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HIV, breast-feeding and under-5 mortality: modelling the impact of policy decisions for or against breast-feeding.
J Trop Med Hyg 1993; 96(4):203-11JT

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.

Authors+Show Affiliations

Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8345538

Citation

Del Fante, P, et al. "HIV, Breast-feeding and Under-5 Mortality: Modelling the Impact of Policy Decisions for or Against Breast-feeding." The Journal of Tropical Medicine and Hygiene, vol. 96, no. 4, 1993, pp. 203-11.
Del Fante P, Jenniskens F, Lush L, et al. HIV, breast-feeding and under-5 mortality: modelling the impact of policy decisions for or against breast-feeding. J Trop Med Hyg. 1993;96(4):203-11.
Del Fante, P., Jenniskens, F., Lush, L., Morona, D., Moeller, B., Lanata, C. F., & Hayes, R. (1993). HIV, breast-feeding and under-5 mortality: modelling the impact of policy decisions for or against breast-feeding. The Journal of Tropical Medicine and Hygiene, 96(4), pp. 203-11.
Del Fante P, et al. HIV, Breast-feeding and Under-5 Mortality: Modelling the Impact of Policy Decisions for or Against Breast-feeding. J Trop Med Hyg. 1993;96(4):203-11. PubMed PMID: 8345538.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HIV, breast-feeding and under-5 mortality: modelling the impact of policy decisions for or against breast-feeding. AU - Del Fante,P, AU - Jenniskens,F, AU - Lush,L, AU - Morona,D, AU - Moeller,B, AU - Lanata,C F, AU - Hayes,R, PY - 1993/8/1/pubmed PY - 1993/8/1/medline PY - 1993/8/1/entrez KW - Acquired Immunodeficiency Syndrome KW - Breast Feeding KW - Child Mortality KW - Child Survival KW - Computer Programs And Programming KW - Demographic Factors KW - Developing Countries KW - Diseases KW - Health KW - Hiv Infections KW - Infant Nutrition KW - Information KW - Information Processing KW - Length Of Life KW - Mathematical Model KW - Models, Theoretical KW - Mortality KW - Nutrition KW - Policy KW - Population KW - Population Dynamics KW - Research Methodology KW - Survivorship KW - Viral Diseases SP - 203 EP - 11 JF - The Journal of tropical medicine and hygiene JO - J Trop Med Hyg VL - 96 IS - 4 N2 - 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. SN - 0022-5304 UR - https://www.unboundmedicine.com/medline/citation/8345538/HIV_breast_feeding_and_under_5_mortality:_modelling_the_impact_of_policy_decisions_for_or_against_breast_feeding_ L2 - http://www.diseaseinfosearch.org/result/9735 DB - PRIME DP - Unbound Medicine ER -