Factors Influencing the Choice of Infant Feeding Options Among HIV Positive Mothers Attending Health Facilities in Ogoja, Cross River State, Nigeria
CHAPTER ONE
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
CHAPTER TWO
LITERATURE REVIEW
This chapter presents the review of related literature from books, abstracts and journals. The conceptual review covered socio-demographic factors, socio-economic factors, socio-cultural factors, maternal factors, infant factors and health system factors. The chapter also dealt with theoretical review, empirical review and summary of literature review.
Conceptual review
Concept of various infant feeding options available among HIV positive mothers
Globally, the incidence of the spread of the HIV pandemic is worrisome; this is because the spread of the virus has taken an alarming dimension in recent times. More worrisome is the rate at which infants are contracting the virus from HIV infected mothers. An estimated 590,000 infants acquired HIV-1 from their mothers in 1998; 90% were in Sub-Saharan Africa. About two-thirds were infected during pregnancy or at delivery and the other one-third through breastfeeding (Okon, 2011). This number has increased geometrically within the last ten years. In 2008, about 1,000,000 infants born of HIV infected parents tested positive, and about 78% of these numbers are in Sub- Saharan Africa, while in 2009, Nigeria had about 672,000 infants born of HIV infected mothers out of which about 597,000 tested positive (Federal Government of Nigeria ‘FGN’, 2009),
The balance between life saving benefits and the risk of transmission through breastfeeding complicates infant feedings in communities affected by HIV. Cognizant of the problem, UNAIDS\WHO\ UNICEF in 2008 developed a guideline in the context of infant feeding by women whose HIV status is unknown and HIV positive women. The feeding option for women who are HIV negative or unknown status is to exclusively breastfeed their newborn for the first six months, introduce complementary food after six months and continue breastfeeding for two years and beyond. The recommended option for HIV positive women is, avoid breast feeding when Replacement feeding is acceptable, feasible, affordable, sustainable and safe (AFASS). Nonetheless, when AFASS criteria cannot be met, mothers may be advised to exclusively breast feed and avoid mixed feedings. Other feeding options recommended are; heat treated expressed breast milk or wet nursing of the newborn by HIV negative surrogate mothers when the AFASS criteria is not possible (Adejuyigbe, Orji, Onayade, Makinde and Anyabolu 2008: Chopra and Rollins 2008).
It is however regrettable to note that since the adoption of the World Health Organization infant feeding guidelines for HIV positive mothers by Nigerian government, little has been done with respect to assessing the implications of this for HIV-positive mothers, as well as the enabling environment needed for effective implementation. Exclusive breastfeeding is the feeding of the infant with breast milk only with exception of prescribed medicines, up to six months from the day of birth. In this situation, the HIV positive mother is expected to feed the new born baby strictly on the mother’s breast milk, either directly expressed or expressed and pasteurized. Exclusive replacement feeding (infant formula, porridge and other foods apart from breast feeding) on the other hand is also another infant feeding option available to HIV positive mothers.
Although breastfeeding accounts for a fraction of mother to child transmission of HIV, in countries where both fertility and rates of HIV infection among pregnant women are high, the issue of HIV transmission through breastfeeding is of public health importance (WHO, 2011). Breastfeeding significantly improves child survival by protecting against diarrhea diseases, pneumonia and other potentially fatal infections, while it enhances quality of life through its nutritional, psychosocial and social benefits. As a result, not breastfeeding presents substantial disadvantages and risks to both children and mothers (UNAIDS/WHO/UNICEF 2008; and Matji, Wittenberg, Makin, Jeffery, Maclntyre and Forsyth, 2008).
UNICEF and WHO in 1998 recommended that breastfeeding should continue to be protected, promoted and supported among HIV-negative mothers and among mothers of unknown HIV status. The guidelines promote fully informed and free choice of infant feeding methods for HIV-positive mothers. Counseling HIV-infected mothers should include the best available information on the benefits of breastfeeding, on the risk of HIV transmission through breastfeeding and on the risks and possible advantages of alternative methods of infant feeding. The consequence of these recommendations is as follows: compared to HIV-negative mothers for whom the decision to breastfeed is supported by international and national recommendations as well as long-standing cultural practices, mothers with HIV are expected to assume increasing responsibility for infant feeding decisions (Senyonga, Muwonge and Nankya 2004). Most previous researches have focused on weighing competing risks of HIV transmission through breastfeeding against risks of increased child morbidity and mortality associated with not breastfeeding (Kassahun, Jennifery, Nadra and Grey 2004).
In breast feeding as an option for infant feeding by HIV positive mothers or mothers whose sero-status are unknown, breastfeeding can take the form of wet nursing, exclusive breastfeeding, expressed breast milk using cup and spoon and heated breast milk (pasteurized milk). Whether the breast milk is pasteurized or given fresh, the recommendation holds that mothers should breastfeed their new born babies. Furthermore, mothers need to be supported in their feeding choices, whether it is to exclusively breastfeed or use of breast milk substitute after receiving adequate information. Additional studies are needed to assess growth patterns and nutritional status of these infants, interventions to improve participation, care and support for HIV positive mothers and partner/family involvement in supporting mothers’ choice of infant feeding options.
CHAPTER THREE
RESEARCH METHODS
This chapter presents the research design, area of study, population of the study, sample and sampling procedure, instrument for data collection, validity of instrument and reliability of instrument, ethical consideration, and procedure for data collection, method of data collection and method of data analysis.
Research Design
Descriptive survey design was adopted for this study, the research design approach is present-oriented and based on on-going event as it provides a detailed description of existing factors influencing infant feeding options of HIV positive mothers. This design was successfully used by Laar and Govender (2011) in a study of factors influencing the choices of infant feeding of HIV-positive mothers in South Ghana; The role of counselors, mothers, families and socio-economic status. The survey design is considered appropriate for this study because it allowed for description of the phenomenon as they exist in their natural setting at a time of the research.
Study Area
General Hospital Ogoja and Roman Catholic Mission (RCM) Maternity Hospital are situated in Ogoja Local Government Area of Cross River State, Nigeria. Ogoja is bounded in the north by Bekwarra Local Government Area of Cross River State, in the west, by Mbube, bounded by Yala Local Government of Cross River State, in the south; Ogoja is bounded by Ikom and some part of Boki Local Government Areas of Cross River State and Ebonyi State in the east.
The people of Ogoja are predominantly farmers; they grow crops like yam, cassava, potato, rice, millet, guinea corn, groundnut, cocoyam, water yam, palm oil, plantain and banana. Fairly large populations of the study area are students. Ogoja has a campus of the Cross River University of Technology, School of Nursing and Midwifery, some primary and secondary schools, 68 health centers, health post and a private school of health technology.
The RCM Hospital is owned by the Roman Catholic Mission, while the health post and the health centers are owned by government. There are five private clinics in Ogoja, two owned by qualified medical doctors, one by a qualified retired chief nursing officer and the other two by retired army officers who are neither medical doctors nor nurses. In terms of medical facilities for HIV, CT and accessing ARVs, other support services for HIV positive client and non positive clients are only General Hospital Ogoja and the RCM Maternity Hospitals that has facilities for ARVs. Government presence is conspicuously felt here.
Population of the Study
The target population for this study included all HIV positive mothers who were registered and were accessing Anti Retro-Viral Therapy (ART) or attending support group meetings in the health facilities (General Hospital Ogoja, and RCM Maternity Hospital, Ogoja) from January-December 2011-2013. They were 92 registered HIV positive mothers in General Hospital Ogoja and 44 from RCM Hospital, making it a total of 136 registered HIV positive mothers.
CHAPTER FOUR
PRESENTATION OF RESULTS
In this chapter, the results obtained from data analysis with their interpretations were presented. One hundred and thirty six (136) copies of questionnaire were administered to HIV positive nursing mothers attending health facilities in general hospital, Ogoja and R.C.M maternity hospital Ogoja. All the 136 questionnaire administered were properly completed and returned giving 100% return rate. Results of each research question are presented.
Research question one: what are the socio-demographic factors influencing the choices of infant feeding options?
In answering this research question, interest is on examining the influence of some selected socio-demographic factors, used in the study, on the respondents’ infant feeding options.
CHAPTER FIVE
DISCUSSION OF FINDINGS
This chapter discusses the findings of the study on factors influencing the choice of infant feeding options among HIV positive mothers attending health facilities in Ogoja, Cross River State. The first section discussed the major findings of the study based on the research questions and the examination of their significance within the context of the previous research works. Subsequent discussion focused on the implications and generalization of findings, the conclusion, recommendations and suggestion for further study.
Discussion of Major Findings
The discussion is presented under the following factors influencing infant feeding in the study; socio-demographic factors, maternal factors, infant factors and health system factors
Research question 1: What are the socio-demographic factors influencing the choice of infant feeding options?
The findings of this study showed that marital status (x2 =20.924, P≤.05) and religious status (x2 =14.972, P≤.05) influenced infant feeding options. It is not a surprised observation because it is a general opinion in the society that once a woman is married, she dances to marital tunes. Again today, people rely so much on their religious beliefs. These findings are in agreement with the study of Coutsoudis (2005) and Coutsoudis, Coovadia, Pillary and Kuhn (2005) who found out that religious beliefs, occupation, marital status and age influence the choice of infant feeding options. However, findings disagree with that of Maru and Haider (2009) where household cost, spousal disclosure and educational qualification influenced safer choices of infant feeding options.
Research question 2: Which maternal factors influence the choices of infant feeding options?
Findings from the study indicated that only maternal health condition (x2 = 12.436, p<.02) and time to breastfeed baby (x2 = 11.065, p<.05) that are significant factors influencing infant feeding options amongst other maternal factors. The above findings agreed with Buskens (2005); Bland et al., (2007), Okon (2010) and Laar and Laar (2012) who held that it is worthy of note that women with certain health conditions/problems like hepatitis, HIV and STI’s are likely to pass on to their infants, hence may change their infant feeding options.
Research question 3: What infant factors influence choice of infant feeding options?
Findings indicated that in infant factors influencing their feeding options, only baby’s refusal to take breast milk (x2 = 18.318, p<.05) significantly influenced mothers’ choice of infant feeding options. This finding is in agreement with the view of McNaghtan et al., (2007) who found out that infant with certain abnormalities refused breast milk. Minnie and Greeff (2006) and Ome-Gliemann et al., (2006) then added that certain health conditions of a mother like mastitis make her breast milk sore, causing baby to refuse sucking. Hoat, Huong and Xuan (2010) also observed that prematurity in infant results in low birth weight, which can influence the choice of HIV positive mother’s feeding options.
Research question 4: What are the health system factors that can influence infant feeding options?
The study revealed that none of the health system factors significantly influenced infant feeding options. This may be peculiar to the research area, making findings contrast to the study of Magavero, Norton and Saag (2011) who found out that infant feeding option made by any HIV positive mother is a product of the quality of health information and services available to such a mother. Leshabari, Blystad, De-Paoli and Moland (2007) and Laar and Laar (2012) found out that the type of health system any country has constitutes a great deal to the quality of services rendered to its citizens including HIV counseling, assessment of ARV drugs and other services. Bloom, Goldbloom and Stevens (2008) found out that prevailing climate of acceptance for all individuals, are essential components for encouraging patient-provider relationship linked to adherence of ART and HIV positive care, for this study environment was encouraging but findings contrast to the above views.
Implications of the Findings to the study
The findings of this study have some implications as follows:
- Factors that influence the choice of infant feeding options are interrelated (socio-demographic, maternal, infant and health system factors).
- One or a combination of these factors is enough to influence HIV positive mother from choosing her infant feeding options.
- What HIV positive mothers perceive and believe, can influence their infant feeding options.
- Finally, the issue of health system factor may not influence infant feeding options amongst HIV positive mothers, because HIV positive mothers know when, what and how to choose their infant feeding options.
Limitation of the study
The present study was peculiar because no such study has been carried out in Ogoja, Cross River, Nigeria. Furthermore, it was a little difficult to gain co-operation from few respondents, as they wanted to be gratified with gifts, food and money after responding to the questions. The researcher also encountered language interpretations and shortage of time in carrying out the research.
Summary
This study x-rayed factor influencing the choices of infant feeding options among HIV positive mothers in Ogoja, Cross River state, Nigeria. The objectives were; To find out the socio-demographic factors influencing the choice of infant feeding option among HIV positive mothers, to determine maternal factors influencing the choice of infant feeding options among HIV positive mothers, to identify infant factors influencing the choice of infant feeding options among HIV positive mothers and to identify health system factors that can influence the choice of infant feeding options among HIV positive mothers. Relevant literatures were reviewed to cover the objectives of the study. The research design was descriptive survey design approach which is present oriented and based on on-going event. There was no sampling technique as the study population was small. A total population of one hundred and thirty six was involved in the study. A validated questionnaire structured by the researcher with the help of experts was used to collect data. Data obtained were analyzed using Chi-square statistic. Major findings of the study revealed that;
- Marital and religious statuses are factors that had influence on the choice of infant feeding options among HIV positive mothers.
- Maternal health condition and limited time to breast feed baby can influence the choice of infant feeding options among HIV positive mothers.
- Baby’s refusal to take breast milk can influence the choice of infant feeding options.
- Health system factor were identified as less important factor that can influence infant feeding options among HIV positive mothers in Ogoja, Cross River state, Nigeria.
Conclusion
Based on the findings of this study, the following conclusions were made, that HIV positive nursing mothers attending health facilities in Ogoja, Cross River State identified factors influencing the choice of infant feeding options as marital status, religious status, maternal health and baby’s refusal to take breast milk. That the issue of choosing infant feeding options do not solely depend on one single factor, rather it involves the combination and interaction of other factors.
Recommendations
Based on the findings, the discussion and implications drawn from this study, the following recommendations were made:
- HIV positive mothers should be sensitized by HIV/PMTCT counselors so that they will be equipped with necessary knowledge to enable them identifies proper infant feeding options.
- The federal ministry of health should make available the guidelines for PMTCT with particular reference to infant feeding for Nigerians, as this will help reduce the confusion on what infant feeding options to adopt by HIV positive mothers.
- NGO’s in collaboration with government should organize radio, television, newspaper programme that will educate the populace on PMTCT and infant feeding options.
- HIV positive mothers should be desensitized from this urge of stigmatization and gratification. There is need for seminars, workshops and outreach programme to be periodically organized and implemented in order to equip these workers towards utilizing their inner potentials and be made to understand that there is more to life even with HIV infection.
Suggestion for further studies
This study has provided empirical information about factors influencing infant feeding options among HIV positive mothers. This study opens avenue to some other areas that could be investigated in order to improve PMTCT. However, it is never appropriate to make definite conclusions on only this single study, considering the limitations and short comings of this study. There is therefore the need to replicate this study in a wider area or institution in order to provide empirical support and make for lapses for the findings of the present.
REFERENCES
- Abiona, T.C., Onayade, A. A., Ijadunola, K.T., Obiajunwa, P.O., Aina, O.I., & Thairu, L.N., (2006). Acceptability, feasibility and affordability of infant feeding options for HIV-infected women: A qualitative study in south-west Nigeria. Maternal Child Nutrition, 2: 135-144.
- Abusoman, O.E.,(2011). Infant feeding choices and practices of HIV –positive mothers at lower Umfolozi District, War Memorial Hospital, Empangeni, KwaZulu-Natal province.Retrived October 31, 2012.
- Adejuyigbe, E., Orji, E., Onayade, A., Makinde, N., & Anyabolu, H., (2008). Infant feeding intentions and practices of HIV-positive mothers in southwestern Nigeria. Journal of Human Lactation, 24: 303-310.
- Aidam, B. A., Escamilla, R. P., Lartey, A., (2005). Lactation counseling increases breastfeeding rates in Ghana. J. Nutr; 135: 1691-1695.
- Ajayi, A.D., Hellandendu,J & Odekunle,F., (2011). Socio-demographic correlates of breastfeeding practices among mothers in kogi state, Nigeria, West African Journal of Nursing 22(1); 28-35.
- American International Health Alliance (AIHA)., (2008). Infant feeding practices of mothers of known HIV status in Lusaka, Zambia. Health Policy and Planning 18(2): 156-162.
