Factors influencing infant feeding prctices among HIV/AIDS-Positive mothers attending the PMTCT programme at Gulu Referral and Lacor Hospitals

Abstract

Background Breastfeeding is usually the best way to feed infants, yet the advent of HIV has complicated this practice in our mothers today. There is enough evidence that exclusively breastfed infants are more protected against childhood morbidity and mortality from respiratory and gastrointestinal infections than those who are mixed fed or exclusively formula fed. Objectives The aim of the study was to determine the infant feeding practices and factors influencing these practices among mothers attending PMTCT program in Gulu Regional Referral and Lacor Hospitals. Study design This was a descriptive cross sectional study. Study methods The study employed both qualitative and quantitative methods of data collection. Two hundred HIV-positive mothers with infants aged 0 to 12 months were enrolled during the study period between July and August 2007. Four focus group discussions, one for the fathers and three for mothers, each consisting 8-10 participants, as well as key informant interviews were conducted to discuss feeding practices and factors influencing these practices among HIV-positive mothers. Quantitative data was entered using EPI Data 3.1 and analyzed using SPSS 11.0 and qualitative data analyzed in themes with direct quotations from respondents given. Study findings The three infant feeding practices described among HIV-positive mothers attending PMTCT program in Gulu and Lacor hospitals were: replacement feeding, exclusive breastfeeding and mixed feeding practiced by 155 (77.5%), 23 (11.5%) and 22 (11%) of the mothers respectively. The age specific proportion exclusive breastfeeding at 0-3 months was 36.6% (OR 7.10 95% CI 0.99-1.73), and 4-6 months was 9.5% (OR 36.2 95% CI 4.83-5.40). Factors that positively influenced replacement feeding were: demonstration of infant feed preparation to the mother by the health workers (OR 25.1 95% C1 7.56-83.60); HIV test done on infant (OR 8.65 95% CI 2.25-33.22); HIV serostatus disclosure to the spouse (OR 5.1 95% C1 1.5 1-17.24) and spouse support towards feeding practice (OR 4.9 95% CI 1.62-14.83). Exclusive breast feeding was positively influenced by the mother being married (OR 5.4 95% CI 1.09-26.45) and male sex (OR 5.8 95% CI 1.13-29.44) and mixed feeding was positively influenced by the infants positive serostatus (p value 0.003, OR 28) and negatively influenced by and demonstration of feed preparation to the mother (OR 0.22 95% CI 0.08-0.61). Factors which influenced feeding practices from focus group discussions and key informant interviews were poverty, lack of serostatus disclosure to spouse and spouse support and need for PMTCT HIV infection. Conclusion Replacement feeding was the predominant feeding practice among the study population. Exclusive breastfeeding was practiced by mothers with infants aged 0-3 months and a small proportion of mothers practiced mixed feeding. Replacement feeding was influenced by infant feed preparation demonstration and by HIV test on the infant. Exclusive breastfeeding was influenced by infant male sex and mother being married. Recommendation Mothers who choose to do replacement feeding should be supported for successful replacement feeding practice. There is need for more health education and information to prevent mixed feeding. Mothers should be encouraged and supported to disclose to their spouses. Male involvement should be promoted to ensure successful PMTCT programs.