Infant feeding practice and adherence to Ugandan infant feeding guidelines among HIV positive and HIV negative mothers

Introduction: In previous decades, the basis of child health and survival strategy in the developing countries has been the promotion of breastfeeding. However, transmission of HIV through breast milk to infants in the postnatal period has caused uncertainty over the best feeding technique. Previous policies in Uganda promoted breastfeeding even among HIV positive mothers without offering an informed choice of feeding mode. Consequently, the Ugandan Ministry of Health developed and adopted policy guidelines on feeding of infants and young children in the context of HIV/AIDS in 2001. However, little is known about their impact on infant feeding behaviour in Bushenyi district. Methods: This cross-sectional study conducted in Bushenyi district, Uganda, compared 94 HIV positive and 100 HIV negative mothers with infants aged less than 12 months on infant feeding practice, on the predictors of the different modes of infant feeding practice, and adherence to Ugandan infant feeding guidelines. Results: All HIV negative and 55% of HIV positive mothers were breastfeeding their infants aged less than 12 months. Among breastfeeding mothers, 85% of the HIV negative were breastfeeding non-exclusively. Of concern to the possibility of HIV transmission, 61% of the HIV positive mothers who were breastfeeding were doing so non-exclusively. Adherence to Ugandan infant feeding guidelines was higher in HIV positive mothers (67%) than in HIV negative mothers (41%). HIV negative mothers were more likely to be adherent if the mothers youngest infant was not a first-born (OR= 0.30, 95% CI = 0.10 0.88) and if they were aware of HIV transmission during pregnancy (OR = 2.60, 95% CI = 1.02 6.66). The single most predictive factor of adherence among HIV positive mothers was attendance at an infant feeding counselling session (OR= 5.63, 95% CI = 2.1514.73). Conclusions: Counselling support is necessary for mothers to make infant feeding choices that are viable and sustainable. The self-reported method of assessing adherence in our study could have been sub-optimal and may therefore overestimate the adherent proportions reported here. Addressing development of better assessment methods and methods for improving adherence to guidelines is crucial for preventive strategies. Recommendations: Increase coverage of infant feeding counselling by introducing peer counsellors in the community