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Infant feeding practices among HIV-positive women in Dar es Salaam, Tanzania, indicate a need for more intensive infant feeding counselling
- Sera L Young, Kiersten A Israel-Ballard, Emily A Dantzer, Monica M Ngonyani, Margaret T Nyambo, Deborah M Ash, Caroline J Chantry
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- Journal:
- Public Health Nutrition / Volume 13 / Issue 12 / December 2010
- Published online by Cambridge University Press:
- 29 June 2010, pp. 2027-2033
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- Article
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Objective
To assess feeding practices of infants born to HIV-positive women in Dar es Salaam, Tanzania. These data then served as a proxy to evaluate the adequacy of current infant feeding counselling.
DesignA cross-sectional survey of infant feeding behaviours.
SettingFour clinics in greater Dar es Salaam in early 2008.
SubjectsA total of 196 HIV-positive mothers of children aged 6–10 months recruited from HIV clinics.
ResultsInitiation of breast-feeding was reported by 95·4 % of survey participants. In the entire sample, 80·1 %, 34·2 % and 13·3 % of women reported exclusive breast-feeding (EBF) up to 2, 4 and 6 months, respectively. Median duration of EBF among women who ever breast-fed was 3 (interquartile range (IQR): 2·1, 4·0) months. Most non-breast-milk foods fed to infants were low in nutrient density. Complete cessation of breast-feeding occurred within 14 d of the introduction of non-breast-milk foods among 138 of the 187 children (73·8 %) who had ever received any breast milk. Of the 187 infants in the study who ever received breast milk, 19·4 % received neither human milk nor any replacement milks for 1 week or more (median duration of no milk was 14 (IQR: 7, 152) d).
ConclusionsInfant feeding practices among these HIV-positive mothers resulted in infants receiving far less breast milk and more mixed complementary feeds than recommended, thus placing them at greater risk of both malnutrition and HIV infection. An environment that better enables mothers to follow national guidelines is urgently needed. More intensive infant feeding counselling programmes would very likely increase rates of optimal infant feeding.
9 - Growth, nutrition, and metabolism
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- By Caroline J. Chantry, Department of Clinical Pediatrics, University of California Davis Medical Center, Sacramento, CA, Jack Moye, Jr., Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, NIH, Bethesda, MD
- Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
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- Book:
- Handbook of Pediatric HIV Care
- Published online:
- 23 December 2009
- Print publication:
- 04 May 2006, pp 273-308
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Summary
In recent years, growth, nutrition and metabolism of HIV-infected children have received increased attention for several reasons. It has been recognized for the past decade that HIV-infected children generally do not grow as well as their uninfected counterparts, but more recent evidence suggests that this is often true even in the face of adequate virologic control. Given also that growth is a predictor of survival, there has been closer scrutiny of nutritional and metabolic factors that can contribute to poor growth. Additionally, potentially serious metabolic complications of HIV infection and/or antiretroviral therapies overlap with nutritional aspects of the infection and have prompted attention to the pathophysiology of malnutrition in these children.
The current state of knowledge regarding the complex interrelationships of nutrition, HIV disease, antiretroviral therapy, and growth is reviewed in this chapter. Recommendations for nutritional monitoring and support are discussed, as are therapies for certain recognized causes of malnutrition in HIV-infected children. Briefly described are the complications and recommended treatments for fat redistribution, hyperlipidemia, insulin resistance, osteonecrosis, and mitochondrial toxicity. Finally, nutritional issues most germane to resource-poor settings are highlighted.
Definitions: malnutrition, growth failure
Pediatric HIV disease may lead to multiple nutritional deficiencies. Deficiencies of adequate macronutrients (protein or calories) and/or micronutrients (vitamins, minerals) to maintain optimal health status is referred to as undernutrition or, more commonly, malnutrition. Many definitions for growth failure or failure to thrive (FTT) exist.
16 - Growth, nutrition, and metabolism
- from Part II - General issues in the care of pediatric HIV patients
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- By Caroline J. Chantry, Assistant Professor of Clinical Pediatrics, University of California Davis Medical Center, Sacramento, CA, Jack Moye, Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, NIH, Bethesda, MD
- Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read, National Cancer Institute, Bethesda, Maryland
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- Book:
- Textbook of Pediatric HIV Care
- Published online:
- 03 February 2010
- Print publication:
- 28 April 2005, pp 244-268
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- Chapter
- Export citation
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Summary
In recent years, growth, nutrition, and metabolism of HIV-infected children have been receiving increased attention for several reasons. It has been recognized for the past decade that HIV-infected children generally do not grow as well as their uninfected counterparts, but more recent evidence suggests that this is often true even in the face of adequate virologic control. Given also that growth is a predictor of survival, there has been closer scrutiny of nutritional and metabolic factors that can contribute to poor growth. Additionally, potentially serious metabolic complications of HIV infection and/or antiretroviral therapies overlap with nutritional aspects of the infection and have prompted attention to the pathophysiology of malnutrition in these children.
The current state of knowledge regarding the complex interrelationships of nutrition, HIV disease, antiretroviral therapy, and growth is reviewed in this chapter. Recommendations for nutritional monitoring and support are discussed, as are therapies for certain recognized causes of malnutrition in HIV-infected children. Briefly described are the complications and recommended treatments for fat redistribution, hyperlipidemia, insulin resistance, osteonecrosis, and mitochondrial toxicity. Finally, nutritional issues most germane to resource-poor settings are highlighted, as are areas in which further research is needed.
Definitions: malnutrition and growth failure
Pediatric HIV disease can lead to multiple nutritional deficiencies. Deficiencies of adequate macronutrients (protein or calories) and/or micronutrients (vitamins, minerals) to maintain optimal health status is referred to as undernutrition or, more commonly, malnutrition. Many definitions for growth failure or failure to thrive (FTT) exist.