Collection of standardized information on infant feeding in the context of mother-to-child transmission of HIV.

Complete avoidance of breast-feeding is the surest way to avoid mother-to-child transmission (MTCT) of HIV through breast-feeding, but replacement feeding exposes infants, especially those born in developing countries, to the risk of other infectious diseases with consequent increase in morbidity and mortality. One study has suggested that exclusive breast-feeding during the first months of life carries a lower risk of HIV transmission than when other foods are given in addition to breast milk. Other studies have provided limited data on the risks of HIV transmission according to different patterns of breast-feeding, but studies have used different definitions of breast-feeding patterns and have analysed their data with adjustment on different risk factors. This hampers our ability to understand the mechanisms underlying HIV transmission through breast milk and the risks associated with different infant feeding practices. Consequently it is difficult to determine the best interventions to reduce the risk of transmission and the development of optimal policies. In collaboration with research teams involved with infant feeding research, the World Health Organization has developed a tool to assist studies on MTCTto collect information in a standardized manner, using common definitions and terms. The purpose is to facilitate comparisons between studies and the quantification of the risks of transmission according to various feeding patterns, after adjusting for potential confounding variables. The tool includes a core questionnaire to record infant feeding practices and other key information on the mother's and the infant's health. It also provides guidance on methods of analysis and presentation of the complex data on infant feeding. The tool can be used in prospective research studies on MTCT prevention, as well as providing the framework to assess infant feeding patterns in intervention programmes, such as those providing intensive counselling to mothers on infant feeding. The tool will facilitate the compilation of information from these studies which will ultimately provide scientific basis for updating guidelines and policies on infant feeding by mothers infected with HIV. Copyright 2001 John Wiley & Sons, Ltd.