Biological and behavioural determinants

Relationship of exclusive breast-feeding to infections and growth of Tanzanian children born to HIV-infected women

Ramadhani S Mwiru^a1 c1, Donna Spiegelman^a2a3, Christopher Duggan^a1a4, Karen Peterson^a1a5a6, Enju Liu^a1, Gernard Msamanga^a7, Said Aboud^a8 and Wafaie W Fawzi^a1a2a9

^a1 Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Building II Room 320, Boston, MA 02115, USA

^a2 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

^a3 Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA

^a4 Clinical Nutrition Service, Division of GI/Nutrition, Children's Hospital, Boston, MA, USA

^a5 Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA

^a6 Human Nutrition Program, Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA

^a7 Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

^a8 Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

^a9 Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA

Abstract

Objective We examined the relationships between exclusive breast-feeding and the risks of respiratory, diarrhoea and nutritional morbidities during the first 2 years of life among children born to women infected with HIV-1.

Design We prospectively determined the incidence of respiratory illnesses, diarrhoea, fever, hospitalizations, outpatient visits and nutritional morbidities. Generalized estimating equations were used to estimate the relative risks for morbidity episodes and Cox proportional hazards models to estimate the incidence rate ratios of nutritional morbidities.

Setting Dar es Salaam, Tanzania.

Subjects The sample consisted of 666 children born to HIV-infected women.

Results The 666 children were followed for 2 years. Exclusive breast-feeding was associated with lower risk for cough (rate ratio (RR) = 0·49, 95 % CI 0·41, 0·60, P < 0·0001), cough and fever (RR = 0·44, 95 % CI 0·32, 0·60, P < 0·0001) and cough and difficulty breathing or refusal to feed (RR = 0·31, 95 % CI 0·18, 0·55, P < 0·0001). Exclusive breast-feeding was also associated with lower risk of acute diarrhoea, watery diarrhoea, dysentery, fever and outpatient visits during the first 6 months of life, but showed no effect at 6–24 months of life. Exclusive breast-feeding did not significantly reduce the risks of nutritional morbidities during the first 2 years of life.

Conclusions Exclusive breast-feeding is strongly associated with reductions in the risk of respiratory and diarrhoea morbidities during the first 6 months of life among children born to HIV-infected women.

(Received February 11 2010)

(Accepted September 20 2010)

(Online publication February 16 2011)

Keywords

• Breast-feeding;
• Morbidity;
• Tanzania

Correspondence:

^c1 Corresponding author: Email rmwiru@hsph.harvard.edu