Feeding practices for children aged 0-24 months and feeding alternatives for those born to hiv positive mothers and their association with nutritional status: a case study of Kisii district Hospital -Kenya
Poor breastfeeding and infant feeding practices have adverse effects on the health and nutritional status of children, HIV being one of the major confounding circumstances in infant feeding. Against the backdrop of this realization, efforts are therefore required to protect, promote and support appropriate infant feeding practices. The study was designed to assess the infant feeding practices and feeding alternatives available for children of the untested mothers and those born to HIV positive mothers, and the factors determining choice of infant feeding alternatives. The Mother-to- child transmission (MCTC) knowledge level of mothers and the general nutrition status of the children were also assessed.* The study was cross sectional and explanatory. It was carried out in Kisii District hospital on a sample of 186 children aged 0-24 months with their respective mothers or caretakers as respondents. A previously pre-tested and structured questionnaire was used to collect data on: infant feeding practices; breast milk alternatives; MTCT knowledge of the mothers; anthropometry of the children; socio-economic and demographic characteristics of the households; morbidity; and nutritional status. In addition focus group discussions, key informant interviews and observations were used as supplementary methods of data collection.* Simple descriptive statistics, bivariate analysis (chi-square test) and multivariate logistic regression analysis were performed on the data using SPSS (version 12.01) and Epi Info (version 6) software.* In general there were significant differences in the infant feeding practices by the non tested mothers from those of the HIV positive mothers. The main complementary foods given were cow milk, uji, meat, pulses and eggs. The HIV positive mothers gave significantly more meat, legumes and eggs than the non-tested mothers.* On 19.5% of the children below the age of 2 months were exclusively breastfed. The practice of giving pre-lacteal (cow milk and herbal concoctions was common. Complementary foods mainly cow’s milk and uji were introduced early at a mean age of 2-3 months due to perceived milk insufficiency. Up to 85.4% of the children had been breast fed. Slightly more than half of the mothers introduce breast milk within the first 24 hours of delivery. Breast feeding was mainly on demand and continued to the second year (median 23 months) of life of the infant.* There were significant differences p<0.05 between the level of use of the infant feeding alternatives by the HIV positive mothers and by the non- tested mothers. The main alternatives were wet nursing, breast milk, cow milk. Cow milk was the most popular alternative and wet nursing was significantly more acceptable to the HIV positive mothers than the non tested mothers. The HIV positive mothers had a higher MTCT knowledge level than the non-tested mothers. The maternal MTCT knowledge was poor at 19.6 among the non tested mothers and a bit higher among the HIV positive mothers at 39.4%. The choice of infant feeding alternative was influenced by a number of factors including: cultural attitudes, health and nutrition education and knowledge on MTCT.* Exclusive breastfeeding was significantly associated with nutritional status of the child in regards to the underweight status of the child. Children who were not exclusively breastfed had a higher likelihood of being underweight. Immunization status of the child also had significant association with the nutritional status of the child.* Marital status of the mother has significant association with wasting and underweight status. Age of the index child also has a significant association with wasting and underweight status.* The nutritional status of the children born to the non tested mothers indicated that: 9.9% were severely stunted, 0.8% was severely wasted and 6% were severely underweight. However the nutritional status of children born to the HIV positive mothers indicated that 46.4% were severely stunted, 28.6% were severely wasted, and 35.7% were severely underweight.* There were significant differences (P=<0.05) in the morbidity patterns of the children born to HIV Positive mothers in comparison to the non-tested mothers. Anaemia and pneumonia were significantly more prevalent among children born to HIV positive mothers than among those born to the non tested mothers.* The two main predictors of the nutritional status were age of the child, and exclusive breastfeeding. The nutritional status of children born to HIV positive mothers was significantly poorer than that of the children born to untested mothers. The level of use of alternatives was significantly higher among the HIV positive mothers than among the non tested ones.