Knowledge on mother-to-child transmission (MTCT) of human immuno-deficiency virus (HIV) and alternative infant feeding practices: a case study of Boro division, Siaya district
Mother to child transmission (MTCT) accounts for 90% of HIV infections in children, with one third occurring through breastfeeding. Breast milk transmission is markedly higher in breastfeeding populations as is the case in Kenya, where breastfeeding is still the most feasible, accessible and effective intervention for child survival. As part of efforts to reduce transmission through breast milk, there has been a shift in policy regarding breastfeeding. Mothers aware of this are likely to seek alternative ways of infant feeding in cases where babies are born to HIV -infected mothers. It was therefore, the aim of this study to assess the knowledge of mothers/caregivers about HIV /AIDS and Mother-to-child transmission (MTCT) of HIV and the alternative infant feeding practices that could be adopted by HIV -positive mothers or orphans as replacement to breastfeeding. A cross-sectional survey was conducted during the months of September-October 2000 in Siaya District. The specific objectives were: 1. To determine the level of awareness about HIV/AIDS and its transmission through breast milk. 2. To determine infant feeding practices in the community. 3. To determine attitude towards specific recommended infant feeding practices. Two divisions, Karemo and Boro, in Siaya district were covered during the study. A total of 188 mothers or caregivers of children below six months participated in the study and responded to the main questionnaire. Consecutive sampling method was used for the main questionnaire with all households with an infant below 6 months included in the study due to their low numbers. Focus group discussions, key-informant and indepth interviews were also used to enrich quantitative data collected using the main study instrument. Results show that there is a high level of awareness about HIV/AIDS, MTCT and particularly transmission through breast milk. Unfortunately, about 15% of mothers did not know that a mother could transmit HIV to her baby. Most respondents also did not see delivery time as a possible cause of transmission. There were also a few misconceptions where respondents, especially those with little education, had incorrect information on transmission methods. There were some positive feeding practices with almost all (98.9%) the infants still on breast milk. A few mothers initiated breastfeeding within the first hour (21.7%) while a handful (2.6%) were exclusively breastfeeding their babies. On the other hand, negative practices such as mixed feeding and poor choice of alternative feeds were also noted. There is widespread mixed feeding, from as early as the second week of life in some cases, a factor that increases chances of HIV transmission through breastfeeding. Cow's milk was the most popular as a breast milk alternative and is readily available in the community although there is need to increase its availability at the household level and also improve on its preparation to make it nutritionally adequate and safe. Surrogate nursing and the use of other breast milk alternatives were not acceptable to most respondents for fear of cross infection due to unknown status of both baby and wet nurse. From these findings we can conclude that the level of awareness about HIV IAIDS and MTCT is very high, but details are required for better understanding, and to enable mothers make informed and appropriate choices if there is need. Mixed feeding is the main practice as opposed to the recommended exclusive breastfeeding in the first six months of life. There is need for widespread counselling about HIV/AIDS and MTCT as well as on infant feeding practices. Therefore, it is recommended that: I. Mothers and their partners should be targeted with relevant information on HIV/AIDS, MTCT and infant feeding. 2. Voluntary counselling and testing services should be provided at the community level for mothers and their partners to enable them know their status in order to make informed choices. 3. Training and refresher courses are necessary for traditional birth attendants (TBAs) and community health workers (CHWs) by health workers to create awareness among the TBAs and CHWs and using them to disseminate information. 4. Counselling be provided on infant feeding, highlighting advantages of exclusive breastfeeding as well as the risks associated with mixed feeding, breastfeeding and replacement feeding in the context of HIV IAIDS. 5. Men be sensitised about their role in HIV and infant feeding practices and decision making. This will help reduce the fear of stigmatisation. 6. Education on the proper use, suitability and preparation of alternative feeds that have potential such as cow's milk, goat milk and soya should be given. Production and distribution of milk should be improved to increase availability at the household level.