Infant-feeding practices of mothers of known HIV status in Lusaka, Zambia.
BACKGROUND
Between 25 and 44% of mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) occurs through breastfeeding. As a result, feeding guidelines for infants of HIV-infected mothers are being formulated in many resource-poor countries. The impact of introducing these guidelines on mothers' actual feeding practices has not previously been examined. Infant-feeding practices of mothers of known HIV status who should have received advice during pre- and post-test HIV counselling were assessed and compared with those of uninfected mothers.


METHODS
Mothers of infants aged 2-12 months, 55 HIV-infected and 85 HIV-uninfected, were recruited from the HIV Family Support Unit in Lusaka, Zambia. HIV status was known to 121 of these mothers, who had all received pre- and post-test HIV counselling. Feeding practices were determined by verbal questionnaire.


RESULTS
All mothers breastfed but only 35% of infants below 4 months were exclusively breastfed (received breast milk only). HIV-infected mothers introduced fluids and weaned their infants significantly earlier than HIV-uninfected mothers (p = 0.03 and p = 0.002, respectively). Infants of HIV-infected mothers had significantly lower weight for age Z (WAZ) scores indicating poorer nutritional or health status (p = 0.004). Commercial formula milk and cow's milk were used by 36 mothers as breast milk substitutes, and were introduced at a median age of 2.5 months. Thirteen mothers gave cow's milk, and no mother added water to cow's milk (as recommended), with two adding sugar and four adding salt.


CONCLUSIONS
Infant-feeding practices of HIV-infected mothers differed significantly from HIV-uninfected mothers, and this may contribute to their poorer growth. Paradoxically these mothers feeding practice could be putting these infants at greater risk of both non-HIV-related morbidity and HIV transmission, as early introduction of foods other than breast milk may increase MTCT.
Liverpool School of Tropical Medicine, Department of Child Health, UK. aika@liverpool.ac.uk
Aika A A
AA
Omari
Chewe
C
Luo
Chipepo
C
Kankasa
Ganapati J
GJ
Bhat
James
J
Bunn
D000328:Adult; D001942:Breast Feeding / Q000009:adverse effects* / Q000523:psychology; D003657:Decision Making; D005260:Female; D017408:Guidelines as Topic; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D007223:Infant; D007225:Infant Food; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D009035:Mothers / Q000523:psychology*; D015024:Zambia