Number of HIV-exposed infants who are exclusively breastfed at three months of age

Background

The World Health Organization recommends that women living with HIV exclusively breastfeed their infants, rather than offer mixed feeding, if they are on antiretroviral therapy (ART) and live in a resource-poor setting, given the difficulty associated with accessing clean water and formula in these settings. Mixed feeding—feeding both breastmilk and other food or liquid—has been shown to increase risk of HIV transmission in contrast to exclusive breastfeeding during the first six months postpartum. This recommendation was a response to higher rates of diarrhea, malnutrition, and other diseases in non-breastfed children. Recently, prevention of mother-to-child transmission (PMTCT) care has focused on achieving HIV-free survival with the provision of antiretrovirals (ARVs) to breastfed HIV-exposed infants. If HIV-positive women breastfeed without treatment for two years, it is estimated that their infants have a 10–20-percent chance Mixed feeding can damage the gut wall of infants, making them more susceptible to the virus. However, mixed feeding is still unfortunately common practice among children less than six months of age in many countries with high HIV prevalence. Babies who are not breastfed at all are fourteen times more likely to die from diarrhea or respiratory infections than babies who are exclusively breastfed for the first six months. Provision of ARVs has made breastfeeding dramatically safer, often reducing risk of transmission by 1 to 2 percent.

It is important for national programs to mandate which infant feeding practices and interventions will be used by all maternal and child health services, including counsel provided by community workers. Community programs are imperative to help mothers to feed their babies and take ARVs in line with national policy. This indicator can be used by community programs to determine the extent to which HIV-positive mothers are choosing positive infant feeding practices in line with recommendations.

Numerator

Number of HIV-positive infants who are being exclusively breastfed by their mothers at three months of age during the reporting period

Unit of measure

Number

Calculation

Sum results across reporting period

Method of measurement

It is recommended that data for this indicator be collected during administration of 14-week third diphtheria, pertussis, and tetanus vaccination (DPT3) for infants, because this vaccination occurs about halfway between when infants are born and when exclusive breastfeeding should discontinue. Community workers should use this visit as a marker of when they should collect this information and ask the mother whether she is exclusively breastfeeding. Community workers can coordinate with vaccination service delivery points to link mothers and infants to services and ascertain breastfeeding status. If the mother was exclusively breastfeeding (the infant is given no formula, food, or water) during the 24 hours prior to this visit and the visit occurred during the reporting period, then she can be counted towards this indicator. Otherwise, community workers can ask HIV-positive mothers directly about infant feeding practices the previous day to determine what the infant ate or drank in the past 24 hours (during the last day or at night).

National programs that adopt policies of breastfeeding and ARVs should recommend that HIV-positive mothers breastfeed their infants for 12 months and that infants be exclusively breastfed for the first six months. Community programs should not advocate that HIV-infected mothers only breastfeed if they are on ART, although every effort should be made to accelerate access to ART for PMTCT.

Data source

This information can be collected through nutritional state monitoring forms and client appointment cards.

Disaggregation

• Age (0–5 months, 6–11 months, 12–23 months, and 0–23 months)
• Sex

Data quality considerations

Note that asking about a 24-hour recall usually tends to overestimate the number of mothers who are truly exclusively breastfeeding; mothers may have been given other liquids or foods in the many days since birth. However, this has been determined as the most effective way to determine exclusive breastfeeding. This indicator relies on accurate age assessment, and the community worker should verify the child’s age, if possible, instead of relying solely on the word of the caregiver. The overall number reported for this indicator should equal the sum of individuals in each disaggregation type. It is recommended that only one type of age disaggregation be used throughout, and overlap should be avoided.

Reporting frequency

Community workers should collect this information regularly, but they should monitor progress monthly with support from their supervisors. The indicator should be reported on a quarterly basis.

Data element

Exclusive breastfeeding of HIV-exposed infants

Category

Vulnerable Children, Prevention of Mother-to-Child Transmission, HIV Prevention

References

Prevention of mother-to-child transmission (PMTCT) of HIV. (2018). Retrieved from  https://www.avert.org/professionals/hiv-programming/prevention/prevention-mother-child

Stringer, E., Chi, B., Chintu, N., Creek, T., Ekouevi, D., Coetzee, D., . . . Stringer, J. (2011). Monitoring effectiveness of programmes to prevent mother-to-child HIV transmission in lower-income countries. Retrieved from http://www.who.int/bulletin/volumes/86/1/07-043117/en/

The United Nations Children’s Fund. HIV and Infants Feeding. (n.d.). Retrieved from https://www.unicef.org/nutrition/index_24827.html