CHAPTER ONE
INTRODUCTION
Background to the Study
Infant feeding is essential in the first year of life and a
key determinant of child survival and development. Breastfeeding is a universal
socio-culturally acceptable, nutritious way to feed infants and enhances
children immunity (UNAIDS, 2015). However, research indicates that breast milk
contributes about 15% of the risk of HIV transmission from an infected mother
to the child, especially when mixed feeding is practiced before weaning
(Nduati, Richardson & John, 2011). In sub Saharan Africa, mother to child
transmission (MTCT) of HIV is responsible for about 90% of infection in
children, and about half of these infection thought have been acquired through
breast feeding (Newell, 2016). The dilemma posed between lifesaving benefit and
risk of transmission through breastfeeding complicate infant feedings in a
communities affected by HIV/AIDS.
Globally, it is estimated that 35% of under-five mortality is due to HIV
and AIDS (UNAIDS, 2015).
Prevention of mother-to-child transmission (PMTCT) of HIV is
an important intervention in the prevention and control of HIV and AIDS to
reduce child mortality and increase the rate of child survival (UNAIDS, 2015).
A culturally acceptable, low cost approach to infant feeding is essential to
prevent HIV transmission through breast milk (Coovadia, Rollins, Bland, Little,
Coutsoudi, Bennish & Newell, 2014). In countries not affected by HIV,
improving infant feeding can reduce mortality by up to 19%. The impact could be
greater in HIV affected populations if interventions that reduce HIV
transmission through breastfeeding could be successfully linked to strategies
that improve infant feeding practices (Coovadia et al., 2014). However, this is
confounded by the complexity of identifying the most appropriate infant feeding
practices that fit household and social circumstances of mothers. The World
Health Organization recommends that in light of the effectiveness of
Anti-retrovirals (ARVs), HIV infected mothers should continue breast feeding
their infant until twelve months of age (WHO, 2010).This capitalizes on the
maximum benefit of breast feeding to improve the infant’s chances of survival
while reducing the risk of HIV transmission.
The Nigerian national HIV guidelines states that avoidance
of all breastfeeding by HIV-infected mothers is recommended “when replacement
feeding is acceptable, feasible, affordable, sustainable and safe (AFASS).
Otherwise, exclusive breastfeeding is recommended during the first months of
life” (Federal Ministry of Health, 2010). This calls on governments and donors
to increase commitment to and resources for improving infant feeding practices
in HIV affected populations. The investment should be targeted to effectively
prevent infants from becoming infected with HIV through breastfeeding, improve
HIV free-survival of infants and achieve international developments goals, such
as Millennium Development Goals (MDGs) and those set by United Nations General
Assembly Special Session on HIV and AIDS (UNGASS) (WHO, 2010). The risk of HIV
transmission increases (25-45%) with the age of infant and maternal practice of
mixed feeding before 6 months of life (Federal Ministry of Health, 2010). Supporting optimal infant feeding practices
was a challenge for health systems (WHO, 2010).
The main challenge is how to improve, through optimal
feeding the nutritional status, growth and healthy development and thus
survival of infants and young children in the given circumstances in the middle
of HIV/AIDS pandemics (World Health Organization WHO, 2010). The World Health Organizations
guideline on HIV and infant feeding which was revised in 2010 recommends that
in order to reduce the risk of the baby becoming infected, mothers or their
infants are advised to take a course of antiretroviral drugs through the
breastfeeding period. Mothers are also
advised to exclusively breastfeed their infants for 6 months meanwhile
introduces other food substances while continuing breastfeed up to a year. The
guideline also lists special conditions needed to safely formula feed (WHO,
2010). Some studies revealed that the
risk of mother to child transmission is lower among mothers who exclusively
breastfed when compared to those who practiced mixed feeding. Evidences also
indicates that exclusive replacement feeding (ERF) is associated with low risk
of post natal HIV transmission and high mortality when compared to breast
feeding (Kuhn, Kankasa, Semrau, Kasonde, Scott, 2017).
There are limited comprehensive intervention package
available to postpartum mothers in most health facilities in Cross River State.
Feeding of the HIV-exposed infant in settings where a high premium is placed on
breastfeeding is a major challenge. This study therefore is aimed at
determining factors influencing the choice of infant feeding options among HIV
positive mothers attending health facilities in Calabar South, Calabar, Cross
River State