Exclusive Breastfeeding And Prevention Of Mother To Child Transmission Of HIV Among Pregnant Women

Project and Seminar Material for Public Health

Exclusive Breastfeeding And Prevention Of Mother To Child Transmission Of HIV Among Pregnant Women


Abstract


This study was carried out to examine 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. Specifically, the study 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 employed the survey descriptive research design. A total of 100 responses were validated from the survey. From the responses obtained and analysed, the findings revealed that exclusive breastfeeding helps in the prevention of mother-to-child transmission of HIV-1 infection. Also,the use of exclusive breastfeeding has helped to reduce mortality rates in exclusive breast-fed infants. Furthermore, Exclusive breast-fed infants have had HIV-free survival. The study recommend 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.


Chapter One


Introduction

1.1 Background of the study

The fact that formula feeding can be difficult to achieve in resource poor settings, coupled with breastfeeding’s recorded benefits for preventing malnutrition and serious infectious diseases, has resulted in exclusive breastfeeding being recommended by WHO for women living with HIV in resource poor settings provided they have access to ART. Formula feeding is recommended for women living with HIV in countries in high resource settings (Ngoma-Hazemba and Ncama, 2016; WHO, 2016). The fact that advice for women is different in low and high resource settings has led to a certain amount of confusion about the best approach to breastfeeding for women living with HIV(Ngoma-Hazemba and Ncama, 2016)One study from Malawi reported that while the majority of mothers chose to exclusively breastfeed because “that’s the advice they give to HIV-positive women”, most mothers reported mixed feeding in the first six months. A number of reasons were given for this including traditional feeding practices, a poor understanding of what exclusive breastfeeding involves, as well as poor communication about why women should exclusively breastfeed (Levy, 2010).Research from Tanzania compared two hospitals that offered different infant feeding options. Hospital A promoted exclusive breastfeeding as the only infant feeding option, while hospital B followed Tanzanian PMTCT infant feeding guidelines which promote patient choice. Women in hospital A trusted the advice given and were confident in their ability to exclusively breastfeed, whereas women in hospital B expressed confusion and uncertainty about how to best feed their infants (Vaga, 2014).In a study carried out in Jos, Nigeria, it was revealed that women who primarily gave formula milk complained of family pressure as their reason for breastfeeding (Sheela, Pam, Dilhatu, Edwina, Buki and Anuri, 2015). In Zaria, mothers that practiced formula feeding complained of feelings of anger and guilt as well as inadequacy for not being able to play their motherly role of breast-feeding their babies. They also complained of high cost of formula, the fear of stigmatization and social discrimination. These often force them to breast-feed (Musa, Muktar and Adulkadir, 2016). Factors that supported formula feeding include active coping ability, disclosure of status to spouse or important family members, household income, educational status of mother, occupation of mother and mode of delivery especially by caesarian section (Yetayesh and Jemal, 2014).


1.2 Statement of the Problem

The effectiveness of exclusive breastfeeding among HIV exposed infants is still unclear. There are numerous controversial and ethical issues surrounding this intervention. Through postnatal experience, some health care professionals do not approve of exclusive breastfeeding in HIV cases due to reported high transmission rates; as a result they fail to reinforce exclusive breastfeeding when it is applicable. Mothers are exposed to the HIV stigma if they do not breastfeed, as there is an assumption that the mother is HIV positive, while in other cases women suffer the abuse of family members, especially from male family members. Most women lack information on the effectiveness of exclusive breastfeeding in HIV exposed infants. Exclusive breastfeeding is considered the best feeding option in poorly resourced communities where formula feeding is not feasible, unacceptable, unsafe, not sustainable and unaffordable. An extensive literature search has shown that exclusive breastfeeding reduces other significant risks, such as increased diarrhoea and pneumonia morbidity and mortality (Thior et al., 2006:1-13: Newell 2004:5). Exclusive breastfeeding with antiretroviral prophylaxis is associated with less than 5% HIV transmission. In the MITRA Plus trial from Tanzania, ART and breastfeeding was associated with a cumulative transmission at six months of only 5.0% (less than 1% had been infected during the period of breastfeeding) (Kilewo, Karlsson, Ngarina, Massawe, Lyamuya et al., 2008:1). The AMATA study in Rwanda, found that only one out of 174 (0.6%) breastfeeding women on maternal Highly Active Antiretroviral Therapy transmitted HIV to her infant (Peltier, Ndayisaba, Lepage, Griensven, Leroy et al., 2009:2415). Coovadia et al., (2007:1107) conducted a study in Durban, South Africa and found that mixed feeding was associated with an increased HIV transmission rate, while exclusive breastfeeding had a lower transmission rate. This influenced the revision of the present UNICEF, WHO and UNAIDS infant feeding guidelines. Exclusive formula feeding has a 0% HIV transmission rate but the rate of mortality from causes other than HIV is higher (Peltier et al., 2009:2415). Despite HIV infection via breastfeeding in HIV exposed infants, breastmilk has been proved to be a cost effective intervention and is associated with good maternal and child health.


1.3 Objective of the study

  1. 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.
  2. To examine the extent the use of exclusive breastfeeding has helped to reduce mortality rates in exclusive breast-fed infants.
  3. To find out the extent exclusive breast-fed infants have had HIV-free survival.

1.4 Research Questions

The following questions guide this study:

  1. To what extent has exclusive breastfeeding helped in the prevention of mother-to-child transmission of HIV-1 infection?
  2. To what extent has the use of exclusive breastfeeding helped to reduce mortality rates in exclusive breast-fed infants?
  3. To what extent has exclusive breast-fed infants have had HIV-free survival?

1.5 Significance of the study

Individual study results can often not be generalised. By combining outcomes of various trials, this systemic review can yield reliable and evidence based results. The primary aim of this systematic review was to critically appraise and review the evidence based on the effectiveness of exclusive breastfeeding in the prevention of HIV transmission from mother to child as compared to exclusive formula feeding. Across the studies, the efficacy of exclusive breastfeeding has been determined through comparison with exclusive formula feeding and mixed feeding. The secondary aim was to summarize evidence on mortality and HIV free survival in HIV exposed breastfed infants.

Therefore, results of this research will inform practice and awareness can be raised regarding effective feeding options in HIV exposed infants in both, the community and among patients. The study will serve as reference material for further research.


1.6 Scope of the study

The Study focuses on 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 use Lagos State College of Health Technology, fondly called LASCOHET as the case study.


1.7 Definition of terms

AIDS:

An abbreviation for Acquired Immunodeficiency Syndrome.

Antiretroviral Therapy:

It is the therapy given to reduce HIV transmission from mother to infant or to treat the infection. In developing countries a single dose of nevirapine remains widely used and has been proven to reduce HIV transmission via breast milk during the early postpartum period when the majority of breast milk transmission occurs (Lehman et al 2008:2).

Exclusive breastfeeding:

Implies that an infant receives 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 (Newell, 2004:1).

Formula Feeding:

Infant milk artificially prepared with more or less similar contents as breast milk but does not contain colostrum. (Nolte 2007:249)

HIV:

Human immunodeficiency virus is a virus that attacks cells that help the body fight infection, making a person more vulnerable to other diseases.


Chapter Five


Summary, Conclusions and Recommendations:

5.1 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.


5.2 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


5.3 Conclusions

Based on the finding of this study, the following conclusions were made:

  1. Exclusive breastfeeding helps in the prevention of mother-to-child transmission of HIV-1 infection.
  2. The use of exclusive breastfeeding has helped to reduce mortality rates in exclusive breast-fed infants.
  3. Exclusive breast-fed infants have had HIV-free survival.

5.4 Recommendations

Based on the responses obtained, the researcher proffers the following recommendations:

  1. 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.
  2. 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.
  3. 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.
  4. 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.

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