Exploring Infant Feeding Practices and associated factors among HIV Positive Mothers Attending Early Infant Diagnosis Clinic in Northern Uganda.

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Ivan mutawulira, Jane Nakachwa, Laymond Muharabu, Abel Wilson Walekhwa, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1357502/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background World Health Organisation recommends mothers with Human Immune Virus/Acquired Immune Deficiency Syndrome to exclusively breastfeed their infants for the first six months and there after introduce complimentary feeding up to one year. This study assessed the infant feeding practices and their determinants among HIV positive mothers with infants 0–12 months. Methodology: A cross sectional study design adopting qualitative and quantitative data collection procedures was used. Study was carried out from Awach Health Center IV in Gulu city, Uganda. We enrolled 108 participants who were HIV positive mothers with an infant from October to December 2021. It was simple random sampling for collecting quantitative data using an interviewer administered semi structured questionnaire. Two Focuss Group Discussions (FGDs) and 5 Key informants interviews (KII) were used to obtain qualitative data. Data was collected edited coded and entered into epi info. The data was analysed using SPSS version 22. Qualitative data was analysed using Atlas.ti software. Results Of the 108 mothers, 83/108 (77%) practiced exclusive breastfeeding, 25/108 (23%) mixed feeding. Qualitative results also showed that exclusive breastfeeding was the preferred choice. Of the respondents 104/108 (96.3%) believed HIV can be transmitted to their babies. Factors associated with infant feeding practices at multivariant level at 5% significance were age of the child (OR = 0.706, 95% CI: 0.2100.988), income level (OR = 1.296, 95% CI: 1.150-10.631), knowledge on Prevention of Mother to Child Transmission (OR = 16, 95% CI: 3.618–34.18), Early infant diagnosis clinic visits (OR = 0.118, 95% CI: 0.019–0.704) and the place of delivery (OR = 1.976, 95% CI: 1.295–13.233). Conclusion Majority of the mothers practiced Exclusive breastfeeding, although a high number still practice mixed feeding. Majority of mothers had good knowledge about prevention of mother to child transmission. The factors identified in our study that influence infant feeding practices were Early infant diagnosis clinic visits, age of the child, place of delivery, knowledge on Prevention of Mother to Child Transmission. Mothers should deliver from hospitals, more sensitizations for these mothers to appreciate the benefits of exclusive breastfeeding. Pediatrics Sexual & Reproductive Medicine Key words Infant feeding HIV positive Exclusive breastfeeding Gulu Uganda Figures Figure 1 Figure 2 Background Exclusive breastfeeding is defined as feeding infants only breast milk, be it directly from breast or expressed, except drops or syrups consisting of vitamins, mineral supplements or medicine. The WHO guidelines recommend that in settings where breastfeeding is judged to be the safest infant feeding option, mothers with HIV should exclusively breastfeed their infants for the first six months and continue to breast feed for at least 12 months while introducing complementary foods (WHO, 2016). Even with these recommendations, mothers do not practice it because of a range of reasons. There by creating a cave of early infant diagnosis of morbidities to infants as it is influenced by the feeding choice that the mothers make (Chantry et al., 2011 ) Although there is a risk of HIV infection through breastfeeding, the risk of mortality and morbidity is higher if infants are taking replacement feeding. In many resource limited settings, HIV exposed infants who were not breastfed were up to six times more likely to die from diarrheal diseases, malnutrition and pneumonia (WHO, 2016) The benefits of breastfeeding are incomparable and comprise the prevention of infant infectious diseases and reduction of leukaemia, sudden infant death syndrome, type 1 and 2 diabetes and obesity (Ip, Chung, Raman, Trikalinos, & Lau, 2009 ). EBF for the first 6 months of the infants carries a 4-10-fold decreased risk of MTCT of HIV compared to mixed breastfeeding. This may be due to unhygienic practices, increasing the risk of diarrhoea, other foods and liquids which alter the gastro intestinal tract integrity and may therefore lead to MTCT of HIV in mixed fed infants (Miller, Iliff, Stoltzfus, & Humphrey, 2002 ). Breast feeding is an important component of the wellbeing and survival of children, particularly in poor resource setting. Breast milk provides optimal nutrition, contains anti bodies that protect infants and is unlikely to become contaminated (Kramer & Kakuma, 2012 ). The overall prevalence of EBF in sub-Saharan Africa is low which was at 36%, prevalence was highest in Rwanda and lowest in Gabon, despite the fact that Sub-Saharan Africa is the home of higher rates of MTCT, malnutrition, infant and mortality rate (Yalçin, Berde, Yalçin, & epidemiology, 2016). The current evidence suggests that high income countries practice shorter duration of breastfeeding compared with low- and middle-income countries. However, within low- and middle-income countries, approximately only 37% of infants younger than six months are exclusively breastfed. Just scaling up and promoting breastfeeding to the universal level could prevent 823,000 annual death in children under 5 years and 13810 of these under 2 years (Victora et al., 2016 ). In Uganda a study done showed that Proportion of HIV exposed infants that were exclusively breastfed reduced with increasing age of the infant, the incidence of non-exclusively breastfeeding at 6 weeks and 14 weeks post-partum were 22.5% and 42.9%. By the time infants were 14 weeks of age almost half of them were not exclusively breastfeeding (Napyo et al., 2020 ). Several studies have showed low rates of exclusive breastfeeding in outside countries however very few of such studies have been done in Uganda particularly Northern region. Therefore, the aim of this study was to assess the infant feeding practices among HIV positive and factors that influence the choice of the feeding practices. Methods Study area The study was conducted from Awach Health Centre IV in the HIV early infant Diagnosis (EID) clinic. EID is a specialised clinic where HIV exposed infants and their mothers seek care. Awach Health Centre IV is found in Awach subcounty, which is found in Aswa County in Gulu district, Northern Uganda. It is about 35.1km from Gulu city via Gulu-Patiko road, and Gulu city is 335km from Kampala the capital city of Uganda, it is located on latitude 3001011and longitude 3202315911 (Fig. 1 ,this map was adapted from (Walekhwa et al., 2022 ). This is the major health centre in Aswa health sub district, it is located north of Paroma close to Awach public nursery and primary school. Awach subcounty has 4 parishes and 32 villages. Has a population of 22,576. The area is blessed with topical savanna climate, with rainy and sunny seasons. Major economic activities are trade through business and subsistence farming. The quickest transport in the area is by use of commercial motorcycle. Major language spoken in Gulu is Acholi. Study population The study population consisted of all mothers who are HIV positive and having a child 0–12 months from 18–49 years, attending EID from Awach Health Centre IV and were present during the time of data collection. Every Thursdays about 25–30 HIV positive breastfeeding mothers came to the facility to get their medications Sample size The Kish and Leslie formula of sample size determination was used to generate the minimum number of HIV positive mothers required for the study (kish,1965), giving us a sample size of 108 participants. Sampling procedure We used simple random sampling during each day of data collection, small pieces of paper were written yes and no, then they were put in a container and eligible participants were asked to pick. Those who picked yes consented and were interviewed. For example, if on a given day, we had 30 participants, we interviewed 80% of the participants, therefore we made 24 pieces had yes and 6 pieces had no, then the pieces were distributed to all the participants those who chose yes were interviewed. We held two Focussed group discussion (FGD’s) where participants were selected using simple random sampling. They were given small pieces of papers labelled either 1, 2 or 3, those who picked 1 were in group 1 and those who picked 2 were in group 2 and those in group 3 were not interviewed. We picked 5 Key informants purposively because they had knowledge about breast feeding practices in the HIV context, these were, 2 PMTCT nurses, 2 midwives and I councillor Data collection tools. Quantitative data was collected by trained and experienced research assistants using a brief interviewer administered questionnaire. Qualitative data was collected using FGD guide and key informant guide. The collection tools were pretested from Atanga health centre III which is a neighbour to the study site. Data collection procedure The data was collected for over a period of 6 weeks. Interviews started from 9am to 4pm East African Time (EAT). In Awach Health Centre IV, Thursdays was the day of EID Cclinic. It usually received 25–30 patients on every Thursday. The researchers moved on a boda boda from Gulu city to the facility, which took about 50 minutes. On reaching the facility, with the help of the nurses, the eligible participants were chosen then an Interviewer semi structured questionnaire was used on respondents who were randomly selected and consented. The questions were cantered on infant feeding practices and associated factors. The data was collected by the researchers themselves. Data management and analysis The data was analysed using statistical package for the social sciences (SPSS) for windows version 22. Descriptive statistics including measures of central tendency (that is mean and median) and dispersion as standard deviation (SD) and range, as well as frequencies and percentages were used to describe the study population. The infant feeding practices of the mothers was described using pie charts and bar graphs. Bivariate analysis (odds ratio) was conducted to establish associations between various variables and infant feeding practices. Variables which showed significant association were further subjected to multivariate analysis (logistic regression) to establish the determinants of infant feeding practices. A P value of < 0.005 was used as the basis for statistical significance. Qualitative interviews were conducted in English using KI and FGD guides. Each interview was transcribed real time by the research assistant. A total of 57 codes for KIs and 11 for FGD were originally generated. The codes generated were analysed for consistence and either divergence or convergence. Those that converged formed a particular theme and this was deduced by the data analysis team. Those that diverged also formed a particular theme and this was also noted. The codes were developed from the objective of the study and transcribed data, and then entered into ATLAS version 8 software for analysis. Using deductive thematic analysis, the categorised data was used to develop main themes which made the final results of our study. A total of 4 main themes emerged from this data analysis, the included (1) barriers to EMTCT, (2) common infant feeding practices among the mothers, (3) roles of health workers on the choice of infant feeding practice among HIV positive mothers, (4) factors that influence the choice of the infant feeding practice. These themes were documented as key outcomes of our study and consequent quotes attached quotes attached to back up our findings. Ethical considerations Ethical approval for the study was obtained from Gulu University Research Ethics Committee on the 14th of October, 2021 IRB No. GUREC-2021-76 (supplementary 1). Permission was sought from the administration of Awach Health Centre IV and obtained on the 15th of October 2021. Participants were fully informed about the study and written consent was sought for before anyone was interviewed. Any participant was free to accept or decline in participating in the study. Confidentiality was guaranteed by ensuring that the participant’s names are not known but questionnaires were just numbered. The participants had a right to withdraw from the interview at any given time of the interview. The participants were allowed to ask questions before, during and after the study, any time of their convenience. The participants were informed that after the study they will not receive any incentive. The researcher administered the questionnaire in a privately secluded room to ensure privacy and confidentiality of these respondents Results Response, a total of 108 HIV positive mothers were surveyed with 100% response rate Socio-demographic and socio-economic characteristics of participants. A total of 108 mothers participated in the study, making the response rate of 100%. The age range of the study population was from 16 to 43 years. The mean age of the mothers was 28 + 6.07 years while the mean age of the infants was 5.7 + 2.86 months. Majority 89 (82.4%) of the participants were unemployed, 91 (84.3%) had an income of one hundred thousand per month and majority (71%) had no house helpers (Table 1 ). Table 1 Sociodemographic characteristics of the participants (9–13 years) Age of the child (months) Mean + SD 0–6 months 7–12 months 5.7 + 2.86 68 63.0 37.0 Mothers age (years) Mean + SD 16–25 26–35 36–45 28 + 6.07 40 37.0 55 50.9 13 12.0 Employment status Salaried job Self employed Unemployed 7 6.5 11.1 89 82.4 Average monthly income 100000 100000–200000 > 500000 91 84.3 7 6.5 10 9.3 House helper for house work? Yes No 31 28.7 71.3 Infant feeding practices Proportion of HIV positive mothers practicing the different infant feeding practices Out of the 108 HIV positive mothers studied, 77% of the mothers practiced recommended feeding practice for the first 6 months (Exclusive breast feeding) while 23% of the mothers practiced mixed infant feeding practices. Knowledge of HIV positive mothers on EMTCT among children 0–12 months in Awach H/C IV. The results in Table 2 below summarizes the knowledge of mothers on EMTCT. On transmission of HIV, mothers had high knowledge 104 (96.3%) of the mothers believe HIV positive mothers can transmit HIV virus to the babies. Out of the total respondents, mothers had medium knowledge 61 (56.5%), and low knowledge 40 (37%), knew that MTCT of HIV virus can occur breast feeding and during delivery respectively. 97.2% and 96.3% of the mothers believe MTCT of HIV can be prevented and EMTCT is important for both the child and the mother. Majority (44.4%) of the mothers had attended EID clinic at least three times. Table 2 Knowledge of HIV positive mothers on EMTCT in Awach H/C IV. Characteristics Frequency (N = 108) Percentage (%) Can HIV positive mothers transmit HIV to babies Yes No I don’t know 104 96.3 3 2.8 1 0.9 When can HIV be transmitted from mother to child During pregnancy During delivery During breast feeding I don’t know 6 5.6 40 37.0 61 56.5 1 0.9 Is MTCT of HIV preventable Yes No 97.2 3 2.8 Is EMTCT important for child/mother Yes I don’t know 104 96.3 4 3.7 How many times have you attended EID clinic? 1–3 times 4–6 times More than 6 times 48 44.4 34 31.5 24.1 Factors associated with infant feeding methods Table 3 Multivariable analysis of factors associated with the choice of infant feeding practices among HIV positive mothers Characteristics AOR (95% CI) P-Value Age of the child 0–6 months 7–12 months 1.0 0.706 (0.210–0.988) 0.043* Average monthly income 100000 > 500000 1.0 1.296 (1.150-10.631) 0.013* Is MTCT of HIV preventable Yes No 1.0 16 (3.618–34.18) 0.040 Number of EID clinic attendance? 1–3 times 4–6 times More than 6 times 1.0 0.303 (0.090-1.000) 0.05* 0.118 (0.019–0.704) 0.019* Where did you deliver from? Home Facility 1.0 1.976 (1.295–13.233) 0.038* BARRIERS TO EMTCT Long distance to the facility The distance to the facility poses a big challenge to EMTCT. The long distance makes majority of the mothers fail to follow their scheduled dates hence leading to por adherence “Long distance, delays or leads to failure to turn up sometimes hence makes mothers not to comply to their treatment” KI-001 Inadequate human resource The number of health workers in the facility affects effective program of EMTCT. Due to the few numbers, less time is given to the mothers. The low number coupled with higher number of patients also leads to long waiting some of them go away before being attended to especially counselling and attending to their issues. “Human resource is a major problem, because when we take this unit, we are only three and at times you need to go out and follow up so it is not easy” KI-002 Common infant feeding practices among the mothers The most common infant feeding practice as indicated by both the KI and FGD was exclusive breastfeeding for six months. This the recommended infant feeding practice among HIV positive mothers. “exclusive breastfeeding for six months if the mother has no problem with the breast, this is what most mothers do for the first six months since they cannot afford exclusive formula feed” K-005 Roles of health workers on the choice of infant feeding practice among HIV positive mother According to the key informants, health workers have a big role to play in influencing mothers in the choice of the infant feeding practice. “yes, we encourage exclusive breastfeeding because it is safe in preventing infections to the mothers and is cheap for the mothers to practice” (KI-003) “Yes, we provide the mothers with information about the different infant feeding practices including the benefits and disadvantages of each method, we even counsel them which one to use” KI-004 Factors that influence the choice of infant feeding practices According to the findings from the interview and the FGD’s. there were many factors elaborated to have influence on the mother’s choice of the feeding practice. These factors included poverty of lack of resources for exclusive formula feeding, social influence on the mothers, lack of adequate information. “poverty, I would prefer my child to feed on formula milk so that I can reduce the risk of transmission but I don’t have the money to buy. (KI-005) “I also think some mothers do not have enough information about the different feeding options ” (KI-005 ) “economic status, mothers would want to choose a safer method for example formula feeding but it is expensive” (KI-002) Discussion In this study we assessed the infant feeding practices and associated factors among HIV positive mothers. we found out that 83/108(77%) practice exclusive breastfeeding, 25/108 (23%) practice mixed feeding. On transmission of HIV, 104/108 (96.6%) believe HIV can be transmitted from the mother to the babies. out of the total respondents 61/108(56.4%) and 40/108(37%) believe HIV can be transmitted during breastfeeding and delivery respectively. Factors associated with the infant feeding practice included, age of infant, EID visits, place of delivery, income level. Qualitative analysis showed that the most practiced infant feeding was EBF, barriers to EMTCT included long distance and inadequate staff, factors influencing the choice of infant feeding practice included, poverty, social influence on the mother, influence of the health workers. The findings of this study revealed that majority 83/108(77%), practiced EBF. This could be attributed to the good PMTCT counselling services, the improvement of Antenatal Care (ANC), and bringing such services closer to the communities. This finding was in line with various studies done from Ethiopia and Kenya that also showed that majority of the mothers practiced EBF. However, the findings of this study were lower than those found in a study done in Ethiopia that showed 89% practicing EBF (Olorunfemi & Dudley, 2018 ). Also, lower than a study done in Debre Markos Referral hospital that showed that 85.8% practiced EBF (Wakwoya, Zewudie, & Gebresilasie, 2016 ). This could be attributed to the fact that these studies were done in an Urban setting, and probably these respondents were more informed about the benefits of breast milk in an HIV context. Also, these urban people could be exposed to literature through TVs and radios about the benefits of breastmilk. Their educational status was also higher than the one in our study. On the contrary, the findings of this study were higher than other studies for example a study done in Kenya showed that 71.4% (Andare et al., 2019 ), slightly lower than ours. This can be explained that in the study a certain percentage could have practiced formula feeding. Our study further noted that 25/108(23%), close to a quarter of the mothers practiced mixed infant feeding. This finding was higher than a study than in Kenya that showed that 18.2% practiced mixed feeding (Andare et al., 2019 ). The rate of mixed feeding in this study was also higher than in the study done in Ethiopia (14.2) (Wakwoya et al., 2016 ). A likely explanation of this finding is because mothers perceived that the milk was insufficient for the baby especially as the demand for milk increases as the baby grows. 0% practiced formula feeding. There was no formula feeding most likely because it was not readily accessible, feasible and affordable in a rural area like Awach. On transmission of HIV, majority, 104 (96.3%) of the mothers believed HIV positive mothers can transmit HIV to the babies. This can be attributed to the increased attendance of ANC, and creating an EID clinic so that the mothers can continuously be sensitized. This in agreement with a study done in Lesotho where 96% believed HIV can be transmitted to their babies (Olorunfemi & Dudley, 2018 ) however another study done in Malawi showed very low comprehensive knowledge about PMTCT (52%) (Kafulafula, Hutchinson, Gennaro, & Guttmacher, 2014 ) this could be because of low PMTCT services in the country. Out of the total respondents, 61/108 (56.5%), and 40/108 (37%), knew that MTCT of HIV virus can occur during breast feeding and delivery respectively. These findings were lower than findings in a research held in Ethiopia that showed that 84% and 87.8% knew that HIV can be transmitted during delivery and breastfeeding respectively (Gebre, Feyasa, & Dadi, 2021 ). This could be attributed to the fact that this study was done in an urban setting so mothers in the urban are most likely to be informed. 97.2% and 96.3% of the mothers believe MTCT of HIV can be prevented and EMTCT is important for both the child and the mother. This is explained by bringing ANC closer to the population that is to say Health Center IIs and village levels, and probably the health workers being closer to the mothers and teaching them about PMTCT in a friendly way. Majority (44.4%) of the mothers had attended EID clinic at least three times. This knowledge coupled with boosted EID clinic attendance can help to eliminate HIV transmission to the infants because mothers are more likely to be cautious about preventive measures taught by health workers. Exclusively breastfed infants reduced with the Age of the child (OR = 0.706, 95%). This could be explained by the fact that in the early months of life, mothers give more attention to their children and stay with them longer hence most likely to exclusively breastfeed. Compared to later months of life where mothers perceive that the child has grown and the breast milk may not be enough hence propelling the mother to start mixed feeding. This is in line with a study done in Lira Uganda that showed HIV exposed infants that were exclusively breasted reduced with increasing age (Napyo et al., 2020 ). We also found out that Older mothers were 1.545 times more likely to practice EBF compared to young mothers. This can be explained by the fact the older mothers are more likely to have other children and so could have been counselled and sensitized about the benefits of breastfeeding compared to their counterparts. This lines with a study done in Lesotho that revealed that mothers who had earlier feeding counselling were more likely to practice EBF compared to late counselling (Olorunfemi & Dudley, 2018 ). The study further revealed that Educated mothers are 4.3 times more likely to practice recommended infant feeding practices compared to uneducated. This could be explained by the fact that educated mothers are more likely to comprehend the benefits of EBF, and also have high chances of getting exposed to good information about recommended infant feeding practices through TVs and radios. This was in line with a study done in Kenya where education had an 0R = 0.27 on determinants of complimentary feeding (Andare, Ochola, & Chege, 2019 ) Our study found out that Mothers who delivered from a health facility were 1.97 times more likely to follow recommended infant feeding practices compared to those who delivered from home. This may be due to the counselling these mothers get from the midwives during delivery and encouragement from their fellow mothers. This is comparable to a study done in rural South Nyanza Kenya which revealed that hospital delivery was associated with high rates of EBF (Onono, Cohen, Jerop, Bukusi, & Turan, 2014 ). According to the findings from the interviews and FGDs, there were many factors elaborated to have influence on the mother’s choice of the feeding practice. These factors included, Poverty with lack of resources for exclusive formula feeding, social influence on the mothers, lack of adequate information about the different feeding options among others. Our study noted that mothers who were knowledgeable about prevention of mother to child transmission were 16 times more likely to practice recommended infant feeding compared to mothers who did not have the knowledge. Mothers knowledgeable about PMTCT had the backup reasons as to breastfeed exclusively compared to their counterparts. This finding can be related to a study done in Ethiopia which showed that mothers with sufficient knowledge about PMTCT were more likely to practice EBF (Mebratu, Mengesha, Tegene, Alano, & Toma, 2020 ), however on the contrary another study showed knowledge on PMTCT were not associated with EBF (Onono et al., 2014 ) The strengths of this study included using random sampling method that enabled generalization of results since the study population was highly representative. The study used both qualitative and quantitative data, we pretested the questionnaire hence doing corrections where necessary, it had a very high response rate, in data analysis logistical regression was done however it had the following limitations, the sample size was small; Data was collected from Only one HCIV and so the results may not represent entire Gulu or Uganda. The study was hospital based and the results are only limited to those who came to Awach not entire sub county and possibility of social desirability bias. It was an undergraduate project with minimal funding thereby affecting sample size and the scope of the study. only two FGD’s were done limiting on the data gathered. Conclusions And Recomendations Majority of HIV positive mothers in Awach practice the recommended infant feeding practices. However, there is still a knowledge gap on whether HIV is transmitted through pregnancy, delivery or breast feeding, the factors associated with the choice of infant feeding practice in Awach included education level, place of delivery and knowledge on PMTCT. We therefore recommend the Ministry of Health to increase funding on PMTCT services We also recommend the health facility to Hold sensitizations of the mothers by mid wives at least weekly. We highly recommend the Mothers to deliver from hospitals, since mothers who delivered from health facilities were more likely to practice the recommended breastfeeding practices than their counter parts. The Mothers should follow the recommended guidelines and should attend ANC. More research about this topic involving a large sample size and different hospitals should be done to bring out a clear picture. Declarations Declarations We declare that this report entitled “infant feeding practices and associated factors among HIV positive mothers attending EID clinic from Awach Health Centre IV, Gulu Uganda” was our work composed solely by us, undersigned and to the best of our knowledge has never been submitted to any institution of higher learning for any award and where it was stated we referenced and cited it. Abel Wilson Walekhwa is an associate Editor for Epidemiology and Infection journal, University of Cambridge Press. Therefore, the work presented is entirely our own. Availability of data and materials All the project materials and data about this project are available. These can be accessed by contacting the first author (Ivan Mutawulira) on [email protected] . Competing Interests All authors declare no financial and non-financial competing. All authors confirm that we have had full access to all the data in the study and accept responsibility to submit for publication. Funding The funding for this research was from individual authors Authors’ Contributions IM, LM, JN, AWW Conceptualized the study, designed study protocol, processed ethical approvals, conducted data collection, developed the first draft of the manuscript. AWW reviewed the first manuscript draft. VK gave technical supervision for the field teams. All authors reviewed and approved the final version of the manuscript. Acknowledgement We would like to thank all the Respondents for providing the necessary information that made this study a success. We appreciate our families who were supportive during this study. Our sincere appreciation goes to the districts’ leadership and Awach Health Centre administration who permitted us to do the study. We thank Gulu university administration for their guidance through the entire study. Abbreviations AIDS: Acquired Immunodeficiency Syndrome. ANC: antenatal care EBF: Exclusive Breastfeeding EFM: Exclusive Formula Feeding EID: Early Infant Diagnosis EMTCT: Elimination of Mother to Child Transmission FGD: focused group discussion HEI’s: HIV exposed infants HIV: Human Immune Deficiency Virus MOH : Ministry of Health. PCR: polymerase chain reaction UNAIDS: Joint United Nations Program on HIV and AIDS UNFPA: United Nations Population Fund UNICEF: United Nations Children’s Fund UPHIA : Uganda Population-based HIV Impact Assessment WHO: World Health Organization References Alemu, Y. M., Habtewold, T. D., & Alemu, S. M. (2018). 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PloS one, 16 (8), e0256419-e0256419. doi: 10.1371/journal.pone.0256419 Hannan, J., Etowa, J. B., Babatunde, S., Stephens, C. N., Barfield, L., Galarza, M. G.,.. . Phillips, J. C. (2021). Determinants of Adherence to National Infant Feeding Guidelines by Black Mothers Living with HIV. Ethnicity & disease, 31 (1), 31–40. doi: 10.18865/ed.31.1.31 Kafulafula, U. K., Hutchinson, M. K., Gennaro, S., & Guttmacher, S. (2014). Maternal and health care workers' perceptions of the effects of exclusive breastfeeding by HIV positive mothers on maternal and infant health in Blantyre, Malawi. BMC pregnancy and childbirth, 14 , 247–247. doi: 10.1186/1471-2393-14-247 Luba, T. R., Feng, Z., Gebremedhin, S. A., Erena, A. N., Nasser, A. M., Bishwajit, G., & Tang, S. (2017). Knowledge about mother-to-child transmission of HIV, its prevention and associated factors among Ethiopian women. Journal of global health, 7 (2), 020414020414. doi: 10.7189/jogh.07.020414 Mebratu, L., Mengesha, S., Tegene, Y., Alano, A., & Toma, A. (2020). Exclusive BreastFeeding Practice and Associated Factors among HIV-Positive Mothers in Governmental Health Facilities, Southern Ethiopia. Journal of nutrition and metabolism, 2020 , 7962054–7962054. doi: 10.1155/2020/7962054 Mihret, M. S., Asaye, M. M., Mengistu, B. A., & Belete, H. (2020). Mixed Infant Feeding Practice and Associated Factors among HIV-Positive Women under Care in Gondar City's Public Health Facilities within Two Years PostpEIDum: A Cross-Sectional 52 Study. International journal of pediatrics, 2020 , 4597962–4597962. doi: 10.1155/2020/4597962 Napyo, A., Tumwine, J. K., Mukunya, D., Waako, P., Tylleskär, T., & Ndeezi, G. (2020). Exclusive breastfeeding among HIV exposed infants from birth to 14 weeks of life in Lira, Northern Uganda: a prospective cohort study. Global health action, 13 (1), 1833510–1833510. doi: 10.1080/16549716.2020.1833510 Olorunfemi, S. O., & Dudley, L. (2018). Knowledge, attitude and practice of infant feeding in the first 6 months among HIV-positive mothers at the Queen Mamohato Memorial hospital clinics, Maseru, Lesotho. African journal of primary health care & family medicine, 10 (1), e1-e12. doi: 10.4102/phcfm.v10i1.1438 Onono, M. A., Cohen, C. R., Jerop, M., Bukusi, E. A., & Turan, J. M. (2014). HIV serostatus and disclosure: implications for infant feeding practice in rural south Nyanza, Kenya. BMC public health, 14 , 390–390. doi: 10.1186/1471-2458-14-390 Wakwoya, E. B., Zewudie, T. A., & Gebresilasie, K. Z. (2016). Infant feeding practice and associated factors among HIV positive mothers in Debre Markos Referral Hospital East Gojam zone, North West Ethiopia. The Pan African medical journal, 24 , 300–300. doi: 10.11604/pamj.2016.24.300.8528 Chantry, C. J., Wiedeman, J., Buehring, G., Peerson, J. M., Hayfron, K., K'Aluoch, O.,.. . Abrams, B. J. B. M. (2011). Effect of flash-heat treatment on antimicrobial activity of breastmilk. 6 (3), 111–116. HIV/AIDS., J. U. N. P. o., & Organization, W. H. (2008). 2008 report on the global AIDS epidemic : World Health Organization. 53 Ip, S., Chung, M., Raman, G., Trikalinos, T. A., & Lau, J. J. B. m. (2009). A summary of the Agency for Healthcare Research and Quality's evidence report on breastfeeding in developed countries. 4 (S1), S-17-S-30. Kramer, M. S., & Kakuma, R. (2012). Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev, 2012 (8), Cd003517. doi: 10.1002/14651858.CD003517.pub2 Miller, M., Iliff, P., Stoltzfus, R. J., & Humphrey, J. J. T. L. (2002). Breastmilk erythropoietin and mother-to-child HIV transmission through breastmilk. 360 (9341), 1246–1248. Napyo, A., Tumwine, J. K., Mukunya, D., Waako, P., Tylleskär, T., & Ndeezi, G. (2020). Exclusive breastfeeding among HIV exposed infants from birth to 14 weeks of life in Lira, Northern Uganda: a prospective cohort study. Glob Health Action, 13 (1), 1833510. doi: 10.1080/16549716.2020.1833510 Organization, W. H. (2016). Guideline: updates on HIV and infant feeding: the duration of breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Victora, C. G., Bahl, R., Barros, A. J., França, G. V., Horton, S., Krasevec, J.,.. . Rollins, N. C. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet, 387 (10017), 475–490. doi: 10.1016/s0140-6736(15)01024-7 Yalçin, S. S., Berde, A. S., Yalçin, S. J. P., & epidemiology, p. (2016). Determinants of exclusive breast feeding in sub Saharan Africa: a multilevel approach. 30 (5), 439–449. Andare, N., Ochola, S., & Chege, P. (2019). Determinants of infant feeding practices among mothers living with HIV attending prevention of mother to child transmission Clinic at 54 Kiambu Level 4 hospital, Kenya: a cross-sectional study. Nutrition journal, 18 (1), 64–64. doi: 10.1186/s12937-019-0490-y Gebre, M. N., Feyasa, M. B., & Dadi, T. K. (2021). Levels of mother-to-child HIV transmission knowledge and associated factors among reproductive-age women in Ethiopia: Analysis of 2016 Ethiopian Demographic and Health Survey Data. PloS one, 16 (8), e0256419-e0256419. doi: 10.1371/journal.pone.0256419 Hannan, J., Etowa, J. B., Babatunde, S., Stephens, C. N., Barfield, L., Galarza, M. G.,.. . Phillips, J. C. (2021). Determinants of Adherence to National Infant Feeding Guidelines by Black Mothers Living with HIV. Ethnicity & disease, 31 (1), 31–40. doi: 10.18865/ed.31.1.31 Kafulafula, U. K., Hutchinson, M. K., Gennaro, S., & Guttmacher, S. (2014). Maternal and health care workers' perceptions of the effects of exclusive breastfeeding by HIV positive mothers on maternal and infant health in Blantyre, Malawi. BMC pregnancy and childbirth, 14 , 247–247. doi: 10.1186/1471-2393-14-247 Mebratu, L., Mengesha, S., Tegene, Y., Alano, A., & Toma, A. (2020). Exclusive Breast-Feeding Practice and Associated Factors among HIV-Positive Mothers in Governmental Health Facilities, Southern Ethiopia. Journal of nutrition and metabolism, 2020 , 7962054–7962054. doi: 10.1155/2020/7962054 Napyo, A., Tumwine, J. K., Mukunya, D., Waako, P., Tylleskär, T., & Ndeezi, G. (2020). Exclusive breastfeeding among HIV exposed infants from birth to 14 weeks of life in Lira, Northern Uganda: a prospective cohort study. Global health action, 13 (1), 1833510–1833510. doi: 10.1080/16549716.2020.1833510 Olorunfemi, S. O., & Dudley, L. (2018). Knowledge, attitude and practice of infant feeding in the first 6 months among HIV-positive mothers at the Queen Mamohato Memorial 55 hospital clinics, Maseru, Lesotho. African journal of primary health care & family medicine, 10 (1), e1-e12. doi: 10.4102/phcfm.v10i1.1438 Onono, M. A., Cohen, C. R., Jerop, M., Bukusi, E. A., & Turan, J. M. (2014). HIV serostatus and disclosure: implications for infant feeding practice in rural south Nyanza, Kenya. BMC public health, 14 , 390–390. doi: 10.1186/1471-2458-14-390 Wakwoya, E. B., Zewudie, T. A., & Gebresilasie, K. Z. (2016). Infant feeding practice and associated factors among HIV positive mothers in Debre Markos Referral Hospital East Gojam zone, North West Ethiopia. The Pan African medical journal, 24 , 300–300. doi: 10.11604/pamj.2016.24.300.8528 Walekhwa, A. W., Nakazibwe, B., Nantongo, M., Wafula, S. T., Bulafu, D., Ayugi, B.,.. . Tindyebwa, T. (2022). Drivers of the Second Wave and clinical characteristics of COVID-19 cases in Uganda: A Retrospective Study of Confirmed SARS-CoV-2 cases, March-June, 2021. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1357502","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":83634690,"identity":"14f2138e-fcb6-4598-aeae-0ee5ae68f3cf","order_by":0,"name":"Ivan mutawulira","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYBACNjiLnbGBgaECyGBmbiBCSwJIJUjLGRiDIABrAWLGNhCPgBY+ieSjm3l/2CVuOMzc9uHnvNpo/naglh8V23A7TCIt7TZPQjJQC2PzzN5tx3NnHGZsYOw5cxu3Fp4zZkAtzLkgLQy8247lNgC1MDO2EdRSD9bC+HfOsdz5BLWw94C0HAZrYeZtqAExCGlpS7s5J+14/UyQFpljB3I3ArUcxOcX+WbmYzfe2FQb8x1vf8z4pqYud975wwcf/KjArQUdHAaTB4hWDwR1pCgeBaNgFIyCEQIA/UxafAZI2O0AAAAASUVORK5CYII=","orcid":"","institution":"Gulu University, Uganda","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ivan","middleName":"","lastName":"mutawulira","suffix":""},{"id":83636470,"identity":"e9169a55-f77c-49c4-9180-bdf2e7e4b5ac","order_by":1,"name":"Jane Nakachwa","email":"","orcid":"","institution":"Gulu University, Uganda","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jane","middleName":"","lastName":"Nakachwa","suffix":""},{"id":83636471,"identity":"185ace6b-c502-47da-8d8b-e52d7592493c","order_by":2,"name":"Laymond Muharabu","email":"","orcid":"","institution":"Gulu University, Uganda","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Laymond","middleName":"","lastName":"Muharabu","suffix":""},{"id":83636472,"identity":"39272f78-499c-447b-a872-fd90b8c562df","order_by":3,"name":"Abel Wilson Walekhwa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYFACHgaGBwwSMkAW4wMQl48oLQkMEkCSgdkAxGUjUguIZGCTAPEJajE4fvbgg8Q2Cx759t5jlV9z7GTYGJgfPrqBT8uZvGSDxDYJHoMz59Juy25LBjqMzdg4B48WswM5ZhKJ24BaJHLMbktuYwZq4WGTxqvl/BvzHyAt8jNyzIolt9UToeVGjhkDSAsDkMH4cdthwlrsb7xLlkj8B/LLGWNpxm3HediYCfhFsj/34IcPZ+rk5Nt7DD/+3FZtz8/e/PAxPi0ogJkHTBKrHAQYf5CiehSMglEwCkYMAAANkkMcXk766gAAAABJRU5ErkJggg==","orcid":"","institution":"Makerere University, School of Public Health","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Abel","middleName":"Wilson","lastName":"Walekhwa","suffix":""},{"id":83638254,"identity":"72077050-5fc6-4a03-a3c9-ea67bf071992","order_by":4,"name":"Vincent Kayina","email":"","orcid":"","institution":"Gulu University, Uganda","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Vincent","middleName":"","lastName":"Kayina","suffix":""}],"badges":[],"createdAt":"2022-02-14 09:06:28","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":true,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":true,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-1357502/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1357502/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":18208519,"identity":"4d4033a3-d88b-4713-9386-91735120c730","added_by":"auto","created_at":"2022-02-14 19:40:55","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":47805,"visible":true,"origin":"","legend":"\u003cp\u003eMap of Uganda showing location of Gulu District\u003c/p\u003e","description":"","filename":"groupimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-1357502/v1/7946b3d493e7aacba9e4bffe.jpeg"},{"id":18208518,"identity":"6a081efd-dd15-46b2-b46a-2a0bb016a7fa","added_by":"auto","created_at":"2022-02-14 19:40:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":6306,"visible":true,"origin":"","legend":"\u003cp\u003eThe infant feeding practices among the mothers\u003c/p\u003e","description":"","filename":"Onlinedrawingimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-1357502/v1/e16f5b5eff97e0fb3a1dcabc.png"},{"id":18208521,"identity":"6fee23bb-4689-469f-8b10-4aced81c1f97","added_by":"auto","created_at":"2022-02-14 19:40:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":589544,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1357502/v1/490bbd22-0c2e-47ae-bd2e-7e02c0d2cb10.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eExploring Infant Feeding Practices and associated factors among HIV Positive Mothers Attending Early Infant Diagnosis Clinic in Northern Uganda.\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eExclusive breastfeeding is defined as feeding infants only breast milk, be it directly from breast or expressed, except drops or syrups consisting of vitamins, mineral supplements or medicine. The WHO guidelines recommend that in settings where breastfeeding is judged to be the safest infant feeding option, mothers with HIV should exclusively breastfeed their infants for the first six months and continue to breast feed for at least 12 months while introducing complementary foods (WHO, 2016). Even with these recommendations, mothers do not practice it because of a range of reasons. There by creating a cave of early infant diagnosis of morbidities to infants as it is influenced by the feeding choice that the mothers make (Chantry et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2011\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAlthough there is a risk of HIV infection through breastfeeding, the risk of mortality and morbidity is higher if infants are taking replacement feeding. In many resource limited settings, HIV exposed infants who were not breastfed were up to six times more likely to die from diarrheal diseases, malnutrition and pneumonia (WHO, 2016) The benefits of breastfeeding are incomparable and comprise the prevention of infant infectious diseases and reduction of leukaemia, sudden infant death syndrome, type 1 and 2 diabetes and obesity (Ip, Chung, Raman, Trikalinos, \u0026amp; Lau, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). EBF for the first 6 months of the infants carries a 4-10-fold decreased risk of MTCT of HIV compared to mixed breastfeeding. This may be due to unhygienic practices, increasing the risk of diarrhoea, other foods and liquids which alter the gastro intestinal tract integrity and may therefore lead to MTCT of HIV in mixed fed infants (Miller, Iliff, Stoltzfus, \u0026amp; Humphrey, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2002\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBreast feeding is an important component of the wellbeing and survival of children, particularly in poor resource setting. Breast milk provides optimal nutrition, contains anti bodies that protect infants and is unlikely to become contaminated (Kramer \u0026amp; Kakuma, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). The overall prevalence of EBF in sub-Saharan Africa is low which was at 36%, prevalence was highest in Rwanda and lowest in Gabon, despite the fact that Sub-Saharan Africa is the home of higher rates of MTCT, malnutrition, infant and mortality rate (Yal\u0026ccedil;in, Berde, Yal\u0026ccedil;in, \u0026amp; epidemiology, 2016).\u003c/p\u003e \u003cp\u003eThe current evidence suggests that high income countries practice shorter duration of breastfeeding compared with low- and middle-income countries. However, within low- and middle-income countries, approximately only 37% of infants younger than six months are exclusively breastfed. Just scaling up and promoting breastfeeding to the universal level could prevent 823,000 annual death in children under 5 years and 13810 of these under 2 years (Victora et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). In Uganda a study done showed that Proportion of HIV exposed infants that were exclusively breastfed reduced with increasing age of the infant, the incidence of non-exclusively breastfeeding at 6 weeks and 14 weeks post-partum were 22.5% and 42.9%. By the time infants were 14 weeks of age almost half of them were not exclusively breastfeeding (Napyo et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Several studies have showed low rates of exclusive breastfeeding in outside countries however very few of such studies have been done in Uganda particularly Northern region. Therefore, the aim of this study was to assess the infant feeding practices among HIV positive and factors that influence the choice of the feeding practices.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy area\u003c/h2\u003e \u003cp\u003eThe study was conducted from Awach Health Centre IV in the HIV early infant Diagnosis (EID) clinic. EID is a specialised clinic where HIV exposed infants and their mothers seek care. Awach Health Centre IV is found in Awach subcounty, which is found in Aswa County in Gulu district, Northern Uganda. It is about 35.1km from Gulu city via Gulu-Patiko road, and Gulu city is 335km from Kampala the capital city of Uganda, it is located on latitude 3001011and longitude 3202315911 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e,this map was adapted from (Walekhwa et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This is the major health centre in Aswa health sub district, it is located north of Paroma close to Awach public nursery and primary school. Awach subcounty has 4 parishes and 32 villages. Has a population of 22,576. The area is blessed with topical savanna climate, with rainy and sunny seasons. Major economic activities are trade through business and subsistence farming. The quickest transport in the area is by use of commercial motorcycle. Major language spoken in Gulu is Acholi.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThe study population consisted of all mothers who are HIV positive and having a child 0\u0026ndash;12 months from 18\u0026ndash;49 years, attending EID from Awach Health Centre IV and were present during the time of data collection. Every Thursdays about 25\u0026ndash;30 HIV positive breastfeeding mothers came to the facility to get their medications\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample size\u003c/h2\u003e \u003cp\u003eThe Kish and Leslie formula of sample size determination was used to generate the minimum number of HIV positive mothers required for the study (kish,1965), giving us a sample size of 108 participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSampling procedure\u003c/h2\u003e \u003cp\u003eWe used simple random sampling during each day of data collection, small pieces of paper were written yes and no, then they were put in a container and eligible participants were asked to pick. Those who picked yes consented and were interviewed. For example, if on a given day, we had 30 participants, we interviewed 80% of the participants, therefore we made 24 pieces had yes and 6 pieces had no, then the pieces were distributed to all the participants those who chose yes were interviewed. We held two Focussed group discussion (FGD\u0026rsquo;s) where participants were selected using simple random sampling. They were given small pieces of papers labelled either 1, 2 or 3, those who picked 1 were in group 1 and those who picked 2 were in group 2 and those in group 3 were not interviewed. We picked 5 Key informants purposively because they had knowledge about breast feeding practices in the HIV context, these were, 2 PMTCT nurses, 2 midwives and I councillor\u003c/p\u003e \u003cp\u003e \u003cb\u003eData collection tools.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eQuantitative data was collected by trained and experienced research assistants using a brief interviewer administered questionnaire. Qualitative data was collected using FGD guide and key informant guide. The collection tools were pretested from Atanga health centre III which is a neighbour to the study site.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData collection procedure\u003c/h2\u003e \u003cp\u003eThe data was collected for over a period of 6 weeks. Interviews started from 9am to 4pm East African Time (EAT). In Awach Health Centre IV, Thursdays was the day of EID Cclinic. It usually received 25\u0026ndash;30 patients on every Thursday. The researchers moved on a boda boda from Gulu city to the facility, which took about 50 minutes. On reaching the facility, with the help of the nurses, the eligible participants were chosen then an Interviewer semi structured questionnaire was used on respondents who were randomly selected and consented. The questions were cantered on infant feeding practices and associated factors. The data was collected by the researchers themselves.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData management and analysis\u003c/h2\u003e \u003cp\u003eThe data was analysed using statistical package for the social sciences (SPSS) for windows version 22. Descriptive statistics including measures of central tendency (that is mean and median) and dispersion as standard deviation (SD) and range, as well as frequencies and percentages were used to describe the study population. The infant feeding practices of the mothers was described using pie charts and bar graphs. Bivariate analysis (odds ratio) was conducted to establish associations between various variables and infant feeding practices. Variables which showed significant association were further subjected to multivariate analysis (logistic regression) to establish the determinants of infant feeding practices. A P value of \u0026lt;\u0026thinsp;0.005 was used as the basis for statistical significance. Qualitative interviews were conducted in English using KI and FGD guides. Each interview was transcribed real time by the research assistant. A total of 57 codes for KIs and 11 for FGD were originally generated. The codes generated were analysed for consistence and either divergence or convergence. Those that converged formed a particular theme and this was deduced by the data analysis team. Those that diverged also formed a particular theme and this was also noted. The codes were developed from the objective of the study and transcribed data, and then entered into ATLAS version 8 software for analysis. Using deductive thematic analysis, the categorised data was used to develop main themes which made the final results of our study. A total of 4 main themes emerged from this data analysis, the included (1) barriers to EMTCT, (2) common infant feeding practices among the mothers, (3) roles of health workers on the choice of infant feeding practice among HIV positive mothers, (4) factors that influence the choice of the infant feeding practice. These themes were documented as key outcomes of our study and consequent quotes attached quotes attached to back up our findings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003efor the study was obtained from Gulu University Research Ethics Committee on the 14th of October, 2021 IRB No. GUREC-2021-76 (supplementary 1). Permission was sought from the administration of Awach Health Centre IV and obtained on the 15th of October 2021. Participants were fully informed about the study and written consent was sought for before anyone was interviewed. Any participant was free to accept or decline in participating in the study. Confidentiality was guaranteed by ensuring that the participant\u0026rsquo;s names are not known but questionnaires were just numbered. The participants had a right to withdraw from the interview at any given time of the interview. The participants were allowed to ask questions before, during and after the study, any time of their convenience. The participants were informed that after the study they will not receive any incentive.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe researcher administered the questionnaire in a privately secluded room to ensure privacy and confidentiality of these respondents\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eResponse, a total of 108 HIV positive mothers were surveyed with 100% response rate\u003c/p\u003e \u003cp\u003e \u003cb\u003eSocio-demographic and socio-economic characteristics of participants.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA total of 108 mothers participated in the study, making the response rate of 100%. The age range of the study population was from 16 to 43 years. The mean age of the mothers was 28\u0026thinsp;+\u0026thinsp;6.07 years while the mean age of the infants was 5.7\u0026thinsp;+\u0026thinsp;2.86 months. Majority 89 (82.4%) of the participants were unemployed, 91 (84.3%) had an income of one hundred thousand per month and majority (71%) had no house helpers (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of the participants (9\u0026ndash;13 years)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge of the child (months) Mean\u0026thinsp;+\u0026thinsp;SD\u003c/p\u003e \u003cp\u003e0\u0026ndash;6 months\u003c/p\u003e \u003cp\u003e7\u0026ndash;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c2\"\u003e \u003cp\u003e5.7\u0026thinsp;+\u0026thinsp;2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMothers age (years) Mean\u0026thinsp;+\u0026thinsp;SD\u003c/p\u003e \u003cp\u003e16\u0026ndash;25\u003c/p\u003e \u003cp\u003e26\u0026ndash;35\u003c/p\u003e \u003cp\u003e36\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c2\"\u003e \u003cp\u003e28\u0026thinsp;+\u0026thinsp;6.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003cp\u003eSalaried job\u003c/p\u003e \u003cp\u003eSelf employed\u003c/p\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAverage monthly income\u003c/p\u003e \u003cp\u003e100000\u003c/p\u003e \u003cp\u003e100000\u0026ndash;200000\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;500000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHouse helper for house work?\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e71.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eInfant feeding practices\u003c/h2\u003e \u003cp\u003e \u003cb\u003eProportion of HIV positive mothers practicing the different infant feeding practices\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOut of the 108 HIV positive mothers studied, 77% of the mothers practiced recommended feeding practice for the first 6 months (Exclusive breast feeding) while 23% of the mothers practiced mixed infant feeding practices.\u003c/p\u003e \u003cp\u003e \u003cb\u003eKnowledge of HIV positive mothers on EMTCT among children 0\u0026ndash;12 months in Awach H/C IV.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe results in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below summarizes the knowledge of mothers on EMTCT. On transmission of HIV, mothers had high knowledge 104 (96.3%) of the mothers believe HIV positive mothers can transmit HIV virus to the babies. Out of the total respondents, mothers had medium knowledge 61 (56.5%), and low knowledge 40 (37%), knew that MTCT of HIV virus can occur breast feeding and during delivery respectively. 97.2% and 96.3% of the mothers believe MTCT of HIV can be prevented and EMTCT is important for both the child and the mother. Majority (44.4%) of the mothers had attended EID clinic at least three times.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKnowledge of HIV positive mothers on EMTCT in Awach H/C IV.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (N\u0026thinsp;=\u0026thinsp;108)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eCan HIV positive mothers transmit HIV to babies\u003c/b\u003e\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eWhen can HIV be transmitted from mother to child\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDuring pregnancy\u003c/p\u003e \u003cp\u003eDuring delivery\u003c/p\u003e \u003cp\u003eDuring breast feeding\u003c/p\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eIs MTCT of HIV preventable\u003c/b\u003e\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eIs EMTCT important for child/mother\u003c/b\u003e\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eHow many times have you attended EID clinic?\u003c/b\u003e\u003c/p\u003e \u003cp\u003e1\u0026ndash;3 times\u003c/p\u003e \u003cp\u003e4\u0026ndash;6 times\u003c/p\u003e \u003cp\u003eMore than 6 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFactors associated with infant feeding methods\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eMultivariable analysis of factors associated with the choice of infant feeding practices among HIV positive mothers\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAge of the child\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0\u0026ndash;6 months\u003c/p\u003e \u003cp\u003e7\u0026ndash;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.706\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.210\u0026ndash;0.988)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.043*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAverage monthly income\u003c/b\u003e\u003c/p\u003e \u003cp\u003e100000\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;500000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(1.150-10.631)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.013*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eIs MTCT of HIV preventable\u003c/b\u003e\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(3.618\u0026ndash;34.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eNumber of EID clinic attendance?\u003c/b\u003e\u003c/p\u003e \u003cp\u003e1\u0026ndash;3 times\u003c/p\u003e \u003cp\u003e4\u0026ndash;6 times\u003c/p\u003e \u003cp\u003eMore than 6 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.090-1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.05*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.019\u0026ndash;0.704)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.019*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eWhere did you deliver from?\u003c/b\u003e\u003c/p\u003e \u003cp\u003eHome\u003c/p\u003e \u003cp\u003eFacility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(1.295\u0026ndash;13.233)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.038*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eBARRIERS TO EMTCT\u003c/b\u003e \u003c/p\u003e \u003cp\u003eLong distance to the facility\u003c/p\u003e \u003cp\u003eThe distance to the facility poses a big challenge to EMTCT. The long distance makes majority of the mothers fail to follow their scheduled dates hence leading to por adherence\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Long distance, delays or leads to failure to turn up sometimes hence makes mothers not to comply to their treatment\u0026rdquo;\u003c/em\u003e \u003cb\u003eKI-001\u003c/b\u003e\u003c/p\u003e \u003cp\u003eInadequate human resource\u003c/p\u003e \u003cp\u003eThe number of health workers in the facility affects effective program of EMTCT. Due to the few numbers, less time is given to the mothers. The low number coupled with higher number of patients also leads to long waiting some of them go away before being attended to especially counselling and attending to their issues.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Human resource is a major problem, because when we take this unit, we are only three and at times you need to go out and follow up so it is not easy\u0026rdquo;\u003c/em\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eKI-002\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCommon infant feeding practices among the mothers\u003c/h2\u003e \u003cp\u003eThe most common infant feeding practice as indicated by both the KI and FGD was exclusive breastfeeding for six months. This the recommended infant feeding practice among HIV positive mothers.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;exclusive breastfeeding for six months if the mother has no problem with the breast, this is what most mothers do for the first six months since they cannot afford exclusive formula feed\u0026rdquo;\u003c/em\u003e \u003cb\u003eK-005\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eRoles of health workers on the choice of infant feeding practice among HIV positive mother\u003c/h2\u003e \u003cp\u003eAccording to the key informants, health workers have a big role to play in influencing mothers in the choice of the infant feeding practice.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;yes, we encourage exclusive breastfeeding because it is safe in preventing infections to the mothers and is cheap for the mothers to practice\u0026rdquo;\u003c/em\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e(KI-003)\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Yes, we provide the mothers with information about the different infant feeding practices including the benefits and disadvantages of each method, we even counsel them which one to use\u0026rdquo;\u003c/em\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eKI-004\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eFactors that influence the choice of infant feeding practices\u003c/h2\u003e \u003cp\u003eAccording to the findings from the interview and the FGD\u0026rsquo;s. there were many factors elaborated to have influence on the mother\u0026rsquo;s choice of the feeding practice. These factors included poverty of lack of resources for exclusive formula feeding, social influence on the mothers, lack of adequate information.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;poverty, I would prefer my child to feed on formula milk so that I can reduce the risk of transmission but I don\u0026rsquo;t have the money to buy.\u003c/em\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e(KI-005)\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I also think some mothers do not have enough information about the different feeding options\u003c/em\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e\u0026rdquo; (KI-005\u003c/span\u003e \u003cb\u003e)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;economic status, mothers would want to choose a safer method for example formula feeding but it is expensive\u0026rdquo;\u003c/em\u003e \u003cb\u003e(KI-002)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study we assessed the infant feeding practices and associated factors among HIV positive mothers. we found out that 83/108(77%) practice exclusive breastfeeding, 25/108 (23%) practice mixed feeding. On transmission of HIV, 104/108 (96.6%) believe HIV can be transmitted from the mother to the babies. out of the total respondents 61/108(56.4%) and 40/108(37%) believe HIV can be transmitted during breastfeeding and delivery respectively. Factors associated with the infant feeding practice included, age of infant, EID visits, place of delivery, income level. Qualitative analysis showed that the most practiced infant feeding was EBF, barriers to EMTCT included long distance and inadequate staff, factors influencing the choice of infant feeding practice included, poverty, social influence on the mother, influence of the health workers.\u003c/p\u003e \u003cp\u003eThe findings of this study revealed that majority 83/108(77%), practiced EBF. This could be attributed to the good PMTCT counselling services, the improvement of Antenatal Care (ANC), and bringing such services closer to the communities. This finding was in line with various studies done from Ethiopia and Kenya that also showed that majority of the mothers practiced EBF. However, the findings of this study were lower than those found in a study done in Ethiopia that showed 89% practicing EBF (Olorunfemi \u0026amp; Dudley, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Also, lower than a study done in Debre Markos Referral hospital that showed that 85.8% practiced EBF (Wakwoya, Zewudie, \u0026amp; Gebresilasie, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). This could be attributed to the fact that these studies were done in an Urban setting, and probably these respondents were more informed about the benefits of breast milk in an HIV context. Also, these urban people could be exposed to literature through TVs and radios about the benefits of breastmilk. Their educational status was also higher than the one in our study. On the contrary, the findings of this study were higher than other studies for example a study done in Kenya showed that 71.4% (Andare et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), slightly lower than ours. This can be explained that in the study a certain percentage could have practiced formula feeding. Our study further noted that 25/108(23%), close to a quarter of the mothers practiced mixed infant feeding. This finding was higher than a study than in Kenya that showed that 18.2% practiced mixed feeding (Andare et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The rate of mixed feeding in this study was also higher than in the study done in Ethiopia (14.2) (Wakwoya et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). A likely explanation of this finding is because mothers perceived that the milk was insufficient for the baby especially as the demand for milk increases as the baby grows. 0% practiced formula feeding. There was no formula feeding most likely because it was not readily accessible, feasible and affordable in a rural area like Awach.\u003c/p\u003e \u003cp\u003eOn transmission of HIV, majority, 104 (96.3%) of the mothers believed HIV positive mothers can transmit HIV to the babies. This can be attributed to the increased attendance of ANC, and creating an EID clinic so that the mothers can continuously be sensitized. This in agreement with a study done in Lesotho where 96% believed HIV can be transmitted to their babies (Olorunfemi \u0026amp; Dudley, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) however another study done in Malawi showed very low comprehensive knowledge about PMTCT (52%) (Kafulafula, Hutchinson, Gennaro, \u0026amp; Guttmacher, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) this could be because of low PMTCT services in the country. Out of the total respondents, 61/108 (56.5%), and 40/108 (37%), knew that MTCT of HIV virus can occur during breast feeding and delivery respectively. These findings were lower than findings in a research held in Ethiopia that showed that 84% and 87.8% knew that HIV can be transmitted during delivery and breastfeeding respectively (Gebre, Feyasa, \u0026amp; Dadi, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This could be attributed to the fact that this study was done in an urban setting so mothers in the urban are most likely to be informed. 97.2% and 96.3% of the mothers believe MTCT of HIV can be prevented and EMTCT is important for both the child and the mother. This is explained by bringing ANC closer to the population that is to say Health Center IIs and village levels, and probably the health workers being closer to the mothers and teaching them about PMTCT in a friendly way. Majority (44.4%) of the mothers had attended EID clinic at least three times. This knowledge coupled with boosted EID clinic attendance can help to eliminate HIV transmission to the infants because mothers are more likely to be cautious about preventive measures taught by health workers.\u003c/p\u003e \u003cp\u003eExclusively breastfed infants reduced with the Age of the child (OR\u0026thinsp;=\u0026thinsp;0.706, 95%). This could be explained by the fact that in the early months of life, mothers give more attention to their children and stay with them longer hence most likely to exclusively breastfeed. Compared to later months of life where mothers perceive that the child has grown and the breast milk may not be enough hence propelling the mother to start mixed feeding. This is in line with a study done in Lira Uganda that showed HIV exposed infants that were exclusively breasted reduced with increasing age (Napyo et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). We also found out that Older mothers were 1.545 times more likely to practice EBF compared to young mothers. This can be explained by the fact the older mothers are more likely to have other children and so could have been counselled and sensitized about the benefits of breastfeeding compared to their counterparts. This lines with a study done in Lesotho that revealed that mothers who had earlier feeding counselling were more likely to practice EBF compared to late counselling (Olorunfemi \u0026amp; Dudley, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The study further revealed that Educated mothers are 4.3 times more likely to practice recommended infant feeding practices compared to uneducated. This could be explained by the fact that educated mothers are more likely to comprehend the benefits of EBF, and also have high chances of getting exposed to good information about recommended infant feeding practices through TVs and radios. This was in line with a study done in Kenya where education had an 0R\u0026thinsp;=\u0026thinsp;0.27 on determinants of complimentary feeding (Andare, Ochola, \u0026amp; Chege, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) Our study found out that Mothers who delivered from a health facility were 1.97 times more likely to follow recommended infant feeding practices compared to those who delivered from home. This may be due to the counselling these mothers get from the midwives during delivery and encouragement from their fellow mothers. This is comparable to a study done in rural South Nyanza Kenya which revealed that hospital delivery was associated with high rates of EBF (Onono, Cohen, Jerop, Bukusi, \u0026amp; Turan, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). According to the findings from the interviews and FGDs, there were many factors elaborated to have influence on the mother\u0026rsquo;s choice of the feeding practice. These factors included, Poverty with lack of resources for exclusive formula feeding, social influence on the mothers, lack of adequate information about the different feeding options among others. Our study noted that mothers who were knowledgeable about prevention of mother to child transmission were 16 times more likely to practice recommended infant feeding compared to mothers who did not have the knowledge. Mothers knowledgeable about PMTCT had the backup reasons as to breastfeed exclusively compared to their counterparts. This finding can be related to a study done in Ethiopia which showed that mothers with sufficient knowledge about PMTCT were more likely to practice EBF (Mebratu, Mengesha, Tegene, Alano, \u0026amp; Toma, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), however on the contrary another study showed knowledge on PMTCT were not associated with EBF (Onono et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe strengths of this study included using random sampling method that enabled generalization of results since the study population was highly representative. The study used both qualitative and quantitative data, we pretested the questionnaire hence doing corrections where necessary, it had a very high response rate, in data analysis logistical regression was done however it had the following limitations, the sample size was small; Data was collected from Only one HCIV and so the results may not represent entire Gulu or Uganda. The study was hospital based and the results are only limited to those who came to Awach not entire sub county and possibility of social desirability bias. It was an undergraduate project with minimal funding thereby affecting sample size and the scope of the study. only two FGD\u0026rsquo;s were done limiting on the data gathered.\u003c/p\u003e"},{"header":"Conclusions And Recomendations","content":"\u003cp\u003eMajority of HIV positive mothers in Awach practice the recommended infant feeding practices. However, there is still a knowledge gap on whether HIV is transmitted through pregnancy, delivery or breast feeding, the factors associated with the choice of infant feeding practice in Awach included education level, place of delivery and knowledge on PMTCT. We therefore recommend the Ministry of Health to increase funding on PMTCT services We also recommend the health facility to Hold sensitizations of the mothers by mid wives at least weekly. We highly recommend the Mothers to deliver from hospitals, since mothers who delivered from health facilities were more likely to practice the recommended breastfeeding practices than their counter parts. The Mothers should follow the recommended guidelines and should attend ANC. More research about this topic involving a large sample size and different hospitals should be done to bring out a clear picture.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe declare that this report entitled \u0026ldquo;infant feeding practices and associated factors among HIV positive mothers attending EID clinic from Awach Health Centre IV, Gulu Uganda\u0026rdquo; was our work composed solely by us, undersigned and to the best of our knowledge has never been submitted to any institution of higher learning for any award and where it was stated we referenced and cited it. Abel Wilson Walekhwa is an associate Editor for Epidemiology and Infection journal, University of Cambridge Press. \u0026nbsp;Therefore, the work presented is entirely our own.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the project materials and data about this project are available. These can be accessed by contacting the first author (Ivan Mutawulira) on\u0026nbsp;\u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no\u0026nbsp;financial and non-financial competing.\u0026nbsp;All authors confirm that we have had full access to all the data in the study and accept responsibility to submit for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe funding for this\u0026nbsp;research was from individual authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIM, LM, JN, AWW\u0026nbsp;Conceptualized the study, designed study protocol, processed ethical approvals, conducted data collection, developed the first draft of the manuscript.\u0026nbsp;AWW reviewed the first manuscript draft.\u0026nbsp;VK\u0026nbsp;gave technical supervision for the field teams. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the Respondents for providing the necessary information that made this study a success. We appreciate our families who were supportive during this study. \u0026nbsp;Our sincere appreciation goes to the districts\u0026rsquo; leadership and Awach Health Centre administration who permitted us to do the study. We thank Gulu university administration for their guidance through the entire study.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eAIDS:\u0026nbsp;\u003c/strong\u003eAcquired Immunodeficiency Syndrome.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eANC:\u0026nbsp;\u003c/strong\u003eantenatal care\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEBF:\u0026nbsp;\u003c/strong\u003eExclusive Breastfeeding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEFM:\u0026nbsp;\u003c/strong\u003eExclusive Formula Feeding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEID:\u0026nbsp;\u003c/strong\u003eEarly Infant Diagnosis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEMTCT:\u0026nbsp;\u003c/strong\u003eElimination of Mother to Child Transmission\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFGD:\u0026nbsp;\u003c/strong\u003efocused group discussion\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHEI\u0026rsquo;s:\u0026nbsp;\u003c/strong\u003eHIV exposed infants\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHIV:\u0026nbsp;\u003c/strong\u003eHuman Immune Deficiency Virus\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMOH\u003c/strong\u003e: Ministry of Health.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePCR:\u0026nbsp;\u003c/strong\u003epolymerase chain reaction\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUNAIDS:\u0026nbsp;\u003c/strong\u003eJoint United Nations Program on HIV and AIDS\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUNFPA:\u0026nbsp;\u003c/strong\u003eUnited Nations Population Fund\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUNICEF:\u0026nbsp;\u003c/strong\u003eUnited Nations Children\u0026rsquo;s Fund\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUPHIA\u003c/strong\u003e: Uganda Population-based HIV Impact Assessment\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHO:\u0026nbsp;\u003c/strong\u003eWorld Health Organization\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eAlemu, Y. 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Ethnicity \u0026amp; disease, \u003cem\u003e31\u003c/em\u003e(1), 31\u0026ndash;40. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18865/ed.31.1.31\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKafulafula, U. K., Hutchinson, M. K., Gennaro, S., \u0026amp; Guttmacher, S. (2014). Maternal and health care workers\u0026apos; perceptions of the effects of exclusive breastfeeding by HIV positive mothers on maternal and infant health in Blantyre, Malawi. BMC pregnancy and childbirth, \u003cem\u003e14\u003c/em\u003e, 247\u0026ndash;247. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1471-2393-14-247\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMebratu, L., Mengesha, S., Tegene, Y., Alano, A., \u0026amp; Toma, A. (2020). Exclusive Breast-Feeding Practice and Associated Factors among HIV-Positive Mothers in Governmental Health Facilities, Southern Ethiopia. \u003cem\u003eJournal of nutrition and metabolism, 2020\u003c/em\u003e, 7962054\u0026ndash;7962054. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2020/7962054\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eNapyo, A., Tumwine, J. K., Mukunya, D., Waako, P., Tyllesk\u0026auml;r, T., \u0026amp; Ndeezi, G. (2020). Exclusive breastfeeding among HIV exposed infants from birth to 14 weeks of life in Lira, Northern Uganda: a prospective cohort study. Global health action, \u003cem\u003e13\u003c/em\u003e(1), 1833510\u0026ndash;1833510. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/16549716.2020.1833510\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eOlorunfemi, S. O., \u0026amp; Dudley, L. (2018). Knowledge, attitude and practice of infant feeding in the first 6 months among HIV-positive mothers at the Queen Mamohato Memorial 55 hospital clinics, Maseru, Lesotho. African journal of primary health care \u0026amp; family medicine, \u003cem\u003e10\u003c/em\u003e(1), e1-e12. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4102/phcfm.v10i1.1438\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eOnono, M. A., Cohen, C. R., Jerop, M., Bukusi, E. A., \u0026amp; Turan, J. M. (2014). HIV serostatus and disclosure: implications for infant feeding practice in rural south Nyanza, Kenya. BMC public health, \u003cem\u003e14\u003c/em\u003e, 390\u0026ndash;390. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1471-2458-14-390\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWakwoya, E. B., Zewudie, T. A., \u0026amp; Gebresilasie, K. Z. (2016). Infant feeding practice and associated factors among HIV positive mothers in Debre Markos Referral Hospital East Gojam zone, North West Ethiopia. The Pan African medical journal, \u003cem\u003e24\u003c/em\u003e, 300\u0026ndash;300. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.11604/pamj.2016.24.300.8528\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWalekhwa, A. W., Nakazibwe, B., Nantongo, M., Wafula, S. T., Bulafu, D., Ayugi, B.,.. . Tindyebwa, T. (2022). Drivers of the Second Wave and clinical characteristics of COVID-19 cases in Uganda: A Retrospective Study of Confirmed SARS-CoV-2 cases, March-June, 2021.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Gulu University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Key words, Infant feeding, HIV positive, Exclusive breastfeeding, Gulu, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-1357502/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1357502/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWorld Health Organisation recommends mothers with Human Immune Virus/Acquired Immune Deficiency Syndrome to exclusively breastfeed their infants for the first six months and there after introduce complimentary feeding up to one year. This study assessed the infant feeding practices and their determinants among HIV positive mothers with infants 0\u0026ndash;12 months.\u003c/p\u003e\u003ch2\u003eMethodology:\u003c/h2\u003e \u003cp\u003eA cross sectional study design adopting qualitative and quantitative data collection procedures was used. Study was carried out from Awach Health Center IV in Gulu city, Uganda. We enrolled 108 participants who were HIV positive mothers with an infant from October to December 2021. It was simple random sampling for collecting quantitative data using an interviewer administered semi structured questionnaire. Two Focuss Group Discussions (FGDs) and 5 Key informants interviews (KII) were used to obtain qualitative data. Data was collected edited coded and entered into epi info. The data was analysed using SPSS version 22. Qualitative data was analysed using Atlas.ti software.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf the 108 mothers, 83/108 (77%) practiced exclusive breastfeeding, 25/108 (23%) mixed feeding. Qualitative results also showed that exclusive breastfeeding was the preferred choice. Of the respondents 104/108 (96.3%) believed HIV can be transmitted to their babies. Factors associated with infant feeding practices at multivariant level at 5% significance were age of the child (OR\u0026thinsp;=\u0026thinsp;0.706, 95% CI: 0.2100.988), income level (OR\u0026thinsp;=\u0026thinsp;1.296, 95% CI: 1.150-10.631), knowledge on Prevention of Mother to Child Transmission (OR\u0026thinsp;=\u0026thinsp;16, 95% CI: 3.618\u0026ndash;34.18), Early infant diagnosis clinic visits (OR\u0026thinsp;=\u0026thinsp;0.118, 95% CI: 0.019\u0026ndash;0.704) and the place of delivery (OR\u0026thinsp;=\u0026thinsp;1.976, 95% CI: 1.295\u0026ndash;13.233).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMajority of the mothers practiced Exclusive breastfeeding, although a high number still practice mixed feeding. Majority of mothers had good knowledge about prevention of mother to child transmission. The factors identified in our study that influence infant feeding practices were Early infant diagnosis clinic visits, age of the child, place of delivery, knowledge on Prevention of Mother to Child Transmission. Mothers should deliver from hospitals, more sensitizations for these mothers to appreciate the benefits of exclusive breastfeeding.\u003c/p\u003e","manuscriptTitle":"Exploring Infant Feeding Practices and associated factors among HIV Positive Mothers Attending Early Infant Diagnosis Clinic in Northern Uganda.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-02-14 19:40:53","doi":"10.21203/rs.3.rs-1357502/v1","editorialEvents":[{"type":"communityComments","content":1}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9ae1f7be-a9bb-43de-946f-806851bf26d3","owner":[],"postedDate":"February 14th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":10399260,"name":"Pediatrics"},{"id":10399261,"name":"Sexual \u0026 Reproductive Medicine"}],"tags":[],"updatedAt":"2022-02-14T19:40:53+00:00","versionOfRecord":[],"versionCreatedAt":"2022-02-14 19:40:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1357502","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1357502","identity":"rs-1357502","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}