Adherence to infant feeding practices among HIV positive mothers with infants aged below six months in Rakai district.

Abstract

INTRODUCTION: Adherence to infant feeding practices among HIV positive mothers is associated with good health outcomes, which are intended to reduce transmission of HIV from mother to child. The basis of child health and survival strategy in the developing countries has been the promotion of breast feeding. However, breast feeding accounts for up to 30% of HIV transmission from mothers to infants. In Uganda, policies previously promoted breastfeeding even among HIV positive mothers without offering an informed choice of feeding mode. In 2001, however, the ministry of health developed and adopted policy guidelines on feeding of infants and young children in the context of HIV/AIDS. However, little is known about the adherence to infant feeding practices in Rakai district. GENERAL OBJECTIVE: To identify factors affecting adherence to infant feeding practices among HIV positive mothers with infants aged below six months in Rakai district. METHODOLOGY: A cross-sectional study was conducted in Rakai district; Uganda between February to may 2008. Human immune deficiency virus (HIV) positive mothers, who had infants aged less than 6 months and had attended ANC and consented/ assented to the study were enrolled, using a semi-structured interviewer administered questionnaire. Purposive sampling of five government sites and three private sites offering PMTCT was done. Consecutive enrolment of the mothers was done on every clinic day. Univariate analysis was done, and involved running of frequencies, comparison of means and ranges. Bivariate analysis involved cross tabulations of the independent variables and adherence status results, generating statistical tests of significance like odd ratio, 95% confidence intervals and Chi square. The significant findings at bivariate analysis and the none significant ones, but from literature review and biological basis were found to affect adherence status were included in logistic regression (multivariate analysis). RESULTS: After logistic regression, factors found to favour adherence to infant feeding practices were; having three or less children (AOR 2.5, C1: 1.1-6.4) and having an infant aged three or less months (AOR 3.9, C1:1.7-9.0) Factors found not to favour adherence to infant feeding were; Low education (primary seven and below) of respondent (AOR 0.2, C1:0.1-0.8), group mode of infant feeding counselling (AOR 0.3, C1:0.1-0.7), few (one) counselling session (AOR 0.1, C1:0.1-0.4), and knowing one route of MTCT of HIV (AOR 0.3, C1:0.1-0.7). CONCLUSION: Mixed feeding was the most practiced form of infant feeding, with replacement feeding associated with adherence to the chosen infant feeding option. Factors found to favour adherence to infant feeding practices were; having three or less children and having an infant aged three or less months. Respondents having education of up to primary seven, group mode of infant feeding counselling and fewer (one) number of counselling sessions, did not favour adherence to infant feeding practices. Likewise, community factors like knowledge of only one method of MTCT of HIV did not favour adherence to the infant feeding option. RECOMMENDATIONS: Adherence can be improved through the DHT encouraging mothers to practice accelerated weaning (exclusive breast feeding for three months) because of higher level of adherence in the first three months. The DHT out to encourage mothers to attend at least three infant feeding counselling sessions and to opt and scale up individual counselling which provides privacy. Encouragement of male partner involve in PMTCT programmes ought to be scaled up. There is a need to use more a robust analytical study design to ascertain the influence of numerous factors on adherence to chosen infant feeding options.