[pronut-hiv] Replacement feeding: Has there been any research on goat, camel or donkey milk?

["francis khadudu" <fkwere@yahoo.com>]

Thanks for these interesting presentations. In addition to the cow milk has there been any research on goat, camel or donkey milk as these are consumed and consideredd delicacies in some communities.

Kind Regards

 Francis Were

"Quick, Timothy C (GH/OHA/TLR)" <TQuick@usaid.gov> wrote:  
I think it's worth pointing out that aside from the issues around micronutrient inadequacy/imbalances and differences in osmolarity of cow milk (modified and unmodified) that may increase the risk of dehydration during episodes of diarrhea (Ted Greiner has described this in previous postings to Pronut-HIV), there is extensive literature on the problem of intestinal bleeding caused by cow milk, especially in the first 6 months of life.

It was previously considered a problem primarily in terms of the occult bleeding leading to anemia and iron deficiency. However, it can at least be postulated that damage to the intestine may serve as a portal for HIV infection if there is ANY continued breastfeeding by an HIV+ mom. We don't have any data to support or refute this, but I certainly would want to advise any HIV+ mothers to discontinue all breastfeeding before providing cow milk to that infant. As has been stated by others, cow milk should be considered a last resort if exclusive breastfeeding is discontinued (or not initiated) and there is absolutely no formula available. 

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:


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 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.