Abstract
Introduction Breastfeeding is the ideal food source for all newborns globally. However, in the era of Human Immune Deficiency Virus (HIV) infection, feeding practice is a challenge due to mother-to-child HIV transmission. Therefore, this systematic review and meta-analysis aimed to estimate the national prevalence of exclusive breastfeeding and mixed feeding practices among HIV positive mothers and its association with counseling and HIV disclosure status to the spouse in Ethiopia. Methods We searched all available articles from the electronic databases including PubMed, EMBASE, Google Scholar, and the Web of Science. Moreover, reference lists of the included studies and the Ethiopian institutional research repositories were used. Searching of articles was limited to the studies conducted in Ethiopia and published in English language. We have included observational studies including cohort, cross-sectional, and case-control studies. The weighted inverse variance random effects model was used. The overall variations between studies were checked through heterogeneity test (I2). Subgroup analysis by region was conducted. To assess the quality of the study, the Joanna Briggs Institute (JBI) quality appraisal criteria were employed. Publication bias was checked with the funnel plot and Egger's regression test. Result A total of 18 studies with 4,844 participants were included in this study. The national pooled prevalence of exclusive breastfeeding and mixed feeding practices among HIV positive mothers were 63.43% (95% CI: 48.19, 78.68) and 23.11% (95% CI: 10.10, 36.13), respectively. In the subgroup analysis, the highest prevalence of exclusive breastfeeding practice was observed in Tigray (90.12%) and the lowest in Addis Ababa (41.92%). Counseling on feeding option with an odds ratio of 4.32 (95% CI: 2.75, 6.77) and HIV disclosure status to the spouse with an odds ratio of 6.05 (95% CI: 3.03, 12.06) were significantly associated with exclusive breast feedings practices. Conclusion Most mothers report exclusive breastfeeding, but there are still almost a quarter of mothers who mix feed. Counseling on feeding options and HIV disclosure status to the spouse should be improved.
Highlights
Breastfeeding is the ideal food source for all newborns globally
The overall pooled odds ratio of exclusive breastfeeding practices among Human Immune Deficiency Virus (HIV) positive mothers who had been counseled on feeding options was 4.32 (Figure 5)
The overall pooled odds ratio (OR) of exclusive breastfeeding practices among HIV positive mothers who disclosed their HIV status to the spouse was 6.05 (Figure 6)
Summary
About 90% of pediatrics HIV infection is Mother-To-Child Transmission (MTCT), which may occur during pregnancy, delivery, and breastfeeding [1]. Avoiding breastfeeding can eliminate the risk of mother-to-child HIV transmission in the postnatal period, but mixed and replacement feeding practices were associated with increased infant mortality and morbidity in sub-Saharan Africa countries [8]. Even though exclusive breastfeeding is the best choice of feeding option in the first 6 months of the postnatal period, mother-to-child HIV transmission through breastfeeding is a major concern [14, 15]. Such a dilemma can be addressed through effective counseling and by disclosing their HIV status to their families [16, 17].
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