The 2014 West Africa Ebola outbreak saw a substantial number of healthcare workers (HCWs) being infected, despite the use of personal protective equipment (PPE). PPE is intended to protect HCWs when caring for patients with Ebola virus disease (EVD), but PPE may play a role in the spread of Ebola in healthcare environments. Before the removal of PPE, chemical disinfection may prevent the transfer of pathogens to HCWs, but the efficacy of common disinfectants against enveloped viruses, such as Ebola, on PPE surfaces is relatively unknown. The purpose of this study is to assess the efficacy of two common disinfectants, chlorine bleach (Clorox® bleach) and quaternary ammonium (Micro-Chem Plus®), used in healthcare settings for inactivation of enveloped viruses on PPE. The virucidal activity of the two disinfectants were tested against bacteriophage Φ6, an enveloped, non-pathogenic surrogate for enveloped viruses, on Tyvek suit surfaces. Virus was dried onto Tyvek suit surface, exposed to the disinfectants at use-dilution for a contact time of one minute, and the surviving virus was quantified using a double agar layer (DAL) assay. The Clorox® bleach and Micro-Chem Plus® produced a >3.21 log10 reduction and >4.33 log10 reduction, respectively, in Φ6 infectivity. The results of this study suggest that chlorine bleach and quaternary ammonium are effective in the inactivation of enveloped viruses on Tyvek suit surfaces. Chemical disinfection of PPE should be considered as a viable method to reduce the spread of pathogenic, enveloped viruses to HCWs, patients, and other environmental surfaces in healthcare settings.

Vård- och omsorgspersonal utför ett klientnära arbete och samarbetar och får handledning av arbetsterapeuter. Studier visar att brister i kommunikation och samarbete, leder till minskad säkerhet för klienten. Den arbetsterapeutiska handledningen uppskattades av vård- och omsorgspersonalen då det underlättade i deras arbete. Idag saknas det forskning som närmare studerar vård- och omsorgspersonalens erfarenheter av arbetsterapeutiskt samarbete och handledning. Syfte: Syftet med studien var att beskriva vård- och omsorgspersonalens erfarenheter av samarbete och handledning av arbetsterapeuter. Metod: Författarna valde en kvalitativ ansats. Studiens data material insamlades via semistrukturerade intervjuer. Tio yrkesverksamma personer som arbetade inom kommunal vård- och omsorgs valde att delta i studien. Informanterna intervjuades via mobiltelefon samt personligt möte Intervjuerna analyserades med hjälp av kvalitativ innehållsanalys. Analysen av intervjumaterialet resulterade i tre huvudkategorier samt två underkategorier Resultat: Resultatet visar att tillgänglighet till arbetsterapeut, kommunikation inom teamet och förhållningssättet hos arbetsterapeuten var av stor betydelse för vård- och omsorgspersonalen. Handledningen av arbetsterapeuter ansågs vara fördelaktig i det klientnära arbetet. Slutsats: Tillgänglighet av arbetsterapeut främjar samarbete och handledning och arbetsterapeuter bör vara pedagogiska, lyhörda och tydliga i sin kommunikation. Den arbetsterapeutiska handledningen ansågs som betydelsefull och informanterna efterfrågade mer handledning och ett närmare samarbete. / Background: Healthcare workers whom perform close to the client and collaborates and get supervision from occupational therapists. Several studies shows that a lack of communication and teamwork leads to insufficient patients safety. The study also show that occupational therapist supervision was appreciated by healthcare workers as it facilitated their work. However recent research is lacking in the study of healthcare professionals experience of occupational therapy supervision. Purpose: The purpose of the study was to describe the healthcare personnel experiences of collaboration and supervision of occupational therapist.Method: The authors chose a qualitative approach and the study method is collected via semi-structured interviews. Ten professionals who worked in healthcare service in municipality participated. The interviews performed by mobile and personal meeting. Interviews were analyzed by qualitative content analysis. Analysis of the interview material resulted in three main categories and two subcategories. Results: Results show that the availability of the occupational therapist, communication within the team, and the occupational therapists approach was of great importance to healthcare workers. Supervision and management of occupational therapist was considered beneficial in the client centered work. Conclusion: Accessibility of occupational therapist promotes cooperation and supervision. Occupational therapists should be educational, responsive and clear in their communication. The occupational therapy supervision was considered important and the informants demanded more guidance and closer cooperation.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2016-04-04T16:57:05Z No. of bitstreams: 1 Tiago Pereira de Souza Fatores....pdf: 1305801 bytes, checksum: 2cf226c83a5027d515c816ab9f57d2bb (MD5) / Approved for entry into archive by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2016-04-04T16:57:21Z (GMT) No. of bitstreams: 1 Tiago Pereira de Souza Fatores....pdf: 1305801 bytes, checksum: 2cf226c83a5027d515c816ab9f57d2bb (MD5) / Made available in DSpace on 2016-04-04T16:57:21Z (GMT). No. of bitstreams: 1 Tiago Pereira de Souza Fatores....pdf: 1305801 bytes, checksum: 2cf226c83a5027d515c816ab9f57d2bb (MD5) Previous issue date: 2015 / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / INTRODUÇÃO: Embora a vacina influenza seja anualmente recomendada para todos trabalhadores de saúde, estudos revelam que a cobertura vacinal desse grupo frequentemente é baixa. Diferentes fatores podem influenciar a vacinação contra a influenza, sendo necessário utilizá-los a favor da ampliação da cobertura vacinal. OBJETIVO: Identificar fatores que influenciam a prática de vacinar-se contra influenza entre trabalhadores de saúde. MATERIAIS E MÉTODOS: estudo transversal, ocorrido num Complexo Hospitalar de Salvador, Bahia. Utilizou-se um questionário autoaplicável, e os modelos "Conhecimento, Atitudes e Práticas" (CAP) e "Health Belief Model" (HBM). A vacinação contra influenza em 2014 (autorreferida) representou a variável principal, e fatores sociodemográficos, histórico de outras vacinas, conhecimentos e atitudes constituíram variáveis independentes. Considerou-se haver "conhecimento adequado", quando 75,0% ou mais dos indivíduos julgaram determinada informação corretamente.As análises foram feitas por regressão logística no Stata, versão 13, utilizando-se o teste qui-quadrado ao nível de 5% de significância, odds ratio, e intervalos de confiança de 95%. O modelo multivariado foi ajustado por sexo, idade e profissão, sendo composto pelas variáveis com p valor igual ou inferior a 0,20 na análise bivariada. A verificação de modelos alternativos mais adequados foi feita por retirada retrógrada, utilizando-se como parâmetro o "Critério de Informação de Akaike" (AIC). RESULTADOS: A amostra foi de 755 indivíduos, destacando-se técnicos de enfermagem (41,4%), enfermeiros (15,2%) e médicos (14,7%). Predominaram trabalhadores do sexo feminino (82,5%), entre 19 e 39 anos (82,4%), com 5 anos ou menos de experiência (67,5%). A cobertura vacinal global foi de 61,5%, sendo a maior entre enfermeiros (69,0%) e a menor entre médicos (49,1%). Os principais motivadores da vacinação foram conhecer a recomendação da vacina para si (49,0%), confiar em vacinas no geral (41,6%) e na eficácia da vacina influenza (35,4%). Os principais desmotivadores foram esquecimento (37,3%), inconveniência de locais/horários (22,5%) e não saber da campanha (16,3%). A principal estratégia que facilitaria a vacinação foi vacinar os trabalhadores no seu próprio setor de trabalho (56,6%). O conhecimento foi adequado no julgamento de 9/16 das informações, com destaque para médicos (15/16) e enfermeiros (13/16). A maior adequação (94,6% de acerto) refere-se à indicação da vacina para todo trabalhador de saúde, e o conhecimento menos adequado foi sobre a incapacidade da vacina causar a influenza (32,0% de acerto). Os fatores associados à vacinação foram: conhecer que pessoas saudáveis também precisam se vacinar contra influenza (OR=3,15 ; IC95%: 1,74 - 5,71); saber que a vacina não protege por muitos anos (OR=2,08 ; IC95%: 1,30 - 3,33); e não ter medo dos efeitos adversos pós-vacinais (OR=1,93 ; IC95%: 1,26 - 2,95). CONCLUSÕES: a vacinação contra influenza é influenciada por conhecimentos, atitudes e questões organizacionais/operacionais.Medidas educativas e de desmistificação de questões relacionadas à influenza e à vacina, bem como ampliação de dias/horários e locais de vacinação de acordo com a conveniência dos trabalhadores de saúde, devem compor as estratégias voltadas à elevação da cobertura da vacina influenza neste grupo. / INTRODUCTION: Although the influenza vaccine is recommended annually for all health workers, studies show that vaccination coverage of this group is often low. Different factors can influence the vaccination against influenza, it is necessary to use them in favor of the expansion of vaccination coverage. GOAL: To identify factors that influence the practice of vaccination against influenza among health workers. MATERIALS AND METHODS: A cross-sectional study, which took place in a hospital complex in Salvador, Bahia. We used a self-administered questionnaire, and the models "Knowledge, Attitudes and Practices"(CAP) and "Health Belief Model"(HBM). Influenza vaccination in 2014 (self-reported) was the main variable, and sociodemographic factors, history of other vaccines, knowledge and attitudes were independent variables. Considered to be "appropriate knowledge" as 75.0% or more of subjects judged certain information correctly. Analyses were performed by logistic regression using Stata, version 13, using the chi-squared test at 5% significance, odds ratio, and 95% confidence intervals. The multivariate model was adjusted for sex, age and profession, being composed of the variables that had a pvalue less than or equal to 0.20 in the bivariate analysis. The verification of most suitable alternative models was performed by backward withdrawal, using as a parameter the "Akaike Information Criteria" (AIC). RESULTS: The sample consisted of 755 individuals, mainly nursing technicians (41.4%), nurses (15.2%) and physicians (14.7%). There was a predominance of female workers (82.5%), between 19 and 39 years (82.4%), with five years or less experience (67.5%). The global vaccination coverage was 61.5%, the highest among nurses (69.0%) and lowest among physicians (49.1%). The main motivators to get vaccinated were to know the recommendation of the vaccine for themselves (49.0%), trust in vaccines in general (41.6%) and in the effectiveness of influenza vaccine (35.4%). The main demotivating were forgetfulness (37.3%), inconvenience locations/times (22.5%) and not knowing the campaign (16.3%). The main strategy would facilitate the vaccination was to inoculate workers in their own work sector (56.6%). The knowledge was adequate in evaluating 9/16 of information, especially physicians (15/16) and nurses (13/16). Most adequacy (94.6% accuracy) refers to the indication of the vaccine for all healthcare workers, and less adequate knowledge was about the inability of the vaccine cause influenza (32.0% accuracy). The factors associated with vaccination were: to know that healthy people also need to be vaccinated against influenza (OR = 3.15; CI95%: 1.74 to 5.71); know that the vaccine does not protect for many years (OR = 2.08, CI95%: 1.30 to 3.33); and not be afraid of post-vaccination adverse events (OR = 1.93; CI95%: 1.26 to 2.95). CONCLUSIONS: Influenza vaccination is influenced by the knowledge, attitudes and organizational/operational issues. Educational measures and demystifying issues related to influenza and the vaccine, as well as expansion of days/times and vaccination sites according to the convenience of healthcare workers, should compose strategies aimed at raising the coverage of influenza vaccine in this group.

Introdução: A tuberculose é uma doença de repercussão mundial que desafia os serviços de saúde (SS). Estima-se que um terço da população mundial apresenta a forma latente da doença. Os profissionais da saúde (PAS) inseridos na assistência direta podem ter maior probabilidade de contágio; entretanto, os índices de ocorrência da doença nesta população não foram, até o momento, reconhecidos de forma sistemática. Objetivo: Estimar a prevalência e a incidência de tuberculose ocupacional nos serviços de saúde. Método: Trata-se de uma revisão sistemática de literatura segundo protocolo do Joanna Briggs Institute, que buscou responder quais os índices de tuberculose ocupacional nos SS. Foram considerados estudos primários que incluíssem dados de incidência e prevalência de tuberculose ocupacional ou de viragem tuberculínica em PAS. Foram definidos como PAS indivíduos em formação ou formados em cursos na área da saúde e que atuam na assistência direta. Quanto a SS, foram consideradas instituições de atendimento em qualquer um dos níveis assistenciais e que realizam atendimento direto a pacientes suspeitos ou portadores de tuberculose em suas fases transmissíveis, de forma a manter a homogeneidade da investigação. Foram excluídos os relatos de surtos e as ações dirigidas a populações em geral. Resultados: Foram identificadas 2.081 citações potencialmente relevantes em dez bases de dados, sem limites de tempo e idioma, a seleção final levou a 17 estudos. Em todos os artigos selecionados o desfecho estudado foi tuberculose latente. Não foram identificados estudos com dados com relação à tuberculose doença. O teste tuberculínico foi utilizado em 88,2% dos estudos. A prevalência de tuberculose latente (TL) variou entre 0,1% e 59,7% e a taxa de incidência anual variou de 3,3% a 26%. Um estudo identificou a densidade de incidência de 547/100.000 pessoas/ano. Conclusão: As evidências demonstram que a tuberculose é um importante agravo entre os PAS nos Serviços de Saúde, com importantes variações de acordo com o contexto. Os resultados indicam que a despeito da relevância do fenômeno, ainda há lacunas de informação sobre a incidência e a prevalência da tuberculose doença em PAS. / Introduction: Tuberculosis is a disease of worldwide repercussion that defies health care services (HS). It is estimated that one-third of the world population has a latent form of the disease. Healthcare workers (HCW) dealing with direct patient assistance may have higher contagion probability. However, the rates of the disease occurrence in this population have not been established in a systematic way yet. Objective: To estimate the global prevalence and incidence of occupational tuberculosis in HS by means of the literature review. Method: This is a systematic literature review according to the Joanna Briggs Institute, which sought to identify the rates of occupational tuberculosis in HCW. Primary studies were considered to include data on the incidence and prevalence of occupational tuberculosis or tuberculin skin test reaction in HCW. Reports of outbreaks and actions addressed to the community in general were excluded. Results: Out of ten cross-referenced databases, 2,081 potentially relevant studies were identified, without time and language limits, and the final selection was 17 studies. In all the articles selected, the outcome was latent tuberculosis. No studies with data regarding the tuberculosis disease were identified. The tuberculin skin test was used in 88.2% of the studies. The prevalence of latent tuberculosis ranged from 0.1 % to 59.7%. The annual incidence rate varied from 3.3% to 26%. As the risk and occupational exposure the absence of vaccination prior, the duration of care and performance in tuberculosis specific services were shown as relevant factors. One study identified the density of incidence of 547/100,000 people per year. Conclusion: Evidence indicates that tuberculosis is a relevant disease with the HCW and has important rates variations according to the context. The results demonstrate that despite the relevance of the phenomenon, there are still gaps in information on the incidence and prevalence of the tuberculosis disease in HCW.

Magister Commercii (Information Management) - MCom(IM) / Health information systems (HIS) have much to offer in managing healthcare costs and in improving the quality of care for patients. However, the adoption of HIS can cause problems to health professionals in terms of efficiency as well as to the entire health organization in terms of acceptability and adaptability. The development of a national Information and Communication Technology (ICT) policy in Zambia was initiated in 2001 through an extensive consultation process which involved academics and civil society organizations. The aim of using ICT is to improve the quality of health service delivery at local levels. Maramba and Mahatma Gandhi Clinics are the largest primary health care (PHC) clinics in Livingstone and have been prioritized for the implementation of an electronic medical record (EMR) system. The current study explored health care workers' perceptions and experiences of the use of ICTbased EMR and factors that could determine acceptability of EMR at Maramba and Mahatma Gandhi clinics to feed into future program improvement.

Magister Public Health - MPH / Adolescent pregnancy holds numerous health and social risks for mother and child. Adolescent access to maternal health services is of vital importance to ensure that pregnant adolescents receive timely and effective health care. Evidence suggests that adolescents tend to seek medical care late in their pregnancies and attend fewer than the recommended four antenatal visits. This results in missed opportunities to improve maternal and newborn health due to untreated sexually transmitted diseases and uninhibited mother-to-child HIV transmission, resulting in low birth weight among other poor pregnancy outcomes. Sub-Saharan Africa has the highest rate of adolescent births worldwide, in keeping with evidence that low-to-middle income countries have the highest rates of adolescent pregnancy. Adolescent pregnancy in South Africa remains a public health concern, and the Mitchells Plain sub-district has a particularly high rate of adolescent pregnancy. The aim of this study was thus to explore the barriers to access for maternal health care services amongst pregnant adolescents in the Mitchells Plain sub-district.

Influenza is a major concern across healthcare environments. Annual vaccination of healthcare workers (HCWs) remains essential for maintaining the health and availability of HCWs, as well as influenza prevention in healthcare environments. Yet, annual vaccination coverage among HCWs continues to be below recommended standards during pandemic (pH1N1) and non-pandemic (sINFLU) influenza seasons. The primary aim of this research is to inform the design and implementation of effective HCW targeted influenza vaccination campaigns via a 1) systematic review of the existing literature on HCW pH1N1 vaccination, 2) qualitative content analysis of motivators and barriers to HCW pH1N1 and sINFLU vaccination, as well as 3) quantitative regression analysis of modifiable factors predicting pH1N1 and sINFLU vaccination. The qualitative and quantitative analysis processes were applied to data collected from a large-scale multi-professional sample of HCWs. Findings from all analysis sections were found to be consistent. Most attitudes, beliefs, motivators, and barriers influencing HCW influenza vaccination were similar for pH1N1 and sINFLU vaccinations. Yet, a number of notable differences were also identified. HCWs were likely to accept vaccination if they perceived, 1) vaccination to be safe, 2) vaccination to be protective against influenza for self, loved ones, patients or communities, and 3) influenza to be a serious and severe infection to self and others. Additionally, encouragement from supervisors and colleagues, physicians, and loves ones also enhanced vaccine uptake. Most HCWs avoided vaccination because of 1) limited knowledge or misinformation about vaccination, 2) concern for vaccine induced side-effects and 3) assuming vaccination was not a requirement for healthy adults. With respect to pH1N1 vaccination, mass media communications, perceptions of novel vaccinations, and rapid vaccine development processes especially deterred HCW pH1N1 vaccination. Future vaccination programs targeting HCWs should look towards influencing HCWs’ vaccination attitudes and promoting pro-vaccination cultures in healthcare workplaces.

We conducted a cross-sectional survey to assess the anxiety, distress, and turnover intention (likelihood to leave their current job) of healthcare workers in Peru during the COVID-19 pandemic. Our results reported that 21.7% healthcare workers in Peru experienced severe anxiety, whereas 26.1% of them experienced severe mental distress. A higher level of education related with a lower level of anxiety. Younger workers had a higher level of turnover intention than their older colleagues did. Healthcare workers in the private sector had a higher turnover intention than those in the public sector. Most importantly, people who were geographically far from Lima, the epicenter in Peru, during the outbreak experienced less anxiety and mental distress, corroborating the ripple effect and disconfirming the typhoon eye theory. However, the direction of these relationships can change depending on the type of institutions (public versus private) and the type of employees' contract (full time versus part time). Our research helps provide insights for clinical professionals in identifying the vulnerable groups to mental disorders in Peru. This is the first study to assess anxiety, mental distress, and turnover intention in healthcare workers in Peru during the COVID-19 pandemic. Copyright

Bakgrund: Demenssjukdomen drabbar delar av hjärnan och följder av sjukdomen kanbland annat bli kommunikationshinder och svårigheter i att förklara sina behov, vilket kanleda till svårigheter vid smärtidentifiering och smärtlindring. Syfte: Syftet med litteraturstudien var att beskriva vårdpersonalens erfarenheter av attidentifiera och lindra smärta hos personer med demens. Metod: Litteraturstudie baserades på åtta studier utförd med kvalitativ design. Studiernaåterfanns i två databaser. Urvalet av artiklar genomfördes i tre steg. Inklusionskriteriernavar bland annat artiklar som var etisk godkända och innefattade vårdpersonal mederfarenhet av att arbeta med personer med demens och smärta. Inkluderade artiklarkvalitetsgranskades enligt Olsson & Sörensens bedömningsmall för kvalitativa studier. Devalda studierna analyserades med Fribergs femstegsmodell. Resultat: Analysen resulterade i tre kategorier och sju underkategorier. Kategorierna sompresenteras var: ”att skapa relationer”, ”att möta utmaningar” och ”att seförbättringsåtgärder”. Underkategorierna presenterade goda relationer, utmaningargällande smärtidentifiering och smärtlindring, samt behov av utbildning och tid. Konklusion: Vårdpersonal behöver ytterligare utbildning i smärtidentifiering förpersoner med demens. Personcentrerad vård är viktig för att på bästa möjliga sätt lindrasmärta hos personer med demens. För att uppnå personcentrerad vård ska det finnas engod relation till personen med demens, vilket fortsatt forskning bör fokusera på. / Background: The dementia disease affects parts of the brain and consequences of thedisease can include communication barriers and difficulties in explaining the needs, whichcan lead to difficulties in pain assessment and pain relief. Aim: The aim of this literature study was to explain healthcare professionals’ experiencesof identifying and relieving pain in dementia patients. Method: This study was based on eight qualitative studies, attained from two databases.The included studies were ethically approved and concerned the aim of the literaturestudy. The quality of the studies was reviewed using Olsson & Sörensen’s assessmenttemplate for qualitative studies. Lastly, the articles were analysed using Friberg’s five stepmodel. Results: The analysis resulted in three categories and seven sub-categories. Thecategories presented were: ”creating relations”, ”meeting challenges”, and “identifyingimprovement measures”. The sub-categories concerned patient-worker relations, obstaclesregarding pain assessment and pain relief and lack of time, as well as the need foreducation. Conclusion: Healthcare professionals need additional education in pain assessment forpatients with dementia. Person-centered care is important to effectively relieve pain indementia patients. To achieve person-centered care, good relations with the patient shouldbe established, which further research should focus on.

Magister Public Health - MPH / South Africa’s Infant and Young Child Feeding (IYCF) policy guidelines of 2013 and its 2017 amendments recommend that mothers, including those living with HIV, exclusively breastfeed their infants until 24 months of age, followed by their gradual weaning. The 2013 changed policy guidelines occurred to align with global WHO recommendations of six-month exclusive breastfeeding for all HIV positive mothers, and consequently no longer recommended free formula feed as an option for HIV-positive mothers attending public sector services, except in limited circumstances. Despite these policy guidelines, less than a third of South African mothers exclusively breastfeed their infants. The other two thirds of mothers either formula feed or mixed feed their infants. Mixed feeding or exclusive breastfeeding by HIV positive mothers who have either not been on antiretroviral therapy (ART) long enough or are insufficiently adherent to ART to suppress their viral loads, can potentially lead to increased risk of Mother to Child Transmission (MTCT) of the Human Immunodeficiency Virus (HIV). Since healthcare workers (HCWs) play a key role in promoting the IYCF policy guidelines and encouraging its practice among HIV-positive mothers, it is crucial to determine the extent to which HCWs understand and subscribe to this important policy. Using purposeful sampling and in-depth qualitative interview techniques, this qualitative study explored the attitudes of HCWs towards different infant feeding options, especially for HIV positive mothers, against the background of their understanding of the changes in IYCF policy guidelines between 2013 and 2017. The participants in this study included ten HCWs selected from three primary health care facilities in Khayelitsha (Western Cape, South Africa), and two programme coordinators based at the Western Cape’s Department of Health Khayelitsha substructure office. By interviewing this diverse sample of HCW cadre, the study aimed to explore their perceptions related to the factors which facilitate IYCF policy implementation versus those that hinder the implementation of this policy. The findings revealed that HCWs interviewed had good overall familiarity with the IYCF policy guidelines. However, their depth of understanding and acceptability of the policy varied, especially in the context of high HIV MTCT risk. Suboptimal implementation of the policy occurred due to inadequate policy dissemination, diverse views on the limitations of the policy, such as the promotion of only exclusive breastfeeding as an option and an unclear rationale for recent policy changes. Additionally, HCWs high workload and insufficient training on the changed 2017 guidelines were identified as barriers to effectively implementing the new infant feeding policy guidelines. HCW further perceived that personal, socio-cultural and health system factors influenced new mothers’ decisions and/or ability to breastfeed. These findings highlight that improved policy dissemination strategies and training should be used to increase HCWs knowledge regarding infant feeding counselling content, including HIV MTCT risk. Western Cape Department of Health alignment and implementation of relevant National Department of Health HIV policies should occur to decrease MTCT risk while breastfeeding. Peer support groups could provide maternal support for continued postnatal ART adherence and for sustained safer feeding practices. Finally, while exclusive breastfeeding is the optimal feeding choice generally for mothers, future revision of the 2017 IYCF policy should consider allowing HCW to act more flexibly in the maternal guidance they provide on infant feeding options. This could allow greater discretion for HCW in infant feeding counselling of mothers, particularly for those women who are HIV positive. This would promote improved patient-centred counselling that takes into account both maternal socio-cultural context and the right to make individualised decisions regarding infant feeding.