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Infant feeding in the context of HIV: a qualitative study of health care workers’ knowledge of recommended infant feeding options in Papua New Guinea

Lisa M Vallely1*, Angela Kelly12, Martha Kupul1, Ruthy Neo1, Voletta Fiya1, John M Kaldor3, Glen DL Mola4 and Heather Worth2

Author Affiliations

1 Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea

2 International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia

3 Kirby Institute, University of New South Wales, Sydney, Australia

4 School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea

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International Breastfeeding Journal 2013, 8:6  doi:10.1186/1746-4358-8-6

Published: 7 June 2013



Interventions to prevent mother to child transmission of human immunodeficiency virus (HIV) during childbirth and breastfeeding can reduce HIV infections in infants to less than 5% in low and middle income countries. The World Health Organization (WHO) recommends all mothers, regardless of their HIV status, practice exclusive breastfeeding for the first six months of an infant’s life. In line with these recommendations and to protect, promote and support breastfeeding, in 2009 the PNG National Department of Health revised their National HIV infant feeding guidelines, reinforcing the WHO recommendation of exclusive breastfeeding for the first six months followed by the introduction of other food and fluids, while continuing breastfeeding.

The overall aim of this paper is to explore health care workers’ knowledge regarding infant feeding options in PNG, specifically as they relate to HIV exposed infants.


As part of a study investigating women’s and men’s experiences of prevention of mother to child transmission (PMTCT) services in two sites in PNG, 28 key informant interviews were undertaken. This paper addresses one theme that emerged from thematic data analysis: Health care workers’ knowledge regarding infant feeding options, specifically how this knowledge reflects the Papua New Guinea National HIV Care and Treatment Guidelines on HIV and infant feeding (2009).


Most informants mentioned exclusive breastfeeding, the majority of whom reflected the most up-to-date National Guidelines of exclusive breastfeeding for six months. The importance of breastfeeding continuing beyond this time, along with the introduction of food and fluids was less well understood. The most senior people involved in PMTCT were the informants who most accurately reflected the national guidelines of continuing breastfeeding after six months.


Providing advice on optimal infant feeding in resource poor settings is problematic, especially in relation to HIV transmission. Findings from our study reflect those found elsewhere in identifying that key health care workers are not aware of up-to-date information relating to infant feeding, especially within the context of HIV. Greater emphasis needs to be placed on ensuring the most recent feeding guidelines are disseminated and implemented in clinical practice in PNG.

Prevention of mother to child transmission; Infant feeding practices; Exclusive breastfeeding; Health care worker knowledge