Break out C5 Nabukera

Infant Feeding and HIV Prevention: A Needs Assessment: Mbarara, Uganda.: 

Infant Feeding and HIV Prevention: A Needs Assessment: Mbarara, Uganda. Sarah K. Nabukera, MD, MPH.1,2 Juliet A. Mwanga, MBchB, MMED.3 Jude Senkungu, MBchB, MMED.3 1Department of Maternal & Child Health UAB, School of Public Health 2 Department Community Health 3 Department of Pediatrics Mbarara University of Science & Technology 12th Annual CDC MCH Epidemiology Conference Atlanta, Georgia December, 2006

Presentation Outline: 

Presentation Outline Background Study Objectives Methodology Findings Comments Implications for future research

Background: 

Background In 1999, the first research findings on how ARVS could prevent mother-to-child transmission of HIV where published. Over the last 5 years, several perinatal HIV prevention programs have been implemented in several developing countries.

Background: 

Background Programs have had varying degrees of success in different countries. One issue that has raised great concern and debate in the health sector regards breastfeeding.

Background: 

Background Different recommendations have been proposed by WHO to deal with the issue, include Artificial feeding exclusively. Exclusive breast feeding with early weaning. Normal breastfeeding and weaning. Countries have been encouraged to adapt recommendations that best meet the needs of the population.

Problem Statement: 

Problem Statement Given that background, there is limited information as to how PMTCT programs have addressed infant feeding issues from providers and clients perspectives.

Study Objectives: 

Study Objectives To investigate feeding practices used by HIV positive mothers enrolled in perinatal HIV prevention program. To identify the challenges faced by caregivers in meeting the nutritional needs of their infants.

Study Objectives (cont.): 

Study Objectives (cont.) To identify health workers’ challenges in providing services to HIV positive mothers and their infants. To identify potential solutions for future intervention to address the problems.

Methodology: 

Methodology

Methods: 

Methods Study Design Cross sectional needs assessment study. Study Population HIV positive mothers attending an infant follow-up clinic. Health care workers.

Methods (cont): 

Methods (cont) Study Setting Mbarara Regional hospital Main referral hospital in Southwest Teaching hospital In 2002 hospital implemented first pilot PMTCT program. Included, VCT, and use of Nevirapine for HIV positive mothers

Methods (cont): 

Methods (cont) Data collection Interviewer-administered questionnaire survey (mothers). Key informant interviews (health workers). IRB approval was obtained for this study. Informed consent was obtained from all study participants.

Data Analysis: 

Data Analysis Content analysis was done for key informant interviews. Survey data were analyzed using SPSS Statistical package (version 12) Focused mainly on descriptive statistics.

Study Findings: 

Study Findings

Key Informant Interviews: 

Key Informant Interviews Eighteen health workers participated in the key informant interviews.

Services Provided: 

Services Provided

Key Informant Interviews: 

Key Informant Interviews 72% of providers received training regarding prenatal HIV counseling 61% reported receiving training on infant nutritional issues for HIV positive mothers Only 20% of interns received any training

Key Informant Interviews: 

Key Informant Interviews 61% of providers indicated that they provide counseling on infant nutrition. 60% of health workers felt that mothers were not receiving adequate information on infant nutritional issues.

Barriers/Challenges: 

Barriers/Challenges Health workers’ barriers included; Inadequate training Time constraints Other challenges faced; Socio-cultural barriers Stigma Lack of spousal support Cultural beliefs regarding breastfeeding

Barriers/Challenges: 

Barriers/Challenges Economic barriers Poverty, families unable to provide alternative feeding methods Health system barriers Poor staffing Insufficient training Uncoordinated follow up system

Proposed Solutions: 

Proposed Solutions Better coordinated follow up system with home visits. Training for health workers and general community. Increased staffing for the health sector. Provision of supplemental feeds.

Survey: 

Survey 42 mothers were interviewed for the survey, Mean age: 27.9 (SD. 8.5). 64% married (monogamous). At least 50% had primary school education.

Survey: 

Survey Approximately 90% attended prenatal care 70% participated in PMTCT program. 55% received Nevirapine treatment. Over 80% received information on infant feeding, and prevention of re-infection.

Infant Feeding Options: 

Infant Feeding Options 51% of mothers opted to exclusively breast feed for 3 months, with accelerated weaning. 29% opted for modified cow’s milk. 3% opted for formula feeding. 12% opted for exclusive breast feeding with normal weaning.

Feeding Practices: 

Feeding Practices 72% of mothers ever breastfed. 61% exclusively breastfed for the first 3 months. For infants older than 3 months, 56% of mothers had discontinued breastfeeding.

Alternative Feeding Practices: 

Alternative Feeding Practices For 33% of infants, artificial feeds were introduced with in first 3 months. 37% of infants are fed 4-7 times a day. Cow’s milk is the main alternative food, (60%).

Adherence to Selected Feeding Option: 

Adherence to Selected Feeding Option Adherence to selected feeding choice was poor. STIGMA main factor cited by all mothers for poor adherence to selected feeding method.

Comments: 

Comments There are gaps in the delivery services for the PMTCT program. Providers are poorly trained to counsel on infant nutritional issues. Breastfeeding is an important cultural function for many mothers. While mothers opted for the best feeding option, adherence is poor.

Strength & Limitations: 

Strength & Limitations The study gives an idea as to what challenges perinatal HIV programs face in resource constrained countries. Study is limited as it was conducted in only one program, and had a limited sample size.

Take Home Message: 

Take Home Message There is a need to ensure balance between HIV prevention and the social-cultural need for breastfeeding. STIGMA needs to be addressed if programs are to succeed.

Take home message (cont.): 

Take home message (cont.) Health workers need continuing education especially regarding strategies for HIV prevention as there are constant changes going on.

Implication for future research: 

Implication for future research Further research needed to identify best strategies for addressing social stigma. How best to encourage male partners to get involved in reproductive health issues as a whole.

Acknowledgments: 

Acknowledgments Dr John Ehiri, PhD. (UAB). Advisor Dr JoAna Stallworth, PhD (CDC). Technical assistance The Sparkman Center for Global Health (UAB). Provided funding for this project Staff and patients, Mbarara Regional Hospital.