Marseille 2007
| Abstract #528 - Early cessation of breastfeeding in Kenya: experiences from the Kesho Bora Study (Nairobi, Kenya) | ||||
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Session: 40.1: Children (Parallel) on Tuesday @ 14.00-16.00 in PR Chaired by Lorraine Sherr, Peter Laugharn Authors: Presenting Author: Dr Saskia Walentowitz - Univeristy of Berne, Switzerland |
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| Additional Authors: BA Emmy Kageha, Prof Alice Desclaux, | ||||
| Aim: Though advised by international recommendations as a preventive measure, early cessation of breastfeeding is a critical event that remains poorly documented. Related practices were explored by a qualitative study on the socio-cultural determinants of HIV-infection through breastmilk, realized within the ANRS 1271 / WHO Kesho Bora Study in Nairobi, Kenya. | ||||
| Method / Issue: The study participants make an informed choice between exclusive breastfeeding up to 6 months and free formula feeding. A breastfeeding mother who decides to change her feeding option is also provided with formula after AFASS assessment. 18 participants who opted to breastfeed were interviewed between one to three months, and again between six and nine months after birth. Ethnographic observations where regularly held at the study clinic and during infant feeding counselling sessions. | ||||
| Results / Comments: 12 women decided to stop breastfeeding before 6 months: 2 had stopped breastfeeding at 4 months, 6 at 4 months, 2 at 3 months and 2 at 1 month. 2 mothers continued to breastfeed their HIV + infants, one baby died at 3 months before weaning, 2 mothers mixed fed and 2 mothers breastfed exclusively for 5 months. The mothers reasons for early breastfeeding cessation are manyfold, lack of breastmilk being most frequently cited, along with feeling weak, being sick, going back to work and a negative PCR test result for the baby. In Kenya where early mixed feeding is the norm, mothers opt for a compromise to conform to the local infant feeding pattern while avoiding mixed feeding. If not-breastfeeding from birth is socially unacceptable, not-supplementing the infants diet becomes difficult to prevent after three months. Replacement feeding becomes easier to explain since working mothers usually breastfeed only during night, while the baby feeds on replacement food during daytime. A PCR test is done at three months, thus coinciding with the moment when social pressure towards mixed feeding becomes strong. Mothers seem to cope with the risk of early HIV-transmission through breastmilk, yet difficult to distinguish from intrapartum-transmission; but when a child turns out HIV-free, they dont want to expose it to the virus any longer. Most mothers report difficulties with early cessation of breastfeeding despite continuous high quality medical care and counselling support. They experience diarrhoea episodes, babies who refuse formula or difficulties with preparing the milk. While most mothers are well aware of the benefits of exclusive breastfeeding, some state that formula feeding from birth would be a better option, thinking that problems arise rather from the abrupt change than from the use of formula itself. | ||||
| Discussion: The results show that HIV-infected breastfeeding mothers balance social and medical prescriptions regarding infant feeding that must be understood as a process including cultural norms about the childs health and development. In-depth studies are crucial to identify and understand the critical moments in this process in order to improve the prevention of negative feeding outcomes. | ||||
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