[pronut-hiv] Abrupt cessation of breastfeeding in the context of HIV/AIDS- what do we know?

["materu" <materu@ud.co.tz>]

Breastfeeding in the context of HIV/AIDS: Do we really know the reality? and what does it mean? (2)


I Agree with Stacia that very few mothers in our African setting do
breastfeed exclusively.  Even without HIV/AIDS, breastfeeding mothers are
not getting enough support for them to be able to breast feed exclusively,
to deal with minor problems like engorged breasts, cracked nipples, how
to practice proper attachment etc.  This makes the situation of infant
feeding for HIV positive mothers more difficult.  This Probably calls for an
approach that will focus on infant and child feeding to all mothers.

Most of infant feeding and HIV practices which have been monitored are
mostly within the PMTCT research programmes, and I think very little (if
anything) has been done out side the research setting (even those who pass
out of the research) especially in regard to what mothers do when they stop
breastfeeding, and if they stop at all.

What I think might be useful is the idea which is coming up, of introducing
cup feeding with expressed breast milk before stopping breast feeding, and
if acceptable and feasible, continuing with heated expressed breast
milk,especially for those who have no other affordable, feasible and
acceptable alternative.  This should again go with a lot of support to the
mother, but this goes back to who is going to give this support!!  Infant
feeding counsellors are far too few to be able to give adequate and quality
care and support.  Community support is probably what we would all want to
build, but this also needs to start with orientation to those who will give
these services (volunteers, CBOs etc.), this needs lots of efforts!!  But
then as it is now, Stigma is another hindering stone. We are still remaining
with more questions than answers!

Mary Materu
Nutritionist
The Centre for Counselling, Nutrition and Health
Care (COUNSENUTH)
432 United Nations Rd./Kilombero Str.
P.O. Box 8218, Dar es Salaam, Tanzania.
E-mail: mailto:materu@ud.co.tz



----- Original Message -----
From: "Kristof & Stacia Nordin" <nordin@eomw.net>
To: <pronut-hiv@healthnet.org>
Sent: Monday, September 29, 2003 6:05 PM
Subject: [pronut-hiv] Abrupt cessation of breastfeeding in the context of
HIV/AIDS- what do we know?


>
> Breastfeeding in the context of HIV/AIDS: Do we really know the reality?
and what does it mean?
>
> >From my experience in Malawi, I have not ever in my 6 years here met a
> mother who exclusively breastfeeds, A LOT of education and counselling /
> support to the mother will be needed to go along with these
recommendations.
> I agree with the previous suggestion that money for staff at the education
> level needs to be made available.
>
> I also agree that we need the development of practical guidelines for
people
> who want to implement the recommendations for Infant feeding.  I do not
> directly have experience with this, hopefully people who are working in
> PMTCT-type settings can document their experiences for us.
>
> Ideas to abrubt cessastion:  I am also not aware of anyone who has tried
to
> abruptly cease breastfeeding at 6 months, but as a breastfeeding mother
> myself, when I am away from my baby for several feedings, I simply
> hand-express some milk into a sink / toilet / or other convenient location
> to avoid engorgement.  This could be an idea to help mothers when they
stop
> breastfeeding.  As to the reducing the trauma to a child, a large amount
of
> other forms of tender loving care and distraction - maybe including having
> the mother away from the child for a few days?
>
> Just ideas!
>
> Stacia Nordin, RD
> nordin@eomw.net
>
> ----- Original Message -----
> From: "kamogediso mokongwa" <nkamo6017@hotmail.com>
> To: <pronut-hiv@healthnet.org>
> Subject: [pronut-hiv] Abrupt cessation of breastfeeding in the context of
HIV/AIDS- what do we know?
>
> Cessation of breastfeeding in the context of HIV/AIDS- Do we really know
> the reality? and what does it mean?
> >
> > I am also interested in any guidelines on abrupt cessation.  I need
> further
> > and better advise on the issue.  I onced tried abrupt ceassation as I
had
> to
> > go back to nursing school.  After my breasts had engorged I went back to
> my
> > village and continued to breastfeed.  In short, without any
> education/enlightenment
> >  on abrupt ceassation,  a lot of nursing mothers are going to suffer,
not
> to mention the emotional trauma on the child.
> >
> > I suggesst the issues raised by Micheline Nitru too must be addressed
once
> > and for all.  In Botswana, there doesnt seem to be any (new) guidelines
on
> > the preparation of infant formula which is given free by the Goverment
of
> > Botswana.  I was advised by an officer at the Community Health Division
> that
> > there were no (new) guidelines but that one must follow the instructions
> > given by the manufacturers.  But most women may not be able to read,
> particularly
> >  if the instructions are in English.  In any event, the main problem
with
> formula feeding is that if it
> > is not prepared in accordance with the instructions, e.g., too much
water
> or
> > too much formula, then things may not go right. Therefore it cannot be
> > assumed that all mothers would be able follow the instructions to
prepare
> > formula.
> >
> > On the issue of the development of national policies and  the
enforcement
> of
> > the International Code on Marketing of Breastmilk Substitutes, that
indeed
> > is a great idea but countires must go further and enact  legislation in
> line
> > with the Code. Of course that will be a step in the right direction and
> will
> > help in the long run.
> >
> > What we need right now, in the short term, are the guidelines on
> acceptable,
> > feasible, affordable, sustainable and safe exlcusive brestfeeding as
> > articulated by Peggy Henderson from the WHO.
> >
> >
> > I think the Botswana model is ok., more especially that Botswana can
> afford
> > free infant formula and ARVs.  The question is given all that, she still
> > does not seem to be doing well!!!   According to UNDP Resident
> > Representative Bjorne Forde, a lot is being done in Botswana to fight
the
> > scourge, "but we are not getting there". (Mmegi Newspaper 26 September -
> 01
> > Ocotber 2003). Mr. Forde rightly pointed out that the political will is
> > there.
> >
> > One may then ask, what is the problem!!  Could it be that the programmes
> in
> > place, if any, are not being reviewed or are not implemented, coupled
with
> > the atitude that we members of the public/patients  receive from the
> health
> > officials?
> >
> > Granted, AIDS is incurable but it is a chronic and manageable disease
and
> > there is effective treatment in the form of ARVs, which are distributed
> > "free of charge in Botswana".  A lot of people are happly to go for
their
> > monthly "units" (As in free MAscom airtime units). Be that as it may,
some
> > do not want to know their HIV status because  most health officials
still
> > attach death to AIDS.  So most people think that once they are diagnosed
> > they will die the next day.  The message sent out to the people is not
> > right.  I have come accross posters, some at clinics and Government
> offices
> > which are to the effect that "WITH AIDS THERE IS NO BAIL AND NO APPEAL"
> > Most people interpret the message to mean that once one is diagnosed HIV
> > positive, it will be the end of the world. This statement might have
been
> > true before 1996!! So I think the UNDP Resident Representative, who is
> > really worried about the situation in Botswana, must concentrate on the
> > message being sent out to the people.
> >
> >
> > IDM Botswana in counjunction with UNICEF once organised a course on HIV
> > counselling and the course tackled issues such as the International Code
> on
> > Marketing of Breastmilk Substitues, breast management etc., etc.  Mrs.
> > Otilia Phomaphi and her collegues did a good job and I wish, funds
> > permitting, the course could be ROLLED OUT/CASCADED to other areas, but
> not
> > at the slow pace at which ARVs rolled out.
> >
> >
> >
> >
> > >From: "Ann Burgess" <annburgess@sol.co.uk>
> > > >Subject: [pronut-hiv] Abrupt cessation of breastfeeding in the
context of HIV/AIDS
> > >Date: Thu, 25 Sep 2003 09:51:14 -0400 (EDT)
> > >
> Abrupt cessation of breastfeeding at six months for HIV positive
mothers.What do we know?
> > >
> Many thanks for the useful update from the Nairobi Conference on infant
feeding.
>
> Can anyone tell me if there are accepted guidelines on advising HIV+
> mothers how to stop exclusive breastfeeding quickly when the baby is 6
months
> old?
>
> Just how quickly should this be done; how do you prevent engorgement,etc;
> is  there any stigma attached to this practice, etc, etc?
>
> How many mothers are actually following the advice to stop breastfeeding
quickly?
> > >
> > >Ann Burgess
> > >Nutrition Consultant

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