Can breastfeeding reduce malaria risk?

October 2010

Investigators in Uganda enrolled HIV-unexposed, HIV-exposed, and HIV-infected children in an observational cohort study to determine the effect of breastfeeding on malaria risk. Results were published in October 2010 in the Journal of Acquired Immune Deficiency Syndrome. All participants received an insecticide-treated bednet, and exposed and infected children received daily trimethoprim-sulfamethoxazole (TS) prophylaxis, as did their mothers. Exposed children who remained HIV-free after the cessation of breastfeeding stopped TS prophylaxis. Because the ages at which HIV-infected children stopped breastfeeding clustered beyond and before 15 months, the authors stratified their analysis into groups of 6-15 months and >15-24 months.

Breastfeeding was protective against malaria among exposed and infected children 6-15 months of age but not among those >15-24 months of age. Analysis was not possible for unexposed children 6-15 months because nearly all were breastfeeding, nor for exposed children >15-24 months because hardly any were breastfeeding. No association was seen between malaria incidence and breastfeeding in unexposed children. Infected children were no more likely to get malaria than exposed children, suggesting that HIV infection was not an independent risk factor for malaria, and children taking TS were 60 percent less likely to get malaria than those who were not (unexposed children). The authors recommended more research to determine the mechanism by which breastfeeding may reduce the risk of malaria in children taking TS and concluded that the results provided more evidence on the risks of early cessation of breastfeeding.

Breastfeeding and the risk of malaria in children born to HIV-infected and uninfected mothers in rural Uganda