Feeding of HIV-exposed children in a city in south of Brazil: family capability, clinical and social conditions

Bick, Marília Alessandra; Ceretta, Paulo Sergio; Paula, Cristiane Cardoso de

doi:10.1590/1806-93042019000400015

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 19 (4) • Oct-Dec 2019 • https://doi.org/10.1590/1806-93042019000400015 copy

Feeding of HIV-exposed children in a city in south of Brazil: family capability, clinical and social conditions

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to evaluate the association between the sociodemographic and clinical aspects of the caregiver and the child, the family’s ability to prepare and administer milk and complementary feeding of children exposed to HIV.

Methods:

cross-sectional study performed with 72 caregivers, in Brazil, through the tool of sociodemographic and clinical characterization of the caregiver and the Capability to Care for HIV-Exposed Children Assessment Scale.

Results:

there was a high capability to feed (76.6%), both for milk (85.0%) and comple-mentary (65%) feeding. For the milk feeding, accessing the health unit in any situation (p=0.003), having other child exposed to HIV (p=0.013), maintaining the follow-up in the health service (p=0.048) and not consuming alcohol (p=0.045) influenced on the higher probability of the caregiver to present high capability, while residing in the peri-urban area (p=0.002) indicated moderate capability. For the complementary feeding, the higher the schooling (p=0.025), the number of appointments scheduled for the child (p=0.045) and the child being followed up in the health service (p=0.035), the higher the probability of obtaining high capability.

Conclusions:

the exposure of social and clinical factors of caregivers influences the ability to feed. To ensure adequate nutrition, it is necessary for the health services to be able to consider the geo-socio-cultural characteristics of families in the elaboration of guidelines.

Key words
HIV; Infectious disease transmission; Family; Infant nutrition

Variables	N=72	%
Exposure to breast milk.
Yes	6	8.3
No	66	91.7
Type of milk feeding
Cow's milk	27	37.5
Infant formula	42	58.3
Cow's milk and infant formula	3	4.2
Frequency of milk feeding*
Adequate	46	63.9
Inadequate	26	36.1
Complementary feeding
Yes	60	83.3
No	12	16.7
Frequency of complementary feeding^* * Rated according to ministerial recommendations.15 +n=60. ⁺
Adequatete	19	31.6
Inadequate	41	68.4

Variables	Never		Rarely		Sometime		Often		Always
Variables	n	%	n	%	n	%	n	%	n	%
Aspects related to milk feeding (n=72)
Child was breastfed by another woman^* * considered for the sum with inverted scores.	69	95.8	1	1.4	2	2.8	-	-	-	-
Dilutes the milk as recommended for the age or by professional guidance	2	2.8	-	-	-	-	-	-	70	97.2
Offers milk according to age or professional recommendation	5	6.9	-	-	9	12.5	1	1.4	57	79.2
Shares the child's milk can with others^* * considered for the sum with inverted scores.	69	95.8	-	-	1	1.4	-	-	2	2.8
When the child does not drink the milk immediately after preparation, uses it within two hours	25	34.7	2	2.8	7	9.7	2	2.8	36	50
When leaving the house, takes boiled, filtered or mineral water to prepare the milk when feeding the child	7	9.7	6	8.4	-	-	1	1.4	58	80.5
When leaving the house, take boiled, filtered or mineral water to give to the child	17	23.6	-	-	5	6.9	3	4.2	47	65.3
Before preparing the milk, observes the conditions of the can and the expiry date	6	8.4	3	4.2	-	-	-	-	63	87.4
Before preparing the milk, washes hands with soap and water	2	2.4	3	4.2	10	14	-	-	57	79.6
Aspects related to complementary feeding (n=60)
Introduces food as recommended for the age or by professional guidance	13	21.6	2	3.2	5	8.3	1	1.6	39	65.3
Offers meals according to age or professional guidance	13	21.6	2	3.2	6	10.0	5	8.3	34	56.9
Adds sugar to the food^* * considered for the sum with inverted scores.	35	58.6	6	10.0	9	15.0	2	3.2	8	13.2
Offers ultra-processed foods^* * considered for the sum with inverted scores.	25	41.6	5	8.3	21	35.1	3	5.0	6	10.0
Liquefies the baby food^* * considered for the sum with inverted scores.	38	63.6	3	5.0	10	16.6	1	1.6	8	13.2
Offers scraped or mashed fruits	14	23.2	1	1.6	10	16.6	3	5.0	32	53.6
Reuses the leftover food to offer later^* * considered for the sum with inverted scores.	46	76.8	-	-	3	5.0	2	3.2	9	15.0
Sanitizes fruits and vegetables under running water and sodium hypochlorite	44	73.6	1	1.6	1	1.6	-	-	14	23.2
Washes hands with soap and water before preparation	-	-	-	-	8	13.2	1	1.6	51	85.0

Socioeconomic variables of the caregiver	Capability to prepare and administer the milk feeding (dimension II)				p	Capability to prepare and administer complementary feeding (dimension III)				p
	Low / Moderate		High			Low / Moderate		High
	n	%	n	%		n	%	n	%
Age group (years)					0.941					0.362
18-27	4	14.3	24	85.7		11	47.8	12	52.2
28-37	6	16.7	30	83.3		9	29.0	22	71.0
38-47	1	12.5	7	87.5		3	50.0	3	50.0
Gender					0.716^* * Fisher's exact test.					0.573
Male	0	-	2	100.0		0	-	2	100.0
Female	11	15.7	59	84.3		23	39.6	35	60.4
Marital Status					0.809					0.304
Stable Union	9	16.7	45	83.3		15	34.1	29	65.9
Single	2	11.8	15	88.2		8	53.3	7	46.7
Divorced	0	-	1	100.0		0	-	1	100.0
Education Level					0.141					0.169
1^st-4^th grade	1	4.8	20	95.2		5	26.3	14	73.7
5^th-8^th grade	0	-	7	100.0		0	-	6	100.0
High school	7	19.4	29	80.6		12	44.4	15	55.6
College	2	33.3	2	33.3		3	50.0	3	50.0
No education	1	50.0	1	50.0		2	100.0	0	-
Family income					0.830					0.028
Nothing	1	14.3	6	85.7		3	60.0	2	40.0
<1 minimum wage	1	7.7	12	92.3		2	16.7	10	83.3
1-2 minimum wages	6	18.8	26	81.3		8	33.3	16	66.7
>2 minimum wages	3	15.0	17	85.0		9	47.4	10	52.6
Area of residence					0.002					0.345
Urban	9	15.0	51	85.0		19	38.0	31	62.0
Rural	0	-	10	100.0		1	11.1	8	88.9
Peri-urban	2	100.0	0	-		1	100.0	0	-
Employment					0.378					0.965
Registered job	2	13.3	13	86.7		5	41.7	7	58.3
Unregistered job	3	30.0	7	70.0		3	37.5	5	62.5
Unemployed	6	12.8	41	87.2		14	35.0	26	65.0
Use of alcohol					0.045^* * Fisher's exact test.					0.178
Yes	7	26.9	19	73.1		9	50.0	9	50.0
No	4	8.7	42	91.3		13	31.0	29	69.0
Use of drugs					0.059^* * Fisher's exact test.					0.870
Yes	2	66.7	1	33.3		2	66.7	1	33.3
No	9	13.0	60	67.0		20	35.1	37	64.9

Clinical variables of the caregiver and are for the child	Capability to prepare and administer the milk feeding (dimension II)				p	Capability to prepare and administer complementary feeding (dimension III)				p
	Low / Moderate		High			Low / Moderate		High
	n	%	n	%		n	%	n	%
HIV diagnosis time (years)					0.433					0.101
<1	1	11.1	8	88.9		2	28.3	5	71.4
1-5	7	23.3	23	76.7		8	32.0	17	68.0
6-10	3	14.3	18	85.7		9	47.4	10	52.6
≥11	0	-	9	100.0		2	28.6	5	71.4
Not infected	0	-	3	100.0		1	50.0	1	50.0
Maintaining their health follow-up					0.147					0.867
Hard	1	10.0	9	90.0		3	30.0	7	70.0
Intermediary	0	-	18	100.0		4	28.6	10	71.4
Easy	9	22.5	31	77.5		15	44.1	19	55.9
Not performed	1	25.0	3	75.0		0	-	2	100.0
Another child under their cares				0.423^* * Teste exato de Fisher.					0.209
Yes	8	17.0	39	83.0		17	44.7	21	55.3
No	3	12.0	22	88.0		5	22.7	17	77.3
Another child under their care					0.013					0.986
0	0	-	9	100.0		0	-	4	100.0
1	1	6.7	14	93.3		5	38.5	8	61.5
2	0	-	4	100.0		1	50.0	1	50.0
3	0	-	5	100.0		2	40.0	3	60.0
4	2	66.7	1	33.3		1	33.3	2	66.7
Child maintains health follow-up					0.117					0.035
Yes	4	17.4	19	82.6		7	38.9	11	61.1
No	7	14.3	42	85.7		15	35.7	27	64.3
Child's number of appointments					0.846					0.398
1-4	6	15.0	34	85.0		15	48.4	16	51.6
5-8	3	14.3	18	85.7		7	35.0	13	65.0
9-12	2	22.2	7	77.8		1	11.1	8	88.9
Accesses the health unit near their residence					0.314^* * Teste exato de Fisher.					0.468
Yes	6	15.6	41	84.4		16	40.0	24	60.0
No	5	12.5	20	87.5		5	14.3	15	85.7
Accesses the health unit in which situations					0.003					0.196^* * Teste exato de Fisher.
Follow-up	2	4.2	2	4.2		1	2.5	3	7.5
Vaccines	3	6.3	6	12.6		5	12.5	2	5.0
Any situation	1	2.1	33	70.6		10	25.0	19	47.5
Child has a health problem					0.467^* * Teste exato de Fisher.					0.876
Yes	1	9.1	10	90.9		4	36.4	7	63.6
No	10	16.4	51	83.6		18	36.7	31	63.3

Variables	Gross PR	Adjusted PR	p*
Marital status
Stable Union	0.83 (0.74-0.93)	0.77 (0.63-0.93)	0.010
Single	0.88 (0.74-1.05)	0.75 (0.54-1.02)	0.075
Divorced	1	-	-
HIV Diagnosis Time (years)
<1	0.88 (0.70-1.12)	0.85 (0.64-1.13)	0.285
1-5	0.76 (0.62-0.93)	0.72 (0.54-0.94)	0.018
6-10	0.85 (0.72-1.02)	0.82 (0.67-1.00)	0.059
≥11	1.00 (0.00-0.00)	0.97 (0.86-1.10)	0.671
Does not have	1	-	-
How it is to maintain the child's health follow-up
Not performed	1.22 (1.06-1.40)	1.31 (1.00-1.71)	0.044
Hard	1.03 (0.78-1.35)	1.03 (0.78-1.36)	0.793
Intermediary	1.12 (0.91-1.39)	1.11 (0.89-1.39)	0.313
Easy	1	-	-
Accesses the health unit near their residence
Yes	1.11 (0.87-1.41)	1.81 (0.91-1.52)	0.204
No	1	-	-

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[1] Author’s contribuitions

Bick MA and Cardoso de Paula C contributed to the study’s conception and design, analysis and interpretation of data, writing of the article, relevant critical review of the intellectual content and final approval of the version to be published. Ceretta PS contributed to the analysis and interpretation of the data and final approval of the version to be published.