Factors Influencing The Choice Of Infant Feeding Options Among HIV Positive Mothers Attending Health Facilities

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Factors Influencing The Choice Of Infant Feeding Options Among HIV Positive Mothers Attending Health Facilities


Abstract


The survey study was conducted on factors influencing the choice of infant feeding options among HIV positive mothers attending health facilities in Ogoja, Cross River State. The purpose was to investigate factors influencing the choice of infant feeding options among HIV positive mothers in Ogoja, Cross River State. Four objectives and four research questions were used to guide the study. Literatures were reviewed. The population for the study was all HIV positive mothers attending health facilities in Ogoja from January-December 2011-2013, with a total of 136 registered HIV positive mothers. There was no sampling because the total population was included in the study. The instrument for data collection was questionnaire with two sections. Section A had 8 items on socio-demographic characteristics. Section B was made up of 10 items rating scale of Yes and No. Data was analyzed using chi-square statistics. Result revealed that marital status (x2= 20.924, p<.00), religious status (x2 = 14.972, p<.05), maternal health condition (x2=12.436, p<.02), limited time to breastfeed baby because of work (x2 =11.065, p<.04) and baby’s refusal to take breast milk (x2 = 18.318, p<.00) significantly influenced HIV positive mothers’ choice of infant feeding options. Major findings reveal that marital status, religious status, maternal health condition, limited time to breast feed baby because of work and baby’s refusal to take breast milk had significant influence on infant feeding options. Based on the findings it was recommended that HIV positive mothers should be sensitized by HIV/PMTCT counselors with necessary knowledge for the choice of infant feeding options.


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 Ogoja Local Government Area of Cross River State.


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 Ogoja, Cross River State, 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 Ogoja, Cross River State.


Objectives of the Study

The specific objectives of this study are to;

  1. Determine socio-demographic factors influencing the choices of infant feeding options
  2. Identify maternal factors influencing the choice of infant feeding options
  3. Identify factors in the infant that can influence choices of feeding
  4. Identify health system factors influencing the choices of infant feeding options

Research Questions

  1. What are the socio-demographic and socio-economic factors influencing the choices of infant feeding options?
  2. Do maternal factors influence the choices of infant feeding options?
  3. What infant factors influence choice of infant feeding options?
  4. 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.

  1. 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.
  2. 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.
  3. To HIV positive mothers, it will service as a guide to their choices of infant feeding options.
  4. 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 Ogoja and Roman Catholic Maternity (RCM) Hospital Ogoja. 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 monthly 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.


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:

  1. Factors that influence the choice of infant feeding options are interrelated (socio-demographic, maternal, infant and health system factors).
  2. One or a combination of these factors is enough to influence HIV positive mother from choosing her infant feeding options.
  3. What HIV positive mothers perceive and believe, can influence their infant feeding options.
  4. 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;

  1. Marital and religious statuses are factors that had influence on the choice of infant feeding options among HIV positive mothers.
  2. Maternal health condition and limited time to breast feed baby can influence the choice of infant feeding options among HIV positive mothers.
  3. Baby’s refusal to take breast milk can influence the choice of infant feeding options.
  4. 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:

  1. 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.
  2. 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.
  3. NGO’s in collaboration with government should organize radio, television, newspaper programme that will educate the populace on PMTCT and infant feeding options.
  4. 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.


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