Determinants of infant feeding intent and appropriateness of choices for formula feeding in the Djoungolo Prevention of Mother-To-Child Transmission of HIV programme, Yaounde,

Cameroon

(M0PDD0303)

XIX AIDS Conference Washington DC,July 2012

A.E. Njom Nlend1, B. Bagfegue Ekani2, A. Tchouamo2, A. Mbi3, and the Mother & Child Djoungolo Network

Background

• The dilemma of infant feeding in HIV context of poor resource setting remains unresolved and the practice of replacement feeding can contribute to lower child survival. (De Paoli, 20, Coutsoudis 2009

• Appropriate infant feeding counseling can reverse such risk as well as limiting spill-over (WHO,2010.)

Objective

• To describe infant feeding intents of HIV positive women and determine the appropriateness of choice of those opting for formula-feeding after the counseling process.

Methods

• Routine infant feeding counseling of HIV positive mother offered by short-course trained counselors during the pregnancy or in the early-post partum.

• Intents of formula FEEDING assessed FOR feasibility by using a generic acceptable, feasible, affordable sustainable , secure( AFASS) score composed of 7 variables grading from 0 to 2

Generic Score for Assessing feasibility accessibility affordability sustainability ( AFASS) score

1-Which kind of water are you using ? 5- Shall you be able to prepare formula feeding and clean t

Tap water he bottle even during the night ?Pump NoRiver,:stream Yes not easily2- What kind of fecal disposal is available in your house Yes easily

Modern water closet 6 Which financial amount can you get monthly to buy milk

Traditional latrines and attend facility appointments for the follow-up of the baby

No latrines 10000 FCFA/month3- Have you disclosed your status to your husband? 20000 FCFA/month

No > 20000 FCFA /monthYes 7- Which kind of energy do you use4-Which reason will you give to your family if you were Wood

asked to explain why you don’t breastfeed your child Charcoal

Don’t know GasConfused Each item ranking from 0 to 2 Coherent reason clearly explained Total score 14

Measurement

• % of women who had an AFASS >10 and or who fullfilled at least 4 conditions

• Factors predicting replacement feeding choice (univariate)

RESULTS (1)SOCIOECONOMICS CHARACTERISTICS OF THE COHORT

N % N %

MATRIMONIAL 950 FECAL DISPOSAL 928

SINGLE 323 34 MODERN 299 32

COHABITING 457 48 TRADITIONAL 699 68

MARRIED 170 18 WATER 928

LEVEL OF EDUCATION 890 tap water 848 91

PRIMARY 228 26 others (public taps, streams) 81 9

SECONDARY 560 63 FINANCES 919

>SECONDARY 102 11 <10000 582 63

PARITY 920 10000-20000 261 28

NULLIPAROUS 266 29 ≥20000 76 8

MULTIPAROUS 654 71 source of energy 927

FEEDING OF PREVIOUS CHILD 660 Wood or charcoal 172 19

breastfeeding 322 49 gas 712 77

formula feeding 95 14 kerosene 43 5

mixed feeding 243 37 Preparation BF 925

OPTION CHOSEN* 924 yes 23 2,5

exclusive formula feeding 578 63 yes but not easily 115 12,5

exclusive breastfeeding 346 37 yes easily 787 85

STATUS DISCLOSED 922 AFASS SCORE 920

NO 228 25 <10 223 24

YES 694 75 ≥10 697 76

0tan28a5660280tan9a56609

0tan19a5660190tan29a566029

0tan9a566090tan19a5660190tan29a566029

0tan9a566090tan19a5660190tan29a5660290tan10a566010

0tan7a56607

0tan25a566025

0tan13a566013

0tan2a56602

0tan17a5660170tan22a566022

0tan28a566028

AA AME

Cumulative access from one to 4 conditions : safe water, préparation of RFHability to explain, kind of energy, additional condition : disclosure .

Among 924 women counseled, 63% intended to formula feed their babies while 37% where planning to breastfeed. The AFASS criteria >10 was met by 87% who intend to practise formula

feeding compared to 57 of those who intend to breastfeed. Inappropriate formula feeding choice ( AFASS <10) was twice likely in women counseled during post partum period as against

during pregnancy ( 0R: 1,8 1.3-2.4, p=0.02).

RESULTS(2)Factors associated with artificial feeding intentVariable OR 95%CI p-valueMarried 1,5 1.08-2,25 0.02Tertiary education 2,17 1.36-3.46 ≤0.001

Non BF of the previous child 1,8 1.33-2.19 ≤0.001

AFASS score > 105.04 3.64-6.57 ≤0.001

HIV status disclosed to the partner 1.68 2.24-2.28 ≤0.001

CONCLUSION

• in Djoungolo, after infant feeding counseling, replacement feeding intent is mostly appropriate fitting mother's environment and livelihood. In addition,

• The desire to breastfeed remains real as more than ½ women who choose to breastfeed met the conditions to practice formula feeding.

THANKS

ACAPFAS

B.P. 5777 Nlongkak Yaoundé