Kalu SO, Reynolds F, Petra GB, Ikechebelu JI, Dada MO, Oluboyo BO and Igwegbe AO
Background: The HIV epidemic has significantly altered the context within which women make decisions about how they will feed their infants. This study examined the antenatal infant feeding choices and actual infant feeding practices of HIV-positive mothers in order to assess adherence to the 2010 WHO national infant feeding guidelines in Nnewi, Nigeria.
Methods: The study was conducted between January 2012 and February 2013 at Nnamdi-Azikiwe University Teaching Hospital (NAUTH) in Nnewi-Anambra State, Nigeria. It was a prospective cohort study of HIV positive women attending the Prevention of Mother-To-Child Transmission (PMTCT) clinic in NAUTH. Women received HIV Counseling and Testing (HCT) from trained HIV positive women working in the hospital and from members of HIV support groups. The women made an informed decision on their infant feeding choice and received antiretroviral (ARV) treatment or prophylaxis (WHO option B) following WHO 2010 guidelines. Each mother-baby pair was followed up until the HIV sero-status of the baby was determined by DNA PCR (6-8weeks after cessation of breastfeeding).
Results: The overall HIV MTCT rate was 19 of 583 (3.3%; 95% confidence interval (CI): 2.0 - 5.0). Only 94 (16.1%; 95% CI: 13.2 - 19.4) mothers complied with the WHO 2010 recommendation of exclusive breastfeeding (EBF) and ARV treatment or prophylaxis. Overall, 431 (73.9%) mother-baby pairs received prophylactic ARV intervention; in 88 (15.1%) pairs, the baby or the mother received ARV; while in 64 (11.0%) pairs, neither mother nor baby received ARV. When the mother-baby pair received ARV, MTCT was 0.8%, 1.7% and 5.9% for Exclusive Formular Feeding (EFF), EBF and Mixed Feeding (MF), respectively. When either mother or baby received intervention, MTCT rates increased to 3.3%, 4.8% and 7.7% for EFF, EBF and MF, respectively. The rate of MTCT was further increased to 5.1%, 6.7% and 23.5% when neither mother nor baby received intervention for EFF, EBF and MF respectively.
Conclusion: EFF is still the infant feeding option preferred and practiced by majority of our HIV positive mothers despite the promotion of the safety of EBF with ARV interventions according to WHO 2010 guideline. It will take some time to change existing belief in EFF for us to achieve the required shift to EBF in our practice area. We also demonstrated that ARV treatment/chemoprophylaxis for both mother and baby is an important measure for achieving the reduction of MTCT of HIV in breastfeeding setting mixed feeding practice is associated with an increased rate of MTCT and should be strongly discouraged. Increasing the uptake of ARV treatment/ chemoprophylaxis and ensuring appropriate counseling about infant feeding practices have the potential to markedly decrease the rate of MTCT of HIV in developing countries.
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