Hospitalization and Mortality Among Primarily Nonbreastfed Children During a Large Outbreak of Diarrhea and Malnutrition in Botswana, 2006

Abstract

Most of the severe morbidity and mortality in this outbreak occurred in children who were HIV negative and not breastfed. Feeding and nutritional factors were the most important determinants of severe illness and death. Breastfeeding is critical to infant survival in the developing world, and support for breastfeeding among HIV-negative women, and HIV-positive women who cannot formula feed safely, may prevent further high-mortality outbreaks.

Paediatric HIV testing beyond the context of prevention of mother-to-child transmission: a systematic review and meta-analysis

“…Furthermore, when examining the most commonly assessed context, paediatric inpatient facilities, both triggered and universal testing yielded high paediatric HIV prevalence. Although triggered testing identifi ed a slightly larger proportion of HIV-positive people out of those tested, this was not signifi cantly diff erent to the proportion Huang 2013 16 Ali 2007 6 Alison 2011 7 Bachou 2006 10 Cohen 2013 13 Creek 2010 14 De Maayer 2011 15 Hallbauer 2014 17 Kankasa 2009 18 McCollum 2010 19 Nansera 2012 21 Nathoo 2012 22 Obiagwu 2013 detected with universal testing. Given that both proportions are very high, universal testing seems like a reasonable option in the context of paediatric inpatient programmes.…”

“…7 Paediatric inpatient programmes were the most common context (17), 6,7,10,[13][14][15][16][17][18][19][21][22][23][24][25]29,30 followed by nutrition centres (four), 9,11,12,27 EPI centres (three), 20 programmes (three). 8,20,31 The assessment for quality showed that most of the included studies (20) [9][10][11][12][15][16][17][18][19][20][22][23][24][25][26][27][28][29][30][31] were of fair or good quality and the remainder (six) [6][7][8]13,…”

“…We did a stratifi ed analysis of paediatric HIV prevalence in southern and eastern Africa (20 studies) 8,[10][11][12][13][14][15][16][17][18][19][20][21][22][24][25][26][27]28,29 versus that in west and central Africa (four). 9,23,28,31 Paediatric HIV prevalence across contexts in southern and eastern Africa was 17·8% (95% CI 12·8-22·7) and prevalence in west and central Africa was 9·8% (95% CI 4·2-15·3).…”

“…Because of the small numbers of studies from Asia and Oceania, these geographical settings were not included in stratifi ed analyses. We did stratifi ed analysis examining universal (eight studies) 7,16,18,19,22,23,25,29 versus triggered testing (nine) 6,10,[13][14][15][16]22,24,30 in inpatient settings. Paediatric HIV prevalence detected via triggered testing (21·3%, CI 11·6-31·0) was slightly, but not signifi cantly (p=0·95), higher than that detected with universal testing (21·2%, 13·8-28·7; appendix pp 10-11).…”

The aetiology of diarrhoea, pneumonia and respiratory colonization of HIV-exposed infants randomized to breast- or formula-feeding

“…[24][25][26] This study was undertaken before a large outbreak of diarrhoeal disease in infants in Botswana which coincided with heavy rains and found that cryptosporidium and entero-pathogenic E. coli were common, and formulafeeding was strongly associated with infant mortality. 27 As far as we know, this is the first study to use molecular techniques to test for multiple viral and atypical pathogens and compare the organisms associated with pneumonia by both infant HIV infection and randomized feeding status. No significant differences among viral and atypical organisms by infant HIV-status or feeding strategy were found, although our study was designed to be descriptive and may not have had the power to detect differences.…”