Effects Of Different Feeding Options On Infants Born To Hiv Positive Mothers In Nakuru Municipality, Kenya

TABLE OF CONTENTS

DECLARATION .......................................................................................................... ii

DEDICATION ............................................................................................................. iii

ACKNOWLEDGEMENTS ......................................................................................... iv

TABLE OF CONTENTS ..............................................................................................v

LIST OF TABLES..........................................................................................................viii

LIST OF FIGURES ..................................................................................................... ix

ACRONYMS AND ABBREVIATIONS………………………………………………..x

ABSTRACT……………………………………………………………………………...xi

CHAPTER ONE: INTRODUCION .............................................................................1

1.1: Background Information ....................................................................................1

1.2: Statement of the Problem ...................................................................................3

1.3: Justification of the study.....................................................................................3

1.4: Research Question ..............................................................................................4

1.5: Hypothesis ...........................................................................................................5

1.6: Broad Objectives of the study ............................................................................5

1.7: Specific Objectives of the study. ..........................................................................5

1.8: Assumptions of the study ....................................................................................5

1.9: Significance of the study .....................................................................................6

1.10: Delimitations and Limitations of the study ......................................................6

1.11: Operational Definitions of Terms.....................................................................6

CHAPTER TWO: LITERATURE REVIEW ........................................................... 10

2.1: Overview of infant feeding. .............................................................................. 10

2.2: Benefits of Breastfeeding .................................................................................. 10

2.3: Role of PMTCT on choice of Infant Feeding………………………………….12

2.4.0: Infant Feeding options for HIV Positive mothers…………………………..12

2.4.1: Exclusive Breast feeding……………………………………………………...13

2.4.2: Wet Nursing…………………………………………………………………...14

2.4.3: Heat Treated Breast Milk…………………………………………………….14

2.5.0: Exclusive Replacement Feeding……………………………………………...15

2.5.1: Infant Formula………………………………………………………………...17

2.5.2: Animal Milk…………………………………………………………………...19

2.6.0: Infant Feeding and HIV Transmission ......................................................... 20

2.6.1: Strategies for Reducing Transmission of HIV ……………………………...21

CHAPTER THREE: MATERIALS AND METHODS ............................................. 23

3.1 Study Design ...................................................................................................... 23

3.2 Study Area .......................................................................................................... 23

3.3 Variables............................................................................................................. 23

3.4 The Target Population ....................................................................................... 23

3.5 The Study Population ........................................................................................ 24

3.5.1 Inclusion Criteria ........................................................................................ 24

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3.5.2 Exclusion Criteria ....................................................................................... 24

3.6 Sampling Procedure ........................................................................................... 25

3.6.1. Sample size determination ......................................................................... 25

3.7: Research Instruments ....................................................................................... 26

3.8: Pre-testing the Instrument ............................................................................... 26

3.8.1 Validity ........................................................................................................ 27

3.8.2 Reliability .................................................................................................... 27

3.9: Data Quality Control ........................................................................................ 27

3.9.1: Data collection procedure .......................................................................... 27

3.9.2: Data Analysis.............................................................................................. 28

3.10: Ethical Consideration ..................................................................................... 29

CHAPTER FOUR: RESULTS AND DISCUSSION .................................................. 30

4.1: Demographic characteristics of caregivers ...................................................... 30

4.1.1: Maternal education distribution................................................................ 31

4.1.2: Income level and occupation distribution ................................................. 31

4.1.3: Maternal age and number of children ...................................................... 31

4.2: Caregivers’ knowledge regarding Infant feeding options ............................... 32

4.2.1: HIV Counseling and Testing. .................................................................... 32

4.2.2: Caregivers knowledge on infant feeding recommendations ..................... 33

4.3: Infant Feeding Options. .................................................................................... 36

4.3.1: Exclusive Breastfeeding ............................................................................. 36

4.3.2: Mixed Feeding ............................................................................................ 37

4.3.3: Infant Formula Feeding ............................................................................. 40

4.3.4: Animal milk ................................................................................................ 41

4.3.5: Wet Nursing ............................................................................................... 43

4.3.6: Heat treated breast milk. ........................................................................... 44

4.4: Factors Influencing the Choice of Infant Feeding options by HIV Positive Mothers .................................................................................................................... 44

4.4.1: Cost ............................................................................................................. 44

4.4.2: Perception of MTCT .................................................................................. 46

4.4.3: Cultural Beliefs, Maternal Illness or Death .............................................. 46

4.4.4: Inaccessibility and Inconvenience in Preparation of Replacement Foods .............................................................................................................................. 47

4.4.5: Ignorance .................................................................................................... 48

4.4.6: Stigma and family pressure ....................................................................... 49

4.4.7 Maternal age ................................................................................................ 49

4.4.8: Maternal parity .......................................................................................... 51

4.5.0: Effects of the Chosen Feeding Options. ........................................................ 51

4.5.1: Distribution of Infants by sexes……………………………………………53

4.5.2: Mean weight of infants ............................................................................... 52

4.5.3: Association between chosen feeding options and infant nutritional status .............................................................................................................................. 54

4.5.4: Association between feeding options and infant morbidity ...................... 55

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CHAPTER V: DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS. ... 58

5.1: Introduction ...................................................................................................... 58

5.2: Discussion .......................................................................................................... 58

5.2.1: Caregivers’ Knowledge Regarding Infant Feeding .................................. 58

5.2.2: Infant Feeding Options .............................................................................. 59

5.2.3: Factors influencing choice of infant feeding options................................. 61

5.2.4: Effects of Feeding options on infant growth, nutritional status and morbidity .............................................................................................................. 64

5.3: Conclusion ......................................................................................................... 66

5.4: Recommendations. ............................................................................................ 67

5.5: Suggestions for further research ...................................................................... 69

REFERENCES ............................................................................................................ 69

APENDICES ................................................................................................................ 75

Appendix I: Questionaires ....................................................................................... 76

Appendix II: Map of Study Area ............................................................................ 85

Appendix III: Work plan for Research..............…………...………………………88

Appendix IV: Research Budget……………………………………………………..89