Abstract

ObjectiveTo report on risk factors for severe events (hospitalisation or infant death) within the first half of infancy amongst HIV-unexposed infants in South Africa.MethodsSouth African data from the multisite community-based cluster-randomised trial PROMISE EBF promoting exclusive breastfeeding in three sub-Saharan countries from 2006 to 2008 were used. The South African sites were Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal. This analysis included 964 HIV-negative mother–infant pairs. Data on severe events and infant feeding practices were collected at 3, 6, 12 and 24 weeks post-partum. We used a stratified extended Cox model to examine the association between the time to the severe event and covariates including birthweight, with breastfeeding status as a time-dependent covariate.ResultsSeventy infants (7%) experienced a severe event. The median age at first hospitalisation was 8 weeks, and the two main reasons for hospitalisation were cough and difficult breathing followed by diarrhoea. Stopping breastfeeding before 6 months (HR 2.4; 95% CI 1.2–5.1) and low birthweight (HR 2.4; 95% CI 1.3–4.3) were found to increase the risk of a severe event, whilst maternal completion of high school education was protective (HR 0.3; 95% CI 0.1–0.7).ConclusionsA strengthened primary healthcare system incorporating promotion of breastfeeding and appropriate caring practices for low birthweight infants (such as kangaroo mother care) are critical. Given the leading reasons for hospitalisation, early administration of oral rehydration therapy and treatment of suspected pneumonia are key interventions needed to prevent hospitalisation in young infants.

Highlights

  • South Africa has made insufficient progress towards achieving Millennium Development Goal (MDG) 4 to reduce under-five mortality rates by 2015, with an annual average rate of reduction between 1990 and 2012 of 1.4% (UNICEF 2013)

  • Monia and diarrhoea is increasing as effective prevention of mother-to-child transmission (PMTCT) has resulted in a rapid decline of perinatal HIV transmission (Barron et al 2013; Kerber et al 2013)

  • This paper reports on factors associated with hospitalisation or death in the first 6 months of life in a cohort of HIV-unexposed infants in South Africa using data from a large multicountry community randomised trial known as PROMISE exclusively breastfed (EBF) (Tylleskar et al 2011)

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Summary

Introduction

South Africa has made insufficient progress towards achieving Millennium Development Goal (MDG) 4 to reduce under-five mortality rates by 2015, with an annual average rate of reduction between 1990 and 2012 of 1.4% (UNICEF 2013). After HIV, which is estimated to account for 28% of under-five mortality, pneumonia (12%) and diarrhoea (5%) are important contributors (Requejo et al 2013). Monia and diarrhoea is increasing as effective prevention of mother-to-child transmission (PMTCT) has resulted in a rapid decline of perinatal HIV transmission (Barron et al 2013; Kerber et al 2013). There are large gaps in coverage of certain basic child health interventions between the richest and poorest wealth quintiles.

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