LETTERS

Infant feeding in the context of HIV-positive mothers

George Kent

Department of Political Science, University of Hawaii, Honolulu, Hawaii 96822 USA (email: kent@hawaii.edu)

Editor – I would like to comment on the article by Bahl et al. published in the June 2005 issue of the Bulletin (1). The authors state in the conclusion section of the abstract that the study's findings have two major implications. The first implication states that "the extremely high risks of infant mortality associated with not being breastfed need to be taken into account when informing HIV-infected mothers about options for feeding their infants."

In fact, there are not extremely high risks of infant mortality associated with not being breastfed in all settings. If it were intended that this be understood as applying to resource-poor settings, it should have been indicated as such by the authors.

The second implication states that "the risks of death are similar for infants who are predominantly breastfed and those who are exclusively breastfed suggests that in settings where rates of predominant breastfeeding are already high, promotion efforts should focus on sustaining these high rates rather than on attempting to achieve a shift from predominant breastfeeding to exclusive breastfeeding."

The study monitored health outcomes only until the infants were six months of age. This does not provide an adequate basis for concluding that there was no significant difference in health outcomes. Other readily available studies clearly support the view that infants have better health outcomes when they are exclusively breastfed than when they are mixed fed.

At the very least, this second implication should have specified that it was referring only to the risks of death in the first six months, and it should have acknowledged that substantial differences in mortality and morbidity were likely to appear at later times. Also, the authors should have indicated that it applied only to resource-poor settings.

It appears that the cases studied in the paper by Bahl et al. were not ones in which the mother was diagnosed as HIV-positive. The stated objective of the study makes no reference to the HIV status of mothers. In general, studies on infant feeding in the context of maternal HIV infection generally are based on the premise that the effects of breastfeeding by HIV-positive mothers on their infants' health are likely to be different from those of HIV-negative mothers. To help guide choices with regard to methods of feeding, we need studies on infant feeding patterns and mortality and morbidity outcomes for HIV-infected mothers. The relevance of studies with mothers who are not known to be infected is highly questionable.

Competing interests: none declared.

References

1. Bahl R, Frost C, Kirkwood BR, Edmond K, Martines J, Bhandari N, et al. Infant feeding patterns and risks of death and hospitalization in the first half of infancy: multicentre cohort study. Bull World Health Organ 2005;83:418-26.