Breastfeeding and infant feeding in the era of HIV: A case of two districts in Zambia
Nyirenda, Elizabeth Tamara
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Research has shown that exclusively breastfed HIV exposed infants have lower mortality and morbidity. It is against this background that the United Nations World Health Organisation (WHO) recommended that infants born to HIV positive women should be exclusively breastfed until replacement feeding is Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS). Infant and Young Child Feeding (IYCF) is a critical issue that needs to be addressed with utmost attention if we are to ensure an HIV free generation. Appropriate interventions should be taken especially with regard to breastfeeding because UNAIDS estimates that in the absence of intervention to prevent transmission of HIV from mother- to - child, 25 to 45 percent of HIV infected mothers will pass the virus to their infants. The purpose of this study was to investigate awareness, attitudes, intentions and practices towards breastfeeding and infant feeding in the era of HIV and how expert recommendations on infant feeding have reached the target population and the extent to which they have been adhered to. The study was carried out in two urban districts of Zambia and a non- intervention exploratory study design was employed. A questionnaire was used to collect data from a total of 500 women aged 16-49 conveniently selected from 10 randomly selected clinics in Lusaka and Kitwe. Data were entered using Census and Survey Processing System (CsPro version 4.1) and analysed using Statistical Package for Social Sciences (SPSS version 16). Bi-variate analysis was used to determine the existence of relationships between variables. Overall, breastfeeding prevalence among mothers was high and women were highly aware of the benefits of breastfeeding and mother- to -child transmission of HIV through breastfeeding. Most women were aware that HIV positive women can breastfeed their infants; however they, stated that they would not be comfortable breastfeeding their infants if they were found HIV positive. Forty three percent (43.2%) of the respondents knew of HIV positive women who were breastfeeding in their communities. Most women (69.7%) preferred commercial infant formula as the best alternative for feeding HIV exposed infants. Women (90.4%) considered wet nursing as taboo and alien. Expressed Heat Treated (EHT) breast milk was known only to few mothers (18.4%) and, very few mothers (9.6%) knew that wet nursing was an option for feeding infants born to HIV positive mothers. In conclusion, the dilemma between exclusive breastfeeding and replacement feeding continues to be a daunting task not only for mothers but also for the health workers, policy makers and the nation at large. The findings have shown that fear to transmit HIV to infants during breastfeeding and stigma are the major deterrents to exclusive breastfeeding resulting in most women resorting to formula feeding even when AFASS criteria were not met. Lack of proper information compounds this problem and lack of full community support, also as a result of the former, continues not only to put infants at high risk of mortality and morbidity but also negates the effort of virtual elimination of mother to child transmission by 2015.