Collection of standardized information on infant feeding in the context ofmother-to-child transmission of HIV

Complete avoidance of breast-feeding is the surest way to avoid mother-to-c hild transmission (MTCT) of HIV through breast-feeding, but replacement fee ding exposes infants, especially those born in developing countries, to the risk of other infectious diseases with consequent increase in morbidity an d mortality. One study has suggested that exclusive breast-feeding during t he first months of life carries a lower risk of HIV transmission than when other foods are given in addition to breast milk. Other studies have provid ed limited data on the risks of HIV transmission according to different pat terns of breastfeeding, but studies have used different definitions of brea st-feeding patterns and have analysed their data with adjustment on differe nt risk factors. This hampers our ability to understand the mechanisms unde rlying HIV transmission through breast milk and the risks associated with d ifferent infant feeding practices. Consequently it is difficult to determin e the best interventions to reduce the risk of transmission and the develop ment of optimal policies. In collaboration with research teams involved wit h infant feeding research, the World Health Organization has developed a to ol to assist studies on MTCT to collect information in a standardized manne r, using common definitions and terms. The purpose is to facilitate compari sons between studies and the quantification of the risks of transmission ac cording to various feeding patterns, after adjusting for potential confound ing variables. The tool includes a core questionnaire to record infant feed ing practices and other key information on the mother's and the infant's he alth. It also provides guidance on methods of analysis and presentation of the complex data on infant feeding. The tool can be used in prospective res earch studies on MTCT prevention, as well as providing the framework to ass ess infant feeding patterns in intervention programmes, such as those provi ding intensive counselling to mothers on infant feeding. The tool will faci litate the compilation of information from these studies which will ultimat ely provide scientific basis for updating guidelines and policies on infant feeding by mothers infected with HIV. Copyright (C) 2001 John Wiley & Sons , Ltd.