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ADHERENCE TO INFORMED CHOICE OF INFANT FEEDING OPTION AMONG HIV-POSITIVE MOTHERS AT NAUTH NNEWI AND OUTCOME OF THEIR INFANTS AT 6 MONTHS OF AGE
Abstract
Adherence to infant feeding recommendations is a very important determinant of HIV
free survival of infants of HIV-positive mothers. Due to the high burden of MTCT of
HIV, childhood deaths attributable to HIV as well as malnutrition in Nigeria, this study
was carried out to determine the adherence to choice of infant feeding option among HIV
positive mothers at NAUTH, Nnewi and the outcome of their infants at 6 months of age.
A descriptive longitudinal study was carried out among 142 HIV-positive mother-infant
pairs. The mothers were interviewed at enrolment (within 24 hours of delivery) to
document relevant socio-demographic and obstetric characteristics as well as choice of
infant feeding option. The actual infant feeding practice of the mothers, difficult
challenges encountered as well as occurrence of diarrhoea and hospital admissions were
documented during follow-up visits. The anthropometric parameters of the infants were
documented within 24 hours of birth and at each follow-up visit. The HIV status of the
infants were determined at 6 weeks and 6 months of age using DNA PCR. Data analysis
was done using SPSS software (version 17). Outcome measures at 6 months were
survival, HIV status, nutritional status and morbidity pattern.
Majority of the mothers (72.5%) opted for exclusive formula feeding during the first 6
months although most of the mothers that chose exclusive formula feeding did not have
the basic requirements for safe replacement feeding. Major reasons given for choice of
infant feeding option were avoidance of MTCT among 90.3% of formula feeding mothers
as well as fear of suspicion of HIV-positive status (51.3%) or non affordability of the cost
of replacement feeding (38.3%) among breastfeeding mothers. No factor was significantly
associated with choice of infant feeding option.
There was high rate of non-adherence to initial choice of infant feeding option and early
commencement of complementary feeding in both formula fed and breastfed categories.
Only 7.8% of formula fed and 20.5% of breastfed infants were not on complementary
feeds at 6 months of age. Mothers that chose to formula feed were significantly more
likely to commence complementary feeding at an earlier age. The major reasons for non
adherence to exclusive formula feeding were financial constraints(43.2%) and milk not
being enough for baby (53.6%). On the other hand, the major reason for not breastfeeding
exclusively for 6 months was fear of MTCT with further exposure of baby to
breastmilk(51.6%). Factors significantly associated with early commencement of
complementary feeds were the number and type of pre-natal infant feeding counselling,
having higher number of children, not being married and lower level of mother’s
educational status. The practice of mixed feeding occurred within 5 weeks of delivery in
3(7.9%) breastfeeding and 3(2.9%) formula feeding mothers but the difference was not
statistically significant.
MTCT occurred in one formula fed (1.0%) and one breastfed (2.6%) infant giving an
overall MTCT rate of 1.4% at 6 months. However, the prevalence of moderate to severe
malnutrition (37.3% using weight-for-age), occurrence of diarrhoea (53.5%) and hospital
admissions (14.8%) were high among all the infants. Although the infants of mothers that
chose to formula feed were more likely to have diarrhoea and moderate to severe
malnutrition, the association was only statistically significant for stunting and having low
OFC-for-age. The only mortality occurred in a formula fed baby at 6 months.
Among formula fed infants, early introduction of complementary feeds and having less
than 4 feeding utensils were significantly associated with occurrence of diarrhoea while
low educational status of mother, low social class, having at least one dead sibling,
occurrence of diarrhoea, hospital admission and early commencement of complementary
feeding were significantly associated with moderate to severe malnutrition. Among
breastfed infants, occurrence of diarrhoea and early introduction of complementary feeds
were significantly associated with moderate to severe malnutrition.
The option of breastfeeding is more appropriate for most HIV-positive mothers at
NAUTH, Nnewi. The national guideline for feeding of infants of HIV-positive mothers
should be fully implemented in the centre and breastfeeding HIV-positive mothers should
be adequately supervised and counselled. Further studies are needed to determine the
content and quality of infant feeding counselling at NAUTH, Nnewi. Large community
based studies are also needed to examine the practice and success of current national
infant feeding guideline for HIV-positive mothers.
