More specifically, counselling should focus on emphasizing the risks of mixed feeding with solids which are more hazardous than predominant feeding with water-based fluids.
However, given that exclusive breastfeeding is rarely practised in African communities [10], [42], [43], unless extensive counselling has been provided [5], [44], [45], it is helpful for policy makers and health workers to appreciate the difference in risks for HIV transmission between predominant feeding with water-based fluids compared to mixed feeding with solids.
Figure 1 shows the life-table curves presenting the proportion discontinuing exclusive breastfeeding and starting predominant feeding, the proportion discontinuing predominant feeding and starting complementary feeding and those receiving replacement feeding, meaning not receiving any breast milk, at the different points in time.
30 A considerable proportion (17%) of infants less than 6 months were predominantly breastfed, suggesting a need for counselling mothers, caregivers and key family members on the risks associated with predominant feeding.
Infants acted as their own controls as they were randomly crossed over to different feeds, which included a whole predominant casein feed, whey hydrolysate and soya formula.
According to the WHO definition, exclusive breast feeding refers to only breast feeding with no other food or drink, whereas predominant breast feeding refers to mainly breast feeding with some other liquids such as water.
This work also identified corn as the overwhelmingly predominant animal feed for the beef and chicken served at fast food restaurants.
Currently only mixes of whey and casein have been used suggesting that a predominant whey feed (that also contains casein) may have better GE properties in GOR (Table 3).
Full breast feeding was defined as predominant breast feeding without any formula or solids, but allowing water and vitamins.
