Maternal and Child Health, Nutrition, and Hiv

Abstract

Reducing maternal and child mortality was established as a global priority with the signing of the Millennium Declaration in September 2000. Neonatal vitamin A supplementation and very early breastfeeding initiation are scalable interventions which may improve infant survival. Although breastfeeding has proven benefits for infant health, the potential health consequences of breastfeeding for HIV-infected women are not well studied. In paper one, “The effect of neonatal vitamin A supplementation on morbidity and mortality at 12 months: A randomized trial”, we assessed the efficacy of neonatal vitamin A supplementation (NVAS) in reducing infant morbidity and mortality. Using data from an individually randomized clinical trial of 31,999 infants in Tanzania, we found that NVAS did not affect the risk of death or the incidence of morbidities. However, we noted that postpartum maternal vitamin A supplementation modified the effect of neonatal vitamin A supplementation on infant mortality. In paper two, “Effect of delayed breastfeeding initiation on infant survival: a systematic review and meta-analysis”, our objective was to synthesize the evidence regarding the association between breastfeeding initiation time and infant morbidity and mortality. We pooled five studies, including 136,047 infants. We found a clear dose-response relationship; the risk of neonatal mortality increased with increased delay in breastfeeding initiation. We found a similar pattern when the analysis was restricted to exclusively breastfed infants or low birthweight infants. There was limited evidence regarding the association between breastfeeding initiation time and infant morbidity and growth. We concluded that health policy frameworks and models to estimate newborn and infant survival should consider the independent survival benefit associated with early initiation of breastfeeding. In paper three, “Breastfeeding and Maternal Health among HIV-infected Women in Tanzania”, our objective was to assess the relationship between infant feeding practices and the incidence of maternal mortality, morbidity, and indicators of poor nutritional status from six weeks to two years postpartum in a prospective cohort of Tanzanian women living with HIV. We concluded that breastfeeding may be associated with mixed health outcomes. Additional research should investigate whether HIV-infected women require nutritional support, in addition to antiretroviral therapy, during and after lactation.