuthill E, McGrath J, Young S. Commonalities and differences in infant feeding attitudes and practices in the context of HIV in sub-Saharan Africa: a metasynthesis. AIDS Care 2014; 26(2): 214-25.
[http://dx.doi.org/10.1080/09540121.2013.813625] [PMID: 23879637]
[21]
Joint United Nations Programme on HIV/AIDS (UNAIDS). New survey results indicate that Nigeria has an HIV prevalence of 1·4%. http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2019/march/20190314_nigeria
[22]
Adeyinka DA, Olakunde BO, Oladimeji O, Ezeanolue EE. HIV Indicator and Impact Survey: considerations for Nigeria. Lancet HIV 2019; 6(6): e348-50.
[http://dx.doi.org/10.1016/S2352-3018(19)30153-5] [PMID: 31162110]
[23]
Chabikuli ON, Gwarzo U, Olufunso A, Reidpath D, Allotey P, Ibrahim M, et al. Closing the prevention of mother-to-child transmission gap in Nigeria: An evaluation of service improvement intervention in Nigeria. S Afr Fam Pract 2014; 55(1): 96-102.
[http://dx.doi.org/10.1080/20786204.2013.10874310]
[24]
Joint United Nations Programme on HIV/AIDS (UNAIDS). The Gap Report. Geneva, Switzerland: UNAIDS 2014.
[25]
Olakunde BO, Adeyinka DA, Olawepo JO, et al. Towards the elimination of mother-to-child transmission of HIV in Nigeria: a health system perspective of the achievements and challenges. Int Health 2019; 11(4): 240-9.
[http://dx.doi.org/10.1093/inthealth/ihz018] [PMID: 31028402]
[26]
Joint United Nations Programme on HIV/AIDS (UNAIDS). Progress Report on the Global Plan. Geneva, Switzerland: UNAIDS 2015.
[27]
Aliyu MH, Varkey P, Salihu HM, Iliyasu Z, Abubakar IS. The HIV/AIDS epidemic in Nigeria: progress, problems and prospects. Afr J Med Med Sci 2010; 39(3): 233-9.
[PMID: 21416794]
[28]
Federal Ministry of Health (FMOH), Department of Family Health, Abuja. National policy on infant and young child feeding in Nigeria 2010.
[29]
Cutilli CC. Seeking health information: what sources do your patients use? Orthop Nurs 2010; 29(3): 214-9.
[PMID: 20505493]
[30]
Swoboda CM, Van Hulle JM, McAlearney AS, Huerta TR. Odds of talking to healthcare providers as the initial source of healthcare information: updated cross-sectional results from the Health Information National Trends Survey (HINTS). BMC Fam Pract 2018; 19(1): 146.
[http://dx.doi.org/10.1186/s12875-018-0805-7] [PMID: 30157770]
[31]
Iliyasu Z, Galadanci HS, Emokpae P, Amole TG, Nass N, Aliyu MH. Predictors of exclusive breastfeeding among health care workers in urban Kano, Nigeria. J Obstet Gynecol Neonatal Nurs 2019; 48(4): 433-44.
[http://dx.doi.org/10.1016/j.jogn.2019.04.285] [PMID: 31132334]
[32]
Al-Mujtaba M, Sam-Agudu N, Khatri RJ. Barriers to the practice of exclusive breastfeeding among HIV-positive mothers in sub-Saharan Africa: A scoping review of counselling, socioeconomic and cultural factors. J AIDS HIV Res 2016; 8(6): 70-9.
[http://dx.doi.org/10.5897/JAHR2015.0353]
[33]
Iliyasu Z, Galadanci HS, Iliyasu ML, et al. Determinants of Infant Feeding Practices Among HIV-Infected Mothers in Urban Kano, Nigeria. J Hum Lact 2019; 35(3): 592-600.
[http://dx.doi.org/10.1177/0890334419835171] [PMID: 31002763]
[34]
Samuel FO, Olaolorun FM, Adeniyi JD. A training intervention on child feeding among primary healthcare workers in Ibadan Municipality. Afr J Prim Health Care Fam Med 2016; 8(1): e1-6.
[http://dx.doi.org/10.4102/phcfm.v8i1.884] [PMID: 27796119]
[35]
National Population Commission (NPC) [Nigeria] and ICF Macro. Nigeria Demographic and Health Survey 2008 Abuja, Nigeria: National Population Commission and ICF Macro . 2009.
[36]
Lunney KM, Iliff P, Mutasa K, et al. Associations between breast milk viral load, mastitis, exclusive breast-feeding, and postnatal transmission of HIV. Clin Infect Dis 2010; 50(5): 762-9.
[http://dx.doi.org/10.1086/650535] [PMID: 20121424]
[37]
Shapiro RL, Smeaton L, Lockman S, et al. Risk factors for early and late transmission of HIV via breast-feeding among infants born to HIV-infected women in a randomized clinical trial in Botswana. J Infect Dis 2009; 199(3): 414-8.
[http://dx.doi.org/10.1086/596034] [PMID: 19090775]
[38]
Semrau K, Kuhn L, Brooks DR, et al. Dynamics of breast milk HIV-1 RNA with unilateral mastitis or abscess. J Acquir Immune Defic Syndr 2013; 62(3): 348-55.
[http://dx.doi.org/10.1097/QAI.0b013e31827e64d4] [PMID: 23202812]
[39]
Willumsen JF, Filteau SM, Coutsoudis A, et al. Breastmilk RNA viral load in HIV-infected South African women: Effects of subclinical mastitis and infant feeding. AIDS 2003; 17(3): 407-14.
[http://dx.doi.org/10.1097/00002030-200302140-00015] [PMID: 12556695]
[40]
Willumsen JF, Filteau SM, Coutsoudis A, Uebel KE, Newell ML, Tomkins AM. Subclinical mastitis as a risk factor for mother-infant HIV transmission. Adv Exp Med Biol 2000; 478: 211-23.
[http://dx.doi.org/10.1007/0-306-46830-1_19] [PMID: 11065074]
[41]
Lwanga SK, Lemeshow S. Sample size determination in health studies: A practical manual. World Health Organization 1991; pp. 29-32.
[42]
Van Rensburg LJ, Nel R, Walsh CM. Knowledge, opinions and practices of healthcare workers related to infant feeding in the context of HIV. Health SA Gesondheid 2016; 21: 129-36.
[http://dx.doi.org/10.1016/j.hsag.2015.12.001]
[43]
Corp IBM. IBM SPSS Statistics for Windows, Version 220. Armonk, NY: IBM Corp. Released 2013.
[44]
Pearson K. On the criterion that a given system of deviations from the probable in the case of a correlated system of variables is such that it can be reasonably supposed to have arisen from random sampling. Philos Mag 1900; 5(50): 157-75.
[http://dx.doi.org/10.1080/14786440009463897]
[45]
Fisher RA. On the interpretation of χ2 from contingency tables, and the calculation of P. J R Stat Soc 1922; 85: 87-94.
[http://dx.doi.org/10.2307/2340521]
[46]
Katz MH. Multivariable analysis-A practical guide for clinicians and public health researchers. Cambridge, U.K.: Cambridge University Press 2011; pp. 45-51.
[http://dx.doi.org/10.1017/CBO9780511974175]
[47]
Ashipa T, Ofili AN, Onakewhor JUE, Adejumo AO. Health Workers’ Knowledge of Preventing Mother-To-Child Transmission of HIV in Benin City, Edo State, Nigeria. J Community Med Prim Health Care 2017; 29(1): 1-10.
[48]
Murila F, Obimbo MM, Musoke R, Tsikhutsu I, Migiro S, Ogeng’o J. Breast-feeding and human immunodeficiency virus infection: assessment of knowledge among clinicians in Kenya. Int J Nurs Pract 2015; 21(1): 37-42.
[http://dx.doi.org/10.1111/ijn.12218] [PMID: 24256108]
[49]
Mkontwana P, Steenkamp L, Von der Marwitz J. Challenges in the implementation of the Infant and Young Child Feeding policy to prevent mother-to-child transmission of human immunodeficiency virus in the Nelson Mandela Bay District. South Afr J Clin Nutr 2013; 26(2): 25-32.
[http://dx.doi.org/10.1080/16070658.2013.11734447]
[50]
Shah S, Rollins NC, Bland R. Child Health Group. Breastfeeding knowledge among health workers in rural South Africa. J Trop Pediatr 2005; 51(1): 33-8.
[http://dx.doi.org/10.1093/tropej/fmh071] [PMID: 15601651]
[51]
Vallely LM, Kelly A, Kupul M, et al. Infant feeding in the context of HIV: a qualitative study of health care workers’ knowledge of recommended infant feeding options in Papua New Guinea. Int Breastfeed J 2013; 8(1): 6.
[http://dx.doi.org/10.1186/1746-4358-8-6] [PMID: 23742201]
[52]
Piwoz EG, Ferguson YO, Bentley ME, et al. UNC Project BAN Study Team. Differences between international recommendations on breastfeeding in the presence of HIV and the attitudes and counselling messages of health workers in Lilongwe, Malawi. Int Breastfeed J 2006; 1(1): 2.
[http://dx.doi.org/10.1186/1746-4358-1-2] [PMID: 16722580]
[53]
West NS, Schwartz SR, Yende N, et al. Infant feeding by South African mothers living with HIV: implications for future training of health care workers and the need for consistent counseling. Int Breastfeed J 2019; 14(11): 11.
[http://dx.doi.org/10.1186/s13006-019-0205-1] [PMID: 30815026]
[54]
WHO. Consensus statement.. WHO HIV and infant feeding technical consultation held on behalf of the inter-agency task team (IATT) on prevention of HIV infections in pregnant women, mothers, and their infants. Geneva 2006.www.who.int/child-adolescent-health/New_Publications/NUTRITION/consensus_statement.pdf
[55]
Moore RE, Townsend SD. Temporal development of the infant gut microbiome. Open Biol 2019; 9(9)190128
[http://dx.doi.org/10.1098/rsob.190128] [PMID: 31506017]
[56]
Goga AE, Doherty T, Jackson DJ, et al. Infant feeding practices at routine PMTCT sites, South Africa: results of a prospective observational study amongst HIV exposed and unexposed infants - birth to 9 months. Int Breastfeed J 2012; 7: 4.
[http://dx.doi.org/10.1186/1746-4358-7-4] [PMID: 22472507]
[57]
Sankar MJ, Sinha B, Chowdhury R, et al. Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr 2015; 104(467): 3-13.
[http://dx.doi.org/10.1111/apa.13147] [PMID: 26249674]
[58]
Magoni M, Bassani L, Okong P, et al. Mode of infant feeding and HIV infection in children in a program for prevention of mother-to-child transmission in Uganda. AIDS 2005; 19(4): 433-7.
[http://dx.doi.org/10.1097/01.aids.0000161773.29029.c0] [PMID: 15750397]
[59]
Njom Nlend AE, Motaze ACN, Sandie A, Fokam J. HIV-1 transmission and survival according to feeding options in infants born to HIV-infected women in Yaoundé, Cameroon. BMC Pediatr 2018; 18(1): 69.
[http://dx.doi.org/10.1186/s12887-018-1049-3] [PMID: 29458337]
[60]
Anígilájé EA, Dabit OJ, Olutola A, Ageda B, Aderibigbe SA. HIV-free survival according to the early infant-feeding practices; a retrospective study in an anti-retroviral therapy programme in Makurdi, Nigeria. BMC Infect Dis 2015; 15: 132.
[http://dx.doi.org/10.1186/s12879-015-0871-6] [PMID: 25888418]
[61]
Becquet R, Bland R, Leroy V, et al. Duration, pattern of breastfeeding and postnatal transmission of HIV: pooled analysis of individual data from West and South African cohorts. PLoS One 2009; 4(10)e7397
[http://dx.doi.org/10.1371/journal.pone.0007397] [PMID: 19834601]
[62]
Becquet R, Ekouevi DK, Menan H, et al. ANRS 1201/1202 Ditrame Plus Study Group. Early mixed feeding and breastfeeding beyond 6 months increase the risk of postnatal HIV transmission: ANRS 1201/1202 Ditrame Plus, Abidjan, Côte d’Ivoire. Prev Med 2008; 47(1): 27-33.
[http://dx.doi.org/10.1016/j.ypmed.2007.11.014] [PMID: 18190955]
[63]
Coovadia HM, Rollins NC, Bland RM, et al. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet 2007; 369(9567): 1107-16.
[http://dx.doi.org/10.1016/S0140-6736(07)60283-9] [PMID: 17398310]
[64]
Coutsoudis A, Pillay K, Spooner E, Kuhn L, Coovadia HM. South African Vitamin A Study Group. Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. Lancet 1999; 354(9177): 471-6.
[http://dx.doi.org/10.1016/S0140-6736(99)01101-0] [PMID: 10465172]
[65]
Bobat R, Moodley D, Coutsoudis A, Coovadia H. Breastfeeding by HIV-1-infected women and outcome in their infants: a cohort study from Durban, South Africa. AIDS 1997; 11(13): 1627-33.
[http://dx.doi.org/10.1097/00002030-199713000-00012] [PMID: 9365768]
[66]
Earle S, Hadley R. Men’s views and experiences of infant feeding: A qualitative systematic review. Matern Child Nutr 2018; 14(3)e12586
[http://dx.doi.org/10.1111/mcn.12586] [PMID: 29349895]
[67]
Engebretsen IM, Moland KM, Nankunda J, Karamagi CA, Tylleskär T, Tumwine JK. Gendered perceptions on infant feeding in Eastern Uganda: Continued need for exclusive breastfeeding support. Int Breastfeed J 2010; 5: 13.
[http://dx.doi.org/10.1186/1746-4358-5-13] [PMID: 20977712]
[68]
Radzyminski S, Callister LC. Mother’s Beliefs, Attitudes, and Decision Making Related to Infant Feeding Choices. J Perinat Educ 2016; 25(1): 18-28.
[http://dx.doi.org/10.1891/1058-1243.25.1.18] [PMID: 26848247]
[69]
McCarter-Spaulding D. Is breastfeeding fair? Tensions in feminist perspectives on breastfeeding and the family. J Hum Lact 2008; 24(2): 206-12.
[http://dx.doi.org/10.1177/0890334408316076] [PMID: 18436973]
[70]
Dachew BA, Bifftu BB. Breastfeeding practice and associated factors among female nurses and midwives at North Gondar Zone, Northwest Ethiopia: A cross-sectional institution based study. Int Breastfeed J 2014; 9: 11.
[http://dx.doi.org/10.1186/1746-4358-9-11] [PMID: 25057283]
[71]
Akinyinka MR, Olatona FA, Oluwole EO. Breastfeeding Knowledge and Practices among Mothers of Children under 2 Years of Age Living in a Military Barrack in Southwest Nigeria. Int J MCH AIDS 2016; 5(1): 1-13.
[http://dx.doi.org/10.21106/ijma.79] [PMID: 27622007]
[72]
Mahmood SE, Srivastava A, Shrotriya VP, Mishra P. Infant feeding practices in the rural population of north India. J Family Community Med 2012; 19(2): 130-5.
[http://dx.doi.org/10.4103/2230-8229.98305] [PMID: 22870418]
[73]
Genetu H, Yenit MK, Tariku A. Breastfeeding counseling and support are associated with continuous exclusive breastfeeding from one week to six months of age among HIV exposed infants in north Gondar zone, Ethiopia: a cross-sectional study. Int Breastfeed J 2017; 12: 21.
[http://dx.doi.org/10.1186/s13006-017-0113-1] [PMID: 28439291]
[74]
Chale LE, Fenton TR, Kayange N. Predictors of knowledge and practice of exclusive breastfeeding among health workers in Mwanza city, northwest Tanzania. BMC Nurs 2016; 15: 72.
[http://dx.doi.org/10.1186/s12912-016-0192-0] [PMID: 28050163]
[75]
Ogbonna K, Govender I, Tumbo J. Knowledge and practice of the prevention of mother-to-child transmission of HIV guidelines amongst doctors and nurses at Odi Hospital, Tshwane District. S Afr Fam Pract 2016; 1(1): 1-5.
[http://dx.doi.org/10.1080/20786190.2016.1228561]
[76]
Sunguya BF, Poudel KC, Mlunde LB, et al. Effectiveness of nutrition training of health workers toward improving caregivers’ feeding practices for children aged six months to two years: a systematic review. Nutr J 2013; 12: 66.
[http://dx.doi.org/10.1186/1475-2891-12-66] [PMID: 23688174]
[77]
Sunguya BF, Mlunde LB, Urassa DP, et al. Improving feeding and growth of HIV-positive children through nutrition training of frontline health workers in Tanga, Tanzania. BMC Pediatr 2017; 17(1): 94.
[http://dx.doi.org/10.1186/s12887-017-0840-x] [PMID: 28376725]

Rights & Permissions Print Cite
Article Metrics
7
© 2024 Bentham Science Publishers | Privacy Policy