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[pronut-hiv] Uganda: Breastfeeding Dilemma for HIV-Positive Mothers

  • From: "ProNut-HIV" <>
  • Date: Tue, 24 Aug 2010 14:35:23 -0400
24 August 2010

The new World Health Organisation (WHO) recommendation that HIV-positive
mothers on antiretroviral therapy (ARVs) can exclusively breastfeed
their babies for up to twelve months without infecting them has created
confusion among HIV-positive mothers in Uganda as information about the
new guidelines struggles to reach them.

For the last decade the policy in Uganda had been to advise HIV-positive
mothers to exclusively breast-feed for three months.
But phone calls during a television talk show on the benefits of
breastfeeding exposed the confusion among HIV-positive mothers about the
new recommendations. Many mothers said they needed to clarify and
understand how best they can protect their babies from HIV infection.

"I am now confused," said Maria Sebadukka, an HIV-positive mother," we
are being given conflicting information on how to feed our children.
Some health workers say we should not breastfeed. But now you say we
can?" she asked.
"I am HIV-positive and my child is negative. Should I start
breastfeeding her now?" another caller asked.

During the 2010 HIV Conference in Vienna in July, the WHO passed new
recommendations saying mothers may safely breastfeed provided they or
their infants receive ARVs during the breastfeeding period of up to one
year. This has been shown to give infants the best chance of protection
against HIV transmission.

Dr. Elizabeth Madraa, head of Food and Nutrition at the ministry of
health explained that six to 12 months of breast feeding is adequate to
cover the initial immunity a baby needs. However, mixed feeding is not
recommended as the baby's gut is vulnerable to infection.

But Madraa admits that it may be difficult to convince some mothers of
the new guidelines.
"People are not ready for the new guidelines. We really need to come out
and sensitise pregnant HIV-positive mothers very well on these new
recommendations because they are still not yet convinced," she said.

Dr Lydia Mungherera, executive director of The AIDS Support Organisation
(TASO) and patron of Mamas Club, an organisation for HIV-positive
mothers agrees.
"Many are still very scared of infecting their children. Many are not
yet aware of these new guidelines so this needs a lot of awareness
raising and the training of health workers including midwives," she
said. She also said that new policies are not as widely circulated in Uganda as they should be: "Community nurses and midwives should be trained and any new policies should be quickly circulated."

Lack of access to antenatal care, ARVs and information also affects the
implementation of the new guidelines.

While antenatal visits are vital for prevention of mother-to-child
transmission (PMTCT), 58 percent of births in Uganda still take place at
home, according to the Uganda Demographic Health Survey (UDHS) 2006.

There are also rural-urban disparities with the proportion of births
occurring in a health facility being higher in urban areas (79 percent)
than rural areas (36 percent) thus leaving a dilemma of how rural women
can be sensitised about the new guidelines.
Access to health care is also a challenge with 86 percent of women
saying they encounter at least one serious problem in accessing it.
Sixty five percent of women say they have financial constraints while 55
percent find the distance to the health facility is very far.

Florence Mukhaye Buluba, programme officer for the International
Community of Women living with HIV and AIDS Eastern Africa added that
stigma also discouraged women from following clinical instructions of
exclusive breastfeeding following pressures from in-laws and spouses.

In Uganda mother-to-child transmission is estimated to have contributed
to 20,500 new HIV infections, according to the 2009 Uganda AIDS
Commission report. Without treatment, around 15 to 30 percent of babies
born to HIV-positive women will become infected with HIV during
pregnancy and delivery.

A further five to 20 percent will become infected through breastfeeding,
says the 2009 UNAIDS Epidemic Update.
The health ministry said they are doing something about this. "We have
planned for a massive public awareness campaign. The plans are there to
make sure that women get access to information and understand these new
guidelines," said Samalie Namukosa Bananuka, Head of Nutrition, PMTCT
department in the health ministry.

The new WHO guidelines recommend that national authorities in each
country decide which infant feeding practice should be promoted and
supported by their maternal and child health services.
Uganda is yet to take an official stand based on its capacity to
universally roll out the PMTCT programme and sensitise women countrywide
about the new recommendations.

"Government is to hold a meeting next month to discuss the
implementation of the new guidelines. If Uganda does not find its
implementation feasible, then we shall not adopt it but rather stick to
the current policy. That's what we are yet to discuss," National PMTCT
Coordinator, Dr. Godfrey Esiru told IPS.