Breastfeeding and the Risk of Malaria in Children Born to HIV-Infected and Uninfected Mothers in Rural Uganda

Background: Early cessation of breastfeeding increases morbidity and mortality of children born to HIV-infected mothers in resource-limited settings. However, data on whether breastfeeding reduces the risk of malaria in HIV-exposed and HIV-infected children is limited. Methods: We prospectively followed 99 HIV-unexposed children, 202 HIV-exposed children, and 45 HIV-infected children in a high malaria transmission area in Uganda. All children were given insecticide-treated bednets. HIV-exposed and HIV-infected children were given trimethoprim-sulfamethoxazole prophylaxis. Malaria diagnosis was based on fever and a positive blood smear. Date of breastfeeding cessation was determined through monthly questionnaires. Associations between breastfeeding and the risk of malaria were modeled through binomial generalized estimating equations using multivariate analysis adjusting for repeated measures, age, and location of residence. Analyses were stratified according to mothers' and children's HIV status. Results: Breastfeeding was associated with a significantly lower risk of malaria in 6-15 months old HIV-exposed children (relative risk [RR] = 0.62; P = 0.008) and 6-15 months old HIV-infected children (RR = 0.31; P = 0.002). However, breastfeeding was not protective against malaria for >15-24 months old HIV-unexposed (RR = 1.14; P = 0.21) or >15-24 months old HIV-infected children (RR = 1.11; P = 0.75). Conclusions: HIV-infected mothers should be counseled about the importance of breastfeeding and trimethoprim-sulfamethoxazole prophylaxis to protect their young children and themselves against malaria.