General infections

One of the most important benefits of breast milk is its ability to protect against common childhood infections such as diarrhoea, pneumonia, neonatal sepsis and acute otitis media (Golding, 1998; Duncan et al.,1993; Goldman, 1993; Ashraf et al., 1991; Huffman et al., 1990; Lucas A., 1990; Habicht et al., 1986 & 1988; Victora et al., 1987; Hanson et al., 1985). It has been assumed, but not proven, that the breast milk of HIV-infected women also protects infants against these infections.

In a study in Kinshasa of 19 infected children, development of clinical AIDS was not associated with two particular types of infant feeding practice (Ryder et al., 1991). However, morbidity was significantly higher in 237 non-HIV-infected children (of both infected and uninfected mothers) who were not exclusively breastfed, compared with 81 uninfected infants who were exclusively breastfed during the first six months of life (Ryder et al., 1991). In Durban, South Africa, exclusively breastfed infected children had a slower rate of progression to AIDS than those on mixed feeds (Bobat et al., 1997).

Two recent studies from South Africa compared partially breastfed and exclusively formula-fed HIV-infected infants (Bobat et al., 1997; Gray et al., 1996). In these studies, both groups had similar frequencies of failure to thrive, diarrhoea, and pneumonia. Uninfected infants of HIV-positive mothers also had a comparable frequency of these conditions, whether they were partially breastfed or exclusively formula-fed. However, these results should be interpreted with great caution since the failure to detect a difference in health outcomes between breastfed and formula-fed infants may reflect factors specific to these studies. These include: short duration of exclusive breastfeeding and the inclusion of infants that had stopped breastfeeding in the breastfeeding group; a relatively safe environment (water, electricity, sanitation etc.) that minimized the risks of formula feeding; and a relatively literate, urban study population with access to continual health care, as part of a research study design. It is unlikely that these findings would be replicated in studies from other settings in sub-Saharan Africa without additional support being given to women who choose not to breastfeed.