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Diarrhea morbidity and mortality increases with weaning prior to 6 months among uninfected infants born to HIV-infected mothers in Zambia
Presented by Ashraf Fawzy (United States).
A. Fawzy1, S. Arpadi1, G. Aldrovandi2, C. Kankasa3, M. Sinkala4, M. Mwiya3, D. Thea5, L. Kuhn1, Zambia Exclusive Breastfeeding Study Group
1Columbia University - Mailman School of Public Health, New York, United States, 2Childrens Hospital, Los Angeles, United States, 3University Teaching Hospital, Lusaka, Zambia, 4Lusaka District Health Management Team, Lusaka, Zambia, 5Boston University, Boston, United States
Background: Early weaning is recommended to reduce HIV transmission but may have deleterious consequences for the well-being of uninfected infants. Here we evaluate the effects of early weaning on diarrhea morbidity and mortality.
Methods: As part of a trial in Lusaka, Zambia, HIV-infected mothers were randomly assigned to exclusive breastfeeding for 4 months followed by rapid weaning to study-provided replacement foods or to exclusive breastfeeding for 6 months followed by introduction of complementary foods and continued breastfeeding for a duration of the mother's choice. Morbidity and mortality attributable to diarrhea was assessed in 593 HIV-uninfected singletons alive and still breastfeeding at 4 months. Diarrheal episodes since last visit assessed by maternal report, and diarrhea-related hospitalizations or deaths were determined. Intent to treat and analyses based on actual feeding practices were conducted using regression methods with adjustment for potential confounders.
Results: Diarrhea was rare in the first four months (< 10%) but steadily increased from 10.3% at 4.5 months to 40.4% at 9 months, remaining high until 15 months, then declining to 23.2% by 24 months. The risk of diarrhea was 1.8-fold (1.3-2.4) higher between 4-6 months in the intervention group. Based on actual practice, those who weaned had a 3-fold (2.3-4.0) increased risk of diarrhea between 4-6 months. Compared to those who breastfed exclusively, weaned infants had a 3.5-fold (2.6-4.7) increased risk of diarrhea and non-exclusively breastfed infants a 2.5-fold (1.7-3.8) increased risk between 4-6 months. Children who weaned were 4.9-fold (1.4-17.4) more likely to be hospitalized for or die from diarrheal illness during the first six months of life. All these associations persisted after adjusting for potential confounders.
Conclusions: Early weaning poses substantial risk for uninfected infants, despite the provision of education and replacement foods, and is associated with a more than 3-fold increased risk of severe morbidity and diarrhea-related deaths.
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