Re: [pronut-hiv] Infant Formula for AIDS orphan infants - Introduction of food to be earlier (3)

["Marie McGrath" <marie@ennonline.net>]

I agree. I feel that earlier introduction of complementary foods than 
six months is moving into risky territory on many counts, including 
stage of development, nutritional intake and increased infection risk.  

Infants who are not breastfed are much more likely to die than breastfed 
infants and where there is absolutely no option of wet nursing or 
expressed breastmilk, then exclusive feeding with an appropriate 
breastmilk substitute with sterile preparation and equipment (which 
translates into lots of boiling water and cup feeding) will be the next 
best option.

Returning to the original query, I am keen to know if this 
is an isolated case under discussion or a bigger issue in Malawi where 
infants under six months whose mother has died or is very ill have no 
option of wet nursing? Local purchase of an infant formula should be an 
option and if it is not available, then I am keen to know why not and 
what we can do to address this.
Marie McGrath
ENN

Okanda, John wrote:

> 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
>
>  
>