Promotion of WHO Feeding Recommendations: A Model Evaluating the Effects on HIV-Free Survival in African Children

Abstract

In Africa, HIV and feeding practices deeply affect child mortality. To prevent mother-to-child transmission, the World Health Organization recommends exclusive breastfeeding for 6 months and replacement feeding when acceptable, feasible, affordable, and sustainable. Determining the proportion and number of children saved with exclusive breastfeeding and replacement feeding is essential to design and implement crucial nationwide policies. Using data on 31 sub-Saharan countries and a decision tree for risk assessment, the authors estimated the number of children's lives potentially saved according to 6 scenarios that combine exclusive breastfeeding for 6 months or replacement feeding with 3 promotion strategies. Among all HIV-negative children born to HIV-positive mothers who die in sub-Saharan Africa per year, 52 315 (9.6%) would be saved yearly with exclusive breastfeeding versus 21 638 (4.0%) with replacement feeding. Promotion support would double these numbers (110 625 vs 45 330; ie, 20.3% vs 8.3%), and with additional prenatal group education, 132 633 versus 54 192 lives would be saved (24.3% vs 9.9%). Wherever replacement feeding is not possible, exclusive breastfeeding with promotion support and prenatal group education would save 1 of 4 exposed children. J Hum Lact . 24(2):140-149.

En África, el VIH y las prácticas de lactancia materna afectan profundamente la mortalidad infantil. Para prevenir la transmisión madre-hijo, la OMS recomienda lactancia materna exclusiva durante 6 meses (LME) y alimentación de sustitución (AS) cuando sea aceptable, factible, asequible, sostenible y segura. Determinar la proporción de niños que se salvan con LME y AS es esencial para diseñar e implementar pólizas cruciales a nivel nacional. Se usaron datos de 31 países de la región del sub-Sahara y el modelo de decisión por evaluación de riesgo, estimamos números potenciales de salvar vidas infantiles en 6 áreas que combinan LME por 6 meses o AS con tres estrategias de promoción. Entre todos los niños VIH negativos, nacidos de madres VIH positivas, que murieron en África Sub-Sahara por año, 52,315 (9.6%) se pondrían salvar al año con LME vs 21,638 (4.0%) con AS. La promoción de apoyo puede duplicar estos números (110,625 vs 45,330; i.e., 20.3% vs 8.3%), y además con grupos educativos prenatales, 132,633 vs 54,192 vidas se podrían salvar (24.3 vs 9.9%). Si la alimentación de sustitución no es posible, la lactancia materna exclusiva con promoción de apoyo y grupos educativos prenatales pueden salvar uno de 4 niños expuestos.

Keywords

infant nutrition HIV infections infant mortality disease-free survival decision trees

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