Experiences with Early Cessation of Breast Feeding Among HIV Infected Women in Kampala, Uganda

Dr. Paul M. BakakiMakerere University - Johns Hopkins UniversityResearch Collaboration, Kampala - Uganda

Paper presented at the HIV and Infant FeedingWABA-UNICEF Colloquium

September 20-21, 2002. Arusha, Tanzania

Mulago Hospital Assessment Center

Antenatal Clinic, Mulago Hospital

Group Pre-Test Counselling

Giving Results

MU-JHU House

General Background

HIV transmission through breast milk is between 7-16%.

Mixed and prolonged breastfeeding are risk factors for increased transmission.

Exclusive breastfeeding with early cessation reduces the risk of transmission.

Early cessation of breastfeeding may be stressful and stigmatizing.

Study Background HIV infected mothers enrolled in HIVNET 012

trial received infant feeding counselling antenatally (1997-98).

150 mothers with HIV negative babies at 6 weeks received intensive infant feeding counselling (1998-1999). Counselled to stop breastfeeding abruptly by 6

months. Local food alternatives and preparation demonstrated. 44.7% (67/150) stopped breastfeeding by 7 months.

Methods In December 2001 mothers who stopped

breastfeeding by 7 months were invited to share experiences.

6 Focus Group Discussions (FDGs’) and 10 Key Informant Interviews (KI's) were conducted using questionnaire guides.

Discussions were tape-recorded and written verbatim in Luganda.

Transcription and back translation to English done.

Quantitative and qualitative data was sorted, grouped, tabulated and analyzed.

Focus Group Discussion

Key Informant Interview

ResultsSocio demographics47 mothers were involved in FDGs Average age of mothers was 24 years 66% of the mothers were in their 20's 53% of the mothers had 2-3 children 53% of the mothers were married 26% of the mothers were single 17% of the mothers were separated 4% of the mothers were widowed Majority of the mothers (over 90%) earn less

than 1 dollar a day.

Process of Cessation 45% (21/47) of the mothers practiced mixed

breastfeeding throughout the 6 months 55% (26/47) of the mothers practiced exclusive

breastfeeding for varying periods Overall exclusive breastfeeding with early cessation

rates were low at 6% (3/47) 65% (17/26) of the mothers practiced exclusive breast

feeding in the first 6 weeks 32% (8/26) of the mothers practiced exclusive breast

feeding in the first 3 months

Weaning foods included cow's milk, porridge, irish potatoes.

Factors favoring Early Cessation

Health education, counselling and support from clinic.

Early disclosure of HIV status to spouse and family.

Support from community (Elderly women).

Negative infant HIV test. Availability of alternative feeds.

Hindrances of Early Cessation

Fear of indirect disclosure and stigmatization. Coping phase of mother's HIV status (Denial). No or late disclosure of HIV status to spouse

and family. Contradicting messages from health workers. Inability to utilize local foods. Cultural beliefs (wastage of breast milk). Financial dependence.

Problems of Early Cessation 53% (25)of the mothers had engorged painful

breasts with fever. 40% (19) of the mothers had sick babies; with

diarrhea, fever, cough, weight loss. 15% (7) of the mothers had experienced stress

from crying babies, sleepless nights or poor sexual life.

49% (23) of the mothers got pressurized by husband’s relatives, neighbours and family to resume breastfeeding.

23% (11) of the mothers lacked alternative feeds.

Case studyCase Study of a Problematic Husband of a Mother in a Key Informant Interview

“Despite the fact that my husband was well aware of my sero status, he was not

helpful at all, mainly when it came to buying milk for the baby, instead I was just

harassed, beaten and mistreated. Initially he could go for work leaving some money

to buy food and milk. Since I knew my sero status and the risk of prolonged

breastfeeding, I used not to have lunch and used the money to buy the child’s milk

and sugar. I used to starve and if I had not been firm I would not have managed. I

also used to have tea with no sugar. Time came when my husband became so

serious and told me to leave his house yet I did not have anywhere to go since my

mother was staying far away from where I was and I could not raise transport to

her place. I initially refused but he sold the mattress on which I was sleeping with

my child. I really had a rough time, as I could not sleep on a wooden bed without a

mattress. He also sold things like cups, plates and refused to pay house rent. When

I saw all this, I left for a friend’s place where I stayed and I was treated as a human

being. The neighbors wanted to know why I stopped breast feeding and relatives were

almost forcing me to resume breast feeding but my child did not cry a lot for breast milk

since I had started her on other feeds”.

Solutions to some of the Problems Engorged Breasts: Aspirins, traditional

remedies (banana leaf ribs, cold compress, cold drinks).

Support from clinic: Treatment for acute illnesses, food supplements, and nutrition education.

Mothers lied to neighbours, relatives and spouses about reasons why they were not breastfeeding.

Mothers' Recommendations for success of of Early Cessation

1. Spouse involvement from antenatal clinics.2. Peer counselling and support.3. Consistent health education messages to mothers and fathers.4. Income generating projects for

mothers.

Replacement Feeding?

AcknowledgementI am grateful to the mothers who gave us the detailed personal information during the discussions.

 

The research team, Richard, Jessica, Harriet, Lydia and Teopista are commended for the long hours, hard work and intellect they committed to the success of the study.

 

My sincere thanks go to ESARO UNICEF Regional Office for funding this study. I specifically thank Arjan, the Program Officer Nutrition Section, for encouraging us to carry out the study making useful criticisms to the proposal and report.