1. Determinants of infant feeding intent and appropriateness of choices for formula feeding in the Djoungolo Prevention of Mother-To- Child Transmission of HIV programme, Yaounde, Cameroon (M0PDD0303) XIX AIDS Conference Washington DC,July 2012 A.E. Njom Nlend 1, B. Bagfegue Ekani 2, A. Tchouamo 2, A. Mbi 3, and the Mother & Child Djoungolo Network

2. Background The dilemma of infant feeding in HIV context of poor resource setting remains unresolved and the practice of replacement feeding can contribute to lower child survival. (De Paoli, 20, Coutsoudis 2009 Appropriate infant feeding counseling can reverse such risk as well as limiting spill-over (WHO,2010.)

3. Objective To describe infant feeding intents of HIV positive women and determine the appropriateness of choice of those opting for formula-feeding after the counseling process.

4. Methods Routine infant feeding counseling of HIV positive mother offered by short-course trained counselors during the pregnancy or in the early-post partum. Intents of formula FEEDING assessed FOR feasibility by using a generic acceptable, feasible, affordable sustainable, secure( AFASS) score composed of 7 variables grading from 0 to 2

5. Generic Score for Assessing feasibility accessibility affordability sustainability ( AFASS) score 1-Which kind of water are you using ?5- Shall you be able to prepare formula feeding and clean t Tap waterhe bottle even during the night ? PumpNo River,:streamYes not easily 2- What kind of fecal disposal is available in your houseYes easily Modern water closet 6 Which financial amount can you get monthly to buy milk Traditional latrines and attend facility appointments for the follow-up of the baby No latrines10000 FCFA/month 3- Have you disclosed your status to your husband?20000 FCFA/month No> 20000 FCFA /month Yes7- Which kind of energy do you use 4-Which reason will you give to your family if you were Wood asked to explain why you don’t breastfeed your childCharcoal Don’t knowGas Confused Each item ranking from 0 to 2 Coherent reason clearly explained Total score 14

6. Measurement % of women who had an AFASS >10 and or who fullfilled at least 4 conditions Factors predicting replacement feeding choice (univariate)

7. RESULTS (1) SOCIOECONOMICS CHARACTERISTICS OF THE COHORT N% N% MATRIMONIAL950FECAL DISPOSAL928 SINGLE32334MODERN29932 COHABITING45748TRADITIONAL69968 MARRIED17018WATER928 LEVEL OF EDUCATION890tap water84891 PRIMARY22826others (public taps, streams)819 SECONDARY56063FINANCES919 >SECONDARY10211<1000058263 PARITY92010000-2000026128 NULLIPAROUS26629≥20000768 MULTIPAROUS65471source of energy927 FEEDING OF PREVIOUS CHILD660Wood or charcoal17219 breastfeeding32249gas71277 formula feeding9514kerosene435 mixed feeding24337Preparation BF925 OPTION CHOSEN*924yes232,5 exclusive formula feeding57863yes but not easily11512,5 exclusive breastfeeding34637yes easily78785 STATUS DISCLOSED922AFASS SCORE920 NO22825<1022324 YES69475≥1069776 Among 924 women counseled, 63% intended to formula feed their babies while 37% where planning to breastfeed. The AFASS criteria >10 was met by 87% who intend to practise formula feeding compared to 57 of those who intend to breastfeed. Inappropriate formula feeding choice ( AFASS <10) was twice likely in women counseled during post partum period as against during pregnancy ( 0R: 1,8 1.3-2.4, p=0.02).

8. RESULTS(2) Factors associated with artificial feeding intent Variable OR95%CIp-value Married1,51.08-2,250.02 Tertiary education2,171.36-3.46≤0.001 Non BF of the previous child1,81.33-2.19≤0.001 AFASS score > 10 5.043.64-6.57≤0.001 HIV status disclosed to the partner 1.682.24-2.28≤0.001

9. CONCLUSION in Djoungolo, after infant feeding counseling, replacement feeding intent is mostly appropriate fitting mother's environment and livelihood. In addition, The desire to breastfeed remains real as more than ½ women who choose to breastfeed met the conditions to practice formula feeding.

10. THANKS