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      Realities and challenges of breastfeeding policy in the context of HIV: a qualitative study on community perspectives on facilitators and barriers related to breastfeeding among HIV positive mothers in Baringo County, Kenya

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          Abstract

          Background

          Although recent policies have sought to increase the rates of exclusive breastfeeding (EBF) and continued breastfeeding for HIV exposed infants, few programs have considered the multiple social and cultural barriers to the practice. Therefore, to generate evidence for exclusive and continued breastfeeding policies in Kenya, we examined community perspectives on the facilitators and barriers in adherence to EBF for the HIV positive mothers.

          Methods

          Qualitative research was conducted in Koibatek, a sub-County in Baringo County Kenya, in August 2014 among 205 respondents. A total of 14 focus group discussions ( n = 177), 14 In-depth Interviews and 16 key informant interviews were conducted. Transcribed data was analyzed thematically. NVivo version 10.0 computer qualitative software program was used to manage and facilitate the analysis.

          Results

          Facilitators to exclusive breastfeeding were perceived to include counselling at the health facility, desire to have a healthy baby, use of antiretroviral drugs and health benefits associated with breastmilk. Barriers to EBF included poor dissemination of policies, knowledge gap, misinterpretation of EBF, inadequate counselling, attitude of mother and health workers due to fear of vertical HIV transmission, stigma related to misconception and misinformation that EBF is only compulsory for HIV positive mothers, stigma related to HIV and disclosure, social pressure, lack of male involvement, cultural practices and traditions, employment, food insecurity.

          Conclusions

          There are multiple facilitators and barriers of optimal breastfeeding that needs a holistic approach to interventions aimed at achieving elimination of mother to child transmission. Extension of infant feeding support in the context of HIV to the community while building on existing interventions such as the Baby Friendly Community Initiative is key to providing confidential support services for the additional needs faced by HIV positive mothers.

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          Most cited references 50

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          Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect.

          The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823,000 annual deaths in children younger than 5 years and 20,000 annual deaths from breast cancer. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor.
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            Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta-analysis.

            To systematically review the evidence on the associations between breastfeeding and overweight/obesity, blood pressure, total cholesterol and type 2 diabetes.
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              The risks of partner violence following HIV status disclosure, and health service responses: narratives of women attending reproductive health services in Kenya

              Introduction For many women living with HIV (WLWH), the disclosure of positive status can lead to either an extension of former violence or new conflict specifically associated with HIV status disclosure. This study aims to explore the following about WLWH: 1. the women's experiences of intimate partner violence (IPV) risks following disclosure to their partners; 2. an analysis of the women's views on the role of health providers in preventing and addressing IPV, especially following HIV disclosure. Methods Thirty qualitative interviews were conducted with purposively selected WLWH attending clinics in Kenya. Data were coded using NVivo 9 and analyzed thematically. Results Nearly one third of the respondents reported experiencing physical and/or emotional violence inflicted by their partners following the sero-disclosure, suggesting that HIV status disclosure can be a period of heightened risk for partner stigma and abuse, and financial withdrawal, and thus should be handled with caution. Sero-concordance was protective for emotional and verbal abuse once the partner knew his positive status, or knew the woman knew his status. Our results show acceptance of the role of the health services in helping prevent and reduce anticipated fear of partner stigma and violence as barriers to HIV disclosure. Some of the approaches suggested by our respondents included couple counselling, separate counselling sessions for men, and facilitated disclosure. The women's narratives illustrate the importance of integrating discussions on risks for partner violence and fear of disclosure into HIV counselling and testing, helping women develop communication skills in how to disclose their status, and reducing fear about marital separation and break-up. Women in our study also confirmed the key role of preventive health services in reducing blame for HIV transmission and raising awareness on HIV as a chronic disease. However, several women reported receiving no counselling on safe disclosure of HIV status. Conclusion Integration of partner violence identification and care into sexual, reproductive and HIV services for WLWH could be a way forward. The health sector can play a preventive role by sensitizing providers to the potential risks for partner violence following disclosure and ensuring that the women's decision to disclose is fully informed and voluntary.
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                Author and article information

                Contributors
                bmogesi@unicef.org
                jokimiywe@gmail.com
                sera.young@northwestern.edu
                fwekesah@aphrc.org
                mwanjohi@aphrc.org
                muriukigp@gmail.com
                nyovani.madise@afidep.org
                P.Griffiths@lboro.ac.uk
                ekimani@aphrc.org
                Journal
                Int Breastfeed J
                Int Breastfeed J
                International Breastfeeding Journal
                BioMed Central (London )
                1746-4358
                8 May 2021
                8 May 2021
                2021
                : 16
                Affiliations
                [1 ]United Nations Children’s Fund (UNICEF), Nairobi, Kenya
                [2 ]GRID grid.9762.a, ISNI 0000 0000 8732 4964, Department of Foods, Nutrition and Dietetics, , Kenyatta University, ; Nairobi, Kenya
                [3 ]GRID grid.16753.36, ISNI 0000 0001 2299 3507, Institute of Policy Research, , Northwestern University, ; Evanston, USA
                [4 ]GRID grid.413355.5, ISNI 0000 0001 2221 4219, Maternal and Child Wellbeing Unit, African Population and Health Research Center, ; Nairobi, Kenya
                [5 ]GRID grid.7692.a, ISNI 0000000090126352, Julius Global Health, Julius Center for Health Sciences and Primary Care, , University Medical Center Utrecht, Utrecht University, ; Utrecht, the Netherlands
                [6 ]GRID grid.507436.3, Institute of Global Health Equity Education, University of Global Health Equity, ; Kigali, Rwanda
                [7 ]African Institute for Development Policy, Lilongwe, Malawi
                [8 ]GRID grid.6571.5, ISNI 0000 0004 1936 8542, School of Sports, Exercise and Health Sciences, , Loughborough University, ; Loughborough, UK
                [9 ]GRID grid.11951.3d, ISNI 0000 0004 1937 1135, MRC/WITS Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, , University of the Witwatersrand, ; Johannesburg, South Africa
                [10 ]GRID grid.52788.30, ISNI 0000 0004 0427 7672, Wellcome Trust, ; London, UK
                [11 ]GRID grid.8756.c, ISNI 0000 0001 2193 314X, Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, , University of Glasgow, ; Glasgow, G31 2ER UK
                [12 ]GRID grid.11956.3a, ISNI 0000 0001 2214 904X, Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre, Stellenbosch University, ; Stellenbosch, South Africa
                [13 ]GRID grid.40263.33, ISNI 0000 0004 1936 9094, International Health Institute, Brown University School of Public Health, ; Providence, USA
                Article
                385
                10.1186/s13006-021-00385-1
                8106855
                33964950
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                Funding
                Funded by: NIH and the USAID through the Partnership for Enhanced Engagement in Research (PEER) Health Program, administered by the National Academy of Sciences (NAS) to Kenyatta University and the African Population and Health Research Center and conducted as part
                Award ID: (Grant # PGA2000003677/8).
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                © The Author(s) 2021

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