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The aim of the study was to conduct a rapid assessment of breastfeeding knowledge amongst health workers in an area of high HIV prevalence. A cross-sectional survey using semi-structured questionnaires and problem-based scenarios was carried out. Responses were compared to those recommended in the World Health Organization (WHO) Breastfeeding Counselling Course. The setting was a rural area of KwaZulu Natal, with a population of 220 000 people. At the time of the study approximately 36 per cent of pregnant women were HIV-infected and no programme to prevent mother-to-child transmission was in place. A convenient sample of 71 healthcare workers (14 doctors, 25 professional nurses, 16 staff nurses, and 16 community health workers) were included in the study. Over 50% of respondents had given breastfeeding advice to clients over the previous month. However, there were significant discrepancies in breastfeeding knowledge compared to WHO recommendations. Ninety-three per cent (n=13) of doctors knew that breastfeeding should be initiated within 30 min of delivery, but 71 per cent (n=10) would recommend water, and 50 per cent (n=7) solids to breastfed infants under 6 months of age. Fifty-seven per cent (n=8) considered glucose water necessary for neonatal jaundice, constipation, and for infants immediately after delivery. Only 44 per cent (n=7) of staff nurses and 56 per cent (n=14) of professional nurses knew that breastfeeding should be on demand. The majority would recommend water, formula milk, and solids to breastfed infants under 6 months of age, and glucose water for neonatal jaundice and immediately after delivery. Knowledge of community health workers differed most from WHO recommendations: only 37 per cent (n=6) knew that breastfeeding should be initiated within 30 min of delivery, 68 per cent (n=11) thought breastfeeding should be on schedule and not on demand, and the majority would recommend supplements to infants under 6 months of age. Few respondents suggested taking a feeding history or observing a breastfeed in response to the problem scenarios. The most commonly given responses to problems of babies who were perceived to be thirsty, unsatisfied, or crying after feeds was to supplement with other fluids or feeds. There is a need for systematic and ongoing training in breastfeeding and infant feeding counselling in the context of HIV, so that breastfeeding is not undermined by the current HIV pandemic, and exclusive breastfeeding continues to be promoted for all HIV-uninfected women, women of unknown status, and HIV-infected women who choose to breastfeed.