[pronut-hiv] pronut-hiv] Re: rapid cessation at 6 months (2)

["Nkuoh Godlove" <nnkuoh@yahoo.com>]

Ted:
Thanks for your concern. We have not kept statistics for follow up on this. But from the responses we get from these mothers in the Support meetings, we can actually deduce that we are succeeding. We are careful not to put pressure on them in providing them with options.

Nkuoh Godlove.


------ Ted Greiner wrote:
Nkuoh,

I wonder if you are doing any follow up of what
happens to the babies whose mothers follow this
advice?

When health workers put pressure on mothers to conform
to any particular recommendation (for example when
health policies are draconian, as in Uganda--exclusive
breastfeeding for 3 months and weaning within one
day), then mothers who fail to comply tend to hide
this fact, and health workers then not only are
failing to obtain the desired behavior, they lose
their ability to follow what actually is going on in
the community.

We need to recognize the need to do AFASS assessment
postnatally also in order to decide if and when a
woman can stop breastfeeding before the typical age of
cessation in her circumstances. If mothers cannot
provide infant formula or an equivalent product at six
months and meet the AFASS criteria, then severe
malnutrition and other life-threatening health
problems are likely to occur. Trying to compose a diet
for a young infant without access to infant formula or
other expensive fortified foods is extremely
challenging; without access to this or animal foods of
any kind it is impossible. A linear programming tool
one can use to help in composing a diet based on local
foods can be found at
http://www.nutrisurvey.de/lp/lp.htm.

By the way, it may not be appropriate to "demonize"
mixed feeding after six months of exclusive
breastfeeding. We do not know anything about how much
HIV transmission will take place in such a situation.
It will almost certainly NOT be as much as mixed
feeding at 0-3 months, the only ages we have data for
(from Coutsoudis et al in Durban and the ZVITAMBO
studies in Harare). This is because the infant gut and
immune systems are much more mature at six months than
at birth.

Rapid cessation of breastfeeding can cause mastitis
and this in turn can lead to increased HIV
transmission during the period of weaning. 

Stopping breastfeeding 6 or 12 months before the
common 2-year norm will still reduce HIV transmission
somewhat, since transmission continues at a fairly
steady pace per month the child is breastfed. This
will be much less difficult for both mother and child
than stopping at 6 months, especially abruptly. 

Best of course would be to do research in difference
scenarios to provide better guidance regarding the
best way to achieve the highest possible levels of
HIV-free survival.

Ted Greiner