Assessment of factors influencing infant feeding practices among HIV positive mothers in Rongo District, Western Kenya
Wapang’ana, Godfrey Nyongesa
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Infant feeding is critical and a key determinant of good nutrition and health status, survival and development. Breast feeding is universal and socio-culturally acceptable method of child feeding. Breast milk is nutritionally balanced and provides immunity against diseases. However, breast milk can transmit HIV from mother to child. This has posed public health dilemma. A lot of work has been done on HIV including MTCT but there remains a dearth of information related to appropriate feeding for infants of mothers infected with HIV. Some suggested infant feeding in theory have lots of merit but not much has been done to determine their practical feasibility especially in the African rural setting. The study was designed to assess infant feeding practices and viable breast milk alternatives for infants born to HIV positive mothers and the socio-cultural and economic conditions surrounding the choice of such practices in a rural community in Western Kenya. The study carried out in Rongo district between June and July 2011 had three objectives namely: to 1) determine maternal knowledge on mother-to-child transmission of HIV, 2) investigate the alternatives infant feeding practices used in the community and 3) determine factors influencing mothers’ decision on the choice of infant feeding alternatives. Descriptive cross-sectional study design employing both quantitative and qualitative methodologies was used. Multistage sampling technique was used. Stratified sampling was used to sample 5 health facilities out of 18 to be included in the study. Health facilities were divided into three strata based on government classifications, that is, L2, L3 and L4. Health facilities in each stratum were assigned a numbers. This was written on a piece of paper and folded. 2 health facilities in each stratum were sampled using simple random sampling. 111 HIV positive mothers with children aged 0-12 months attending services in the sampled health facilities were randomly assigned numbers and systematically sampled to participate in the study. Data collection involved administration of semi-structured questionnaire to one hundred and eleven HIV positive mothers with infants. In addition, focus group discussion (FGD) guide was used to collect information from elderly women, women in age bracket 15-49 years and men whose spouses were within 15-49 years age bracket. Key informant guide (KII) was used to collect data from health facility in-charges. Data was analyzed using SPSS version 16.0. Maternal knowledge on MTCT of HIV was high (66.7%) in the study area. However, this had no association with maternal choice of infant feeding practice (P=0.09). On the other hand, maternal knowledge indicated some association with level of formal education attained (P=0.07) and exposure to other information received through health talks and or counseling from health workers or media (P=0.06). Despite high level of maternal knowledge, majority of respondents practiced mixed infant feeding before 6 months, which increases MTCT of HIV. The choice of alternative infant feeding practice was influenced by a number of factors among them; cultural attitudes, level of income and availability and affordability of food. Strong association was noted; income (P=0.05), cultural attitudes (P=0.045), pressure from family members (P=0.045), stigma and discrimination, belief about HIV transmission from mother to child (P=0.05) and HIV has no cure (P=0.03) and household food availability (P=0.014). Cow’s milk is the most preferred infant feeding option (99.1%) followed by commercial infant formula (96.4%). Wet nursing is the least preferred option. In conclusion, the choice of infant feeding practice is not associated with level of maternal knowledge of MTCT of HIV. Commonly used infant feeding options include cow milk, porridge and commercial formula. World Health Organization guidelines on infant feeding in HIV recommends exclusive breast feeding to infants for six months.