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Re: [pronut-hiv] Is EBF only recommended to HIV positive mothers in developing countries? (4)


  • From: "Thuts" <maphosat@yahoo.com>
  • Date: Tue, 10 Aug 2010 00:44:38 -0700 (PDT)

Sara, it will seem there was a n ommision on my article from the previous one that i sent i wonder if it was sent. i am also trying to follow up your reply and i will give you more details.

------------
Hi Sarah,

I appreciate the question that you have just raised and its very critical for us to look at this issue closely. I feel the first key point is to consider the issue relating to MTCT. While we all agree that breastfeeding transmits HIV during the postnatal period it is imperative to note that in the first 6 months it contributes 100% of the child's diet.  Furthermore when exclusive breastfeeding is properly managed and sustained without ARV or ARP then breastfeeding MTCT can be reduced to as low as less than 5% and latest studies that include the Kesho Bora study: Maternal anti-retroviral therapy during pregnancy and breastfeeding prevents more infections than short-course prophylaxis, the Mma Bana study:Mother-to-child transmission reduced to less than 1% in breastfeeding mothers who receive ART   and the Breastfeeding,
Antiretroviral, and Nutrition study:Giving ART to mothers or ARV prophylaxis to infants during breastfeeding equally effective at reducing HIV transmission studies it is clear that if the mothers are provided with ART then we are bound to reduce transmission to as low as less than 1 percent and some of these studies have given birth to the latest WHO Rapid Advise that you might need to just read through.


Then the other point relates to the increased mortality and child morbidity realising that formula can never be equalled to breastfeeding in terms of the protective effects. Several studies have shown that children that are not being bresatfed are likely to have more frequent infections and the likelyhood of mortality is high. This is eapecially in the context of the developing countries. We really seem not to meet AFASS which was recommended strongly after the WHO consensus statemeny of 2006: A-Acceptable: (how many women are being stigmatized of being HIV positive and breasfeeding is regarded as a culture in Africa, Asia and other developing countries and formula is likely not to be
accepted: giving rise to women likely changing their feeding option when they get back home and increasing the rates of mixed feeding) F- Feasible: ( How possible is it for women make formula, read the labels, get enough time to prepare even at night etc), A-Accessible: (Is formula accessible to every mother anytime within the travelling radius that is reacheable by all and are we not gpoing to experience any pipeline breaks that might affect the infant's feeding babits etc), S-Sustainable: (If you opt for formula or brestfeeding can you possible sustain, do you have enough money to buy formula, possible incresed electricity bills, refrigerator, utensils, running water etc) S-Safe:( Are you
there all the time to ensure that the milk is properly prepared, have running clean water, you have a refrigerator on access 24/7, Boiling and making formula 24 hrs and a minimum of 8 feeds or more on child's demand.  Clearly th equestion is how many mothers can afford to meet AFASS. From own assessment i believe you can have a very little proportion if not non.


Therefore within the clearly clinical context yes its likely for MTCT to occur but should we have at least 1 percent of the children getting the HIV virus or have about 50% or more of the children dying due to malnutrition with the highest risk be attributable to lack of bresatfeeding as well as improper feeding practices. I therefore want conclude that some people only have the breast as the only food for the infant easpecially in the first year of life.
Poverty levels are very high ranging above 50% in most of the counteries in the region then can we afford not to breastfeed.


Other people might say give infant formula to all HIV positive breastfeeding women and stop breastfeeding but its not only about formula its about the factors on  external and the internal environment of the mother, culture,economics to mention a few. The majority live in areas were you travel a minimum of 10km only to fetch unsafe water from a river therfore i we considering them as we think of not bresatfeeding.

Lastly health services are aslo critical and from experience counselling mothers on AFASS and ensuring that she makes an informed decision cannot take a health work less than 2hours to do effective counselling. If we have an either breastfeed or formula feed are we not creating a burden to our already overstretched human resources. It is better to have guidelines that are in the context of the country and implementation feasibility should be looked at closely.

In conclusion Sarah i believe that exclusive breastfeeding in the first 6 months and continued bresatfeeding up to at least 12 months and ensuring that PMTCT services are provided to the mother without breaking the supply chain is very critical and we will save more lives of our children as well as increase HIV free survival. Lets all go back to the basics and ensur we promote only what is feasible.


I also encourage all for us to provide the best for the children's start by ensuring that breastfeeding remains the best and formula milk promotion to mothers, governments and policy makes is brought to any end because conflict of interest has brought a dillema of misunderstanding facts.

Greetings and for further details you can contact me in the details below

 Thulani Maphosa
Chief Programmes Officer
IBFAN Africa
Tel: 0026824043803
Cell: 00268-6023803
email: ibfan.maphosat@realnet.co.sz


---------Sarah Mutisya wrote:


Hi Thulani,

Thank you for writing back and thank you  for the study leads. however, your
comments seem contradicting:

"I appreciate the question that you have just raised and it's very critical
for us to look at this issue closely."

I strongly agree with you and hope we as pronut-HIV stakeholders will work
on taking this issue to a higher level.

"Furthermore when exclusive breastfeeding is properly managed and sustained
without ARV or ARP then breastfeeding MTCT can be reduced to as low as less
than 5%"

Who in this case goes without ARV, is it the mother or the infant? From a
health point of view when a mother goes without ARVs, we are compromising
both the mothers' and infants' health. If the mother is without ARVs, her
viral load count increased and her immune gets weaker. In this case she is
not able to look after her child well. Other the other end, if an infant is
not put any prophylaxis, then they have an added risk of being infected with the
virus.

"Several studies have shown that children that are not being breastfed are
likely to have more frequent infections and the likelyhood of mortality is
high."
I absolutely agree with you in this case.  The main reason we encourage
mothers to breastfeeding is for the passage of healthy antibodies from
breast milk to the infant before the infant is able to produce their own
antibodies. However, this applies to HIV-free mothers.

I think our best bet is to focus more on how HIV positive mothers can have
HIV negative children.
The following link has more information on both breastfed and not breastfed
children:

http://www.thebody.com/content/art13590.html

--
Kind regards,

Sarah Mutisya, MPH



-------Thulani Maphosa wrote:

> Hi Sarah,
>
> I appreciate the question that you have just raised and its very critical
> for us to look at this issue closely. I feel the first key point is to
> consider the issue relating to MTCT. While we all agree that breastfeeding
> transmits HIV during the postnatal period it is imperative to note that in
> the first 6 months it contributes 100% of the child's diet.  Furthermore
> when exclusive breastfeeding is properly managed and sustained without ARV
> or ARP then breastfeeding MTCT can be reduced to as low as less than 5% and
> latest studies that include the Kesho Bora study: Maternal anti-retroviral
> therapy during pregnancy and breastfeeding prevents more infections than
> short-course prophylaxis, the Mma Bana study:Mother-to-child transmission
> reduced to less than 1% in breastfeeding mothers who receive ART and the
> Breastfeeding, Antiretroviral, and Nutrition study:Giving ART to mothers or
> ARV prophylaxis to infants during breastfeeding equally effective at
> reducing HIV transmission
> studies it is clear that if the mothers are provided with ART then we are
> bound to reduce transmission to as low as less than 1 percent and some of
> these studies have given birth to the latest WHO Rapid Advise that you might
> need to just read through.
>
>
> Then the other point relates to the increased mortality and child morbidity
> realising that formula can never be equalled to breastfeeding in terms of
> the protective effects. Several studies have shown that children that are
> not being bresatfed are likely to have more frequent infections and the
> likelyhood of mortality is high. This is eapecially in the context of the
> developing countries. We really seem not to meet AFASS which was recommended
> strongly after
> the WHO consensus statemeny of 2006: A-Acceptable (how many women are being
> stigmatized of being HIV positive and breasfeeding is regarded as a culture
> in Africa,
>
>
>  Thulani Maphosa
> Chief Programmes Officer
> IBFAN  Africa
> Tel: 0026824043803
> Cell: 00268-6023803
> email: ibfan.maphosat@realnet.co.sz

>
> ---- Sarah Mutisya wrote:
>
> Dear colleagues,
>
> Is exclusive breastfeeding only recommended to HIV positive mothers in
> developing countries? From experience, any HIV positive mother in the USA
> is not
> allowed to breastfeed their infants for the risk of HIV transmission.
>
> My thinking is the reason why mortality is high in infants who are  formula
> feed in developing countries is not more from lack of antibodies provided
> by
> breast milk, but more of the poor hygiene used in preparation of the
> formula and
> cost being too high, so the child doesn't get enough.
>
> Someone, please help me understand the main idea of exclusive breastfeeding
> for prevention of transmission of HIV from mother to child.  I do
> understand the
> health and survival part of exclusive breastfeeding, but not the
> transmission
> part, according to the argument in this article.
>
> Kind regards,
>
> Sarah Mutisya, MPH
>
>
> --- Ward, James  wrote:
>
> >
> > Dear  colleagues,
> >
> > During World Breastfeeding Week, please join us in reinforcing and
> sharing
> > the importance of breastfeeding for preventing the transmission of HIV
> from
> > mothers to babies and for improving the health and survival of children
> > around the world.
> >
> > For decades, the public health community has recommended that women
> > exclusively breastfeed their infants, citing breastmilk's important
> > nutritional benefits and the protection it offers against infection and
> > disease.
> >
> > Yet over the past ten years, in response to the HIV epidemic, child
> health
> > programs have made major shifts in the ways mothers feed and nurture
> their
> > infants. Some mothers, worried about transmitting HIV through breast
> milk,
> > have stopped breastfeeding altogether, while others have shortened their
> > usual duration of breastfeeding.
> >
> > But, we now know that  children of HIV-positive mothers can greatly
> benefit
> > from breastfeeding. Exclusive breastfeeding for six months not only
> reduces
> > the risk of HIV transmission compared to breastfeeding along with adding
> > other foods and fluids, it also improves a child's chances of surviving
> and
> > remaining HIV free. On the other hand, replacing breast milk with infant
> > formula increases mortality by as much as six times, and stopping
> > breastfeeding early can have a three-fold increase on mortality.
> >
> > Nutrition interventions are strongly needed that can both prevent
> > mother-to-child transmission of HIV and protect children's overall
> health.
> > Mothers with HIV must receive support and clear information about how
> best
> > to feed their babies to keep them healthy, encourage their growth and
> > development, and keep them free of HIV.
> >
> > Here are recommendations from the Infant &  Young Child Nutrition (IYCN)
> > Project for improving child health and HIV-free survival:
> >
> > Increase support for breastfeeding. Improve counseling for mothers on
> > infant feeding to promote exclusive and continued breastfeeding, and
> expand
> > support to mothers.
> >
> > Avoid providing infant formula as a routine part of programs to prevent
> > mother-to-child transmission of HIV.
> >
> > Strengthen education about complementary feeding. Promote local,
> > nutrient-rich complementary foods.
> >
> > Prioritize antiretroviral (ARV) therapy and prophylaxis among pregnant
> and
> > lactating women. Implement programs to provide CD4 count testing to
> identify
> > pregnant and lactating women in need of ARV therapy. Make extended infant
> > prophylaxis regimens available for women who do not meet criteria for ARV
> > therapy for their own health.
> >
> > Improve coordination  between maternal care services and HIV treatment
> > services to provide mothers with a full package of nutrition and health
> > interventions.
> >
> > Here are a few ways you can learn more about the latest research and
> > developments in infant feeding and HIV. Please share these resources with
> > colleagues working in nutrition and prevention of mother-to-child
> > transmission of HIV.
> >
> > Read an article by the IYCN Projects Wasiu Afolabi about Nigeria's
> > experience ( http://www.iycn.org/point-of-view2.php#reason )interpreting
> > and adopting the new World Health Organization (WHO) guidelines on infant
> > feeding and HIV.
> >
> > Download the new full-length WHO guidelines on infant feeding and HIV (
> > http://www.iycn.org/resources-alphabetical.php#rapidadvice ).
> >
> > View and share our research brief (
> >
> http://www.iycn.org/files/Final_Infant_feeding_and_HIV_Review_0710lowres.pdf
> )
> >summarizing the latest evidence on infant feeding and HIV and
> > recommendations for improving child health and HIV-free survival.
> >
> > Read a summary of the AIDS 2010 conference satellite session on infant
> > feeding and HIV ( http://www.iycn.org/newopportunities.php ), co-hosted
> by
> > IYCN, the Elizabeth Glaser Pediatric AIDS Foundation, WHO, and
> > mothers2mothers.
> >
> > Look for more IYCN resources on infant feeding and HIV coming soon.
> During
> > World Breastfeeding Week and beyond, let's spread the word about the
> > benefits of good infant feeding practices for preventing HIV and
> improving
> > the health and survival of children around the world.
> >
> > Sincerely,
> > Denise Lionetti, Project Director
> > Infant & Young Child Nutrition Project
> >
> >
> > Jay Ward
> >  Communications Assistant
> > Infant & Young Child Nutrition (IYCN) Project
> > PATH
> >
> > Address: 1800 K St. NW Suite 800 | Washington, DC 20006 USA
> > Tel:        202.822.0033 | Fax: 202.457.1466 | Skype: james.r.ward
> > Web:      www.iycn.org | www.path.org
>
>
>
>
_