Determinants of adherence to exclusive breast feeding among HIV positive mothers attending child welfare clinic at Pumwani maternity hospital, Nairobi County, Kenya
Koima, Winnie Jepkogei
MetadataShow full item record
Globally, the estimated number of children below 15 years of age living with HIV increased from 1.6 million in 2001 to 2.5 million in 2009. Almost 90% of these children live in sub-Saharan Africa. Over 90% the new infections of HIV are acquired through Mother-To-Child Transmission (MTCT). According to Kenya Aids Indicator Survey (KAIS) report of 2007, nearly 1 out of 10 pregnant women in Kenya are infected with HIV. Exclusive Breast Feeding (EBF) of a child remains the best and safest source of nutrition for the vast majority of infants worldwide and a recommended method of Prevention of Mother to Child Transmission (PMTCT) of HIV. Despite this evidence, Exclusive Breast Feeding (EBF) is at 13% in Kenya. The aim of this study was to identify the factors that influence adherence to exclusive breast feeding among HIV positive mothers attending Child Welfare Clinic at Pumwani Maternity Hospital, Nairobi County. This was a descriptive cross-sectional study utilizing quantitative and qualitative approaches targeting HIV positive mothers with infants aged above 6-12 months. Purposive sampling technique was used to get the 188 study participants who were interviewed using semi-structured questionnaires. In addition, 2 Focused Group Discussions (FGDs) comprising 10 participants each who included peer counselors, community health workers and opinion leaders was conducted using the FGD guide. Key informants from the health facility; 1 clinical officer, 4 nurses, and 1 nutritionist were interviewed using the Key Informant Interview (KII) questionnaire guide. The data from semi-structured questionnaires was analyzed using SPSS version 17.0 software. Descriptive statistics were generated and cross tabulation (Chi-Square test and Fischer’s exact test) was done for relationships of variables. Logistic regression was done to assess the effect of various explanatory variables on adherence to EBF among HIV positive mothers. The recordings of the FGDs and KIIs were transcribed and main concepts identified. The qualitative data was triangulated with the quantitative data to enhance validity and reliability of the study findings. The results showed proportion of women who adhered to EBF at 69.1%. The following factors influenced adherence to EBF positively: presence of main breadwinner (OR=3.44, p=0.003), food availability (p=<0.001), availability of transport (OR=4.00, p=0.013), mother on ARVs postnatally (OR=0.35, p=0.002), Knowledge on MTCT of HIV (p=<0.001), being taught about EBF in ANC and PNC (OR=7.78, p=0.002), expressing breast milk (p=<0.001), disclosure of HIV status to husband (OR=2.46, p=0.007) and relative (OR=2.29, p=0.033). In conclusion, information sharing on MTCT of HIV antenatally and postnatally should be strengthened in the health facilities and the community using community strategy to improve EBF. Secondly, mothers should also be taught how to express breast milk to feed the baby when the mother is away for long hours. Finally, vulnerable women to be linked to income generating community projects for food security empowerment.