title: Severe events in the first 6 months of life in a cohort of HIV-unexposed infants from South Africa: effects of low birthweight and breastfeeding status.
abstract: OBJECTIVE
  To report on risk factors for severe events (hospitalisation or infant death) within the first half of infancy amongst HIV-unexposed infants in South Africa.
  
  
  METHODS
  South African data from the multisite community-based cluster-randomised trial PROMISE EBF promoting exclusive breastfeeding in three sub-Saharan countries from 2006 to 2008 were used. The South African sites were Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal. This analysis included 964 HIV-negative mother-infant pairs. Data on severe events and infant feeding practices were collected at 3, 6, 12 and 24 weeks post-partum. We used a stratified extended Cox model to examine the association between the time to the severe event and covariates including birthweight, with breastfeeding status as a time-dependent covariate.
  
  
  RESULTS
  Seventy infants (7%) experienced a severe event. The median age at first hospitalisation was 8 weeks, and the two main reasons for hospitalisation were cough and difficult breathing followed by diarrhoea. Stopping breastfeeding before 6 months (HR 2.4; 95% CI 1.2-5.1) and low birthweight (HR 2.4; 95% CI 1.3-4.3) were found to increase the risk of a severe event, whilst maternal completion of high school education was protective (HR 0.3; 95% CI 0.1-0.7).
  
  
  CONCLUSIONS
  A strengthened primary healthcare system incorporating promotion of breastfeeding and appropriate caring practices for low birthweight infants (such as kangaroo mother care) are critical. Given the leading reasons for hospitalisation, early administration of oral rehydration therapy and treatment of suspected pneumonia are key interventions needed to prevent hospitalisation in young infants.
authors: Health Systems Research Unit, Medical Research Council, Cape Town, South Africa; School of Public Health, University of the Western Cape, Cape Town, South Africa.
authors: Tanya
authors: T
authors: Doherty
authors: Debra
authors: D
authors: Jackson
authors: Sonja
authors: S
authors: Swanevelder
authors: Carl
authors: C
authors: Lombard
authors: Ingunn M S
authors: IM
authors: Engebretsen
authors: Thorkild
authors: T
authors: Tylleskär
authors: Ameena
authors: A
authors: Goga
authors: Eva-Charlotte
authors: EC
authors: Ekström
authors: David
authors: D
authors: Sanders
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D001942:Breast Feeding; D015331:Cohort Studies; D003967:Diarrhea; D004522:Educational Status; D006678:HIV; D015658:HIV Infections; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D016016:Proportional Hazards Models; D012120:Respiration Disorders; D012307:Risk Factors; D012720:Severity of Illness Index; D013019:South Africa; D055815:Young Adult
keywords: Afrique du Sud; South Africa; Sudáfrica; allaitement maternel; bajo peso al nacer; breastfeeding; faible poids de naissance; hospitalisation; hospitalización; lactancia materna; low birthweight; nutrición; nutrition