Re: [pronut-hiv] Exclusive breastfeeding or exclusive replacement feeding

["Thuts" <maphosat@yahoo.com>]

Colleagues

After all this discssion with the married guys may i ask the following question:
  
In resource poor settings  with all the challenges that we are facing,  should we be counseling about the 2 options of Exclusive Breastfeeding and Exclusive Replacement Feeding?  or better off talk about "Exclusive Bresatfeeding unless medically indicated?" 


--- Lina Njoroge wrote: 

Hi Married guys.

Thank you for your inquiries and you are in the right forum.
I have been following your emails and I do applaud you for looking for professional Nutrition advise.I agree with John and as Nutritionist we give you the facts and you make the informed choice. So,in regards to the choice of feeding your second baby, understand the available options and make an informed choice.

In terms of Infant feeding choice it is either Exclusive breastfeeding for the first six months or Exclusive replacement feeding for the first six months. of worth noting is the transitioning after six months which will highly depend on your choice.but that can be discussed when you get there.

If you choose exclusive breastfeeding,then its important to really get in depth information and even demonstration on how to do it correctly in terms of attachment,positioning of the baby while breast feeding.Also checking for oral thrush in the infants mouth helps to make it safe.There is more information on this and even pictures to show you but it would benefit you to have a one -on -one with a Nutritionist to discuss further.Its important to do growth monitoring of the baby and also ensure good nutritional status of the mother especially during breastfeeding (and of course the father) as there is need for increased nutrient intake for the mother during the lactation period.More in depth infor on this available.

To choose Replacement feeding your choice should be based on  a simple criteria referred to as AFASS citeria which simply stands for ;
A: Affordable That you and your family can be able to pay for the cost of the replacement feeds(only commercial infant formula recommended) plus other hidden costs of fuel,clean water,without compromising the families health and nutrition spending.(in your case you can from the emails i have read).You require 40 to 44 tins of Infant formula for the six months
F: Feasible You as the mother or any other family member have adequate time ,Knowledge and skills and other resources to prepare feeds and to feed your baby as well as have support to cope with family,community and social pressures( I guess all those questions that your husband deals with)
A: Acceptable As a mother  or as parents,as long as you do not percieve any signifacant barriers to choosing a feeding option for cultural or social reasons or for fear of stigma or discrimination. Your choice of feeding your child should not be as a result of any pressure or culture.
S: Sustainable As long as you have access to a continous supply of all ingredients and products needed to implement the feeding option safely for as long as the baby needs it S: Safe  That replacement feeds are correctly and hygienically stored, prepared and fed in nutritionally adequate quantities (basic hygiene practices,clean hands,clean utensils etc) of worth noting,safety is not in hygiene only but also the reconsitution of the feed to ensure that it is not over or under diluted.Number of feeds, frequency and duration are all important for eadequate growth and developement of the child.

So if one meets these conditions ,then they can go ahead. But you still need (whichever Infant feeding choice you make,to have indepth discussion with a qualified Nutritionist/Dietician to explore your options.)

Now in terms of Nutrition mangement, it is critical to see a nutritionist who will be able to do a proper clinical Nutrition assessment(Medical Nutrition Therapy for HIV which includes Nutrition assessment,counsellingand therapy interventions) as there is scientific evidence of  relationship between HIV and Nutrition status and the immune system.

The Goal for Medical Nutrition Therapy is

    * Optimize Nutrition status immunity and overall wellbeing
    * Prevent the developement of specific Nutrient deficiencies
    * prevent loss of weight and Lean Body mass
    * To reduce risk of onsent or complications of cormobiditeis(ie diabetes, cardiovascular diseases, liver or Kidney diseases.)
    * to Maximize the effectiveness of medical and pharmacological treatments
    * Minimize health care cost.Basically a comprehensive Nutrition assessment is important for each of you so as to tailor a personalized diet plan.Its important to also know what regimen of  ARV drugs you are on as this will also help determine the diet plan (Although most ARVs do not have alot of restrictions in terms of diet, there are certain Nutrients that may hinder or enhance drug absorption or vice versa.Also certain drug regimens may have adverse effects if combined with Alcohol and can cause other complications like pancreatitis and or liver toxicity.Taking plenty of water is also important. 

A comprehensive Nutrition assessment will include A,B,C,D, E ;
Anthropometric measurements -taking the weight, height and BMI,Waist circumference,body fat percentage( as there may be Physical body changes eg fat redistribution): 
Biochemical assessment of eg Blood sugar,cholesterol or lipid profile(as there may be metabolic changes),Haemoglobin levels to check for anaemia( there are some drugs that will induce anaemia),Albumin levels,liver function tests, Kidney function test such as Urea and creatinine levels. 
Clinical signs and symptoms (eg rashes,mouth ulcers,hair,palour,skin changes, etc)
Dietary assessment which will determine whether you are getting adequate nutreints based on your diet History, eating habits etc.Any clinical signs or symptoms.It is also important to know whetehr one is taking any other types of drugs apart from ARVS or other herbal remedies or supplements(As there may be drug-drug or drug-nutrient interraction and certain supplements or herbal remedies are contraindicated with  certain ARVs. And Most importantly prompt/early nutrition intervention wil reduce the progression of  HIV and make the immune stronger and reduce the risk incidences of opprtunistic infections.Evaluation or follow up is important to monitor especialy weight changes or any other nutrition related complications such as lack of appetite,vomitting, diahrroea, change in taste ,etc and how to cope/manage these symptoms.

But  I thought its important for you to know this since you took this step of trying to get the right information on Nutrition. So nutrition care and  support is individualized,very specific and specialized Care and support.And is available right here in Kenya and need not be expensive.Its just a matter of using the locally available foods to help you come up with an adequate and Nutritious diet.But it has to start form the Nutrition assessment.
So, I hope I have given you a brief synopsis of what Nutrition care and support is without overwhelming  you with too much information for now.

Lina Njoroge
Clinical nutritionist