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After nearly 28 years, The Communication Initiative (The CI) Global is entering a new chapter. Following a period of transition, the global website has been transferred to the University of the Witwatersrand (Wits) in South Africa, where it will be administered by the Social and Behaviour Change Communication Division. Wits' commitment to social change and justice makes it a trusted steward for The CI's legacy and future.
 
Co-founder Victoria Martin is pleased to see this work continue under Wits' leadership. Victoria knows that co-founder Warren Feek (1953–2024) would have felt deep pride in The CI Global's Africa-led direction.
 
We honour the team and partners who sustained The CI for decades. Meanwhile, La Iniciativa de Comunicación (CILA) continues independently at cila.comminitcila.com and is linked with The CI Global site.
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Morbidity and mortality in breastfed and formula-fed infants of HIV-1-infected women: A randomized clinical trial

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Mbori-Ngacha, D., R. Nduati, et al. (2001). "Morbidity and mortality in breastfed and formula-fed infants of HIV-1-infected women: A randomized clinical trial." Journal of the American Medical Association 286(19): 2413-2420.

Context: Breast-feeding among women infected with human immunodeficiency virus type 1 (HIV-1) is associated with substantial risk of HIV-1 transmission, but little is known about the morbidity risks associated with formula feeding in infants of HIV-1-infected women in resource-poor settings.

Objective: To compare morbidity, nutritional status, mortality adjusted for HIV-1 status, and cause of death among formula-fed and breastfed infants of HIV-1-infected women.

Design: Randomized clinical trial conducted between 1992 and 1998.

Setting: Four antenatal clinics in Nairobi, Kenya.

Participants: Of 401 live-born, singleton, or first-born twin infants of randomized HIV-1-seropositive mothers, 371 were included in the analysis of morbidity and mortality.

Interventions: Mothers were randomly assigned either to use formula (n = 186) or to breastfeed (n = 185) their infants.

Main Outcome Measures: Mortality rates, adjusted for HIV-1 infection status; morbidity; and nutritional status during the first 2 years of life.

Results: Two-year estimated mortality rates among infants were similar in the formula-feeding and breast-feeding arms (20.0% vs 24.4%; hazard ratio [HR], 0.8; 95% confidence interval [Cl], 0.5-1.3), even after adjusting for HIV-1 infection status (HR, 1.1; 95% Cl, 0.7-1.7). Infection with HIV-1 was associated with a 9.0-fold increased mortality risk (95% Cl, 5.3-15.3). The incidence of diarrhea during the 2 years of follow-up was similar in formula and breastfeeding arms (155 vs 149 per 100 person-years, respectively). The incidence of pneumonia was identical in the 2 groups (62 per 100 person-years), and there were no significant differences in incidence of other recorded illnesses. Infants in the breastfeeding arm tended to have better nutritional status, significantly so during the first 6 months of life.

Conclusions: In this randomized clinical trial, infants assigned to be formula fed or breastfed had similar mortality rates and incidence of diarrhea and pneumonia during the first 2 years of life. However, HIV-1-free survival at 2 years was significantly higher in the formula arm. With appropriate education and access to clean water, formula feeding can be a safe alternative to breastfeeding for infants of HIV-1-infected mothers in a resource-poor setting.