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

International Breastfeeding Journal

Louise Kuhn¹  Mickey Chopra⁴  Mark Colvin²  David Sanders⁵  Debra J Jackson⁵  Tanya Doherty⁵  Ameena E Goga³ 

[1] Gertrude H. Sergievsky Center, Columbia University, 630 W 168 Street, New York, NY 10032, USA;Maromi Health Research, Inthuthuko Building (2nd Floor, HSRC), 750 Francois Rd, Durban, 4001, Private Bag X07, Dalbridge 4014, South Africa;Department of Paediatrics and Child Health, Kalafong Hospital, Pretoria, South Africa;UNICEF New York, UNICEF House, 3 United Nations Plaza, New York, NY 10017, USA;School of Public Health, University of the Western Cape, PB X17, Modderdam Road, Bellville, Cape Town 7535, South Africa

关键词: Formula Feeding;    HIV-free survival;    Breastfeeding;    HIV and Infant Feeding;    PMTCT;   

Others  :  801480
DOI  :  10.1186/1746-4358-7-4

 received in 2011-09-26, accepted in 2012-04-03,  发布年份 2012

【 摘 要 】

Background

We 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.

Methods

Infant 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.

Results

Six 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%).

Conclusions

Although 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.

【 授权许可】

   
2012 Goga et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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