Abstract:
Background: World Health Organization recommends exclusive breastfeeding (EBF) for 6 months with maternal
active antiretroviral therapy (ART) to prevent mother-to-child transmission (PMTCT) of HIV. However, EBF in low
resource settings remains low. We explored perspectives of EBF by HIV-infected mothers and health care workers in
Busia County with a high prevalence of HIV to understand factors infuencing the practice.
Methods: A mixed methods cross-sectional survey using concurrent quantitative and qualitative data collection
methods was conducted at PMTCT clinics. Data on socio-demography, young infant feeding practices, maternal and
infant health was collected between February 2013 and August 2015 from 371 purposively sampled HIV-infected
mother-infant dyads using a semi-structured questionnaire. Focus group discussions with mothers, in-depth inter‑
views and passive observation of health care workers during interaction with mothers were conducted. Signifcance
of diference between mothers practicing EBF or not was tested by Chi-square and Fisher’s exact tests setting signif‑
cance level at 5%. Qualitative data was coded and content analyzed to generate themes.
Results: Three hundred and forty-nine (94%) mothers practiced EBF. Maternal comprehension of EBF to PMTCT of
HIV infuenced choice and practice of EBF (P value=0.019 and<0.001 respectively). Health care workers emphasized
adherence to ART and ofered nutritional supplementation during EBF. Health care workers’ nutritional counseling in
the context of maternal HIV was poor. Mentor mothers shared their experiences with mothers and ofered live case
demonstrations of their successfully EBF, healthy and HIV-uninfected children. The main threats to EBF were teenage
motherhood, low maternal education and working during EBF.
Conclusions: EBF among HIV-infected mothers in Busia County, Kenya was high. Health education and counselling
by health care workers, maternal comprehension of ART adherence to PMTCT of HIV, nutritional supplementation
and mentor mothers’ peer counseling using live case demonstrations of HIV-uninfected EBF children promoted and
sustained practice of EBF for 6 months. Teenage motherhood, low maternal education and having to work threatened
EBF