Premasticating Food for Weaning African Infants: A Possible Vehicle for Transmission of HIV

BACKGROUND: Although premastication of food for weaning infants might have nutritional benefit, it is also associated with transmission of pathogens. We investigated premastication practices in Cape Town, South Africa, in lower socioeconomic status caregivers of infants below 2 years of age. METHODS: A previously reported questionnaire was adapted for South African conditions. A convenience sample of infant caregivers was captured at public maternal/pediatric and HIV outpatient clinics and home visits. RESULTS: We interviewed 154 caregivers, 92% of whom were the biological mothers (median age: 29). Of these, 70% were black, and 29% were colored. There were 106 (69%) caregivers who practiced premastication. The median age of infants who received premasticated food was 6 (interquartile range: 4-6) months. Forty-six (43%) infants were teething, and 44 (42%) had oral mucosal lesions while receiving premasticated food. Fifty-five (52%) caregivers reported an oral condition, mostly bleeding gums, mouth sores, and thrush, and 41 (39%) caregivers reported blood in the food. Premasticating caregivers had a significantly lower educational level than those caregivers who did not engage in this practice. Premastication practices were cultural (40%), habit (20%), and on mother's advice (75%). Reasons for premastication were to pretaste (68%), encourage eating (61%), estimate food temperature (85%), and homogenize food (60%). CONCLUSIONS: Counselors and caregivers should be aware of the adverse effects of premastication. Education should include advice to avoid premastication and to seek health advice for oral conditions in the caregiver and child. More studies are needed to better define the extent and risks of premastication, including its possible role in increasing HIV-1 transmission. Pediatrics 2011; 128: e579-e590