Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: HIV infection poses a major obstacle in breastfeeding as it represents the most common way
by which children acquire HIV. Exclusive breastfeeding has been discovered as the most
effective intervention in preventing mother-to-child transmission of HIV, mortality and
promotion of HIV free survival.
The main objective was to evaluate the evidence on the effectiveness of exclusive
breastfeeding versus formula feeding and/ or mixed feeding in the prevention of HIV-1
transmission from mother to child.
To identify the studies, an electronic search was conducted using PUBMED/MEDLINE,
CINAHL, CENTRAL and EMBASE databases. Electronic journals, which include the
Southern African Journal of HIV medicine (SAJHIV), HIV Medicine Journal and American
Journal of Public Health, were also accessed. Manual searches were carried out. In
addition, relevant experts were contacted in order to locate more data. There were no
limitations with regards to date and language.
The review considered studies on infants who were vertically HIV-1 exposed (mother HIV
positive during pregnancy, birth and breastfeeding). These infants were exclusively
breastfed for six months with administration of antiretroviral prophylaxis and were compared
to infants exclusively formula fed. The outcomes measured were vertically acquired HIV
infection; mortality and HIV free survival up to 24 months of age.
Two reviewers independently selected articles which met the inclusion criteria. They
independently extracted the data using a data extraction tool. Disagreements were solved
by discussion. Data was then meta-analysed using Rev Man 5.1.0.
Methodological quality of each trial was assessed by the reviewers using the Cochrane
assessment tool for risk of bias.
Two randomised clinical trials and one intervention cohort study (n=2112 infants) comparing
exclusive breastfeeding with exclusive formula feeding were included. HIV infection was
associated with exclusive breastfeeding as compared with exclusive formula feeding (Risk
ratio 1.67, 95% CI 1.26 to 2.23, p=0.0005). Exclusive formula feeding was associated with
high mortality from infections (Risk ratio of 0.67 95% CI 0.43 to 0.83, p=0.002 Chi²= 1.30,
p=0.52, I²=0%). There were no statistically significant differences in HIV free survival
between exclusive breastfeeding and exclusive formula feeding as measured by trialists at 9, 18 and 24 months (Risk ratio 1.19, 95% CI, 0.92 to 1.54, p=0.19, Chi²= 3.15, p=0.21, I²=36
% 3 studies, 1012 infants). None of the studies included reported on mixed feeding.
Complete avoidance of breastfeeding is effective in preventing mother-to-child transmission
of HIV. HIV infection during breastfeeding might be an indicator of mixed feeding and poor
adherence. Formula feeding is only applicable in settings where formula milk is accessible,
feasible, acceptable, safe and sustainable (AFASS) because formula feeding carries a high
risk of mortality from causes other than HIV. If the AFASS criteria cannot be met, mothers
should be encouraged to exclusively breastfeed and ensure that their infants completely
adhere to the antiretroviral prophylaxis because they decrease the rate of vertical HIV-1
transmission. / AFRIKAANSE OPSOMMING: MIV besmetting veroorsaak ‘n groot struikelblok vir borsvoeding, omdat dit die mees
algemene manier is waarop babas met MIV besmet word. Eklusiewe borsvoeding is as die
mees effektiewe intervensie ontdek in die voorkoming van moeder na kind oordrag van MIV,
morbiditeit en die bevordering van MIV vrye oorlewing.
Die hoofdoelwit is om die effektiwiteit van eksklusiewe borsvoeding teenoor formule-voeding
en of gemengde voeding in die voorkoming van MIV oordrag van moeder na kind te
evalueer.
Elektroniese navorsing is gedoen deur gebruik te maak van PUBMED/MEDLINE, CINAHL,
CENTRAL en EMBASE databasisse. Elektroniese joernale wat die Southern African Journal
of HIV medicine (SAJHIV), HIV Medicine Journal and American Journal of Public Health
insluit, is ook gebruik. Handnavorsing is ook gedoen, asook relevante data van kenners op
die gebied, is verkry. Geen beperking is geplaas op taal of tyd nie.
Studies op babas wat blootgestel is aan die MIV-1 (moeder MIV positief gedurende
swangerskap en borsvoeding) is in die oorsig oorweeg. Hierdie babas is eksklusief vir 6
maande gerborsvoed, met of sonder anti-retrovirale behandeling, en is vergelyk met
eksklusiewe formule-voeding. Die resultaat was dat almal tot op 24 maande gemeet is aan
MIV besmetting, mortaliteit en MIV vrye oorlewing.
Twee resensente het onafhanklik artikels geselekteer wat aan die ingeslote kriteria voldoen
het. Hulle het onafhanklik data geselekteer deur van ’n selekteringsinstrument gebruik te
maak. Misverstande is deur besprekings opgelos. Data was daarna gemeet en gemetaanaliseer
deur Rev Man 5.1.0.
Die metadologiese kwaliteit van elk proeflopie is geassesseer deur die resensente wat
gebruik gemaak het van die Cochrane evalueringsinstrument om die risiko van
onewewigtigheid uit te skakel.
Twee ewekansige kliniese proewe en een intervensie kohort studie (n = 2112 babas) wat
eksklusiewe borsvoeding vergelyk met 'n eksklusiewe formule-voeding is ingesluit. MIVinfeksie
wat verband hou met 'n eksklusiewe borsvoeding is vergelyk met eksklusiewe
formule-voeding (risiko verhouding van 1.67, 95% CI 1.26 tot 2,23, p=0.0005). Eksklusiewe
formule-voeding hou verband met 'n hoë mortaliteit van infeksies met ’n risiko verhouding
van 0.67, 95% CI 0.43 tot 0.83, p = 0.52, Chi ² = 1.30, p = 0.52, I ² = 0%. Daar is geen statisties beduidende verskille in MIV-vrye oorlewing tussen eksklusiewe borsvoeding en
eksklusiewe formule-voeding nie wat deur die proefnemers gemeet is op 9, 18 en 24
maande (risiko verhouding 1.19, 95% CI, 0.92 tot 1.54, p = 0,19, Chi ² = 3,15, p = 0.21, I ² =
36% 3 studies, 1012 babas). Nie een van die ingeslote studies het verslag gedoen oor
gemengde voeding nie.
Algehele vermyding van borsvoeding is effektief in die voorkoming van Moeder na Kind
oordrag van MIV. MIV-infeksie gedurende borsvoeding mag ’n aanduiding van gemengde
voeding en swak nakoming wees. Formule voeding is alleenlik van toepassing in situasies
waar formule-melk toeganklik, uitvoerbaar, veilig en volhoubaar is, want formule-voeding dra
’n hoë risiko van mortaliteit weens ander oorsake buiten MIV. Indien daar nie aan hierdie
kriteria voldoen kan word nie, behoort moeders aangemoedig te word om eksklusief te
borsvoed en seker te maak dat hulle babas die antiretrovirale profilaksie getrou neem, want
dit verlaag die koers van vertikale MIV-1 oordrag.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/20326 |
| Date | 15 March 2012 |
| Creators | Phuti, Angel |
| Contributors | Khondowe, Oswell, Harper, Kim, Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | 114 p. |
| Rights | Stellenbosch University |
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