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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
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
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.
1.1 BACKGROUND OF THE STUDY
Globally about 30-40 million men, women and children are infected with HIV, 28.5
million of them from Sub-Saharan Africa (UNAIDS, 2002). Each day more than 6000
young people aged 15-24 years are newly infected with HIV. It is estimated that there are
10-15 million Aid’s orphans worldwide, 83 percent of them from Sub-Saharan Africa.
Women take up more than half the number of people living with HIV/AIDS (PLWHA).
In Kenya since the first AIDS case was reported in early 1980s, the epidemic has
expanded in alarming proportions. The current female to male ratios in Kenya is 1:9 one
of the highest Africa, while 10 percent of all PLWHA are children (NASCOP 2002).
Increasing numbers of children who have HIV infection, especially in the countries
hardest hit by the pandemic. In 2002 an estimated 3.2 million children less than 15 years
of age were living with HIV/AIDS, a total of 80,000 were newly infected and 610,000
About 70-80 percent of HIV transmission is through sexual contact. Besides HIV can be
transmitted through parenteral contamination, and perinatal (mother to child) modes . In
children 90 percent of HIV transmissions are as a result of mother to child transmission
during pregnancy, delivery and breastfeeding (Preble and Piwoz, 2000). The remaining
10 per cent is from blood contamination or sexual abuse. According to a sentinel survey
done 30% of women attending antenatal care were diagnosed HIV positive. (NASCOP
2004). In Kenya 1 million children are born every year. Therefore this parallel puts about
300,000 newborn infants at risk of HIV every year.
Since in developing countries total of transmission varies between 25-45 percent, hence
between 75000 – 135,000 are actually infected with HIV. However, not all mothers’
access health care hence more undiagnosed cases go unattended. By far the main source
of HIV infection in young children is Maternal to Child Transmission (MTCT). The
virus may be transmitted during pregnancy labour and delivery, or by breastfeeding.
HIV/AIDS however transmitted has been estimated to account for about 8% of deaths in
children below 5 years of age in Sub –Saharan Africa. In areas where the prevalence of
HIV in pregnant women exceeded 35% the contribution of HIV/AIDS to childhood
mortality was as high as 42%. (Lancet, 2002). Rates of MTCT range from 14-25% in
developed countries and 13-42% in developing countries, where breastfeeding is more
If a mother is infected with HIV, it may thus be preferable to replace breast milk to reduce
the risk of HIV transmission to her infant. The risk of replacement or alternative feeding
should be less than the potential risk of HIV transmission through infected breastmilk, so
that infant morbidity and mortality from other causes do not increase. The risk of HIV
infection through breastfeeding needs to be weighed against the great dangers posed by
artificial feeding. If the only consideration were to prevent HIV from infecting the child
through breast milk, the recommendation would be for the infected mothers not to
breastfeed, and usually to use infant formula. This is what is widely recommended to HIV
Infected mothers in industrialized countries and affluent mothers in non- industrialized
countries. For infected mothers living in poor conditions in developing countries
however, it is important to consider very carefully the risks related to not breastfeeding
and whether there are alternative feeding methods (Latham, 1999; WHO/UNICEF, 1992).
In a rural community where access to clean water and sanitation is inadequate, where
families are too poor to afford enough fuel to prepare food and to sterilize feeding bottles or
to buy sufficient infant formula, deaths from diarrhea and respiratory infections could far
out-number those from HIV. The problem is further aggravated by cultural or social
stigmas that a community may attach to substitute feeding and to HIV/AIDS in general.
There is need for intensified research to guide formulation of and/or influence policy and
intervention programs on this matter. Hitherto there has not been good data available on
the relative risks and benefits of different feeding options (Morrision, 1999). We do not
know which options would save the most lives, be of least cost to society, and have the
fewest negative effects. Health workers and policy makers in are not sure or well
informed to decide on what appropriate actions or advice to give to a mother who is HIV
positive on how to feed her infant (Latham, 1998).
Despite the huge amount of work done on HIV/AIDS including on MCTC, there still
remain some important gaps in knowledge in areas related to appropriate feeding for
infants of mothers infected with HIV-1. Such gaps result into a good deal of confusion in
the minds of health workers, and policy makers are often uncertain about policy
Some feeding options that are appropriate for mothers living in advantaged positions may
be totally. The fourth millennium development goal MDG calls for a two-thirds reduction
between 1990 and 2015 in deaths of children aged less than 5 years. Less than 10% of
HIV infected pregnant women have access to appropriate health care. (UNAIDS 2006)
It is this fraction of infants that have become a major challenge to health professionals
and policy makers alike. It gives a glummer of hope to role that HIV transmission can be
reduced from 25-45 percent to near zero. This endeavor requires a complete package of
health care including maternity and family planning; increased antenatal care; VCT
services for HIV possible use of ART drugs; and safe alternatives to HIV infected
mothers breast milk.
Multidisciplinary efforts are required to curb the rapid spread of HIV. This study is to
explore the prevailing feeding practices, while acknowledging that reduction of postnatal
HIV transmission through breast milk is particularly problematic in resource poor
settings as there are completing risks which are individual and context specific.
1.2 STATEMENT OF THE PROBLEM
Some feeding options that are appropriate for mothers living in advantaged positions may
be totally inappropriate for mothers whose families are less privileged. Some suggested
infant feeding methods in theory have merit, but little investigation has been done to
determine their feasibility, in practical terms, and in different settings.
All evidence suggests that mixed breast and formula feeding is the most dangerous -
feeding option for the young infant because it results in greater risks both of HIV and
other infections. It has been noted that the regimens supporting formula feeding to
reduce MTCT of HIV need especially to consider risks of non- compliance in
different settings. Even in an elaborate urban clinical trial in Kenya, in which
women were assigned either to breastfeed or formula feed, it was reported that there was
poor compliance in the formula group (Nduati et al., 2000). It was difficult to assure
exclusive formula feeding even by mothers who had agreed to participate in the trial,
where infant formula was provided free, punctuated with occasional free counselling. The
question that arises is what then, is the likelihood of compliance elsewhere where
expensive formula needs to be purchased, piped water is lacking and very limited
counselling is given.
A major concern is that formula feeding from the day of birth will result in great increases
in child morbidity, malnutrition and mortality. There are no reliable data from poor families
in Sub-Saharan Africa because almost all babies are breastfed. But, data from other
developing countries (Brazil, Pakistan and Philippines) show that infants who are not
breastfed are likely to have mortality rates from diarrhea, acute respiratory infections, and
other infectious diseases 5-6 times higher than breastfed babies in the first two months of
life (Victoria et al., 1999).
Of more concern still, is what impact not breastfeeding will make on the infected mother's
social standing, health, fertility and vertical transmission to subsequent children. If large
numbers of women do not breastfeed because of fears of HIV transmission, there may be a
spill over effect and gains made over the years through efforts to protect, support and
promote breastfeeding could be reversed. Where significant number of mothers opts not
to breastfeed, it is imperative that studies are undertaken to evaluate the consequences.
Studies on possible stigmatization of women who may opt not to breastfeed need careful If
For individual women who opt not to breastfeed, studies need to be done on the fertility
implications, because they are much more likely than those who do to have an early
pregnancy, which may place the next infant at risk of both HIV, and of becoming an
orphan (Stecklov, 2000).
1.3 JUSTIFICATION FOR THE STUDY
HIV is currently a global pandemic which has a multifaceted effect in the way in which it
has affected humanity. No single approach has been successful hence multidisciplinary
and multi-sectorial efforts are required to deal with it to be able to have effective
interventions. This study is one of such kinds of efforts aimed in the prevention of
vertical transmission of HIV. In the study area Kisii District (Central); a report released
by the medical officer of Health indicated that 14 % of the pregnant mothers at the
District hospital are HIV positive. Hence there is need to limit MTCT by using
appropriate locally prepared and also appropriate commercial infant feeding options.
1.4.1 Main Objective:
The main objective of this study was to assess the infant feeding practices of children
aged 0-24 months and feeding alternatives available, for infants born to HIV Positive
mothers in Kisii district, Kenya.
1.4.2 Specific objectives
1. To determine the socio-economic and demographic characteristics of the families
of non-tested mothers and HIV positive mothers.
2. To determine the feeding practices of the children aged 0-24 months.
3. To determine the infant feeding alternatives for the infants born to the HIV
4. To determine the nutritional status of the infants aged 0-24 months.
5. To determine maternal knowledge on Maternal To Child Transmission of HIV
6. To determine the factors determining the HIV Positive mothers choice of the
7. To determine the prevailing morbidity/disease patterns of the children.
Based on the objectives this study tested 3 null hypotheses
1. There exists no difference between the feeding practices and alternatives for
children from non-tested mothers and those from HIV Positive mothers.
2. The relationship between infant feeding practices and nutritional status of
children aged 0-24 months is not significant.
3. There is no difference between the morbidity patterns of children born to the
non-tested mothers and those born to the HIV Positive mothers.
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