Effect of infant feeding mode and maternal nutritional supplementation on the nutrition and health of HIV positive mothers and their infants.
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Date
2012
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Abstract
Background: Breastfeeding is known to have benefits both for maternal and child health. Some
questions around the benefits and risks of breastfeeding in the presence of HIV infection still remain
unclear.
Aims: To study the effects of infant feeding mode by HIV-positive mothers, on maternal and child
health. In addition, to assess the effect of nutritional supplementation to HIV-positive lactating
mothers on nutritional and health status of mothers and their infants and on the quality of breastmilk.
Methods: The study had 2 components; a prospective study to examine the impact of infant feeding
mode on nutritional and health indices in mothers and their infants and within it a nested
randomized controlled clinical trial to study the impact of a daily 50 g soya/peanut based
supplement during breastfeeding on the above parameters. The measurements included
anthropometry; body composition indicators (using both deuterium dilution and BIA); haematology
and biochemical markers; as well as incidence rates of opportunistic infections and clinical disease
progression. Breastmilk was analysed for both macro and micronutrients. Cervical screening was
offered to all the women.
Results: AFASS criteria were fulfilled by 38.7% of the formula feeding mothers. No significant
differences between the formula feeding and breastfeeding groups in terms of haematological,
immunological and body composition changes were seen. Breastfeeding mothers had significantly
lower events with high depression scores (p=0.043). Longer duration of breastfeeding was observed
to be significantly associated with a mean increase in CD4 count (74 cells/μL) and better health
outcomes. The supplement made no significant impact on any maternal or child outcomes except for
a limited effect on mothers with low BMI, where it was significantly associated with preventing loss
of lean body mass (p=0.026). Breastfeeding infants had a significantly lower risk of diarrhoea and
hospitalisation at 3 months (p=0.006 and 0.014 respectively). Both breastfeeding and longer
duration of breastfeeding was significantly associated with better development scores and growth
parameters. Supplementation made no impact on breastmilk composition. Of the 86 mothers who
agreed for cervical screening, 27.6% had human papilloma virus infection.
Conclusions: Breastfeeding is not harmful to the mother despite the presence of HIV infection. On
the contrary we observed both breastfeeding and longer breastfeeding duration to be associated with
better maternal and child outcomes. Mothers are still choosing formula feeding inappropriately
presumably because of the availability of free formula and/or sub-optimal counseling. The new
(2010) local PMTCT guidelines based on WHO recommendations should reverse this. Food
insecurity was prevalent amongst 32% of our study population, highlighting the need to include
sustainable and empowering solutions to encounter this problem. Less sustainable solutions such as
nutritional supplementation should be targeted to the malnourished and in emergency situations.
Description
Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2012.
Keywords
Lactation--Nutritional aspects., Mothers--Nutrition., HIV-positive women., Dietary supplements., Infants--Nutrition., Theses--Paediatrics and child health.