Perception and practice of breastfeeding among HIV positive mothers receiving care for prevention of mother to child transmission in South-East, Nigeria

  • International Breastfeeding Journal, Volume 13, No. 1, Year 2018

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Study Justification:
– The study aimed to investigate the perceptions and practices of breastfeeding among HIV-positive mothers receiving care for prevention of mother-to-child transmission (PMTCT) in South-East, Nigeria.
– This topic is important because although the risk of HIV transmission through breastfeeding is reduced with antiretroviral therapy, there is still controversy surrounding infant feeding by HIV-positive mothers. Understanding the perceptions and practices can inform policymakers, program managers, and service providers in making decisions regarding infant feeding options.
Study Highlights:
– The majority of HIV-positive mothers knew that HIV could be transmitted through breast milk.
– Most mothers perceived any type of breastfeeding as beneficial to the infant.
– Over three-quarters of the mothers breastfed their infants, citing personal choice, cultural norms, fear of HIV status being disclosed, and pressure from family members as reasons.
– Marital status and being the household income provider were found to be associated with the practice of breastfeeding, but they were not significant predictors.
– Fear of stigma negatively affected the practice of breastfeeding.
– Economic independence and support from family members were identified as important factors for HIV-positive mothers to practice recommended infant feeding options.
Recommendations for Lay Reader and Policy Maker:
– Promote awareness and education about the risks and benefits of breastfeeding among HIV-positive mothers.
– Provide support and resources for economic independence of HIV-positive mothers to enable them to make informed choices about infant feeding.
– Develop strategies to reduce stigma and discrimination faced by HIV-positive mothers, which can impact their decision to breastfeed.
– Strengthen the implementation of comprehensive PMTCT services, including HIV testing, antiretroviral treatment, post-exposure prophylaxis for infants, PCR testing, and infant feeding counseling.
– Encourage collaboration between public, private, and faith-based health facilities to ensure access to quality maternal and child health care services.
Key Role Players:
– Policymakers and government officials responsible for developing and implementing guidelines and policies related to PMTCT and infant feeding.
– Healthcare providers, including doctors and nurses, who offer PMTCT services and provide counseling to HIV-positive mothers.
– Community leaders and organizations involved in HIV/AIDS awareness and support programs.
– Non-governmental organizations (NGOs) working in the field of maternal and child health, HIV/AIDS, and women empowerment.
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers on PMTCT services and counseling.
– Development and dissemination of educational materials and resources for HIV-positive mothers.
– Awareness campaigns and community outreach programs to reduce stigma and discrimination.
– Support programs for economic empowerment of HIV-positive mothers, such as vocational training and income-generating activities.
– Monitoring and evaluation activities to assess the impact of the recommendations and ensure quality of services.
– Collaboration and coordination efforts between different health facilities and organizations, including meetings and workshops.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides descriptive statistics and cross-tabulation of variables, which helps in understanding the perceptions and practices of breastfeeding among HIV positive mothers. However, the study is limited to a specific geographical area and may not be representative of the entire population. To improve the evidence, future studies could include a larger sample size and a more diverse population to increase generalizability.

Background: Although the risk of HIV transmission through breastfeeding is reduced considerably with the use of antiretroviral therapy, infant feeding by HIV positive mothers remains controversial. Weighing risks against benefits generates intense debate among policymakers, program managers and service providers in sub-Saharan Africa, considering that the major causes of infant death of malnutrition and infectious diseases, could be prevented if mothers breastfeed their babies. Whereas breastfeeding involves some risk of HIV transmission, not breastfeeding poses considerable risk to infant survival. This study investigated perceptions and practice of breastfeeding of HIV-exposed infants among HIV positive mothers. Methods: A cross-sectional descriptive study was conducted in Enugu metropolis among HIV positive mothers receiving care for prevention of mother-to-child transmission of HIV from two public and two private hospitals. Interviewer-administered questionnaire survey was done with 550 participants as they exited the final point of service delivery. Descriptive statistics of perception and practice variables and cross tabulation of selected variables was performed. Results: Most mothers knew that HIV could be transmitted through breast milk. The majority perceived any type of breastfeeding as beneficial to the infant: 230 (83.6%) in private facilities, and 188 (68.4%) public facilities. Over three-quarters of the mothers breastfed their infants and their reasons for breastfeeding included personal choice, cultural norms, fear of HIV status being disclosed and pressure from family members. A statistical significant association was found between; (i) practice of breastfeeding and marital status, (p<0.01), and (ii) practice of breastfeeding and household income provider (p=0.02). However, neither marital status (AOR 1.4; 95% CI 0.3, 6.8) nor being the household income provider (AOR 4.9; 95% CI 0.6, 12.9) is a significant predictor of breastfeeding of HIV-exposed infants. Conclusions: Breastfeeding remains a common trend among HIV positive women and it is associated with economic independence of women and social support. Fear of stigma negatively affects practice of breastfeeding. Hence, HIV positive mothers need economic independence and the support of family members to practice recommended infant feeding options.

The study was conducted in 2015 in the metropolis of Enugu city, capital of Enugu state. Enugu is located in the Southeast geopolitical zone of Nigeria [16]. Women and children constitute about 62% of the population [16]. The prevalence of HIV among pregnant women attending antenatal clinic in Nigeria was estimated as 3% [17]. According to the UNAIDS 2017 report, 32% of HIV positive pregnant women had access to ART in 2016, and there were 37,000 new infections among children [9]. It has been reported that MTCT rate is about 32% in Nigeria [18]. A range of public, private and faith-based health facilities serve as key sources of maternal and child health care delivery (Uzochukwu BSC, Onwujekwe OE, Soludo E, Nkoli E, Uguru NP, The District Health System in Enugu State, Nigeria: An analysis of policy development and implementation, unpublished). PMTCT services are offered in some of these facilities in the State. However, only two public and two private facilities were offering comprehensive PMTCT services at the time of the study. All four facilities were included in this study and they are, for public facilities, University of Nigeria Teaching Hospital (UNTH) and Enugu state University Teaching Hospital (ESUTH); and for private facilities, Annunciation specialist Hospital and Mother of Christ specialist Hospital. PMTCT services are offered daily by skilled health workers (doctors and nurses). Comprehensive PMTCT services consisting of HIV testing for mothers, antiretroviral treatment for mothers, post-exposure prophylaxis for infants, Polymerase chain reaction (PCR) testing for infants and infant feeding counselling are offered to pregnant women and mothers living with HIV in Nigeria. These services are offered in line with the Nigerian National PMTCT guideline [19] and the 2010 WHO guideline for HIV and infant feeding, which also provide for women living with HIV to choose to breastfeed with maternal or infant antiretroviral cover [13]. The aim of the study was to examine the perception and practice of breastfeeding of HIV-exposed infants among HIV positive mothers receiving comprehensive care for PMTCT in public and private hospitals in Enugu metropolis. The study used a cross-sectional descriptive design and HIV positive mothers were interviewed as they exited the final point of service delivery for the day. The study population consisted of HIV positive women receiving care for PMTCT during pregnancy, childbirth and postnatal care. Additionally, women who had babies in the 12 months preceding the study and were still receiving care for PMTCT were included in the study. This is because PMTCT services are provided to mothers until 12 months after delivery, when they are either transferred to adult ART clinic, if they do not become pregnant in the period, or remain in the PMTCT clinic, if they become pregnant. In order to achieve a power of at least 80% with 95% confidence using a prevalence value of 11% as utilization of PMTCT services, a minimum sample size of 500 was calculated and increased to 550 to account for possible incomplete or non-response of 10%. Proportionate method was used to allocate women to be sampled from each facility and participants were selected consecutively as they exited the PMTCT clinic. Table 1 shows the number of women on PMTCT in each facility and the samples selected. The formula used to calculate sample size per facility is as follows: Proportionate allocation of sample selected per facility Pre-tested interviewer administered questionnaires were used to collect information on demographic characteristics of respondents, perception and practice of any type of breastfeeding disaggregated by type of facility (public vs private). Information was also obtained on their individual perception of positive HIV status, as well as their family and community members’ perceptions and support for HIV positive people. The questionnaire was translated to the local language, and validated through pre-testing and expert review. Data was collected between February and July 2015 by trained field workers and health workers (nurses) working in the PMTCT centers. Descriptive statistics was performed using Statistical Package for Social Sciences (SPSS) software version 20. Frequencies and proportions were calculated for categorical variables while means were calculated for numeric variables. Demographic characteristics and perception of HIV status were cross-tabulated with clients’ practice of infant breastfeeding. Chi square test was used to examine the association between, (1) practice of infant breastfeeding and respondents’ demographic characteristics, and (2) practice of infant breastfeeding and perception of HIV positive status. Statistical significance was reported if p value was less than 0.05. Logistic regression analysis was done to identify the determinants of breastfeeding among HIV positive mothers. The independent variables that had statistically significant association with practice of breastfeeding at p value of less than 0.05 were included in the model.

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Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile health (mHealth) applications: Develop mobile applications that provide information and support to HIV positive mothers regarding breastfeeding and prevention of mother-to-child transmission. These apps can provide personalized guidance, reminders for medication and appointments, and access to a support network.

2. Telemedicine services: Implement telemedicine services that allow HIV positive mothers to consult with healthcare providers remotely. This can help overcome geographical barriers and improve access to specialized care and counseling.

3. Community-based support groups: Establish community-based support groups for HIV positive mothers, where they can share experiences, receive emotional support, and learn from each other. These groups can also provide education on breastfeeding and address stigma and discrimination.

4. Economic empowerment programs: Develop programs that focus on economic empowerment of HIV positive mothers, providing them with opportunities for income generation and financial independence. This can help address the financial barriers that may prevent mothers from accessing maternal health services.

5. Sensitization and awareness campaigns: Conduct sensitization and awareness campaigns targeting healthcare providers, policymakers, and the general public to address misconceptions and reduce stigma related to breastfeeding among HIV positive mothers. This can help create a supportive environment and encourage the adoption of recommended infant feeding options.

6. Integration of services: Ensure the integration of maternal health services, HIV care, and infant feeding counseling within healthcare facilities. This can improve coordination of care and provide comprehensive support to HIV positive mothers throughout the continuum of care.

7. Capacity building for healthcare providers: Provide training and capacity building programs for healthcare providers on the latest guidelines and best practices for maternal health, HIV care, and infant feeding. This can enhance their knowledge and skills in providing quality care to HIV positive mothers.

It is important to note that the implementation of these innovations should be context-specific and tailored to the local healthcare system and cultural norms.
AI Innovations Description
Based on the description provided, here is a recommendation that can be developed into an innovation to improve access to maternal health:

1. Establish support groups and community-based programs: Develop support groups and community-based programs specifically for HIV positive mothers receiving care for prevention of mother-to-child transmission (PMTCT) of HIV. These programs can provide a safe and supportive environment for mothers to share their experiences, receive counseling, and access information on breastfeeding and infant feeding options. This can help address the fear of stigma and provide the necessary social support for mothers to practice recommended infant feeding options.

2. Strengthen economic empowerment initiatives: Recognizing that economic independence is associated with breastfeeding among HIV positive women, it is important to implement economic empowerment initiatives targeted at these mothers. This can include providing vocational training, microfinance opportunities, and income-generating activities to improve their economic status. By empowering these women economically, they will have the resources and independence to make informed decisions about infant feeding options.

3. Enhance healthcare provider training: Conduct training programs for healthcare providers, including doctors and nurses, on the latest guidelines and recommendations for infant feeding among HIV positive mothers. This training should emphasize the importance of providing non-judgmental and supportive care to these mothers, addressing their concerns and fears, and providing accurate information on the risks and benefits of different feeding options. By improving healthcare provider knowledge and skills, mothers will receive better support and guidance in making informed decisions about infant feeding.

4. Increase awareness and education: Implement targeted awareness and education campaigns to increase knowledge and understanding of infant feeding options among HIV positive mothers, their families, and the wider community. These campaigns should address misconceptions and myths surrounding breastfeeding and HIV transmission, and provide clear and accurate information on the benefits of breastfeeding with appropriate antiretroviral cover. By increasing awareness and education, mothers and their support networks will be better equipped to make informed decisions about infant feeding.

5. Strengthen healthcare infrastructure: Improve the availability and accessibility of comprehensive PMTCT services in both public and private healthcare facilities. This includes ensuring that all healthcare facilities offering PMTCT services have trained healthcare providers, adequate resources, and the necessary infrastructure to provide comprehensive care. By strengthening the healthcare infrastructure, more HIV positive mothers will have access to the necessary support and services for safe infant feeding practices.

By implementing these recommendations, it is possible to develop innovative approaches that improve access to maternal health, specifically in the context of breastfeeding among HIV positive mothers receiving care for PMTCT. These approaches can address the barriers and challenges faced by these mothers, and ultimately contribute to improved maternal and child health outcomes.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations for improving access to maternal health:

1. Strengthening PMTCT Services: Enhance the availability and quality of comprehensive PMTCT services in both public and private healthcare facilities. This includes ensuring access to HIV testing, antiretroviral treatment for mothers, post-exposure prophylaxis for infants, PCR testing for infants, and infant feeding counseling.

2. Promoting Breastfeeding Education: Implement targeted education programs to increase awareness and knowledge about the benefits and risks of breastfeeding among HIV-positive mothers. This can help dispel misconceptions and provide accurate information to make informed decisions.

3. Addressing Stigma and Discrimination: Develop strategies to reduce stigma and discrimination faced by HIV-positive mothers, particularly related to breastfeeding. This can involve community sensitization campaigns, training healthcare providers on non-discriminatory practices, and creating supportive environments for HIV-positive mothers.

4. Empowering Women: Support economic empowerment initiatives for HIV-positive mothers to improve their ability to make choices regarding infant feeding options. This can include providing income-generating opportunities, vocational training, and access to financial resources.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that measure access to maternal health, such as the percentage of HIV-positive mothers receiving comprehensive PMTCT services, the percentage of mothers practicing recommended infant feeding options, and the reduction in stigma and discrimination.

2. Collect baseline data: Gather data on the current status of access to maternal health services, including the perception and practice of breastfeeding among HIV-positive mothers. This can be done through surveys, interviews, and existing data sources.

3. Implement interventions: Implement the recommended interventions in selected healthcare facilities or communities. This can involve training healthcare providers, conducting awareness campaigns, and providing economic empowerment programs.

4. Monitor and evaluate: Continuously monitor the implementation of interventions and collect data on the selected indicators. This can be done through regular surveys, interviews, and monitoring systems. Evaluate the impact of the interventions by comparing the post-intervention data with the baseline data.

5. Analyze the data: Analyze the collected data to assess the impact of the interventions on improving access to maternal health. This can involve statistical analysis, such as calculating percentages, conducting chi-square tests, and performing logistic regression analysis to identify determinants of breastfeeding among HIV-positive mothers.

6. Draw conclusions and make recommendations: Based on the analysis, draw conclusions about the effectiveness of the interventions in improving access to maternal health. Identify areas of success and areas that require further improvement. Make recommendations for scaling up successful interventions and addressing challenges.

7. Continuous improvement: Use the findings from the evaluation to inform future interventions and improve access to maternal health services. This can involve refining existing interventions, developing new strategies, and advocating for policy changes.

By following this methodology, it is possible to simulate the impact of recommendations on improving access to maternal health and make evidence-based decisions for further interventions.

Statistics:
Citations: 6
Authors: 7
Identifiers:
DOI: 10.1186/s13006-018-0191-8
Research Areas:
Community Interventions, Disparities, Food Security, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Workforce
Study Countries:
Nigeria
Study Design:
Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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