Infant Feeding Practices of HIV Positive Mothers and Its Association with Counseling and HIV Disclosure Status in Ethiopia: A Systematic Review and Meta-Analysis

Abstract

Introduction. Breastfeeding is the ideal food source for all newborns globally. However, in the era of Human Immune Deficiency Virus (HIV) infection, feeding practice is a challenge due to mother-to-child HIV transmission. Therefore, this systematic review and meta-analysis aimed to estimate the national prevalence of exclusive breastfeeding and mixed feeding practices among HIV positive mothers and its association with counseling and HIV disclosure status to the spouse in Ethiopia. Methods. We searched all available articles from the electronic databases including PubMed, EMBASE, Google Scholar, and the Web of Science. Moreover, reference lists of the included studies and the Ethiopian institutional research repositories were used. Searching of articles was limited to the studies conducted in Ethiopia and published in English language. We have included observational studies including cohort, cross-sectional, and case-control studies. The weighted inverse variance random effects model was used. The overall variations between studies were checked through heterogeneity test (I2). Subgroup analysis by region was conducted. To assess the quality of the study, the Joanna Briggs Institute (JBI) quality appraisal criteria were employed. Publication bias was checked with the funnel plot and Egger’s regression test. Result. A total of 18 studies with 4,844 participants were included in this study. The national pooled prevalence of exclusive breastfeeding and mixed feeding practices among HIV positive mothers were 63.43% (95% CI: 48.19, 78.68) and 23.11% (95% CI: 10.10, 36.13), respectively. In the subgroup analysis, the highest prevalence of exclusive breastfeeding practice was observed in Tigray (90.12%) and the lowest in Addis Ababa (41.92%). Counseling on feeding option with an odds ratio of 4.32 (95% CI: 2.75, 6.77) and HIV disclosure status to the spouse with an odds ratio of 6.05 (95% CI: 3.03, 12.06) were significantly associated with exclusive breast feedings practices. Conclusion. Most mothers report exclusive breastfeeding, but there are still almost a quarter of mothers who mix feed. Counseling on feeding options and HIV disclosure status to the spouse should be improved.

Mixed Infant Feeding Practice and Associated Factors among HIV-Positive Women under Care in Gondar City’s Public Health Facilities within Two Years Postpartum: A Cross-Sectional Study

“…The proportion of HIV-positive women practicing MIF was found to be 21.6%. The figure is comparable with the findings of the studies done in Addis Ababa-23.3% [24] and a systematic review and meta-analysis finding of Ethiopian pooled prevalence-23.11% [13].…”

“…This significant association conversely entails that infant feeding counseling (i.e., counseling on PMTCT) during ANC visit has a positive role on the appropriate infant feeding practice as it is observed in the current study that almost all (98.7%) of ANC attendees had received PMTCT counseling. This implication is further supported by existing evidences which show a positive correlation between infant feeding counseling during antenatal care and exclusive infant feeding practice [13,25,40].…”

“…However, more strict emphasis is provided for HIV-positive mothers, since MIF practice imposes vertical mother to child transmission (MTCT) of HIV along with many other adverse outcomes, and thus, the prevalence of EBF practice is expected to be more common in HIV-positive women [5]. In Ethiopia, the pooled prevalence of EBF practice is 59.3% in the general population [12] and 63.4% among HIV-positive women [13] which is comparable to the figures in most SSA countries, but, lower compared with the global figure and inconsistent to the strategies intended to eliminate MTCT of HIV by 2030 [5,11]. On the other hand, the practice of MIF in the first six months of infant age remains high (23.1%) in Ethiopia [13].…”

“…In Ethiopia, the pooled prevalence of EBF practice is 59.3% in the general population [12] and 63.4% among HIV-positive women [13] which is comparable to the figures in most SSA countries, but, lower compared with the global figure and inconsistent to the strategies intended to eliminate MTCT of HIV by 2030 [5,11]. On the other hand, the practice of MIF in the first six months of infant age remains high (23.1%) in Ethiopia [13]. MIF practice is also common in the study area-Gondar city.…”

Exclusive breastfeeding among HIV exposed infants from birth to 14 weeks of life in Lira, Northern Uganda: a prospective cohort study

“…Several studies have shown low rates of exclusive breastfeeding among HEI [ 6 , 11 , 12 , 14 15 16 ]. Risk factors for these low rates are not well understood and vary with in different contexts.…”