Re: [pronut-hiv] Wet nursing a much safer option than breastmilk substitute feeding (3)

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

Dear Tim
The order in which I made that statement is likely misleading and would 
be better stated as:

I think it would be well worth exploring local practices and cultural issues around wet nursing and pursuing this further - wet nursing is *potentially* a much safer option than breastmilk substitute feeding. 

My statement was not based on data on the safety of wet nursing in the context of HIV/AIDS and you raise key considerations around this. My opinion on wet nursing came from a real worry regarding the risks of breastmilk substitute feeding posed to young infants in the context we are discussing. Sometimes I think we can lean towards options that we are familiar with and for workers coming from developed countries, infant formula may seem an easier option partly through familiarity. However I wanted to highlight that other options like wet nursing may well be appropriate and safer in Malawi (or may not be, as you suggest) but are worth not only thinking about but actually investigating as an option.
Regards
Marie


Quick, Timothy C (GH/OHA/TLR) wrote:

>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