An Evaluation of the Quality of Counselling Provided to Mothers in Three PMTCT Pilot Sites in South Africa

The aim of this study was to assess the quality of counselling provided to mothers through the programme to prevent mother-to-child transmission (PMTCT) of HIV in South Africa. This was a cross-sectional descriptive study and data collection methods included structured observations of consultations and exit interviews with sixty mothers attending clinics in three purposively selected PMTCT sites across South Africa. One feedback workshop was held in each site with key role players to discuss the findings and to enhance interpretation and understanding. Twenty two counsellors were observed including both lay counsellors and nurses. The general quality of communication skills was very good and 73% of HIV negative mothers were informed of the advantages of exclusive breastfeeding (EBF). However only 1 of 34 HIV positive mothers was informed about the possible side effects of nevirapine and none was told what to do when it occurred. Only 2 HIV positive mothers were asked about essential conditions for safe formula feeding before a decision about an infant feeding option was made. None of the twelve mothers choosing to breastfeed was shown how to position the baby correctly on the breast or asked whether they thought EBF was feasible. Fewer than a quarter of mothers expressed confidence in performing the actions required and 85% could not define the term EBF. The site that had received more training and supervised support performed best. The poor quality of counselling in the PMTCT programme will reduce the effectiveness of these programmes. As they are being scaled up there needs to be far more attention paid towards the counselling of mothers especially with regard to optimal infant feeding.