Early Impact of the World Health Organization(WHO) 2010 Infant and Young Child Feeding(IYCF) Policy Revision on Infant Feeding Patterns and Infant Health Outcomes in Kwa Zulu-Natal(KZN), South Africa(SA)

BACKGROUND: Human Immunodeficiency Virus(HIV) transmission via breast milk, in an era of a global HIV pandemic, complicated breast feeding practices and triggered responsive changes in IYCF guidelines during the past decade. The KZN Department of Health was the first South African health authority to embrace the WHO 2010 IYCF policy revision. Effective 1 January 2011, exclusive breast feeding(EBF) during the first 6-months of life, including EBF of infants of HIV-infected mothers, was recommended, with antiretroviral(ARV) prophylaxis for HIV-exposed infants whose mothers weren’t receiving ARV therapy, and the phasing out of free formula-feed. This study aimed to investigate early outcomes and the impact of IYCF policy revisions in KZN, by assessing infant feeding practices, infant morbidity, and infant mortality. 

METHODS: The study was conducted at first-level IYCF service points in KZN, during June and July,2012. Mixed-method, observational study designs were used. Thirty facilities were randomly selected, using a probability-proportionate-to-size, “30-by-7, cluster-sampling-technique.” Mothers/caregivers of infants presenting for the infant’s 14-week immunisation visit were interviewed on infant feeding practices. Purposive sampling was used to select urban and rural facilities, where focus group discussions(FGDs) were held to assess perceptions and acceptance of IYCF policy revisions among mothers/caregivers of infants <6-months, and health care workers(HCWs) involved with IYCF care. Finally, KZN District Health Information System(DHIS) data was used to evaluate trends in infant morbidity and mortality.

RESULTS: Survey findings revealed an EBF rate of 34.3%[CI±10%] among infants <6-months in KZN, 80%[CI±10%] were breastfed at some point, and breastfeeding was continued among 61.4%[CI±10%]. There was a high rate,56.6%[CI±10%], of mixed feeding(MF). These results correlated with FGD evidence of MF, which was reportedly impacted by perceptions of infants’ satiety, concerns of optimal nutrition and weight gain, the influence of elder family members, and issues of practicality when mothers were scholars or employed away from home. Review of trends reflected by KZN DHIS infant mortality rates, 6-week HIV-PCR test results, and under-5 diarrhoea, showed no changes in the year following IYCF policy revision.

CONCLUSIONS: The current EBF rate of 34%, for infants <6-months in KZN, occurred after 1½ years of IYCF policy revision. Guidelines were not yet fully implemented in many settings, though this was the highest EBF rate reported in KZN and SA to date. MF remains a challenge in KZN. Targeted interventions to address identified barriers could improve EBF rates for infants <6-months, decrease MF rates, and ultimately improve health outcomes of infants in KZN.