Survival and morbidity of breastfeeding versus formula feeding infants and young children of HIV-infected women who are on PMTCT follow up on selected hospitals in Addis Ababa, Ethiopia, 2013: a retrospective cohort study.
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Date
2013-08
Authors
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Journal ISSN
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Publisher
Addis Abeba University
Abstract
BACKGROUND: Nearly 90% of the almost half a million children who yearly become infected
with HIV through their mothers live in sub-Saharan Africa. Infant feeding in the context of HIV
is complex because of the major influence that feeding practices and nutrition have on child
survival. HIV-infected mothers face a dilemma regarding how to feed their newborn infants due
to the competing risk of HIV transmission associated with breast-feeding and the risk of
increased morbidity and mortality associated with formula feeding.
OBJECTIVE: To compare the survival and health benefits of breast feeding and formula
feeding infants and young children of HIV infected women followed the PMTCT programs.
Method: A retrospective cohort study design was employed to compare the HIV free survival of
exposed infants and young children who were on breast fed and formula fed. Data was extracted
from PMTCT registration book and exposed infants follow up card. Data were entered in Epi
info (version 3.5.3 software) and exported into SPSS version 16 and STATA version11 statistical
software for analysis. Infants and young children morbidity and HIV infection (i.e., the
complement of HIV-free survival) were compared by using Kaplan- Meier time-to-event method
and long rank test was used to compare HIV free survival between the two groups. Cox
regression analysis was used to assess the determinant factors.
RESULTS: Overall probability of HIV free survival in formula fed infants and young children
was significantly higher than breast fed infants and young children (log rank test statistics =6.13,
df=1, p=0.013). Breast fed infants and young children had four (adjusted HR =3.8, 95%CI 1.311.1)
times
higher
risks
to
acquire
HIV
infection
as
compared
to
formula
fed
infants
and
young
children.
Mothers who didn’t use any PMTCT intervention had five fold risk to transmit HIV
infection to their infants (Adjusted HR=4.8, 95%CI; 1.1-22.5). There was no statistical
significant different risk of developing any types of morbidity between the two groups (log rank
statistics =0.92, df=1, p=0.34). There were totally seven deaths of infants in both cohorts.
Conclusion and recommendations: the 18 month cumulative probability of HIV free survival
was significantly lower in the breast feeding infants and young children as compared to formula
fed infants and young children. Using formula feeding or Breastfeeding and receiving ARVs
prophylaxis should be the one that will most likely give infants the greatest chance of HIV-free
survival.
Description
Keywords
HIV-infected women ,infants , young children