Menu ENN Search

Effects of breastfeeding: Implications for Policies on HIV and Infant Feeding

Summary of published paper

The recognition that HIV is transmitted through breast-milk has raised important questions about strategies that promote breastfeeding in areas of high HIV prevalence. As this question is particularly relevant to emergency situations where levels of communicable diseases are often high, Field Exchange has continued to publish relevant findings on this subject (see Field Exchange 3, 8 and 9).

Theoretical models have been developed to assess the advantages and disadvantages of breastfeeding for HIV positive women as well as for women of unknown HIV status who live in areas of high HIV prevalence. These models have taken into account the risk of transmission through breastfeeding with regard to the age of the infant, the protection afforded by breast-milk against infectious disease mortality, the underlying HIV prevalence, and the rate of infant and child mortality. However, according to a recent WHO/UNAIDS1 review an important limitation of these models was the poor quantification of the relative risks for mortality associated with lack of breastfeeding. Such models used relative risk estimates ranging from 1.3 to 7.9 and no model allowed for variable levels of protection within the first year of life.

A recent study has addressed the protective effect of breastfeeding according to the age and sex of the infant, the cause of death and the education status of the mother. Information on 1223 deaths of children under two years of age was obtained from 8 studies conducted between 1980-98. It was found that protection from breast-milk declined steadily with age during infancy (5.8 for infants <2 months, 4.1 for 2-3 month olds, 2.6 for 4-5 month olds, 1.8 for 6-8 month olds and 1.4 for 9-11 month olds). In the first six months of life protection against diarrhoea was substantially greater than against deaths due to acute respiratory infection. For second year deaths, the pooled risk ratios from five of the studies ranged between 1.6-2.1. Protection was highest when maternal education was low.

The researchers recognised that observational studies of breastfeeding and infant health may be affected by a number of methodological problems including self-selection, reverse causality, i.e. feeding changes as a result of the illness, and confounding. An attempt was therefore made in the study to avoid reverse causality by recording breast-feeding before the fatal illness episode. It was also recognised that the studies used did not employ a uniform protocol for defining causes of death. Furthermore, most of the studies did not provide sufficient information on breast-feeding patterns (exclusive, predominant, or partial) to allow a pooled analysis of this variable.

Conclusions and recommendations

The authors of the study recommend that the findings on relative risk should be used in future simulations of the impact of withholding breastfeeding in HIVpositive mothers. The results will also help assess the risks and benefits associated with breastfeeding for children of different ages.

Particular attention is drawn to the higher levels of protection seen among less educated women, particularly for deaths between the ages of 6-11 months. The results are said to be consistent with the finding that infant-mortality differentials according to breastfeeding status are virtually non-existent in more developed countries where maternal education is high.

The authors suggest that the main policy issue arising out of the research is whether or not HIV positive mothers with low levels of schooling and income will be able to safely feed their infant with breast-milk substitutes.

Show footnotes

1WHO (2000) Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. WHO collaborative study team on the role of breastfeeding on the prevention of infant mortality. The Lancet, vol 355. February 5th, 2000

More like this

Resource: Infant feeding and risk of severe diarhoea in Basrah City, Iraq - A case-control study

Mahmood DA, Feachem RG, Huttly SRA. Infant feeding and risk of severe diarrhoea in Basrah City, Iraq: A case-control study. Bull WHO 1989;67(6):701-6. Country: Iraq, Setting:...

FEX: Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect

Summary of research1 Location: Global What we know: The decision not to breastfeed a child impacts on the health, nutrition and development of a child and on women's...

Resource: Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis

Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. WHO Collaborative Study Team on the Role of...

FEX: Infant feeding patterns and HIV–1 transmission

Letters in the Lancet1 In the last issue of Field Exchange we summarised an article published in the Lancet by Anna Coutsoudis and colleagues which found that there are...

FEX: Infant feeding strategies and PMTCT - Mashi trial from Botswana

Summary of published research1 Arecently published paper compares the efficacy and safety of two infant feeding strategies for the prevention of postnatal mother-to-child HIV...

Resource: Infant feeding practices in complex emergencies

O'Connor ME, Burkle FM Jr, Olness K Prehospital Disaster Med. 2001 Oct-Dec;16(4):231-8. The majority of deaths associated with complex emergencies are attributed to infants...

FEX: Early initiation of breastfeeding reduces neonatal mortality

Summary of published research1 A recently published study assessed the contribution of the timing of initiation of breastfeeding to neonatal death. The study also set out to...

FEX: Contribution of six risk factors to achieving the 25x25 non-communicable disease mortality reduction target

Summary of study1 Location: Global What we know: Non-communicable diseases (NCDs) cause more than 35 million deaths every year and account for more than half of the deaths in...

FEX: Issue 29 Editorial

There are two major themes running through this issue of Field Exchange. The first is a focus on Southern Africa and the programmatic challenges presented by HIV/AIDS and the...

FEX: Infant Feeding Alternatives for HIV Positive Mothers in Kenya

By Tom Oguta, Abiud Omwega and Jaswant Sehmi Tom Oguta is currently a PhD student of Nutrition at the University of Nairobi. He has worked as a Research Officer at KIRDI...

FEX: HIV and Child Mortality

Summary of published research1 HIV contributes substantially to child mortality, but factors underlying these deaths are inadequately described. With individual data from seven...

en-net: relationship between a summary of infants and young child feeding practices and child anthropometric outcomes

Hello, Has anyone on this platform examined the relationship between an index of infants and young child feeding practices and child anthropometric outcomes? How do you...

FEX: Effect of Breastfeeding and Formula Feeding on Transmission of HIV-1

Summary of published clinical trial Transmission of human immunodeficiency virus type 1 (HIV-1) is known to occur through breastfeeding, but the magnitude of risk has not been...

FEX: Infant Feeding Patterns and Risk of Death

Summary of published paper1 Current WHO guidelines recommend that HIV positive mothers should avoid breastfeeding only if replacement feeding is acceptable, feasible,...

FEX: Livelihood assessment approaches in emergencies

A paper and recently summarised editorial1,2 Violations of the International Code of Marketing of Breastmilk Substitutes have been previously reported in Field Exchange3. A...

FEX: Using IMRs to inform policy decisions on infant feeding and HIV

Summary of published research1 Feeding bottles in a camp in Pakistan A recently published paper presents an analysis of the impact of WHO infant feeding recommendations in...

FEX: Counselling on infant feeding choice: Some practical realities from South Africa

By Tanya Doherty (pictured), Mickey Chopra and Mike Colvin Tanya is currently a senior scientist at the Health Systems Trust and Medical Research Council in Capetown, South...

en-net: Publications on Flash heating of breastmilk

Am greatly interested in literature about flash heating of breastmilk, in the context of HIV. Are there any publications about the effectiveness and efficacy of this...

FEX: NGOnut discussion summaries - cassava poisoning, and HIV and breastfeeding

The following are edited summaries of e-mail correspondence from the NGO Nutrition Association (NGO Nut) which may be of interest to readers. The NGO Nut was recently set up...

en-net: Breastfeeding problems and food supplements. Any association?

Why is it in the SFP we find the following as admission criteria: 'Lactating women with an infant - 6 months if they have breastfeeding problems or if the infant is not...

Close

Reference this page

Effects of breastfeeding: Implications for Policies on HIV and Infant Feeding. Field Exchange 10, July 2000. p2. www.ennonline.net/fex/10/effects

(ENN_3428)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.