Research question
What is the impact of HIV on the health of mothers and their children – both HIV infected, and HIV-exposed but uninfected?
Fit with Africa Centre research portfolio
This research fits in Objective 1 of the Africa Centre’s current research activities – understanding the impact of ART roll-out at individual, household, clinic and community level. This work builds on the history of PMTCT research conducted at the Centre, and the involvement of the Centre in the PMTCT programme in the sub-district.
Data sources
A number of data sources are used for this work including data from the HIV Treatment and Care Programme (ARTemis), ACDIS, the VTS, new data collection from the family clinic, and the newly established clinical ART cohort.
Methods/study design
The PhD work by James Ndirangu contributes to the research, who will analyse the morbidity and mortality of infants and mothers both in the pre-ART and ART era using the VTS data. In addition, with a paediatrician from the Institute of Child Health, London, we are developing a fellowship application to explore the development of HIV-infected, and HIV-exposed but uninfected, children using a battery of locally validated developmental tools – this will be new data collected from the HIV family clinis. Further, building on our body of work around childhood vaccinations, we are validating collection of vaccination data in the ACDIS against prospectively collected data in the VTS. Finally, we are examining mother’s infant feeding choices and how they influence their children’s weight and growth trajectories in the first year post-partum, stratifying women into those who lose weight in the first year post-partum ( - 5kg difference), gained weight ( + 5 kg difference) or weight remained stable.
Preliminary findings
In an analysis of growth of children by maternal and infant HIV status, allowing for feeding mode, we showed that 1,261 children of HIV infected mothers grew as well as a reference group of 1,061 children of HIV uninfected mothers, irrespective of feeding mode.
We have analysed women’s morbidity and mortality in the first 2 years post delivery, according to HIV status and infant feeding practices. Among HIV uninfected women the mortality rate was 8.6 deaths per 1000 person years while among HIV infected women it was 55.68 deaths per 1000 person years. The prevalence of serious morbidity in those who died postnatally was 30.6% (22/72) compared to 9.2% (234/2552) in those who survived (p<0.001). Among those who died the most prevalent serious morbidity, although not necessarily the cause of death, was dysentery, accounting for 36.4% (8/22) of events, while the second most prevalence was pulmonary TB. Among mothers who died postnatally there was no significant association between the intensity of feeding and maternal HIV infection status.
In the analysis of maternal weights post-partum, mother’s feeding choice in the first 6 months post-partum appears to affect post-partum maternal weight trajectories in the unadjusted models and single stratified cross-tabulations. Women who exclusively breastfed appear to have more stable post-partum weight trajectories than women who formula fed.
Policy implications
AS HIV becomes a chronic disease, and more children survive beyond early childhood, questions regarding the growth and development of children become increasingly important. Optimal infant feeding practices appear to ameliorate the effect of being born to an HIV infected mother and strengthen the recommendation of exclusive breastfeeding for HIV infected women in terms of long term child health. We also add to the literature that exclusive breastfeeding appears to have no detrimental effect on the health of mothers infected with HIV, which informs the WHO guidelines relating to infant feeding in resource-limited setting with high HIV prevalence.