Relationship between mortality and feeding modality among children born to HIV-infected mothers in a research setting (original) (raw)
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Bulletin of the World Health Organization, 2005
Objective To determine the association of different feeding patterns for infants (exclusive breastfeeding, predominant breastfeeding, partial breastfeeding and no breastfeeding) with mortality and hospital admissions during the first half of infancy. Methods This paper is based on a secondary analysis of data from a multicentre randomized controlled trial on immunization-linked vitamin A supplementation. Altogether, 9424 infants and their mothers (2919 in Ghana, 4000 in India and 2505 in Peru) were enrolled when infants were 18-42 days old in two urban slums in New Delhi, India, a periurban shanty town in Lima, Peru, and 37 villages in the Kintampo district of Ghana. Mother-infant pairs were visited at home every 4 weeks from the time the infant received the first dose of oral polio vaccine and diphtheria-pertussis-tetanus at the age of 6 weeks in Ghana and India and at the age of 10 weeks in Peru. At each visit, mothers were queried about what they had offered their infant to eat or drink during the past week. Information was also collected on hospital admissions and deaths occurring between the ages of 6 weeks and 6 months. The main outcome measures were all-cause mortality, diarrhoea-specific mortality, mortality caused by acute lower respiratory infections, and hospital admissions. Findings There was no significant difference in the risk of death between children who were exclusively breastfed and those who were predominantly breastfed (adjusted hazard ratio (HR) = 1.46; 95% confidence interval (CI) = 0.75-2.86). Non-breastfed infants had a higher risk of dying when compared with those who had been predominantly breastfed (HR = 10.5; 95% CI = 5.0-22.0; P < 0.001) as did partially breastfed infants (HR = 2.46; 95% CI = 1.44-4.18; P = 0.001). Conclusion There are two major implications of these findings. First, the extremely high risks of infant mortality associated with not being breastfed need to be taken into account when informing HIV-infected mothers about options for feeding their infants. Second, our finding that the risks of death are similar for infants who are predominantly breastfed and those who are exclusively breastfed suggests that in settings where rates of predominant breastfeeding are already high, promotion efforts should focus on sustaining these high rates rather than on attempting to achieve a shift from predominant breastfeeding to exclusive breastfeeding.
Breast feeding and infant mortality
Early Human Development, 1997
The evidence linking bottle feeding to infant and early childhood mortality has been reviewed. Ecological studies of national time trends in infant mortality do not parallel breast feeding trends in those countries, and indicate that falling death rates are more likely to be related to better health care facilities and social conditions. Direct studies of deaths provide some contradictory findings; meta-analyses are not informative because of the many differences in statistical and sample methodology. The methodology exhibited in most studies is more likely to have over-rather than under-estimated a relationship between bottle feeding and infant mortality. Retrospective analyses must take account of changes in feeding pattern due to early signs of illness. Prospective population studies able to account for large numbers of potential confounders provide the best estimates, especially if proportional hazards models are used. Two such studies have been carried out-both showed protective effects of breast feeding. 0 1997 Elsevier Science Ireland Ltd.
The Lancet Global Health, 2016
Background Although the benefi ts of exclusive breastfeeding for child health and survival, particularly in the post-neonatal period, are established, the independent benefi cial eff ect of early breastfeeding initiation remains unclear. We studied the association between timing of breastfeeding initiation and post-enrolment neonatal and postneonatal mortality up to 6 months of age, as well as the associations between breastfeeding pattern and mortality. Methods We examined associations between timing of breastfeeding initiation, post-enrolment neonatal mortality (enrolment 28 days), and post-neonatal mortality up to 6 months of age (29-180 days) in a large cohort from three neonatal vitamin A trials in Ghana, India, and Tanzania. Newborn babies were eligible for these trials if their mother reported that they were likely to stay in the study area for the next 6 months, they could feed orally, were aged less than 3 days, and the primary caregiver gave informed consent. We excluded infants who initiated breastfeeding after 96 h, did not initiate, or had missing initiation status. We pooled the data from both randomised groups of the three trials and then categorised time of breastfeeding initiation as: at ≤1 h, 2-23 h, and 24-96 h. We defi ned breastfeeding patterns as exclusive, predominant, or partial breastfeeding at 4 days, 1 month, and 3 months of age. We estimated relative risks using log binomial regression and Poisson regression with robust variances. Multivariate models controlled for site and potential confounders. Findings Of 99 938 enrolled infants, 99 632 babies initiated breastfeeding by 96 h of age and were included in our prospective cohort. 56 981 (57•2%) initiated breastfeeding at ≤1 h, 38 043 (38•2%) at 2-23 h, and 4608 (4•6%) at 24-96 h. Compared with infants initiating breastfeeding within the fi rst hour of life, neonatal mortality between enrolment and 28 days was higher in infants initiating at 2-23 h (adjusted relative risk 1•41 [95% CI 1•24-1•62], p<0•0001), and in those initiating at 24-96 h (1•79 [1•39-2•30], p<0•0001). These associations were similar when deaths in the fi rst 4 days of life were excluded (1•32 [1•10-1•58], p=0•003, for breastfeeding initiation at 2-23 h, and 1•90 [1•38-2•62], p=0•0001, for initiation at 24-96 h). When data were stratifi ed by exclusive breastfeeding status at 4 days of age (p value for interaction=0•690), these associations were also similar in magnitude but with wider confi dence intervals for initiation at 2-23 h (1•41 [1•12-1•77], p=0•003) and for initiation at 24-96 h (1•51 [0•63-3•65], p=0•357). Exclusive breastfeeding was also associated with the lower mortality during the fi rst 6 months of life (1-3 months mortality: exclusive vs partial breastfeeding at 1 month 1•83 [1•45-2•32], p<0•0001, and exclusive breastfeeding vs no breastfeeding at 1 month 10•88 [8•27-14•31], p<0•0001). Interpretation Our fi ndings suggest that early initiation of breastfeeding reduces neonatal and early infant mortality both through increasing rates of exclusive breastfeeding and by additional mechanisms. Both practices should be promoted by public health programmes and should be used in models to estimate lives saved. Funding Bill & Melinda Gates Foundation through a grant to the WHO.
American Journal of Clinical Nutrition, 2009
Background: Early exclusive breastfeeding (EBF) is recommended by the World Health Organization, but EBF rates remain low throughout the world. For infants born to breastfeeding HIV-positive mothers, early EBF is associated with a lower risk of postnatal transmission than is feeding breast milk together with other liquids or foods. No studies conducted in Africa have reported any benefits of EBF for infants born to HIV-negative women. Objective: The objective was to compare the rate of sick clinic visits by infants aged 43-182 d according to breastfeeding exclusivity [EBF, predominant breastfeeding (PBF), and mixed breastfeeding (MBF)]. Design: We compared rates of all-cause clinic visits and clinic visits related to diarrhea and lower respiratory tract infection (LRTI) among a cohort of 9207 infants of HIV-negative mothers during 2 age intervals: 43-91 and 92-182 d according to exclusivity of breastfeeding. Breastfeeding exclusivity was defined in 2 ways (''ever since birth'' and ''previous 7 d'') and was assessed at 43 and 91 d. Results: EBF between birth and 3 mo was significantly protective against diarrhea between 3 and 6 mo of age with the ''ever since birth'' definition [incidence rate ratios (IRRs) of 8.83 (95% CI: 1.07, 65.53) and 8.76 (95% CI: 1.13, 68.09) for PBF and MBF, respectively] and with the ''previous 7 d'' definition [2.04 (95% CI: 1.11, 3.77) and 2.05 (95% CI: 1.13, 3.72) for PBF and MBF, respectively]. The adverse effect of MBF on LRTI visits was weaker, reaching borderline significance only by the ''ever since birth'' definition during the 43-91-d interval (IRR: 1.91; 95% CI: 0.99, 3.67). Conclusion: Early EBF is associated with a significant reduction in sick clinic visits, especially those due to diarrhea.
International Breastfeeding Journal
Background Breastfeeding practices and their impact on infant health and survival are unquestionably of global interest. The aim of this study was to examine the link between breastfeeding initiation within one hour of birth, breastfeeding duration and childhood mortality in sub-Saharan Africa. Methods This study used data from the Demographic and Health Survey, which was conducted in 35 Sub-Saharan African countries between 2008 and 2017. Early initiation and duration of breastfeeding, food consumption indices, and infant mortality were all important variables. Analysis used percentage, median/interquartile range, and regression models (logistic, linear, Cox). Results Early initiation of breastfeeding within one hour after birth was lowest in Chad (23.0%) and highest in Burundi (85.0%). The pooled median duration of breastfeeding was 12 months. Female children had 3% significant lower odds of consuming tinned, powdered or fresh milk, compared with male children (OR 0.97; 95% CI 0.9...
Effects of Cessation of Breastfeeding in HIV-1-Exposed, Uninfected Children in Malawi
Clinical Infectious Diseases, 2011
Background. We assessed morbidity rates during short intervals that accompanied weaning and cumulative mortality among HIV-exposed, uninfected infants enrolled in the postexposure prophylaxis of infants in Malawi (PEPI-Malawi) trial. Methods. Women were counseled to stop breastfeeding (BF) by 6 months in the PEPI-Malawi trial. HIVuninfected infants were included in this analysis starting at age 6 months. Breastfeeding and morbidity (illness and/ or hospital admission and malnutrition [weight-forage Z-score, #2]) were assessed during age intervals of 6-9, 9-12, and 12-15 months. BF was defined as any BF at the start and end of the interval and no breastfeeding (NBF) was defined as NBF at any time during the interval. The association of NBF with morbidity at each mutually exclusive interval was assessed using Poisson regression models controlling for other factors. Cumulative mortality among infants aged 6-15 months with BF and NBF was assessed using an extended Kaplan-Meier method. Results. At age 6 months, 1761 HIV-uninfected infants were included in the study. The adjusted rate ratios for illnesses and/or hospital admission for NBF, compared with BF, was 1.7 (P , .0001) at 6-9 months, 1.66 (P 5 .0001) at 9-12 months, and 1.75 (P 5 .0008) at 12-15 months. The rates of morbidity were consistently higher among NBF infants during each age interval, compared with BF infants. The 15 months cumulative mortality among BF and NBF children was 3.5% and 6.4% (P 5 .03), respectively. Conclusions. Cessation of BF is associated with acute morbidity events and cumulative mortality. Prolonged BF should be encouraged, in addition to close monitoring of infant health and provision of support services.
SURVIVAL ANALYSIS OF CONTINUED BREASTFEEDING DURATION AND DETERMINANTS OF EARLY WEANING IN TANZANIA
2024
The purpose of this study was to assess the duration of breastfeeding among women of reproductive age in Tanzania and to identify determinants associated with early cessation of breastfeeding. Data for the study were drawn from the Tanzania demographic and health survey 2022. The study included mothers of 698 children from all regions. The kaplan-meier and stratified cox’s hazard model were employed for the analysis of breastfeeding-related data. The kaplan-meier survival estimate showed that the probability of mothers who continue to breastfeeding was high (90.12%) for the first month. the breastfeeding rates then declined to 38.97% at 12 months, 2.58% at 24 months and the maximum of 35 months of breastfeeding. The mean and median duration of breastfeeding in Tanzania were 10.24642 and 10 months respectively. The stratified cox regression analysis revealed that younger mothers, mothers having higher education, higher maternal parity, were significant determinants of early weaning of breastfeeding in Tanzania. Then, we recommend that the breastfeeding-promotion programs in Tanzania should give special attention to young mothers, and mothers with higher education, those who have higher parity, hence these mothers tend to breastfeed their child for a relatively shorter period of time.