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Gebremariam ZM, Getahun G, Sahile A, Kejela Y, Getachew Y, Sisay F. Infant feeding practices and associated factors among HIV-positive mothers of infants aged 0-6 months at public health facilities in Addis Ababa, Ethiopia. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:28. [PMID: 38378624 PMCID: PMC10877894 DOI: 10.1186/s41043-024-00496-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/05/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND In the era of HIV infection, exclusive breast-feeding highly recommended for infants aged less than 6 months. Avoidance of exclusive breast-feeding by HIV-infected mothers recommended when replacement feeding is acceptable, feasible, affordable, sustainable and safe. The prevalence of exclusive breast-feeding has remained very low worldwide. Despite this fact, there is limited information on infant feeding practices of HIV-positive mothers and factors that affect the practice in the current study area. OBJECTIVE This study assessed the magnitude of infant feeding practice and associated factors among HIV-positive mothers of infants aged 0-6 months at public health facilities in Addis Ababa, Ethiopia. METHODS A multicenter facility-based cross-sectional study design was employed among a total of 397 study participants. The study participants were selected using a simple random sampling technique. The completeness of the data was checked, coded, cleaned and entered into Epi-data version 4.6 software, and exported to SPSS version 24 for analysis. Descriptive statistics and Binary logistic regression model were employed for the analysis with adjusted odds ratio (AOR) with a 95% CI and a P value ≤ 0.05 to determine the strength of association between infant feeding practice and its independent factors. RESULTS The overall magnitude of appropriate infant feeding practice among HIV-positive mothers was 82.6% (95% CI 80.9-88.2). Good knowledge of mother's toward infant feeding (AOR: 1.26, 95%, CI 1.11-3.34), better household monthly income, ≥ 6001 Ethiopian birr (AOR: 1.62, 95% CI 1.33-5.14) and favorable attitude of mother's toward infant feeding (AOR: 1.71, 95% CI 1.01-2.92) were statistically significant associated factors with the recommended way of infant feeding practice. CONCLUSIONS AND RECOMMENDATIONS Hence, the current study area is the capital city of the Ethiopia, where a relatively educated population lived in, there was an opportunity for better income, and appropriate infant feeding practice among HIV-positive mothers was found slightly higher than even the overall national target (70%) that was planned by 2020. Therefore, different stakeholders should develop strategic plan to excel females' education coverage and thereby their knowledge and attitude toward infant feeding to fully eradicate mother-to-child transmission of diseases.
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Affiliation(s)
- Zewdu Minwuyelet Gebremariam
- Menelik II Medical and Health Science College, City Administration of Addis Ababa Health Bureau, Addis Ababa, Ethiopia.
- City Administration of Addis Ababa Health Bureau, Addis Ababa, Ethiopia.
| | - Genanew Getahun
- Menelik II Medical and Health Science College, City Administration of Addis Ababa Health Bureau, Addis Ababa, Ethiopia
| | | | - Yared Kejela
- City Administration of Addis Ababa Health Bureau, Addis Ababa, Ethiopia
| | - Yeworkwuha Getachew
- Menelik II Medical and Health Science College, City Administration of Addis Ababa Health Bureau, Addis Ababa, Ethiopia
| | - Fasil Sisay
- Menelik II Medical and Health Science College, City Administration of Addis Ababa Health Bureau, Addis Ababa, Ethiopia
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Adane B, Malede A, Sewunet B, Kumlachew L, Moges M, Woretaw L, Temesgen T, Bewket Y, Gete M, Yirdaw G, Ayele A, Adane M. Determinants of Trachomatous Inflammation-Follicular Among Children Aged 1 to 9 Years Old in a Rural Area of Gozamn District, Northwestern Ethiopia: A Matched Case-Control Study. ENVIRONMENTAL HEALTH INSIGHTS 2023; 17:11786302231169941. [PMID: 37122686 PMCID: PMC10134110 DOI: 10.1177/11786302231169941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Abstract
Background Approximately 1.9 million people worldwide are blind or visually impaired due to trachoma, and trachoma remains endemic in 44 countries. Amhara in Ethiopia has the highest burden of trachoma in the world. A key indicator of whether active trachoma requires public health intervention is the incidence of trachomatous inflammation-follicular in children aged 1 to 9 years. However, limited study has been conducted on the determinants in rural communities. This study therefore aimed to fill this gap by identifying determinants in the Gozamn district of northwestern Ethiopia. Methods A community-based case-control study was carried out between March 15 and April 30, 2021. Five or more follicles on the epitaxial conjunctivae that are larger than 0.5 mm were considered a case. Controls were free of any sign of trachoma. A semi-structured questionnaire and an observational checklist were used to gather the data, and STATA version 14 was used for the analysis. Using a 95% confidence interval, both bivariable and multivariable conditional logistic regression was performed. Results A total of 726 mothers/caregivers participated in this study, with a participation rate of 98.4%. Children from poor families (mAOR = 4.68; CI: 2.80-6.21), households where the water source is far from home (>30 minutes) (mAOR = 4.91; KI: 1.37-12.56), mean daily water consumption (<20 l/c/d) (mAOR = 4.42; CI:1.71-11.39), face washing frequency less than once a day (mAOR = 10.64; CI: 2.58-18.84), cloth washing frequency once a month or less (mAOR = 9.18; CI: 2.20-18.62), and mothers or caregivers with poor knowledge of active trachoma (mAOR = 3.88; CI: 1.47-10.22) were determinants of trachomatous inflammation-follicular. Conclusions We conclude that infrequent faces and clothes washing; unavailability of water, children in poor families, and poor knowledge of mothers/caregivers were risk factors. Health education initiatives about active trachoma, its prevention, and control methods focusing on personal hygiene are so required.
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Affiliation(s)
- Balew Adane
- Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Balew Adane, Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Amhara 269, Ethiopia.
| | - Asmamaw Malede
- Department of Environmental Health Science, College of Medicine and Health Sciences, Wollo University, Wollo, Ethiopia
| | - Birhanu Sewunet
- Department of Environmental Health Science, College of Medicine and Health Sciences, Wollo University, Wollo, Ethiopia
| | - Lake Kumlachew
- Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mekonnen Moges
- Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Lebasie Woretaw
- Department of Environmental Health Science, College of Medicine and Health Sciences, Wollo University, Wollo, Ethiopia
| | - Tegegn Temesgen
- Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Yenewa Bewket
- Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Menberu Gete
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Getasew Yirdaw
- Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Agernesh Ayele
- Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Metadel Adane
- Department of Environmental Health Science, College of Medicine and Health Sciences, Wollo University, Wollo, Ethiopia
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Kassa Mekonnen C, Gizaw Demissie N, Kindie Abate H, Wako Beko Z. Infant feeding practices and its associated factors among HIV positive mothers attending public health institutions at Gondar Town, Northwest Ethiopia, 2019: An institutional based cross-sectional study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Mussa A, Taddese HB, Maslova E, Ajibola G, Makhema J, Shapiro RL, Lockman S, Powis KM. Factors Associated with Infant Feeding Choices Among Women with HIV in Botswana. Matern Child Health J 2021; 25:1376-1391. [PMID: 33950327 PMCID: PMC8355043 DOI: 10.1007/s10995-021-03155-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In resource-constrained settings, infant feeding decisions among women with HIV (WHIV) must balance the risk of infant HIV acquisition from breastfeeding with increased mortality associated with formula feeding. WHO guidelines recommend countries principally promote a single feeding method for WHIV, either breastfeeding or formula feeding. In 2016, Botswana revised its policy of formula feeding for infants born to WHIV, instead promoting exclusive breastfeeding during the first 6 months of life. METHODS We sought to understand factors influencing infant feeding choices among WHIV by administering a questionnaire to pregnant and postpartum WHIV (2013-2015) participating in a clinical trial in Botswana (the Mpepu Study). Logistic regression analyses were used to identify factors associated with infant feeding choices. RESULTS Of 810 surveyed participants, 24.0% chose breastfeeding and 76.0% chose formula feeding. Women were more likely to choose formula feeding if advised by a health worker to formula feed (aOR 1.90; 95% CI 1.02-3.57) or if they harboured doubts about the potency of antiretroviral treatment (ART) to prevent infant HIV acquisition (aOR 9.06; 95% CI 4.78-17.17). Women who reported lack of confidence in preparing infant formula safely (aOR 0.09; 95% CI 0.04-0.19) or low concerns about infant HIV acquisition (aOR 0.35; 95% CI 0.22-0.55) were significantly less likely to formula feed. DISCUSSION Perceptions about ART effectiveness, social circumstances and health worker recommendations were key influencers of infant feeding choices among WHIV. Health system factors and maternal education interventions represent ideal targets for any programmatic actions aiming to shape informed decision-making towards HIV-free survival of infants.
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Affiliation(s)
- Aamirah Mussa
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.
| | | | | | | | - Joseph Makhema
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Roger L Shapiro
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Shahin Lockman
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, USA
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, USA
| | - Kathleen M Powis
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, USA
- Divisions of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, USA
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Abdullahi MA, Iliyasu Z, Adamu AL, Abubakar IS, Salihu HM, Aliyu MH. Correlates of infant feeding practices among HIV-positive mothers and controls in northeast Nigeria. Curr HIV Res 2021; 19:398-410. [PMID: 34109912 DOI: 10.2174/1570162x19666210607115010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite the global decline in pediatric HIV infections, infants in sub-Saharan Africa still acquire HIV infection through inappropriate feeding. OBJECTIVE The aim of the study was to compare knowledge and predictors of infant feeding behavior between mothers living with HIV and controls of unknown HIV status in Gombe, northeast Nigeria. METHOD A cross-section of clinic-based samples of 84 HIV-positive mothers and 170 controls of unknown status were interviewed using validated questionnaires. Knowledge scores and self-reported infant feeding practices were analyzed. Multivariate logistic regression models were employed to determine predictors for infant feeding practices. RESULTS Transmission risk perception (95.2% vs. 65.3%) (p<0.05) and adequate knowledge of infant feeding (77.4% vs. 51.2%) (p<0.05) were higher among HIV-positive mothers. Compared to mothers of unknown status (56.5%), a higher proportion of HIV-positive mothers (84.5%) reported breastfeeding the infant exclusively for 6 months (p<0.05). In contrast, mixed feeding was more prevalent among controls (19.4% vs. 4.8%) (p<0.05). Further, over a third (39.3%) of HIV-positive mothers and 27.6% of controls weaned their infants at ≥12 months (p>0.05). Antenatal attendance, hospital delivery, knowledge and positive attitude predicted infant feeding practices in both groups. The predictive roles of education and parity were limited to HIV-positive mothers, while the effects of maternal age and infant death were restricted to controls. CONCLUSION Risk perception, knowledge, and exclusive breastfeeding rates were higher among mothers living with HIV. Antenatal care, hospital delivery, knowledge, and attitude predicted infant feeding practices in both groups. Girl child education, antenatal care, hospital delivery, and sustained promotion of exclusive breastfeeding with antiretroviral therapy are key to HIV-free infant survival.
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Affiliation(s)
| | - Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Kano. Nigeria
| | - Aishatu L Adamu
- Department of Community Medicine, Bayero University, Kano. Nigeria
| | - Isa S Abubakar
- Department of Community Medicine, Bayero University, Kano. Nigeria
| | - Hamisu M Salihu
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Muktar H Aliyu
- Department of Health Policy and Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Tennessee, United States
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Kusuma MTPL, Kidd T, Muturi N, Procter SB, Yarrow L, Hsu WW. The Symbolic Meaning of HIV: Understanding Lecturers' Ambivalence over Teaching HIV to Dietetic Students. J Int Assoc Provid AIDS Care 2021; 19:2325958220939755. [PMID: 32662324 PMCID: PMC7361481 DOI: 10.1177/2325958220939755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Responding to the increasing reports of health students and professionals demonstrating stigmatized attitudes toward people living with HIV (PLHIV), this article examined the learning process that takes place during their academic training. Using symbolic interactionism as a theoretical framework, we studied the way lecturers in dietetic schools in Indonesia make meaning of their understanding and experience of HIV in relation to their teaching conduct. We found that the current curriculum does not provide adequate opportunities for students to learn and interact with PLHIV. Participants described HIV discussion is mainly limited to the clinical aspects and essential treatment as they were uncomfortable discussing HIV with the students. The ostensible symbolic meaning of HIV among dietetic lecturers in Indonesia was compounded with limitations and restrictions affecting their teaching practices and attitudes to PLHIV. Future intervention is required to help lecturers recognize their degree of awareness and personal values about HIV.
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Affiliation(s)
- Mutiara Tirta Prabandari Lintang Kusuma
- Department of Nutrition and Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia.,Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
| | - Tandalayo Kidd
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
| | - Nancy Muturi
- A.Q. Miller School of Journalism and Mass Communications, College of Arts and Sciences, Kansas State University, Manhattan, KS, USA
| | - Sandra Butin Procter
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
| | - Linda Yarrow
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
| | - Wei-Wen Hsu
- Department of Statistics, College of Arts and Sciences, Kansas State University, Manhattan, KS, USA
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Feeding Practices among Human Immunodeficiency Virus-Exposed Infants in Ethiopia: Systematic Review and Meta-Analysis. ADVANCES IN PUBLIC HEALTH 2021. [DOI: 10.1155/2021/9068074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Infant and young child feeding in the context of human immunodeficiency virus- (HIV-) infected mothers has significant challenges due to the risk of transmission of the virus via breastfeeding. In Ethiopia, a number of independent studies have been conducted to assess the feeding practice of HIV-exposed infants. But, there is no concrete evidence to show the national figure in Ethiopia. Hence, this review and meta-analysis aims to estimate the pooled prevalence of feeding practices among HIV exposed infants in Ethiopia. Methods. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. Articles were searched through search engines in PubMed, Cochrane Library, Google Scholar, and direct Google search. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument adapted for cross-sectional study design was used for quality assessment. The random effects model was used to estimate the pooled prevalence of infant feeding practices. Heterogeneity and publication bias were assessed. Trim and fill analysis was performed. Additionally, meta-regression was also performed. Results. In this review, a total of 26, 22, and 22 studies and 7413, 6224, and 6222 study participants for exclusive breastfeeding, replacement feeding, and mixed feelings were included, respectively. The overall pooled prevalence of exclusive breastfeeding, replacement feeding, and mixed feeding of HIV exposed infant was 63.99 % (95% Confidence Interval (CI): 52.32, 75.66), 16.13% (95% CI: 11.92, 20.32), and 20.95% (95% CI: 11.35, 30.58)) in Ethiopia, respectively. Conclusion and Recommendations. In Ethiopia, almost three in five HIV-exposed infants were exclusively breastfed. But still, mixed feeding during the period of first 6 months was practiced in almost one-fifth of the exposed infants in Ethiopia. Additionally, replacement feeding was also practiced even though not recommended for developing countries. Therefore, the government of Ethiopia should strengthen the health institutions to implement the existing infant feeding strategies and guidelines to increase exclusive breastfeeding for the first 6 months and to avoid mixed feeding during the periods of six months.
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Dagnew AB, Teferi MD. A systematic review and meta-analysis on adoption of WHO-recommended infant feeding practices among HIV positive mothers in Ethiopia. BMC Pregnancy Childbirth 2021; 21:194. [PMID: 33685405 PMCID: PMC7941701 DOI: 10.1186/s12884-021-03662-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of the World Health Organization (WHO) recommended infant feeding practices for HIV exposed infants is low in developing countries. There is no nationwide representative study was done in Ethiopia. Therefore, this study aimed to assess the pooled prevalence of WHO-recommended infant feeding practices among HIV-positive mothers in Ethiopia. METHODS EMBASE, PubMed, Google Scholar, CINHAL, Web of Science, Cochrane library, and hand searches of references were extensively searched to find out the primary articles. This study was included in all primary articles published in peer review journals regarding the recommended infant feeding practices in Ethiopia. Reviewers were used a standardized Microsoft Excel format to extract the data and analyzed it with Stata 11 version software. The pooled prevalence of recommended infant feeding practices among HIV exposed infants was estimated by a random-effect model. The sources of variation between the studies were identified by the I 2 statistics test. Furthermore, the source of heterogeneity was checked by subgroup and meta-regression analyses. Sensitivity analysis was also carried out for included articles to identify extreme values that affect the outcome of pooled results. RESULTS A total of twenty-one articles were included in this study. The random effect pooled prevalence of WHO-recommended infant feeding practices in Ethiopia was 82.76% (95% Confidence Interval [CI]: 75.4, 90.11) with the heterogeneity of I2 = 93.7 with a value of p < 0.001. The subgroup analysis result showed that the highest prevalence of WHO-recommended infant feeding practices was observed in the retrospective cohort study design, 89.45%, and the lowest prevalence was found in cross-sectional studies, 80.67%. Mothers who disclosed their HIV serostatus to their spouses OR = 2.88(2.27, 3.66) and attended antenatal care visits OR = 4.62(3.13, 6.83) were more likely to follow the WHO-recommended infant feeding practices than their counterparts. CONCLUSION Two out of ten HIV exposed infants received mixed feeding in Ethiopia. Health professionals should support and counsel HIV positive mothers to disclose their HIV serostatus to their spouses and advertisements in general or community health workers can get this message out to encourage using antenatal care services during the pregnancy period were recommended to increase the adoption of WHO recommended infant feeding practices and decrease their infant's risk of morbidity, including HIV infection.
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Affiliation(s)
| | - Mulat Dagnew Teferi
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Asfaw T. Prevalence and Determinants of Appropriate Child Feeding Practice Among Mothers Having Children with and without Diarrhea Aged 6–23 Months in Debre Berhan Town, Ethiopia. RESEARCH AND REPORTS IN NEONATOLOGY 2021. [DOI: 10.2147/rrn.s289640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Goon DT, Ajayi AI, Adeniyi OV. Sociodemographic and lifestyle correlates of exclusive breastfeeding practices among mothers on antiretroviral therapy in the Eastern Cape, South Africa. Int Breastfeed J 2021; 16:18. [PMID: 33593419 PMCID: PMC7885516 DOI: 10.1186/s13006-021-00366-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/08/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Exclusive breastfeeding (EBF) is associated with a reduction of postnatal HIV transmission and optimal infant growth. Given that the factors influencing exclusive breastfeeding are multi-factorial and context-specific, we examined the prevalence and factors associated with exclusive breastfeeding practice in the first 6 months among mothers on antiretroviral therapy in the Eastern Cape, South Africa. METHODS This was a cross-sectional study conducted between January to May 2018, on 469 parturient women enlisted in the prevention of mother-to-child HIV transmission cohort study in the Eastern Cape. Mothers were asked to recall whether they breastfed their infant exclusively with breast milk from birth and if so, to state how long they did. We collected relevant sociodemographic, lifestyle, and maternal information by interview. Bivariate and multivariable logistic regression analyses were fitted to determine the sociodemographic and lifestyle factors associated with exclusive breastfeeding practice. RESULTS The prevalence of six-month exclusive breastfeeding, measured since birth, was 32.0%. E Exclusive breastfeeding's prevalence was significantly higher among married women (36.8%), unemployed women (36.6%), non-smokers (32.7%), and those who never drank alcohol (37.0%). Unemployed women (adjusted odds ratio [AOR] 1.66, 95% Confidence Interval [CI] 1.08-2.56) and those with grade 12 or less level of education (AOR 2.76, 95% CI 1.02-7.49) had a higher likelihood of practising EBF for 6 months since birth while mothers who consumed alcohol (AOR 0.54, 95% CI 0.34-0.85) were less likely to practice EBF for 6 months. CONCLUSIONS The prevalence of six-month exclusive breastfeeding in the study, although comparable with sub-Saharan Africa and worldwide prevalence, remains suboptimal. Advocacy campaigns on EBF must target alcohol cessation and the creation of a favourable workplace environment for lactating mothers.
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Affiliation(s)
- Daniel Ter Goon
- Department of Public Health, University of Fort Hare, 5 Oxford Street, East London, 5201 South Africa
| | - Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Centre, APHRC Campus, Manga Close, Nairobi, Kenya
- Sociology Department, University of Fort Hare, East London, 5201 South Africa
| | - Oladele Vincent Adeniyi
- Department of Public Health, University of Fort Hare, 5 Oxford Street, East London, 5201 South Africa
- Department of Family Medicine, East London Hospital Complex, Cecilia Makiwane Hospital, East London, South Africa
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Ansha MG, Kuti KA, Tasew ST. Infant Feeding Practice and Associated Factors Among HIV Positive Mothers at Health Institution of Shashemene Town, South Ethiopia. J Family Reprod Health 2020; 14:124-130. [PMID: 33603804 PMCID: PMC7865201 DOI: 10.18502/jfrh.v14i2.4357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To assess Infant feeding practice and associated factors among HIV positive mothers at health institution of Shashemene town, South Ethiopia. Materials and methods: Facility based cross sectional study was conducted. The study used all the study population as source of data since they are small in number hence sample size calculation was not needed. This study was conducted at health institutions which provide ART and PMTCT service at Shashemene town. Structured questionnaires were developed by reviewing different literatures. Data collectors were trained and data were collected from February to March 2018. The data were analyzed using statistical package for social science (SPSS) version 20, descriptive statistics as well as bivariate and multivariate analysis were computed to identify the independent predictor of infant feeding practice and to control effect of confounders. Results: On this study majority 175 (90.7%) of respondent breast feed their infants. Regarding feeding option about 154 (79.8%) chose EBF followed by complementary feeding. Concerning feeding practice majority of respondent 172 (89.1%) utilize safe feeding practice. On multivariate analysis only Counseling provided by health professional on infant feeding option was found as independent predictors of infant feeding practice with [AOR = 4.538 (CI = 1.099, 18.736)]. Conclusion: Higher proportion of HIV positive mothers follow safe infant feeding practice. Counseling by health professional was found as independent predictors of infant feeding practice. Further counseling by health professional needed to discourage mixed feeding practice.
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Affiliation(s)
| | - Kemal Ahmed Kuti
- Department of Public Health, Madda Walabu University, Goba, Ethiopia
| | - Selamawit Tesfaye Tasew
- Department of Communicable Diseases Control, Shashemene Town Health Office, Shashemene, Ethiopia
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Exclusive Breast-Feeding Practice and Associated Factors among HIV-Positive Mothers in Governmental Health Facilities, Southern Ethiopia. J Nutr Metab 2020; 2020:7962054. [PMID: 33014458 PMCID: PMC7519186 DOI: 10.1155/2020/7962054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 08/16/2020] [Accepted: 08/31/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Globally, over 90% of HIV infections among children are due to mother-to-child transmission and breastfeeding accounts for 5–20% of the burden. Avoidance of inappropriate feeding practices and practicing exclusive breastfeeding is recommended to reduce mother-to-child HIV transmission, but it is hardly practiced. The aim of this study was to determine the prevalence of exclusive breastfeeding practice and associated factors among HIV-positive mothers attending governmental PMTCT clinics in Southern Ethiopia. Methods An institution-based cross-sectional study was conducted from April to May 2019. The participants of the study were 209 HIV-positive mothers at the selected PMTCT sites. The study subjects were drawn from 10 health institutions located at 6 towns in Southern Ethiopia which constituted six hospitals and four health centers. Quantitative data were collected using the pretested structured questionnaire. Logistic regression analysis was used to determine the association between the predictors and outcome variable. Results Among the 209 participants, 81.6% (95% CI: 75.8–86.5) practiced exclusive breastfeeding and 18.4% (95% CI: 13.5–23.7) practiced mixed feeding. Mothers who had attended the recommended four antenatal visits [AOR: 3.01, 95% CI (1.1–8.28)], who had disclosed their serostatus [AOR: 3.17, 95% CI (1.12–8.99)], who had sufficient knowledge about infant feeding practice [AOR: 3.32, 95% CI (1.15–9.55)], and favorable attitude towards infant feeding practice [AOR: 5.39, 95% CI (1.65–17.6)] were more likely to practice exclusive breastfeeding. Conclusion Exclusive breastfeeding was predominantly practiced. But mixed feeding was also being practice considerably. Improving maternal knowledge and attitude towards appropriate infant feeding practice through appropriate counseling on ANC visits could significantly improve EBF practice. It was also evident that promoting disclose of serostatus could empower the mothers to make an informed decision on how to appropriately feed their newborn.
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Mixed Infant Feeding Practice and Associated Factors among HIV-Positive Women under Care in Gondar City's Public Health Facilities within Two Years Postpartum: A Cross-Sectional Study. Int J Pediatr 2020; 2020:4597962. [PMID: 32695187 PMCID: PMC7350176 DOI: 10.1155/2020/4597962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 05/14/2020] [Accepted: 06/02/2020] [Indexed: 11/18/2022] Open
Abstract
Background Mixed infant feeding practice remains a major setback for effective prevention of mother to child transmission of HIV program and updated evidences on this issue is essential for better interventions. Therefore, this study was aimed at assessing the proportion and associated factors of mixed infant feeding practice among HIV-positive women under care in public health institutions in Gondar city within two years postpartum, Ethiopia, 2017. Methods A cross-sectional study was conducted on 485 HIV-positive women under care in Gondar City's health facilities from May 1 to June 30/2017. Data were collected via interviewer administered questionnaire supplemented with chart review, entered into Epinfo version 7.0 and then exported to SPSS version 20.0. Both bivariable and multivariable analyses were done, and the statistical significance of each variable was claimed based on the adjusted odds ratio (AOR) with 95% confidence interval (CI) and its P value ≤0.05. Result The proportion of HIV-positive women practicing mixed infant feeding was 21.6%. Whereas, about 73.8% and 4.5% of the mothers demonstrated exclusive breastfeeding and exclusive replacement feeding, respectively. Mixed infant feeding practice was independently predicted by lack of antenatal care (AOR = 6.9; 95% CI: 3.4, 14.1) and home delivery (AOR = 2.8; 95% CI: 1.4, 5.4). Conclusion The magnitude of mixed infant feeding practice was higher than the reports of many other studies, and its predictors were connected to poor adherence to maternal health care service utilization. Hence, stakeholders need to work more on ANC and facility delivery service coverage.
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Breastfeeding Support Offered at Delivery is Associated with Higher Prevalence of Exclusive Breastfeeding at 6 Weeks Postpartum Among HIV Exposed Infants: A Cross-Sectional Analysis. Matern Child Health J 2020; 23:1308-1316. [PMID: 31214949 DOI: 10.1007/s10995-019-02760-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective HIV-exposed uninfected infants are almost twice as likely to die compared to infants born to HIV-uninfected women. HIV-exposed uninfected children whose mothers are on ART and who are breastfed have the lowest risk of dying by 24 months of age. Interventions to improve breastfeeding among HIV-infected mothers are needed. We aimed to assess the association between support/counseling provided by healthcare workers following delivery and the rate of exclusive breastfeeding (EBF) at 6-week postpartum. Methods This is a secondary analysis of data collected as part of a trial to evaluate the effect of conditional cash transfers on retention in and uptake of PMTCT services. Between April 2013 and August 2014, newly diagnosed HIV-infected women, ≤ 32 weeks pregnant, registering for antenatal care (ANC), in 89 clinics in Kinshasa, Democratic Republic of Congo, were recruited and followed through 6 weeks postpartum. At 6-week, participants were asked if they had given anything other than breastmilk to their infant in the 24 h preceding the interview (No = EBF) and whether a nurse or a doctor talked to them about breastfeeding after they gave birth (YES = received breastfeeding support/counseling). Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) measuring the strength of the association between EBF and receiving breastfeeding support/counseling by a healthcare provider following delivery. Results Of 433 women enrolled, 328 attended a 6-week postpartum visit including 320 (97%) with complete information on EBF. Of those 320, 202 (63%) reported giving nothing other than breastmilk to their infant in the previous 24 h; 252 (79%) reported that a healthcare provider came to talk to them about breastfeeding following delivery. Mothers who reported receiveing breastfeeding support/counseling from a healthcare provider were more likely to exclusively breastfeed compared to those who did not (69% vs. 38%, OR 3.74; 95% CI 2.14-6.54). Adjustment for baseline sociodemographic characteristics did not change the association substantially, (adjusted OR 3.72; 95% CI 2.06-6.71). Conclusion for Practice Receipt of breastfeeding support/counseling from a healthcare provider after delivery among HIV-infected mothers in care at 6-weeks postpartum in Kinshasa almost quadrupled the odds of EBF.
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Wubneh CA, Endalamaw A, Tebeje NB. Predictors of mortality among HIV exposed infants at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Ital J Pediatr 2019; 45:137. [PMID: 31699137 PMCID: PMC6839236 DOI: 10.1186/s13052-019-0740-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/23/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In the era of highly active antiretroviral therapy, vertical HIV transmission has been decreased. This may increase fertility desire of HIV infected women and an increasing number of HIV exposed infants as a result. A high probability of mortality among HIV exposed infants was reported across different countries. However, few studies are found on mortality of HIV exposed infants, in particular, no study was conducted before in the current study area. METHODS Institution based retrospective cohort study from July 2013 to December 2017 was conducted. A total of 408 HIV exposed children were selected through simple random sampling technique. Data were extracted from registration book by using data extraction tool, which is adapted from the Ethiopian Federal Ministry of Health HIV exposed infant follow-up form. Kaplan-Meier survival curve was used to show the probability of mortality rate. Bivariable and multivariable cox regression models were used to identify predictors of mortality. RESULTS Overall mortality rate was found to be 8.88 (95% CI: 6.36-12.36) per 100 child-year. Infant with death of at least one parent (AHR = 3.32; 95% CI: 1.503-7.32), non-exclusive breastfeeding (AHR = 0.10; 95% CI: 0.037-0.302), growth failure (AHR = 2.9; 95% CI: 1.09-8.09), presence of sign and symptom of HIV infection (AHR = 2.99; 95% CI: 1.33-6.74), and low birth weight (AHR = 2.6; 95% CI: 1.007-6.78) were found to be predictors of infant mortality. CONCLUSIONS Mortality of HIV exposed infants was high in Ethiopia. Prevention of the occurrence of HIV infection symptom, growth failure, and low birth weight is essential and further treat early whenever they occurred. Still, behavioral change interventions on mother who practice non-exclusive breastfeeding are indicated. Especial care for orphan infants is required due to their nature of vulnerability to varieties of health problem.
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Affiliation(s)
- Chalachew Adugna Wubneh
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Aklilu Endalamaw
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Nigusie Birhan Tebeje
- Unit of Community Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, P.O.BOX=196, Gondar, Ethiopia
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Determinants of infant feeding practices among mothers living with HIV attending prevention of mother to child transmission Clinic at Kiambu Level 4 hospital, Kenya: a cross-sectional study. Nutr J 2019; 18:64. [PMID: 31677638 PMCID: PMC6825715 DOI: 10.1186/s12937-019-0490-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 09/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus infection and acquired immune deficiency syndrome is global pandemic with around 150,000 children infected with HIV in 2015. In Kenya, it is estimated that 11,000 children who are under 15 years old were infected. Safe infant feeding practices are the major important determinants of the prevention of mother to child transmission. The decision to breastfeed or not is considered a very tough choice for mothers living with HIV. This study assessed the infant feeding practices and its determinants among mothers living with HIV with infants 0-12 months old. METHODS This was a mixed methods cross-sectional study adopting qualitative and quantitative data collection procedures. A sample of 180 systematically selected mothers living with HIV with infants 0-12 months old attending prevention of mother to child transmission clinic participated in the study. RESULTS Exclusive breastfeeding rate was 71.4%, mixed feeding (18.2%) and replacement feeding (10.4%). Complementary feeding with continued breastfeeding rate was 63.1%. Similarly, qualitative results showed that exclusive breastfeeding was the most preferred feeding method by mothers living with HIV. Age (Adjusted Odds Ratio (AOR) 0.19; (95% Confidence Interval (CI) 0.41, 0.85; p = 0.030) and infant feeding practice knowledge (AOR 0.20; 95% CI 0.06, 0.64; p = 0.007) were determinants of exclusive breastfeeding. Education AOR 0.17; 95% CI 0.03, 0.85; p = 0.002) and occupation (AOR 3.91; 95% CI 1.24, 12.32; p = 0.020) were determinants of complementary feeding with continued breastfeeding. CONCLUSION Exclusive breastfeeding is attainable in this population. However, poor infant feeding practice knowledge led to non-adherence to safe infant feeding practices such as exclusive breastfeeding. Socio-demographic factors such as age, education and occupation were established as determinants of infant feeding practices among mothers living with HIV. Ministry of Health should come up with strategies on infant feeding counseling that are aligned to a local context, to allow mothers to understand the importance of recommended infant feeding options for HIV-exposed infants.
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Negash S, Mesfin F, Egata G. Infants and young children feeding practice and associated factors among HIV positive mothers of children 0-23 months in health centers of Gulele sub-city, Addis Ababa, Ethiopia. BMC Res Notes 2019; 12:666. [PMID: 31639058 PMCID: PMC6805466 DOI: 10.1186/s13104-019-4729-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 10/12/2019] [Indexed: 11/10/2022] Open
Abstract
Objective A health facility based cross sectional study design was conducted among 358 randomly selected HIV positive mothers attending at four health centers from February 1 to 28, 2018. Magnitude of HIV positive mothers’ child feeding practice and associated factors was assessed according to WHO recommendation. Data were collected using structured pretested questionnaire and entered into EPI data version 3.1 and exported to SPSS version 20 computer software for analysis. Result The magnitude of recommended way of infant feeding practice among HIV positive mothers attending public health centers in Gulele sub-city is 37.4%, 95% CI (32.26–42.67). Statistically significant correlates of HIV exposed infant feeding practice of mothers in this study were knowledge of mother on HIV exposed infant feeding practice (AOR = 1.80 (95% CI 1.04–3.01)), head of family being father (AOR = 0.17 (95% CI 0.03–0.87)), having family (relatives) support (AOR = 2.05 (95% CI 1.00–4.18)) and information on HIV exposed infant feeding, practice (AOR = 1.77 (95% CI 1.07–2.93)).
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Affiliation(s)
- Samuel Negash
- Department of Public Health, College of Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia.
| | - Firehiwot Mesfin
- College of Health and Medical Science, School of Public Health, Haramaya University, Dire Dawa, Ethiopia
| | - Gudina Egata
- College of Health and Medical Science, School of Public Health, Haramaya University, Dire Dawa, Ethiopia
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Dagnew AB, Tewabe T, Birhie A, Birehanu M, Alehegn T, Simachew A, Tsegaw A. Factors Associated with Compliance with World Health Organization-Recommended Infant-Feeding Practices by Mothers with HIV Infection in Northwest Ethiopia. Curr Ther Res Clin Exp 2019; 91:39-44. [PMID: 31871507 PMCID: PMC6911861 DOI: 10.1016/j.curtheres.2019.100568] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/08/2019] [Indexed: 11/26/2022] Open
Abstract
Even though World Health Organization (WHO) recommends infant feeding options for HIV exposed infants, level of recommended infant feeding practices was still low in Ethiopia. This institutional study was done in prevention of mother-to-child transmission (PMTCT) clinic services among HIV exposed infants and having follow up in this clinics. Recommended infant feeding practices is an options to tackle vertical HIV infections especially for developing countries. Generally, prevalence of recommended infant feeding among HIV exposed infants in the study area was sub optimal. Mother's educational status, attendance to antenatal visits attendance to postnatal follow up and disclosure of mother's HIV status to their spouse were the predictors of recommended infant feeding practices.
Background The World Health Organization has recommended either exclusive replacement feeding or exclusive breastfeeding options for HIV-exposed infants for the first 6 months of life. Objective The purpose of this study was to assess the factors associated with noncompliance with these recommendations among a population of HIV-infected mothers of young infants in Bahir Dar City, Amhara Regional State, Ethiopia. Methods An institutional based cross-sectional study was conducted from March 1 to May 15, 2018. A structured interview was conducted with 213 HIV-positive mothers. Descriptive statistics were used to show the frequency distributions of factors associated with noncompliance with World Health Organization-recommended infant-feeding practices. Both bivariate and multivariate logistic regression analyses were performed to identify the variables predictive of infant-feeding practices. Results All mothers were undergoing antiretroviral therapy. Only 83.5% claimed to be following World Health Organization-recommended infant-feeding practices. Bivariate analysis showed that high school or greater educational status [Adjusted odds ratio (AOR) = 3.6 (95% CI = 4.2, 9.5)], having attended antenatal visits [AOR = 6.7 (95% CI = 5.6, 10.9)] and postnatal follow-up visits [AOR = 6.9 (95% CI = 4.2, 9.3)], and disclosure of HIV status to their spouse [AOR = 8.2 (95% CI = 6.2, 10.7)] were associated with adherence to recommended infant-feeding practices. Conclusions The prevalence of recommended infant feeding practices among HIV-exposed infants in the study area was suboptimal compared with the ≥90% recommended by the World Health Organization. Higher educational status of the mother, antenatal and postnatal follow-ups, and disclosure of HIV status to spouses were predictors of adherence to the recommended infant-feeding practices. Although not yet proven in a prospective clinical trial, providing more education for women, improving attendance at antenatal and postnatal follow-up visits, encouraging the disclosure of HIV status to spouses, and educating mothers about proper infant-feeding options during follow-up visits may all be useful to increase compliance.
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Affiliation(s)
| | - Tilahun Tewabe
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Asmamaw Birhie
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mastewal Birehanu
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tirualem Alehegn
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abigiya Simachew
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Agereselam Tsegaw
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Infant Feeding Practices of HIV Positive Mothers and Its Association with Counseling and HIV Disclosure Status in Ethiopia: A Systematic Review and Meta-Analysis. AIDS Res Treat 2019; 2019:3862098. [PMID: 31467708 PMCID: PMC6699255 DOI: 10.1155/2019/3862098] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/27/2019] [Accepted: 06/25/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction Breastfeeding is the ideal food source for all newborns globally. However, in the era of Human Immune Deficiency Virus (HIV) infection, feeding practice is a challenge due to mother-to-child HIV transmission. Therefore, this systematic review and meta-analysis aimed to estimate the national prevalence of exclusive breastfeeding and mixed feeding practices among HIV positive mothers and its association with counseling and HIV disclosure status to the spouse in Ethiopia. Methods We searched all available articles from the electronic databases including PubMed, EMBASE, Google Scholar, and the Web of Science. Moreover, reference lists of the included studies and the Ethiopian institutional research repositories were used. Searching of articles was limited to the studies conducted in Ethiopia and published in English language. We have included observational studies including cohort, cross-sectional, and case-control studies. The weighted inverse variance random effects model was used. The overall variations between studies were checked through heterogeneity test (I2). Subgroup analysis by region was conducted. To assess the quality of the study, the Joanna Briggs Institute (JBI) quality appraisal criteria were employed. Publication bias was checked with the funnel plot and Egger's regression test. Result A total of 18 studies with 4,844 participants were included in this study. The national pooled prevalence of exclusive breastfeeding and mixed feeding practices among HIV positive mothers were 63.43% (95% CI: 48.19, 78.68) and 23.11% (95% CI: 10.10, 36.13), respectively. In the subgroup analysis, the highest prevalence of exclusive breastfeeding practice was observed in Tigray (90.12%) and the lowest in Addis Ababa (41.92%). Counseling on feeding option with an odds ratio of 4.32 (95% CI: 2.75, 6.77) and HIV disclosure status to the spouse with an odds ratio of 6.05 (95% CI: 3.03, 12.06) were significantly associated with exclusive breast feedings practices. Conclusion Most mothers report exclusive breastfeeding, but there are still almost a quarter of mothers who mix feed. Counseling on feeding options and HIV disclosure status to the spouse should be improved.
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Nyoni S, Sweet L, Clark J, Ward P. A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts. BMC Public Health 2019; 19:570. [PMID: 31088541 PMCID: PMC6518720 DOI: 10.1186/s12889-019-6949-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The most recent World Health Organization (WHO) guidelines on Human Immunodeficiency Virus (HIV) and infant feeding promotes exclusive breastfeeding (EBF) in resource limited settings for the prevention of mother to child transmission (PMTCT) of HIV. Literature reveals poor uptake of WHO feeding guidelines, with mixed feeding being a regular practice. In light of the limited success in EBF promotion, a realist review was conducted, analysing the use of feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa, where the majority of HIV childhood infections occur. We considered what mechanisms were at play, for whom and in what circumstances they led to exclusive breastfeeding. METHODS Because infant feeding counselling is a complex social intervention with a non-linear causal pathway for preventing mother to child HIV transmission, a realist methodology was chosen for this study. Using Pawson's five stage sequence for conducting realist reviews, the results are presented as a set of identified and refined context-mechanism-outcome (CMO) configurations. These CMO configurations were used to show how particular outcomes occurred in specific contexts due to a generative mechanism and were developed through identifying a review question and program theory, searching for primary studies, quality appraisal, data extraction and data synthesis. RESULTS From an initial 1010 papers, 27 papers met the inclusion criteria and were used to refine the program theory. Exclusive breastfeeding occurred when a woman was motivated regarding motherhood, had correct learning and understanding about infant feeding practices through counselling, no fear of breastfeeding or the impact of opposing feeding related cultural beliefs, and the support from others to be assertive about their feeding choices when faced with pressure to mix-feed. An additional CMO configuration was added during the refinement of the program theory identifying that mothers needed to not just understand but also prioritize EBF advice over cultural beliefs and stigma. CONCLUSION The intended audience for this review are researchers and health care workers in PMTCT, particularly sub-Saharan Africa, who may benefit from the work that has been done to identify contexts for the success and failures of EBF.
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Affiliation(s)
- Simangaliso Nyoni
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Linda Sweet
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, 5001, Australia.
| | - Jacinta Clark
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Paul Ward
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Gejo NG, Weldearegay HG, W/tinsaie KT, Mekango DE, Woldemichael ES, Buda AS, Dinsa LH, Alemayehu M, Goba G. Exclusive breastfeeding and associated factors among HIV positive mothers in Northern Ethiopia. PLoS One 2019; 14:e0210782. [PMID: 30650156 PMCID: PMC6334918 DOI: 10.1371/journal.pone.0210782] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 01/03/2019] [Indexed: 11/18/2022] Open
Abstract
Background It is estimated that sub-optimal feeding, especially non-exclusive breastfeeding in the first 6months of life, results in 1.4million deaths and 10% of disease burden in children younger than five years. Worldwide, it is estimated that only 34.8% of infants are exclusively breastfed for the first 6months of life, the majority receiving some other food or fluid in the early months. Besides, the Ethiopian demographic and health survey (2016) stated that the median duration of exclusive breastfeeding in Tigray region was 3.8 months which is shorter than the recommended duration. The main purpose of this study was to determine the magnitude of exclusive breastfeeding practice and associated factors among HIV positive mothers in public hospitals of Tigray region, Northern Ethiopia. Methods A facility based cross-sectional study was conducted from July 9 to October 11, 2016, in public hospitals of Tigray region. Data was collected by using structured questionnaire using face-to-face interview among 304 eligible women through a systematic sampling technique. Data was analyzed using SPSS version 20.0. Binary and multiple variable logistic regressions (“odds ratio”) analyses were calculated with 95% CI and p value ≤ 0.05 as significance were used. Result Two hundred seventy (88.8%) of mothers practiced exclusive breastfeeding for the first six months of life. Infant feeding counseling during antenatal care of last pregnancy [AOR = 6.9, 95% CI; 2.63, 17.99], knowledge on exclusive breastfeeding (AOR = 5.5, 95% CI; (2.12, 14.02] and attitude towards exclusive breastfeeding [AOR = 7.9; 95% CI; 2.96, 21.21] had significant association with exclusive breastfeeding practice. Conclusions A high proportion of mothers practiced exclusive breastfeeding for the first six months of life. Infant feeding counseling, knowledge and attitude towards exclusive breastfeeding practice were the predictors of exclusive breastfeeding among HIV positive mothers. Strengthening infant feeding counseling during antenatal care and improving mothers’ knowledge and attitude on exclusive breastfeeding is essential.
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Affiliation(s)
- Negeso Gebeyehu Gejo
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
- * E-mail:
| | | | | | - Dejene Ermias Mekango
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University Hosanna, Ethiopia
| | - Ermias Sahile Woldemichael
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan, Ethiopia
| | - Alula Seyum Buda
- Department of Nursing, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Leta Hinkosa Dinsa
- Department of Midwifery, College of Medicine and Health Sciences, Wollega University, Nekemte Ethiopia
| | - Mussie Alemayehu
- Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Gelila Goba
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois
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Assessment of Knowledge, Attitude, and Practice of HIV Positive Mothers on Antiretroviral Treatment towards Infant Feeding in Gondar Town Health Institutions, North West Ethiopia, 2017. Int J Pediatr 2019; 2019:9107989. [PMID: 30713565 PMCID: PMC6332993 DOI: 10.1155/2019/9107989] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/18/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction The world health organization recommends feeding practices for infants born from Human Immunodeficiency Virus infected mothers to be safe to both the infant and the mother. This includes prevention of mother to child transmission of the virus and at the same time meeting nutritional requirements of the child. This requires prioritizing prevention of HIV transmission through breastfeeding against non-HIV morbidity and mortality especially from malnutrition and serious illnesses such as diarrhea, among nonbreastfed infants. Objective This study was aimed at assessing knowledge, attitude, and practice of HIV positive mothers on antiretroviral therapy towards infant feeding. Method Institution based cross-sectional study was conducted among 402 HIV positive mothers at ART clinics of Gondar town from March 1 to April 18, 2017. Systematic random sampling technique was used to select study participants. Data was collected using a structured, pretested, interviewer-administered questionnaire. The collected data was entered into Epi Info version 7 and analyzed using SPSS version 20 software. Result A total of 402 participants were interviewed with a 100% response rate. The mean age of participants was 29.24 (SD±10.06) years. The overall level of participant good knowledge and favorable attitude was 68.91% and 75.87%, respectively. Only 23.7% of mothers were practicing infant feeding according to WHO recommendation.
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Esubalew F, Atenafu A, Abebe Z. Feeding practices according to the WHO- recommendations for HIV exposed children in northwest Ethiopia: A cross-sectional study. Clin Nutr ESPEN 2018; 28:114-120. [PMID: 30390866 DOI: 10.1016/j.clnesp.2018.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 08/17/2018] [Accepted: 08/27/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Malnutrition is a major problem for HIV exposed children, which is mainly caused by inappropriate feeding practice. Hence, the study aimed to assess adherence to optimal complementary feeding practices recommended by the WHO and associated factors among HIV exposed infants and young children aged 6-18 months in selected Amhara Regional Hospitals, northwest Ethiopia. METHODS An institution based cross-sectional study was conducted from March 10 to April 30, 2017. Systematic random sampling was employed to select study participants. A 24hr dietary recall was used to assess compliance with child optimal complementary feeding practice. Children were considered to have received optimal complementary feeding when they fulfill the criteria of the timely introduction of solid, semi-solid or soft foods, and minimum acceptable diet. Both bi-variable and multivariable binary logistic regression analysis were applied to identify factors associated with optimal complementary feeding practice. RESULTS In this study, about 25.5% of HIV exposed children received optimal complementary feeding. More than two thirds, (70.7%), and more than a third, (36.9%), of the children received the recommended meal frequency and minimum acceptable diet, respectively. Father's education; primary (AOR = 2.39; 95%CI: 1.18, 4.88) and higher (AOR = 2.44; 95%CI: 1.37, 4.34), rich household wealth status (AOR = 2.08; 95%CI: 1.13, 3.82), and satisfactory media exposure (AOR = 1.70; 95%CI: 1.04, 2.78), and mothers disclosing that they have HIV (AOR = 1.78; 95%CI: 1.07, 2.98) were positively associated with optimal feeding practices. CONCLUSION Optimal complementary feeding practice was not at the level recommended by the WHO. Household wealth status, mother's HIV disclosure, and paternal educational status were positively associated with optimal complementary feeding practices among HIV exposed children. Therefore, a social safety net program for HIV positive mothers is recommended. In addition, strengthening maternal counseling about disclosure of HIV status and increased media promotion of optimal child feeding is important to achieve the recommended feeding goals.
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Affiliation(s)
- Frizer Esubalew
- Gondar University Comprehensive Specialized Hospital, Gondar, Ethiopia.
| | - Azeb Atenafu
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Zegeye Abebe
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Ejara D, Mulualem D, Gebremedhin S. Inappropriate infant feeding practices of HIV-positive mothers attending PMTCT services in Oromia regional state, Ethiopia: a cross-sectional study. Int Breastfeed J 2018; 13:37. [PMID: 30140299 PMCID: PMC6098608 DOI: 10.1186/s13006-018-0181-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 08/13/2018] [Indexed: 11/24/2022] Open
Abstract
Background Inappropriate infant feeding affects the probability of mother-to-child transmission of HIV and HIV-free survival of infants. However, in Ethiopia limited evidence exists regarding the infant feeding practice of mothers who are HIV-positive. The aim of this study was to determine the prevalence and predictors of inappropriate infant feeding among HIV-positive mothers attending the prevention of mother-to-child transmission (PMTCT) service in Adama and Bushoftu towns, Oromia, central Ethiopia. Methods A cross-sectional study was conducted in ten PMTCT service providing health facilities in the towns; 283 mother-infant pairs were enrolled. Appropriate infant feeding practice was defined as exclusive breastfeeding in the first six months of age. Logistic regression was employed to analyze the data and the outputs are presented using adjusted odds ratio (AOR) with 95% confidence intervals (CI). Results One hundred thirty of the infants were aged below six months, 103 between 6 and 11 months and 50 were older than 12 months. The prevalence of inappropriate infant feeding was 14.5% (95% CI 10.6, 18.7). About 6.3% and 8.3% practiced exclusive replacement feeding and mixed feeding respectively, in the first six months. Only 1.8% ever expressed their breast milk to feed their baby and none practiced wet nursing. Among 38 mothers who already discontinued breastfeeding 52.6% did so before 12 months of age. Mothers who were HIV-positive and had received antenatal (AOR = 0.05: 0.01, 0.30) and postnatal visits (AOR = 0.18: 0.04, 0.81); received infant feeding counseling (AOR = 0.18: 0.06, 0.55); and disclosed their HIV status to their partners (AOR = 0.28: 0.12, 0.63), showed a reduction of practicing inappropriate infant feeding. Mothers having breast problems (AOR = 4.89: 1.54, 15.60) and infants with mouth ulcers (AOR = 6.41: 2.07, 19.85) were more likely to practice inappropriate feeding. Conclusion Prompt management of breast complaints in mothers and mouth ulcer in infants; and provision of nutrition counseling to HIV-positive mothers, especially during antenatal and postnatal care, may help to improve the infant feeding practices for HIV exposed infants.
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Affiliation(s)
- Daba Ejara
- Meda Welabu University, Shashamene Campus, Shashamene, Ethiopia
| | - Demelash Mulualem
- 2School of Nutrition, Food Science and Technology, Hawassa University, Hawassa, Ethiopia
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Ngoma-Hazemba A, Ncama BP. The role of community volunteers in PMTCT programme: Lessons from selected sites in Zambia to strengthen health education on infant feeding and follow-up of HIV-positive mother-infant pair. Afr J Prim Health Care Fam Med 2018; 10:e1-e8. [PMID: 29943606 PMCID: PMC6018380 DOI: 10.4102/phcfm.v10i1.1665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/14/2018] [Accepted: 03/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background A global debate surrounding health care delivery at the lowest level of the community has aroused interest among researchers. In settings where skilled health workforce is scarce, the community relies on volunteers to provide care. Aim To explore the role of community-based volunteers (CBVs) and their perspectives on human immunodeficiency virus (HIV) and infant feeding to gain insights into the implementation of prevention of mother-to-child transmission (PMTCT) interventions at community level. Setting The study was conducted in Lusaka using Ngombe and Chelstone health facilities to recruit participants. Fieldwork took place from January 2014 to September 2014. Methods An exploratory descriptive qualitative study employing focus group discussions was conducted with CBVs. Convenient sampling was used to recruit 10 participants from each site. All transcribed interviews were imported into the Nvivo 10 for open coding and analysis. Results Although the role of community volunteers was to support and teach mothers on infant feeding in relation to HIV, the known cultural norms and practices had a bearing on how they tailored their information on breastfeeding to mothers. However, their link of the community to the health facilities cannot be overemphasised in these settings. Conclusion The role of community volunteers in PMTCT interventions can be strengthened by improving their training through use of appropriate educational materials and support of required resources. Lessons from these sites can inform future research to design community-based interventions and develop health education materials that are sensitive to cultural norms and practices in this and similar settings.
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Olorunfemi SO, Dudley L. Knowledge, attitude and practice of infant feeding in the first 6 months among HIV-positive mothers at the Queen Mamohato Memorial hospital clinics, Maseru, Lesotho. Afr J Prim Health Care Fam Med 2018; 10:e1-e12. [PMID: 29781690 PMCID: PMC5968867 DOI: 10.4102/phcfm.v10i1.1438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 10/23/2017] [Accepted: 11/08/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The balance between the risks of transmission of human immunodeficiency virus (HIV) through breastfeeding and its life-saving benefits complicates decisions about infant feeding among HIV-positive mothers in the first 6 months. OBJECTIVE The aim of this study was to assess the knowledge, attitude and practice of infant feeding among HIV-positive mothers attending the prevention of mother-to-child transmission services in Maseru, Lesotho.Method and setting: This observational cross-sectional study was done by collecting data from HIV-positive mothers attending the filter clinics of Queen Mamohato Memorial hospital in Maseru, Lesotho. HIV-positive mothers with infants below the age of 6 months attending the clinics at the time of the study were interviewed using a standardised questionnaire. We described the sociodemographic profile of the mothers, the information and education received on prevention of mother-to-child transmission (PMTCT) infant feeding options, the mothers' knowledge, attitudes and practices of infant feeding, and assessed risk factors for improved knowledge, attitudes and practices. RESULTS The majority (96%) of the 191 HIV-positive mothers who participated in the survey knew about the PMTCT programme and related breastfeeding services. Most of the participants chose to breastfeed (89%), while only 8% formula-fed their infants. Knowledge received during the PMTCT programme was significantly associated with the decision to exclusively breastfeed their infants. Earlier infant feeding counselling and education was associated with more exclusively breastfeeding as compared to late infant feeding counselling (p < 0.001). CONCLUSION The study found that HIV-positive mothers attending health clinics in Maseru, Lesotho, had high knowledge, and appropriate attitudes and practices with respect to infant feeding; and that early counselling and education improved infant feeding methods among these mothers.
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Affiliation(s)
- Stephen O Olorunfemi
- Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University.
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Chintalapudi N, Hamela G, Mofolo I, Maman S, Hosseinipour MC, Hoffman IF, Flax VL. Infant and Young Child Feeding Decision Making and Practices: Malawian Mothers' and Fathers' Roles in the Context of HIV. J Hum Lact 2018; 34:68-76. [PMID: 28841399 PMCID: PMC6667220 DOI: 10.1177/0890334417719245] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few studies in low- and middle-income countries have examined the roles of couples in infant and young child feeding decision making and practices, and there is no corresponding data in the context of human immunodeficiency virus (HIV). Research aim: This study aimed to explore mothers' and fathers' perceptions of their roles in feeding decision making and practices. METHODS The authors conducted in-depth interviews with 15 mothers and their male partners, recruited from the catchment areas of two urban and two rural government clinics in Lilongwe District, Malawi. The mothers were ≥ 18 years of age, were HIV positive, and had a child < 24 months of age. Twelve of the 15 fathers were also HIV positive. The interviews were analyzed using content analysis. RESULTS Mothers were responsible for child care, including breastfeeding and complementary feeding. Fathers provided monetary support for purchasing food and offered verbal support to encourage mothers to implement recommended feeding practices. Many fathers found it difficult to support adequate complementary feeding because of household food insecurity. Mothers were advised on child feeding during prevention of mother-to-child transmission clinic visits. No fathers in this study accompanied women to clinic appointments, so they were less well-informed about feeding than mothers. Fathers usually deferred to mothers in feeding decision making. One-third of mothers wanted fathers to be more involved in child feeding. CONCLUSION Malawian mothers' and fathers' roles in feeding decision making in the context of HIV align with local gender norms. Strategies are needed to improve fathers' knowledge of and involvement in child feeding, as desired by mothers.
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Affiliation(s)
- Nainisha Chintalapudi
- 1 Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Suzanne Maman
- 3 Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Mina C Hosseinipour
- 2 UNC Project-Malawi, Lilongwe, Malawi.,4 Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Irving F Hoffman
- 2 UNC Project-Malawi, Lilongwe, Malawi.,4 Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Valerie L Flax
- 1 Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,5 RTI International, Research Triangle Park, NC, USA
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Rasheed MH, Philemon R, Kinabo GD, Maxym M, Shayo AM, Mmbaga BT. Adherence to Exclusive Breastfeeding and Associated Factors in Mothers of HIV-Exposed Infants Receiving Care at Kilimanjaro Christian Medical Centre, Tanzania. East Afr Health Res J 2018; 2:33-42. [PMID: 34308173 PMCID: PMC8279206 DOI: 10.24248/eahrj-d-16-00365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 10/26/2017] [Indexed: 11/20/2022] Open
Abstract
Background: More than 90% of HIV in children occurs through mother-to-child transmission. Breastfeeding is one of several factors associated with transmission of HIV, and, because of this, infant feeding practice is one of the cornerstones in the effort to reduce HIV transmission in children. World Health Organization guidelines from 2012 recommend exclusive breastfeeding to all infants for first 6 months of life. However, many factors contribute to the adherence of mothers to exclusive breastfeeding (EBF) recommendations. The aim of this study was to determine what factors likely influence adherence to exclusive breastfeeding in mothers of HIV-exposed infants receiving care at Kilimanjaro Christian Medical Centre. Methods: A cross-sectional hospital-based study was conducted from September 2012 to March 2013 at Kilimanjaro Christian Medical Centre in Moshi. All mothers of HIV-exposed infants aged 6 to 12 months receiving care at child-centred family care clinic who consented to participate in the study were included. Data were collected using a pretested structured questionnaire and analysed using SPSS version 16.0 statistical package. Results: Of the 128 mothers of HIV-exposed infants enrolled in the study, 71 (55.5%) adhered to EBF for 6 months. No statistical significance was seen between adherence status and maternal characteristics in bivariate analysis (P>.05). The mean age and standard deviation of initiating other foods by mothers who did not adhere was 3.32 months ± 1.24. Of 57 (44.5%) non-adherent mothers, one-tenth of them practised mixed breastfeeding and the rest stopped breastfeeding completely. Fear of postnatal transmission of HIV through breastfeeding and inadequate breast milk production were the most common reasons for non-adherence to EBF. Conclusion: Adherence to the recommended duration for EBF by mothers to their HIV-exposed infants is still a challenge. Ongoing intensive feeding counselling and education on EBF may increase the number of mother who can adhere to EBF in our society.
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Affiliation(s)
- Murtaza Husain Rasheed
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Rune Philemon
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Grace Damas Kinabo
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Maya Maxym
- Kapi'olani Medical Center for Women and Children, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Aisa Mamuu Shayo
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Blandina Theophil Mmbaga
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania
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Postnatal HIV transmission in breastfed infants of HIV-infected women on ART: a systematic review and meta-analysis. J Int AIDS Soc 2017; 20:21251. [PMID: 28362072 PMCID: PMC5467610 DOI: 10.7448/ias.20.1.21251] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: To systematically review the literature on mother-to-child transmission in breastfed infants whose mothers received antiretroviral therapy and support the process of updating the World Health Organization infant feeding guidelines in the context of HIV and ART. Methods: We reviewed experimental and observational studies; exposure was maternal HIV antiretroviral therapy (and duration) and infant feeding modality; outcomes were overall and postnatal HIV transmission rates in the infant at 6, 9, 12 and 18 months. English literature from 2005 to 2015 was systematically searched in multiple electronic databases. Papers were analysed by narrative synthesis; data were pooled in random effects meta-analyses. Postnatal transmission was assessed from four to six weeks of life. Study quality was assessed using a modified Newcastle-Ottawa Scale (NOS) and GRADE. Results and discussion: Eleven studies were identified, from 1439 citations and review of 72 abstracts. Heterogeneity in study methodology and pooled estimates was considerable. Overall pooled transmission rates at 6 months for breastfed infants with mothers on antiretroviral treatment (ART) was 3.54% (95% CI: 1.15–5.93%) and at 12 months 4.23% (95% CI: 2.97–5.49%). Postnatal transmission rates were 1.08 (95% CI: 0.32–1.85) at six and 2.93 (95% CI: 0.68–5.18) at 12 months. ART was mostly provided for PMTCT only and did not continue beyond six months postpartum. No study provided data on mixed feeding and transmission risk. Conclusions: There is evidence of substantially reduced postnatal HIV transmission risk under the cover of maternal ART. However, transmission risk increased once PMTCT ART stopped at six months, which supports the current World Health Organization recommendations of life-long ART for all.
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Ayana D, Tariku A, Feleke A, Woldie H. Complementary feeding practices among children in Benishangul Gumuz Region, Ethiopia. BMC Res Notes 2017; 10:335. [PMID: 28750674 PMCID: PMC5531090 DOI: 10.1186/s13104-017-2663-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/21/2017] [Indexed: 11/15/2022] Open
Abstract
Background Appropriate complementary feeding helps to reduces child’s risk of undernutrition, infectious disease and related mortality. However, complementary feeding practices are sub-optimal in Ethiopia. There is, however, also limited evidence in the country, particularly of Pawie District. Therefore, this study aimed to assess timely initiation of complementary feeding and associated factors among mothers who had children aged 6–23 months in Pawie District, Benishangul Gumuz Regional State. Methods A community based cross-sectional study was conducted in Pawie District from February 01 to March 29, 2015. A multi-stage sampling technique was employed to select 806 mother–child pairs. Multivariable logistic regression analysis was used to investigate factors associated with timely initiation of complementary feeding. Adjusted odds ratio (AOR) with corresponding 95% Confidence Interval was calculated to show the strength of association. A p value of <0.05 was used to declare significance of association. Results The overall prevalence of timely initiation of complementary feeding was 61.8%. One quarter (23.7%) of children had good dietary diversity and 32.7% of children aged 12–23 months were fed with appropriate meal frequency. Mother’s place of residence: urban settlement [AOR = 2.11, 95% CI 1.47, 3.02] and postnatal checkup [AOR = 1.68, 95% CI 1.15, 2.45] were significantly associated with timely initiation of complementary feeding. Conclusions The prevalence of timely initiation of complementary feeding was low in Pawie District. Therefore, further strengthening maternal postnatal care utilization is a key to improve timely initiation of complementary feeding. Moreover, attention needs to be given to the rural mothers.
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Affiliation(s)
- Dula Ayana
- Department of Nursing, Pawe Health Science College, Pawe District, Ethiopia
| | - Amare Tariku
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Amsalu Feleke
- Department of Health Service Management and Heath Economics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haile Woldie
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Genetu H, Yenit MK, Tariku A. Breastfeeding counseling and support are associated with continuous exclusive breastfeeding from one week to six months of age among HIV exposed infants in north Gondar zone, Ethiopia: a cross-sectional study. Int Breastfeed J 2017; 12:21. [PMID: 28439291 PMCID: PMC5401345 DOI: 10.1186/s13006-017-0113-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 04/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, exclusive breastfeeding prevents 1.3 million child deaths and has an added benefit for people living with the Human Immune Deficiency Virus (HIV) by preventing mother-to-child transmission of HIV. However, literature is scarce in Ethiopia; therefore this study aimed to assess the rate of continuous exclusive breastfeeding from the end of the first week to 6 months of age, among HIV exposed infants (aged 7-20 months) who were followed up in government hospitals of North Gondar Zone, Ethiopia, and associated factors. METHODS An institutional based cross-sectional study was conducted from February 21 to March 30, 2016. All mother-child pairs (367) attending the chronic HIV care clinic in government hospitals of North Gondar Zone were included in the study. Exclusive breastfeeding was defined as the practice of feeding only breast milk (including expressed breast milk) during the first 6 months and no other liquids and solid foods except medications. However since prelacteal feeding is a deep rooted norm in the study setting, we report continuous exclusive breastfeeding from the end of first week to 6 months of age of infants, ignoring all prelacteal feeding offered at birth. A binary multivariable logistic regression analysis was employed to identify factors associated with exclusive breastfeeding. RESULTS The overall prevalence of continuous exclusive breastfeeding among HIV exposed infants was 86.4%. According to the multivariable analysis; breastfeeding counseling (Adjusted Odds Ratio [AOR] = 5.1, 95% Confidence Interval [CI] 1.4, 18.2), breastfeeding support (AOR = 3.7, 95% CI 1.3, 10.5), and not experiencing obstetric problems (AOR = 3.4, 95% CI: 1.3, 8.8) were associated with higher odds of continuous breastfeeding. CONCLUSIONS In this study, most HIV exposed infants were continuously breastfed from the end of first week to 6 months of age. Breastfeeding counseling, breastfeeding support and experiencing obstetric problems were identified as significant determinants of continuous breastfeeding. Therefore, breastfeeding counseling and support should be strengthened to improve the coverage of optimal exclusive breastfeeding practice. Moreover, prompt diagnosis and treatment of obstetric problems should be initiated.
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Affiliation(s)
| | - Melaku Kindie Yenit
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Amare Tariku
- Department of Human Nutrition, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Lenja A, Demissie T, Yohannes B, Yohannis M. Determinants of exclusive breastfeeding practice to infants aged less than six months in Offa district, Southern Ethiopia: a cross-sectional study. Int Breastfeed J 2016; 11:32. [PMID: 27990174 PMCID: PMC5148885 DOI: 10.1186/s13006-016-0091-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 11/29/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND World Health Organization (WHO) recommends timely initiation of breastfeeding after birth and only feeding breast milk to infants during the first 6 months of life. It was estimated that exclusive breastfeeding can reduce infant deaths by 13%. The practice of exclusive breastfeeding is suboptimal in many parts of Ethiopia to a varied extent. Factors associated with exclusive breastfeeding practice and the proportion of its practice was not well documented in Offa district. Therefore, this study was aimed to assess the determinants of exclusive breastfeeding in the first 6 months of life in Offa district, Southern Ethiopia. METHODS A community-based cross-sectional study was carried out in 396 mothers of infants younger than 6 months using random sampling. Data were collected from mothers of the infants by trained interviewers. Exclusive breastfeeding was measured by the history of infant feeding in the prior 24 h. Pretested and structured questionnaires adopted from standard questionnaires and Ethiopia linkages modules were used. Multivariate logistic regression was used to identify factors significantly influencing exclusive breastfeeding practice. RESULTS Based on findings of this study of 396 participants, the proportion of exclusive breastfeeding was 78.0% and awareness of exclusive breastfeeding and bottle feeding were 85.6 and 6.1% respectively. About 6% of infants were given prelacteal feeds. The number of infants fed cow milk was 12.9%, formula 7.8%, water 8.5%, fruits and semisolids 1.5%, over 24 h prior to the survey. The initiation of breastfeeding within one h (AOR 2.2; 95% CI 1.1, 4.27), attending formal education (AOR 4; 95% CI 2.20, 7.25), having an awareness on the benefits of exclusive breastfeeding (AOR 6; 95% CI 3.10, 11.70) and knowledge of colostrum feeding (AOR 2.1; 95% CI 1.11, 4.27) had a statistically significant association with exclusive breastfeeding in the study area. CONCLUSIONS The practice of exclusive breastfeeding as well as awareness was worthy in Offa district. Additionally the proportion of bottle feeding use was small. However, feeding other than breast milk was associated with the perception that breast milk alone was insufficient for their child. Strategies on promoting exclusive breastfeeding practice must focus on strengthening women's education and awareness creation activities further.
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Affiliation(s)
- Ayele Lenja
- Integrated Family Health Program, Wolaita Sodo Cluster Office, Wolaita Sodo, Ethiopia
| | - Tsegaye Demissie
- Public Health Nutrition, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Bereket Yohannes
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia ; University of Bergen, Bergen, Norway ; Hawasa University, Awassa, Ethiopia
| | - Mulugeta Yohannis
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Ngoma-Hazemba A, Ncama BP. Analysis of experiences with exclusive breastfeeding among HIV-positive mothers in Lusaka, Zambia. Glob Health Action 2016; 9:32362. [PMID: 27914189 PMCID: PMC5136125 DOI: 10.3402/gha.v9.32362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 11/04/2016] [Accepted: 11/06/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Exclusive breastfeeding in the first 6 months offers protection from postnatal HIV infection but remains low in resource-poor settings. Documentation of experiences with exclusive breastfeeding is needed to strengthen infant feeding counselling by health care workers. OBJECTIVE To explore HIV-positive mothers' experiences with exclusive breastfeeding during the first 6 months of the infant's life. DESIGN A health facility- and community-based exploratory qualitative study was conducted among 30 HIV-positive mothers practising exclusive breastfeeding and meeting the selection criteria. In-depth interviews were conducted four times with the same participants at 6 days, 6 weeks, 12 weeks and 18 weeks after giving birth. Interviews were transcribed verbatim and files were imported into QRS NVivo Version 10 for coding, and data were analysed using the framework analysis. RESULTS We found that mothers were aware of the risks of mother-to-child transmission of HIV through breastmilk and recognised the benefits of exclusive breastfeeding to their exposed babies. However, they were particularly concerned about achieving HIV-free survival for their exposed infants because of problems faced during the first 6 months of infant feeding. Although they reported being supported by their families and/or friends, their poor health and nutrition impacted how well they cared for their infants' well-being. CONCLUSIONS We conclude that exclusive breastfeeding was difficult to achieve because of individual circumstances. Therefore, prevention of mother-to-child transmission interventions that adopt a once-off infant feeding counselling do not achieve adequate preparation on the part of mothers to practice exclusive breastfeeding. There is a need to provide frontline health care workers with steps for consideration during infant feeding counselling.
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Affiliation(s)
- Alice Ngoma-Hazemba
- Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia;
| | - Busisiwe Purity Ncama
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa;
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Wakwoya EB, Zewudie TA, Gebresilasie KZ. Infant feeding practice and associated factors among HIV positive mothers in Debre Markos Referral Hospital East Gojam zone, North West Ethiopia. Pan Afr Med J 2016; 24:300. [PMID: 28154655 PMCID: PMC5267789 DOI: 10.11604/pamj.2016.24.300.8528] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/05/2016] [Indexed: 11/11/2022] Open
Abstract
Introduction The dilemma posed between lifesaving benefit and risk of transmission through breast feeding complicates infant feedings among communities grossly affected by HIV/AIDS. According to the world health organization’s guideline which was revised in 2010, exclusive breast feeding and exclusive replacement feeding are the recommended infant feeding practices for HIV positive mothers. The aim of this study was to assess infant feeding practice and associated factors among HIV positive mothers in Debre Markos Referral Hospital, North West Ethiopia. Methods An institutional based cross sectional study was conducted from May to September 2013. A Randomly selected 260 HIV positive mothers were included. The data were collected by using a pretested and structured questionnaire. Bivariate and multivariate analysis were performed to check association and to control confounders. Results From a total of 260 HIV positive mothers, 85.8% of them were feeding their children based on the recommended feeding way of infant feeding practice with the remaining percentage 14.2% were practicing mixed feeding. In multivariate analysis mothers attending high school and above AOR = 5.3 [95% CI = 1.25-22.1], having antenatal care follow up AOR = 5.5 [95% CI = 1.5-20.16], being on anti-retro viral therapy AOR = 6.5 [95% CI = 1.88-22.51] and disclosure of HIV status AOR = 7.1 [95% CI = 1.26-39.76] were found to be independently associated with infant feeding practice. Conclusion This study revealed that large proportion of HIV positive mothers had followed the recommended infant feeding practice and significantly high number of mothers had practiced mixed feeding. Educating mothers, increasing ANC utilization, counseling mothers to start ART, encouraging and supporting mothers to disclose their HIV status were recommended.
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Affiliation(s)
- Elias Bekele Wakwoya
- School of Nursing and Midwifery, College of Health and Medical science, Haramaya University, Harar, Ethiopia
| | | | - Kahsay Zenebe Gebresilasie
- Department of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Lang’at PC, Ogada IA, Steenbeek A, Odinga G, Mwachiro MM. Do the feeding practices and nutrition status among HIV-exposed infants less than 6 months of age follow the recommended guidelines in Bomet County, Kenya? BMC Nutr 2016. [DOI: 10.1186/s40795-016-0084-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Matovu J, Onyango-Makumbi C, Namuli P, Tanga E, Kagawa M, Nalwadda G, Motevalli M, Semitala F, O’Gara E, Fowler M. WHO 2010 infant feeding guidelines in resource-limited settings: attitudes of human immunodeficiency virus-infected women and other role players in Kampala, Uganda. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2014.11734489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nankumbi J, Muliira JK. Barriers to infant and child-feeding practices: a qualitative study of primary caregivers in Rural Uganda. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2015; 33:106-116. [PMID: 25995727 PMCID: PMC4438654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to explore the barriers to the use of appropriate infant and young child-feeding practices by primary caregivers living in a rural Ugandan district. A community-based qualitative design and focus group discussions were used for collecting data from primary caregivers of children aged 0 to 24 month(s). On an average, each of the four focus group discussions had 11 participants. The focus group discussions were conducted using a structured interview guide and were tape-recorded. The recorded data were later transcribed and analyzed using qualitative thematic analysis techniques. All the participants were females, and the majority had low levels of education and at least one child in the age-group of 0-24 month(s) in their household. The findings show that the main barriers to the use of appropriate infant and young child-feeding practices fall under four themes: caregiver's knowledge about breastfeeding, caregiver's knowledge about complimentary feeding, influence of culture custodians on the caregivers, and patterns and burden of other responsibilities the caregivers have in the household. The four categories of barriers imply that there are various missed opportunities to implement hospital and community-based interventions to improve infant and young child-feeding practices, which is one way of preventing malnutrition. Therefore, in rural areas of Uganda, the major factors responsible for the high prevalence of malnutrition among infants and children are still those related to knowledge, culture, and social status of the primary caregivers.
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Affiliation(s)
- Joyce Nankumbi
- Department of Nursing, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda
| | - Joshua K. Muliira
- College of Nursing, Sultan Qaboos University, PO Box 66 Al Khod, Muscat, Sultanate of Oman
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Tam M, Amzel A, Phelps BR. Disclosure of HIV serostatus among pregnant and postpartum women in sub-Saharan Africa: a systematic review. AIDS Care 2015; 27:436-50. [DOI: 10.1080/09540121.2014.997662] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lawani LO, Onyebuchi AK, Iyoke CA, Onoh RC, Nkwo PO. The challenges of adherence to infant feeding choices in prevention of mother-to-child transmission of HIV infections in South East Nigeria. Patient Prefer Adherence 2014; 8:377-81. [PMID: 24707171 PMCID: PMC3972024 DOI: 10.2147/ppa.s61796] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Global and national efforts in the 21st century are directed toward the elimination of new pediatric HIV infections through evidence-based infant feeding interventions for the prevention of mother-to-child-transmission, with patient preference, motivation, and adherence identified as key factors for success. OBJECTIVES This study assessed the challenges faced by HIV-infected parturients in adhering to the national infant feeding recommendations and their infant feeding preference for prevention of mother-to-child transmission in South East Nigeria. METHODS This is a cross-sectional, descriptive, questionnaire-based study of 556 parturients infected with HIV/AIDS. RESULTS The mean age of the participants was 28.0±5.3 years. The infant feeding choices were made jointly by both partners (61.1%) in the antepartum period. The HIV status disclosure rate was 89.2%. A large proportion (91.7%) practiced exclusive breastfeeding with highly active antiretroviral therapy, and 7.6% practiced mixed feeding because of nonadherence to their choice and national/international recommendations on infant feeding in the context of HIV/AIDS. This was mainly a result of pressure from family members (42.8%) and cultural practices (28.5%). Multivariate logistic regression analysis indicates that adherence was strongly associated with age, marital status, and employment status, but not with residence, educational status, or parity. CONCLUSION Exclusive breastfeeding is predominately the infant feeding choice among HIV-infected parturients in South East Nigeria, but there is still a gap between infant feeding preference and adherence to standard practice as a result of sociocultural challenges associated with risk for mixed feeding and the risk for mother-to-child-transmission of HIV by nursing mothers.
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Affiliation(s)
- Lucky O Lawani
- School of Postgraduate Studies, Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria
- Correspondence: Lucky O, Lawani School of Postgraduate Studies, Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu State, 400001, Nigeria, Tel +234 803 669 1209, Email
| | - Azubuike K Onyebuchi
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Chukwuemeka A Iyoke
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria
| | - Robinson C Onoh
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Peter O Nkwo
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria
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