The decision-support needs of HIV-Positive mothers regarding infant feeding at a PMTCT Clinic in Kenya

Abstract

Introduction: It is estimated that 630,000 children worldwide became infected with HIV/AIDS in 2003. More than 90% of these infections are through mother-to child-transmission (MTCT) (UNAIDS 1998). The risk of HIV transmission through mother’s milk has rendered infant feeding choice a most critical issue and so far it has created considerable uncertainty and fear among the HIV-infected childbearing women. Objective: The study aimed at exploring the decision-support needs of HIV-positive mothers who attend the Prevention of Mother to Child Transmission of HIV (PMTCT) clinic at the Academic Model Providing Access to Health care (AMPATH), Moi Teaching and Referral Hospital (MTRH) facility in Western Kenya regarding infant feeding. Setting: Moi Teaching and Referral Hospital, AMPATH centre, Western Kenya. Study design: This was a cross sectional descriptive study. Study population: The target population encompassed HIV infected antenatal mothers who were above 18 years of age, and who were followed-up in the PMTCT program at the AMPATH centre. Methods: Participants were selected using consecutive sampling. A pre-tested structured questionnaire was used based on the Ottawa Decision Support guide. Data Analysis: The SPSS V.12.01 programme was used to analyse the data. Data was summarized using proportions for categorical data and the mean for continuous data. Results: A total of 164 (95.9%) participants completed the questionnaire. Their mean age was 30 (sd 5.6) years. The mean gestational period was 31.9 (sd 7.9) weeks. The majority, 104 (63.4%) chose to breastfeed while 60(36.6%) chose not to breastfeed. Thirty four, (21%) had difficulties in making a choice because they were unsure of what was best to do and that infant formula was too expensive. One hundred and twenty one, (74.7%) sought help from health care providers in choosing the best feeding option for the baby while, 98 (59.8%) reported that the purpose for choosing the best feeding option was in order to reduce HIV transmission. The major problems faced by HIV infected mothers in choosing the best feeding option included: Forty eight, (29.3%) cannot afford to buy infant formula and forty six (28%) mentioned HIV status as a hindering factor towards choosing the best feeding option. Conclusion: Decision making capacity among HIV infected women is generally low especially regarding infant feeding. There is also evidence of knowledge gaps regarding HIV positive women’s decision making about infant feeding options. Recommendations: There is need to incorporate a multi-disciplinary decision-support framework using the Ottawa decisional support guide into the AMPATH PMTCT program in order to empower women with knowledge regarding infant feeding in the context of HIV and to enable them to become effective decision-makers in areas pertaining their own health and that of their family members.