Comparison of nutritional status between breastfed and replacement fed infants born to HIV infected mothers in Nairobi

Abstract

Infants born to HIV infected mothers may be at a higher risk of altered nutritional status secondary to feeding practices. Exclusive replacement feeding (ERF) is costly and poor mothers in the society may not adhere to guidelines on replacement feeding for example over diluting the formula milk and inappropriate cleaning of utensils among others. The recommended exclusive breastfeeding (EBF) practice has challenges based on cultural beliefs and practices related to infant feeding in Kenya. The overall objective of the study was to compare nutritional status of breastfed and replacement fed infants born to Human Immunodeficiency Virus (HIV) infected mothers in Nairobi. This was a cross-sectional study conducted in Nairobi North District in four City Council health centers (Kariobangi, Baba Dogo, Mathare North and Kasarani). Study subjects were a dyad of HIV infected mother and her child selected using random sampling. A sample size of 110 was targeted distributed in the selected facilities proportionately. The study tool was a questionnaire. A salter scale was used to weigh the children and a height board (stadiometer) was used to measure the length. Data was analyzed using statistical analysis (stata) software and Epi info™ for anthropometric data analysis. There was a significant difference (p=0.02) in mean weight for age Z scores between EBF and ERF infants. The study findings show a positive correlation between ERF and negative growth gradients (p=0.037), wasting (p=O.OI9), higher family income (p=0.025). Formula milk over dilution also had a positive correlation with underweight (p=0.035). There was also a positive correlation between abnormal growth gradients and ERF (p=0.03), respiratory infections (p=0.013), past gastrointestinal problems (p=0.023) while underweight was positively correlated with respiratory infection (p=0.02l)and past gastrointestinal problems (p=0.47). A multivariate logistic regression analysis revealed an association between wasting and mode of infant feeding (p=0.014) and also with abnormal growth gradient (p=0.043). There was also significant association between stunting and mode of infant feeding (p=0.003) while abnormal growth gradients were significantly associated with the age of the infant (p=0.002) with older infants tending to have experienced abnormal growth gradients. EBF infants had better nutrition status compared to ERF infants. HIV infected women should be counseled on exclusive breastfeeding for the first six months of life unless replacement feeding is acceptable, affordable, sustainable and safe for infants before this time. The study duration was eight months.