Alternatives for infants born HIV- infected mothers in infant feeding practices and potential breastmilk Homa-Bay District
Huge amount of work has been done on HIV/AIDS including on MTCT, but there still remains a dearth of information in areas related to appropriate feeding for infants of mothers infected with HIV. Some suggested infant feeding methods in theory have lots of merit but not much has been done to determine their practical feasibility especially in African rural settings. This study was therefore designed to assess the infant feeding practices and viable breastmilk alternatives for infants born to HIV positive mothers and the sociocultural, health, technological and economic conditions surrounding the choice of such practices in a rural community in South Western Kenya. The study carried out in Nyarongi and Riana Divisions in Homa-Bay district during the period of September - December 2000 had three objectives namely: to determine, 1) maternal knowledge on MTCT of HIV in the community, 2) the prevailing infant feeding practices in the community and among the HIV positive mothers; and 3) the factors affecting mothers' decision on the various feeding alternatives. The study involved the administration of semi-structured questionnaires to one hundred and twelve mothers with infants in addition to Focus Group Discussions, key informant interviews, case studies and observations among a sample of eleven sero-positive mothers. The maternal knowledge on MTCT of HIV was very low in the study area, standing at about 8.9%. The MTCT knowledge was found to influence the alternative feeding choice as mentioned by the non-tested mothers (p=0.001, OR=1.41; 95%CI, 1.04- 3.86). Those with high MTCT knowledge tended to be more receptive and considered feeding alternatives other than cowmilk like expressed breastmilk, formula (p=0.036; OR=2.44; 95%CI, 1.66- 6.04) and milk from milk bank (p=0.015; OR=1.34; 95%CI, 1.13- 5.50) than their counterparts with low MTCT knowledge. The predominant feeding practice traditionally and presently was mixed feeding with virtually none of the babies below 4 months of age exclusively breastfed. The practice of giving prelacteals (mainly plain water and/or herbal drinks) is common. Complementary foods, mainly cowmilk and/or uji are introduced early at a median age of 2-3 months because of perceived insufficient breastmilk or the mother being away from the baby. Breastfeeding is, however, a universal practice with 98.2% having breastfed their babies. Most mothers introduce breastmilk in the first 24 hours of delivery, breastfeed on demand and continue breastfeeding to the second year with median breastfeeding duration of 23 months. The choice of feeding alternative is influenced by a number of factors among them, cultural attitudes, information/instruction received from the health facility, ability to afford the feed and knowledge on MTCT. Wet-nursing is practicable in the community especially by the more elderly women, but has cultural constraints. Infant formula is acceptable among the HIV positive mothers, but is too expensive for them to afford and cowmilk is the most common, acceptable and accessible, even though there is poor knowledge on its modification/dilution. Other suggested feeding alternatives like goatmilk, expressed and heat-treated breastmilk, breastmilk from milk bank and dry powder milk are generally unacceptable in this community. The study recommends that Health/Nutrition education targeted at the sero-positive mothers, but also for the general population; improved community-based medical and family planning services; improved supply of cowmilk in the community; digging of boreholes and latrines for better sanitation among other interventions can help reduce MTCT rate in this area.