Re: [pronut-hiv] Micronutrient supplements for babies born to HIV positive mothers (5)

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

There are recipes in the annexes of Module 2 infant feeding in 
emergencies training materials available on the ENN website, 
http://www.ennonline.net
However the same limitations regarding micronutrient content as cows 
milk apply.
Marie

Rachel Stern wrote:

>Are there recommendations for home preparation of breastmilk replacement 
>formula based on sheeps milk? goats milk? buffalo milk, in areas where that is available?
>Rachel Stern
>----- zipporah Bukania wrote:
>
>
>---how does a HIV mother get to know that the
>alternative to mothers milk is cows milk?
>
>I want to believe this is a mother who has contact with a health
>care providers, therefore the one of the
>responsibility and on my view a strategy of the health
>care provider after teaching the mother on feeding
>options for HIV mothers should be to have mineral
>(Micronutrient syrups)drops to give to the mothers who
>choose not to breastfeed.
>
>and adding mineral drops does not necessary mean
>mother must literally add to the milk, all they need
>to do is give the babies the mineral syrups in form of
>medication as prescribed.
>
>Health systems are trying to promote PMTCT, and if
>this is being done then we need to go all the way and
>make options available for the infected mothers.
>
>zipporah Bukania
>
>
>
> cener <cener@wananchi.com> wrote:
>
>  
>
>> Zippy,
>>Can you suggest how a poor mother somewhere in the
>>middle of a remote
>>village is going to add vitamins and minerals to cow
>>milk?.
>>
>>Alice Ojwang-Ndong.  "M Nutr (Stellenbosch)"
>>Nutrition  & Dietetic Consultant,
>>Center For Nutrition Education and Research
>>P.O.BOX 8105,00200, Nairobi.
>>
>>"Healthy Choices, Longer Life"
>>cener@wananchi.com
>>
>>
>>----- zipporah bukania wrote:
>>
>>
>>The best replacement to mothes milk is formula
>>milk because its been prepared to be closest mothers
>>milk, however in its absence in the first 6 months
>>of
>>life its wise to give those babies home modified
>>formulas such as cows milk, but with vitamin and
>>mineral supplementtion to meet the deficits.
>>
>>plant sources will cause more harm than good to the
>>babies, so lets be careful on this.
>>
>>zipporah bukania>
>>    
>>
>>>-----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.
>>>