Effectiveness of the WHO/UNICEF guidelines on infant feeding for HIV-positive women: results from a prospective cohort study in South Africa
Abstract
BACKGROUND: The World Health Organization (WHO) and UNICEF recommend that HIV-positive women should avoid all breastfeeding only if replacement feeding is acceptable, feasible, affordable, sustainable and safe. Little is known about the effectiveness of the implementation of these guidelines in developing country settings. OBJECTIVE: To identify criteria to guide appropriate infant-feeding choices and to assess the effect of inappropriate choices on infant HIV-free survival. METHOD: Prospective cohort study of 635 HIV-positive mother-infant pairs across three sites in South Africa to assess mother to child transmission of HIV. Semistructured questionnaires were used during home visits between the antenatal period and 36 weeks after delivery to collect data concerning appropriateness of infant feeding choices based on the WHO/UNICEF recommendations. RESULTS: Three criteria were found to be associated with improved infant HIV-free survival amongst women choosing to formula feed: piped water; electricity, gas or paraffin for fuel; and disclosing HIV status. Using these criteria as a measure of appropriateness of choice: 95 of 311 women who met the criteria (30.5%) chose to breastfeed and 195 of 289 women who did not meet the criteria (67.4%) chose to formula feed. Infants of women who chose to formula feed without fulfilling these three criteria had the highest risk of HIV transmission/death (hazard ratio, 3.63; 95% confidence interval, 1.48-8.89). CONCLUSIONS: Within operational settings, the WHO/UNICEF guidelines were not being implemented effectively, leading to inappropriate infant-feeding choices and consequent lower infant HIV-free survival. Counselling of mothers should include an assessment of individual and environmental criteria to support appropriate infant-feeding choices.
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Household piped water was one of the three stability factors needed to reduce HIV transmission for newborn infants.
“Household piped water was one of the three stability factors needed to reduce HIV transmission for newborn infants (Doherty et al., 2007).”
From A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health (2020) · cites this paper as Doherty et al., 2007
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A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health
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- Authors
- Doherty, T., Chopra, M., Jackson, D., Goga, A., Colvin, M., & Persson, L.-A.
- Affiliations
- Uppsala University (SE)
- University of the Western Cape (ZA)
- Columbia University (US)
- Centre for AIDS Development, Research and Evaluation (ZA)
- Corresponding author
- Doherty, Tanya
- Venue
- AIDS
- Published
- 2007-08-20
- Volume
- 21
- Issue
- 13
- Pages
- 1791-1797
- ISSN
- 0269-9370 (ISSN-L)
- OpenAlex
- W1993806523
- Cited by
- 118
- References
- 18
- Citations by year
- 2025: 1 · 2022: 4 · 2021: 3 · 2020: 5 · 2019: 7 · 2018: 5 · 2017: 4 · 2016: 6 · 2015: 10 · 2014: 4 · 2013: 5 · 2012: 8
- FWCI
- 9.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- AIDS (publishedVersion)
- PubMed (publishedVersion)
- Funders
- UNICEF
- Inyuvesi Yakwazulu-Natali
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Epidemiology › Breastfeeding Practices and Influences
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- infant feeding, HIV-positive mothers, replacement feeding, breastfeeding, mother-to-child transmission of HIV, guideline implementation, piped water, household fuel, HIV status disclosure, maternal counseling, South Africa
- MeSH terms
- Adolescent, Adult, Bottle Feeding, Breast Feeding, Choice Behavior, Developing Countries, Epidemiologic Methods, Female, Humans, Infant Nutritional Physiological Phenomena, Infant, Newborn, Socioeconomic Factors, South Africa, HIV Infections, Practice Guidelines as Topic, Infectious Disease Transmission, Vertical, Guideline Adherence
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