Vol. 12 - Num. 48
Victorio Torres Feceda, M Wachirab, R Bedella, J Mwangib, D Dalmauc, L Kocholab, S Morenoa, G Mutheeb, G Riarab, R Ngarurob
bMinisterio de Servicios Médicos. Kenia.
cSociedad Española Interdisciplinaria de SIDA (SEISIDA).
Correspondence: V Torres. E-mail: firstname.lastname@example.org
Reference of this article: Torres Feced V, Wachira M, Bedell R, Mwangi J, Dalmau D, Kochola L, et al. Safe replacement of breast milk to prevent VIH vertical transmission in the Central Province of Kenia. Rev Pediatr Aten Primaria. 2010;12:595-614.
Published in Internet: 14-01-2011 - Visits: 23461
Background: breast feeding accounts for up to 40% of perinatally acquired HIV infection in sub-Saharan Africa. HIV infected mothers are advised by World Health Organization (WHO) to completely avoid breast feeding only if replacement feeding is acceptable, feasible, affordable, safe and sustainable (AFASS).
Methods: data were obtained from 3 Ministry of Health PMTCT programs in Central Province, Kenya. HIV positive pregnant women received AZT starting at 28 weeks + intrapartum SD-NVP if CD4>350 or TARGA if CD4<350. HIV exposed infants received AZT + NVP. Infant formula, water filters and thermos flasks were provided to women opting not to breast-feed their infants. ADN-PCR for HIV was obtained at 6 weeks of age.
Results: most mothers (66-96%) opted for replacement feeding (RF). Eight hundred and eighty one infants received RF either from birth or after initial breast feeding or cow’s milk. Five hundred and fifteen infants (58%) were discharged after reaching 6 months of age; 272 (31%) were still active (<6 months). There were 59 defaulters (6.7%) and 12 relocations (1.4%). Twenty three infants died (2.6%). HIV-infected infants were more than 10 times more likely to die before 6 months of age than HIV-uninfected infants [OR 10.55 (2.51-41.5) P < 0.001]. Morbidity was low; the incidence of diarrhoea and respiratory tract infection was 15.3 and 42.4 per 100 person-years respectively.
Interpretation: it is possible to support safe replacement feeding in resource-limited contexts under routine program conditions within public sector health facilities by employing a feeding methodology that is feasible for mothers and safe for infants.
Keywords● Bottle feeding ● HIV Infection ● Prevention ● Vertical Transmission
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