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RE: [pronut-hiv] WHO technical background paper on the feeding ofnon-breast-fed infants (2)

  • From: "Micheline Ntiru" <>
  • Date: Fri, 24 Jun 2005 14:22:53 +0200

Dear Ted
Please send me the yahoo invitation so that I can create a
username/password for this group so that I can access this interesting
web link. Thanks, Micheline

Micheline K. Ntiru
Regional Adviser/Acting Country Director
Helen Keller International (HKI)
Work Tel: (27) 11 327 6292/3 327 6513
Cel: (27) 72 603 0558
Fax (27) 11 327 6286

----- pronut-hiv wrote:




Several papers have been recently added to the files available on
the WABA HIV and Infant Feeding website
( You
will need the username and password you chose to access the site--
let me know if you have trouble and I can have a new invitation sent
to you by Yahoo so you can choose new ones.

Among these new files is the paper referred to in the subject line
above from the Food and Nutrition Bulletin. This is an issue of
growing concern in low-income settings. Increasingly, policy makers
in low-income settings are realizing that there is little net
benefit in terms of HIV-free survival rates to be gained by avoiding
breastfeeding entirely, and much to be gained by promoting exclusive
breastfeeding to everyone, including HIV+ mothers for whom complete
avoidance of breastfeeding is not AFASS.

There is also increasing evidence, some presented in papers you will
find on the website, such as the one by Chopra et al from South
Africa, that pushing low-income mothers toward choosing replacement
feeding from birth leads to increases in the more dangerous types of
mixed feeding. ZVITAMBO data suggests that the normative use of non-
nutritive fluids along with breast milk in the early months of life
is not as dangerous as the simultaneous use of breast milk and other
milks and solid foods--which is not normative before 3-4 months (and
not advised before six months of course).

But the question of how to do an AFASS assessment to guide the
mother in deciding when to stop breastfeeding has received far too
little attention. For example, unlike the AFASS assessment done in
pregnancy, the current nutritional status of the child can be taken
into consideration. (While a well-nourished child may not do well
without breast milk, a poorly nourished child may well die and thus
stopping breastfeeding is then not feasible.)

Another important topic to discuss in assessing AFASS postnatally is
what a low-income mother can feed her infant. One way of looking for
an answer to that question is provided in this WHO Technical
Background paper now uploaded to the website. You may also find it a
report of a meeting on that topic useful as well

But I am afraid that, while theoretically scientifically impeccable, it
is complex and not yet very practical for use by PMTCT counsellors. WHO
is planning to issue further guidelines, and when they do, a link to
them will be added here, along with notification about it.


Ted Greiner
WABA Research Task Force