Evaluation of sub-Saharan African women's breastfeeding practices by HIV status: New information from Demographic and Health Surveys

The WHO recommendations for HIV-positive mothers are to exclusively breastfeed or replacement feed when replacement feeding is AFASS (Acceptable, Feasible, Affordable, Sustainable and Safe) to reduce mother-to-child transmission of HIV (MTCT). These guidelines are problematic to implement in sub-Saharan Africa due to stigma associated with not breastfeeding; non-exclusive breastfeeding norms; and low awareness of HIV status. Beyond MTCT, the issue of whether breastfeeding is harmful to the nutritional status of HIV-positive mothers is hotly contested.

Data are from nationally-representative Demographic and Health Surveys conducted between 2003-2006 in Burkina Faso, Cameroon, Ethiopia, Guinea, Ghana, Kenya, Lesotho, Malawi, Niger, Rwanda, Senegal, and Zimbabwe. Descriptive and multivariate methods were used to investigate factors associated with current breastfeeding practice and HIV status of mothers. Relationships between women's current breastfeeding practice with her body mass index (BMI) and hemoglobin levels were also investigated.

Maternal awareness of MTCT or PMTCT was associated with both exclusive and replacement breastfeeding as opposed to mixed feeding, following WHO recommendations. Both HIV-positive and –negative women were more likely to follow WHO infant feeding guidelines if they had been tested for HIV and received their results in the last 12 months.

Breastfeeding was not found to be differentially harmful to HIV-positive mother's nutritional status, either in terms of BMI or hemoglobin levels.

Results suggest areas for improvement of maternal adherence to WHO breastfeeding guidelines to reduce the risk of MTCT. This study also found no difference in the nutritional status of breastfeeding mothers according to HIV status, providing evidence to support encouragement of exclusive breastfeeding to reduce MTCT.