Breastfeeding versus formula-feeding

The Ditrame Plus study reported on the two-year mortality rates and alternatives to prolonged breastfeeding among mother-infant pairs in Cote d'Ivoire. Each woman received peripartum ARV prophylaxis and the choice after delivery to avoid  breastfeeding or to exclusively breastfeed up to the fourth months. After that point. breastfeeding would cease. Each mother made her own choice of feeding method.¹

For two years after delivery, nutritional, psychosocial, and biological follow-up was done with all mother-infant pairs. Breast milk substitutes were provided at no cost. Breastfeeding was chosen by 262 mothers and formula feeding by 295 mothers. All women in the study lived in an urban area with access to clean water.

At two years, the occurrence of adverse health outcomes, severe events, and validated morbidity were comparable between children who had been formula-fed and those who had been breastfed, even after adjusting for possible confounders. However, the incidence of diarrhoea and acute respiratory infection was significantly higher among formula-fed children and the incidence of malnutrition was significantly higher in breastfed children. Of the formula-fed children, 37% remained free from any adverse health outcome versus 34% of the short-term breastfed children.The 2-y probability of presenting with a severe event was the same among formula-fed (14%) and short-term breast-fed children (15%). 

The investigators also compared their data with infant mortality rates from an earlier study in which breastfeeding lasted longer (a mean duration of eight months). The overall 18-month probability of survival was similar in formula-fed, short-term breastfed, and longer-term breastfed infants who were not HIV-infected. The occurrence of death was not associated with the infant’s feeding option.

In summary, there was no difference in adverse events, severe illness, hospitalisation or death over two years of follow-up between short-term breastfed and formula-fed children. The investigators concluded that given appropriate nutritional counselling and care, access to clean water, and an adequate supply of breast milk substitutes, early weaning and formula-feeding were safe for HIV-exposed children.