Determinants of Infant Feeding Practices among Mothers Living With HIV Attending Kiambu Level 4 Hospital, Kiambu County, Kenya
Andare, Naureen Achieng'
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Despite the evidence that safe infant feeding practices by mothers living with HIV are major determinants of effective PMTCT services, most researches show that infant feeding decisions made by mothers living with HIV are influenced by a number of factors thus leading to poor feeding practices. This study therefore investigated infant feeding practices and its determinants among mothers living with HIV with infant 0-12 months of age attending PMTCT clinic at the Kiambu Level 4 Hospital. The study adopted a cross sectional analytical design that targeted 180 randomly selected mothers and Key Informants (health workers) at the hospital. The study employed purposive sampling method to select the hospital while systematic random sampling was used to select the respondents. A researcher-administered questionnaire, Focus Group Discussion (FGD) guides and Key Informant Interview (KII) guides were used to gather information from the respondents. The results showed that 68.9% of the mothers were married with 53.0% unemployed. Most of the children (91.7%, 95% CI; 86.6 - 95.3) had ever been breastfed with 69.7% having been initiated to breastfeeding within 1 hour of birth. Majority of the mothers (79%, 95% CI; 71.8 - 84.8) still breastfeeding. Exclusive breastfeeding rate was 71.4%, mixed feeding (18.2%) and replacement feeding (10.4%) for children below 6 months old. For children above 6 months, complementary feeding with continued breastfeeding rate was 63.1% and complementary feeding without breast-milk was 36.9%. Based on the findings of the FGDs and KIIs, the majority of the mothers were aware of the importance of practicing exclusive breastfeeding for the first 6 months of life and continued breastfeeding from 6-12 months when the infant is on ARVs. The mothers were also knowledgeable on dangers of mixed feeding. Mothers perceived infant feeding choice as the responsibility of the health worker and yet the health workers had contradicting information about the recommended guidelines. Young mothers were more likely to practice exclusive breastfeeding (chi square test; p=0.048) than the older mothers. Maternal age was a determinant of exclusive breastfeeding (Odds Ratio [OR] 0.15; 95% CI 0.03 - 0.82; P = 0.028), mother's occupation a determinant of replacement feeding (OR 0.3; 95% CI 0.17 - 0.72; P = 0.005), education a determinant of complementary feeding with continued breastfeeding (OR 0.35; 95% CI 0.19 - 0.66; P = 0.001) and maternal knowledge a determinant of mixed feeding practices (OR 0.12; 95% GI 0.02 - 0.63; P = 0.013). Mothers living with HIV should be provided with counseling on safe infant feeding options and assisted in making appropriate feeding choices. The Ministry of Health should strengthen health support systems by empowering stakeholders that have great influence on mothers' infant feeding choice such as health workers. The Ministry of Health should target mothers with behavior change communication programmes to address negative maternal attitudes towards infant feeding practices in the context of HIV. Longitudinal studies should be conducted to investigate infant feeding practices over time.