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Abstract
Diarrhea morbidity and mortality increases with weaning prior to 6 months among uninfected infants born to HIV-infected mothers in Zambia
A. Fawzy1, S. Arpadi1, G. Aldrovandi2, C. Kankasa3, M. Sinkala4, M. Mwiya3, D. Thea5, L. Kuhn1, Zambia Exclusive Breastfeeding Study Group
Background: Early weaning is recommended to reduce HIV transmission but may have deleterious consequences for the well-being of uninfected infants. Here we evaluate the effects of early weaning on diarrhea morbidity and mortality.
Methods: As part of a trial in Lusaka, Zambia, HIV-infected mothers were randomly assigned to exclusive breastfeeding for 4 months followed by rapid weaning to study-provided replacement foods or to exclusive breastfeeding for 6 months followed by introduction of complementary foods and continued breastfeeding for a duration of the mother's choice. Morbidity and mortality attributable to diarrhea was assessed in 593 HIV-uninfected singletons alive and still breastfeeding at 4 months. Diarrheal episodes since last visit assessed by maternal report, and diarrhea-related hospitalizations or deaths were determined. Intent to treat and analyses based on actual feeding practices were conducted using regression methods with adjustment for potential confounders.
Results: Diarrhea was rare in the first four months (< 10%) but steadily increased from 10.3% at 4.5 months to 40.4% at 9 months, remaining high until 15 months, then declining to 23.2% by 24 months. The risk of diarrhea was 1.8-fold (1.3-2.4) higher between 4-6 months in the intervention group. Based on actual practice, those who weaned had a 3-fold (2.3-4.0) increased risk of diarrhea between 4-6 months. Compared to those who breastfed exclusively, weaned infants had a 3.5-fold (2.6-4.7) increased risk of diarrhea and non-exclusively breastfed infants a 2.5-fold (1.7-3.8) increased risk between 4-6 months. Children who weaned were 4.9-fold (1.4-17.4) more likely to be hospitalized for or die from diarrheal illness during the first six months of life. All these associations persisted after adjusting for potential confounders.
Conclusions: Early weaning poses substantial risk for uninfected infants, despite the provision of education and replacement foods, and is associated with a more than 3-fold increased risk of severe morbidity and diarrhea-related deaths.
5th IAS Conference on HIV Pathogenesis and Treatment
Abstract no.
TUAC104
Suggested Citation
"A.Fawzy, et al.
Diarrhea morbidity and mortality increases with weaning prior to 6 months among uninfected infants born to HIV-infected mothers in Zambia .
:
5th IAS Conference on HIV Pathogenesis and Treatment:
Abstract no.
TUAC104 "
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