Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
International Breastfeeding Journal
Published in: International Breastfeeding Journal 1/2016

Open Access 01-12-2017 | Research

What influences feeding decisions for HIV-exposed infants in rural Kenya?

Authors: Helen M. Nabwera, Joyline Jepkosgei, Kelly W. Muraya, Amin S. Hassan, Catherine S. Molyneux, Rehema Ali, Andrew M. Prentice, James A. Berkley, Martha K. Mwangome

Published in: International Breastfeeding Journal | Issue 1/2016

Login to get access

Abstract

Background

Infant feeding in the context of human immunodeficiency virus (HIV) poses unique challenges to mothers and healthcare workers in balancing the perceived risks of HIV transmission and nutritional requirements. We aimed to describe the decision-making processes around infant feeding at a rural HIV clinic in Kenya.

Methods

We used a qualitative study design. Between March and August 2011, we conducted in-depth interviews (n = 9) and focus group discussions (n = 10) with purposively selected hospital and community respondents at Kilifi County Hospital, Kenya. These respondents had all experienced of infant feeding in the context of HIV. These interviews were informed by prior structured observations of health care worker interactions with carers during infant feeding counselling sessions.

Results

Overall, women living with HIV found it difficult to adhere to the HIV infant feeding guidance. There were three dominant factors that influenced decision making processes: 1) Exclusive breastfeeding was not the cultural norm, therefore practising it raised questions within the family and community about a mother’s parenting capabilities and HIV status. 2) Women living with HIV lacked autonomy in decision-making on infant feeding due to socio-cultural factors. 3) Non-disclosure of HIV status to close members due to the stigma.

Conclusion

Infant feeding decision-making by women living with HIV in rural Kenya is constrained by a lack of autonomy, stigma and poverty. There is an urgent need to address these challenges through scaling up psycho-social and gender empowerment strategies for women, and introducing initiatives that promote the integration of HIV infant feeding strategies into other child health services.
Appendix
Available only for authorised users
Literature
1.
Coutsoudis A. Infant feeding dilemmas created by HIV: south African experiences. J Nutr. 2005;135(4):956–9.PubMed
2.
Leshabari SC, Blystad A, Moland KM. Difficult choices: infant feeding experiences of HIV-positive mothers in northern Tanzania. Sahara-J. 2007;4(1):544–55.CrossRefPubMed
3.
Hufton E, Raven J. Exploring the infant feeding practices of immigrant women in the north west of England: a case study of asylum seekers and refugees in Liverpool and Manchester. Maternal & Child Nutrition. 2016;12(2):299–313.CrossRef
4.
Richardson BA, John-Stewart GC, Hughes JP, Nduati R, Mbori-Ngacha D, Overbaugh J, et al. Breast-milk infectivity in human immunodeficiency virus type 1-infected mothers. J Infect Dis. 2003;187(5):736–40.CrossRefPubMedPubMedCentral
5.
Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. Bellagio child survival study group: how many child deaths can we prevent this year? Lancet. 2003;362(9377):65–71.CrossRefPubMed
6.
7.
Lunney KM, Jenkins AL, Tavengwa NV, Majo F, Chidhanguro D, Iliff P, et al. HIV-positive poor women may stop breast-feeding early to protect their infants from HIV infection although available replacement diets are grossly inadequate. J Nutr. 2008;138(2):351–7.PubMed
8.
WHO/UNICEF. Global strategy for infant and young child feeding. Geneva: World Health Organization; 2003.
9.
Kimmons JE, Dewey KG, Haque E, Chakraborty J, Osendarp SJ, Brown KH. Low nutrient intakes among infants in rural Bangladesh are attributable to low intake and micronutrient density of complementary foods. J Nutr. 2005;135(3):444–51.PubMed
10.
WHO. Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet. 2000;355(9202):451–5.CrossRef
11.
Coovadia HM, Rollins NC, Bland RM, Little K, Coutsoudis A, Bennish ML, et al. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet. 2007;369(9567):1107–16.CrossRefPubMed
12.
Iliff PJ, Piwoz EG, Tavengwa NV, Zunguza CD, Marinda ET, Nathoo KJ, et al. Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS. 2005;19(7):699–708.CrossRefPubMed
13.
WHO. Guidelines on HIV and infant feeding 2010. Principles and recommendations for infant feeding in the context of HIV and a summary of the evidence. Geneva: WHO; 2010.
14.
Mbori-Ngacha D, Nduati R, John G, Reilly M, Richardson B, Mwatha A, et al. Morbidity and mortality in breastfed and formula-fed infants of HIV-1-infected women: a randomized clinical trial. The Journal of the American Medical Association. 2001;286(19):2413–20.CrossRefPubMed
15.
Hilderbrand K, Goemaere E, Coetzee D. The prevention of mother-to-child HIV transmission programme and infant feeding practices. S Afr Med J. 2003;93(10):779–81.PubMed
16.
Thior I, Lockman S, Smeaton LM, Shapiro RL, Wester C, Heymann SJ, et al. Breastfeeding plus infant zidovudine prophylaxis for 6 months vs formula feeding plus infant zidovudine for 1 month to reduce mother-to-child HIV transmission in Botswana: a randomized trial: the Mashi study. The Journal of the American Medical Association. 2006;296(7):794–805.CrossRefPubMed
17.
Kuhn L, Aldrovandi GM, Sinkala M, Kankasa C, Semrau K, Mwiya M, et al. Effects of early, abrupt weaning on HIV-free survival of children in Zambia. N Engl J Med. 2008;359(2):130–41.CrossRefPubMedPubMedCentral
18.
Kagaayi J, Gray RH, Brahmbhatt H, Kigozi G, Nalugoda F, Wabwire-Mangen F, et al. Survival of infants born to HIV-positive mothers, by feeding modality, in Rakai, Uganda. PLoS One. 2008;3(12):e 3877.CrossRef
19.
Cournil A, Van de Perre P, Cames C, de Vincenzi I, Read JS, Luchters S, et al. Early infant feeding patterns and HIV-free survival: findings from the Kesho-Bora trial (Burkina Faso, Kenya, South Africa). Pediatr Infect Dis J. 2015;34(2):168–74.CrossRefPubMed
20.
Chikhungu LC, Bispo S, Rollins N, Siegfried N, Newell ML. HIV-free survival at 12-24 months in breastfed infants of HIV-infected women on antiretroviral treatment. Tropical Medicine International Health. 2016;21(7):820–8.CrossRefPubMedPubMedCentral
21.
Fawzy A, Arpadi S, Kankasa C, Sinkala M, Mwiya M, Thea DM, et al. Early weaning increases diarrhea morbidity and mortality among uninfected children born to HIV-infected mothers in Zambia. J Infect Dis. 2011;203(9):1222–30.CrossRefPubMedPubMedCentral
22.
Arpadi S, Fawzy A, Aldrovandi GM, Kankasa C, Sinkala M, Mwiya M, et al. Growth faltering due to breastfeeding cessation in uninfected children born to HIV-infected mothers in Zambia. Am J Clin Nutr. 2009;90(2):344–53.CrossRefPubMedPubMedCentral
23.
Siegfried N, van der Merwe L, Brocklehurst P, Sint TT. Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection. The Cochrane Database of Systematic Reviews. 2011;7:CD003510.
24.
Kuhn L, Reitz C, Abrams EJ. Breastfeeding and AIDS in the developing world. Curr Opin Pediatr. 2009;21(1):83–93.CrossRefPubMed
25.
Schwartz SR, Kumwenda N, Kumwenda J, Chen S, Mofenson LM, Taylor AW, et al. Maternal highly active antiretroviral therapy and child HIV-free survival in Malawi, 2004-2009. Matern Child Health J. 2016;20(3):542–9.CrossRefPubMedPubMedCentral
26.
Thomas TK, Masaba R, Borkowf CB, Ndivo R, Zeh C, Misore A, et al. Triple-antiretroviral prophylaxis to prevent mother-to-child HIV transmission through breastfeeding--the Kisumu breastfeeding study, Kenya: a clinical trial. PLoS Med. 2011;8(3):e1001015.CrossRefPubMedPubMedCentral
27.
Omer SB, Six Week Extended Dose Nevirapine (SWEN) Study Team. Twelve-month follow-up of six week extended dose Nevirapine randomized controlled trials: differential impact of extended-dose nevirapine on mother-to-child transmission and infant death by maternal CD4 cell count. AIDS. 2011;25(6):767–76.CrossRefPubMed
28.
29.
Kesho Bora Study Group, de Vincenzi I: Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial. The Lancet Infectious Diseases 2011, 11(3):171–180.
30.
31.
Engebretsen IM, Moland KM, Nankunda J, Karamagi CA, Tylleskar T, Tumwine JK. Gendered perceptions on infant feeding in eastern Uganda: continued need for exclusive breastfeeding support. Int Breastfeed J. 2010;5:13.CrossRefPubMedPubMedCentral
32.
Granato SA, Gloyd S, Robinson J, Dali SA, Ahoba I, Aka D, et al. Results from a rapid national assessment of services for the prevention of mother-to-child transmission of HIV in cote d'Ivoire. J Int AIDS Soc. 2016;19(5 Suppl 4):20838.PubMedPubMedCentral
33.
Adedimeji A, Abboud N, Merdekios B, Shiferaw M. A qualitative study of barriers to effectiveness of interventions to prevent mother-to-child transmission of HIV in Arba Minch Ethiopia. International Journal of Population Research. 2012;2012:1–7.CrossRef
34.
Kimani-Murage EW, Wekesah F, Wanjohi M, Kyobutungi C, Ezeh AC, Musoke RN, Norris SA, Madise NJ, Griffiths P. Factors affecting actualisation of the WHO breastfeeding recommendations in urban poor settings in Kenya. Maternal and Child Nutrition. 2015;11(3):314–32.
35.
36.
37.
McCoy SI, Buzdugan R, Mushavi A, Mahomva A, Cowan FM, Padian NS. Food insecurity is a barrier to prevention of mother-to-child HIV transmission services in Zimbabwe: a cross-sectional study. BMC Public Health. 2015;15:420.CrossRefPubMedPubMedCentral
38.
Salfield JR, Oppenheimer SJ, Fulford AJ, Powers HJ, Harrison C, Mugambe M. Food consumption patterns analysed as food portions rather than nutrients in east coast Kenya: a cluster sample survey. J Hum Nutr Diet. 1992;5:225–35.CrossRef
39.
Bejon P, Mohammed S, Mwangi I, Atkinson SH, Osier F, Peshu N, Newton CR, Maitland K, Berkley JA. Fraction of all hospital admissions and deaths attributable to malnutrition among children in rural Kenya. Am J Clin Nutr. 2008;88(6):1626–31.CrossRefPubMedPubMedCentral
40.
41.
42.
Hassan AS, Sakwa EM, Nabwera HM, Taegtmeyer MM, Kimutai RM, Sanders EJ, et al. Dynamics and constraints of early infant diagnosis of HIV infection in rural Kenya. AIDS Behav. 2012;16(1):5–12.CrossRefPubMed
43.
44.
Kamuya DM, Marsh V, Kombe FK, Geissler PW, Molyneux SC. Engaging communities to strengthen research ethics in low-income settings: selection and perceptions of members of a network of representatives in coastal Kenya. Developing World Bioethics. 2013;13(1):10–20.CrossRefPubMedPubMedCentral
45.
Bhutta ZA, Labbok M. Scaling up breastfeeding in developing countries. Lancet. 2011;378(9789):378–80.CrossRefPubMed
46.
47.
48.
Green J, Thorogood N. Beginning data analysis in: qualitative methods for Health Research. 2nd ed. London: Sage Publications Ltd; 2009. p. 201–32.
49.
Marquis GS, Lartey A, Perez-Escamilla R, Mazur RE, Brakohiapa L, Birks KA. Factors are not the same for risk of stopping exclusive breast-feeding and introducing different types of liquids and solids in HIV-affected communities in Ghana. Br J Nutr. 2016;116(1):115–25.CrossRefPubMed
50.
Victora CG, Bahl R, Barros AJ, Franca GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90.CrossRefPubMed
51.
Diji AK, Bam V, Asante E, Lomotey AY, Yeboah S, Owusu HA. Challenges and predictors of exclusive breastfeeding among mothers attending the child welfare clinic at a regional hospital in Ghana: a descriptive cross-sectional study. Int Breastfeed J. 2017;12:13.CrossRefPubMedPubMedCentral
52.
Wojcicki JM. Time to consider moving beyond exclusive breastfeeding in southern Africa. Child Aust. 2017;4:1.
53.
54.
Odeny BM, Pfeiffer J, Farquhar C, Igonya EK, Gatuguta A, Kagwaini F, et al. The stigma of exclusive breastfeeding among both HIV-positive and HIV-negative women in Nairobi, Kenya. Breastfeed Med. 2016;11:252–8.CrossRefPubMedPubMedCentral
55.
Bezner Kerr R, Dakishoni L, Shumba L, Msachi R, Chirwa M. "we grandmothers know plenty": breastfeeding, complementary feeding and the multifaceted role of grandmothers in Malawi. Social Sciences & Medicine. 2008;66(5):1095–105.CrossRef
56.
Talbert AW, Ngari M, Tsofa B, Mramba L, Mumbo E, Berkley JA, et al. "when you give birth you will not be without your mother" a mixed methods study of advice on breastfeeding for first-time mothers in rural coastal Kenya. Int Breastfeed J. 2016;11:10.CrossRefPubMedPubMedCentral
57.
Aubel J, Toure I, Diagne M. Senegalese grandmothers promote improved maternal and child nutrition practices: the guardians of tradition are not averse to change. Social Sciences & Medicine. 2004;59(5):945–59.CrossRef
58.
Nankumbi J, Muliira JK. Barriers to infant and child-feeding practices: a qualitative study of primary caregivers in rural Uganda. Journal of Health Population and Nutrition. 2015;33(1):106–16.
59.
Doherty T, Chopra M, Nkonki L, Jackson D, Persson LA. A longitudinal qualitative study of infant-feeding decision making and practices among HIV-positive women in South Africa. J Nutr. 2006;136(9):2421–6.PubMed
60.
Thairu LN, Pelto GH, Rollins NC, Bland RM, Ntshangase N. Sociocultural influences on infant feeding decisions among HIV-infected women in rural Kwa-Zulu Natal South Africa. Maternal & Child Nutrition. 2005;1(1):2–10.CrossRef
61.
Doherty T, Chopra M, Nkonki L, Jackson D, Greiner T. Effect of the HIV epidemic on infant feeding in South Africa: "when they see me coming with the tins they laugh at me". Bull World Health Organ. 2006;84(2):90–6.CrossRefPubMedPubMedCentral
62.
Murithi LK, Masho SW, Vanderbilt AA. Factors enhancing utilization of and adherence to prevention of mother-to-child transmission (PMTCT) service in an urban setting in Kenya. AIDS Behav. 2015;19(4):645–54.CrossRefPubMed
63.
Maman S, van Rooyen H, Groves AK. HIV status disclosure to families for social support in South Africa (NIMH project accept/HPTN 043). AIDS Care. 2014;26(2):226–32.CrossRefPubMed
64.
Colombini M, James C, Ndwiga C, Mayhew SH. The risks of partner violence following HIV status disclosure, and health service responses: narratives of women attending reproductive health services in Kenya. J Int AIDS Soc. 2016;19(1):20766.CrossRefPubMedPubMedCentral
65.
Zamudio-Haas S, Mudekunye-Mahaka I, Lambdin BH, Dunbar MS. If, when and how to tell: a qualitative study of HIV disclosure among young women in Zimbabwe. Reproductive Health Matters. 2012;20(39 Suppl):18–26.CrossRefPubMed
66.
Bunn J, Kerac M. Excess mortality risk associated with HIV in a large Malawi nutritional rehabilitation unit. Malawi Med J. 2007;19:95.
67.
Gewa CA, Oguttu M, Yandell NS. Maternal nutrition in rural Kenya: health and socio-demographic determinants and its association with child nutrition. Maternal & Child Nutrition. 2012;8(3):275–86.CrossRef
68.
Gewa CA, Yandell N. Undernutrition among Kenyan children: contribution of child, maternal and household factors. Public Health Nutr. 2012;15(6):1029–38.CrossRefPubMed
69.
Bergman M, Nygren-Brunell O, Vilakati D, Malqvist M. Prolonged exclusive breastfeeding through peer support: a cohort study from a community outreach project in Swaziland. J Community Health. 2016;41(5):932–8.CrossRefPubMed
70.
Woelk GB, Kieffer MP, Walker D, Mpofu D, Machekano R, Project ACCLAIM Study Group. Evaluating the effectiveness of selected community-level interventions on key maternal, child health, and prevention of mother-to-child transmission of HIV outcomes in three countries (the ACCLAIM project): a study protocol for a randomized controlled trial. Trials. 2016;17:88.CrossRefPubMedPubMedCentral
71.
Bland RM, Rollins NC, Coutsoudis A, Coovadia HM. Breastfeeding practices in an area of high HIV prevalence in rural South Africa. Acta Paediatr. 2002;91(6):704–11.CrossRefPubMed
72.
Buskens I, Jaffe A, Mkhatshwa H. Infant feeding practices: realities and mind sets of mothers in southern Africa. AIDS Care. 2007;19(9):1101–9.CrossRefPubMed
73.
Sibeko L, Coutsoudis A, Nzuza S, Gray-Donald K. Mothers' infant feeding experiences: constraints and supports for optimal feeding in an HIV-impacted urban community in South Africa. Public Health Nutr. 2009;12(11):1983–90.CrossRefPubMed
74.
WHO Strategic approaches to the prevention of HIV infection in infants In: Report of a WHO meeting, 20–22 march 2002. Morges, Switzerland WHO; 2003.
75.
76.
77.
Tuthill EL, Chan J, Butler LM. Challenges faced by health-care providers offering infant-feeding counseling to HIV-positive women in sub-Saharan Africa: a review of current research. AIDS Care. 2015;27(1):17–24.CrossRefPubMed
78.
Chinkonde JR, Hem MH, Sundby J. HIV and infant feeding in Malawi: public health simplicity in complex social and cultural contexts. BMC Public Health. 2012;12:700.CrossRefPubMedPubMedCentral
79.
Shayo EH, Vaga BB, Moland KM, Kamuzora P, Blystad A. Challenges of disseminating clinical practice guidelines in a weak health system: the case of HIV and infant feeding recommendations in Tanzania. Int Breastfeed J. 2014;9:188.CrossRefPubMedPubMedCentral
80.
Tuthill E, McGrath J, Young S. Commonalities and differences in infant feeding attitudes and practices in the context of HIV in sub-Saharan Africa: a metasynthesis. AIDS Care. 2014;26(2):214–25.CrossRefPubMed
81.
Hosey KN, Kalula A, Voss J. Establishing an online continuing and professional development library for nurses and midwives in east, central, and southern Africa. The Journal of the Association of Nurses in AIDS Care. 2016;27(3):297–311.CrossRefPubMedPubMedCentral
82.
Greene JC. Mixed methods in social inquiry. San Francisco: John Wiley; 2007.
83.
Richards H, Emslie C. The 'doctor' or the 'girl from the University'? Considering the influence of professional roles on qualitative interviewing. Fam Pract. 2000;17(1):71–5.CrossRefPubMed
Metadata
Title
What influences feeding decisions for HIV-exposed infants in rural Kenya?
Authors
Helen M. Nabwera
Joyline Jepkosgei
Kelly W. Muraya
Amin S. Hassan
Catherine S. Molyneux
Rehema Ali
Andrew M. Prentice
James A. Berkley
Martha K. Mwangome
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Breastfeeding Journal / Issue 1/2016
Electronic ISSN: 1746-4358
DOI
https://doi.org/10.1186/s13006-017-0125-x

Other articles of this Issue 1/2016

International Breastfeeding Journal 1/2016 Go to the issue

Research

Infant feeding pattern in the first six months of age in USA: a follow-up study

Research

Factors associated with intention to exclusive breastfeed in central women’s hospital, Yangon, Myanmar

Research

Infant feeding knowledge, perceptions and practices among women with and without HIV in Johannesburg, South Africa: a survey in healthcare facilities

Research

The effect of family policies and public health initiatives on breastfeeding initiation among 18 high-income countries: a qualitative comparative analysis research design

Review

Stakeholder views of breastfeeding education in schools: a systematic mixed studies review of the literature

Research

Child feeding practices and diarrheal disease among children less than two years of age of the nomadic people in Hadaleala District, Afar Region, Northeast Ethiopia