Potential impact of infant feeding recommendations on mortality and HIV-infection in children born to HIV-infected mothers in Africa: a simulation.
Potential impact of infant feeding recommendations on mortality and HIV-infection in children born to HIV-infected mothers in Africa: a simulation.
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婴儿喂养建议对非洲艾滋病毒感染母亲出生的儿童死亡率和艾滋病毒感染的潜在影响：一种模拟。
DOI：
10.1186/1471-2334-8-66
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发表时间：
2008-05-16
影响因子：
3.7
通讯作者：
Sickbert-Bennett, Emily E.
中科院分区：
文献类型：
--
作者：
Atashili, Julius;Kalilani, Linda;Seksaria, Vidyunmala;Sickbert-Bennett, Emily E.
虽然母乳喂养占艾滋病毒母婴传播的15-20%，但在一些发展中国家并不禁止母乳喂养，因为不母乳喂养的死亡率较高。我们评估了缩短纯母乳喂养（EBF）持续时间的建议以及对这些建议的遵守情况不佳对艾滋病毒感染和婴儿死亡率的潜在影响。我们开发了一个确定性的数学模型，主要使用在乌干达或肯尼亚进行的已发表的研究的参数，并考虑到不遵守导致混合喂养的做法。结果包括感染艾滋病毒和/或死亡的儿童人数（累计死亡率）在感染艾滋病毒的妇女所生的儿童在6种婴儿喂养建议方案中的每一种方案后2年的死亡率：100%依从性的完全补充喂养（ERF），100%依从性的6个月EBF，100%依从性的4个月EBF，70%依从性的ERF，在基础模型中，将EBF的持续时间从6个月减少到4个月，艾滋病毒感染减少了11.8%，而死亡率增加了0.4%。当推荐EBF 6个月时，15%的婴儿的混合喂养使HIV感染和死亡率分别增加2.1%和0.5%;当推荐EBF 4个月时，分别增加1.7%和0.3%。在敏感性分析中，当a）母乳喂养婴儿的死亡率大于50/1000人-年，B）纯母乳喂养婴儿的感染率小于2/1000母乳喂养婴儿每周，c）从HIV到AIDS的进展率小于15/1000感染婴儿每周，或d）每年每1000名感染艾滋病毒/艾滋病的婴儿中，因艾滋病毒/艾滋病死亡的人数少于200人。建议缩短这些环境中感染艾滋病毒的妇女所生婴儿的母乳喂养时间，可能会大大减少婴儿艾滋病毒感染，但不会降低死亡率。当推荐使用较短时间的EBF时，可以通过同时降低从HIV到AIDS的进展速度和/或HIV/AIDS死亡率来降低死亡率，这可以通过在婴儿中使用HAART来实现。
Although breast-feeding accounts for 15–20% of mother-to-child transmission (MTCT) of HIV, it is not prohibited in some developing countries because of the higher mortality associated with not breast-feeding. We assessed the potential impact, on HIV infection and infant mortality, of a recommendation for shorter durations of exclusive breast-feeding (EBF) and poor compliance to these recommendations. We developed a deterministic mathematical model using primarily parameters from published studies conducted in Uganda or Kenya and took into account non-compliance resulting in mixed-feeding practices. Outcomes included the number of children HIV-infected and/or dead (cumulative mortality) at 2 years following each of 6 scenarios of infant-feeding recommendations in children born to HIV-infected women: Exclusive replacement-feeding (ERF) with 100% compliance, EBF for 6 months with 100% compliance, EBF for 4 months with 100% compliance, ERF with 70% compliance, EBF for 6 months with 85% compliance, EBF for 4 months with 85% compliance In the base model, reducing the duration of EBF from 6 to 4 months reduced HIV infection by 11.8% while increasing mortality by 0.4%. Mixed-feeding in 15% of the infants increased HIV infection and mortality respectively by 2.1% and 0.5% when EBF for 6 months was recommended; and by 1.7% and 0.3% when EBF for 4 months was recommended. In sensitivity analysis, recommending EBF resulted in the least cumulative mortality when the a) mortality in replacement-fed infants was greater than 50 per 1000 person-years, b) rate of infection in exclusively breast-fed infants was less than 2 per 1000 breast-fed infants per week, c) rate of progression from HIV to AIDS was less than 15 per 1000 infected infants per week, or d) mortality due to HIV/AIDS was less than 200 per 1000 infants with HIV/AIDS per year. Recommending shorter durations of breast-feeding in infants born to HIV-infected women in these settings may substantially reduce infant HIV infection but not mortality. When EBF for shorter durations is recommended, lower mortality could be achieved by a simultaneous reduction in the rate of progression from HIV to AIDS and or HIV/AIDS mortality, achievable by the use of HAART in infants.
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影响因子：
11.8
作者：
Giaquinto, C;Ruga, E;Horban, A
通讯作者：
Horban, A
影响因子：
3.8
作者：
Bertolli, J;Hu, DJ;Simonds, RJ
通讯作者：
Simonds, RJ
DOI：
10.2471/blt.04.019448
发表时间：
2006-02-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Doherty, Tanya;Chopra, Mickey;Greiner, Ted
通讯作者：
Greiner, Ted
影响因子：
3.8
作者：
HU, DJ;HEYWARD, WL;HEYMANN, DL
通讯作者：
HEYMANN, DL
影响因子：
3.8
作者：
Magoni, M;Bassani, L;Vella, S
通讯作者：
Vella, S