Community's perception of infant feeding options in the context of HIV: A case study of Kosirai Division, Nandi-North District.

Abstract

The increasing cases of mother to child transmission of HIV infections are alarming. , Breastfeeding has been found to be one of the routes for transmission leading to calls for HIV positive mothers to adopt alternative infant feeding options by Prevention of Mother-to-Child Transmission (PMTCT) programs. The community in which an infected mother lives has been found to influence her decision on whether to breast-feed or not. To ensure their effectiveness PMTCT programs should conduct formative research at facility and community levels, as thorough consultation with communities is a prerequisite to any infant feeding program. The aim of this study was to determine community's perception of infant feeding options in the context of HIV. The specific objectives of the study were: To describe infant feeding practices in Kosirai community; To determine Kosirai community's knowledge of infant feeding options for HIV positive women; To determine Kosirai community's attitudes on infant feeding options for HIV positive women. A cross-sectional study was carried out in Kosirai Division, Nandi-North District. The target population was community members aged 18-45 years and key informants aged 18 and above. A total of 385 respondents participated in the survey with 191 (49.6%) women and 194 (50.4%) men. In addition a total of 30 key informants (15 lactating mothers of unknown HIV status, 4 HIV infected mothers, 6 traditional birth attendants, 3 women leaders and 2 health providers) were engaged in the study to provide additional insight information. Multistage sampling method was used to identify community members for the survey while snowballing sampling method was used to identify key informants. Quantitative research method (structured questionnaires) and qualitative research method (key informant interviews) were used to collect data. Quantitative data was analyzed using the computer package- SPSS while qualitative data was transcribed and the content analyzed in form of themes. The findings reflect views and opinions of married members of the community who had a moderate level of education. Farming was the main source of income however; half of the women (49.7%) had no source of income of their own. Most of the respondents (85.5%) knew of breastfeeding as a route of HIV transmission with sex (p=0.003) and age (p=O.OOO)being highly significant. Most of the respondents were not aware of PMTCT with only 7.5% knowing of at least one component of PMTCT. Breastfeeding was the norm in the community and with the emergence of HIV /AIDS mothers who do not breastfeed are prone to stigmatization. Cow milk was the main breast milk substitute in the area and was given to infants as early as 2 weeks. Although the milk is usually diluted, no particular measurements are taken and no nutrients are added to make it nutritionally adequate. Weaning foods are given between 3 to 6 months. Partners, mothers or mother in-laws were found to influence infant feeding practices. Infant formula was the most recommended infant feeding option to HIV infected mothers at the community health center and although given freely, non-compliance among infected mothers still existed. Those infant feeding options known to community members were most preferred, making cow milk the most popular (93.5%) infant feeding option in the context of HIV/AIDS. Heating expressed milk, wet nursing and milk banks, which were not known, were least preferred. Knowledge of PMTCT however, did not affect attitudes and preferences of infant feeding options. Stigma was still a problem in the community and although 97.9% believed that infected mothers needed support only 83.3% were willing to support HIV infected mothers (90.5% of the women and 76.3% of the men with p = 0.001). Cow milk was the most preferred infant feeding option and thus efforts should be made to educate mothers on the appropriate way to modify the milk to make it nutritionally adequate. Views of community members should be considered when advising HIV infected mothers on the appropriate infant feeding options. However, the decision of which option to adopt should be left to the mother.