The Acceptance and Feasibility of Replacement Feeding at 6 Months as an HIV Prevention Method in Lilongwe, Malawi: Results From the BAN Study

Parker, Megan; Bentley, Margaret E.; Chasela, Charles; Adair, Linda S.; Piwoz, Ellen; Jamieson, Denise J.; Ellington, Sascha; Kayira, Dumbani; Soko, Alice; Mkhomawanthu, Chimwemwe; Tembo, Martin; Martinson, Francis; Horst, Charles M. van der

doi:10.1521/aeap.2011.23.3.281

Cited by 17 publications

(19 citation statements)

References 38 publications

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“…These findings, together with high levels of LNS adherence, indicate that use of LNS as a breastmilk replacement was feasible in the full BAN sample, as previously documented in a small subsample (42). The results of the present study are applicable in the current prevention of MTCT environment, because ARVs are not universally available and some HIVinfected mothers continue to wean early even when AFASS conditions are not met.…”

Section: Discussionsupporting

confidence: 67%

“…In addition, prevalence of any diarrhea in BAN infants was lower for similar time periods than among Zambian HIV-exposed infants who were weaned at 4 mo (43% at 7-9 mo and 44% at 10-12 mo) as well as those who were still breastfed (38% at 7-9 mo and 39% at 10-12 mo) (5). This could be attributable in part to the provision of LNS (which is resistant to bacteriologic growth) as a breastmilk replacement or to the counseling on replacement feeding practices provided by the study (19,42).…”

Section: Discussionmentioning

confidence: 99%

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Lipid-Based Nutrient Supplements Are Feasible As a Breastmilk Replacement for HIV-Exposed Infants from 24 to 48 Weeks of Age

Flax

Bentley

Chasela

et al. 2013

The Journal of Nutrition

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The Breastfeeding, Antiretrovirals, and Nutrition (BAN) Study randomized HIV-infected mothers and their infants to receive either maternal lipid-based nutrient supplements (LNS) during lactation or no LNS and then to 1 of 3 antiretroviral drug (ARV) arms (maternal, infant, or no drugs). Assigned interventions were provided from 0 to 28 wk and all infants (n = 1619) were given LNS during (24-28 wk) and following (28-48 wk) weaning. This paper assesses the feasibility of infant LNS as a breastmilk replacement and uses longitudinal random effects models to examine associations of interventions, morbidity, and season with weight-for-age (WAZ), length-for-age (LAZ), and BMI-for-age (BMIZ) Z-scores from 24 to 48 wk. Infant LNS adherence was high (94.1% ate it daily). From 24 to 48 wk, mean WAZ (-0.42 to -0.76 SD; P < 0.001) and LAZ (-0.93 to -1.56 SD; P < 0.001) steadily declined, whereas BMIZ remained >0 throughout. A higher LAZ was associated with assignment to the maternal LNS arm (β=0.19; P < 0.05). Lower WAZ and BMIZ were associated with seasonal food insecurity (β=-0.08 and -0.09, respectively; both P < 0.001), fever (β=-0.07 and -0.13; both P < 0.001), diarrhea (β=-0.19 and -0.23; both P < 0.001), and assignment to the infant ARV arm (β=-0.17 and -0.17; both P < 0.05). The magnitude of the season and morbidity effects was small and BAN infants had higher weights and lengths than their counterparts in the general population. High LNS adherence and the modest impact of morbidity on growth indicate that LNS is a feasible breastmilk replacement for HIV-exposed infants weaned early, but controlled trials are needed to quantify the effects of LNS on growth in this population.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Lipid-Based Nutrient Supplements Are Feasible As a Breastmilk Replacement for HIV-Exposed Infants from 24 to 48 Weeks of Age

Flax

Bentley

Chasela

et al. 2013

The Journal of Nutrition

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“…Another study by the same group indicated that while families place a high value on complementary foods, the quality of these foods is often low in energy and nutrient density (Parker et al . ). Their findings suggest that LNS appears to provide some benefit to children's complementary food intake, but does not solve all nutrient gaps nor provide adequate diets post supplementation.…”

Section: Discussionmentioning

confidence: 97%

Impact of lipid‐based nutrient supplementation (LNS) on children's diet adequacy in Western Uganda

Ickes

Adair

Brahe

et al. 2015

Maternal & Child Nutrition

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Lipid-based nutrient supplements (LNS) can help treat undernutrition; however, the dietary adequacy of children supplemented with LNS, and household utilisation patterns are not well understood. We assessed diet adequacy and the quality of complementary foods by conducting a diet assessment of 128 Ugandan children, ages 6-59 months, who participated in a 10-week programme for children with moderate acute malnutrition (MAM, defined as weight-for-age z-score < −2). Caregivers were given a weekly ration of 650 kcal day ) of a peanut/soy LNS. Two 24-h dietary recalls were administered per child. LNS was offered to 86% of targeted children at least once. Among non-breastfed children, over 90% met their estimated average requirement (EAR) cut-points for all examined nutrients. Over 90% of breastfed children met EAR cut-points for nutrient density for most nutrients, except for zinc where 11.7% met cut-points. A lower proportion of both breastfed and non-breastfed children met adjusted EARs for the specific nutritional needs of MAM. Fewer than 20% of breastfed children met EAR nutrient-density guidelines for MAM for zinc, vitamin C, vitamin A and folate. Underweight status, the presence of a father in the child's home, and higher programme attendance were all associated with greater odds of feeding LNS to targeted children. Children in this community-based supplemental feeding programme who received a locally produced LNS exhibited substantial micronutrient deficiencies given the special dietary needs of this population. These results can help inform programme strategies to improve LNS targeting, and highlight potential nutrient inadequacies for consumers of LNS in community-based settings.

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“…Parker et al . () reported mothers mixing LNS into porridge and occasionally into milk formula or serving it on bread. The timing of introduction of LNS corresponded with the interval in which the range of complementary foods increases, perhaps increasing the likelihood of integration of LNS with other complementary foods.…”

Section: Discussionmentioning

confidence: 99%

Preventative lipid‐based nutrient supplements (LNS) and young child feeding practices: findings from qualitative research inHaiti

Lesorogol

Jean-Louis

Green

et al. 2015

Maternal & Child Nutrition

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To prevent undernutrition in an urban slum in Haiti, a lipid-based nutrient supplement (LNS) was introduced through a randomised control trial. Food supplementation for young child nutrition has a long history in Haiti, but there is little empirical information regarding the effects of supplementation on young child feeding practices. One of the concerns raised by supplementation is that it may disrupt other positive feeding practices such as breastfeeding and use of other complementary foods, with negative consequences for child nutrition. We conducted 29 in-depth interviews with mother-baby pairs from the three comparison groups: control, 3-month LNS supplementation and 6-month LNS supplementation. Findings from those in the LNS groups indicated high acceptance and satisfaction with LNS and perceptions that it positively affects child health and development. LNS was integrated into and enhanced ongoing complementary feeding practices. The effects of LNS use on duration and perceived quantity of breastfeeding were variable, but generally, breastfeeding was maintained during and after the intervention. Interviews generated insights into beliefs regarding infant and young child feeding practices such as introduction and use of complementary foods, and breastfeeding duration, exclusivity and cessation. Implications for the use of LNS in public health nutrition programmes are discussed.

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The Acceptance and Feasibility of Replacement Feeding at 6 Months as an HIV Prevention Method in Lilongwe, Malawi: Results From the BAN Study

Cited by 17 publications

References 38 publications

Lipid-Based Nutrient Supplements Are Feasible As a Breastmilk Replacement for HIV-Exposed Infants from 24 to 48 Weeks of Age

Lipid-Based Nutrient Supplements Are Feasible As a Breastmilk Replacement for HIV-Exposed Infants from 24 to 48 Weeks of Age

Impact of lipid‐based nutrient supplementation (LNS) on children's diet adequacy in Western Uganda

Preventative lipid‐based nutrient supplements (LNS) and young child feeding practices: findings from qualitative research inHaiti

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