carry when they are expected to make a choice against a behavior like breastfeeding that is considered a normative behavior in their culture. In the light of this observation the new 2010 KwaZulu-Natal PMTCT guidelines [42] which are
based on the WHO recommendations [20] are very encouraging as they take away the burden of choice and guilt from
the mother and instead mothers are presented with one option
(as they are with all other public health interventions).
Women should therefore feel more confident that policy makers have considered evidence and have made a value
judgement on which intervention (breastfeeding with infant prophylaxis or formula feeding) provides the best health and
survival outcome for their infant in their particular setting.Baseline anthropometric measures were similar in all
groups. Infants in the breastfeeding group did significantly better in terms of all growth parameters by 14 weeks of age
viz. weight gain, z scores for weight/age, BMI/age, weight/length, MUAC/age and TSF/age. However by 6 months,
though the mean measurements were higher in the breastfeeding group, only the mean BMI remained significantly
higher (P = 0.045) that could be explained by the fact that 26% of the breastfeeding group had discontinued breastfeeding by 4 months of age. Our results are in keeping with those of other studies with formula fed and breastfed HIV
exposed infants [43, 44]. Significantly more (P = 0.047) breastfed infants had
achieved age appropriate milestones by 14 weeks; this difference was no longer significant at 6 and 9 months
which could be due to early cessation of breastfeeding by some of the mothers as explained above. Our finding
concurs with previous documents of this benefit of breastfeeding have been well-documented [45].
Breastfeeding was significantly associated with a 69% lower incidence of diarrhoea at 3 months (P = 0.006).
There was also a significantly higher incidence of hospital admissions in the formula-feeding group (7 vs. 0; P =0.014); as well as more visits with infants not having attained their age appropriate milestones (5 vs. 0; P =0.047). The differences were no longer significant at 6 months and later. Once again our finding of the benefit of
breastfeeding in decreasing the risk as well as hospitalization for diarrhoea has been well documented [1, 18].
As mentioned earlier, only 38.7% of the mothers who chose to formula feed actually fulfilled the AFASS criteria.
There is still a need to increase the knowledge on breastfeeding practices amongst health care workers in the hospitals where most of our mothers delivered as only 34% of their infants were put to the breast within the first hour of
delivery. This of course could also be due to the disempowerment of mothers when faced with more educated
health care workers and a need for them to conform to whatever is being advised or told to them rather than taking
part in decision making.