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Experiences with Early Cessation of Breast Feeding Among HIV Infected Women in Kampala, Uganda. Dr. Paul M. Bakaki Makerere University - Johns Hopkins University Research Collaboration, Kampala - Uganda Paper presented at the HIV and Infant Feeding WABA-UNICEF Colloquium
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Experiences with Early Cessation of Breast Feeding Among HIV Infected Women in Kampala, Uganda Dr. Paul M. Bakaki Makerere University - Johns Hopkins University Research Collaboration, Kampala - Uganda Paper presented at the HIV and Infant Feeding WABA-UNICEF Colloquium September 20-21, 2002. Arusha, Tanzania
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.
Results Socio demographics 47 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 study Case 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.
Acknowledgement I 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.
