Determinants of Exclusive Breast Feeding Practice among HIV Positive Mothers in North East Ethiopia: A mixed method study

Abstract

Background: Exclusive breast feeding (EBF) of Human Immune Virus (HIV) exposed infants for the first six months is strongly recommended and vital for protecting them against common childhood illnesses including diarrhea and pneumonia. Despite its benefit, EBF practice is low in developing countries including Ethiopia. There is a paucity of evidence for factors associated with EBF among HIV positive mothers. Objectives: To assess exclusive breast feeding practice and its associated factors among HIV positive mothers attending Prevention of mother to child transmission and Anti-retroviral therapy clinics in public Health facilities of Debre Birhan town Amhara National Regional State, Ethiopia from February 01, 2020 to Apr 30, 2020Methods: Facility based convergent mixed methods design was used to conduct the study in public Health facilities of Debre Birhan town. Structured interviewer-administered questionnaires were used to collect data from 432 participants selected by systematic random sampling technique. Epi info version 7 and SPSS version 20 were used for data entry and analysis respectively. Descriptive and inferential statistics were computed during the analysis. Two focus group discussions and 25 in-depth interviews and observational checklist were held to collect data on barriers for exclusive breast feeding practice and thematic analysis was used to identify important insights on the study topic. Bivariate and multivariate logistic regression were conducted to select candidate variable and determine adjusted effect of independent variables respectively using p-value less than 0.05. The output from multivariate logistic regression were reported with 95% confidence interval.Results: The prevalence of exclusive breast feeding, mixed feeding and exclusive formula feeding practice were 89.8%, 6.9% and 3.2% respectively. Having information about EBF (No=0.02, 95% CI; 0.01, 0.12), time taking from home to workplace (less than 30 min=4.96, 95% CI; 1.17, 20.95), disclosing HIV status (No= 0.09, 95% CI; 0.02, 0.37), place of residence (urban=5.37, 95% CI; 1.12, 25.77), living with mother/mother in-law (No=6.03, 95% CI; 1.26, 28.86), knowledge about EBF (poor knowledge=0.06, 95% CI; 0.01, 0.34) were main factors for exclusive breast feeding practice. Poor counseling, non-disclosure of HIV status and pressure from mother/mother in-law were the commonly raised reasons by FGD and IDI participants for non-exclusive breast feeding practice. Conclusions: Majority of HIV positive mothers were practicing exclusive breast feeding for the first six month. Strengthening information dissemination, providing quality health services and empowering mothers through integrated interventions help to promote exclusive breast feeding practice among mothers living with HIV.

Association between household environmental conditions and nutritional status of women of childbearing age in Nigeria

“…There is a renewed commitment by different stakeholders on ending the burden of undernutrition. The adoption of the Sustainable Development Goals (SDGs), the United Nations’ proclamation of a Decade of Action on Nutrition (2016–2025) and the Rome Declaration on Nutrition and the Framework for Action in the year 2014 by world leaders, suggested that well thought out and clear-cut actions are needed to tackle undernutrition [ 16 ]. Addressing undernutrition in all its forms will play a significant role in achieving goals 1 to 3 of the SDGs and other global targets relating to non-communicable diseases [ 17 ].…”

Multi-Level Correlates of the Nutritional Status of Nigerian Women of Reproductive Age

“…In Ethiopia, undernutrition was highest among nulliparous women (34%) followed by in women with six or more children (30%). 24 Similarly, a study in Bangladesh found that the risk of being underweight was higher among young mothers who had more than two children compared to their counterparts. 25 A similar result was observed among women in Western China where the odds of having chronic energy deficiency was higher with high parity.…”

“…Married women had the lowest prevalence of undernutrition while the prevalence was highest, at 36%, among women who had never married, 32% among widows and 29% among divorced women; the odds of being malnourished were 1.9 times higher in women who had never married than in currently married women (p-value < 0.001). 24 Figure 1. A conceptual framework for analysing the causes of malnutrition in women of reproductive age in Nigeria.…”

“…28 Household size has been demonstrated to be significantly correlated with the BMI of women aged 15-49 years 29 Increasing household size has been associated with falling rates of overweight and obesity. 24 It is also an independent negative predictor of chronic energy deficiency and dietary diversity, likely due to its negative effect on intra-household food distribution, reduced availability of food which will in turn limit access to different food groups. 8,30…”

Qualitative exploration of the dynamics of women’s dietary diversity. How much does economic empowerment matter?

“…Numerous studies have utilised the MDD-W measure to find a strong link between improved dietary diversity and health outcomes ( 6 , 9 – 11 ) . Evidence also suggests that there are many determinants of improved dietary diversity for women with different contextual factors playing an important role in women’s food consumption ( 9 , 12 , 13 ) .…”