Omari Aika A A, Luo Chewe, Kankasa Chipepo, Bhat Ganapati J, Bunn James
Liverpool School of Tropical Medicine, Department of Child Health, UK.
Health Policy Plan. 2003 Jun;18(2):156-62. doi: 10.1093/heapol/czg020.
Between 25 and 44% of mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) occurs through breastfeeding. As a result, feeding guidelines for infants of HIV-infected mothers are being formulated in many resource-poor countries. The impact of introducing these guidelines on mothers' actual feeding practices has not previously been examined. Infant-feeding practices of mothers of known HIV status who should have received advice during pre- and post-test HIV counselling were assessed and compared with those of uninfected mothers.
Mothers of infants aged 2-12 months, 55 HIV-infected and 85 HIV-uninfected, were recruited from the HIV Family Support Unit in Lusaka, Zambia. HIV status was known to 121 of these mothers, who had all received pre- and post-test HIV counselling. Feeding practices were determined by verbal questionnaire.
All mothers breastfed but only 35% of infants below 4 months were exclusively breastfed (received breast milk only). HIV-infected mothers introduced fluids and weaned their infants significantly earlier than HIV-uninfected mothers (p = 0.03 and p = 0.002, respectively). Infants of HIV-infected mothers had significantly lower weight for age Z (WAZ) scores indicating poorer nutritional or health status (p = 0.004). Commercial formula milk and cow's milk were used by 36 mothers as breast milk substitutes, and were introduced at a median age of 2.5 months. Thirteen mothers gave cow's milk, and no mother added water to cow's milk (as recommended), with two adding sugar and four adding salt.
Infant-feeding practices of HIV-infected mothers differed significantly from HIV-uninfected mothers, and this may contribute to their poorer growth. Paradoxically these mothers feeding practice could be putting these infants at greater risk of both non-HIV-related morbidity and HIV transmission, as early introduction of foods other than breast milk may increase MTCT.
25%至44%的人类免疫缺陷病毒（HIV）母婴传播是通过母乳喂养发生的。因此，许多资源匮乏的国家正在制定针对感染HIV母亲所生婴儿的喂养指南。此前尚未研究过引入这些指南对母亲实际喂养行为的影响。对已知HIV感染状况、在HIV检测前后咨询中应已获得建议的母亲的婴儿喂养行为进行了评估，并与未感染母亲的喂养行为进行了比较。
从赞比亚卢萨卡的HIV家庭支持单位招募了年龄在2至12个月婴儿的母亲，其中55名感染HIV，85名未感染HIV。这些母亲中有121名知道自己的HIV感染状况，她们都接受了HIV检测前后的咨询。通过口头问卷确定喂养行为。
所有母亲都进行母乳喂养，但4个月以下婴儿中只有35%是纯母乳喂养（仅接受母乳）。感染HIV的母亲比未感染HIV的母亲更早给婴儿添加流食并断奶（分别为p = 0.03和p = 0.002）。感染HIV母亲的婴儿年龄别体重Z（WAZ）评分显著更低，表明营养或健康状况较差（p = 0.004）。36名母亲使用商业配方奶和牛奶作为母乳替代品，开始使用的中位年龄为2.5个月。13名母亲喂牛奶，没有母亲按建议在牛奶中加水，2名母亲加糖，4名母亲加盐。
感染HIV母亲的婴儿喂养行为与未感染HIV母亲有显著差异，这可能导致她们生长较差。矛盾的是，这些母亲的喂养行为可能使这些婴儿面临更高的非HIV相关发病风险和HIV传播风险，因为过早引入母乳以外的食物可能增加母婴传播。
