[pronut-hiv] Survey on infant feeding for adherence to infant feeding choices in rural Cameroon

["Nkuoh Godlove" <nnkuoh@yahoo.com>]

QUALITY IMPROVEMENT IN PREVENTION OF MOTHER TO CHILD HIV TRANSMISSION (PMTCT) PERIPARTUM AND DURING INFANT FEEDING

Infant feeding survey among members of support groups of people living with HIV in Rural Cameroon by MR. NKUOH GODLOVE NKWAIN, RN/counselors Trainer

Infant feeding counseling is usually provided to women who are infected with HIV as part of the health care activities. This is practiced by many mother child health programs around the continent including the Cameroon Baptist Convention Health Board (CBCHB). CBC HB is a faith-based NGO in Cameroon, West Africa and Started PMTCT in Feb 2000 with a grant from US-based Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). The women are given options and allowed to make a choice on one of the infant feeding option. The survey summarized below had as main objectives:

1.To assess how well HIV infected women adhere to their choice of infant feeding
2.To determine the best time to dispense the nevirapine (NVP) tablet to HIV infected antenatal patients.

 60 women who are members of seven of our support groups (group of PLWHA) in rural communities and who had infants below six months participated in this survey.

Results
Of the 60 women who participated in the survey, 9 (15%) had children <1 month old, 18 (30%) 1-2months, and 33 (55%) 3-6 months. Most of the participants were farmers, housewives or teachers.  48 (80%) of them were married, and about 65% were church members.  The average number of years spent in school was 9.3 years (range 0-17years).  Of the 54 women who answered the question on their partners occupation, 12 (22.2%) were farmers, 7 (13%) were drivers; 9 (16.7%) were doing business and 26(48%) were involved in other occupations.  They received antenatal care in faith-based institutions and private clinics as follows: CBC 23(37.7%), government 10(16.4%), Presbyterian 16(26.2%), Catholic, 2(3.3%), and private 10(16.4%).

Of the 60 women surveyed, 57(95%) found they were HIV positive only during pregnancy in the prenatal clinics and 56(91.8%) of them received single dose NVP for prophylaxis. Though only 16% of them received the NVP tablet at first prenatal visit, 50% responded that the most appropriate time to dispense NVP was during the first prenatal visit; while 26.4% and 23.2% respectively preferred dispensation during later prenatal visits or after they arrive at the health units in labor.

Ninety three percent of the respondents had received counseling on infant feeding choices during pre- and postpartum periods.  

44% exclusively breast-fed, Reasons:
1. The instructions on formula feeding seemed complicated and difficult to follow.
2. Much pressure from parents, family members and in-laws to breastfeed, rather than formula feed, since they did not know the mothers status.
3. Breast feeding was cheaper and available
4.Babies under 6 months will not do well with formula feed


27.7% gave formula feed.
Reasons:
1. Medical advice from health care workers
2. Fear of infecting the baby
3. Advice from support group and friends

 
27.7% mixed feeding.
Reasons given:

1.Baby was not satisfied with breast milk and was crying too much.
2.They felt guilty about not breastfeeding at least part of the time.

Many mothers gave water to their infants at different times: 1-6days=4(7.2%), 1-4weeks=10(18.2%), 1-3months=6(11%), 3 months and above=12(21.8%), Not given yet=23(41.2%). They gave the following reasons:
1.Baby was thirsty and crying too much.
2.There was too much heat
3.I already gave mixed feeding to my baby
4.I know that water helps in digestion very well
5.Pressure from my parents and in-laws.
6.To reduce milk consumption because milk was getting finished.

Out of 39 participants, 19(48%) had fed their babies with other feeds within the period up to 6 months and 74.5% responded that no episodes of diarrhea were noticed with these feeds. They gave the following reasons:

1.  Baby was crying and refusing breast milk. 
2.  Baby was not satisfied 
3.  Financial difficulties. 
4.  To supplement or complement breast milk.
5.  To reduce the risk of infecting the child.

CONCLUSIONS

1.Infant feeding counseling is vital and should not be omitted especially during pre-and postpartum periods,

2.About 45% of the women in our program exclusively breastfeed (no water or other feeds) their babies up to 6 months of age. This is enhanced by the regular education provided during monthly meetings 

3.This survey supports our practice of providing NVP pills to the HIV infected woman at first antenatal visit

4.Counseling and testing for HIV and providing prophylactic treatment is an important aspect to reduce risk of infecting the infant and should not be omitted during prenatal clinics as this can be the only opportunity for her to know her status. 

4.Knowing that most women choose breast milk as an option for infant feeding, and since 45% of the participants responded that they exclusively breastfed, it can therefore be concluded that despite the challenges involved in infant feeding, most of them actually adhere to their infant feeding choices.


Mr. Nkuoh Godlove Nkwain, Registered Nurse/Counselors Trainer.
PMTCT Coordinator
C. B. C. Health Board, Mbingo Baptist Hospital
P MB 42 via Bamenda, Cameroon
002377565537.
nnkuoh@yahoo.com or MBHCameroon@aol.com

Pius M.Tih, PhD, MPH; Director CBC HB.  
C. B. C. Health Board; PO Box 1 Bamenda, Cameroon
002377764781
piustih@aol.com 

Thomas K. Welty, MD, MPH.
twelty@earthlink.net

CAMEROON BAPTIST CONVENTION HEALTH BOARD (CBCHB)
July-August 2004