Abstract:

Mother to child transmission of HIV is the major route of HIV infection in children and is responsible for nearly 90% of childhood infections. International guidelines on infant feeding for HIV- positive mothers promote exclusive replacement feeding (ERF) or exclusive breastfeeding (Laar and Govender, 2013). In spite of these guidelines, poor maternal, infant and young child nutrition (MIYCN) practices are widely documented in Korogocho, with potential detrimental effects on child growth and survival. Rates of exclusive infant feeding, both breast-feeding and formula-feeding, are suboptimal in Korogocho slums with exclusive breastfeeding for the first six months being at about two per cent. (Kimani-Murage et al., 2013). This study was thus carried out with the main objective of assessing the infant feeding challenges of HIV positive mothers in this slum which leads them to practice poor infant feeding. Purposive sampling was used to select the study site and simple random sampling was used to select a sample of 103 calculated using Fischer’s method from a target population of 140. Data was collected using interviewer administered questionnaires and three focus group discussions were conducted. Quantitative data was cleaned, coded, entered and analyzed using SPSS Version 16. Qualitative data was analyzed using a three stage thematic approach through transcription of the tape recordings, summarization, thematical description and direct reporting where necessary. Quantitative data was presented in the form of tables and textual summaries. Results from this study showed poor knowledge of appropriate infant methods as only 46 (44.7%) mothers were satisfied with the infant feeding counseling they had received from the health personnel. Poor clinic attendance by 61(59.2%) of the mothers may have led to short and few sessions and it also affected the time of infant feeding thus the poor quality of counseling. Most of the mothers were aware of mother to child transmission (MTCT) of HIV through breastfeeding and 62(60.2%) knew that it could be prevented through exclusive breastfeeding, 60 (58.3%) through replacement feeding and 54 (52.4%) through early and abrupt cessation of breastfeeding though quite a number lacked this knowledge. The concerns raised by breastfeeding mothers included; 29(56.9%) inability to produce sufficient milk, 23 (45.1%) infections in the baby’s mouth, 19 (37.3%) breast infections and 9(11.8%) inability to control the feeding due to the influence of the extended family. Feelings of guilt 33(94.3%) and cost of replacement feeding 26(74.3%) were the major concerns among replacement feeding mothers. Though 17 (16.5%) had ceased breastfeeding early, up to 15(88.2%) of them lacked advice on the appropriate feeding methods after breastfeeding cessation. Mothers in this study were aware of the WHO recommendations on infant feeding and MTCT through breastfeeding and its prevention. However, they faced several challenges which include poor knowledge on appropriate infant feeding methods, inability to produce sufficient milk, high cost of replacement food and lack of knowledge on appropriate infant feeding practices after cessation of breastfeeding. More emphasis should be put on proper clinic attendance by the mothers as this will provide additional time for the health personnel to provide full information infant feeding. Provision of information on appropriate infant feeding practices after cessation of breastfeeding should be enhanced. Further investigations are required to determine the cause of insufficient milk production by the mothers.

References:

[1] Aidam BA, Pérez-Escamilla R, Lartey A. (2005) Lactation counseling increases exclusive breast-feeding rates in Ghana. Journal of Nutrition. 33: 1691-1695. jn.nutrition.org/content/135/7/1691.full

[2] Aika AAO, Luo C, Kankasa C, Bhat GJ, Bunn J. (2003) Infant-feeding practices of mothers of known HIV status in Lusaka, Zambia. Health Policy and Planning; 18: 156-162.)

[3] Alcala M. (2005) State of the world population. UNFPA Publication. New York, USA

[4] Asefa A, Beyene H. (2013) Awareness and knowledge on timing of mother-to-child transmission of HIV among antenatal care attending women in Southern Ethiopia: a cross sectional studyJournal of Reproductive Health10: 66

[5] Background. Korogocho Slum Upgrading Programme (KSUP http://www.ksup.org

[6] Becquet R, Ekouevi DK, Viho I, Sakarovitch C, Toure H, Castetbon K. (2005b). Acceptability of exclusive breast-feeding with early cessation to prevent HIV transmission through breast milk, ANRS 1201/1202 Ditrame Plus, Abidjan, Cote d’Ivoire. Journal of Acquired Immune Deficiency Syndrome, 40 (5): 600-608.

[7] Bezner KR, Dakishoni L, Shumba L, Msachi R, Chirwa M. (2008) “We grandmothers know plenty:” breastfeeding, complemantary feeding and the multifaceted role of grandmothers in Malawi. Soc. Sci. Med.66 (5):1095-105

[8] Bhandari N, Bahl R, Mazumdar S, Martines J, Black RE, Bhan MK.(2003). Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomized controlled trial. Lancet, 361 (9367): 1418-1423.

[9] Bland RM, Rollins NC, Coutsoudis A, and Coovadia HM. (2002). Breastfeeding practices in an area of high HIV prevalence in rural South Africa. Acta Paediatrica, 91 (6): 704-711.

[10] Burr C K. (2011) Reducing Maternal-Infant HIV Transmission http://hab.hrsa.gov/deliverhivaidscare/clinicalguide11/cg-402_pmtct.html

[11] Chopra M, Doherty T, Jackson D, Ashworth A. (2005) Preventing HIV transmission to children: quality of counseling of mothers in South Africa. Journal of Paediatrics94: 357-363.

[12] Chopra M, Rollins N. (2007) Infant feeding in the time of HIV: Assessment of infant feeding policy and programs in four African countries scaling up prevention of mother to child transmission programs. Global Health Sciences Literature Digest. Available at:http://hivinsite.ucsf.edu/InSite?page=jl-20-02. Accessed September 15, 2013.

[13] Coutsoudis A, Pillay K, Kuhn L, Spooner E, Tsai WY, and Coovadia HM.(2001). Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: prospective cohort study from Durban, South Africa. AIDS, 15 (3): 379-387.

[14] Coutsoudis A. (2005). Infant feeding dilemmas created by HIV: South African experiences. Journal of Nutrition, 135 (4): 956-959.

[15] Desclaux A, Alfieri C. (2009) Counseling and choosing between infant-feeding options: Overall limits and local interpretations by health care providers and women living with HIV in resource-poor countries (Burkina Faso, Cambodia, Cameroon) Journal of Social Science and Medicine.30:203-210

[16] De Paoli MM, Manongi R, and Klepp KI. (2001). Counsellor’s perspectives on Antenatal HIV testing and infant feeding dilemmas facing women with HIV in northern Tanzania. Reproductive Health Matters, 10 (20): 144-156.

[17] De Paoli MM, Manongi R, Helsing E, and Klepp KI. (2002). Exclusive Breastfeeding in the era of AIDS. Journal of Human Lactation, 17 (4): 313-320.

[18] De Paoli MM, Manongi R, Klepp KI. (2004) Are infant feeding options that are recommended for mothers with HIV acceptable, feasible, affordable, sustainable and safe? Pregnant women’s perspectives. Public Health Nutrition; 7: 611-619).

[19] Doherty T, Chopra M, Nkonki L, Jackson D, Persson L. (2006a) A Longitudinal Qualitative Study of Infant-Feeding Decision Making and Practices among HIV-Positive Women in South Africa. Journal of Nutrition; 136: 2421-2426

[20] Doherty T, Chopra M, Nkonki L, Jackson D, Greiner T. (2006 b) “Effect of the HIV epidemic on infant feeding in South Africa: “when they see me coming with the tins they laugh at me”. Bulletin of World Health Organisation; 84(2):90-96

[21] Ehrnst A, Zetterstrom R. (2005) Feeding practices of HIV-1-infected mothers: The role of counselors. Acta Paediatrica, 2005; 94: 263 - 265.)

[22] Emina J, Beguy D, Zulu EM, Ezeh AC, Muindi K, Elung’ata P, Otsola JK, Ye Y. (2009) Monitoring of health and demographic outcomes in poor urban settlements: evidence from the Nairobi Urban Health and Demographic Surveillance System. Journal Urban Health 2011, 88(2):S200-S218.

[23] Engebretsen IMS, Moland KM, Nankunda J, Karamagi CA, TylleskärT, Tumwine JK. (2010) Gendered perceptions on infant feeding in Eastern Uganda: continued need for exclusive breastfeeding support International Breastfeeding Journal, 5:13 http://www.internationalbreastfeedingjournal.com/content/5/1/13

[24] Fawzi W, Msamanga G, Spiegelman D, Renjifo B, Bang H, Kapiga S. (2002). Transmission of HIV-1 through breastfeeding among women in Dar es Salaam, Tanzania. Journal of Acquired Immune Deficiency Syndrome, 31 (3): 331-338.

[25] GOK. (2009) Korogocho Slum Upgrading Programmehttp://www.ksup.org/

[26] Haddis M, Jerene D. (2006) Awareness of antenatal care clients on mother-to-child transmission (MTCT) of HIV infection and its prevention in Arba Minc Ethiopian Journal of Health Development20(1):56-60 http://www.ajol.info/index.php/ejhd/article/view/10012

[27] Iliff, PJ, Piwoz EG, Tavengwa NV, Zunguza C, Marinda ET, Nathoo KJ. (2005). Early exclusive breast-feeding reduces the risk of postnatal HIV-1 transmission and increases HIV free survival. Journal of Acquired Immune Deficiency Syndrome, 19: 699-708.

[28] Kafulafula UK, Hutchinson MK, Gennaro S, Guttmacher S, Kumitawa A.(2013) Exclusive breastfeeding prenatal intentions among HIV-positive mothers in Blantyre, Malawi: a correlation study. BMC Pregnancy Childbirth. http://www.ncbi.nlm.nih.gov/pubmed/24195765

[29] Kiarie JN, Richardson BA, Mbori-Ngacha D, Nduati RW, John-Stewart GC. (2004) Infant feeding practices of women in a perinatal HIV-1 prevention study in Nairobi, Kenya. Journal of Acquired Immune Deficiency Syndrome, 35 (1): 75-81.

[30] Kimani-Murage EW, Kyobutungi C, Ezeh AC, Wekesah F, Wanjohi M, Muriuki P, Musoke RN, Norris SA, Griffiths P, Madise NJ. (2013) Effectiveness of personalized, home-based nutritional counseling on infant feeding practices, morbidity and nutritional outcomes among infants in Nairobi slums: study protocol for a cluster randomized controlled trial. Trials 2013, 14:445 http://www.trialsjournal.com/content/14/1/445

[31] Koniz-Booher P, Burkhalter B, deWagt A, Iliff P, Willumsen.(Eds) (2004). HIV and infant feeding. A compilation of programmatic evidence, Published for UNICEF and USAID by the Quality Assurance Project, University Research Co., LLC, Bethesda, MD.

[32] Korogocho. BEGA KWA BEGA Development project. Accessed 2009-06-02 http://www.begakwabega.com/Korogocho-eng.html

[33] Korogocho. St. John’s sports society http://stjohnssportssociety.weebly.com/about-us.html

[34] Kuhn L, Stein Z, Susser M. (2004) Preventing mother-to-child transmission in the new millennium: the challenge of breast feeding. Paediatric and Perinatal Epidemiology, 18: 10-16.

[35] Laar AS, Govender V. (2013) Individual and Community Perspectives, Attitudes, and Practices to Mother-to-Child-Transmission and Infant Feeding among HIV Mothers in Sub-Saharan Africa: A Systematic Literature Review. International Journal of MCH and AIDS2: 152-162

[36] Leroy V, KaronJM, Alioum A, Ekpini ER, van de Perre P, Greenberg AE.(2003) Postnatal transmission of HIV-1 after a maternal short-course zidovudine peripartum regimen in West Africa. AIDS, 17(10): 1493-1501.

[37] Leshabari SC, Koniz-Booher P, Astrom AN, De Paoli MM, Moland KM. (2006) Translating global recommendations on HIV and infant feeding to the local context: the development of culturally sensitive counseling tools in the Kilimanjaro Region, Tanzania. Implementation Science. 1:22 doi: 10.1186/1748-5908-1-22. Accessed January 1, 2013.

[38] Mnongya L M. (2013) Dilemma of choice between breastfeeding and replacement feeding among HIV positive mothers in Tanzania http://www.ajol.info/index.php/dmsj/article/view/88971

[39] Muluye D, Woldeyohannes D, Gizachew M, Tiruneh M. (2012) Infant feeding practice and associated factors of HIV positive mothers attending prevention of mother to child transmission and antiretroviral therapy clinics in Gondar Town health institutions, Northwest Ethiopia. BMC Public Health. 2012 Mar 26; 12:240. doi: 10.1186/1471-2458-12-240.

[40] Mugenda O, Mugenda A. (1999). Research Methods: Qualitative and Quantitative Approaches. Act Press, NBI.

[41] Nicolaj N. (2005) Korogocho the land and the people. Monthly Review Press Book, Nairobi

[42] Omari AA, Luo C, Kankasa C, Bhat GJ, and Bunn J. (2003) Infant-feeding practices of mothers of known HIV status in Lusaka, Zambia. Health Policy and Planning. 18 (2): 156-162.

[43] Piwoz EG, Bentley ME. (2005) Women's Voices, Women's Choices: The Challenge of Nutrition and HIV/AIDS135(4):933-7. http://www.ncbi.nlm.nih.gov/pubmed/15795465

[44] Rea MF, Gomes dos Santos R, Sanchez-Moreno CC. (2007) Quality of infant feeding counseling for HIV positive mothers in Brazil: Challenges and achievements. Acta Paediatrica; 96:94–99.

[45] Rollins Meda N, Becquet R, Coutsoudis A, Humphrey J, Jeffrey B. (2004) Preventing postnatal transmission of HIV-1 through breast-feeding: modifying infant feeding practices. Journal of Acquired Immune Deficiency Syndrome, 35 (2):188-195.

[46] Sadoh E, Adeniran A, Abhulimhen-Iyoha I.(2008) Infant-feeding Practices among HIV-infected Mothers in an HIV-treatment Programme. Health Population and nutrition Journal. 2008; 26: 463-467.

[47] Shah S, Rollins NC, Bland RM. (2005) Breastfeeding knowledge among health workers in rural South Africa. Journal of Tropical Paediatrics, 51 (1):33-38

[48] Shapiro RL, Lockman S, Thior I, Stocking L, Kebaabetswe P, Wester C, Peter T, Marlink R, Essex M, and HeymannJ. (2003) Low adherence to recommended infant feeding strategies among HIV-infected women: results from the pilot phase of a randomized trial to prevent mother-to-child transmission in Botswana. AIDS Educationand Prevention, 15 (3): 221-230.

[49] Suryavanshi N, Jonnalagadda S, Erande AS, Sastry J, Pisal H, Bharucha KE, Shrotri Pandurang M, Bulakh PM, Phadke MA, Robert C, Bollinger RC, and Shankar AV. (2003) Infant Feeding Practices of HIV-Positive Mothers in India Journal of Nutrition 133:1326-1331

[50] Thairu LN, Pelto GH, Rollins NC, Bland RM, and Ntchangase N. (2005) Socio-cultural influences on infant feeding decisions among HIV-infected women in rural Kwa-Zulu Natal, South Africa. Maternal and Child Nutrition, 1: 2-10.

[51] UNAIDS. (2010) UNAIDS Report on the Global AIDS Epidemic 2010. Available at: http://www.unaids.org/en/dataanalysis/Accessed September 13, 2012.)

[52] UNAIDS. (2011) AIDS at 30;Nations at the crossroads. Section 3

http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/20110531

[53] UNAIDS. (2012). Report on the Global AIDS Epidemic. Geneva: Joint United Nations Programme on HIV/AIDS

[54] UNAIDS. (2013) Report on the Global AIDS Epidemic. Geneva: Joint United Nations Programme on HIV/AIDS.

[55] UNICEF. (2012) Nutrition HIV and Infant Feeding

http://www.unicef.org/nutrition/index_24827.html

[56] Wendo C. (2003) HIV-positive mothers in Uganda resort to breastfeeding. The Lancet; 16; 362 (9383) 542.)

[57] Wikipedia. (2013) Korogocho- Wikipedia, the free encyclopedia http://en.wikipedia.org/wiki/Korogocho

[58] WHO. (2003) UNICEF; UNFPA; UNAIDS. HIV and Infant Feeding: guidelines for Decision-makers, Reviewed. Geneva, Switzerland World Health Organization

[59] WHO. (2006) WHO HIV and Infant Feeding Technical Consultation Held on behalf of the Inter-agency Task Team (IATT) on Prevention of HIV Infections in Pregnant Women, Mothers and their Infants: Geneva, Switzerland World Health Organization

[60] WHO. (2007) HIV Transmission through Breastfeeding. A Review of Available Evidence An Update from 2001 to 2007).

[61] WHO. (2011) WHO, UNAIDS and UNICEF. Towards universal access: scaling up priority HIV /AIDS interventions in the health sector. Progress report, 2011. Geneva, World Health Organization.

[62] Young SL, Mbuya NNM, Chantry JC. (2011) Current Knowledge and Future Research on Infant Feeding in the Context of HIV: Basic, Clinical, Behavioral, and Programmatic. Perspectives Advances in Nutrition.; 2: 225-243.