Postpartum vitamin A supplementation for HIV-positive women is not associated with mortality and morbidity of their breastfed infants: evidence from multiple national surveys in sub-Saharan Africa

Samson Gebremedhin

doi:10.1186/s12887-020-02131-8

Abstract

BackgroundVitamin A supplementation (VAS) in the postpartum period improves the vitamin A concentration of breast milk and vitamin A status is an important predictor of childhood survival. It is also known that Vitamin A Deficiency (VAD) is more prevalent in HIV-infected women. This study investigated the association between vitamin A supplements provided to HIV-positive women in the postpartum period and mortality and morbidity of their breastfed infants in sub-Saharan Africa (SSA) where the prevalence of VAD and HIV is high.MethodsThis cross-sectional study was conducted based on the secondary data of 838 HIV-positive women (309 vitamin A supplement and 529 non-supplemented) extracted from the datasets of 43 Demographic and Health Surveys (DHS) conducted in 26 SSA countries between 2003 and 2015. The data of HIV-positive women who gave a live birth in the preceding 6 months of the survey and who were breastfeeding their infants at the time of the survey or who breastfed their deceased infants until the time of death, were included in the analysis. The association of postpartum VAS with early infant mortality (death in the first 6 months of birth) and morbidity secondary to fever, diarrhoea and cough with respiratory difficulties in the preceding 2 weeks was assessed by mixed-effects logistic regression model and interpreted using adjusted odds ratio (AOR) with the 95% confidence intervals (CI).ResultsAbout one-third (36.9%) of the HIV-positive women received VAS soon after the recent delivery. The early infant mortality rate per 1000 live births in vitamin A supplemented group was 100 (95% CI: 67–133) and the corresponding level for non-supplemented group was 125 (95% CI: 97–154). Yet, in the multivariable model adjusted for seven potential confounders, the association was not significant (AOR = 1.10: 95% CI, 0.57–2.13). Similarly, postpartum VAS was not significantly associated with the occurrence of cough with difficult breathing (AOR = 0.65: 95% CI, 0.39–1.10), diarrhoea (AOR = 0.89: 95% CI, 0.50–1.58) and fever (AOR = 1.19: 95% CI 0.78–1.82) in their breastfed infants.ConclusionVAS provided to HIV-positive women in the immediate postpartum period does not have significant association with the mortality and morbidity of their breastfed infants.

Highlights

Vitamin A supplementation (VAS) in the postpartum period improves the vitamin A concentration of breast milk and vitamin A status is an important predictor of childhood survival
Two-thirds (64.8%) of the respondents were selected from male-headed households and 40.5% were from households of richer or richest wealth quintiles
This study based on secondary data of multiple Demographic and Health Surveys (DHS) conducted in sub-Saharan Africa (SSA) countries, found no statistically significant association between vitamin A supplement provided to Human Immunodeficiency Virus (HIV)-positive women in the postpartum period and, mortality and morbidity from fever, diarrhoea ARIrelated symptoms among their breastfed infants

Summary

Introduction

Vitamin A supplementation (VAS) in the postpartum period improves the vitamin A concentration of breast milk and vitamin A status is an important predictor of childhood survival. It is known that Vitamin A Deficiency (VAD) is more prevalent in HIV-infected women. This study investigated the association between vitamin A supplements provided to HIV-positive women in the postpartum period and mortality and morbidity of their breastfed infants in sub-Saharan Africa (SSA) where the prevalence of VAD and HIV is high. Vitamin A deficiency (VAD) is a major public health problem in many low- and middle-income countries. More than 120 countries have moderate or severe public health significance of VAD as measured by biochemical insufficiency in pre-school children [1]. Low serum retinol concentration affects 33% of children and 15% of pregnant women. Established consequences of VAD among young children include increased risk of mortality and severity of infections, blindness, growth retardation and anemia [1]. During pregnancy VAD predisposes to anemia, clinical infections and night blindness [2]

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