Re: [pronut-hiv] Feeding young infants who have little or no access totheir mother's milk (2)

["Kristof & Stacia Nordin" <nordin@eomw.net>]

Ted,

But what about the use of soy formulas?  Someone took the time and energy to run trials on it, and it is a leguinous plant food.  I admit to being a 
non-expert in the area of making an infant formula, but I believe that if we wanted to develop something based on local resources to assist children 
without breastmilk options to eat, that we can do it.  We need to work with groups like INFOODS / FAO to test the chemical composition of our local foods so that we can assess the options we have, and then work with food science professionals and researchers to do proper testing of various 
formulations.

I agree with all you lay out below and especially what Danielle contributed (culture, build on local knowledge).  Our local cultures and beliefs are a place to start fostering positive changes as we evolve new cultures.  To do this, identifying our unhealthy and healthy cultural activities is part of our work and lives.  Wet nursing is still very popular in portions of Malawi and when I was breastfeeding my daughter, I had to repeat many times to my friends and neighbors that no one else was to breastfeed my daughter when I was away as my community uses the practice to assist each other.  If I could have found a healthy, non-HIV infected woman to help me breastfeed my daughter I would have welcomed it, but it was not an option in my community.

I hope that some of the people on this list are in a position to continue to work on finding solutions with local cultures on this issue.

Stacia

~~~~~~~~~~~~~~~~~~~~~~
Stacia Nordin, RD
International Nutrition Consultant
Specialist in Sustainable Food & Nutrition Security
~~~~~~~~~~~~~~~~~~~~~~
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
~~~~~~~~~~~~~~~~~~~~~~

----- "Ted Greiner"wrote:


Stacia,

  It is very expensive and demanding, especially from an ethical point of 
view, to do any kind of research on breast milk substitutes, especially 
randomized trials. I can't imagine any human ethics committee approving any 
study on plant sources of iron for such a trial.

  I agree with the points Marie made earlier. Where the mother's milk is 
only partly or not at all available, solutions should be based on whether 
this is likely to be a temporary or permanent situation.

  Finding a wet nurse is the best solution, not only for feeding the infant 
but for hopefully arranging long-term care in those cases when the mother is 
dead or likely to die in the near future. Where this can be predicted during 
the pregnancy and HIV testing is available, an HIV-negative wet nurse, 
ideally from the mother's family, should be identified before the birth; 
should be educated on avoiding risk of getting HIV, and provided with any 
support required to breastfeed two infants, to relactate, or, if expertise 
exists, to begin to induce lactation before the baby is born.

  Second best would be to organize a local breast milk bank. An excellent 
example exists in South Africa 
(http://www.unicef.org/southafrica/hiv_aids_809.html) but more informal 
solutions of this type can be found even for an individual child. I 
witnessed such a case 27 years ago in Yemen when a mother was not willing to 
care for one of her newborn twins--which she was sure would die. A health 
care worker got her to agreed to take the baby if it could be kept alive for 
the first couple weeks of life. She did so by obtaining breast milk from 
other women in the area for those weeks--but this took a lot of work and 
caring for the baby. Obviously these days one would also want to be sure the 
donors were HIV-negative.

  Third best would be infant formula and fourth best home-made formula as 
described in WHO documents. But as Peggy Papathakis warned here and in her 
article in WHO Bulletin, locating the proper micronutrients is very 
challenging and likely to be so expensive that it's hard to imagine many 
scenarios where this option is going to be better than infant formula.

  I don't mean to sound cavalier, like any of this is easy. And I realize 
that there are likely to be cases where none of these solutions will work, 
especially in isolated African communities affected by HIV.

  Regards,

  Ted Greiner, PhD
Senior Nutritionist
Director, Ultra Rice Program
  PATH
1800 K St NW, Suite 800
Washington DC 20006 USA
tel +1 202 822-0033
fax +1 202 457-1466
tgreiner@path-dc.org
www.path.org
PATH: A catalyst for global health

---- Stacia Nordin wrote:

All the more reason for someone to work on
something that can be made from
local sources ASAP.   You state 2 big problems
below (water and plant
nutrients -although I'm a skeptic on negativity
of tyring formulation based on some plants), what
solution to you lean toward?

Sounds like there is no perfect solution at the
moment.  We need to do the
best we can with what we have.

Stacia