Barriers to implementation of prevention of mother to child transmission of HIV infection during the breastfeeding period among mothers of infants in Ilala municipal in Dar es Salaam

Abstract

PMTCT during breastfeeding is one of the most public heath challenge confronting researchers. About ~HIV infection in children is acquired through MTCT. Breastfeeding contributes to the overall risk ofMTCT by 14%. PMTCT has been implemented as the main strategy for preventing transmission of HIV from mother to child in order to save the lives of large numbers of children born to HIV infected mothers. However a number ofPMTCT programmes have experienced a number of challenges during implementation. A crossectional analytical study was done in Ilala district Dar es Salaam Tanzania from June to July 2003 with the obj ective of finding out barriers to implementation ofPMTCT during breastfeeding period. A total of384 mothers aged 15-47 years were interviewed. Information on barriers to implementation ofPMTCT was obtained through quantitative method by using structured interviews and qualitative using focus group discussions (FGD's) method. The results showed that most (92.4%) of the respondents were aware of mother to child transmission of HI V, but the level of knowledge on the period of transmission was not as high (54.3%). Similarly awareness ofPMTCT of HI V was high (91.9%) but the level of knowledge of methods ofPMTCT was poor (62.6%). Factors that contributed to the poor knowledge ofPMTCT were low level of education and younger age.

VII The prevalence of breast feeding was found to be 97.9 %( 376/384). The few who were not breastfeeding were advised to stop breastfeeding by a doctor because their mi lk was bad. Information on MTCT was obtained from clinics 60.3% (246/408) and media where radio was the commonest. Regarding breastfeeding practice, about 83.0% (346/417) of mothers would give cow milk or fonnula milk to the young babies. The remaining few said they usually let the baby breastfeed from another woman. Of the four breastfeeding options majority 97.2%(67/69) of the mothers would prefer to give to their babies formula milk only two mothers favoured exclusive breastfeeding, arguing that even little amount of mother's milk may contain viruses. Asked whether they would advise a friend who is HIV positive to breastfeed or not, majority (90.4%) of the mothers said they would advise not to breastfeed to avoid transmission. The few who would advise others to continue breastfeeding argued that formula milk is expensive and the mother's milk is important for the baby. Majority 69.7 %( 267/383) of the mothers expressed worries on stigmatisation should a mother who is HIV positive stop breastfeeding. This study found that, mothers were aware ofMTCT, PMTCT and breastfeeding options but their level of knowledge was poor. Stigma was the commonest barrier to p implementation o~MTCT; therefore there is a need to educate mothers on PMTCT, and to develop strategies for reducing stigma.