Exclusive Breastfeeding and Prevention of Mother-to-Child Transmission of HIV Among Pregnant Women
Chapter One
Objective of the study
- To evaluate the extent exclusive breastfeeding is in the prevention of mother-to-child transmission of HIV-1 infection as compared to exclusive formula feeding and/ or mixed feeding with the use of antiretroviral prophylaxis.
- To examine the extent the use of exclusive breastfeeding has helped to reduce mortality rates in exclusive breast-fed infants.
- To find out the extent exclusive breast-fed infants have had HIV-free survival.
CHAPTER TWO
REVIEW OF LITERATURE
INTRODUCTION
Our focus in this chapter is to critically examine relevant literatures that would assist in explaining the research problem and furthermore recognize the efforts of scholars who had previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps.
EXCLUSIVE BREASTFEEDING
According to Newell (2004:1), exclusive breastfeeding is whereby an infant is fed with only breast milk, and no other liquids or solids, not even water, with the exception of drops or syrups consisting of vitamins, mineral supplements or medicines.
Breastfeeding and HIV
For optimal growth, development and health, infants should be exclusively breastfed for their first six months. Such infants should then receive nutritionally adequate and safe complementary foods, while breastfeeding continues up to 24 months and beyond. This intervention is effective in cases of HIV-free breastfeeding mothers, otherwise the risk of mother to child transmission of HIV can double to about 40%, especially if antiretroviral prophylaxis and effective interventions are not followed (Newell, 2004:1). HIV infected mothers may consider expressing and heat treating breastmilk as an interim feeding strategy: · If antiretroviral drugs are temporarily not available; or · To assist mothers to stop breastfeeding; or · In special circumstances, such as low birth weight infants or otherwise ill infants in the neonatal period; or · When the mother is unwell and temporarily unable to breastfeed or when temporary breastfeeding problems, such as mastitis, occur (WHO, 2009:20). Laboratory evidence demonstrates that heat treatment of expressed milk from HIV infected mothers, if correctly done, inactivates HIV. Furthermore, there is no significant proof or evidence that heat treatment alters the nutritional content of the breast milk; hence, breast milk treated this way should be adequate to support normal growth and development WHO (2009:20).
Characteristics of breast milk
Breast milk consists of colostrum, transitional and mature milk (Nagin, 2008:1; Nolte, 2008:233; Leroy, 2007:6-7). Colostrum is the thick yellow milk secreted by the breasts during the first few days after delivery. Generally, it is a leftover mixture of materials present in the mammary gland and ducts at delivery (Leroy, 2007:6; Nagin 2008:1). According to Leroy (2007:6), it gradually evolves into mature milk at 3-14 days postpartum. Colostrum has a low protein and fat content (Nolte, 2007:233), and contains more antibodies and white blood cells than mature breastmilk (Leroy 2007:6). It aids in the formation of protective bacteria, or bifidus flora, in the gastrointestinal tract and also eases the movement of meconium (Nagin 2008:1). According to Horvath et al., (2010:4), epidermal growth factor in colostrum helps to make the gastrointestinal tract less permeable to viral infection. Nagin (2008:1), states that breast milk consists of water as its largest component (90%), oligosaccharides, vitamins, minerals, hormones, growth factors and protective agents. It also has 10% solids for energy and growth (Nagin 2008:1). During the past decades, breastfeeding has been reinforced to improve both maternal and child health. Holmes and Salvage (2007:1065), indicated immediate and long term benefits of breastfeeding which includes it being a cost effective intervention for child survival and could prevent 13-15% of child deaths in low income countries. Breastfeeding protects against common infections such as diarrhoea, pneumonia, neonatal sepsis and otitis media. According to Newell (2004:5), a study conducted in Brazil found that infants who were not breast-fed were 17 times at higher risk of hospital admission (OR 16.7, 95% CI, 7.7-36.0).
CHAPTER THREE
RESEARCH METHODOLOGY
Introduction
This chapter gives the methodology that the researcher used in the study. The research design, population of the study, sampling and sample size, methods of data collection, and method of data analysis.
Area of Study
Lagos State College of Health Technology, formerly known as School of Hygiene was established in 1920 by Dr I. Oladipo Oluwole based on the prevailing health situations and low human health resources available in the community. The then School of hygiene offered six major health courses before incorporating the training of community midwives and nurses into its program between 1957 and 1966.
On the 21st of February, 1977, Lagos State College of Health Technology, under the directive of the Federal Military Government was transformed from a School of hygiene to a School of Health Technology as a result of the Third National Development Plan (1975 – 1980) on National Basic Health Service Scheme (NBHSS) which mandated the train middle level manpower for the health sector.
On the 22nd of January, 2004, Lagos State College of Health Technology’s establishment was assented by the former Governor of Lagos State, Asiwaju Bola Ahmed Tinubu and the Lagos state college of health technology’s governing council was constituted and inaugurated in July, 2012 by Babatunde Raji Fashola’s Administration.
Research Design
Research designs are perceived to be an overall strategy adopted by the researcher whereby different components of the study are integrated in a logical manner to effectively address a research problem. In this study, the researcher employed the survey research design. This is due to the nature of the study whereby the opinion and views of people are sampled.
Population
According to Udoyen (2019), a study population is a group of elements or individuals as the case may be, who share similar characteristics. These similar features can include location, gender, age, sex or specific interest. The emphasis on study population is that it constitute of individuals or elements that are homogeneous in description.
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
DATA PRESENTATION
Table 4.1: Demographic data of respondents
CHAPTER FIVE
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS:
Introduction
This chapter summarizes the findings into the “breastfeeding and prevention of mother to child transmission of HIV among pregnant women, using Lagos State College of Health Technology, Lagos state as case study”. The chapter consists of summary of the study, conclusions, and recommendations.
Summary of the Study
In this study, our focus was to examine the exclusive breastfeeding and prevention of mother to child transmission of HIV among pregnant women, using Lagos State College of Health Technology, Lagos state as case study. The study specifically was aimed at evaluating the extent exclusive breastfeeding is in the prevention of mother-to-child transmission of HIV-1 infection as compared to exclusive formula feeding and/ or mixed feeding with the use of antiretroviral prophylaxis, finding out the extent the use of exclusive breastfeeding has helped to reduce mortality rates in exclusive breast-fed infants, and discover the extent exclusive breast-fed infants have had HIV-free survival.
The study adopted the survey research design and randomly enrolled participants in the study. A total of 100 responses were validated from the enrolled participants where all respondent are active workers in the Lagos State College of Health Technology., Lagos state
Conclusions
Based on the finding of this study, the following conclusions were made:
- Exclusive breastfeeding helps in the prevention of mother-to-child transmission of HIV-1 infection.
- The use of exclusive breastfeeding has helped to reduce mortality rates in exclusive breast-fed infants.
- Exclusive breast-fed infants have had HIV-free survival.
Recommendations
Based on the responses obtained, the researcher proffers the following recommendations:
- Some mothers opt for breastfeeding as a personal choice and this shouldn’t hinder the health care workers from supporting and encouraging them to adhere completely to this feeding option. The use of anti-retroviral prophylaxis as prescribed should also be emphasized.
- There are several challenges regarding the promotion of exclusive breastfeeding especially in HIV positive mothers. Socio-cultural barriers play a major role. Health care workers and public health policy makers can aim at attending everyone at a community level.
- Mothers to Mothers and community breastfeeding counsellors should be expanded and aim at doing home visits, organising health education workshops at community level. Home or family visits may also help individual family members to get more clarity and understanding. These programmes should encourage the entire community, convince them to involve themselves in issues regarding HIV and breastfeeding especially before large scaled studies can be done because these factors hinder research and daily evidence based practice.
- HIV activists’ programmes aims at supporting those infected and affected using personal experience should be organized.There is a need in the community to have such people especially those who opted for exclusive breastfeeding with an HIV positive status. Such people may bring hope, encouragement and support to these HIV positive mothers.
REFERENCES
- Agu, V., Peltzer, K., Seager, J., Setswe, G., Wabiri, N. & Banyini, M. 2009. The development of Harmonised minimum standards for guidance on HIV testing and counselling and prevention of Mother-To-Child Transmission Of HIV in the SADC region, HTC country report South Africa. Available: http://ebookbrowse.com/6315- agu-htc-southafrica-pdf-d53062689. [Accessed 22/01/2011].
- Balopi, A. 2010. Botswana: HIV positive mothers not convinced to exclusively breastfeed. (Online). Available: http://www.globalissues.org. [Updated September 2010]. [Accessed 06/07/2011].
- Becquet, R., Bland, R., Leroy, V., Rollins, N. C., Ekouevi, D. K., Coutsoudis, A., Dabis, F., Coovadia, H. M., Salamon, R. & Newell, M. L. 2009. Duration, pattern of breastfeeding and postnatal transmission of HIV: pooled analysis of individual data from West and South African cohorts. PLoS One, 4, e7397.
- Bedri, A., Gudetta, B., Isehak, A., Kumbi, S., Lulseged, S., Mengistu, Y., Bhore, A. V., Bhosale, R., Varadhrajan, V., Gupte, N., Sastry, J., Suryavanshi, N., Tripathy, S., Mmiro, F., Mubiru, M., Onyango, C., Taylor, A., Musoke, P., Nakabiito, C., Abashawl, A., Adamu, R., Antelman, G., Bollinger, R. C., Bright, P., Chaudhary, M. A., Coberly, J., Guay, L., Fowler, M. G., Gupta, A., Hassen, E., Jackson, J. B., Moulton, L. H., Nayak, U., Omer, S. B., Propper, L., Ram, M., Rexroad, V., Ruff, A. J., Shankar, A. & Zwerski, S. 2008.
