Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Survival of infants born to HIV-positive mothers, by feeding modality, in Rakai, Uganda

TitleSurvival of infants born to HIV-positive mothers, by feeding modality, in Rakai, Uganda
Publication TypeJournal Article
Year of Publication2008
AuthorsKagaayi, J, Gray, RH, Brahmbhatt, H, Kigozi, G, Nalugoda, F, Wabwire-Mangen, F, Serwadda, D, Sewankambo, N, Ddungu, V, Ssebagala, D, Sekasanvu, J, Kigozi, G, Makumbi, F, Kiwanuka, N, Lutalo, T, Reynolds, SJ, Wawer, MJ
JournalPloS one
ISBN Number1932-6203
Accession Number19065270
KeywordsAdolescent, Adult, Bottle Feeding/statistics & numerical data, Breast Feeding/epidemiology, Decision Making, Disease-Free Survival, Female, Follow-Up Studies, HIV Seropositivity/epidemiology/mortality/transmission, Humans, Infant Mortality, Infant, Newborn, Infectious Disease Transmission, Vertical/prevention & control/statistics & numerical data, Kaplan-Meiers Estimate, Middle Aged, Pregnancy, Survival Rate, Uganda/epidemiology

BACKGROUND: Data comparing survival of formula-fed to breast-fed infants in programmatic settings are limited. We compared mortality and HIV-free of breast and formula-fed infants born to HIV-positive mothers in a program in rural, Rakai District Uganda. METHODOLOGY/PRINCIPAL FINDINGS: One hundred eighty two infants born to HIV-positive mothers were followed at one, six and twelve months postpartum. Mothers were given infant-feeding counseling and allowed to make informed choices as to whether to formula-feed or breast-feed. Eligible mothers and infants received antiretroviral therapy (ART) if indicated. Mothers and their newborns received prophylaxis for prevention of mother-to-child HIV transmission (pMTCT) if they were not receiving ART. Infant HIV infection was detected by PCR (Roche Amplicor 1.5) during the follow-up visits. Kaplan Meier time-to-event methods were used to compare mortality and HIV-free survival. The adjusted hazard ratio (Adjusted HR) of infant HIV-free survival was estimated by Cox regression. Seventy-five infants (41%) were formula-fed while 107 (59%) were breast-fed. Exclusive breast-feeding was practiced by only 25% of breast-feeding women at one month postpartum. The cumulative 12-month probability of infant mortality was 18% (95% CI = 11%-29%) among the formula-fed compared to 3% (95% CI = 1%-9%) among the breast-fed infants (unadjusted hazard ratio (HR) = 6.1(95% CI = 1.7-21.4, P-value < 0.01). There were no statistically significant differentials in HIV-free survival by feeding choice (86% in the formula-fed compared to 96% in breast-fed group (Adjusted RH = 2.8[95%CI = 0.67-11.7, P-value = 0.16] CONCLUSIONS/SIGNIFICANCE: Formula-feeding was associated with a higher risk of infant mortality than breastfeeding in this rural population. Our findings suggest that formula-feeding should be discouraged in similar African settings.