ASSESSMENT OF INFANT FEEDING PRACTICE OF HIV

POSITIVE MOTHERS AND HIV STATUS OF THEIR

INFANTS IN ADAMA HOSPITAL & MEDICAL COLLEGE

Adama , Ethiopia

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 Jun 2015

ADAMA, ETHIOPIA

Abstracts
Background:

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 I
Table of Content
Content Page
Abstract ……………………………………………………………………………………...I
Table of Content .................................................................................................................. ...II
Abbreviation………………………………………………………………………………….III
Chapter 1. Introduction
1.1 Back ground ..............................................................................................................1
1.2 Statement of the problem ..........................................................................................2
1.3 Significant of the Study---------------------------------------------------------------------- 3

Chapter 2 Literature Review..................................................................................................4

2.1 HIV Transmission risks ............................................................................................9
2.2 Infant feeding practice ..............................................................................................5
2.3 Predisposing factor: Knowledge and attitude about feeding option and PMTCT.....07
2.3.1 Enabling factor ..............................................................................................08
2.3.2 Reinforcing factors.........................................................................................08
2.3.3 Breast –related problems ...............................................................................09
2.3.4 Childhood illnesses........................................................................................09

Chapter 3 objective
3.1 General Objective ----------------------------------------------------------------------------10
3.2 Specific Objective ---------------------------------------------------------------------------10
3.3 Scope of the study----------------------------------------------------------------------------10
Chapter 4. Methodology of the Study
4.1 Study Area.................................................................................................................11

4.2 Study Design.............................................................................................................11

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 4.3 Source of population .................................................................................................11
4.4 Study population ......................................................................................................11
4.5 Inclusion Criteria ------------------------------------------------------------------------------11
II
4.6 Exclusion Criteria------------------------------------------------------------------------------12
4.7 Study period ------------------------------------------------------------------------------------12
4.8 Sample size and Sampling Technique.......................................................................12
4.9 Data collection method..............................................................................................13
4.10 Study variables.........................................................................................................13
4.11 Data quality control--------------------------------------------------------------------------13
4.12 Data analysis technique ---------------------------------------------------------------------13
4.13 Data dissemination plan ---------------------------------------------------------------------14
4.14 Operational Definition------------------------------------------------------------------------14
3.15 Ethical consideration ...............................................................................................15

Chapter 5 Result -------------------------------------------------------------------------------------- 18-33

Discussion……………………………………………………………………………34
Conclusion……………………………………………………………………………38
Recommendation…………………………………………………………………… 39
 Appendix 1---------------------------------------------------------------------------------------40
 Appendix 2
 Reference ------------------------------------------------------------------------------------- --47

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6
Abbreviation

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 III

CHAPTER 1
1. INTRODUCTION

Infancy, period from birth to about 2 years of age. This first stage of life is an important time,
characterized by physical and emotional growth and development.

Breastfeeding is the cornerstone of child survival, even in HIV contexts. Infant mortality is six
times greater among non-breastfed infants than those breastfed. At the same time, breastfeeding
is recognized as one small factor in the transmission of HIV from an HIV-positive mother to her
infant if the mother is not taking ARVs. (Transmission of HIV from the HIV-positive mother to
her child may occur during pregnancy, delivery or through breastfeeding.) HIV transmission
increases with duration of mixed feeding, and if the mother is re-infected during the
breastfeeding period. It presents a dilemma for policy makers, programmers, researchers and the
mothers themselves, especially in contexts where ARVs are not available.

According to the 2007 AIDS epidemic up date, 33.2 million people are estimated to be living
with HIV with 2.5 million new infections. More than two third (68%) of adults and nearly 90%
of children infected with HIV live in sub-Saharan Africa and more than three fourth (76%) Aids

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death in 2007 occurred there. In sub Saharan Africa almost 61% of adult livings with HIV were
women. (1)

The HIV pandemic created enormous challenges to the survival of mankind worldwide. Ethiopia
is one of the country’s most severely hit by the epidemic. Beside the dominate retro sexual
transmission, vertical virus transmission from mother to child accounts for more than 90% of
pediatric AIDS. (3)

According to calibrated single point estimate (2007), the national adult prevalence is reported to
be 2.1% (7.7% in urban and 0.9% in rural areas). Around 977,394 Ethiopian are living with
HIV/Aids and among them, 59% are women.
An estimated 75, 420 HIV positive pregnant women are anticipated nationally. The results
indicated that the national and rural HIV prevalence for Ethiopia has stabilized while the urban
prevalence is declining. (3, 12)
Mother to child transmission (MTCT) can occur during pregnancy, at the time of delivers, and
after birth through breast feeding. Based on previous documented report on MTCT, it is
estimated that MTCT rates. Without any anti-retroviral intervention is in the range of 15 to 30%
while in the absence of breastfeeding. When there is exclusive breast feeding (0 – 6 month) and
prolonged feeding (18-24 month) the chance of acquiring the disease is 25-35% and 30 to 45%
respectively. Intervention such as ARV treatment during pregnancy and elective cesarean section
can reduce the risk of MTCT to as low as 3-6%. (2, 14)
Mother to child transmission (MTCT) is the most common mode of HIV transmission in children
which is vertically transmitted from HIV positive pregnant women to her unborn baby during
pregnancy, labor and delivery or through breast feeding. (2)

Of the ten countries worldwide with the greatest number of infected children the top nine are all
in sub-Saharan Africa. Nearly 90% of all HIV- positive children live in sub-Saharan Africa (1)
cohort study conducted in Ethiopia estimated that the rate of MTCT in Ethiopia is in the range of
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29% - 47% which is similar with rates reported in developing countries. (13-42%). In Ethiopia
there were 14,148 HIV positive births in 2007 and in Addis Abeba it was 2000. (3)

Without intervention, HIV infected mothers have a 35% overall risk of transmitting HIV to their
child comprehensive PMTCT intervention can reduce the risk of HIV infection. (12)
The cumulative breast feeding transmission is 15% when breast feeding continued for two years
or more. The balance between BF(breast feeding) lifesaving benefit and the risk of transmission
complicates infant feeding in communities affected by HIV. There, for WHO, UNICEF,
UNAIDS and UNFPA developed a guide line on HIV and infant feeding for HIV status is
unknown mother, (HIV negative women) and HIV positive women. Feeding option for HIV
positive women is avoid BF when replacement feeding is acceptable, feasible, Affordable,
sustainable and safe (AFASS) if not Exclusive breast feeding, Heat treated expressed breast milk
and wet nursing.
In Ethiopia, infant feeding practice of mothers of unknown HIV status having children less than
12 month is assessed. However, there is still a gap in assessment of HIV positive mothers in
relation to mother to child transmission risk and associated factor. Therefore, this study is
proposed to fill this gap.

The following will be some of the importance of this study:

• To give awareness towards the mother to child HIV/AIDS transference during breastfeeding
• To increase the knowledge of the researcher
• For next generation this study will be used as a source document on the same title and study.

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 CHAPTER 2
2. LITERATURE REVIEW

2.1 HIV Transmission risks

Mother to child transmission is the most common mode of HIV transmission in children which
can be vertical transmitted from HIV positive pregnant women to unborn baby during pregnancy,
delivery or through breast feeding to. Ethiopia has adopter the united nation strategic approach to
the prevention of transmission of HIV to infants and young children have four areas.
1. Primary prevention of HIV infection
2. Prevention of unintended pregnancies among HIV infected women
3. Prevention of HIV transmission from infected women to their infants
4. Treatment, care and support of HIV infected women, their infants and their families.

Without specific intervention to reduce the risk of transmission, estimated rates of MTCT from
14-25% in Europe and America and from 13-42% in developing countries. A study conducted in
Durban, south Africa shows that, infant feeding practice of HIV-infected women involved in a
trial were documented prospectively. Women were counseled on infant feeding choices
according to UNAIDS guide lines, and those who chose to breastfeed were encouraged to
practice exclusive breast feeding.

Children exclusively breast fed to least 3 months were less likely to be infected (14.3%) than
those receiving mixed feeding before 3 months (24.1%). After adjustment for potential
confounders maternal (CD4: CD8 ratio, syphilis screening test results, and preterm delivery’s),

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exclusive breastfeeding carried a significantly lower risk of HIV 1 transmission than mixed
feeding and an equivalent risk to no breastfeeding. (33)

In addition, randomized clinical trial conducted in antenatal clinics in Nairobi, Kenya, with a
median follow-up period of 24 months indicated that compliance with the assigned feeding
modality was 96% in the breast feeding arm and 70% in the formula arm median duration of
breast feeding was 17 months. The cumulative probability of HIV- 1 infection at 24 months was
36.7% in the breast feeding arm and 20.5% the formula arm. The estimated rate of breast milk
transmission was (16.2%). (10)

Breast feeding is one of the routes of HIV transmission in breast feeding infants, the risk of
transmission could be related to the duration of breast – feeding, the time of exposure, the
infectiousness of the milk, and the present of HIV antibodies in the milk. A study conducted in
Malawi showed that in breast fed infant who were found to be HIV negative by PCR at 1 month
of age (and whose only remaining risk factor was thus breast feedings), the rate of infection was
5.2% at 6 months, 9% at 1 year, and 13.8% at 2 years of age. (17, 18, 19)

2.2 Infant feeding practice

The cumulative breast feeding transmission of HIV is 15% when breast feeding continued for
two years or more, As a result feeding guidelines for infants of HIV- infected mothers are being
formulated in many resource –poor countries. The latest united Nation policy statement on HIV
and infant feeding was issued in 2001 says, “when replacement feeding is acceptable, feasible,
affordable, sustainable and safe, avoidance of all breast feeding by HIV infected mother is
recommended. For women who are HIV negative or of unknown HIV status, exclusive breast
feeding for the first six months is a single infant feeding recommendation that may protect their
infant becoming infected with HIV. (18, 19, 29, 30)
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A study conducted in Zambia showed that, infant-feeding practices of mother of known HIV
status who had all received pre- and post-test HIV counseling. Feeding practice were determined
by verbal questionnaire. All mothers breastfed but only 35% of infant below 4 months were
exclusively breast fed (received breast milk only). (24)

Cross sectional study also conducted in Cameroon revealed that, 47 mother were included in the
study and the positive sero-status for HIV was discovered before pregnancy for 8.7% of the
mothers, for 67.4% during pregnancy and for 23.9% during delivery. 87.2% of the mothers
option for replacement feeding since birth and 8.5% option for breast feeding. The option
practice during the first six months were for 10% breast feeding and 84.8% replacement feeding
while 4.3% practice mixed feeding.

Infant feeding choice and option practice were not associated with the age of mother. The
moment of the sero diagnosis, neither with the rank of pregnancy, nor with the economic status.
the option choice and practiced was correlated with education level and the practice of feeding
option was linked with material status. (27)

Another cross sectional study, in Uganda to find the prevalence and factors associated with EBF
from deliver showed that amongst mothers of infant 0-6 mother or age in community with a high
HIV/AIDS burden. A prevalence of EBF of 35.1% was found. Factors positively associated with
EBF from birth, after logistic regression, were: delivery from a health unit and mother having a
normal vagina delivery. (26)

The population base line survey (national) conducted in Ethiopia, July 2004 revealed that the
total executive breast feeding rate for infant is 36.4% with some significant regional variation,
17% of infant (0.<5 month) fed breast milk and water only, 28% fed breast milk and any other
liquid, 16% fed milk and solids, and 4% on ERF. (5)

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2.3 Predisposing factor: Knowledge and attitude about feeding option and
PMTCT
Studies in Hong Kong, China on pregnant women attending antenatal care clinic at different time
indicated that, they have good knowledge of HIV/AIDS (91.6%), and 62% to 89% knew that
using condoms reduce the chance of getting HIV/AIDS.

However women were less knowledgeable on MTCT (57%). knowledge of means of reducing of
HIV transmission to her baby (transmission through breast feeding) were very less (15.7%).
Their knowledge was significantly associated with their educational level (15, 16).

Similarly a study conducted in Ghana on voluntary counseling and HIV testing of pregnant
women has shown, 74.4% of the subjects mentioned sex and blood transfusion and 25%, from
Mother to child as means of HIV transmission. On specific inquiry in this study 51.1%
mentioned that MTCT could occur during pregnancy and delivery and 31.5% during
breastfeeding (20).

The study conducted in Gurage zone, south Ethiopia about awareness of feeding option of HIV
positive mothers, 84% of the respondents were aware of the recommended feeding options of
infants below six months born to HIV positive women. Subjects who had good knowledge about
HIV/AIDS, and those residing in the urban areas were more likely to mention the recommended
feeding options OR (95%CI)= 2.53 (1.40, 1.56) and (95%CI) = 1.83 (1.13, 2.96), respectively.
Only 24% mentioned that mother to child transmission occurs via breast milk. Respondents with
good knowledge on HIV/AIDS were twice likely to know the usefulness of VCT during
pregnancy in preventing MTCT. (9, 11)

In assessment of PMTCT awareness and knowledge covering PMTCT sites in 6 regions of

Ethiopia on lactating mothers, 98% of them had heard of HIV/AIDS, about 44% of the women

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were able to name at least 2 modes of HIV transmission with 26% of MTCT only 13% of women
correctly identify the three ways of that HIV can be transmitted from mother to child:

(During pregnancy, delivery and through breastfeeding) and 23% did not mention any means of
PMTCT during pregnancy. (14)

Other study done in Jimma town, Ethiopia on pregnant and locating mothers 38.8% of pregnant
mothers and 41.8% of lactating mothers had sufficient knowledge about MTCT and PMTCT.
(13)
2.3.1 Enabling factor
On PMTCT of HIV in developing countries, the availability of MCH services vary from place to
place. Even though over all median acceptability rate of VCT was 65% in Africa while in
Thailand reached 95%. The current strategy to reduce MTCT was that; all effort should be made
to proper voluntary HIV counseling and testing to all pregnant during the antenatal period. It is
recommended that they avoid breast feeding when possible since VCT is now seen as entry point
for these preventive services. (2, 4, 32).

2.3.2 Breast –related problems

A sick mother might change her infants feeding behavior due to her disease or the maternal
illness might be the direct cause of increased transmission through breast milk. A prospective
study conducted in south Africa shows that of 179 HIV positive mother who had been breast
feeding, Cracked nipple were experienced by 21 (12%) mothers and this was usually in the first
months of life and rarely was associated with bleeding. (35,36,38)
Women were asked about any breast-related problems they may have had while breast feeding.
About 13% of the women reported experiencing breast-related problems while breastfeeding.
The most commonly reported problems were sore nipple and engorgement. Cross tabs showed a
significant linear association between breast problems and the timing of initiation. (5)

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2.3.3 Childhood illnesses
An infection of child may result in change of feeding of mother and infections like oral lesion,
upper respiratory tract infection and gastro enteritis facilitates direct transmission of the virus to
infants.
A base line longitudinal study conducted in the United states revealed that, the infant feeding
practice study was administered by mail beginning when the mother was approximately 6
months pregnant and continuing unit the infant was one year old, infant feeding and health status
information were collected when the infant was at month 2,3,4,5,6,7 months old.
The result indicated that 5.4% of infants reportedly experienced diarrhea between 2 and 7
months of age, 6.8% to 13.2% experienced an ear infection. When looked at the relationship
between feeding and diarrhea, it showed that infants who received formula had an 80% and 70%
increase in their risk of developing diarrhea and ear infection. (37) A cohort study from Durban
SouthAfrica showed that, the frequency of failure to thrive and episodes of diarrhea and
pneumonia were not significantly different between the exclusively breast feeding, exclusively
formula feeding and mixed feeding. (7). According to the baseline survey in Ethiopia, thirty- six
percent of mothers whose HIV status is unknown reported their infant to have at least one illness
in the last 2 weeks before the survey. (5)

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 CHAPTER 3
3. OBJECTIVE

3.1 General Objective

To assess infant feeding practice of HIV positive mothers and their infants HIV status in Adama
Hospital Medical College PMTCT, ART site and child follow-up clinic.

3.2 Specific Objective

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 CHAPTER 4
4. Methodology of the Study

4.1 Study area

The study will be conducted in Adama Town Geda Health
Center Oromia Region of Ethiopia.In Adama Town There are
around Five Health Center in Adama Administrative Town,
Oromia Regional State.
4.3. SOURCE OF POPULATION
The source of population were all adult ART clients (>18 years of
age) of St. Francis Health center.
4.4. STUDY POPULATION
Hundred patients were selected from all adult PLWHA (>18 years
of age) who visited ART clinics more than three month in ST.
Francis health center during the study period.
4.6 Study variables

Dependent variable
• Client satisfaction on the services
Independent variable

 Socio demographic characteristics of the clients (address, age, marital status,

religion, occupation, education and in-come);
 Provider and client interaction, waiting time, consultation duration and
convenience of working hours;

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 Access to services (diagnosis, drugs, information and psycosocial and
economic supports to clients);
 Privacy, confidentiality, characteristics of the care and services, equipments,
drugs, reagents; and latrine services
4.7 Data collection instrument& procedure

A structured questionnaire were prepared by the investigator and used

for all clients at St. Francis health center ART clinic during the study
periods, which were not excluded with exclusion criteria and volunteer to
participate in the study. The questionnaire was intended to collect the
client’s socio demographic characteristics, client satisfaction on quality
of ART services at St. Francis health center. The questionnaire was
tested prior the actual data collection time. The data was collected from
Jun1-June 30.
4.8. Data processing & analysis

Data was analyzed by simple calculator were used for data management.
The data was done by principal investigator.
4.9 Ethical consideration

Approval was obtained before starting data collection from central health
college dean office. The procedure and purpose of the study was
explained to those concerned individuals and bodies. Then an informed
consent was obtained initially during interview. Cultural values on the
nature of the issue was given priority and the respondent right to stop
the interview at any time of data collection process was mentioned

4.2. Study period

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Duration of study will cover from 20/09/2008 to-
20/10/2008 E.C.
4.3. Study Design
Study design will be descriptive cross-sectional survey.
4.7 Sample size determination:
The sample size will be determined using the
formula for estimating a single population proportion.
n= (Z a/2)2 p (1-p)
d2

Where:
n=the required sample size
Z=The value of Z in the standard normal distribution
that corresponds to a-level 0.05.
p=Assumed proportion of knowledge of TB
patients=P=50%
d=The margin of error (precision) =5%
So n=(0.05*1.96)2*0.5(1-o.5)
( 0.05)

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n=384
Taking a 10% non-response rate, the total sample size is
NRR=10%*384=38.4
=38
Total Sample size will be =384+38=422

4.7. Sampling Technique

Through examining three month reports (from June 1 to August
30) of 2015 of the---------- health facilities providing MDR TB
diagnosis and treatment services, the patient load across the
facilities was compared. Based on the result, those facilities that
have optimal client flow & documentation was purposefully
selected.
Hence, the calculated sample size was allocated to the facilities
based on their case load during the previous three months.
Finally, those TB patients that fulfill the inclusion criteria were
interviewed until the calculated sample size attained for the
respective facilities.

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 4.10. Operational Definition
· Knowledge: It is information that an individual is aware of it.
In this study it was measured based on the ability of patients
correctly identify and respond to cause (1question), mode of
transmission and factors related to transmission (2questions),
sign & symptoms(7 questions), possible ways of prevention
of tuberculosis(3questions) and treatment(1question).Each
correct answer had one point.
-Overall knowledge: It is the summary of all the above 14
questions. The mean was considered to classify high and low
knowledge.
-High Knowledge:-Knowledge score that fell above the mean.
-Low Knowledge: - Knowledge score below the mean.
· Attitude: is the perception or outlook regarding tuberculosis.
It was measured by feelings towards the cause (2 questions),
treatment and about the follow up (3 questions) and felling
when others knew that you had TB (1 question). Six
questions show respondents’ agreement or disagreement. Each
had one point if correctly answered. The base for classification
of favorable and un favorable was the mean of each score.

-Favorable Attitude: - Attitude score that fell above the mean.

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-Unfavorable Attitude:-Attitude score below the mean.
· Practice: is the overt behavior, habit or custom that a person
does, follow up or carry out in his/her daily life. It was
measured based on previous health seeking behavior, decisions
and actions taken to seek treatment and advice. Twelve
questions were used to assess the experience and practice of the
patients. Each had one point if correctly answered. The base for
classification of favorable and unfavorable was the mean of
each score.
-Favorable Practices: - practice score that fell above the mean.
-Unfavorable Practices:-practice score below the mean.
· Smear positive pulmonary TB: A patient with two sputum
specimens positive for acid fast bacilli by microscopy.
· Smear Negative pulmonary TB: A patient with three sputum
specimens negative for acid fast bacilli by microscopy.
· Multi drug-resistant TB: Mycobacterium tuberculosis
resistant to ionized and rifampicin, with or without resistance to
other drugs.
· Extra pulmonary TB: Tuberculosis in organs other than the
lungs.
· Optimal client flow: Three month reports (from June 1 to
August 30) of 2010 of health facilities providing TB diagnosis
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and treatment services, the patient load more than 150 TB
patients.

4.12. Data quality control

The questionnaire will prepare originally in English and then
translated in to Afan oromo for the actual data collection and
back translated in to English. One day training will given for
supervisors and data collectors and the questionnaire will pre-
tested.
4.14 Limitation of study
· Care takers knowledge attitude and practices regarding TB
and its treatment not addressed.
· The study was conducted only on patients who are diagnosed
and taking TB treatment.
· Since the design is cross sectional temporal relations could
not be assessed.
4.15. Dissemination of Results
Primarily this study will be defended in the HO, as partial
fulfillment of the degree . It is also serve as an input for
Adama Health Office and other partners working on TB
program.

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Annexes 1

Consent Form for quantitative in English

Good morning/afternoon, my name is--------------------------------, I came from Adama. I

am going to give you some research/study questions to respond. The purpose of the
research is Assessment of infant feeding practice of HIV positive mothers and HIV status
of their infants in adama hospital medical college.

I have chosen you randomly to talk to you, since you are one of getting service in this
hospital. Your participation will help us to attain the intended objectives. Responding the
questionnaire will require about an hour of your time. There are different questions that
you would like to respond. These questions are about your socio-demographic and SRH
story. You are not expected to write your name. Any information you may provide is
very confidential. Your name will not be provided. Your participation in this study is
voluntary.
If you agree to be in this study, please let me know by saying
YES------------------------------, NO-------------------------------------
If s/he is not volunteer, s/he will be exempted.
If s/he agrees, the questionnaire will be given to respond.
Thank you for your assistance!
Place----------------------------- Date----------------------- Time---------------------

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¾eUU’ƒ pê
Ö?“ ÃeØM˜ እ”ÅU” ›Å\/ªK< (እ”Å ›Óvu<) eT@ ----------------------- ÃvLM::
¾S×G<ƒ Ÿ²=G< Ÿ›ÇT ’¨<:: ›G<” እ ²=I ¾}Ñ–G<ƒ ¾]c`‹/¾U`U` ØÁo‹”
›”Ç=SMc<M˜ MÖÃqƒ ’¨<:: ¾U`U\ ¯LT HIV ካለባቸው እናቶች የተወለዱ ህጻናት
የአመጋገብ ስርአት መገምገም እና በደማቸው HIV መኖሩን እና አለመኖሩን ማረጋገ Ø ነው<::
እ`e u²=I ሆስፒታል ¨<eØ ŸT>ÑKÑK< ›”Æ eKJ’< SMe እ”Ç=SMc<M˜ }S`ÖªM::
¾ እ`e u²=I Ø“ƒ Sd}õ KU`U\ ¯LT Sd"ƒ Ã[ÇM:: ØÁo‡” KSSKe ¨Å ÓTi W¯ƒ
èeÉxM::

¾T>SMc<M˜ ¾}KÁ¿ ØÁo‹ ›K<˜:: እ’²=I”U ØÁo‹ ¾ እ`e” ¾TIu^©“ Ç=V¡^c=Á©

እ”Ų=G<U ¾}ªMÊ Ö?“ ታ]¢‹ “†¨<:: eU” Síõ ›ÃÖupxƒU:: T”—¨<”U ¾T>WÖ<ƒ”
S[Í T>eØ^©’~ እ ÏÓ u×U ¾Öuk ’¨<:: ¾²=I Ø“ƒ }d ታ ò ¾T>J’<ƒ uSM"U ðnÉ w‰
’¨<::

eK²=I ’í ¾J’ SMe” KSeÖƒ S<K< ðnŘ’ƒ” unM Á[ÒÓÖ<M—M;

ðkÅ— J’ªM ---------------- ›ÃÅK<U ------------------

ðkÅ— "MJ’< nK SÖÃl ›Ã"H@ÉU::

ðnÅ— ŸJ’< Kƒww` u×U ›ScÓ“KG<::

nKSÖÃl እ”Ç=VK<ƒ Ãc׆ªM::

x ታ  ------------------ k” ----------------- c¯ƒ ---------------

27
 Region__________
Sub city___________
Hospital name_________

Result code

Completed 1
Refused 2
Partially completed 3
Other (specify)

Checked by ; name_______________signature_____________date____________

Name of interviewer_______________
Date of interview_____/____/_____
Date month year

Part 1 socio demographic data

No Questions Coding categories Skip to

01 How old are you

02 Sex Male 1
Female 2

03 What is your current marital status? (circle the response)

Single 1
Married 2
Divorced 3
Widowed 4

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 1. Orthodox
04 2. Protestant
What is your religion? 3. Muslim
4. Catholic
5. Other (specify)-----------
05 What is your ethnic group 1. Amhara
2. Oromo
3. Tigrie
4 Other (specify) --------------
06 What is the highest educational level Unable to read & writ 1
you completed? Grade 1-8 2
Grade 9-10+2 3
10+2 completed & above 4

Part 2 obstetric history

07 Did you attend ANC during your last Yes 1 If no

pregnancy No 2 skip 08

08 At what gestational age started ANC ______week_____month

09 What was your type of delivery SVD 1
C/S 2
Instrumental 3
Others 4

10 Have ART been given to you during Yes 1

pregnancy No 2

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Part 3 knowledge about PMTCT and infant feeding option
11 What are the routes of transmission of More than one answer is possible
HIV one person to another? 1.by having unsafe sexual
intercourse
2.from mother to child
3.by using unsafe blood transfusion
4.using contaminated sharps objects
5.others

12 When do you think an HIV/AIDS +Ve During pregnancy 1

pregnant woman transmit the virus to During delivery 2
her baby? During breast feeding 3
Others 4

13 What are the preventive methods to By taking medicine 1

prevent transmission of HIV/ADIS By safe delivery 2
from mother to child? By not breast feeding 3
By exclusive breast feeding 4
Others 5
14 What kind of infant feeding option Replacement feeding 1
recommended for HIV pos mother Exclusively breast feeding 2
Other 5
15 Has your husband been tested for HIV? Yes 1
No 2
I don’t know
16 When did you have your recent HIV Before marriage 1
test During this pregnancy 2
During delivery 3
If other specify______ 4

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Part 4: infant feeding practice
17 What is the age of your child? ______days
______weeks
18 Sex of your child Male 1
Female 2
19 Did you ever breastfed your child Yes 1 If no skip
No 2 22
20 How long after birth did you first put to Within first hour 1
the breast Within first 8 hours 2
After 8 hours 3

21 What food or fluid provided? Butter 1

Water 2
Tea3
Water & sugar 4
Others 5
22 since birth, have you given your child Yes 1 If no skip
any food/fluid others than breast milk? No 2 to 26
23 What kind of utensils you used to feed Bottle 1
the child Cup with spoon 2
Others specify 3
24 Have you treated the expressed milk Yes 1
with heat No 2
25 Have you ever practiced exclusive Yes 1 If no skip
replacement feeding No 2 to 33
26 What kind of replacement food you are Commercial infant formula 1
giving to your child? Home prepared formula 2
Fresh animal milk, full
cream(pasteurized or powdered
milk),ultra high temperature
milk both alternatively 3
27 How frequent you prepared formula _____________times a day
/cow milk to feed the child per day
28 Do you boil water to wash the utensil Yes 1 If no skip
No 2 to Q44
29 Have you started complimentary food Yes 1 If no skip
No 2 to 48
30 At what age of the child did you start ____________month
complimentary food

31
Part 5 maternal health
31 Have you had breast related or other Yes 1
illness since your last delivery? No 2
32 What was your illness? -breast problem 1
-nipple 2
-other 3
33 Did you seek treatment Yes 1
No 2
Part 6 infant health
34 Has the infant ever been yes 1
sick? No 2
35 Has the infant shown any of Mouth sores 1
the following sings Fast or difficult breath 2
Fever 3
Diarrhea 4
Others specify ….
36 Was your infant receiving Yes 1
treatment? No 2
Part 7 Cessation of breast feeding
NO Question Coding categories Skip to
37 Are you currently breastfeeding your Yes 1
child? No 2
38 At what age of your child do you <6 months 1
intend to stop breast feeding? Six to 12 months 2
13 to 18 months 3
19 to 24 months 4
>24 months 5
39 Have you completely stopped breast Yes 1
feeding? No 2
Part 8- Infant HIV test result
No Question
40 Condition of infant test 1) not tested 2) test result registered
41 Frequency of infant test?.................
42 . HIV results of infants
Age of child during testing HIV result type of test
………………… ………………. …………….

32
 የሆስፒታል ስም ---------- ----------------------------------------

የተጠየቁበት ቀን ------------------ ወር ------------ ዓ.ም ----------

v¡ KÁ”Ç”Æ ØÁo Ÿ}cÖ<ƒ U[Ý‹ ÃJ“K< wK¨< Ácu<ƒ” U`Ý ¨ÃU U`Ý‹”
Á¡wu<ƒ:: ›ß` SMe ¨ÃU }ÚT] SMe KT>g< u}cÖ¨< vÊ x ታ Là Ãíõ ::

¡õM ›”É: ¾TIu^©“ Ç=VÓ^òÁ© SÖÃq‹

ØÁo SMe
1. ïታ 1. ¨”É 2. c?ƒ

2. ÉT@ e”ƒ ’¨< ------------------------›Sƒ

3. ¾Òw‰ 1. ÁLÑu<(›Ów}¨< ¾TÁ¨<l)

2. ÁÑu<
G<’@
3. ¾ð~
4. vLD ¾V}vƒ/T>e~ ¾V}‹uƒ

4. HÃT•ƒ 1. *`„Ê¡e 2 ýa}e}”ƒ 3 S<eK=U

4. "„K=¡ 5. K?L(ÃÖke)-----------------
UӃլ<;

5. Ôd(wH@`) 1. *aV 2. ›T^ 3. ƒÓ_ 4. K?L

(ÃÖke)-------------------
UӃլ<;

2. ¾ƒUI`ƒ Å[Í<; 1. T”uw ›“ S ፃ õ ¾TËM

2. ከ 1-8
3. ከ 9-12 4. 12 ›“ በላይ

ክፍል
ሁለት፡-
እርግዝናን
በተመለከተ፡

33
3. በመጨርሻ እርግዝናዎ ጊዜ የቅደመ ወሊድ ክትትል ነበርዎት
አዎ  አልነበረዎትም 

4. በስንተኛዉ እርግዝና ወር ክትትል ጀመሩ

በ-------------በሳምንት------------በወር

5. በምን አይነት መንገድ ወሊዱ

በማህፀን  በኦፕራሲኦን  በመሳሪያ በመደገፍ  በሌላ -----------------

6. በእርግዝናዎ ወቅት HIV መድሃኒት ይወስዱ ነበር

አዎ  አልወስድም 

ክፍል ሦስት፡- ከእናት ወደ ልጅ የ HIV መተላለፊያ መንገድ መከላከያና የህፃናት የአመጋገቡ አማራጭ
እዉቀትን በተመለከተ

7. ኤች አይ ቪ መተላለፊያ መንገዶች ምንድናቸው (ሆናሉ ያሉትን መልስ ሁሉ ምልክት ያድርጉ. 1.

ጥንቃቄ የጎደለው ግብረ-ሥጋ ግንኑነት 
1. ኤች ኤ ቪ ካለበት እናት ወደ ልጅ 
2. ኤች አይ ቪ ያለበት ደም መወሰድ 
3. ስለታማ መሳሪያ በጋራ መጠቀም  4. ሌላ ይጠቀስ -----------
8. HIV ያለበት እርጉዝ እናት ቫይረሱን ወደ ልጇ መቼ የምታስተላልፊ ይመስልሻል
1. በእርግዝና ወቅት  2. በወሊድ ወቅት 
3. ጡት በምታጠባበት ወቅት  4. ሌላ (ይጠቀስ)------------------

13 HIV ከእናት ወደ ልጅ እንደሚተላለፍ ምን አይነት መከላከያ ይጠቀማሉ

1. የ HIV መድሃኒት በመውሰድ 
2. ጥንቃቄ ባለው መንገድ መውለድ 
3. የእናት ጡት ባለማጥባት 
4. ከእናት ጡት ዉጪ ተጨማሪ ምግብ ባለመስጠት  5. ሌላ (ይጠቀስ) ------------
9. HIV +Ve ለሆነች እናት ምን አይነት የጨቅላ ህፃን አመጋገቡ ይመረጣል
1. ጡትን የሚተኩ ምግቦች  2 ጡትን ብቻ ማጥባት  3. ሌላ
10. ባለቤትዎ የኤች አይ ቪ ምርመራ አድርገው ያዉቃሉ
1. አዎ  2. አያዉቅም  3. አላውቅም 
11. በቅርብ ምርመራ መች ነው

34
 1. ከጋብቻ በፊት  3. በምወልድበት ጊዜ 
2. በዚህ እርግዝና ጊዜ  4. ሌላ (ይጠቀስ) ----------------------
ክፍል አራት፡ የህፃናት አመጋገብ ዘዴ

12. የልጅሽ እድሜ ስንት ነው

----------- ቀን ----------- ሳምንት

13. የልጁ ፆታ ወንድ  ሴት 

14. ከወለድሽ ጊዜ ጀምሮ ልጅሽን ጡት ታጠቢው ነበር
አዎ አጠባለሁ  አላጠባም 

15. ለምን ያህል ጊዜ ጡት አጠባሽው

1. በወለድሽው በመጀመሪያው አንድ ሰዓት 
2. በወለድሽው በመጀመሪያ 8 ሰዓት 
3. ከስምንት ሰዓት በኋላ 
16. የትኛው ምግብ ወይም ፈሳሽ ነው አስፈላጊዉ
1. ቅቤ  2. ውሃ  3. ሻይ 
4. ዉሃና ስኳር  5. ሌላ ካለ -----------------------
17. ልጅዎን እንደወለዱ ከጡት ዉጪ ምግብ /ፈሳሽ ሰጥተውታል
1. አዎ  2. አልሰጠሁም 
3. አልሰጠሁም ከሆነ ጥያቄ ቁ. 22 ይዝለሉ

18. ምን አይነት የመመገቢ እቃ ይጠቀማሉ

1. ጡጦ  2. ሲኒና ማንኪያ  3. ሌላ ይጠቀስ-----------------------
19. የሚጠቀሙትን ወተት ያፈሉታል
1. አዎ  2. አላፈላም 
20. ከጡት ዉጪ ያሉ ምግቦችን ተጠቅመው ያውቃሉ
1. አዎ  መልስዎ አላውቅም ከሆነ
2. አላውቅም 
21. ከእናት ጡት ውጪ የትኛውን አይነት ምግብ ይጠቀማሉ
1. የፋብሪካ ውጤት የሆኑ የታሸገ ወተት  3. የእንሰሳት ወተት 
2. በቤት የተዘጋጁ ምግብ  4. ሌላ ካለ ---------------------
22. በቀን ለምን ያህል ጊዜ የላም ወተት ወይም የታሸገ ወተት ለልጅዎ ይመግባሉ
----------------- ጊዜ

23. የመመገቢያ እቃውን በፈላ ውሃ ያጥባሉ

1. አዎ  2. አላጥብም 
24. ለልጅዎ ተጨማሪ ምግብ ጀምረዋል
1. አዎ  2. አልጀመርኩም 

35
25. በስንተኛው እድሜ ተጨማሪ ምግብ ጀመሩ ------------------- ወር
ክፍል አምስት ፡- የእናቶች የጤና ሁኔታ
26. በእርግዝና ወቅት ከጡት ጋር የተያያዘ ህመም አጋጥሞሽ ያውቃል ወይ
1. አዎ  አላጋጠመኝም 
27. ህመምሽ ምን ነበር
1. በጡት ችግር  2. የጡት ጫፍ ችግር  3. ሌላ -------------------
28. ታክመሽ ነበር 1. አዎ  2. አልታከምኩም 
ክፍል ስድስት፡- የህፃኑ የጤና ሁኔታ
29. ህፃኑ ታሞ ያዉቃል 1. አዎ  2. አያዉቅም 
30. ህፃኑ ከሚከተሉት ምክንያቶች የትኛው ታይቶበታል
1. የአፍ መቁሰል  3. ትኩሳት 
2. የአተነፋፈስ ችግር  4. ተቅማጥ  5. ሌላ -------------
31. ህፃኑ መድሃኒት ወስዶ ያዉቃል 1. አዎ  2. አያውቅም 
ክፍል ሰባት ፡- ጡት ስለማቋረጥ
32. አሁን ጡት እየጠባች ነው 1. አዎ  2. አይደለም 
33. ልጅሽን በስንት እድሜው ማጠባት አቆምሽ
1. ከ 6 ወር በታች  4. ከ 19-24 ወር  3. ከ 13-18 ወር 
2. ከ 6-12 ወር  5. ከ 24 ወር በላይ 
34. ልጅሽን በፍፁም ጡት ማጥባት አቁመሻል 1. አዎ  2. አላቆምኩም 
ክፍል ስምንት ፡- የህፃት የምርመራ ውጤት
35. የህፃናቱ የምርመራ ሁኔታ
1. ያልተመረመሩ  2. የምርመራ ውጤቱ የተመዘገበ 
36. ምን ያህል ጊዜ ተመረመሩ ------------------------------
37. የምርመራ ዉጤት ሲመረመር የነበረዉ እድሜ HIV ውጤት
-------------------------- -----------------------
የምርመራዉ አይነት --------------------------------

eK ƒww` u×U ›ScÓ“KG<˜

36
Thank you for you cooperation

Annexes 2
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Distr: General: 3-20
3. FHAOCO, FMOH. Guideline for prevention of mother to child transmission of HIV in
Ethiopia: federal HIV/AIDS prevention and control office, federal ministry of healty July
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South Africa, 2005. AIDS: 1997 November; 11(13): 1627-1633.

37
8. W, Msamaga G, Spiegelman etal. Transmission HIV- through breast feeding among
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11. Tefera Belachew, Challojira Awareness about feeding options for infants born to HIV
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39