Social determinants of mixed feeding behavior among HIV-infected mothers in Jos, Nigeria

Abstract

Mixed feeding confers excess risk of mother-to-child transmission (MTCT) of HIV compared with exclusive breastfeeding and exclusive formula feeding. We undertook a qualitative and quantitative cross-sectional survey to identify the social determinants of mixed feeding among a subset of the 469 HIV-infected women enrolled in a MTCT prevention program in Jos, Nigeria. Formula was provided free-of-cost. Of the 91 participants, 68 (75%) exclusively formula fed, 7 (8%) exclusively breastfed, and 16 (18%) practiced mixed feeding. Of the mixed feeding women, seven primarily formula fed and nine primarily breastfed. Women who primarily formula fed described family pressure as the reason for mixed feeding, while women who primarily breastfed reported insufficient breast milk. In a multivariate analysis, lack of partner support of the feeding decision predicted mixed feeding behavior (OR: 4.2; 95% CI: 1.2–14.9; p=0.03). Disclosure of HIV status was significantly correlated (p<0.001) with partner support. HIV prevention interventions aimed at reducing mixed feeding should encourage supportive partner relationships that facilitate disclosure of HIV status. Attention should also be made to the differing pressures faced by women attempting to exclusively breast feed and exclusively formula feed.

Keywords:

• mixed feeding
• PMTCT
• breastfeeding
• bottle feeding
• social determinants
• HIV
• acquired immunodeficiency syndrome

Acknowledgements

We thank all women and children enrolled in the study; ?eld, clinic, and data management staff at the Plateau State Virology Research Center, in particular, Felicia Okolo who assisted in the data management during the study; Dr Brian Forsyth for his mentorship during the analysis and writing process; and Duncan SR Maru for his assistance in statistical analysis. We also acknowledge the Fogarty AIDS International Training Research Program (D43 TW001041-09) for providing research training support during the study implementation and the Bill and Melinda Gates Foundation through collaboration with the Harvard University School of Public Health's AIDS Prevention Initiative in Nigeria (APIN) for funding support.