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Number and percentage of HIV-exposed infants who are exclusively breastfeeding at DPT3 visit

Export Indicator

Number and percentage of HIV-exposed infants who are exclusively breastfeeding at DPT3 visit
What it measures

Feeding of HIV-exposed infants, derived from 24-h recall, measured at the time of the third dose of diphtheria, pertussis and tetanus vaccine (DPT3), which is often around 3 months of age or at the closest visit after 3 months.
Infant feeding practices can also be stratified using “percentage of HIV-exposed infants who are receiving replacement feeding at DPT3 visit” and the “percentage of HIV-exposed infants who are receiving mixed feeding at DPT3 visit”.

Rationale

HIV can be transmitted during breastfeeding even in settings where 100% of HIV-infected pregnant women receive either lifelong antiretroviral therapy or antiretroviral medicines as prophylaxis for the prevention of mother-to-child transmission of HIV. Mixed feeding before 6 months of age increases the risk for HIV transmission when compared with exclusive breastfeeding. WHO therefore recommends that when mothers known to be HIV-infected breastfeed, they should be given ARVs to reduce the risk of transmission and also exclusively breastfeeding for the first 6 months, introduce complementary feeds from 6 months and continue breastfeeding until 12 months of age. Coverage with the third dose of diphtheria, pertussis and tetanus vaccine close to the recommended age of 14 weeks is relatively high in most countries. It is proposed to collect data at this time because most infants are seen then and it is mid-way between birth and the time at which exclusive breastfeeding would stop, making it comparable to the way that exclusive breastfeeding is usually reported for the general population in demographic and health surveys.

Numerator

Number of HIV-exposed infants who were exclusively breastfeeding at or around the DPT3 visit

Denominator

Infants will be aged around 3 months or more. The denominator is the same for all three indicators: the number of HIV-exposed infants whose feeding practice has been assessed at a DPT3 visit.

Calculation

Numerator / Denominator

Method of measurement

The numerators are calculated from national programme records aggregated from facility registers.
Ideally, data from appropriate sites and registers such as a stand-alone or integrated HIV-exposed infant registers should be aggregated, depending on where the services are and where data are recorded.
At each visit, the health-care provider should enquire about infant-feeding practices during the previous 24 hours, by asking: “What did you give your infant to eat or drink yesterday during the day and during the night?”
After each response, the health provider should ask: “Anything else?” The response will be recorded as exclusive breastfeeding, replacement feeding or mixed feeding. While this information is collected and recorded on the child health card at every visit, providers should record it in the register only once, during the third visit for diphtheria, pertussis and tetanus vaccination. This record will be used for compilation and reporting to national level. In settings where HIV-exposed infants are seen in HIV care and treatment facilities, data should be collected at a visit when the infant is around 3 months The denominator is calculated from the total number of exposed infants whose feeding was assessed. Exposed infants who did not attend facilities are not included in the denominator. All public, private and nongovernmental organization-run health facilities that provide HIV-exposed infant follow-up services should be included.
In countries where follow-up care for HIV-exposed infants has been integrated into community outreach services, a system for collecting data at community level should be established for this indicator.
Countries may wish to consider collecting this information at other times, for example at both 6 weeks and 6 months. They may also wish to calculate the indicators with different denominators, such as the estimated number of HIV-exposed infants who should have received follow-up care.

Measurement frequency

Annual

Disaggregation
Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

The indicators measure progress in safer infant-feeding practices by HIV-infected women. They can also be used to indicate the quality of counselling on infant feeding (low rates of mixed feeding are likely to indicate adequate counselling and support) and to model the effect of the intervention in a country (see core indicator 10). The indicators give no information about the quality of the replacement feeding given or the effect of the feeding practices on child survival. The information can be compared with that from population surveys (e.g. demographic and health surveys) to monitor infant-feeding practices in the general population.
The indicators may not reflect the actual distribution of feeding practices for HIV-exposed infants at national level, as they do not include HIV-exposed infants who have died, infants whose exposure status is unknown or HIV-exposed infants whose mothers did not attend a facility with their infant for the third dose of diphtheria, pertussis and tetanus vaccine or for another reason at or around 3 months.

Further information

Taking stock of maternal, newborn, and child survival: 2000–2010 decade report annex. Geneva: WHO; 2010. Available from: http://www.countdown2015mnch.org/documents/2010report/CountdownAnnexes.pdf.
WHO Guidelines on HIV and infant feeding 2010. Geneva: WHO; 2010. Available from: http://whqlibdoc.who.int/publications/2010/9789241599535_eng.pdf
Measure Evaluation PRH, Family Planning and Reproductive Health Indicators Database. Available from: https://www.cpc.unc.edu/measure/prh/rh_indicators/specific/bf/proportion...
Monitoring and Evaluating the Prevention of Mother-to-Child Transmission of HIV: A guide for national programmes. Towards the Elimination of Mother-to-Child Transmission, 2011. Available at: http://www.who.int/hiv/pub/me/en/index.html.