Criteria to Guide Appropriate Infant Feeding Choices in the Context of HIV - Implementing the Who/Unicef Guidelines in South Africa

APHA Scientific Session and Event Listing

4052.0: Tuesday, November 06, 2007 - 8:45 AM

Abstract #155993

Tanya Doherty, MPH PhD, Health Systems Trust, Riverside Centre, Main Road, Rondebosch, Cape Town, 7700, South Africa, Debra J. Jackson, MPH DSc, School of Public Health, University of the Western Cape, P.O. Box 16239, Vlaeberg, Cape Town, 8018, South Africa, 27-83-327-7331, bessrfam@iafrica.com, Mickey Chopra, MSc, Health Systems Research Unit, Medical Research Council, PO Box 19070, Parowvallei, Tygerberg, 7505, South Africa, Ameena Goga, MBCHB, Mailman School of Public Health, Columbia University, 60 Haven Avenue, #5F, New York, NY 10032, Mark Colvin, MBCHB, CADRE, 750 Francois Rd, Inthuthuko Building (2nd Floor, HSRC), Durban, 4001, South Africa, and Lars Åke Persson, Prof, International Maternal and Child Health, Uppsala University, SE 751 85, Uppsala, SE 751 85, Sweden.

BACKGROUND: WHO and UNICEF recommend that HIV positive women should avoid all breastfeeding only if replacement feeding is acceptable, feasible, affordable, sustainable and safe. We sought to identify criteria to guide appropriate infant feeding choices, and to assess the effect of inappropriate choices on infant HIV-free survival.

METHODS: A prospective cohort study of 635 HIV positive mother-infant pairs across three sites in South Africa. Data were collected during home visits using semi-structured questionnaires from antenatal through 36 weeks post-delivery. Criteria associated with the WHO/UNICEF recommendations were collected to assess appropriateness of infant feeding choices. Infant HIV status was determined by HIV DNA PCR.

RESULTS: Three criteria were found to be associated with improved infant HIV-free survival amongst women choosing to formula feed: piped water; electricity, gas or paraffin for fuel; and disclosing HIV status. Using these criteria as a measure of appropriateness of choice: 95/311 (30.5%) women who chose to breastfeed made an inappropriate choice and 195/289 (67.4%) women who chose to formula feed made an inappropriate choice. Infants of women who chose to formula feed without these three criteria had the highest risk of HIV transmission/death (HR 3.63, 95%CI 1.48-8.89). Infants of women who chose to breastfeed despite having the three criteria for appropriate formula feeding also had an increased risk of transmission/death (HR 3.35, 95% CI 1.25-8.96).

CONCLUSIONS: Within operational settings the WHO/UNICEF guidelines are not being implemented effectively leading to inappropriate infant feeding choices being made. Inappropriate choices led to lower infant HIV-free survival.

Learning Objectives:

Understand the WHO recommendations for infant feeding in the context of HIV.
To examine the quality of infant feeding counseling in South Africa.
To discuss the impact of infant feeding choices on infant HIV-free survival

Keywords: HIV/AIDS, Infant Health

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Breastfeeding Programs and Evaluation

The 135th APHA Annual Meeting & Exposition (November 3-7, 2007) of APHA