Individual and Community Perspectives, Attitudes, and Practices to Mother-to-Child-Transmission and Infant Feeding among HIV-Positive Mothers in Sub-Saharan Africa: A Systematic Literature Review.

Abstract

Objectives:International guidelines on infant feeding for HIV- positive mothers promote Exclusive Replacement Feeding (ERF) (infant formula or animal milk) or exclusive breastfeeding (with no supplements of any kind). A mixed feeding pattern, where breastfeeding is combined with other milks, liquid foods or solids, has been shown to increase the risk of transmission of HIV and is strongly discouraged. However, little is known about the ability of women to adhere to recommended feeding strategies to prevent mother-to-child transmission (MTCT) of HIV from breast milk. The objective of this study was to assess the individual and community-level factors that affect perspectives, attitudes and practices of HIV-positive mothers on MTCT and infant feeding in sub-Saharan Africa as documented in peer-reviewed and grey literature.Methods:This work is based on an extensive review of peer-reviewed articles and grey literature from the period 2000-2012. The literature search was carried out using electronic databases like Medline Ovid, Google Scholar, PubMed and EBSCOhost. Both quantitative and qualitative studies written in English language on HIV and infant feeding with particular emphasis on Sub-Saharan Africa were included.Results:The review found low adherence to the chosen infant feeding method by HIV-positive mothers. The following factors emerged as influencing infant feeding decisions: cultural and social norms; economic conditions; inadequate counselling; and mother’s level of education.Conclusions and Public Health Implications:Unless local beliefs and customs surrounding infant feeding is understood by policy makers and program implementers, Prevention of Mother-to-Child Transmission (PMTCT) programs will only be partially successful in influencing feeding practices of HIV-positive women. Hence programs should provide affordable, acceptable, feasible, safe and sustainable feeding recommendations that do not erode strong cultural practices. Advice to HIV-positive mothers should be based on local conditions that are acceptable to the community.

PCR Results and PMTCT Treatment Outcomes among HIV-Exposed Infants in a Tertiary Hospital in Nigeria, 2010-2014

“…[17,18] It must however, be stated clearly that only exclusive breastfeeding and/or feeding with breast milk substitute alone has been shown to be safer than mixed feeding as a feeding option for infants of HIV positive mothers. [9] Early mixed feeding has been associated with four-fold risk of HIV transmission at six months of age for HIV-exposed babies who previously tested negative at six weeks of age. [6,10,16]…”

“…EID commenced in the center in 2009 and since then DBS samples for DNA PCR collected in EkSUTH were analyzed in OAUTH, Osun State, Nigeria which is the regional head area for PCR analysis for Institute of Human Virology, Nigeria (IHVN). [9,12] IHVN provides support for training of health workers in treatment of HIV patients in Nigeria. [12] Results usually become available in about two months from the time of sample collection.…”

“…[4,6] Despite sustained effort at preventing mother to child transmission of HIV, infant of HIV positive mothers are still at risk of becoming infected, especially in developing countries where resources for patients’ care are limited. [7-9] In the year 2010, new pediatric HIV infection was estimated at 390,000 globally and only 23% of HIV infected children have access to antiretroviral drugs. [8,10] Data from previous studies show that only 10-12% of HIV-exposed infants have access to EID.…”

Barriers to the practice of exclusive breastfeeding among HIV-positive mothers in sub-Saharan Africa: A Scoping Review of counselling, socioeconomic and cultural factors

“…Previous reviews on HIV and infant feeding in SSA have explored associations between breastfeeding and postnatal transmission, and the benefits of EBF versus the health hazards of EFF in low-resource settings (Musa, 2011;Seth, 2012). However only 3 reviews expanded their scope to include social determinants affecting infant feeding practices (Laar et al,2013;Lazarus et al, 2013;Tuthill et al, 2014). The first review was limited only to South Africa (Lazarus et al, 2013), while the other 2 were systematic reviews conducted with respect to SSA (Laar et al,2013;Tuthill et al, 2014).…”

“…However only 3 reviews expanded their scope to include social determinants affecting infant feeding practices (Laar et al,2013;Lazarus et al, 2013;Tuthill et al, 2014). The first review was limited only to South Africa (Lazarus et al, 2013), while the other 2 were systematic reviews conducted with respect to SSA (Laar et al,2013;Tuthill et al, 2014). In this scoping review, an expanded examination of socioeconomic, cultural and infant feeding counselling-related barriers to the WHOAl-Mujtaba et al 71…”