Feeding Practices among Human Immunodeficiency Virus-Exposed Infants in Ethiopia: Systematic Review and Meta-Analysis

Background. Infant and young child feeding in the context of human immunodeficiency virus- (HIV-) infected mothers has significant challenges due to the risk of transmission of the virus via breastfeeding. In Ethiopia, a number of independent studies have been conducted to assess the feeding practice of HIV-exposed infants. But, there is no concrete evidence to show the national figure in Ethiopia. Hence, this review and meta-analysis aims to estimate the pooled prevalence of feeding practices among HIV exposed infants in Ethiopia. Methods. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. Articles were searched through search engines in PubMed, Cochrane Library, Google Scholar, and direct Google search. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument adapted for cross-sectional study design was used for quality assessment. The random effects model was used to estimate the pooled prevalence of infant feeding practices. Heterogeneity and publication bias were assessed. Trim and fill analysis was performed. Additionally, meta-regression was also performed. Results. In this review, a total of 26, 22, and 22 studies and 7413, 6224, and 6222 study participants for exclusive breastfeeding, replacement feeding, and mixed feelings were included, respectively. The overall pooled prevalence of exclusive breastfeeding, replacement feeding, and mixed feeding of HIV exposed infant was 63.99 % (95% Confidence Interval (CI): 52.32, 75.66), 16.13% (95% CI: 11.92, 20.32), and 20.95% (95% CI: 11.35, 30.58)) in Ethiopia, respectively. Conclusion and Recommendations. In Ethiopia, almost three in five HIV-exposed infants were exclusively breastfed. But still, mixed feeding during the period of first 6 months was practiced in almost one-fifth of the exposed infants in Ethiopia. Additionally, replacement feeding was also practiced even though not recommended for developing countries. Therefore, the government of Ethiopia should strengthen the health institutions to implement the existing infant feeding strategies and guidelines to increase exclusive breastfeeding for the first 6 months and to avoid mixed feeding during the periods of six months.

Characteristics and outcomes of HIV-exposed infants in Homa Bay County, Kenya, 2015

Homa Bay County in south-western Kenya has a low uptake of antenatal care services and the highest prevalence of HIV in the country. We present the findings of a retrospective review of HIV-exposed infants (HEI) who sought early infant diagnosis services in the county throughout 2015. HEI who were breastfed >6 months, had replacement feeding and did not receive prophylaxis were 2–6 times more likely to be HIV-positive.

Factors affecting mothers’ choice of breastfeeding vs. formula feeding in the lower Umfolozi district war memorial hospital, KwaZulu-Natal

The aim of this study was to determine which factors influence choice of breast- versus the formulafeeding of infants. This may help to understand where the focus should lie in the promotion of breastfeeding. A structured questionnaire was completed by a 100 women and focus-group discussions were held with 22 women who delivered babies at the Lower Umfolozi District War Memorial Hospital (LUDWM) in Kwazulu-Natal. Most of the mothers (72%) chose breastfeeding and 58% intended to breastfeed for only 6 months. One-third (33%) were influenced by health care professionals and 44% of the mothers made their own decisions in their feeding method. Only one participant stated that she chose formula-feeding due to her HIV-positive status, but in the focusgroup discussions, the fear of transmission of HIV through breast-milk was stated as an important reason why mothers chose replacement-feeding. Significantly more HIV-infected than uninfected mothers chose replacement-feeding as the feeding method and mothers who chose breastfeeding were significantly older than mothers who selected replacement-feeding. They made their infantfeeding decision earlier than those who chose replacement-feeding. Findings showed that the majority of women in this study did not have access to running water and flush toilets in their houses.In these areas where replacement-feeding will not be acceptable, feasible, affordable, sustainable and safe, due to lack of sanitation and poor socio-economic status, health professionals should promote exclusive breastfeeding for 6 months, even though there is a high prevalence of HIV infection.OpsommingDie doel van die studie was om te bepaal watter faktore vroue in hulle keuse van bors- of bottelvoeding beïnvloed. Dit sal help om te verstaan op watter faktore gesondheidswerkers moet fokus wanneer borsvoeding bevorder word. ’n Gestruktureerde vraelys is voltooi deur 100 vroue en fokusgroepbesprekings is met 22 vroue wat by die Laer-Umfolozi Distrik Gedenk-hospitaal(LUDWM) geboorte geskenk het gehou. Die meerderheid vroue (72%) het borsvoeding gekies,58% het voorgeneem om vir 6 maande te borsvoed. ’n Groot aantal vroue (97%) het inligting oor babavoedingskeuses by gesondheidswerkers ontvang. Een derde van die vroue (33%) is deur die gesondheiswerkers beïnvloed en 44% van die deelnemers het aangedui dat niemand hulle beïnvloed het nie. Beduidend meer MIV-geïnfekteerde as ongeïnfekteerde moeders het kunsvoeding bo borsvoeding verkies. Net een moeder het gerapporteer dat sy kunsvoeding gekies het as gevolg van haar MIV-positiewe status, maar in die fokusgroepbespreking is die mening gelug dat die vrees van MIV oordrag deur borsmelk grootliks bygedra het dat MIV geïnfekteerde moeders kunsvoeding gekies het. Die moeders wat borsvoeding gekies het was beduidend ouer en het die voedingsmetode beduidend vroeër gekies as die wat kunsvoeding gekies het. Die resultate dui aan dat kunsvoeding nie aanvaarbaar, uitvoerbaar, bekostigbaar, volhoubaar en veilig is in die studie-area nie, as gevolg van swak sanitasie en die swak sosio-ekonomiese toestande. Gesondheidswerkers behoort dus eksklusiewe borsvoeding vir die eerste ses maande te bevorder, al is die prevalensie van MIVinfeksie.