Predictors of Breast Feeding Behavior among HIV Positive Women in Kenya

Presenter:Eunice Kimunai, PhD, RN

September, 2013

My interest in the topic:

34 million people are infected with HIV in 2010 (WHO, 2012).

Estimated 30 million deaths to date (WHO, 2012).

Approximately 2.7 million people were newly infected with the HIV virus in 2010 (WHO, 2012).

My interest in the topic:

More than 2 million children are living with HIV/AIDS (WHO, 2012).

Infection of most children is through mother-to-child HIV transmission (MTCT) or vertical transmission (WHO, 2012).

Mother-to-child HIV transmission is almost entirely avoidable.

My interest in the topic:

In developed nations, MTCT has been reduced to less than 5% (WHO, n.d.b).

Without implementation of evidence-based interventions, the rate of MTCTC is estimated to be 15%-45% (WHO, n.d.b).

Purpose of study

The purpose of this quantitative study is to test the relationships among HIV counseling, HIV treatment, knowledge of HIV transmission from mother to child and breastfeeding behaviors.

Problem Statement

The problem addressed in this study was HIV transmission from mother to child and whether the variables of HIV counseling, HIV treatment, and knowledge of HIV transmission from mother to child impact breastfeeding behaviors to prevent the transmission of HIV from mother to child.

Research Question

The research question addressed in this study is:

– What is the relationship between HIV counseling and breastfeeding behaviors among HIV positive Kenyan women?

– What is the relationship between HIV treatment and breastfeeding behaviors among HIV positive Kenyan women?

– What is the relationship between knowledge of HIV transmission from mother to child and breastfeeding behaviors among HIV positive Kenyan women?

Theoretical Base

Andersen’s behavioral model for health utilization.

According to Andersen (1995), the decision to utilize health care services is determined by an individual’s predisposition to utilize health care services, factors that make it easier or harder to use health care services, and an individual’s need for health care services.

Overview of Literature Review

By the end of 2007, USAID (2010) estimated that there were 1.6 to 1.9 million people who were living with HIV/AIDS (PLWHA) in Kenya.

The main mode of transmission of the HIV virus is though heterosexual sex.

Rate of women was twice that of men Rate of rich was higher than poor

Overview of Literature Review

According to the Kenya National Bureau of Statistics (2011), there are approximately 10% of pregnant women in Kenya who are living with HIV/AIDS.

Prevention of mother-to-child HIV transmission (PMTCT) is the foundation of reducing the burden of MTCT(Baek & Rutenberg, 2010).

Overview of Literature Review

Researchers have identified many challenges that result in low utilization of prevention of mother-to-child HIV transmission (PMTCT) services in Kenya.

These challenges include:– low and late enrollment of pregnant women in

antenatal clinics (ANC.

Overview of Literature Review

– Late enrollment to ANC services also contributes to ineffective intervention in PMTCT services.

– Male involvement in PMTCT services has remained low in resource-poor settings (Nkuoh et al., 2010).

– Stigma and discrimination has remained rampant (Arulogun et al., 2007).

Overview of Literature Review

– Lack of health care facilities, shortages of health care staff, and a shortage of supplies and drugs negatively impacts PMTCT service effectiveness (Anand et al., 2009; Bancheno et al., 2010; Medley & Kennedy, 2010).

– Infant feeding has remained a challenge.

Overview of Literature Review

61% of women in Kenya received HIV counseling during prenatal care.

52% of mothers reported taking all of their prescribed medication

47% took it until they felt better Over 65% of mothers reported giving all

prescribed medication to their children (Ellis et al., 2006).

Overview of Literature Review

In Kenya, 44% of all mother-to-child HIV transmission was due to breastfeeding, and 75% of all transmission related to breastfeeding occurred in the first six months of a child’s life (Richardson et al., 2003).

Overview of Literature Review

There is a gap in the literature on the interrelationships and predictor value between HIV counseling, HIV treatment, knowledge of HIV transmission from mother to child and breastfeeding behaviors.

Research Design & Sample Selection

This research is a quantitative research study and the design chosen for this research is a correlation study design.

My study utilized a correlational study to examine the relationships between independent variables and dependent variable.

Research Design & Sample Selection

I conducted a sample size determination using G*Power 3.1 for multiple linear regression analysis using the following determinations: effect size of 0.15, alpha level of 0.05, power of 90% (Faul, et al., 2007).

I achieved an output for the total sample size of 136.

In the current dataset, 167 women were identified as meeting inclusion criteria.

Data Collection & Analysis

I utilized secondary data from Demographic and Health Surveys (DHS).

I analyzed the data using Statistical Package for the Social Sciences (SPSS), version, 19.0.

I conducted multiple linear regression and logistic regression analyses.

Results - Descriptives

The sample included 167 participants. Education: primary education (67.7%) and secondary

education (19.2%). Wealth: richest (29.9%) and poorer (23.4%). . Ethnicity: Luo (48.5%), Luhya (25.7%), and Kikuyu

(9.0%). Literacy: read whole sentences (64.6%) and parts of

sentences (22.0%). Age: average age of the participants was 28 years with a

minimum of 16 years and maximum of 48 years.

Results – Primary Analysis

The hypotheses were tested using two regression models:

– multiple linear regression model to test the effects of the IVs on Duration of Breastfeeding.

– logistic regression model to evaluate the effects of the IVs on the odds of Still Breastfeeding.

For hypothesis 1, it was found that having talked during antenatal visit regarding AIDS transmission from mother to child was predictive of a shorter duration of breastfeeding.

Results – Primary Analysis Cont.

For hypothesis 2, it was found that having used drugs for avoiding AIDS transmission to baby during pregnancy reduced the odds of still breastfeeding.

For hypothesis 3, it was found that knowledge regarding AIDS transmission by breastfeeding was not predictive of duration of breastfeeding and odds of still breastfeeding.

Discussion–Results Interpretation

The results were mixed and contradictory. Possible explanations:

– the providers give conflicting information during antenatal visits

– women were more receptive to messages about breast feeding at one time versus the other

– women in this study could have received information about breast feeding from other Medias or channels

– mothers who were taking HIV treatment could be stopping breastfeeding because they did not want to transfer the HIV drugs to their babies through breast milk.

– mothers who have access to antiretroviral medications could also have better access to supplemental feeding.

Discussion - Limitations

Recall bias could influence the final reported information

Sites selected for surveillance may not be representative

I did not know how long the mother had been breastfeeding if she was still breastfeeding

Correlation research method implies relationship but not causation

Discussion - Recommendations

Future research should look at how PMTCT guidelines are interpreted by the providers and how the patients interpret the information that they receive from the providers

Qualitative research could explain the contradictory results

Implication for Social Change

My research could help providers, clinics, and organizations improve their practices, thus, resulting in reduction of the rate of mother-to-child HIV/AIDS transmission in Kenya.

Questions

Thank you…..

References

Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior, 36(1), 1–10. doi:10.2307/2137284

Anand, A., Shiraishi, R. W., Sheikh, A. A., Marum, L. H., Bolu, O., Mutsotso, W., Sabin, K., et al. (2009). Site factors may be more important than participant factors in explaining HIV test acceptance in the prevention of mother-to-child HIV transmission programme in Kenya, 2005. Tropical Medicine & International Health: TM & IH, 14(10), 1215-1219. doi:10.1111/j.1365-3156.2009.02367.x

Arulogun, O., Adewole, I., Olayinka-Alli, L., & Adesina, A. (2007). Community gate keepers’ awareness and perception of prevention of mother-to-child transmission of HIV services in Ibadan, Nigeria. African Journal of Reproductive Health, 11(1), 67-75. Retrieved from http://www.bioline.org.br/rh

References

Baek, C., & Rutenberg, N. (2010). Implementing programs for the prevention of mother-to-child HIV transmission in resource-constrained settings: Horizons studies, 1999 -- 2007. Public Health Reports, 125(2), 293-304. Retrieved from http://www.publichealthreports.org/

Bancheno, W., Mwanyumba, F., & Mareverwa, J. (2010). Outcomes and challenges of scaling up comprehensive PMTCT services in rural Swaziland, Southern Africa. AIDS Care, 22(9), 1130-1135. doi:10.1080/09540121003615079

Ellis, A., Gogel, R., Roman, B., Watson, J., Indyk, D., & Rosenberg, G. (2006). The STARK study: a cross-sectional study of adherence to short-term drug regimens in urban Kenya. Social Work in Health Care, 42(3/4), 237-250. Retrieved from http://www.tandf.co.uk/journals/wshc

References

Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior research methods, 39(2), 175–191.

Kenya Demographic and Health Surveys (2010). Service provision assessment survey. Retrieved April 20, 2012 from http://www.measuredhs.com/pubs/pdf/SPA17/SPA17.pdf

Kenya National Bureau of Statistics (2011). Kenya national bureau of statistics AIDS control unit. Retrieved July 12, 2011 from http://www.knbs.or.ke/hivaids.php

Kenya National Bureau of Statistics (KNBS) and ICF Macro (2010). Kenya Demographic and Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro. Retrieved from http://www.measuredhs.com/pubs/pdf/FR229/FR229.pdf

References

Medley, A. M., & Kennedy, C. E. (2010). Provider challenges in implementing antenatal provider-initiated HIV testing and counseling programs in Uganda. AIDS Education And Prevention: Official Publication Of The International Society For AIDS Education, 22(2), 87-99. Retrieved from http://www.researchgate.net/journal/1943-2755_AIDS_education_and_prevention_official_publication_of_the_International_Society_for_AIDS_Education

Nkuoh, G. N., Meyer, D. J., Tih, P. M., & Nkfusai, J. (2010). Barriers to Men’s Participation in Antenatal and Prevention of Mother-to-Child HIV Transmission Care in Cameroon, Africa. Journal of Midwifery & Women’s Health, 55(4), 363–369. doi:10.1016/j.jmwh.2010.02.009

References

Richardson, B., John-Stewart, G., Hughes, J., Nduati, R., Mbori-Ngacha, D., Overbaugh, J., & Kreiss, J. (2003). Breast-milk infectivity in human immunodeficiency virus type 1-infected mothers. Journal of Infectious Diseases, 187(5), 736–740. Retrieved from http://jid.oxfordjournals.org.ezp.waldenulibrary.org/

USAID (2010). HIV/AIDS health profile. Retrieved March 10, 2012 from http://www.usaid.gov/our_work/global_health/aids/Countries/africa/kenya.pdf

WHO (n.d.).HIV/AIDS. Retrieved March 7, 2012, from http://www.who.int/mediacentre/factsheets/fs360/en/index.html