Betty Mogesi Samburu1, Judith Kimiywe2, Sera Lewise Young3, Elizabeth W Kimani-Murage4,5,6,7,8, Frederick Murunga Wekesah4,9, Milka Njeri Wanjohi4, Peter Muriuki4,10, Nyovani Janet Madise11, Paula L Griffiths12,13. 1. United Nations Children's Fund (UNICEF), Nairobi, Kenya. bmogesi@unicef.org. 2. Department of Foods, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya. 3. Institute of Policy Research, Northwestern University, Evanston, USA. 4. Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya. 5. Wellcome Trust, London, UK. 6. Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G31 2ER, UK. 7. Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre, Stellenbosch University, Stellenbosch, South Africa. 8. International Health Institute, Brown University School of Public Health, Providence, USA. 9. Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. 10. Institute of Global Health Equity Education, University of Global Health Equity, Kigali, Rwanda. 11. African Institute for Development Policy, Lilongwe, Malawi. 12. School of Sports, Exercise and Health Sciences, Loughborough University, Loughborough, UK. 13. MRC/WITS Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Abstract
BACKGROUND: Although recent policies have sought to increase the rates of exclusive breastfeeding (EBF) and continued breastfeeding for HIV exposed infants, few programs have considered the multiple social and cultural barriers to the practice. Therefore, to generate evidence for exclusive and continued breastfeeding policies in Kenya, we examined community perspectives on the facilitators and barriers in adherence to EBF for the HIV positive mothers. METHODS: Qualitative research was conducted in Koibatek, a sub-County in Baringo County Kenya, in August 2014 among 205 respondents. A total of 14 focus group discussions (n = 177), 14 In-depth Interviews and 16 key informant interviews were conducted. Transcribed data was analyzed thematically. NVivo version 10.0 computer qualitative software program was used to manage and facilitate the analysis. RESULTS: Facilitators to exclusive breastfeeding were perceived to include counselling at the health facility, desire to have a healthy baby, use of antiretroviral drugs and health benefits associated with breastmilk. Barriers to EBF included poor dissemination of policies, knowledge gap, misinterpretation of EBF, inadequate counselling, attitude of mother and health workers due to fear of vertical HIV transmission, stigma related to misconception and misinformation that EBF is only compulsory for HIV positive mothers, stigma related to HIV and disclosure, social pressure, lack of male involvement, cultural practices and traditions, employment, food insecurity. CONCLUSIONS: There are multiple facilitators and barriers of optimal breastfeeding that needs a holistic approach to interventions aimed at achieving elimination of mother to child transmission. Extension of infant feeding support in the context of HIV to the community while building on existing interventions such as the Baby Friendly Community Initiative is key to providing confidential support services for the additional needs faced by HIV positive mothers.
BACKGROUND: Although recent policies have sought to increase the rates of exclusive breastfeeding (EBF) and continued breastfeeding for HIV exposed infants, few programs have considered the multiple social and cultural barriers to the practice. Therefore, to generate evidence for exclusive and continued breastfeeding policies in Kenya, we examined community perspectives on the facilitators and barriers in adherence to EBF for the HIV positive mothers. METHODS: Qualitative research was conducted in Koibatek, a sub-County in Baringo County Kenya, in August 2014 among 205 respondents. A total of 14 focus group discussions (n = 177), 14 In-depth Interviews and 16 key informant interviews were conducted. Transcribed data was analyzed thematically. NVivo version 10.0 computer qualitative software program was used to manage and facilitate the analysis. RESULTS: Facilitators to exclusive breastfeeding were perceived to include counselling at the health facility, desire to have a healthy baby, use of antiretroviral drugs and health benefits associated with breastmilk. Barriers to EBF included poor dissemination of policies, knowledge gap, misinterpretation of EBF, inadequate counselling, attitude of mother and health workers due to fear of vertical HIV transmission, stigma related to misconception and misinformation that EBF is only compulsory for HIV positive mothers, stigma related to HIV and disclosure, social pressure, lack of male involvement, cultural practices and traditions, employment, food insecurity. CONCLUSIONS: There are multiple facilitators and barriers of optimal breastfeeding that needs a holistic approach to interventions aimed at achieving elimination of mother to child transmission. Extension of infant feeding support in the context of HIV to the community while building on existing interventions such as the Baby Friendly Community Initiative is key to providing confidential support services for the additional needs faced by HIV positive mothers.
Entities:
Keywords:
Barriers; Continued breastfeeding; Exclusive breastfeeding; Facilitators; HIV; Kenya; Policy
Authors: Maricianah A Onono; Craig R Cohen; Mable Jerop; Elizabeth A Bukusi; Janet M Turan Journal: BMC Public Health Date: 2014-04-23 Impact factor: 3.295
Authors: Helen M Nabwera; Joyline Jepkosgei; Kelly W Muraya; Amin S Hassan; Catherine S Molyneux; Rehema Ali; Andrew M Prentice; James A Berkley; Martha K Mwangome Journal: Int Breastfeed J Date: 2017-07-12 Impact factor: 3.461
Authors: Elizabeth W Kimani-Murage; Judith Kimiywe; Mark Kabue; Frederick Wekesah; Evelyn Matiri; Nelson Muhia; Milka Wanjohi; Peterrock Muriuki; Betty Samburu; James N Kanyuira; Sera L Young; Paula L Griffiths; Nyovani J Madise; Stephen T McGarvey Journal: Trials Date: 2015-09-28 Impact factor: 2.279