RE: [pronut-hiv] Wet nursing a much safer option than breastmilk substitute feeding (2)

["Quick, Timothy C (GH/OHA/TLR)" <TQuick@usaid.gov>]

Marie -- Is there evidence is to support the conclusion that "Wet
nursing is a much safer option than breast milk substitute feeding"?

First there is the issue of whether the wet nurse is confirmed
HIV-negative and whether she subsequently becomes infected during
lactation.  There are also anecdotal reports of transmission of HIV from
in utero/intrapartum-infected infants to uninfected wet nurses.  I think
part of "exploring local practices and cultural issues around wet
nursing" would be to understand whether wet nursing is done under
informed and free choice or whether there is any element of familial,
socio-economic or other sorts or coercion around wet nursing.

I agree that early exclusive breastfeeding will be the best option for many
exposed infants, but I think jumping to promote wet nursing should be
considered with caution and perhaps with more data and analysis.  Tim

Tim Quick, PhD, MS
Senior Technical Advisor for Nutrition & HIV/AIDS
USAID Office of HIV/AIDS, 5.10.20
1300 Pennsylvania Avenue NW
Washington, DC 20523
1-202-712-0974 (office)
1-301-275-6652 (cell)
1-202-216-3015 (fax)
tquick@usaid.gov
 
 

-----Marie McGrath wrote:

Dear Katherine
Have you contacted UNICEF in Malawi? Wet nursing is a much safer option 
than breastmilk substitute feeding and I think it would be well worth 
exploring local practices and cultural issues around wet nursing and 
pursuing this further. Death from diarrhoea through poor artificial 
feeding is going to pose a bigger more immediate risk than HIV 
transmission is. A recent analysis (reference below) showed that in 
countries where IMR > 25/1000 live births, /exclusive breastfeeding for 
six months ^ /produces the best outcome when compared to replacemnet 
feeding from birth or no postnatal intervention. This study is not 
intended for use for individual decisions for infant feeding but 
indicates the risks of replacement feeding in low-income countries.
Regards
Marie McGrath
ENN


Piwoz EG and Ross JS (2005): Use of Population-Specific Infant Mortality

Rates to Inform Policy Decisions Regarding HIV and Infant Feeding^. The 
American Society for Nutritional Sciences J. Nutr. 135:1113-1119, May
2005



Katherine Schwarz wrote:

>Thank you so much for the information.  I'm a nutritionist from the US
working here in Malawi and we certainly never studied what one does in
situations like this.
>  I'm working in a hospital here and we have a few babies whose mothers
have either died or are too sick to produce breast milk.  So for some,
they may have a chance to breast feed later on if the mother gets
better, but some will not.  The orphanages here have a bigger problem
than I do in the hospital.  We have a maternity ward and I've thought
about asking new mothers to be wet nurses, but so many are HIV+ and even
more don't know their status, that that's problemmatic.
>  I have no idea why infant formula isn't available anymore in Malawi.
I'm in touch with the Ministry of Health, but they haven't provided an
explanation either, nor a solution.
>  But we will do the best we can.
>  Thanks again for your reply,
>  Katherine Schwarz
>
>Marie McGrath <marie@ennonline.net> wrote:
>  
>Dear Kathy
>You can access resources on infant feeding that include artificial 
>feeding on the Emergency Nutrition Network (ENN) website 
>(http://www.ennonline.net) - Module 2 training material includes a 
>section that deals with the management of artificially fed infants and 
>annexes recipies with guidelines on cup feeding young infants, etc. If 
>you send me your mailing address, I am happy to send youa print copy of

>the resources. Although they have been developed for emergency
settings, 
>they are applicable in non-emergency settings.
>As previous respondents have said, wet nursing would be a preferable
and 
>much safer option for infants under six months. Is this just an
isolated 
>case you are talking about?
>If there is no source of breastmilk, then locally purchased infant 
>formula would have a nutritional advantage over a modular feed which is

>distinctly lacking in micronutrients and there are no formulations 
>around whereby you could practically add micronutrients to a modular 
>feed. It also depends whether you are talking about temporary use of a 
>breastmilk subsitute until a mother recovers, so a few days of a 'home 
>recipe' feed will have less significance than if a young infant is
going 
>to be dependant on it.
>Finally, I am very interested to know why has imported infant formula 
>become scarce in Malawi?
>Regards
>Marie McGrath
>Emergency Nutrition Network
>
>Waindim Dorcas wrote:
>
>  
>
>>You can prepare corn pap mixed with soyar bean powder or ground
groundnuts, this will be very nutritive for the baby.
>>Dorcas, AWARE HIV/AIDS
>>CBCHB, Cameroon
>>
>>Waindim Dorcas
>>
>>---- 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
>>
>>
>>    
>>
>>