title: Heat treatment of expressed breast milk is a feasible option for feeding HIV-exposed, uninfected children after 6 months of age in rural Zimbabwe.
abstract: In the context of a prevention of mother to child transmission of HIV program promoting exclusive breast-feeding (EBF) to 6 mo and offering HIV-PCR testing at approximately 6 mo, we ascertained the feasibility of expressing and heat-treating (EHT) all breast milk fed to HIV-exposed, uninfected infants following 6 mo of EBF. Twenty mother-baby pairs were enrolled from a hospital in rural Zimbabwe. Research nurses provided lactation, EHT, and complementary feeding counseling through 21 home visits conducted over an 8-wk period and collected quantitative and qualitative data on the mothers' EHT experiences, children's diets, and anthropometric measurements. Mothers kept daily logs of EHT volumes and direct breast-feeding episodes. Mothers successfully initiated and sustained EHT for 4.5 mo (range, 1-11 mo), feeding 426 +/- 227 mL/d (mean +/- SD). By wk 2 of follow-up, children were receiving EHT and Nutributter-enriched complementary foods that satisfied 100% of their energy requirements. During the 8-wk follow-up period, no growth faltering was experienced [changes in weight-for-age, weight-for-length, and length-for-age Z scores = +0.03 +/- 0.50; +0.77 +/- 1.59; and +0.02 +/- 0.85 (mean +/- SD), respectively]. Stigma was not a major deterrent, likely due to a social marketing campaign for EBF that promoted EHT as a practice to sustain breast-feeding for all women. This study provides evidence that resource-poor rural women can initiate and sustain EHT given family and health systems support. EHT provides a strategy for improving the diets of HIV-exposed but uninfected children after direct breast-feeding has ceased.
authors.affiliation: Zvitambo Project, Harare, Zimbabwe.
authors.forename: Mduduzi N N
authors.initials: MN
authors.lastname: Mbuya
authors.forename: Jean H
authors.initials: JH
authors.lastname: Humphrey
authors.forename: Florence
authors.initials: F
authors.lastname: Majo
authors.forename: Bernard
authors.initials: B
authors.lastname: Chasekwa
authors.forename: Alison
authors.initials: A
authors.lastname: Jenkins
authors.forename: Kiersten
authors.initials: K
authors.lastname: Israel-Ballard
authors.forename: Monica
authors.initials: M
authors.lastname: Muti
authors.forename: Keriann H
authors.initials: KH
authors.lastname: Paul
authors.forename: Rufaro C
authors.initials: RC
authors.lastname: Madzima
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Moulton
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stoltzfus
mesh_terms: D001827:Body Height; D004279:DNA, Viral / Q000032:analysis; D002149:Energy Intake; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission*; D006266:Health Education; D006358:Hot Temperature; D006801:Humans; D007223:Infant; D007225:Infant Food; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007774:Lactation; D008297:Male; D008895:Milk, Human / Q000821:virology*; D009753:Nutritive Value; D016133:Polymerase Chain Reaction; D012424:Rural Population; D015430:Weight Gain; D015030:Zimbabwe
chemical_list: D004279:DNA, Viral