Infant feeding practices at routine PMTCT sites, South Africa: results of a prospective observational study amongst HIV exposed and unexposed infants - birth to 9 months

Abstract

BackgroundWe sought to investigate infant feeding practices amongst HIV-positive and -negative mothers (0-9 months postpartum) and describe the association between infant feeding practices and HIV-free survival.MethodsInfant feeding data from a prospective observational cohort study conducted at three (of 18) purposively-selected routine South African PMTCT sites, 2002-2003, were analysed. Infant feeding data (previous 4 days) were gathered during home visits at 3, 5, 7, 9, 12, 16, 20, 24, 28, 32 and 36 weeks postpartum. Four feeding groups were of interest, namely exclusive breastfeeding, mixed breastfeeding, exclusive formula feeding and mixed formula feeding. Cox proportional hazards models were fitted to investigate associations between feeding practices (0-12 weeks) and infant HIV-free survival.ResultsSix hundred and sixty five HIV-positive and 218 HIV-negative women were recruited antenatally and followed-up until 36 weeks postpartum. Amongst mothers who breastfed between 3 weeks and 6 months postpartum, significantly more HIV-positive mothers practiced exclusive breastfeeding compared with HIV-negative: at 3 weeks 130 (42%) versus 33 (17%) (p < 0.01); this dropped to 17 (11%) versus 1 (0.7%) by four months postpartum. Amongst mothers practicing mixed breastfeeding between 3 weeks and 6 months postpartum, significantly more HIV-negative mothers used commercially available breast milk substitutes (p < 0.02) and use of these peaked between 9 and 12 weeks. The probability of postnatal HIV or death was lowest amongst infants living in the best resourced site who avoided breastfeeding, and highest amongst infants living in the rural site who stopped breastfeeding early (mean and standard deviations: 10.7% ± 3% versus 46% ± 11%).ConclusionsAlthough feeding practices were poor amongst HIV-positive and -negative mothers, HIV-positive mothers undertake safer infant feeding practices, possibly due to counseling provided through the routine PMTCT programme. The data on differences in infant outcome by feeding practice and site validate the WHO 2009 recommendations that site differences should guide feeding practices amongst HIV-positive mothers. Strong interventions are needed to promote exclusive breastfeeding (to 6 months) with continued breastfeeding thereafter amongst HIV-negative motherswho are still the majority of mothers even in high HIV prevalence setting like South Africa.

Infant Feeding Modes and Determinants Among HIV-1–Infected African Women in the Kesho Bora Study

“…In those sites, the EBF rate was lower than in an intervention study in KwaZulu-Natal 23 but greater than in several other studies. 24,25 Ceasing breastfeeding by 6 months seemed particularly difficult for Burkinabe women, despite free provision of a fortified infant food mix from 6 to 12 months. 14 Seventeen percent of those whose infants were HIV uninfected by 6 weeks of age still breastfed at 7 months, and several cases of weaning failure were registered due to family pressure.…”

HIV Infection, Viral Load, Low Birth Weight, and Nevirapine Are Independent Influences on Growth Velocity in HIV-Exposed South African Infants

“…Infants were categorized into the following four feeding groups at 5 wk to determine the effect of early feeding on growth: 1) EBF, defined as breast milk only (no other fluids or semisolid/solid foods) with or without prescribed medicines; 2) exclusive formula feeding, defined as commercial infant formula milk only without any breast milk; 3) mixed breastfeeding, defined as breast milk with nutritive liquids or solids; or 4) mixed formula feeding (MFF), defined as commercial infant formula milk with other nutritive liquids and solids, without breast milk (23).…”

High-risk enteric pathogens associated with HIV infection and HIV exposure in Kenyan children with acute diarrhoea

“…Potential confounders, including site, year of enrollment (2011, 2012, 2013), household income, number persons/room, and drinking water source and treatment were included stepwise in multivariable models and maintained in the final model if they changed the PR for the main exposure variable of interest (HIV or HEU) by more than 10%. Variables that we considered to plausibly be on the causal pathway between HIV and enteric pathogens included breastfeeding history (exclusive breastfeeding duration, current breastfeeding), nutritional status indicators (HAZ and WHZ) and recent CTX use [27–30]. Potential mediators were individually added to age-adjusted models.…”