Nutrition status and feeding practices of infants born of HIV positive mothers in Kenya : a case of Homa- Bay PMTCT clinic
Odida, Lynett Ochuma
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HIV/AIDS has become a major global catastrophe. There are 2.5 million children under 15 years of age who are living with HIV/AIDS. In Kenya, there are 90,000 children who are HIV positive. The probability of an HIV positive mother transmitting the virus during pregnancy is 5-8%, 10-20% during labour and delivery, and 10-15% during breastfeeding. To prevent HIV transmission to infants through breastfeeding, UNICEF/UNAIDS/WHO have formulated guidelines on infant feeding for HIV positive mothers. Current infant feeding guidelines provide for major breastfeeding options such as exclusive and continued breastfeeding, modified breastfeeding, replacement feeding, and breastfeeding by an HIV negative woman. HIV positive mothers find themselves in a great dilemma in choosing of a feeding method since in most African settings breastfeeding is the norm. Accurate information on nutritional adequacy and risks of the several feeding options is still incomplete. The Mothers are counseled but the growth of the infants is not measured against the mode of feeding. It is on this basis that this study sought to determine the feeding practices by HIV positive mothers and nutritional status of the infants and the relationship between the two. The study targeted infants 0-12 months born to HIV positive mothers attending Homa-Bay prevention of mother to child transmission (PMTCT) Clinic. Purposive sampling was used to select mothers who are HIV positive and have undergone nutrition counselling on infant feeding options and have infants aged 0-12 months. Mothers attending clinic between April and July 2005 who knew their HIV status and were willing to participate in the study were interviewed. The entire population of 100 was included in the study. An interview schedule was used to gather data. Anthropometrical indices were used to determine the nutritional status of infants. Data were analyzed using the statistical package for the social sciences (SPSS). Anthropometrical indices were analyzed using Epi-info. Chi Square was used to determine relationships between feeding practices and nutritional status of infants born to HIV positive mother. The results showed that knowledge of transmission through breastfeeding does not change women's preference for breastfeeding. About 89% of the respondents had breastfed their infants. Mixed feeding was the most common (79 %) followed by exclusive breastfeeding (16%) early cessation (3%) and commercial; infant formula and home-prepared milk had 1% respectively. No mother opted for wet nursing and heat-expressed milk. The nutrition status of the infants was generally poor. Only 24.9% fell within the normal reference range, stunting prevalence rate was 21.5 %, wasting 17% and stunting and wasting was 31 %. There was a significant difference (p values) on nutritional status between those who breastfed and those on alternative feeding. The chi-square results (X2=7.44; df=3; p=0.05) indicated that there was a significant difference between feeding practice and nutritional status of infants. The contingency coefficient showed that 27% of the observed variations in nutritional status could be attributed to breastfeeding. In conclusion, the results indicate that despite many programmes designed to reduce MTCT of HIV, the feeding practices of mothers have not changed. The findings of this study reaffirm the need for a concerted effort and strategic campaigns on exclusive breastfeeding as a most effective form of intervention in resource poor settings. The study is useful in counseling of HIV positive mothers on infant feeding options. The researcher recommends that replacement feeding be made more available or at reduced costs in rural setting and HIV positive women should receive information on infant feeding prior to conception to allow sufficient time for reflection on the feeding options.