OBJECTIVE:

We examined the relationships between exclusive breast-feeding and the risks of respiratory, diarrhoea and nutritional morbidities during the first 2 years of life among children born to women infected with HIV-1.

DESIGN:

We prospectively determined the incidence of respiratory illnesses, diarrhoea, fever, hospitalizations, outpatient visits and nutritional morbidities. Generalized estimating equations were used to estimate the relative risks for morbidity episodes and Cox proportional hazards models to estimate the incidence rate ratios of nutritional morbidities.

SETTING:

Dar es Salaam, Tanzania.

SUBJECTS:

The sample consisted of 666 children born to HIV-infected women.

RESULTS:

The 666 children were followed for 2 years. Exclusive breast-feeding was associated with lower risk for cough (rate ratio (RR) = 0·49, 95 % CI 0·41, 0·60, P < 0·0001), cough and fever (RR = 0·44, 95 % CI 0·32, 0·60, P < 0·0001) and cough and difficulty breathing or refusal to feed (RR = 0·31, 95 % CI 0·18, 0·55, P < 0·0001). Exclusive breast-feeding was also associated with lower risk of acute diarrhoea, watery diarrhoea, dysentery, fever and outpatient visits during the first 6 months of life, but showed no effect at 6-24 months of life. Exclusive breast-feeding did not significantly reduce the risks of nutritional morbidities during the first 2 years of life.

CONCLUSIONS:

Exclusive breast-feeding is strongly associated with reductions in the risk of respiratory and diarrhoea morbidities during the first 6 months of life among children born to HIV-infected women.