Table 2.
Included studies 2006–2010
| Study | Participants | Infant feeding Outcomes | Findings |
|---|---|---|---|
| Qualitative | |||
| Doherty et al., 2006 | 40 HIV+ women; mean age 24y; community health workers. | 25 women EBF, 15 EFF. 80% (20) women who had chosen EBF introduced other liquids within the 1st month. | Women who chose to EFF had problems accessing formula milk; women were only able to maintain exclusive feeding practices for a short time due to a variety of constraints; Those who chose FF reported concern about HIV infection was the top reason for their infant-feeding choice. |
| Doherty et al., 2006 | 27 HIV+ women; mean age 25y. | 2 (18%) who initiated breastfeeding were still EBF at 12 wks.; 3 stopped between 6 and 12 wks.; Formula-feeders: 88% (14) did not give breast milk to their infants. | HIV-positive women encounter many challenges in maintaining exclusive infant feeding, such as insufficient support from health staff and family pressure. |
| Sibeko et al., 2009 | 11 women (HIV+ and HIV-), mean age 25y | FF – 4 women; MF – 5; EBF – 2 women. 25% (1/4) women who chose to formula feed was able to EFF. | Non-disclosure of HIV status influenced feeding choices, which resulted in mixed feeding. Bad infant feeding advice created confusion and resulted in subpar practices such as mixed feeding. |
| Andreson et al., 2013 | 14 HIV+ women & buddy pairs, > = 18y; data for 12 women | Study end date (2 to 6 months infants), − 6 women were EBF and 6 were FF. | Buddies can provide good support for HIV+ women. |
| Randomized Controlled Trials | |||
| Bork et al., 2014 | 751 infants (366 boys, 385 girls) |
Ever breastfed: Durban −57.1% (101), KwaZulu 80.9% (72). Breastfeeding (4-6 months): 41, 53% for Durban and KwaZulu- Natal, respectively. |
Not breastfeeding was associated with increased risk of serious infections particularly between 0 and 2.9 months. |
| Ijumba et al., 2015 | 1821 (intervention) and 2136 (control) pregnant women, median age 23y. 30 Com. Health workers (CHW): 15 Intervention and Control group respectively; | 76% (1242/1629) women in intervention and 74% (1380/1865) women in control initiated breastfeeding after birth; 34.4% (561) intervention and 32.5% (607) control breast-fed within 1 h of birth. | CHWs had positive effect on EBF, particularly on HIV- women. |
| Bork et al., 2013 | 1028 HIV+ mother–infant pairs | 56% (565) women were still breastfeeding at 3 months postpartum: 30% EBF, 18% predominant breastfeeding, and 8% partial. EBF: 90.4, 73.1, 69.9, 56.8, and 80.0% for Bobo-Dioulasso, Mombasa, Nairobi, Durban, and Somkhele, respectively. | Overall, EBF was brief, particularly for boys. |
| Cournil et al., 2013 | 795 HIV+ women |
77.7% 618 initiated breastfeeding at birth; 22.3% (177) mothers never breastfed. |
By 6 months post-delivery, infants weaned/not breastfed had approximately seven-fold higher risk of dying compared with infants being breastfed. |
| Tylleskär et al., 2011 | 2579 mother-infant pairs | EBF prevalence in South Africa at 12 weeks (24-h recall) in the intervention and control groups: 10% (56/535) 6% (30/485), respectively. | No differences found for the prevalence of diarrhea at age 12 weeks or 24 weeks between the clusters within the countries; No significant change in EBF rates for South Africa which were low at baseline. |
| Doherty et al., 2014 | 964 HIV- mother–infant pairs; mean age 24y in Rietvlei and Umlazi and 25y in Paarl | 34% (114/330), 20% (57/283) and 36% (127/351) of HIV-negative women in Paarl, Rietvlei and Umlazi, respectively, stopped breastfeeding before 6 months postpartum. | For HIV-unexposed infants: low birthweight and short rates of breastfeeding increased risk of hospitalization/death during 1st 6 months of birth. |
| Doherty et al., 2012 | Sub-group analysis of data for 999 women who ever breastfed; median age 22y in Rietvlei and Umlazi; 24y in Paarl. | At 12 weeks postpartum - 20% HIV- and 40% HIV+ women had stopped breastfeeding; 97% HIV- women and 42% HIV+ women ever breastfed. | Less than optimal early feeding practices; Early cessation of breastfeeding occurs among both HIV- and HIV+ women. |
| Engebretsen et al., 2014 | 2579 mother-infant pairs in 3 countries: 794 - Burkina Faso, 765 – Uganda, 1020 - South Africa | < 4% women in Burkina Faso and about 50% in South Africa initiated breastfeeding within the 1st hour of birth. | Behavior change may not have occurred in South Africa. |
| Ramokolo et al., 2015 | 641 HIV unexposed children, median age 22 months | Infants using any breast milk changed from 89.3% (3 weeks) to 79.4% (12 weeks); Cereal use at 12 weeks −79.5% who were not breastfed, and 59.6% who were breastfed. | Infant feeding actions in the first 12 weeks can predict the development of childhood overweight and obesity. |
| Observational | |||
| Goga et al., 2009 | 665 HIV+ & 218 HIV- women (age range 21–30) and infants; | Complete breastfeeding cessation (CBC) HIV+: 43.6% (88) reported CBC by 24 weeks.; HIV-neg: 97% initiated EBF. |
Although national guidelines advise HIV+ women to breastfeed, they stop by 24 weeks; 39–44% of women practicing EBF/PBF at week 3 complied with recommendations. |
| Becquet et al., 2009 | 2190 HIV+ women, aged ≥16 years | 90% of infants in both studies continued to be breastfed by 3 months of age; Mixed feed - 22% of infants by 3 months of age. | Breastfeeding duration is the primary contributor to HIV postnatal transmission; risk is quite similar for both exclusive & predominantly fed infants; Risk of postnatal HIV infection was 3.9% for infants breastfed less than 6 months, and 8.7% for those breastfed for at least 6 months. |
| Bland et al., 2007 | 2491 women (1253 HIV+, 1238 HIV-); median age 25 | HIV+ women (EBF −78%; replacement feeding 42%; HIV- women: 75% maintained intentions to EBF and < 1% (11) infants were not breastfed. | For most women counselling helped with matching infant feeding intentions based on existing resources for appropriate feeding. Most HIV+ women did not have resources for safe replacement feeding, so they decided to EBF. |
| Bland et al., 2008 | HIV-women (1219 infants); HIV+ women (1217 infants); | Median duration of EBF: HIV-, 177 days; HIV+, 175 days; EBF at 3 & 5 months: HIV- women (83.1, 76.5%); HIV+ women (72.5, 66.7%) respectively. | Both HIV+ and HIV- women can maintain EBF for 6 months with support in the home from trained lay counselors. |
| Chetty et al., 2014 | 2340 women (1197 HIV-, 1143 HIV+); Median age: HIV- (21.8y); HIV+ (25.1y) |
Median duration of EBF: HIV- (179 days); HIV+ (175 days); Birth to 5 months feeding patterns: EBF – HIV- 76.9% (920); HIV+ 66.7% (762); Mixed feeding - HIV- 11.9% (143); HIV+ 8.8% (101); No breastfeeding – HIV-10.4% (125); HIV+ 24.1% (275). |
Breastfeeding did not increase postpartum weight loss; HIV+ women lost less weight during 1st 6 months & 12 months postpartum than HIV- women. |
| Coovadia et al., 2007 | 2722 HIV+ and HIV- pregnant women, median age, 25.1y | 83% (1132/1372) HIV-exposed infants initiated EBF from birth; median time for cumulative EBF, 159 days. EBF at 26 weeks – 37% (415/1132). | Mixed breastfeeding increased HIV transmission risk; EBF infants were less likely to get HIV than breastfed infants who used solid foods; HIV+ women can receive support to EBF. |
| Doherty et al., 2007 | 635 HIV+ mother–infant pairs, mean age: Intent to EFF, 25.8y; Intent to EBF, 25.3y | 13% who intended to breastfeed were EBF at 12 weeks; 42% mixed feeding; Predominantly breastfeeding (11%); EFF (33.5%). | Risk of getting HIV or death in both breastfeeding groups was high due to low rates of EBF; Inappropriate infant feeding choices were made based on the availability of 3 factors (piped water, electricity, gas or paraffin for cooking fuel, and early disclosure of HIV status). |
| Ghuman et al., 2009 | 168 HIV+ & HIV-women, mean age 24y | 97% (163) infants got breast milk as their first feed, 3% (5) were formula-fed; At 14 weeks: EBF was 18%; 52% got water; and 73% solids; 87% (20/23); Week 14: 11% HIV+ women were EBF, and 63% (12/19) mixed feeding. | Most women were not adhering to recommended infant feeding guidelines by 14 weeks of age; Women were unable to maintain EBF. HIV+ mothers breastfed at birth and more likely to formula feed than HIV- women. |
| Goga et al., 2012 | 665 HIV+ and 218 HIV- women; Median age: HIV-pos 25; HIV-neg 23 | EBF at 3 weeks: HIV+ 42% (130) vs HIV- 17% (33); 47% (271) HIV+ women reported no breastfeeding; HIV- women at weeks 3 and 12: 17% (33) and 3% (5) practiced EBF. | While feeding practices were subpar among both groups of women, HIV-positive women engaged in more safer practices. |
| Matji et al., 2009 | 222 HIV+ and 53 HIV- women; | At 6 weeks: 94% HIV- mothers were breastfeeding, 69% HIV+ mothers were FF; Intro of food by 6 weeks: 14% HIV- mothers; 1 HIV+ mother had stopped breastfeeding by 6 weeks. | Influences in the home environment resulted in changes in infant feeding practices. |
| Patil et al., 2015 | 2053 infants; median age 3–12 days | Breastfeeding initiation within 1 h - 59.7%; EBF at 30 days - 29.5%; Partially Breastfed at 30 days - 36.6%; Completely weaned by 30 days - 2.6%. | Shift from EBF in the first month of life. Liquids and solids were usually given to infants in the first month. |
| Rollins et al., 2013 | 2789 women; Median age: HIV-pos 25.0y; HIV-neg 21.7y | 81.4% HIV+ and 92.9% HIV- mothers EBF at 6–8 weeks; 61.8 and 72.6% at 3–4 months; median time for cessation of breastfeeding-171 days. | EBF was associated with less adverse events with mixed feeding or not breastfeeding in both HIV exposed and unexposed infants. |
| Rossouw et al., 2016 | 47 mother–infant pairs, 25 HIV-exposed and 22 HIV-unexposed infants | HIV-exposed infants: One mother initiated breastfeeding and continued up to 18 months; HIV-unexposed infants: all mothers initiated breastfeeding with > 50% within an hour of birth. 62 and 52% of HIV-unexposed mothers were breastfeeding at 12 and 18 months respectively. No infant EBF at 6 months. |
Among both groups, there was low compliance with breastfeeding guidelines and dietary diversity. Breastfeeding rates were low in HIV-exposed infants due to free formula distribution at health facilities. |
| Ahmadu-Ali et al., 2013 | 386 women, mean age 25y | At 6 weeks: 53.1% (205) women were EBF; 26.6% (103) EFF; 20.3% (78) mixed feeding. EBF at 6 weeks: 52.7% (157) – HIV-neg vs 60.6% (43) HIV-pos. | HIV- women reported more counselling during antenatal care than HIV+ women; EBF was lower in HIV+ than HIV- women. |
| Faber et al., 2007 | 505 infants, mean age 9 months; 441 mothers, 64 caregivers, mean age 25y | Breastfeeding initiated - 96% infants; breast milk only - 58%; mixed feeds - 23%; bottle feeds only - 18%. 61% infants had solid foods before 6 months. | Exclusive breastfeeding to age 6 months was rarely practiced. Trained community health workers should help with poor infant feeding practices and micronutrient deficits. |
| Kyei et al., 2014 | 2660 women, 13–50 years | 42.5% vs 57.5% women were still breastfeeding; 70.6% of those who stopped breastfeeding breastfed < 24 months. | Study showed duration of breastfeeding in Vhembe district decreased from > 24 months to just 18 months. |
| Ladzani et al., 2011 | 815 HIV-positive women; mean age - 27.7 years | 50% EFF, 35.6% EBF, 12.4% mixed feeding. EBF within 1 h of delivery - < 50%; EFF within 1 h of delivery - > 50%. | Knowledge gaps of PMTCT and infant feeding policy contributed to inappropriate feeding choices. Variables associated with mixed feeding: Vaginal delivery; infant hospitalization, and currently pregnant. Variables associated with FF: older age, knowing the HIV status of the infant; and higher HIV transmission/breastfeeding knowledge. |
| Ukpe et al., 2009 | 33 mothers & infants; Mean age women − 30.7y; Mean age infants - 3.5 months. | ERF - 50% (15/30); EBF - 27% (8/30); − Mixed feeding 23% (7/30). | ERF was the most frequent infant feeding practice. Women who FF used different types of commercial milk. Quality of counselling should be strengthened to enhance infant feeding practices. |
| Yako and Nzama, 2013 | 60 women, mean age 26.5y; 53% (32) were HIV-negative and 46.7% (28) were HIV-positive | At six weeks: EBF group – 13.3% (8/19) breastmilk only; mixed feeding – 11.7% (7/19). EFF group – formula only 30% (18/41); Mixed feeding – 15% (9/41). | Educate mothers on best infant feeding practices, including non-introduction of foods/liquids at inappropriate ages. |
| Zunza et al., 2011 | 95 HIV-positive mother-infant pairs, Mean age, 27y | EFF - 97% (62); Formula – 78% (50); EBF – 2 women; Mixed feeding – 19% (12). | Advice needed on breast health during breastfeeding period and optimal infant feeding practices. |
| Gbadamosi et al., 2017 | 186 infants, ages 1 to 12 months |
0.6% infants were EBF for > 3 months; 78% breastfeeding at 9 months; 39.5% mixed feeding by end of 1st month; 0.6% EBF > 6 months. |
Complimentary foods provided at an early age; EBF was rarely practiced; Interventions needed to support and promote recommended infant feeding guidelines. |
| Aku A., 2013 | 125 HIV-positive mother-infant pairs, mean age, 27.8 years | Replacement feeds −84.3%; Mixed feeding −11.2%; Intro of solids − 10.4%; Mean age for intro of solids - 47 days. | Infant feeding choices influenced by family; SES factors affected growth and nutrition of HIV-exposed infants. |
| Abusomwan, Osaigbovo Ebenezer, 2011 | 395 HIV-pos mothers; 14 to 49 years | EBF - 77.7%, 6 weeks after delivery; Mixed feeding - 3%; replacement feeding - 19.3%. | EBF was the primary infant feeding choice and practice; Hardly any mixed feeding occurred in this group of HIV-positive women. |
| Jacobs-Jokhan, D., 2011 | 200 HIV-pos women, mean age 30y | EFF - 84.5%; EBF −14%; Mixed feed − 1.5%. | Study showed that babies born to mothers who did not receive infant feeding counselling were twice as likely to be HIV positive; Infant feeding counselling is necessary component of antenatal care; HIV-pos women should be counselled soon after diagnosis and throughout care. |
| Masters, D., 2006 | 42 HIV-pos women, < 19 to 49 years | Exclusively formula milk and water - 52% (22); Mixed feeds - 48% (40). | Cultural norms influence infant feeding practices, particularly introduction of solids/liquids. Women EFF wanted to prevent HIV transmission. |
| Mushaphi et al., 2008 | 185 mother-infant pairs; mean age, 25.83y | EBF (0–6 months) - 7.6% of women; 97% - still breastfeeding; 3% had stopped; 43,2% gave solid foods at three months, and 15% < 2 months. | Early introduction of other foods; Although breastfeeding was practiced by many of the mothers, EBF was rare. |
| Some et al., 2017 | 1225 mother-infant pairs- all sites; 222 from East London, South Africa; > 18 years |
EBF- first 3 days - 93.4% (199); Mixed feeding first 3 days - 2.3% (5). Breastfeeding initiation within 1 h of birth – 57.7%. Median duration of any breastfeeding was 40.6 weeks. |
More mothers in South Africa had to return to work after a few months, stopping them from continuing to breastfeed; Improvements needed in breastfeeding and complementary feeding of children, particularly those who are HIV-exposed. |
Legend: EBF Exclusive breastfeeding, EFF Exclusive formula feeding, MF Mixed feeding