Centre for International Health, University of Bergen, Bergen, Norway.
BMC Health Serv Res. 2010 Sep 6;10:260. doi: 10.1186/1472-6963-10-260.
Health workers' counselling practices are essential to improve infant feeding practices. This paper will assess how infant feeding counselling was done and experienced by counsellors and mothers in Eastern Uganda in the context of previous guidelines. This has implications for implementation of the new infant feeding guidelines from 2009.
This paper combines qualitative and quantitative data from Mbale District in Eastern Uganda. Data was collected from 2003 to 2005 in a mixed methods approach. This includes: key-informant interviews among eighteen health workers in the public hospital, health clinics and non-governmental organisations working with people living with HIV, fifteen focus group discussions in the general population and among clients from an HIV clinic, two cross-sectional surveys including 727 mothers from the general population and 235 HIV-positive mothers.
The counselling sessions were often improvised. Health workers frequently had pragmatic approaches to infant feeding as many clients struggled with poverty, stigma and non-disclosure of HIV. The feasibility of the infant feeding recommendations was perceived as challenging among health workers, both for HIV-positive mothers and in the general population. Group counselling with large groups was common in the public health service. Some extra infant feeding teaching capacities were mobilised for care-takers of undernourished children. A tendency to simplify messages giving one-sided information was seen. Different health workers presented contradicting simplified perspectives in some cases. Outdated training was a common concern with many health workers not being given courses or seminars on infant feeding since professional graduation. Other problems were minimal staffing, lack of resources, and programs being started and subsequently stopped abruptly. Many of the HIV-counsellors in the non-governmental organisations got extended training in counselling which seemed to be beneficial.
Health workers were faced with challenges related to workload, resources, scientific updating, and also a need to adjust to frequent changes in programs, recommendations and guidelines. The clients were faced with difficult choices, poverty, lack of education and stigma. Feasibility of the recommendations was a major concern. Systematic approaches to update health workers should be a priority.
卫生工作者的咨询实践对于改善婴儿喂养实践至关重要。本文将评估在东乌干达以前的指导方针背景下，咨询员和母亲如何进行和体验婴儿喂养咨询。这对实施 2009 年新的婴儿喂养指南具有重要意义。
本文结合了来自乌干达东部姆巴莱区的定性和定量数据。数据于 2003 年至 2005 年期间采用混合方法收集。这包括：对在公立医院、诊所和非政府组织工作的 18 名卫生工作者进行重点人物访谈，在普通人群和艾滋病毒诊所的客户中进行 15 次焦点小组讨论，进行两项横断面调查，包括普通人群的 727 名母亲和 235 名艾滋病毒阳性母亲。
咨询会议经常是即兴的。由于许多客户面临贫困、耻辱和艾滋病毒不披露问题，卫生工作者经常采取务实的婴儿喂养方法。卫生工作者认为，艾滋病毒阳性母亲和普通人群都难以实施婴儿喂养建议。公共卫生服务中常见的是对大量人群进行集体咨询。为营养不良儿童的照顾者调动了一些额外的婴儿喂养教学能力。在某些情况下，存在简化信息传递的倾向，即呈现片面的信息。不同的卫生工作者在某些情况下呈现出相互矛盾的简化观点。许多卫生工作者缺乏最新培训，自毕业后未参加过婴儿喂养课程或研讨会，这是一个常见的问题。其他问题包括人员配备不足、资源匮乏以及项目开始后又突然停止。许多非政府组织的艾滋病毒咨询员接受了扩展咨询培训，这似乎是有益的。
卫生工作者面临着与工作量、资源、科学更新以及适应方案、建议和指南频繁变化相关的挑战。客户面临着艰难的选择、贫困、缺乏教育和耻辱。建议的可行性是一个主要关注点。更新卫生工作者的系统方法应成为当务之急。
