Full Project – FACTORS INFLUENCING THE CHOICE OF INFANT FEEDING OPTIONS AMONG HIV POSITIVE MOTHERS ATTENDING NATIONAL HOSPITAL ABUJA, NIGERIA

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CHAPTER ONE

INTRODUCTION

Background to the Study

Human immune-deficiency virus (HIV) is a chronic, health problem with symptoms appearing anytime from several months to years. HIV is found among all known populations of the world, including the embryonic population (unborn babies) and the breastfed babies. World Health Organization, (WHO, 2011) revealed that more than eleven million people worldwide had died of AIDS, while another 3.6 million of people are already infected with HIV, with a daily infection rate of over 16,000 people globally. It was observed by Anyebe, Whiskey, Ajayi, Garba, Ochigbo and Lawal (2011) that by 2002, 42 million people had been infected with HIV/AIDS globally, 38.6 million of them were adults of which 19.2 million were women. More than 3 million children below the age of 15 were infected worldwide within the same period with about 5 million new infections being recorded yearly. Nearly two thirds of these are in Sub-Saharan Africa. Globally, an estimated 600,000 children are infected vertically (in utero) each year, while in places where women do not breastfeed, most of the transmission occurs at the time of labor and delivery, (Okon, 2011).

In Nigeria where most women breastfeed, there is an additional risk. About 800,000 were infected out of 5.8 million in 2003 were infants and children of which 90% of these got infected through their mothers, occurring at three levels; antepartum, intrapartum and breastfeeding (Okon, 2011). There is no cure for HIV currently available, but prevention of mother to child transmission (PMTCT) appears to be the most important intervention (Family Health International, 2004). American international health alliance (AIHA, 2008) in Ajayi, Hellandendu and Odekunle (2011) posited that ‘’ther e is no cure for HIV, but prevention of vertical transmission of HIV to include voluntary counseling and testing, (VCT) , ante-retroviral therapy, elective caesarean section; replacement of infant feed or modified breastfeeding, and restrictive use of invasive procedure such as artificial rupture of membrane, (ARM),episiotomies and cleansing of the birth canal with a microbite during labor and delivery.

Sadoh, Adeniran and Abhulimhen-Iyohas (2008) opined that exclusive breastfeeding is the ideal practice among HIV infected mothers in the first six months of life, as recommended currently, followed by replacement feeding (any formula food rather than breast milk) depending on the acceptability, feasibility, affordability, sustainability and safety (AFASS) of the later. These recommendations are predicted on the transmissibility of HIV via breast milk. Several factors affect infant feeding practices such as non-affordability, non availability of portable drinking water and lack of information, especially in those who do not know their HIV status. Chopra, Doherty and Jackson (2005) observed that for HIV positive mothers to choose their infant feeding options, their choices may be based on; family income, maternal and paternal education, maternal age, access to storage facilities, access to clean drinking water and adequate sanitation and cultural values.

Okelle (2011), observed that babies have specific nutritional needs and are born with an underdeveloped immune system. Therefore, they need food like breast milk to meet these demands. The Federal Ministry of Health (FMOH, 2011) adopted WHO (2010) guidelines that emphasize breastfeeding values exclusively for the first six months of life once mother is on ARVs, then with the introduction of appropriate complementary food while continuing breastfeeding for up to two years and beyond with HIV infected mothers. It also stated that antiretroviral (ARVs) drugs should be made available for HIV positive mothers to reduce the risk of transmission through breastfeeding until one week after the end of breastfeeding and strongly recommends that all mothers including HIV infected mothers should breastfeed their infants.

Based on FMOH standard, Adejuyigbe, Orji, Onayade, Makinde and Anyabolu (2008) and Maru and Haidar (2009) then recommended that health workers should no longer counsel HIV infected mothers on infant feeding options, but to provide information on all the feeding options available, and allow HIV infected mothers to make a choice based on individual circumstances. If HIV infected mother decides not to breast feed, health workers can provide support on proper nutrition safe for the infant or refer to where she can receive such support. Several factors can influence the mother’s choice of breast feeding and complimentary feed, this research therefore was designed to examine factors influencing the choices of infant feeding options among HIV positive mothers in National Hospital Abuja.

Statement of problem

HIV/AID’S has become a global scourge leading to millions of deaths worldwide. Individuals, governments and non-governmental organizations have been battling with it in an attempt to control, reduce and possibly eliminate this pandemic. These attempts have been through campaigns, supply of relatively cheap or free anti-retroviral drugs and other preventive measures such as prevention of mother to child (PMTCT) (Okon 2011).Indeed, studies have shown that HIV could be transmitted from infected mothers to their nursing babies, such transmission is possible through feeding options (Oguta,2004 and Kuhn, Aldrovardi and Sinkala 2007). Such mode of transmission has increased the likelihood of infants being infected and has attracted attention globally.

FMOH (2007) observed that HIV infection among infants has been on the increase and that it is one of the major causes of childhood death. The report further observed that this case is worsened by the feeding options adopted by HIV infected mothers. To buttress this finding, Ajayi, Hellandendu and Odekunle (2011) in their study showed that more than 90% of HIV infected infants were from mother to child during birth or breast feeding. Hence feeding option is one of the critical modes of HIV transmission from mothers to infants. Despite the guide by FMOH and observations, the researcher has observed in clinical practice, that there seem to be misconceptions by HIV infected mothers on infant feeding options. Granted that infants contract HIV from their mother’s during birth or during breast feeding, there is the growing awareness about the available infant feeding options adopted by HIV positive mothers, if this then is the case, what are the factors influencing the choices of feeding options adopted by HIV positive mothers? This research therefore is intended to examine the factors influencing the choices of infant feeding options among HIV positive mothers in National Hospital Abuja, Nigeria.

Purpose of the study

The purpose of this study was to investigate factors influencing the choice of infant feeding options among HIV positive mothers in National Hospital Abuja. .

Objectives of the study

The specific objectives of this study are to;

• determine socio-demographic factors influencing the choices of infant feeding options
• identify maternal factors influencing the choice of infant feeding options
• identify factors in the infant that can influence choices of feeding
• identify health system factors influencing the choices of infant feeding options

Research questions

• What are the socio-demographic and socio-economic factors influencing the choices of infant feeding options?
• Do maternal factors influence the choices of infant feeding options?
• What infant factors influence choice of infant feeding options?
• What are the health system factors that can influence infant feeding options?

Significance of the study

This research will be useful in so many ways to different people and other related fields.

To the nurses, medical doctors and other health care givers, the outcome of this research will inform policy recommendations on the choices of infant feeding options among HIV positive mothers and how they can advice policies and practices.

To health care providers in the voluntary counseling sessions and other stand alone facilities and support groups, the outcome of this research will be a useful guide and reference materials during their counseling sessions and support group activities.

To HIV positive mothers, it will service as a guide to their choices of infant feeding options. To other researchers in this field and other related fields, the outcome of this research will serve as a guide during intervention project design and planning.

Scope of Study

This study was delimited to HIV positive mothers within the two health facilities studied, General Hospital National Hospital Abuja and Roman Catholic Maternity (RCM) Hospital National Hospital Abuja. It also covers socio demographic factors, mother factors, infant factors, and health system factors.

Operational definition of terms

Factors influencing infant feeding choices; these are socio demographic, health system, mother and infant factors.

Replacement or artificial feeding: this is feeding an infant with formula food rather than breast milk.

Socio demographic factors: are mother’s age, educational background, religion, marital status, mother’s occupation, husband’s occupation and month ly income.

Mother factors: are mothers’ behavior towards breast feeding, experiences at pregnancy and delivery.

Health system factors: Is the health services rendered in health care settings.

Infant factors; are experiences at birth to thirty six months.

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Full Project – FACTORS INFLUENCING THE CHOICE OF INFANT FEEDING OPTIONS AMONG HIV POSITIVE MOTHERS ATTENDING NATIONAL HOSPITAL ABUJA, NIGERIA