Determinants of adherence to the exclusive breast feeding option among HIV Positive mothers in eight selected health centres in Lusaka District
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Exclusive breastfeeding (EBF) practice in the context of Human Immunodeficiency Virus (HIV) remains a challenge especially when the infant is HIV negative because breastmilk may contain HIV. Some studies have shown a consistent lower risk postnatal HIV transmission from mother to infant of about 4% among exclusively breastfed infants (Kuhn et. al 2009 & WHO 2009). In Zambia, “EBF is recommended for HIV-infected women for the first six months of life unless replacement feeding is acceptable, feasible, affordable, sustainable and safe (AFASS) for them and their infants before that time” (MOH & NFNC 2007:3). The study was motivated by inadequacies in reviewed literature on determinants of adherence to EBF among HIV infected women relating to design, setting and scope. The overall objective was to assess determinants of adherence among HIV infected mothers aged 18 to 49 years with children aged 0 to 12 months in eight selected health centres in Lusaka district. The design was cross sectional and used quantitative and qualitative methods. Study sites were stratified into high and medium centres. Sites and respondents were selected using simple random sampling. Quantitative sample included 400 respondents. Qualitative data was collected from Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) from 44 mothers and 8 health workers respectively. Questionnare and questionnaire guides were used to collect quantitative and qualitative data respectively. Quantitive data was analysed using Statistical Package for Social Sciences. Associations were derived using Chi-square test and were adjusted using logistic regression. Statistical significance level was set at P-value less than 0.05. Framework analysis was used to analyse qualitative data. Study design limited the study as respondent‟s feeding practices could not be followed up at various stages.Findings showed that marital status and breast condition related illnesses determined adherence to EBF. For example married mothers were 2.88 times more likely to report adherence than their single counterparts. Mothers who did not suffer from any form of breast condition were 5.34 times more likely to report adherence compared to those who suffered from some form of breast condition. Other determinants were service, socio-economic and cultural related.The study recommends that government should invest in strengthening the Infant and Young Child Feeding (IYCF) programme in the context of HIV. First, pre and in-service curricula for health workers should be reviewed and updated to include IYCF issues. Furthermore, male involvement, health centre and community support systems which focus on Preventing Mother-To-Child-Transmission (PMTCT) issues should be strengthened and expanded. Continued health workers‟ capacity building regarding feeding in HIV context and provision of Job aids for use during counselling and nutrition education to ensure that consistent messages are passed on to the mothers. Issues of culture detrimental to feeding practices of mothers should be addressed by nutrion education. Future research should undertake a prospective study to follow-up baby-mother pairs‟ feeding practices from birth up to six months of age so as to reduce on recall bias.The study concludes that the main determinants of adherence to EBF were marital status, breast condition, counselling and nutrition education, socio-economic status and acceptability of breastfeeding as a cultural norm in relation to status disclosure.