Breastfeeding knowledge, attitudes and practices of HIV-positive women in Africa: A systematic review

BACKGROUND: Breastfeeding is essential for ensuring the health and survival of children, particularly in regions where diarrhoea, pneumonia and malnutrition are common causes of child mortality. In sub-Saharan Africa, over one million HIV-positive women become pregnant each year and face significant challenges in infant feeding due to limited access to treatment and safe water. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months and continuous breastfeeding up to 24 months in conjunction with antiretroviral treatment. The aim of this study was to assess the knowledge, attitudes, and practices (KAP) of HIV-positive mothers in Africa during the last 10 years, to provide evidence for public health strategies. METHODS: A systematic review was conducted on studies that explored the KAP surrounding recommended infant feeding practices among HIV-exposed children in African countries. The review followed the PRISMA guidelines and searched major databases for articles published between 2013 and 2024. RESULTS: Of the 586 articles identified, 22 met the inclusion criteria. 70% of the studies were conducted in Ethiopia, South Africa, and Kenya and 95% of the studies were carried out in healthcare facilities. Mothers demonstrated good knowledge, attitudes, and practices regarding EBF for HIV-exposed children, but exhibited limited knowledge and negative attitudes towards continuous breastfeeding practice. Healthcare workers were reported as their primary source of information. Stigma associated with practicing EBF and returning to work were identified as major reasons for early cessation of breastfeeding. CONCLUSION: The knowledge, attitudes, and practices related to the infant feeding practices currently recommended by WHO for HIV-positive mothers were found to be limited. There is little evidence regarding the situation in other countries, particularly among vulnerable women with limited access to the health system. Public health policies must be strengthened to ensure that health workers are adequately trained in the current guidelines in order to improve adherence to infant feeding practices among HIV-positive mothers.

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Food security
  • Social support
  • Health services
  • Stigma/discrimination
  • Other
• Population(s)
  • Women
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
  • Prevention
• Engagement and Care Cascade
  • Treatment
• Prevention
  • Biomedical interventions
  • Education/media campaigns
• Health Systems
  • Delivery arrangements