HOSPITALISATION AND DEATH EVENTS IN A COHORT OF INFANTS FROM SOUTH AFRICA: EFFECTS OF LOW BIRTH WEIGHT AND BREASTFEEDING STATUS
Tanya Doherty1, T. Doherty2, D. Jackson3, S. Swanevelder4, C. Lombard4, D. Sanders5, I. Engebretsen6, T. Tylleskär6, A. Goga2
1Medical Research Council
2Health Systems Research Unit, Medical Research Council, Cape Town, South Africa
3School of Public Health, University of the Western Cape, Cape Town, South Africa
4Biostatistics, Medical Research Council, Cape Town, South Africa
5School of Public health, University of the Western Cape, Cape Town, South Africa
6Centre for International Health, University of Bergen, Bergen, Norway
Purpose/Objective
South Africa, despite being classified as an upper middle income country, is not on track to reach Millennium Development Goal 4. Low coverage of interventions with proven effectiveness, such as exclusive breastfeeding promotion contribute to this situation. This paper reports on risk factors for severe events (hospitalisations or infant death) within the first half of infancy taking into account breastfeeding status.
Materials and Methods
South African data from the multi-site community-based cluster-randomized trial PROMISE EBF (ClinicalTrials.gov no: NCT00397150) promoting exclusive breastfeeding from 2006 to 2008 were used. 964 HIV negative mother-infant pairs were included in this analysis. Data on severe events and infant feeding practices were collected at 3, 6, 12 and 24 weeks postpartum. We used a stratified extended Cox model to examine the association between different covariates and severe infant events, with breastfeeding status as a time dependent covariate.
Results
Seventy (7%) infants in the cohort experienced a severe event. The median age at first hospitalisation was eight weeks and the two main reasons for hospitalisation were cough and difficult breathing followed by diarrhoea. Breastfeeding status (HR 2.4; 95% CI 1.2-5.1) and low birth weight (HR 2.4; 95%CI 1.3-4.3) were both found to increase the risk of a severe event, whilst maternal completion of high school education was protective (HR 0.3; 95% CI 0.1-0.7).
Conclusions
A strengthened primary health care system incorporating promotion of breastfeeding and appropriate caring practices for low birth weight infants (kangaroo mother care) is needed to prevent hospitalisation events in young infants.