Erna Morden
(MPH 2015)

March 13, 2017

Erna’s MPH thesis addressed one of the IeDEA-SA objectives, namely to establish and describe a sub-cohort of HIV-infected pregnant women and their exposed infants. The protocol included background information on sites contributing to this cohort of HIV-exposed uninfected (HEU) infants. The literature review included maternal disease factors, the use of antiretroviral therapy and the association between feeding modality and growth, focusing on studies conducted on the African continent. The manuscript detailed the methodology, results and interpretation of longitudinal analysis of growth among HEU infants in IeDEA-SA. This cohort of HEU infants included 2621 infants from two South African sites. The median birth WAZ was -0.65 (IQR -1.46; 0.0), 51% were male and there was a median of 2 visits per infant. The feeding modalities practiced were: 0.5% exclusive breastfeeding, 7.9% unknown breastfeeding exclusivity, 78.6% mixed breastfeeding and 10.6% formula feeding. Mothers with a CD4 <200 cells/μl delivered infants with a lower birth WAZ (adjusted ß -0.253 [95% CI -0.043; -0.072], p = 0.006) compared to mothers with a CD4 ≥500 cells/≧l. Similarly, mothers who did not receive antiretroviral (ARVs) drugs delivered infants with a lower birth WAZ (adjusted ß -0.49 [95% CI -0.78; -0.20], p = 0.001) compared to mothers who received antenatal ARVs. Antenatal maternal ARVs and CD4 cell count did not have an effect on postnatal growth. Mixed effects models using maximum likelihood estimation for the longitudinal analysis of growth showed that exposure to breast milk positively influenced growth, albeit the effect was small. Overall, less severe maternal disease and the use of ARVs positively impacted birth weight. Mixed feeding was common, and any breastfeeding may have a positive effect on longitudinal growth. Since 2014, Erna has been working for the Western Cape Department of Health within the Health Impact Assessment Directorate, Epidemiology and Disease Surveillance sub-directorate.