Formula feeding a dangerous option in rural Africa

December 2008

Results from a study in Rakai, Uganda, confirmed once again that promoting formula feeding for HIV-exposed infants can be dangerous in certain settings. In a program-based intervention in a mostly rural area, mothers received antenatal infant feeding counseling and chose exclusive breastfeeding or formula feeding. By 12 months, formula-fed infants had a 6 times greater risk of mortality compared to breastfed infants (18% vs. 3%). Despite very low adherence to exclusive breastfeeding, HIV-free survival was 96% among breastfed infants and only 86% among formula-fed infants (p=.16) at 12 months. The lack of significance may be due to a relatively small sample size. Even though the program provided free formula, utensils, and significant support, many mothers did not wash utensils before using them, gave formula in bottles, used unsafe drinking water, and had difficulty preparing formula in correct proportions. The authors concluded that programs should not promote formula feeding in rural Africa.

Survival of Infants Born to HIV-Positive Mothers, by Feeding Modality, in Rakai, Uganda