TABLE OF CONTENT
Title Page
Approval – – – – – – – – ii
Certification – – – – – – – – iii
Dedication – – – – – – – – iv
Acknowledgements – – – – – – – – v
Table of contents – – – – – – – – – vi
List of figures – – – – – – – – – – vii
List of Tables – – – – – – – – – viii
List of Appendices – – – – – – – – – ix
Abstract – – – – – – – – x
CHAPTER ONE: INTRODUCTION
Background to the Study – – – – – – – – 1
Statement of Problem – – – – – – – – 2
Purpose of the Study – – – – – – – – 4
Research Questions – – – – – – – 4
Significance of the Study – – – – – – – – 4
Scope of the Study – – – – – – – – 5
Operational Definition of Terms – – – – – 5
CHAPTER TWO: LITERATURE REVIEW
- Conceptual Review – – – – – – – – 6
- Concept of Various Infant Feeding Options Available
Among HIV Positive Mothers – – – – – – 6
- Factors Influencing Choices of Infant Feeding Options Among HIV Positive Mothers; – – – – – – 9
- Socio-Demographic Factors – – – – – – 11
- Maternal Factors – – – – – – – – 11
- Infant Factors – – – – – – – – 14
- Health System Factors – – – – – – – 15
- Theoretical Review – – – – – – – 19
- Application of the Theory to the Study – – – – 20
- Empirical Review – – – – – – – 23
- Summary of Literature Review – – – – – 29
CHAPTER THREE: RESEARCH METHODS
Research Design – – – – – – – – 41
Study Area – – – – – – – 41
Population of the Study – – – – – – – – 42
Sample – – – – – – – 42
Inclusion criteria – – – – – – – – 42
Sampling Procedure – – – – – – – 42
Instrument for Data Collection – – – – – – 42
Validity of the Instrument – – – – – – – 43
Reliability of the Instrument – – – – – – – 43
Ethical Consideration – – – – – – – – 43
Procedure for Data Collection – – – – – – – 43
Method of Data Analysis – – – – – – – 44
CHAPTER FOUR: PRESENTATION OF RESULTS
Demographic Distribution of the Respondents – – – 45
Summary of Findings – – – – – – – – 58
CHAPTER FIVE: DISCUSSION OF FINDINGS
Discussion of major Findings – – – – – – – 59
Implication of the Findings – – – – – – – 61
Limitations of the Study – – – – – – – – 61
Summary – – – – – – – 62
Conclusion – – – – – – – 63
Recommendations – – – – – – – – 63
Suggestions for Further Studies – – – – – – – 64
REFERENCES – – – – – – 65
APPENDICES – – – – – – – – –
74
LIST OF FIGURES
Figure 1: Adopted model of Mercer’s Maternal Role Attainment of Becoming a Mother
LIST OF TABLES
Table 1: Socio demographic factors 56
Table 2: Maternal factors 58
Table 3: Infant factors 59
Table 4: Health system factors 60
APPENDICES
Appendix Title Page
- Questionnaire – – – – 75-77
- Informed consent – – – – 78
- Reliability (Spearson-Brown correlation coefficient) 79
- Chi-square statistics – – – 80-110
- Identification letter – – – 111
- Certificate of Ethical approval – – – – 112
ABSTRACT
The survey study was conducted on factors influencing the choice of infant feeding options among HIV positive mothers attending health facilities in Ogoja, Cross River State. The purpose was to investigate factors influencing the choice of infant feeding options among HIV positive mothers in Ogoja, Cross River State. Four objectives and four research questions were used to guide the study. Literatures were reviewed. The population for the study was all HIV positive mothers attending health facilities in Ogoja from January-December 2011-2013, with a total of 136 registered HIV positive mothers. There was no sampling because the total population was included in the study. The instrument for data collection was questionnaire with two sections. Section A had 8 items on socio-demographic characteristics. Section B was made up of 10 items rating scale of Yes and No. Data was analyzed using chi-square statistics. Result revealed that marital status (x2= 20.924, p<.00), religious status (x2 = 14.972, p<.05), maternal health condition (x2 =12.436, p<.02), limited time to breastfeed baby because of work (x2 =11.065, p<.04) and baby’s refusal to take breast milk (x2 = 18.318, p<.00) significantly influenced HIV positive mothers’ choice of infant feeding options. Major findings reveal that marital status, religious status, maternal health condition, limited time to breast feed baby because of work and baby’s refusal to take breast milk had significant influence on infant feeding options. Based on the findings it was recommended that HIV positive mothers should be sensitized by HIV/PMTCT counselors with necessary knowledge for the choice of infant feeding options.
CHAPTER ONE
INTRODUCTION
Background to the Study
Human immune-deficiency virus (HIV) is a chronic, health problem with symptoms appearing anytime from several months to years. HIV is found among all known populations of the world, including the embryonic population (unborn babies) and the breastfed babies. World Health Organization, (WHO, 2011) revealed that more than eleven million people worldwide had died of AIDS, while another 3.6 million of people are already infected with HIV, with a daily infection rate of over 16,000 people globally. It was observed by Anyebe, Whiskey, Ajayi, Garba, Ochigbo and Lawal (2011) that by 2002, 42 million people had been infected with HIV/AIDS globally, 38.6 million of them were adults of which 19.2 million were women. More than 3 million children below the age of 15 were infected worldwide within the same period with about 5 million new infections being recorded yearly. Nearly two thirds of these are in Sub-Saharan Africa. Globally, an estimated 600,000 children are infected vertically (in utero) each year, while in places where women do not breastfeed, most of the transmission occurs at the time of labor and delivery, (Okon, 2011).
In Nigeria where most women breastfeed, there is an additional risk. About 800,000 were infected out of 5.8 million in 2003 were infants and children of which 90% of these got infected through their mothers, occurring at three levels; antepartum, intrapartum and breastfeeding (Okon, 2011). There is no cure for HIV currently available, but prevention of mother to child transmission (PMTCT) appears to be the most important intervention (Family Health International, 2004). American international health alliance (AIHA, 2008) in Ajayi, Hellandendu and Odekunle (2011) posited that ‘’there is no cure for HIV, but prevention of vertical transmission of HIV to include voluntary counseling and testing, (VCT) , ante-retroviral therapy, elective caesarean section; replacement of infant feed or modified breastfeeding, and restrictive use of invasive procedure such as artificial rupture of membrane, (ARM),episiotomies and cleansing of the birth canal with a microbite during labor and delivery.
Sadoh, Adeniran and Abhulimhen-Iyohas (2008) opined that exclusive breastfeeding is the ideal practice among HIV infected mothers in the first six months of life, as recommended currently, followed by replacement feeding (any formula food rather than breast milk) depending on the acceptability, feasibility, affordability, sustainability and safety (AFASS) of the later. These recommendations are predicted on the transmissibility of HIV via breast milk. Several factors affect infant feeding practices such as non-affordability, non availability of portable drinking water and lack of information, especially in those who do not know their HIV status. Chopra, Doherty and Jackson (2005) observed that for HIV positive mothers to choose their infant feeding options, their choices may be based on; family income, maternal and paternal education, maternal age, access to storage facilities, access to clean drinking water and adequate sanitation and cultural values.
Okelle (2011), observed that babies have specific nutritional needs and are born with an underdeveloped immune system. Therefore, they need food like breast milk to meet these demands. The Federal Ministry of Health (FMOH, 2011) adopted WHO (2010) guidelines that emphasize breastfeeding values exclusively for the first six months of life once mother is on ARVs, then with the introduction of appropriate complementary food while continuing breastfeeding for up to two years and beyond with HIV infected mothers. It also stated that antiretroviral (ARVs) drugs should be made available for HIV positive mothers to reduce the risk of transmission through breastfeeding until one week after the end of breastfeeding and strongly recommends that all mothers including HIV infected mothers should breastfeed their infants.
Based on FMOH standard, Adejuyigbe, Orji, Onayade, Makinde and Anyabolu (2008) and Maru and Haidar (2009) then recommended that health workers should no longer counsel HIV infected mothers on infant feeding options, but to provide information on all the feeding options available, and allow HIV infected mothers to make a choice based on individual circumstances. If HIV infected mother decides not to breast feed, health workers can provide support on proper nutrition safe for the infant or refer to where she can receive such support. Several factors can influence the mother’s choice of breast feeding and complimentary feed, this research therefore was designed to examine factors influencing the choices of infant feeding options among HIV positive mothers in Ogoja Local Government Area of Cross River State.
Statement of problem
