Infant feeding in the context of HIV: pilot data on new indicators in under-five clinics in Lesotho
Background: With support from the World Health Organization (WHO), the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) conducted a study in Lesotho to examine two indicators on infant feeding practices and postnatal antiretroviral (ARV) use among HIV-exposed infants. The objective was to determine whether the data for the indicators reflected actual feeding practices and ARV uptake among HIV-exposed infants. The infant feeding indicator was defined as the percentage of those who were exclusively breastfed, those receiving exclusive replacement feeding, and those who were mixed fed at 3 months of age. The other indicator was on postnatal ARV use.
Methods: The cross‐sectional pilot study was conducted at six under‐five clinics in Lesotho from August to December 2012. Health care workers using new under-five registers recorded feeding practices and ARV use for infants from birth to 6 months. Exit interviews were conducted by study staff to gather more information. The results of the two sources of data were compared. All participants gave informed consent. IRB approval was obtained.
Results: The final sample size was 603 caregiver-infant pairs, with 95.7% (n=577) who were mothers. At 3 months of age, the proposed age for the infant feeding indicator, 81% were exclusively breastfed, 12% were exclusively replacement fed and 7% received mixed feeding. There was 90.2% agreement (kappa = 0.69) in responses recorded in the under-five clinic registers during routine visits with the responses given during exit interviews. Other results indicated that of those who attended ANC, 90.5% (504/577) received counseling on how to feed their infant. Exclusive breastfeeding was common among HIV-positive mothers (80.3%). Mixed feeding was more frequently reported among HIV‐negative mothers than among HIV‐positive mothers (9.3% vs. 2.9%).
All 577 mothers reported having been tested for HIV at ANC, and 95.8% (553/577) knew their HIV status while expecting their most recent infant. Overall, 204 women (36%) were HIV‐positive.
Of infants, 98.1% (N=201) were reported to have been initiated on NVP at birth.
Conclusions: The infant feeding indicator reflects responses during routine care and was feasible to collect, thus the infant feeding indicator is recommended for use globally. The indicator on ARV use needs more refining.
A. Tiam1, E. Bobrow2, M. Nyabela1, A. Ahimbisibwe1, A. Isavwa1, T. Diaho3, L. Sehiri3, A. Thompson2, C. Mazzeo4, R. Machekano5
1Elizabeth Glaser Pediatric AIDS Foundation, Clinical ServicesProgram Implementation, Maseru, Lesotho, 2Elizabeth Glaser Pediatric AIDS Foundation, Research, Washington, United States, 3Ministry of Health, Family Health-Nutrition, Maseru, Lesotho, 4Consultant, Washington, United States, 5Stellenbosch University, Cape Town, South Africa