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Complementary Feeding and Diarrhea and Respiratory Infection Among HIV-Exposed Tanzanian Infants
Pili Kamenju1, Enju Liu, Ellen Hertzmark
1Departments of *Global Health and Population; †Epidemiology; ‡Biostatistics; §Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; ‖Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; ¶Nutrition Section, United Nations Children's Fund (UNICEF), New York, NY; #Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; and **Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA.
Insights
Poor complementary feeding practices, including low dietary diversity and food consistency, increase the risk of diarrhea and acute respiratory infection (ARI) in HIV-exposed infants. Ensuring adequate nutrition is crucial for infant health.
Area of Science:
- Pediatric Nutrition
- Infectious Disease Epidemiology
- HIV/AIDS Research
Background:
- Complementary feeding is critical for infant development and disease prevention.
- HIV-exposed infants face unique health challenges, including increased susceptibility to infections.
- Understanding the impact of feeding practices on morbidity in this vulnerable population is essential.
Purpose of the Study:
- To investigate the association between complementary feeding practices and the risk of diarrhea and acute respiratory infection (ARI).
- To evaluate the role of the Infant and Child Feeding Index (ICFI) and its components in predicting illness risk.
- To provide evidence for targeted nutritional interventions in HIV-exposed infants.
Main Methods:
- Prospective study involving 2092 HIV-exposed infants aged 6-24 months in Dar es Salaam, Tanzania.
- Utilized the Infant and Child Feeding Index (ICFI) to assess complementary feeding (breastfeeding, food consistency, dietary diversity, etc.).
- Employed generalized estimating equations to analyze the relative risks of diarrhea and ARI episodes.
Main Results:
- Low ICFI scores were linked to a higher risk of dysentery and respiratory infections.
- Reduced dietary diversity was associated with increased risks of dysentery and respiratory infections.
- Inadequate food consistency significantly increased the risk of respiratory infections.
Conclusions:
- Suboptimal complementary feeding, indicated by low ICFI, dietary diversity, and food consistency, is associated with increased morbidity from diarrhea and ARI in HIV-exposed infants.
- These findings highlight the importance of optimizing feeding practices to reduce infection risks in this population.
- Interventions should focus on improving dietary diversity and food consistency for HIV-exposed infants.
Objective:
To examine the association between complementary feeding and risks of diarrhea and acute respiratory infection (ARI) among HIV-exposed infants aged 6-24 months.
Design:
We prospectively used an Infant and Child Feeding Index (ICFI) to measure complementary feeding practices (breastfeeding status, food consistency, dietary diversity, food group frequency, and meal frequency). We determined the association of ICFI and each of its components with the risk of diarrhea and ARI. Generalized estimating equations were used to estimate the relative risks for morbidity episodes.
Setting:
Dar es Salaam, Tanzania.
Subjects:
A total of 2092 HIV-exposed infants followed from 6 months of age to 24 months of age.
Results:
The ICFI score ranged from 0 to 9; the median score was 6 (interquartile range = 4-7). Low ICFI scores were likely associated with increased risk of dysentery [low vs. high tertile risk ratio (RR): 1.40; 95% confidence interval (CI): 0.93 to 2.10; P for trend = 0.02] and respiratory infection (low vs. high tertile RR: 1.16; 95% CI: 0.96 to 1.41; P for trend = 0.01). Low dietary diversity scores were likely associated with higher risk of dysentery (low vs. high tertile RR: 1.47; 95% CI: 0.92 to 2.35; P for trend = 0.03) and respiratory infection (low vs. high tertile RR: 1.41; 95% CI: 1.13 to 1.76; P for trend = 0.01). Low food consistency scores were associated with higher risk of respiratory infection (RR: 1.77; 95% CI: 1.40 to 2.26; P < 0.01).
Conclusions:
In this setting, low ICFI, dietary diversity, and food consistency scores were likely associated with increased risk of diarrhea and ARI among HIV-exposed infants.
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