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  • Title: HIV, breast-feeding and under-5 mortality: modelling the impact of policy decisions for or against breast-feeding.
    Author: Del Fante P, Jenniskens F, Lush L, Morona D, Moeller B, Lanata CF, Hayes R.
    Journal: J Trop Med Hyg; 1993 Aug; 96(4):203-11. PubMed ID: 8345538.
    Abstract:
    A computer model was developed to assess the impact on under-5 child mortality of breast-feeding practices in developing countries in the context of HIV infection. The model was used to estimate the effect on mortality of cessation of breast-feeding among mothers HIV-positive and mothers HIV-negative at birth, for both urban and rural settings. Using parameter values for a hypothetical East African country, cessation of breast-feeding in urban areas was predicted to result in increases in under-5 mortality of 108% for children of mothers HIV-negative at birth, and 27% for those HIV-positive at birth, with slightly larger increases in rural areas, suggesting that breast-feeding should continue to be promoted. A sensitivity analysis was conducted to identify critical values of key variables for which a review of policies encouraging breast-feeding is indicated. This showed that, even under extreme assumptions, cessation of breast-feeding among mothers HIV-negative at birth (but at risk of acquiring HIV during the lactation period) would increase under-5 mortality. For mothers HIV-positive at birth, the key variables are the additional risk of vertical transmission attributable to breast-feeding, the under-5 mortality rate (U5MR) in breast-fed children, and the relative risk of mortality in non-breast-fed compared to breast-fed children. Depending on the values of these key variables, there may be some urban populations with low U5MR in which the positive and negative effects on under-5 mortality of a policy change are finely balanced. However, no change in policy should be made in these areas until more precise information is available on the key variables, and the many adverse consequences of such a change have been fully explored. A computer model was developed to assess the impact on under-5 child mortality of breastfeeding practices in developing countries in the context of HIV infection and then used to estimate the comparative effects on mortality of ceasing breastfeeding among HIV-seropositive (HIV+) and HIV-seronegative (HIV-) mothers at birth in rural and urban settings. Employing parameter values for a hypothetical East African country, it was found that ceasing breastfeeding in urban areas would result in increases in under-5 mortality of 108% for children of HIV-mothers at birth and 27% among children of mothers HIV+ at birth; slightly larger increases would result in rural areas. These results suggest that breastfeeding should continue to be promoted. Even under extreme conditions, discontinuing breastfeeding among HIV-mothers would increase under-5 mortality. For HIV+ mothers, however, whether or not the policy of promoting breastfeeding should be reviewed hinges upon the values of the additional risk of vertical transmission attributable to breastfeeding, the under-5 mortality in non-breast-fed children, and the relative risk of mortality in non-breast-fed compared to breastfed children. It is possible that some urban populations have under-5 mortality which is so low that it may be a close call as to whether breastfeeding is ultimately positive or negative for child survival. Even so, no change in policy should be made until more precise information on the key variables is obtained and the potential adverse consequences of such a policy change are fully explored.
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