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Citation Information

Type Thesis or Dissertation - Master of Public Health
Title Determinants of adherence to exclusive breast feeding among HIV positive mothers attending child welfare clinic at Pumwani maternity hospital, Nairobi County, Kenya
Publication (Day/Month/Year) 2013
URL http://etd-library.ku.ac.ke/bitstream/handle/123456789/6980/Koima, Winnie​Jepkogei.pdf?sequence=1&isAllowed=y
Globally, the estimated number of children below 15 years of age living with HIV
increased from 1.6 million in 2001 to 2.5 million in 2009. Almost 90% of these children
live in sub-Saharan Africa. Over 90% the new infections of HIV are acquired through
Mother-To-Child Transmission (MTCT). According to Kenya Aids Indicator Survey
(KAIS) report of 2007, nearly 1 out of 10 pregnant women in Kenya are infected with
HIV. Exclusive Breast Feeding (EBF) of a child remains the best and safest source of
nutrition for the vast majority of infants worldwide and a recommended method of
Prevention of Mother to Child Transmission (PMTCT) of HIV. Despite this evidence,
Exclusive Breast Feeding (EBF) is at 13% in Kenya. The aim of this study was to
identify the factors that influence adherence to exclusive breast feeding among HIV
positive mothers attending Child Welfare Clinic at Pumwani Maternity Hospital, Nairobi
County. This was a descriptive cross-sectional study utilizing quantitative and qualitative
approaches targeting HIV positive mothers with infants aged above 6-12 months.
Purposive sampling technique was used to get the 188 study participants who were
interviewed using semi-structured questionnaires. In addition, 2 Focused Group
Discussions (FGDs) comprising 10 participants each who included peer counselors,
community health workers and opinion leaders was conducted using the FGD guide. Key
informants from the health facility; 1 clinical officer, 4 nurses, and 1 nutritionist were
interviewed using the Key Informant Interview (KII) questionnaire guide. The data from
semi-structured questionnaires was analyzed using SPSS version 17.0 software.
Descriptive statistics were generated and cross tabulation (Chi-Square test and Fischer’s
exact test) was done for relationships of variables. Logistic regression was done to assess
the effect of various explanatory variables on adherence to EBF among HIV positive
mothers. The recordings of the FGDs and KIIs were transcribed and main concepts
identified. The qualitative data was triangulated with the quantitative data to enhance
validity and reliability of the study findings. The results showed proportion of women
who adhered to EBF at 69.1%. The following factors influenced adherence to EBF
positively: presence of main breadwinner (OR=3.44, p=0.003), food availability
(p=<0.001), availability of transport (OR=4.00, p=0.013), mother on ARVs postnatally
(OR=0.35, p=0.002), Knowledge on MTCT of HIV (p=<0.001), being taught about EBF
in ANC and PNC (OR=7.78, p=0.002), expressing breast milk (p=<0.001), disclosure of
HIV status to husband (OR=2.46, p=0.007) and relative (OR=2.29, p=0.033). In
conclusion, information sharing on MTCT of HIV antenatally and postnatally should be
strengthened in the health facilities and the community using community strategy to
improve EBF. Secondly, mothers should also be taught how to express breast milk to
feed the baby when the mother is away for long hours. Finally, vulnerable women to be
linked to income generating community projects for food security empowerment.

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