Determinants of Adherence to the Exclusive Breastfeeding Option among HIV Positive Mothers in Eight Selected Health Centres in Lusaka District

Background: Exclusive breastfeeding practice in high prevalence settings remains a challenge because of likelihood of HIV transmission through breast milk. Understanding determinants influencing adherence to exclusive breastfeeding in Zambia is also a challenge. We investigated determinants of adherence to exclusive breastfeeding among HIV infected mothers aged 18 to 49 years with children aged 0 to 12 months in eight selected health centres in Lusaka district. Methods: A cross-sectional survey among 400 respondents was conducted in selected health centres using probability proportional to size stratified random sampling. Multivariate logistic regression results were stratified by age and educational level. Focus Group Discussions with 44 respondents and In-depth Interviews with eight nurses were also conducted. Framework analysis (Ritchie and Spencer 1994) was used for qualitative data analysis. Results: Overall, most mothers (74.0%, n=296, CI: 0.69, 0.78) adhered to exclusive breastfeeding. Multivariate results showed that being married (AOR, 2.88; 95% CI 1.45, 5.71) and having not suffered from breast conditions (AOR, 5.34; 95% CI 2.08, 13.7) determined adherence irrespective of age and educational level. Those of incomes less than $125 were more likely to report adherence (AOR 2.44; 95% CI 1.76, 11.0) than those of above $125 despite secondary education status. Focus Group Discussions and In-depth Interviews' results complemented these findings. Women who received nutrition education (n=17) and understood that mixed feeding facilitated Mother-To-Child-Transmission (MTCT) of HIV (n=10) reported adherence. In-depth Interview results revealed that mothers who understood benefits and risks of breastfeeding through counselling also adhered to exclusive breastfeeding. Both women and nurses reported that non-availability of resources to sustain Exclusive Replacement Feeding for first six months determined adherence. Conclusion: High adherence among married respondents irrespective of age suggests a role for social support in determining adherence. Higher odds of adherence among those without breast related conditions regardless of educational level and with incomes below $125, suggests importance of understanding that reduced risk of MTCT of HIV in the absence of breast related conditions and inadequate finances to sustain exclusive replacement feeding with formula could have determined adherence.