Determinants of adherence to elimination of mother to child transmission feeding guidelines for HIV-exposed infants of mothers living with HIV in Mpigi district

Abstract

Background: Breast milk contains antibodies as well as innate factors that function to inhibit this uptake of the virus, which is why a mixed diet of breast milk and formula has a higher risk for infection than a diet of breast milk alone. Furthermore, mixed feeds can cause inflammation of the mucosal membranes of the baby, allowing HIV to be more readily taken up if mixed feeding is used. This was the basis of the currently followed guidelines by the World Health Organization where exposed infants have to be exclusively breastfed, non adherence of which has been associated with increased Mother to Child Transmission. Areas like Mpigi district that have been noted for having being ravaged by the HIV epidemic have HIV transmission rates from mother to child, including during breastfeeding higher than the national average at rates upwards of 4% Objective: The purpose of the study was to assess the determinants of adherence to feeding guidelines for exposed infants among mothers living with HIV in Mpigi district Method: The study adopted a facility based descriptive cross sectional research design: The hospital (Nkozi hospital) was purposively sampled to avoid a possible case of eliminating the hospital during the random sampling procedure. The health centers from which the study respondents were obtained where sampled using simple random sampling. At the health facilities, consecutive sampling was used to sample the respondents. Structured interviews and structured questionnaires were used as data collection methods and tools respectively. Data were entered, cleaned and analyzed using SPSS for windows version 20.0 Results: It was found that more than half of the mothers living with HIV in Mpigi district adhered to the breastfeeding guidelines for exposed infants (n = 161, 62%). At individual level, mothers who had fears of infecting baby while breastfeeding were less likely to adhere to feeding guidelines for exposed infants (AOR = .530, CI = .314 - .895). Mothers who had delivered their last born child normally were three times as likely (AOR = 3.492, CI = 2.260 - 5.931) to adhere to feeding guidelines for exposed infants, while mothers who had disclosed HIV status to anyone else were three point five times as likely to adhere to feeding guidelines for exposed infants (AOR =3.564, CI = 1.338 - 4.941) compared to those who had not disclosed their status to anyone else apart from their partner. Bivariate results showed that the was no statistically significant relationship between infant characteristics and adherence to infant feeding guidelines for exposed infants (p<0.05). The study still did not find any statistically significant relationship between the health service characteristics and adherence to the infant feeding guidelines for exposed infants Conclusion: Adherence to feeding adherence for exposed infants among mothers living with HIV in Mpigi district is fairly highly but not satisfactory, it being below the threshold of 80%. About 6 out of every 10 mothers adhere to the guidelines, implying that 4 out of every 10 children born to these mothers are at a very high risk of HIV transmission and could be the ones contributing to the postpartum infant sero conversion rates in the district. The level of adherence to feeding guidelines for exposed infants among mothers living with HIV in Mpigi district feeding is significantly determined by individual characteristics of the mothers living with HIV, while infant and health service characteristics do have a significant influence on that level of adherence. Recommendations: More reassurance and health education needs to be done at both facility and community levels in order to demystify the old notion of all time HIV transmission for as long as breastfeeding is done