Project Duration: 1999 to 2006

• Download a complete copy of World LINKAGES/Zambia
• Download World LINKAGES Zambia 1997-2005 Final Report
• Download Cost and Effectiveness Analysis of LINKAGES' Ndola Demonstration Project in Zambia prepared by Abt Associates
• Download Empowering Communities to Respond to HIV/AIDS – Ndola Demonstration Project on Maternal and Child Health, Operations Research Final Report
• Download Cost and Effectiveness Analysis of the Expansion Phase of the LINKAGES Infant and Young Child Feeding and PMTCT Program in Zambia
• Download Antenatal, Postnatal and Child Health Book (developed in Zambia)
• Download Prevention of Mother-to-Child Transmission (PMTCT) of HIV Communication Guide for Health Workers

Background
Exclusive breastfeeding protects against severe diarrhea and acute respiratory infection, major causes of infant illness and death in Zambia and other sub-Saharan African countries. While more than 95 percent of Zambian infants are breastfed during their first year of life, only 26 percent of infants 0-3 months are exclusively breastfed. Because breastfeeding can transmit HIV, infant feeding counseling can help mothers in areas of high HIV prevalence make informed choices of infant feeding methods, balancing breastfeeding's lifesaving benefits with the risk of HIV transmission. Studies in South Africa suggest that exclusive breastfeeding may actually protect infants against HIV, while mixed feeding (breast milk plus infant formula or other breast milk substitutes) presents the greatest danger.

The UNAIDS report on the global HIV/AIDS epidemic (2002) estimated that in Zambia, 31 percent of women in urban antenatal care clinics were infected with HIV. Most Zambians do not know their HIV status.

Program Design and Implementation
In September 1997, LINKAGES conducted an assessment visit to Zambia, working in close collaboration with the Central Board of Health (CBoH) through the National Food and Nutrition Commission (NFNC). It was recommended that a demonstration project be established focusing on infant feeding in an antenatal clinic in an area of high HIV prevalence. In 1999, the Ndola Demonstration Project (NDP) was initiated to pilot the integration of infant feeding and HIV counseling and testing into maternal and child health and community services. The goal of the program was to enable women to make and act effectively on informed choice to feed their infants optimally.

LINKAGES worked with the Central Board of Health, the National AIDS Control Program, the National Food and Nutrition Commission and District Health Management teams to design and put into place a comprehensive array of interventions that included (1) the design of formative research, household observations of current and trials of recommended infant and young child feeding practices; (2) behavior change communication strategies, messages, and media to help people prevent HIV infection and make informed infant feeding and reproductive health decisions; (3) strengthening of PMTCT interventions in MCH services through an essential antenatal care package, VCT, ARV prophylaxis, safe delivery practices, infant feeding counseling based on informed choice, and follow-up care and support in the community; (4) capacity building of health providers and counselors to prevent MTCT and counsel mothers and families on infant feeding; (5) assessment and strengthening of community capacity for counseling and referrals; (6) monitoring and evaluation through collecting and analyzing infant feeding and PMTCT service delivery data with local partners and the Horizons Program. As a result of the project's work, a 12-day training course on integrated infant feeding and PMTCT was offered to health care practitioners throughout Zambia and Africa.

Results
Findings from clinic surveys suggest that it is possible for women of known and unknown HIV status to exclusively breastfeed for up to six months. Exclusive breastfeeding increased from 57 percent in 2000 to 74 percent in 2004. Timely initiation of breastfeeding within the first hour increased as well, from 53 percent in 2000 to 70 percent in 2004.

Additional information on project results is available in a report prepared by the Horizons Program, one of LINKAGES' partners in Zambia. To view the Operations Research Final Report, click here.