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BMC Public Health
Published in: BMC Public Health 1/2009

Open Access 01-12-2009 | Research article

Infant feeding among HIV-positive mothers and the general population mothers: comparison of two cross-sectional surveys in Eastern Uganda

Authors: Lars T Fadnes, Ingunn MS Engebretsen, Henry Wamani, Nulu B Semiyaga, Thorkild Tylleskär, James K Tumwine

Published in: BMC Public Health | Issue 1/2009

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Abstract

Background

Infant feeding recommendations for HIV-positive mothers differ from recommendations to mothers of unknown HIV-status. The aim of this study was to compare feeding practices, including breastfeeding, between infants and young children of HIV-positive mothers and infants of mothers in the general population of Uganda.

Methods

This study compares two cross-sectional surveys conducted in the end of 2003 and the beginning of 2005 in Eastern Uganda using analogous questionnaires. The first survey consisted of 727 randomly selected general-population mother-infant pairs with unknown HIV status. The second included 235 HIV-positive mothers affiliated to The Aids Support Organisation, TASO. In this article we compare early feeding practices, breastfeeding duration, feeding patterns with dietary information and socio-economic differences in the two groups of mothers.

Results

Pre-lacteal feeding was given to 150 (64%) infants of the HIV-positive mothers and 414 (57%) infants of general-population mothers. Exclusive breastfeeding of infants under the age of 6 months was more common in the general population than among the HIV-positive mothers (186 [45%] vs. 9 [24%] respectively according to 24-hour recall). Mixed feeding was the most common practice in both groups of mothers. Solid foods were introduced to more than half of the infants under 6 months old among the HIV-positive mothers and a quarter of the infants in the general population. Among the HIV-positive mothers with infants below 12 months of age, 24 of 90 (27%) had stopped breastfeeding, in contrast to 9 of 727 (1%) in the general population. The HIV-positive mothers were poorer and had less education than the general-population mothers.

Conclusion

In many respects, HIV-positive mothers fed their infants less favourably than mothers in the general population, with potentially detrimental effects on both the child's nutrition and the risk of HIV transmission. Mixed feeding and pre-lacteal feeding were widespread. Breastfeeding duration was shorter among HIV-positive mothers. Higher educational level and being socio-economically better off were associated with more beneficial infant feeding practices.
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Literature
1.
Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HP, Shekar M: What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008, 371 (9610): 417-440. 10.1016/S0140-6736(07)61693-6.CrossRefPubMed
2.
Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J: Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008, 371 (9608): 243-260. 10.1016/S0140-6736(07)61690-0.CrossRefPubMed
3.
Arifeen S, Black RE, Antelman G, Baqui A, Caulfield L, Becker S: Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums. Pediatrics. 2001, 108 (4): E67-10.1542/peds.108.4.e67.CrossRefPubMed
4.
Bhandari N, Bahl R, Mazumdar S, Martines J, Black RE, Bhan MK: Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomised controlled trial. Lancet. 2003, 361 (9367): 1418-1423. 10.1016/S0140-6736(03)13134-0.CrossRefPubMed
5.
Kramer MS, Kakuma R: Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev. 2002, CD003517-1
6.
Kuhn L, Stein Z, Susser M: Preventing mother-to-child HIV transmission in the new millennium: the challenge of breast feeding. Paediatr Perinat Epidemiol. 2004, 18 (1): 10-16. 10.1111/j.1365-3016.2003.00528.x.CrossRefPubMed
7.
Kuhn L, Aldrovandi GM, Sinkala M, Kankasa C, Semrau K, Mwiya M, Kasonde P, Scott N, Vwalika C, Walter J, Bulterys M, Tsai WY, Thea DM: Effects of early, abrupt weaning on HIV-free survival of children in Zambia. N Engl J Med. 2008, 359 (2): 130-141. 10.1056/NEJMoa073788.CrossRefPubMedPubMedCentral
8.
Coovadia H, Kindra G: Breastfeeding to prevent HIV transmission in infants: balancing pros and cons. Curr Opin Infect Dis. 2008, 21 (1): 11-15. 10.1097/QCO.0b013e3282f40689.CrossRefPubMed
9.
Coovadia HM, Rollins NC, Bland RM, Little K, Coutsoudis A, Bennish ML, Newell ML: Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet. 2007, 369 (9567): 1107-1116. 10.1016/S0140-6736(07)60283-9.CrossRefPubMed
10.
Iliff PJ, Piwoz EG, Tavengwa NV, Zunguza CD, Marinda ET, Nathoo KJ, Moulton LH, Ward BJ, Humphrey JH: Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. Aids. 2005, 19 (7): 699-708. 10.1097/01.aids.0000166093.16446.c9.CrossRefPubMed
11.
Nduati R, John G, Mbori-Ngacha D, Richardson B, Overbaugh J, Mwatha A, Ndinya-Achola J, Bwayo J, Onyango FE, Hughes J, Kreiss J: Effect of breastfeeding and formula feeding on transmission of HIV-1: a randomized clinical trial. Jama. 2000, 283 (9): 1167-1174. 10.1001/jama.283.9.1167.CrossRefPubMed
12.
Embree JE, Njenga S, Datta P, Nagelkerke NJ, Ndinya-Achola JO, Mohammed Z, Ramdahin S, Bwayo JJ, Plummer FA: Risk factors for postnatal mother-child transmission of HIV-1. Aids. 2000, 14 (16): 2535-2541. 10.1097/00002030-200011100-00016.CrossRefPubMed
13.
Doherty T, Chopra M, Jackson D, Goga A, Colvin M, Persson LA: Effectiveness of the WHO/UNICEF guidelines on infant feeding for HIV-positive women: results from a prospective cohort study in South Africa. AIDS. 2007, 21 (13): 1791-1797. 10.1097/QAD.0b013e32827b1462.CrossRefPubMed
14.
Leshabari SC, Blystad A, de Paoli M, Moland KM: HIV and infant feeding counselling: challenges faced by nurse-counsellors in northern Tanzania. Hum Resour Health. 2007, 5: 18-10.1186/1478-4491-5-18.CrossRefPubMedPubMedCentral
15.
Doherty T, Chopra M, Nkonki L, Jackson D, Greiner T: Effect of the HIV epidemic on infant feeding in South Africa: "When they see me coming with the tins they laugh at me". Bull World Health Organ. 2006, 84 (2): 90-96. 10.2471/BLT.04.019448.CrossRefPubMedPubMedCentral
16.
17.
Edmond KM, Zandoh C, Quigley MA, Amenga-Etego S, Owusu-Agyei S, Kirkwood BR: Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics. 2006, 117 (3): e380-386. 10.1542/peds.2005-1496.CrossRefPubMed
18.
Luo C: Evaluation of a pilot programme and a follow up study of infant feeding practices during the scaled-up programme in Botswana. Eval Program Plann. 2002, 25: 421-431. 10.1016/S0149-7189(02)00053-8.CrossRef
19.
Uganda Bureau of Statistics: Population and Housing Census Report for Uganda 2002. Entebbe: Ministry of Finance, Planning and Economic Development, Uganda. 2003
20.
Hladik W, Musinguzi J, Kirungi W, Opio A, Stover J, Kaharuza F, Bunnell R, Kafuko J, Mermin J: The estimated burden of HIV/AIDS in Uganda, 2005–2010. Aids. 2008, 22 (4): 503-510. 10.1097/QAD.0b013e3282f470be.CrossRefPubMed
21.
Engebretsen IM, Wamani H, Karamagi C, Semiyaga N, Tumwine J, Tylleskar T: Low adherence to exclusive breastfeeding in Eastern Uganda: a community-based cross-sectional study comparing dietary recall since birth with 24-hour recall. BMC Pediatr. 2007, 7: 10-10.1186/1471-2431-7-10.CrossRefPubMedPubMedCentral
22.
Thorne C, Newell ML: Prevention of mother-to-child transmission of HIV infection. Curr Opin Infect Dis. 2004, 17 (3): 247-252. 10.1097/00001432-200406000-00013.CrossRefPubMed
23.
Gaillard P, Piwoz E, Farley TM: Collection of standardized information on infant feeding in the context of mother-to-child transmission of HIV. Stat Med. 2001, 20 (23): 3525-3537. 10.1002/sim.1092.CrossRefPubMed
24.
Wamani H, Tylleskar T, Astrom AN, Tumwine JK, Peterson S: Mothers' education but not fathers' education, household assets or land ownership is the best predictor of child health inequalities in rural Uganda. Int J Equity Health. 2004, 3 (1): 9-10.1186/1475-9276-3-9.CrossRefPubMedPubMedCentral
25.
Filmer D, Pritchett LH: Estimating wealth effects without expenditure data – or tears: an application to educational enrollments in states of India. Demography. 2001, 38 (1): 115-132.PubMed
26.
Wamani H, Astrom AN, Peterson S, Tylleskar T, Tumwine JK: Infant and young child feeding in western Uganda: knowledge, practices and socio-economic correlates. J Trop Pediatr. 2005, 51 (6): 356-361. 10.1093/tropej/fmi048.CrossRefPubMed
27.
Leach A, McArdle TF, Banya WA, Krubally O, Greenwood AM, Rands C, Adegbola R, de Francisco A, Greenwood BM: Neonatal mortality in a rural area of The Gambia. Ann Trop Paediatr. 1999, 19 (1): 33-43. 10.1080/02724939992617.CrossRefPubMed
28.
Kikafunda JK, Walker AF, Collett D, Tumwine JK: Risk factors for early childhood malnutrition in Uganda. Pediatrics. 1998, 102 (4): E45-10.1542/peds.102.4.e45.CrossRefPubMed
29.
Fadnes LT, Engebretsen IM, Wamani H, Wangisi J, Tumwine JK, Tylleskar T: Need to optimise infant feeding counselling: A cross-sectional survey among HIV-positive mothers in Eastern Uganda. BMC Pediatr. 2009, 9 (1): 2-10.1186/1471-2431-9-2.CrossRefPubMedPubMedCentral
30.
31.
Becquet R, Leroy V, Ekouevi DK, Viho I, Castetbon K, Fassinou P, Dabis F, Timite-Konan M: Complementary feeding adequacy in relation to nutritional status among early weaned breastfed children who are born to HIV-infected mothers: ANRS 1201/1202 Ditrame Plus, Abidjan, Cote d'Ivoire. Pediatrics. 2006, 117 (4): e701-710. 10.1542/peds.2005-1911.CrossRefPubMedPubMedCentral
32.
33.
Victora CG, Fenn B, Bryce J, Kirkwood BR: Co-coverage of preventive interventions and implications for child-survival strategies: evidence from national surveys. Lancet. 2005, 366 (9495): 1460-1466. 10.1016/S0140-6736(05)67599-X.CrossRefPubMed
34.
Coovadia HM, Bland RM: Preserving breastfeeding practice through the HIV pandemic. Trop Med Int Health. 2007, 12 (9): 1116-1133.CrossRefPubMed
35.
Homsy J, Kalamya JN, Obonyo J, Ojwang J, Mugumya R, Opio C, Mermin J: Routine intrapartum HIV counseling and testing for prevention of mother-to-child transmission of HIV in a rural Ugandan hospital. J Acquir Immune Defic Syndr. 2006, 42 (2): 149-154. 10.1097/01.qai.0000225032.52766.c2.CrossRefPubMed
36.
Blettner M, Sauerbrei W, Schlehofer B, Scheuchenpflug T, Friedenreich C: Traditional reviews, meta-analyses and pooled analyses in epidemiology. Int J Epidemiol. 1999, 28 (1): 1-9. 10.1093/ije/28.1.1.CrossRefPubMed
37.
Bland RM, Rollins NC, Solarsh G, Broeck Van den J, Coovadia HM: Maternal recall of exclusive breast feeding duration. Arch Dis Child. 2003, 88 (9): 778-783. 10.1136/adc.88.9.778.CrossRefPubMedPubMedCentral
Metadata
Title
Infant feeding among HIV-positive mothers and the general population mothers: comparison of two cross-sectional surveys in Eastern Uganda
Authors
Lars T Fadnes
Ingunn MS Engebretsen
Henry Wamani
Nulu B Semiyaga
Thorkild Tylleskär
James K Tumwine
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2009
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-9-124

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