Association between infant feeding practices and infant growth by maternal HIV and antiretroviral therapy status: A prospective study in Cape Town, South Africa

Rhoda, Janice

Association between infant feeding practices and infant growth by maternal HIV and antiretroviral therapy status: A prospective study in Cape Town, South Africa

Thesis / Dissertation

2024

Publisher

University of Cape Town

Department

Department of Public Health and Family Medicine

Faculty

Faculty of Health Sciences

Abstract

Background Infants who are HIV-Exposed Uninfected (HEU) may experience adverse growth outcomes compared to those who are HIV Unexposed Uninfected (HUU). Breastfeeding (BF) provides infants with the necessary nutrients to grow optimally irrespective of maternal HIV status. The initiation and duration of BF may also be related to infant growth. We compared growth parameters from birth up to 12 months old in infants who were HEU and HUU, investigating associations with types of infant feeding practices (BF and complementary feeding) and Household Food Security Status (HFSS) under the current era of universal Antiretroviral therapy (ART) in pregnancy policies in South Africa. Methods Pregnant women living with and without HIV were enrolled at their first antenatal visit. Feeding data and infant anthropometry were collected at birth, 7 days, 10 weeks, 6 months, and 12 months postpartum. Infant weight and length at birth were converted to weight-for-age (WAZ) and length-forage (LAZ) using Intergrowth-21st software, and the World Health Organization (WHO)-Anthro survey analyzer tool was used to obtain these and weight-for-length z-scores (WLZ) from 10 weeks old. Linear mixed effects (LME) models were fit to compare WAZ, LAZ and WLZ between infants who were HEU and HUU controlling for a priori selected variables. Results Overall, 796 mother-infant pairs were included, 400 (50%) were HUU and 396 (50%) were HEU. A high proportion of all infants had ever breastfed, although this was lower in infants who were HEU compared to HUU (90% vs 93%; p = 0.118). Infants who were HEU vs HUU had a significantly shorter median duration of BF [73 days; IQR 12-222 vs 209 days; IQR 72-365 [p < 0.001]). There were no differences between the two groups regarding the types of complementary feeding. By 12 months, both infants who were HEU vs HUU had high proportions of overweight (17% vs 21%; p 0.22). WAZ and LAZ on average were lower in infants HEU than HUU [β = -0.147; 95% CI: -0.327, 0.033] and [β = - 0.146; 95% CI: -0.339, 0.471] keeping age at visit, maternal age, duration of BF, HFSS, employment and marital status constant. Conclusion Infants who were HEU had lower WAZ and LAZ compared to those who were HUU after adjusting for covariates. At 12 months, high proportions among both groups were overweight; which may be partly related to sub-optimal complementary feeding practices. Public health interventions need to be aimed at strengthening BF practices among the population of infants who are HEU and improving complementary feeding practices for all infants.

Keywords

Medicine

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