Heat treatment of expressed breast milk is a feasible option for feeding HIV-exposed, uninfected children after 6 months of age in rural Zimbabwe

Abstract

In the context of a prevention of mother to child transmission of HIV program promoting exclusive breast-feeding (EBF) to 6 mo and offering HIV-PCR testing at approximately 6 mo, we ascertained the feasibility of expressing and heat-treating (EHT) all breast milk fed to HIV-exposed, uninfected infants following 6 mo of EBF. Twenty mother-baby pairs were enrolled from a hospital in rural Zimbabwe. Research nurses provided lactation, EHT, and complementary feeding counseling through 21 home visits conducted over an 8-wk period and collected quantitative and qualitative data on the mothers' EHT experiences, children's diets, and anthropometric measurements. Mothers kept daily logs of EHT volumes and direct breast-feeding episodes. Mothers successfully initiated and sustained EHT for 4.5 mo (range, 1-11 mo), feeding 426 +/- 227 mL/d (mean +/- SD). By wk 2 of follow-up, children were receiving EHT and Nutributter-enriched complementary foods that satisfied 100% of their energy requirements. During the 8-wk follow-up period, no growth faltering was experienced [changes in weight-for-age, weight-for-length, and length-for-age Z scores = +0.03 +/- 0.50; +0.77 +/- 1.59; and +0.02 +/- 0.85 (mean +/- SD), respectively]. Stigma was not a major deterrent, likely due to a social marketing campaign for EBF that promoted EHT as a practice to sustain breast-feeding for all women. This study provides evidence that resource-poor rural women can initiate and sustain EHT given family and health systems support. EHT provides a strategy for improving the diets of HIV-exposed but uninfected children after direct breast-feeding has ceased.

Figures

FIGURE 1

Dietary energy consumption from EHT milk, complementary foods (CF), and Nutributter (NB) as the percent of the RDA by 6- to 9-mo-old infants over the 8-wk follow-up period. Values are means, n = 20.

FIGURE 2

Volume of breast milk expressed daily (A) and during each expressing episode compared with the number of expressing episodes (B) over the 8-wk follow-up period. Values are means and 95% CI (A), n = 20.

FIGURE 3

Differences in energy intakes from EHT milk and complementary foods (CF) between children whose ponderal (A) and linear (B) growth did (ΔWAZ < 0, n = 10; ΔLAZ < −0.1, n = 10) and did not falter (ΔWAZ ≥0, n = 10; ΔLAZ ≥−0.1, n = 10) between recruitment and the final visit. Bars represent means ± SE. Asterisks indicate that means differed: ** P < 0.01; *** P < 0.001.