Research on Ways of HIV Positive mothers of feeding their children

1. KNOWLEDGE AND ATTITUDE ON FEEDING OPTIONS IN MOTHERS OF HIV
POSITIVE CHILDREN UNDER 5 YEARS IN TRANSNZOIA COUNTY, KENYA

2. ii
TABLE OF CONTENTS
DECLARATION.....................................................................Error! Bookmark not defined.
TABLE OF CONTENTS...........................................................................................................ii
LIST OF FIGURES ...................................................................................................................v
DEFINITION OF TERMS .......................................................................................................vi
ABSTRACT........................................................................................................................... viii
CHAPTER ONE........................................................................................................................1
INTRODUCTION AND BACKGROUND INFORMATION .................................................1
1.1 Background ......................................................................................................................1
1.2 Problem statement............................................................................................................2
1.3 Justification ......................................................................................................................2
1.4 Objectives of the study.....................................................................................................3
1.4.1 Broad objective..........................................................................................................3
1.4.2 Specific objectives.....................................................................................................3
1.5 Research questions...........................................................................................................3
2.1 Introduction......................................................................................................................6
2.2 Socio demographic factors influencing choice of feeding options in mothers of HIV
positive children.....................................................................................................................6
2.2 .1 Age............................................................................................................................6
2.2.2 Ethnicity.....................................................................................................................7
2.2.3 Religion .....................................................................................................................7
2.2.4. Marital status ............................................................................................................7
2.2.5 Level of education .....................................................................................................7
2.2.6 Occupation.................................................................................................................8
2.2.7 Income .......................................................................................................................8

3. iii
2.2.8 Culture .......................................................................................................................8
2.2.9 Employment status ....................................................................................................8
2.3Knowledge as a factors influencing feeding options available for mothers of HIV
positive children.....................................................................................................................9
2.4 Mothers attitude on feeding options available for HIV positive children......................10
2.5 Infant and young child feeding options available for HIV positive mothers.................10
2.5.1 Exclusive replacement feeding................................................................................10
2.5.2 Exclusive breastfeeding...........................................................................................11
2.6 Wet nursing ....................................................................................................................11
2.7Commercial infant formula.............................................................................................11
2.8 Home modified milk ......................................................................................................12
2.9 Unmodified cow’s milk..................................................................................................12
2.10 Early cessation of breastfeeding and heat treatment of expressed breast milk ............12
2.11 Recommendations for ages up to six months...............................................................13
CHAPTER THREE; METHODOLOGY ................................................................................14
3.1 Area of study..................................................................................................................14
3.2 Study design...................................................................................................................14
3.3 Study variables ...............................................................................................................14
3.4 Study population ............................................................................................................14
3.5 Sampling procedure and sample size .............................................................................15
3.5.1 Sampling procedure.................................................................................................15
3.5.2 Sample size..............................................................................................................15
3.6 Data collection instruments.......................................................................................16
3.7 Pre-test of instruments....................................................................................................17
3.7.1 Validity and reliability of the study instruments................................................17

4. iv
3.8 Inclusion and exclusive criteria......................................................................................17
3.9 Data collection process...................................................................................................17
3.10 Ethical and consideration issues...................................................................................18
3.10.1 Consent from school and hospital .........................................................................18
3.10.2 Confidentiality of clients .......................................................................................18
REFERENCES ........................................................................................................................19
APPENDICES........................................................................................................................21
APPENDIX: QUESTIONAIRE...........................................................................................21
APPENDIX II: WORK PLAN.............................................................................................25
APPENDIX III: BUDGET...................................................................................................26
APPENDIX IV: MAP OF THE STUDY AREA.................................................................27

5. v
LIST OF FIGURES
Figure 1.1: Conceptual framework ..........................................Error! Bookmark not defined.

6. vi
DEFINITION OF TERMS
Antibody - Special kind of blood protein that is synthesized in the lymphoid in
Apoptosis - Programmed cell death
Diarrhoea - Increase in frequency fluidity and volume of bowel movement
Mastitis - Inflammation of the breast
Meconium - The first stool of a newborn baby
Pneumonia - An infection that inflames the air sacs in one or both lungs
Wet nursing - Having another woman breastfeed baby for another woman

7. vii
LIST OF ABBREVIATIONS AND ACRONYMS
AFASS - Available, Feasible, Affordable, Sustainable, Safe
AIDS - Acquired Immunodeficiency Syndrome
ARVS - Anti-Retroviral
CCC - Comprehensive Care Centre
HIV - Human Immunodeficiency Virus
IMCI - Integrated Management of Childhood Illness
MOH - Ministry of Health
PMTCT- Prevention of Mother to Child Transmission
UN - United Nations
WHO - World Health Organization

8. viii
ABSTRACT
HIV&AIDS is a serious health problem throughout the world in general and developing
countries in particular. It has continued to spread steadily in general population in Africa
since its appearance in early 1980s. It causes a lot of issues in society and also health care.
Mother to child transmission through breast milk is one of the problems caused by
HIV&AIDS pandemic overall half of breast transmission takes place by the first 6 weeks of
life and three quarters by 6 months of life. There’s early evidence that mixed feeding
increases the breast milk transmission of HIV. Due to poor hygienic conditions and low socio
economic status among any society in Kenya, use of industrialized breast milk in infant has
been proposed. The broad objective of this study is to determine the level of knowledge and
attitudes on feeding options in mothers of HIV positive children under 5 years at Kitale
district Hospital. The research will be carried out by researcher using various methodologies
which involved the use of questionnaire which will be given to mothers to fill. Simple
random sampling method will be used to collect data. Data will be analyzed by calculating
descriptive statistics and will be presented in pie charts, bar graphs and tables. The study will
place within December 2017 it cost approximately 13000ksh.The researcher will use at least
150 mothers with HIV/AIDS positive children under 5 years who attend CCC clinic at Kitale
district hospital. These will establish the most opted methods due to socio-economic
constrains and will it will be able to understand and encourage the government to help the
mothers to feed children to avoid the transmission of HIV among the under fives.

9. 1
CHAPTER ONE
INTRODUCTION AND BACKGROUND INFORMATION
1.1 Background
In 2011, a global initiative was launched to reduce the number of new HIV infections via
mother-to-child transmission by 90% by 2015. The WHO identified 22 priority countries,
with the top 10 (Angola, Botswana, Burundi, Cameroon, Chad, Cote d’ivoire, Democratic
Republic of the Congo, Ethiopia, Ghana, and India) accounting for 75% of the global
PMTCT service need (WHO, 2009). It was estimated that the effective scaling up of
interventions in these countries would prevent over 250,000 new infections annually. Outside
of the priority countries, in mid- 2015, Cuba became the first country to eliminate the mother-
to-child transmission of HIV. As PMTCT is not 100% effective, elimination is defined as a
reduction of PMTCT transmission to such low levels that it no longer constitutes a public
problem (WHO, 2007). In 2014 1.2 million women in 21 priority countries still required
these services. The global plan aimed to reduce the number of new HIV infections among
women of reproductive age by 50% between 2009 and 2014.PMTCT has reduced paediatric
MTCT during pregnancy, delivery or breastfeeding (MOH, 2007).Important feeding
continues to be one of the important practices influencing child survival and development
worldwide, and is also recognized as a critical component of care and support during the
prenatal period for women. As part of national response to HIV&AIDS in Kenya and
prevention of mother to child transmission(PMTCT), effective counseling on infant feeding
to ensure that correct and consistent messages are given and identified critical intervention in
service provision (WHO, 2008). The Kenyan government in collaboration with multilateral
and bilateral agencies has recently spearheaded response to this need to equip health and
nutrition staffs with an integrated set of job aids or counseling tools (WHO, 2007).

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1.2 Problem statement
Prevention of mother to child transmission (PMTCT) of HIV has the importance of: primary
prevention of HIV among women of child bearing age, prevention of unintended pregnancies
among women living with HIV, prevention of HIV transmission from woman living with
HIV to her infant and provision of appropriate treatment, care and support to women living
with HIV and their children and families (WHO,2010).This is important because HIV&AIDS
pandemic is causing problems for most affected societies and their health systems. One of the
methods is PMTCT through breast milk as economic and hygienic conditions do not always
assure safe replacement feeding in developing countries. Mother to child transmission rates
for HIV is estimated at 25-30% in primarily breastfed population of Sub-Saharan Africa. In
Kenya, an estimated 300,000 newborn babies are at risk of HIV infection every year. Hence it
is preferred that if the mother is infected has to replace breast feeding to reduce risk of
transmission, (WHO, 2004). Options include breast feeding and formula feeding.
Unfortunately in regions with poor sanitation, unclean water used to mix formula has caused
serious illnesses and death among formula fed infants, who are more likely than breast fed to
die diarrhoea, malnutrition. An appropriate choice of infant feeding is fundamental to
optimizing infant survival and minimizing infant morbidity, (WHO, 2010). The main aim of
this study is to determine the level of knowledge and attitudes on feeding options in mothers
of HIV positive children under 5 years at Kitale District Hospital
1.3 Justification
The researcher will use the research study to explain the significance of having the
knowledge and positive attitude on feeding options in children who are HIV positive (WHO
,2010) to the mothers attending CCC clinic at Kitale district hospital as it gave them wide
range of feeding options..The research will help the government to make policies that can
help to increase the knowledge and attitudes of the mothers with HIV positive children.

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1.4 Objectives of the study
1.4.1 Broad objective
To determine the level of knowledge and attitude of feeding options in mothers of HIV
positive children under five years at Kitale district hospital.
1.4.2 Specific objectives
1. To determine the socio-demographic factors of mothers of HIV positive children
under five years attending Kitale district Hospital.
2. To determine the attitudes on feeding options available amongst mothers of HIV
positive children under five years at Kitale district Hospital.
3. To assess the level of knowledge on feeding options available in mothers of HIV
children under five years at Kitale district Hospital.
4. To identify feeding methods used by mothers of HIV positive children under five
years at Kitale district Hospital.
1.5 Research questions
1. What are socio-demographic factors of mothers of HIV positive children under five years
attending Kitale district Hospital?
2. What are the attitudes on feeding options available for mothers of HIV children under
five years at Kitale district Hospital?
3. What is the level of knowledge on feeding options available for mothers of HIV positive
children under five years at Kitale district Hospital?
4. What are the infant feeding methods used by mothers of HIV children under five years at
Kitale district Hospital?

12. 4
1.6 Significance of the study
In 2011, a global initiative was launched to reduce the number of new HIV infections via
mother-to-child transmission by 90% by 2015. The WHO identified 22 priority countries,
with the top 10 (Angola, Botswana, Burundi, Cameroon, Chad, Cote d’ivoire, Democratic
Republic of the Congo, Ethiopia, Ghana, and India) accounting for 75% of the global
PMTCT service need (WHO, 2009).
The World Health Organization (WHO) promotes a comprehensive approach to PMTCT
programmes which includes: preventing new HIV infections among women of child bearing
age, preventing HIV transmission from a woman living with HIV to her baby, providing
appropriate treatment, care and support to mothers living with HIV and their children and
families and preventing unintended pregnancy among women living with HIV (WHO, 2010).
The global plan aimed to reduce the number of new HIV infections among women of
reproductive age by 50% between 2009 and 2014.PMTCT has reduced paediatric morbidity
and mortality (WHO, 2010). In Kenya,90% HIV of children with HIV infection is due to
MTCT during pregnancy, delivery or breastfeeding (MOH, 2007). The study is of
significance to the mothers attending CCC clinic at Kitale District hospital as it gives them
wide range of feeding options.

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1.7 Conceptual Framework
Figure 1.1: Conceptual framework
Sources: Researcher (2017)
Independent variables such as age, occupation, education, religion, culture and income
interact to bring out the outcome which is the dependent variables such as knowledge,
attitude and practises. These interactions provide feedback which acts as a reinforcement
towards the level of knowledge and attitude of mothers on the feeding options. These factors
have been captured in literature review as socio-demographic factors influencing the feeding
options in mothers of HIV positive children. Women at a young age and educated tend to
have knowledge and positive attitude and easily understand the feeding options which are
provided by the clinicians at the hospital. Those women who are bared by factors such as
region, culture and ethnicity tend not use the feeding options which leads to negative
outcome, as shown in the figure below.
Dependent variable (OUTCOMES)Independent variable
Level of knowledge
and attitudes on
feeding options of
mothers with HIV
positive children
Socio-demographic factors
- Age
- Marital status
Socio-economic factors
- Education
- Occupation
Socio-cultural factors
- Religion
- Cultural beliefs
- Ethnicity

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CHAPTER TWO; LITERATURE REVIEW
2.1 Introduction
Feeding options is the establishment of feeding practices that are comfortable and promising
to both the mother and infant. It is crucial for emotional wellbeing of both and for ensuring
adequate nutrient intake for the baby. Women should be counselled about possible different
feeding alternatives. A baby should be fed on milk only for the first 6 months after which
balance complimentary foods are added to the diet. The mother’s choice of feeding options
needs to be respected. It is necessary to encourage couple decision making. There is good
evidence that decision made by couple is upheld. Mothers may choose breast milk;
commercial infant formula or home modified infant formula (MOH, 2006).
2.2 Socio demographic factors influencing choice of feeding options in mothers of HIV
positive children
2.2 .1 Age
Literature has consistently identified lower maternal age as predictors of lower breastfeeding
rates (Scott et al., 1999). A young mother with her first child may find it difficult to believe
that she cans breastfeed successfully. Breastfeeding fails easily in a young school girl who
has a baby that she really did not want (King et al., 1983). The young women to a large extent
perceive their breasts in terms of attractiveness rather than their function. Women age above
25 years has been repeatedly associated with a longer duration of breastfeeding. It is probable
that older women know more about the benefits of breastfeeding and have more realistic
outcome expectations (Scott et al., 2001).

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2.2.2 Ethnicity
Ethnicity may influence level of knowledge and attitude on feeding options in mothers of
HIV positive children through cultural beliefs and practices. For instance mothers know that
breast feeding protects the infant against diseases. The strength of the belief in superiority of
breast milk over formula may influence maternal choice on infant feeding option (WHO,
2010)
2.2.3 Religion
The Islamic holy book, the Quran, recommends that mother’s breastfeed their children for
two years if possible and states that every infant has the right to be breastfed. This may
influence maternal choice on infant feeding option. Other religions support breastfeeding. For
example, the La Leche League International was founded by Catholic in support of
breastfeeding (Jessica, 2007).
2.2.4. Marital status
Single mothers have great difficulty in supporting themselves and caring for the baby
especially if they are young. Single mothers have less family support. Without this support,
activities outside the home such as having to work might prevent exclusive breastfeeding. It
is often best if the mother and the baby can stay together and be supported as a family. They
can breastfeed at least partially (Ebrahim, 1991).
2.2.5 Level of education
Generally, educated women tend to breastfeed less and are likely to introduce supplementary
feeding earlier than those with little or no education. This is attributed to the fact that a better
educated woman is more likely to work away from home which makes breastfeeding difficult
(Luan, 2003).

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2.2.6 Occupation
It has been noted that mothers who work outside the homecare less likely to breastfeed
exclusively compared to mothers who do not work away from home. Thus not working
outside the home is important predictor of exclusive breast-feeding (WHO, 2006).
2.2.7 Income
Lack of funds to purchase infant formula feeds and poor hygienic condition makes it difficult
to practice exclusive breastfeeding. When mothers’ income household is high, they are more
likely to practice exclusive replacement feeding, safest way to prevent infant from HIV
infection, (Doherly et al., 2009).
2.2.8 Culture
Decision to breastfeed is very often influenced more by socio-cultural health considerations
(Henderson et al., 2000). Cultural beliefs have a significant influence on breastfeeding
practices, (Ergenekon et al., 2006). In most African countries breastfeeding is still considered
an important part of traditional culture and is actively supported and promoted by community
members, (walker et al., 2000).Culturally, most African communities practice mixed feeding
instead of exclusive breastfeeding (Bland et al.,2002).
2.2.9 Employment status
A woman may choose not to breastfeed because she plans to go back to work outside home
soon after baby is born and feels it is too difficult to work and also to breastfeed. Other
women find it hard to maintain their milk supply when separated from their babies and may
be forced to stop breastfeeding (Fisher et al., 1990).

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2.3Knowledge as a factors influencing feeding options available for mothers of HIV
positive children
Knowledge is a familiarity, awareness or understanding of someone or something, such as
facts, information, description, or skills which is acquired through experience or education by
perceiving, discovering or learning (WHO, 2006). Infant feeding information should be
initiated at ANC clinic and this will help the mother to make an informed decision about
infant feeding. Although breastfeeding accounts for only part of mother-to-child transmission
of HIV, in countries where both fertility and rates of HIV infection among pregnant women
are high, the issue of HIV transmission through breastfeeding is of public health importance
(WHO, 2007). There is a pressing need for countries to develop sound policies on HIV and
infant feeding methods for HIV-positive mothers. Counselling HIV-infected mothers should
include the best available information on benefits of breastfeeding, on risk of breastfeeding.
Infant feeding information should be initiated at the ANC clinic and this will help the mother
to make decision about infant feeding, (MOH, 2005).
The consequence of this recommendation is that compared to HIV-negative mothers for
whom the decision to breastfeed is supported by international and national recommendations
as well as long- standing cultural practices, mothers with HIV are expected to assume
increasing responsibility for infant feeding decisions. Providing information about infant
feeding options needs to be individualized. This information must be unbiased and accurate
to help women make a decision that is in keeping with their personal values and beliefs.
Truly informed decision-making can only take place when mother is given both the fullest
possible information from which to draw her conclusions and appropriate, culturally-located
support for the course of action she chooses (WHO, 2006). Early detection of HIV is also
needed to enable mothers to recognize their role in infant feeding. Women should receive the

18. 10
information as early as possible; either prior to conception or during prenatal care, the
importance of early detection is influencing infant feeding choice (WHO, 1998).
2.4 Mothers attitude on feeding options available for HIV positive children
An attitude is a view or opinion that is formed by values and beliefs including self esteem,
hope, faith and confidence. A value is a belief that is important to an individual. Values can
be influenced by religions, education, cultural factors or by other personal experience (MOH,
2005). An attitude is neither predicted by beliefs about outcomes of behaviour nor subjective
nor is predicted by normative beliefs. Fathers of infant feeding options, familial influences
and socio-economic factors including cost of infant formula can influence attitude towards
breastfeeding, normative beliefs and beliefs about outcomes have been shown to be
associated with breastfeeding intentions (Ducket et al.,1998).Commitment to breastfeeding is
made well before a woman becomes pregnant (Pascoe et al.,2002). Majority of pregnant
mothers make infant feeding decision before or very early in pregnancy (Dennis et al., 2000).
2.5 Infant and young child feeding options available for HIV positive mothers
MOH guidelines promote and support breastfeeding of HIV negative women and women of
unknown status. In many settings in Kenya, there is high risk of the infant being sick if the
HIV mothers don’t breastfeed. At the same time there is significant breast milk transmission
of HIV.To address this complex decision, the Government of Kenya promotes the right of
parents of HIV exposed infant to choose how to feed their infants following guidelines on
different infant feeding options (MOH, 2007).
2.5.1 Exclusive replacement feeding
It involves giving the baby only commercial breast milk substitutes. This method requires
time, safe water, fuel and utensils for its preparation and administration. There should be
adequate finances to ensure continuity of supply. The amount to be given to the baby should

19. 11
be calculated basing on the baby’s weight. A baby requires 150ml per body weight (WHO,
2011).
2.5.2 Exclusive breastfeeding
Exclusive breastfeeding means an infant receives only breast milk and no water, glucose, tea,
or other liquids or food with exception of medicine. It’s recommended until a child is 6
months of age (MOH,2007).Exclusive breastfeeding is associated with more than 50%
reduced risk of HIV transmission of HIV compared to non-exclusive breastfeeding (MOH,
2006).Exclusive breast feeding for the first 6 months helps a child to grow and develop
maximum potential. It should be initiated within half to one hour after birth. It also provides
the best food for baby by supplying all nutrients and water baby needs for 6 months. It also
contains colostrums which protect the baby against infections. Colostrums helps baby in
acquiring immunity. Breast milk in addition gives the baby special vitamins, other nutrients
and antibodies which strengthen the baby and make it fight against infections. All breast milk
is very gentle and doesn’t irritate sensitive digestive tract, (MOH, 2007).
2.6 Wet nursing
Wet nursing is practicable in some traditional settings where a relative breastfeeds the infant.
Wet nursing means that a woman feeds for another woman’s child. Wet nursing is considered
only when potential nurse is informed of her risk of acquiring HIV from the infant in
question. A wet nurse has to be offered HIV counselling and testing and has to be voluntary
take at least and is found negative.
2.7Commercial infant formula
Infant formula is the most complete breast milk substitute and contains adequate
micronutrients, (Alex zusman, 2000).Modified infant formula requires reconstitution with
water and there’s always an inherent risk of contamination on resonations when infant

20. 12
formula is used, the family has to be reliable and access to sufficient formula clean water,
utensils, skills and tie to prepare it accurately and hygienically MOH, 2004). There are four
separate formula’s available; a powder that is combined with water, a condensed liquid that is
diluted with equal amounts of water, a ready to pour type which requires no dilution and
individually pre packed bottles of formula. .
2.8 Home modified milk
It is only suitable when commercial formula is not available. Infant requires about fifteen
litres of modified milk formula per month for the first six months in addition to five
millilitres of multivitamin. Infants who are fed on home modified formula require
micronutrients supplements because animal milk is relatively low in zinc, iron, vitamin A,
and vitamin C. Fresh animal milk must be modified by diluting the milk with water that has
been boiled vigorously for a few seconds, bringing this mixture to boil, removing the mixture
immediately telly from heat and adding sugar and micronutrient supplement (MOH, 2005).
WHO indicate that home modified milk should no longer be recommended for replacement
feeding for infant’s less than six months except as a short term stop gap measure in situations
where a suitable breast milk substitute is not available,(WHO,2011).
2.9 Unmodified cow’s milk
This type of milk is not recommended for infants under 6 months of age. It could be
considered as an exceptional option by the HIV positive mothers when supplies of cow’s
milk are reliable and affordable, (Oguta et al,2004).
2.10 Early cessation of breastfeeding and heat treatment of expressed breast milk
This reduces length of time for which infant is exposed to HIV through breast milk. HIV
positive mothers should be advised to stop breastfeeding as soon as she is able to prepare and

21. 13
give her infant adequate and hygienic alternative reasons. Mothers who find it difficult for
social and cultural reasons should avoid breastfeeding completely,(
Oguta et al.,2004).
2.11 Recommendations for ages up to six months
Children should exclusively be breastfed from birth up to six months of life. This means that
the child takes only breast milk and no additional food, water or other fluids with exception
of medicine and vitamins is needed. Children at this age should breastfed often day and night
at least 8 times in 24 hours (MOH 2007).

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CHAPTER THREE; METHODOLOGY
3.1 Area of study
This study is to be carried out in Transnzoia county, Saboti constituency, Matisi ward at
Kitale district hospital which is located on approximately 10 acres of land which provides
service to about 150,000 residents of the region. The researcher selected the area because
the hospital has a higher number of children under five who are HIV positive and the mothers
lack knowledge, practice and have negative attitudes on the feeding options and the
researcher is well aware and conversant with the area.
3.2 Study design
A descriptive cross sectional design, based on qualitative and quantitative data collection
processes
3.3 Study variables
Dependent variables; knowledge, attitude, practices
Independent variables; education, occupation, age, sex, religion
3.4 Study population
The study targeted mothers with HIV positive children aged 0-5 years attending Kitale
district hospital and any other client who can benefit from the research. The study frame will
be 150 women who attend the CCC clinic at the Kitale district hospital.

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3.5 Sampling procedure and sample size
3.5.1 Sampling procedure
Simple random sampling method will be used to select respondents hence every person in the
study population will have equal chance of being chosen. The sample will be gotten through
numbering, whereby some papers written on numbers equal to the patients present.
3.5.2 Sample size
The sample size will be determined using the formula by fisher et al.(1999
n=
Where;
n= desired sample size
z=statistic of the standard normal deviate corresponding with the selected confidence limit
95% given as 1.96
p=portion in the target population estimate to have characteristics being measured
(knowledge and attitude on feeding options in mothers of HIV positive children under
5years) 50%(0.5)
q=statistical notation for 1-p (1-0.5)=0.5
d=the degree of accuracy required as 0.05
Therefore;

24. 16
For a study involving 150 mothers with HIV positive children under 5 years who attend CCC
clinic at Kitale district hospital in Matisi ward, the final estimate sample size(nf) will be
calculated as follows;
Where; nf= the desired sample size (where the population is less than 10000)
n= the desired sample size (where the population is greater than 10,000)
N= the estimate of the population size
1= constant of correction
Therefore; nf =
=384/1+2.6
=384/3.6
=107 respondents
3.6 Data collection instruments
The study will use questionnaires to collect data. Questionnaires will be preferred because
they consist of many items combined and more reliable measure of constructs than would any
single item. It also gives respondents freedom to express their views or opinion and make
suggestions.

25. 17
3.7 Pre-test of instruments
Pre-test is where research instruments are tested on (statistically) small sample of respondents
before a full-scale study, in order to identify any problems such as unclear wording or clarity
of instructions.10% of the sample size will be taken to test the appropriateness of the research
tools and necessary amendments to be taken accordingly.
3.7.1 Validity and reliability of the study instruments
Validity refers the indication of how sound the research is, it measures the degree to which
the variables measure what it is intended to measure. Validity in data collections means that
the findings truly represent the phenomenon the researcher claims to measure. The instrument
will be evaluated by supervisors for content validity that is the extent to which the
questionnaire content will be suitable for the intended respondents. Content validity is done
by expert judgment. The researcher will seek for the expertise of other researchers who
conducted research on similar studies to check if the instruments were viable to collect data.
This will be done before using the instruments for data collection.
Reliability is a measure of the degree to which a research instrument yields consistent results.
A sample is taken to test the reliability of the instruments.
3.8 Inclusion and exclusive criteria
All HIV mothers with babies 0-5 years old were included in the research regardless of
income or level of education but were attending CCC at the district Hospital with exclusion
of those who are mentally unwell and those who will not be able to communicate properly.
3.9 Data collection process
The research will collect data using different methods such as interviews where he/she
interact with the client face to face and ask the research questions

26. 18
3.10 Ethical and consideration issues
3.10.1 Consent from school and hospital
The researcher will seek permission from the school authority to go to the study area and seek
permission from hospital management team and records department before carrying out the
study.
3.10.2 Confidentiality of clients
The clients will be informed fully and in details the aims of the study and why the researcher
chose to carry out the study in the hospital. The research will be for learning purposes and
they will be assured that any information given will be confidential.

27. 19
REFERENCES
MOH, (2004): Feeding alternatives for HIV positive mothers in Kenya,
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MOH, (2005): Participants’ Manual, Kenya national prevention of mother to child
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MOH, (2006): Essential care annual, HIV pregnancy and infant transmission, 23-25
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4th
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MOH, (2007): Intergrated management of childhood illnesses, page 1 2 3rd
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, 2010
WHO, (2004): Promoting proper feeding for infants and young children. Geneva
Fromhttp://www.who.int/nutrition/topics/infantfeeding/en/. Site visited on
11/05/2012

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WHO, (2006): Guidelines for antiretroviral therapy, nutrition in HIV children, page 143-144
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WHO, (2007): HIV and infant feeding update. Geneva, http://www.who. Site visited on 28
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WHO, (2009): HIV and infant feeding updated recommendation on HIV children, 3rd
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5 April 2011

29. 21
APPENDICES
APPENDIX: QUESTIONAIRE
The information you provide will be treated with confidentiality. Please tick (√) where
necessary.
SOCIO-DEMOGRAPHIC DATA
1. Age 13-23 24-29
30-35 35-40
2. Gender Male Female
3. Marital status Married
Single
Divorced Separated
Widowed
4. Level of education.
Not educated Primary
Secondary College
University
5. Place of residence ___________________________
6. Employment status.
Employed Not employed
Self employed

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7. Religion
Christian Muslim
Other, specify………………………………………………………
8. Occupation ...............................................................................................
9. Source of income ..................................................................................
10. Parity 1-2 3-4
5-6 7 or more
11. Type of marriage Polygamous Monogamous
12. Culture Dictates breastfeeding
FEEDING METHODS
Breastfeeding Bottle Feeding
Wet Nursing Gavage Feeding
Parental Feeding
Attitude
No Statements Agree Disagree Neutral
1 All newborns should breast fed for long time
2 Every mother must breastfeed her newborn
3 Wet nursing is acceptable in African tradition
4 Breastfeeding is better than any other type of feeding for infants
5 Alternative feeds are preferred to exclusive breastfeeding
6 My culture don’t allow child to breastfeed
7 Exclusive replacement feeding is expensive

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8 Exclusive breastfeeding is for minimum 6 months
9 Commercial milk formulas are for the urban rich
10 Home modified milk is expensive compared to other feeding
methods
11 Unmodified cows milk is not recommended for infant below 6
months
12 Early cessation of breastfeeding should be practiced
Knowledge
1. Have you ever heard of PMTCT services?
Yes No
2. If yes, where did you hear the information?
i) Market place ii) Church
iii) Private clinic
iv) Others specify …………………………..
3. What is the role of PMTCT?
i) Prevent spread of HIV from mother to child
YES NO
ii) Educate others on importance of PMTCT services
YES NO
iii)Provision of appropriate treatment, care and support to women living with HIV and
their children and families
4. Is breast feeding important?
Yes No

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5. Are there options in case a mother can’t breastfeed?
Yes No
6. If yes which ones?
Bottle feeding Wet nursing
7. How long should a baby be breastfeed?
Up to 6 months above 6 months
8. Should HIV positive mother’s breastfeed?
Yes No

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APPENDIX II: WORK PLAN
Monthly
Activity
Sep Oct Nov Dec Jan Feb Marc
Selection of
research topic
Writing of
concept paper
Development of
research proposal
Data collection
Data analysis
report writing
Submission of
approved report.

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APPENDIX III: BUDGET
Item Quantity Price/unit Total
Pencils 4 25 100
Pens 5 30 150
Erasers 2 20 40
Rims of foolscaps 1 400 400
Flash disks 1 500 500
Printing 2 2000
Photocopy 300
Binding 250
Meals 2000 2000
Transport per week 4 weeks 1000 per week 4000
miscellaneous 3000 3000
Total 12740

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APPENDIX IV: MAP OF THE STUDY AREA
Study area