Re: [pronut-hiv] Survey on infant feeding for adherence to infant feeding choices in rural Cameroon (3)

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

Hi Rachel,
For those who opt for breast feeding , we do recommend exclusive breast feeding for a period not exceeding six months and weaning abruptly to cup. And continuing with a breast milk substitute like commercially made infant formula, or our locally made infant formula and gradually introducing other family foods. Thanks.
Nkuoh


Rachel Stern <sternworks@verizon.net> wrote:

Thanks for reporting this interesting survey. Could you please let us know 
in the future, how many of the babies are HIV infected or become HIV 
infected.

Also, what are feeding recommendations for breastfed infants at 6 months of age. Are they abruptly weaned, and if so, onto what? or is mixed feeding ok after 6 months?

Thank you
Rachel Stern
----- "Nkuoh Godlove"wrote: 


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



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