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?

Feeding Practices among Human Immunodeficiency Virus-Exposed Infants in Ethiopia: Systematic Review and Meta-Analysis

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.

A systematic review and meta-analysis on adoption of WHO-recommended infant feeding practices among HIV positive mothers in Ethiopia

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 I² 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.

Cessation of breastfeeding and associated factors in the era of elimination of mother to child transmission of HIV at Ndejje health center, Uganda: a retrospective cohort study

Background

Breastfeeding an infant exposed to Human Immunodeficiency Virus (HIV) carries the risk of HIV acquisition whilst not breastfeeding poses a higher risk of death from malnutrition, diarrhea, and pneumonia. In Uganda, mothers living with HIV are encouraged to discontinue breastfeeding at 12 months but data are limited. We examined the frequency and factors associated with cessation of breastfeeding at 1 year among mothers living with HIV at Ndejje Health Center IV, a large peri-urban health facility in Uganda.

Methods

This retrospective cohort study involved all mothers living with HIV and enrolled in HIV care for ≥12 months between June 2014 and June 2018. We abstracted data from registers, held focus group discussions with mothers living with HIV and key informant interviews with healthcare providers. Cessation of breastfeeding was defined as the proportion of mothers living with HIV who had discontinued breastfeeding at 1 year. We summarized quantitative data descriptively, tested differences in outcome using Chi-square and t - tests, and established independently associated factors using modified Poisson regression analysis at 5% statistical significance level. We thematically analyzed qualitative data to enrich and triangulate the quantitative results.

Results

Of 235 participants, 150 (63.8%) had ceased breastfeeding at 1 year and this was independently associated with the infant being male (Adjusted Risk Ratio [aRR] 1.25, 95% confidence interval [CI] 1.04, 1.50), the mother being multiparous (aRR 1.26, 95% CI 1.04–1.53), and the initiation of breastfeeding being on the same-day as birth (aRR 0.06, 95% CI 0.01–0.41). The reasons for ceasing breastfeeding included male infants over breastfeed than females, maternal literacy and knowledge adequacy about breastfeeding, support and reminders from the partner, and boys can bite once they get teeth.

Conclusion

Suboptimal proportion of infants were ceased from breastfeeding at 1 year and this might increase the risk of mother to child transmission of HIV. Cessation of breastfeeding was more likely among male infants and multiparous mothers but less likely when breastfeeding was initiated on the same-day as birth. Interventions to enhance cessation of breastfeeding should target none multiparous mothers and those with female infants.

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

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.

Infant feeding practices among HIV-exposed infants less than 6 months of age in Bomet County, Kenya: an in-depth qualitative study of feeding choices

BACKGROUND

In children, HIV can be acquired from the mother during pregnancy, delivery and through breast milk. The WHO recommends exclusive breast feeding or exclusive replacement feeding for the first 6 months after birth for HIV-exposed infants. Barriers such as HIV-related stigma, inadequate resources, lack of access to safe water and negative cultural beliefs have been shown to influence infant feeding among HIV-exposed infants in some settings. In Kenya, there is limited literature on the barriers. The purpose of this study was to identify barriers to optimal feeding among HIV-exposed infants 0-5 months of age attending a mission hospital in Bomet County, Kenya.

METHODS

A cross-sectional qualitative study was conducted at a referral mission hospital in Bomet County, Southwest Kenya. Four focused group discussions were conducted among mothers/caregivers of HIV-exposed infants aged 0-5 months in accordance with their infant feeding practices, while two key informant interviews were also held with healthcare workers. All sessions were audio recorded and later transcribed verbatim. Content analysis was performed, and conclusions were made based on identified themes.

RESULTS

Factors influencing the infant feeding choices were: financial constraints, cultural beliefs and practices, HIV-related stigma and conflicting knowledge among mothers/caregivers and healthcare workers on the recommendations for feeding HIV-exposed infants 0-5 months of age.

CONCLUSIONS

Health worker retraining in and reinforcement of WHO guidance on feeding HIV exposed/infected infants will clarify misconceptions around feeding HIV exposed/infected infants, though there remain social and economic barriers to full implementation.