title: Promotion of WHO feeding recommendations: a model evaluating the effects on HIV-free survival in African children.
abstract: In Africa, HIV and feeding practices deeply affect child mortality. To prevent mother-to-child transmission, the World Health Organization recommends exclusive breastfeeding for 6 months and replacement feeding when acceptable, feasible, affordable, and sustainable. Determining the proportion and number of children saved with exclusive breastfeeding and replacement feeding is essential to design and implement crucial nationwide policies. Using data on 31 sub-Saharan countries and a decision tree for risk assessment, the authors estimated the number of children's lives potentially saved according to 6 scenarios that combine exclusive breastfeeding for 6 months or replacement feeding with 3 promotion strategies. Among all HIV-negative children born to HIV-positive mothers who die in sub-Saharan Africa per year, 52,315 (9.6%) would be saved yearly with exclusive breastfeeding versus 21,638 (4.0%) with replacement feeding. Promotion support would double these numbers (110,625 vs 45,330; ie, 20.3% vs 8.3%), and with additional prenatal group education, 132,633 versus 54,192 lives would be saved (24.3% vs 9.9%). Wherever replacement feeding is not possible, exclusive breastfeeding with promotion support and prenatal group education would save 1 of 4 exposed children.
authors.affiliation: Hospices Civils de Lyon, Service de Biostatistique, Lyon, France.
authors.forename: Sandra
authors.initials: S
authors.lastname: David
authors.forename: Fatima
authors.initials: F
authors.lastname: Abbas-Chorfa
authors.forename: Philippe
authors.initials: P
authors.lastname: Vanhems
authors.forename: Béatrice
authors.initials: B
authors.lastname: Vallin
authors.forename: Jean
authors.initials: J
authors.lastname: Iwaz
authors.forename: René
authors.initials: R
authors.lastname: Ecochard
mesh_terms: D017954:Africa South of the Sahara; D001942:Breast Feeding; D003968:Diarrhea, Infantile / Q000401:mortality*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008297:Male; D012449:Safety; D013997:Time Factors; D014944:World Health Organization