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To the Editor: Despite the significant progress in prevention of the vertical transmission of human immunodeficiency virus (HIV) in industrialized countries, including perinatal antiviral drugs, little progress has been made in developing countries, especially in sub-Saharan Africa. However, recent studies suggested that multivitamin supplementation might be a feasible and cost-effective approach to reduce the risk of vertical transmission as well as progression of HIV, although ongoing clinical trials should be awaited to ensure its efficacy.1 Another potential strategy is avoiding breastfeeding. Breast milk is an important source of mother-to-child transmission, which is estimated to be responsible for one third to half of mother-to-child transmission worldwide.2 A recent study showed that an estimated risk of late postnatal transmission was 3.2 per 100 child-years of breastfeeding follow-up.3 In Côte d'Ivoire, which has one of the highest HIV prevalence rates (more than 10%),4 stopping breastfeeding at 6 months is already being considered for women infected with HIV.5
To assess the perception of HIV and acquired immunodeficiency syndrome (AIDS) and the practice of breastfeeding in the western villages of Côte d'Ivoire, we conducted structured interviews between March 18-28, 1998, with 150 individuals who were older than 15 years selected by visiting every fifth house from the entrance of the villages, and in-depth interviews with 20 individuals, including community leaders, their wives, and health practitioners.
Sixty-six (44%) of the structured interviews and 13 (65%) of the in-depth interviews were with women. The mean (SD) age was 40.9 (17.4) years, and 48 women (60.8%) were of childbearing age (15-49 years). Forty women of childbearing age had children, among whom 38 (95.0%) were exclusively breastfeeding and 2 (5.0%) were partially breastfeeding. A total of 105 (70.0%) of the respondents had heard about AIDS. Among them, 100 (95.2%) thought it was fatal, 48 (45.7%) knew it was preventable, and none of them knew that it could be transmitted through breast milk. As for the practice of breastfeeding, the average infants' age to start weaning was about 8 months, but the breastfeeding itself was continued, on average, until 18 months.
This extended period of breastfeeding implies an increased risk of the postnatal vertical transmission of HIV in this region. In the in-depth interview, some women reported that breastfeeding provided a way to pacify the babies as well as to provide nutrition. Although a variety of nutritious foods were available in markets, most of the women in this area gave their babies only liquid (water, juice, or milk) for weaning. This practice might lead to malnutrition and consequent vulnerability to other communicable diseases as studies have shown.6
Therefore, even if early cessation of weaning were to be recommended, there could be a trade-off between a reduction of postnatal HIV transmission and an increase of malnutrition and other communicable diseases. Furthermore, it would be difficult to modify the women's breastfeeding and weaning practices due to their knowledge, traditional beliefs, and socioeconomic factors. Further sociocultural studies are needed to establish better strategies for behavioral modification of breastfeeding and other practices in these regions.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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