During each visit, the health provider should inquire about infant-feeding practices during the previous 24 hours and record the response as one of three types – exclusively breastfeeding, replacement feeding, or mixed feeding. While this information should be recorded at each visit, only the DPT3 vaccination visit at about 14 weeks postpartum or the closest visit after the infant is at least 3 months old should be used to calculate this indicator.  The denominator is calculated from the total number of HIV-exposed infants whose infant feeding practices were assessed. Where the data are available, the indicator can be disaggregated by province and district, urban/rural location, and type of facility (e.g., public, private, community-based).

Data Source(s):

Ideally data can be aggregated from sites and registers, such as stand-alone sites or integrated HIV service facility infant registers, depending on where the services are located and where data are recorded. Efforts should be made to include data from public, private, non-governmental, and community-based health facilities that provide HIV-exposed infant follow-up services.

Purpose:

This indicator allows the monitoring of program or country progress toward safer infant feeding practices among HIV-positive mothers and their exposed infants. It can be used as a proxy of the quality of infant feeding counseling with low rates of mixed feeding (the least healthy form) as a likely indicator of adequate counseling and support.  The information can be compared with population-based surveys, such as DHS which monitor infant-feeding in the general population. The indicator is included in the PEPFAR list of new generation indicators (PEPFAR, 2009) and the WHO/UNICEF/UNAIDS (2011) guide on indicators for monitoring the health sector response to HIV/AIDS.

Issue(s):

The indicator does not provide information about the quality of replacement feeds or the impact of infant-feeding practices on child survival. Using a 24-hour recall period to measure current status may slightly overestimate the proportion of exclusively breast-fed infants because some infants who are given other liquids or foods irregularly may not have received them in the 24 hours before the survey. The indicator may not reflect the actual feeding patterns for HIV-exposed infants at national or district levels since it does not include infants who may have already died, whose HIV status is unknown, or infants whose mothers did not attend a facility with their infants for DPT3 or at around 3 months.

PEPFAR, 2009, The President’s Emergency Plan for AIDS Relief: Next Generation Indicators Reference Guide, Washington, DC: USAID/PEPFAR.  https://www.k4health.org/toolkits/igwg-gender/president%E2%80%99s-emergency-plan-aids-relief-next-generation-indicators-reference