Growth, feeding practices, and haemoglobin levels in 6 to 12 month-old infants exposed and unexposed to maternal HIV status in a peri-urban area in Gauteng province, South Africa

Abstract

Introduction: Undernutrition is a significant public health issue, primarily caused by inappropriate feeding practices that negatively impact infant growth and development. In Sub-Saharan Africa, South Africa has the highest prevalence of human immunodeficiency virus (HIV). Antiretroviral therapy (ART) programmes reduce the infection rate, but leave infants exposed to maternal HIV infection but uninfected (HEU), and more than one million HEU infants are born annually. HEU infants are at a higher risk of mortality and morbidity than HIV-unexposed-uninfected (HUU) infants, leading to poor growth and increased risk of stunting, underweight and anaemia. Limited information exist on the growth, feeding practices and haemoglobin levels of 6-12 months old infants. Aim: To compare the growth, feeding practices, and haemoglobin levels of HEU and HUU infants aged 6–12-months, and determine the relationship between growth, feeding practices and haemoglobin levels in these infants, stratified by maternal HIV status. Methods: This cross-sectional study with repeated measurements was embedded in the Siyakhula Study, where data collection started in October 2018 until August 2023. Infants’ anthropometric measurements (weight, length, head circumference and mid-upper-arm circumference), feeding practices (complementary- and breastfeeding, food frequently consumed, and dietary intake), and haemoglobin level (a marker for anaemia) were collected using calibrated scales, structured questionnaires and the HemoCue® device by trained research assistants using a local language. Hand expressed breastmilk was analysed for the nutrient composition of copper, iron, manganese, selenium, and zinc using the inductively coupled plasma mass spectroscopy method. Results: The study included 181 infants (86 HEU; 95 HUU), with 58% males. High percentages of low birth weight was found in HEU than HUU infants (22% vs. 13%; p<0.001). Length-for-age Z-scores (LAZ) (p<0.05), weight-for-age Z-scores (WAZ) (p<0.05), and mid-upper-arm circumference-for-age Z-scores (MUACAZ) (p<0.05) were lower in HEU versus HUU infants at 6 and 9 months. Lower weight-for-length Z-scores (WLZ) (−0.2±1.2 vs. 0.2±1.2; p=0.020) was observed at 12 months in HEU infants. The HEU and HUU infants were introduced to complementary foods too early, and lower breastfeeding rates were found in HEU than HUU infants at 9 (36% vs. 57%; p=0.013) and 12 months (25% vs. 48%; p=0.005). Only 11% of HEU and 6% of HUU achieved a minimum dietary-diverse diet and flesh foods consumption was significantly higher in HEU (24%) than HUU (11%) at 12 months. Dietary fat intakes were low in HEU and HUU infants, with iron, calcium, and vitamin A intakes higher in HEU than HUU infants at 12 months. Haemoglobin levels and anaemia was similar in HEU and HUU infants but more percentages of anaemia were found in HEU than HUU infants at 6 (27% vs. 18%) and 9 months (33% vs. 29%). Haemoglobin levels positively correlated with WAZ (p=0.039), LAZ (p=0.007), and MUACAZ (p=0.039) at 9 months, and at 12 months WAZ (p=0.018) and WLZ (p=0.041) in HEU infants. Conclusion: The HEU infants had suboptimal growth and inappropriate feeding practices including lower breastfeeding rates than HUU infants. The HEU infants had higher dietary intakes, dietary diversity, and flesh consumption than HUU infants. Infant growth and feeding habits are impacted by maternal HIV infection but better infant feeding counselling and implementation need to be prioritized for all South African mothers, irrespective of the HIV status.