774
Rates of Diarrhea Associated with Early Weaning among Infants in Kisumu, Kenya
T Thomas1, Rose Masaba*1, A van Eijk2, R Ndivo1, P Nasokho1, M Thigpen3, and M Fowler4
1Kenya Med Res Inst/CDC, Kisumu; 2Univ of Amsterdam, The Netherlands; 3CDC, Atlanta, GA, US; and 4Makerere Univ-Johns Hopkins Univ Res Collaboration, Kampala, Uganda
Background: The Kisumu
Breastfeeding Study (KiBS)
is assessing the effect of HAART from 34 weeks’ gestation through 6 months’
postpartum on HIV transmission and infant health. To reduce mother-to-child HIV
transmission in resource-poor settings, WHO recommends exclusive breastfeeding
for 6 months with rapid weaning. Women in KiBS are encouraged to follow this policy and wean over 2
weeks before HAART is discontinued. Mothers are instructed to use local foods
while weaning.
Methods: We compared rates of diarrhea and related
hospitalizations during the first year of life of HIV– infants in KiBS with HIV– infants of HIV+
mothers in an HIV vertical transmission study conducted from 1996 to 2001 in
Kisumu. No infant nutrition intervention was promoted; infants were fed
according to traditional feeding practices, which often involves introduction
of complementary foods and water by 2 to 3 months and breastfeeding beyond 12
months.
Results: Overall diarrhea incidence over the 12 months was
significantly lower in KiBS (5.7 episodes/100
infant-months of observation) than in the vertical transmission group (8.7; RR
= 0.66; 0.55 to 0.79). KiBS diarrhea rates peaked
during the peri-weaning period at 6 and 7 months and
then declined in contrast to vertical transmission rates, which remained
elevated after 3 months. Serious diarrhea resulting in hospitalizations peaked
in KiBS at 6 months and was significantly higher
overall than in vertical transmission (RR = 3.60; 2.31 to 5.63). There were 2
HIV– KiBS infant deaths due to diarrhea
(ages 7 and 12 months).
Conclusions: While overall rates
of diarrhea among KiBS
infants were significantly lower than among traditionally fed infants in the vertical
transmission study, exclusive breastfeeding and rapid weaning at 6 months was
associated with increased risk of diarrhea and related hospitalizations among KiBS infants during
weaning. This risk should be anticipated during weaning for HIV-exposed infants
following WHO infant feeding guidelines for resource-poor settings. Instruction
on hygiene, sanitation, and water purification is critical during pre-weaning
counseling.
|
Age
(months)
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
Overall
|
|
All diarrhea,
KiBS
(n=144)
|
2.6
|
3.6
|
5.0
|
5.6
|
6.5
|
16.4
|
9.6
|
3.9
|
4.0
|
3.6
|
4.7
|
3.1
|
5.7
|
|
All diarrhea, vertical transmission
(n=347)
|
3.0
|
4.5
|
9.7
|
9.7
|
5.7
|
10.1
|
11.6
|
9.6
|
11.2
|
13.0
|
9.7
|
11.5
|
8.7
|
|
Hospital, KiBS (n=44)
|
0.4
|
0.9
|
0.5
|
0.9
|
1.9
|
6.6
|
3.8
|
2.0
|
1.0
|
1.5
|
1.0
|
0.5
|
1.8
|
|
Hospital, vertical transmission
(n=34)
|
0.1
|
0.3
|
0.2
|
0.5
|
1.2
|
0.5
|
0.4
|
0.8
|
0.6
|
0.8
|
0.5
|
0.5
|
0.5
|
|
