HIV-infected motherschoice and perceptions of feeding methods for their infants : a qualitative study conducted in Atua and Agomanya in the Manya Krobo district of Ghana

Abstract

Transmission of HIV in breast milk is well established, but public health approaches to its prevention in resource poor setting remain problematic. HIV-infected women are advised to avoid breastfeeding if possible, otherwise exclusive breastfeeding for the first few months followed by abrupt weaning is recommended. Exclusive breastfeeding may be associated with less risk of Mother-to-child transmission(MTCT) of HIV than mixed feeding. Yet exclusive breastfeeding is not commonly practised in Ghana. Prolonged and partial breastfeeding is the norm. The aim of this study is to investigate HIV-infected mothers choice and perceptions of feeding methods for their infants through qualitative in-depth interviews. In order to achieve this objective, the following research questions were investigated: What are the feeding methods practised by the HIV-infected mothers in Atua and Agomanya? What is the rationale for mothers choice of feeding methods and what are their infant feeding experiences? How did mothers understand and interpret the information on infant feeding methods conveyed to them by the counselors? This study is based on qualitative in-depth-interviews with 17 HIV-infected mothers who were participating in a PMTCT trial in Atua and Agomanya in the Eastern Region of Ghana. The local feeding guide was: 3 to 6 months exclusive breastfeeding followed by abrupt weaning or the use of infant feeding formula. Safe breastfeeding practices were also encouraged. Infant feeding formula was not provided by the trial. All the 17 mothers reported that they had initially chosen to exclusively breastfeed their babies for 3 to 6 months followed by abrupt weaning. At the time of interviews, seven of the mothers had exclusively breastfed for about three to six months and weaned, six were practising mixed feeding, and four were exclusively breastfeeding. The factors that influenced the choice of infant feeding method were: the mothers fear of being stigmatized, poverty and inadequate information provided by counselors on infant feeding methods. The mothers were constrained by poverty to use replacement foods of nutritional adequacy. It was apparent that mothers had not understood the information provided on infant feeding methods by the counselors. This study indicates that exclusive breastfeeding can be an acceptable andpractical method of infant feeding for HIV-infected mothers but there is the need to intensify nd improve the exclusive breastfeeding promotions activities. These results also indicate that infants weaned at 3 or 6 months may be predisposed to malnutrition and infant morbidities. There is the need to assess how traditional maize porridge (Koko) and other family foods used as replacement food can adequately meet the nutritional needs of infants. The factors that influenced HIV-infected mothers choice of infant feeding methods and their experiences in practising infant feeding recommendations should be used to form policies for programmes on HIV and infant feeding.