Effect of a Point‐of‐Use Water Treatment and Safe Water Storage Intervention on Diarrhea in Infants of HIV‐Infected Mothers

Abstract

To reduce mother-to-child transmission of human immunodeficiency virus (HIV) in resource-poor settings, the World Health Organization recommends exclusive breast-feeding for 6 months, followed by rapid weaning if replacement feeding is affordable, feasible, available, safe, and sustainable. In the Kisumu Breastfeeding Study (trial registration: Clinicaltrials.gov identifier NCT00146380), infants of HIV-infected mothers who received antiretroviral therapy experienced high rates of diarrhea at weaning. To address this problem, mothers in the Kisumu Breastfeeding Study were given safe water storage vessels, hygiene education, and bleach for household water treatment. We compared the incidence of diarrhea in infants enrolled before (cohort A) and after (cohort B) implementation of the intervention. Cohort B infants experienced less diarrhea than cohort A infants, before and after weaning (P < .001 and P = .047, respectively); however, during the weaning period, there were no differences in the frequency of diarrhea between cohorts (P = 0.89). Testing of stored water in cohort B homes indicated high adherence (monthly range, 80%-95%) to recommended chlorination practices. Among infants who were weaned early, provision of safe water may be insufficient to prevent weaning-associated diarrhea.

Drinking Water Quality, Feeding Practices, and Diarrhea among Children under 2 Years of HIV-Positive Mothers in Peri-Urban Zambia

“…Although the research is limited, there is promising evidence that both children born to HIV-positive mothers and PLHIV may benefit from safe drinking water and other environmental health improvements. 39,[42][43][44] In areas where the source water is of relatively good quality, such as in some of our study sites, protecting drinking water during storage may be sufficient to ensure household water quality. Safe storage containers have the potential to substantially reduce recontamination of drinking water in the household at low cost and subsequently, reduce diarrheal disease.…”

Follow-Up Study to Assess the Use and Performance of Household Filters in Zambia

“…18 Furthermore, use may be particularly high among HIV-positive mothers with young children because of increased concern and awareness of health; chlorination use has been found to be high among similar populations. 19,20 It is also possible that filter use was higher because local health staff used during the RCT continued to reside and work in the project areas after that RCT terminated.…”

Genetic Analyses of HIV-1 env Sequences Demonstrate Limited Compartmentalization in Breast Milk and Suggest Viral Replication within the Breast That Increases with Mastitis

“…MTCT through breastfeeding occurs primarily in sub-Saharan Africa, where the use of artificial infant formula is often not feasible because of cost and the associated infant mortality from infections due to the use of unsafe water and the lack of the protective effects of breast milk (19,38,51). Numerous strategies to reduce postnatal HIV-1 infection of infants while preserving the advantages of breastfeeding have been evaluated, including maternal use of combination antiretroviral therapy or infant antiretroviral prophylaxis during the period of breastfeeding (5,25,26,30,40).…”