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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.
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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 ‘’there is no cure for HIV, but prevention of
vertical transmission of HIV to include voluntary counseling and testing, (VCT) , anteretroviral
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)
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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
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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.
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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
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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.
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.
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.
To HIV positive mothers, it will service as a guide to their choices of infant feeding options.
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.
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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.