Word counts: 1) Abstract: 240 words 2) Text: 3,718 words......Max 2,948 (excluding references) Number of tables: 3. Number of figures: 1 Abstract Objective: To compare breastfeeding practices determined by mothers' own recall versus a stable isotope technique (deuterium oxide dilution) among HIV-infected and HIV-uninfected mothers at 6 weeks and 6 months postpartum. Methods: Exclusive breastfeeding (EBF) rates were assessed cross-sectionally at 6 weeks and 6 months postpartum among 75

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... ve and 68 HIV-negative women attending postnatal care. EBF was derived from own 24-hour recall of foods that were fed to the infant and by objective measurement of non-human milk water intake using deuterium oxide (DO) dilution technique. Results: Multivariable logistic analyses were adjusted for infant sex, gravidity, maternal age, marital status and maternal education. Using recall method, a greater proportion of HIV-infected mothers exclusively breastfed than HIV-uninfected mothers both at 6 weeks postpartum [94.1% versus 76.9%, respectively (aOR: 7.81; 95% CI: 1.9-31.6, p=0.004)] and at 6 months postpartum [75% versus 59.7%, respectively (aOR: 2.27; 95% CI: 1.0-5.3, p=0.058)]. At 6 weeks postpartum EBF rates from the DO technique were 23.5% and 13.8% for HIV-positive and HIVnegative mothers, respectively (aOR: 0.35; 95% CI: 0.11-1.04, p=0.059). At 6 months postpartum, the DO technique determined EBF rates were 43.3% among HIV-positive and 24.2% among HIV-negative mothers, respectively (aOR: 2.4; 95% CI: 1.0-5.7, p=0.048). Conclusions: HIV-infected mothers are more likely to exclusively breastfeed compared to HIVuninfected mothers. In this resource poor setting, maternal recall overestimates EBF rates as compared to the deuterium oxide dilution technique. Validating EBF recall data using the objective DO technique is highly recommended for accurate tracking towards global targets on breastfeeding practices.