MOTHERS ATTENDING PREVENTION OF MOTHER TO CHILD TRANSMISSION KNOWLEDGE AND ATTITUDE OF EXCLUSIVE BREASTFEEDING AMONG HIV POSITIVE CLINIC IN MATERNAL AND CHILD HEALTH CARE, BARRACKS ROAD, UYO AKWA IBOM STATE
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This research sought to examine knowledge and attitude of exclusive breastfeeding among HIV positive mothers attending prevention of mother to child transmission clinic, using maternal and child health care clinic in Barracks Road, Uyo Akwa Ibom State as a case study. The study was guided by three research questions and two hypotheses. A survey research design was adopted and a random sampling technique was used to select seventy (70) respondents which were majorly breast feeding mothers from the study area. However, only thirty (30) responded to the questionnaire.The study made use of both the primary and secondary method of data collection. The major instrument for the studywas the questionnaire. Data collected were analyzed by used of Chi-square statistical tool andsimple percentages. The finding of the study revealed thatthe respondents received infant-feeding counseling during the antenatal period, and that the healthcare workers told them how to breastfeed correctly, and what exclusive breastfeeding entails. Also that the practice of ART among HIV positive mothers do reduce the risks of HIV transmission during breastfeeding. It was concluded thatmost of the women in the study area still had negative perceptions about certain aspects of the services and the EBF recommendations.It was suggested that the Ministry of Health should provide a one-on-one mentoring on the benefits and the implications of breastfeeding for the HIV positive mother and the baby.
1.1 Background to the Study
Breastfeeding is the superior and ideal form of nutrition naturally designated for infants because of it richness in essential nutrients which support proper nourishment and growth of infants (AK, Mbachu, Uzochukwu, Elias, Omotowo, Agunwu, & Obi, 2018). Breast milk contains lifesaving immunity against infectious childhood illnesses because it confers antibodies such as immunoglobulin A, G,M and E which act as first line defense against some common childhood illnesses such as diarrhoea, pneumonia and ear infections (Newman, 1995). Breastfeeding therefore plays a major role in reducing infant morbidity and mortality (Lawrence, 2004). Despite the importance of breastfeeding to infants, exclusive breastfeeding for the first six months of life after birth reduces the risk of postpartum transmission of HIV from an infected mother to her baby (Fletcher, 2008).
Human immunodeficiency virus (HIV) and AIDS infection are the leading causes of mortality and morbidity amongst women and children, particularly in the sub-Saharan African countries where the prevalence of HIV is high. Twenty low and middle income countries, including Nigeria, account for the highest estimated numbers of pregnant women living with HIV (UNAIDS, 2011). Nigeria accounts for about 10% of all HIV/AIDS cases in the world (UNAIDS, 2006). Globally, women constitute 48% of adults infected with HIV; in Nigeria, they constitute 57%. The prevalence is highest among productive young people between the ages of 20 and 29 years, with 60% of new infections occurring in the 15-25 years age group (Federal Ministry of Health of Nigeria, 2006). Breastfeeding in Nigeria is universal with almost all babies being breastfed. However, the practice of exclusive breastfeeding (EBF) is rare with only 17% of children younger than six months being exclusively breastfed (Nigerian Demographic and Health Survey, 2008).
Exclusive breastfeeding (EBF) is simply the process of feeding an infant with only breast milk, and no additional liquids or solids, not even water, apart from drops or syrups consisting of vitamins, minerals supplements or medicines (WHO, 2008). Exclusive breastfeeding in the first six (6) months of life help boost infants’ immune system and protects them from diarrhea and acute respiratory infections which are leading causes of infant mortality in the developing world (UNICEF, 2006). Human Immunodeficiency Virus abbreviated as (HIV) is a virus that attacks the body’s immune system. And if the virus is not treated, it can lead to (acquired immunodeficiency syndrome) also known as AIDS. The world health organization (WHO) recommends feeding practices for infants born from Human Immunodeficiency Virus (HIV) infected mothers to be safe to both the infant and the mother. This includes prevention of mother to child transmission (PMTCT) of the virus and at the same time meeting nutritional requirements of the child. This requires prioritizing prevention of HIV transmission through breastfeeding against non-HIV morbidity and mortality especially from malnutrition and serious illnesses such as diarrhea, among non-breastfed infants (UNICEF, 2006).
According to the (World Health Organization, 2016), increasingly evidence have shown that giving antiretroviral drugs to the mother or to the infant can significantly reduce HIV transmission through breastfeeding. Katepa-Bwalya, Mukonka, Kankasa, Masaninga, Siziya and Babaniyi (2015) conducted a study that sought to establish the appropriate time to start breastfeeding, duration of exclusive breastfeeding and when to start complementary feeding. The results of the study indicate that only 50% of women who participated in the study had some knowledge about breastfeeding. However, another study was conducted by (Teka, Assefar and Haileslassie, 2015) the results showed that 77% of women who participated in the study indicated that the advantage of breastfeeding is for prevention of pregnancy. In a separate study by (Mekuria and Edris, 2015), results showed that the majority (90.1%) of the study participants had received breastfeeding information, (61.7%) of mothers did not have enough knowledge of breastfeeding and (57.4%) of mothers knew that the first milk (colostrum) should be given to infants. The results from these studies suggest that knowledge levels around breastfeeding are a significant determinant of the breastfeeding behavior (Mekuria & Edris 2015).
Acknowledging the fact that HIV can be transmitted through breast milk, the WHO developed a series of infant feeding guidelines which guides HIV positive mothers on how to feed their babies (Shayo, Vaga, Moland, Kamuzora & Blystad, 2014). This study will examine the knowledge and attitude of exclusive breastfeeding among HIV positive mothers attending prevention of mother to child transmission clinic in Akwa Ibom State.
1.2 Problem Statement
The risk of HIV transmission through breast milk and preserving its life saving benefit is challenge for many HIV positive mothers in Nigeria. United Nations Children’s Emergency Fund (UNICEF) estimated that not breastfeeding is responsible for 1.5 million children death per year. The largest burden of these infection and deaths occur in developing countries like Nigeria (Fletcher, 2008). Knowledge and awareness of mother to Child Transmission (MTCT) of HIV, also known as vertical transmission, remains a major challenge in Akwa Ibom State. Nursing mothers infected with HIV positive can transfer the virus to their infants during pregnancy, labour, delivery and breastfeeding. Although mother to Child Transmission (MTCT) of HIV is largely preventable especially when early detected, there are still challenges with breastfeeding transmission in regions where coverage of antiretroviral treatment (ART) among pregnant women is very low (Bekere, 2014). Nursing mothers with knowledge about antiretroviral treatment (ART) in Akwa Ibom State is relatively low. And most women in the study area have negative perceptions of exclusive breastfeeding influenced by their socio-cultural factors and educational level. Adherence to infant feeding recommendations is a very important determinant of HIV free survival of infants of HIV-positive mothers. Due to the high burden of MTCT of HIV, childhood deaths attributable to HIV as well as malnutrition in Nigeria, this study was carried out to determine the knowledge and attitude of exclusive breastfeeding among HIV positive mothers attending prevention of mother to child transmission clinic in maternal and child health care, Barracks Road, Uyo Akwa Ibom State.
1.3 Aims/Objectives of the Study
The primary aim of this study is to examine the knowledge and attitude of exclusive breastfeeding among HIV positive mothers attending prevention of mother to child transmission clinic in maternal and child health care, Barracks Road, Uyo Akwa Ibom State. The specific objectives are:
- To determine the adherence to choice of infant feeding option among HIV positive mothers at maternal and child health care centre, Barracks Road, Uyo.
- To ascertain whether the practice of ART among HIV positive mothers reduce the risks of HIV transmission during breastfeeding.
- To find out if feeding infants with other food before six months increases the risk of HIV transmission from the mother to infants.
1.4 Significance of the Study
It is often imperative to question what would be the significance of any endeavor, be it academic or otherwise. This is also applicable in this study. The researcher anticipates that at the completion of this study, it will give a clear insight on the knowledge and attitude of exclusive breastfeeding among HIV positive mothers attending prevention of mother to child transmission clinic in maternal and child health care, Barracks Road, Uyo Akwa Ibom State. The findings here will also add to the knowledge on prevention of mother-to-child transmission (PMTCT) practices among nurses who are the frontline sensitizers. The findings of the study will provide a current perceptual database that will inform the public and more importantly the policy makers on the feelings and views of HIV positive mothers about exclusive breastfeeding so that appropriate alternatives to motivate the adherence of exclusive breastfeeding recommendations and its support, would be developed by breastfeeding mothers, helpers and the populace of Nigeria. The results of the study will assist the researcher in understanding knowledge and attitudes of HIV positive mothers on exclusive breastfeeding and ultimately identifying problems and misconceptions about exclusive breastfeeding. The information obtained may have influence in the formulation or amendment of infants feeding policies, strategy or awareness campaign strategies to address the knowledge and attitudes of HIV positive mothers on exclusive breastfeeding.
1.5 Research Questions
To achieve the objective of this study, the following questions are formulated.
- Do HIV positive mothers adhere to the choice of infant feeding options recommended at maternal and child health care centre, Barracks Road, Uyo?
- Does the practice of ART among HIV positive mothers reduce the risks of HIV transmission during breastfeeding?
- Does feeding infants with other food before six months increases the risk of HIV transmission from the mother to infants?
1.6 Research Hypotheses
The following hypotheses will be tested in the course of the study;
H0: The practice of ART among HIV positive mothers does not reduce the risks of HIV transmission during breastfeeding.
H1: The practice of ART among HIV positive mothers do reduce the risks of HIV transmission during breastfeeding.
H0: feeding infants with other food before six months does not increases the risk of HIV transmission from the mother to infants.
H2: feeding infants with other food before six months increases the risk of HIV transmission from the mother to infants.
1.7 Scope of the Study
This study focuses mainly on the knowledge and attitude of exclusive breastfeeding among HIV positive mothers. The study focused on HIV disease which poses a serious health challenge to Nigeria. The study will be limited to nursing mothers and health workers (Nurses) in maternal and child health care, Barracks Road, Uyo. It will therefore, be carried out among the Nurses and breast feeding mothers women in maternal and child health care centre in Uyo, Akwa Ibom state.
1.8 Limitations of the study
The main limitation of this study was that it was conducted in only one health facility and this may limit the extent to which the results can be generalized. Only women who attended the antenatal clinic and consented to participate in the study over the period of the visits were interviewed. This may have resulted in selection bias, because the views of women who utilised other sources of antenatal care such as private clinics and traditional birth attendants would not have been reflected in this study.
However, the maternal and child health care centre is one major place in the Uyo local government area where PMTCT services is being provided at the time of this study. Thus, only pregnant women visiting the facility would have been eligible to assess the PMTCT services delivered in that area. It was difficult to reach the target number of respondents for questioning because not all HIV positive women coming to the clinic were willing to corporate with the researcher. Therefore, it could safely be assumed that the results obtained are applicable to the women in this area who utilise public and traditional health care facilities.
1.9 Definitions of Concepts
In order to clarify the concepts used in this study, the following definitions are provided:
Knowledge is the expertise and skills acquired by a person through experience or education in the theoretical or practical understanding of a subject, in this case the knowledge of EBF. Knowledge in this study is defined as the information or understanding of education received by HIV-positive women (Thomson et al. 2018).
Attitude is the predisposition or tendency to respond positively or negatively towards a certain idea, object, person or situation (Business Dictionary, 2015). Attitude in this study refers to either positive or negative reactions or responses of HIV-positive women on EBF.
Exclusive breastfeeding is feeding an infant breast milk only, with no supplementary feeding such as water, juice, animal milk or solid foods for the first six months of life, except vitamins, minerals and medication prescribed by a doctor or healthcare worker when medically indicated (Department of Health 2013). In this study, EBF refers to feeding breast milk only for six months without adding anything, unless medically indicated; i.e. no formula, water, syrups or traditional medicines.
Mother-to-child transmission (MTCT) of HIV: is the passing of HIV from a woman infected with HIV to her baby during pregnancy, labour, delivery or breastfeeding (AIDSinfo, 2012).
Antiretroviral Therapy (ART): is the recommended treatment for HIV, involves taking fixed doses of a combination of three or more anti-HIV medicines from at least two different drug classes every day to control the virus (AIDSinfo, 2012).
HIV Positive Women: refer to women who have taken an HIV test whose results have been confirmed positive and who know their status (South Africa 2013:69). For the aim of this study HIV positive women are breastfeeding mothers who tested positive and confirmatory tests were done, and they are collecting ART in maternal and child health care centre, Uyo.
Human immunodeficiency virus (HIV): This is the virus that causes HIV infection. During HIV infection this virus attacks and destroys the infection-fighting CD4 cells of the body’s immune system. Loss of CD4 cells makes it difficult for the body to fight infection. HIV is a sexually transmitted infection. It can also be spread by contact with infected blood, or from mother to child during pregnancy, childbirth or breast-feeding. It can take years before HIV weakens your immune system to the point that you have AIDS (HIV/AIDS-mayo Clinic, 2015).