FACTORS INFLUENCING THE CHOICE OF INFANT FEEDING OPTIONS AMONG HIV POSITIVE MOTHERS ATTENDING HEALTH FACILITIES IN CALABAR SOUTH, CALABAR, CROSS RIVER STATE

CHAPTER ONE

INTRODUCTION

1. Background to the Study

Infant feeding is essential in the first year of life and a key determinant of child survival and development. Breastfeeding is a universal socio-culturally acceptable, nutritious way to feed infants and enhances children immunity (UNAIDS, 2015). However, research indicates that breast milk contributes about 15% of the risk of HIV transmission from an infected mother to the child, especially when mixed feeding is practiced before weaning (Nduati, Richardson & John, 2011). In sub Saharan Africa, mother to child transmission (MTCT) of HIV is responsible for about 90% of infection in children, and about half of these infection thought have been acquired through breast feeding (Newell, 2016). The dilemma posed between lifesaving benefit and risk of transmission through breastfeeding complicate infant feedings in a communities affected by HIV/AIDS.  Globally, it is estimated that 35% of under-five mortality is due to HIV and AIDS (UNAIDS, 2015).

Prevention of mother-to-child transmission (PMTCT) of HIV is an important intervention in the prevention and control of HIV and AIDS to reduce child mortality and increase the rate of child survival (UNAIDS, 2015). A culturally acceptable, low cost approach to infant feeding is essential to prevent HIV transmission through breast milk (Coovadia, Rollins, Bland, Little, Coutsoudi, Bennish & Newell, 2014). In countries not affected by HIV, improving infant feeding can reduce mortality by up to 19%. The impact could be greater in HIV affected populations if interventions that reduce HIV transmission through breastfeeding could be successfully linked to strategies that improve infant feeding practices (Coovadia et al., 2014). However, this is confounded by the complexity of identifying the most appropriate infant feeding practices that fit household and social circumstances of mothers. The World Health Organization recommends that in light of the effectiveness of Anti-retrovirals (ARVs), HIV infected mothers should continue breast feeding their infant until twelve months of age (WHO, 2010).This capitalizes on the maximum benefit of breast feeding to improve the infant’s chances of survival while reducing the risk of HIV transmission.

The Nigerian national HIV guidelines states that avoidance of all breastfeeding by HIV-infected mothers is recommended “when replacement feeding is acceptable, feasible, affordable, sustainable and safe (AFASS). Otherwise, exclusive breastfeeding is recommended during the first months of life” (Federal Ministry of Health, 2010). This calls on governments and donors to increase commitment to and resources for improving infant feeding practices in HIV affected populations. The investment should be targeted to effectively prevent infants from becoming infected with HIV through breastfeeding, improve HIV free-survival of infants and achieve international developments goals, such as Millennium Development Goals (MDGs) and those set by United Nations General Assembly Special Session on HIV and AIDS (UNGASS) (WHO, 2010). The risk of HIV transmission increases (25-45%) with the age of infant and maternal practice of mixed feeding before 6 months of life (Federal Ministry of Health, 2010).  Supporting optimal infant feeding practices was a challenge for health systems (WHO, 2010).

The main challenge is how to improve, through optimal feeding the nutritional status, growth and healthy development and thus survival of infants and young children in the given circumstances in the middle of HIV/AIDS pandemics (World Health Organization WHO, 2010). The World Health Organizations guideline on HIV and infant feeding which was revised in 2010 recommends that in order to reduce the risk of the baby becoming infected, mothers or their infants are advised to take a course of antiretroviral drugs through the breastfeeding period.  Mothers are also advised to exclusively breastfeed their infants for 6 months meanwhile introduces other food substances while continuing breastfeed up to a year. The guideline also lists special conditions needed to safely formula feed (WHO, 2010).  Some studies revealed that the risk of mother to child transmission is lower among mothers who exclusively breastfed when compared to those who practiced mixed feeding. Evidences also indicates that exclusive replacement feeding (ERF) is associated with low risk of post natal HIV transmission and high mortality when compared to breast feeding (Kuhn, Kankasa, Semrau, Kasonde, Scott, 2017).

There are limited comprehensive intervention package available to postpartum mothers in most health facilities in Cross River State. Feeding of the HIV-exposed infant in settings where a high premium is placed on breastfeeding is a major challenge. This study therefore is aimed at determining factors influencing the choice of infant feeding options among HIV positive mothers attending health facilities in Calabar South, Calabar, Cross River State