Relationship between mortality and feeding modality among children born to HIV-infected mothers in a research setting: the Kesho Bora Study
Identifieur interne : 004D06 ( Main/Exploration ); précédent : 004D05; suivant : 004D07Relationship between mortality and feeding modality among children born to HIV-infected mothers in a research setting: the Kesho Bora Study
Auteurs : Amandine Cournil [France] ; Isabelle De Vincenzi [Suisse] ; Philippe Gaillard [Suisse] ; Cécile Cames [France] ; Paulin Fao [Burkina Faso] ; Stanley Luchters [Kenya, Belgique, Australie] ; Nigel Rollins [Afrique du Sud, Suisse] ; Marie-Louise Newell [Afrique du Sud] ; Kirsten Bork [France] ; Jennifer S. Read [États-Unis]Source :
- AIDS : (London) [ 0269-9370 ] ; 2013.
Descripteurs français
- Pascal (Inist)
- Wicri :
English descriptors
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Abstract
Objective: To assess the relationship between infant feeding practices and mortality by 18 months of age among children born to HIV-infected mothers in the Kesho Bora trial (Burkina-Faso, Kenya and South Africa). Methods: Enrolled HIV-infected women were counseled to choose between breastfeeding up to 6 months or replacement feeding from delivery. Multivariable Cox models were used to compare the infant mortality risks according to feeding practices over time defined as never breastfed, weaned or still breastfed. The category 'still breastfed' was disaggregated as exclusively, predominantly or partially breastfed to compare modes of breastfeeding. The relationship between weaning and mortality was also assessed using marginal structural models to control for time-dependent confounders, such as maternal or infant morbidity (reverse causality). Results: Among 795 mothers, 618 (77.7%) initiated breastfeeding. Mortality rates by 18 months among uninfected and infected children were 6 and 38%, respectively. Never breastfed and weaned children were at greater risk of death compared with those still breastfed. Adjusted hazard ratios were 6.7 [95% confidence interval (CI)=2.5-17.9; P<0.001] and 6.9 (CI=2.8-17.2; P<0.001) for never breastfed and weaned children, respectively. Estimation of the effect of weaning using marginal structural models led to similar results. No statistically significant differences were observed according to mode of breastfeeding (exclusive, predominant or partial). Conclusion: Within 6 months after birth, weaned or never breastfed children were at about seven-fold higher risk of dying compared with children who were still breastfed despite a context in which interventions were provided to reduce risks associated with replacement feeding.
Affiliations:
- Afrique du Sud, Australie, Belgique, Burkina Faso, France, Kenya, Suisse, États-Unis
- Languedoc-Roussillon, Maryland, Occitanie (région administrative), Province de Flandre-Orientale, Région flamande
- Gand, Montpellier
- Université de Gand
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aut.</sZ></inist:fA14><country>Afrique du Sud</country><wicri:noRegion>University of KwaZulu-Natal</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization</s1><s2>Geneva</s2><s3>CHE</s3><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Geneva</wicri:noRegion></affiliation></author><author><name sortKey="Newell, Marie Louise" sort="Newell, Marie Louise" uniqKey="Newell M" first="Marie-Louise" last="Newell">Marie-Louise Newell</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Africa Centre for Health and Population Studies, University of KwaZulu-Natal</s1><s2>Somkhele</s2><s3>ZAF</s3><sZ>8 aut.</sZ></inist:fA14><country>Afrique du Sud</country><wicri:noRegion>Somkhele</wicri:noRegion></affiliation></author><author><name sortKey="Bork, Kirsten" sort="Bork, Kirsten" uniqKey="Bork K" first="Kirsten" last="Bork">Kirsten Bork</name><affiliation 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aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Languedoc-Roussillon</region><settlement type="city">Montpellier</settlement></placeName></affiliation></author><author><name sortKey="De Vincenzi, Isabelle" sort="De Vincenzi, Isabelle" uniqKey="De Vincenzi I" first="Isabelle" last="De Vincenzi">Isabelle De Vincenzi</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>WHO, Reproductive Health and Research</s1><s2>Geneva</s2><s3>CHE</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Geneva</wicri:noRegion></affiliation></author><author><name sortKey="Gaillard, Philippe" sort="Gaillard, Philippe" uniqKey="Gaillard P" first="Philippe" last="Gaillard">Philippe Gaillard</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>WHO, Reproductive Health and Research</s1><s2>Geneva</s2><s3>CHE</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Geneva</wicri:noRegion></affiliation></author><author><name sortKey="Cames, Cecile" sort="Cames, Cecile" uniqKey="Cames C" first="Cécile" last="Cames">Cécile Cames</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Institut de Recherche pour le Développement, University of Montpellier</s1><s2>Montpellier</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Languedoc-Roussillon</region><settlement type="city">Montpellier</settlement></placeName></affiliation></author><author><name sortKey="Fao, Paulin" sort="Fao, Paulin" uniqKey="Fao P" first="Paulin" last="Fao">Paulin Fao</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Centre Muraz</s1><s2>Bobo-Dioulasso</s2><s3>BFA</s3><sZ>5 aut.</sZ></inist:fA14><country>Burkina Faso</country><wicri:noRegion>Centre Muraz</wicri:noRegion></affiliation></author><author><name sortKey="Luchters, Stanley" sort="Luchters, Stanley" uniqKey="Luchters S" first="Stanley" last="Luchters">Stanley Luchters</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>International Centre for Reproductive Health (ICRH)</s1><s2>Mombasa</s2><s3>KEN</s3><sZ>6 aut.</sZ></inist:fA14><country>Kenya</country><wicri:noRegion>International Centre for Reproductive Health (ICRH)</wicri:noRegion></affiliation><affiliation wicri:level="4"><inist:fA14 i1="05"><s1>International Centre for Reproductive Health, Ghent University</s1><s2>Ghent</s2><s3>BEL</s3><sZ>6 aut.</sZ></inist:fA14><country>Belgique</country><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName><orgName type="university">Université de Gand</orgName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Centre for International Health, Burnet Institute</s1><s2>Melbourne, Victoria</s2><s3>AUS</s3><sZ>6 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Melbourne, Victoria</wicri:noRegion></affiliation></author><author><name sortKey="Rollins, Nigel" sort="Rollins, Nigel" uniqKey="Rollins N" first="Nigel" last="Rollins">Nigel Rollins</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>University of KwaZulu-Natal</s1><s2>Durban</s2><s3>ZAF</s3><sZ>7 aut.</sZ></inist:fA14><country>Afrique du Sud</country><wicri:noRegion>University of KwaZulu-Natal</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization</s1><s2>Geneva</s2><s3>CHE</s3><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Geneva</wicri:noRegion></affiliation></author><author><name sortKey="Newell, Marie Louise" sort="Newell, Marie Louise" uniqKey="Newell M" first="Marie-Louise" last="Newell">Marie-Louise Newell</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Africa Centre for Health and Population Studies, University of KwaZulu-Natal</s1><s2>Somkhele</s2><s3>ZAF</s3><sZ>8 aut.</sZ></inist:fA14><country>Afrique du Sud</country><wicri:noRegion>Somkhele</wicri:noRegion></affiliation></author><author><name sortKey="Bork, Kirsten" sort="Bork, Kirsten" uniqKey="Bork K" first="Kirsten" last="Bork">Kirsten Bork</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Institut de Recherche pour le Développement, University of Montpellier</s1><s2>Montpellier</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Languedoc-Roussillon</region><settlement type="city">Montpellier</settlement></placeName></affiliation></author><author><name sortKey="Read, Jennifer S" sort="Read, Jennifer S" uniqKey="Read J" first="Jennifer S." last="Read">Jennifer S. Read</name><affiliation wicri:level="2"><inist:fA14 i1="10"><s1>Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health</s1><s2>Bethesda, Maryland</s2><s3>USA</s3><sZ>10 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>NVPO/ OASH/OS/DHHS</s1><s2>Washington, DC</s2><s3>USA</s3><sZ>10 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>NVPO/ OASH/OS/DHHS</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">AIDS : (London)</title><title level="j" type="abbreviated">AIDS : (Lond.)</title><idno type="ISSN">0269-9370</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">AIDS : (London)</title><title level="j" type="abbreviated">AIDS : (Lond.)</title><idno type="ISSN">0269-9370</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term><term>Africa</term><term>Breast feeding</term><term>Child</term><term>Feeding</term><term>Human immunodeficiency virus</term><term>Maternal diseases</term><term>Models</term><term>Mortality</term><term>Prognosis</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Pathologie de la mère</term><term>SIDA</term><term>Mortalité</term><term>Alimentation</term><term>Afrique</term><term>Enfant</term><term>Virus immunodéficience humaine</term><term>Allaitement</term><term>Modèle</term><term>Pronostic</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Mortalité</term><term>Enfant</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objective: To assess the relationship between infant feeding practices and mortality by 18 months of age among children born to HIV-infected mothers in the Kesho Bora trial (Burkina-Faso, Kenya and South Africa). Methods: Enrolled HIV-infected women were counseled to choose between breastfeeding up to 6 months or replacement feeding from delivery. Multivariable Cox models were used to compare the infant mortality risks according to feeding practices over time defined as never breastfed, weaned or still breastfed. The category 'still breastfed' was disaggregated as exclusively, predominantly or partially breastfed to compare modes of breastfeeding. The relationship between weaning and mortality was also assessed using marginal structural models to control for time-dependent confounders, such as maternal or infant morbidity (reverse causality). Results: Among 795 mothers, 618 (77.7%) initiated breastfeeding. Mortality rates by 18 months among uninfected and infected children were 6 and 38%, respectively. Never breastfed and weaned children were at greater risk of death compared with those still breastfed. Adjusted hazard ratios were 6.7 [95% confidence interval (CI)=2.5-17.9; P<0.001] and 6.9 (CI=2.8-17.2; P<0.001) for never breastfed and weaned children, respectively. Estimation of the effect of weaning using marginal structural models led to similar results. No statistically significant differences were observed according to mode of breastfeeding (exclusive, predominant or partial). Conclusion: Within 6 months after birth, weaned or never breastfed children were at about seven-fold higher risk of dying compared with children who were still breastfed despite a context in which interventions were provided to reduce risks associated with replacement feeding.</div></front></TEI><affiliations><list><country><li>Afrique du Sud</li><li>Australie</li><li>Belgique</li><li>Burkina Faso</li><li>France</li><li>Kenya</li><li>Suisse</li><li>États-Unis</li></country><region><li>Languedoc-Roussillon</li><li>Maryland</li><li>Occitanie (région administrative)</li><li>Province de Flandre-Orientale</li><li>Région flamande</li></region><settlement><li>Gand</li><li>Montpellier</li></settlement><orgName><li>Université de Gand</li></orgName></list><tree><country name="France"><region name="Occitanie (région administrative)"><name sortKey="Cournil, Amandine" sort="Cournil, Amandine" uniqKey="Cournil A" first="Amandine" last="Cournil">Amandine Cournil</name></region><name sortKey="Bork, Kirsten" sort="Bork, Kirsten" uniqKey="Bork K" first="Kirsten" last="Bork">Kirsten Bork</name><name sortKey="Cames, Cecile" sort="Cames, Cecile" uniqKey="Cames C" first="Cécile" last="Cames">Cécile Cames</name></country><country name="Suisse"><noRegion><name sortKey="De Vincenzi, Isabelle" sort="De Vincenzi, Isabelle" uniqKey="De Vincenzi I" first="Isabelle" last="De Vincenzi">Isabelle De Vincenzi</name></noRegion><name sortKey="Gaillard, Philippe" sort="Gaillard, Philippe" uniqKey="Gaillard P" first="Philippe" last="Gaillard">Philippe Gaillard</name><name sortKey="Rollins, Nigel" sort="Rollins, Nigel" uniqKey="Rollins N" first="Nigel" last="Rollins">Nigel Rollins</name></country><country name="Burkina Faso"><noRegion><name sortKey="Fao, Paulin" sort="Fao, Paulin" uniqKey="Fao P" first="Paulin" last="Fao">Paulin Fao</name></noRegion></country><country name="Kenya"><noRegion><name sortKey="Luchters, Stanley" sort="Luchters, Stanley" uniqKey="Luchters S" first="Stanley" last="Luchters">Stanley Luchters</name></noRegion></country><country name="Belgique"><region name="Région flamande"><name sortKey="Luchters, Stanley" sort="Luchters, Stanley" uniqKey="Luchters S" first="Stanley" last="Luchters">Stanley Luchters</name></region></country><country name="Australie"><noRegion><name sortKey="Luchters, Stanley" sort="Luchters, Stanley" uniqKey="Luchters S" first="Stanley" last="Luchters">Stanley Luchters</name></noRegion></country><country name="Afrique du Sud"><noRegion><name sortKey="Rollins, Nigel" sort="Rollins, Nigel" uniqKey="Rollins N" first="Nigel" last="Rollins">Nigel Rollins</name></noRegion><name sortKey="Newell, Marie Louise" sort="Newell, Marie Louise" uniqKey="Newell M" first="Marie-Louise" last="Newell">Marie-Louise Newell</name></country><country name="États-Unis"><region name="Maryland"><name sortKey="Read, Jennifer S" sort="Read, Jennifer S" uniqKey="Read J" first="Jennifer S." last="Read">Jennifer S. 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