In 2003, an estimated 630,000 children worldwide became infected with HIV, the vast majority of them during their mother’s pregnancy, labor, and delivery, or as a result of breastfeeding (UNAIDS 2004). In the absence of any intervention, a third to a half of mother-to-child transmission occurs through breastfeeding (WHO 2004).
Infant feeding guidelines on the prevention of mother-to-child HIV transmission (PMTCT) in Kenya recommend that HIV-infected mothers be counseled about the risks of breast milk
transmission of HIV and be given three options for feeding: (a) exclusive breastfeeding for six months and abrupt cessation, (b) replacement feeding with commercial infant formula, and (c) replacement/home modified formula (cow, goat, or camel milk or soy protein) (NASCOP 2002).
The objective of counseling on HIV and infant feeding is to assess the mother’s personal circumstances in order to help her select the best feeding option for her and her baby (Koniz-Booher et al. 2004). Infant feeding counseling is crucial because normative practices in Kenya, such as mixed feeding, can be detrimental to an infant of an HIV-positive mother.
The Horizons Program, in collaboration with International Medical Corps (IMC) and Steadman Research Services International (SRSI), is conducting an operations research study testing several community-based strategies to reduce mother-to-child transmission of HIV in a densely settled urban slum in Nairobi, Kenya. The strategies being piloted by IMC include moving PMTCT services closer to the population via a mobile clinic, and increasing psychosocial support for HIV-positive women through the use of traditional birth attendants (TBAs) and peer counselors. Peer counselors are HIV-positive women who have already received
PMTCT services. The effectiveness of each of these strategies on women’s utilization of key PMTCT services will be measured by comparing baseline to follow-up data. This research update presents key findings about infant feeding counseling and practice of mothers in this community and the extent to which actual infant feeding practice is consistent with recommended
practice. An important feature of this community-based study is the availability of data on infant feeding and reported HIV status.