Effects of cessation of breastfeeding in HIV-1-exposed, uninfected children in Malawi

Taha E. Taha, Donald Hoover, Shu Chen, Newton I. Kumwenda, Linda Mipando, Kondwani Nkanaunena, Michael C. Thigpen, Allan Taylor, Mary Glenn Fowler, Lynne M. Mofenson

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Abstract

Background. We assessed morbidity rates during short intervals that accompanied weaning and cumulative mortality among HIV-exposed, uninfected infants enrolled in the postexposure prophylaxis of infants in Malawi (PEPI-Malawi) trial. Methods. Women were counseled to stop breastfeeding (BF) by 6 months in the PEPI-Malawi trial. HIV-uninfected infants were included in this analysis starting at age 6 months. Breastfeeding and morbidity (illness and/or hospital admission and malnutrition [weight-for-age Z-score, ≤2]) were assessed during age intervals of 6-9, 9-12, and 12-15 months. BF was defined as any BF at the start and end of the interval and no breastfeeding (NBF) was defined as NBF at any time during the interval. The association of NBF with morbidity at each mutually exclusive interval was assessed using Poisson regression models controlling for other factors. Cumulative mortality among infants aged 6-15 months with BF and NBF was assessed using an extended Kaplan-Meier method. Results. At age 6 months, 1761 HIV-uninfected infants were included in the study. The adjusted rate ratios for illnesses and/or hospital admission for NBF, compared with BF, was 1.7 (P,<.0001) at 6-9months, 1.66 (P=.0001) at 9-12 months, and 1.75 (P = .0008) at 12-15 months. The rates of morbidity were consistently higher among NBF infants during each age interval, compared with BF infants. The 15 months cumulative mortality among BF and NBF children was 3.5% and 6.4% (P = .03), respectively. Conclusions. Cessation of BF is associated with acute morbidity events and cumulative mortality. Prolonged BF should be encouraged, in addition to close monitoring of infant health and provision of support services.

Original languageEnglish (US)
Pages (from-to)388-395
Number of pages8
JournalClinical Infectious Diseases
Volume53
Issue number4
DOIs
StatePublished - Aug 15 2011

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Malawi
Breast Feeding
HIV-1
Morbidity
HIV
Mortality

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Taha, T. E., Hoover, D., Chen, S., Kumwenda, N. I., Mipando, L., Nkanaunena, K., ... Mofenson, L. M. (2011). Effects of cessation of breastfeeding in HIV-1-exposed, uninfected children in Malawi. Clinical Infectious Diseases, 53(4), 388-395. https://doi.org/10.1093/cid/cir413
Taha, Taha E. ; Hoover, Donald ; Chen, Shu ; Kumwenda, Newton I. ; Mipando, Linda ; Nkanaunena, Kondwani ; Thigpen, Michael C. ; Taylor, Allan ; Fowler, Mary Glenn ; Mofenson, Lynne M. / Effects of cessation of breastfeeding in HIV-1-exposed, uninfected children in Malawi. In: Clinical Infectious Diseases. 2011 ; Vol. 53, No. 4. pp. 388-395.
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abstract = "Background. We assessed morbidity rates during short intervals that accompanied weaning and cumulative mortality among HIV-exposed, uninfected infants enrolled in the postexposure prophylaxis of infants in Malawi (PEPI-Malawi) trial. Methods. Women were counseled to stop breastfeeding (BF) by 6 months in the PEPI-Malawi trial. HIV-uninfected infants were included in this analysis starting at age 6 months. Breastfeeding and morbidity (illness and/or hospital admission and malnutrition [weight-for-age Z-score, ≤2]) were assessed during age intervals of 6-9, 9-12, and 12-15 months. BF was defined as any BF at the start and end of the interval and no breastfeeding (NBF) was defined as NBF at any time during the interval. The association of NBF with morbidity at each mutually exclusive interval was assessed using Poisson regression models controlling for other factors. Cumulative mortality among infants aged 6-15 months with BF and NBF was assessed using an extended Kaplan-Meier method. Results. At age 6 months, 1761 HIV-uninfected infants were included in the study. The adjusted rate ratios for illnesses and/or hospital admission for NBF, compared with BF, was 1.7 (P,<.0001) at 6-9months, 1.66 (P=.0001) at 9-12 months, and 1.75 (P = .0008) at 12-15 months. The rates of morbidity were consistently higher among NBF infants during each age interval, compared with BF infants. The 15 months cumulative mortality among BF and NBF children was 3.5{\%} and 6.4{\%} (P = .03), respectively. Conclusions. Cessation of BF is associated with acute morbidity events and cumulative mortality. Prolonged BF should be encouraged, in addition to close monitoring of infant health and provision of support services.",
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Taha, TE, Hoover, D, Chen, S, Kumwenda, NI, Mipando, L, Nkanaunena, K, Thigpen, MC, Taylor, A, Fowler, MG & Mofenson, LM 2011, 'Effects of cessation of breastfeeding in HIV-1-exposed, uninfected children in Malawi', Clinical Infectious Diseases, vol. 53, no. 4, pp. 388-395. https://doi.org/10.1093/cid/cir413

Effects of cessation of breastfeeding in HIV-1-exposed, uninfected children in Malawi. / Taha, Taha E.; Hoover, Donald; Chen, Shu; Kumwenda, Newton I.; Mipando, Linda; Nkanaunena, Kondwani; Thigpen, Michael C.; Taylor, Allan; Fowler, Mary Glenn; Mofenson, Lynne M.

In: Clinical Infectious Diseases, Vol. 53, No. 4, 15.08.2011, p. 388-395.

Research output: Contribution to journalArticle

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T1 - Effects of cessation of breastfeeding in HIV-1-exposed, uninfected children in Malawi

AU - Taha, Taha E.

AU - Hoover, Donald

AU - Chen, Shu

AU - Kumwenda, Newton I.

AU - Mipando, Linda

AU - Nkanaunena, Kondwani

AU - Thigpen, Michael C.

AU - Taylor, Allan

AU - Fowler, Mary Glenn

AU - Mofenson, Lynne M.

PY - 2011/8/15

Y1 - 2011/8/15

N2 - Background. We assessed morbidity rates during short intervals that accompanied weaning and cumulative mortality among HIV-exposed, uninfected infants enrolled in the postexposure prophylaxis of infants in Malawi (PEPI-Malawi) trial. Methods. Women were counseled to stop breastfeeding (BF) by 6 months in the PEPI-Malawi trial. HIV-uninfected infants were included in this analysis starting at age 6 months. Breastfeeding and morbidity (illness and/or hospital admission and malnutrition [weight-for-age Z-score, ≤2]) were assessed during age intervals of 6-9, 9-12, and 12-15 months. BF was defined as any BF at the start and end of the interval and no breastfeeding (NBF) was defined as NBF at any time during the interval. The association of NBF with morbidity at each mutually exclusive interval was assessed using Poisson regression models controlling for other factors. Cumulative mortality among infants aged 6-15 months with BF and NBF was assessed using an extended Kaplan-Meier method. Results. At age 6 months, 1761 HIV-uninfected infants were included in the study. The adjusted rate ratios for illnesses and/or hospital admission for NBF, compared with BF, was 1.7 (P,<.0001) at 6-9months, 1.66 (P=.0001) at 9-12 months, and 1.75 (P = .0008) at 12-15 months. The rates of morbidity were consistently higher among NBF infants during each age interval, compared with BF infants. The 15 months cumulative mortality among BF and NBF children was 3.5% and 6.4% (P = .03), respectively. Conclusions. Cessation of BF is associated with acute morbidity events and cumulative mortality. Prolonged BF should be encouraged, in addition to close monitoring of infant health and provision of support services.

AB - Background. We assessed morbidity rates during short intervals that accompanied weaning and cumulative mortality among HIV-exposed, uninfected infants enrolled in the postexposure prophylaxis of infants in Malawi (PEPI-Malawi) trial. Methods. Women were counseled to stop breastfeeding (BF) by 6 months in the PEPI-Malawi trial. HIV-uninfected infants were included in this analysis starting at age 6 months. Breastfeeding and morbidity (illness and/or hospital admission and malnutrition [weight-for-age Z-score, ≤2]) were assessed during age intervals of 6-9, 9-12, and 12-15 months. BF was defined as any BF at the start and end of the interval and no breastfeeding (NBF) was defined as NBF at any time during the interval. The association of NBF with morbidity at each mutually exclusive interval was assessed using Poisson regression models controlling for other factors. Cumulative mortality among infants aged 6-15 months with BF and NBF was assessed using an extended Kaplan-Meier method. Results. At age 6 months, 1761 HIV-uninfected infants were included in the study. The adjusted rate ratios for illnesses and/or hospital admission for NBF, compared with BF, was 1.7 (P,<.0001) at 6-9months, 1.66 (P=.0001) at 9-12 months, and 1.75 (P = .0008) at 12-15 months. The rates of morbidity were consistently higher among NBF infants during each age interval, compared with BF infants. The 15 months cumulative mortality among BF and NBF children was 3.5% and 6.4% (P = .03), respectively. Conclusions. Cessation of BF is associated with acute morbidity events and cumulative mortality. Prolonged BF should be encouraged, in addition to close monitoring of infant health and provision of support services.

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DO - 10.1093/cid/cir413

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