INFANTS OF HUMAN IMMUNODEFICIENCY VIRUS (HIV) POSITIVE MOTHERS AT THE JOS UNIVERISTY TEACHING HOSPITAL: PATTERN OF FEEDING AND HEALTH STATUS DURING THE FIRST SIX MONTHS OF LIFE

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INFANTS OF HUMAN IMMUNODEFICIENCY VIRUS (HIV) POSITIVE MOTHERS AT THE JOS UNIVERISTY TEACHING HOSPITAL: PATTERN OF FEEDING AND HEALTH STATUS DURING THE FIRST SIX MONTHS OF LIFE

Abstract

Background : The Clinical relevance of this study rests on the fact that exclusive breastfeeding despite being the best for child survival, is a known route of HIV transmission. Formula feeding, an alternative mode of feeding, is associated with considerably morbidity and mortality. It would be necessary to assess the effect of counselling and support for HIV positive mothers on infant feeding choices and health status in such infants.

Objective: This study was therefore undertaken to document outcome in HIV infected mothers after due counselling, infant feeding choices and health status during the first six months of life as seen at JUTH.

Subjects and Methods: The subjects consisted of infants of HIV positive mothers aged 0-6 months delivered at JUTH over the period march 2003 to may 2004.The babies were products of a programme on prevention of mother to child transmission (PMTCT) of HIV. They attended the paediatric infectious diseases clinic. HIV positive pregnant women attending ANC at JUTH were adequately mobilized, educated and counselled during their antenatal visits, at their delivery and during the first 6 months, with particular reference to feeding options which were exclusive breastfeeding (EBF) and breast milk substitutes (BMS).These infants mothers were followed up from birth till six months. The mothers were given prophylactic nevirapine 200mg in labour and their babies’ syrup nevirapine 2mg/kg in the first 72hours of life. Physical examination was carried out and anthropometric measurements were taken on each infant. Three millilitres of venous blood was collected through the ante cubital vein from each baby under aseptic conditions at birth, 6 weeks, 3 months and 6 months and assayed for HIV using the polymerase chain reaction (PCR) method. History of common infections was assessed at each visit. Results: There was a total of 164 mother infant pairs recruited, 14 of the infants died before the end of study and 10 were excluded because they practised mixed feeding. The causes of death of those infants on EBF were septicaemia 2(66.7%), and one had paediatric AIDS. The commonest cause of death amongst the BMS infants was
dehydration 4 (80.0%). The mothers from the upper socioeconomic class accounted for18 (13%) of the study population, while the middle and lower class accounted for 66(47%) and 56(40%) respectively. The results from 140 survivors were subjected to analysis. The infants delivered by spontaneous vertex delivery were 112 (80.0%), 27 (19.3%) by caesarean section and 1 (0.7%) by forceps delivery. The sex distribution of the study infants was males 62 and females 78 a male female ratio of 1:1.25. From the available PCR result 16 (16.2%) were HIV positive and 83 (83.8%) negative at 6 months giving a mother-to-child transmission rate of 19.4%. In relation to the feeding choices 11 (35.5%) of infants on EBF were HIV positive and 5 (6.0%) of infants on BMS were HIV positive.(p < 0 .05).

The most common morbidity among the infants on EBF was upper respiratory tract infection (coryza) which occurred in 23 (0.59 episodes per child). The other morbidities included diarrhoea 14(0.36 episodes per child) and lower respiratory tract infection 6(0.15 episodes per child). For the infants on BMS URTI (coryza) occurred in 70(0.69 episodes per child), while diarrhoea and lower respiratory tract infections occurred in 69(0.68) and 12(0.12) episodes per child respectively. The frequencies of occurrence of URTI amongst the EBF and BMS was not statistically different, (X2=2.17 p=0.14).Occurrence of diarrhoea was significantly higher amongst the infants on BMS compared with EBF, (X2=20.51 p=0.001).LRTI was significantly more frequent among the BMS infants than EBF,(X2=20.73 p=0.001). All the illnesses recorded were not severe.

The mean weight gain for six months for the EBF male infants was 4.3 + 0.96kg and BMS males 4.2 + 0.79kg( “t” = – 0.194 p = 0.85).The six months gain in weight for EBF females and BMS females was 3.4 + 0.14kg and 3.8 + 0.5kg respectively(“t” = – 1.9 p = 0.06). Mean gain in length for EBF male was 17.2 + 1.9cm and BMS male 16. 1 + 1.5cm (“t” = 0.391 p value = 0. 70). BMS females mean gain in length 15.8±0.5cm was significantly more than EBF females 13.6 + 0.3cm (“t” = – 2.719 p = 0.01). Data on the measurements of the mean gain in mid upper arm circumference of EBF and BMS male infants showed values of 3.5±0.16cm and 3.6±0.55cm respectively with no statistically significant difference. (“t” test = – 0.427 p = 0.67).The EBF and
BMS female infants mean gain in MUAC was 3.3±0.15cm and 3.5±0.59cm respectively (“t”=-1.699 p=0.09).There was no observed statistically significant difference. The mean gain in occipito frontal circumference for EBF and BMS male infants was 8.4±0.1cm and 9.0±0.0cm respectively (“t”=165 p=0.24).For the EBF and BMS female infants the mean gain in OFC was 8.0±0.1cm and 7.7±0.2cm (“t”=-0.303 p=0.76).There was no statistically significant differences. There were no significant differences in the rate of development of the study infants.

Conclusion: It was concluded that breast milk played a potentially significant role in mother to child transmission of HIV in this population. Short period of exclusive breast feeding and replacement feeding are possible infant feeding choices for HIV positive women following adequate counselling. The use of formula to reduce HIV transmission through breastfeeding is a safe and viable option even in resource poor settings, if maternal education, a regular supply of formula (milk), and access to health care are available.

INFANTS OF HUMAN IMMUNODEFICIENCY VIRUS (HIV) POSITIVE MOTHERS AT THE JOS UNIVERISTY TEACHING HOSPITAL: PATTERN OF FEEDING AND HEALTH STATUS DURING THE FIRST SIX MONTHS OF LIFE

 

 

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