FACTORS INFLUENCING INFANT FEEDING CHOICES BY MOTHERS ATTENDING PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV CLINIC IN OYO STATE

Abstract

Mother-To-Child Transmission (MTCT) of HIV is responsible for more than 90.0% of HIV infections in children, and breastfeeding is one of the common routes of transmission. Factors influencing infant feeding choices of HIV positive mothers vary from one cultural setting to another. However, there is little literature on the factors influencing infant feeding choices of HIV positive mothers in Oyo State where breastfeeding is the cultural norm. This study therefore determined factors influencing infant feeding choices of HIV positive mothers enrolled in Prevention of Mother to Child Transmission (PMTCT) HIV clinics in Oyo State. This is a cross-sectional survey of 600 HIV-positive women with babies between ages six weeks and one year. In a two-stage sampling procedure, 600 out of 13,562 HIV positive women were selected through systematic random sampling from six out of ten PMTCT clinics in Oyo State. A semi-structured interviewer-administered questionnaire was used to obtain data on respondents' socio-demographics, infant feeding options such as Exclusive Breast Feeding (EBF), Exclusive Replacement Feeding (ERF) and Mixed Feeding (MF), reasons for the choice of options, disclosure of HIV status, antenatal care visits and influence of family and neighbours on the choice of feeding options. Four Focus Group Discussion (FGDs) sessions were conducted with the aid of an FGD guide and analysed using thematic approach. Data were analysed using descriptive statistics and logistic regression at 5% level of significance. Majority of the mothers (86.0%) were married and aged 31.0 ± 5.7 years. Slightly above half (53.0%) had 2 children and more than two-third had disclosed their HIV status to their spouses. About two-third (61.0%) were traders with 75.0% earning monthly income ≥N5,000.00k. Half of the mothers had ≥6 antenatal care visits and 85.0% had infant feeding counselling. Infant feeding choices among the mothers were EBF (61.0%), ERF (26.0%) and MF (13.0%). The choice of EBF, ERF and MF were influenced by fear of stigmatisation (55.0%), disclosure of HIV status to spouse (67.0%) and neighbours' advice (66.0%) respectively. Predictors of ERF were; being a civil servant [AOR = 5.7, C.I. = 2.5- 16.4), desire to reduce the risk of transmission of HIV [AOR = 2.5, C.I. = 1.0-11.3) and disclosure of HIV status to spouses (AOR=5.0, C.I. =3.8-23 .0]. Predictors of EBF were: monthly income [AOR = 2.6, C.I. =1.4-4.5), infant feeding counselling [AOR = 2.7. C.I. = 1.6-6.9)] and fear of stigmatisation [AOR - 7.2. C.I. = 2.1-23.6 ]. Predictors of MF were: parity < 3 [AOR = 2.0. C.I. = 1.7-5.21- receiving neighbours' advice [AOR = 4.6. C.I. = 1.6-24.4) and infant illness [AOR = 6.8. C. I. = 4.0 -35.1 ). FGDs revealed family pressure as the major factor for MF practice. Although a high proportion of mothers practiced exclusive breastfeeding. mixed feeding is still being practiced due to family pressure. It is therefore recommended that family members' education on safer infant feeding practices in the context of HIV is advocated.