Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. e701-e710 (doi:10.1542/peds.2005-1911)

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Complementary Feeding Adequacy in Relation to Nutritional Status Among Early Weaned Breastfed Children Who Are Born to HIV-Infected Mothers: ANRS 1201/1202 Ditrame Plus, Abidjan, Côte d'Ivoire

Renaud Becquet, PhD^a, Valériane Leroy, MD, PhD^a, Didier K. Ekouevi, MD, PhD^b, Ida Viho, MD^b, Katia Castetbon, PhD^c, Patricia Fassinou, MD^d, François Dabis, MD, PhD^a, Marguerite Timite-Konan, MD^d and ANRS 1201/1202 Ditrame Plus Study Group

^a Unité INSERM 593, Institut de Santé Publique Epidémiologie Développement, Université Victor Segalen, Bordeaux, France
^b Projet ANRS 1201/1202 Ditrame Plus, Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
^c Unité de Surveillance et d'Epidémiologie Nutritionnelles, Institut de Veille Sanitaire, Conservatoire National des Arts et Métiers, Paris, France
^d Service de pédiatrie, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire

OBJECTIVE. In high HIV prevalence resource–constrained settings, exclusive breastfeeding with early cessation is one of the conceivable interventions aimed at the prevention of HIV through breast milk. Nevertheless, this intervention has potential adverse effects, such as the inappropriateness of complementary feeding to take over breast milk. The purpose of our study first was to describe the nature and the ages of introduction of complementary feeding among early weaned breastfed infants up to their first birthday and second was to assess the nutritional adequacy of these complementary foods by creating a child feeding index and to investigate its association with child nutritional status.

METHODS. A prospective cohort study in Abidjan, Côte d'Ivoire, was conducted in HIV-infected pregnant women who were willing to breastfeed and had received a perinatal antiretroviral prophylaxis. They were requested to practice exclusive breastfeeding and initiate early cessation of breastfeeding from the fourth month to reduce breast milk HIV transmission. Nature and ages of introductory complementary feeding were described in infants up to their first birthday by longitudinal compilation of 24-hour and 7-day recall histories. These recalls were done weekly until 6 weeks of age, monthly until 9 months of age, and then quarterly. We created an index to synthesize the nutritional adequacy of infant feeding practices (in terms of quality of the source of milk, dietary diversity, food, and meal frequencies) ranging from 0 to 12. The association of this feeding index with growth outcomes in children was investigated.

RESULTS. Among the 262 breastfed children included, complete cessation of breastfeeding occurred in 77% by their first birthday, with a median duration of 4 months. Most of the complementary foods were introduced within the seventh month of life, except for infant food and infant formula that were introduced at age 4 months. The feeding index was relatively low (5 of 12) at age 6 months, mainly as a result of insufficient dietary diversity, but was improved in the next 6 months (8.5 of 12 at 12 months of age). Inadequate complementary feeding at age 6 months was associated with impaired growth during the next 12 months, with a 37% increased probability of stunting.

CONCLUSION. Adequate feeding practices around the weaning period are crucial to achieving optimal child growth. HIV-infected women should turn to early cessation of breastfeeding only when they are counseled properly to provide adequate complementary feeding to take over breast milk. Our child feeding index could contribute to the assessment of the nutritional adequacy of complementary feeding around the weaning period and therefore help to detect children who are at risk for malnutrition.

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Key Words: breastfeeding • HIV • infant nutrition • nutritional status

Abbreviations: WHO—World Health Organization • ANRS—Agence Nationale de Recherches sur le Sida • CI—confidence interval • RR—relative risk

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Accepted Oct 13, 2005.

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