RE: [pronut-hiv] Infant Formula for AIDS orphan infants - Introduction of food to be earlier (2)

["Okanda, John" <JOkanda@ke.cdc.gov>]

 Good, but we should also remember that these food mixtures are being introduced to infants. their guts are not yet well developed to handle most of these mixtures, but milk. We should be careful not to damage the young gut at this stage, lest we have a lot of hospitalizations due to gastroenteritis.  

John Okanda


-----Rachel Stern wrote:


Yes. And introduction of food may need to be earlier  than what is commonly recommended for exclusively breastfed infants.

----- "Kristof & Stacia Nordin" wrote:



For iron, you could use cooked greens, beans, fish, insects -
they could be pounded, strained and/or made into a strong soup (little water and lots of food).  It would take some testing of different options to try and get an high vitamin/mineral water, or high powder.  Just ideas at this point!

They are things we are going to work on for an older population.

Stacia

----- "Rachel Stern"wrote:


Stacia describes pretty much the recipe for homemade formula that was used
in the US for about 40 years or so, during the period when bottlefeeding
became widespread but there was little or no commercial formula. Yes, it may 
be low in some nutrients, but in the absence of an alternative, it should 
work.

By the way, has anyone looked at those vitamin/mineral guidelines recently? 
vitamin D would not generally be a problem in warm, sunny areas, but vitamin 
C could be provided by supplementary juice if vitamins weren't available. 
Iron is a problem.

Rachel Stern


----- "Peggy Papathakis" wrote:


I investigated the nutritional adequacy of the "home prepared" infant
feeding options in South Africa, and found these to be low in multiple
vitamins and minerals, and in essential fatty acids.  If any of these
alternate infant feeeding milks are to be the sole source of nutition, then
perhaps the addition of soy oil and a mulitiple vitamin and mineral
preparation are needed as well.  Below is the reference and abstract.

  Papathakis and Rollins. Bulletin of the World Health Organization | March
2004, 82 (3)
  Objective Little is known about the nutritional adequacy and feasibility
of breastmilk replacement options recommended by WHO/UNAIDS/UNICEF. The
study aim was to explore suitability of the 2001 feeding recommendations for
infants of HIV-infected mothers
  for a rural region in KwaZulu Natal, South Africa specifically with
respect to adequacy of micronutrients and essential fatty acids, cost, and
preparation times of replacement milks.
  Methods Nutritional adequacy, cost, and preparation time of home-prepared
replacement milks containing powdered full cream milk (PM) and fresh full
cream milk (FM) and different micronutrient supplements (2 g UNICEF
micronutrient sachet, government supplement
  routinely available in district public health clinics, and best available
liquid paediatric supplement found in local pharmacies) were compared. Costs
of locally available ingredients for replacement milk were used to calculate
monthly costs for infants aged one, three, and six months. Total monthly
costs of ingredients of commercial and home-prepared replacement milks were
compared with each other and the average monthly income of domestic or shop
workers. Time needed to prepare one feed of replacement milk was simulated.
  Findings When mixed with water, sugar, and each micronutrient supplement,
PM and FM provided <50% of estimated required amounts for vitamins E and C,
folic acid, iodine, and selenium and <75% for zinc and pantothenic acid. PM
and FM made with UNICEF
  micronutrient sachets provided 30% adequate intake for niacin. FM prepared
with any micronutrient supplement provided no more than 32% vitamin D. All
PMs provided more than adequate amounts of vitamin D. Compared with the
commercial formula, PM and FM
  provided 8-60% of vitamins A, E, and C, folic acid, manganese, zinc, and
iodine. Preparations of PM and FM provided 11% minimum recommended linoleic
acid and 67% minimum recommended á-linolenic acid per 450 ml mixture. It
took 21-25 minutes to optimally
  prepare 120 ml of replacement feed from PM or commercial infant formula
and 30-35 minutes for the fresh milk preparation. PM or FM cost
approximately 20% of monthly income averaged over the first six months of
life; commercial formula cost approximately 32%.
  Conclusion No home-prepared replacement milks in South Africa meet all
estimated micronutrient and essential fatty acid requirements of infants
aged <6 months. Commercial infant formula is the only replacement milk that
meets all nutritional needs.
  Revisions of WHO/UNAIDS/UNICEF HIV and infant feeding course replacement
milk options are needed. If replacement milks are to provide total
nutrition, preparations should include vegetable oils, such as soybean oil,
as a source of linoleic and a-linolenic acids, and additional vitamins and
minerals.


  Peggy Papathakis

Kristof & Stacia Nordin <nordin@eomw.net> wrote:

Malawi has Guidlines through the Ministry of Health, although not sure if
they've been officially released? What I have in my files for choices are:

N.B. PLEASE HAVE THESE CONFIRMED BEFORE YOU USE THEM, I do NOT have
experience using this myself:

Breastfeeding:
· exclusive breastfeeding (EBF)
· heat treated expressed breastmilk
· wet nursing

Replacement Feeding:
· modified cow's or goat's milk
· full-cream milk powder
· commercial infant formula

Breastfeeding Options

** Exclusive Breastfeeding:
If EBF is practiced the baby should be exclusively breastfed for six months.
The EBF means that the baby is only offered breast milk (no other liquids
even water), however EBF allows for the administration of medicines and
vitamin drops. During The EBF reduces the transmission rate from the mother
to the baby, and ensures the health and nutrition of the baby in addition to
offering health benefits to the mother.

Babies who are being EBF should receive unlimited feedings (on demand), with
the no limits placed on suckling time and length of breastfeeding session.
Newborn babies should be fed eight to twelve times in a 24 hours period.
(reference PMTCT guidelines).

** Heat Treated Expressed Breastmilk:
This option involves expressing the breastmilk from the HIV+ mother and
heating it, then cooling and feeding to the baby. The considerations under
this option involve the parents' ability to provide enough fuel for heating
the milk and to safely store the expressed heat-treated breastmilk.

** Wet Nursing:
This is where a woman is requested, or volunteers to breastfeed another
woman's baby. The wet nurse must be informed of the risk of acquiring HIV
from an infected baby. This option should include the following
considerations:
· The wet nurse is counseled and tested HIV negative
· The wet nurse is practicing safe sex e.g. condom use throughout
breastfeeding period
· The wet nurse is available to breastfeed their infant frequently
and for as long as is necessary
· Consent has been obtained from parent/principle guardian

Replacement Feeding (Breastfeeding Alternatives):

Whenever replacement feeding is used, the infant should be fed using a cup
because bottle-feeding increases the chance of infections that can cause
diarrhea.

** Modified Cow's or Goat's Milk (Full Cream):
Cow's milk has more protein and a greater concentration of sodium,
phosphorous and other salts than human breast milk, therefore it is
important to prepare the milk in the following proportions according to the
age and weight of the baby:

The basic formula is to use 150ml feed / kg body weight per day, at a
diution of 100ml milk : 50 ml water : 10 gm sugar.

(hopefully this table comes across, the columns are:)
A = Average wt of child
B = milk
C = water
D = sugar
E = Total volume / day
F = Number of feeds (24 hour)

A B C D E F
3 kg 320 ml 160 ml 32 g 480 ml 8 x 60 ml
4 kg 420 ml 210 ml 42 g 630 ml 7 x 90 ml
5 kg 480 ml 240 ml 48 g 720 ml 6 x 120 ml
6 kg 600 ml 300 ml 60 g 900 ml 6 x 150 ml
7 kg 700 ml 350 ml 70 g 1050 ml 6 x 175 ml

One average sized teaspoon = 5 grams of sugar
(eg 32g of sugar is 6 teaspoons of sugar)

** Full Cream Milk Powder:
· 80 ml clean water + 10 g powdered milk = 80ml full strength milk
· to the 80 ml of full strength milk add 40 ml of clean water =120 ml of
infant feed
· add 8g of sugar

· Feed the child the mixture at least 8 times in 24 hours
· The volume needs to be adjusted to the weight of the baby at
150ml/kg/day (same table above)

(End recommendations)

I am also happy to wet nurse a child that needs it, as long as that child
can stay with me, and travel with me where ever I go in Malawi (I can
express milk and leave it with a caregiver as well when I travel overseas).
I have tested HIV negative many times and I practice safe sex.

Stacia

~~~~~~~~~~~~~~~~~~~~~~
Stacia Nordin, RD
International Nutrition Consultant
Specialist in Sustainable Food & Nutrition Security and HIV/AIDS
~~~~~~~~~~~~~~~~~~~~~~
Personal contacts:
Post Dot Net X-124, Crossroads, Lilongwe, Malawi
Physical Location: Chitedze Trading Centre, Lilongwe, Malawi (Africa)
+265 1-707-213 (home)
+265 9-333-073 (home cell)
nordin@eomw.net
~~~~~~~~~~~~~~~~~~~~~~

----- "Katherine Schwarz" wrote:

April 8, 2006

Does anyone out there know of any substitute for infant formula for
infants (under 6 months) whose mothers are too sick to breastfeed or whose
mothers have died. As you may know, imported infant formula had become very
scarce in Malawi and is now just about impossible to find.
Any suggestions you might have would be appreciated.

Kathy Schwarz
Zomba Central Hospital