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Morbidity in relation to feeding mode in African HIV-exposed, uninfected infants during the first 6 months of life: the Kesho Bora study

Morbidity in relation to feeding mode in African HIV-exposed, uninfected infants during the first 6 months of life: the Kesho Bora study
Morbidity in relation to feeding mode in African HIV-exposed, uninfected infants during the first 6 months of life: the Kesho Bora study
Background: refraining from breastfeeding to prevent HIV transmission has been associated with increased morbidity and mortality in HIV-exposed African infants.

Objective: the objective was to assess risks of common and serious infectious morbidity by feeding mode in HIV-exposed, uninfected infants ?6 mo of age with special attention to the issue of reverse causality.

Design: HIV-infected pregnant women from 5 sites in Burkina Faso, Kenya, and South Africa were enrolled in the prevention of mother-to-child transmission Kesho Bora trial and counseled to either breastfeed exclusively and cease by 6 mo postpartum or formula feed exclusively. Maternal-reported morbidity (fever, diarrhea, and vomiting) and serious infectious events (SIEs) (gastroenteritis and lower respiratory tract infections) were investigated for 751 infants for 2 age periods (0–2.9 and 3–6 mo) by using generalized linear mixed models with breastfeeding as a time-dependent variable and adjustment for study site, maternal education, economic level, and cotrimoxazole prophylaxis.

Results: reported morbidity was not significantly higher in nonbreastfed compared with breastfed infants [OR: 1.31 (95% CI: 0.97, 1.75) and 1.21 (0.90, 1.62) at 0–2.9 and 3–6 mo of age, respectively]. Between 0 and 2.9 mo of age, never-breastfed infants had increased risks of morbidity compared with those of infants who were exclusively breastfed (OR: 1.49; 95% CI: 1.01, 2.2; P = 0.042). The adjusted excess risk of SIEs in nonbreastfed infants was large between 0 and 2.9 mo (OR: 6.0; 95% CI: 2.2, 16.4; P = 0.001). Between 3 and 6 mo, the OR for SIEs was sensitive to the timing of breastfeeding status, i.e., 4.3 (95% CI: 1.2, 15.3; P = 0.02) when defined at end of monthly intervals and 2.0 (95% CI: 0.8, 5.0; P = 0.13) when defined at the beginning of intervals. Of 52 SIEs, 3 mothers reported changes in feeding mode during the SIE although none of the mothers ceased breastfeeding completely.

Conclusions: not breastfeeding was associated with increased risk of serious infections especially between 0 and 2.9 mo of age. The randomized controlled trial component of the Kesho Bora study was registered at Current Controlled Trials (www.controlled-trials.com) as ISRCTN71468401
0002-9165
1559-1568
Bork, K.A.
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Cournil, A.
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Read, J.S.
4112bc5e-37ca-46ce-8fe9-34695605e651
Newell, M.L.
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Cames, C.
7b12f275-420f-483f-a764-d5cdb5cfd42c
Meda, N.
026c6876-e9a7-4511-965e-512a4cc00d65
Luchters, S.
f45e9ce6-a602-4af1-b101-6eb188f62b13
Mbatia, G.
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Naidu, K.
d73b5b8a-fbfe-41cc-935e-ec4940de1173
Gaillard, P.
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de Vincenzi, I.
920d517a-517f-4e63-8329-0462a9c69f43
Bork, K.A.
1a01829f-3ba0-4223-a019-e8f4998208f5
Cournil, A.
ef22ffea-a017-4e77-b6b6-7577d8ddb235
Read, J.S.
4112bc5e-37ca-46ce-8fe9-34695605e651
Newell, M.L.
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Cames, C.
7b12f275-420f-483f-a764-d5cdb5cfd42c
Meda, N.
026c6876-e9a7-4511-965e-512a4cc00d65
Luchters, S.
f45e9ce6-a602-4af1-b101-6eb188f62b13
Mbatia, G.
1780ee64-1b87-45f0-b466-db63180d46d9
Naidu, K.
d73b5b8a-fbfe-41cc-935e-ec4940de1173
Gaillard, P.
88a20bd6-7e0c-4c5d-8303-1c1c7c3e0efe
de Vincenzi, I.
920d517a-517f-4e63-8329-0462a9c69f43

Bork, K.A., Cournil, A., Read, J.S., Newell, M.L., Cames, C., Meda, N., Luchters, S., Mbatia, G., Naidu, K., Gaillard, P. and de Vincenzi, I. (2014) Morbidity in relation to feeding mode in African HIV-exposed, uninfected infants during the first 6 months of life: the Kesho Bora study. American Journal of Clinical Nutrition, 100, 1559-1568. (doi:10.3945/ajcn.113.082149).

Record type: Article

Abstract

Background: refraining from breastfeeding to prevent HIV transmission has been associated with increased morbidity and mortality in HIV-exposed African infants.

Objective: the objective was to assess risks of common and serious infectious morbidity by feeding mode in HIV-exposed, uninfected infants ?6 mo of age with special attention to the issue of reverse causality.

Design: HIV-infected pregnant women from 5 sites in Burkina Faso, Kenya, and South Africa were enrolled in the prevention of mother-to-child transmission Kesho Bora trial and counseled to either breastfeed exclusively and cease by 6 mo postpartum or formula feed exclusively. Maternal-reported morbidity (fever, diarrhea, and vomiting) and serious infectious events (SIEs) (gastroenteritis and lower respiratory tract infections) were investigated for 751 infants for 2 age periods (0–2.9 and 3–6 mo) by using generalized linear mixed models with breastfeeding as a time-dependent variable and adjustment for study site, maternal education, economic level, and cotrimoxazole prophylaxis.

Results: reported morbidity was not significantly higher in nonbreastfed compared with breastfed infants [OR: 1.31 (95% CI: 0.97, 1.75) and 1.21 (0.90, 1.62) at 0–2.9 and 3–6 mo of age, respectively]. Between 0 and 2.9 mo of age, never-breastfed infants had increased risks of morbidity compared with those of infants who were exclusively breastfed (OR: 1.49; 95% CI: 1.01, 2.2; P = 0.042). The adjusted excess risk of SIEs in nonbreastfed infants was large between 0 and 2.9 mo (OR: 6.0; 95% CI: 2.2, 16.4; P = 0.001). Between 3 and 6 mo, the OR for SIEs was sensitive to the timing of breastfeeding status, i.e., 4.3 (95% CI: 1.2, 15.3; P = 0.02) when defined at end of monthly intervals and 2.0 (95% CI: 0.8, 5.0; P = 0.13) when defined at the beginning of intervals. Of 52 SIEs, 3 mothers reported changes in feeding mode during the SIE although none of the mothers ceased breastfeeding completely.

Conclusions: not breastfeeding was associated with increased risk of serious infections especially between 0 and 2.9 mo of age. The randomized controlled trial component of the Kesho Bora study was registered at Current Controlled Trials (www.controlled-trials.com) as ISRCTN71468401

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Published date: December 2014
Organisations: Faculty of Medicine

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Local EPrints ID: 379613
URI: http://eprints.soton.ac.uk/id/eprint/379613
ISSN: 0002-9165
PURE UUID: 2d8e0b28-28a2-465a-af5f-70ec7d7a00ac
ORCID for M.L. Newell: ORCID iD orcid.org/0000-0002-1074-7699

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Date deposited: 06 Aug 2015 11:06
Last modified: 05 Nov 2019 01:37

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Contributors

Author: K.A. Bork
Author: A. Cournil
Author: J.S. Read
Author: M.L. Newell ORCID iD
Author: C. Cames
Author: N. Meda
Author: S. Luchters
Author: G. Mbatia
Author: K. Naidu
Author: P. Gaillard
Author: I. de Vincenzi

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