“I am the father and head of the household, but I can’t just give commands”: Father’s involvement, roles, and support practices in care, feeding, and ART adherence for HIV exposed uninfected infants in Zambia

Abstract

Background: HIV exposed infants who are uninfected may be at risk for poorer health outcomes and often face challenges such as living in poverty. Infant care and feeding practices are especially important for these infants as they are more likely to experience stressors putting them at a higher risk for poor health and development. While prevention of mother-to-child transmission (PMTCT) programs have had success in reducing rates of transmission and increasing antiretroviral therapy (ART) adherence, they are often focused solely on mothers. Family-centered approaches have the potential to be more effective than engaging mothers solely since fathers can influence whether the mother is following optimal care and feeding practices and may either support or hinder ART adherence. Objectives: This study aimed to explore fathers' involvement in infant care and feeding, examine fathers’ views of their roles in infant care and feeding and the roles of other family members, and to assess the types of support practices fathers engage in to help with infant care, feeding, and ART adherence. Methods: Eight interviews with fathers from a larger qualitative, formative research study in Lusaka, Zambia were analyzed using thematic analysis. Results: Fathers in this study are involved in infant feeding by providing food or drink to the baby and by encouraging and supporting both breastfeeding and responsive feeding. Fathers consider play as both a way to show love to the baby and as a form of learning. Fathers engaged in a variety of care and stimulation activities. Fathers generally believe that both parents are responsible for care and feeding and fulfill a variety of roles, the most common being a provider for the family followed by encouraging or reminding mothers to breastfeed. The main types of support practices that fathers offer fall under financial or practical help and encouragement of breastfeeding and/or ART adherence. Conclusions: Fathers are involved and interested in infant care and feeding and can potentially have a positive influence on breastfeeding, responsive feeding, as well as child development. Fathers' perception of their roles aligned closely with the actual support practices they engage in to encourage or facilitate breastfeeding, stimulation activities, and ART adherence. Findings support the need for PMTCT programs that are more family-centered and utilize the promising potential of father support in improving rates of optimal care and feeding practices as well as increasing ART adherence.Bachelor of Science in Public Healt