Prevalence and factors associated with exclusive breastfeeding among HIV-exposed infants (from birth to week 26) in Kampala City and Mukono District, Uganda

Abstract

The stagnant HIV prevalence among adults has resulted in an increase in the number of HIV- exposed infants, many of whom are uninfected. Increasingly, it is acknowledged that these infants are at greater risk of childhood infections in comparison to their unexposed counterparts. Exclusive breastfeeding is a childhood intervention that could ameliorate this risk and international guidelines on infant feeding for HIV- positive mothers now promote exclusive breastfeeding or exclusive replacement feeding. Despite increased counselling and awareness aimed at addressing the barriers, exclusive breastfeeding among HIV-positive mothers is still sub-optimal and data on the prevalence of exclusive breastfeeding among HIV-exposed infants is scanty. To investigate the prevalence and factors associated with exclusive breastfeeding among HIV-exposed infants from birth to week in Kampala City and Mukono district. A mixed method study that utilized secondary quantitative data in a retrospective cohort study and primary data from a qualitative study. Data were collected from mothers receiving health care in three public health facilities in Kampala City and Mukono district. Quantitative data were obtained from a sample of 1563 mother-infant dyads. Data were extracted from a database of an on-going trial and analysed using STATA 15. Univariate, bivariable and multivariable analysis were conducted to determine any associations using modified Poisson regression. Qualitative data were collected from both key informants and indepth interviewees using a key informant interview guide and an in-depth interview guide respectively. These participants were selected purposively and interviews were done through face-to-face interview sessions between the respondent and a member of the research team. The interviews were transcribed, translated and exported to NVivo for thematic analysis Results; The prevalence of exclusive breastfeeding among HIV exposed infants reduced with increase in infants’ age from 81.8% at week 6 to 79.2% at week 10, 75.0% at week 14 and 51.6% at week 26. Exclusive breastfeeding among HIV exposed infants was affected by place of enrolment [Mukono General Hospital (PR=0.86, 95% CI: (0.808, 0.923)), Kitebi HC III (PR=0.93, 95% CI: (0.876, 0.979))], breast health (PR=0.78, 95% CI: (0.63, 0.97)), and the infant health status (PR=1.24, 95% CI: (1.1539, 1.3316)), i.e. mothers that had breast illness and sick infants were less likely to exclusively breastfeed while on the other hand qualitatively maternal diet, expensive formula feeds, infant health, family support, deliberate non- adherence, absence of drugs at the facility, and cost of services were the factors mentioned, these hindered exclusive breastfeeding among HIV-exposed Infants. The prevalence of exclusive breastfeeding among HIV exposed infants reduced with increasing child age from 6 weeks to 26 weeks being influenced by factors such as health stats of the child, maternal nutritional status, family support and maternal perceptions.